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: amoxicillin / lisinopril attending: chief complaint: shortness of breath major surgical or invasive procedure: central venous line placement and removal history of present illness: pt is a 62 yo f with emphysema and dmii who presents with fevers and shortness of breath. pt reports runny nose for the past week, in addition to cough non-productive of sputum. two days before admission, she experienced chills and rigors. she also report today a fever up to 105.1 at home, some muscle aches in her arms. denies cp but admits to some sob and doe. took some tylenol efor the fever and took some vicodin for a headache on saturday (which is currently not present). experienced some nausea on the way to the ed. denies neck stiffness or photophobia. her symptoms worsened to a point where her daughters urged her to come for evaluation today. reports some 'black' diarrhea in the ed, non-bloody. no recent antibiotic use. she denies abdominal pain, new rashes, or dysuria. . in the emergency department, vs were: 100.1 119 74/27 16 94%. pt received tylenol 1 gram po x1, vancomycin, levofloxacin, and zofran. labs significant for wbc of 21.2, cre of 1.8 (baseline of 1.0), lactate of 3.2->2.9 with 4 l ivfs. r ij was placed in the ed. vs on transfer wre 96/52 14 and 96% on 4 l nc. on the floor, patient had a 10 beat run x2 of polymorphic vt versus torsades. she remained hemodynamically stable. stat repeat labs showed a mg of 1.0 which was replated with 4 grams of magnesium sulfate iv x1. 1 l ns bolus was given with increase of map to 60. given mvo2 was 68%, elevated lactate to 3.2 despite 5 l ns resuscitation, and cre of 2.1, levophed gtt was initiated. past medical history: diabetes mellitus: managed by oral hypoglycemics hypertension hyperlipidemia breast ca- lumpectomy in emphysema/copd: - multiple hospitalizations in the past but none recently; never intubated, not on home o2 hypothyroidism anxiety irritable bowel syndrome peptic ulcer disease allergic rhinitis tobacco abuse gout osteoarthritis morbid obesity benign adrenal adenoma depression social history: she is currently working as a school bus driver and a supervisor; she hasn't driven a bus since her hip surgery, but was recently cleared to return. she quit smoking as a new year's resolution. she previously smoked three packages of cigarettes per day for 46 years and has quit two times previously for up to one year. she drinks occasional alcohol. no illegal drugs or ivdu. family history: mother and father with cad; father with emphysema physical exam: vs - temp 98.5f, bp115/65 , hr103 , r16 , 96o2-sat % ra general - well-appearing woman in nad heent - nc/at, perrl, eomi, sclerae anicteric, mmm, op clear. dentures in place. no oral lesions noted. neck - supple, no thyromegaly, jvd cannot be appreciated. rij in place. lungs - increased effort with inspiration. increased duration of expiratory phase. bronchial breath sounds b/l in upper lung fields. brief inspiratory crackles auscultated b/l in mid/lower lung fields. decreased bs at bases. faint expiratory wheezes auscultated b/l more so in lower fields r>l. heart - faint heart sounds. tachycardic. no m/r/g nl s1-s2 abdomen - hypoactive bs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - 1+ peripheral pulses (dps). trace pitting edema b/l. skin - no rashes or lesions lymph - no cervical lad neuro - awake, a&ox3, cns ii-xii grossly intact mae . pertinent results: cbc wbc rbc hgb hct mcv mch mchc rdw plt ct 4.4 3.05 8.4 25.7 85 27.5 32.6 17.5 137 5.1 2.99 8.3 25.2 84 27.6 32.8 17.6 111 10.01 3.14 8.7 26.6 85 27.6 32.7 17.2 111 21.2 4.25 11.6 35.6 84 27.4 32.7 16.8 152 . cmp glucose urean creat na k cl hco3 angap 121 15 1.0 137 3.9 104 28 9 .9 141 4.2 108 25 12 . . alt ast alkphos totbili 05:07 41 34 145 0.9 01:29 17 6 134 0.9 . . microbiology: gram stain (final ): pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci in pairs. 1+ (<1 per 1000x field): gram negative diplococci. . . cxr- single ap upright portable view of the chest was obtained. there is moderate right middle lobe consolidation, worrisome for pneumonia. the left lung is clear. no pleural effusion or pneumothorax is seen. the cardiac silhouette is not enlarged. there is calcification at the aortic knob. the mediastinum is not widened. . impression: moderate right base consolidation, most likely in the right middle lobe, worrisome for pneumonia. . imaging: cxr- as compared to the previous radiograph, there is no relevant change. large right middle and lower lung pneumonia. no newly appeared parenchymal opacities. no pneumothorax, no reactive pleural effusions. no pulmonary edema. unchanged size of the cardiac silhouette. unchanged right internal jugular vein catheter. . 04:35am blood lactate-1.0 brief hospital course: community acquired pneumonia complicated by septic shock: presented with shortness of breath, fever, and leukocytosis as well as fevers to 105.1 farenheit at home. presented with evidence of endo-organ ischemia with lactate of 3.2 and creatinine of 2.1. cxr showed probable right middle/lower lobe pna. empirically started on vancomycin and levofloxacin. had hypotension to the 70's systolic prompting transfer to the icu. icu course complicated by brief episode of polymorphic ventricular tachycardia at which time patient found to have mg of 1.0. treated with magnesium which resolved episode. bolused several liters of fluid but remained hypotensive, prompting brief use of levophed drip. antibiotic coverage broadedned to include aztreonam. sputum cultures positive for gram positive cocci in pairs as well as gram negative diplococci. antibiotics changed to ceftraixone, levofloxacin, and vancomycin. continued to improve with oxygen requirements titrated down to room air. transferred to the general medical floors, where her antibiotic regimen was narrowed to ceftraixone and levofloxacin. she continued to improve on this course. given her icu admission for community acquired pneumonia, she was continued on cefpodoxime and levofloxacin for a total of a seven day course. should have follow up chest xray in six to eight weeks to assess for resolution of pulmonary disease. acute renal failure: likely pre-renal in the setting of hypotension from sepsis. creatinine intiially 2.1, but was down to baseline of 1.0 by the morning of . and hctz held in the setting of acute renal failure. restarted and hctz by time of discahrge. pancytopenia: thought to be dilutional in the setting of aggressive ivfs. hct baseline 33-35, platelets 150s. continued to have pancytoopenia on the general medical floors. by time of discharge, wbc 4.4, hct 25.7, plt 137. should follow up cbc to check for resolution of pancytopenia. if continues, should assess for drug induced cytopenia, or primary bone marrow disorder with peripheral smear and potential heme/onc follow up. copd/asthma: continued with albuterol/ipratropium, fluticasone/salmeterol, inhalers as well as montelukast. continued to have wheezes and cough while in house. diabetes mellitus ii: oral hypoglycemics held, pt started on iss while in hospital. restarted on oral hypoglycemics at time of discharge. normal glycemic during hosptial stay. hypertension: anti-hypertensives (metoprolol, losartan, hctz) held in setting of sepsis. restarted prior to discharge. hyperlipidemia: continued statin. gout: held allopurinol in setting of renal failure. restarted by time of discharge. tobacco abuse: nicotine patch. counseled on the importance of smoking cessation. hypothyroidism: continue levothyroxine. pending labs: none transitional issues: none medications on admission: albuterol sulfate 90 mcg hfa aerosol inhaler 2 puffs q4h:prn sob allopurinol 300 mg po daily fluticasone 50 mcg 1 - 2 sprays each nostril once a day fluticasone-salmeterol 500 mcg-50 mcg 1 puff bidipratropium-albuterol - 0.5 mg-2.5 mg/3 ml solution for nebulization - use via(s) nebulizer four times a day as needed for acute asthma levothyroxine 50 mcg tablet - 1 tablet(s) by mouth once a day before breakfast lidocaine 5 % tp daily 12h on 12h off losartan-hydrochlorothiazide 50 mg-12.5 mg po daily metformin 1000 mg po bid metoprolol succinate - 25 mg sr po daily montelukast 10 mg tablet po daily omeprazole 20 mg po daily simvastatin 20 mg po daily tylenol mvi nicotine lozenge discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 2. levofloxacin 750 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 3 days. disp:*3 tablet(s)* refills:*0* 3. cefpodoxime 100 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 3 days. disp:*12 tablet(s)* refills:*0* 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) inhalation every four (4) hours as needed for shortness of breath or wheezing. 5. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 6. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 7. allopurinol 300 mg tablet sig: one (1) tablet po once a day. 8. fluticasone 50 mcg/actuation spray, suspension sig: spray nasal once a day: sprays per nostril once a day. 9. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day: wash mouth out with water after use. 10. ipratropium-albuterol 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: one (1) nebulization inhalation qid prn: use as needed for acute asthma exacerbation. 11. levothyroxine 50 mcg tablet sig: one (1) tablet po once a day. 12. losartan-hydrochlorothiazide 50-12.5 mg tablet sig: one (1) tablet po once a day. 13. metformin 1,000 mg tablet sig: one (1) tablet po twice a day: take after breakfast and supper for diabetes. 14. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day: hold for sbp<100/ hr< 60. 15. acetaminophen extra strength 500 mg tablet sig: 1-2 tablets po once a day as needed for pain: can take up to four times a day as needed for pain. 16. multivitamin tablet sig: one (1) tablet po once a day. 17. nicotine (polacrilex) 4 mg lozenge sig: one (1) buccal prn as needed for tobacco craving. 18. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day: stool softener. 19. one touch ultra test strip sig: one (1) miscellaneous once a day: use once a day 2 hours after main meal for diabetes management of blood sugar. discharge disposition: home discharge diagnosis: primary: community acquired pneumonia complicated by pneumosepsis . secondary: diabetes mellitus: managed by oral hypoglycemics hypertension hyperlipidemia breast ca- lumpectomy in emphysema/copd: hypothyroidism peptic ulcer disease tobacco abuse discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was an absolute pleasure being involved in your care ms . you came to the hopsital with fevers and shortness of breath and were found to have a serious pneumonia (lung infection). because of the infection you also dropped your blood pressures and required a brief stay in the intensive care unit. you were treated with antibiotics and improved. your medications have changed as follows: . 1. we added cefpodoxime 200mg twice per day- take this for 3 more days 2. we added levofloxacin 750mg daily- take this for 3 more days . please continue to take your other medications as you have been. . thank you for letting us participate in your care! followup instructions: please keep your follow up appointment with your primary care doctor : . department: - adult med when: friday at 9:00 am with: , md building: (, ma) campus: off campus best parking: free parking on site procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified anemia, unspecified acute kidney failure with lesion of tubular necrosis diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis unspecified acquired hypothyroidism personal history of malignant neoplasm of breast personal history of tobacco use paroxysmal ventricular tachycardia other and unspecified hyperlipidemia septic shock chronic obstructive asthma, unspecified knee joint replacement leukocytosis, unspecified peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction irritable bowel syndrome allergic rhinitis due to other allergen 

Answer: The patient is high likely exposed to