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: history of present illness: this is a 65 year old woman with a history of chronic obstructive pulmonary disease, bipolar disorder, status post abdominal aortic aneurysm, who was transferred from outside hospital, intubated secondary to no available intensive care unit beds at outside hospital. apparently, the patient presented from home with increased shortness of breath, fever of uncertain duration. she had no vomiting, diarrhea, chest pain or palpitations. per outside hospital, other systems reviewed and negative. on presentation to the outside hospital, she was saturating 84% on four liters nasal cannula with an arterial blood gas of 7.17/77/44/27/67% on bipap 15/6 with 15 liters oxygen. she was then intubated after failing bipap. further history is not available as the patient is currently intubated and sedated. past medical history: 1. recent diagnosis of chronic obstructive pulmonary disease without pulmonary function tests. 2. bipolar disorder. 3. anxiety. 4. narcotic dependence. 5. status post right total knee replacement. 6. status post abdominal aortic aneurysm repair. allergies: prednisone and bactrim. physical examination: vital signs revealed a temperature of 101.2, pulse 74, blood pressure 120/60 on assist control 700/16. in general, intubated and sedated but arousable. head, eyes, ears, nose and throat anicteric. neck supple with no lymphadenopathy or jugular venous distention. lungs - rhonchorous bilaterally. no decreased breath sounds. laboratory data: white blood cell count was 9.7, hematocrit 53.8, platelet count 198,000, neutrophils 85, lymphocytes 10%. sodium 141, potassium 4.6, chloride 102, bicarbonate 33, blood urea nitrogen 32, creatinine 1.6, glucose 185. chest x-ray showed mild upper zone redistribution with borderline cardiomegaly, no infiltrate. electrocardiogram showed normal sinus rhythm, left atrial dilatation, t wave inversions in iii and v1 without comparison. hospital course: 1. respiratory failure - this was felt secondary to chronic obstructive pulmonary disease causing hypercapnia and congestive heart failure causing hypoxia. a transthoracic echocardiogram was obtained which demonstrated left atrial mild dilatation and elongation, right atrial dilatation, mild symmetric left ventricular hypertrophy and hyperdynamic systolic dysfunction with an ejection fraction of 75% without wall motion abnormalities. this was felt to represent diastolic dysfunction as the patient with evidence of congestive heart failure on examination and chest x-ray. she was diuresed with intravenous lasix and started on diltiazem for rate control. the patient was treated with aspirin and her cardiac enzymes cycled which were negative for myocardial infarction. the patient was felt also to be in exacerbation of her chronic obstructive pulmonary disease given significant wheezing on examination. she was not treated with p.o. steroids secondary to history of bipolar disorder exacerbated by steroid use. she was treated with inhaled steroids and inhaled bronchodilators. she was started on ceftriaxone and azithromycin for questionable community acquired pneumonia versus bronchitis exacerbating her chronic obstructive pulmonary disease. repeat chest x-ray demonstrated persistent left lower lobe consolidation. the patient did well with this treatment and was extubated in 24 hours. she continued diuresis and treatment for chronic obstructive pulmonary disease. the patient was then transferred to the floor. the patient did well until , when she was found to be rather somnolent in bed. arterial blood gas demonstrated a ph of 7.33, pco2 81, and po2 of 54, bicarbonate of 45. this arterial blood gas was felt to be representing a chronic respiratory acidosis and metabolic compensation. given her multiple psychiatric medications and pain medications, we discontinued her neurontin, discontinued her gabapentin and flexeril, decreased her fentanyl patch to 25 and decreased her trazodone dose. the patient has since done well and her breathing is approaching her baseline although she remains oxygen dependent which she was not on at home. plan is to continue diuresis, bronchodilators and inhaled steroids. she will be followed as an outpatient after rehabilitation with pulmonary function tests and a sleep study by her primary care physician, was during her hospitalization. 2. acute renal failure - the patient was admitted with a creatinine of 1.6 of unclear etiology. repeat twelve hours later was 1.0 and the patient remained in the 0.7 to 0.9 range for the remainder of the hospital course. it is unclear the etiology of her elevated creatinine. 3. bipolar disorder - we avoided the use of oral prednisone secondary to risk of her psychiatric exacerbation. she was continued on her psychiatric medications but we were unable to get in contact with her psychiatrist to confirm each of these. 4. chronic back pain - the patient was continued on her fentanyl patch and gabapentin and flexeril. as noted above, her fentanyl patch was decreased to 25. her gabapentin was discontinued and her flexeril was discontinued as well secondary to sedation. this may be reevaluated at a further date. until then, she was treated with p.r.n. percocet. 5. polycythemia - it was felt this is likely secondary to the patient's chronic respiratory acidosis. tsh was checked and is normal. liver function tests, b12 and folate are pending at the time of this dictation. these may be followed up as an outpatient basis. the patient does deny significant alcohol use. 6. deconditioning - the patient complains of chronic weakness at home. her neurologic examination was unrevealing. tsh and electrolytes were normal. she was continued with physical therapy and will need further physical therapy on a rehabilitation basis. 7. tobacco abuse - the patient was extensively counseled on the need for her to quit smoking. she was started on a nicotine patch. she reports an allergy to wellbutrin which was therefore not started. condition on discharge: stable. discharge status: to rehabilitation. discharge diagnoses: 1. respiratory failure. 2. chronic obstructive pulmonary disease. 3. diastolic heart failure. 4. bipolar disorder. 5. acute renal failure. follow-up plans: the patient will follow-up with dr. after discharge from rehabilitation and with her psychiatrist, dr. , at . medications on discharge: 1. levofloxacin 500 mg p.o. once daily times four days. 2. senna one tablet p.o. twice a day p.r.n. 3. lactulose 30ml p.o. three times a day p.r.n. 4. docusate 100 mg p.o. twice a day. 5. nicotine patch 14 mg q24hours times five weeks. 6. trazodone 100 mg one to two tablets p.o. q.h.s. 7. citalopram 20 mg p.o. once daily. 8. zonisamide 100 mg p.o. once daily. 9. aspirin 325 mg p.o. once daily. 10. clonazepam 1 mg p.o. three times a day. 11. olanzapine 40 mg p.o. q.p.m. 12. acetaminophen 325 mg two tablets q6hours. 13. enoxaparin 40 mg q24hours while the patient immobile. 14. guaifenesin 100 mg p.o. q6hours p.r.n. 15. ibuprofen 400 mg two tablets p.o. q8hours. 16. pantoprazole 40 mg p.o. once daily. 17. fentanyl patch 25 mcg one patch q24hours. 18. bumetanide 1 mg p.o. once daily. 19. albuterol inhaler two puffs q4hours. 20. ipratropium inhaler two puffs q6hours. 21. fluticasone inhaler two puffs twice a day. 22. albuterol nebulizer q4hours p.r.n. 23. ipratropium nebulizer q6hours p.r.n. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube arterial catheterization diagnoses: pneumonia, organism unspecified acidosis congestive heart failure, unspecified acute kidney failure, unspecified obstructive chronic bronchitis with (acute) exacerbation opioid type dependence, continuous acute respiratory failure acute diastolic heart failure schizoaffective disorder, unspecified 

Answer: The patient is high likely exposed to