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: fosamax / zyvox / heparin agents / statins-hmg-coa reductase inhibitors attending: chief complaint: respiratory distress major surgical or invasive procedure: none history of present illness: dr. is an 80 year old woman with a pmh significant for copd, cad s/p pci, af, htn, and pad who presents with 5-7 days of increased dyspnea and productive cough now admitted to the micu for respiratory distress. the patient reports that over the past 5-7 days, she has developed worsening productive cough described as yellowish/greenish sputum, dyspnea on exertion, and fatigue. she was seen by her pcp 2 days prior to admission and was started on prednisone 60 mg daily, and also prescribed amoxicillin that she has not yet started. she reports that since starting prednisone, she has not had any improvement, and thus presented to the ed for further evaluation. . in the ed, initial vs 98.8, 100, 160/82, 30, 78%2l nc. cxr was negative for focal consolidation. labs notable for a wbc of 16.2 and an inr 4.2. abg 7.28/72/66 on an unknown amount of supplemental oxygen. she was placed on nppv, but became transiently hypotensive to 80/40 with improvement after nppv discontinued. the patient received 125 mg iv solumedrol, ceftriaxone, and azithromycin. she was then admitted to the micu for further management. past medical history: - cad with h/o anterior mi s/p pci - chf (lvef 40-45%) - htn - atrial fibrillation - h/o cva w/o residual deficits - copd - spinal stenosis with both leg weakness wheelchair bound - breast cancer - leg weakness - peripheral artery disease - osteoarthritis - pud social history: she is a retired psychiatrist. she lives alone, hha twice weekly. uses a wheelchair, former smoker - 150 pk-yrs, quit in . family history: significant for hypertension and history of arrhythmias in her mother. stroke in both mother and father. father had asthma. physical exam: admission exam: vs: 98.2, 83, 109/46, 21, 97%3l nc gen: appears mildly uncomfortable, a&ox3 heent: mm dry, op clear, intradermal cyst/lipoma over right lateral neck (chronic per pt) cv: rr, nml s1+s2, no m/r/g pulm: minimal air movement throughout. diffuse expiratory wheezes bilaterally abdom: soft, ntnd, nabs extrem: non-palpable pulses. no edema. . discharge exam: vs: 98.1, 94-114/50-66, 70s-80s, 14, 93-100% on 3l general: wdwn woman who appears comfortable, a&ox3. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva pink, mmm. neck: supple, jvp not elevated. cardiac: irregular, nml s1/s2, no m/r/g. lungs: some expiratory wheezes, no crackles. abdomen: soft, ntnd. nabs. extremities: feet mildly deformed, cool to touch. 1+ dp pulses. no edema. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: admission labs: 09:05am blood wbc-18.2*# rbc-5.81* hgb-16.0 hct-49.9*# mcv-86 mch-27.5 mchc-32.0 rdw-14.6 plt ct-222 09:05am blood neuts-75* bands-2 lymphs-13* monos-7 eos-2 baso-0 atyps-1* metas-0 myelos-0 09:05am blood pt-41.3* ptt-34.5 inr(pt)-4.2* 09:05am blood glucose-88 urean-25* creat-0.8 na-139 k-4.6 cl-96 hco3-34* angap-14 . pertinent labs: 09:14am blood lactate-1.6 02:20pm blood lactate-1.2 02:39am blood ck-mb-7 ctropnt-<0.01 ck(cpk)-78 04:09am blood tsh-0.43 07:32pm blood free t4-1.4 02:20pm blood abg ph-7.45 pco2-55* po2-53* base xs-11 02:20pm blood lactate-1.2 . discharge labs: 06:05am blood wbc-10.5 rbc-5.04 hgb-14.1 hct-43.9 mcv-87 mch-28.0 mchc-32.1 rdw-14.8 plt ct-202 06:05am blood pt-35.4* ptt-44.9* inr(pt)-3.6* 06:05am blood glucose-65* urean-27* creat-0.8 na-137 k-5.6* cl-95* hco3-45* angap-3* 06:05am blood calcium-8.6 phos-2.8 mg-1.9 . microbiology: blood cx: negative urine legionella ag: negative sputum cx: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): heavy growth commensal respiratory flora. moraxella catarrhalis. heavy growth. influenza a/b by dfa: negative . imaging: cxr: 1. severe panlobular emphysema, without focal consolidation. 2. large hiatal hernia. 3. severe osteopenia and degenerative changes. brief hospital course: 80 year old woman with copd, cad s/p pci, htn, and afib, admitted with respiratory distress; hospital course complicated by afib with rvr. . # respiratory distress: history and hypercarbia consistent with copd exacerbation. cxr without focal consolidation to suggest lobar pneumonia, although sputum culture returned with heavy moraxella growth. patient was treated with a 5 day course of levofloxacin and a corticosteroid taper: prednisone 40mg daily through , then 20mg daily from , then 10mg daily from . we continued the patient's home atrovent prn sob/wheezing. the patient has a chronically elevated bicarbonate which is likely compensation for her chronic respiratory acidosis in the setting of severe copd. recommend trending her bicarb. o2 sats are in the low-mid 80s on ra but 93-100% on 3l. . # afib with rvr/atrial flutter: the patient had repeated episodes of aflutter/afib with rvr to 150s. she was rate controlled with metoprolol which was uptitrated to 37.5mg q6h. she was also started on an amiodarone load: 200mg tid x1 week (), then 200mg x1 week (), then 200mg daily. hr has been stable in the 70s-80s. would tolerate hr to the 130s as long as patient is asymptomatic. if hr increases beyond the 130s and is sustained, or patient becomes symptomatic, would uptitrate the metoprolol and consider rehospitalization. coumadin was continued, however her inr was difficult to maintain in the therapeutic range (), so she briefly required bridging with lovenox. unfortunately, there were several days when she was not treated with a full dose of the lovenox, putting her at risk for atrial clots. we attempted a tee with cardioversion, however were unable to perform the tee due to difficulty monitoring the patient's o2 sats. the decision was made to continue anticoagulation with coumadin and perform an outpatient cardioversion in weeks. someone from the electrophysiology department at will contact the patient with details regarding this. . # coagulopathy: inr was 4.2 on admission so coumadin was held. coumadin was later restarted, however the inr drifted down to 1.6 on so lovenox was added. the inr increased to 3.1 on at which point coumadin was again held. inr was 3.6 upon discharge. we are continuing to hold the coumadin for now. the lovenox has been stopped. recommend following inr daily and restarting coumadin when inr drops below 3. goal inr . . # cad: chest pain free. cardiac enzymes wnl. continued asa, but held lisinopril due to hyperkalemia. . # chf: ef 40-45%. euvolemic on exam. holding lisinopril as noted above. started metoprolol as noted above. . # hyperkalemia: potassium has ranged from 5.3-5.9. unclear cause, though we are holding the patient's home lisinopril. serial ekgs have been negative for t wave changes and the patient is asymptomatic. medications on admission: 1. asa 81mg daily 2. coumadin 3-4mg daily 3. lisinopril 2.5mg daily 4. levothyroxine 37.5mcg daily 5. atrovent 2 puffs prn 6. prednisone 60mg daily started on 7. omeprazole 20mg daily 8. colace daily 9. ca-vit d 10. omega 3 fatty acids 11. vitamin e 12. vitamin c 13. multivitamin 14. acidophilus 15. garlic 16. magnesium 250mg daily discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. levothyroxine 75 mcg tablet sig: 0.5 tablet po daily (daily). 3. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation qid (4 times a day) as needed for shortness of breath or wheezing. 4. prednisone 10 mg tablet sig: as directed tablet po once a day: take 40mg daily through , then 20mg daily through , then 10mg daily through . 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. colace 100 mg capsule sig: one (1) capsule po once a day. 7. calcium+d oral 8. omega-3 fatty acids oral 9. vitamin e natural blend oral 10. vitamin c oral 11. multivitamin tablet sig: one (1) tablet po once a day. 12. acidophilus oral 13. garlic oral 14. magnesium 250 mg tablet sig: one (1) tablet po once a day. 15. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po q6h (every 6 hours). 16. amiodarone 200 mg tablet sig: as directed tablet po as directed: take 200mg tid through , then 200mg from , then 200mg daily. discharge disposition: extended care facility: senior healthcare of discharge diagnosis: copd exacerbation pneumonia atrial fibrillation with rapid ventricular rate discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: wheelchair-bound. discharge instructions: dr. , you were admitted with difficulty breathing from a copd exacerbation and pneumonia which was treated with antibiotics. you went into atrial fibrillation which we treated with medications including coumadin (a blood thinner). we will perform a cardioversion within the next 3-4 weeks. someone will contact you with the appointment for this. . we made the following changes to your medications: - held coumadin since your inr is high; the rehab physicians will monitor this and tell you when to restart the coumadin - held lisinopril due to high potassium - started metoprolol tartrate 37.5mg every 6 hours - started prednisone 40mg daily through , then 20mg daily from , then 10mg daily from - started amiodarone 200mg tid through , then 200mg from , then 200mg daily . please weigh yourself every morning and call your doctor if your weight goes up by more than 3 pounds in one day. followup instructions: department: cardiac services when: monday at 2:20 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: atrial cardioversion diagnoses: hyperpotassemia abnormal coagulation profile pneumonia due to other gram-negative bacteria congestive heart failure, unspecified unspecified acquired hypothyroidism atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation atrial flutter acute respiratory failure other specified cardiac dysrhythmias chronic systolic heart failure disorder of bone and cartilage, unspecified 

Answer: The patient is high likely exposed to