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: keflex attending: chief complaint: mental status changes, hypoglycemia major surgical or invasive procedure: endotracheal intubation picc line placement central line placement history of present illness: 65 year-old woman with a history of type 2 dm, mi, and multiple transferred from an osh with mental status changes and hypoglycemia. history was obtained from patient's daughters. has a 5-day history of cough productive of yellow, green sputum, nausea + vomiting, and diarrhea. daughter notes decreased po intake. unsure if patient has had fevers or chills. diarrhea described as dark brown; no melena or bright red blood. this morning around noon, daughter noted slurred speech, right facial droop, and right arm weakness. at the time, patient complained of paresthesias in right hand. daughter noted patient was confused and called ems. ems noted blood glucose of 33. she was given 2 amps of glucose and taken to hospital. she received an additional 2 amps of d50 and a dose of ceftriaxone. head ct was reportedly negative. troponin i elevated at 1.29 with ck=1880. she was transferred to for further care. . daughters deny any recent changes to patient's medications. as far as they know, she took her normal medication doses this morning. of note, daughters report a history of tias associated with slurred speech, right facial droop, and right-sided weakness but deny any associated confusion in prior episodes. past medical history: 1. type 2 dm 2. stemi in ; cath at showed 40% lad, 30% diagonal, 40% lcx, rca 2x 75%+ lesions; stented x2 3. s/p cva in 4. hx of tias 5. htn 6. hypercholesterolemia social history: lives with 2 of her daughters in . current smoker with 50-70 pack-year smoking history. no etoh. patient is normally bed-bound but can ambulate with a walker. family history: non-contributory physical exam: t 100.5 hr 80 bp 110/45 rr 25 96% 2l nc gen: obese; alert and oriented x3 heent: atraumatic; pupils 3->2 bilaterally; dry mucus membranes neck: supple cv: distant heart sounds due to body habitus; rrr; no murmurs appreciated lungs: distant breath sounds due to body habitus; no crackles or wheezes appreciated abd: soft, obese; non-tender to palpation; nl bowel sounds; no evidence of panniculitis extrem: no c/c/e skin: warm, intact neuro: a+ox3, but only intermittently answers questions appropriately; unable to obtain detailed history from patient; able to answer some 'yes' or 'no' questions appropriately; unable to cooperate with full neuro exam; no facial droop noted; + slurred speech; 5/5 strength in lue; 4/5 strength in rue; strength in lle; pt did not cooperate with examination of rle. + babinski bilaterally. pertinent results: ct head with and without contrast: 1. small focus of contrast enhancement in the left frontal lobe, not fully characterized. differential diagnosis includes developmental venous anomaly, evolving infarct, and less likely infection or tumor. mri is recommended for further characterization. 2. no evidence of intracranial hemorrhage. 3. hypodense focus in the pons. differential diagnosis include central pontine myelinolysis and ischemic stroke. mri is recommended for further characterization. . ct chest with and without contrast: 1. near-complete left lower lobe collapse. 2. diffuse subtle centrilobular opacities and peribronchial thickening is consistent with small airways infection, possibly viral or bacterial in etiology. 3. endotracheal tube is at the level of the carina and should be repositioned for standard positioning. 4. right upper lobe nodule, 4 mm, which could be followed conservatively with chest ct in one year. . echocardiogram: the left atrium is elongated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve is not well seen. there is a minimally increased gradient consistent with minimal aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. there is an anterior space which most likely represents a fat pad. . carotid series duplex ultrasound: moderate plaque with bilateral 40-59% carotid stenosis. of note both degrees of stenosis will fall to the lower end of the range. . cta head 7 x 6 mm enhancing mass within the left frontal lobe with associated prominent vessels which may represent cavernoma with associated developmental venous anomaly or capillary telangiectasia. however,an underlying arteriovenous malformation cannot be excluded on the basis of these images. an mri/mra or diagnostic cerebral angiography is recommended to further evaluate this finding. . ultrasound of bilateral lower extremity veins: no evidence of bilateral lower extremity deep venous thrombosis . wbc-6.1 rbc-4.23 hgb-11.9*# hct-34.7*# mcv-82# mch-28.0 mchc-34.2 rdw-16.1* plt ct-231 wbc-8.8 rbc-3.82* hgb-10.9* hct-32.8* mcv-86 mch-28.6 mchc-33.3 rdw-16.6* plt ct-411 glucose-196* urean-35* creat-0.5 na-140 k-4.3 cl-100 hco3-32 angap-12 glucose-31* urean-26* creat-1.2* na-142 k-3.8 cl-101 hco3-31 angap-14 alt-22 ast-63* ld(ldh)-367* ck(cpk)-1675* alkphos-64 amylase-38 totbili-0.1 calcium-9.0 phos-2.5* mg-2.6 caltibc-290 ferritn-57 trf-223 vitb12-294 folate-15.0 %hba1c-6.5* triglyc-133 hdl-27 chol/hd-3.1 ldlcalc-31 tsh-0.40 free t4-0.99 cortsol-23.4* brief hospital course: 65 y/o female with a h/o t2dm, tia, htn, morbid obesity, and hyperlipidemia who was admitted to the micu for concern for tia/stroke concern. the following issues were addressed during this admission. . on arrival to the ed, t=101.1, hr=70, bp=137/52, rr=22, o2 sat = 100% on nrb. blood glucose was 31, and she was given an additional unit of d50. she was also given 2 mg of morphine. her slurred speech remained unchanged. she was transferred to the micu for further care. . 1. respiratory failure on arrival to micu, the patient was awake and alert with mild confusion. subsequently, the patient had a sharp decline in mental status and became more somnolent - concerning for an acute change intravascularly. the patient was intubated due to concern for airway protection. upon correction of hypercarbia, her mental status improved and she was awake and able to follow commands while intubated. it was felt that her mental status changes on presentation might be at least partially attributable to hypercarbia secondary to obesity/sleep apnea. the patient was extubated on and transitioned to bipap, but she did not tolerate bipap initially and was subsequently re-intubated later that day. over the course of the next week, she was weaned off pressure support and successfully extubated on . she was started on bipap at night with settings of . at the time of discharge to rehab, she should be started on 15/5 of bipap at night. she will ultimately need a formal sleep study after discharge to further characterize appropriate bipap settings. . 2. mental status changes/stroke-like symptoms the pt had a negative head ct, per osh. a repeat head ct was obtained at after the patient's acute decline in mental status upon arrival in the micu, and neurology was consulted. ct was negative for an acute process. per family, the patient's symptoms of dysarthria and right-sided weakness are consistent with prior tias, but the patient has never been confused as she was during this episode. the patient's stroke-like symptoms were felt to most likely represent a re-expression of her prior cva in the setting of pna/hypoglycemia/hypercarbia. per neurology recommendations, a carotid ultrasound was obtained on which showed moderate plaques (40-59%) bilaterally. since no significant carotid stenosis was identified, neuro recommended a cta to rule out intracranial stenosis. cta on showed no evidence for stenosis but did reveal a 7 x 6 mm enhancing mass within the left frontal lobe with associated prominent vessels, thought to represent cavernoma with associated developmental venous anomaly or capillary telangiectasia. this finding should be followed-up as an outpatient. she will follow up with interventional neurosurgery upon discharge. neurology initially recommended an mri/mra but the pt was not able to fit in the mri to morbid obesity so a cta of the head was obtained. . 3. elevated troponin patient with history of stemi s/p stent placement. no acute st segment or t-wave changes on serial ekgs. pt denied any chest pain on admission. ck and ckmb trended down over the course of her hospitalization; troponin was initially persistently elevated at 0.15 but trended downward. echocardiogram on showed lvef=60% with lvh; unable to exclude focal wall motion abnormalities due to quality of study. the patient was continued on her home dose of asa and lipitor. her beta-blocker and ace inhibitor were held pending hemodynamic stabilization. her bb was gradually reinitiated. she may be re-started on her acei upon discharge. . 4. hypoglycemia/glycemic control/t2dm likely multifactorial in etiology (decreased po intake, pre-renal, possible excess intake of oral hypoglycemic agents, especially glyburide). tsh and thyroid function tests were within normal limits. a cortisol level was not consistent with adrenal insufficiency. after resolution of the patient's hypoglycemia, glycemic control was achieved with an insulin drip. this was gradually transitioned to subcutaneous lantus administration with insulin sliding scale coverage. the pt achieved adequate glycemic control upon discharge to rehab. she will be continued on both her long-acting and short-acting insulin regimen. . 5. fever/cap concern for infection, given patient's recent history of productive cough and diarrhea. chest ct was concerning for cap. she had a fever to 101.1 in ed but a normal white count. blood cultures both from hospital and showed no growth. urine culture was negative. she was started on levofloxacin and vancomycin. as the patient's fever gradually resolved over the course of her hospitalization, vancomycin was discontinued. levofloxacin was subsequently discontinued after the pt completed an 8-day course. . 6. hypotension after intubation, the patient temporarily required levophed to maintain her blood pressure when sbp decreased to 70s. she was weaned off levophed within 24 hours. . 7. atrial fibrillation on the evening of , the patient went into atrial fibrillation with rvr. hr ranged from 100s to 130s. she began complaining of chest pressure, and was given aspirin, morphine, and nitros. 2 sets of cardiac enzymes showed negative ck and troponin of 0.4. the patient's a-fib did not respond to lopressor or diltiazem, and she was subsequently started on an amiodarone drip. while on the drip, she converted to normal sinus rhythm with gradual resolution of her chest pain. amiodarone was discontinued, and she was started on po metoprolol which she tolerated well. she remained in normal sr upon discharge to rehab. . 8. nutrition tube feeds were initiated through an og tube while the patient was intubated. her diet was advanced to regular diet soon after extubation. medications on admission: metformin 1000 mg lipitor 40 mg daily isosorbide 60 mg daily avandia 8 mg daily glyburide 10 mg atenolol 25 mg tid amitriptyline 150 mg qhs lisinopril 40 mg daily amoxicillin discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 6. insulin please follow attached regular sliding scale. please continue lantus 35 units at bedtime. 7. fluoxetine 10 mg capsule sig: two (2) capsule po daily (daily). 8. hexavitamin tablet sig: one (1) cap po daily (daily). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 11. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day). 12. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: community acquired pneumonia type 2 diabetes mellitus hypertension . secondary: morbid obesity hyperlipidemia obstructive sleep apnea discharge condition: the patient was discharged hemodynamically stable afebrile with appropriate follow up. discharge instructions: please call your pcp or seek medical attention in the ed if you experience any chest pain, shortness of breath, nausea, vomiting, diarrhea, abdominal pain, fever, or any other concerning symptom. . please keep all follow up appointments. they are listed below. . please take all medications as prescribed. they will be continued at rehab. followup instructions: please follow up with dr. of the neurointerventionalist service regarding the incidental finding of a vascular malformation on your ct of the head. please call for an appointment at . . recommend referral for sleep study to evaluate for sleep apnea. . please follow up with your pcp . on , at 10:45am. procedure: venous catheterization, not elsewhere classified 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 non-invasive mechanical ventilation arterial catheterization diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) tobacco use disorder unspecified essential hypertension atrial fibrillation percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia acute respiratory failure diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled morbid obesity dehydration late effects of cerebrovascular disease, aphasia other nonspecific abnormal serum enzyme levels other nonspecific abnormal results of function study of brain and central nervous system 

Answer: The patient is high likely exposed to