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: patient recorded as having no known allergies to drugs attending: chief complaint: found down major surgical or invasive procedure: intubation history of present illness: history was obtained from a friend who talks with her a few times a week, but the last time he saw her was 4 years ago (history was not obtained from her neighbor who found her), and also from ed records. . 84 f with unknown medical history, was found down tonight on her kitchen floor by her neighbor. neighbor noticed that she had been sob and panting over the past few days, and he kept telling her she had to go to a physician, she refused. he was walking by her this afternoon and heard moaning. he unlocked the door to her and found her lying on the kitchen floor, no blood or apparent trauma. she states that she fell off the couch due to sudden weakness, no cp, no abd pain. +back pain due to position in bed. neighbor called 911 and patient was brought to ed. . in the ed, sbp was 60s, received 2l with bp still in 70s, received 2 more l with little sbp improvement. sats started dropping to 85, so she was intubated for airway protection and had lij central line placed. norepinephrine was started and sbp improved to 110s. t102 rectally. ngt put out 250 ml coffee ground fluid, received 1 u rbc. uo 230 ml after 4 l ivf. . ua was positive, cxr shows lll infiltrate. wbc 21, bands 5. hct 35.5. lactate 4.1. inr 1.9. ck 1677, mb 21, trop 0.03. ct chest shows lll infiltrate, aorta is mildly dilated but nonaneurysmal with no dissection, large goiter, rml centrilobular nodules suggestive of atypical mycobacterial infection, large hiatal hernia with intrathoracic stomach. . at baseline, the patient is independent, lives alone, walks with a cane, pays a woman who does her shopping for her. past medical history: goiter on r side of neck l hip replacement hypertension social history: has no close relatives, is a private person. never been married, has no children. used to work at in unknown job. likes brandy before bed but unknown if has etoh problem, doesn't smoke, no illicit drugs. lives alone in . has a siamese cat, frank, for the last 10 years. family history: unknown physical exam: vs: 100.8 / 116/65 / 103 99% on ac 550 pulling in 600 / 15 breathing 7 over vent at rr 22 / 5 / 0.5 . gen: sedated, arousable to voice and holding hand, looks comfortable heent: jvd 7 cm, no lad, intubated, perrl. 6x6 cm goiter, soft and mobile in r central neck. lungs: coarse breath sounds, clear anteriorly chest: petechiae on upper chest, upper arms, in axillary areas bl heart: 2/6 systolic flow murmur, no r/g abd: soft, +bs, surgical scar ruq, nd, nt extr: no c/c/e, 2+ dp bl neuro: withdraws from painful stimuli skin: petechiae as noted on chest/back pertinent results: ct chest: impression: 1. within the limitations of a non-iv contrast examination, the aorta is mildly dilated but non-aneurysmal with no secondary evidence of dissection. 2. there is a large goiter. correlate with physical exam and thyroid biochemical profile. if indicated, consider thyroid ultrasound for further evaluation. 3. likely small focus of evolving pneumonia or aspiration in the lateral basal segment of the left lower lobe. 4. centrilobular nodules in the right middle lobe suggestive of atypical mycobacterium infection (indolent and chronic). 5. large hiatal hernia with resultant intrathoracic stomach. . ct c spine: findings: there is no fracture. there is exaggeration of the lordotic curvature otherwise no malalignment noted. there is disc space narrowing at c5-c6 and c6-c7 with small marginal osteophytes. the _____ osteophytes favor the right lateral recess resulting in bony neural foraminal encroachment. endotracheal and nasogastric tubes are evident. there is a large heterogeneous thyroid, likely goiter. otherwise, the prevertebral and other soft tissues of the neck are unremarkable. impression: degenerative disc disease as detailed above. no acute traumatic findings. . cxr: findings: there has been interval withdrawal of a left internal jugular central venous catheter with tip now in the left brachiocephalic vein. the remainder of the lines and tubes are in unchanged position. again seen is a large hiatal hernia with an intrathoracic stomach. there is mild airspace opacity adjacent to the left heart border. the remainder of the examination remains unchanged. impression: 1. interval withdrawal of left internal jugular central venous catheter with 2. mild airspace opacity adjacent to the left heart border. . abdominal u/s: . ct abdomen/pelvia: 03:10pm plt smr-low plt count-92* 03:10pm neuts-94* bands-5 lymphs-1* monos-0 eos-0 basos-0 atyps-0 metas-0 myelos-0 03:10pm wbc-21.3* rbc-4.07* hgb-12.3 hct-35.5* mcv-87 mch-30.3 mchc-34.8 rdw-15.6* 03:10pm ethanol-neg 03:10pm ck-mb-21* mb indx-1.3 03:10pm ctropnt-0.03* 03:10pm ck(cpk)-1677* 12:25am blood ck-mb-32* mb indx-0.9 ctropnt-0.05* 11:33am blood ck-mb-16* mb indx-0.8 ctropnt-0.03* 12:25am blood alt-65* ast-165* ld(ldh)-542* ck(cpk)-3747* alkphos-221* amylase-33 totbili-0.9 06:09am blood ck(cpk)-2938* totbili-0.6 11:33am blood alt-63* ast-139* ck(cpk)-1894* alkphos-132* totbili-0.5 03:10pm blood glucose-78 urean-47* creat-2.3* na-137 k-3.8 cl-99 hco3-19* angap-23* 06:09am blood fdp-* 11:33am blood fibrino-353 d-dimer-* 12:25am blood fibrino-261 05:10pm blood pt-19.5* ptt-40.3* inr(pt)-1.9* 12:25am blood pt-16.9* ptt-35.7* inr(pt)-1.6* 11:33am blood pt-15.6* ptt-35.2* inr(pt)-1.4* . ct abdomen/pelvis impression: 1. left lower lobe consolidation, probably representing pneumonia. small bilateral pleural effusions. 2. very large hiatal hernia containing contrast. ng tube in place. 3. stranding in the mesentery and perirenal spaces, consistent with history of recent percussive resuscitation. 4. bilateral staghorn calculi. 5. enlargement of left adrenal gland, which is not specific for adenoma as there is no definite mass. dedicated imaging with adrenal ct or mri is recommended for further evaluation. . abdominal ultrasound: the gallbladder is unremarkable without evidence of stones or wall edema. the common bile duct is not dilated. the liver is coarsened in echotexture. there are multiple echogenic portal triads. there are no focal lesions. the portal vein is patent with appropriate directional flow. the right kidney measures 13.5 cm. the left kidney measures 12.6 cm. there are no stones or hydronephrosis bilaterally. the spleen and visualized portions of the pancreas are unremarkable brief hospital course: 84 f found down, temperature of 102 and significant leukocytosis admitted with severe sepsis from gu source. . # severe sepsis: initially required levophed in order to maintain maps. there was question.- on ceftriaxone and azithro for cap and uti, flagyl for possible aspiration pna, start . no growth from cultures (urine or blood). eventually found to have staghorn calculus in kidneys and believed most likely to be urinary source of infection. later also question of aspiration pneumonia. received 10 day course of flagyl and finishing 14 day course cap/urinary antibiotic (one more day of levofloxacin). initially had element of dic as well, resolved. patient transferred to floor with stable blood pressure. . # respiratory insufficiency: was intubated for airway protection after sats dropped to 85% after receiving 2 l ns. hypoxemia may have been from element pulmonary fluid overload, although also treated for aspiration pneumonia. . # uti: urine cultures remained no growth but received broad spectrum coverage. has staghorn calculi which puts her at increased risk of recurrence. has follow up appointment with urology to address. . # leukocytosis: patient had wbc count peak at , down to on day of discharge. given flagyl empirically for c diff, although stools negative here. have been all reactive to infection but will follow up with hematology as an outpatient. . # ugib: coffee ground fluid from ngt. received 1 u rbc in ed. has a large hiatal hernia with resultant intrathoracic stomach. predispose to ugib and gastritis. cont ppi. h. pylori serology was negative. . # goiter on r side of neck: tsh and rest of tfts wnl in 12/. mild airway involvement. should get ultrasound as outpatient and endocrine follow up arranged. repeat tfts in 6 weeks. . # adrenal gland: enlargement of left adrenal gland, which is not specific for adenoma as there is no definite mass. dedicated imaging with adrenal ct or mri is recommended for further evaluation as an outpatient. . # anxiety: patient reports longstanding anxiety. started on ssri and given lorazepam prn, as well as trazodone to help with sleep. reports some increased symptom control with combination. should be reviewed in outpatient setting. . # dispo: patient deconditioned after micu admission. will be discharged to rehab today for str with plan for eventual discharge home. medications on admission: given lorazepam previously by pcp. discharge medications: 1. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 2. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed for diarrhea. 5. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 1 days. 6. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime). 7. lorazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. discharge disposition: extended care facility: for the aged - discharge diagnosis: severe sepsis from urinary tract infection staghorn calculi leukocytosis, most likely from infection acute renal failure (pre renal and infection) goiter gastritis anxiety/depression discharge condition: good discharge instructions: please take your medications as prescribed. you will need to follow up with multiple physicians after discharge. please see the appointments below. you have been found to have a large stone in your kidneys that needs to be reevaluated by the urologists after discharge. you also have been found to have a goiter that needs to be followed up as an outpatient. your primary care doctor (dr. will arrange this. your white blood cell count got very high here. most likely this was from infection and has now resolved, but you will need to follow up with hematology as an outpatient as well. followup instructions: provider: , md phone: date/time: 1:30 provider: , hematology/oncology-cc9 date/time: 1:30 provider: , .o. phone: date/time: 11:30 (general medicine/geriatrics) dr (urology) @ 10:15am phone:( procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube transfusion of packed cells diagnoses: urinary tract infection, site not specified acute kidney failure, unspecified unspecified septicemia severe sepsis diaphragmatic hernia without mention of obstruction or gangrene dysthymic disorder acute respiratory failure defibrination syndrome pneumonitis due to inhalation of food or vomitus septic shock infection and inflammatory reaction due to other vascular device, implant, and graft hemorrhage of gastrointestinal tract, unspecified phlebitis and thrombophlebitis of superficial veins of upper extremities calculus of kidney nontoxic uninodular goiter 

Answer: The patient is high likely exposed to