Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: lisinopril attending: chief complaint: confusion and lethargy major surgical or invasive procedure: bipap and cpap ventilation history of present illness: 77yo wf presents w confusion for 3-4 days. i communicated w the pt via italian interpreter over the phone. the interpreter did not understand the pt very well. i talked to her daughter-in-law ) to obtain the hx. she has been talking non-sensically for 3-4 days. she fell asleep several times during the day. she did not use c pap machine consistently at night for osa. the pt uses wheelchair to ambulate for several years knee pain. she has been eating and voiding well denies cp, sob, ha, dizziness or any other sx past medical history: htn, chf, cad hyperlipidemia dm2 afib on coumadin gout sleep apnea copd le venous stasis social history: denies smoking, etoh use lives w son and daughter in law uses wheelchair to ambulate family history: noncontributory physical exam: 97.1, 84, 150/70, 20, 97% on 3l gen: morbid obese, aaox1 (to person), nad heent: grossly intact, eomi neck: supple heart: irregularly irregular w 3/6 sem lung: decreased bs equally bilateral. ctab abd: bs+, soft, nt/nd ext: bilateral le skin change venous stasis neuro: non focal, me ue, le. could not eval dtr as pt did not relax. pertinent results: wbc-9.3 rbc-3.48* hgb-10.5* hct-32.8* mcv-94 mch-30.1 mchc-31.9 rdw-15.7* plt ct-363 neuts-80.1* lymphs-13.4* monos-4.9 eos-1.4 baso-0.2 pt-17.4* ptt-25.8 inr(pt)-1.6* glucose-208* urean-11 creat-0.9 na-141 k-3.9 cl-101 hco3-33* calcium-8.6 phos-2.8 mg-2.2 blood asa-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 07:40pm blood lactate-2.0 11:10pm urine color-yellow appear-clear sp -1.019 blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg rbc-0-2 wbc-0 bacteri-none yeast-none epi-0-2 12:09am urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg 07:40pm blood ck(cpk)-45 ck-mb-notdone ctropnt-0.02* 03:07am blood ck(cpk)-53 ck-mb-notdone ctropnt-0.02* 07:15am blood ck(cpk)-39 ck-mb-2 ctropnt-<0.01 03:40pm ck(cpk)-40 ck-mb-2 10:33am blood ck(cpk)-25* ck-mb-3 ctropnt-<0.01 abg data: 10:25pm blood type-art rates-/20 o2 flow-3 po2-96 pco2-60* ph-7.37 caltco2-36* not intubated 02:46pm blood type-art po2-43* pco2-66* ph-7.35 caltco2-38* 01:26am blood type-art po2-128* pco2-68* ph-7.33* caltco2-37* 07:50am blood type-art po2-248* pco2-65* ph-7.35 caltco2-37* wbc-9.7 rbc-3.57* hgb-10.8* hct-34.1* mcv-95 mch-30.2 mchc-31.7 rdw-15.7* plt ct-330 pt-18.9* ptt-26.6 inr(pt)-1.8* glucose-106* urean-8 creat-0.6 na-144 k-3.9 cl-101 hco3-34* alt-9 ast-12 ld(ldh)-217 alkphos-65 amylase-22 totbili-0.5 03:40am blood lipase-23 pcxr: apparent interval improvement in the degree of pulmonary congestion. cardiomegaly is stable. ekg: a fib w vr controlled, pvc, nl axis. no signi change since . ct head: there is no evidence of infarctin, hemorrhage, mass effect, shift of normally midline structures or hydrocephalus. there has been no change since the prior study. the ventricles and sulci are prominent consistent with age-related involutional change. no definite osseous abnormalities are appreciated. there are no air-fluid levels within the paranasal sinuses. the mastoid air cells are bilaterally poorly pneumatized. the middle ear cavities are clear. the soft tissues appear unremarkable. cta chest: 1. no evidence of central or segmental pulmonary embolism. 2. stable cardiomegaly. 3. mild increase in the size of the small bilateral pleural effusions with associated atelectasis compared to the study. 4. patchy areas of increased lucency within both lungs, may relate to air trapping. cxr: possible new right pleural effusion. evaluation with standard pa and lateral radiograph would be recommended for precise evaluation of these findings. pulmonary hypertension. ruq us: cholelithiasis, without evidence of acute cholecystitis. : a comparison is made with the prior chest x-rays of the 6th. tracheostomy tube is again seen. a nasogastric tube is present. the position of the left picc line remains unaltered. the heart is enlarged. bilateral pleural effusions are present and there is generally increased pulmonary plethora even allowing for the supine position and i suspect the presence of failure. pneumonia less likely. . cxr:indication: picc line placement. repeat ap view of the chest is obtained at 18:20 hours for picc line placement and shows that the picc line is within the right atrium. dr. discussed this with and advised a repeat film after repositioning. . labs on discharge: 05:49am 10.5 3.32* 10.0* 30.4* 92 30.1 32.8 15.7* 387 source: line-picc line differential neuts bands lymphs monos eos baso atyps metas 04:56am 80.8* 11.4* 4.4 3.2 0.2 source: line-picc basic coagulation (pt, ptt, plt, inr) pt ptt plt ct inr(pt) 05:49am 387 source: line-picc line 05:49am 19.4* 28.7 1.9* source: line-picc line hemolytic workup ret aut 04:34am 1.9 diff added 9:51am chemistry renal & glucose glucose urean creat na k cl hco3 angap 05:49am 176* 13 0.6 144 3.6 106 33* 9 trough/vanco estimated gfr (mdrd calculation) estgfr 12:31am using this1 source: line-picc 1 using this patient's age, gender, and serum creatinine value of 0.6, estimated gfr = >75 if non african-american (ml/min/1.73 m2) estimated gfr = >75 if african-american (ml/min/1.73 m2) for comparison, mean gfr for age group 70+ is 75 (ml/min/1.73 m2) gfr<60 = chronic kidney disease, gfr<15 = kidney failure enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili 04:30am 4 9 49 0.6 source: line-picc other enzymes & bilirubins lipase 03:40am 23 lft added @ 12:16 cpk isoenzymes ck-mb ctropnt probnp 04:34am 4 <0.*2 chems added 9:53am 1 <0.01 ctropnt > 0.10 ng/ml suggests acute mi 2 reference values vary with age, sex, and renal function;at 35% prevalence, ntprobnp values; < 450 have 99% neg pred value; >1000 have 78% pos pred value;see online lab manual for more detailed information chemistry totprot albumin globuln calcium phos mg uricacd iron 05:49am 8.6 2.3* 2.0 trough/vanco antibiotics vanco 05:49am 16.81 trough/vanco 1 updated reference range as of == represents therapeutic trough cardiac/pulmonary digoxin 03:00am 1.2 toxicology, serum and other drugs asa acetmnp bnzodzp barbitr tricycl 07:40pm neg neg neg neg neg lab use only redhold 07:40pm hold blood gas blood gases type temp rates tidal v peep fio2 o2 flow po2 pco2 ph caltco2 base xs intubat vent comment 08:25am art 94 54* 7.39 34* 5 whole blood, miscellaneous chemistry glucose lactate na k cl 08:25am 1.0 hemogloblin fractions ( cooximetry) hgb calchct 10:45am 11.3* 34 brief hospital course: 77 y.o. italian speaking female with pmhx of osa, obesity, atrial fibrillation, dm who was transferred to the micu for concern for hypercarbic respiratory failure. . 1) respiratory failure: tracheostomy , on bipap continuously at pressure support of 15 and positive end expiratory pressure of 5 with oxygen saturations greater than 95%. . patient has copd and osa and is non-compliant with cpap, likely causing chronic co2 retention. patient's baseline seems to be 50s to mid 60s recently and she is compensated given elevated bicarbonate values. in addition, to elevated pco2 is the patient's hypoxia on room air. pulmonary embolism was ruled out on cta. postulated that there was a possible contribution of obesity-hyperventilation syndrome for explanation for hypoxia. initially. on bipap on admission to with improved abg. changed bipap to o2 via nc with repeat abg showing adequate oxygenation. transitions to cpap with improvement in pco2 and po2. primary problem is that patient becomes agitated at night and does not keep cpap mask on. haldol did not improve patient's agitation. patient initially improved with zyprexa, but continue to experience trouble wearing cpap. ativan was tried, but proved to be over sedating. patient with medication given adequate trial of cpap, and bipap, but still failed to improve mental status and continued to resist wearing a mask. . discussion with family, especially son who is healthcare power of attorney and translator if the patient is unable to tolerate the mask and/or does not improve mental status she may need tracheostomy. completed 3 days of nightly ventilation with no clearing of delirium. patient continues to struggle against mask. feel tracheostomy is indicated to provide more stable airway. tracheostomy placed , quickly weaned off of midazolam. patient stabilized on trazodone and zyprexa for delirium. . within 24 hours of placing tracheostomy, patient developed new infiltrate on cxr, increased sputum and fever to 100.8. patient treated empirically for hospital-acquired pneumonia. patient sputum rare mrsa growth. will finish 10 -day course of vancomycin and cefepime on . . patient also diuresed as cxr while in hospital show bilateral pleural effusions not seen on admission. during diuresis patient has required electrolyte monitoring and repletion. will continue to diurese patient at rehabilitation facility. . patient with tracheostomy at time of discharge doing well on bipap continuously at pressure support of 15 and positive end expiratory pressure of 5 with oxygen saturations greater than 95%. tolerating trials on tracheostomy mask while sitting up. -----at facility, continue antibiotics vancomycin 1 gm q12h and cefepime 2gm q12h until -----after antibiotic course if finished, if not needed for another purpose, pull picc. -----continue to diurese patient until bun and cr bump. then transition patient to po regimen. patient initially admitted on standing po lasix. . 2) mental status changes: alert at time of discharge. able to follow simple commands. . on admission altered mental status initially attributed to hypercarbia given recent transfer to the micu for similar co2 of 65 in early . hypercarbia treated as above with no to minimal clearing of mental status. . infectious work-up for altered mental status was initially negative including blood and urine cultures. patient recognizes family, disoriented as to location, date, reason for hospitalization with waxing and levels of alertness = delirium. patient was started on ativan which was too sedating. patient was tried on haldol with no effect. patient was stabilized on zyprexa and trazodone. this has improved patient's sleep/wake cycles which had been initially disturbed and the patient is more alert at time of discharge. . patient mental status was complicated by low grade fevers. the work-up of these fevers revealed a pan-sensitive proteus urinary tract infection which was treated for a seven day course. patient re-spiked fever with increased secretions and diagnosed with a hospital acquired pneumonia . patient currently being treated with vancomycin and cefepime. ----- finish vancomycin/cefepime course for pneumonia (see above) ----- avoid benzodiazepines ----- continue zyprexa 5mg and trazodone 25 mg qhs to assist with sleep/wake cycles ----- patient may have some component of underlying dementia. . 3) fever/leukocytosis: patient course complicated by low grade fevers and leukocytosis. these have been attributed to urinary tract infection, and pneumonia. also be a component of atelectasis. at time of discharge patient afebrile greater than 48 hours, and leukocytosis resolving. ---- complete antibiotic course as above. . 4) hypernatremia: resolved. occurred in the setting of diuresis. ----- free water flushes 150ml q4hr. ----- monitor daily electrolytes . 5) hypoxemia: resolved. patient became acutely hypoxic after removal of bipap 10/4 am. strongly suspect patient went into flash pulmonary edema. o2 sats to 78% with hr in afib to 160s at times, rapidly improved with reinitiation of bipap. no change in patients co2 by abg. this episode of hypoxemia was managed by reinitiating bipap, giving iv lopressor for keep hr <100 and diuresis, 20 mg iv lasix, goal volume decrease 0.5l over 24 hours. ecg was unremarkable. bnp was at baseline . 6) atrial fibrillation: rate-controlled and anticoagulated on coumadin. digoxin being held given recent elevated level. will continue to hold digoxin for now as patient is rate controlled. pt. can follow-up with pcp for further . coumadin held and and received 10 mg vitamin k in preparation for tracheostomy. patient tolerated procedure well and was retarted on coumadin 2 mg daily . held coumadin for inr of 3 . ---- metoprolol 50 mg tid for rate control. ---- coumadin 2mg qhs ---- monitor inr . 7) diabetes - well controlled. has been well controlled since admit to the icu with simple iss and home dosing of glyburide. additionally has some component of diabetic neuropathy and was on gabapentin as an outpatient, but held secondary to ams. glyburide held while patient npo, but restarted with patient tube feeds. ---- continue glyburide ---- restart gabapentin at rehabilitation facility and monitor mental status . 8) htn: controlled while in intensive care unit. uptitrated betablocker for better heart rate control of atrial fibrillation. ---- metoprolol 50 mg tid ---- restart isosorbide mononitrate 10 mg tid (on extended release as outpatient, but this could not be delivered via dopoff). . 9) hyperlipidemia: no active issues. - statin . 10) gout: does not report any joint pain at this time, no evidence of acute flair. - allopurinol. . 11) abdominal pain - resolved. pt reported abdominal pain on exam this am. though clear language barrier, she was indicating her entire abdomen. given h/o cholelithiasis without cholecystitis, we rechecked her lfts - all were wnl. additionally, spoke with husband via an interpretor who confirms that pt still has ams, but denies all abdominal pain at this time. ----- continue proton pump inhibitor ----- ensure regular bowel movements . 12) ventricular tachycardia - no new episodes. 48 beat run of vtach around time of transfer to icu. will discuss with outpt cardiologist. could be resultant from fever or occult ischemia despite no ekg changes. electrolytes wnl, negative tox screen. prior echo with evidence of structural heart disease. ce wnl . ---- monitor daily electrolytes and replete as needed. . 13) electrolytes - aggressively replete electrolytes in setting of recent diuresis. . 14) nutrition - on tube feeds s/p tracheostomy. ---- consult speech/swallow re: po intake . 15) ppx - coumadin - bowel regimen - ppi . 16) access: picc placed , also has piv . 17) communication: son - ( who is health care power of attorney . 18) code status: full . 19) dispo: to acute rehabilitation. medications on admission: 1. kcl 20meq 2tabs daily 2. isosorbide 30mg daily 3. gabapentin 300mg 4. furosemide 20mg 2tabs qam, 1tab qhs 5. allopurinol 300mg daily 6. coumadin 2mg daily 7. tramadol 50mg 1-2tabs q6h prn 8. lipitor 20mg daily 9. glyburide 5mg discharge medications: 1. gabapentin 300 mg capsule sig: one (1) capsule po q12h (every 12 hours). 2. allopurinol 300 mg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 4. glyburide 5 mg tablet sig: one (1) tablet po bid (2 times a day). 5. warfarin 2 mg tablet sig: one (1) tablet po hs (at bedtime). 6. erythromycin 5 mg/g ointment sig: one (1) ophthalmic (2 times a day). 7. tramadol 50 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 8. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for to skin folds . 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 10. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 11. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain: do not exceed 4 grams per day. 12. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 5 days: final day: final dose: pm. disp:*10 gram* refills:*0* 13. cefepime 2 gram recon soln sig: two (2) recon soln injection q12h (every 12 hours) for 5 days: final day: final dose: pm. disp:*20 recon soln(s)* refills:*0* 14. isosorbide mononitrate 10 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 15. lopressor 50 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 16. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po daily at 1800 (). disp:*30 tablet, rapid dissolve(s)* refills:*2* 17. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. disp:*30 tablet(s)* refills:*0* 18. furosemide 40 mg/5 ml solution sig: 20-40 mg po twice a day: goal diuresis: until bun/cr bump. then transition to stable regimen. disp:*150 ml* refills:*2* 19. speech/swallow needs speech/swallow eval for potential to take po discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary diagnosis: obstructive sleep apnea hypercarbia altered mental status diabetes mellitus copd urinary tract infection pneumonia . secondary diagnoses: atrial fibrillation on coumadin discharge condition: stable, using bipap 15/5 with oxygen saturations >95%, tolerating brief trach collar trials while sitting, alert, able to follow simple commands discharge instructions: you were admitted with change in mental status and sleep apnea. you were initially placed on bipap but transitioned quickly to your cpap machine. you did not tolerate your cpap machine or an additional trial on bipap and continued to have trouble with your mental status. you underwent a tracheostomy to help with your breathing. your breathing on the tracheostomy with the bipap machine is much improved. you are ready to be discharged for pulmonary rehabilitation and weaning from the bipap. your mental status has improved. you will still need use either cpap or bipap every night to help with your breathing. . you were discovered to have an urinary tract infection and pneumonia. you were treated with antibiotics for these infections and you have greatly improved. you will need to complete your course of antibiotics. . please call 911 or return to the hospital if you experience chest pain, shortness of breath, fevers, confusion, weakness or other concerning symptoms. followup instructions: you have the following scheduled appointments: provider: , apg (sb) phone: date/time: 10:30 . please follow-up with your primary care physician within week after discharge from rehab. procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation temporary tracheostomy diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified chronic airway obstruction, not elsewhere classified gout, unspecified atrial fibrillation paroxysmal ventricular tachycardia acute respiratory failure diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled hyperosmolality and/or hypernatremia proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site 

Answer: The patient is high likely exposed to