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: codeine / digoxin / amiodarone / bactrim / lisinopril attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: yof with pmh dm ii, hl, cad s/p lad stemi in , nstemi with bms to lad presents with progressive dyspnea and orthopnea and is admitted to the ccu for hypoxia. . according to the patient's daughter, the patient developed progressive dyspnea three days ago. the symptoms progressed and last night she developed orthopena and paroxsymal nocturnal dyspnea. she was agitated and confused overnight and this morning felt presyncopal while trying to get out of bed. . she presented to the ed where initial vitals were t:97.6 p:90 bp:104/66 rr:14 sats dropped to 85 on nc (flow not recorded), up to 99% on nrb. she complained of dyspnea, denied chest pain. labs were remarkable for wbc: 8.1 hct:33.6, cr 1.0, trop-t: 0.09 lactate:2.6 inr: 4.7. cxr showed bilateral effusions and pulmonary edema. she was given lasix 40mg iv, and started on bipap, complained of nausea and was given zofran. she became hypotensive to sbp 77 asleep, came to high 80's while awake, she was started peripheral dopamine and admitted to the ccu. vitals on transfer bp:98/67 p:111 rr:26 sao2 100% on bipap . on arrival to the ccu, vitals were bp:107/64 p:101 rr: 24 sao2 95% on 5lnc with shovel mask. she was somnolent and moderately confused, occasionally pulling at lines. she reported that her breathing was comfortable, denied neck/back/chest pain, denied presyncope. past medical history: 1. cardiac risk factors: +diabetes, +dyslipidemia, -hypertension 2. cardiac history: -cabg: n/a -percutaneous coronary interventions: s/p stemi in w/ stent to lad - s/p nstemi treated w/ bms to prox and mid lad -pacing/icd: n/a 3. other past medical history: -osteoporosis -cva - small vessel stroke in r mca territory (no residual effects) -osteoarthritis (knees) -b/l rotator cuff injuries -status post hysterectomy 20 years ago -l posterior tibialis injury (l leg brace) -r bimalleus fracture (external cast) -aspiration pna in , treated with ctx, azithromycin, clindamycin -s/p cataracts surgery social history: employment: had worked as a billing administrator for volkswagon and other companies around the area for 35 years. tobacco: never smoker. alcohol: has a drink once in a while, less than once a week. illicits: denies heroin, cocaine, marijuana. family history: son with triple bypass. parents died of "old age" physical exam: admission exam bp:107/64 p:101 rr: 24 sao2 95% on 5lnc with shovel mask general: elderly female slumped forward in bed, somnolent but arrousable, oriented to hospital. heent: pale conjunctiva, mucous membs moist, neck: supple with jvp of 10 cm in 45 degree angle. cardiac: tachycardic, s1/s2 regular rate, holosystolic murmur at the apex. lungs: bilateral inspiratory rales at mid thorax, decreased breath sounds r>l to mid thorax, dullness to percussion over the same area abdomen: soft, ntnd. no hsm or tenderness. extremities: peripheral edema to mid calf bl with right sided chronic venous stasis changes. pulses: right: trace dp and pt pulses, left: trace dp and pt pulses discharge exam: vs: tm 97.3 bp 90-102/50-61 hr 70-110 rr 18-20 sao2 98% ra general: elderly female in nad heent: pale conjunctiva, mucous membs moist, neck: supple with jvd 2 cm above clavicle cardiac: irregularly irregular, s1/s2 regular rate, holosystolic murmur at the apex lungs: ctab with slight expiratory wheezes, no increased wob abdomen: soft, ntnd. no hsm or tenderness. extremities: right upper extremity with large hematoma and diffuse ecchymosis failed picc attempt. resolving. pulses: 1+ pulses bilaterally, uses bilat braces for standing. pertinent results: admission labs 09:30am blood wbc-8.1 rbc-3.30* hgb-11.0* hct-33.6* mcv-102* mch-33.2* mchc-32.6 rdw-17.6* plt ct-185 09:30am blood neuts-90.8* lymphs-5.4* monos-2.9 eos-0.1 baso-0.7 10:30am blood pt-45.2* ptt-30.2 inr(pt)-4.7* 10:30am blood glucose-215* urean-22* creat-1.0 na-142 k-4.8 cl-107 hco3-23 angap-17 02:49am blood calcium-9.4 phos-4.7*# mg-1.8 10:30am blood tsh-2.8 01:48pm blood type-art po2-63 pco2-41 ph-7.37 base xs--1 09:37am blood glucose-227* lactate-3.5* na-136 k-7.1* cl-108 calhco3-19* cardiac enzymes 10:30am blood ck(cpk)-44 06:36pm blood ck(cpk)-46 02:49am blood ck(cpk)-38 08:58pm blood ck(cpk)-76 09:30am blood ctropnt-0.09* 10:30am blood ck-mb-8 06:36pm blood ck-mb-9 ctropnt-0.27* 02:49am blood ck-mb-8 ctropnt-0.28* 08:58pm blood ck-mb-5 ctropnt-0.24* microbiology: - urine culture : escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s - blood culture : no growth - blood culture : no growth - pleural fluid culture (left side) : gram stain 2+ pmns, no organisms. culture no growth for bacteria, anaerobes, fungus. afb smear negative. afb culture pending at the time of discharge. - pleural fluid culture (right side) : gram stain 2+ pmns, no organisms. culture no growth for bacteria, anaerobes, fungus. afb smear negative. afb culture pending at the time of discharge. - urine culture : pending at the time of discharge imaging/studies cxr () impression: increased bilateral moderate pleural effusions with compressive lower lobe atelectasis, with probable mild chf. cxr () n the interim, there has been placement of bibasilar pigtail catheters with markedly reduction of bilateral pleural effusions. small left greater than right pleural effusions remain. there is persistent left lower lobe retrocardiac opacity, most likely due to left lower lobe collapse. there is a discoid atelectasis in the right lower lobe. there is no evident pneumothorax. cxr () there is mild-to-moderate cardiomegaly, unchanged compared with . there is upper zone redistribution and diffuse vascular blurring, consistent with chf, unchanged allowing for technique. there is increased retrocardiac density, consistent with left lower lobe collapse and/or consolidation, probably slightly improved. the left hemidiaphragm is elevated, with air in the fundus immediately below it. there is patchy opacity at the right base, likely reflecting atelectasis. there is minimal blunting of both costophrenic angles. however, the bilateral effusions seen on exam have diminished in size. bilateral chest tubes again noted, slightly different in configuration, particularly on the right. no pneumothorax is detected. cxr no significant change in upper zone pulmonary vascular redistribution consistent with pulmonary vascular congestion, cardiomegaly, and small bilateral pleural effusions. discharge labs: 06:55am blood wbc-5.7 rbc-3.11* hgb-10.1* hct-31.0* mcv-100* mch-32.6* mchc-32.8 rdw-16.6* plt ct-186 06:55am blood glucose-150* urean-26* creat-0.8 na-140 k-4.3 cl-98 hco3-33* angap-13 06:55am blood mg-2.1 10:48pm urine color-yellow appear-hazy sp -1.017 10:48pm urine blood-tr nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-lg 10:48pm urine rbc-10* wbc-154* bacteri-none yeast-many epi-10 transe-5 10:48pm urine casthy-40* 10:48pm urine mucous-rare brief hospital course: admission weight 62kg dry weight 56kg primary reason for admission: y/o woman with pmh dm ii, hl, cad s/p lad stemi in , nstemi with bms to lad presents with progressive dyspnea and orthopnea and is admitted to the ccu for hypoxia secondary to chf exacerbation. active issues: #acute on chronic chf and bilateral pleural effusions: pt was admitted in and echo at that time showed lvef of 30-35%. cxr on admission showed pleural effusions (singificantly increased in size from prior imaging in ) and pulmonary edema consistent with chf exacerbation. physical exam also consistent with volume overload with severe lower extremity peripheral edema. repeat echocardiogram showed regional lv wall motion abnormality with ef of ~25%. she was hypoxic on admission to the point of requring nrb oxygen, though never intubated per code status (dnr/dni). she was intitially treated with a lasix drip with improvement in her oxygen requirement. nitrates and morphine were held in the setting of hypotension. despite diuresis, pleural effusions persisted. interventional pulmonology was consulted and bilateral pigtail catheters were insterted and drained a total of 1.5l of pleural fluid which was culture negative (afb culture only pending at the time of discharge). upon discharge patient was euvolemic on exam, symptomatically improved, with oxygen saturations on room in in the mid 90s. dischrage cxr showed resolution of pulmonary edema with small residual effusions, significantly improved since admission. she will be discharged on torsemide 10 mg po daily for volume control, and has been educated in low-sodium diet by nutrition consult team. she is not on given borderline-low blood pressures, but current plan is for addition of once stable on outpatient follow up. she may also benefit from spironolactone or low-dose digoxin if chronically symptomatic. #hypotension: pt has baseline sbps ranging in low 100s. in , pt hypotensive to 77 and started on dopamine drip. hypotension thought to be secondaruy to worsening lv dysfunction with cardiogenic shock. given tachycardia and episodes of afib dopamine was changed to vasopressin. on day 3, pt successfully weaned off pressors and sbps remained stable throughout the remainder of admission. # atrial fibrillation: patient with history of atrial fibrillation and was previously anticoagulated with warfarin. however, given supratherapeutic inrs (see below) and hematoma with attempted picc placement, she was felt to be a poor candidate for triple therapy. she was placed on subq heparin during this stay, and aspirin dose was increased to 325 mg. current plan is for anticoagulation with aspirin and plavix alone to reduce risk of clot. during this admission, the patient was initially in sinus rhythm on telemetry but subsequently developed multiple episodes of atrial fibrillation with rate to 100s-110s. her metoprolol was uptitrated as pressures would allow, and she was discharged on 200 mg metoprolol sucinate daily. amiodarone was suggested to improve rhythm/rate control; however her daughter is concerned that this medication was responsible for a skin reaction during a prior admission and did not want her mother to receive this medication. in the future, amiodarone may be considered if there is poor rate control with current dose of metoprolol succinate as blood pressures may not tolerate further uptitration. # somnolence: upon admission pt was somnolent and reportedly confused. abg shows pco2 41 with po2 63 suggesting that somnolence is related to hypoxia rather than hypercarbia. at baseline patient is oriented x3, she enjoys baseball and is able to name team members. pt was pancultured to rule out sepsis as source. as hypoxia improved, somnolence resolved. she did have an episode of confusion in the evening of in the setting of low blood pressure to systolic of 90 (other vitals including temperature and o2 sat were stable). her pm beta blocker was held, and u/a and culture were rechecked. her symptoms self-resolved and were attributed to low blood pressure with possible component of sundowning. upon discharge patient back to baseline, alert, oriented and interactive. # uti: pt had urine culture positive for pan-sensitive e. coli. she was started on 10 day course of cefpodoxime on . she had repeat u/a with urine culture checked on , and this showed 154 wbc, +le, -nitrites, -bacteria, +yeast. no changes were made to her medications. culture from was pending at the time of discharge. # anticoagulation/hematoma: inr elevated on admission at 4.7 and her coumadin was held. the following day the inr was 7. patient was treated with vitamin k for pigtail catheter placement. pt developed hematoma in r. arm after attempted picc line placement. pressure dressings were applied. heparin was stopped. hcts remained stable. # cad: pt has hx of lad stemi in and nstemi with bms to lad. ekg on admision shows std in v3-v6 which are likely related to lv strain in the setting of lvh and tachycardia. cardiac enzymes peaked at ckmb 8 and troponin 0.28. pt was changed from asa 81 to 325 and continued on plavix, atorvastatin and metoprolol. chronic issues: . # diabetes mellitus: -she remained on insulin ss for the majority of her hosptial course, but home metformin and glipizide were restarted prior to discharge. . transitional issues: - pt will require follow up with pcp and cardiology. she will be sent to rehab for a brief period, with plans to return home where she is overseen by her daughter, who is very involved. - pleural fluid (left and right side) afb cultures were pending at the time of discharge (afb smear negative) - urine culture from pending at the time of discharge (u/a from showed 154 wbc, +le, -nitrites, -bacteria, +yeast) - for her systolic heart failure, she should be started on as an outpatient as blood pressures allow. she may also benefit from low-dose digoxin if she experiences symptoms. her torsemide may require uptitration to maintain euvolemia. - for her atrial fibrillation, her warfarin has been held given the risk of bleeding with concurrent aspirin and clopidogrel. her metoprolol succinate has been uptitrated to 200 mg po daily but may require further titration depending on blood pressure and rates while in atrial fibrillation. amiodarone was briefly initiated but stopped based upon family's concern that this medication caused rash and malaise during a prior admission. it may be appropriate to re-consider use of this medication in the future if rate control proves difficult. medications on admission: metoprolol succinate er 100 mg plavix 75 mg daily metformin 500 mg daily atorvastatin 80 mg daily glipizide 2.5 mg daily aspirin 325 mg daily warfarin 2 mg mwf, 1mg ttss omega 3 fish oil -- unknown strength discharge medications: 1. torsemide 10 mg tablet sig: one (1) tablet po once a day. 2. metoprolol succinate 100 mg tablet extended release 24 hr sig: two (2) tablet extended release 24 hr po once a day. 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. metformin 500 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 6. glipizide 2.5 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 7. psyllium 1.7 g wafer sig: one (1) wafer po daily (daily). 8. senna 8.6 mg tablet sig: 1-2 tablets po hs (at bedtime): hold for loose stools. 9. multivitamin tablet sig: one (1) tablet po daily (daily). 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 11. cefpodoxime 100 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 5 days. 12. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 13. omega 3 fish oil 684-1,200 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. discharge disposition: extended care facility: livingcenter - elmhurst - discharge diagnosis: acute on chronic systolic congestive heart failure bilateral pleural effusions paroxsysmal atrial fibrillation urinary tract infection coronary artery disease 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 caring for you at . you had an acute exacerbation of your congestive heart failure and required bipap ventilation and furosemide intravenously to get rid of the extra fluid. you also had pleural effusions, a collection of fluid near the base of the lung. this was drained and has reaccumulated slightly. you will see the pulmonologist in a few weeks to assess the effusions again. in the meantime, we have changed the furosemide to torsemide to help keep the fluid from reaccumulating. your atrial fibrillation has been intermittant and is very fast when it occurs. we have increased the metoprolol to prevent a fast heart rate and your warfarin has been discontinued because you are already on 2 other strong blood thinners. dr. feels that the risk of serious bleeding from 3 blood thinners is greater than the risk of a stroke at this time. please weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. . we made the following changes to your medicines: 1. increase metoprolol to slow your heart rate 2. decrease atorvastatin to lower your cholesterol 3. discontinue warfarin, you will get some protection from blood clots from the aspirin and plavix 4. start senna and metamucil to prevent constipation 5. complete course of cefpodoxime for uti (5 more days) followup instructions: department: cardiac services when: tuesday at 2:00 pm with: dr. building: sc clinical ctr campus: east best parking: garage department: radiology when: tuesday at 10:45am am for: walk-in chest x-ray prior to appt building: , campus: west best parking: garage department: west clinic when: tuesday at 11:15 am with: , md campus: west best parking: garage md, procedure: venous catheterization, not elsewhere classified thoracentesis diagnoses: abnormal coagulation profile coronary atherosclerosis of native coronary artery unspecified pleural effusion urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation hematoma complicating a procedure percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure cardiogenic shock osteoporosis, unspecified old myocardial infarction long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits do not resuscitate status acute on chronic systolic heart failure osteoarthrosis, unspecified whether generalized or localized, lower leg 

Answer: The patient is high likely exposed to