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: codeine / lasix / diltiazem / ativan attending: chief complaint: respiratory failure major surgical or invasive procedure: et intubation arterial line femoral line bronchoscopy history of present illness: this is a 83 year old female with h/o asthma, copd, htn, diastolic dysfunction, and trachobronchomalacia s/p y stent with recent admission for copd and chf exacerbations who initially presented from rehab on with worsening sob and respiratory failure. noted to be more sob that evening at rehab and transferred to hospital where sbp 189/53, hr 110, o2 sat 99-100% on nrb. started on nitro gtt, r femoral line placed, and intubated for abg of 7.17/92/86. labs notable for wbc 17.0 (67.2n, 0b), hct 27.9, bnp 1555, cr 1.7, ck 31, tropi 0.06 (nl < 0.10). ekg with j point elevation in v1-2 that was initially concerning for stemi. transferred to . . in the ed, tm 99.2, bp initially 178/78 which improved after 1 inch nitropaste and uptitrating nitro gtt, o2 sat 100% on ac vent. given asa 325 mg x 1, cardiology called to review ekgs who thought ekgs were unremarkable for acs. admitted to micu for further management after receiving solumedrol 125 mg iv x 1. past medical history: 1. asthma/copd - recently admitted for a flare on and treated with nebulizers, steroids, and a course of azithromycin. last seen by dr. in pulmonology in , when he thought she was deconditioned from her time in the hospital although adequately medicated. recommended a cardiology consult at this time for what he believed to be significant diastolic dysfunction secondary to long-standing hypertension. 2. paralyzed left hemidiaphragm s/p pericardial window procedure, performed per old cardiology notes for recurrent pericardial effusions. pericardial biopsy c/w inflammation with no evidence of malignancy. 1:40, dsdna and rf negative. 3. severe hypertension with diastolic dysfunction - per pcp notes typically controlled in the 160's unless patient experiences an asthma flare when it shoots to 170's-180's. notably systolic pressures were in the 130's during her last hospital admission, presumably the reason why her hctz and enalapril doses were halved. patient is poorly compliant and most recently has not been taking her antihypertensives due to her ill son-in-law, unable to pick up her meds from the pharmacy. 4. hyperlipidemia 5. chronic renal insufficiency (creatinine around 1.4). 6. polymyalgia rheumatica. 7. osteoporosis. 8. trigeminal neuralgia - reportedly seen by optometry and referred to dr. of . 9. iron-deficient anemia 10. gastritis social history: ms. is a widow of many years and a mother of three. she lives in the bottom unit of a shared home with her daughter and son-in-law, who provide her with a large amount of care and support. although ms. b is able to complete most of her adl's, she relies on her daughter for shopping and cooking. while she doesn't specifically say it, her increasing dependence on her children has taken a bit of its toll on her. this may be partially responsible for her decreased med compliance - the patient relies on others to go to cvs to pick up her meds. her daughter had the flu prior to ms. ' hospitalization, and because of this, she was unable to pick up her medications on time. additionally, it sounds as if the patient doesn't leave her house very often. she comments on how she doesn't like to walk outside or to sit on her porch. ms. would rather watch television, socializing with friends infrequently. family history: diabetes mellitus in siblings and children. no bleeding or clotting disorders. mom with ?mi physical exam: vs: tm 99.4 hr77-104 bp111-160/36-61 rr18-20 o2: 93-99% 2l nc 24 hr is/os: 683/915 8hr is/os 260/474 3.7l gen: elderly female heent: eomi, perrl, sclera anicteric neck: supple, jvd approximately 12 cm above sternal notch cv: distant heart sounds, reg rate, normal s1, s2. no m/r/g. chest: resp were unlabored, no accessory muscle use while on vent. fair air mvmt b/l with faint expiratory wheezing and diffuse rhonchorous sounds abd: soft, nt, obese, no hsm or other palpable masses ext: + pitting edema bilaterally over les, wwp skin: no rash pertinent results: initial admission: 10:33pm type-art po2-345* pco2-58* ph-7.35 total co2-33* base xs-4 intubated-intubated 09:27pm k+-5.6* 09:08pm ck(cpk)-45 09:08pm ctropnt-0.12* 09:08pm ck-mb-notdone probnp-* 09:08pm calcium-9.4 phosphate-4.1 magnesium-2.2 09:08pm urine hours-random 09:08pm urine gr hold-hold 09:08pm wbc-14.6*# rbc-2.81* hgb-8.2* hct-26.2* mcv-94 mch-29.4 mchc-31.4 rdw-15.0 09:08pm neuts-91.4* lymphs-4.9* monos-3.5 eos-0.1 basos-0.1 09:08pm plt count-386 09:08pm pt-12.4 ptt-23.0 inr(pt)-1.0 09:08pm urine color-yellow appear-clear sp -1.011 09:08pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 09:08pm urine rbc-0-2 wbc- bacteria-few yeast-none epi- second micu admission (): blood: 08:52am blood wbc-10.4 rbc-2.55* hgb-7.4* hct-23.2* mcv-91 mch-29.0 mchc-31.8 rdw-14.7 plt ct-342 03:38am blood wbc-6.9 rbc-2.35* hgb-7.0* hct-21.0* mcv-90 mch-29.9 mchc-33.5 rdw-15.2 plt ct-271 03:54am blood wbc-7.3 rbc-2.43* hgb-7.3* hct-21.1* mcv-87 mch-30.0 mchc-34.4 rdw-14.9 plt ct-198 01:24am blood wbc-8.7 rbc-2.85* hgb-8.6* hct-24.5* mcv-86 mch-30.2 mchc-35.1* rdw-15.4 plt ct-186 02:44am blood wbc-11.2* rbc-3.09* hgb-9.1* hct-26.8* mcv-86 mch-29.5 mchc-34.2 rdw-15.8* plt ct-262 02:12am blood wbc-16.0* rbc-3.46* hgb-10.0* hct-29.8* mcv-86 mch-29.0 mchc-33.8 rdw-14.6 plt ct-319 10:35am blood wbc-12.7* rbc-3.05* hgb-9.2* hct-26.7* mcv-88 mch-30.0 mchc-34.3 rdw-15.7* plt ct-261 03:30am blood wbc-10.0 rbc-3.11* hgb-9.0* hct-27.7* mcv-89 mch-29.0 mchc-32.6 rdw-15.5 plt ct-269 micro: blood culture, routine (final ): no growth. urine culture (final ): gram negative rod(s). ~9000/ml. urine culture (final ): no growth. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): gram negative rod(s). smear reviewed; results confirmed. respiratory culture (final ): 10,000-100,000 organisms/ml. oropharyngeal flora. _ _ _ ________________________________________________________________ imaging: ct pelvis 6/23/08:1) no retroperitoneal hematoma or fluid in the pelvis. soft tissue anasarca. 2) soft tissue density nodules along anterior abdominal wall, probably injection sites. cxr : an et tube and ng tube have been removed. a bronchial stent is identified. right- sided picc line tip terminates in the mid svc. enlargement of the cardiac silhouette persists. there is mild leftward mediastinal shift, persistent elevation of the left hemidiaphragm, and retrocardiac opacity likely representing atelectasis. consolidation cannot be excluded. small right- sided pleural effusion and basilar atelectasis are unchanged. upper extremity u/s : no evidence of dvt in the right upper extremity. limited evaluation of the peripheral segment of the right brachial vein due to overlying bandage. echo : the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is severe global left ventricular hypokinesis (lvef = 20 %). no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size is normal. with severe global free wall hypokinesis. 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. mild (1+) mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with severe global biventricular hypokinesis c/w diffuse process. mild mitral regurgitation. borderline pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , biventricular systolic function is new. ct abdomen/pelvis : 1. interval development of moderate amount of pelvic free simple fluid. 2. no evidence of retroperitoneal hematoma. 3. multiple renal cysts, some of which are simple and others which are hyperdense, as described above. these need follow up with us or mr in 6 months. 4. aortic and vascular calcifications with focal displacement of aortic calcifications just above the aortic bifurcation which could represent calcified mural thrombus or intramural hematoma, unchanged. 5. pneumopericardium. 6. small right pleural effusion. echo : the left atrium is dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is moderate to severe global left ventricular hypokinesis (lvef = 30 %). there is no ventricular septal defect. right ventricular chamber size is normal. with borderline normal free wall function. 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. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the left ventricular ejection fraction is increased. brief hospital course: overall summary: 83 yo f with h/o copd, asthma, htn, diastolic chf with recent admission for respiratory failure thought to be copd and chf exacerbation who presented from rehab with sob and respiratory failure requiring intubation and micu admission. initially extubated and weaned down to 2l nc. on day of planned discharge () she had a pea arrest. she was resuscitated with chest compressions and epinephrine, reintubated, and transferred back to the micu. she was briefly hypotensive with intubation, but became hypertensive to the 170s-180s later during her hospital course which was managed with multiple oral and iv medications including nicardipine, labetalol (po and iv), clonidine patch, nitro drip. she was extubated on and continued to complained of significant anxiety, chest pain compressions, and difficulty coughing up secretions. she had persistent respitatory difficulty requiring high flow mask on and . when initially admitted her code status was full. after family meeting on she was switched to dnr/dni. during the night of she had an episode of bradycardia to the 30s, which resolved spontaneously. on the morning of , she was agitated and called for decreasing o2 saturation and increasing bradycardia. nasal airway was placed and supplemental o2 was given but these did not increase o2 sats. her o2 sat and heart rate continued to drop and she became bradycardic. the bradycardia transitioned to asystole, and she expired at 8:45am on . . <br> respiratory failure: initial respiratory failure at presentation most likely copd/asthma exacerbation and worsening of underlying diastolic chf, especially as bps elevated. required intubation from to . was treated for asthma/copd/chf exacerbation, extubated, and transferred to the floor. however on she had a pea arrest likely hypercarbic respiratory failure (abg showed ph of ~7) and was resusciated, re-intubated and transferred back to the micu. in the micu she had persistent difficulty passing sbts; a trial on showed that she had small tidal volumes and extubation was delayed. on she had a risb of 67 and passed a sbt. she was extubated without difficulty. post-extubation she complained of significant r chest pain which was treated with a lidocaine patch and fentanyl. she also complained of respiratory secretions which she had difficulty coughing up; she was treated with guaifenicin. she did well on a shovel mask most of the day but in the evening desatted to the high 80s and was placed on a high flow mask with fio2 of 40%. on she complained of persistent difficulty coughing up secretions and also complained of significant anxiety. respiratory difficulty continued through , though her o2 sats were generally in the 90s throughout this period. on am, her o2 sat dropped over the course of 15 minutes before she expired as per above. <br> copd/asthma: she was treated for copd/asthma exacerbation throughout her hospital course (beginning on ) with a slow steroid taper. her nebs, fluticasone, and cromolyn were continued during hospitalization. she had no other evidence of acute copd exacerbation during her hospital course. . <br> htn: she had a very labile bp in the setting of discontinuation of ace-i due to arf, hyperkalemia. was controlled with increased dose of po nicardipine and prn hydralazine, stabilized hd 3 on nifedipine 60mg q8h. at the time of re-intubation on was briefly hypotensive, and her clonidine patch was discontinued, but then blood pressure continued to rise and she became hypertensive to the 170s-180s systolic. she was put back on her home clonidine patch as well as a nitro drip and nicardipine. her blood pressures continued to spike intermittently to the 180s+ and a labetalol drip was started. she continued to exhibit intermittent episodes of hypertension and nitro and labetalol drips were needed intermittently, though the overall goal was to decrease the nitro drip as much as possible. her acei was not able to be restarted as her creatinine was persistently above the baseline (her baseline is 1.6-2 and she ranged from 2.2-2.6 during second micu admission). her htn had a significant anxiety component and she was given morpine once as well as ativan 0.5mg iv on 2 occasions to decrease anxiety. this did appear to help as when her anxiety was better controlled her bps were also better controlled, but in general she was extremely labile. . <br> cardiac: 1) cad: innitially she had ekg changes concerning for nstemi. cardiology reviewed ekgs and felt she was not having acs. cardiac enzymes were stable from . it was thought that ekg changes were likely due to lvh and j point elevation. slightly increased troponin and ck post chest compressions on later trended downwards on and she was ruled out for mi. asa and statin were continued throughout hospital course. 2) pump: known diastolic chf, last baseline tte in revealed lvef > 55%, pcwp > 18mmhg. admitted and diuresed in micu. after pea, an echo showed a lvef ~20% likely the pea. she was given lasix initially with the goal to keep a negative fluid balance. when she no longer showed clinical evidence of volume overload, lasix was used to keep fluid balance even. a repeat echo on showed an lvef of ~30% with global lv hypokinesis and significant pulmonic regurgitation. her persistent low ef after pea arrest is indicative that cardiac failure was likely one of the primary reasons for her death. 3) rate: remained in nsr. slightly tachycardic as well as bradycardic at different points. episode of bradycardia to the 30s on the night of , spontaneously resolved. bradycardia starting the morning of persisted until time of death. . <br> trachobronchomalacia s/p y stent placement on . ett tube was placed b/w stent and trachea, causing dyspnea / wheezes. interventional pulmonary consulted after re-intubation on and felt that the stent should be left in place until she was more stable. . <br> acute on chronic renal failure baseline cr 1.6 - 1.9, was slightly elevated at initial admission and at time of second micu admission . on - cr continued to be elevated at 2.2. cr was elevated to 2.3. on and cr was increasingly elevated at 2.6. her acei was held at admission and was not restarted during her hospital course. <br> anemia has baseline iron deficiency of anemia and anemia of chronic disease. hct was in mid 20s until , when it was 21 in the am and 20.1 in the pm. she was transfused 1 unit of prbc. repeat hct post-transfusion was 22.2. hct morning of was 21.1; repeat hct in the pm was 20.9. she was transfused another 1 unit of prbc. a ct of the abdomen showed moderate free fluid in the dependent pelvis but no retroperitoneal hematoma. guaiacs were negative and labs showed no evidence of hemolysis. hematocrit stabilized and rose to around 25-26 during the rest of her hospital stay. <br> fen/gi ngt was placed, lytes were repleted prn. patient complained of abdominal pain on which resolved by , though still complained of gas pains. was given simethicone and pains resolved. tube feeds were started on . <br> osteoporosis: home calcium, vitamin d, and bisphosphonates were continued <br> access: femoral line was placed during the code and removed on . picc line was placed on . r aline was placed on . <br> ppx: heparin sc/pneumoboots, colace, ppi, insulin ss <br> code: full starting at initial admission; changed to dnr/dni after family meeting on . medications on admission: 1. atorvastatin 10 mg qd 2. nifedipine 180 qd 3. cholecalciferol 800mg qd 4. calcium carbonate 500 mg tid 5. docusate sodium 100 mg 6. detrol la 2 mg q24 7. aspirin 325 mg qd 8. carbamazepine 100 mg 9. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qmonday: with 0.3mg patch for 0.4mg total. 10. clonidine 0.3 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qmonday: with 0.1mg patch for 0.4mg total. 11. alendronate 70 mg qthurs 12. cromolyn 800 mcg/actuation 2 puffs q6 13. ferrous sulfate 325 mg qd 14. omeprazole 20 mg 15. senna 8.6 mg tablet sig: 1-2 tablets po bid 16. sodium chloride 0.65 % aerosol 17. fexofenadine 60 mg 18. guaifenesin 1200mg 19. acetaminophen 650mg q6 20. lidocaine hcl 1 % (10 mg/ml) nebs prn 21. budesonide 0.25 mg/2 ml 1 neb q6 22. albuterol sulfate 2.5 mg q6hrs 23. ipratropium bromide 0.02 q6hrs 24. albuterol sulfate 2.5 mg q2hrs prn 25. bisacodyl 10 mg qd 26. prednisone 5 mg tablet sig: taper tablet po once a day: 20mg daily for 3 more days, then 15mg daily for 5 days, then 10mg daily ongoing until pulmonary appointment with dr. on . 27. enalapril maleate 20 qd 28. debrox 6.5 % discharge medications: none discharge disposition: expired discharge diagnosis: chronic obstructive pulmonary disease complicated by hypercarbic respiratory failure and pea arrest. congestive heart failure hypertension discharge condition: expired discharge instructions: this patient expired at 8;45 am on . md, procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy diagnoses: anemia, unspecified polymyalgia rheumatica congestive heart failure, unspecified acute kidney failure, unspecified acute on chronic diastolic heart failure chronic kidney disease, unspecified acute respiratory failure chronic obstructive asthma with (acute) exacerbation hypertensive chronic kidney disease, malignant, with chronic kidney disease stage i through stage iv, or unspecified 

Answer: The patient is high likely exposed to