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: erythromycin base / vitamin k analogues attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: patient is a 82 yo woman with pmh cad s/p cabg, s/p mv repair (for mvp with mr) in who presents with c/o increased sob from baseline over past 3 days. per patient and family, reports at baseline, pt experiences sob with exertion, including climbing stairs. however, over the past 3 days, patient has been experiencing increased sob, so that she appears sob with talking, with sitting down, etc. patient denies any chest pain/pressure, orthopnea, pnd, weight gain, le swelling, although does say she used to get those symptoms prior to her mv repair. other than the sob, patient reports + diaphoresis at night (which she reports also noting prior to her mv repair), feeling weak and tired, decreased appetite. family denies any change in mental status. . of note patient's recent medication changes include: hctz started 1.5-2 mos ago. otherwise no medication changes. per patient's family, she does not always take her medications, including her potassium. . also of note, patient and her family report patient had a mechanical fall 3 days ago, which they also say was the onset of her symptoms, although they do think it is coincidental. the fall is reported as mechanical as pt tripped over the rug. no loc, did not hit her head, no change in ms or balance since that time. . in ed, patient received in ekg which did not show any st changes, 1 set negative ce (trop = 0.02, ck 39). labs notable for cr to 1.3 from baseline 0.8, k 2.4, d dimer 997. pt was given asa, started on hep gtt (in case acs), given 80mg po kcl. . currently pt denies sob (although appears tachypnic). just c/o weakness and feeling tired. ros otherwise as above. past medical history: 1.) cad s/p cabg ( - also took sample of chamber wall as appeared to be atrial myxoma, although pathology diagnosed organized thrombus) - c/b sternal staph infection (oxacillin sensitive staph aereus) - therefore sternum removed w/ latissimus dorsi flap over sternal area. 2.) mv repair - corkscrew # 30 mitral annuloplasty ring ( at same time as cabg above) 3.) hx of paroxysmal a fib 4.) dementia (early alzheimer's) 5.) s/p cholecystectomy 6.) s/p tah social history: lives next door to son and daughter etoh no drugs no smoking family history: father died at 61 with mi physical exam: in ed: t:95.3 hr: 92 bp: 116/66 rr: 25 o2 sat: 97% on 4l aao x3, hard of hearing heent: perrl eomi neck: supple resp: crackles 1/3 up base cv: systolic murmur, rr abd: soft ntnd +bs gu: no cva tenderness ext: no le edema +dp pulses b/l skin: no rashes neuro: no focal numbness or weakness pertinent results: cxr: the heart is enlarged. pulmonary vascular markings are increased with kerley b lines evident. there is no focal consolidation. there is no pneumothorax. osseous structures are unremarkable. impression: chf. . : renal us: renal ultrasound: the right kidney measures 9.3 cm. within the upper pole of the right kidney is a 0.7 x 1.2 x 1.1 cm simple cyst. within the right lobe of the liver is an 1.2 x 0.7 x 1 cm simple cyst. the left kidney measures 10 cm. there are no renal masses, stones, or hydronephrosis. the bladder contains a foley catheter is otherwise unremarkable. impression: simple right renal and right hepatic cysts. . echo: : conclusions: 1. the left atrium is moderately dilated. the left atrium is elongated. the right atrium is markedly dilated. 2. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). 3. right ventricular chamber size is normal. right ventricular systolic function is normal. 4.the aortic valve leaflets (3) are mildly thickened. moderate (2+) aortic regurgitation is seen. 5.the mitral valve is redundant and thick. a mitral valve annuloplasty ring is present. moderate to severe (3+) mitral regurgitation is seen. 6.moderate to severe tricuspid regurgitation is seen. 7.there is severe pulmonary artery systolic hypertension. 8.there is no pericardial effusion . : ct head with contrast: conclusion: limited study due to motion artifact. no large intracranial hemorrhage is identified. no gross intracranial mass effect is evident. a 7.5-mm lytic lesion at the right parietal bone may represent a venous , although a metastatic deposit cannot be excluded and can be considered in the appropriate clinical setting. . : cxr: findings: again seen is an endotracheal tube with tip 4.8 cm above the carina. the tip of the endotracheal tube is pressing against the right lateral wall of the trachea and deviating it slightly. the ng tube is in the stomach. there is a swan-ganz catheter with tip in the pulmonary outflow tract. there is increased hazy opacity in bilateral lower lungs, left greater than right, and also in the low left mid lung suggesting patchy focal infiltrates. these have increased compared to the prior day. there is no pneumothorax. . : ruq us impression: 1. gallbladder not visualized. is this patient status post cholecystectomy? 2. multiple anechoic lesions in the liver consistent with cysts with one of these lesions suggestive of a septated cyst. 3. no biliary ductal dilatation . : ct chest impression: 1. no pulmonary embolism. 2. status post cabg with median sternotomy, with unchanged appearance of the sternum. marked cardiomegaly with marked right atrial enlargement. 3. small bilateral pleural effusions, increased compared to the prior study. 4. increased ground glass opacity with interlobular septal thickening in bilateral lungs, which probably representing worsening pulmonary edema. more confluent opacities in bilateral upper lobes, also increased compared to the prior study, which may represent infectious process such as multifocal pneumonia. please correlate clinically. . : cxr: impression: increased patchy pulmonary alveolar opacities consistent with worsening failure. . : an et tube is present, tip approximately 2.5 cm above the carina. it points toward the right mainstem bronchus and close followup is therefore recommended. an ng tube is present, tip beneath diaphragm extending off film. right ij central line is present, tip overlying svc/ra junction. there is moderate cardiomegaly. there are patchy interstitial and alveolar infiltrates, diffusely throughout both lungs. these appear somewhat less confluent than on the film from one day earlier, particularly in the left upper zone. no effusions are identified. impression: diffuse interstitial and alveolar infiltrates, with slight interval improvement compared with one day earlier. lines and tubes as described. . micro data: 9:30 pm urine **final report ** urine culture (final ): culture workup discontinued. further incubation showed contamination with mixed fecal flora. clinical significance of isolate(s) uncertain. interpret with caution. escherichia coli. >100,000 organisms/ml.. presumptive identification. trimethoprim/sulfa sensitivity testing confirmed by . organism. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ 8 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 8 s gentamicin------------ <=1 s imipenem-------------- <=1 s levofloxacin----------<=0.25 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s . 05:16pm plt count-152 05:16pm anisocyt-1+ poikilocy-1+ macrocyt-1+ 05:16pm neuts-65.5 lymphs-23.4 monos-6.4 eos-4.5* basos-0.2 05:16pm wbc-6.1 rbc-3.71* hgb-11.9* hct-34.7* mcv-94 mch-32.2* mchc-34.4 rdw-16.7* 05:16pm calcium-9.3 phosphate-3.4 magnesium-1.7 05:16pm ck-mb-notdone 05:16pm ctropnt-0.02* 05:16pm ck(cpk)-39 05:16pm glucose-83 urea n-35* creat-1.3* sodium-143 potassium-2.4* chloride-100 total co2-31 anion gap-14 06:20pm d-dimer-997* 06:20pm pt-13.5* ptt-22.7 inr(pt)-1.2 brief hospital course: 82f w/cad s/p cabg, s/p mv repair (for mvp with mr) in admitted to the ccu after being found in respiratory distress on the floor. her course in the ccu was complicated by 4 episodes of acute pulmonary edema of unknown etiology for which she required intubation for appropriate ventilation and oxygenation. it was felt that her repiratory distress was most likely secondary to cardiac issues and pulmonary hypertension. an extensive workup was done to try to determine whether there were reversible cardiopulmonary etiologies. her cardiac workup included: - echo which showed- ef 50% with 2+ mr, 2+ tr, old mvr - cardiac catherization which revealed pcwp: 17mmhg, lvedp: 16mmhg, pap: 67/25 with lvef: 55% and ci: 3.13. in addition, her coronary anatomy showed 60% lcx s/p stent. - multiple attempts at cardioversion with medication and electricity - pressure support # rhythm: the patient's heart rhythm shifted quite often during her time here. she was originally in afib/aflutter on floor - tried to control with bb. initially delayed becaues of fluid overload; eventually, she was cardioverted on to sinus and heparinized as patient may reconvert to afib/flutter. she had a long history of paf, for which she was not anticoagulated for because of compliance issues her dysrhythmias were felt that to be secondary to signals coming from multiple foci - the shifts varied b/w a rate 80s-120s. on , she was restarted on amiodarone (no loading as patient was previously on amiodarone). we also felt that there was also some concern for amiodarone toxicity given 2 year history of amiodarone usage- > however, felt better to restart the amio in face of continuing arrhythmias. of note, the patient had an episode of bradycardia with a junctional rate of low 40s with a drop in bp to 60s on at 4am - > unclear as to the precipitant of this -> ep felt that this was likely a pac (possibly increased vagal tone) -> would not like to do any interventions given recent cardioversion and short episode. nodal agents were avoided and atropine was kept at bedside. . # pulmonary: on night of , patient developed tachypnea on floor and was intubated; required pressor support with levophed and fluids. unclear whether patient aspirated vs acute pulmonary edema. she was cardioverted to sinus rhythm in the ccu. she was swanned in the ccu and then started on dobutamine and lasix. eventually weaned off of levophed. she was extubated on -> and tolerated this well -> and only intermittently requiring cpap -> reintubated on for respiratory disress. there were no clear precipitants for this last episode. - cath was done to assess cornary anatomy. it showed that patient has pulm htn - likely from valvular disease. - developed diffuse pulmonary opacification - which may have been hydration for cath and was +2.3l over 2 days. a pulmonary consult was called to help to elucidate the etiology of this recurrent pulmonary edema. diuresis was held as this was not felt to be more of an ards type picture. . - cta on ruled out chronic/subacute pes - during her course in the ccu, she was broadly covered with antibiotics including unasyn/zosyn, vancomycin and azithromycin. these were discontinued on with close monitoring for signs of infection. . # ams: on night of , patient had episode of delirium/agitation - this was most likely secondary to overmedication with sedatives. it was unclear as to whether this was due to psychotropic medications or delirium from multiple medical problems. . # uti on admission, patient was on cipro for cipro sensitive e coli uti -> switched to unasyn given ? of aspiration -> on -> changed to zosyn for pseudomonas coverage (3 days of intubation) - added on vancomycin 1g q 48 given ? aspiration to cover for mrsa - zosyn/vanco transiently stopped on because of ox sensitive sputum cx-> restarted overnight of . # arf: arf from admission resolved with hydration # lytic lesion on skull: - spep/upep negative - metastatic disease vs venous from prior comparison . # withdrawl of care: - on , family discusssion was held with health care team and family of patient, including health care proxy (daughter of patient.) during the discussion, it became clear that it was not the patient's desire to be intubated for a long period of time; in addition, the patient's pulmonary status had not been improving over the course of this hospitalization. hence, the decision was made to withdraw care except for sedation. in addition, the patient was made dnr/dni. shortly thereafter on the night of , the patient passed away peacefully with her daughter and son-in-law at her bedside. medications on admission: ibuprofen 400 tid potassium hctz 25 qd namenda 10 univasc 15 qd asa 325 qd amiodarone 200mg daily paxil 30 qhs discharge medications: none discharge disposition: extended care facility: for the aged - ltc discharge diagnosis: deceased discharge condition: deceased discharge instructions: na followup instructions: na procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures diagnostic ultrasound of heart other and unspecified coronary arteriography insertion of endotracheal tube other electric countershock of heart pulmonary artery wedge monitoring transfusion of packed cells injection or infusion of nesiritide insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified acute kidney failure, unspecified atrial fibrillation aortocoronary bypass status other complications due to heart valve prosthesis other chronic pulmonary heart diseases hypopotassemia acute respiratory failure unspecified hearing loss alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance dehydration diastolic heart failure, unspecified delirium due to conditions classified elsewhere cardiac rhythm regulators causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to