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: erythromycin base attending: chief complaint: hypercarbic respiratory failure major surgical or invasive procedure: mechanical ventilation and intubation history of present illness: this is an 81 yo female with end-stage copd, dm2, crf, anemia of renal disease, diastolic chf, h/o dvt, pmr, oa, osa, h/o c diff who was discharged from on after a copd exacerbation, treated with po steroids and levofloxacin. she was discharged to a rehab and was doing ok. of note, she was not on several of her home copd meds on discharge. however, her family noted that she was becoming progressively more lethargic and tired during her stay. her o2 had been increased from 2 to 3 liters. family denies any fevers, chills, or cough. she presented to hospital early today with increasing shortness of breath. abg there showed 7.16/139. intubated there at her husbands request and transferred to as her prior care was here. in the ed, initial vs: 88 138/100 16 97% on the ventilator. a cxr showed a possible retrocardiac opacity so she was given vanc/ctx for abx and 2l ns. bps trended down to the 80s-90s but daughter at bedside stated she would not want a central line. she was successfully managed with ivf and extubated. she was then transferred to the floor for further management. ros: further ros unable to be obtained due sedation. past medical history: copd on 2.5-3.5l o2 nc, no h/o intubation, never seen by pulmonologist, severely disabled, chronic hypercarbia and history of co2 narcosis dm2 x 50 years diastolic chf, last hospitalized for this 1 year ago crf stage 3, creatinine 2.0 in anemia of renal disease on epogen osa on cpap h/o dvt - patient states that 50 years ago she injured her left leg, never went to the hospital for it and it might have been a phlebitis pmr on steroids x 50 years oa - particularly left shoulder osteoporosis, vertebral compression fx h/o c diff per records but daughter 't aware, patient states it might have been 3-4 years ago h/o fall cognitive decline, h/o agitation and confusion at night social history: former nurse, trained at hospital, lives at home with husband, daughter lives in , quit smoking decades ago family history: asked but not contributory physical exam: on arrival to the micu vitals - 97.8, 83, 111/52, 96% ac 400, 16, 40%, 5: general: intubated and sedated, twitching heent: perrl, eomi cardiac: rrr, 2/6 sem lung: diffuse rhonchi abdomen: soft, nt/nd, +bs ext: no edema neuro: intubated and sedated pertinent results: urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- 16 i cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- =>128 r tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s 4:30 am urine site: catheter **final report ** urine culture (final ): escherichia coli. presumptive identification. of two colonial morphologies. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- 16 i cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- =>128 r tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. 04:30am blood wbc-9.0 rbc-4.50 hgb-11.2* hct-36.6 mcv-81* mch-24.9* mchc-30.7* rdw-16.6* plt ct-255 06:10am blood wbc-7.4 rbc-4.00* hgb-10.0* hct-32.2* mcv-81* mch-25.1* mchc-31.2 rdw-16.7* plt ct-213 04:30am blood neuts-81.3* lymphs-14.7* monos-3.6 eos-0.3 baso-0.2 06:25am blood neuts-56.5 lymphs-31.6 monos-11.3* eos-0.5 baso-0 04:30am blood glucose-119* urean-54* creat-2.7* na-145 k-6.8* cl-98 hco3-38* angap-16 06:10am blood glucose-100 urean-52* creat-3.3* na-145 k-4.3 cl-99 hco3-34* angap-16 06:10am blood calcium-9.1 phos-3.9 mg-2.2 07:28am blood type-art po2-73* pco2-63* ph-7.45 caltco2-45* base xs-16 04:22am blood type- po2-145* pco2-63* ph-7.44 caltco2-44* base xs-16 comment-green top 04:46am blood lactate-2.4* 06:23am blood lactate-0.6 imaging: cxr impression: status post extubation. slight improved aeration at lung bases with residual atelectasis adjacent to effusions. echo the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with preserved left ventricular systolic function. mild right ventricular dilation with probable mild hypokinesis. moderate pulmonary hypertension. cxr single upright portable view of the chest: an endotracheal tube terminates approximately 2 cm from the carina. an enteric tube extends below the diaphragm and terminates below the bottom of the radiograph. lung volumes are low. there is dense retrocardiac opacity which could reflect atelectasis or consolidation. there may be bilateral pleural effusions. moderate cardiomegaly is likely unchanged. scarring at the lung apices is again noted. hilar fullness is likely related to low lung volumes. aortic arch calcifications are noted. pulmonary vascular structures are otherwise normal in caliber. impression: ett terminates 2.1 cm from the carina. dense retrocardiac opacity could reflect atelectasis, effusion or consolidation. brief hospital course: ms. is an 81 year old woman with copd, type ii diabetes, chronic renal failure, anemia of renal disease, diastolic chf, h/o dvt, pmr, oa, osa, and a history of c. diff who presented to an osh with hypercarbic respiratory failure. she was intubated and transfered to for further care on . in the micu, she was weaned off mechanical ventillation on . she was transferred to the medical floor on the evening of . . # hypercarbic respiratory failure: patient had just been discharged from the hospital for a copd exacerbation when she went into hypercarbic respiratory failure. this exacerbation seems to have been caused by increased oxygen in the setting of her advanced copd. she was extubated on the evening of . she received bipap overnight. she was started on 60 mg of prednisone daily, this was gradually decreased to a dose of 30 mg on the day of discharge. she was continued on standing ipratropium and albuterol. she can desaturate with minimal exertion. her oxygen saturation goal was 88-92%. . # acute on chronic renal failure: baseline of ~2.0. her creatinine peaked at 3.8 after receiving heavy doses of furosemide while in the icu. renal was consulted and felt the increase in creatinine was likely due to volume depletion. she was given a fluid bolus and continued on gentle hydration. her creatinine improved to 3.3 on the day of discharge to rehab. per renal, they felt that she should continue gentle fluids on the day after her discharge at rehab and to continue monitoring her i/os. a foley catheter was inserted to accurately monitor her urine output. this should be removed as soon as possible at rehab. her creatinine should be followed daily until there is a significant improvement. s he should follow up with a nephrologist as an outpatient once she leaves rehab, per the renal team. if her creatinine does not improve or worsens, she should see a nephrologist sooner. the inpatient renal team also recommended to discontinue her alendronate given her degree of renal insufficiency. # venous insufficiency: patient has a history of venous insufficiency. she should wear compression stockings. of note, her left lower leg has chronic venous stasis changes. the area is slightly pink, but has remained stable throughout her hospital course. there was no sign of infection. the area was marked and followed daily. # uti: she had a positive urinalysis during her previous hospitalization and at the start of this hospitalization. she received coverage with cefepime for three days in the icu. on the floor she received two days of bactrim. this was changed to ceftriaxone for the remaining two days out of concern for bactrim causing the increased creatinine. she finished 7 days of treatment on . # diastolic chf: she is on a home regimen of furosemide 80 mg twice daily. this was restarted in the icu when she appeared volume overloaded. this was discontinued as her creatinine increased. patient was given back fluids. when appropriate, please restart furosemide slowly at 40 mg daily. titrate up to her home dose. # diabetes: she was continued on a sliding scale regimen. her morning blood sugars were well controlled. however, she had elevations in her afternoon and evening blood sugars coinciding with the expected effects of her morning dose of prednisone. # depression: she was continued on her home dose of escitalopram. however, this was stopped on out of concern for her renal failure. given the long half life of the medication, this was not tapered. she is not acutely depressed. this medication can be restarted when renal function improves if it is thought to be needed. # anemia: patient was continued on epoetin alfa 10,000 unit/ml solution. she did not receive any injections during this admission. # gerd: home omeprazole was switched to pantoprazole. . # osteoporosis: she was on calcium. her alendronate was discontinued due to renal failure. # pmr: she is on a home dose of 10 mg prednisone. she was on much higher doses while in the hospital. she was placed on a slow taper to ultimately decrease to 10mg prednisone daily # swallowing: she was evaluated by speech and swallow who placed her on a diet of pureed solids and nectar thick liquids. she should have a reevaluation as her mental status and strength improves. she was not placed on a diabetic diet in order to increase her desire to eat and drink. # delirium/hallucinations: ms. was oriented x2 while on the medical floor. her memory and recall gradually improved. she recalled a hallucination at night on . her medication list was analyzed and potentially offending agents were discontinued. her hallucination was thought to be due to delerium or prednisone. if it continues, she should have further follow-up with geriatrics/psychiatry. # prophylaxis: she received subcutaneous heparin and pantoprazole. # code: ms. was a full code during this admission. palliative care had extensive discussions with her and her family. she had previously expressed desires to not be intubated. however, she and her family agreed to pursue intubation if needed again. medications on admission: ipratropium bromide 1 neb q6h prn dyspnea docusate sodium 100 mg po bid as needed for constipation. calcium carbonate 500 mg po bid alendronate 70 mg po qthur escitalopram 10 mg po daily omeprazole 20 mg po daily fexofenadine 60 mg tablet po bid epoetin alfa 10,000 unit/ml qweek riss levofloxacin 250 mg po daily until . prednisone taper from 60mg to home dose of 10mg daily albuterol sulfate neb q4h as needed for dyspnea. . additional home meds not on list when d/c'd : lasix 80 mg kcl 20 meq spiriva daily flovent 220 mcg discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 4. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q6h (every 6 hours). 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q4h (every 4 hours) as needed for sob/wheeze. 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 8. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 11. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed for shortness of breath. 12. prednisone 10 mg tablet sig: three (3) tablet po daily (daily). 13. insulin lispro 100 unit/ml solution sig: sliding scale units subcutaneous asdir (as directed). 14. epoetin alfa 10,000 unit/ml solution sig: one (1) injection injection once a week. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: hypercarbic respiratory failure acute on chronic renal failure chronic obstructive pulmonary disease secondary diagnosis: urinary tract infection hypernatremia diastolic congestive heart failure type ii diabetes mellitus osteoporosis polymyalgia rheumatica swallowing difficulties discharge condition: activity status:out of bed with assistance to chair or wheelchair level of consciousness:lethargic but arousable mental status:confused - sometimes discharge instructions: you were admitted to the hospital with respiratory failure. you had a breathing tube placed when an ambulance brought you to another hospital. when you came to , you were taken care of in the intensive care unit. you breathing began to improve and the breathing tube was removed. you were also treated for a urinary tract infection while you were at the hopsital. your breathing and strength got better while you were in the hospital. however, you required a significant amount of assistance to perform activities. because of this you are going to a pulmonary rehabilitation facility. we changed several of your medications while you were in the hospital. you are now taking 30 mg of prednisone. your doctors be slowly decreasing this amount over the next couple of days and weeks. we stopped your fexofenadine, alendronate, and escitalopram. these medications may be added back as your kidney function improves. followup instructions: you should follow up with a nephrologist when you leave rehab if your renal function improves to baseline. if your renal function remains poor or worsens, you should follow up with a nephrologist sooner. you should follow up with your primary care physician when you leave rehab. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: acidosis anemia in chronic kidney disease obstructive sleep apnea (adult)(pediatric) polymyalgia rheumatica esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified long-term (current) use of steroids adrenal cortical steroids causing adverse effects in therapeutic use diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified obstructive chronic bronchitis with (acute) exacerbation personal history of tobacco use depressive disorder, not elsewhere classified paroxysmal ventricular tachycardia chronic kidney disease, stage iii (moderate) acute respiratory failure hypotension, unspecified osteoporosis, unspecified personal history of venous thrombosis and embolism hyperosmolality and/or hypernatremia drug-induced delirium chronic diastolic heart failure venous (peripheral) insufficiency, unspecified other dependence on machines, supplemental oxygen osteoarthrosis, unspecified whether generalized or localized, shoulder region dysphagia, unspecified 

Answer: The patient is high likely exposed to