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: no known allergies / adverse drug reactions attending: chief complaint: hemoptysis major surgical or invasive procedure: intubation bronchoscopy rigid bronchoscopy bronchial artery embolization history of present illness: this is a 79 year old female with pmh history significant for tuberculosis treated 20 years prior, bronchiectasis on 2l home oxygen, asd s/p surgical repair with resultant atrial fibrillation, history of subdural hematoma and rectus sheath hematoma secondary to coumadin and multiple tias off of anticoagulation, on dabigatran for several weeks who presented initially to osh for hemoptysis and transferred to for further evaluation. per report, patient with several coughing episodes last night with hemoptysis of several teaspoons of bright red blood. she went to bed without incident. on the day of admission, patient developed massive amounts of hemoptysis (several cupfulls) at 1pm today, and was taken to an osh. there, she was found to be tachycardic to the 120s and hypoxic to 85% (on unclear amount of oxygen) with stable hematocrit of 42.7 and an inr of 1.1. other labs notable for wbc of 15.3, dig level of 0.7, trop of 0.01, ck: 51, sodium 126. she was intubated for airway protection. chest radiograph without acute process. thoracic surgery team performed bronchoscopy who found blood in the rll; no intervention was performed. ng tube was placed and drained coffee ground material. at ed, initial vital signs were 130/80, 80, 16, 100%. repeat hct was 39.5 and inr was 1.3. ng lavage was clear. chest radiograph demonstrated opacities bilaterally concerning for blood vs. aspiration. ip was consulted and patient was taken emergently to or for rigid bronchoscopy, which demonstrated large clot in rll with active oozing around the clot. bal was performed. left lung was suctioned of blood. double lumen endotracheal tube was placed to protect the left lung. plan was for ir to evaluate patient for bronchial artery embolization. past medical history: - atrial fibrillation, previously on coumadin but now on dabigatran - history of subdural bleed 3 years ago while on coumadin with some dysarthria and right sided weakness - history of multiple tias (most recently 2 weeks ago) while off coumadin (restarted coumadin several years ago) -> stopped definitively on 10/. restarted dabigatran several weeks ago. - history of large rectus sheath hematoma in - htn - gerd - history of tuberculosis treated 20 years ago - bronchiectasis with home oxygen of 2l - asd s/p surgical repair 10 years prior with development of atrial fibrillation after procedure - chronic hyponatremia ? secondary to siadh social history: lives with family in . prior 15 pack year smoking history. no alcohol or other illicit drug use. family history: nc physical exam: admission: vs: temp: bp: 126/61 hr: 74 rr: 25 o2sat, 100% on vent. gen: intubated heent: pupils round, 3mm, and sluggishly reactive to light resp: lungs clear to auscultation from the anterior chest wall cv: rrr, s1 and s2 wnl, no m/r/g abd: soft, nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: intubated, pupil exam as above. . discharge: vs: temp: 96.4 bp: 144/78 hr: 64 rr: 18 o2sat: 98%2l nc ga: aox2, nad heent: mmm. no lad. no jvd. neck supple. cards: irreg irreg, s1/s2 heard. no murmurs/gallops/rubs. pulm: ctab, no wheezes or rhonchi abd: soft, nt, +bs. no g/rt. palpable r periumbical subcutaneous mass, non-tender, non-fluctuant extremities: wwp, no edema in le bilaterally. dps, pts 2+. skin: dry, ecchymoses on ue bilaterally neuro/psych: cns ii-xii grossly intact. 4/5 strength in u/l ext, r<l. sensation intact to lt. gait deferred. able to perform dotw forward. pertinent results: admission labs: 06:10pm glucose-108* urea n-18 creat-0.5 sodium-131* potassium-4.3 chloride-91* total co2-31 anion gap-13 06:10pm osmolal-273* 06:10pm wbc-10.7 rbc-4.16* hgb-12.8 hct-39.5 mcv-95 mch-30.8 mchc-32.4 rdw-14.8 06:10pm neuts-86.4* lymphs-10.0* monos-3.1 eos-0.3 basos-0.3 06:10pm plt count-231 06:10pm pt-15.1* ptt-34.1 inr(pt)-1.3* 03:08 digoxin 0.8* . discharge labs: 05:47am blood wbc-6.2 rbc-3.27* hgb-10.0* hct-30.5* mcv-93 mch-30.6 mchc-32.9 rdw-14.8 plt ct-545* 05:47am blood glucose-86 urean-15 creat-0.5 na-136 k-3.8 cl-95* hco3-34* angap-11 05:47am blood calcium-8.6 phos-3.4 mg-2.2 . cardiac enzymes: ck-mb ctropnt 05:09 2 <0.011 21:43 2 <0.011 13:01 2 <0.011 05:43 2 <0.011 03:59 2 <0.011 . microbiology: stool clostridium difficile toxin a & b test-neg stool clostridium difficile toxin a & b test-neg blood culture-neg mini-bal gram stain-gnrs; respiratory culture-pseudomonas aeruginosa. 10,000-100,000 organisms/ml; legionella culture-preliminary; fungal culture-ngtd; acid fast smear-neg; acid fast culture-ngtd bronchoalveolar lavage gram stain-final; respiratory culture-final {pseudomonas aeruginosa, pseudomonas aeruginosa} inpatient urine culture-neg blood culture-neg urine culture-neg bronchial washings gram stain-neg; respiratory culture- pseudomonas aeruginosa | pseudomonas aeruginosa | | amikacin-------------- 32 i 16 s cefepime-------------- 16 i 16 i ceftazidime----------- 2 s 4 s ciprofloxacin--------- =>4 r =>4 r gentamicin------------ =>16 r =>16 r meropenem------------- 1 s 1 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ =>16 r =>16 r acid fast smear-neg; acid fast culture-preliminary; fungal culture-ngtd; potassium hydroxide preparation-cancelled; legionella culture-neg mrsa screen-neg . imaging: chest radiograph (): 1. et tube 6 cm above carina. 2. endogastric tube side port just at the ge junction, would recommend advancing approximately 5 more cm to ensure that it is within the stomach. 3. patchy opacities throughout the lungs may represent aspiration or hemorrhage in this patient with hemoptysis. 4. prominent right apical opacity may be prominent assymetic pleural thickening. recommend correlation with history of malignancy and chest ct for further evaluation. . bronch report (): large clot in rll, actively oozing around clot. clot was not disturbed. . tte (): the left and right atria are moderately dilated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the right ventricular cavity is dilated. free wall motion is low normal. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. mild to moderate (+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: suboptimal image quality. normal biventricular cavity sizes with preserved global biventricular systolic function. pulmonary artery hypertension. moderaet mitral regurgitation. mild aortic regurgitation. . rigid bronch report (): once the patient was relaxed, the rigid bronchoscope was introduced into the oral cavity and followed along the double lumen endotracheal tube until the cords were visualized. at that point in time, the tracheal cuff on the double lumen was deflated and the tube was pulled back as the rigid scope intubated the cords and was positioned in the trachea. once in good position, jet ventilation was started. the flexible bronchoscope was then introduced through the rigid barrel and complete airway surveillance was done to subsegmental bronchi. noted was a large amount of clot burden on the right side, but no active bleeding. the left side was clear and some minimal areas of secretions were all cleared with the flexible scope. large amounts of clot were removed from the all segments of the right lower lobe, including the posterior segment as well as the right middle lobe. there were no signs of active bleeding. no endobronchial lesion visualized. the flexible scope was then removed. a cook catheter was introduced through the rigid scope. the rigid was removed and a single lumen a tracheal tube introduced via direct visualization by anesthesia. the tube was then confirmed to be approximately 2 cm above the carina via bronchoscopy. the bronchoscope was removed. the procedure was ended with no complications. brief hospital course: -please check cbc and chem 7 in 1 week to monitor for resolution of isolated thrombocytosis, check renal function, potassium after starting ace-i . 79f w/pmh significant for bronchiectasis, afib s/o ir guided embolization for hemoptysis now called out from micu for continued medical management of vap; episode of chest pain during admission w/ekg changes, ces negative x 3. . micu course - ; transferred to floor from - . # hemoptysis: resolved s/p right bronchial artery embolization. initially unclear etiology, with broad differential including bleeding in setting of bronchiectasis on dabigatran and overlying infection. on admission to the micu was s/p bronch demonstrating large clot in rll with oozing. double lumen endotracheal tube was in place to protect the left lung from future bleeding and underwent emergent ir bronchial artery embolization of right bronchial artery embolization using 300-500 mic embospheres -> enlarged hypertrophic arteries suggestive of bleeding. 2 arteries supplying rll, both embolized. subsequently the patient did well and was able to have a regular ett placed. she had a repeat bronch showing no bleeding but copiuous secretions concerning for a vap which was treated as below. her hematocrits remained stable and after consultation with her pcp it was decided that she would no longer be an anticoagulation candidate but could be restarted on asprin 325mg daily for stroke prevention in setting of afib with recent tias. pt was successfully extubated and weaned to home baseline o2 requirement of 2l prior to discharge without difficulty. . # respiratory failure/vap. intitially was intubated in the setting of hemoptysis however once bleeding resolved she continued to have rll collapse on xray concerning for another process. a bronch revealed no bleeding but copious secretions concerning for vap. she was treated with vanc and zosyn until sputum and bal cultures grew out two strains gnrs and antibiotics were broadened to tobramycin. when speciation and sensitivities grew out two strains of pseudomonas antibiotics were weaned to zosyn. id was consulted who recommended completing a 15 day course of zosyn (day 1 to ). she had a difficult time weaning from the vent and diuresis was initiated in the hope of improving her respiratory status. she was successfully extubated on and weaned to baseline o2 requirement without issues. . # atrial fibrillation: developed secondary to asd surgical repair. patient with history of cerebral bleed on coumadin and tia without anticoagulation. anticoagulation was held in the setting of hemoptysis and as above after consultation with her pcp she was restarted only on aspirin 325mg daily for cva ppx. her home rate controlling agents were initially held in the setting of her bleed and slowly added back (metoprolol, diltiazem, and digoxin). had episodes of afib with rvr in icu, now resolved. metoprolol titrated up to 150mg daily for improved rate control. patient was on short acting diltizem four times a day as an inpatient; this was switched to long acting diltiazem on discharge. . # diarrhea: in setting of tube feeds via ngt while patient was being cleared by speech and swallow. resolved after stopping tube feed. denied abdominal pain, n/v, remained afebrile; c. diff negative x 2 and no leukocytosis. . # chest pain: 30 minute episode of l sided chest pressure days prior to discharge, resolved with slng x 1, dynamic ekg changes notable for st depressions in lateral leads, resolved when chest pain free. ce negative x 3. echo performed earlier this admission w/dilated atria, intact systolic function. medical management by uptitrating beta blockage, continuing asa, and starting statin, ace-i. patient was on atorvastatin 80mg as an inpatient, but switched to simvastatin 40mg on discharge in light of ldl of 119, lisinopril 5mg for improved bp control, cardiac/renal protection. . # thrombocytosis: isolated thrombocytosis without elevated wbc, fevers or other signs or symptoms of infection. started to trend downward prior to discharge. . # bronchiectasis: patient with baseline o2sats in the low 90s on 2l. she was continued on home nebulizers. . # gerd: continued on ppi. . # htn: held home antihypertensives initially in setting of bleed. metoprolol and diltiazem were later restarted. metoprolol increased as above, started lisinopril 5mg daily. . # hyponatremia: chronic per outside records, attributed to siadh. sodium within known range, improved with 250cc ns bolus, free water restriction to 1l/day. home demeclocycline briefly held in icu, but then continued. na 136 on discharge. . # prophylaxis: patient received heparin products during this admission. . # code: full medications on admission: - albuterol inhaler - aspirin 81mg po daily - cardizem cd 240mg po daily - colace - combivent 2 puffs qid - dabigatran 150mg po bid - demeclocycline 150mg po bid - digoxin 0.25mg mwf, 0.125 other days - flonase - lasix 60mg po daily - prilosec 20mg po daily - spiriva - toprol 50mg po daily - zyrtec 10mg po daily discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: inhalation every six (6) hours as needed for shortness of breath or wheezing. 2. cardizem cd 240 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. 3. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day: please hold for loose stools. 4. combivent 18-103 mcg/actuation aerosol sig: two (2) inhalation four times a day as needed for shortness of breath or wheezing. 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. demeclocycline 150 mg tablet sig: one (1) tablet po twice a day. 7. digoxin 125 mcg tablet sig: one (1) tablet po 4x/week (,tu,th,sa). 8. digoxin 250 mcg tablet sig: one (1) tablet po 3x/week (mo,we,fr). 9. flonase 50 mcg/actuation spray, suspension sig: one (1) spray each nostril nasal once a day as needed for nasal congestion. 10. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 11. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. 12. metoprolol succinate 50 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po daily (daily). 13. zyrtec 10 mg capsule sig: one (1) capsule po once a day. 14. simvastatin 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 15. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 16. quetiapine 25 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for anxiety/insomnia. 17. outpatient lab work check cbc and chem-7 in 1 week () to monitor for resolution of isolated thrombocytosis & check renal function and potassium after starting lisinopril. discharge disposition: extended care facility: at discharge diagnosis: primary: hemoptysis, ventilator associated pneumonia, chest pain secondary: bronchiectasis, atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. , . you were admitted for coughing up blood. you required a breathing tube to protect your lungs. the bleeding was controlled and you did not have any more cough with blood after the breathing tube was taken out. you were also found to have a lung infection and received antibiotics. you had some chest pressure while you were in the hospital; you did not have a heart attack. . please make the following changes to your medications: - stop lasix - stop dabigatran . - increase toprol xl to 150mg daily by mouth for your heart rate and blood pressure - increase aspirin to 325mg daily by mouth for your heart and to thin your blood . - start simvastatin 40mg by mouth daily for your heart - start lisinopril 5mg by mouth daily for your heart and blood pressure - start quetiapine 12.5 mg at night as needed for anxiety/insomnia . please continue all other medications as prescribed. . in 1 week () you should get outpatient lab work to check a cbc and chem-7 in to monitor for resolution of your high platelet count & check your kidney function and potassium after starting lisinopril. . it was a pleasure to meet you and participate in your care. followup instructions: **please call your primary care doctor to make an appointment for 1-2 weeks after you leave rehab.** . name: , p location: address: , , phone: fax: procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances injection or infusion of other therapeutic or prophylactic substance closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus aortography arteriography of other specified sites central venous catheter placement with guidance diagnoses: esophageal reflux congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia atrial fibrillation acute on chronic diastolic heart failure pulmonary collapse acute respiratory failure personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits diarrhea anticoagulants causing adverse effects in therapeutic use ventilator associated pneumonia other disorders of neurohypophysis bronchiectasis without acute exacerbation pseudomonas infection in conditions classified elsewhere and of unspecified site essential thrombocythemia foreign body in other specified parts bronchus and lung other hemoptysis 

Answer: The patient is high likely exposed to