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: demerol / codeine / zocor / crestor / lescol / fosamax / percocet / advair diskus / azulfidine / celexa / cymbalta / augmentin / pradaxa / statins-hmg-coa reductase inhibitors / phenergan / penicillins attending: chief complaint: hypoxia, persistent fever major surgical or invasive procedure: - mechanical ventilation - bronchoscopy history of present illness: 62 y/o f with pmh of cad s/p multiple pcis (at least 9 dess placed in 8 separate pcis since ), paroxysmal afib (on warfarin), hypertension, hyperlipidemia, history of pericarditis, severe ra (on prednisone 5, leflunomide, remicaide), gerd, pulmonary fibrosis (but fvc 76% of predicted in with dlco 65% of predicted), and other issues, admitted to osh on . initially presented with flu-like symptoms and a subjective fever for about one week. in the ed there, cxr showed baseline interstitial pattern and possible right basilar infiltrate. she was noted to have a'red hot' leg in the ed, but no obvious joint effusion. in the ed, she spiked a fever to 102.8, persisting and never falling below 100.8 during her hospitalization. wbc was 15.4 (no bands), esr>120, crp>18. creatinine was 1.3 on admission, down to 0.9 with fluids. flu was negative and blood, urine, c. diff cultures have been negative to date. she was given levofloxacin and vancomycin for pulmonary and skin coverage; antibiotics were broadened to levofloxacin, ceftazidime and vancomycin iv and po. her sbp was in the 90s in the ed, she was volume resuscitated and sbp improved. tte and osh showed an ef of 50% without valvular lesions. spo2s have been in the low to mid 90s on 3l nasal cannulae. she has also had bad joint pain during her hospitalization. ct chest showed diffuse airspace disease, bilateral reticular changes of uncertain etiology, with the differential including infection, edema and fibrosis. she was seen by rheumatology at the osh, who felt she likely ha a flare of her ra. steroids were increased from prednisone 5mg to 40mg. leflunomide toxicity was also raised as a possible etiology, but level is pending and it is unclear when it will come back. on the night of , she experienced chest pain which resolved with 3x nitroglycerin. troponin was elevated to 0.389, but with no ekg changes. ekgs showed old left bundle branch block, but no stt wave changes.interventricular conduction delay with a qrs of 93 was noted on subsequent ekgs. her lasix was held given recent , but other cardiac medications were maintained. anticoagulation with heparin or lovenox were thoguht to be contraindicated in the setting of anemia and therapeutic inr. on arrival to the micu, she appears ill, unable to complete full sentences and frequently short of breath. she was able to corroborate the above history. she also reports possible tick exposure at the and in the garden of her home in the last few weeks. no sick contacts or recent travel. reports pain in neck and shoulders, intermittently also in her back. reports minimal cough, but acknowledges a runny nose. past medical history: - cad w chronic angina -- pci to midlad (des) and rca (des) in -- pci to ostial lad, ostial lcx and d1 (des) in -- pci to ostial lcx (des) in for isr -- pci to prox-rca (des) in -- pci to lcx (des) for isr and rca in (nstemi) -- pci to rcax2, lcx x1, ladx1 (des) for isr in -- pci to rcax2 and ladx2, lcx (des) in (nstemi) -- pci to rca (desx2) in - paroxysmal atrial fibrillation dx - hypertension - hyperlipidemia - pericarditis - carotid artery disease (80%-) s/p cea - severe ra since early adulthood - raynaud's disease - gastritis - gerd c/ esophagus - hiatal hernia - pulmonary fibrosis - asthma - recurrent le cellulitis - s/p multiple joint replacements (fused r wrist, titanium l wrist) - djd s/p c4-5 neck fusion - chronic back pain - bilateral torn rotator cuffs - s/p tah for precancerous uterine lesion - s/p tonsillectomy - anxiety/depression - ? bullous pemphigoid social history: lives with husband, retired. daughter is very involved in her care smoking - former, quit 30 years ago etoh - rare illicit - none family history: father had his 1st cabg in his 50's, mother with ptca at age 52 physical exam: admission physical exam: vitals: t: 98.3 bp: 125/63 p: 87 r: 140/58 )2: 93% non-rebreathe mask. general: tired, ill-appearing female in nad. unable to complete full sentences, short of breath and coughing and gasping for breath. heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: diffuse loud coarse polyphonic crackles bilaterally, worse at lung bases, but extending to 4/5ths of chest, with apical sparing. abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: right calf erythematous, edematous, with area of erythema well within previously drawn boundaaries demarcating area of cellulitis. distal pulses palpable. bilateral hand deformities with ulnar deviation, mcp subluxation, boutonniere and swan neck deformities. neuro: cnii-xii grossly intact. tone, power, reflexes, coordination, sensation intact and equal in all four extremities. discharge physical exam: vitals: 98.8 154/74 83 20 97% on 2.5l nc gen: pleasant, nad heent: open sores around mouth chest: diffuse inspiratory crackles throughout, but most notable in the bases cv: rrr, no murmurs, rubs, or gallops abdomen: soft, nt, nd, bs+ extremities: right leg with area of erythema that is now less than the drawn boundaries demarcating area of cellulitis. distal pulses palpable. bilateral hand deformities with ulnar deviation, mcp subluxation, boutonniere and swan neck deformities. wwp. 1+ edema in bilateral hands and on b/l feet neuro: a&ox3. pertinent results: admission labs: 01:19am pt-66.9* ptt-32.2 inr(pt)-6.1* 01:19am hypochrom-normal anisocyt-occasional poikilocy-normal macrocyt-occasional microcyt-normal polychrom-normal 01:19am neuts-91* bands-0 lymphs-5* monos-4 eos-0 basos-0 atyps-0 metas-0 myelos-0 01:19am wbc-15.5*# rbc-3.11* hgb-9.2* hct-29.0* mcv-93 mch-29.6 mchc-31.8 rdw-16.1* 01:19am calcium-8.0* phosphate-3.3 magnesium-1.7 01:19am ck-mb-7 ctropnt-0.08* 01:19am alt(sgpt)-27 ast(sgot)-41* ld(ldh)-422* alk phos-67 tot bili-0.4 01:19am glucose-102* urea n-20 creat-1.2* sodium-137 potassium-4.3 chloride-107 total co2-20* anion gap-14 05:21am freeca-1.09* 05:21am o2 sat-69 05:21am lactate-1.6 05:21am type-central ve po2-48* pco2-46* ph-7.28* total co2-23 base xs--4 06:25am lactate-1.4 06:25am type-art temp-38.1 rates-30/ peep-10 o2-100 po2-78* pco2-39 ph-7.33* total co2-21 base xs--4 aado2-602 req o2-98 vent-controlled 10:49am pt-75.0* inr(pt)-6.9* 01:54pm ck-mb-4 ctropnt-0.11* 01:54pm ck(cpk)-77 06:27pm pt-15.5* ptt-26.8 inr(pt)-1.4* 06:27pm vanco-23.2* 06:27pm calcium-8.0* phosphate-3.7 magnesium-1.6 06:27pm ck-mb-4 ctropnt-0.09* 06:27pm probnp-3964* 06:27pm ck(cpk)-86 06:27pm glucose-176* urea n-23* creat-1.3* sodium-137 potassium-4.0 chloride-105 total co2-20* anion gap-16 imaging: - cxr (): cardiomediastinal silhouette cannot be evaluated. it is obscured by the lung abnormalities. mid and lower extensive lung opacities have markedly increased from . differential diagnosis is broad including diffuse multifocal pneumonia, ards. this could be superimposed to a more chronic interstitial lung abnormality. there are small bilateral pleural effusions. - tte (): the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with hypokinesis of the inferior septum and inferior wall. the remaining segments contract normally (lvef = 45-50 %). the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with regional systolic dysfunction c/w cad (pda distribution). compared with the prior study (images reviewed) of , the overall findings are similar. micro: swab viral culture: r/o herpes simplex virus - negative; varicella-zoster culture- negative direct antigen test for herpes simplex virus types 1 & 2 direct antigen test for herpes simplex virus types 1 & 2- {herpes simplex virus type 1} rapid respiratory viral screen & culture respiratory viral culture-negative; respiratory viral antigen screen-negative bronchoalveolar lavage gram stain-negative; respiratory culture-negative; legionella culture-negative; potassium hydroxide preparation-negative; immunoflourescent test for pneumocystis jirovecii (carinii)-negative; fungal culture-negative; acid fast smear-negative; acid fast culture-preliminary; viral culture: r/o herpes simplex virus-preliminary blood culture blood culture, routine-negative blood culture blood culture, routine-negative urine urine culture-negative sputum immunoflourescent test for pneumocystis jirovecii (carinii)-negative sputum gram stain-negative; respiratory culture-negative; legionella culture-negative; fungal culture-preliminary {yeast} mrsa screen mrsa screen-negative notable labs aspergillus galactomannan - negative antigen b-glucan - negative anca - negative anti-gbm - negative discharge labs: 06:20am blood wbc-9.0 rbc-3.11* hgb-8.7* hct-26.8* mcv-86 mch-28.1 mchc-32.5 rdw-18.7* plt ct-106* 06:20am blood glucose-74 urean-20 creat-0.8 na-134 k-4.0 cl-100 hco3-26 angap-12 06:20am blood calcium-8.1* phos-2.5* mg-1.7 05:20am blood vanco-23.2* brief hospital course: 62 f with extensive pmh including cad s/p multiple pcis, pafib on coumadin, pulmonary fibrosis, rheumatoid arthritis, transferred here from osh with worsening hypoxia and persistent fevers. # hypoxia: thought to be multifactorial with contributions from an infectious process, pulmonary hemorrhage in the setting of a supra-therapeutic inr, and volume overload. cxr showed diffuse puffy infiltrate b/l most consistent with ards. bal was negative for all infectious agents tested, and tick-borne panel was negative. on bronchoscopy, blood was visualized, consistent with pulmonary hemorrhage. she was intubated for airway protection, kept on ards settings, treated for hcap with vancomycin/ceftazidine/levofloxacin for a total of 8 days, and was diuresed with daily goal for -1-1.5l. she was transfused one unit of blood on and two units of ffp on . her inr was supratherapeutic on admission and warfarin was discontinued indefinitely. workup for vasculitis including anca and anti-gbm were negative. she improved on these interventions and was successfully extubated. her hematocrit remained stable for the rest of her hospitalization. immediately following extubation it was noted that she had some stridor, but appeared comfortable. upon chin-lift maneuver, the stridor disappeared, suggesting a supra-glottic cause. for this she was started on steroids. her stridor resolved the following day and the steroids was discontinued. she was transferred to the inpatient floor where she continued to do well. her antibiotics was continued for a total of 8 days. she was continued on pcp . she continued on diuresis with lasix as needed for volume overload. # nstemi: on , she experienced chest pain and troponin leak. she did not have ekg changes consistent with ischemia. she was maintained on aspirin and plavix. she underwent an echo, which was essentially unchanged from prior. her troponins trended down. per cardiology recommendations, her aspirin was decreased to 162mg daily and warfarin was held indefinitely. # fever: reportedly she had persistent fever while in osh. however, she was afebrile during her stay at . differential included infectious source such as pneumonia or cellulitis vs. inflammatory secondary to rheumatoid arthritis. she was treated as above for pneumonia, and her fever curve was trended. # rle cellulitis: improved with antibiotics and supportive care. she was continued on vancomycin iv with plan to complete a 14 days course. # hsv infection: positive culture from oral swab. bal negative for hsv. she was started on acyclovir with plan to complete a 7 day course. ophthalmology consult was obtained with no sign of hsv keratitis. # acute kidney injury: resolved with ivf rehydration in osh. # paroxysmal atrial fibrillation: per discussion with cardiology, the decision was made to not restart her coumadin in the setting of pulmonary hemrrohage. she was maintained on a beta blocker and home diltiazem for rate control. # anemia: baseline hct 27-31. likely contributions from anemia of chronic disease and acute hemorrhage. she was transfused for a goal hct>21. #) nutrition: poor nutrition due to painful oral ulcers and poor denture. she was seen by speech and swallow who recommended continuing with regular diet with ensure supplements. her nutrition improved as the oral ulcers improved with acyclovir. # chronic issues: -htn: she was continued with metoprolol and home imdur and diltiazem -hld: continued on niacin -gastritis/gerd: continued on pantoprazole -ra: on infliximab every 6 weeks and leflunomide daily. she was given home hydrocodone-acetaminophen, tylenol, and ultram. -anxiety/insomnia/depresion: continued on bupropion transitional issues: -holding warfarin indefinitely. continuing with aspirin and plavix -on acyclovir for a total of 7 days (last day on ) -please ensure right leg cellulitis is improving, plan for vancomycin for total of 14 days (last day on ) medications on admission: the preadmission medication list is accurate and complete. 1. acetaminophen 1000 mg po bid:prn pain 2. alprazolam 0.25 mg po bid:prn anxiety 3. aspirin ec 325 mg po daily 4. atenolol 25 mg po qam hold for sbp <100 or hr<60 5. atenolol 12.5 mg po daily in the evening 6. bupropion hcl *nf* 300 mg oral daily 7. cetirizine *nf* 10 mg oral daily 8. clopidogrel 75 mg po daily for the recommended duration 9. diltiazem extended-release 180 mg po daily 10. fish oil *nf* (docosahexanoic acid-epa;<br>omega 3-dha-epa-fish oil;<br>omega-3 fatty acids;<br>omega-3 fatty acids-fish oil;<br>omega-3 fatty acids-vitamin e;<br>salmon oil-omega-3 fatty acids) 120-180 mg oral 11. hydrocodone-acetaminophen (5mg-500mg) 1 tab po q6h:prn pain 12. leflunomide *nf* 20 mg oral daily 13. multivitamins 1 tab po daily 14. nitroglycerin sl 0.3 mg sl q5min:prn chest pain 15. pantoprazole 40 mg po q12h 16. pravastatin 20 mg po m-w-fri 17. prednisone 5 mg po daily 18. tramadol (ultram) 50 mg po q4h:prn pain hold for sedation, rr<12 19. isosorbide mononitrate (extended release) 30 mg po daily 20. b complex *nf* (b complex vitamins) 0 units oral daily 21. coenzyme q10 *nf* 50 mg oral 22. furosemide 20 mg po daily:prn ankle edema 23. infliximab 100 mg iv once duration: 1 doses every six weeks 24. lactobacillus rhamnosus gg *nf* 10 billion cell oral daily reason for ordering: wish to maintain preadmission medication while hospitalized, as there is no acceptable substitute drug product available on formulary. pt dooses 3 caps daily 25. niaspan extended-release *nf* (niacin) 500 mg oral 26. warfarin md to order daily dose po days (,mo,tu,we,th,fr,sa) discharge medications: 1. acetaminophen 1000 mg po bid:prn pain 2. aspirin 162 mg po daily 3. bupropion hcl *nf* 300 mg oral daily 4. clopidogrel 75 mg po daily for the recommended duration 5. diltiazem extended-release 180 mg po daily 6. hydrocodone-acetaminophen (5mg-500mg) 1 tab po q6h:prn pain 7. isosorbide mononitrate (extended release) 30 mg po daily 8. pantoprazole 40 mg po q12h 9. pravastatin 20 mg po m-w-fri 10. prednisone 5 mg po daily 11. tramadol (ultram) 50 mg po q4h:prn pain hold for sedation, rr<12 12. acyclovir 300 mg iv q8h 13. artificial tears 1-2 drop both eyes q6h:prn dry eyes 14. albuterol 0.083% neb soln 1 neb ih q6h:prn dyspnea, wheeze 15. ipratropium bromide neb 1 neb ih q6h:prn sob 16. maalox/diphenhydramine/lidocaine 15-30 ml po qid mouth pain 17. sulfameth/trimethoprim ss 1 tab po daily 18. alprazolam 0.25 mg po bid:prn anxiety 19. b complex *nf* (b complex vitamins) 0 units oral daily 20. cetirizine *nf* 10 mg oral daily 21. coenzyme q10 *nf* 50 mg oral 22. fish oil *nf* (docosahexanoic acid-epa;<br>omega 3-dha-epa-fish oil;<br>omega-3 fatty acids;<br>omega-3 fatty acids-fish oil;<br>omega-3 fatty acids-vitamin e;<br>salmon oil-omega-3 fatty acids) 120-180 mg oral 23. furosemide 20 mg po daily:prn ankle edema 24. infliximab 100 mg iv once duration: 1 doses every six weeks 25. lactobacillus rhamnosus gg *nf* 10 billion cell oral daily reason for ordering: wish to maintain preadmission medication while hospitalized, as there is no acceptable substitute drug product available on formulary. pt dooses 3 caps daily 26. leflunomide *nf* 20 mg oral daily 27. multivitamins 1 tab po daily 28. niaspan extended-release *nf* (niacin) 500 mg oral 29. nitroglycerin sl 0.3 mg sl q5min:prn chest pain 30. metoprolol tartrate 12.5 mg po q6h 31. vancomycin 1000 mg iv q 24h 32. polyethylene glycol 17 g po daily:prn constipation 33. senna 1 tab po bid:prn constipatino 34. prochlorperazine 10 mg po q6h:prn nausea 35. heparin 5000 unit sc tid discharge disposition: extended care facility: - discharge diagnosis: primary: pneumonia, pulmonary hemorrhage, non-st segement elevation myocardium infarction, cellulitis, pulmonary edema, hsv infection secondary: paroxysmal atrial fibrillation, rheumatoid arthritis, anemia 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: dear ms. , it was a pleasure taking care of you during your stay at . you were admitted to the hospital because of a very bad infection and bleeding in your lungs that required you to be intubated. your infection was treated with antibiotics and your warfarin was held due to the bleeding in your lungs. you also have a viral infection around your mouth causing sores. you were treated with acyclovir to help with the infection. please continue with acyclovir for a total of 7 days (last day on ). you also have an infection in your right leg that is being treated with an antibiotic (vancomycin). you will need to continue with this antibiotic for a total of 14 days (last day on ) followup instructions: please make sure you follow up with your primary care physician procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified anemia of other chronic disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension long-term (current) use of steroids acute kidney failure, unspecified atrial fibrillation asthma, unspecified type, unspecified personal history of tobacco use percutaneous transluminal coronary angioplasty status diaphragmatic hernia without mention of obstruction or gangrene other and unspecified hyperlipidemia anxiety state, unspecified acute respiratory failure other shock without mention of trauma cellulitis and abscess of leg, except foot postinflammatory pulmonary fibrosis long-term (current) use of anticoagulants family history of ischemic heart disease rheumatoid arthritis raynaud's syndrome stridor unspecified gastritis and gastroduodenitis, without mention of hemorrhage barrett's esophagus herpes simplex without mention of complication acquired absence of both cervix and uterus arthrodesis status acute edema of lung, unspecified pemphigoid tear film insufficiency, unspecified senile nuclear sclerosis wrist joint replacement 

Answer: The patient is high likely exposed to