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: sulfa (sulfonamide antibiotics) / tetracycline attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization intubation history of present illness: ms. is a 82f with copd on home o2, anxiety, htn, and prior cad with previous anatomy unknown who presented to an osh with sob and chest pain. initially presented to on with chest pain and brown sputum. cta was done that reportedly showed no pe, and patient ruled out by biomarkers. patient was discharged to her nursing home, but returned to 3-4 days ago c/o increasing chest pain and dyspnea, as well as hemoptysis. this was treated with cefuroxime and patient reportedly had resolution of her hemoptysis at that time. on patient returned to osh with chest pain and increased dyspnea requiring bipap. at osh, thought to have rul pna and started on pip/tazo/vancomycin/levaquin. placed on bipap and initially in the icu. developed cp this morning with setting of tachycardia to 120s, ekg reportedly showed lateral st depressions. labs notable for tropn 0.36->16.3, ck 26->516. she was given asa, plavix 600mg, nitro and started on heparin and nitro drips. she was transferred to for cardiac cath. in cath lab, patient found to have 2vd with des placed in lcx, and bms in rca with difficulty passing wire. her cath was complicated by dissection of the rca. three bms placed in region of dissection with good angiographic result. patient started on dopamine in the lab. atropine given for hypotension/bradycardia. dopamine weaned to off. on arrival to the ccu, the patient was in marked respiratory distress. breath sounds were notable for diffuse wheezing and ronchi, and she was tacypneic in the high 20's with belly breathing. placed on 100% nrb with o2 sat's in low 90's and abg revealed significant acidosis. she was given nebs, 40mg iv lasix, and morphine on arrival. ultimately, she required intubation after failure to improve with medical therapy. further ros could not be obtained as patient intubated. past medical history: non-obstructive cad by cath copd on home o2 htn hypothyroidism on synthroid hip fracture s/p orif pelvic fracture spinal stenosis anxiety neuropathy social history: resident of nursing home. she has four children. denies alcohol use. can walk short distances at baseline, but uses a wheelchair for longer distances. 25 pack year history, quit 20 years ago. family history: father deceased at 46 from tuberculosis. fh notable for copd and lung ca but there is no known family history of premature coronary artery disease or sudden death. physical exam: exam per admitting resident: general appearance: well nourished eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic, endotracheal tube, og tube cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: not assessed), (left dp pulse: not assessed) respiratory / chest: (breath sounds: crackles : , bronchial: , wheezes : ) abdominal: soft, non-tender, bowel sounds present, not distended extremities: right lower extremity edema: trace, left lower extremity edema: trace skin: cool neurologic: attentive, follows simple commands pertinent results: admission labs 06:01pm blood wbc-16.5* rbc-3.24* hgb-9.4* hct-29.5* mcv-91 mch-29.1 mchc-32.0 rdw-14.9 plt ct-449* 06:01pm blood pt-15.9* ptt-33.3 inr(pt)-1.4* 06:01pm blood glucose-139* urean-19 creat-0.9 na-127* k-5.3* cl-93* hco3-28 angap-11 06:07pm blood calcium-7.9* phos-2.5* mg-1.7 07:43pm blood lactate-0.6 discharge labs 07:00am blood wbc-13.1* rbc-3.49* hgb-9.8* hct-30.4* mcv-87 mch-28.0 mchc-32.2 rdw-14.7 plt ct-327 05:49am blood pt-15.1* ptt-27.0 inr(pt)-1.3* 07:00am blood glucose-82 urean-15 creat-0.7 na-134 k-4.1 cl-94* hco3-37* angap-7* 05:49am blood albumin-3.1* calcium-8.9 phos-4.0 mg-2.1 arterial blood gases initial: 05:02pm blood type-art po2-107* pco2-64* ph-7.26* caltco2-30 base xs-0 after intubation: 07:43pm blood type-art temp-35.6 po2-115* pco2-41 ph-7.39 caltco2-26 base xs-0 intubat-intubated most recent" 12:19pm blood type-art temp-37.2 rates-/22 o2 flow-4 po2-86 pco2-50* ph-7.46* caltco2-37* base xs-9 intubat-not intuba vent-spontaneou cardiac enzymes 06:01pm blood ck(cpk)-320* ck-mb-54* mb indx-16.9* ctropnt-1.45* 02:58am blood ck(cpk)-160 ck-mb-27* mb indx-16.9* 06:07pm blood ck(cpk)-92 ck-mb-notdone ctropnt-0.68* other labs 06:16am blood ret aut-2.6 02:58am blood hapto-224* 02:58am blood %hba1c-5.3 eag-105 02:58am blood triglyc-139 hdl-32 chol/hd-3.8 ldlcalc-61 06:07pm blood anca-negative b 06:07pm blood -negative 06:07pm blood c3-102 c4-18 anti-gbm - negative microbiology sputum cx - yeast blood cx - negative c.diff - negative legionella urinary antigen - negative cardiac cath final diagnosis: 1. two vessel coronary artery disease. 2. successful placement of des to lcx. 3. successful placement of bms x 3 to rca. 4. successful angioseal of right femoral access site. cxr () - findings: no previous images. the cardiac silhouette is enlarged and there is fullness of pulmonary vessels consistent with elevated pulmonary venous pressure. opacification at the right base could reflect pleural effusion and underlying consolidation or atelectasis. opacification in the right upper zone is strongly suggestive of pneumonia. a prominence of the right hilar region raises the possibility of a with post-obstructive consolidation. some opacification at the left base is also consistent with atelectasis or consolidation. cxr () - impression: improvement in pulmonary hemorrhage. worsening of left lower lobe atelectasis. ct chest - impression: 1. probable active pulmonary hemorrhage. 2. chronic, exudative or slightly hemorrhagic pleural effusions, and reactive adenopathy. 3. mild subglottic tracheal narrowing and bibasilar bronchomalacia. 4. nodular enlarged thyroid gland. 5. coronary, aortic vascular calcifications. echo - the left atrium is moderately dilated. left ventricular wall thicknesses and cavity size are normal. there is very mild regional left ventricular systolic dysfunction with basl to mid infero-lateral hypokinesis. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. an eccentric, posteriorly directed jet of moderate to severe (3+) mitral regurgitation is seen (? papillary muscle dysfunction?). the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. ct head - impression: 1. no acute intracranial process. note that ct has limited sensitivity for the detection of acute infarction and mr can be considered as clinically indicated. 2. mucosal thickening and air-fluid level seen involving the paranasal sinuses. recommend clinical correlation for pansinusitis. 3. extensive chronic small vessel ischemic changes. brief hospital course: #repiratory distress: likley multifactorial, due to pre-existing copd complicated by pulmonary hemorrhage secondary to nstemi with pneumonia and previous anticoagulation. she was intubated and suctioned and was put on iv furosemide for respiratory distress; albuterol and ipratropium nebs and predisone for copd management; and on vanc/zosyn/levoflox for treatment of pneumonia. the initial sputum culture () grew mrsa and capnocytophaga species, but her sputum/blood culture from is unremarkable apart from rare growth of yeast in sputum. her anxiety also needed control since it episodically exacerbated her respiratory function and was a barrier to extubation. her respiratory function ultimately improved. with haldol and lorazepam for anxiety, she was extubated after spontaneous breathing trial on 4th day of admission. she was also placed on a nitroglycerine gtt to help with hypertension in the post-extubation period, preventing flash pulmonary edema and further respiratory distress. # pneumonia: as above, pt's initial sputum culture from grew mrsa and capnocytophaga species. sputum cultures from , however, only revealed yeast. she was treated with vancomycin/zosyn/levofloxacin, which was ultimately narrowed to vancomycin and zosyn. she was discharged to complete a 2-week course of vanc/zosyn. # hemoptysis: chest ct revealed pulmonary hemorrhage. pulmonary was consulted and performed a bronchoscopy, which did not show evidence of ongoing hemorrheage. her pulmonary hemorrhage can be explained by left atrial pressure overload secondary to nstemi complicated by pneumonia and previous anticoagulation as above. autoimmune origin is unlikely as per pulmonary consult, although autoimmune screening has been done. , anca, c3, c4 are normal and anti-gbm negative. by the time of discharge, she was not experiencing any further hemopytsis. # coronary artery disease: she underwent cardiac catheterization on the day of admission for her nstemi, which revealed two vessel coronary disease. des to left circumflex and 3x bms to right coronary artery were placed. her cardiac catheterization was complicated by dissection of the right coronary artery, which was successfully covered by the bms. she was discharged on aspirin, clopidogrel and aotrvastatin. she was also discharged on metoprolol and lisinopril. # anxiety: pt has a history of anxiety which has been managed with valium in the past. on extubation, she was found to be extremely anxious mangaged with ativan, but also became delerious with prn haldol used. her delirium resolved but she continued to experience anxiety. geriatrics was consulted who made recommendation for remeron at night. if she tolerated this, they recommended uptitrating remeron, while simultaneously tapering off celexa. they also recommended close monitoring of her memory testing and possible neuro-psych evaluation. # hypertension: monitored by arterial line. she has background history of hypertension, but her hypotension on admission could be secondary to nstemi or also could have been sepsis from pneumonia. she was managed with dopamine initially, with improvement in ther blood pressure. she was ultimately weaned off of pressors. at the time of discharge, her anithypertensive regimen consisted of metoprolol and lisinopril. # anemia: presumably due to pulmonary hemorrhage, which was seen on chest ct. bronchoscopy performed after her chest ct did not show any evidence of ongoing pumonary hemorrhage. she received a total of 2 units of rbcs during her hospitalization. by the time of discharge, her hematocrit was stable. # copd: as above, copd was likely a contributing factor to the patient's respiratory distress. she was treated with nebs as well as prednisone. at discharge, she was continued on her nebs. she was placed on a prednisone taper. # hyponatremia: initially she was hyponatremic presumably due to dehydration and furosemide. hyponatremia resolved as her dehydration was corrected. # thyroid: she has background history of hypothyroidism. she is on levothyroxine sodium 50 mcg po/ng daily as usual. medications on admission: home medications: -oxycodone 5mg po bid -valium 2.5mg po tid -warfarin 2mg daily -ceftin 500mg po bid -synthroid 50ucg po daily -prednisone 5mg daily -mucinex 600mg po bid -oyster shell calcium daily -spiriva 18 ucg daily -lasix 40mg daily in am, 20mg daily in pm -lopressor 12.5mg daily -miralax 17 grams po bid -senokot 1 tablet -colace 100mg po bid -celexa 40mg daily -klor-con 20meq daily -omeprazole 40mg medications on transfer from : -vancomycin -pip/tazo -metoprolol -s/p clopidogrel 600mg -atorvastatin 80mg -asa -levothyroxine -pantoprazole -methylprednisolone 80mg -diazepam 2.5mg -oxycodone discharge medications: 1. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 2. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): do not stop this medicine for at least one year without speaking to dr. . 5. citalopram 40 mg tablet sig: one (1) tablet po once a day. 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) vial inhalation q2h (every 2 hours) as needed for wheezing. 7. ipratropium bromide 0.02 % solution sig: one (1) vial inhalation q6h (every 6 hours). 8. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical q24 (): take off for 12 hours at night. apply to lower back for psinal stenosis. . 9. lisinopril 10 mg tablet sig: 1.5 tablets po daily (daily): hold sbp < 100. 10. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 11. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed for diarrhea. 12. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) syringe injection (2 times a day). 14. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 15. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 16. acetaminophen 500 mg tablet sig: two (2) tablet po q 8h (every 8 hours): please wean off in weeks if pain is well controlled. . 17. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 18. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 19. ranitidine hcl 150 mg capsule sig: one (1) capsule po twice a day. 20. prednisone 10 mg tablet sig: four (4) tablet po once a day for 1 days: give on . 21. prednisone 10 mg tablet sig: three (3) tablet po once a day for 3 days: give on . 22. prednisone 10 mg tablet sig: two (2) tablet po once a day for 3 days: give . 23. prednisone 10 mg tablet sig: one (1) tablet po once a day for 3 days: give 3-17-3-19, then d/c. . 24. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: one (1) bag intravenous q8h (every 8 hours) for 6 days. 25. vancomycin 1,000 mg recon soln sig: 1250 (1250) mg intravenous once a day for 5 days. discharge disposition: extended care facility: hospital - discharge diagnosis: primary nstemi secondary pneumonia acute diastolic congestive heart failure discharge condition: level of consciousness: alert and interactive mental status: confused - sometimes activity status: out of bed with assistance to chair or wheelchair discharge instructions: you were admitted to the hospital because you were having chest pain. you were found to have had an heart attack and stents were placed in your heart blood vessels during a heart catheterization. you also had a pneumonia and heart failure, and had difficulty breathing on your own so you were intubated. the following changes were made to your medications. 1. start taking plavix to keep the stents open and prevent another heart attack. don't miss or stop taking plavix for at least one year. 2. start remeron to control your anxiety and help your appetite 3. stop taking valium, spiriva, omeprazole, lasix and ceftin 4. start taking vancomycin and zosyn to treat your pneumonia, your last day will be . 5. start taking tylenol every 8 hours to prevent let hip pain. 6. start taking nebulizer treatments to help you breathe. 7. start taking advair to help you breathe and recover from the pneumonia. 8. take loperamide after each loose stool to treat diarrhea 9. take prednisone in tapering to help your breathing and wheezes. 10. take insulin for your high blood sugars, the prednisone raises blood sugars. . weigh yourself every day. call provider if weight increases more than 3 pounds in 1 day or 6 pounds in 3 days. followup instructions: primary care: dr phone: 81- please make an appt to see once you are out of rehab. . cardiology: , md phone: date/time: friday at 9:40am. md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization insertion of endotracheal tube arterial catheterization closed [endoscopic] biopsy of bronchus insertion of drug-eluting coronary artery stent(s) excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels insertion of four or more vascular stents procedure on vessel bifurcation diagnoses: pneumonia, organism unspecified acidosis other iatrogenic hypotension subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension unspecified acquired hypothyroidism obstructive chronic bronchitis with (acute) exacerbation personal history of tobacco use anxiety state, unspecified acute respiratory failure acute diastolic heart failure unspecified hereditary and idiopathic peripheral neuropathy spinal stenosis, unspecified region other orthopedic aftercare other agents affecting blood constituents causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to