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: penicillins / gadolinium-containing agents / aztreonam attending: chief complaint: mental status changes major surgical or invasive procedure: none history of present illness: 49 year old female vasculopath with multiple medical problems including on insulin pump, esrd on hd, cad s/p cabg (lima to lad, svg to om1, d1 and rca) complicated by infection of l saphenectomy site, last cath with lad 50% mid and to distal, patent svg to d1 with 90% distal lesion, lcx with diffuse dz and 90% stenosis, and patent grafts, recent p-mibi with moderate reversible anterior defect (unchanged from ) prior to l 5th metatarsal amputation for osteomyelitis, presents with 5 days of fever (to 101.2), chills, cough with sputum and no blood, doe and generalized weakness. her sugars have also been difficult to control on her insulin pump. pt fell down 2 days ago secondary to weakness and loosing balance, no loc, head trauma or back/hip pain. denies cp, palpitations, nausea, vomiting, weight gain, presyncope, orhtopnea, or pnd. past medical history: 1. cad: as above. dr. is cardiologist. 2. esrd: diabetes. on hd x 3 years. 2. --neck exploration, thyroid and parathyroidectomy for secondary hyperparathyroidism 3. --gangrenous left toe/osteomyelitis 4. s/p bilateral fem- bipass 5. left anterior tibial angioplasty 5. r (critical)>l ras 6. contrast nephropathy 7. cva x 2: l-residual weakness 8. multiple skin grafts to thigh and buttocks for calciphlaxysis 9. seizures 10. dm1 since 4 years of age: neuropathy, retinopathy, nephropathy 11. reactive airway disease 12. copd 13. rll pna 14. cellulitis social history: she is a tobacco user times 30 years and has occasional drinks alcohol. otherwise, unremarkable. family history: negative for heart disease or diabetes. physical exam: 99.1 81 112/42 16 93% on 4.5l nc gen: lethargic, non-toxic, nad heent: eomi, perrl, scattered hard exudates and cotton spots, no neovascularization, mm dry. neck: no jvd, thyroidectomy scar. no bruits audible. heart: rrr, nl s1 and s2. no murmurs. +s4. lungs: diffuse rhonchi and wheezing. decreased breath sounds bibasilarly. no abd: soft, nt/nd. +bs ext: no edema. 1+dp/pt on left. very faint dp/pt on r. no femoral bruits. pertinent results: 09:35am wbc-6.1 rbc-3.16* hgb-10.3* hct-34.1* mcv-108* mch-32.6* mchc-30.2* rdw-17.0* plt count-168 09:35am neuts-85.4* lymphs-10.1* monos-4.2 eos-0 basos-0.2 09:35am glucose-374* urea n-34* creat-5.4*# sodium-134 potassium-3.8 chloride-92* total co2-29 anion gap-17 albumin-3.7 calcium-8.3* phosphate-4.3# magnesium-2.1 09:35am ck(cpk)-1223* ck-mb-14* mb indx-1.1 ctropnt-3.01* 04:25pm ck(cpk)-1244* ck-mb-8 ctropnt-2.82* 10:29pm ck(cpk)-1218* ck-mb-9 ctropnt-2.58* 10:29pm tsh-0.83 10:15am urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-sm urobilngn-neg ph-6.5 leuk-mod cxr-patchy new opacity within the superior segment of the left lower lobe concerning for pneumonia. ecg-sinus rhythm, long qtc interval, probable anteroseptal infarct, age indeterminate, low qrs voltages in limb leads since previous tracing, no significant change ct head- no intracranial hemorrhage or mass effect. echo- 1. the left atrium is mildly dilated. 2. the left ventricular cavity size is normal. there is mild global left ventricular hypokinesis. overall left ventricular systolic function is mildly depressed. ef 50% 3. the right ventricular cavity is dilated. right ventricular systolic function appears depressed. 4. the aortic valve leaflets (3) are mildly thickened. 5. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. 6. compared with the findings of the prior study (tape reviewed) of , lv function has decreased. ct chest- 1. extensive multifocal ground glass opacities bilaterally. the rapid course of development compared to the recent chest-xrays favours pulmonary edema. however, lack of siginficant pleural effuions and upper lobe involvement argues against pulmonary edema. other considerations include atypical infection and hypersensitivity pneumonitis. 2. mediastinal lymph nodes. 3. left lower lobe and right lower lobe areas of consolidation could represent pneumonia or aspiration. cta chest- no evidence of pulmonary embolus. no interval change in bilateral diffuse ground-glass opacities, bibasilar patchy consolidation, small left pleural effusion, and mediastinal lymphadenopathy mri head- diffusion images demonstrate no evidence of slowed diffusion to indicate acute infarct. no evidence of mass effect or midline shift are seen. subtle right frontal hyperintensities are unchanged from the previous study of and , and could be due to a chronic right frontal cortical infarct or changes of small vessel disease. there is no evidence of new infarct identified. the suprasellar and craniocervical regions are normal in the sagittal images. brief hospital course: # sob/respiratory failure-pt initially presented with sob and mental status changes. she was empirically started on lecofloxacin for possible pna. dfa's were negative. however there was also concern that her resp status could be effected by hf, pe, and/or copd flare. she had no improvement and give her recent hosp stays was added gent and vanco for broad coverage. despite this she continued to worsen. she continued to have periods of hypoxia with fever. blood and urine cultures were negaitve. she worsened with interstitial pattern on cxr and increased wheezing. pt then had episode of sever hypoxia and required nimv and was sent to for bipap. there viral culture demonstarted parainfluenza. they also checked cta which ruled out any evidence of pe. because it was felt the virus was also causing a copd flare she was on steroids and responded well and were tapered slowly. she then returned to the florr and did well until she had second decompensation after dialysis with hypoxia. she once again required short admission to the micu for observation. once again a cta was negaitve for pe. she was continued on steroids and completed a 14 day course of levo/gent/vanco for presumed super infection. after second icu stay returned to the floor and was afebrile, no leukocytosis. slowly was weaned off of o2, started on mdi for copd. on discharge she was ambulating without supplemental o2 and maintaining sats. sent home on steroid taper with mdi's. # visual changes- complained of right eye visual problems. by ophtho. got mri head which did not show any stroke or signs of optic neuritis. visual problems felt to be vasculopathy (retinal artery ischemia) associated with htn, diabetes. recommmended optimizing regimens for these chronic illnesses. # dm- insulin pump was stopped intially and she was started on lantus and riss. she was followed by throughout here stay. insulin regimen was adjusted accordingly. she remained on this regimen until discharge when her pump was restarted. # cad-pt presented with sob . trop elavated to 3.00 when baseline had been 0.04, without any significant ecg changes. she was seen by cardilogy who felt she had nstemi likely demand ischemia/ failure and recommended optimizing medical management. concern for some myositis statin so this was held. she remained cp free during stay and troponin trended down. cshe was continued on bb, aspirin, plavix, imdur, acei # chf- echo done in house showed ef of 50% with mild global hypokinesis. # hypothyroid- cont on levothyroxine # mental status changes- initial ct head showed no evidence of ischemia, bleed. later mri confirmed this result. ms changes felt to be secondary to hypoxia, infection, medications, and failure. her psychiatric meds were adjusted but ultimately was able to restart them all. as she imprved from a respiratory and id standpoint here mental status gradually improved and returned to baseline. # psych- on multiple pysch meds. some were initially held due to sedating effects. as her ms improved these were gradually restarted per psych recs. # esrd - she remained on schedule of hd on mwfsa. followed by throughout hospital stay. # h/o seizures- she was continued on phenytoin. levels were checked and doasge adjusted as needed. no seizures during her hospital stay. medications on admission: asprin 81 qd, calcitriol 0.5mcg qd, plavix 75 mg qd, indur 30mg qd, folate, prevacid 30mg qd, wellbutrin sr 300 , levoxyl 250mcg qd, renagel 800 with meals, albuterol prn, flovent , serevent , dilantin 300mg qd, celexa 10mg qd, reglan 10mg with dinner, tums 500 between meals, sennakot, dulcolax, methadone prn, dilaudid prn discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. calcitriol 0.25 mcg capsule sig: two (2) capsule po daily (daily). disp:*60 capsule(s)* refills:*2* 3. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. isosorbide mononitrate 30 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). disp:*30 tablet sustained release 24hr(s)* refills:*2* 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 7. levothyroxine sodium 125 mcg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. salmeterol xinafoate 50 mcg/dose disk with device sig: one (1) disk with device inhalation q12h (every 12 hours). disp:*qs disk with device(s)* refills:*2* 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 12. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 13. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 14. fluticasone propionate 110 mcg/actuation aerosol sig: four (4) puff inhalation (2 times a day). disp:*qs * refills:*2* 15. metoclopramide hcl 10 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 16. nicotine 14 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). disp:*15 patch 24hr(s)* refills:*0* 17. phenytoin sodium extended 100 mg capsule sig: three (3) capsule po once a day. disp:*90 capsule(s)* refills:*2* 18. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*30 cap(s)* refills:*2* 19. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day) as needed for constipation. disp:*qs * refills:*2* 20. atorvastatin calcium 40 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 21. citalopram hydrobromide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 22. bupropion hcl 100 mg tablet sustained release sig: two (2) tablet sustained release po bid (2 times a day). disp:*120 tablet sustained release(s)* refills:*2* 23. clonazepam 1 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). disp:*30 tablet(s)* refills:*2* 24. prednisone 10 mg tablet sig: 2-4 tablets po once a day for 2 weeks: please take 4 tabs for 4 days, then 3 tabs for another 5 days then 2 tabs for another 6 days, then taper it per your doctor's evaluation. disp:*45 tablet(s)* refills:*0* 25. ipratropium bromide 18 mcg/actuation aerosol sig: one (1) puff inhalation twice a day. disp:*1 bottle* refills:*2* 26. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*15 tablet(s)* refills:*0* 27. mirtazapine 45 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: pneumonia parainfluenza infection diabetes nstemi hyperlipidemia hypothyroid anemia secondary to failure esrd on hemodialysis discharge condition: stable, ambulating on room air, chest pain free discharge instructions: please take your medicine as directed, you are on prednisone taper and need to be seen by your doctor for re evaluation within 2 wks for tapering dosage. please make follow up appt as directed. please have your liver function tests ast, alt done within 1 month. please go to ed or call 911 if have worsening shortness of breath, chest pain, unremitting fever or other concerning symptoms. followup instructions: call psych at for follow up in wks. provider: , md where: lm center phone: date/time: 1:00 please call dr. at for follow up in wk. you will need to discuss with dr. about referral to pulmonology to follow your lung disease. you will need to follow up with your ophthamologist (eye doctor) dr. at . procedure: hemodialysis diagnoses: anemia in chronic kidney disease subendocardial infarction, initial episode of care urinary tract infection, site not specified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure delirium due to conditions classified elsewhere other toe(s) amputation status diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled asthma, unspecified type, with (acute) exacerbation influenza with pneumonia fitting and adjustment of insulin pump retinal ischemia 

Answer: The patient is high likely exposed to