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 70 year old female patient with a history of chest pressure radiating to bilateral shoulders associated with nausea and dizziness. this occurs occasionally after meals or with exertion. these episodes have been intermittent over the past two years, however, worsening in the last couple of weeks prior to admission. she did undergo an exercise tolerance test, which was positive in of this year and was ultimately referred for cardiac catheterization. she underwent cardiac catheterization on , and this revealed significant aortic stenosis with an aortic valve area of 0.7, a mean gradient of 36, as well as 70 percent left main coronary artery disease and a 99 percent right coronary artery occlusion. she underwent angioplasty and taxus stent placement to the ostial right coronary artery at that time. subsequent echocardiography revealed left ventricular ejection fraction of 60 percent and severe aortic stenosis with an aortic valve area of 0.6. she was referred to dr. for aortic valve replacement surgery as well as coronary artery bypass graft. past medical history: hypertension. hypercholesterolemia. noninsulin dependent diabetes mellitus, diet controlled. gastroesophageal reflux disease. status post cholecystectomy. status post bilateral carotid endarterectomy. history of transient ischemic attacks in the past. medications on admission: 1. lipitor 80 mg p.o. once daily. 2. lopressor 50 mg p.o. twice a day. laboratory data: preoperatively, laboratory values were unremarkable. hospital course: the patient was taken to the operating room on , same day admission, where she underwent an ascending aortic replacement as well as an aortic valve replacement with a number 21 millimeter pericardial tissue valve and coronary artery bypass graft times one with left internal mammary artery graft to the left anterior descending coronary artery. postoperatively, she was transported from the operating room to the cardiac surgery recovery unit in good condition. the night of surgery into postoperative day number one, she remained on nipride, nitroglycerin and milrinone intravenous drips as well as insulin and propofol. she remained intubated overnight. the patient received a fair amount of blood products during the operation. please see operative report for full details of surgical events. the patient was begun on labetalol drip to wean her off the nipride due to her hypertension in the initial postoperative period. she was also given lasix to enhance diuresis. she was ultimately weaned from mechanical ventilation, successfully extubated late in the day on postoperative day number one. she had significant difficulty with pulmonary effort and respiratory distress. she had wheezes and tachypnea with some hypoxia as well on a 60 percent face mask. she was treated with inhaled bronchodilators as well as aggressive pulmonary toilet and bipap intermittently to assist with her respiratory difficulties. on postoperative day number two, the patient had some episodes of atrial fibrillation with a ventricular rate in the 120s to 140s with some hypotension but this was transient and did not require pressors. on postoperative day number three, the patient's respiratory status had become more stable although she did have expiratory wheezes which were audible. she continued to receive aggressive pulmonary toilet and diuresis. she was begun on captopril for hypotension and was on amiodarone for her atrial fibrillation. the patient remained in the cardiac surgery recovery unit for the next few days due to difficulty with her respiratory status, requiring aggressive pulmonary toilet and bronchodilators. she also had mental status changes where she became quite agitated and combative at times requiring large doses of sedation as well as one to one sitters for patient safety. her diuresis had been increased. it was noted shortly after a period of agitation that the patient did have a significant amount of fluid draining from her sternal incision at the distal pole. this was serosanguinous to dark brown thin fluid in nature. she was ultimately placed on vancomycin for the sternal drainage. she was also noted to have had a positive gram stain in her sputum. this was on postoperative day number seven. gram stain was initially positive for gram negative rods, four plus, and this culture grew out to be h. influenza and the patient had already been placed on levofloxacin at that time for empiric gram negative coverage for sputum. over the next few days, the patient continued to progress well. her agitation had resolved by postoperative day number seven. she did require some intermittent noninvasive ventilation via bipap, but by postoperative day number seven to day eight, this had significantly resolved. aggressive diuresis was continued as were bronchodilator treatments and she did seem to respond nicely to this. she remained in the intensive care unit, however, for the next few days. on , postoperative day number nine, there was question by the nurses as to whether the patient had difficulties with aspiration as she was noted to have some coughing pretty much whenever she did eat. speech and swallow evaluation was obtained and a bedside evaluation done by the speech therapy department revealed a significant amount of signs and symptoms of aspiration at the bedside. she was referred for a video swallow study. the video swallow study was obtained the following day, . the findings of that were decreased laryngeal elevation with epiglottic deflection with residue in the vallecula, especially with solids and penetration/trace aspiration, especially with thin liquids. it was the recommendation of the speech and swallow therapy team at that time that the patient just take nectar thick liquids and pureed foods. she would be best advised to avoid all solid foods as well as all thin liquids at this time. over the next few days, the patient continued to progress from a pulmonary standpoint with aggressive pulmonary toilet and continued diuresis. she did have one more episode of atrial fibrillation on postoperative day number nine, but this was nonsustained. her lopressor was increased and she converted back to normal sinus rhythm, which she has remained in since then. because of the significant improvement in the patient's respiratory status, she was ultimately transferred from the cardiac surgery recovery unit to the telemetry floor on postoperative day number nine. she continued to progress with cardiac rehabilitation and physical therapy to increase her mobility. she was ultimately weaned off of oxygen to room air. over the weekend of , and , she had two notable episodes of choking at which point she became cyanotic, diaphoretic and had long periods of pauses on her telemetry monitor. this was apparently associated with her eating solid food although the patient has been advised not to and was on a dysphagia diet but she had apparently gotten access to some cake on her own and had choked on it. reinforcement has been aggressive regarding her diet and her advising her not to take any solids because of the aspiration. speech and swallow therapy has followed her on a regular basis and their most recommendation consisted of a long discussion with the patient as well as with her husband and children to reinforce the significance of her aspiration and the absolute diet restrictions that she must be under upon discharge. the patient as well as her husband and children did verbalize understanding of this and have agreed to comply with the diet restrictions for the patient's safety. the patient has remained in room air for a number of days now. she has diuresed to well below her preoperative weight. she has had no more episodes of aspiration. her most recent chest x-ray was yesterday, , and this revealed no acute cardiopulmonary process. the patient is ready to be discharged home today with visiting nurses as well as recommendation to follow-up with outpatient speech therapy to work on her dysphagia and reinforce dietary restrictions because of it. physical examination on discharge is as follows: temperature 98.3, pulse 88 and normal sinus rhythm, blood pressure 140/70. her weight today is 70 kilograms. her preoperative weight was 77 kilograms. room air oxygen saturation is 94 percent. most recent laboratory values include a sodium of 141, potassium 3.9, chloride 102, co2 29, blood urea nitrogen 29, creatinine 1.0, glucose 98. white blood cell count 13.1, hematocrit 36.4, platelet count 442,000. on physical examination, neurologically, she is grossly intact. she has no apparent neurologic deficits. pulmonary examination - her lungs are clear to auscultation bilaterally. coronary examination is regular rate and rhythm, her sternum is stable, her incision is clean with no further drainage. she has not had sternal drainage now for approximately three days and her vancomycin had been discontinued yesterday. her abdomen is benign. her extremities are warm with no peripheral edema noted today. medications on discharge: 1. zantac 150 mg p.o. twice a day. 2. plavix 75 mg p.o. once daily for three months or until discontinued by the patient's primary cardiologist, dr. . 3. levofloxacin 250 mg p.o. once daily for seven days. this is simply for prophylaxis for her sternal drainage which has ceased as well as her h. influenza although she has completed probably an adequate course by this point. 4. lopressor 100 mg p.o. twice a day. 5. lipitor 40 mg once daily. 6. combivent meter dose inhaler p.r.n. shortness of breath or wheezes. 7. enteric coated aspirin 325 mg p.o. once daily. 8. glyburide 5 mg p.o. twice a day. 9. amiodarone 400 mg p.o. once daily times one week, then 200 mg p.o. once daily times two weeks or until discontinued by the patient's cardiologist, dr. . of note, the patient also has right femoral suture line with staples in place. these staples should be discontinued approximately one week from today by the visiting nurse. discharge diagnoses: coronary artery disease, status post coronary artery bypass graft. aortic stenosis,status post aortic valve replacement and ascending aortic replacement. postoperative atrial fibrillation. severe dysphagia. condition on discharge: good. follow up: the patient is to follow-up with dr. , cardiac surgeon, in three weeks. the patient is to follow-up with her primary cardiologist, dr. , in approximately two weeks, and with the patient's primary care physician, . , in two weeks. , m.d. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart non-invasive mechanical ventilation open and other replacement of aortic valve with tissue graft resection of vessel with replacement, aorta, abdominal transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled cardiac complications, not elsewhere classified atrial fibrillation aortic valve disorders old myocardial infarction 

Answer: The patient is high likely exposed to