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: service:medicine history of present illness: the patient is an 85 year old female with coronary artery disease, aortic stenosis, congestive heart failure, asthma, status post recent hospitalization for pulmonary edema and pneumonia, presenting one day after discharge with the chief complaint of increased nursing home. a chest x-ray was done showing a new right upper lobe infiltrate and progression of an old right lower lobe infiltrate. the patient was intubated on , for respiratory distress, with oxygen saturation in the 70% range on three liters nasal cannula, with an arterial blood gas showing ph 7.17, pco2 86, po2 65 on 100% nonrebreather. the patient was extubated on , without complications and arterial blood gases prior to transfer to the medical floor was on , showing a ph of 7.40, pco2 48, po2 111. on the general medical floor, the patient had a chief complaint of sore throat which she blamed on intubation. otherwise, the patient did not report any shortness of breath. past medical history: 1. coronary artery disease. three vessels disease, nonoperable. cardiac catheterization on , showed 80% left main, 100% mid left anterior descending, 80% proximal circumflex. 2. moderate aortic stenosis with a valve area of 0.9 cm2. 3. paroxysmal atrial fibrillation. 4. pacemaker. 5. right cerebrovascular accident. 6. breast cancer, status post left mastectomy. 7. hypercholesterolemia. 8. hypertension. 9. congestive heart failure with an ejection fraction of 50%. 10. asthma. medications on transfer from intensive care unit: . procainamide 500 mg p.o. q.i.d. 2. colace 100 mg p.o. b.i.d. 3. k-dur 20 meq p.o. q.d. 4. lactulose 3 mg p.o. t.i.d. 5. coumadin 1 mg p.o. q.h.s. 6. protonix 40 mg p.o. q.d. 7. iron sulfate 325 mg p.o. q.d. 8. lopressor 37.5 mg p.o. b.i.d. 9. neurontin 200 mg p.o. b.i.d. 10. atrovent nebulizer q4hours. 11. aspirin 325 mg p.o. q.d. 12. alphagan eye drops b.i.d. 13. trusopt eye drops b.i.d. 14. synthroid 50 mcg p.o. q.d. 15. diflucan 100 mg p.o. q.d. 16. levofloxacin 250 mg p.o. q.d. 17. tube feeds. 18. vancomycin one gram intravenous b.i.d. allergies: epinephrine, penicillin, bactrim. social history: the son was very involved in the patient's care. code status full. physical examination: on admission, temperature 98.6, blood pressure 112/60, heart rate 68, respiratory rate 18, oxygen saturation 98% on four liters nasal cannula. in general, the patient was an elderly russian female in no acute distress. head and neck examination - the pupils are equal, round, and reactive to light and accommodation. extraocular movements are intact. the oropharynx is clear. there is no jugular venous distention, lymphadenopathy or carotid bruits. cardiac - regular rate and rhythm, ii/vi systolic ejection murmur which was heard loudest at the base and apex, without radiation to the neck. no gallops. lungs - bilateral wheezes and crackles. abdomen is soft, nontender, nondistended, no hepatosplenomegaly or masses. normal bowel sounds. extremities - no cyanosis, clubbing or edema, 1+ dorsalis pedis pulses bilaterally. laboratory data on transfer: white blood cell count 7.0, hematocrit 30.5, platelets 353,000. prothrombin time 20.2, partial thromboplastin time 39.7, inr 3.8. sodium 139, potassium 3.3, chloride 100, bicarbonate 32, blood urea nitrogen 9, creatinine 0.7, glucose 118. last arterial blood gases on , revealed ph 7.4, pco2 48, po2 111. sputum gram stain and culture done on , showing more than 25 polymorphonuclear leukocytes, less than 10 epithelial cells, 3+ gram positive cocci in pairs and clusters, 1+ gram negative rods. urinalysis showed white blood cells, few bacteria, 0-2 epithelial cells. urine culture showed less than 10,000 organisms. hospital course: this was an 85 year old female with coronary artery disease, severe aortic stenosis, congestive heart failure, asthma, status post recent hospitalization for pulmonary edema, pneumonia, presenting one day after discharge from recent hospitalization with shortness of breath and desaturations. the patient was found to have progressive infiltrates on chest x-ray consistent with a persistent pneumonia, probably an aspiration pneumonia. 1. infectious disease - the patient was continued on a two week course of levofloxacin and flagyl, and a seven day course of vancomycin. as the patient had worsening pulmonary status during her hospital stay, the levofloxacin and flagyl were continued beyond a two week course and cefepime was added for broad coverage. as the patient's clinical status deteriorated and the patient was made dnr/dni and then comfort measures only, her antibiotics were discontinued on , as the patient only had a single lumen picc line and was on intravenous morphine for pain control and comfort. 2. pulmonary - the patient had a history of pulmonary edema and was admitted with a multilobar pneumonia, presumed secondary to aspiration. the patient was continued on antibiotics with triple therapy (levofloxacin, flagyl and cefepime which was added later on for broadening coverage). the patient had multiple episodes of desaturation when transferred to the general medical floor which initially were relieved by administering lasix intravenous in addition to small doses of morphine sulfate for treating episodes of pulmonary edema which were presumed to be causing these frequent episodes of shortness of breath. on , the patient experienced an episode of desaturation to 88% on five liters after which an oxygen face tent was placed, with mild improvement in oxygen saturation to 93%. a chest x-ray was obtained which revealed right lung collapse. the patient was subsequently placed on a 100% face mask and was saturating 88 to 92%. the patient was then placed on bipap with reinflation of the right lung. however, the patient persisted to remain on 100% face mask. as the patient refused subsequent bipap, the patient was continued on conservative measures for the remainder of her hospital course to manage her respiratory condition. the patient was continued on oxygen, nebulizers p.r.n., and was positioned on her left side to promote blood flow to the good lung. 3. cardiovascular - coronary artery disease - the patient had left main disease which was inoperable. as the patient had in the past experienced severe hypotension with nitrates, nitrates were avoided. the patient was continued on beta blockade. the patient was given morphine sulfate intermittently for relief of ischemic pain. paroxysmal atrial fibrillation - the patient was initially on lopressor, procainamide and low dose diltiazem with good control of her heart rate. however, the patient's subsequently started experiencing intermittent episodes of atrial fibrillation to a heart rate of 120s, which were initially well controlled with intermittent boluses of intravenous lopressor. during the hospital course, the patient developed a wide complex tachycardia, and the electrophysiology service was consulted to see whether the patient could have her pacer adjusted so that the ventricles would not be paced at the same rate as her atria during episodes of atrial fibrillation. the electrophysiology service simply suggested continuing procainamide and lopressor at their current doses, with adjustment of procainamide to keep the q-tc interval less than 500. with further difficulty controlling the patient's heart rate, the patient was placed on a diltiazem drip. this was later changed to the oral form in interest of intravenous access. congestive heart failure - the patient was given lasix intravenous standing dose and lasix intravenous p.r.n. for episodes of interval pulmonary edema during hospital stay. 4. gastrointestinal - the patient was placed on aggressive bowel regimen. the patient was initially on tube feeds through nasogastric tube. however, at one point during the hospital course, tube feeds were suctioned through the patient's mouth, and were subsequently discontinued in light of the presumed risk of aspiration. 5. code status - the patient was initially a full code on transfer from intensive care unit to the general medical floor. as the patient's clinical status deteriorated, the primary medical team had numerous discussions with the patient and her son re; code status. there was much resistance of the son to making his mother dnr/, as he seemed to think the best thing to do for her as well as for himself would be to prolong her life as much as possible. there was a period during the hospital stay where her son went out of state, and she expressed to us her desire to be made dnr/dni. holding true to the patient's wishes, the patient was subsequently made dnr/dni. as the patient's clinical status deteriorated, she was requiring persistent oxygen requirement, was becoming more visibly short of breath, was becoming hypotensive, and was having frequent bouts of atrial fibrillation which were very difficult to control. the son finally agreed that the patient should be made comfort measures only, in light of the futility of her medical condition. the patient was subsequently taken off all intravenous medications except for a morphine drip, which was titrated to comfort. the patient was taken off all monitors including telemetry monitoring, oxygen saturation monitoring and monitoring of vital signs. the patient expired on . , m.d. dictated by: medquist36 d: 18:30 t: 19:49 job#: procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified atrial fibrillation aortic valve disorders acute respiratory failure other and unspecified angina pectoris pneumonitis due to inhalation of food or vomitus chronic obstructive asthma, unspecified 

Answer: The patient is high likely exposed to