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, abdominal pain major surgical or invasive procedure: none history of present illness: ms. is a 79 yo female with copd,chf, dementia who was transferred from rehab due to increasing sob and abdominal pain. per pcp note, pt has had increasing "moans", sob, and abd pain/distension over past week, which is a change from baseline. she was seen by psychiatry at nh, who questioned psychotic depression and started seroquel and paxil. pt also had non-contrast abd ct at on , which reportedly showed "no acute process." she had cxr on which showed "interval improvement" of bilateral opacities. per the pt's daughter, pt had pneumonia in and has had gradually decreasing function since then. the daughter also reports pt's mental status has decreased significantly over the past week. she has had frequent "panic attacks." r arm contracture has also occurred over the past several weeks, however the daughter is unsure of the cause. in the , pt was found to have a pna on cxr and was started on bipap for hypercarbic resp failure. her bp initially was up to 206/88, but this decreased without antihypertensive therapy. temp was up to 100.6, with o2 sat 92% on 4l nc (increased to 100% on bipap). her code status was reportedly reversed from dnr/dni to only dnr (but intubatable). she was given solumedrol 125mg iv, 2l ns, levofloxacin 500mg iv, and morphine 2mg iv. she currently is not able to converse due to resp distress, agitation, and bipap machine, however she nods "yes" to almost every question. past medical history: 1)primary intermedullary ependymoma/astrocytoma, spinal cord tumor (in the process of being worked up per daughter, s/p xrt and steroid taper at , oncologist dr. 2)remote hx of brain tumor s/p vp shunt placement 3)h/o thoracic aneurysm 4)s/p recent pna 5)copd 6)chf (unknown ef) 7)mvr (bioprosthetic mv) 8)atrial fibrillation (on coumadin) 9)dementia 10)h/o urinary retention (had foley cath at rehab) social history: lives at rehab. pt needs total care with adl's. other social hx not obtained. family history: fam hx of depression. physical exam: vitals: t 99.5 bp 147/110 hr 87 rr 17 o2sat 100% on bipap 10/4/40% gen: pt in resp distress, using accessory muscles, on bipap, awake, alert, moaning heent: op slightly dry, but not fully examined due to bipap machine neck: supple. jvd approximately to earlobe cardio: irregularly irregular, 2/6 sem @ apex resp: diffuse exp wheezes bilaterally (although difficult to discern from pt making "squeeking" noises while exhaling) abd: soft, nt, mildly distended, +bs, no rebound/guarding ext: trace bl le edema. lue ecchymoses neuro: awake, alert, r arm with contracture. knows she is in "hospital", but unable to speak further due to agitation and bipap machine. asked her to squeeze my fingers, and she nodded "no". pertinent results: laboratory results: 06:00pm blood wbc-10.6 rbc-3.89* hgb-12.5 hct-36.6 mcv-94 mch-32.0 mchc-34.0 rdw-15.9* plt ct-506* 06:10am blood wbc-12.7* rbc-3.08* hgb-10.1* hct-31.2* mcv-101* mch-32.8* mchc-32.4 rdw-15.8* plt ct-411 05:27am blood wbc-8.1 rbc-2.89* hgb-9.2* hct-28.1* mcv-97 mch-31.8 mchc-32.7 rdw-16.1* plt ct-398 03:25am blood pt-25.9* ptt-24.2 inr(pt)-2.6* 05:27am blood pt-20.4* ptt-27.2 inr(pt)-2.0* 06:00pm blood glucose-121* urean-19 creat-0.7 na-135 k-4.6 cl-92* hco3-31 angap-17 06:00pm blood alt-21 ast-39 ld(ldh)-536* ck(cpk)-128 alkphos-70 amylase-68 totbili-0.4 06:10am blood alt-41* ast-26 ld(ldh)-373* alkphos-51 totbili-0.4 06:00pm blood ck-mb-4 ctropnt-0.09* 11:29am blood ck-mb-notdone ctropnt-0.07* 06:19am blood ck-mb-notdone ctropnt-0.08* 06:00am blood probnp-1752* 01:00am blood calcium-8.9 phos-4.3 mg-1.9 04:40am blood vitb12-1446* folate-14.8 03:12pm blood lactate-1.2 relevant imaging: 1)cxray (): retrocardiac opacity, possibly representing atelectasis versus focal consolidation. likely small bilateral pleural effusions. 2)ct abdomen/pelvis (): 1. no evidence of pulmonary embolism. 2. bibasilar consolidation, likely atelectasis, although evolving infection cannot be entirely excluded. moderate right and small left pleural effusion. 3. coronary artery calcifications. 4. multiple hepatic cysts. 5. sigmoid diverticula without evidence of diverticulitis 3)ct head (): limited study due to motion. no acute intracranial hemorrhage. no mass effect. no evidence of dilatation of the ventricles. 4)abdomen xray (): no evidence of obstruction. 5)echo (): symmetric lvh with preserved global and regional biventricular systolic function. minimal aortic stenosis with mild regurgitation. normally-functioning mitral bioprosthesis. moderate tricuspid regurgitation. ef 70-80%. . 6) ct abdomen/pelvis : impression: 1. airspace opacity of the dependent bilateral lower lobes is thought more likely to represent atelectasis; however, underlying infection cannot be definitively excluded. 2. small right pleural effusion and minimal left pleural effusion. 3. multiple well-defined hypodense foci scattered throughout the liver, the larger of which are consistent with cysts. several smaller lesions are too small to definitively characterize. 4. numerous sigmoid diverticula without evidence of acute diverticulitis. . 7) cxr : feeding tube present, with distal tip directed cephalad in the fundus. right picc line remains in place in the superior vena cava. cardiac and mediastinal contours are widened but without change from the prior radiograph. previously reported pulmonary edema has slightly progressed with increased perihilar haziness. bilateral pleural effusions are present, best visualized on the lateral view, small in size. . discharge labs: 08:21am blood wbc-8.4 rbc-2.89* hgb-9.2* hct-28.2* mcv-98 mch-31.9 mchc-32.7 rdw-15.9* plt ct-377 05:28am blood pt-16.0* ptt-29.5 inr(pt)-1.5* 08:21am blood glucose-107* urean-14 creat-0.6 na-141 k-3.7 cl-104 hco3-33* angap-8 brief hospital course: ms. is a 79 yo female with copd, dementia, here with pna, hypercarbic respiratory failure, abd pain, and abnormal ekg. 1) respiratory failure: patient presented with respiratory acidosis and was admitted to the micu for closer monitoring. respiratory decompensation likely occurred in the setting of pneumonia seen on cxray, copd, and chf exacerbation. she was placed on levaquin, then vancomycin and zosyn. zosyn and levaquin were stopped and she was continued on vancomycin for 2 weeks since sputum cultures grew mrsa. her oxygen saturations improved with antibiotics and agressive diuresis. she also completed a short prednisone taper for her copd. per daughter, she requires at least 2l at baseline at rehab. she was continued on 2l nc with o2 sats in high 90s. she was continued on lasix po and this was progressively decreased to 20mg daily. 2)abdominal pain: patient presented with several week history of diffuse abdominal pain. all imaging studies, including ct scan abdomen/pelvis, were negative for acute pathology that could explain her symptoms. it was thought that she was constipated. she did have bowel movements that were extremely loose in nature. lactate was normal and guiac negative suggestive of mesenteric ischemia being unlikely. gi was consulted and they recommended a repeat ct abdomen/pelvis which was unchanged. she was started on oxycodone standing and narcotics were tapered due to effects on her bowels. her bowel regimen was optimized with colace, senna, and miralax. her abdominal pain and distention improved following bowel movements. she was decreased to oxycodone 2.5mg q8hr prn pain. 3)elevated troponins/ekg changes: patient presented with mildly elevated troponins and diffuse st depressions in the anterolateral leads. likely demand ischemia given respiratory distress and underlying infection. given patient's persistent abdominal pain, it was thought that this may be an anginal equivalent. cardiology was consulted and agreed with agressive diuresis as well as change from ccb to b-blocker. there were no new wall motion abnormalities on both echos. she did have significant lvh with hyperdynamic ef~70-80's. no further imaging or studies were recommended. 4)atrial fibrillation: patient remained in afib throughout her hospital stay. her digoxin was d/c'ed in the micu. she was continued on verapamil for rate control. verapamil was changed to metoprolol, per cardiology recommendation, as a result of increasing abdominal pain and distention. she was continued on coumadin with close monitoring of her inr. her inr became supratherapeutic to >6 at which point her coumadin was held for one dose and she was given vitamin k. her inr then became subtherapeutic and her coumadin was continued. her inr on the day of discharge was 1.5 5)hypertension: patient presented with sbp in 200's on admission but quickly returned to baseline. she was continued on outpatient regimen of verapamil, but this was changed to metoprolol during her hospital stay. 6) delirium/dementia/agitation: per patient's daughter, she has had an acute decline in her mental status over past several weeks. the daughter and pcp denied any history of dementia. she was initially started on quetiapine and lorazepam but given the increased sedative effects of the quetiapine this medication was stopped. she was continued on ativan prn and her mental status contineud to wax and wane throughout her hospital stay likely from her comorbidities. she remained oriented to self but not to time or place. the etiology of her delirium was thought to be multifactorial with a prolonged hospital stay and significant comorbitities contributing. she remained afebrile with a stable wbc count so infection was thought not to be contributing. her electrolytes were wnl and her b12 and folate were also normal. she was started on depakote for mood stabilization at 250mg . she was also started on paxil 30mg daily for her depression. she was evaluated by psychiatry given her delirium and history of depression and they recommended seroquel 12.5 mg tid prn for anxiety/agitation. they also recommended decreasing her paxil to 20mg daily. on the day of discharge the patient was more alert and appropriate following these medication adjustments. 7) h/o brain/spinal tumors: patient being followed closely at . she received xrt in and was supposed to undergo a repeat mri of her c-spine. this was attempted during this admission but given her agitation this could not be done. further work-up will be deferred to as an outpatient. she will likely need mri c-spine as an outpatient at . . 8) fen: ngt was initially placed since patient had poor mental status. when her mental status improved the ngt was removed and she tolerated po intake appropriately. she was evalauted by speech and swallow who determined that she could tolerate a regular diet without signs of aspiration. she requires significant encouragement to take po. . 9) sacral decubitus ulcer: patient was evaluated by wound care nurse who recommended dressing changes every 2-3 days with following protocol: clean with commercial cleanser, pat dry, apply protective barrier wipe to periwound tissue, apply duoderm gel, cover with allevyn foam adhesive 5x5". this should be continued at rehab. she also requires repositioning every 2 hours. there was no sign of infection at the site. medications on admission: coumadin 3.5 mg qd flovent 110mcg 1 puff gabapentin 300mg qhs mom 30ml qd prn verapamil 120mg qd amoxicillin 2g prn dental procedures klonopin 0.25mg doxycycline 100mg (started to be completed ) levaquin (started , finished ) digoxin 0.125mg qd morphine (roxanol) 2mg q2h prn morphine (roxanol) 4mg q12h seroquel 25mg maalox 15ml q6h prn atrovent nebs q4h prn albuterol nebs q4h prn lasix 40mg qd sorbitol 15ml qd colace 250mg qd senna 2 tabs qhs paxil 20mg dulcolax 10mg qhs dexamethasone 0.125mg q12h (started ) discharge medications: 1. fluticasone 110 mcg/actuation aerosol : one (1) puff inhalation (2 times a day). 2. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 3. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day). 4. senna 8.6 mg tablet : one (1) tablet po twice a day. 5. warfarin 3 mg tablet : one (1) tablet po hs (at bedtime). 6. metoprolol tartrate 25 mg tablet : 0.5 tablet po bid (2 times a day). 7. oxycodone 5 mg tablet : 0.5 tablet po every eight (8) hours as needed for pain. 8. albuterol sulfate 0.083 % solution : one (1) neb inhalation every four (4) hours as needed. 9. ipratropium bromide 0.02 % solution : one (1) neb inhalation q6h (every 6 hours) as needed. 10. bisacodyl 10 mg suppository : one (1) suppository rectal daily (daily) as needed for constipation. 11. paroxetine hcl 20 mg tablet : one (1) tablet po once a day. 12. acetaminophen 500 mg tablet : two (2) tablet po every six (6) hours. 13. maalox 200-200-20 mg/5 ml suspension : five (5) ml po three times a day. 14. lasix 20 mg tablet : one (1) tablet po once a day. 15. polyethylene glycol 3350 17 g (100%) powder in packet : one (1) powder in packet po daily (daily). 16. quetiapine 25 mg tablet : 0.5 tablet po tid (3 times a day) as needed for anxiety/agitation. 17. divalproex 125 mg capsule, sprinkle : two (2) capsule, sprinkle po bid (2 times a day). discharge disposition: extended care facility: for the aged - ltc discharge diagnosis: mrsa pneumonia copd atrial fibrillation constipation sacral decubitus ulcer chf dementia/delirium discharge condition: afebrile. respiratory status stable. tolerating po. moving bowels. discharge instructions: please take all of your medications as directed . if you experience difficulty breathing, chest pain, inability to eat, high fevers or other concerning symptoms, please call your doctor or come to the emergency room. followup instructions: procedure: venous catheterization, not elsewhere classified diagnoses: congestive heart failure, unspecified unspecified essential hypertension hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified atrial fibrillation other persistent mental disorders due to conditions classified elsewhere malignant neoplasm of brain, unspecified constipation, unspecified acute respiratory failure other and unspecified angina pectoris methicillin susceptible pneumonia due to staphylococcus aureus retention of urine, unspecified pressure ulcer, lower back heart valve replaced by transplant diastolic heart failure, unspecified kyphosis (acquired) (postural) other alteration of consciousness presence of cerebrospinal fluid drainage device mixed acid-base balance disorder other dependence on machines, supplemental oxygen 

Answer: The patient is high likely exposed to