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: morphine attending: chief complaint: sob/copd major surgical or invasive procedure: mechanical intubation central line placement right femoral and right ij arctic sun s/p pea arrest history of present illness: 56 yo f with pmh copd and asthma who presented to osh with increasing sob x 3d. per family, despite report of sob, she was doing relatively fine until the day of admission, when she developed n/v/d. daughter came over to help transport pt to ed and says at that time she was c/o feeling like she "couldn't breathe" and having sweats. called paramedics who took patient to osh. at osh, pt was somnolent and minimally responsive. she was trialed on bipap and then intubated for resp distress and airway protection ams. after intubation her pressures dropped to 80s systolic and she was started on a levophed drip via ej peripheral line and sedated with propofol. a cxr showed a lll consolidation, so she was started on azithro/ctx and solumedrol and given 2l ivf. labs significant for na 141, k 3.8, bicarb 31, ag 9, cr 1.3, lactate 2.2, lfts wnl, inr 1.04, wbc 25.5, hct 41.9, plt 218she was transferred to . at she triggered on arrival for o2 sat 65%, though this was thought to be inaccurate pulse ox and first vital set in ed records noted to be 137, 68/55, 16, 99% ett. labs significant for wbc 18.8 (84% pmn), hct 38.3, plats 203, cr 1.6 (chem-7 otherwise unremarkable). u/a neg with 23 hyaline casts. patient had no prior records and baselines unknown. cxr showed lll pna. she was broadened to vanc/cefepime and the propofol was weaned. a right ij was placed and she was continued on levophed (at 4.5 upon transfer) with fentanyl/midaz for sedation. pressures improved to 92/57 with pressors. she was tachy to 130s on arrival. on transfer, hr 115, 92/57, 96% on cmv. she was sent for cta to r/o pe on way up to micu floor. on arrival to micu, vs 99.5, 111, 88/55, 16, 100% cmv. shortly after arrival to micu, pressures dropped and pt became pulseless. pt noted to have high auto-peep of 23 prior to arrest. a code blue was called and chest compressions started immediately. rhythm check was performed and pt noted to be in pea arrest. pt was coded for approx. 10 minutes after which time pulse was regained. during that time period she received 2 amps of epi, 2 amps of bicarb, and started on an epi drip. labs prior to arrival in micu revealed unremarkable electrolyte panel. decreased bs noted on left both before and during code, likely to lll pna. pt was very difficult to ventilate and there was concern for large ptx, however, this was not seen on cxr. cta was negative for pe. echo performed at bedside during code did not show pericardial effusion. repeat echo after code showed global hypokinesis. etiology was never identified but most likely explanation for arrest was thought to be worsened resp failure and subsequent acidosis. immediately after code we were unable to assess mental status since pt was already heavily sedated. arctic sun protocol was initiated and pt was paralyzed with cisatrocurium. she was on three pressors after stabilization - levophed, epinephrine, and neosynephrine with pressure 102/59, hr 105, 100% on cmv. review of systems: unable to obtain. sick contacts - baby granddaughter with h/o mrsa with whom she has frequent contact past medical history: copd (emphysema) - diagnosed 3 years ago, intubated at that time for 2 days, on 3l o2 at home asthma anxiety benign ovarian tumor s/p resection social history: lives at home with family. no pets. former smoker, quit 3 years ago. family history: nc physical exam: admission physical vitals: t:99.0 bp: 130/75 p: 120 r: 17 18 o2: 95% 2l nc general: alert, oriented x 3 male in no acute distress , speaking in full sentences. heent: sclera anicteric, dry mucous membranes, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rhythm,tachycardic, normal s1 + s2, no murmurs, rubs, gallops lungs: left insp. crackles, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley placed ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . discharge physical physical examination general: awake, alert, able to sit up with minimal assistance, pleasant, occasional cough heent/neck: mmm, clear oropharynx, no scleral icterus lungs: few scattered wheezes, no rhales, decreased air movement bilaterally cardiac: regular, no gallops, rubs abdomen: soft, non-distended, non-tender, bowel sounds present extremities: no edema neuro: awake, alert, appropriate. able to sit up with minimal assistance. pertinent results: admission labs 10:49pm type- po2-53* pco2-77* ph-7.10* total co2-25 base xs--7 10:49pm lactate-3.1* 10:44pm type-art po2-162* pco2-74* ph-7.14* total co2-27 base xs--5 10:19pm type-art po2-365* pco2-99* ph-7.02* total co2-28 base xs--8 intubated-intubated 10:06pm type-central ve po2-73* pco2-129* ph-6.95* total co2-31* base xs--8 10:06pm lactate-4.4* 09:54pm glucose-211* urea n-20 creat-1.5* sodium-142 potassium-4.8 chloride-108 total co2-27 anion gap-12 09:54pm ck(cpk)-124 09:54pm ck-mb-4 ctropnt-<0.01 09:54pm calcium-6.8* phosphate-5.3* magnesium-1.9 09:54pm wbc-23.8* rbc-3.17* hgb-10.0* hct-31.1* mcv-98 mch-31.4 mchc-32.0 rdw-13.6 09:54pm plt count-174 09:54pm pt-17.1* ptt-65.0* inr(pt)-1.6* 08:05pm temp-36.7 rates-/14 tidal vol-400 peep-5 o2-50 po2-94 pco2-65* ph-7.17* total co2-25 base xs--5 intubated-intubated vent-spontaneou 08:05pm o2 sat-95 06:24pm type-art rates-14/0 tidal vol-450 peep-5 o2-100 po2-397* pco2-61* ph-7.22* total co2-26 base xs--3 aado2-251 req o2-50 intubated-intubated vent-controlled 06:15pm urine color-yellow appear-hazy sp -1.014 06:15pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.0 leuk-neg 06:15pm urine hyaline-23* 06:15pm urine mucous-few 06:00pm glucose-98 urea n-19 creat-1.6* sodium-145 potassium-3.8 chloride-109* total co2-24 anion gap-16 06:00pm estgfr-using this 06:00pm ck(cpk)-143 06:00pm ck-mb-4 ctropnt-0.01 06:00pm wbc-18.8* rbc-4.00* hgb-12.3 hct-38.3 mcv-96 mch-30.8 mchc-32.1 rdw-13.6 06:00pm neuts-84* bands-11* lymphs-4* monos-1* eos-0 basos-0 atyps-0 metas-0 myelos-0 06:00pm hypochrom-normal anisocyt-occasional poikilocy-normal macrocyt-normal microcyt-normal polychrom-occasional stippled-occasional 06:00pm plt count-203 06:00pm urine color-yellow appear-clear sp -1.014 06:00pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.0 leuk-neg 06:00pm urine rbc-1 wbc-3 bacteria-few yeast-none epi-0 06:00pm urine granular-1* hyaline-23* 06:00pm urine mucous-occ . 07:25am blood wbc-21.2* rbc-3.28* hgb-10.0* hct-31.5* mcv-96 mch-30.4 mchc-31.7 rdw-13.8 plt ct-160 03:52am blood wbc-25.0* rbc-3.41* hgb-10.3* hct-32.0* mcv-94 mch-30.2 mchc-32.2 rdw-14.0 plt ct-131* 03:46am blood wbc-14.5* rbc-3.00*# hgb-9.3*# hct-28.1* mcv-94 mch-31.0 mchc-33.1 rdw-14.0 plt ct-65* 03:21pm blood wbc-12.9* rbc-2.54* hgb-7.9* hct-24.6* mcv-97 mch-31.1 mchc-32.1 rdw-13.8 plt ct-47* 03:10am blood wbc-14.3* rbc-2.65* hgb-8.2* hct-25.1* mcv-95 mch-30.9 mchc-32.7 rdw-13.6 plt ct-47* 04:15am blood wbc-18.6* rbc-3.60* hgb-11.2* hct-34.0* mcv-94 mch-31.0 mchc-32.8 rdw-14.0 plt ct-78* 09:51pm blood wbc-17.0* rbc-3.48* hgb-10.8* hct-33.2* mcv-95 mch-31.0 mchc-32.5 rdw-14.0 plt ct-83* 03:52am blood neuts-95.8* lymphs-2.2* monos-1.7* eos-0 baso-0.4 03:14am blood neuts-82* bands-5 lymphs-0 monos-6 eos-0 baso-0 atyps-2* metas-4* myelos-0 promyel-1* 03:46am blood neuts-83* bands-1 lymphs-3* monos-11 eos-0 baso-0 atyps-0 metas-2* myelos-0 nrbc-1* 03:10am blood neuts-90* bands-2 lymphs-3* monos-3 eos-0 baso-0 atyps-0 metas-2* myelos-0 07:25am blood plt ct-160 03:52am blood pt-13.5* ptt-24.0* inr(pt)-1.3* 03:14am blood pt-12.7* ptt-22.5* inr(pt)-1.2* 03:46am blood plt ct-65* 03:46am blood pt-12.6* ptt-22.6* inr(pt)-1.2* 02:50am blood glucose-155* urean-24* creat-0.7 na-140 k-5.0 cl-98 hco3-33* angap-14 03:19pm blood glucose-233* urean-28* creat-0.6 na-141 k-4.4 cl-96 hco3-38* angap-11 07:25am blood glucose-101* urean-29* creat-0.6 na-146* k-4.3 cl-101 hco3-40* angap-9 04:12am blood glucose-210* urean-33* creat-0.8 na-145 k-4.2 cl-98 hco3-42* angap-9 03:47pm blood glucose-149* urean-51* creat-1.0 na-146* k-3.0* cl-98 hco3-41* angap-10 11:25pm blood glucose-319* urean-45* creat-1.0 na-145 k-5.4* cl-98 hco3-39* angap-13 03:52am blood alt-35 ast-25 ld(ldh)-514* alkphos-78 totbili-0.9 03:14am blood alt-39 ast-38 ld(ldh)-577* alkphos-80 totbili-0.5 03:59am blood ld(ldh)-199 totbili-0.1 03:10am blood alt-52* ast-17 ld(ldh)-187 ck(cpk)-134 alkphos-73 totbili-0.2 04:15am blood alt-89* ast-59* ld(ldh)-252* alkphos-59 totbili-0.6 04:11am blood alt-54* ast-56* alkphos-56 totbili-0.7 02:50am blood calcium-9.3 phos-3.0 mg-2.2 03:19pm blood calcium-9.0 phos-3.4 mg-2.2 07:25am blood calcium-8.4 phos-4.0 mg-2.3 04:12am blood calcium-9.0 phos-2.7 mg-2.4 03:59am blood hapto-375* 11:06am blood %hba1c-5.3 eag-105 09:15pm blood type-art po2-106* pco2-53* ph-7.40 caltco2-34* base xs-5 05:08pm blood type-art po2-102 pco2-69* ph-7.29* caltco2-35* base xs-3 02:53pm blood type-art temp-37.1 rates-/21 tidal v-400 peep-0 fio2-40 po2-138* pco2-50* ph-7.43 caltco2-34* base xs-8 intubat-intubated vent-spontaneou 11:39am blood type-art rates-/17 peep-8 fio2-40 po2-124* pco2-46* ph-7.44 caltco2-32* base xs-6 intubat-intubated vent-spontaneou 09:35pm blood type-art po2-124* pco2-44 ph-7.41 caltco2-29 base xs-3 04:11pm blood glucose-164* 04:10am blood lactate-1.6 01:23am blood lactate-3.4* 08:51pm blood lactate-3.6* 05:53pm blood lactate-3.8* 02:10am blood lactate-2.5* 10:49pm blood lactate-3.1* 10:06pm blood lactate-4.4* tte: impression: suboptimal image quality. normal biventricular cavity sizes with low normal global systolic function. right ventricular cavity enlargement with mild free wall hypokinesis. compared with the prior study (images reviewed) of , global left ventricular systolic function is improved. the severity of mitral regurgitation and tricuspid regurgitation are now reduced. cta chest: 1. dense consolidation in the left upper lobe, consistent with pneumonia. small parapneumonic left effusion. findings are superimposed on a background of emphysema. 2. no evidence of pulmonary embolism. 3. no acute findings within the abdomen or pelvis. brief hospital course: 56 year old female with pmh copd and asthma who transferred from osh with lll pna who went into pea arrest upon arrival to micu s/p resuscitation on arctic sun cooling protocol now extubated, treated for strep pneumonia, and severe copd exacerbation. # lll pna-found to have a lingular/lll consolidation on cxr. grew strep pneumomia from sputum cx. treated with 8 days of ceftriaxone and levofloxacin. --> will need pneumovax on or after discharge from rehab facility #copd exacerbation- was intubated for resp failure and started on iv steroids during whole admission which was transitioned to oral prednisone 40 mg daily on . was also placed on standing albuterol q4h and ipratroipium q6h during the admission and is stable on this regimen. will need aggressive pulm rehab and outpatient pulmonology follow up. has not been on bipap since which she intermittently needed since extubation on . will benefit from formal sleep eval. goal oxygen sat should be 90-94% given severe copd. placed on bactrim prophylaxis, home pantoprazole and started calcium and vitamin d. --> please slow taper prednisone but should not be discontinued until followed by pulmonology due to severity of her asthma and her history on always being on prednisone. #constipation-severe until when it was resolved with aggressive bowel reg of lactulose, senna, colace and bisacodyl. now having florid bowel movements. # leukocytosis: s/p treatment for pna. be secondary to left shift from steroids. cxr improved. no fevers. lines pulled but wbc count stable at approx. 20 for days. # thrombocytopenia: likely ceftriaxone induced, hit ab negative, now resolved. # anemia: hemolysis labs negative. guaiac stools neg. likely marrow suppression from medications vs acute illness, stable hct at approx. 30. # hypernatremia: at times has been mildly hypernatremic to 148, resolved with oral water intake, with normal sodium level on #hyperglycemia- start 8 units of lantus, and sliding scale. likely due to iv steroids. running low 100s. will adjust dosing as needed ,please monitor sugar as steroids are weaned off as want to avoid hypoglycemia. --> please monitor her sugars and decrease lantus as needed. she did not require insulin prior to her hospital stay on higher dose steroids. # nutrition: was receiving tube feeds through ng tube because of failed speech and swallow eval. on passed a second speech and swallow eval and started oral intake. # communication: hcp is daughter # code: full code medications on admission: tiotropium 1 cap daily advair 500/50 one puff albuterol inhaler 2 puff q4h prn albuterol neb q4h prn prednisone 10mg po daily lorazepam 1mg q4h prn citalopram 20mg po daily oxygen 3l pantoprazole 40mg po daily discharge medications: 1. sulfameth/trimethoprim ss 1 tab po daily 2. pantoprazole 40 mg po q12h 3. albuterol 0.083% neb soln 1 neb ih q4h 4. albuterol 0.083% neb soln 1 neb ih q2h:prn sob/wheezing 5. fluticasone-salmeterol diskus (500/50) 1 inh ih 6. ipratropium bromide neb 1 neb ih q6h 7. lorazepam 0.5-1 mg po q4h:prn anxiety 8. glargine 8 units bedtime insulin sc sliding scale using hum insulin 9. bisacodyl 10 mg po/pr daily:prn constipation 10. docusate sodium (liquid) 100 mg po bid 11. senna 1 tab po bid:prn constipation 12. artificial tear ointment 1 appl both eyes prn dry eyes 13. chloraseptic throat spray 1 spry po q6h:prn odynophagia 14. heparin 5000 unit sc tid 15. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 16. glucagon 1 mg im q15min:prn hypoglycemia protocol 17. diltiazem extended-release 360 mg po daily hold for sbp<100 or hr<60 18. prednisone 40 mg po daily 19. citalopram 20 mg po daily 20. vitamin d 1200 unit po daily discharge disposition: extended care facility: - discharge diagnosis: copd exacerbation pneumonia strep pea arrest discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure caring for you at the hospital. . you were admitted to the hospital after having difficulty breathing. you were intubated and put on a breathing machine for a period of time. you were found to have a pneumonia and a severe copd exacerbation. your admission was complicated by your heart stopping and you underwent cpr and a cooling protocol. you recovered and were taken off the breathing machine. you are now being transferred to a rehab facility for further care. . please follow the attatched medication list which will be continued at rehab. . please establish care with a pulmonologist once leaving rehab. . you should also receive pneumovax with your primary care physician after discharge followup instructions: follow with the rehab facility procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances other bronchoscopy cardiopulmonary resuscitation, not otherwise specified diagnoses: acidosis anemia, unspecified adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified acquired coagulation factor deficiency severe sepsis personal history of tobacco use constipation, unspecified acute and chronic respiratory failure cardiac arrest paralytic ileus chronic obstructive asthma with (acute) exacerbation pneumococcal septicemia [streptococcus pneumoniae septicemia] pneumococcal pneumonia [streptococcus pneumoniae pneumonia] hyperosmolality and/or hypernatremia cephalosporin group causing adverse effects in therapeutic use other dependence on machines, supplemental oxygen other secondary thrombocytopenia secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified 

Answer: The patient is high likely exposed to