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: penicillins / univasc / tetanus & diphtheria tox,adult / zoloft / remeron attending: chief complaint: increased dyspnea major surgical or invasive procedure: pulmonary intubation (at osh) history of present illness: 78 y/o woman with cad multiple pcis (9 stents), chf with preserved ejection fraction, mild pulm hypertension, cva, htn, niddm, pvd, and microscopic colitis who presented to on the night of with fever, severe dyspnea, wheezing, malaise, nausea, and one episode of watery diarrhea. on presentation, she was hypoxemic to 70% on ra. she had crackles and wheezing on lung exam. cxr showed possible lll infiltrate, pulmonary edema. the patient received aspirin, 40mg iv lasix, and 750mg iv cipro. initially, the patient was given metoprolol and the rest of her home meds including losartan, aspirin, , and lipitor were continued. she was placed on bipap. overnight, she developed more dyspnea and hypoxemia and o2 sat dropped to 82% on nrb. abg was 7.32/32/54 on bipap. the patient was intubated started on lasix gtt, nitro gtt, and heparin gtt. on arrival to the floor, patient was intubated but awake, able to answer questions and follow commands, and in no acute distress. she denied any chest pain or abdominal pain. vitals on transfer were 99.4, 111/49, 64, 15, 100% on 100% fio2. past medical history: 1. cardiac risk factors: diabetes, hyperlipidemia, hypertension 2. cardiac history: -extensive cad s/p multiple stents -cabg: none -pacing/icd: none 3. other past medical history: # h/o cva # visceral stenosis (70% stenosis of the celiac, sma, and followed by ) # pvd # dm ii - not on insulin # hypertension # migraine headaches # gastritis - no peptic ulcer disease history. # depression x30 years, initially reactive social history: widowed, daughter lives with her. previously independent. -tobacco history: denies -etoh: will have one drink when she goes out to dinner. family history: mother had cad and mi. father died at a young age of mi. physical exam: on admission: vs: 99.4, 111/49, 64, 15, 100% on 100% fio2. general: 78yo female. intubated but awake and in nad. able to answer questions and follow commands. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp 8cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. 1/6 systolic murmur at llsb. no thrills, lifts. no s3 or s4. lungs: mechanical ventilations. decreased lung sounds at left lung base, crackles in lll. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: trace edema. palpable dp pulses. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. on discharge: general: 78yo female. alert and oriented x3 and in nad. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp 7cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. 2/6 systolic murmur at llsb. no thrills, lifts. no s3 or s4. lungs: trace fine bibasilar crackles, normal work of breathing, no accessory muscle use abdomen: soft, ntnd. no hsm or tenderness. + bs extremities: no edema. palpable dp pulses. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: labs on admission: 10:27am blood wbc-16.0*# rbc-2.46*# hgb-7.5*# hct-23.1*# mcv-94 mch-30.6 mchc-32.5 rdw-14.2 plt ct-266# 01:57am blood pt-15.0* ptt-54.3* inr(pt)-1.4* 01:57am blood ret aut-1.2 10:27am blood glucose-191* urean-46* creat-2.2* na-141 k-4.5 cl-111* hco3-21* angap-14 10:27am blood calcium-8.2* phos-4.7* mg-1.9 02:06pm blood type-art po2-69* pco2-37 ph-7.33* caltco2-20* base xs--5 10:24pm blood type-art peep-5 fio2-40 po2-94 pco2-28* ph-7.42 caltco2-19* base xs--4 intubat-intubated 02:06pm blood lactate-1.0 hemeatology labs: 01:57am blood ret aut-1.2 05:40pm blood caltibc-140* ferritn-842* trf-108* cardiac labs: 10:27am blood ck-mb-17* ctropnt-1.17* 02:28pm blood ck-mb-19* mb indx-6.9* ctropnt-1.25* 02:28pm blood ck(cpk)-277* 07:52pm blood ck-mb-19* mb indx-7.1* ctropnt-1.32* 07:52pm blood ck(cpk)-267* 01:57am blood ck-mb-12* mb indx-6.0 ctropnt-1.34* 01:57am blood ck(cpk)-200 09:53am blood ck-mb-11* ctropnt-1.32* 05:40pm blood ck-mb-9 ctropnt-1.37* 05:40pm blood ck(cpk)-174 06:11am blood ck-mb-6 ctropnt-1.59* 06:11am blood ck(cpk)-77 04:03am blood ck-mb-5 ctropnt-1.55* 04:03am blood ck(cpk)-51 ua: 11:35pm urine blood-sm nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-sm 11:35pm urine rbc-1 wbc-8* bacteri-few yeast-none epi-1 11:35pm urine casthy-17* 05:36pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 11:35pm urine color-straw appear-hazy sp -1.009 05:36pm urine color-straw appear-clear sp -1.007 microbiology: 11:35 pm urine source: catheter. **final report ** urine culture (final ): no growth. 10:27 am blood culture source: venipuncture. **final report ** blood culture, routine (final ): no growth. 2:27 pm blood culture source: venipuncture. **final report ** blood culture, routine (final ): no growth. 11:35 pm blood culture source: venipuncture. **final report ** blood culture, routine (final ): no growth. 1:00 am sputum site: endotracheal **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): gram negative rod(s). respiratory culture (final ): no growth. blood culture : ngtd x 6 days images/studies: ekg : sinus rhythm. slight st segment elevation with t wave inversions in the anterior leads raises concern for evolving myocardial infarction. clinical correlation is suggested. inferior st-t wave changes may also be due to ischemia. compared to tracing #1 there are now deep t waves seen in leads v3-v6 raising concern for ischemia. clinical correlation is suggested. ekg : sinus rhythm. st segment elevation with t wave inversions seen in the anterior precordial leads raises concern for ischemia. inferior st-t wave changes also raise some concern for ischemia. compared to tracing #2 no interim change. ekg :sinus rhythm. left atrial abnormality. compared to the previous tracing of there is further evolution of recent or ongoing anterolateral and apical myocardial infarctions. clinical correlation is suggested. ekg : sinus rhythm with increase in rate as compared to the previous tracing of . there is further evolution of acute anterolateral and apical myocardial infarctions. followup and clinical correlation are suggested. the q-t interval remains prolonged. cxr : endotracheal tube with distal tip in the right mainstem bronchus. unchanged bilateral pulmonary edema and left lower lung atelectasis with possible pleural fluid. cxr : the left mid and lower lung consolidation is redemonstrated, concerning for large infectious process associated with pleural effusion. patient continues to be in interstitial pulmonary edema, moderate in severity. the et tube tip is 4 cm above the carina. ng tube is in the stomach. cxr : small right and moderate left pleural effusions are grossly unchanged allowing the difference in position of the patient. cardiomediastinal contours are unchanged, partially obscured by the pleural and parenchymal abnormalities. moderate pulmonary edema is stable. left mid and left lower lobe consolidations are unchanged. labs on discharge: 06:00am blood wbc-11.3* rbc-2.40* hgb-7.3* hct-22.6* mcv-94 mch-30.6 mchc-32.5 rdw-14.2 plt ct-424 06:00am blood glucose-201* urean-58* creat-1.9* na-142 k-4.0 cl-111* hco3-18* angap-17 06:00am blood mg-2.2 brief hospital course: 78 y/o woman with cad s/p multiple pcis (9 stents), chf with preserved ejection fraction, mild pulmonary hypertension, cva, htn, niddm, pvd, and microscopic colitis who presented to with dyspnea and hypoxemia c/b acute respiratory failure requiring intubation and tranferred to . # nstemi/cad: patient with significant prior history of 3 vessel cad s/p multiple pcis and stents. enzymes positive and trending up at , ekg upon arrival here with t-wave inversions in v3-v6. cardiac enzymes were trended and peaked and plauteued on hod 2. she was continued on a heparin gtt to complete 48 hour treatment. home asa, , statin, and metoprolol were continued. on hod 4 there was concern for evolving changes on ekg. cardiac enzymes at that time were elevated to trop of 1.59, however with flat ck and ckmb. a cath was considered, however it was determined not to be acute evolution and not urgent. will likely need cath as an outpatient. # diastolic heart failure: patient with history of diastolic chf with preserved ejection fraction. initially not significantly volume overloaded on exam, weight is similar from recent cardiology visit. likely flash pulmonary edema due to sustained hypertension and tachycardia (patient with another recent admission to for flash pulmonary edema in setting of gastritis). the patient was diuresed with iv lasix bolus prn. she recieved 40 mg iv on hod 1 with poor response. she recieved 80mg iv x 2 on hod 2 with ok response. on hod 4 she recieved 120mg iv lasix in the am with poor uop and then recieved 5 mg metolazone followed by 120 mg iv lasix with good uop response. on hod 6 patient appeared dry and required 500 cc of fluids. the patient was initially managed with nitro gtt for afterload reduction, but then was transitioned to home hydralazine, amlodipine, losartan, and imdur. the medications were adjusted and patient was discharged on the following regimen: hydralazine 50mg tid, isosorbide 120mg daily, and losartan 50mg daily for afterload and 20mg lasix daily for diuresis. # pneumonia: elevated wbc with lll opacity on cxr on admission. patient recieved 750 of cipro at osh and was initially started on levofloxacin 500mg q48h upon arrival to . the patient then spiked a fever on hod 1 and she was broadened to cefepime and vanc to cover for hcap given recent hospitalization. she was treated for 8 days with day 1 of treatment 10/09/10/10, patient completed antibiotics on day of discharge (). # hypoxic respiratory failure: likely due to a combination of pulmonary edema and pneumonia. patient was intubated on arrival. propofol and fentanyl were used for sedation. the patient was successfully extubated on hod 2. # gout flair: the patient developed gout flare (right podagra) on . she was started on oxycodone 2.5 mg q6h for pain. secondary to patient's renal function colchicine and nsaids were avoided. she was therefore started on prednisone 30 mg x 1 day, 20 mg am x 1 day, and then will complete slow taper over 7 days. # normocytic anemia: patient with anemia dating back to . as low as this admission previously in . patient with hct of 23 on admission. patient with normal reticulocyte count and iron studies consistent with anemia of chronic disease (low iron, low tibc, high ferritin). patient was started on iron supplementation and will need gi workup as an outpatient to rule out gi loss as part of low iron. patient's hct was trended and she remained stable and asymptomatic and did not require blood transfusion. hct on discharge of 22.6. # ckd: the patient has a history of ckd with cr ranging from 1.7 - 3.3 over the last 1.5 years. baseline appears to be low 2's. cr on admission of 2.2. medications were renally dosed and nephrotoxins were avoided when possible. cr was trended and 1.9 on discharge. # type ii diabetes: the patient's home metformin was held and the patient was maintained on humalog iss. # hypertension: the patient's home medications were initially held and she was on nitro gtt on arrival. she was weaned off nitro gtt and home medications were restarted as tolerated. eventually she was on home amlodipine, losartan, hydralazine, metoprolol, and imdur. # hyperlipidemia: home atorvastatin was continued. # depression: home mirtazapine was continued. patient on desvenlafaxine at home, not on formulary at , gave venlafaxine in the meantime to avoid ssri withdrawl. # hypothyroidism: home levothyroxine continued. transitional issues: - need outpatient cath. - needs gi work up as an outpatient. - patient insturcted to weigh self every morning, and call dr if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. -patient to have chem-7 on monday with results sent to dr. medications on admission: the preadmission medication list is accurate and complete. 1. metoprolol tartrate 150 mg po bid 2. losartan potassium 50 mg po daily 3. aspirin 81 mg po daily 4. mirtazapine 45 mg po hs 5. hydralazine 50 mg po tid 6. furosemide 20 mg po daily 7. atorvastatin 80 mg po daily 8. metformin xr (glucophage xr) 500 mg po daily do not crush 9. omeprazole 20 mg po daily 10. clopidogrel 75 mg po daily 11. amlodipine 10 mg po daily 12. trazodone 75 mg po hs:prn insomnia 13. levothyroxine sodium 100 mcg po daily 14. zolpidem tartrate 5 mg po hs 15. nitroglycerin sl 0.3 mg sl prn chest pain 16. isosorbide mononitrate (extended release) 120 mg po daily 17. pristiq *nf* (desvenlafaxine) 50 mg oral daily discharge medications: 1. amlodipine 10 mg po daily 2. aspirin 81 mg po daily 3. atorvastatin 80 mg po daily 4. clopidogrel 75 mg po daily 5. isosorbide mononitrate (extended release) 120 mg po daily 6. levothyroxine sodium 100 mcg po daily 7. mirtazapine 45 mg po hs 8. trazodone 100 mg po hs:prn insomnia 9. metformin xr (glucophage xr) 500 mg po daily do not crush 10. nitroglycerin sl 0.3 mg sl prn chest pain 11. omeprazole 20 mg po daily 12. escitalopram oxalate 5 mg po daily 13. furosemide 20 mg po daily 14. hydralazine 50 mg po tid 15. losartan potassium 50 mg po daily 16. prednisone 10 mg po daily duration: 3 days rx *prednisone 10 mg one tablet(s) by mouth daily disp #*3 tablet refills:*0 17. metoprolol succinate xl 150 mg po daily rx *metoprolol succinate 100 mg 1.5 tablet(s) by mouth daily disp #*45 tablet refills:*2 18. outpatient lab work please check chem-7 on monday with results to dr. at phone: fax: icd9: 428 19. ferrous sulfate 325 mg po daily discharge disposition: home with service facility: discharge diagnosis: non st elevation myocardial precautions hospital acquired pneumonia acute on chronic diastolic congestive heart failure anemia discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mrs. , you were transferred to a fever and trouble breathing. you were found to have a pneumonia and were treated with 8 days of intravenous antibiotics. you also were in heart failure with too much fluid on board and we gave you diuretics to remove the extra fluid. changes to your home medications include: -change metoprolol to once daily formulation (metoprolol succinate xl 150mg daily) -start prednisone for your gout flare. you will take 3 more days of prednisone at home. please call dr. if the gout returns. -start iron for your anemia weigh yourself every morning, call dr if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. please take all of your medicines as directed. it was a pleasure taking care of your during your hospitalization and we wish you the best going forward. followup instructions: please make an appt to see dr. in 1 month. . department: when: thursday at 2:20 pm with: , md building: (, ma) campus: off campus best parking: on street parking procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnoses: pneumonia, organism unspecified anemia of other chronic disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism acute on chronic diastolic heart failure other chronic pulmonary heart diseases peripheral vascular disease, unspecified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified acute respiratory failure osteoarthrosis, unspecified whether generalized or localized, site unspecified iron deficiency anemia, unspecified migraine, unspecified, without mention of intractable migraine without mention of status migrainosus delirium due to conditions classified elsewhere diverticulosis of colon (without mention of hemorrhage) acute gouty arthropathy insomnia, unspecified long-term (current) use of aspirin restless legs syndrome (rls) bipolar i disorder, most recent episode (or current) depressed, unspecified celiac artery compression syndrome hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage i through stage iv, or unspecified 

Answer: The patient is high likely exposed to