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: history of present illness: this is a -year-old woman with a history of dementia who was transferred from the nursing home for three weeks of cough with lethargy and decreased p.o. intake over the last two to three days. per the nursing home and the medical doctor covering for her primary care physician, patient has had a cough over the last two weeks when she was also noted to have increasing lower extremity edema. she was started on lasix for presumed for congestive heart failure. however, the cough persisted and now with production of yellow sputum. moreover, over the last two to three days, the patient has had decreased p.o. there were no fevers, per nursing home records, and there was no report of vomiting or witnessed aspiration. the patient did receive a flu shot, but there is no record of recent pneumovax. she is now transferred to the for further evaluation. while in the emergency department, the patient was noted to be hypotensive. she was given a total of 3 liters of intravenous fluids. when pressure remained low, she was started on dopamine via peripheral line in the emergency department. the medical intensive care unit team was called to evaluate. however, while still in the emergency department, the patient became hypoxic and subsequently lost any palpable pulse. cardiopulmonary resuscitation was initiated, and the patient was given a total of 4 mg of epinephrine, 1 mg of atropine, and 1 amp of sodium bicarbonate by emergency department staff for pulseless electrical activity. she was also intubated for hypoxic respiratory failure. after about 10 minutes, the patient regained her pulse, and saturations improved. she was then transferred to the medical intensive care unit for further evaluation and treatment. the family was , and the patient's daughter consented to placement of arterial and central venous lines. past medical history: 1. hypertension. 2. dementia. 3. status post pacemaker, (?vvi based on cxr). 4. macular degeneration. medications on admission: outpatient medications included dyazide 18.75/12.5, prinzide 20/12.5, calcium and vitamin d, iron 325 mg p.o. q.d., risperdal 1 mg p.o. q.h.s., albuterol and atrovent meter-dosed inhaler q.i.d., zestril 20 mg p.o. q.d., lasix 10 mg p.o. q.d. over the last two weeks. allergies: no known drug allergies. social history: she lives at the nursing home; daughter is ; full code. physical examination on presentation: temperature of 97.2, heart rate of 72, blood pressure of 106/70, pulse of 84, oxygen saturation of 100% ventilator setting of ac 550/14, positive end-expiratory pressure of 10, fio2 of 0.8; arterial blood gas on these settings was 7.39/25/277. in general, intubated and sedated, sporadically moved upper and lower extremities, withdrew to pain in all extremities. head, eyes, ears, nose, and throat revealed pupils were reactive, anicteric. mucous membranes were moist. no oral lesions. neck was supple, no jugular venous distention, no lymphadenopathy. lungs revealed coarse vented breath sounds throughout. heart had a regular rate and rhythm. normal first heart sound and second heart sound. a holosystolic murmur at the apex radiating to the axilla. also had a 1/6 systolic murmur at the right upper sternal border. abdomen was soft, obese, and nontender, normal active bowel sounds. extremities revealed 1+ bilateral lower extremity edema, and no clubbing. pertinent laboratory data on presentation: laboratories from , revealed complete blood count with white blood cell count of 9.5, hematocrit of 31.8, platelets of 290, mean cell volume of 86. rdw of 14.8. different of 76% polys, 14% lymphocytes. chem-7 was as follows: sodium of 141, potassium of 5.3, chloride of 107, bicarbonate of 20, blood urea nitrogen of 88, creatinine of 1.7, glucose of 123. urinalysis with positive nitrites, positive leukocyte esterase, 0 red blood cells, 21 to 50 white blood cells, many bacteria, 2 epithelial cells. laboratory from , at 6 a.m. revealed arterial blood gas of 7.39/25/277. free calcium of 1.05. radiology/imaging: chest x-ray of , revealed singular ventricular pacer lead in place, prominence of upper zone pulmonary vasculature and slight perihilar haze, blunting of both cp angles, overall mild congestive heart failure. hospital course: 1. infectious disease: blood cultures and urine cultures were sent. given the urinalysis, the patient was started on empirically levofloxacin for urinary tract infection as well as tested for creatinine clearance for a question of enterococcal urinary tract infection, and the patient was started on vancomycin as well. this regimen was also thought to cover pneumonia very adequately with levofloxacin, vancomycin, and flagyl. 2. cardiovascular: the patient was hypotensive in the emergency department and was given 3 liters of fluid as well as started on dopamine in the emergency department. this was switched to levophed for increased constriction in addition to some mild cardiopulmonary inotrope. an echocardiogram was performed which showed an ejection fraction of 20%, akinetic septum and anterior wall, and hypokinetic apex. the right ventricular free wall was hypertrophied with free wall hypokinesis. severe aortic stenosis was noted with a peak gradient of 68. 3. renal: the patient had an increased blood urea nitrogen and creatinine, probable prerenal in etiology and secondary to hypotension; whether this was due to sepsis, congestive heart failure, or volume depletion, or a combination of these. she continued to be hydrated with improvement in creatinine. 4. mental status: the patient had a negative head ct 48 hours out. the patient continued to have poor mental status. there may have been a possible small stroke, not visible on the ct scan. she was unresponsive shortly after she arrived in the emergency department, and since then had not regained any semblance of prior function. she did withdraw to pain in her extremities at times. 5. fluids/electrolytes/nutrition: the patient continued to be hydrated aggressively to maintain blood pressure. 6. gastrointestinal: the patient had a transaminitis on admission which was thought to be due to cephalic liver. this continued to be followed and came down appropriately. 7. prophylaxis: heparin subcutaneous. 8. access: left arterial line, right femoral central line. 9. communication: granddaughter, daughter, and family. it was decided after some time on to make the patient comfort measures only given the poor prognosis. all of the patient's medications, and fingersticks, as well as laboratory draws were discontinued and she was started on morphine for comfort. maximal steps were taken to make sure the patient was comfortable during her last hours. the patient passed on , at 10:10 p.m. 10. code status: do not resuscitate, comfort measures only. , m.d. dictated by: medquist36 d: 15:47 t: 19:11 job#: procedure: enteral infusion of concentrated nutritional substances diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified unspecified essential hypertension other pulmonary insufficiency, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere cardiac pacemaker in situ 

Answer: The patient is high likely exposed to