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: percocet / sulfa (sulfonamide antibiotics) / penicillins / tetracycline / darvon / nabumetone attending: chief complaint: respiratory distress major surgical or invasive procedure: intubation picc line insertion and removal history of present illness: 70 yo f with copd, found after a fall by her group home aide this morning. she was tachypneic and given a nebulizer. 911 was then called. ems found the patient to be mottled and in severe respiratory distress, so she was intubated in the field. group home staff notes that she had a sore throat and difficulty swallowing since yesterday. in the ed, initial vitals were sbp 110s then became hypotensive to the 60s. she received 3.5l of normal saline. she was given vancomycin and zosyn, then started on peripheral levophed. a right ij was placed in the ed but cxr showed it coiled in the neck so it was removed. on arrival to the micu, patient's vs were bp 100/70, hr 112, o2 93%. she was on assist control with fio2 50% and peep of 10. she was able to move her upper extremities and grimaced to pain. past medical history: 1. chronic obstructive pulmonary disease. 2. mild intellectual disability. 3. depression. 4. osteoarthritis. 5. hypercholesterolemia. 6. osteoporosis. 7. gastroesophageal reflux disease. 8. thyroid and lung nodules. 9. scoliosis. 10. lumbar spinal stenosis with radiculopathy and lumbar disc degeneration. 11. venous insufficiency with history of left lower extremity ulcer 12. sciatica. past surgical history: 1. appendectomy. 2. cholecystectomy. 3. left oophorectomy. social history: the patient lives in a group home with 24-hour assistance. she attends an adult day health program five days a week. she walks short distances but uses a wheelchair for longer distances. tobacco - former smoker alcohol - none family history: notable for heart disease, breast cancer, diabetes, and depression. physical exam: on admit general: sedated and intubated cv: tachycardic with regular rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: diffusely rhonchorous abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding gu: foley present ext: grimace to pain, moving upper extremities pertinent results: head ct w/o contrast no ich or calvarial frx. cxr overall cardiac and mediastinal contours are likely stable given patient rotation on the current examination. no evidence of pulmonary edema. probable bibasilar opacities with possible associated pleural effusions favoring bibasilar atelectasis, although pneumonia cannot be entirely excluded. no obvious pneumothorax is seen. ct-spine - no fracture or acute alignment abnormality. diffuse pharyngeal stranding that extends into the prevertebral region is nonspecific in the setting of intubation, but a ligamentous injury cannot be excluded. . neck xray: impression: an endotracheal tube is seen with its tip at the thoracic inlet. there is a right internal jugular central line with tip projecting over the right lung apex. there is a loop more proximally which likely is external. clinical correlation is advised. visualized lung apices are grossly clear. . cxr: findings: in comparison with the study of , the monitoring and support devices remain in place. cardiomediastinal contours are stable. bibasilar opacifications are consistent with substantial pleural effusions and compressive atelectasis. in the appropriate clinical setting, supervening pneumonia would have to be considered. . 7/3 l shoulder xray .left shoulder: there is no fracture or dislocation. mild ac joint, degenerative changes are present. the visualized portion of the left chest preliminary reportwall and lung show no gross abnormality. .left humerus: there is no fracture or dislocation. no soft tissue preliminary reportabnormalities are seen. . cxr: right picc line is most likely in the right atrium and should be pulled back for approximately 4 cm. heart size and mediastinum are stable. interval resolution of bibasal consolidations as well as substantial decrease in pleural effusion is demonstrated with only linear bibasal atelectasis seen. heart size and mediastinum are unchanged. there is no pneumothorax. . microbiology: throat culture viral culture-pending; viral culture: r/o herpes simplex virus-final inpatient urine legionella urinary antigen -final inpatient sputum gram stain-final; respiratory culture-final {yeast} inpatient mrsa screen mrsa screen-final inpatient blood culture blood culture, routine-final emergency blood culture blood culture, routine-final emergency urine urine culture-final . 06:00am blood wbc-8.9 rbc-3.14* hgb-10.1* hct-30.9* mcv-98 mch-32.2* mchc-32.7 rdw-14.6 plt ct-206 05:50am blood wbc-9.2 rbc-3.24* hgb-10.3* hct-32.2* mcv-99* mch-31.8 mchc-32.0 rdw-14.5 plt ct-212 06:57am blood wbc-8.7 rbc-3.36* hgb-10.5* hct-32.8* mcv-98 mch-31.3 mchc-32.1 rdw-15.1 plt ct-212 09:43am blood wbc-8.5 rbc-3.45* hgb-10.8* hct-34.0* mcv-99* mch-31.3 mchc-31.7 rdw-14.3 plt ct-219 05:14am blood wbc-9.9 rbc-3.30* hgb-10.5* hct-32.1* mcv-98 mch-31.9 mchc-32.7 rdw-14.1 plt ct-210 05:26am blood wbc-11.1* rbc-3.18* hgb-10.1* hct-30.8* mcv-97 mch-31.6 mchc-32.6 rdw-14.7 plt ct-183 03:12am blood wbc-13.4* rbc-3.21* hgb-10.2* hct-31.0* mcv-97 mch-31.9 mchc-33.0 rdw-14.2 plt ct-163 06:00am blood wbc-21.1* rbc-3.17* hgb-10.2* hct-30.4* mcv-96 mch-32.0 mchc-33.4 rdw-14.4 plt ct-155 03:21am blood wbc-26.1* rbc-3.38* hgb-10.9* hct-32.1* mcv-95 mch-32.2* mchc-33.9 rdw-14.4 plt ct-147* 04:21am blood wbc-21.9* rbc-3.46* hgb-11.2* hct-33.6* mcv-97 mch-32.5* mchc-33.5 rdw-14.1 plt ct-136* 05:14pm blood wbc-20.2* rbc-3.77* hgb-11.9* hct-38.2 mcv-101* mch-31.6 mchc-31.2 rdw-13.8 plt ct-153 07:35am blood wbc-19.5* rbc-4.15* hgb-13.5 hct-41.4 mcv-100* mch-32.6* mchc-32.7 rdw-13.8 plt ct-162 06:00am blood pt-11.6 inr(pt)-1.1 07:35am blood fibrino-187 06:00am blood glucose-93 urean-13 creat-1.0 na-144 k-3.9 cl-111* hco3-24 angap-13 05:50am blood glucose-90 urean-16 creat-1.2* na-146* k-3.1* cl-110* hco3-29 angap-10 06:57am blood glucose-76 urean-19 creat-1.2* na-146* k-3.4 cl-110* hco3-29 angap-10 05:14am blood glucose-98 urean-22* creat-1.2* na-146* k-3.4 cl-107 hco3-34* angap-8 05:26am blood glucose-100 urean-25* creat-1.1 na-147* k-3.2* cl-108 hco3-32 angap-10 06:00am blood alt-36 ast-27 ld(ldh)-200 alkphos-64 totbili-0.6 03:21am blood alt-49* ast-51* alkphos-64 totbili-0.8 04:21am blood alt-68* ast-76* alkphos-62 totbili-0.7 05:14pm blood ck(cpk)-362* 05:14pm blood ck-mb-5 07:35am blood ctropnt-<0.01 03:11pm blood %hba1c-pnd 05:14am blood vanco-29.1* 06:09am blood vanco-11.1 07:35am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg brief hospital course: 70-year-old female with copd who was found down and presented with respiratory failure and septic shock. active problems # septic shock: the patient had septic shock likely secondary to pneumonia. she was intubated in the field and recieved over 13l iv fluid. when she arrived to the hospital she was hypotensive and required pressor support. cxr showed vascular congestion and possible right lower lobe pneumonia. she was given vancomycin, zosyn and azithromycin. after she stablized, she improved with diuresis and was extubated. labs all improved and she was eventually hemodynamically stable. antibiotic course was completed during admission. was the last day of therapy. # respiratory failure secondary to pneumonia: likely worsened by septic shock. she improved with antibiotics. she was extubated on . post extubation she continued to improve with diuresis. she received 8 days of antibiotics. she was on room air at the time of discharge and had been on room air in the days preceding discharge. . # acute copd exacerbation: pt was felt to have an acute flare of copd upon transfer out of the icu. therefore, she was continued on her bronchodialator therapy and started on prednisone therapy, 40mg daily on . she continued on 40mg daily during admission. her discharge recommendation is to continue 40mg x2 more days then to begin a taper as follows: 30mg x2 days, 20mg x2 days, 10mg x2 days, 5mg x2 days then stop. # found down prior to admission-details unclear. concern for possible fall. she initially had a c-spine collar for concern for ligamentous injury, however, upon extubation she had her c-spine cleared. she did have shoulder pain, however, x-rays of her shoulder and elbow, were negative for fractures or acute pathology. likely secondary to musculoskeletal trauma from the fall. . #aphthous ulcers/odynophagia- pt was noted to have what appear to be apthous ulcers in her mouth/pharynx. throat swab was sent and viral culture to r/o hsv is still pending at the time of discharge. pain control with tylenol. she was offered viscous lidocaine and magic mouth wash (diphenydramine, lidocaine, maalox) for pain and symptom relief. she did not continue these medications due to the taste. -viral culture is still pending at the time of dc . #htn, benign-appears to be a new diagnosis. unclear if due to stress surrounding her hospitalization. however, she was started on lisinopril 5mg daily (the equivalent of captopril dosing during admission) and amlodipine 5mg daily with good effect. wound continue to assess her bp in the outpatient setting for further adjustment of these medications prn. . #hypernatremia-pt was diuresed in the icu. she had intermittent mild hypernatremia during her hospital course. this resolved with increasing her intake of free water. her po intake was limited at times due to her apthous ulcers which could account for this as well. . #anemia-appeared stable during admission without suggestion of active bleeding. likely due to acute significant illness. would consider further work up in the outpatient setting with consideration of iron studies and colonoscopy. . #hyperglycemia-pt was noted to have mild hyperglycemia while in the icu. she was started on sliding scale insulin at that time. hbaic was drawn and results are still pending at the time of discharge. this could be stress effect vs. steroid administration. however, pt did not require any insulin on the day of discharge and required minimal insulin preceding this. would continue to monitor finger sticks upon discharge especially while on steroids to determine need for continuation of sliding scale insulin or alternative therapy. . fen: regular, soft diet, dm . dvt ppx: hep sc tid . chronic problems: # intellectual disability: supportive care . # spinal stenosis: she was continued on her home gabapentin and standing tylenol. she had an appointment at the pain clinic on the day of dc. this will need to be rescheduled. . #depression-continued home meds-paroxetine, seroquel, trazodone transitional issues: 1.continued blood sugar monitoring to determine if pt has diabetes (aic still pending) and to determine if she will require any further therapy such as additional of oral hypoglycemics or insulin 2.monitoring of her blood pressure while on new medications-lisinopril and amlodipine for ongoing titration of dose and to assess need for continuing of therapy 3.monitor chemistry panel for hypernatremia -pending at the time of discharge-hbaic and throat viral culture medications on admission: albuterol sulfate - 90 mcg hfa aerosol inhaler - 2 puffs by mouth every 4 hours as needed for wheezing, shortness of breath alendronate - 70 mg tablet - 1 tablet(s) by mouth once a week in the a.m. as instructed budesonide-formoterol - 160 mcg-4.5 mcg/actuation hfa aerosol inhaler - 2 puffs by mouth twice a day clobetasol-emollient - 0.05 % cream - apply very small amount to the affected area twice daily until symptoms improve after improvement (1-2 weeks) space to every day, then every other day, then gradually stop. same re gabapentin - 300 mg capsule - 1 capsule(s) by mouth three times a day ipratropium bromide - (prescribed by other provider; 17 mcg three times a day.) - dosage uncertain omeprazole - (prescribed by other provider) - 40 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth once a day paroxetine hcl - 30 mg tablet - 1 tablet(s) by mouth daily in am polyethylene glycol 3350 - 17 gram/dose powder - 1 tablespoon(s) by mouth dissolved in water as directed every 2 days as needed for constipation with no bowel movement after 2 days quetiapine - 200 mg tablet - 1 tablet(s) by mouth daily in pm quetiapine - 100 mg tablet - 1 tablet(s) by mouth in the morning simvastatin - 20 mg tablet - 1 tablet(s) by mouth daily in the evening tiotropium bromide - 18 mcg capsule, w/inhalation device - 1 puff inhaled once daily trazodone - 150 mg tablet - 1 tablet(s) by mouth at bedtime triamcinolone acetonide - (prescribed by other provider) - 0.1 % cream - apply to itchy skin twice a day as needed for itch can be used on arms and legs. not for use on face , groin, eyes,. wash hands after use. as needed as needed acetaminophen - 500 mg tablet - 2 tablet(s) by mouth three times a day calcium carbonate - 500 mg (1,250 mg) tablet - 1 tablet(s) by mouth twice a day cholecalciferol (vitamin d3) - 400 unit tablet - 2 (two) tablet(s) by mouth once a day dextromethorphan-guaifenesin - 100 mg-10 mg/5 ml liquid - 1 to 2 tsp by mouth every four (4) hours as needed for cough docusate sodium - 100 mg capsule - 1 capsule(s) by mouth twice a day loratadine - 10 mg tablet - 1 (one) tablet(s) by mouth once a day in the morning for allergy symptoms multivitamin - tablet - 1 tablet(s) by mouth q a.m. sennosides - 8.6 mg tablet - 1 tablet(s) by mouth twice a day discharge medications: 1. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 2. paroxetine hcl 30 mg tablet sig: one (1) tablet po daily (daily). 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: inhalation every 4-6 hours as needed for shortness of breath or wheezing. 4. alendronate 70 mg tablet sig: one (1) tablet po once a week. 5. budesonide-formoterol 160-4.5 mcg/actuation hfa aerosol inhaler sig: two (2) inhalation twice a day. 6. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. paroxetine hcl 30 mg tablet sig: one (1) tablet po once a day. 8. quetiapine 100 mg tablet sig: two (2) tablet po qpm (once a day (in the evening)). 9. quetiapine 100 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 10. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. 11. trazodone 150 mg tablet sig: one (1) tablet po once a day. 12. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 13. calcium 500 with d 500 mg(1,250mg) -400 unit tablet sig: one (1) tablet po twice a day. 14. colace 100 mg capsule sig: one (1) capsule po twice a day. 15. miralax 17 gram powder in packet sig: one (1) po every 2 days as needed for constipation: every 2 days if no bm after 2 days. 16. acetaminophen 500 mg tablet sig: two (2) tablet po q 8h (every 8 hours). 17. senna 8.6 mg capsule sig: one (1) capsule po twice a day. 18. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 19. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 20. prednisone taper start 7/10=40mg x2 days. then 30mg x2 days. then 20mg x2 days. then 10mg x2 days. then 5mg x2 days then stop. 21. lidocaine viscous 2 % solution sig: one (1) mucous membrane twice a day as needed for pain: for mouth ulceration pain. 22. loratadine 10 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: septic shock respiratory failure pneumonia acute copd exacerbation . secondary diagnosis: cognitive deficits discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted with a severe infection that caused you to have low blood pressure and difficulty breathing. you were initially in the icu where you had to be on a breathing machine. you were given iv fluids, antibiotics and blood pressure support medications. eventually, your symptoms improved and you were transferred to the regular medical floor. you were started on steroids for a copd flare. you breathing improved and you did not require oxygen. you are being discharged to a rehab facility to work on improving your strength. you also developed throat ulcers and were offered medication for discomfort. . the following changes were made to your medications: 1.start amlodipine 5mg daily for blood pressure 2.start lisinopril 5mg daily for blood pressure 3.prednisone taper for copd. 40mg x2 days. then 30mgx2 days, then 20mg x2 days, then 10mg x2 days, then 5mg x2 days then stop. . please take all of your medications as prescribed and follow up with the appointments below. followup instructions: department: pain management center-you will need to reschedule this appointment when: monday at 3:30 pm with: ,md building: one place (, ma) campus: off campus best parking: parking on site department: obstetrics and gynecology when: monday at 3:00 pm with: , md building: sc clinical ctr campus: east best parking: garage department: gerontology when: wednesday at 8:30 am with: , md building: lm campus: west best parking: garage procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more diagnoses: anemia, unspecified pure hypercholesterolemia acute kidney failure, unspecified unspecified septicemia severe sepsis obstructive chronic bronchitis with (acute) exacerbation depressive disorder, not elsewhere classified acute respiratory failure pneumonitis due to inhalation of food or vomitus septic shock hyperosmolality and/or hypernatremia scoliosis [and kyphoscoliosis], idiopathic spinal stenosis, unspecified region other abnormal glucose pain in joint, shoulder region venous (peripheral) insufficiency, unspecified mild intellectual disabilities benign essential hypertension oral aphthae 

Answer: The patient is high likely exposed to