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: effexor / cefepime attending: chief complaint: neck pain, sob major surgical or invasive procedure: none history of present illness: 69f h/o htn, hypothyroidism, tracheobronchomalacia s/p surgery , copd on 4l home o2, osa on vpap, prior admission for pna with and icu stay, who p/w 3d of pain in back of head, unsteady gait, and cough. pt states that her symptoms began 3-4 days ago with pain in the back of her head, more significant on the r side. it starts at the back of the head, near the occiput, and travels up the scalp to the forehead. this pain is intermittent, shooting sharp pain that happens every 5-10 min and has been increasing in frequency. she has tried ibuprofen for the pain but with no relif. she denies any associated dizziness, lightheadedness, or blurry vision. she has also been having a productive cough of thick, yellow sputum, along with increasing oxygen requirement. she notes that she has oxygen at home, but usually only uses it in the car (at 4l) but recently has been having to use it during the day as well. her wife, who is at her bedside, has noticed that the pt has had an unsteady gait for the past few days in which the pt will stumble after walking a few steps and she states she has to catch the pt to prevent her from falling. in ed vs were 98.6 86 122/68 16 95% 4l. labs significant for wbc 18.7 with left shift. cxr demonstrated large lul consolidation, widening of mediastinum lymphadenopathy. given levaquin 750mg iv x1. vs on transfer t 102.1, hr 88, bp 115/59, rr 22 - 26, spo2 95% on 4lo2 nc. on the floor, t 101.7, bp 124/60. she appeared comfortable and was accompanied by her wife who was at her bedside. her wife noted that she felt she had an upper respiratory tract infection about 4-5 days prior. she was experiencing the shooting pains at the back of her head during the interview, but she stated it didn't prevent her from doing her daily activities. she endorsed an intentional 70lb weight loss in the past 16 mos. review of systems: (+) per hpi (-) denies fever, chills, night sweats. denies sinus tenderness, rhinorrhea or congestion. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: hypertension hypothyroid restless leg syndrome copd tbm depression elevated cholesterol osteoarthritis gerd obstructive sleep apnea past surgical history: bilateral knee replacements oophorectomy on left tonsillectomy rotator cuff repair social history: lives with wife. works for the census bureau collecting data in hospitals. no current tobacco use, smoked 3ppd, quite 25 years ago. no history of drug use. she is a recovering alcoholic, sober since . the patient's weekly exercise regimen consists of exercising three times per week for 1 hour. family history: father: hypothyroidism, early onset alzheimer's disease, died at 65. mother: died of cva at age 85. physical exam: admission physical exam vs: t 100.1, bp 120/60, p 90, r 32, o2 93 4l ga: aox3, nad, calm and appropriate heent: perrla. mmm. no lad. no jvd. neck supple. cards: rrr s1/s2 heard. s3 auscultated. no murmurs/gallops/rubs. pulm: decreased breath sounds l>r, but no rales/wheezes/rhonchi abd: soft, nt, nd, +bs. extremities: wwp, no edema. radials, dps, pts 2+. skin: dry and intact pertinent results: admission labs 01:50pm blood wbc-18.7*# rbc-4.16* hgb-12.7 hct-38.5 mcv-93 mch-30.7 mchc-33.1 rdw-12.9 plt ct-256 01:50pm blood neuts-92.5* lymphs-3.8* monos-2.8 eos-0.8 baso-0 01:50pm blood glucose-115* urean-15 creat-1.0 na-134 k-3.5 cl-93* hco3-26 angap-19 05:55am blood alt-28 ast-34 alkphos-106* totbili-0.4 01:50pm blood calcium-8.5 phos-2.8 mg-2.3 12:06pm blood type-art po2-78* pco2-32* ph-7.50* caltco2-26 base xs-1 microbiology blood culture x2: blood culture x2: legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. mrsa screen: positive influenza dfa: negative and sputum cultures: contaminated by oral flora urine culture: pending at time of d/c, no growth to date blood culture: pending at time of d/c, no growth to date imaging ecg: normal sinus rhythm. left atrial enlargement. incomplete right bundle-branch block. compared to the previous tracing of ventricular bigeminy no longer exists. chest (pa & lat): there is widening of the mediastinum, particularly the right lower paratracheal region, compatible with lymphadenopathy, as demonstrated on the recent chest cts from and . there is a new consolidative opacity in the left upper lobe compatible with pneumonia. lungs are hyperinflated with lucency and relative attenuation of pulmonary vascular markings in the upper lobes compatible with underlying emphysema. no pleural effusion or pneumothorax is present. there are mild degenerative changes of the thoracic spine. right-sided rib deformities are unchanged. ct head w/o contrast: there is no evidence of acute hemorrhage, large acute territorial infarction, or large masses. there are bilateral subcortical and periventricular white matter hypodensities in keeping with chronic small vessel ischemic changes. ventricles and sulci are normal in size and configuration. mucosal thickening is seen in all the paranasal sinuses, most severe in the left frontal and right sphenoid sinus, with sparing of the right frontal sinus, which is . mastoid air cells are well pneumatized. chest (portable ap): lung volumes are lower today than yesterday and there is mild vascular congestion but not florid pulmonary edema. lower lung volumes exaggerate the size of the already large area of consolidation in the left upper lobe, but the overall impression is that it has grown. there is no appreciable left pleural effusion. mediastinal fullness suggests central lymph node enlargement, not surprising in the face of a large area of pneumonia. heart size is top normal. no pneumothorax. patient has had right chest surgery, entailing posterior upper rib fractures, which are not completely fused. ct chest w/o contrast: there is dense consolidation with air bronchograms centered predominantly within the lingula with extension into the apicoposterior segment of the superior lobe. scattered additional predominantly peripheral interstitial abnormalities were present on the prior examination and likely represent fibrosis. there is severe upper lobe predominant emphysema. a 3-mm left apical pulmonary nodule is unchanged (3:7), as is a 4-mm left lower lobe pulmonary nodule (3:27) dating back to , establishing one-year stability. there is mild bilateral dependent atelectasis. there are coronary artery and aortic calcifications. no pericardial effusion is seen. a left hilar node measures 2.0 cm in short axis, a right paratracheal node 1.5 cm in short axis, and a prevascular node 1.6 cm in short axis, all increased in size from ct. other smaller reactive nodes are noted throughout the mediastinum. chest x-ray: impression: compared to the film from two days prior, there has been some interval partial clearing of the dense left-sided infiltrate, which although still present, has slightly more aerated lung within it. right upper rib fractures are again seen secondary to prior surgery. there continues to be mild vascular congestion. chest x-ray: findings: in comparison with the study of , there is little overall change in the appearance of the heart and lungs. extensive bilateral opacifications are unchanged. no evidence of pleural effusion or vascular congestion kub: 1. normal gas pattern without evidence of obstruction or ileus. 2. no free air. 3. compression fracture of l5. cxr: pneumonia in the axillary region of the left lung continues to clear. change in patient positioning is probably responsible for greater prominence to the prevascular mediastinum crossing the upper portion of the right hilus. the heart is normal size. emphysema is severe, and the pulmonary fibrosis is likely at the lung periphery. there are no findings to suggest new pneumonia. discharge labs: 06:02am blood wbc-15.6* rbc-4.44 hgb-13.6 hct-40.6 mcv-91 mch-30.6 mchc-33.4 rdw-13.2 plt ct-587* 06:02am blood plt ct-587* 06:02am blood glucose-89 urean-23* creat-1.0 na-141 k-4.0 cl-104 hco3-28 angap-13 06:02am blood calcium-8.8 phos-4.4 mg-2.2 brief hospital course: 69f h/o htn, hypothyroidism, tracheobronchomalacia s/p surgery , copd on 4l home o2, osa on vpap, prior admission for pna with and icu stay, who p/w 3d of pain in back of head, unsteady gait, lul pna. # pneumonia - pt's high fever, cough, leukocytosis, chest x-ray all consistent with pneumonia. she was initially treated with levofloxacin 750mg po daily but on the second hospital day, pt triggered for fever to 103.2 and hypoxia. she was transfered to the icu on a non-rebreather mask with oxygen saturation sat 94%. her antibiotics were broadened to include vancomycin and cefepime upon transfer. while in the micu, her cefepime was discontinued due to adverse reaction (rash). she was continued on vancomycin. levaquin and tobramycin were added for double gram-negative coverage. her symptoms and radiographic findings improved significantly with this regimen that she finished on . # leukocytosis: despite improvement on the above antibiotic regimen for pneumonia, she developed a leukocytosis which peaked at 20 without clear cause. cxr and kub as well as laboratory studies were unrevealing. c diff infection was considered but patient did not stool and no sample was collected. given her overall clinic improvement with a lack of and pain or diarrhea and improving leukocytosis further testing was deferred. surveillance cultures remained no growth to date at the time of discharge. # copd/tracheobronchiomalacia - pt was continued on her home advair, zafirlukast, sprivia, proair, with albuterol nebs q6 standing, q2prn. # neck/head pain - etiology unclear. could be occipital neuralgia given the transient, intermittent, sharp shooting nature of the pain. pain was refractory to tylenol, increased dose of gabapentin, lidocaine patch and soft collar brace. # osa - vpap per home settings. # hypothyroidism - continued levothyroxine at home dose # gerd - continued home omeprazole # dyslipidemia - continued pravastatin # hypertension - continued triamterene-hctz . transitional: - follow up final blood and urine cultures. medications on admission: cabergoline 0.5 mg qod for rls fluticasone proprionate 50mcg: 2 sprays each nostril advair (inhaler) 250/50: 1 puff gabapentin 600mg qam, 900 mg qhs levothyroxine 137 mcg daily omeprazole delayed-release 40mg pravastatin 40 mg qhs sertraline 100 mg twice a day tolterodine 4 mg once a day triamterene-hydrochlorothiazid - 37.5-25 mg once a day zafirlukast 20mg ascorbic acid 500mg once daily calcium/mg/zn 333/133/5mg ferrous sulfate 65 mg centrum silver for women vitamin e 400 iu qd dha (fishoil/omega3oil) 250mg daily ic albuterol 90 mcg inhaler 1-2 puffs iprat-albuterol (via nebulizer) 1 0.5-3.0 mg ampule up to qid discharge medications: 1. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 2. zafirlukast 20 mg tablet sig: one (1) tablet po bid (2 times a day). 3. triamterene-hydrochlorothiazid 37.5-25 mg capsule sig: one (1) cap po daily (daily). 4. gabapentin 300 mg capsule sig: three (3) capsule po qhs (once a day (at bedtime)). 5. gabapentin 300 mg capsule sig: two (2) capsule po qam (once a day (in the morning)). 6. levothyroxine 137 mcg tablet sig: one (1) tablet po daily (daily). 7. sertraline 50 mg tablet sig: one (1) tablet po bid (2 times a day). 8. pravastatin 20 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 9. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 10. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation qid (4 times a day) as needed. 11. ipratropium-albuterol 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: one (1) cap inhalation qid prn as needed for shortness of breath or wheezing. 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po bid (2 times a day). 13. cabergoline 0.5 mg tablet sig: one (1) tablet po qod: rls. 14. fluticasone 50 mcg/actuation spray, suspension sig: one (1) puff nasal once a day: in each nostril. 15. tolterodine 4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po once a day. discharge disposition: extended care facility: health care center - discharge diagnosis: bacterial lobar pneumonia secondary dx: osa pulmonary hypertension pulmonary fibrosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mrs. , it was a pleasure taking care of you. you were admitted to the hospital for pneumonia. because you have underlying lung disease, you became very ill and temporarily required icu level care. you were treated with iv antibiotics and your condition improved. you are currently stable and we now believe that you are safe to leave the hospital for rehab. . please continue taking all of your home medications. . followup instructions: department: medical specialties when: monday at 1 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage department: rheumatology when: thursday at 12:30 pm with: , md building: lm bldg () campus: west best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux pure hypercholesterolemia unspecified essential hypertension unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified acute respiratory failure primary pulmonary hypertension postinflammatory pulmonary fibrosis knee joint replacement restless legs syndrome (rls) other dependence on machines, supplemental oxygen bacterial pneumonia, unspecified 

Answer: The patient is high likely exposed to