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: tetracyclines attending: chief complaint: dyspnea major surgical or invasive procedure: intubation history of present illness: 62 y/o f with pmhx of cad s/p mi, copd on 2l home o2 and iga deficiency who presents with progressive sob, productive cough over one week from home. in the ed, initial vs were: t 98.1 p 110 bp 121/79 r 35 sats 96% on nrb with abg 7.35/62/112. she was intubated in ed for effort and impending respiratory failure and placed on ac 14/350/5/100% with abg 7.24/84/359. patient was given solumedrol 125mg iv, ceftriaxone 1gm iv, azithro 500mg iv, and vancomycin 1gm iv with nebs and placed on propofol for sedation. rml infiltrate was seen on cxr. ng aspirate appeared bloody after intubation, but guaiac negative from below. on arrival to the icu pt was sedated. review of sytems: limited sedation past medical history: - copd, last pfts with fvc 1.72, fev1 0.82, fev1/fvc 66% (61% and 40% predicted respectively); intubated several times in the past. on 2l home o2. - iga deficiency, was on iv gamma globulin with dr. . - cad s/p mis in (flu symptoms), (jaw pain), nstemi in (chest pain with left arm discomfort). cath in with ptca/stent to lcx. cath in with stent placement to rca and lcx. - hypertension - hyperlipidemia - gastritis, on ppi - osteoporosis, with history of multiple compression and rib fractures from coughing - history of thrush/ esophagitis steroid therapy - depression - tremor social history: she lives with her daughter, , son-in-law and 3 grand-children. she is a widow. she is an ex-smoker, with about a 30-pack-year smoking history, quit in . no etoh. uses a cane and walker to ambulate. family history: mother with dm, father with pancreatic cancer. physical exam: vitals: t: 98.6 bp: 140/80 p:112 r:27 o2: 100% on ac 350/24/5/50% fio2 general: intubated and sedated, cachetic heent: sclera anicteric, dry mucous membranes, oropharynx clear neck: supple, jvp not elevated, no lad lungs: severely kyphotic, diffuse wheezes, decreased bs throughout, occassional rhonchi cv: sinus tachycardic, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no cyanosis or edema pertinent results: 09:52pm type-art peep-5 o2-50 po2-113* pco2-73* ph-7.28* total co2-36* base xs-4 intubated-intubated 04:07pm urine blood-sm nitrite-neg protein-30 glucose-neg ketone-15 bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 04:07pm urine rbc-0-2 wbc-0-2 bacteria-few yeast-none epi-0-2 trans epi-0-2 renal epi-0-2 04:07pm urine amorph-many uric acid-mod 11:41am type-art po2-94 pco2-57* ph-7.36 total co2-34* base xs-4 11:41am lactate-1.1 07:31am type-art temp-37 rates-14/ tidal vol-350 peep-5 o2-100 po2-359* pco2-84* ph-7.24* total co2-38* base xs-5 aado2-289 req o2-53 -assist/con intubated-intubated 06:50am urine rbc-* wbc- bacteria-0 yeast-none epi-0 06:30am glucose-115* urea n-29* creat-0.7 sodium-139 potassium-4.4 chloride-95* total co2-34* anion gap-14 06:30am ck(cpk)-20* 06:30am ctropnt-<0.01 06:30am wbc-14.4* rbc-4.64 hgb-12.1 hct-38.8 mcv-84 mch-26.2* mchc-31.3 rdw-15.9* 06:30am neuts-65 bands-15* lymphs-12* monos-7 eos-1 basos-0 atyps-0 metas-0 myelos-0 06:30am plt smr-high plt count-496*# 06:30am pt-12.3 ptt-23.2 inr(pt)-1.0 06:29am type- po2-112* pco2-62* ph-7.35 total co2-36* base xs-6 06:29am lactate-1.3 studies: brief hospital course: 62 y/o f with pmhx of copd and pulm htn who presents with sob, cough and increased sputum production with hypercarbic respiratory failure requiring intubation in ed. . # hypercarbic respiratory failure: bad underlying copd and new rml pna which . pt with h/o severe obstructive lung disease. has h/o multiple intubations in recent months. dfa was negative for viral infections. sputum gram stain demonstrated gram negative rods which were not present on culture. she was initially treated with vancomycin/zosyn/azithro in setting of h/o psuedomonal pneumonia and quickly transitioned to fluoroquinolone for planned 7 day course. she was able to be extubated on the day of admission and transitioned to bipap then off to nasal cannula 2-3 l to maintain sats 88-93%. she initially received solumedrol 125mg iv on presentation which was transitioned to po prednisone with plan for slow taper. she received 50mg po on the day of discharge with plan for 40mg the day following then to decrease the prednisone by 5mg every three days until off. she was started on spiriva, singulair, salmeterol for her underlying copd/asthma. her home fluticasone inhaler was discontinued in the setting of po steroids. she is to continue on nebulizers as needed. her primary care doctor was made aware of planned steroid taper prior to discharge. . # episode of coffee ground - from og tube found in ed. likely gastritis in setting of long-term antibiotic use. she remained hemodynamically stable and had no further episodes. started on ppi while in icu and transitioned to h2-blocker on discharge given use of plavix for cad. . # cachexia - profound. work up for malginancy so far negative. this is likely a result of her end-stage copd. patient would require ng tube feeds which she is not interested in to meet her metabolic need in discussion with nutrition. plan for nutritional supplements with each meal. . # hyperglycemia - steroids. she has required minimal insulin sliding scale. will continue on discharge until patient tapers off steroids. . # cad: stable, last ef 50-55%. no evidence of current ischemia. continued on plavix, lisinopril, statin during this stay and on discharge. . # sinus tachycardia: chronic, stable, and persistent. ekg with question of multifocal atrial tachycardia also likely a result of her underlying copd. she was started on diltiazem prior to discharge in attempts to improve her heart rate. . # depression: stable on home regimen. she was continued on nortriptyline, paroxetine. . # fen: cardiac diet w/ supplement with each meal . # prophylaxis: subcutaneous heparin . # code: full code, discussed with patient during this admission possibility of hospice, but not currently interested . # communication: patient, daughter . # disposition: snif medications on admission: clopidogrel 75 mg po daily paroxetine hcl 10 mg po daily fentanyl 25 mcg/hr patch 72 hr q72h (every 72 hours). montelukast 10 mg po daily simvastatin 20mg po daily nortriptyline 25 mg po hs docusate sodium 200 mg po bid omeprazole 20 mg po once a day. fluticasone 110 mcg (2) puff (2 times a day). salmeterol 50 mcg/dose disk with device : one inhalation q12h albuterol sulfate 2.5 mg /3 ml (0.083 %) solution q2-4h prn ipratropium bromide 0.02 % solution q6h (every 6 hours) prn ergocalciferol (vitamin d2) 50,000 unit one po 2x/week (,we). calcium carbonate 500 mg tablet chewable po tid w/meals oxycodone-acetaminophen 5-325 mg 1-2 tablets po q6h prn multivitamin po daily senna 8.6 mg po bid prn prednisone taper at home discharge medications: 1. heparin (porcine) 5,000 unit/ml solution : one (1) injection injection tid (3 times a day). 2. clopidogrel 75 mg tablet : one (1) tablet po daily (daily). 3. nortriptyline 25 mg capsule : one (1) capsule po hs (at bedtime). 4. simvastatin 10 mg tablet : two (2) tablet po daily (daily). 5. montelukast 10 mg tablet : one (1) tablet po daily (daily). 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation inhalation q4h (every 4 hours). 7. ipratropium bromide 0.02 % solution : one (1) inhalation inhalation q4h (every 4 hours). 8. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 9. oxycodone-acetaminophen 5-325 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for pain. 10. fentanyl 50 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 11. paroxetine hcl 20 mg tablet : 0.5 tablet po daily (daily). 12. levofloxacin 250 mg tablet : one (1) tablet po q24h (every 24 hours) for 2 days: to complete a 7 day course, day #1 . 13. ranitidine hcl 150 mg tablet : one (1) tablet po daily (daily). 14. tiotropium bromide 18 mcg capsule, w/inhalation device : one (1) cap inhalation daily (daily). 15. salmeterol 50 mcg/dose disk with device : one (1) disk with device inhalation q12h (every 12 hours). 16. prednisone 5 mg tablet : as directed tablet po once a day: start 40mg x1 day, then 35mg x3days, 30mgx3days, 25mgx3days, etc until completed course. 17. multivitamin tablet : one (1) tablet po daily (daily). 18. diltiazem hcl 30 mg tablet : one (1) tablet po qid (4 times a day). 19. insulin lispro 100 unit/ml solution : as directed units subcutaneous asdir (as directed). 20. senna 8.6 mg tablet : one (1) tablet po twice a day as needed for constipation. discharge disposition: extended care facility: rehabilitation & nursing center - discharge diagnosis: severe chronic obstructive pulmonary disease flare health-care associated pneumonia cachexia discharge condition: hemodynamically stable requiring 2-3l o2 via nasal cannula to maintain o2 sats 88-93%. she has persistent sinus tachycardia ranging 110-120s. discharge instructions: you have been treated for a copd flare and pneumonia requiring non-invasive ventilation and stay in the micu. you are going to a rehab to complete your steroid taper and antibiotic course. followup instructions: please follow up with your primary care provider; , m.d. phone: date/time: 11:20 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: acidosis unspecified essential hypertension adrenal cortical steroids causing adverse effects in therapeutic use other chronic pulmonary heart diseases depressive disorder, not elsewhere classified other and unspecified hyperlipidemia acute and chronic respiratory failure cachexia osteoporosis, unspecified old myocardial infarction unspecified gastritis and gastroduodenitis, with hemorrhage chronic obstructive asthma with (acute) exacerbation hypovolemia other abnormal glucose bacterial pneumonia, unspecified selective iga immunodeficiency 

Answer: The patient is high likely exposed to