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 failure major surgical or invasive procedure: intubation with mechanical ventilation - history of present illness: 70 year-old woman with severe kyphoscoliosis and chronic restrictive lung disease/hypoventilation with some obstructive component and sleep disordered components as well, on home o2; presenting to ed with shortness of breath. ems was called to her home today for worsening respiratory distress. reportedly had sats in the 40% range and placed on a non-rebreather mask. nebs given en route. noted to become very lethargic with ems. in the ed, initial vs were: t96.8 112 160/78 30 97% on nrb. oriented x2 and noted to be lethargic. poor air movement and intubated. patient was given solumedrol 125 mg iv, zosyn, vancomycin, and started on propofol gtt. high pressures following intubation. was reparalyzed with vecuronium 10 mg x1. changed to pcv, last setting fio2 0.7, peep 6, peak pressures 40 with abg 7.37/77/184. in the , patient denies shortness of breath, chest pain, headache, abdominal pain, leg pain. when questioned does endorse feeling unwell in days prior to ed presention - endorses cough and diarrhea, no fevers. does not answer when asked if wearing bipap at nighttime, but endorses wearing oxygen. she was recently admitted from for altered mental status. she was found to have acute on chronic hypercarbic respiratory failure but was able to be managed on nippv alone. past medical history: - severe kyphoscoliosis s/p operative repair in . last spirometry fvc 30% pred (490cc), fev1 27% pred (300cc), ratio 0.62, dlco 17% pred - severe sleep disordered breathing - hypoventilation syndrome due to severe restrictive lung disease - asthma - chronic hypercapneic, hypoxic respiratory failure- resting abg ph of 7.40 and pco2 of 85 on continuous home oxygen - chronic diastolic heart failure - pulmonary hypertension - tte with tr gradient 60-70, rvh and mild rv dilation in setting of elevated pcwp. - large hiatal hernia - gerd - hypertension - h/o severe skin burns as child - osteoporosis - h/o hip and back pain social history: prior smoke (x 11 years) but quit in . no alcohol. lives with daughter and performs own adls (bathing, dressing, cooking). previously worked as a home health aide. widowed. family history: father died of liver cancer. daughter with breast cancer at 45. also history of colon cancer. no history of pulmonary disease. physical exam: exam in the icu: general: alert, intubated, no distress. heent: sclera anicteric, perrl, mmm, visible oropharynx is clear neck: supple, jvd appears ~4 cm asa, no lad. lungs: clear to auscultation bilaterally, diffuse end expiratory wheezing with prolonged expiratory phase. cv: regular rate and rhythm, s1 + s2, sm best at lusb, loud p2. prominent impulse at left sternal border. abdomen: markedly and tightly scarred from abdomen into pelvis and upper thighs. denies tenderness to palpation. ext: cool, 2+ pulses, no clubbing, no edema. neuro: alert with mild sedation. follows complex commands. strength 5/5 in both ue and le distal motor groups. exam on the floor: vs: 99.6 134/82 93 18 100% on 2l gen: nad, kyphotic heent: eomi, mmm, no oral lesions neck: supple, jvp flat chest: ctab, small lung volume cv: rrr, normal s1 and s2 abd: soft, nontender, nondistended, bowel sounds present ext: no ble edema neuro: alert, fully oriented, cn 2-12 intact, sensory intact, strength 5/5 bue/ble, fluent speech psych: calm, appropriate pertinent results: admission labs : pt-10.9 ptt-26.7 inr(pt)-0.9 neuts-79.1* lymphs-14.0* monos-5.4 eos-1.1 basos-0.3 wbc-5.8# rbc-3.71* hgb-10.5* hct-36.9 mcv-100* plt-132 albumin-3.9 calcium-9.8 phosphate-4.2 magnesium-2.2 ck-mb-5 ctropnt-0.01 probnp-1843* alt(sgpt)-10 ast(sgot)-18 ld(ldh)-246 ck(cpk)-92 alk phos-86 tot bili-0.2 glu-118* urea n-24* cr-1.1 -147* potassium-5.6* chloride-96 co2-46* abg: temp-36.9 rates-20/ tidal vol-290 peep-5 o2-50 po2-99 pco2-51* ph-7.57* total co2-48* base xs-21 -assist/con intubated-intubated urine color-yellow appear-clear sp -1.010 blood-neg nitrite-neg protein-tr glucose-neg ketone-tr bili-neg urobilngn-neg ph-8.5* leuk-tr rbc-6* wbc-4 bacteria-none yeast-none epi-0 mucous-rare stool c-diff: negative urine culture: negative urine legionella: negative sputum culture: negative mrsa screen: negative blood cultures: no growth to date cxr : 1. endotracheal tube approximately 3 cm above the carina. 2. large hiatla hernia. 3. probable bibasilar atelectasis. 4. stable cardiomegaly. cxr : given patient position, the radiograph is limited and difficult to evaluate for interval changes. the endotracheal tube has been removed in the interval. the patient position is grossly unchanged. there is no evidence of pneumothorax, areas of basilar atelectasis cannot be excluded. there is no overt pulmonary edema, but crowding of the vessels and minimally increased vessel diameter could suggest increased pulmonary blood volume. no evidence of interval recurrence of focal parenchymal opacities suggesting pneumonia. brief hospital course: 70 year-old woman with severe kyphoscoliosis and chronic restrictive lung disease/hypoventilation, presenting with hypercarbic respiratory failure. the patient was intubated in the ed and admitted to the icu. acute decompensation was likely multifactorial: cpap noncompliance, chf exacerbation (elevated bnp, and overloaded on admission), copd exacerbation, severe systolic pulmonary htn. ecg at baseline and w/o rising ce making ischemic event less likely. she was treated with lasix for chf, steroids and nebs for copd, and antibiotics for concern for hospital aquired pneumonia with atypical coverage. patient was extubated successfully without any complications and maintained on nasal cannula and nasal bipap overnight. # copd exacerbation: treated w/short course of steroids, nebulizers, and antibiotics. will complete a 10-day course of antibiotics with levofloxacin. # acute on chronic diastolic chf (lvef>75% ): initially volume overloaded. diuresed with iv lasix with improvement in respiratory status. subsequently restarted on her home dose lasix and maintained on her home dose ace-inhibitor. # acute on stage 3 ckd: be poor forward flow from acute on chronic diastolic heart failure (lvef>75%). euvolemic at discharge. # anemia. she was noted to have macrocytosis w/ boarderline b12 levels. f/u as outpatient. # fever: fever with temp 101 on , but afebrile throughout rest of admission. sputum, urine, stool cultures negative. blood culture no growth to date. hap antibiotics started. antibiotics narrowed to levofloxacin to complete a 10-day course. # patient will go home with home vna nursing services medications on admission: - albuterol solution for nebulization q4-6h prn wheeze or dyspnea. - albuterol 90 mcg/actuation, two q6h prn wheeze/dyspnea. - fosamax 70 mg tablet once a week - fexofenadine 180 mg daily - fluocinonide 0.05 % cream topical as directed. - fluticasone sprays nasal daily. - flovent hfa 220 mcg inhaled twice a day. - lasix 80 mg daily. - reglan 10 mg before meals and hs for reflux esophagitis. - lisinopril 40 mg once a day. - naproxen 250 mg 1-2 tabs twice a day as needed for pain - protonix 40 mg once a day. - salmeterol 50 mcg/dose one (1) puff inhalation at bedtime. - docusate 100 mg once a day. - calcium carbonate 500 mg tid - cholecalciferol 800 unit daily - polyethylene glycol 17 gram/dose daily - multivitamin daily - home oxygen medications on transfer from icu: heparin 5000 unit sc tid vancomycin 1000 mg iv q 24h piperacillin-tazobactam 2.25 g iv q6h pantoprazole 40 mg iv q24h multivitamins 1 tab po/ng daily senna 1 tab po/ng :prn constipation azithromycin 250 mg po/ng q24h start: in am cyanocobalamin 1000 mcg po/ng daily lisinopril 40 mg po/ng daily prednisone 20 mg po/ng once duration: 1 doses start: prednisone 10 mg po/ng once duration: 1 doses start: acetaminophen 650 mg po/pr q6h:prn fever, pain docusate 100 mg po bid albuterol 0.083% neb soln 1 neb ih q4h ipratropium bromide neb 1 neb ih q6h furosemide 80 mg po/ng daily discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) unit inhalation every 4-6 hours as needed for shortness of breath or wheezing. 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation four times a day as needed for shortness of breath or wheezing. 3. alendronate 70 mg tablet sig: one (1) tablet po once a week. 4. 180 mg tablet sig: one (1) tablet po once a day. 5. fluocinonide 0.05 % cream sig: one (1) application topical once a day: apply to affected areas. 6. fluticasone 220 mcg/actuation aerosol sig: one (1) puff inhalation twice a day. 7. furosemide 40 mg tablet sig: two (2) tablet po once a day. 8. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 9. reglan 10 mg tablet sig: one (1) tablet po qac and qhs: 30 mins before meals and before sleep for reflux esophagitis. 10. naproxen 250 mg tablet sig: 1-2 tablets po twice a day: use only a max of 3 days per week. 11. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 12. salmeterol 50 mcg/dose disk with device sig: one (1) puff inhalation at bedtime. 13. calcium carbonate 300 mg (750 mg) tablet, chewable sig: two (2) tablet, chewable po twice a day. 14. coenzyme q10 50 mg capsule sig: one (1) capsule po once a day. 15. colace 100 mg capsule sig: one (1) capsule po once a day. 16. ergocalciferol (vitamin d2) oral 17. multivitamin with iron-mineral tablet sig: one (1) tablet po once a day. 18. omega-3 fatty acids-fish oil 360-1,200 mg capsule sig: one (1) capsule po once a day. 19. miralax 17 gram powder in packet sig: one (1) packet po once a day. 20. levofloxacin 750 mg tablet sig: four (4) tablet po q48h (every 48 hours) for 4 doses: take one tablet , , , and . disp:*4 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnoses: 1. acute respiratory failure with intubation 2. acute exacerbation of chronic obstructive pulmonary disease 3. acute exacerbation of chronic diastolic heart failure (lvef>75%) secondary diagnoses: 1. severe kyphoscoliosis with operative repair in . last spirometry fvc 30% pred (490cc), fev1 27% pred (300cc), ratio 0.62, dlco 17% pred 2. severe sleep disordered breathing 3. hypoventilation syndrome due to severe restrictive lung disease 4. asthma 5. chronic hypercapneic, hypoxic respiratory failure- resting abg ph of 7.40 and pco2 of 85 on continuous home oxygen 6. pulmonary hypertension - tte with tr gradient 60-70, rvh and mild rv dilation in setting of elevated pcwp. 7. large hiatal hernia 8. gastroesophageal reflux disease 9. hypertension 10.osteoporosis 11.history of hip and back pain 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 came to the hospital with shortness of breath so severe that you required intubation and mechanical ventilation. your shortness of breath was likely caused by a combination of exacerbation of copd and your heart failure. you responded well to diuresis, antibiotics, nebulizer treatment, and prednisone. you were only on mechanical ventilation for 2 days. you are now back to your baseline. medication changes: start: levofloxacin through to complete a 10-day total antibiotic course. other instructions: please check your weight daily to monitor for fluid retention. if you find that you gain more than pounds above your regular weight, please contact your primary care clinic to help manage your congestive heart failure. followup instructions: it is very important for you to follow up with your primary care physician and pulmonologist given you had such severe respiratory problems this hospital admission. appointment #1: pulmonary department: pulmonary function lab when: monday at 2:10 pm with: pulmonary function lab building: campus: east best parking: garage department: medical specialties when: monday at 2:30 pm with: dr. building: sc clinical ctr campus: east best parking: garage appointment #2: primary care department: when: wednesday at 4:15 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: pneumonia, organism unspecified hyperpotassemia thrombocytopenia, unspecified anemia, unspecified esophageal reflux congestive heart failure, unspecified long-term (current) use of steroids acute kidney failure, unspecified acute on chronic diastolic heart failure other chronic pulmonary heart diseases diaphragmatic hernia without mention of obstruction or gangrene chronic kidney disease, stage iii (moderate) acute and chronic respiratory failure alkalosis osteoporosis, unspecified retention of urine, unspecified other diseases of lung, not elsewhere classified personal history of noncompliance with medical treatment, presenting hazards to health chronic obstructive asthma with (acute) exacerbation hyperosmolality and/or hypernatremia hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified other kyphoscoliosis and scoliosis sleep related hypoventilation/hypoxemia in conditions classifiable elsewhere 

Answer: The patient is high likely exposed to