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: percocet attending: chief complaint: cholecystitis major surgical or invasive procedure: intubation cholecystomy tube placement thoracentesis history of present illness: 74 y/o female with pmh significant for copd, cad, and hypertension admitted to on to the surgery service with two days of epigastric and right upper quadrant pain. she had also been febrile to 101 and had one episode of nausea and vomiting. per notes, her abdominal exam was significant for epitastric and right upper quadrant tenderness; positive gaurding; and no rebound. pt was guiac negative. ct showed a distended gallbladder with wall thickening and a small amount of pericholecystic fluid. common duct was dilated up to 11 mm and the pancreatinc duct was prominent at 5 mm. no free air or fluid. significant atherosclerotic disease with occlusion of the and possible celiac and renal artery stenosis. past medical history: 1. pt has been intubated twice in the past. her most recent pfts from whoed a fvc of 30% predicted, fev1 of 24% predicted, and fev1/fvc of 79% predicted. her marked obstructive ventilatory defect had worsened since pfts from . also with a concurrent restrictive process given her low-normal tlc. 2. coronary artery disease- pt is status post a cardiac catheterization recently at the end of which showed a left anterior descending artery 90% blockage which was stented and her left circumflex artery underwent angioplasty with a balloon. stress in showed a mild fixed septal defect. recent echo from whoed a normal ra and la. lvef with 55% with normal regional lv systolic function. + ar. 1+ mr. r. indeterminate pa systolic pressure. 3. hypertension. 4. hyperlipidemia. 5. borderline pulmonary hypertension. 6. irritable bowel syndrome. 7. s/p total abdominal hysterectomy in . 8. s/p bilateral hernia repair in the remote past social history: pt lives in an facility. she is no longer able to leave her home but does go down for meals. widowed. has six children. her hcp is her daughter . the pt is a retired nurses aid. pt smoked 1 pack per day for 60 years before quiting 1.5 years ago. no etoh or drugs. + pneumovax. family history: nc physical exam: 97.9 103/57 114 23 100% bipap fio2- .50 epap- 8 ipap- 5 gen- lady resting in bed with bipap on. appears uncomfortable. moaning. asking to take mask off. heent- nc at. anicteric sclera. bipap mask in place. cardiac- very faint heart sounds which are difficult to hear over pulmonary sounds. rrr. pulm- coars breath sounds anteriorly and laterally with very poor air movement. abdomen- obese. distended. soft. nt. percutaneous drainage tube in place. extremities- no c/c/e. pertinent results: 03:40pm alt(sgpt)-17 ast(sgot)-18 alk phos-111 amylase-64 tot bili-0.6 03:40pm lipase-16 03:40pm albumin-3.6 12:35am urine color-yellow appear-clear sp -1.010 12:35am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 10:20pm glucose-95 urea n-16 creat-0.8 sodium-139 potassium-3.4 chloride-95* total co2-28 anion gap-19 10:20pm alt(sgpt)-21 ast(sgot)-22 alk phos-131* amylase-63 tot bili-0.9 10:20pm lipase-16 10:20pm wbc-9.2 rbc-4.83 hgb-13.6 hct-40.2 mcv-83 mch-28.2 mchc-33.9 rdw-15.1 10:20pm plt count-330 10:12pm lactate-2.1* . ct 1) distended gallbladder with wall edema and possible pericholecystic fluid. intra and extrahepatic ductal dilatation is noted as well as prominence of the pancreatic duct. further evaluation with ercp or mrcp is recommended. 2) significant atherosclerotic disease with occlusion of the and possible celiac and renal artery stenosis. the patient's abdominal pain could be related to intestinal angina. further evaluation can be obtained with mesenteric cta. 3) no evidence of diverticulitis. 4) stable left pleural effusion. 5) stable right renal cyst. 6) stable small low attenuation focus in the spleen, which is too small to be characterized. . ct 1. cholecystostomy tube in good position with no evidence of fluid collection around it. 2. ostial calcifications with narrowing of the mesenteric vessels with no evidence of bowel wall thickening, edema, or fluid. . cta 1) no evidence of pulmonary embolus. 2) marked interval increase in left-sided pleural effusion and left lower lobe atelectasis. no evidence of central obstructing lesion. 3) unchanged appearance of pulmonary nodules; in the absence of a known primary malignancy, one-year follow-up is recommended to ensure stability. 4) mild upper lobe emphysematous changes. brief hospital course: although it was felt that the pt had cholycytstitis, it was felt that she was an extremely high risk surgical candidate given her significant pulmonary and cardiac disease. therefore, a percutaneous cholecyst tube was placed on instead of doing a cholecystectomy. following this, the pt had a good decreased in her pain and her fevers decreased into the 99 range. doing an ercp was considered but as the pt had normal lfts and bili this was deferred as there was a concern that it would require intubation. on , the pt spiked to 101.2 and redeveloped right upper quadrant tenderness. on , she developed an acutely more distended abdomen associated with nausea. at that time, she began to desatruate to 70% with associated tachypnea, accesory muscle use, and tachycardia into the 130s. an abg at that time was 7.44/39/52. cxr showed minimal worsening of a left lower lobe consolidation with prominent bilateral vascular markings. at that time, the pt was transferred to the sicu for closer monitoring. . in the sicu, her oxygen saturation initially increased to 90% on 4l nc. following transfer, she spiked to 103.6 and was started on vancomycin and zosyn for a left lower lobe pna. she was also started on steroids for her copd component. lfts remained within normal limits and there continued to be good drainage from her choly tube. pt defervesced over the nex few days and her oxygenation stablalized on 4 l nc with a sat in the high 90s and rr in the high teens. then, on the evening of , the pt received 1 mg ativan and 4 mg morphine for anxiety then desatted to 100% on a nrb. in addition, pt had a low blood sugar of 65 which was treated with 1/2 amp d50. abg obtained at that time showed 7.38/56/66. pt also received an extra 40 mg of iv lasix. this morning, after receiving her morning nebs, the pt reported that she could not breath and her oxygen sat began to drop quickly going from 95 to 65%. pt was given another treatment and her bipap settings were increased with an improvement in her sat. however, she became more tachypnic, tachycardic, and was using her accessory muscles to breath. pulmonary saw the pt and was concerned that this acute respiratory failure coud be secondary to bronchospasm. the pt had been off of high dose steroids for 24 hours. however, pe was the primary concern to rule out given her acute hypoxia, tachycardia, and relative hypotension. a cta was negative for pe however demonstrated a large pleural effusion. at this time the patient's respiratory status was quite tenuous requiring mask ventillation. . the effusion was tapped producing 1 l of transudative fluid which was culture negative. the patient's respiratory status markedly improved and her oxygen requirements decreased to 4l nc. she was transferred to the floor where she felt much better. the patient had one desatturation to 89% on 3l on which quickly resolved with nebs. otherwise the patient has been at her baselie which is unfortunately poor. at home she is on l nc and requires freq nebs. she will complete a 14 day course of vanc/zosyn for her pneumonia. . the patient's liver funcitions decreased after tube placement and stayed down. she will complete a 14 day course of vanc/zosyn for her cholecystitis. the patient will have the tube in place for 4-6 weeks total and follow up with ir as an outpatient. . of note the patient noticed numbness in her r hand where her a line was placed. the are was largely ecchymotic. however this improved once the line was taken out and returned to her baseline neuropathy which is equal bilaterally. . furthemore the patient had pain in her feet. she was noted to have pitting edema to her mid calf. she was diuresed with lasix. the patient was also noted to have an ecchymosis on the dorsum of her foot, a phone falling. xrays were negative. medications on admission: k-dur 20 meq tbcr 1 tab po qd morphine sulfate cr 15 mg tb12 1 tab po q 12 h advair diskus 250-50 mcg/dose misc 1 puff novolin n penfill 100 u/ml susp 16 units sc q am, 10 units sc before supper albuterol aer 90mcg 2 puffs 4 times a day as needed atrovent 18 mcg/act aers 2 puffs prednisone 5 mg tabs 1 po q am furosemide 40 mg tabs 1 po q am nitroglycerin 0.4 mg sl tab 1 sl prn cp, may repeat q 5min x 2 aspirin tab 325mg ec 1 po qd lipitor 40 mg tabs 1 po qd discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. insulin regular human 100 unit/ml solution sig: see attached sheet units injection asdir (as directed). 3. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 4. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q2h (every 2 hours) as needed for shortness of breath or wheezing. 5. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation every six (6) hours. 6. prednisone 20 mg tablet sig: as dir tablet po daily (daily): give 60 mg for 3 days, then decrease by 10 every 3 days. 7. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q3h (every 3 hours). 8. atorvastatin calcium 40 mg tablet sig: one (1) tablet po daily (daily). 9. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) puff inhalation (2 times a day). 10. lasix 40 mg tablet sig: one (1) tablet po once a day. 11. piperacillin-tazobactam 4.5 g recon soln sig: one (1) recon soln intravenous q6h (every 6 hours) for 2 days. 12. vancomycin hcl in dextrose 1 g/200 ml piggyback sig: one (1) g intravenous q24h (every 24 hours) for 2 days. discharge disposition: extended care facility: & rehab center - discharge diagnosis: cholecystis copd exacebation pneumonia respiratory failure diabetes discharge condition: stable discharge instructions: please take all medications and make all appointments as listed in the discharge paper work. followup instructions: patient will need to have biliary tube removed by interventional radiology in early (). please call dr. . . 2 day prior to this appointment the tube should be clamped. . please follow up with dr. in weeks. . . provider: breathing tests where: pulmonary function lab phone: date/time: 4:15 . provider: , .d. where: medical specialties phone: date/time: 4:30 procedure: thoracentesis non-invasive mechanical ventilation percutaneous aspiration of gallbladder other cholangiogram other cholangiogram other cholangiogram diagnoses: pneumonia, organism unspecified cellulitis and abscess of trunk unspecified pleural effusion unspecified essential hypertension long-term (current) use of steroids diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled obstructive chronic bronchitis with (acute) exacerbation other chronic pulmonary heart diseases acute and chronic respiratory failure disturbance of skin sensation obesity, unspecified diastolic heart failure, unspecified calculus of gallbladder with acute cholecystitis, with obstruction pain in limb 

Answer: The patient is high likely exposed to