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: patient recorded as having no known allergies to drugs attending: chief complaint: hypotension at rehab. major surgical or invasive procedure: central venous line placement. history of present illness: this is a yo woman with history of stroke, atrial fibrillation on coumadin, chf, copd, crohn's disease, and uterine cancer sent in from rehab for bp of 70/40, hr 65 (on digoxin), 92% on ra. received iv fluids, and hours later, bp continued to be 70/40. patient complained of headache, which is baseline for her. per rehab, patient has had altered mental status and was being treated for copd flare for one day with albuterol and atrovent q4 hours. hx of dementia and cognitive decline but unclear baseline. patient denies chest pain, nausea, vomiting, or diarrhea. she does have shortness of breath with a cough, though has been afebrile. of note patient has a 100 pack-year smoking history. in the ed, initial vs were: t 97.6 p 95 bp 83/58 r 18 o2 97% on ra. hr was irregularly irregular. ekg showed atrial fibrillation without st segment changes. cxr shows a ?l basilar opacity. patient was given 2l iv fluids, without improvement in blood pressure. levophed was started peripherally. a r ij central line was placed, along with 2 peripheral ivs. after starting levophed, bp was 96/71, hr 93, 97% on 2l. the patient was started on vanc/zosyn empirically for pneumonia. on the floor, patient is able to respond to questions but with confusion. unable to provide further history. past medical history: pmh: 1. atrial fibrillation off coumadin. 2. uterine cancer. 3. crohn's disease diagnosed in . 4. barrett's esophagus, gerd 5. depression. 6. chronic obstructive pulmonary disease, which consist of emphysema. 7. arthritis. 8. history of resected left upper lobe pulmonary nodule. 9. history of basal cell carcinoma. 10. history of colonic polyps biopsied in 11. chf 12. vaginitis 13. gait disturbance social history: social hx: -dnr/dni. -hcp= -lives at rehab -100 py tobacco hx -no etoh/drugs family history: family hx: nc physical exam: vitals: t: 97.8 bp:85-97/43-52 p: 84 r: 22-25 o2: 98% general: somnolent, a+ox1 only, no acute distress heent: sclera anicteric, mmm, oropharynx clear. r ij in place. neck: supple, unable to assess jvp, no lad lungs: diminished breath sounds bilaterally. crackles at bases. sparse expiratory wheezes. tight. cv: irregularly irregular. tachycardic. no murmurs heard abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. surgical scar present. ext: warm, well perfused, 2+ pulses, no clubbing, or cyanosis. 1+ non pitting edema neuro: l sided facial droop. a+ox1. recall not intact. speech fragmented. pertinent results: labs at admission: 03:30pm blood wbc-6.9 rbc-3.70* hgb-9.7* hct-28.8* mcv-78*# mch-26.3*# mchc-33.8 rdw-14.5 plt ct-171 03:30pm blood neuts-79.1* lymphs-16.9* monos-3.5 eos-0.2 baso-0.3 03:30pm blood pt-32.7* ptt-36.7* inr(pt)-3.4* 03:30pm blood glucose-109* urean-38* creat-1.6* na-138 k-3.0* cl-100 hco3-25 angap-16 03:30pm blood alt-10 ast-23 ld(ldh)-209 ck(cpk)-140 alkphos-99 totbili-0.2 03:30pm blood ck-mb-5 probnp-3929* 02:34am blood calcium-7.9* phos-2.3* mg-1.8 03:30pm blood caltibc-312 hapto-243* ferritn-69 trf-240 03:30pm blood cortsol-30.2* 03:30pm blood digoxin-1.1 09:39pm blood type- po2-25* pco2-48* ph-7.35 caltco2-28 base xs--1 03:43pm blood lactate-2.5* 09:39pm blood lactate-1.4 anemia labs: 03:30pm blood albumin-3.7 iron-14* 03:30pm blood caltibc-312 hapto-243* ferritn-69 trf-240 cardiac enzymes: 03:30pm blood ck-mb-5 probnp-3929* 03:30pm blood ctropnt-0.03* 02:34am blood ck-mb-7 ctropnt-0.03* 04:44pm blood ck-mb-7 ctropnt-0.03* 01:44am blood ck-mb-7 ctropnt-0.03* 02:00pm blood ck-mb-7 ctropnt-0.04* micro data: blood and urine cultures: negative urine legionella: negative mrsa screen: positive imaging studies: cxr (): left basilar opacity, which may represent atelectasis, but infection is not completely excluded. no evidence for congestive heart failure. cxr (): patient's condition required ap and lateral chest examination while patient is sitting in wheelchair. comparison is made with a preceding single ap chest view of . previously described left lower lung field density obliterating diaphragmatic contour and presenting as retrocardiac density persists. presence of barium contrast, apparently used for an oropharyngeal video study earlier during the day, discloses sizable hiatal hernia which apparently contributions to this retrocardiac density. heart size has not changed and previously described general widening and elongation of thoracic aorta remains the same. pulmonary vasculature is not congested. no new parenchymal infiltrates are seen. mild blunting of right lateral and posterior pleural sinus is present. no pneumothorax identified. cxr (): large hiatal hernia. adjacent basilar lung opacification, probably atelectasis although aspiration pneumonia is not fully excluded. small pleural effusions with improvement on the right. brief hospital course: a yo woman history of atrial fibrillation on coumadin, dementia, copd, diastolic chf now presenting with hypotension and hypoxia from rehab. # hypotension: her blood pressure per nh report was 70/40. despite iv fluids in ed, bp was not responsive. a central line was placed and she was started on levophed. differential includes most likely septic shock from pulmonary source. potential other etiologies were adrenal insufficiency, cardiogenic shock secondary to decomensated chf or mi, and less likely pe. cxr showed left lower lobe infiltrate, concerning for pneumonia, along with sob and cough. blood and urine cultures were sent. cortisol level was normal. she was started empirically on vanc/zosyn for health-care associated pneumonia. in addition, she was started on iv solumedrol and standing nebs for presumptive copd flare and given small boluses of iv lasix (when blood pressure came up) for possible component of decompensated chf. with the above interventions her blood pressure improved to 95-110s systolic, and her mental status improved. she has completed a seven-day course of antibiotics at time of discharge; steroids were stopped prior to discharge and lasix has been stopped due to concern of intravascular volume depletion based on labs. her systolic blood pressure as time of discharge is in the high 90s to low 100s. # altered mental status: she has mild dementia, likely compounded by hearing loss; per nh report she is alert and oriented to person, place and time at baseline. at time of admission she was somnolent. neuro exam was non-focal and lfts were unremarkable. her electrolytes showed a mild hypernatremia, which corrected with iv d5w. her mental status gradually improved with treatment of infection and hypernatremia. at time of discharge, she is alert to person and time, although confused as to place. she has passed speech and swallow evaluation and is tolerating oral diet without problem. # microcytic anemia: her baseline hematocrit is in the low 30s. hematocrit on this admission was 28.8. given the hypotension at admission, there was concern that blood loss might be contributing. iron studies were indicative of deficiency (see above). her hematocrit remained stable, and her blood pressure came up with treatment of infection. there were no blood transfusions necessary. # acute renal failure: her baseline creatinine is 0.9-1.1. creatinine on this admission was 1.6. this was likely prerenal arf in the setting of infection and sepsis, and it resolved with intravenous fluids. # lactic acidosis: her initial lactate was 2.5 in ed, likely secondary to organ hypoperfusion. there was no abdominal pain. the lactic acidosis resolved with fluids and antibiotics. # atrial fibrillation: she takes digoxin for rate control and is anticoagulated on coumadin. digoxin level in ed was within normal limits. she was started on metoprolol iv in the micu for af with rvr. when she was cleared by speech and swallow, she was put back on coumadin and digoxin. metoprolol was continued at a low dose. her rate has been well-controlled in the 70-90s. # diarrhea: she had loose bowel movements after transfer from the icu in the setting of receiving broad spectrum antibiotics for health-care associated pneumonia. first c dificile test was negative. at time of discharge, the diarrhea is resolving. there is a second c dificile test pending. her symptoms may have been due to underlying crohn's disease (in the setting of holding asacol while she was in the icu), and we have restarted asacol prior to discharge. # urinary retention: on the day prior to discharge, she was noted to have post-void residual of 500 ccs after voiding 300ccs. urine output has been ~1500 cc/day, and renal function has been stable. however, due to elevated pvr yesterday she was straight-cathed. she is not on any anti-cholinergic meds or narcotics. her elevated pvr may be due to deconditioning. at the rehab facility, if her pvr is greater than 400cc, she may need to have straight-caths. # fen: recs per speech and swallow for pureed consistency solids with nectar prethickened liquids. supplement meals with ensure. # prophylaxis: anticoagulated on coumadin # code: dnr/dni medications on admission: 1. omeprazole 40mg po bid 2. docusate 200mg po bid 3. polyvinyl alcohol-povidone 1.4-0.6 % 1-2 drops prn 4. fluticasone 110 mcg/actuation aerosol 2 puffs 5. mesalamine 800 mg po bid 6. senna 8.6 mg po bid 7. digoxin 125 mcg po daily 8. simvastatin 20 mg po daily 9. furosemide 40 mg po daily 10. cholecalciferol (vitamin d3) 1000 unit po daily 11. calcium carbonate 500 mg po bid 12. ipratropium-albuterol 18-103 mcg/actuation aerosol 2 puffs q6h 13. warfarin 5 mg po qhs 14. tramadol 50 mg po q6h prn pain discharge medications: 1. vitamin d 1,000 unit capsule sig: one (1) capsule po once a day. 2. tums 500 mg tablet, chewable sig: one (1) tablet, chewable po twice a day. 3. digoxin 125 mcg tablet sig: one (1) tablet po once a day. 4. coumadin oral 5. flovent hfa 220 mcg/actuation aerosol sig: one (1) inhalation twice a day. 6. asacol 400 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po twice a day. 7. zocor 20 mg tablet sig: one (1) tablet po once a day. 8. tylenol 325 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 9. prilosec 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 10. albuterol sulfate 2.5 mg/0.5 ml solution for nebulization sig: one (1) inhalation every 4-6 hours as needed for shortness of breath or wheezing. 11. ipratropium bromide 0.02 % solution sig: one (1) inhalation every 4-6 hours. 12. metoprolol tartrate 25 mg tablet sig: 0.25 tablet po bid (2 times a day). discharge disposition: extended care facility: for the aged - ltc discharge diagnosis: primary healthcare-associated pneumonia hypotension secondary to sepsis . secondary diagnoses atrial fibrillation with rapid ventricular response crohn's disease congestive heart failure, chronic, diastolic chronic obstructive pulmonary disease gastroesophageal reflux disease s/p right mca stroke in discharge condition: vital signs stable. afebrile. mentating at baseline. discharge instructions: you were admitted to the hospital for treatment of low blood pressure. we treated an infection in the lungs and gave you intravenous fluids and the low blood pressure resolved. . please take your medicines as prescribed: -we added metoprolol for better heart rate control -we did not make any other changes to your medicines . please call the doctor or return to the emergency room if you have any lightheadedness, dizziness, cough, fever, or any other new concerning symptoms. followup instructions: please follow-up with your primary care physician weeks: . md procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified acidosis mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified unspecified septicemia severe sepsis atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation other chronic pulmonary heart diseases personal history of tobacco use abnormality of gait other persistent mental disorders due to conditions classified elsewhere regional enteritis of unspecified site septic shock iron deficiency anemia, unspecified personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits hyperosmolality and/or hypernatremia chronic diastolic heart failure incomplete bladder emptying 

Answer: The patient is high likely exposed to