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: bactrim attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: patient is a 65 year old female with past medical history significant for diastolic heart failure, moderate aortic stenosis with valve area of .2 cm2, bronchietasis and copd with stage ii gold criteria and home oxygen 2-4l who was recently admitted to from - for hypercarbic respiratory failure requiring intubation and improvement with aggressive diuresis and treatment for hospital acquired pneumonia/copd exacerbation with prednisone and vancomycin/meropenem/azithromycin. . she was reports doing well at home since coming back from rehab in . she reports being compliant with her diuretics and diet with low salt. she does report occassional canned food intake. she was noted to have diarrhea two days ago with productive (different from her usual ), shortness of breath, hand tremors and occassional pleuritic left chest wall pain yesterday. she reports her only sick contact is her daughter who also had diarrhea but no pulmonary symptoms. she was brought to ed for evaluation of her shortness of breath. . in the ed, her vitals were 97.0 122 145/106 100%6lnc. she was noted to be tachypneic and oxygen saturation of 80% on home oxygen. she was placed on cpap with improvement in her oxygenation. her chest x-ray was concerning for new right lower infiltrate. she was given solumedrol, ceftriaxone and levaquin after blood and urine culture were drawn for presumed pneumonia. she was not given iv lasix in the ed. she was transferred to micu for futher evaluation and management. . in the micu, patient reported feeling better and less short of breath. past medical history: - asthma: (since childhood)/copd s/p multiple intubations: 2l nc (since ) at baseline for spo2 91-95%, last pft ~1 yr ago at osh, trach previously suggested but pt refused - osa: sleep study in , recommended cpap but has not tolerated it well, unclear how compliant since last discharge (made some progress on the fit of the mask). of note, overnight oximetry "better than expected" when measured at rehab. - gerd - anemia (history of gi bleeding) - leukopenia, long standing, unclear etiology - hyperglycemia when previously on prednisone - diastolic heart failure, lvef > 55%, - aortic stenosis (valve area 1.0-1.2 cm^2) - moderate pulmonary htn, pcwp > 18 - atrial fibrillation (on dilt +/- beta blocker), no anticoagulation due to history of gi bleeding social history: -smoking/tobacco: quit smoking in (20 pack years) -etoh: none -illicits: none -lives at/with: sister (a nurse) in , was in rehab until ; has 3 children, 1 died @ 27 in from asthma complication, has a daughter who's a cna. -retired manager of a medical answering services family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. -mother died of cva -father died of lung ca physical exam: on admission: vs: 97.1 109/44 121 97% cpap 10/5 gen: female in moderate distress. alert and oriented to person, place and time heent: perrla. eomi. cpap in place. neck: supple neck. could not appreciate jvd pulm: poor air movement. coarse breath sounds appreciated bilaterally but no inspiratory crackles. card: holosytolic murmur appreciated along the sternal border abd: soft, nontender and nondistended. normoactive bowel sounds. ext: 2+ edema to knee. skin: statis dermatitis rash bilaterally. pertinent results: admission labs: 04:40pm wbc-5.6 rbc-3.61* hgb-10.1* hct-31.7* mcv-88 mch-28.0 mchc-31.9 rdw-16.1* 04:40pm neuts-80.7* lymphs-13.7* monos-3.6 eos-1.3 basos-0.6 04:40pm plt count-186 04:40pm pt-13.7* ptt-25.3 inr(pt)-1.2* 04:40pm glucose-100 urea n-27* creat-1.3* sodium-141 potassium-5.8* chloride-93* total co2-39* anion gap-15 04:40pm probnp-3902* 05:15pm urine color-yellow appear-hazy sp -1.013 05:15pm urine blood-sm nitrite-neg protein-25 glucose-250 ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 05:15pm urine rbc-* wbc->50 bacteria-mod yeast-none epi-0-2 05:48pm type- o2-100 po2-211* pco2-49* ph-7.52* total co2-41* base xs-15 aado2-469 req o2-78 intubated-not intuba comments-cpap 09:55pm ck-mb-2 ctropnt-<0.01 micro: urine culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | ampicillin/sulbactam-- 4 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 piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s 9:55 pm sputum source: expectorated. gram stain (final ): >25 pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. respiratory culture (final ): test cancelled, patient credited. legionella culture (preliminary): no legionella isolated. blood culture x 2: pending urine: legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. 5:00 pm sputum source: expectorated. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive rod(s). respiratory culture (preliminary): sparse growth commensal respiratory flora. gram negative rod(s). sparse growth. 5:30 pm stool consistency: not applicable source: stool. fecal culture (pending): campylobacter culture (final ): no campylobacter found. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). studies: ekg: atrial fibrillation with rapid ventricular response. diffuse baseline artifact with uninterpretable st-t waves in leads v1-v3. rightward axis. non-specific diffuse st-t wave changes. compared to the previous tracing of the ventricular response is faster. otherwise, the findings are similar. cxr: lower lung consolidations concerning for pneumonia, possible small effusions. please note technical limitations and if needed a repeat with more optimized technique may be performed to more clearly assess. cxr: in comparison with the study of , there are lower lung volumes. no change in the appearance of the right picc line. there is enlargement of the cardiac silhouette with mild engorgement of pulmonary vessels that has improved since the prior study. opacification at the left base again suggests volume loss or superimposed consolidation. the possibility of a central obstructing lesion must again be considered. prominence of central pulmonary vessels again could reflect pulmonary artery hypertension. brief hospital course: 65 year old female with past medical history significant for diastolic heart failure, moderate aortic stenosis with valve area of .2 cm2, bronchietasis and copd with stage ii gold criteria and home oxygen 2-4l admitted with one day history of shortness of breath, change in her productive and pleuritic chest pain. #. copd exascerbation and decompensated dchf: this was attributed to elements of copd exacerbation and her diastolic heart failure. she was treated with bipap and started on steroids, initially hydrocort 125mg iv q8 which was gradually tapered to 60mg po prednisone daily by the time she was called out to the floor. then she was transitioned to 30mg of prednisone prior to discharge. she was diuresed with lasix; given a significant metabolic alkalosis she was briefly treated with acetazolamide with continued diuresis. los fluid balance of -5l. iv lasix was stopped and she was put on her home torsemide dose of 40mg . prior to discharge, we held one dose of torsemide and prescribed half of a dose on the morning of , with resuming her home dose in the evening on because of metabolic alkalosis. she remained on cpap at night, and her o2 saturations were titrated between 92-94% on 2-4l of oxygen which is her home baseline. #. urinary tract infection: grew out pan sensitive klebsiella in her urine. she was started on levofloxacin (at the time for empiric coverage of respiratory organisms when this was being entertained on the sob ddx) and then transitioned to cipro when sensitivies grew out (and pna was felt less likely) for a total of a 3 day course. she had episodes of inconitnence in the setting of a foley that was traumatically partially removed. it was replaced, and then discontinued. she had improvement in her incontinence prior to discharge. #. atrial fibrillation: had episodes of rvr. was amiodarone loaded and given diltiazem as her pressures would tolerate, which was gradually uptitrated to 90mg qid. he continued to have episodes of rvr, and given her borderline blood pressures, we started metoprolol 25mg and uptitrated to 37.5mg which caused her to have mildly worse , we decreased it to 25mg , with a decrease in incidence of rvr. amiodarone was discontinued as the risks were thought to outweight the potential benefits in this patient. she was anticoagulated with aspirin alone given a history of a prior gi bleed. #. access: ms. has a picc line in her right brachial vessel which terminates at the junction of the svc and right atrium. this is in good position and ok to use. - please remove picc when no longer needed for access and draws #. anemia: chronic and at baseline throughout admission. this was a stable issue for her. medications on admission: 1. fluticasone-salmeterol 250-50 mcg/dose i puff 2. tiotropium bromide 18 mcg capsule inhalations daily 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) prn 4. montelukast 10 mg tablet 10 mg po qdaily 5. fexofenadine 60 mg po bid 6. omeprazole 20 mg po bid 7. vitamin d 400 units qdaily 8. ferrous sulfate 300 mg po qdaily 9. calcium carbonate 500 mg po tid with meals 10. docusate sodium 100 mg po bid 11. senna 8.6 mg po bid 12. torsemide 40 mg po bid 13. potassium chloride 20 meq po bid 14. metoprolol tartrate 25 mg po bid 15. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 16. diltiazem hcl 420 mg po qdaily discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 4. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). 7. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 8. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety: please do not drive while on this medication, it can make you drowsy. 9. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 10. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 11. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for headache. 12. diltiazem hcl 60 mg tablet sig: one (1) tablet po q6h (every 6 hours): hold for sbp<90 hold for hr<60. 13. prednisone 10 mg tablet sig: three (3) tablet po daily (daily) for 2 days. 14. calcium carbonate 500 mg (1,250 mg) tablet sig: one (1) tablet po three times a day: with meals. 15. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. 16. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: one (1) inh inhalation twice a day. 17. torsemide 20 mg tablet sig: one (1) tablet po daily (daily) for 1 doses: morning of . 18. torsemide 20 mg tablet sig: two (2) tablet po twice a day: starting in the evening of . 19. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). discharge disposition: extended care facility: hospital for continuing medical care - ( center) discharge diagnosis: primary: copd exacerbation acute on chronic diastolic congestive heart failure atrial fibrillation with rapid ventricular response urinary tract infection secondary: anemia of chronic disease depression 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: ms. , it was a pleasure taking part in your care. you were admitted to because of difficulty breathing beyond your baseline. you required a short stay in the icu to control your breathing. they treated your copd with steroids and non-invasive ventilation (bipap) to help dampen the inflammation in your lungs. we also found that you had fluid on your lungs and gave you diuretics iv to help pull that fluid off (lasix). your breathing improved to your baseline. also, your abnormal heart rhythm, called atrial fibrillation was abnormally fast. in the icu they added a medication called amiodarone to help with that. we transitioned you back to metoprolol and diltiazem to help slow the rate down. over the course of your stay, you became weak because of your illness, and will require a short stay in rehab to help you transition home. finally, you had a urinary tract infection which we treated with cipro for three days. we made the following changes to your medications: -changed diltiazem from 480mg daily to 60mg by mouth 4 times a day -changed metoprolol to 37.5mg by mouth twice a day -held your torsemide night time dose on . please take 20mg in the morning on and restart your normal dose of 40mg twice a day in the evening on -continue prednisone 30mg by mouth daily for 2 more days (until ) weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: please follow-up at the appointments below: department: - adult med when: monday at 10:45 am with: () , md building: (, ma) campus: off campus best parking: free parking on site department: adult specialties when: wednesday at 11:00 am with: , md building: (, ma) campus: off campus best parking: parking on site department: adult medicine when: thursday at 3:00 pm with: , md building: (, ma) campus: off campus best parking: free parking on site md procedure: central venous catheter placement with guidance diagnoses: hyperpotassemia anemia of other chronic disease obstructive sleep apnea (adult)(pediatric) esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site atrial fibrillation acute on chronic diastolic heart failure aortic valve disorders other chronic pulmonary heart diseases depressive disorder, not elsewhere classified acute respiratory failure alkalosis rash and other nonspecific skin eruption diarrhea leukocytopenia, unspecified other dependence on machines, supplemental oxygen bronchiectasis with acute exacerbation 

Answer: The patient is high likely exposed to