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) / vioxx / celebrex / lasix attending: chief complaint: dyspnea major surgical or invasive procedure: intubated arterial line history of present illness: 74f morbid obese, history of severe copd, obesity hypoventilation syndrome, obstructive sleep apnea, diabetes, hypertension, diastolic heart failure with recent diuretic initiation and hypothyroidism biba from nursing home with shortness of breath, depressed mental status. her pox was reported to be 60 % on 2l nc and 90 % on 15l o2 nrb in triage. she was scheduled to have icu sleep study on monday to titrate o2/co2 use due to severe ohvs. she was having a few day history of cough - but uncertain if productive or not. . in the ed, initial vs were: 70 22 90% 15l nrb she was initially tried on nippv in er (15/10) but abg suggestive of hypercapneic respiratory failure (ph 7.16 pco2 122 po2 102 hco3 46). she was also placed on nitro gtt. given declining mental status and abg, she was intubated by anesthesia secondary to obesity without complications with usage of etomidate 8, succinycholine 120. she experienced brief period of hypotenstion to sbp 80s after intubation in setting of fentanyl/versed. she was noted to have thick secretions. she was given 250 ml ns bolus x 1 with resultant pressure of sbp 103/49. repeat abg ph 7.36 pco2 70, po2 161, hco3 41 . cxr performed showing mild to moderate congestive heart failure with small bilateral pleural effusions and bibasilar airspace opacities, possibly infection or atelectasis. she was placed on vancomycin, cefepime, levofloxacin for questionable pulmonic process on cxr. she was given bumex 1 mg iv x 1 with poor urine output. labs significant for wbc 17.5 with 78% n, 10 % l, myelos 2 %, cr 1.2 (baseline 0.8), hco3 41 (baseline low to mid 30s), lactate 0.8. blood cultures are pending. she was admitted for respiratory failure with possible component of chf vs. pneumonia and ohvs. past medical history: #. ?copd/restrictive disease due to obesity - recent admission to micu for copd exacerbation #. hypertension #. diabetes mellitus - diet-controlled #. obstructive sleep apnea on bipap 15/? at home #. obesity hypoventilation syndrome #. chf #. hypothyroidism #. hypercholesterolemia #. morbid obesity #. osteoarthritis #. gout #. depression #. gerd social history: she has been non ambulatory since . currently lives in nursing home. 30-40 ppd smoking history; quit . no etoh, ivdu, or illicit drugs. patient is not sexually active. does not excercise regularly. family history: mother with htn physical exam: admission exam: general appearance: no acute distress eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic, endotracheal tube lymphatic: cervical wnl cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (breath sounds: clear : ) abdominal: soft, non-tender, bowel sounds present, obese extremities: right lower extremity edema: trace, left lower extremity edema: trace skin: warm neurologic: responds to: not assessed, movement: not assessed, sedated, tone: not assessed discharge exam: vs: 96.6 131/43 66 18 97%bipap i/o: general: morbidly obese woman in nad, comfortable, appropriate, immobolized in bed. heent: perrla, eomi, sclerae anicteric, dry mm neck: supple, no jvd, no carotid bruits. heart: rrr, no mrg lungs: decreased bs, ctab. abdomen: soft/mildly tender/nd, loud bs extremities: wwp, +1 edema neuro: awake, a&ox3, non-focal pertinent results: admission labs: 04:40pm blood wbc-17.5* rbc-4.12* hgb-11.1* hct-37.8 mcv-92 mch-27.0 mchc-29.4* rdw-18.4* plt ct-272 04:40pm blood neuts-78* bands-4 lymphs-10* monos-2 eos-4 baso-0 atyps-0 metas-0 myelos-2* 04:40pm blood pt-14.4* ptt-33.5 inr(pt)-1.2* 04:40pm blood glucose-131* urean-36* creat-1.2* na-141 k-4.8 cl-97 hco3-41* angap-8 06:02pm blood type-art po2-101 pco2-122* ph-7.16* caltco2-46* base xs-9 04:51pm blood lactate-0.8 ces: 04:00am blood ck-mb-2 ctropnt-0.06* 01:52am blood ck-mb-4 ctropnt-0.03* abgs: 02:02am blood type-art po2-129* pco2-84* ph-7.29* caltco2-42* base xs-10 intubat-not intuba discharge labs: reports: cta: impression: 1. no evidence of pe to the segmental level; no evidence of aortic intramural hematoma or aortic dissection. 2. moderate atelectasis of the right lower lobe and mild atelectasis of the left lower lobe with small bilateral pleural effusions. 3. enlarged epicardial lymph node - 3 month follow-up is recommended after resolution of the current acute illness. . shoulder x-ray (): per discussion with radiologist via phone. severe degenerative changes in joing space between glenoid & humerus, indicative of severe osteoarthritis. also patient's humerus is sitting high in joint space and could be indicative of a rotator cuff injury. no fractures. brief hospital course: 74f morbid obese, history severe copd, obesity hypoventilation syndrome, obstructive sleep apnea, dm, htn, dchf, hypothyroidism presenting with hypercarbic respiratory failure. she was initially intubated for respiratory failure and hypercarbia but was weaned, extubated and started on shovel mask with good result. . # hypercarbic respiratory failure: likely multifactorial from central apnea/ hypoventilation, copd, ?pulmonary edema from chf exacerbation. abg suggestive of reversible component with ventilation. she was initially intubated, extubated easily and successfully treated with bipap. she received a sleep study that showed hypoventilation (c02 75-85) with oxygen-responsive hypoxia. however, the patient had difficulty of air leak around her mouth throughout the night. even with air leak, co2 continued to improve from 85 to 75. oxygen saturations remained 88-93% on 50% face shovel. patient's home bipap settings were changed to 18/8 and she has been stable with these treatments. -upon arrival to the floor, patient's daytime requirement was weaned to baseline of 2.5l nc. . # leukocytosis: the patient was admitted with a mild leukocytosis. cxr did not suggest discrete infiltrate. ua was clean, pan cultures were negative. the patient received vancomycin, cefepime, and levofloxacin on admission. antibiotics were discontinued with the absence of evidence of infection. the patient's leukocytosis improved. . # new mrsa + status: while patient did not have pneumonia, she was screened for mrsa and is found to be mrsa positive. . # acute on chronic diastolic heart failure exacerbation - on admission, cxr showed increased markings compatible with possible chf exacerbation. she was ruled out for mi by ekg and cardiac enzymes. she received bumex in er with unknown urine output. on admission, diuresis was held due to elevated creatinine. with improvement in renal function, patient was given bumex 50 mg x 1, with good response. -after arrival to the floor, patient was restarted on toprol 50 xl daily & bumex 1mg . . # shoulder pain - upon arrival to the floor, patient described worsening of pain in l shoulder. plain film of shoulder shows osteoarthritis and possible rotator cuff injury. pain was controlled with naproxen 250mg po bid. . # ct finding: patient had a chest ct in the icu that should an incidental epicardial lymph node which needs to be followed up on by pcp as outpatient. patient will need pcp to with ct in 3 months and to follow up with patient on results. . # acute renal failure - the patient was admitted with cr 1.2 (baseline cr 0.8). on admission likely due to atn in the setting of hypovolemia. blood pressures normalized and her creatinine returned to baseline. . # copd - chronic. patient did not have evidence of active flare throughout admission. she was continued on duonebs. advair was held while intubated, but was restarted following extubation. . # obesity hypoventilation syndrome and osa - patient underwent sleep consult and sleep study in the icu. sleep recommended bipap 18/8 with mirage large face mask and chin strap . # dm - chronic. patient was maintained on insulin sliding scale throughout admission. . # htn - anti-hypertensives held on admission in the setting of mild hypovolemia. patient's blood pressure returned to baseline and she was restarted on home antihypertensives. # hypothyroidism - chronic. patient was continued on levothyroxine. . # gout - chronic. patient was continued on allopurinol # depression - chronic. patient was continued on bupropion, paroxetine # neuropathy - gabapentin held on admission. . # code status: full medications on admission: from webomr - unable to confirm allopurinol - 100 mg tablet - 1 tablet(s) by mouth twice a day amlodipine - (prescribed by other provider) - 5 mg tablet - 1 tablet(s) by mouth daily bipap - - bipap 15/5 daily bupropion hcl - 100 mg tablet - 1 tablet(s) by mouth three times a day electric hospital bed - - one electric hospital bed fluticasone - (prescribed by other provider) - 50 mcg spray, suspension - 2 sprays daily fluticasone-salmeterol - 250 mcg-50 mcg/dose disk with device - 1 puff inh twice a day gabapentin - (prescribed by other provider) - 300 mg capsule - 1 capsule(s) by mouth nightly ipratropium-albuterol - (prescribed by other provider) - 0.5 mg-3 mg (2.5 mg base)/3 ml solution for nebulization - 1 every six (6) hours levothyroxine - 25 mcg tablet - 1 tablet(s) by mouth daily paroxetine hcl - 40 mg tablet - one tablet(s) by mouth once a day tobramycin-dexamethasone - 0.3 %-0.1 % drops, suspension - 1 drop(s) left eye three times a day accu-chek - strip - 2-3 times a day for blood glucose monitoring, dx; diabetes ascorbic acid - 500 mg tablet - 1 tablet(s) by mouth once a day aspirin - (otc; medication reconciliation) - 81 mg tablet, delayed release (e.c.) - 1 tablet daily bismuth subsalicylate - (prescribed by other provider) - dosage uncertain colace - 100mg capsule - take one pill by mouth qd- magnesium hydroxide - (prescribed by other provider) - dosage uncertain sennosides - 8.6 mg tablet - 1 tablet(s) by mouth twice a day simethicone - (prescribed by other provider) - dosage uncertain discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 2. allopurinol 100 mg tablet sig: one (1) tablet po bid (2 times a day). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q6h (every 6 hours). 5. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 6. acetazolamide 250 mg tablet sig: one (1) tablet po q12h (every 12 hours). 7. bupropion hcl 100 mg tablet sig: one (1) tablet po q 8h (every 8 hours). 8. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 9. bumetanide 1 mg tablet sig: one (1) tablet po twice a day. 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) puff inhalation (2 times a day). 12. ipratropium bromide 0.02 % solution sig: one (1) puff inhalation q6h (every 6 hours). 13. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 14. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. 15. paroxetine hcl 40 mg tablet sig: one (1) tablet po once a day. 16. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 17. polyethylene glycol 3350 17 gram/dose powder sig: one (1) dose po daily (daily) as needed for constipation. 18. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 19. naproxen 250 mg tablet sig: one (1) tablet po twice a day. discharge disposition: extended care facility: st. rehab & nursing home discharge diagnosis: hypercarbic respiratory failure discharge condition: mental status: clear and coherent. activity status: bedbound. level of consciousness: lethargic but arousable. discharge instructions: it was a pleasure taking care of you at the . you were seen and evaluated for symptoms of shortness of breath, decreased oxygen, and changes in mental status. these symptoms were likely due to a number of reasons including chronic conditions of sleep apnea, copd, heart failure, and decreased breathing. you were initially treated in the icu and then transferred to the medicine floor as you stabilized. changes were made to your bipap machine settings, the mask you wear when you sleep to optimize your oxygenation. you will follow up with the sleep doctors at 9am as an outpatient. . the following changes have been made to your medications: --start acetazolamide 250mg by mouth twice daily --start naproxen 250mg by mouth twice daily for osteoarthritis . continue all your other medications as previously prescribed. weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: you have the following appointment: department: medical specialties when: at 9:00 am with: dr. / dr. building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: obstructive sleep apnea (adult)(pediatric) acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism gout, unspecified acute on chronic diastolic heart failure depressive disorder, not elsewhere classified acute respiratory failure morbid obesity unspecified accident carrier or suspected carrier of methicillin resistant staphylococcus aureus precipitous drop in hematocrit mononeuritis of unspecified site leukocytosis, unspecified rotator cuff (capsule) sprain other dependence on machines, supplemental oxygen osteoarthrosis, unspecified whether generalized or localized, shoulder region obesity hypoventilation syndrome body mass index 60.0-69.9, adult 

Answer: The patient is high likely exposed to