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: history of present illness: this is a 63 year old caucasian female with past medical history significant for hypertension, depression and gastroesophageal reflux disease, who was admitted to the medical intensive care unit for left lower lobe pneumonia/effusion, with hypoxia. the patient had been in her usual state of health until approximately three to four days prior to admission when she began to experience productive cough with thick yellow and brown sputum. the following morning, the patient spiked a temperature to 102.8 f., and began to experience some diarrhea. she was seen by a nurse practitioner and given pressin, presumptively for a viral process. she continued to cough over the weekend, spiked fevers with chills and grew progressively short of breath. she finally came to the emergency department at on monday morning, where her o2 saturations were 72 to 80% on two liters nasal cannula. chest x-ray showed a large left lower lobe pneumonia and effusion, and she was given 500 mg of levaquin intravenously and placed on 100% non-rebreather. her arterial blood gas at that time was the following: 7.42, 36, 57. she did not initially want to be intubated and requested being tried on 100% non-rebreather at that time. review of systems: notable for increasing dyspnea on exertion over the last several months; positive orthopnea; no pedal edema. past medical history: 1. hypertension. 2. gastroesophageal reflux disease. 3. depression. 4. incontinence. 5. glaucoma. 6. the patient was scheduled for a stress test the morning of admission. allergies: no known drug allergies; now patient is known to have a drug allergy to penicillin and ceftriaxone. medications on admission: 1. detrol 2 mg p.o. twice a day. 2. hydrochlorothiazide 25 mg p.o. q. day. 3. nortriptyline 50 mg p.o. q. h.s. 4. celexa 20 mg p.o. q. day. 5. prempro 0.625 mg p.o. q. day. 6. neurontin 600 mg p.o. q. h.s. 7. atenolol 100 mg p.o. q. day. 8. accupril 40 mg p.o. q. day. social history: miss is a kindergarten teacher. she has had no sick contacts lately. she has no cigarette or alcohol use. she is married and lives with her husband in . family history: her mother had glaucoma and hypertension. physical examination: on admission, temperature 96.4 f.; heart rate 110 to 114; respiratory rate 32 to 40; blood pressure 144/60; saturating 96% on 100% non-rebreather. in general, this is a thin, tachypneic white female, alert and oriented but fatigued. neck was supple; there were retractions with inspiration. no lymphadenopathy, no jugular venous distention. heart: tachycardic, regular rhythm; no rubs, murmurs or gallops. heart sounds were distant. lungs with decreased breath sounds in the lower half of the left lung field. positive dullness to percussion over the lower half of the left lung; positive egophony. abdomen soft, nontender, nondistended. positive bowel sounds; no hepatosplenomegaly. extremities, clean, dry and intact. positive mottling over the upper extremities bilaterally. no swelling. neurologic: alert and oriented. cranial nerves ii through xii intact. light touch intact overall of the extremities. laboratory: on admission, white blood cell count 21.7, with 43% neutrophils, 51% bands, 1% lymphocytes and 3% monocytes. hematocrit 36.9, platelets 293. chem-7 was the following: sodium 110, potassium 3.2, chloride 76, bicarbonate 20, bun 12, creatinine 0.6, blood sugar 138, lactate was 3.6. blood cultures were obtained times two. urine was obtained for legionellae. chest x-ray showed a large left lower lobe consolidation and effusion. hospital course: in the emergency department, ultrasound guided thoracentesis of the left pleural effusion was attempted, however, ultrasound could not locate a large pocket of fluid and this was cancelled at this time. she was then transferred to the medical intensive care unit for further evaluation and management. 1. respiratory: miss had a repeat arterial blood gas on transfer to the medical intensive care unit which showed the following: ph of 7.44, pco2 32, po2 of 63. the patient was originally very tachypneic up to the 40s but in the next couple of hours had respiratory rate down to 20 with decent oxygenation. however, she began to tire out, became increasingly diaphoretic and she was intubated at 10 p.m. that night. she was placed on ac and has done fairly well for the next few days. the morning after intubation, she was tried on pressure support of 3, peep of zero, and did very well. however, extubation was held secondary to the procedures that were ongoing later that morning. she a bronchoscopy which showed diffuse yellow and brown thick sputum. she also an ultrasound guided thoracentesis of the left pleural effusion via the pleural service. ph of the fluid was 7.39. pleural fluid had 3325 pmns with 81% neutrophils, 5% lymphocytes, 14% monocytes, and 7800 red blood cells. ld was 245, total protein 3.3, glucose 8.9 and ldh was 910. miss had been placed initially on levaquin 500 mg intravenously in the emergency department and then switched to ceftriaxone and azithromycin for community-acquired pneumonia. this was continued for three days. however, on day four, blood cultures began to grow out gram positive cocci which has been discovered to be streptococcus pneumoniae. this was pan-sensitive but miss was placed intermittently on vancomycin intravenously. when sensitivities returned, she was then placed on penicillin, 3,000,000 units every four hours but she developed a drug rash on her back due to the medication. miss was then changed back to levaquin 500 mg intravenously q. day. miss chest x-ray showed evolving pneumonia and inflammation which now involved both right and left sides as well as multiple lobes. infectious disease was consulted who believed that miss had a serious streptococcal pneumonia and recommended ceftriaxone 2 grams q. 24 hours. this was continued for two days but drug rash was now evolving to involve both stomach, chest and neck. at this time, miss was then changed to vancomycin one gram q. 12 hours. she had a repeat chest ct scan which showed worsening effusion on the right side as well as worsening infiltrates bilaterally. she had undergone thoracentesis of the left side including a loculated effusion which was shown to be peri-pneumonic just as the first had been. at this time a right sided thoracentesis was done on , which was also peri-pneumonic in nature. the plan has been that if miss in any way with increasing temperatures or increasing white count, that vats and decortication would be indicated for the left loculated effusion. 2. infectious disease: as stated above, miss has been on multiple antibiotics and now is on vancomycin one gram q. 24 hours. this is day ten of antibiotics which will likely need to be continued for 14 days. white count is finally coming down with her fevers which are lower than prior. of note, bronchoscopy has been repeated once showing continued thick sputum. abdominal and chest ct scan were obtained to rule out other sources of infection. abdominal ct scan was negative for any kind of abscesses. lumbar puncture was also done which showed negative cerebrospinal fluid for infection. finally, an x-ray was done of the left lower extremity to rule out possible hardware as miss has two surgical scars along her left lower extremity. x-rays were negative at that time. 3. cardiovascular: miss had an echocardiogram on , which showed good left ventricular and right ventricular function with ejection fraction greater than 55%. there were no abnormalities. she had been initially sedated with fentanyl and ativan which has been changed intravenous propofol for ventilation dependence. her blood pressure had dropped secondary to the propofol and she was placed on levophed intermittently. levophed and propofol were eventually weaned off and her blood pressure has been stable since. 4. renal: miss creatinine and bun have been stable. she had initial hyponatremia which was treated with fluid restriction and then normal saline with good effect. sodium has been 133 to 134 for the past four to five days. of note, phene was less than 1 with urine osmolality less than 100 and urine sodium less than 10. this was likely secondary to hypervolemia initially with low solutes as urine sodium on admission was greater than 20. she had likely inappropriately had high urine sodium secondary to presumed hypervolemia. urinalysis was also notable for hematuria. 5. fluids, electrolytes and nutrition: miss was placed on tube feeds on day four of her admission. 6. prophylaxis: miss was prophylaxed with protonix intravenously and subcutaneously heparin. line-wise, miss right internal jugular insertion on admission , which was then changed over a wire on for fever. she initially had a right radial artery line which was then changed to the left side for again presumed source of fever. communication has been with her husband. 7. disposition: miss is full code and requires intensive care unit care at this time. , p. m.d.12-948 dictated by: medquist36 procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis other bronchoscopy temporary tracheostomy closed [endoscopic] biopsy of bronchus diagnoses: anemia, unspecified unspecified pleural effusion unspecified essential hypertension other pulmonary insufficiency, not elsewhere classified other specified cardiac dysrhythmias iatrogenic pneumothorax pneumococcal septicemia [streptococcus pneumoniae septicemia] pneumococcal pneumonia [streptococcus pneumoniae pneumonia] other disorders of neurohypophysis 

Answer: The patient is high likely exposed to