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: "sob, respiratory failure." major surgical or invasive procedure: intubation a-line cvl bronchoscopy thoracentesis history of present illness: pt is a 46m with pmh htn, benzodiazepine/opiate abuse, who presents with hypercarbic respiratory failure. he was brought in by ems from home with report of difficulty breathing x 1 day. of note, he presented to the ed in with cough and fever, and was found to have a rll pna, and was recommended to be admitted for iv abx. however, he refused and left ama with a rx for levoquin 750mg x 2 wks. he returned to the ed in , and chest xr at that time showed severe emphysema and interval increase in the right basilar opacity, unlikely to be pneumonia. however, given his symptoms, fever, and prior unresponsiveness to levofloxacin, ed physicians felt that he should be admitted with another course of antibiotics. pt again did not want to be admitted and was discharged with medications for pain control. he called his pcp shortly after and was started on "a repeat course of antibiotics," although which ones are not specified in pcp's note and are not listed in omr. . on arrival to the , pt unable to give history, and initial sat 75% ra. he was noted to have diffuse rhoncorous breath sounds and gurgling upper respiratory sounds as well as pinpoint pupils. pt was initially awake and talking but not making sense. . in the ed, initial vitals were 102.8, 112, 104/56, o2 sats 75%. ekg showed ekg: sr@115 peaked ts qs v1 v2 (no prior). he was intubated immediately for respiratory distress and sedated with fentanyl and versed. his abg after intubation was 7.20/66/366. there was no prior abg. ngt was placed and was noted to have dark brown guiac positive output. he was given protonix 80 mg iv x 1. cxr was done showing right infrahilar pneumonia, and per report there was a concern for pcp pneumonia though this is not documented in the final report. he was given zosyn, gentamycin, and azithromycin (ceftriaxone also ordered but unclear if he got this). he was also given 3l of ns. other labs significant for a k+ of 6.3 (given insulin 10 units, d50, calcium gluconate), and lactate of 6.7. he was also noted to have (cr 2.7 from prior baseline of 0.7), and transaminitis with alt/ast 1798/3141. inr is up to 1.9 from a recent normal baseline of 1.0. ua showed small blood, protein of 30, trace ketones, few bacteria, 4 granular casts, and 64 hyline casts. serum tox screen was initially negative in the ed. on transfer, vent settings were ac, 100% fio2 peep 5, tv:500. access - 2 x 20g piv. . on arrival to the icu, pt's vitals were 37.2c, hr 96, bp 102/49, rr 16, sat 99%. past medical history: -hcv -opiod and benzodiazepine abuse -rll pna tx'd with levofloxacin in and -htn -severe depression -tobacco use -addiction -allergic rhinitis -anxiety -erectile dysfunction -headache -rosacea past surgical history: appendectomy deviated septum repair left shoulder , debridement of biceps tendon tear, open biceps tenodesis social history: -lives with and takes care of his mother, who has dementia in . used to work as an electrician, but has been unemployed for several years with the exception of one month recently. -tobacco: several packs daily for decades -alcohol: none -drugs: opiates and benzo abuse, heroine use in the past family history: mother with dementia father - died from lung cancer sister - colon cancer physical exam: admission exam: vitals: 37.2c, hr 96, bp 102/49, rr 16, sat 99%. general: thin, intubated and sedated middle-aged man, responsive to pain. heent: pupils pinpoint but still responsive to light bilaterally. oral mucosa dry. missing several teeth. neck: supple, jvp ~11 cm, no lad lungs: unable to listen posteriorly because pt becomes very agitated w/ movement. listening anteriorly, pt's breath sounds are clear bilaterally. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley present ext: warm, weak pulses radial and dp bilaterally, no clubbing, cyanosis or edema . discharge pe physical exam: vs: tm 97.9 tc-97.4 hr 71 bp 152/89 rr 16 sao2-100 ra i/o 24-not recorded general: aaox3, in mild amount of discomfort heent: cn 2-12 grossly intact, mmm, has a 3x2cm mass in right neck area with overlying erythema, likely traumatic from known fall neck: no lad, no obvious thyroid masses cvs: rrr, no rmg lungs: ctab, no wrr abdomen: soft, flat, not ttp, no hsm skin: no obvious rashes neuro: aaox3, strength is equal and wnl in all extremities, sensation is intact, relfelxes are 1+ and equal, cn's no abnormalities per above psych: slightly nervous but otherwise wnl derm: tntc lesions brown macular on back pertinent results: admission labs: 06:50am blood wbc-11.1* rbc-4.05* hgb-12.7* hct-38.5* mcv-95 mch-31.4 mchc-33.1 rdw-13.0 plt ct-284 06:50am blood neuts-80* bands-4 lymphs-8* monos-8 eos-0 baso-0 atyps-0 metas-0 myelos-0 06:50am blood pt-15.7* ptt-37.3* inr(pt)-1.5* 06:50am blood glucose-160* urean-39* creat-2.7* na-140 k-6.8* cl-100 hco3-25 angap-22* 06:50am blood alt-1798* ast-3141* ld(ldh)-2520* ck(cpk)-1263* alkphos-63 totbili-0.3 06:50am blood ck-mb-3 ctropnt-0.09* 06:50am blood lipase-10 10:29am blood calcium-7.1* phos-5.2* mg-2.3 06:37pm blood calcium-6.9* phos-4.7* mg-2.2 06:37pm blood hbsag-negative hbsab-positive hbcab-positive 10:49am blood hiv ab-negative 06:50am blood asa-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 06:37pm blood hcv ab-positive* 08:08am blood type-art tidal v-500 peep-5 fio2-100 po2-366* pco2-66* ph-7.20* caltco2-27 base xs--3 aado2-291 req o2-54 -assist/con intubat-intubated 06:59am blood glucose-153* lactate-6.7* na-140 k-6.3* cl-98 calhco3-26 05:09pm blood freeca-1.05* imaging: radiology ct chest w/o contrast impression: 1. bibasal opacities consistent with multifocal pneumonia. 2. complete collapse of the right middle lobe and segments of the right lower lobe. there is obstruction of the right middle lobe bronchus as well as the superior and basal bronchi of the right lower lobe, the etiology of which cannot be determined on this study. mucoid impaction is a possibility; however, other etiologies such as endobronchial neoplasm cannot be excluded. 3. small bilateral pleural effusions, right greater than left, new since . 4. small amount of ascites seen in the visualized upper abdomen, new since , . micro: bronchoalveolar lavage bronchoalveolar lavage sputum gram stain-final; respiratory culture-final {yeast} inpatient urine urine culture-final inpatient mrsa screen mrsa screen-final inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending . cxr impression: 1. decrease in size of right pleural effusion after thoracentesis. no pneumothorax. 2. persistent marked right lower lobe atelectasis. 3. near resolution of left basilar atelectasis. . pleural fluid pleural fluid: negative for malignant cells. mesothelial cells, lymphocytes, and neutrophils brief hospital course: 46 yo m w/ benzo and opiate abuse, recent rll pneumonia admitted to with hypercarbic respiratory failure and septic shock likely due to multifocal pna. . # hypercarbic respiratory failure: patient was intubated and sedated due to hypercarbia likely due to multifocal pna, given findings on chest ct. bronchoscopy showed copious secretions in the right bronchi, however no obvious mucous plugs, per se. no extrinsic compression of bronchi seen, so not likely a post-obstructive component. bal sent, but only returned 1+ gm positive cocci and 2+ pmns in rll and no organisms, 4+ pmns in rml. after 3 days of intubation, patient was given a small amount of iv lasix for suspected pulmonary edema and was successfully extubated on without issue. he was treated with vanc/zosyn/levo (day 1 = ) to cover for cap, atypicals, and anaerobes given the severity of his infection, which he will need to continue for 8 days. pt had no oxygen requirement by and was transferred to the floor for continued iv antibiotics. the patient continued his course of iv antibiotics in house and his picc line was discontinued prior to discharge. . #right sided pleural effusion the patient came out of the icu with a persistent right sided pleural effusion. with his smoking history, we wanted to rule out malignancy as a cause of this. a thoracentesis was done by the ip team. the pleural fluid was negative for malignancy and the patients breathing subjectively improved following the procedure. . #headaches, likely cluster in etiology the patient has a reported history of migraines in the past. he reports his last migraine headache was about 1 year ago. he says he has had headaches similar to this in the past. he was offered abortive therapy with imitrex and he refused saying this had not worked in the past. he is unable to use nsaid's due to his renal dysfunction. he insisted that narcotics were the only thing that helped. i informed him that narcotics may help short term, but may in fact worsen the headache long term. he persisted in wanting narcotics. he had a slight facial asymmetry during one of the headaches so a neurology consult was placed. they suggested supportive care for the headaches and no neuroimaging. the patients headaches improved somewhat, and he strongly preferred home management of his headaches. he was sent home on tramadol, prochlorperazine and a short course of narcotics, which he was told to use sparingly. . # septic shock: likely due to pneumonia. patient presented with shock liver, ams and . he was maintained on ivfs and pressors which were weaned off after several days. infection was treated as above. pt transitioned off pressors rapidly but did have organ dysfunction as a result (shock liver, renal failure). . # acute renal failure: multiple muddy brown granular casts consistent with atn sepsis/hypotension. renal consulted and agreed with atn; no indications for dialysis. cr peaked at 4.9 on and has slowly decreased. atn expected to improve with time. pt's electrolytes were monitored and repleted as needed. discharge creatinine was 3.4. he should follow up closely with renal physicians. . # hyperkalemia: most likely acute renal failure (see above). k+ 6.8 on presentation, treated with calcium gluconate, insulin/dextrose, and bicarb. k+ monitored and improved over icu course to 3.4. pt was not repleted due to renal failure. ecg normal, continued to monitor and replete as renal function improves. . # transaminitis: likely shock liver to hypoperfusion from sepsis vs possible ingestion. hcv positive (confirms on labs), however doubt his hepatitis would cause this degree of transaminitis, given that it is chronic. lfts peaked on with alt 2422, ast 3591, ldh 2610, ck 1228, and continued to trend down over stay. tbili and alk phos remained normal throughout his icu course. . # elevated troponins: likely renal failure, ck-mb flat. trops peaked at 0.14 on and continued to trend down. initial cardiac damage possibly related to septic shock and increased demand on the heart. pt denies any chest pain or discomfort. . # copd: pt has severe bullous emphysema evident on ct. pt is not currently on any outpatient therapy for his copd. pt was started on albuterol and tiotropium nebs in house and will need outpatient follow up. # anxiety: patient had significant anxiety and panic during his time in the icu. psychiatry was consulted as there was concern that the patient might leave ama and the team was concerned about competency. he was started on haldol in addition to his home clonazepam and his behavior improved significantly. he did not have any episodes of agitation or anxiety after transfer from the icu. psychiatry continued to follow the patient on the floor. his haldol was discontinued and the patient was asked about starting an ssri. he said he was tried on many in the past and refused any attempt at starting a new one currently. he requested an increase back to his home dose of klonopin. i explained to the patient that this was not an ideal medication for anxiety. he promised to address this with his pcp. . transitional issues: -follow up with pcp weeks with repeat labs (lytes, bun/creatinine) and address starting a ssri for anxiety and further headache management. also get a follow up cxr in 2 weeks for his cap -follow up with renal in weeks for arf with the above labs drawn (specifically bun and creatinine) -consider follow up with pulmonary for copd management medications on admission: clonazepam 1mg tid prn anxiety oxycodone 15mg gabapentin 300mg po tid discharge medications: 1. radiology please get a pa and lateral cxr for follow up for pleural effusion and pneumonia in weeks prior to follow up with pcp and have results sent to pcp , . 2. outpatient lab work please have a basic metabolic panel (lytes, bun/creatinine) done and send your your pcp , . 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 4. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*30 cap(s)* refills:*2* 5. clonazepam 1 mg tablet sig: one (1) tablet po tid (3 times a day) for 14 days. disp:*42 tablet(s)* refills:*0* 6. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*90 capsule(s)* refills:*2* 7. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 9. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for h/a. disp:*30 tablet(s)* refills:*0* 10. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for h/a. disp:*30 tablet(s)* refills:*0* 11. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for headache for 1 weeks: please minimize this medications and use other medications, avoid nsaid's. disp:*20 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: pneumonia acute renal failure transaminitis hepatitis c anxiety migraine headache discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with respiratory failure, likely due to a pneumonia. you were treated in the icu initially with intubation (mechanical breathing) and antibiotics. you improved slowly and you were transfered out of the icu. you had a repeat ct scan of the chest to evaluate for fluid around your lung and collapse of the lung and it showed persistent fluid. this fluid was removed and your respiratory sympoms improved. you will need a follow up cxr in about 2 weeks. during this hospitalization you were also diagnosed with acute kidney failure, and acute liver injury. this was likely due to low blood pressure from infection (ie pneumonia). your labs were monitored and your kidney and liver function improved. it will be important to follow up with a primary care doctor to make sure that these things continue to improve. you will also need to follow up with a renal physician. . you had headaches and anxiety in the hospital. neurology evalauted you and felt this was likely a migraine or analgesic withdrawal headache. please try and limit the amount of percoset you use. please be sure you follow up with your psychiatrist about your anxiety and consider starting an ssri followup instructions: department: west clinic when: wednesday at 3:30 pm with: , md building: de building ( complex) campus: west best parking: garage department: when: friday at 9:15 am with: , md building: (, ma) campus: off campus best parking: on street parking specialty: psychiatry with: , md address: , ste#508 , phone: **we are working on a follow up appointment with dr. within 1-2 weeks. you will be called at home with the appointment. if you have not heard from the office within 2 days or have any questions, please call the number above.** procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube thoracentesis arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified hyperpotassemia tobacco use disorder acute kidney failure with lesion of tubular necrosis unspecified pleural effusion unspecified essential hypertension acute and subacute necrosis of liver unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified unspecified viral hepatitis c without hepatic coma depressive disorder, not elsewhere classified anxiety state, unspecified acute respiratory failure septic shock migraine, unspecified, without mention of intractable migraine without mention of status migrainosus 

Answer: The patient is high likely exposed to