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: amlodipine attending: chief complaint: copd exacerbation/shortness of breath major surgical or invasive procedure: intubation arterial line placement picc line placement esophagogastroduodenoscopy history of present illness: 87 yo f with h/o chf, copd on 5 l oxygen at baseline, tracheobronchomalacia s/p stent, presents with acute dyspnea over several days, and lethargy. this morning patient developed an acute worsening in dyspnea, and called ems. ems found patient tachypnic at saturating 90% on 5l. patient was noted to be tripoding. she was given a nebulizer and brought to the er. . according the patient's husband, she was experiencing symptoms consistent with prior copd flares. apparently patient was without cough, chest pain, fevers, chills, orthopnea, pnd, dysuria, diarrhea, confusion and neck pain. her husband is a physician and gave her a dose of levaquin this morning. . in the ed, patient was saturating 96% on nrb. cxr did not reveal any consolidation. per report ekg was unremarkable. laboratory evaluation revealed a leukocytosis if 14 and lactate of 2.2. patient received combivent nebs, solumedrol 125 mg iv x1, aspirin 325 mg po x1. mg sulfate 2 g iv x1, azithromycin 500 mg ivx1, levofloxacin 750 mg ivx1, and cefrtiaxone 1g ivx1. patient became tachpnic so was trialed on non-invasive ventilation but became hypotensive to systolics of 80, so noninvasive was removed and patient did well on nrb and nebulizers for about 2 hours. at that time patient became agitated, hypoxic to 87% and tachypnic to the 40s, so patient was intubated. post intubation abg was 7.3/60/88/31. propafol was switched to fentanyl/midazolam for hypotension to the 80s. received 2l of ns. on transfer, patient vs were 102, 87/33, 100% on 60% 450 x 18 peep 5. patient has peripheral access x2. . in the icu, patient appeared comfortable. review of sytems: limited due to patient sedation past medical history: # copd flare fev1 40% in , on 5l oxygen, s/p intubation , s/p distal tracheal to left main stem stents placed . stents d/c'd . tracheobronchoplasty performed , # cad w/ atypical angina (cath - lad 30%, rca 30%, ef 63%) # dyslipidemia # hypothyroidism, # hypertension # hiatal hernia, # lacunar cva, # s/p ped struck -> head injury & rib fx, # depression social history: the patient is married and worked as a clinical psychologist. her husband is a pediatric neurologist at . they have several children, one of which is a nurse. with 40 pack years, quit 5 years ago. social ethanol user. no history of ivdu, but remote history of marijuana use. family history: (+) fhx cad; father with an mi in his 40's, died of a cva at age 59 physical exam: on admission vitals: t: bp: 116/46 p: 92 o2: 100% tv 60% 450 x 18 peep 5 general: intubated, sedated, no apparent discomfort heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: crackles bases bilaterally cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: initial labs 10:55am blood wbc-14.1*# rbc-4.20# hgb-12.6# hct-39.1# mcv-93 mch-30.1 mchc-32.3 rdw-12.6 plt ct-319 10:55am blood neuts-93.9* lymphs-4.4* monos-1.3* eos-0.2 baso-0.2 03:50am blood pt-11.0 ptt-28.7 inr(pt)-0.9 10:55am blood glucose-168* urean-13 creat-0.8 na-140 k-3.5 cl-92* hco3-36* angap-16 03:50am blood calcium-8.8 phos-3.4 mg-2.1 cardiac biomarkers 10:55am blood ck(cpk)-321* ctropnt-0.02* 06:25pm blood ck(cpk)-345* ck-mb-14* mb indx-4.1 ctropnt-0.01 03:50am blood ck(cpk)-845* ck-mb-15* mb indx-1.8 ctropnt-0.01 12:04pm blood ck(cpk)-1030* ck-mb-15* mb indx-1.5 ctropnt-0.01 03:15am blood ck(cpk)-530* ck-mb-9 ctropnt-0.01 probnp-2535* cxr () - impression: hiatal hernia, otherwise unremarkable. limited exam. echo () - there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the estimated cardiac index is normal (>=2.5l/min/m2). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size is normal. with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a prominent fat pad. impression: normal biventricular systolic function. moderate pulmonary artery systolic hypertension. cxr () - kyphotic positioning. compared with one day earlier and allowing for technical differences, the right-sided effusion may be slightly larger. otherwise, no significant change is detected. again seen is retrocardiac opacity consistent with left lower lobe collapse and/or consolidation and a small left effusion. as noted, a right effusion is again seen, possibly slightly larger on the current examination, with underlying collapse and/or consolidation. doubt chf. degenerative changes of the thoracic spine are noted. cardiac enzymes : trop<0.01 : trop 0.03 : trop 0.02 labs at discharge: 05:40am blood wbc-9.5 rbc-3.08* hgb-9.6* hct-28.3* mcv-92 mch-31.2 mchc-33.9 rdw-13.5 plt ct-360 05:40am blood pt-10.4 ptt-22.8 inr(pt)-0.8* 05:30am blood glucose-114* urean-18 creat-0.8 na-142 k-3.5 cl-101 hco3-36* angap-9 05:40am blood calcium-8.9 phos-2.8 mg-2.3 05:40am blood tsh-0.87 brief hospital course: 87 yo f with h/o chf, copd on 5 l oxygen at baseline, tracheobronchomalacia s/p stent, presents with acute dyspnea over several days, no s/p intubation for hypercarbic respiratory failure. # hypercarbic respiratory failure: presents with dyspnea, but no clear cough or fevers. per report, patient felt like this with prior copd exacerbations. leukocytosis supports possible pneumonia, but history and cxr not entirely consistent with this. ekg with signs of demand, but romi negative. sputum gram stain unremarkable, but respitatory viral culture grew parainfluenze type 3 on . patient was initially managed on solumedrol 60 mg iv q8h, and was eventually tapered. with no evidence of pneumonia on cxr and sputum gram stain, antibiotics were stopped . beta-agonists and anticholinergics were continued around the clock. tte revealed mild symmetric lvh with normal ef, increased pcwp (>18mmhg), normal rv, and moderate pulmonary artery systolic hypertension. on , bronchoscopy revealed collapsible, unremarkable airways. patient had difficulty weaning from the vent, and would become interimittenty hypertensive to sbp 200s and tachypnic to the 50s. patient was extubatied on after passing sbt 0/5, but required re-intubation 30 minutes later for worsening secretions, lack of gag reflex, and tachypnea to the 50s. of note, on , the patient was found to have mrsa growing in sputum samples. although it was felt that this likely represented colonization as opposed to true infection, the patient was started on a course of vancomycin (which was stopped after 5 days). after multiple discussions between the patient's family and the icu team, the patient's pcp, the palliative care service, the patient's family ultimately decided that she would not want a tracheostomy. on , extubation was pursued again and was successful. after extubation, her respiratory status improved and she was ultimately called out to the medical floor. on the floor she was progressively weaned to 2lnc with nebs (better than her baseline 5l @home). because of clinical exams revealing mild volume overload, she was intermittently diuresed. she also experienced intermittent shortness of breath with tachypnea but this was thought to be the result of attacks of anxiety with tachypnea. after receiving prn morphine, her breathing status would typically improve. a steroid taper was begun. the patient should continue prednisone 30 mg daily for 3 more days, then 20 mg daily for 4 days, then 10 mg daily for 4 days, then 5 mg daily for 4 days, then stop. . # upper gi bleeding: on , patient had coffee grounds from og tube. lavage for approx 600ccs with clearance. gi perfomred egd which revealed esophagitis, ulcers and blood in the stomach body, d2 diverticulum and large hiatal hernia. h pylori was negative. patient was continued on iv ppi, with plan for repeat egd in 8 weeks, and upper gi series once clinically improved given abnormal anatomy on egd. her hematocrit remained stable with no further episodes of upper gi bleeding throughout the patient's hospitalization. on the floor she was switched to po pantoprazole twice daily. aspirin was held. . # weakness: the patient was found to have generalized weakness at the end of her hospitalization. neurology was consulted and they felt it was likely due to a combination of steroid myopathy and deconditioning from her prolonged bedbound status. a tsh was checked which was normal. they recommended pulmonary and physical rehab. . # cad: history of lad and rca stenosis on cath, but no stents. continued statin and beta blocker, but held aspirin for gi bleeding (see above) . # nutrition: unable to pass ng without direct visualization due to hiatal hernia. ir guided post pyloric ng tube was placed on for tfs and po medications. ng tube was pulled when patient was extubated on . speech and swallow were consulted following the patient's extubation and she was eventually moved to soft solids and thin liquids with 1:1 supervision. # goals of care: pcp . was very involved in discussions regarding patient's code status. palliative care also followed along with the patient. ultimately, at the time of the patient's extubation on , it was decided that the patient would be dnr/dni (although this was later change). the patient's family felt that she would not want a tracheostomy. it was decided that she would not be reintubated and that, if her respiratory status were to worsen after intubation, care would be focused on comfort. however, her status improved in the micu and on the floor and it was then decided that she would remain dnr with intubation (but no tracheostomy) if her breathing deteriorated. after several days with stable or improved overall clinical status, she was deemed suitable for rehabilitation. at the timem of discharge, the patient's code status was do not resuscitate, okay to intubate. medications on admission: # omeprazole 20 mg daily # furosemide 20 mg daily # toprol xl 50 mg daily # lipitor 20 mg daily # folic acid 1 mg daily # centrum daily # diovan 80 mg daily # trazodone 75-100 mg qhs # melatonin 3 mg qhs # aspirin 325 mg daily # albuterol neb prn # duoneb prn # advair 250/50 # zolpidem 2.5 mg qhs prn # synthroid 100 mcg daily # lexapro 20 mg daily discharge medications: 1. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 2. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. trazodone 50 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 6. melatonin 3 mg tablet sig: one (1) tablet po at bedtime. 7. valsartan 160 mg tablet sig: 1.5 tablets po once a day. 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation every 4-6 hours as needed for shortness of breath or wheezing. 9. duoneb 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: one (1) neb inhalation every six (6) hours as needed for shortness of breath or wheezing. 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day. 11. escitalopram 10 mg tablet sig: two (2) tablet po daily (daily). 12. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 13. prednisone 20 mg tablet sig: one (1) tablet po daily () for 4 days: start after 3 days of 30 mg daily. 14. prednisone 10 mg tablet sig: one (1) tablet po daily () for 4 days: start after 4 days of 20 mg daily. 15. prednisone 5 mg tablet sig: one (1) tablet po daily () for 4 days: start after 4 days of 10 mg daily. 16. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 17. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 18. morphine 10 mg/5 ml solution sig: five (5) mg po every four (4) hours as needed for respiratory discomfort: hold for oversedation or rr<12. 19. prednisone 10 mg tablet sig: three (3) tablet po once a day for 3 days. 20. colace 100 mg capsule sig: one (1) capsule po twice a day. 21. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation. 22. humalog insulin sliding scale please use attached humalog insulin sliding scale while on steroids. discharge disposition: extended care facility: center at discharge diagnosis: primary: 1. chronic obstructive pulmonary disease exacerbation 2. respiratory failure with intubation 3. upper gastrointestinal bleed/peptic ulcer disease 4. hypertension 5. anxiety secondary: 1. coronary artery disease 2. hypothyroidism discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the hospital with shortness of breath and respiratory failure and lethargy. in the emergency department, you were breathing very fast and a breathing tube was inserted into your airway to help you breathe. you were admitted to the intensive care unit. there, you were managed with steroids and antibiotics and the tube was eventually removed from your airway, allowing you to breathe on your own. you also underwent bronchoscopy which looked at the inside of your airways. . during your time in the intensive care unit, you developed a gastrointestinal bleed. a tube was placed into your stomach and you underwent an endoscopic procedure to look at your esophagus and stomach. this showed inflammation in your esophagusand ulcers in your stomach. . you should continue to use nasal oxygen by nasal cannula as needed. you should continue the steroid taper as instructed. you should call your doctor or return to the emergency room if you have increasing difficulty breathing or shortness of breath, wheezing, chest pain, blood in your stool or vomiting blood. . there are some changes in your medications. start pantoprazole 40 mg twice daily and stop omeprazole start hydrochlorothiazide start prednisone, taking 30 mg for 3 days, then 20 mg for 4 days, then 10 mg for 4 days, then 5 mg for 4 days, then stop. start colace and senna as needed for constipation can use morphine to alleviate symptoms of respiratory discomfort stop furosemide stop zolpidem stop aspirin increase diovan to 240 mg daily decrease trazodone to 50 mg daily . follow up as indicated below. followup instructions: you have an appointment to follow up with dr. , your primary care physician, at 1pm. his address is , , ,. the phone is . you have an appointment to follow up with dr. in the clinic on at 3pm in the at on the . their phone number is . department: div. of gastroenterology when: wednesday at 3:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: acidosis other iatrogenic hypotension coronary atherosclerosis of native coronary artery unspecified essential hypertension adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified unspecified acquired hypothyroidism obstructive chronic bronchitis with (acute) exacerbation diaphragmatic hernia without mention of obstruction or gangrene other and unspecified hyperlipidemia acute and chronic respiratory failure primary pulmonary hypertension gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction carrier or suspected carrier of methicillin resistant staphylococcus aureus hematemesis esophagitis, unspecified toxic myopathy encephalopathy, unspecified hyperosmolality and/or hypernatremia influenza with other respiratory manifestations other diseases of trachea and bronchus 

Answer: The patient is high likely exposed to