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: patient recorded as having no known allergies to drugs attending: chief complaint: dyspnea major surgical or invasive procedure: cvvh bronchoscopy left ij dialysis line placement history of present illness: 77 yo f hx severe as, cad, cri, dm, htn admitted to osh on w/ acute dyspnea. a chest ct showed airspace consolidation lower lobes b/l, rm and rul, as well as small right pleural effusion. she was started on doxy/azithro, then ctx and avelox for 5days, then changed to cefdinir for 3 days, and then 2 more days of avelox. in total, received 10 d of abx. initial bnp . she subsequently developed arf (cr peaked 5.9), requiring initiation of hd. she initially had renal bx on which was benign. while awaiting bx results she was empirically treated with steroids, which have since been discontinued. she continued to have peristent hypoxemia, was treated with bipap, also required pressors, was intermittently on dopamine, dobutamine, levophed. pt was transferred to on for further care. after admission, she had a trial of diuresis for hypoxia and concern for fluid overload was resistant to diuretics, nicardipine qtt, then placed on cvvhd. pt has 4l removed yesterday and additional 1l removed today. pt notes fair improvement in her dyspnea. she has been receiving bipap nightly and high flow face mask during the day, however today has required continued bipap. she recalls to me very gradual progression of dyspnea over months, + orthopnea. denies any associated fever/chills or cough. she denies nausea, had one episode of vomiting. no chest or abdominal discomfort, no palpitations, no diarrhea or dysuria. her dry weight is 192 lbs, weight 215 lbs at time of admission to ccu. past medical history: cad s/p pci with stents to lad and lcx in ', cath with in-stent proximal lad stenosis 70% planned for cabg with avr. chf with as, mr cri (cr 1.5) htn dm ii hx afib - had been on flecainide, amiodarone, not on coumadin as outpt as she did not want to monitor inr hx uterine ca s/p tah oa gout r cataract social history: widowed, lives alone, has children who live nearby. works as bookkeeper in a flower shop. denies tobacco or recreational drugs, rare etoh. family history: noncontrib physical exam: initial exam on transfer to ccu vs: t 96.4, bp 148/50, hr 53 in nsr, o2 sat 97% on bipap 60%/ gen: pleasant, obese female, speaks in short sentences while on bipap, fully awake, alert, states breathing is considerably improved since initiation of cvvhd heent: anicteric, op clear: neck: l ijv hd catheter emplaced, impressive diffuse ecchymosis involving most of l neck and upper chest cv: rrr, nl s1, s2, iii/vi systlic murmur rusb resp: good breath movement bilaterally abd: soft, obese, nt, nd, + bs extr: 1+ edema b/l, 2+ dp pulses b/l, r wrist with a-line neuro: pleasant, aaox3, mild resp distress on discharge patient had persistant bronchial breath sounds at left mid to lower lung fields. high pitched systolic murmur continued. pedal edema had resolved. chest still had large area of ecchymosis which was resolving. pertinent results: 03:34pm blood wbc-15.1*# rbc-4.06* hgb-11.5* hct-35.2* mcv-87 mch-28.3 mchc-32.7 rdw-15.0 plt ct-221 04:12am blood wbc-13.9* rbc-3.27* hgb-9.4* hct-28.2* mcv-86 mch-28.6 mchc-33.2 rdw-14.9 plt ct-166 02:28am blood wbc-14.0* rbc-3.08* hgb-8.6* hct-26.8* mcv-87 mch-27.8 mchc-31.9 rdw-15.0 plt ct-148* 03:13am blood wbc-8.7 rbc-2.74* hgb-7.9* hct-24.0* mcv-88 mch-28.8 mchc-32.9 rdw-15.3 plt ct-118* 08:13am blood wbc-9.6 rbc-3.34* hgb-9.6* hct-29.3* mcv-88 mch-28.7 mchc-32.7 rdw-15.7* plt ct-95* 06:22am blood wbc-9.1 rbc-3.36* hgb-9.6* hct-28.9* mcv-86 mch-28.7 mchc-33.3 rdw-16.6* plt ct-86* 02:52pm blood hct-28.5* plt ct-87* 06:10am blood wbc-5.1 rbc-2.92* hgb-8.6* hct-26.0* mcv-89 mch-29.6 mchc-33.2 rdw-16.5* plt ct-86* 06:18am blood wbc-4.6 rbc-2.68* hgb-7.9* hct-23.5* mcv-88 mch-29.4 mchc-33.4 rdw-16.8* plt ct-105* 03:34pm blood pt-13.8* ptt-48.5* inr(pt)-1.2* 06:10am blood pt-13.0 ptt-32.6 inr(pt)-1.1 06:17am blood pt-27.0* ptt-33.7 inr(pt)-2.7* 06:18am blood pt-58.5* ptt-36.5* inr(pt)-6.9* 03:10pm blood d-dimer-2767* 06:17am blood ret aut-3.8* 03:34pm blood glucose-163* urean-102* creat-3.8*# na-131* k-4.3 cl-88* hco3-28 angap-19 02:36am blood glucose-166* urean-130* creat-4.3* na-129* k-4.1 cl-89* 06:22am blood glucose-98 urean-13 creat-0.8 na-135 k-4.0 cl-99 hco3-25 angap-15 03:42am blood glucose-92 urean-21* creat-1.4* na-136 k-3.7 cl-99 hco3-24 angap-17 03:01pm blood glucose-122* urean-26* creat-1.7* na-135 k-3.8 cl-100 hco3-23 angap-16 05:13am blood glucose-115* urean-31* creat-1.9* na-135 k-3.5 cl-100 hco3-22 angap-17 06:10am blood glucose-89 urean-41* creat-2.2* na-131* k-4.2 cl-95* hco3-22 angap-18 06:17am blood glucose-111* urean-53* creat-2.7* na-132* k-5.0 cl-97 hco3-24 angap-16 06:18am blood glucose-91 urean-55* creat-2.6* na-135 k-4.9 cl-100 hco3-25 angap-15 03:13am blood probnp-* 06:17am blood caltibc-293 hapto-88 ferritn-443* trf-225 06:43pm blood tsh-5.0* 05:56am blood t4-4.3* t3-35* 03:10pm blood anca-negative b 03:10pm blood anca-negative b 03:10pm blood -negative 03:42am blood pep-hypogammag ife-no monoclo . ct chest without contrast ct of the chest without intravenous contrast: there is dense air bronchogram containing solid and ground-glass consolidation involving the right and left upper lobes (right greater than left), with additional small regions of ground-glass opacification noted within the right middle lobe and right lower lobe with scattered nodular opacities present. additionally, there are small bilateral simple pleural effusions, right slightly greater than left, with adjacent compression atelectasis and/or pneumonia. airways are patent to the subsegmental level and no pathologically enlarged lymph nodes are present, the largest measuring 8 mm in short axis within the precarinal chain. there is marked underlying cardiomegaly with left ventricular and left atrial dilatation, as well as atherosclerotic disease within the coronary circulation, aortic annulus and aorta. artifact is noted from the indwelling swan-ganz catheter whose tip is in the right ventricle. visualized images of the upper abdomen display a probable small cyst of the interpolar portion of the left kidney and bilateral flank edema. no lucent or sclerotic osseous lesions are noted. impression: 1. multifocal predominantly upper lobe pneumonia, with small regions of consolidation and compression atelectasis within the lower lobes. small right slightly greater than left simple pleural effusions. 2. tip of swan-ganz catheter is in the right ventricle . chest ct without contrast findings: since the examination of , there has been removal of the right-sided central venous access catheter and placement of a left internal jugular venous access catheter. there is a new hematoma in the left supraclavicular region which is incompletely imaged but which measures 3.3 x 4.0 cm in transaxial dimension in its imaged portion (2:2). an endotracheal tube terminates above the level of the carina. slight stranding extends into the superior mediastinum from the left supraclavicular hematoma, although there is no evidence of mediastinal hematoma about the great vessels. the aorta is normal in caliber and contour with mural calcifications consistent with atheromatous disease. multiple mediastinal lymph nodes do not meet ct criteria for pathologic enlargement. there are extensive coronary artery calcifications as well as aortic valvular and mitral annular calcifications. the catheter which had been previously coiling in the right atrium has been removed. there is no evidence of pericardial effusion. a nasogastric tube is in place within the stomach, new since the previous examination. bilateral areas of consolidation in the upper lobes have improved since . there is additional improvement of bilateral lower lobe consolidation with residual areas of atelectasis and consolidation at the lung bases. small bilateral pleural effusions have decreased slightly in size. residual areas of patchy and nodular consolidation are present in the upper lobes bilaterally. there is no pneumothorax. limited images of the upper abdomen show a small amount of perihepatic free fluid. hyperdense material within the gallbladder could relate to vicarious excretion of contrast or hyperconcentrated bile. the imaged portion of the liver, spleen, pancreas, adrenal glands, and upper poles of the kidneys appear otherwise within normal limits allowing for non-contrast technique. asymmetric subcutaneous edema in the left chest wall is probably related to dependent positioning, although clinical correlation is recommended. bone windows: no lesions worrisome for osseous metastatic disease are identified. multiplanar reformats: coronal and sagittal reformations are helpful in delineating the above-described findings. impression: 1. new left supraclavicular hematoma, 3.3 x 4.0 cm in diameter and partially imaged. 2. interval improvement in bilateral pulmonary consolidation with residual patchy and nodular opacities consistent with infectious or inflammatory process. followup imaging after treatment is recommended to assess complete resolution. 3. slight improvement in bilateral pleural effusions. . echocardiogram the left atrium is elongated. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). the right atrium is moderately dilated. the estimated right atrial pressure is 10-20mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50-55%). the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are severely thickened/deformed. there is moderate aortic valve stenosis (area 1.0-1.2cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets and supporting structures are mildly thickened. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. impression: moderate aortic valve stenosis. mild symmetric left ventricular hypertrophy with low normal systolic function. at least moderate mitral regurgitation. mild aortic regurgitation. . chest pa/lat brief hospital course: a&p: 77 yo f hx cad, af, dm, htn, chf with mod as (gradient 32 mmhg) who presented with gradually worsening dyspnea, complicated by renal failure. . # hypoxia - pt initially presented with gradual progression of doe, orthopnea, no infectious symptoms. initial imaging with question of infection so treated with empiric course for community acquired pneumonia, which is completed. sputum eventually grew stenotrophomonas and enterobacter which were treated with 7 days of bactrim and cipro respectively. her imaging and exam were felt to be consistent with fluid overload and she was treated with cvvhd with an eventual total diuresis of approximately 10l. there was also felt to be a significant component of atelectasis. she was initially on bipap only nightly, but then progressed to continuous bipap in an effort to recruit alveoli. however even on continusous bipap she began to tire and was intubated. although she was intubated for hypoxic respiratory failure initial abgs after intubation did not show significant a-a gradient and patient was successfully extubated within a few days. while intbuated, she had a bronchoscopy with bal. viral, fungal, and legionella tests were negative. overall hypoxia was felt to be due to a combination of fluid overload, pneumonia, and atelectasis. amiodarone toxicity was considered but this was not entirely clear. she may have an underlying lung process and should have pulmonary followup to evaluate for progression/improvement. at time of discharge she had persistant atelectasis and effusion causing bronchial breath sounds at the left base, and crackles at the bases bilaterally. . # acute diastolic chf and aortic stenosis- pt appeared to be fluid overloaded on arrival felt to be related to as. however echocardiogram and hemodynamics via swan-ganz catheter did not demonstrate severe systolic impairment (either due to ventricular dysfunction or as). still patient did have chronic volume overload, likely exacerbated by renal failure. fluid removed via cvvh and at time of discharge patient was maintaining an even to slightly negative fluid balance. her hypertension was controlled with metoprolol and nifedipine. lisinopril was stopped given renal failure pending stable creatinine. also given patient's as and relatively preserved systolic function, it was not felt that she needed aggressive afterload reduction. . # afib - pt with hx of afib in past, and episode of af during admission, not clearly correlated to chf exacerbation. she was previously on amiodarone, but pattern not fully consistent with amiodarone toxicity. amiodarone and fleccainide were held and while in the ccu she was initially mostly in sinus rhythm but then af became more predominant. metoprolol was titrated for rate control and patient agreed to anticoagulation with warfarin. inr to be followed by pcp, . she was initially started on coumadin 5mg po daily, and her inr climbed as high as 7.0. this occurred in the setting of concurrent antibiotic administration which may have altered the metabolism of coumadin. nonetheless, her coumadin was held until her inr trended back down between . she should see an electrophysiologist in the future for discussion of rhythm control as she will need atrial kick once as progresses. you should continue with coumadin 2mg po daily. you should check your inr daily and dose coumadin accordingly. . # cad - there was no evidence of recent ischemia and she was continued on asa, metoprolol, statin. . # acute on chronic renal failure - pt with some renal dysfunction at baseleine developed acute renal failure after presentation. had full evaluation including renal biopsy which now has been confirmed as negative (, anca neg, c3, c4 nl). now off steroids, renal lytes initially c/w pre-renal, but likely from poor cardiac flow rather than hypovolemia. overall etiology of renal function remains unclear. renal team did not feel she would need further hemodialysis, although she did sustain a significant diminution of her renal function. she does not need to be on a renal diet. she had a renal ultrasound performed which has not been read yet. . # dm - pioglitazone was stopped given renal failure. she should not continue this medication. blood sugars were controlled without need for sliding scale insulin. she should continue to have blood sugar followed and alternate oral hypoglycemics should be considered. . # gout - allopurinol continued at qod dosing which was discussed with nephrology for prevention of gout. . # cad - no evidence of recent ischemia, cont asa, metoprolol, statin. . # thrombocytopenia multiple possible causes including antibiotics, overall illness causing marrow suppression, ttp, heparin-induced thrombocytopenia, consumption while on cvvh. pf4 antibodies were sent given intermediate probability of hit (4t score of 4) and are pending at this time. she was already therapeutically anticoagulated with warfarin so argatroban was not started. she should have platelet count rechecked once she has recovered from acute illness and antibiotics stopped. there was no evidence of hemolysis. . # anemia unclear if anemia was due to generalized marrow suppression vs. renal disease vs. acute blood loss anemia. iron studies suggested anemia of chronic disease/renal insufficiency. her stool was guaiac negative and the subcutaneous ecchymosis she had developed was stable. hemolysis labs negative. initially her anemia was felt to be due to consumption while on cvvh as she did not require tranfusion once off cvvh. given her new renal dysfunction, she should be followed by nephrology and consideration given to erythropoetin therapy. medications on admission: home meds: allopurinol 150mg daily asa 81mg daily lovastatin 40mg daily toprol-xl 25mg daily nifedipine xl 30mg daily actos 30mg daily plavix 75mg daily flecainide 50mg lasix 80mg daily lisinopril 40mg daily . transfer meds: insulin ss allopurinol 150 mg po every other day albuterol inh q4h metoprolol 25 mg po bid aspirin 81 mg po daily nifedipine 30mg daily atorvastatin 40 mg po daily heparin iv drip home med of amiodarone stopped discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. allopurinol 100 mg tablet sig: 1.5 tablets po every other day (every other day). 4. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 5. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed. 6. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. 8. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 9. nifedipine 60 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). 10. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed). 11. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed. 12. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 13. furosemide 80 mg tablet sig: one (1) tablet po once a day. 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 15. outpatient lab work inr check daily 16. coumadin 1-3mg po daily, according to inr discharge disposition: extended care facility: center - , nh discharge diagnosis: primary: chronic systolic congestive heart failure aortic stenosis atrial fibrillation pneumonia acute on chronic renal failure . secondary: diabetes gout discharge condition: good o2 sat 94% 4l discharge instructions: you were admitted to the hospital with difficulty breathing. you were found to have a pneumonia and treated with antibiotics. you were also found to have congestive heart failure. in addition, you developed acute renal failure and received hemodialysis. . your lisinopril and pioglitazone were discontinued, as these medications should not be taken in the setting of acute renal failure. . your amiodarone and flecainide were also discontinued. . your lovastatin was discontinued, and switched with atorvastatin . you were started on coumadin. you will need to have your inr checked daily in order to properly dose your coumadin. you should continue with 2mg po of coumadin and alter the dose accorrding to the inr. . your nifedipine was increased to 60mg po daily for improved blood pressure control. . you will need to follow-up with a pulmonologist to evaluate the etiology of your lung disease. . you will need to follow-up with a nephrologist to discuss the need for iron supplementation. . you will need to follow-up with a cardiologist to discuss treatment for your atrial fibrillation. . please call your doctor or return to the hospital if you experience shortness of breath, chest pain, fever, or any other concerning symptoms. followup instructions: please call your pcp at tp schedule an appointment within two weeks. . please call your cardiologist to schedule an appointment within two weeks. . please call your nephrologist, to schedule an appointment within two weeks. procedure: insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis non-invasive mechanical ventilation arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: thrombocytopenia, unspecified anemia in chronic kidney disease coronary atherosclerosis of native coronary artery pneumonia due to other gram-negative bacteria pure hypercholesterolemia acute kidney failure with lesion of tubular necrosis diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation hematoma complicating a procedure percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified personal history of malignant neoplasm of other parts of uterus pulmonary collapse rheumatic heart failure (congestive) acute respiratory failure personal history of other malignant neoplasm of skin long-term (current) use of insulin unspecified hearing loss mitral valve insufficiency and aortic valve stenosis osteoarthrosis, unspecified whether generalized or localized, site unspecified dermatitis due to drugs and medicines taken internally other postprocedural status kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure electrolyte and fluid disorders not elsewhere classified unspecified cataract sulfonamides causing adverse effects in therapeutic use mixed acid-base balance disorder cataract extraction status 

Answer: The patient is high likely exposed to