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: respiratory distress major surgical or invasive procedure: na history of present illness: 83y/of spanish-speaking with a pmh of copd on home 3l o2, dm2, diastolic chf, admitted with dyspnea. the pt was found to be hypoxic at her nursing home this pm to o2 sat of 80%. pt reports, through her daughter translating, that she has felt a heaviness in her chest for approx 1.5 week with occasional fevers, and productive cough although she has not brought up much. she states that she received an antibiotic at her nh. pt also reports a tingling sensation on the lateral aspect of her left thigh. no calf tenderness, no pleuritic pain. on ros: the pt denies ha, visual changes, chest pain, nausea, vomitting, diarrhea, or dysuria. . in the ed her vitals were 99.3 110 15 100% 10l -> 95% on 4l, the pt was given levaquin 750mg x1, ceftriaxone 1gm x1, tylenol 650mg pr, prednisone 60mg po xl, as well as neb treatments. bcx and ces sent. multiple unsuccesful attempts were made to obtain an blood gas. the pt was subsequently tranferred to the icu. past medical history: -htn -dm2 -cva: bleeding aneurysm x 2, s/p clipping -chf: diastolic (: ef 75%) -copd: fev1 0.46, 27%; fvc 0.48, 20% -seizure d/o (further details unknown) -as social history: lives with daughter. smoked 1ppd x 30-40 years, quit . family history: nc physical exam: vitals: 98.3 99 123/46 13 97% 3l gen: elderly, spanish-speaking woman speaking rapidly and mildly increased respiratory rate with speaking and moving. no accessory muscle use. heent: eomi, mmm, face symmetric neck: supple resp: crackles at bases b/l, no audible wheeze. card: s1s2, borderline tachy with iii/vi systolic murmur at base that radiates to her neck abd: soft, nt, nd, bs+ extr: no le edema b/l neuro: alert but unclear if she is oriented due to language barrier pertinent results: admission labs: . 09:55pm urine rbc-0 wbc- bacteria-many yeast-none epi-0 09:55pm urine blood-neg nitrite-pos protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 09:55pm urine color-yellow appear-clear sp -1.016 09:55pm urine gr hold-hold 09:55pm urine hours-random 10:01pm glucose-141* lactate-2.0 na+-141 k+-5.8* cl--92* tco2-38* 10:15pm plt count-237 10:15pm neuts-82.2* lymphs-10.5* monos-7.1 eos-0.3 basos-0 10:15pm wbc-12.6*# rbc-3.22* hgb-7.1*# hct-26.4* mcv-82 mch-22.0*# mchc-26.8*# rdw-16.4* 10:15pm ck-mb-notdone ctropnt-<0.01 10:15pm ck(cpk)-45 10:15pm estgfr-using this 10:15pm urea n-21* creat-0.6 09:21am plt count-187 09:21am neuts-84.4* lymphs-9.5* monos-6.0 eos-0.1 basos-0 09:21am wbc-11.4* rbc-2.82* hgb-6.2* hct-22.8* mcv-81* mch-21.8* mchc-26.9* rdw-16.4* 09:21am calcium-8.3* phosphate-2.4* magnesium-2.0 09:21am glucose-138* urea n-22* creat-0.6 sodium-141 potassium-5.4* chloride-99 total co2-40* anion gap-7* 03:50pm potassium-5.5* 05:38pm type-art po2-87 pco2-86* ph-7.30* total co2-44* base xs-12 intubated-not intuba 07:04pm k+-5.5* 07:04pm type-art o2 flow-2 po2-61* pco2-81* ph-7.31* total co2-43* base xs-10 intubated-not intuba comments-nasal brief hospital course: # dyspnea: the patient presented with worsening dyspnea and increased 02 requirement from 3l to 4l in the setting of a fever, and mild leukocytosis and productive cough of 1.5 weeks duration. cxr with questioable retrocardiac infiltrate, without over signs of fluid overload and slightly decreased bnp from . she was initially admitted to the micu. her presentation was though to be due to copd excerbation triggered by infection (with concern for hcap). the pt was started on vanc/zosyn/levaquin. subsquently the patient was transferred from the unit to the floor. upon admission to the floor, the patient was somulent and an abg was noted to be 7.31/86/61 on 3l. as the patient had refused abgs while in the micu there was no frame of reference for this result. nevertheless, the patient was re-admitted to the icu for two more days. imaging showed a progressive rll infiltrate and possible lll infiltrate. repeat abg (upon arrival to the unit) was 7.31/81/61 on 3l. bipap was attempted but not tolerated. the patient was continued on broad antibiotics for hcap (vanc/zosyn/levaquin). the patient was also kept on po predisone at 60mg po daily with plans for a slow taper. a tte was performed to assess the pt's aortic stenosis which showed mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. also noted were mild aortic valve stenosis increased pcwp and moderate pulmonary artery systolic hypertension. the patient remained on 3l nc and was subsequently transferred back to the floor. on the floor the patient remained clinically stable. her oxygenation goal was set at 88-92% to prevent co2 retention. geriatrics were involved in patient care. a picc line was placed to aide with antibiotic administration. levo was discontinued on day 3. vanc and zosyn were continued for a 14 day course (started on ). the patient received treatment for 10 days while in the hospital. a picc line was placed for outpatient administration of abx. the patient will need monitoring of the vanc level and appropriate adjustment in dose. for the time being she is being dose 1 g every 24 hrs. if noted to have elevated vanc trough levels vanc may be given every 48 hrs. we recommend tappering prednisone as follows: decrease the dose of prednisone by 10 mg for three days and then decrease the dose again by 10 mg for another three days and so on. the final dose of prednisone should be 10 mg oraly daily. with regards to albuterol and ipratropium these were administered on a regular basis. if the patient continues to improve clinically these may be administered on an as needed basis. # anemia: the patient was noted be anemic at presentation. this has been stable over many months. she was also noted to have hemocult positive stools. a transfusion of two units of prbc was performed with an increase in hct (23 to 25). prior to admision the patient was directed to follow up with gi as she had experienced these problems before. she however could not keep the appointment. it is necessary that she follows up with gi upon discharge to have endoscopic evaluation. this could not be performed inpatient due to concern for decompensation of her respiratory state. # hyperkalemia: upon arrival the pt was found to have a k of 5.4 without ekg changes. the pt received kayexalate x2 after which her hyperkalemia resolved. etiology remains unclear. the patient demonstrated normokalemia for several days prior to discharge. # seizure hx: no evidence of deterioration during this stay. continued phenytoin but her dose was doubled as her phenytoin serum level was low. in several days, please recheck level of phenytoin, and decrease the dose if needed. # dm: this remained stable on insulin sliding scale. while on steroids we increased the morning and evening nph to 6 and five units respectively. pt will require fingerstsick glucose readings and adjustment of insulin as steroids are tapered. # chronic diastolic chf: throughout the stay the patient appeared clinically euvolemic. troponins were negative. the fluid status was closely monitored and she was continued on lisinopril and b-blockers. the patient's lasix was continued at 20 mg po qd. lasix was held for one day as the patient became volume depleted. future monitoring of the volume status is necessary while on lasix therapy. medications on admission: medications: (from last discharge summary) -furosemide 20 mg tablet -pantoprazole 40 mg tablet -metoprolol succinate 100 mg daily -lisinopril 10 mg po daily -albuterol 90 mcg/actuation aerosol inhalation q4h -tiotropium bromide 18 mcg inh -phenytoin 100 mg/4 ml suspension sig: one (1) po tid (3 times a day). -docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day). -senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. -lidocaine 5 %(700 mg/patch) adhesive patch, one (1) adhesive patch, medicated topical qdaily (): please take off for 12 hours each day. -bisacodyl 10 mg suppository sig: 1 pr qhs prn -ferrous sulfate 325 mg po daily -pravastatin 20 mg tablet sig: two (2) tablet po daily -fluticasone 110 mcg/actuation 4 puff inhalation -ipratropium bromide 0.02 % solution sig: 1 q6h prn -albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for -nebulization sig: one (1) inhalation q6h (every 6 hours) as needed. -prednisone 10 mg -insulin sliding scale discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours). 4. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 7. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 8. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 11. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 12. guaifenesin 600 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 13. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day). 14. phenytoin sodium extended 100 mg capsule sig: two (2) capsule po tid (3 times a day). 15. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 16. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours) for 4 days: day 1 on ; to complete 14 day course. 17. prednisone 10 mg tablet sig: three (3) tablet po daily (daily): taper by 10mg q 3 days to final of 10mg qd: 30 mg started on . 18. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours): day 1 on ; to complete 14 day course. 19. polyethylene glycol 3350 100 % powder sig: one (1) po daily (daily) as needed for constipation. 20. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 21. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 22. insulin sliding scale please print a copy of the inpatient sliding scale sheet discharge disposition: extended care facility: of discharge diagnosis: chronic obstructive pulmonary disease exacurbation helath care acquired pneumonia anemia congestive heart failure discharge condition: good discharge instructions: you were admitted with sortness of breath which was found to be caused by exacurbation of your chronic obstructive lung disease. the latter was triggered by a lung infection. we gave you breathing treatments and antibiotics to help fight the infection. please call your regular doctro of go to the ed if you experience shortness of breath, fever, chills, chest pain, increases in you your weight, wheezing or any other symptom that concerns you. followup instructions: an appointment has been scheduled with your regular doctors office on your behalf: :30 am. an appointment with a gastrointestinal doctor (to evaluate your anemia and occult blood in stool) has also been made: 8:30 am. with dr . call : if you have questions regarding the appointemnt procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified hyperpotassemia anemia, unspecified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure aortic valve disorders epilepsy, unspecified, without mention of intractable epilepsy 

Answer: The patient is high likely exposed to