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 57 year-old female with a history of inflammatory breast cancer, morbid obesity, obesity hypoventilation syndrome, obstructive sleep apnea, systolic and diastolic heart failure, hypertension, gastroesophageal reflux disease and anemia who felt short of breath on the morning of . the patient reports that at baseline she has shortness of breath, however, on the day of admission the patient's shortness of breath did not resolve with supplemental oxygen. she reports low grade fevers with chills and sweats with reported temperature to 100.1 with increased fatigue. she reports cough occasional production of clear sputum. she denies chest pain, abdominal pain, diarrhea, nausea or vomiting. she denies urinary tract infection like symptoms. denies recent sick contacts, travel or varying from her routine. she reports medical compliance with her medications. consequently she was brought to the emergency department this a.m. where she was found to be hypoxic with o2 sats in the approximately 75%, hypotensive with blood pressure 90/50 and was treated with supplemental oxygen, intravenous fluids, broad spectrum antibiotics initially on dopamine drip and started on a sepsis protocol. past medical history: 1. asthma. 2. obesity hypoventilation syndrome. 3. obstructive sleep apnea. 4. morbid obesity. 5. congestive heart failure systolic and diastolic dysfunction with an ef of approximately 30 to 35%. 6. inflammatory breast cancer recently treated with herceptin and navelbine. 7. hypertension. 8. gastroesophageal reflux disease. 9. anemia. 10. depression. medications: 1. lisinopril 40 q.d. 2. aspirin 325 q.d. 3. lasix. 4. flovent. 5. protonix. 6. lactulose. 7. toprol xl 12.5 q.d. 8. epogen. allergies: penicillin causes hives. social history: smoked one pack per day times 10 to 15 years. she quit approximately 20 years ago. physical examination: the patient was afebrile on intensive care unit evaluation. tachycardic to 106. blood pressure 92/50, 25, 96% on 2 liters. she was comfortable. she was described as mild tachypneic with some accessory muscle use. jvd was difficult to assess. she had coarse breath sounds anteriorly with moderate air flow throughout. heart tachycardic, regular rhythm, normal s1 and s2. no audible murmurs, rubs or gallops. belly was soft, nontender, nondistended with active bowel sounds. she had 1 to 2+ edema peripherally and evidence of chronic venostasis. no rash was present. laboratory: white blood cell count 2.9, 59 polys, 32 lymphocytes, hematocrit 23.9, platelets 404. her chem 7 was within normal limits. cks of 167, troponin 0.07. she had a chest x-ray, which showed a question of a retrocardiac opacity. she had a ctpa, which was a poor quality study, but was negative for any obvious signs of pe. she had an electrocardiogram that was alternating between normal sinus rhythm and ventricular bigeminy. no acute changes or ischemia were noted. hospital course: in summary this is a 57 year-old female jehovah's witness with a history of morbid obesity, obstructive sleep apnea requiring bipap at night, congestive heart failure, hypertension, anemia and inflammatory breast cancer who was originally admitted from her nursing home for hypoxia and hypotension and treated in the intensive care unit. the patient was initially treated with levofloxacin for pneumonia, bipap and noninvasive pressure ventilation for hypoxia without intubation. she was subsequently transferred to the floor to continue treatment for pneumonia and hypoxia. ctpa was negative for evidence of pe. she was doing well on the floor until when the patient was again noted to become dyspneic with oxygen saturations into the 80%. repeat chest x-ray showed worsening shortness of breath. she was treated with lasix for diuresis and moderate improvement of respiratory status. given her complex medical history she was transferred to the intensive care unit for closer monitoring. on representation to the intensive care unit the patient spiked a fever to 104, developed significant respiratory distress and was then emergently intubated semiemergently admitted and initially treated with broad spectrum antibiotics for her continued respiratory distress. 1. respiratory failure: the patient is currently being treated for multifactorial respiratory failure in the setting of congestive heart failure, marked obesity, obesity hypoventilation syndrome and obstructive sleep apnea who was semiemergently intubated for progressive hypercarbic respiratory failure and a newly developing sepsis. the patient's blood gas prior to intubation was 7.23, 68 and 385. the patient was intubated and continued on her settings. she ultimately had tracheostomy performed on per the ent service. the goal had been to attempt a trial of extubation on the patient on recovery of her mrsa/sepsis. however, she remained difficult intubation and exacerbated primarily by her recurrent congestive heart failure and over 30 liters positive, fluid balance since her admission. at this point in time she remains trached on pressure support ventilation and has been doing quite well. the goal would be to continue diuresis gently approximately 500 cc to negative one liter per day in order to avoid intravascular of the patient and acute renal failure. additionally the patient was treated aggressively for her mrsa sepsis. she completed a course of antibiotics for presumed pneumonia and subsequent treatment for urinary tract infection as well. she continues with trach care and nebulizers prn and aggressive suctioning as needed. 2. congestive heart failure: the patient has known congestive heart failure with an ef of approximately 30 to 35% with no systolic and diastolic dysfunction. she was approximately 30 liters positive for fluid following treatment for mrsa sepsis and remains volume overloaded at this time. goal has been for gentle diuresis. she was initially started on a lasix drip and subsequently developed acute renal failure and that was discontinued and the patient was started on nesiritide with minimal effect on diuresis. ultimately nesiritide was discontinued minimizing her fluid intake and she responded to lasix intravenously prn as needed for goal as stated above. she was seen on the ch service by dr. and upon resolution of her hypotension the patient was started on low dose beta blocker and treatment of her congestive heart failure. 3. mrsa/sepsis: on readmission to the intensive care unit the patient had a temperature of 104 and blood pressures in the 70s. she ultimately had a positive right ij culture tip for mrsa and positive blood cultures from the for mrsa bacteremia 4 out of 4 bottles. the patient was treated with vancomycin and subsequent surveillance cultures were negative. the patient's antibiotics course will be extended for a minimum of four to six weeks intravenous vancomycin for an underlying right ij clot that is being followed serially. the patient was enrolled in the sepsis protocol. she was given intravenous fluids, starting on intravenous hydrocortisone 50 gallop or murmur intravenously q.i.d. and required dopamine for blood pressure support. as stated the patient's sepsis resolved and surveillance cultures were negative. she will be continued on vancomycin for approximately one month. 4. urinary tract infection: the patient had a urinary tract infection from the 28th that was positive for e-coli that was sensitive to ceftazidine. the patient was treated with a seven day course of ceftazidine. repeat urine cultures were negative. 5. hypotension: the patient had known hypotension in relation to her sepsis, however, her hospital course was complicated by persistent hypotension following resolution of her sepsis. empirically while the patient did not demonstrate evidence of adrenal insufficiency removal of intravenous steroids complicated the patient's picture and she subsequently became hypotensive. in addition, the patient responded poorly to natrecor requiring dopamine for blood pressure support in attempt for diuresis. with subsequent discontinuation of the natrecor and continuing of the intravenous hydrocortisone the patient was effectively diuresed and continued to be diuresed at the time of this dictation without significant hypotension. 6. acute renal failure: the patient has a baseline creatinine of .5 to .7 and subsequently developed acute renal failure with a creatinine rising to 2.1 with diuresis presumed to be prerenal. with gentle diuresis her creatinine slowly improved and it was approximately 1.3 at the time of this dictation. goal was to continue diuresis gently in order to avoid acute renal failure. 7. right ij thrombus: the patient has a known right ij thrombus as a presumed complication from right ij line placement in the setting of sepsis. the clot is being followed serially with weakly ultrasound with noticeable resolution in the proximal right subclavian clot that is no more seen as of the ultrasound from . the patient was not anticoagulated given her jehovah's witness status and will be continued to follow serially with ultrasounds. 8. inflammatory breast cancer: the patient is a patient of dr. . she has a recent history of inflammatory breast cancer and had been receiving weekly navelbine and herceptin. the plan was to try to reduce the size of her left breast mass so she could become a candidate for a mastectomy. however, given her repeated decline in her physical condition her chemotherapy has been changed multiple times. she is unable to be staged appropriately because of her weight. however, recent ctpa did not show any obvious metastatic disease. there was some concern that her preexisting lower extremity edema prior to this admission was secondary to a carcinous meningitis, however, that seems to be unfounded and neurology was unable to obtain lp for diagnostic purposes. consequently the plan at this point in time is that the patient will be reconsidered for additional chemotherapy if she is able to become discharged from the hospital and improves her performance status. 9. anemia: the patient is a known jehovah's witness and would significantly benefit from blood transfusions. on presentation her hematocrit was approximately 23 had decreased to 19. heparin products had been avoided and she has not been anticoagulated. she continues on epogen and iron and her hematocrit seems to stabilize between the 23 and 26 range. 10. vaginal spotting: during her hospitalization in the intensive care unit the patient had repeated vaginal spotting with an associated drop in her hematocrit. gynecology was consulted and it was thought that this bleeding was unrelated to her anemia. she does have multiple risk factors for endometrial cancer and the goal would be to image her with a transvaginal ultrasound to sample her endometrium again, however, at this point in time any additional studies were deferred and she is to be contact for follow up in the clinic as her condition improves and she becomes an outpatient. 11. rectal fistula: the patient had a noticeable perirectal fistula on examination with concern that this may have been contributing to her fever and sepsis. surgery was consulted and determined this unlikely as the nidus of infection based on clinical examination findings. no perirectal cellulitis and no obvious abscess formation. unfortunately imaging studies were unable to be obtained given the patient's body habitus. perirectal swab was polymicrobial in nature including mrsa, however, it was thought that this was unlikely to be the source of the patient's mrsa bacteremia though should be considered if the patient has recurrent event without additional line placement. the patient continues to be followed serially with examinations with no obvious signs of infection. 12. fen: the patient remained npo and during the initial part of her hospitalization was started on tube feeds. the patient continues with tube feeds at this time. she unfortunately was not a candidate for peg or open g tube placement given her habitus and potential surgical risks. she continues on her tube feeds at this time. 13. code status: the patient is a jehovah's witness and remains full code at the time of this dictation. disposition: the patient's disposition is pending based upon improvement in her respiratory status with a goal for subsequent transfer to a nursing facility for continued trach care and pulmonary rehabilitation. the remainder of this dictation will be completed by the next medical intensive care unit intern. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances injection of steroid arterial catheterization temporary tracheostomy injection or infusion of nesiritide diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified severe sepsis methicillin susceptible staphylococcus aureus septicemia acute respiratory failure unspecified sleep apnea morbid obesity methicillin susceptible pneumonia due to staphylococcus aureus combined systolic and diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to