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 / betadine / iodine / demerol / lisinopril attending: chief complaint: dyspnea major surgical or invasive procedure: bronchoscopy video swallow history of present illness: 55 year-old female with a history of tracheobronchomalacia, copd/ ?asthma, htn, with recent admissions for copd and y stent placement. the pt presents today with increasing dyspnea, wheezing, cough. these are similar to prior episodes of exacerbation of her underlying disease and she reports a gradual worsening of dyspnea. she does not that for the past few days she has had a dry "barking" cough, where she feels like she has dislodged something. she also notes that her voice sounds deeper for the past few days. . in the ed at hosp, the pt was treated for an allergic reaction with solumedrol and benadryl. she had a history of multiple drug allergies, but had no cutaneous findings to support that on day of admission. the patient received subcutaneous epinephrine, solu-medrol, and multiple nebulization treatments at . her chest x-ray was clear. the patient was transferred to y by . . in the ed, initial vs were: 100 145/83 100 . tachypnic on nrb. pt received an additional neb. patient was given aspirin 325mg, fentanyl citrate and started on bipap. now on nrb, rr 20, p89, 136/70, 98% on nrb. cxr is clear. bilateral rhonchi. concern for chf. add on bnp. ekg is sinus tachycardia, st dep across ant leads, less than 1mm, similar to prior. . on the floor, the patient appears tachypnic on high flow oxygen. she reports that she feels "somewhat" better. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - copd per past notes, though patient nonsmoker and denies history of copd/emphysema or chronic bronchitis or past asthma; no history of breathing difficulties prior to - tbm with previous stent, removed ; later admission for resp distress; y stent replaced - ?laryngeal reflux and paradoxical vocal cord dysfxn - hypertension - hyperlipidemia - ?anaphylactic reaction in - patient recalls this was onset of respiratory symptoms leading to diagnosis of tbm. pt also report having severe allergic rxn while getting allergy tested, required 3 epi pens - numerous right hand surgeries s/p r hand trauma - cholecystectomy - appendectomy - tonsillectomy - back surgery (unclear procedure) - hyperglycemia in setting of steroids social history: denies etoh, tobacco ever. lives with mother, father, and brother. as patient coordinator at hosp. family history: both grandfathers had in their 60's. mother with dm and htn. father with htn. grandfather had some type of blood clot physical exam: vitals: t: 98 bp: 133/70 p: 95 r: 36 o2: 99% high flow general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: bilateral wheezing, poor air movement cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs wbc-5.8 rbc-4.05* hgb-12.1 hct-37.2 mcv-92 rdw-13.8 plt ct-191 neuts-89.6* lymphs-8.1* monos-0.9* eos-1.1 baso-0.2 pt-13.1 ptt-23.7 inr(pt)-1.1 glucose-202* urean-12 creat-0.9 na-138 k-4.2 cl-99 hco3-22 angap-21* calcium-9.7 phos-3.7 mg-1.9 wbc-4.2 rbc-3.55* hgb-11.2* hct-32.6* mcv-92 rdw-13.8 plt ct-193 glucose-104* urean-8 creat-0.6 na-139 k-3.5 cl-104 hco3-23 angap-16 phos-3.9 mg-2.0 . discharge labs: wbc-4.2 rbc-3.55* hgb-11.2* hct-32.6* mcv-92 rdw-13.8 plt ct-193 glucose-104* urean-8 creat-0.6 na-139 k-3.5 cl-104 hco3-23 angap-16 phos-3.9 mg-2.0 . studies / images: ecg : sinus rhythm. right ventricular conduction delay. non-diagnostic repolarization abnormalities. compared to the previous tracing of there is no diagnostic change. cxr : findings: single ap upright portable view of the chest was obtained. haziness at the left lung base most likely relates to overlying soft tissue and underpenetration in this area, although a very small consolidation or trace effusion cannot be entirely excluded. there are low lung volumes. the cardiac and mediastinal silhouettes are unchanged, with the cardiac silhouette borderline to slightly enlarged. cxr : findings: in comparison with the study of , there is no interval change or evidence of acute cardiopulmonary disease. there are low lung volumes, there is no definite evidence of pneumonia, vascular congestion, or pleural effusion. cardiac silhouette is at the upper limits of normal or slightly enlarged. cxr : the breathing assisting device is projecting over the upper chest, preventing the evaluation of that area of the lungs. cardiomediastinal silhouette is stable. imaged portion of the lungs including mid and basal areas is unremarkable. there is no apparent evidence of pleural effusion. cxr : findings: linear atelectasis in the left retrocardiac region is unchanged since the previous study one day prior. no newly developed areas of consolidation, pneumothorax, or pleural effusion. cardiomediastinal silhouette is normal. impression: no acute cardiopulmonary findings. . video swallow: minimal penetration but no gross aspiration seen with multiple consecutive straw sips of liquid consistency. for details please refer to speech and swallow division note in omr. brief hospital course: # dyspnea/respiratory distress: patient initially presented from outside hospital with respiratoyr distress. the osh was concerned for allergic reaction/anaphylaxis though this was thought to be less likely due to absence of any skin findings. of note, she had received steroids, nebulizer treatments, and subcutaneous epinephrine at the outside hospital. she was temporarily in the micu for monitoring. her mucomyst nebulizers were held as these can potentially be irritating to the respiratory tract. she was maintained on her home bipap, and during the day time started on heliox for a short time period. she noted that her symptoms appeared improved while on bipap and heliox. a bedside bronchoscopy was performed by ip on that showed stent in the correct position. ip raised the question of paradoxical vocal cord movement as they visualized some abnormal movements on bronchoscopy. as a result, ent was consulted and a laryngoscopy was performed by ent that noted no paradoxical movement of vocal cords, only minor edema of the posterior cricoids. given her complaints of heartburn, there was concern for a component of reflux; ppi uptitrated to . she underwent speech & swallow evaluation with video swallowing study which showed no evidence of silent aspiration. she was then transferred to the medicine floor. on the medicine floor she was started on saline nebs and advair. overall the patient said that she had improved from her admission. she was discharged with ip follow up and close pcp follow up. . # htn: the patient was continued on her home regimen of amlodipine, metoprolol and clonidine. . # gerd: patient's ppi was increased to . . # le edema: continue home lasix. . # loose stools: on hospital day 2 and 3 the patient was noted to have loose stool. c. difficile antigen was sent and was negative. . # e. coli uti: on routine culture data obtained in the emergency department, the patient was noted to have an e. coli urinary tract infection that was susceptible to ciprofloxacin. she was treated with a 3-day course of cipro and at no time reported dysuria, urgency, or frequency. . medications on admission: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* 2. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 3. acetylcysteine 20 % (200 mg/ml) solution sig: one (1) nebulized treatment miscellaneous q12h (every 12 hours) as needed for stent maintenance. disp:*28 nebulized treatment* refills:*2* 4. guaifenesin 1,200 mg tab, multiphasic release 12 hr sig: one (1) tab, multiphasic release 12 hr po twice a day. disp:*60 tab, multiphasic release 12 hr(s)* refills:*2* 5. benzonatate 100 mg capsule sig: two (2) capsule po tid (3 times a day) as needed for cough. 6. clonidine 0.2 mg tablet sig: one (1) tablet po bid (2 times a day). 7. furosemide 20 mg tablet sig: 0.5 tablet po daily (daily). 8. toprol xl 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 9. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day. 10. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 11. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 12. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation every 4-6 hours as needed for shortness of breath or wheezing. discharge medications: 1. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* 2. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). 3. guaifenesin 1,200 mg tab, multiphasic release 12 hr sig: one (1) tab, multiphasic release 12 hr po twice a day. 4. benzonatate 100 mg capsule sig: two (2) capsule po tid (3 times a day). 5. clonidine 0.2 mg tablet sig: one (1) tablet po twice a day. 6. furosemide 20 mg tablet sig: 0.5 tablet po daily (daily). 7. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 8. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day. 9. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 10. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 11. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). disp:*1 disk with device(s)* refills:*2* 12. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) inhalation inhalation every 4-6 hours as needed for shortness of breath or wheezing. 13. ativan 0.5 mg tablet sig: one (1) tablet po twice a day as needed for anxiety. disp:*15 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: tracheobronchomalacia . secondary diagnosis: copd hypertension hyperlipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted for cough and shortness of breath. you were temporarily monitored in the micu. a bronchoscopy did not show migration of the stent you have in your trachea. an ent study did not show abnormalities of your vocal cords. a speech and swallow study did not show signs that you are aspirating (food passing into trachea). your medications were adjusted to improve your symptoms. . we have made the following changes to your medications: 1. increase omeprazole to 40mg by mouth twice a day 2. stop acetylcystein (mucomyst) nebs 3. start advair 500/50 one inhalation twice a day 4. ativan 0.5mg by mouth twice a day as needed for anxiety followup instructions: name: ,md location: address: , , phone: when: , at 12:15pm . department: endoscopy suite when: tuesday at 11:30 am with: gi clinic building: building (/ complex) campus: east best parking: main garage instructions will be mailed . department: medical specialties when: tuesday at 9:20 am with: , md building: sc clinical ctr campus: east best parking: garage . department: pft when: at 9:30 am department: pulmonary function lab when: at 9:30 am with: pulmonary function lab building: gz building (felbeerg/ complex) campus: east best parking: main garage department: pft when: at 10:30 am . name: dr. department: intervention pulmonary when: wednesday at 8:00 am consult and 9:00am bronchoscopy nothing to eat or drink after midnight the night before your appointment. . please discuss the need to follow up with ent doctors with dr. . procedure: fiber-optic bronchoscopy non-invasive mechanical ventilation laryngoscopy and other tracheoscopy diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux urinary tract infection, site not specified pulmonary collapse other and unspecified hyperlipidemia acute respiratory failure other diseases of trachea and bronchus benign essential hypertension 

Answer: The patient is high likely exposed to