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: ace inhibitors / lisinopril attending: chief complaint: fever / mental status changes major surgical or invasive procedure: arterial line - 10:37 pm presep catheter - 10:39 pm history of present illness: 54 yof w/ a h/o osa, obesity hypoventilation syndrome with multiple admissions for hypercarbic respiratory failure, asd w/ r to l shunt, htn and pan hypopit presents with a fever and mental status changes / depression, found to have a paco2 of 105 on initial abg. . per her daughter the patient woke up in the a.m. did not eat breakfast, did not take her medications, but she was awake and alert. her daughter then left for a period of time and then returned home she was sleeping during conversation. she was complaining of a headache but this has been present for years and unchanged. she was also coughing, productive of yellow sputum, also she had chills x 24hours. the day prior to admission she felt completely fine and was at her baseline. she did use her cpap overnight and has used her nebulizer, she has been using it more frequently. she had not been complaining of any urinary symptoms such as urinary frequency or dysuria; however she felt that she gets tired of urinary frequency with lasix. . initially in the er had a temp of 102.6 hr 82 bp 132/71 and was 95% on a non rebreather. (initial o2 sat in the field was 73% by ems) in er was unable to articulate any sentances. sbp initially 132 then trended down to 80s systolic. attempted cpap initially without success. r ij, arterial line and intubated in er with a bougie. rec'd 6 liters ns and 0.09 of levophed, cvp of 23. rec'd levo / ctx / vanco and nebs as well as solumedrol 125mg iv x 1. past medical history: 1)obstructive sleep apnea on home cpap, 16cm h20 2)obesity hypoventilation - multiple admissions for hypercarbic respiratory failure; pft's consistent with a restrictive defect - pfts: fvc 39%, fev1 37%, fev1/fvc 96%, tlc 59%, dlco reduced 3)asd with right-left shunt (12% shunt fraction documented in nuclear study from ) 4)pulmonary artery hypertension: echo in demonstrated a tr gradient of 33mmhg ?????? followed by 5)hypertension 6)pan-hypopituitarism with partially empty sella on desmopressin, levothyroxine, prednisone ?????? followed by dr. 7)diastolic chf with dilated ra/la on previous echo 8)angioedema (unclear history, possibly related to ace-i) social history: lives with daughter and 3 grandchildren . originally from . goes to program history of tobacco use, no h/o etoh or ivdu family history: non-contributory physical exam: tmax: 37.7 ??????c (99.8 ??????f) tcurrent: 37.6 ??????c (99.7 ??????f) hr: 91 (81 - 91) bpm bp: 117/67(86) {102/61(75) - 150/87(344)} mmhg rr: 15 (12 - 24) insp/min spo2: 97% gen: nad heent: eomi, perrl 2mm to 1mm. mmm, jvp 12cm cor: rrr, no m/g/r, soft heart sounds pulm: lungs ctab anteriorly and laterally abd: soft, obese, nt, nd, +bs, no hsm, no masses ext: 2+ pitting pedal edema bilaterally symmetric neuro: responds to painful stimuli appropriately, does not respond to verbal stimuli. toes are upgoing bilaterally, patellar tendon dtrs diminished bilat symmetrical. perrl. pertinent results: 03:00am blood wbc-8.0# rbc-3.14* hgb-8.5* hct-27.9* mcv-89 mch-27.1 mchc-30.5* rdw-17.1* plt ct-109* 03:00am blood neuts-75.3* lymphs-15.7* monos-7.4 eos-1.3 baso-0.2 03:00am blood plt ct-109* 03:00am blood pt-16.4* ptt-32.8 inr(pt)-1.5* 03:00am blood glucose-92 urean-18 creat-1.3* na-149* k-4.0 cl-109* hco3-34* angap-10 04:54am blood alt-11 ast-24 ld(ldh)-243 alkphos-85 totbili-0.5 03:00am blood calcium-8.4 phos-2.7 mg-2.2 05:45pm blood ctropnt-0.02* 05:45pm blood ck-mb-notdone 11:30pm blood cortsol-29.0* 10:20am blood type-art temp-37.8 rates-/15 peep-0 fio2-40 po2-91 pco2-69* ph-7.31* caltco2-36* base xs-4 intubat-intubated 03:10am blood lactate-1.1 03:10am blood freeca-1.11* brief hospital course: pt's a 54 yo f with h/o osa, obesity hypoventilation syndrome with multiple admissions for hypercarbic respiratory failure, asd w/ r to l shunt, htn and pan hypopit presents with a fever and mental status changes found to have a paco2 of 105 on initial abg in basic hypercarbic respiratory failure and triggered by sepsis - initially tx for pulm source but later evident to be more urospepsis with e. coli. (initially covered with vanc/zosyn/levo - later switched to to just levofloxicin. dosing has been challeging with pt admitted with arf. pt with period of hypotension - tx with levophed - off pressors and now extubated 2 days ago - still with mild low grade temps am of tx to floor. currently without complaints, breathing comfortably on bipap (during night). # urosepsis/uti - patient admitted with fever and possible pulmonary infiltrate as well as hypotension, so she was treated for sepsis due to a pulmonary source (vanc/ zosyn/ levofloxacin for legionella coverge). pt has had recent hospitalization so at risk for hap. additionally, pt ua was positive and urine culture growing e. coli that was resistent to amp. pt blood culture and sputum cx were no growth to date. the patient was stablized in the icu. her coverage was reduced to levofloxacin 250mg q24 for urinary source of infection, but noted still with low grade temps morning of icu tx. patient's levofloxacin was increased to 500 mg po qd. she developed a leukocystosis to 16k on with low-grade fevers to with a tmax of 100.3. her right ij cvc was removed on with tip cultured. the patient subsequently was completely afebrile for over 24 hours with improvemnt of her leukocytosis. all studies to evaluate for ongoing infection were negative to date. patient had rash on leg and arms but not cellulitic in appearance. the patient was completely asymptomatic. of note, the patient is on prednisone 5 mg po qd. -patient to complete 5 more days of levofloxacin 500 mg po qd at home. note made of hx of prolonged qtc interval. -would recommend cbc check at f/u pcp visit in 2 weeks. # hypercarbic respiratory failure: multiple hospitalizations related to hypercarbic respiratory failure thought to be due to obesity hypoventilation syndrome. at this admission, initial pco2 was 105 with improvement on mechanical ventilation. the patient was successfully extubated on and tolerated it well. patient was continued on bipap at night. patient was ambulated by pt with ambulatory sats in mid 90s. -outpatient consideration of chronic trach or intermittant nippv (this was brought up by the icu attending). patient should f/u with her pulmonologist. # htn: pt bp medication were initially held due to hypotension. she was restarted on her home clonidine, valsartan, and metoprolol as outpatient. #acute on chronic, diastolic chf: pt was restarted on her home lasix. #arf: resolved during admission. baseline creatinine is 0.9. #hypernatremia: serum na 155 on am of discharge. repeat sodium checked. likely secondary to free water deficit and/or steroid replacemnt for pan-hypo pit. # panhypopituitarism: partially empty sella, currently on desmopressin, levothyroxine, prednisone at home. - continuing these medications at the current dosage (replacement dosing). #anemia: mcv normocytic. stable. # comm: daughter medications on admission: clonidine 0.1 mg po daily aspirin 81 mg po daily levothyroxine 150mcg po daily desmopressin 0.1 mg po daily prednisone 5 mg po daily lasix 40mg po daily cholecalciferol (vitamin d3) 400 unit po daily calcium carbonate 500 mg po tid miconazole nitrate 2 % powder prn valsartan 80 mg po qpm, 40mg po qam metoprolol tartrate 25 mg po bid pantoprazole 40 mg po daily albuterol nebs q6hrs prn omeprazole 20mg po daily cefpodoxime 200mg x 2 months (1+ month left) 2l nc oxygen discharge medications: 1. levothyroxine 75 mcg tablet sig: two (2) tablet po daily (daily). 2. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 5 days. disp:*5 tablet(s)* refills:*0* 3. desmopressin 0.1 mg tablet sig: one (1) tablet po daily (daily). 4. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 5. aspirin ec 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 6. clonidine 0.1 mg tablet sig: one (1) tablet po once a day. 7. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 8. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po once a day. 9. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po three times a day. 10. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for apply to inner thighs. 11. valsartan 80 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 12. valsartan 40 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 13. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 15. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation every six (6) hours as needed for shortness of breath or wheezing. neb discharge disposition: home with service facility: physicians home care discharge diagnosis: hypercarbic respiratory failure uti with possible urosepsis acute renal failure obesity hypoventilation obstructive sleep apnea rash leukocytosis discharge condition: vital signs stable discharge instructions: return to ed if having fevers, chills, significantly worsening rash, shortness of breath. followup instructions: provider: , md phone: date/time: 4:30 patient to arrange f/u appointment with her pcp , i. in weeks. patient to f/u with dr. of pulmonary at . patient to discuss with dr. role for trach given multiple repeated hospitalizations and intubations. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube arterial catheterization diagnoses: obstructive sleep apnea (adult)(pediatric) urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified acute on chronic diastolic heart failure depressive disorder, not elsewhere classified sepsis acute respiratory failure hypotension, unspecified ostium secundum type atrial septal defect unspecified accident obesity, unspecified hyperosmolality and/or hypernatremia septicemia due to escherichia coli [e. coli] panhypopituitarism 

Answer: The patient is high likely exposed to