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: dyspnea major surgical or invasive procedure: intubation x2 tracheostomy peg tube placement central line placement history of present illness: 78f w/ hx triple negative (er/pr neg, her-2/neu neg) breast cancer s/p lumpectomy and xrt who presented to the ed for severe dyspnea. she was visited by a friend today who noted pt to be very dyspneic so alerted ems. per ems, sao2 73% on ra, up to 85-91% on nrb but alert and mentating. pt states dyspnea has been going on for a while. denied cp, f/c, n/v, abdominal pain but endorses a fall 3 wks ago w/ r-sided hematoma and negative ct scan at that point. . in the ed, rsi was performed and pts vs: 58 99/56 12 99% on ac 400x12 peep 5 fio2 70% cvp 7. r-ij and femoral a-lines were placed in the ed. immediately after rsi, pt became hypotensive despite fluid resuscitation w/ 7l ns, so was started briefly on phenylephrine. u/a was concerning for uti so pt was given one dose of iv ciprofloxacin. as pt's bp continued to stay low, coverage was broadened to iv vancomycin, iv ctx, and iv azithromycin. . initial cxr showed some evidence of l-sided lobar collapse, although not enough to explain pt's profound hypoxia. a cta was performed, which ruled out pulmonary embolus; however left lower lobe and partial lingular collapse with mucous plugging was seen. . on arrival to the micu, pt is sedated, intubated with daughter at bedside. appears comfortable. past medical history: chronic weight loss complex right renal cyst osteoporosis h. pylori (treated) chronic cough insomnia hypertension urinary incontinence breast cancer s/p lumpectomy and xrt s/p cosmetic rhinoplasty (age 17.5) s/p gum surgery s/p tonsillectomy social history: lives alone in an apartment bldg. has a neighbor ( ) who helps out. used to work in mortagage, been out of work since 2-3 years ago, which is when she has been functionally declining. her son was murdered at age 29. has a daughter who is alive, lives nearby. no tobacco/etoh/ivdu. family history: both parents lived into 90s. daughter with osteoporosis. physical exam: admission exam: general: cachectic-appearing woman heent: mmm, normal sclera, ett in place, pupils pinpoint neck: r-ij in place, no jvd appreciated cv: rrr, distant heart sounds lungs: ctab anteriorly abd: soft, nontender, hypoactive bs ext: no c/c/e neuro: sedated . discharge exam: vitals: t 98.9, hr 53, bp 124/63, rr 20 general: cachectic-appearing women, appears tired and weak, nad heent: perrl, mmm, oropharynx clear neck: supple, trach collar in place - no erythema or drainage cv: rrr, nml s1/s2, no m/r/g lungs: coarse bs throughout, no rales or wheezes abdomen: soft, ntnd, nabs, +peg tube extrem: wwp, no edema, 2+ pedal pulses bilaterally neuro: a&ox3, non-vocal but communicates via writing, cns ii-xii intact, 4/5 strength throughout, sensation intact pertinent results: admission labs: 12:40am blood wbc-6.8 rbc-4.50 hgb-14.2 hct-43.5 mcv-97 mch-31.5 mchc-32.6 rdw-12.8 plt ct-238 12:40am blood neuts-51.5 lymphs-43.0* monos-3.8 eos-1.0 baso-0.8 12:40am blood pt-11.1 ptt-21.8* inr(pt)-0.9 12:40am blood glucose-190* urean-20 creat-0.7 na-144 k-4.0 cl-97 hco3-40* angap-11 12:40am blood calcium-9.3 phos-4.8* mg-2.0 . pertinent labs: 12:40am blood ctropnt-0.01 06:45pm blood probnp-747* 04:53am blood alt-31 ast-34 alkphos-29* totbili-0.4 04:01pm blood tsh-9.6* 04:53am blood free t4-1.1 03:21am blood free t4-1.1 04:01pm blood cortsol-10.0 04:25am blood iga-132 04:31am blood vitb12-1540* methylmalonic acid: pending ganglioside ab panel (gm1, asailo-gm-1 and gd1b): pending gq1b igg ab: pending prealbumin: pending . discharge labs: 12:56am blood wbc-4.6 rbc-3.22* hgb-10.4* hct-29.4* mcv-92 mch-32.4* mchc-35.4* rdw-13.9 plt ct-234 12:56am blood glucose-126* urean-19 creat-0.5 na-139 k-3.8 cl-100 hco3-38* angap-5* 12:56am blood calcium-8.7 phos-2.8 mg-2.0 .............................................................. microbiology: blood cx: negative . urine cx: citrobacter >100,000 organisms/ml cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s . bal: gram stain: 2+ polymorphonuclear leukocytes. no microorganisms. respiratory culture: no growth, <1000 cfu/ml. legionella culture: no legionella isolated. immunoflourescent test for pneumocystis jirovecii: negative. viral culture: no cytomegalovirus isolated. . respiratory viral screen: negative . blood cx: negative . urine cx: negative . stool c. diff: negative ................................................................ imaging: cxr: left basilar opacity, atelectasis versus infection. . cta chest: 1. left lower lobe collapse and lingular atelectasis with aerosolized mucus seen filling these bronchi. there is no pathologic lymphadenopathy or enhancing mass seen. bronchoscopy may be useful for further evaluation and treatment. 2. right middle lobe nodule. if there are risk factors such as smoking initial followup ct is recommended in three to six months. if no risk factors are present initial followup ct at 6-12 months. 3. anterior wedge compression deformity of t9, new compared with . . echo: the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: normal biventricular cavity sizes with preserved global and regional biventricular systolic function. . lue u/s: 1. complete thrombosis of the left cephalic vein. 2. non-occlusive thrombosis of the left subclavian and basilic veins. . emg: there is electrophysiologic evidence for diffuse, chronic neurogenic changes in the upper and lower extremities with ongoing denervation in the distal leg muscles, as seen in cervical and lumbosacral polyradiculopathy. clinical correlation is recommended. there is no evidence for pre- or post-synaptic neuromuscular junction disorder, demyelinating polyneuropathy, motor neuron disease, or generalized myopathy. . ct spine w/o con: 1. no evidence of fracture and no change in alignment, when compared to . 2. multilevel spondylosis is not significantly changed compared to that study, including moderately severe narrowing of the spinal canal at the c4 5 through c6-7 level and multilevel neural foraminal narrowing. 3. increased large left pleural effusion. 4. unchanged heterogeneity of the thyroid gland. . mr with and w/o con: degenerative changes, similar to recent ct. no focal suspicious osseous lesion. no high grade spinal canal narrowing. . bilateral le u/s: no dvt. . cxr: limited study demonstrating evidence for volume loss in the left lower lobe and probably a small left pleural effusion. persistent prominence of interstitial markings. brief hospital course: 78f with a remote hx of breast cancer s/p lobectomy and chronic weight loss now admitted for dyspnea and hypoxia s/p intubation with difficulty weaning from the ventilator. . # respiratory failure: multifactorial, in the setting of mucus plugging, left lower lobe pneumonia, and muscle weakness (nutritional and neurologic). the patient completed a course of vancomycin/zosyn for healthcare associated pneumonia, and remains afebrile without leukocytosis. she was extubated on , but was reintubated on for respiratory distress and was unable to be re-extubated after that. her negative inspiratory forces have been very low, suggesting respiratory muscle weakness. a ct and mri of the c-spine were both done, which revealed degenerative changes, but did not reveal any evidence of fracture, misalignment, or nerve impingement. neurology was consulted and an emg was suggestive of a polyradiculopathy, demyelinating disorder, or paraneoplastic syndrome. numerous laboratory tests were sent to test for this (gm1, asailo-gm-1, gd1b, gq1b igg ab), which are still pending. she underwent a tracheostomy and peg tube placement on . she has occasional brief episodes of desaturation which improve with suctioning and are believed to be secondary to mucus plugging. she has been receiving albuterol and ipratropium nebs prn. current ventilator settings are: cmv with a tv 320, rr 12, peep 10, fio2 50%. she should be seen in the neuromuscular clinic at on the ( building, ) on friday at 9:00am. should there be any difficulty in getting the patient to this appointment, please call dr office at (. . # cachexia/weight loss: per the daughter, and in reviewing the patient's recent primary care notes, the patient's weight loss has been an ongoing issue for at least the past six months, and is believed to be related to her depression. no other organic cause has been found. tsh was mildly elevated, but free t4 was normal. cortisol is also normal. her albumin is low and pre-albumin is pending. we started her on tube feeds via an ng tube and then continued them via the peg. we also started fluoxetine for her depression. . # lue dvt: ultrasound revealed an occlusive thrombus of the left cephalic vein, with a non-occlusive thrombus of the left subclavian and left basilic veins, associated with the picc. the picc was pulled and the patient was continued on prophylactic subcutaneous heparin. . # uti: the patient was found to have a citrobacter uti which was treated with a course of ceftriaxone. repeat urine culture was negative. . # anemia: hct stable in the upper 20s to low 30s. normocytic. stool guiac negative and no active bleeding. . # osteoporosis: could restart her home vitamin d and consider starting calcium supplementation. . # depression: per the family, patient very depressed prior to admission, which has likely contributed to her poor po intake and weight loss. currently on fluoxetine 10mg daily (started ). will need to reassess after 2-3 weeks and consider increasing dose to 20mg daily. . # breast cancer: not currently active. . # sacral decub stage 2: continue wound care; barrier creams. pain control with morphine sulfate 15mg q4h prn. . # code status: full code. confirmed with the patient and her daughter . . # contacts: (daughter): ( (h), ( (c), ( (w). medications on admission: 1. vitamin d 50,000 unit once every other wk 2. omeprazole 20 mg before supper to prevent reflux 3. zolpidem 10 mg q hs discharge medications: 1. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 2. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily). 3. folic acid 1 mg tablet : one (1) tablet po daily (daily). 4. therapeutic multivitamin liquid : five (5) ml po daily (daily). 5. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 6. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day). 7. polyethylene glycol 3350 17 gram/dose powder : seventeen (17) gram po daily (daily) as needed for constipation. 8. ondansetron 4 mg iv q8h:prn nausea 9. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler : two (2) puff inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 10. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : 1-2 puffs inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 11. fluoxetine 20 mg/5 ml solution : ten (10) mg po daily (daily). 12. trazodone 50 mg tablet : 0.5 tablet po hs (at bedtime) as needed for insomnia. 13. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). 14. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for fever. 15. morphine 15 mg tablet : one (1) tablet po q4h (every 4 hours) as needed for pain. 16. chlorhexidine gluconate 0.12 % mouthwash : fifteen (15) ml mucous membrane (2 times a day). discharge disposition: extended care facility: - discharge diagnosis: pneumonia mucus plugging cachexia weakness 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: ms. , you were admitted with difficulty breathing and were intubated. we treated you for a pneumonia, however you are very weak and we were unable to take you off the ventilator. it is possible that you may have a muscular or neurologic problem, but we are still waiting for some lab tests to come back. . we made the following changes to your medications: - stopped omeprazole and zolpidem - started lansoprazole, thiamine, folic acid, vitamins, colace, senna, polyethylene glycol, zofran, albuterol, ipratropium, fluoxetine, trazodone, heparin, tylenol, morphine, chlorhexidine oral rinse followup instructions: clinic at on the ( building, ) on friday at 9:00am. should there be any difficulty in getting the patient to this appointment, please call dr office at (. . department: medical specialties when: monday at 9:00 am with: bone density testing building: campus: east best parking: garage . department: medical specialties when: monday at 10:00 am with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube insertion of endotracheal tube fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy diagnoses: pneumonia, organism unspecified anemia, unspecified urinary tract infection, site not specified unspecified essential hypertension personal history of malignant neoplasm of breast depressive disorder, not elsewhere classified pulmonary collapse other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure osteoporosis, unspecified other complications due to other vascular device, implant, and graft pressure ulcer, lower back cervical spondylosis without myelopathy pressure ulcer, stage ii other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms foreign body in larynx inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation acute venous embolism and thrombosis of superficial veins of upper extremity 

Answer: The patient is high likely exposed to