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: aspirin / phenergan / lorazepam attending: chief complaint: transfer from - for possible tracheostomy major surgical or invasive procedure: peg and tracheostomy placement history of present illness: ms. is a 70 year old woman with morbid obesity, obesity hypoventilation syndrome, atrial fibrillation, diabetes, and diastolic heart failure who is transferred from - for tracheostomy placement. she was admitted to - on with hypoxic and hypercarbic respiratory failure of unclear etiology. she was admitted to the icu for non-invasive ventilation, which she could not tolerate; she was subsequently intubated. she was substantially diuresed (~13 kg) with 100mg diamox. mrsa was found on sputum culture (but no white count and no fever), and vancomycin was started (now day #5). piperacillin-tazobactam was added on the day of transfer. her vent settings at the time of transfer were simv 500 x 10, fio2 0.4, peep 5. . the day prior to transfer, she developed a low-grade temperature to 99.3 axillary with systolic blood pressures in the 80's. her beta blocker and calcium channel blocker (which she is on because of atrial fibrillation with rvr) were discontinued, and her rhythm converted into atrial fibrillation with rvr. she was given 2 liters of ivf with improvement of her blood pressure to the 110's, she was loaded with digoxin, and her beta blocker was restarted (at a lower dose) on the day of transfer. of note, her sugars have been difficult to manage, so she was placed on an insulin gtt. of note, she was recently discharged from after an admission for digoxin overdose, atrial fibrillation with rvr, and uti treated with 10 day course of levofloxacin. past medical history: 1. morbid obesity. 2. lymphedema. 3. diabetes. 4. mechanical aortic valve in . 5. atrial fibrillation. 6. hypothyroidism. 7. history of decubitus ulcers. 8. ankle fracture, status post fall in with long rehabilitation. 9. recent dig toxicity admitted to . 10. history of diastolic congestive heart failure (ef greater than 55% with mild lvh, pulmonary capillary wedge pressure of greater than 18, 1+ mr). social history: lives at home with partner (health care proxy). mostly , but can walk with assistance. has nursing assistance 12 hours daily. denies alcohol, tobacco, other drugs. she was recently discharged to after a stay at for dig toxicity. she was discharged on . she is mostly bed bound. she is dependent on others for her activities of daily living. prior to admission to , she was living at home with her partner x 30 years who is also her health care proxy. family history: 2 brothers had age 59, 66. mother and brother with emphysema, both smokers. physical exam: vitals: t 98.6f, hr 100's, bp 105/59, rr 19, sat 98% vent: a/c tv 500, rate 12 (overbreathing), peep 10, fio2 0.5 general: morbidly obese, ventilated, no acute distress heent: eomi, perrl, mmm neck: thick neck, unable to appreciate jvp card: irregularly irregular, normal s1/s2, 2/6 systolic murmur heard loudest at apex resp: clear to auscultation bilaterally anteriorly abd: obese, non-distended. + bowel sounds. back: deferred ext: warm, well-perfused, 2+ dp pulses bilaterally. venous stasis changes. neuro: sedated. pertinent results: 08:25pm blood wbc-10.7# rbc-3.33* hgb-10.5* hct-32.9* mcv-99* mch-31.3 mchc-31.8 rdw-15.4 plt ct-356 02:48am blood wbc-8.8 rbc-2.87* hgb-9.0* hct-28.1* mcv-98 mch-31.4 mchc-32.0 rdw-15.4 plt ct-335 02:48am blood pt-19.4* ptt-81.3* inr(pt)-1.8* 08:25pm blood glucose-186* urean-19 creat-0.8 na-133 k-4.7 cl-96 hco3-34* angap-8 02:48am blood glucose-181* urean-11 creat-0.9 na-138 k-4.9 cl-103 hco3-28 angap-12 08:25pm blood alt-16 ast-25 ld(ldh)-300* alkphos-81 amylase-12 totbili-0.6 02:48am blood calcium-10.0 phos-3.5 mg-2.8* 03:04am blood type-art po2-145* pco2-60* ph-7.38 caltco2-37* base xs-8 . cxr: this is compared with prior study from . there is some blunting of the left costophrenic angle suggestive of a small effusion. the cardiac size is somewhat enlarged. the right picc line has been removed. there has been a median sternotomy with cerclage wires intact. large cardiac silhouette with left-sided effusion, similar to prior study. brief hospital course: 70yf with atrial fibrillation, aortic valve replacement, admitted to - with respiratory failure requiring ventilation, now transferred to for tracheostomy placement. . #) hypoxic/hypercarbic respiratory failure. this was thought to be secondary to obesity hypoventilation syndrome with components of chf and possibly pneumonia. she had completed a course of vancomycin at the osh for mrsa in the sputum so her antibiotics were stopped on admission and she remained afebrile. she was sent for a trach after her inr trended down to <1.5 and tolerated this without difficulty. her sedation was weaned and she tolerated a switch from ac ventilation to ps 15/10 fio2 40% tv ~500. she was oxygenating and ventillating well on these settings and was transfered to pulmonary rehab for further weaning off the vent. she was contined on nebs throughout her admission. . #) hypotension. she was initially hypotensive in the setting of aggressive diuresis. she remained afebrile and did not require pressor support. her bp remained well controlled even with rate control of her afib. . #) atrial fibrillation. she was in poorly controlled atrial fibrillation on admission and was intially treated with digoxin given her borderline blood pressure. as this improved with hydration her home nodal agents were gradually reintroduced (diltiazem and metoprolol). she was rate controlled in the 70s at the time of discharge. . #) diabetes. she was intially managed with an insulin drip but transitioned to long acting and sliding scale insulin prior to discharge. her long acting insulin will need to be readjusted in the future as needed. . #) mechanical aortic valve. she was initally placed on a heparin drip and her inr allowed to trend downwards for her trach/peg. after the procedure her heparin was restarted and she was bridged to a therapeutic inr on coumadin. her inr was 2.0 on the day of discharge and the heparin was stopped. she should have her coumadin titrated to maintain her inr between . . #) hypothyroidism. we continued levothyroxine. . #) depression. we continued escitalopram. . #) f/e/n. she had a peg tube placed and she was started on replete tube feeds at 60ml/hr continuously prior to discharge which she tolerated well. medications on admission: levothyroxine 225mcg daily on transfer: simvastatin 20mg daily insulin drip docusate 100mg vancomycin 1g (day #1 ) zosyn 4.5 grams q6h (day #1 ) escitalopram 20mg daily versed gtt coumadin 5mg daily free water boluses given q8h metoprolol 25mg qid discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 3. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day). 4. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 5. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 6. levothyroxine 75 mcg tablet sig: three (3) tablet po daily (daily). 7. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 8. escitalopram 10 mg tablet sig: two (2) tablet po daily (daily). 9. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 10. warfarin 5 mg tablet sig: one (1) tablet po days (,mo,tu,we,th,fr,sa). 11. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 12. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day): hold for sbp < 100 or rate < 60. 13. diltiazem hcl 30 mg tablet sig: one (1) tablet po qid (4 times a day): hold for sbp < 100 or rate < 60. 14. insulin nph human recomb 100 unit/ml suspension sig: fifty five (55) units subcutaneous twice a day. 15. insulin sliding scale per attached scale discharge disposition: extended care facility: northeast - discharge diagnosis: primary: hypercarbic respiratory failure . secondary: mechanical avr, diabetes ii, morbid obesity, atrial fibrillation discharge condition: stable on her vent settings, interactive, and tolerating peg feeds discharge instructions: please follow the instructions at the rehab facility and take your medications. please call your pcp for an appointment after discharge from rehab followup instructions: please follow-up with your pcp after discharge from rehab (, s. ) md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy diagnoses: congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation heart valve replaced by other means acute respiratory failure morbid obesity chronic diastolic heart failure 

Answer: The patient is high likely exposed to