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 63-year-old female with a history of restrictive lung disease of unclear etiology and syndrome status post whipple in . she presents in hypercarbic respiratory failure status post recent admission to the medical intensive care unit in early following a syncopal episode and similar hypercarbic respiratory failure. on that admission, arterial blood gas in the emergency department showed a ph of 7.14 and a pco2 of 123. the patient was admitted to the neonatal intensive care unit for further treatment. she was briefly treated with noninvasive mask ventilation and her ventilator status improved such that she was off noninvasive mask ventilation within 24 hours. on that admission she was noted to chronically hypoventilate. chest x-ray at the time showed left lower lobe atelectasis. pulmonary function tests done in early showed a restrictive pattern with an fev1 of 45% of predicted, an fvc of 34% of predicted with a ratio of 133% of predicted. additionally a tlc was 53% of predicted, frc was 70% of predicted, rv was 81% of predicted. the rv to tlc ratio was 153% of predicted. dsb (va) was 46% of predicted consistent with moderate reduction of diffusion capacity suggesting the possibility of interstitial disease, in addition to the likely neuromuscular disease that was suggested by her lung volumes. electromyogram was performed to assess for neurologic causes and showed no evidence for disorder of neuromuscular transmission, though there was some paraspinal denervation present acutely. additionally, an mri of the brain showed no lesions that might cause central apnea. over the course of that hospitalization the acidosis resolved without specific intervention and on discharge her blood gases showed a ph of 7.4 and pco2 of 71. she was discharged home on . the patient had been doing well at home although she had complained of some fatigue over the last three weeks. according to her sons she had two very active days just prior to the day of admission. at 7 am on the day of admission her sons left the house to go to work and reported that their mother was awake although still in bed. they returned home at approximately 9 pm and found their mother still in her pajamas, face down in the bed with decreased respirations. they performed rescue breathing and the patient was brought to the emergency department by ems. on arrival her blood gas showed a ph of 7.09, pco2 of 119, po2 of 198 and a bicarbonate of 38 with lactate of 7.4 and she was initiated on bipap and transferred to the medical intensive care unit for further management. for past medical history, allergies, medications, social history and family history, please refer to the admission note from . physical examination: the patient was resting on bipap and did arouse to voice. vital signs were blood pressure 84/38, heart rate 108, respiratory rate 14, saturating 100% on bipap with pressure support of 12 and 10. a repeat blood gas on those settings showed improvement to 7.20, 91, 160 and 40. skin was warm and dry. heent examination was normocephalic, atraumatic, sclerae anicteric. neck was supple with no lymphadenopathy and a jugular venous pressure of approximately 8 cm. lungs had poor inspiratory effort with a few scattered inspiratory squeaks. cardiovascularly she was tachycardic, s1 and s2, no murmur. abdomen was soft and nontender. extremities had no edema although cool hands and feet. on neurological examination the patient nodded to simple questions but was poorly attentive though did follow some simple commands. deep tendon reflexes were 3+/4 in the bilateral upper extremities. laboratory data: for complete admission laboratory studies please refer to the admission note from . briefly, pertinent laboratory studies included a chest x-ray that showed low lung volumes but no infiltrates. electrolytes were sodium 131, potassium 6.4, chloride 84, bicarbonate 28, bun 36, creatinine 1.2, glucose 352, with an anion gap of 19. white blood cell count was 11.8. hemoglobin 12.2, hematocrit 41.1, platelet count 296. hospital course: 1. respiratory failure: after admission the patient was placed on noninvasive mask ventilation and overnight her ph normalized. her pco2 improved. she also received 4?????? liters of normal saline with improvement of her blood pressure. currently the patient is doing well on 1?????? liters nasal cannula oxygen when she is awake and bipap with pressure support of 15 and 5, fio2 of 0.3 when she is sleeping. please note that the patient must be on bipap when she is sleeping otherwise she hypoventilates and goes into respiratory acidosis. her most recent blood gas showed a ph of 7.4 and a pco2 of 70. the etiology of her lung disease remains unclear at this point. high-resolution chest ct showed bilateral pleural effusions, small to moderate in size, right greater than left, with some nodular plaques along the pleura near the effusion. however there was no evidence of interstitial lung disease. right now it is thought that the most likely etiology of her respiratory failure is secondary to a neuromuscular process. emgs on the last admission showed that it was not likely that there was a problem with her synaptic transmission, thus putting myasthenia and lambert-eaton syndrome as the etiological causes low on the list. currently, neurology believes that it is likely that the patient has a myopathy and a muscle biopsy is planned. neurosurgery is aware of the patient and two residents have been , dr. , pager #39-510, and dr. , #90-206. they will be speaking with dr. , the neurosurgery attending today to see if they can arrange for a muscle biopsy this week for this patient. we have spoken with the neuropathologist, dr. , who has informed us that for technical reasons it is extremely important that the pathologist be present in the operating room when the muscle biopsy is taken in order for the muscle to be properly preserved. so once an or day and time is set, they need to be so that they can be present. neurology has said that based on the results of her emgs and on the fact that she has muscle weakness proximal greater than distal, the right deltoid is the best site for biopsy and neurosurgery has been so informed. additionally, the neurology and neuromuscular consultation services have requested that antibodies to -1, musk, and voltage-gated calcium channels be tested for, so we have sent those laboratory studies out. if the muscle biopsy is negative, neurology will consider repeating emgs with nerve conduction studies and possibly an mri of the spine as well. they will also consider doing a tensilon test at that time. finally, a diaphragmatic excursion test at the bedside was performed on and was grossly normal. 2. bacteremia: on the night of to the patient spiked a fever to 103 and cultures drawn at that time showed e. coli present in bottles. the patient was initially started on empiric therapy of ceftriaxone, flagyl, and levofloxacin. sensitivities of e. coli showed that it was in fact sensitive to levofloxacin so that has been continued for a total of a 10-day course and the ceftriaxone and flagyl have been discontinued. since then the patient has been afebrile for 72 hours now. cultures drawn on and have shown no growth to date. the source of the e. coli is presently unclear. urine cultures and urinalysis were negative for urinary tract infection. abdominal ct was negative for an intrahepatic abscess. there had been concern for this because the patient has intermittently increased her liver function tests. the pleural effusion on the patient's right side was tapped on and the results were consistent with an exudate. currently, cultures are pending. the gram stain showed pmns but no bacteria. cytology on the pleural fluid is also pending. 3. increased liver function tests: on admission the patient had increased liver function tests that were at the time thought to be secondary to her respiratory failure and poor oxygenation status on admission. they initially were trending down but bumped up on . they are again trending down. ultrasound and hepatitis serologies were all negative. ultrasound and abdominal ct showed no evidence of biliary disease although ultrasound can miss the majority of retained stones. if she bumps her liver function tests again, we will obtain a magnetic resonance cholangiopancreatography. 4. anemia: over the course of the hospitalization as we have fluid resuscitated the patient, her blood counts have been trending down, currently with a hemoglobin of 7.8 and an hematocrit of 26.7. studies revealed an iron of 18, ferritin of 46, and a calculated tibc of 230 consistent with iron deficiency anemia and we have started the patient on iron. 5. zollinger- syndrome: the patient is status post whipple antrectomy and vagotomy in . despite that procedure the patient has continued to have high gastrin levels and we have maintained her on protonix 40 mg p.o. t.i.d. 6. diabetes mellitus: the patient was noted on her last admission to have high sugars and we have continued her on a sliding scale. she will likely need to be started on an oral hypoglycemic . 7. access: the patient had a left subclavian line placed on . 8. code status: the patient is full code. condition on discharge: the patient's respiratory status has improved greatly since admission, although we still do not have an etiology for this problem. currently she is stable enough to go to the floor, though she needs to remain hospitalized until a diagnostic work-up has been completed and home health has been arranged for her to get training on the bipap machine. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified thoracentesis non-invasive mechanical ventilation open biopsy of soft tissue diagnoses: unspecified pleural effusion intestinal bypass or anastomosis status acute and chronic respiratory failure bacteremia myoneural disorders, unspecified thoracic or lumbosacral neuritis or radiculitis, unspecified glycogenosis abnormality of secretion of gastrin 

Answer: The patient is high likely exposed to