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: fever, altered mental status major surgical or invasive procedure: arterial line placement x2 history of present illness: 72 year old female with cad, chf, copd presenting with altered mental status, hypoxia and fever. the patient was hospitalized from 3/4/08-3/ /08 at an osh for increased shortness of breath. she was treated for chf exacerbation with diuresis and discharged to for rehabilitation. per her daughter, she was improved after her hospital stay and was alert and appropriate at discharge to . she did also report that her mother was weaker at the rehabilitation facility and had difficulty participating with physical therapy. . on the day of admission, the patient had a fever of 101.5. she was given levofloxacin 500 mg po x 1. later that morning, she was found to be hypoxic with abg of 7.36/61/49 on 3l nc. she was started on bipap 19/6 and her oxygenation improved to 92-93%. her family noted that her mental status was very poor, as she was not responding to voice, but only withdrawing to pain. she was taken to the ed at . . upon arrival to the ed, the patient was being bagged by ems and was rapidly put on bipap. her initial vitals were 100.1 83 130/33 27 and 99% on bag. in the ed, her temperature (rectal) was 102.8 and she was given 1 gram of tylenol, 1 gram of vancomycin, 750 mg of levofloxacin and 4.5 g of zosyn. she was maintained on bipap throughout her course and had an ngt placed for abdominal distention. her mental status improved slightly and she was sent to the ed for further management. of note, she also became slightly hypotensive to 84/33 and responded to 101/36 with 200 cc ns. . the patient was hypotensive upon arrival to micu to 65/20. goals were addressed with the patient's daughter and she was aggressively hydrated with minimal improvement in bp. bipap was removed, however, her pressures did not respond. arterial catheter placed and sbp 92/60, improved to 104/70. there was signficant discrepancy between the arterial line pressures and the cuff pressure. through her daughter, the patient denied chest pain, shortness of breath or abdominal pain, she does not like the bipap mask. past medical history: 1. cad: s/p 4-vessel cabg 2. chf: echo w/ 1+ mr, minimal as, ef 40% w/ regional wall motion abnormalities 3. dm type 2 4. htn 5. copd: on home o2 3.5l/m, bipap (settings 14/10) with multiple past admissions w/ pco2 in the 70-80 range 6. schizophrenia: initially symptomatic w/ paranoia and hallucinations, well controlled w/ meds 7. l3 fracture: 8. symptomatic vt: s/p icd in 9. hypothyroidism social history: lives alone in apartment; has home health aide daily; meals are prepared by the pt's daughter; walks independently but sometimes uses walker; uses home o2 at all times and bipap at night; smoked 60 pack-years but quit in ; no alcohol, ivdu, or cocaine use. family history: cad: mother died of mi at unknown age physical exam: vitals: 101.8, 63/41, 72, 17, 99% bipap gen: opens eyes to sternal rub, farsi speaking, no distress, loud/coarse snoring sounds when asleep, resolve when awake heent: on bipap, eomi car: rrr resp: coarse bilat with most sounds around central airways. no crackles ant/lat abd: distended, tympanic, nontender, + bs ext: no edema pertinent results: 1. initial cxr: left retrocardiac density may represent atelectasis or early pneumonia. recommend dedicated pa and lateral view for further evaluation . 2. cxr (): worsening bilateral perihilar opacities worrisome for worsening mild-to-moderate pulmonary edema which might be accompanied by bibasal aspiration. brief hospital course: a/p: 72 year old female with cad, copd, chf and obesity hypoventilation syndrome presenting with fever, altered mental status and hypoxia. . 1. fever: and leukocytosis with left shift: treated for hap/bronchitis with vancomycin/zosyn. she had an unimpressive cxr but had thick copious secretions. sputum culture with gpc. she had an isolated positive blood culture from admission, but surveillance cultures were negative. she had a negative influenza dfa. plan for 8 day course of antibiotics to continue until . picc line in place, but should be pulled after antibiotics completed. . 2. altered mental status: likely related to fever and build up of co2 from underlying infectious process. her mental status waxed and waned in the icu and did not correlate with her co2 level. she tended to improve with bipap, but this was not necessarily consistent. likely related to antipsychotics, baseline psychiatric disturbance and hypercarbia. improved by discharge. . 3. chf: given bolus fluids for hypotension at arrival to micu. she was intermittently diuresed with lasix during this hospitalization. last ef >55%. continued on beta blocker only. at the osh, she had started on diovan, this was discontinued for borderline-low bp. according to the notes, she has been tried on ace-i in the past but these have been stopped because of blood pressure concerns. she was discharged on her pre-hospital dose of lasix. . 4. arf: baseline 0.9-1.0. acute renal failure at admission likely from low flow state. this improved as her fluid balance corrected. 5. schizophrenia: home depakote, abilify and risperdal. continue zoloft. abilify given in the morning improved her mental status, also had decreased dose of risperdal. . 6. cad: aspirin + lipitor + beta blocker. the patient had intermittent episodes of angina, responsive to sl ntg. on discussion via interpreter, the patient has had chronic stable angina since her bypass surgery and uses sublingual nitroglycerin every other day at home. . 7. dm: home medications held at admission as pt npo. she had been discharged on lantus and ssi from osh, but these are not normal medications for her. . 8. copd: continue spiriva, advair and nebs prn. patient requires bipap at night (variable but 14/10 most recently) and supplemental oxygen (3-6l nc). . 9. hypothyroidism: continue levoxyl . 10. fen: diabetic diet . 11. access: piv and a-line . 12. disposition: micu . 13. code: dni. daughter consents to lines, pressors, cpr and patient has icd. . 14. communication: daughter : medications on admission: risperdal 2 mg po qhs atorvastatin 10 mg po qhs lantus 5 u qhs (not taking, new medication) advair abilify 40 mg spiriva qam duoneb prn aspirin 81 mg daily lasix 60 mg qam medroxyprogesteron 10 mg daily glyburide 5 mg levothyroxine 125 mcg daily zoloft 75 mg daily phoslo 2 cap qac depakote er 250 mg tab qam metoprolol sr 25 mg qam discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 3. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) inhalation q2h (every 2 hours) as needed. 4. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 5. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 8. sertraline 50 mg tablet sig: 1.5 tablets po daily (daily). 9. medroxyprogesterone 10 mg tablet sig: one (1) tablet po daily (daily). 10. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). 11. divalproex 250 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po qam (once a day (in the morning)). 12. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 14. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed). 15. risperidone 1 mg tablet sig: one (1) tablet po hs (at bedtime). 16. aripiprazole 10 mg tablet sig: four (4) tablet po qam (once a day (in the morning)). 17. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po qid (4 times a day) as needed. 18. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. 19. oxymetazoline 0.05 % aerosol, spray sig: one (1) spray nasal (2 times a day) as needed for 3 days: day 1 . 20. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day) as needed. 21. piperacillin-tazobactam 2.25 gram recon soln sig: one (1) recon soln intravenous q6h (every 6 hours): will complete 8 day course on . . 22. vancomycin 500 mg recon soln sig: 750mg recon solns intravenous q 12h (every 12 hours): will complete 8 day course on . . 23. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) inhalation q4h (every 4 hours): while awake. 24. insulin regular human 100 unit/ml solution sig: per sliding scale injection asdir (as directed): qachs. 25. furosemide 20 mg tablet sig: three (3) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: altered mental status obesity hypoventilation syndrome chronic obstructive pulmonary disease congestive heart failure hypotension acute renal failure diabetes mellitus discharge condition: stable, on home o2 requirement. mental status at baseline. discharge instructions: you were admitted with low oxygenation and altered mental status. you were treated for bronchitis and your psychiatric medications were altered slightly. you were much improved at discharged to rehabilitation. followup instructions: please see your primary care physician 2 weeks of hospital discharge. dr. . provider: , m.d. phone: date/time: 11:00 provider: function lab phone: date/time: 10:40 procedure: non-invasive mechanical ventilation arterial catheterization diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism paroxysmal ventricular tachycardia acute and chronic respiratory failure chronic systolic heart failure automatic implantable cardiac defibrillator in situ obesity, unspecified hypovolemia paranoid type schizophrenia, chronic obstructive chronic bronchitis with acute bronchitis 

Answer: The patient is high likely exposed to