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: patient recorded as having no known allergies to drugs attending: chief complaint: sob, somnulent major surgical or invasive procedure: none history of present illness: 73 y/o with copd, osa, chf, recnet pna presents with sob and somulence. pt is disoriented and farsi only speaking . history obtained via daughter. daughter reports. 3 days of progressive sob, and increasing fatigue. on 2.5 to 3.5 l nc at baseline, reports sats in 70s on this amount with only minor increase in sat with increase to 8l. uses bipap at night at 16/8, no change in recent use. daughter notes progressive confusion, near falls. denies fevers, chills, cough, chest pain, palpatations, abd pain, urinary sytmpoms . in the ed, initial vs were: t 97.6 p 84 bp 110/58 r 28 o2 sat 100 ra. patient was given 125 iv solumedrol 125mg x1 and levo 750 mg x 1. started on bipap after abg on 4l nc showed 7.24/105/67, 94% on bipap. . on the floor, pt delerious but appears comfortable on bipap past medical history: - cad; s/p 4 vessel cabg in - chf; ef 55%, mild as - obesity hypoventilation syndrome - obstructive sleep apnea - dm2 - ventricular tachycardia; s/p icd in - hypothyroidism - schizophrenia - copd - pneumona treated in at social history: - lives in alone w/home health aide - daily visits from daughter - smoked 1.5 ppd x 30 years, quit in - at baseline can do most adls (wash face, comb hair, etc) family history: - mother died of mi (age unknown) physical exam: vitals: t:97.7 bp: 137/46 p: 71 r: 20 o2: 98% on bipap 8/5 general: alert, dis-oriented, mild resp distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp unable to interperate body habitus, no lad lungs: diffuse expiratory wheeze. minimal left ll crakles. diffusely diminished breath sounds. no ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: tense , non-tender, distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. tympanic to percussion ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. trace edema. pertinent results: labs on admission : wbc-8.1 rbc-3.02* hgb-8.9* hct-26.2* mcv-87 mch-29.4 plt ct-185 neuts-82.1* lymphs-11.7* monos-3.2 eos-2.7 baso-0.3 pt-11.7 ptt-22.7 inr(pt)-1.0 glucose-204* urean-28* creat-1.1 na-132* k-4.8 cl-88* hco3-38* angap-11 ck-mb-notdone probnp-2578* calcium-9.9 phos-3.0 mg-1.8 lactate-0.8 urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg . 09:47pm blood type-art po2-67* pco2-105* ph-7.24* caltco2-47* base xs-12 intubat-not intuba 12:46am blood type-art po2-61* pco2-80* ph-7.31* caltco2-42* base xs-9 blood culture x2: no growth to date urine culture: no growth other studies portable ap cxr: findings consistent with volume overload, likely due to congestive failure. repeat radiography following appropriate diuresis recommended to assess for underlying infection. rle u/s: no dvt of the right lower extremity. cxr: resolving pulmonary edema. no definite consolidation. cta chest: no pe, + pa htn, cardiomegaly and ca atherosclerotic disease, stable prominent mediastinal and b/l hilar ln (unchanged since ) cxr: prelim unchanged brief hospital course: this is a 73 y/o with copd, osa, obesity hypoventilation syndrome, chf presents with sob and somulence x 3 days . # hypercarbic resp failure: co2 of 105 on admit abg, improved to baseline of 80s with bipap. was using home oxygen and bipap. unclear of copd exacerbation, but may be related to bipap noncompliance. she was initially treated in the micu with iv steroids for copd exacerbation, then transitioned to po steroids. she was treated also with a short course of azithromycin. she was transferred from the micu to the floor on , but then was transferred back to the micu after becoming somnolent and agitated, as well as hypoxic. she was again treated with bipap, with improvement in her mental status. she had a cta negative for pe and cxr consistent with improving volume overload. she was seen by the sleep service, who diagnosed obstructive sleep apnea and obesity hypoventilation syndrome. they recommended initiation of bipap at a higher pressure, with abg checks, and allowing hypoxia to stimulate respiratory drive, so that goal o2 sat in the mid 80% range. she will need a formal sleep study as an outpatient to test different masks as well as different pressure settings. at discharge, her o2 sat was 87% on 2l, and her most recent abg showed a hco3 of 71, ph 7.41. . she remains dnr/dni. . # acute diastolic chf exacerbation: her respiratory decompensation appeared multifactorial, with admission cxr appearing volume overloaded. she was diuresed on her home dose of lasix, until she developed evidence of contraction alkalosis, and then it was held. she was discharged on her home dose of lasix, with daily weights. # nsvt: she had a single 9-beat run of nsvt in the icu. repeat ekg and lytes nl. . # dm2: while in the micu the patient had elevated blood sugars. she was managed with her glyburide and sliding scale insulin. her glyburide was increased at discharge to 10 mg po bid. # hyperlipidemia: simvastatin . # acute encephalopathy: hypercarbia exacerbated by steroids. she was initially continued on her home regimen of abilify, risperdal, and artane with haldol prn for extreme agitation. ultram, rozerem, benadryl were held. on her second visit to the icu, due to agitation, she was also seen by psychiatry. they recommended holding risperdal as needed for acute agitation. her mental status improved to baseline with improvement in her hypercarbia. her benadryl and ultram were not restarted. . # fen: she underwent swallow evaluation, and failed. she appears to aspirate chronically. her daughter (also hcp) was aware but refused recs and instead compromised to soft, thickened liquids. . # code: dnr/dni. -has icd in place, interrogated 1m ago. still active. medications on admission: tylneol 100mg q6h tramadol 50mg q6h lidocaine patch daily fluticacone propionate nasal spray qid rozerem 8mg qhs lasix 80mg qam glyburide 5mg toprolol 25mg daily asa 81mg daily colace 100mg qhs levothyroixine 125mcg daily medroxyprogestrone 10mg daily simvastatin 20mg daily diphenhydramine 50mg qhs abilify 40mg qhs risperdal 3mg qhs artane (ictrihexyphenidyl) 2mg qhs prenatal multivit daily calcium wiht vit d selenium 200 mcg daily phoslo 667 x 2 tid klor-con zinc vit b1 duo neb x daily advair hfa daily spriva 18mcg daily ntg prn discharge medications: 1. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain, fever. 2. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical dailyi (). 3. furosemide 80 mg tablet sig: one (1) tablet po once a day. 4. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal four times a day. 5. rozerem 8 mg tablet sig: one (1) tablet po once a day. 6. glyburide 5 mg tablet sig: two (2) tablet po bid (2 times a day): 10 mg in am, 5 mg in pm. disp:*90 tablet(s)* refills:*0* 7. toprol xl 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 11. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 12. aripiprazole 10 mg tablet sig: four (4) tablet po hs (at bedtime). 13. risperidone 1 mg tablet sig: three (3) tablet po hs (at bedtime). 14. trihexyphenidyl 2 mg tablet sig: one (1) tablet po hs (at bedtime). 15. multivitamin tablet sig: one (1) tablet po daily (daily). 16. calcium 500 with d 500 mg(1,250mg) -400 unit tablet sig: one (1) tablet po three times a day. 17. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) puff inhalation (2 times a day). 18. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) capsule inhalation once a day. 19. ibuprofen 600 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. 20. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation every four (4) hours as needed for sob, wheezing. 21. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q4h (every 4 hours) as needed for sob. 22. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: family & services discharge diagnosis: hypercarbic respiratory failure obstructive sleep apnea obestiy hypoventilation syndrome acute diastolic chf exacerbation chronic diastolic chf schizophrenia acute encephalopathy, metabolic discharge condition: stable, o2 sats 87 % on 2l, bipap 18/10 at night. discharge instructions: you were admitted with confusion due to your breathing problems. improved with bipap in the icu, as well as with removing fluid from your lungs. your oxygen level should stay between 83 and 88%, but less than 90%. you need to use your bipap every night at home. the sleep doctors contact to set up an appointment for a new sleep study. weigh yourself every day and call your doctor if your sweight goes up more than 3 lbs. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1.5 l return to the ed if you develop more confusion, trouble breathing, chest pain, palpitations, nausea, vomiting, diarrhea. followup instructions: provider: function lab phone: date/time: 11:40 provider: , m.d. phone: date/time: 12:00 . call the sleep clinic at to set up an appointment with dr. in . the sleep center will call you regarding a sleep study before then ( in the next 2 weeks) . . call the at to get a primary care doctor here at the . . procedure: non-invasive mechanical ventilation diagnoses: obstructive sleep apnea (adult)(pediatric) anemia, unspecified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status paroxysmal ventricular tachycardia constipation, unspecified acute respiratory failure automatic implantable cardiac defibrillator in situ obesity, unspecified metabolic encephalopathy schizophrenic disorders, residual type, unspecified 

Answer: The patient is high likely exposed to