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: metformin attending: chief complaint: hypercarbic respiratory failure major surgical or invasive procedure: endotracheal intubation and ventilation history of present illness: ms. is an 82 year old with woman with a history of dmii, htn, asthma, osa, dchf, peripheral neuropathy who is admitted for ams and hypercapnea. . patient was recently admitted at , at the time she had presented with ams, was found to be hypercarbic and requiring intubation, she was noted to have fluid overload and was diuresed with lasix, she did not have evidence of pneumonia, lenis were negative, and echocardiogram showed a preserved biventricular systolic function without pulmonary hypertension. therefore, it was felt that her hypercarbia was due to not wearing night time bipap for successive days leading to slow increase in her pco2 +/- central apnea. she did well after extubation and was discharged to rehab with nighttime bipap and oral lasix. . per her daughter at baseline prior to previous hospitalization was wheelchair bound most of the day but could make a few independent steps to the bathroom. needed help in adl. demented with occasional visual + auditory halucination. at rehad continued to complain of weakness but did pt, walk around some with a walker. per daughter patient was using bipap rehab but continued to have issues with ill fitting mask. per rehab patient was fine last night, on check this am around 10:15 patient was found to be lethargic. no recent fevers or illness recorded. in the ed patient was conversant and reported wearing her bipap yesterday evening. denied ha, blurry vision, cp, sob, abdominal pain, dysuria, or increased le edema. pt stated she's been compliant with meds at rehab. she stated she feel fine except for "tiredness". states she did not sleep well last night, cannot say why. past medical history: -type 2 diabetes mellitus -hypertension -atypical peripheral neuropathy with cutaneous sensations ("dust on her skin", seen by neurology, on gabapentin + olanzapine) - tactile hallucinosis per pcp : appears to be adult onset asthma. spirometry is restrictive physiology with bronchodilator response. -macular edema s/p surgery -neovascular glaucoma secondary to her proliferative diabetic retinopathy -osa (prescribed bipap, not currently using) -osteoarthritis -dementia -blind in left eye social history: patient is wheelchair bound due to old osteoarthritis and vision loss. born and grew up in the carribean. worked in a chocolate factory in in the . arrived in the us in . denies tobacco, etoh, ivda. she lives with her daughter in . family history: father with diabetes mellitus, died at age 69. mother with heart failure, died at age . oldest daughter with diabetes mellitus and polymyositis. youngest daughter with anoxic brain injury trauma, in rehab. physical exam: admission exam physical examination general: oriented x3, sleepy but arousable to verbal stimuli , denies pain. physical exam is otherwise unchanged from admission: heent: , conjuctiva are hyperemic bilaterally, surgical pupil on the left, non reactive pupils bilaterally, no tenderness with mild pressure on eyes, mmm neck: supple, hard to assess jvp due to habitus,no lad cv: distant reguilar heart, no clear murmurs, rubs, gallops lungs: clear to auscultation bilaterally on anterior auscultation, no wheezes, rales, ronchi abdomen: distended, hypertympanic, non-tender, bowel sounds present, no organomegaly gu: foley in place ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis, tibial edema + bil, rle swelling and + 1 edema on forarm (had right picc during previous hospitalization) neuro: intubated, ventilated and sedated, squeezes hands and wiggles toes to command, moving 4 limbs, normal dtr's throughout, . pertinent results: imaging studies upper extremity u/s doppler findings: -scale and color doppler assessment with pectoral analysis of the bilateral subclavian veins and the right axillary, brachial, basilic, and cephalic veins was performed. there is normal compressibility, flow and augmentation. impression: no right upper extremity dvt. cxr position of the endotracheal tube is unchanged. the exact position of the nasogastric tube cannot be determined on current chest x-ray but appears to be in a satisfactory position on the recently obtained chest ct. tip of the endotracheal tube currently lies 4.2 cm from the carinal angle. the lung fields remain clear. cta chest impression: 1. no pulmonary embolism. 2. no acute aortic syndrome. 3. small left-sided effusion with associated atelectasis. 4. small hiatal hernia. ct head findings: there is no evidence of acute intracranial hemorrhage, edema, mass effect, or acute vascular territorial infarct. -white matter differentiation is preserved. the ventricles and sulci are normal in configuration and size. note is again made of extensive parafalcine calcifications. no fracture is identified. the imaged portions of the mastoid air cells and paranasal sinuses appear well aerated. impression: no acute intracranial process. laboratory studies 12:50pm blood wbc-7.6 rbc-4.62 hgb-12.5 hct-42.1 mcv-91 mch-27.0 mchc-29.6* rdw-14.2 plt ct-194 07:15am blood wbc-7.4 rbc-4.17* hgb-11.6* hct-36.6 mcv-88 mch-27.9 mchc-31.8 rdw-13.8 plt ct-157 01:46pm blood pt-10.9 ptt-33.8 inr(pt)-1.0 12:50pm blood glucose-167* urean-13 creat-0.8 na-146* k-4.6 cl-101 hco3-39* angap-11 07:15am blood glucose-222* urean-18 creat-1.2* na-141 k-4.3 cl-98 hco3-33* angap-14 12:50pm blood alt-32 ast-29 ld(ldh)-274* alkphos-57 totbili-0.1 03:48am blood ck-mb-1 ctropnt-<0.01 12:50pm blood ctropnt-<0.01 probnp-216 12:50pm blood albumin-3.7 calcium-9.4 phos-4.0 mg-2.2 07:15am blood calcium-9.1 phos-4.2 mg-2.0 12:50pm blood d-dimer-514* 12:50pm blood asa-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 01:00pm blood type- po2-79* pco2-89* ph-7.31* caltco2-47* base xs-13 comment-green top 09:08pm blood type-art po2-77* pco2-40 ph-7.61* caltco2-42* base xs-16 09:57am blood type-art po2-79* pco2-62* ph-7.44 caltco2-43* base xs-14 06:44am blood type- po2-59* pco2-65* ph-7.42 caltco2-44* base xs-13 intubat-not intuba 01:00pm blood lactate-0.9 06:44am blood lactate-1.1 07:15am blood wbc-7.4 rbc-4.17* hgb-11.6* hct-36.6 mcv-88 mch-27.9 mchc-31.8 rdw-13.8 plt ct-157 07:15am blood glucose-222* urean-18 creat-1.2* na-141 k-4.3 cl-98 hco3-33* angap-14 brief hospital course: ms. is an 82 year old woman with dmii, htn, asthma, osa, dchf, peripheral neuropathy with recent previous admission with hypercarbic respiratory failure who was admitted again for ams and respiratory failure. . # hypercarbic respiratory failure with alterered mental status: this was felt most likely related to hypercapnea from bipap non-comliance. she was intubated on hd1 for hypercapneic respiratory failure (pco2 of 97). she was extubated on hd2. after extubation she was alert and oriented times three and was called out to the medicine floor. on the floor she continued to do well with nightly bipap. we discussed how important it is for her to use regular bipap every night. she must use bipap every single night. . # acute on chronic diastolic heart failure. she was volume overloaded on presentation. she was diuresed with iv furosemide a total of 3 l while in the micu. she was restarted on 20 mg of furosemide while on the medical floor. this may need to be adjusted in the future. she should have daily weights. . # uti: she had a positive urinalysis in the setting of foley catheter use. she was initially started on ciprofloxacin. subsequently, the culture grew enterocoocus and providencia. she was started on ampicillin and bactrim. she will complete a seven day hospital course. . # type 2 diabetes mellitus: she was initially hypoglycemic, so her nph 70/30 was held on admission. this was gradually restarted on the hospital admission. she was discharged on 60 units in the morning. this will need to be adjusted based on her glucose levels. . # hypertension: continued home blood pressure medications. . # neuropathy/tactile hallucinosis: continude home gabapentin. . # code: ms. was a full code during this admission. medications on admission: 1. betimol 0.5 % drops sig: one (1) ophthalmic three times a day: both eyes. 2. latanoprost 0.005 % drops sig: one (1) ophthalmic at bedtime: both eyes. 3. brimonidine 0.15 % drops sig: one (1) ophthalmic three times a day: both eyes. 4. olanzapine 5 mg tablet, rapid dissolve sig: 0.5 tablet, rapid dissolve po tid (3 times a day) as needed for skin sensations, agitation. 5. olanzapine 5 mg tablet sig: one (1) tablet po at bedtime. 6. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 8. cholecalciferol (vitamin d3) 400 unit tablet, chewable sig: two (2) tablet, chewable po once a day. 9. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po three times a day. 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. acetaminophen 500 mg tablet sig: two (2) tablet po at bedtime. 12. diltiazem hcl 240 mg capsule, extended release sig: one (1) capsule, extended release po daily (daily). 13. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation three times a day as needed for shortness of breath, wheezing. 14. proair hfa 90 mcg/actuation hfa aerosol inhaler sig: two (2) inhalation four times a day as needed for shortness of breath or wheezing. 15. furosamide 20mg daily 16. lisinopril 20 mg tablet sig: one (1) tablet po bid (2 times a day). 17. trusopt 2 % drops sig: one (1) ophthalmic twice a day: both eyes. 18. ibuprofen 600 mg tablet sig: one (1) tablet po three times a day as needed for arthritis pain. 19. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 20. gabapentin 300 mg capsule sig: one (1) capsule po bid (2 times a day). 21. prednisolone acetate 1 % drops, suspension sig: one (1) ophthalmic four times a day: left eye. 22. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 23. insulin nph & regular human 100 unit/ml (70-30) suspension sig: sixty (60) subcutaneous qam. 24. insulin lispro 100 unit/ml cartridge sig: one (1) subcutaneous once a day: per insulin sliding scale. discharge medications: 1. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic tid (3 times a day). 2. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 3. brimonidine 0.15 % drops sig: one (1) drop ophthalmic q8h (every 8 hours). 4. olanzapine 5 mg tablet sig: one (1) tablet po hs (at bedtime). 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk inhalation twice a day. 6. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 8. vitamin d 1,000 unit capsule sig: one (1) capsule po once a day. 9. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. acetaminophen 500 mg capsule sig: two (2) capsule po at bedtime. 12. diltiazem hcl 240 mg capsule, extended release sig: one (1) capsule, extended release po once a day. 13. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 14. proair hfa 90 mcg/actuation hfa aerosol inhaler sig: puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. 15. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 16. lisinopril 20 mg tablet sig: one (1) tablet po bid (2 times a day). 17. dorzolamide 2 % drops sig: one (1) drop ophthalmic (2 times a day). 18. ibuprofen 600 mg tablet sig: one (1) tablet po three times a day as needed for arthritis pain. 19. gabapentin 300 mg capsule sig: one (1) capsule po bid (2 times a day). 20. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day) as needed for constipation. 21. prednisolone acetate 1 % drops, suspension sig: one (1) drop ophthalmic qid (4 times a day). 22. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (5,000 units) injection tid (3 times a day). 23. insulin nph & regular human 100 unit/ml (70-30) suspension sig: forty five (45) units subcutaneous qam. 24. insulin lispro 100 unit/ml solution sig: sliding scale subcutaneous four times a day: take with breakfast, lunch, dinner, before bed according to sliding scale. 25. ampicillin 250 mg capsule sig: two (2) capsule po q6h (every 6 hours) for 4 days: last day is . . 26. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po bid (2 times a day) for 4 days: last day . discharge disposition: extended care facility: - discharge diagnosis: hypercarbic respiratory failure acute on chronic diastolic congestive heart failure diabetes mellitus type ii urinary tract infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: it was a pleasure to take care of you here at . you were admitted for respiratory failure. this was felt to be most likely due to your not using your bipap machine at rehab as well as a small amount of fluid in the lungs. we gave you a some medicine (furosemide or lasix) to help remove some of the extra fluid. it is very important to continue to use bipap. it is critically important to your health to continue to use the bipap machine without exception. you must use it every night. we have made the following changes to your medications: we started two antibiotics to treat a urinary tract infection. these are called bactrim and ampicillin. you will take both of then until . followup instructions: you have the following appointments scheduled: department: center when: wednesday at 10:20 am with: eye imaging building: campus: east best parking: garage department: center when: wednesday at 10:40 am with: , m.d. building: sc clinical ctr campus: east best parking: garage department: neurology when: friday at 11:30 am with: , md building: sc clinical ctr campus: east best parking: garage md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute on chronic diastolic heart failure asthma, unspecified type, unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes acute respiratory failure diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin osteoarthrosis, unspecified whether generalized or localized, site unspecified personal history of noncompliance with medical treatment, presenting hazards to health streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] encephalopathy, unspecified diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms unspecified psychosis history of fall glaucoma associated with vascular disorders swelling of limb proliferative diabetic retinopathy wheelchair dependence dementia, unspecified, without behavioral disturbance glaucoma stage, unspecified 

Answer: The patient is high likely exposed to