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: patient recorded as having no known allergies to drugs attending: chief complaint: hypoxia and hypotension major surgical or invasive procedure: right femoral line placement history of present illness: f with medical problems including diastolic chf (ef 55%), cad, cri, afib who presented to ed in acute respiratory distress. the patient was recently hospitalized several times at , including in , during which time she underwent cardiac catheterization for chf, s/p stent to 90% mid-lad lesion. most recently, pt was in hospital for chf exacerbation. pt reports doing well at home since discharge but does report mild uri symptoms (rhinorrhea and nonproductive cough) and some "sweats" during the past few nights (but no "sweats" during the day). . for the past 1-2 days, the pt missed all of her medications including lasix because her daughter, who keeps track of her medications, was out of town. last night, the patient was breathing comfortably when she was going to bed but awoke at midnight with diaphoresis and shortness of breath which improved somewhat with albuterol and pt was able to fall back asleep. pt then awoke numerous times throughout the night due to sob and this progressed despite using albuterol mdis so pt called ems. . ems noted bp 180/110, hr 104, rr 32, sat 94% on nrb. en route to ed, received 3 sl ntg and 80 iv lasix with minimal improvement and only diuresed 200 cc. in , pt was unable to speak in full sentances. cxr confirmed increased perihilar haziness and interstitial prominence, bilateral effusions consistent with chf but also with right lung haziness concerning for pna. pt was placed on nitro gtt, given 2 mg morphine, levofloxacin and ceftriaxone for empiric coverage and placed on bipap. pt felt symptomatically improved with bipap, then changed to 50% ventimask with sats low 90s, abg 7.39/40/101. pt then admitted to for further monitoring. . upon arrival to , pt reported feeling "much better" and her breathing was "almost normal." pt denied f/c, diarrhea (is in fact constipated), cp, palpitations, orthopnea (sleeps on 2 pillows but prefers to sleep flat), pnd, or increased le edema. denied dietary indiscretions. denied doe & is able to walk (w/walker) about her apt w/o stopping. . icu course: ~ respiratory distress thought to be multifactorial with pulmonary edema secondary to discontinuation of lasix being the main triggering factor. other factors included copd exacerbation in setting of volume overload and possible pneumonia. her pneumonia was treated with ceftriaxone and azithromycin which was later changed to levaquin/azithro. she was started on solumedrol and standing nebulizers. pt had several episodes of respiratory distress, all of which improved with nebs and bipap. she was given prn lasix with a goal of keeping patient one liter negative per day. ~ her bp ran low thought to be due to poor forward flow but she was never on pressors. ~ creatinine rose and urine output fell despite lasix. urine lytes revealed a fena of <1% indicating that pt's chf was likely contributing to poor renal perfusion. further lasix doses were held given that pt appeared intravascularly dry. ~ pt's hct remained low during her icu but pt refused prbc transfusion because of an episode of respiratory distress that the pt had after receiving a transfusion at . past medical history: -chf- echo ef 50-55% with mild mr -coronary artery disease- s/p atheterization : left dominant system; pci lcx, lpda, 50% rca -paroxysmal atrial fibrillation- treated w/ amiodarone, off coumadin due to risk of falls -asthma -s/p thyroid sx -diverticulitis -hypercholesterolemia -right hip fracture -history of tears -chronic renal insufficiency- baseline creatinine low 2's social history: -the patient lives alone but with full-time aide. daughter is main caregiver in terms of administering medications. ambulates with a walker. smoked in her teens but none since. rare etoh use. family history: non-contributory physical exam: temp 98, bp 113/50 (90-120/40-60), hr 80 (60-80), r 20, o2 94% on 3 l n/c i/o: 900/650, total icu los: +3.2l gen: nad, able to speak in full sentences heent: perrl, eomi, mmm neck: jvp 2 cm below angle of mandible cv: irreg irreg, grade 2-3/6 systolic murmur at apex chest: poor movement of air, crackles b abd: +bs, slightly tender and distended groin: femoral line site intact, no erythema or tenderness noted ext: no edema, 1+ dp neuro: alert and oriented, good cognitive function. right eyelid sightly drooped; right leg, right hand, left hand 5/5 strength; left leg 4/5 strength; no dtr on left patella; downgoing toes bilaterally. pertinent results: **(at admission) -wbc 13.9, 54n, 42l, 2m, 3e -hct 31.4, plt 579 -na 141, k+ 4.3, cl 105, bicarb 21, bun 24, creat 2.0 -cxr in ed: cardiomegaly; prominent pulm vasculature; l-lung with diffuse haziness throughout; flat diaphragm w/small bilat pleural effusions. -ecg: sinus @ 83 bpm, l-axis, lbbb pattern, no st/tw-changes compared to old. -abg @ 6 pm: 7.36/41/361 on hi-flow fm -ck 54->51; mb not done; tropt 0.03->0.04. -inr 1.0 . ** cxr: findings consistent with chf with small bilateral pleural effusions. . ** echo: the left atrium is elongated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. brief hospital course: yr old female with hx of cad, dchf, copd, anemia, crf admitted for respiratory distress. . 1. respiratory distress: etiology likely multifactorial including acute pulm edema, asthma/bronchospasm and tracheobronchomalacia. there was initally concern for pneumonia so she was given several days of ceftriaxone and azithromycin for cap. these were stopped once it was clear that she had no pneumonia. there was also a question of upper airway obstruction given pt's multiple prior intubations so pfts were done but were unrevealing as pt was unable to cooperate with testing. a ct of the trachea showed moderate to severe tracheobronchomalacia. given her tracheobronchomalacia and chf, she was given bipap at night in the icu to relieve episodes of respiratory distress. she was started on steroids for a copd flare but these were stopped soon after her transfer to the floor. she was continued on her flovent and nebs. to treat her chf, she was diuresed gently in the icu but this was held once her creatinine started to rise. diuresis was reinitiated on the floor and she diuresed approximately one liter per day. on hd #7, she was breathing comfortably on room air. . 2. chf: an echocardiogram during this admission showed an ef of 55% but an e/a ratio of 2.8 indicating diastolic heart failure. as above, she was diuresed to her dry weight and she was continued on her beta-blocker. . 3. paroxysmal afib: pt has not been coumadinized in past due to risk for falls. she was rate controlled with metoprolol and she continued her amiodarone. . 4. cad: pt with recent cath with stent to lad. pt did not report any chest pain and on admission, her cardiac enzymes were flat x 3. ecg unchanged but lbbb pattern so could mask subtle changes. she was continued on her asa, plavix, bb and statin. . 5. acute on chronic renal failure/oliguria: on admission, pt's creatinine was at baseline of 2.0 but with diuresis, her creatinine started to rise and urine output dropped. a fena indicated prerenal azotemia so she was given gentle fluid boluses to maintain urine output. once her creatinine stabilized, she was again diuresed and her urine output remained >25cc/hr. . 6. normocytic anemia: baseline hct appears to be 27-28 and pt slightly lower than baseline at 25. given her cad, we preferred to transfuse to >30 but pt refused given resp distress following a transfusion at . iron studies on this admission indicate iron def anemia so she was started on iron. she should start epogen as an outpatient. . 7. uti: ua was grossly positive with bacteria and yeast. she was started on treatment with cefpodoxime and her foley was discontinued. . 8. diarrhea: due to diarrhea, c. difficile was checked and found to be positive so she was treated with flagyl, which she must continue after discharge for seven more days. . 9. disposition: per family meeting on , pt expressed her desire to be dnr/dni but then when the medical team accepting the pt asked her again, she stated that she would like to have the breathing tube if necessary to keep her alive until she can see her great-grandchildren. per the daughter's request, a palliative care consult was placed and the pt restated that she was not ready for dnr/dni yet. the patient is being discharged to an extended care facility (scherrill). medications on admission: -advair 500/50 1 puff -albuterol prn -plavix 75 qd -lipitor 20 qd -amiodarone 200 qd -asa 325 qd -metoprolol 50 -lasix 60 qd -levothyroxine 75 mcg qd -flonase 2 sprays qd -mvi discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): hold for loose stools. 4. senna 8.6 mg tablet sig: one (1) tablet po daily (daily): hold for loose stools. 5. levothyroxine sodium 88 mcg tablet sig: one (1) tablet po daily (daily). 6. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 7. atorvastatin calcium 20 mg tablet sig: one (1) tablet po daily (daily). 8. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed: hold for loose stools. 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: two (2) puffs inhalation (2 times a day). 11. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 12. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. 13. lasix 40 mg tablet sig: 1.5 tablets po once a day. discharge disposition: extended care facility: - discharge diagnosis: diastolic congestive heart failure, ejetion fraction 55% emphysema tracheobronchomalacia acute on chronic renal failure urinary tract infection clostridium difficile colitis of the groin secondary: paroxysmal atrial fibrillation coronary artery disease, status post stent of the left anterior descending iron deficiency anemia discharge condition: good, breathing well on room air discharge instructions: take all medications as prescribed and go to all follow-up appointments. call your pcp or go to the ed if you experience worsening shortness of breath, chest pain, fevers, chills or anything else that concerns you. walk only with the help of an ambulatory device. followup instructions: please follow-up with your pcp 1-2 weeks of discharge procedure: venous catheterization, not elsewhere classified non-invasive mechanical ventilation diagnoses: coronary atherosclerosis of native coronary artery pure hypercholesterolemia urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation acute on chronic diastolic heart failure percutaneous transluminal coronary angioplasty status intestinal infection due to clostridium difficile unspecified disorder of kidney and ureter iron deficiency anemia, unspecified chronic obstructive asthma with (acute) exacerbation candidiasis of skin and nails 

Answer: The patient is high likely exposed to