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: dyspnea major surgical or invasive procedure: none history of present illness: 63 y/o woman with pmh significant for severe copd o2 dependent since , requiring multiple intubations, osa, morbid obesity, chf with orthopnea, chronic microcytic anemia with baseline of 30, previous episodes of likely gi bleed (melenic stools and anemia) attributed to nsaids gastritis and occurring while on coumadin for dvt, adrenal insufficiency, htn. on the occasion of these presumed bleeds, there was inability to perform endoscopy at due to anatomy and inability to lie flat. she thus did not receive egd or colonoscopy, but both were planned as outpatient. this time ms comes with 3 days sob, prod cough (greenish white sputum), generally "feels like copd" according to patient. she is also dizzy, + nausea. no cp she denies tarry black stools, has had no maroon stools, no nausea, vomiting, worsening of her heartburn, lightheadedness, syncope before the worsening sob. in the ed, she got nebs, trial of bipap which she did not tolerate, solumedrol for copd. also started ctx/levoflox for a concern of a cxr left sided effusion, and additionally received 40mg iv lasix and her respiratory status improved. finally, her hct was 20; gi aware. plts 89, usually mid-100s & ordered 2 units of blood. prior to transfer, vs were hr 96, bp 113/47, rr 27, sat 97% 6l o2 (uses 3l at home). past medical history: morbid obesity osa hypertension ?peptic ulcer disease (no documentation in the e-files) anemia asthma copd, o2 dependent chf with preserved ef h/o dvt; coumadin stopped because of melenic episode past surgical history umbilical hernia repair gynecologic history she is menopause 14 years ago. never took hormone replacement. she g4, p3, 1 miscarriage. no history of postmenopausal bleeding. no hot flashes. social history: ex-smoker, quit in . occasional alcohol. denies any drugs. family history: multiple family members with hypertension no family member with heart attack or diabetes father died of lung cancer who was a heavy smoker mother died of cva and because of hypertension physical exam: vitals: t:99.3 bp:140/73 hr:94 rr:20 o2sat:99% gen: obese, tired appearing white female heent: eomi, perrl, sclera anicteric, no epistaxis or rhinorrhea, mm dry, op clear neck: difficult to assess jvd body habitus, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline cor: rrr, no m/g/r, normal s1 s2, radial pulses +2 pulm: lungs diffuse end exp wheezes abd: soft, nt, nd, +bs, no hsm, no masses ext: 2+ nonpitting edema with scaling skin, no palpable cords neuro: alert, oriented to person, place, and time. cn ii ?????? xii grossly intact. moves all 4 extremities. strength 5/5 in upper and lower extremities. patellar dtr +1. plantar reflex downgoing. no gait disturbance. no cerebellar dysfunction. skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses. pertinent results: 12:05pm glucose-106* urea n-14 creat-0.8 sodium-140 potassium-4.9 chloride-96 total co2-41* anion gap-8 12:05pm wbc-3.7* rbc-2.75*# hgb-5.9*# hct-20.9*# mcv-76*# mch-21.3*# mchc-28.0*# rdw-16.5* 12:05pm neuts-69.7 lymphs-23.3 monos-4.3 eos-2.4 basos-0.3 12:05pm plt smr-low plt count-89* 12:05pm ck(cpk)-35 12:05pm ck-mb-notdone ctropnt-0.02* probnp-1590* 12:13pm lactate-0.8 07:30pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg cxr: markedly low lung volumes and poor penetration. pulmonary vascular prominence c/w pulmonary edema. increased hilar prominence and peri-hilar haziness also c/w picture of pulmonary edema. increased opacity in left mid-lung zone which may represent pneumonia, atelectasis, or asymettrical edema. moderate cardiomegaly, stable. no evidence of sizable pelural effusion or pneumothorax. ekg: sr nml axis, nml intervals, j point elevated in v2-v3 is unchanged from brief hospital course: 63f with copd, chronic gi bleeding, presents with dyspnea, productive cough, and hypoxia, as well as hct 20 and low plts. #copd exacerbation: likely secondary copd exacerbation secondary to viral illness due to low temperature, no leukocytosis and duration of onset. of note, the patient is on 3 l nc at home. she was treated with a 5 day course of levaquin which ended on . she was also started on a 5 day course of 40 mg of prednisone which will end on . gram stain and cultures show op organisms only. she was continued on albuterol nebs, home advair diskus, ipratroprium, and leukotriene inhibitor. she underwent a tte yesterday which showed moderate as with a valve area between 1-1.2 cm2, so her sob is unlikely to be secondary to as. the patient was transferred from the micu to the medicine service where she continued to clinically improve and in order to maximize her pulmonary status, the patient was discharged to pulmonary rehab. -the patient will benefit from inpatient pulmonary f/u given her severe obstructive lung disease, obesity hypoventilation, obstructive sleep apnea and pulmonary hypertension. . #atrial fibrillation: the patient developed a.fib with rvr while in the hospital and denies a past history of a-fib. she was dry at the time of onset, so she was given ivf and started on 12.5 mg metoprolol . she converted back into sinus. given her severe underlying pulmonary disease, the patient's metoprolol was changed to diltiazem. given the patient's gi bleed and transient nature of her a-fib, she was not started on cardioembolic prophylaxis with either aspirin or coumadin. this was discussed with the patient. . #gi bleed: the patient was found on admission to have a hct of 20 and guaiac positive stools. she had a history of gi bleeds on coumadin. she was transfused a total of 6 units of prbc during her hospitalization and evaluated by gi. she was initally treated with a ppi gtt until her hct stabilized. her hct has been stable for a few days and her stool are guaiac negative. gi recommended an endoscopy to evaluate for an ugi bleed, however as this would entail intubation given the patient's body habitus, the patient wished to choose conservative management and will not undergo the endoscopy. she will need monthly hct checks as an outpatient. patient may be iron-deficient with low mcv (78), although tibc is high-normal and serum ferritin is normal. she was started on iron supplementation started at 325mg po daily. . #fatigue/decreased mobility: patient complains of ??????not being the same person she was 8 days ago.?????? she was able to walk across a room to a commode, but has not been able to do so since her illness began. likely due to copd exacerbation, but may also be decompensated chf, or poor sleep due to icu stay or obesity hyperventilation/osa. pt was consulted and believed that the patient would greatly benefit from pulmonary rehab. . # abdominal pain/diarrhea: the patient developed crampy abdominal pain while hospitalized. this could be due to a peptic ulcer, as patient has had this in the past and would explain anemia or also be due to c.diff in the setting of recent diarrhea. she was continued on the ppi and stool was sent for c.diff which is pending. h. pylori ab is pending. . # chronic diastolic chf: patient had a tte which showed a normal ef and moderate as (valve area of .2 cm2). also mod plum hypertension. amlodipine was discontinued as beta blocker has been started and pressures have been stable in the 110??????s systolic. her lasix was initially held due to negative fluid balance and atrial fibrillation with rapid ventricular rate. she was started on diltiazem as above and continued on her home lasix on discharge. . # osa: the patient is on cpap at home, but likely has a component of obesity hypoventilation syndrome. patient did not tolerate bipap overnight initally and was tried on this, however she did not tolerate it well. would benefit from sleep study as an outpatient. she continued to try bipap overnight while here and was last able to tolerate it for 5 hours. she sould have a sleep study as an outpatient to determine her optimal sleep settings and follow up with sleep medicine, especially as her tte showed moderate pulmonary htn. however, the patient reports significant claustraphobia with prior sleep studies and may not realistically tolerate it. . #thrombocytopenia: the patient has a history of thrombocytopenia with platlets in the low 100's for years. has not been on heparin products, or other drugs which induce thrombocytopenia. unlikely to be hit. could be itp, or related to anemia of chronic disease. unlikely to be dic as there are no signs or symptoms of thrombosis or hemorrhage. haptoglobin normal at 134 mg/dl. has antiplatlet antibodies pending. also is noted to have pancytopenia and would likely benefit from outpatient workup of her pancytopenia. # code: full code medications on admission: albuterol combivent advair singulair spiriva theophylline furosemide amlopidine lisinopril discharge medications: 1. 60 mg tablet sig: one (1) tablet po twice a day. 2. docusate sodium 100 mg tablet sig: one (1) tablet po twice a day. 3. lasix 40 mg tablet sig: one (1) tablet po once a day. 4. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) tablet inhalation once a day. 5. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day. disp:*1 inhaler* refills:*4* 6. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 7. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours): please give brand name and not generic. disp:*60 tablet, delayed release (e.c.)(s)* refills:*4* 9. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 10. prednisone 20 mg tablet sig: two (2) tablet po daily (daily) for 2 days. disp:*4 tablet(s)* refills:*0* 11. potassium chloride 10 meq capsule, sustained release sig: four (4) capsule, sustained release po once a day. 12. diltiazem hcl 180 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. 13. theophylline 100 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. discharge disposition: extended care facility: - discharge diagnosis: anemia, acute gi blood loss copd exacerbation hypoxemia pulmonary hypertension bronchitis, acute obstructive sleep apnea obesity hypoventilation atrial fibrillation with rvr, new onset moderate aortic stenosis discharge condition: vital signs stable, hct 29.9, platelets 91 discharge instructions: return to the ed if you are having worsening sob, fevers, chills, significant chest tightness not responsive to meds, worsening productive cough, confusion, significant lethargy, blood in your , vomiting blood, unexplained dizziness. you presented with anemia of acute, likely upper gi blood loss, with a hct of 21. you opted not to undergo endoscopy and you were transfused blood with resolution of your gi bleeding. you had an episode of irregular heart rate, likely atrial fibrillation, but given your recent significant gi bleed, you were not started on coumadin or aspirin at this time. you should consider be started on aspirin ec 325 mg po qd for cardioembolic prophylaxis given your a-fib. . you also had worsening of your asthma and copd, and were treated with steroids and place in the icu. followup instructions: provider: () , md phone: date/time: 10:40 patient should arrange outpatient sleep study, ask for sleep lab. patient should be followed closely by pulmonologist. procedure: diagnostic ultrasound of heart non-invasive mechanical ventilation transfusion of packed cells diagnoses: thrombocytopenia, unspecified congestive heart failure, unspecified acute posthemorrhagic anemia iron deficiency anemia secondary to blood loss (chronic) atrial fibrillation aortic valve disorders other chronic pulmonary heart diseases acute respiratory failure blood in stool morbid obesity surgical or other procedure not carried out because of patient's decision chronic obstructive asthma with (acute) exacerbation helicobacter pylori [h. pylori] chronic diastolic heart failure acute gastritis, without mention of hemorrhage 

Answer: The patient is high likely exposed to