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: prednisone / penicillins attending: chief complaint: respiratory distress major surgical or invasive procedure: endotracheal intubation history of present illness: ms. is an 89 year-old woman with chf, atrial fibrillation on coumadin, recent bilateral femur fractures s/p orifs at complicated by pneumonia, and recent discharge to rehab 2 weeks ago presents with 1 day of respiratory distress at rehab. her roomate at rehab apparently had a viral illness and then the patient started having similar symptoms. she desaturated to 79% on 2l, 86% on a non-rebreather(no baseline o2 requirement). she was brought to the emergency department at . . upon arrival to the ed, vital signs were temperature 98.3, blood pressure 159/59, hr 73, rr 36, sao2 88% on room air 96% on 3 l nc. patient tachypneic, short of breath with conversation, and had audible gurgling. she received lasix 40 mg iv and was started on a nitroglyercin drip which was later discontinued when respiratory status immproved on bipap. past medical history: # congestive heart failure # atrial fibrillation on coumadin, s/p pacemaker placement # multiple pneumonias, including aspiration pna # hypertension # s/p bilateral supracondylar femur fractures , s/p orif of both distal femurs # dementia # remote history of tuberculosis # history of clostridium difficile # right foot drop secondary to peroneal injury # pulmonary nodule # thyromegaly social history: previously lived with family but recently residing at rehab facility after recent femur fractures with private care nurses also attending. dementia at baseline. family very involved with care. family history: non-contributory physical exam: physical exam on admission: vitals: t 96.9, bp 172/61, hr 90, rr 35, sao2 96% on hi flow 15 l/m and fio2 95% general: chronically ill female, appears in mod resp distress heent: pt refused to allow exam of pupils, eom appear intact cv: irreg irreg, no m/r/g over breath sounds pulm: v.loud upper airway sounds, b/l crackles throughout. abdomen: +bs, soft, non-tender extremities: mild le edema b/l neuro: awakens to voice. answers some questions. moves all extremities but will not cooperate with full neuro exam skin: per nursing, stage ii lumbar decub pertinent results: ecg -atrial fibrillation with controlled ventricular response. right bundle-branch block with secondary st-t wave abnormalities. no previous tracing available for comparison. . ecg -possible atrial fibrillation with bigeminal ventricular premature beats. right bundle-branch block with left anterior fascicular block. compared to tracing of bigeminal ventricular premature beats are present. . chest x-ray -findings: in comparison with the study of , there is little change. again, there is huge stable enlargement of the cardiac silhouette with relatively mild vascular congestion, raising the possibility of pericardial effusion or cardiomyopathy. opacification at the right base persists, consistent with pleural effusion and probable underlying atelectasis. the left base is difficult to evaluate due to obliquity of the patient. single-channel pacemaker device remains in place with its tip in the region of the apex of the right ventricle. . echo -conclusions the left atrium is moderately dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated. right ventricular systolic function is normal. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (area 1.2-1.9cm2). moderate (2+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is a trivial/physiologic pericardial effusion. suboptimal image quality - patient unable to cooperate. impression: mild symmetric hypertrophy with normal systolic function. mild aortic stenosis and moderate aortic regurgitation. the study was limited due to lack of patient cooperation. brief hospital course: # respiratory distress: pt admitted to micu given respiratory distress thought to be due to chf versus pneumonia. she was stable on intubation and received multiple fluid boluses for low blood pressure, urine output. she was started on vancomycin, levofloxacin and metronidazole (pt has pcn allergy) for empiric pna treatment. she was extubated on hd4. when sputum culture was positive for moraxella she was changed to po levofloxacin to complete 10 day course for 10 day course. given pulmonary edema, she received furosemide prn for goal 1l negative daily, then returned to furosemide 20mg qod (home regimen) as pt appeared less fluid overloaded. on , oxygen saturation decreased to high 80s, received chest pt and increased o2 via nc with improved o2sat. has intermittent bipap which was later weaned. she was continued on chest pt, with added guaifenesin ml po q6h to help mobilize secretions; xopenex 1.25-0.5 mg/ml inhalation q6h prn; and ipratropium bromide nebs ih q4h while awake. on the day of discharge she was awake and alert and following commands. her blood gas at time of discharge is ph 7.42, pco2 61, po2 76, hco3 41 on 0.5l nasal cannula with baseline optimal mental status (awake and alert). . # htn: home regimen for htn metoprolol 50mg po tid, furosemide 20mg qod. she was started on metoprolol iv pending swallow evaluation and briefly tried on metoprolol. per patient's previous cardiologist, she has marked orthostatic changes in blood pressure and must tolerate elevated blood pressures in sitting/recumbent position in order to prevent hypotension upon standing. recommend continuing home regimen and outlined above and increasing lasix to 20mg daily when evidence of fluid overload exists. . # atrial fibrillation: pt returned to home dose of metoprolol 50 mg tid for rate control; warfarin restarted at 5.0mg daily (home regimen is 5.5mg daily). recommend regular inr monitoring. . # decubitus ulcers: pt has thoracic, chronic achilles and posterior calf decubitus ulcers. wound care consult obtained and made the following recommendatios: thoracic: full wound healing achilles: keep tendon moistened to prevent dessication. posterior calf: moist wound therapy for autolytic debridement. . # s/p bilateral femur fx: pt continues to be weight-bearing as tolerated. . # fen: pt initially placed on nutren pulmonary tube feeds but returned to po, with nectar prethickened liquids and ground solids. hcp expressed opposition to ng tube placement. recommend calorie counts and nutritional supplements. . # prophylaxis: pt continued on heparin 5000units sc tid, pantoprazole 40mg po daily, humalog iss, and bowel regimen. . # full code . # communication: hcp son medications on admission: lasix 20mg po every other day metoprolol 50mg po tid coumadin 5.5mg daily prilosec 20mg daily lactulose 30ml po bid kcl 10 meq po every other day calcium citrate 950mg po bid zinc sulfate 220mg po daily multivitamin vitamin b12 1000mg po daily vitamin c 500mg po daily oscal 1200mg po bid acetaminophen prn dulcolax supp daily prn fleet enema pr prn discharge medications: 1. insulin lispro 100 unit/ml solution : sliding scale per sheet subcutaneous asdir (as directed). 2. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 3. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 4. cyanocobalamin 500 mcg tablet : two (2) tablet po daily (daily). 5. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 6. warfarin 5 mg tablet : one (1) tablet po daily16 (once daily at 16). 7. olanzapine 5 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po qhs (once a day (at bedtime)) as needed for insomnia, agitation. 8. metoprolol tartrate 50 mg tablet : one (1) tablet po tid (3 times a day). 9. furosemide 20 mg tablet : one (1) tablet po qod (). 10. ipratropium bromide 0.02 % solution : one (1) inhalation q4h (every 4 hours). 11. guaifenesin 100 mg/5 ml syrup : 5-10 mls po q6h (every 6 hours) as needed for secretions. 12. levalbuterol hcl 0.63 mg/3 ml solution : one (1) ml inhalation q 6 hr prn () as needed for sob, wheezing. 13. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 14. lactulose 10 gram/15 ml syrup : fifteen (15) ml po bid (2 times a day). discharge disposition: extended care facility: for the aged - macu discharge diagnosis: congestive heart failure pneumonia discharge condition: good discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet followup instructions: follow-up with dr. of cardiology. call ( to make an appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: pneumonia due to other gram-negative bacteria congestive heart failure, unspecified unspecified essential hypertension unspecified protein-calorie malnutrition atrial fibrillation other persistent mental disorders due to conditions classified elsewhere acute and chronic respiratory failure pneumonitis due to inhalation of food or vomitus pressure ulcer, other site long-term (current) use of anticoagulants cardiac pacemaker in situ chronic diastolic heart failure pressure ulcer, ankle pressure ulcer, upper back 

Answer: The patient is high likely exposed to