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: sulfa (sulfonamide antibiotics) / tetracycline / penicillins attending: chief complaint: respiratory failure major surgical or invasive procedure: none history of present illness: this is an 84 year old female with chronic diastolic heart failure, chronic obstructive pulmonary disease, chronic bilateral pleural effusions status post pleurex cathether placement in , diabetes mellitus, hypertension, and anemia who precented from rehab with acute respiratory failure. she had been at rehab after a prolonged admission chf and pleural effusions requiring pleurex catheter placement. her effusions were transudative and thought to be due to her chf. her medical regimen was optimized and she was sent to rehab. at rehab she had been doing well except for a fall complicated by a left hip fracture and was awaiting orif at the time of her presentation here. she had also received 2 units prbcs for anemia during her stay and had her left sided pleurex catheter removed on after pleurodesis and reported talc therapy. there was also report of a recent ct scan prior to admission noting a right pleural effusion with question of loculations. on the morning of transfer, she was noted to be tachypneic and in respiratory distress. abg was 7.28/69/87. she was put on bipap with improvement. thoracentesis was attempted but fluid could not be removed so she was given lasix 120mg iv x1 and transferred to . on arrival to the micu, she was on a nrb and somnolent, not arousable to stimuli. bipap was initiated and cxr was performed. she was started on vancomycin and aztreonam and ruled out for influenza. she improved rapidly and was oxygenating normally on room air. review of systems: negative except per hpi. past medical history: - chronic bilateral effusions: thought secondary to chf (were transudative during last admission) s/p pleurex catheter placement on l in . - congestive heart failure diastolic dysfunction - copd - anemia - hypertension - hypercholesterolemia - type 2 diabetes mellitus - breast ca s/p lumpectomy/radiation in - right cae - pvd social history: married lives with husband who has dementia, until recently discharged to rehab after previous admission. tobacco: 50 pack year quit 18 years ago. etoh: none family history: father died lung cancer age 51 physical exam: vs: 98.3 hr 87 bp 126/45 rr 26 sat 96-98%/nc gen: alert, conversant, in nad heent: mmm, op clear, perrl, anicteric sclera neck: supple, + jvp to 10cm heart: rrr, 2/6 sem at base, no radiation lungs: crackles to midlung r>l abdomen: soft, nt/nd + bs, no rebound or guarding ext: warm, well perfused, no pitting edema, 1+ dp pulses skin: diffuse ecchymoses neuro: moves all extremities, follows commands. pertinent results: cxr : bilateraly pulm infiltrates with small bilat pleural effusions, and mild pulm edema. effusions intervally improved since last study. ekg: nsr 93 bpm, nl axis and intervals. good r wave progression. no significant change from prior dated . radiology ct chest w/o contrast 1. more loculated moderate bilateral pleural effusion, slightly decreased in size on the right, unchanged on the left with new dense opacities, probably due to talc injection in the intervall. 2. diffuse septal thickening and ground-glass opacity, likely due to pulmonary edema. 3. enlarging mediastinal lymph nodes, likely reactive. 4. patent left lower lobe bronchus with improved aeration of the left lower lobe, but persistent peripheral opacities and atelectasis. 5. extensive coronary artery calcification, mitral annulus and aortic annulus calcifications. 6. clips in the left breast and left axillary region, likely due to prior breast cancer. prior vertebroplasty. 7. small hiatal hernia. radiology hip unilat min 2 views fluoroscopic images show placement of a gamma nail and metallic plate transfixing previously described comminuted fracture of the inner trochanteric region with apparent separation of the lesser trochanter. further information can be gathered from the operative report. brief hospital course: 84f with chf, copd who sustained a hip fracture and pneumonia after pleuodesis/pleurx placement for chronic pleural effusions, now s/p orif on . delirium: patient with delirium in setting of morphine use, mild hypoxia, and hosptialization for hip fracture. currently improved after mimized narcotics, antipsychotics as needed, continued reorientation, low dose quetiapine for sleep. geriatrics followed. pneumonia and hypoxia: patient presented with acute hypoxia likely related to volume overload and pneumonia. she lives in and thus is at risk for mrsa. acute decompensation in the setting of leukocytosis and bilateral pulmonary infiltrate consistent with healthcare assoc pneumonia. she was treated with vanc/levofloxacin for 7 day course to . viral respiratory panel prelim result was negative. a repeat ct showed effusions to be not increased in size from prior. per ip consulatants, likely will not benefit from thoracentesis. o2 sat remained in 80's on room air but easily rose to low 90's on 1l of room air. continued hypoxia presumed due to a degree of persistent heart failure exacerbation. chronic diastolic heart failure: she has diastolic heart failure with an ef of 80% on . she was volume overloaded on exam and x-ray on transfer from the icu. she responded well to two days of 40 mg twice daily iv lasix. diuresis was limited by renal function. as hydralizine and afterload reduction has no demonstrated role in the treatment of diastolic heart failure and is difficult to take because of frequent dosing, this medication was stopped. she was started on an increased dose of metoprolol. she will also be discharged on a slightly increased furosemide dose of 60 mg po bid. hip fracture: she tolerated orif on very well, with a plate and gamma nail placed. she was anticoagulated with lovenox. physical therapy evaluated. she will be discharged to acute rehab for further pt/ot. she may weight bear as tolerated per orthopedics. copd: at baseline, with abg evidence of chronic retention. she was continued on bronchodilators and given oxygen with goal sat 89-92. she was unable to get back down to room air during this admission so will be discharged on 1l o2 by nasal cannula. expectation is she may be able to be advanced back to room air with further gently diuresis. ckd: she is at her baseline of .3. medications were renally dosed and cr. remained stable. mediastinal lymphadenopathy: she was noted to have mediastinal lymphadenopathy at her presentation that was considered most likely due to reactive lymphadenopathy secondary to her pneumonia. this should be followed up with a repeat scan in months. diabetes type 2: she was continued on glargine and a humalog sliding scale. htn: she was continued on her metoprolol on isosorbide. fen: she received a regular/heart healthy diet. prophylaxis: lovenox, ppi, bowel regimen access: midline was discontinued, piv code: dnr/dni, discussed with family medications on admission: lispro insulin sliding scale glargine 15 units qpm bimatoprost 1 drop qhs folic acid 1mg daily simvastatin 20mg hs zolpidem 5mg qhs protonix 40mg daily furosemide 60mg daily hydralazine 25mg tid metoprolol 50mg qid tylenol 325mg q4prn percocet 5/325 1 tab q8prn lorazepam 0.5mg q4 prn keterolac 15mg q4 prn loperamide 2mg q4 prn risendronate 35mg qsaturday epo 40,000 qmonday discharge medications: 1. insulin glargine 100 unit/ml solution sig: fifteen (15) units subcutaneous at bedtime. 2. insulin lispro 100 unit/ml cartridge sig: 0-10 subcutaneous as directed per sliding scale. 3. bimatoprost 0.03 % drops sig: one (1) ophthalmic at bedtime. 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. metoprolol succinate 100 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po daily (daily). 8. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day). 9. risedronate 35 mg tablet sig: one (1) tablet po once a week: on saturday. 10. epoetin alfa 40,000 unit/ml solution sig: one (1) ml injection once a week: on monday. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 13. calcium citrate + d 315-200 mg-unit tablet sig: two (2) tablet po twice a day. 14. quetiapine 25 mg tablet sig: 0.5 tablet po qhs (once a day (at bedtime)) as needed for insomnia. 15. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 16. tramadol 50 mg tablet sig: 0.5 tablet po bid (2 times a day) as needed for pain. 17. enoxaparin 30 mg/0.3 ml syringe sig: one (1) inj subcutaneous q24h (every 24 hours). 18. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): 12 hours on. 19. furosemide 40 mg tablet sig: 1.5 tablets po twice a day: please note, patient's baseline regimen is 40 mg po bid. this increased dose is to achieve some increased diuresis. please continue this dose until patient is able to be weaned to o2 sats of 88-92% on room air. then reduce patient back to 40 mg po bid. 20. outpatient lab work please check bun/cr/na/k/cl/hco3 twice a week while on increased furosemide dose (60 mg po bid). contact md with results. discharge disposition: extended care facility: oak knowle discharge diagnosis: delirium pneumonia acute on chronic diastolic heart failure left hip fracture copd chronic kidney disease diabetes type 2 discharge condition: stable discharge instructions: you were admitted with a fracture and pneumonia. we treated your pneumonia with antibiotics and did operative repair on your hip. you developed delerium and shortness of breath during your hospital course, which were treated by adjusting your medications. please take your medications exactly as instructed to avoid future problems. please visit your local emergency department or call your doctor if you have chest pain, shortness of breath, fevers, chills, acute worsening of your pain, or any other dramatic changes in your health. followup instructions: provider: , md phone: date/time: 3:40 orthopedics np on at 10:20 am. appointment is at ortho clinic. if need to reschedule or cancel call . procedure: open reduction of fracture with internal fixation, femur diagnoses: pneumonia, organism unspecified anemia, unspecified unspecified pleural effusion congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified acute on chronic diastolic heart failure personal history of malignant neoplasm of breast chronic kidney disease, unspecified acute respiratory failure fall from other slipping, tripping, or stumbling delirium due to conditions classified elsewhere closed fracture of intertrochanteric section of neck of femur 

Answer: The patient is high likely exposed to