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: sulfa (sulfonamide antibiotics) / percocet / demerol / amlodipine attending: chief complaint: recurrent pneumonia major surgical or invasive procedure: hemodialysis history of present illness: 74 yo f h/o cad s/p nstemi, des in , severe copd on 4-5l o2 at home and severe tbm, fev1 0.6, esrd on hd, lung cancer, p/w pneumonia. she states that her whole body just feels like jello because she is so weak. this has been going on for several weeks, but fell again today, hit her head. no loc. has been unable to stand for the last day or so. has been fully ambulatory, until recently when she got a walker after she got pneumonia (1.5 months). feels like she can't even hold a cup of tea, it is too heavy and she is too shaky. . of note, she was recently discharged from on for pna. she initially p/w sob, ct findings c/w progression of underlying lung cancer as well as bilateral consolidation; thought to be aspiration in etiology and less likely post-obstructive. patient initially on vanc/zosyn, narrowed to vanc/cefepime after cultures failed significant pathogens. after ct demonstrated recurrence of cancer, discussed w patient, pulmonologist and oncologist, and decided for no acute intervention. continued teselon pearls and guafenicin, codeine, as well as nebs and inhalers. of note, c diff tox returned positive after discharge. flagly 500mg po tid x21 days called into pt pharmacy, and patient notified directly of diagnoses and need for antibiotic treatment. . in the ed initial vital signs were 98.3 76 133/60 20 94% 5l. exam was notable for oropharynx dry. labs were notable for cr. of 5 (baseline of ), wbc of 16.2 with left shift (down from 24 prior on ). patient underwent ekg showed nsr 70, lad, lbbb, no stemi, c/w prior ekg. ct head w/o contrast which showed no acute intra-cranial process. diffuse chronic small vessel ischemic changes. cxr showed right basilar opacity is concerning for developing focal right lower lobe pneumonia. patient was given 1 l of ns, vanc, zosyn. patient was seen by no consults. patient was admitted for pneumonia. vital signs prior to transfer temp 98.4 hr 70 bp 141/70 rr18 99% . on the floor, she continues to feel very weak. she has an intermittent cough that has occasionally produced sputum, but has most often been dry. past medical history: - esrd on hd (mwf - non-small cell lung cancer s/p resection c/b recurrence - severe copd, on 3l o2 at home - coronary artery disease, s/p nstemi in w mid-lad stent - h/o paroxysmal atrial fibrillation, not on anticoagulation - hypertension - dyslipidemia - peripheral vascular disease - anemia - *hemophilia carrier* - constipation - anxiety - h/o mrsa pneumonia, completed vancomycin - h/o uterine ca @ 31, s/p hysterectomy social history: - daughter is rn, works in evenings, and is her hcp - prior to rehab, she lived with daughter in , - h/o smoking, quit 23 yrs ago, 1ppd x 20 yrs - denies etoh - denies ilicit drug family history: - significant bleeding disease in the family- hemophilia in son, brothers, and father - daughter has - positive for cancers in the family - there is no family history of premature coronary artery disease or sudden death. physical exam: admission physical exam: vitals: t: 97.4 bp: 112/78 p: 60 r: 16 o2: 98%ra general: frail eldery woman who is alert, oriented, and no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, nontender lungs: diffuse wheezes and course breath sounds throughout with decreased breath sounds on the right cv: normal rate, regular rhythm, normal s1 + s2, difficult to appreciate extra sounds with lung sounds abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 12:57pm lactate-1.6 12:50pm glucose-108* urea n-63* creat-5.0* sodium-133 potassium-4.4 chloride-86* total co2-32 anion gap-19 12:50pm tsh-1.3 12:50pm wbc-16.2* rbc-4.00*# hgb-13.0# hct-39.5# mcv-99* mch-32.4* mchc-32.8 rdw-18.3* 12:50pm neuts-91.7* lymphs-4.5* monos-3.2 eos-0.1 basos-0.5 12:50pm plt count-326 discharge labs: 05:25am blood wbc-15.6* rbc-4.10* hgb-13.1 hct-41.7 mcv-102* mch-32.1* mchc-31.5 rdw-17.1* plt ct-344 05:25am blood glucose-80 urean-31* creat-3.0*# na-139 k-4.4 cl-96 hco3-33* angap-14 05:25am blood calcium-8.6 phos-3.7 mg-2.3 07:54am blood vitb12-1070* folate-greater th 07:54am blood acetylcholine receptor antibody-pnd 07:54am blood vgkc antibody -pnd c. diff: **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). blood culture: : pending, ngtd reports: : cxr findings: pa and lateral views of the chest were obtained. the dialysis catheter ends in the right atrium, unchanged. increased opacity at the right lung base is concerning for developing pneumonia. stable left basilar opacity is combination of a small left effusion and atelectasis. suture material is redemonstrated in the right upper lung. cardiac and mediastinal silhouettes are stable. there is no pneumothorax. no acute osseous abnormality is identified. impression: right basilar opacity is concerning for developing focal right lower lobe pneumonia. cxr: impression: interval progression of a right lower lobe opacity concerning for worsening pneumonia. unchanged left lower lobe opacity and right hilar mass. ct head: findings: no hemorrhage, large territorial infarction, edema, mass, or shift of normally midline structures is present. diffuse periventricular and subcortical white matter hypodensities are consistent with small vessel ischemic changes. the ventricles and sulci are mildly prominent consistent with cortical atrophy. the basal cisterns are widely patent. the mastoid air cells and paranasal sinuses are well aerated. no fractures or scalp hematoma is present. impression: small vessel ischemic changes. no acute intracranial process. eeg: impression: abnormal eeg due to mild posterior background slowing suggestive of a diffuse mild encephalopathy. c spine x-ray: impression: limited examination of the cervical spine. multilevel degenerative changes and minimal anterolisthesis of c3 on c4. brief hospital course: 74 yo f h/o cad s/p nstemi, des in , severe copd on 4-5l o2 at home and severe tbm, fev1 0.6, esrd on hd, lung cancer, recently treated for mrsa hap and c. diff, p/w pneumonia. # health care associated pneumonia: possibly from aspiration vs. post-obstructive. in the setting of 3 prior lung resections and extensive copd, pt had limited pulmonary reserve. she was treated with iv vancomycin and zosyn and aggressive oxygen therapy. she was transitioned to cefepime and vancomycin to be given in dialysis and po flagyl. she was continue on her copd treatment of spiriva, singulair, albuterol/ipratropium nebulizers prn as well as small doses of morphine/xanax prn for sob/anxiety. she triggered three times during her hospital stay, two for hypoxia and one for afib with rvr. her pneumonia was progressing on imaging and clinically and she was transitioned to vanc//cipro. she continued to be hypoxic to as low as 80% on nrb plus nc and it was decided patient could try cpap in the micu to see if this would aide in her oxygenation. it was felt by family and physicians that the patient would likely not survive this pneumonia without intubation. patient was clearly dnr/dni and it was decided to make the patient cmo. pt was transferred back to floors for remainder of hospitalization and passed away nearly 48 hours after leaving the micu. # tremor/weakness: patient stated she was having difficulty holding water/coffee as it would spill due to her significant tremor. also noted to have falls at home. hit her head at home, and ct was encouragingly negative. neurology evaluated her and felt symptoms were likely secondary to toxic-metabolic etiologies plus albuterol use. however, given her lung cancer, lambert-eaton syndrome could not be ruled out. vjkc and acetylcholinesterase antibodies sent. acetylcholinesterase antibodies were negative while vjkc antibodies were pending at time of death. # recent c. diff infection- completed course of flagyl in outpatient. sent c. diff here which were negative. never had abdominal tenderness/fullness or diarrhea. # hyperlipidemia - she was continued on her home atorvastatin until cmo status. # esrd - continued mwf hd until her transition to cmo of which this was stopped. # htn - she was continued on her home lisinopril and lasix, until cmo when all medicines were held. transitional issues: 1. f/u vjkc antibody lab tests and ensure patient keeps neurology appointment. medications on admission: - multivitamin tablet sig: one (1) tablet po daily (daily). - b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). - atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). - aspirin 325 mg tablet sig: one (1) tablet po daily (daily). - celexa 40 mg tablet sig: one (1) tablet po once a day. - omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid. - amiodarone 200 mg tablet sig: one (1) tablet po once a day: - nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet sublingual three times a day as needed for pain: place 1 under the tongue for chest pain. you may repeat after 5 minutes if pain is not resolved. you may use up to 3 times. you should call your doctor and 911 if pain not resolved. - alprazolam 0.5 mg tablet sig: one (1) tablet po every six (6) hours as needed for anxiety. - sevelamer hcl 400 mg tablet sig: one (1) tablet po tid - acetylcysteine - 20 % (200 mg/ml) solution - 5 ml with albuterol q6 hrs prn - b complex-vitamin c-folic acid - (prescribed by other provider) - 1 mg capsule - 1 capsule(s) by mouth daily - ipratropium-albuterol - (prescribed by other provider) - dosage uncertain - montelukast - 10 mg tablet - 1 tablet(s) by mouth daily - tiotropium bromide - 18 mcg capsule, w/inhalation device - 1 inhalation po daily - neurontin 300 mg po qod discharge medications: none discharge disposition: expired facility: colinial poplin discharge diagnosis: health care associated pneumonia lung cancer death discharge condition: patient passed away discharge instructions: patient passed away followup instructions: patient passed away procedure: hemodialysis diagnoses: pneumonia, organism unspecified anemia of other chronic disease end stage renal disease renal dialysis status coronary atherosclerosis of native coronary artery toxic encephalopathy chronic airway obstruction, not elsewhere classified atrial fibrillation aortocoronary bypass status personal history of tobacco use personal history of malignant neoplasm of other parts of uterus hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease constipation, unspecified other and unspecified hyperlipidemia anxiety state, unspecified old myocardial infarction pressure ulcer, lower back do not resuscitate status atherosclerosis of native arteries of the extremities, unspecified malignant neoplasm of lower lobe, bronchus or lung pressure ulcer, stage ii other dependence on machines, supplemental oxygen other severe protein-calorie malnutrition family history of other blood disorders antiasthmatics causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to