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: over the two weeks prior to admission, mrs. complained of increasing shortness of breath with a cough productive of yellow sputum, flecked with blood. she denied any chills, fever, chest pain or headache. shortly before admission, she was unable to walk more than eight feet without having to rest and catch her breath. she decided to come to the emergency department when she was unable to walk up a flight of stairs without extreme shortness of breath. while at the emergency department, mrs. got up to go to the bathroom, and on her return to her stretcher experienced a hypertensive crisis with systolic blood pressure in the 190s and a heart rate greater than 140. she became tachypneic, short of breath, confused and pulse oximetry could not be obtained. she continued to be very short of breath on 100% nonrebreather. she was intubated for presumed respiratory failure and transported to the medical intensive care unit. past medical history: 1. systemic lupus erythematosus, diagnosed in with awa/ds-dna/anti- positivity. 2. lupus nephritis - membranoproliferative glomerulonephritis. 3. hemolytic anemia. 4. thrombocytopenia. 5. lupus cerebritis. 6. lupus peritonitis, . 7. pleuritis. 8. arthritis. 9. raynaud's syndrome. 10. boop in . 11. hypertension. 12. salmonella bacteremia in . 13. ttp - hus. 14. membranous glomerulonephritis with a necrotizing component and focal crescent formations, mixed type iii/v lupus erythematosus. social history: patient lives in with her brother. she works part time as a tax accountant. she has a negative tobacco history. she stopped drinking alcohol in . she denies any other drug use. she is not currently sexually active. family history: the patient's mother died of lupus at the age of 47. she does not know her father well and is unable to report on his health history. she has seven brothers and sisters. two of her brothers have alcoholism. one sister has insulin dependent diabetes mellitus. there is no significant family history of cancer, asthma or heart disease. allergies: haldol - acute dystonic reaction. sulfa - hives and shortness of breath. biaxin. medications on arrival at the emergency department: lopressor 50 mg b.i.d., zestril 5 mg q.d., prednisone 5 mg q.d., aspirin 81 mg q.d., lipitor 20 mg q.d., prilosec 20 mg q.d., nephrocaps. review of systems: chronic constipation, treated with colace. joint pain significantly worse in winter time with raynaud's. no history of chest pain or palpitations. physical exam on admission to the medical intensive care unit: general: intubated, sedated, middle-aged woman. vital signs: blood pressure 140/90. heart rate 130. temperature 99.1. head, eyes, ears, nose and throat: pupils equal, round and reactive to light. sclerae are anicteric. neck, supple, no lad. chest: bilateral breath sounds anteriorly. no wheezing. coarse bilateral breath sounds throughout. inspiratory crackles. cardiovascular: tachycardic rhythm, no murmurs. abdomen: soft, nontender, nondistended, normal active bowel sounds. light brown guaiac negative stool. extremities: warm without edema. neuro: babinski downgoing bilaterally. sedated. symmetric reflexes. laboratories values on admission: white blood cell count 2.6, differential 57 neutrophils, 2 basophils, 25 lymphocytes, 9 macrophages. hematocrit 28.2, platelets 142,000. mcv 82. sodium 138, potassium 3.7, chloride 98, bicarbonate 28, bun 27, creatinine 7.1, glucose 82. urinalysis: small amount of blood. greater than 300 protein. 2 red blood cells, 1 white blood cell, 20 epithelial cells. electrocardiogram, sinus tachycardia. rate 110, normal axis. twi, v4 through v6, lead i. hospital course: while in the emergency department, mrs. received nitroglycerin paste, lasix 80 mg intravenous, 500 mg levofloxacin, heparin per protocol, versed 1-2 mg per hour via iv drip. after intubation in the emergency department, mrs. received a bedside echocardiogram which showed severe left ventricular systolic functional depression and a small loculated pericardial effusion. right ventricular diastolic collapse was present consistent with impaired filling and tamponade. a chest x-ray at the time showed congestive heart failure with pulmonary edema, although pneumonia could not be excluded. an electrocardiogram revealed t wave inversions laterally. mrs. then underwent ct angiography for pulmonary embolus which was negative; however, the ct showed fluid overload with left and right pleural effusions and pulmonary edema. after intubation and in the medical intensive care unit, mrs. was initially placed on simv plus pfs, but was not well sedated and had rapid respiration rate. an arterial blood gas at the time post intubation was 7.18/55/76. the patient was switched to acv/500/14/fio2 100% with peep of 7.5. arterial blood gases then was 7.24/56/57. initial differential diagnosis at the time of admission to the medical intensive care unit was infectious community- acquired pneumonia versus lupus pneumonitis versus flash pulmonary edema or congestive heart failure. during her stay in the medical intensive care unit, mrs. showed rapid improvement. on , she was started on solu-medrol intravenous 80 mg q. 8 hours, lasix 40 mg q.d. and levofloxacin 500 mg q.d. by , solu-medrol had been changed to 60 mg intravenous q. 8 hours. by , to 40 mg intravenous q. 8 hours. she continued with lasix at 40 mg q.d. and levofloxacin at 500 mg q.d. mrs. was extubated on with adequate 02 saturation. by , a chest x-ray showed significant interval improvement of pulmonary edema with an accompanying decrease in the size of her pleural effusions. mrs. was then discharged to the medicine on . physical examination on admission to the medicine floor: vital signs, temperature 98.6. heart rate 105 with a maximum of 117. blood pressure 142/98 with a maximum systolic blood pressure of 162 and a minimum of 109 in a 24-hour period. respiratory rate 18 to 20 breaths per minute. 02 saturation 99-100% on two liters 02. general: middle-aged african american woman sitting quietly in bed, applying makeup and talking on the phone while eating. head, eyes, ears, nose and throat: oropharynx pink, no injection. cervical range of motion limited by ij line, right neck. no sinus tenderness. no auricular, submandibular, cervical or clavicular lad. pulmonary: rales at the right base and 1/3 up from the base on the left. no dullness on percussion. no accessory muscle use. no wheezes. cardiovascular: regular rate and rhythm. s1, s2 auscultated. no murmurs, rubs or gallops. pulses 2+ at carotids and femorals. palpable pulses at radials and bilateral dorsalis pedis pulses. no jugular venous distention. no carotid or abdominal aortic bruits. abdomen: soft, no organomegaly, no masses palpated. right upper quadrant tenderness at palpation with positive sign, positive bowel sounds. extremities: cool, dry without edema. dermatology: no visible petechia or other lesions. lymph: palpable 1 cm x 1 cm lymph node in right axilla. no lad in left axilla. no inguinal lad. neuro: cranial nerves ii through xii are grossly intact. pupils equal, round and reactive to light. strength: 4+/5 in upper extremities and lower extremities bilaterally. reflexes: in triceps bilaterally, in biceps and brachioradialis bilaterally. in quadriceps bilaterally, 0/4 in ankle jerks. downgoing toes babinski. sensation: sensation to light touch intact in upper and lower extremities. cerebellar signs: finger-to-nose and finger tapping within normal limits. medications on admission to medicine floor: nephrocaps 1 tab po q.d., levofloxacin 250 mg po q.o.d., enteric-coated aspirin 325 mg po q.d., lopressor 50 mg po b.i.d., nifedipine 20 mg po t.i.d., zantac 150 mg po q.d., solu-medrol 40 mg intravenous t.i.d., captopril 7.5 mg po b.i.d., tylenol 650 mg po q. 4-6 hours prn pain, tums 2 tabs po q.a.c. laboratory values on admission to the medicine floor: white blood cell count 13.7, hematocrit 32, platelets 168,000. mcv 81. rdw 19.0. sodium 139, potassium 5.2, chloride 99, bicarbonate 20, bun 60, creatinine 7.1, glucose 125, calcium 8.4, magnesium 2.4, phosphorus 6.0. cardiac enzymes were cycled through to rule out myocardial infarction. troponin values went from 4.5 on to 1.1 on to 0.8 on . ck-mb values went from 8 on to 9 on to 4 on . review by system: 1. pulmonary. mrs. had a series of chest x-rays during her hospitalization. chest x-ray on stated that there was significant interval improvement of the pulmonary edema over previous x-ray the week before. there was also interval decrease in the size of pleural effusions. overall impression was that there had been interval improvement of pulmonary edema and pleural effusion. chest x-ray from stated that there were newly developed bilateral pleural effusions blunting both costophrenic angles. there was also upper zone redistribution suggesting mild congestive heart failure. the heart size was prominent for the portable examination taken. there was no pneumothorax. during her time in the hospital, mrs. had a cough productive of yellow sputum, sometimes tinged with blood, that had resolved by discharge to first clear sputum and then no productive cough and no cough at all by . she denied any shortness of breath at rest or exertion at discharge. 2. cardiovascular. echocardiography was performed on . overall conclusions were that the left ventricle was mildly hypertrophic with sparing of the septum. the overall left ventricular systolic function was severely depressed. right ventricular function was good. the aortic leaflets were mildly thickened. the mitral leaflets were mildly thickened. there was a small circumferential pericardial effusion. the pericardium may have been thickened. compared with a prior study of , the effusion was somewhat smaller, especially anteriorly and right ventricular collapse was less pronounced. ejection fraction was estimated to be between 20-25%. cardiac catheterization was performed on . internal comments were: 1. coronary angiography of this right dominant system revealed normal coronary arteries. the lm as normal. the left anterior descending and its d1 and d2 branches were all normal. the left circumflex artery and its om1 and om2 branches were all normal. the right coronary artery and its am, r-pda, r-pl branches were all normal. 2. hemodynamic measurement revealed mildly elevated pap (32/19/24 mmhg), highly elevated central aortic pressure (170/98/125 mmhg), and highly elevated left ventricular end-diastolic pressure (27 mmhg). no transaortic gradient was seen. 3. left ventriculography revealed global hypokinesis and an estimated ejection fraction of 22%. mitral regurgitation was at least 2+. the final diagnosis was: 1. coronary arteries are normal. 2. moderate mitral regurgitation. 3. severe systolic ventricular dysfunction. blood pressure. blood pressure was difficult to control during mrs. stay in the hospital. her systolic blood pressure was persistently greater than 150. it was particularly well-controlled during the catheterization productive. during nitroglycerin drip the systolic blood pressure was in the 120s, but noted to be in the 160s to 170s with discontinuation of the drip. as a consequence of the catheterization procedure, mrs. developed a hematoma at her right groin. her hematocrit dropped from 25-22 within 24 hours following the procedure while serial hematocrits were taken every 2 hours. her hematocrit stabilized at 22. an ultrasound of the right groin at the time showed the common femoral artery. there was no evidence of pseudoaneurysm or av fistula. there was no hematoma over the puncture site. 3. infectious disease. blood cultures taken at the time of admission were eventually negative. urine cultures also taken showed no growth. a sputum culture showed pmns with more than 10 epithelial cells. there were gram positive cocci in pairs and clusters. there was sparse growth of oropharyngeal flora. legionella urinary antigen was also negative. levofloxacin was discontinued before discharge. 4. renal. during her stay in medical intensive care unit and during her stay on the medicine floor, mrs. underwent dialysis numerous times. during dialysis she consistently received several units of packed red blood cells as well as epogen. 5. heme. as mentioned above, mrs. received numerous units of packed red blood cells during her hospitalization, as well as epogen. iron studies provided the following values: fe: 49 within normal limits. tibc: 211/ trf: 162. haptoglobin: 179. ld: 252. reticulocyte count on : 5.2. her hematocrit on admission was 28.2. her hematocrit on discharge was 32. condition on discharge: stable. diagnoses on discharge: 1. systemic lupus erythematosus. 2. lupus nephritis/membranoproliferative glomerulonephritis with a necrotizing component and focal crescent formations. 3. hypertension. 4. congestive heart failure. disposition: the patient was discharged to home. she was instructed to follow-up with her primary care physician, . , within one week; as well as to make an appointment with dr. . the patient refused to allow the house officer to schedule those appointments and said that she would schedule them herself. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures hemodialysis hemodialysis hemodialysis hemodialysis diagnoses: pneumonia, organism unspecified chronic glomerulonephritis in diseases classified elsewhere systemic lupus erythematosus acute respiratory failure hemorrhage, unspecified other specified alveolar and parietoalveolar pneumonopathies hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage v or end stage renal disease 

Answer: The patient is high likely exposed to