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: history of present illness: this is an addendum to discharge summary dated for , a 61 year-old female with chronic lung and liver disease who presented with acute adult respiratory distress syndrome after total abdominal hysterectomy and bilateral salpingo-oophorectomy. initial presentation, past medical history, allergies, medications, social history, family history, admission physical examination, laboratory studies and hospital course from through has been summarized in prior note. this addendum will summarize hospital course from through . 1. respiratory failure: the patient received a tracheostomy on . she continued a slow weaning off mechanical ventilation, which required massive diuresis including furosemide intravenous drip. a chest x-ray showed persistence of both pulmonary edema and left retrocardiac opacity. aggressive diuresis continued. it is noted that she diureses well to furosemide 80 mg intravenous push. beginning on the evening of the patient was able to tolerate tracheostomy collar with oxygen mask for short periods of time. starting on the patient was able to tolerate tracheostomy collar and oxygen mask continuously and has been free of mechanical ventilation for three days. typical vital signs on tracheostomy collar with passey muir speaking valve, respiratory rate 15 to 28, oxygen saturation 94 to 100% on 10 liter tracheostomy mask, arterial blood gas 7.49/37/110. the patient should have her passy muir valve on with tracheostomy cuff deflated during the day and valve removed with tracheostomy cuff inflated at night. 2. cardiovascular: the patient had hypotension earlier on admission as detailed on prior note. she continued on hydrocortisone and fluticasone for relative adrenal insufficiency through . however, after corticosteroids were stopped, her pressure became mildly low requiring intravenous vasopressors. an infectious workup was negative. acth stimulation test was repeated and showed 11 mm per deciliter at baseline and 19 mg per deciliter after 60 minutes. hydrocortisone was restarted at 50 mg intravenous q 6 hours and continued for another seven days through . on this regimen the patient was no longer hypotensive and all pressors were discontinued on and hs not been started since. arterial line was discontinued on and cuff pressures have been stable since. the patient developed atrial fibrillation with rapid ventricular response requiring a digoxin load earlier in the admission. she remained rather tachycardic and level was checked after several days and found to be 0.4. digoxin was again loaded and the dose was increased to 0.25 mg intravenous q.d. the level on this dose was 0.9. digoxin was switched to po on and the digoxin level should be repeated on . the patient has been on intravenous heparin anticoagulation throughout her hospital stay. the intravenous heparin drip was being discontinued on and the patient should be started on warfarin 2.5 mg po q day tonight. prothrombin time was international normalized ratio should be checked on the morning of and adjustments should be made at the discretion of the rehab and outpatient medical doctors. 3. infectious disease: the patient remained on vancomycin and ceftazidime from through for ventilator associated pneumonia. she continued to have intermittent fevers and leukocytosis. on abdominal ct showed ascites, but no obvious infection. temperature was 100.8 on , a urinalysis, chest x-ray and diagnostic paracentesis were unremarkable for infection. her arterial and central venous access were resighted repeatedly between and in an effort to minimize source of fever. on gram positive coxae grew in one of four blood culture bottles and this happened again in one of four bottles on as well as gram positive coxae growing from the tip of the arterial line discontinued on . all of these cultures grew skin flora such as coagulase negative staphylococcus and were felt to be skin contamination. if the patient continues to have low grade fevers and leukocytosis repeat surveillance blood cultures should be checked next week. at present the patient has been afebrile for several days, but continues to have a moderate leukocytosis with a white blood cell count of 18 to 22. however, there was no sign of active infection. 4. gastrointestinal: the patient is known to have cirrhosis diagnosed from an abdominal ct demonstrating nodular liver edge and ascites. she has never had signs of gastrointestinal bleeding, encephalopathy or spontaneous bacterial peritonitis. it is unclear whether her ascites was due solely to fluid overload from hospitalization or due to persistent liver disease. she is discharged on low doses of furosemide and spironolactone. her fluid status will need to be reevaluated on a regular basis to determine her long term need for this diuretic therapy. the patient has also received multiple doses of subcutaneous vitamin k for elevated inr on this admission. the last dose being one to two weeks ago. 5. hematologic: the patient has a stable hematocrit slightly above 30 and has had no active hematologic issues other then the coagulopathy and leukocytosis described above. 6. endocrine: the patient has been noted to have hyperglycemia on this admission. it is not clear how much of this is due to corticosteroid therapy (now discontinued) and how much is due to underlying diabetes mellitus. we are currently titrating up the patient's nph insulin to cover hypoglycemia caused by nocturnal tube feeds. as of today her insulin dose is adjusted up to 8 units subq q.a.m., 18 units subq q 6:00 p.m. finger stick blood glucoses should continue to be monitored and nph insulin adjusted accordingly. 7. neurological: the patient has experienced gradually resolving delirium over her hospital stay. she is beginning to exhibit signs of anxiety and/or sundowning and has been started on sertraline 50 mg po q day with prn zolpidem. further therapy for anxiety and insomnia should be considered based on the patient's clinical presentation. 8. fluid and electrolytes: the patient received aggressive furosemide diuresis as above. this resulted in multiple electrolyte abnormalities including hypokalemia requiring aggressive potassium repletion as well as acetazolamide for severe metabolic alkalosis and spironolactone. in addition, the patient developed hypernatremia requiring several liters per day of free water repletion. as the patient reached uvolemia the need for furosemide, potassium and free water decreased. in the last several days the patient has become hyponatremic with a serum sodium of approximately 130. all free water supplementation has been discontinued although lasix and spironolactone are continued at low doses as described above. the patient's serum sodium should be monitored twice weekly along with potassium, and oral anticoagulation management as described above. serum urea nitrogen and creatinine should be monitored as well. 9. nutrition: the patient tolerated a blue dye swallowing study without aspiration on . in addition a oropharyngeal swallow showed only mild dysphagia with no aspiration. a dobbhoff nasogastric narrow bore feeding tube was placed and the patient is to be given tube feeds nocturnally, promote with fiber at 90 ml per hour until 7:00 p.m. to 7:00 a.m. during the day, her passy muir valve should be in and she should be allowed to eat a low sodium consistent carbohydrate diet of pureed and thin liquids. she should only eat with her passy muir valve in. feeding tube can be discontinued at such time as the patient is able to take sufficient po to nourish herself. 10. access: subclavian central venous and radial arterial lines have been discontinued. tracheostomy dates to . dobbhoff dates to . the patient has had an indwelling foley catheter since admission, which should be discontinued at such time as the patient is able to manage her own urination. 11. prophylaxis: the patient should receive coumadin with monitoring of international normalized ratio for both deep venous thrombosis and atrial fibrillation prophylaxis. she should continue to receive a proton pump inhibitor as she was on this as an outpatient. discharge condition: stable on transfer to rehab in . discharge medications: folic acid 1 mg po q day, thiamine 100 mg po q day, lansoprazole 30 mg q day, metoprolol 25 mg po b.i.d., coumadin 2.5 mg po q.h.s. check inr and adjust according to results. sertraline 50 mg po q.d., nph insulin 6 units subcutaneous q.a.m., 18 units subcutaneous q 6:00 p.m., please monitor finger stick blood glucoses and adjust nph dose as needed. regular insulin sliding scale. digoxin 0.25 mg po q day please check digoxin level on and adjust dose if needed. furosemide 40 mg po q day, spironolactone 100 mg po q day, please monitor daily weights and fluid status as well as twice weekly serum electrolytes bun and creatinine, adjust diuresis as necessary with the potential with the discontinued diuresis entirely if the patient does not require for uvolemia. zolpidem 5 mg po q.h.s. prn, lactulose 30 ml po q 4 hours prn, combivent mdi prn. discharge diagnoses: 1. pelvic mass status post total abdominal hysterectomy and bilateral salpingo-oophorectomy showing only benign pathology. 2. chronic obstructive pulmonary disease. 3. chronic liver disease secondary to alcohol and hepatitis c. 4. resolving adult respiratory distress syndrome. 5. diverticulosis. 6. low back pain. 7. cholecystectomy. 8. mitral valve prolapse. 9. atrial fibrillation with rapid ventricular response. 10. relative adrenal insufficiency. 11. tracheostomy. 12. anemia of chronic disease. 13. ventilator associated pneumonia resolved. 14. glucose intolerance. 15. hyponatremia. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances percutaneous abdominal drainage temporary tracheostomy other removal of both ovaries and tubes at same operative episode pulmonary artery wedge monitoring peritoneal lavage biopsy of peritoneum continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances percutaneous abdominal drainage temporary tracheostomy other removal of both ovaries and tubes at same operative episode pulmonary artery wedge monitoring peritoneal lavage biopsy of peritoneum diagnoses: unspecified septicemia atrial fibrillation sepsis pneumonitis due to inhalation of food or vomitus other shock without mention of trauma benign neoplasm of ovary 

Answer: The patient is high likely exposed to