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: bactrim ds / terbutaline attending: chief complaint: hypercalcemia major surgical or invasive procedure: intubation blood transfusion bronchoscopy history of present illness: 53 yo transferred to on from nh for symptomatic hypercalcemia and acute renal failure. upon admission, patient reported day period of weakness with loss appetite. night sweats x9 months. no pain/fever/pruritus/abd pain/constipation/diarrhea. in the ed, ca was 14.9, with phos 5.5 and creat 3.3. received ns with lasix and calcitonin in the ed. patient with improvement of serum calcium with fluids and lasix, and decrease in in cr to 2.1 over first 2 days in the the hospital. patient then spiked fever to 103, assoicated with cough. cxr without clear infiltrate. patient subsequently started on azithromycin for presumed bronchitis. on patient received small dose of ativan for anxiety. that evening, she became lethargic with increased respiratory rate and decreased o2 sats to the 80s. ct head at this time was negative for acute process and abg showed marked acute respiratory acidosis (7.24/104/58). nasal bipap was attempted without improvement, and patient was transferred to the for full mask ppv, but was subsequently intubated given persistent decreased mental status. patient was continued on azithomycin and was started on solumedrol . cxr without evidence of new infiltrate. after improvement of mental status, patient was successfully extubated on , and transferred to the floor this evening. she was transitioned from solumedrol to prednisone taper. hospital course also notable for: 1)improved hypercalcemia with fluids and lasix; spep/upep negative. pth wnl; phos elevated. ace pending. awaiting diagnostic procedure. 2)continued renal insufficiency without evidence of nephrolithiasis or hydronephrosis on ultrasound, random urine negative for eosinophils and fena >1%. urine calcium not measured over 24 hours. spep and upep negative. 3)anemia with fe/tibc <15%, with stable hematocrit. upon transfer to floor, patient reports feeling at her baseline respiratory status. she denies any fevers, chills, chest pain, abdnominal pain or skin lesions. she reports that she has had dry and red eyes ever since she began not feeling well. she denies any vision changes. past medical history: 1. asthma, s/p multiple hospitalizations and intubations. now on home o2 3. diastolic congestive heart failure with mild (+1)mitral regurgitation (). 4. history of paroxysmal supraventricular tachycardia (mat) 5. diabetes mellitus. 6. obstructive sleep apnea on bipap 7. hypertension. 8. history of tuberculosis, status post isoniazid treatment. 9. her last exercise stress test was ; she exericsed for 4 minutes of protocol and was stopped for fatigue. very limited functional capacity. at peak exercise the patient reported a sscp (resolved with rest by minute 6 in recovery while sitting). no significant st segment changes were noted. social history: former smoker. lives in . no tobacco or etoh family history: non-contributory physical exam: vs 98.2, 72, 164/75, 20, 94 %2lt gen: obese aaf,slightly tachypneic, though able to speak in word sentences heent: ophtalmologic exam not performed; peerl; mild conjunctival injection; op-clear; no accessory muscle use neck: jvp difficult to assess habitus; supple; no adenopathy lungs: severely diminished breath sounds throughout; rales at r mid lobe; no wheezes; prolonged expiratory phase cvs: s1 s2 rrr no m/r/g abd: obese/s/nt/ no palpable splenomegaly; no inguinal lad extr: trace bilat ; no lesions appreciated pertinent results: 10:10pm blood wbc-5.3 rbc-3.07* hgb-8.6* hct-26.1* mcv-85 mch-27.9 mchc-32.9 rdw-14.2 plt ct-243 10:10pm blood neuts-77.2* lymphs-10.6* monos-7.5 eos-4.4* baso-0.3 10:10pm blood pt-12.6 ptt-22.3 inr(pt)-1.0 10:10pm blood glucose-175* urean-70* creat-3.3*# na-140 k-4.5 cl-88* hco3-41* angap-16 05:35am blood alt-21 ast-21 ld(ldh)-210 alkphos-115 totbili-0.2 10:10pm blood albumin-3.7 calcium-14.9* phos-5.5*# mg-1.8 10:10pm blood tsh-1.1 05:35am blood pth-451 05:35am alt(sgpt)-21 ast(sgot)-21 ld(ldh)-210 alk phos-115 tot bili-0.2 05:35am pep-no specifi 05:35am blood caltibc-337 ferritn-68 trf-259 fe 35 05:06am urine u-pep-no protein 05:06am urine hours-random urea n-272 creat-34 sodium-97 tot prot-<6 calcium-8.9 05:06am urine eos-negative 06:09pm blood vitamin d dihydroxy-pnd 04:44am blood angiotensin 1 - converting -pnd 04:32am blood wbc-6.1 rbc-3.25* hgb-9.3* hct-28.0* mcv-86 mch-28.7 mchc-33.2 rdw-14.3 plt ct-200 04:32am blood plt ct-200 04:32am blood pt-12.7 ptt-20.5* inr(pt)-1.0 05:36pm blood glucose-145* urean-78* creat-1.8* na-146* k-3.8 cl-101 hco3-35* angap-14 05:36pm blood calcium-10.4* phos-6.2* mg-2.2 micro: direct influenza a&b: negative urine culture- negative blood cx- ngtd 9:15 pm sputum gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): moderate growth oropharyngeal flora. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. acid fast culture (pending): radiology: ct chest w/o contrast findings: bilateral axillary lymphadenopathy is noted, with the largest node located on the left measuring 1.6 cm in greatest short axis dimension. mediastinal and bilateral bulky hilar lymphadenopathy is also appreciated. patchy pleural thickening is noted bilaterally. there are wedge-shaped areas of consolidation in two separate locations within the right lung, the features of which likely represent either scarring or atelectasis. given their distribution, infection is less likely. small cystic air spaces are present at the lung apices. no discrete nodules are seen. limited imaging of the upper abdomen demonstrates a large, lamellated calcified gallstone which may be within the gallbladder neck. a small retrocrural and periportal lymph nodes are also present. bone windows: there are no suspicious lytic or sclerotic bony lesions. impression 1. axillary, hilar, and mediastinal bilateral lymphadenopathy. the distribution is more suggestive of a systemic process such as sarcoid or atypical infection, with lung cancer being much less likely. 2. cholelithiasis. cxr: b/l perihilar haziness with upper zone redistribution with upper zone predominence; b/l hilar enlargement; b/l pleural effusions renal u/s: impression: intrinsic renal disease. no nephrolithiasis or hydronephrosis. brief hospital course: this 53 yo aaf with h/o severe asthma, osa, diastolic dysfunction, tuberculosis s/p inh therapy, admitted with hypercalcemia, hyperphosphatemia, arf, anemia, and hilar, medicastinal and axillary lad with hospital course c/b acute hypercarbic respiratory failure s/p extubation at baseline respiratory status, with improved ca, persistent renal insufficiency and anemia. this is a brief hospital course by problem: 1)hypercalcemia with normal pth: diff dx includes malignancy, granulomatous diseases, namely sarcoid, intake of vit d and calcium, although less likely. ace slightly elevated at 74. vit d levels and a repeat pth were pending at discharge. bronchoscopy was not able to be tolerated secondary to desaturations. a formal eye exam was done showing only enlarged lacrimal glands which also can be associated with sarcoid and outpatient eye follow up was arranged. her calcium and phospate levels decreased with hydration, lasix and renagel as needed. 2)adenopathy: hilar, mediastinal and axillary lad-possible secondary to sarcoidosis vs. malignancy (ldh nl). surgery was consulted and felt that an axillary biopsy would not be helpful. they recommended for mediastinoscopy. interventional pulmonary attempted transbronchial biopsy but this was aborted as she desaturated with introduction of the bronchoscope into the pharynx. nephrology did not feel that a renal biopsy would be helpful in determining if she has sarcoid. as she stabilized the issue of what and when to biopsy was deferred to outpatient management. 3) elevated creatinine: resolving, but creatinine still elevated from baseline (0.9), with elevated bun. this patient has chronic intrinsic renal disease, with acute worsening of renal function. she had no hydronerphosis on renal ultrasound and her initial fena >1% and thus indicating a intrinsic process. her urine was negative for eosinophhils. her spep and upep were negative. a renal consult was obtained and the conclusion was that her renal dysfunction was secondary to chronic kidney disease from htn and microvascular disease, for which she needs outpt followup, that was exacerbated by hypercalcemia from calcium supplements and furosemide. it was felt that she did not require a renal biopsy to help elucidate the diagnosis of sarcoid, as the sarcoid findings on biopsy are nonspecific. she was given iv fluids and diuretics as needed through her admission and her creatinine improved to 1.7 at discharge. 4)anemia: the patient has progressive anemia over last 6 months normal reticulocyte count but low index. it is likely that there is a component of mild iron deficiency (fe/tibc<15%, but clearly with muliple other possible etiologies (ie- renal insufficiency; ?reticuloendothial disease ?splenomegaly). she received 2 units prbcs this admission. currently with stable hct. 5)respiratory failure: hypercarbic resp failure requiring intubation. ddx: benzodiazepine intolerance vs asthma exac. currently at baseline s/p extubation on a prednisone taper. we avoided benzos and all sedating agents while she was on the floor. 6)asthma: she was put on a prednisone taper and continued on monoleukast, fluticasone, tiotropium, albuterol inh. she responded well to the prednisone and is currently back at ther baseline functioning 7)htn: we continued here outpatient regimen except for the lisinoril. this was restarted on the day of discharge as her creatinine continued to improve and this has been shown to have long term benefits in diabetics. 8)diastolic chf: we maintained her blood pressure on a beta blocker, hydralazine, and calcium channel blocker. she received lasix as needed for diuresis and management of hypercalcemia. 9)osa: continued on nightly outpatient bipap settings of 18/12 10) dm: we held her outpatient po medications (hold metformin and glipizide given renal failure; hold avandia given need for fluids and risk of heart failure) and maintained her on glargine and riss with qid fs. her sugars were elevated while she was on the prednisone taper. this will continue to need close monitoring as an outpatient. 11)hyperphosphatemia: this appeared to worsen during the admission. she was put on sevelamer with good resolution. 12)osa: continued nightly bipap 14/10 on 3l o2. she tolerated this very well. 13) fever: she developed a fever but her cultures were sterile. she completed a course of azithromycin on . she had no further episodes of elevated temperatures. 14)psych: continued on fluoxentine and buspar medications on admission: prednisone 10 mg p.o. q. day. singulair. aldactone 25 qd. zyrtec lisinopril. metformin. asa 81 qd prozac 10 qd lasix 120 qod - 80 qod metolazone kcl 40 meq qd lipitor 20 qd colace 100 oyster cald 500 pulmicort 200 tid buspirone 5 tid diltiazem er 480 qd glipizide avandia 4 qd . medications at transfer to floor: fluoxetine hcl 10 mg po daily aspirin 81 mg po daily heparin 5000 unit sc tid montelukast sodium 10 mg po daily buspirone 5 mg po tid diltiazem 60 mg po qid hold for sbp <110, hr <50 atorvastatin 20 mg po daily senna 1 tab po bid:prn acetaminophen 325-650 mg po q4-6h:prn fluticasone propionate 110mcg 6 puff ih tiotropium bromide 1 cap ih daily pantoprazole 40 mg iv q24h docusate sodium (liquid) 100 mg po bid albuterol puff ih q6h:prn metoprolol 50 mg po tid hold for sbp<110, hr<55 hydralazine hcl 50 mg po q6h hold for sbp <110 azitromycin 250mg prednisone taper discharge medications: 1. prednisone 20 mg tablet sig: two (2) tablet po qd () for 1 doses. 2. prednisone 20 mg tablet sig: one (1) tablet po qd () for 2 doses. 3. prednisone 10 mg tablet sig: one (1) tablet po qd () for 4 doses. 4. montelukast sodium 10 mg tablet sig: one (1) tablet po daily (daily). 5. fluoxetine hcl 10 mg capsule sig: one (1) capsule po daily (daily). 6. atorvastatin calcium 20 mg tablet sig: one (1) tablet po daily (daily). 7. colace 100 mg capsule sig: one (1) capsule po once a day. 8. buspirone hcl 15 mg tablet sig: one (1) tablet po tid (3 times a day). 9. pulmicort inhalation 10. diltiazem hcl 240 mg capsule, sust. release 24hr sig: two (2) capsule, sust. release 24hr po once a day. 11. prednisone 5 mg tablet sig: one (1) tablet po qd () for 4 doses. 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 13. zyrtec oral 14. glipizide 5 mg tablet sig: 1.5 tablets po once a day. 15. avandia 4 mg tablet sig: one (1) tablet po once a day. 16. metformin hcl 1,000 mg tab,sust rel osmotic push 24hr sig: one (1) tab,sust rel osmotic push 24hr po once a day. 17. metolazone 5 mg tablet sig: one (1) tablet po once a week. 18. insulin regular human 300 unit/3 ml syringe sig: qs subcutaneous four times a day as needed for elevated fingerstick blood sugar: use sliding scale as attached. 19. aldactone 25 mg tablet sig: one (1) tablet po once a day. 20. furosemide 80 mg tablet sig: one (1) tablet po once a day. 21. lisinopril 40 mg tablet sig: 1.5 tablets po once a day. discharge disposition: extended care facility: - discharge diagnosis: hypercalcemia hyperphosphatemia hypercarbic respiratory failure requiring intubation acute on chronic renal failure hypertension severe asthma obstructive sleep apnea requiring bipap diabetes mellitus diastolic congestive heart failure anemia requiring transfusion low grade fever, resolved discharge condition: stable and improved, ambulating with oxygen at her baseline. discharge instructions: follow up with your doctor immediately if you experience fever greater than 100.5, shaking chills, chest pain, palpitations, worsening shortness of breath from your baseline, severe nausea or vomiting, abdominal pain, difficulty or decreased urination, muscle cramps, weakness, numbness or tingling. check your fingerstick blood sugars four times daily. you are being sent home on a prednisone taper. you may resume all your former outpatient medications except for the following changes: 1. do not take oyster cal d or any calcium or vitamin d supplements unless told otherwise by a physician. 2. take lasix 80 mg daily. 3. you may need potassium supplements, but this should be determined by your physician after checking your labwork in two days. please take your medications as instructed. you will need to continue outpatient follow up for your symptoms and for your enlarged lymph nodes. please follow up as an outpatient as below. please use your bipap machine at night. followup instructions: 1. provider: , o.d. where: center phone: date/time: 11:00 2. provider: breathing test where: pulmonary function lab phone: date/time: 3:15 3. provider: , md where: rehab services (dyspnea) phone: date/time: 3:30 4. please follow up with your primary care provider, . , for further workup of your symptoms and enlarged lymph nodes. call to make an appointment. 5. please call the renal clinic at to arrange followup for your kidney disease. 6. please have your chem 10 panel checked in two days. 7. test for consideration post-discharge: vitamin d 25 hydroxy, hba1c procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube transfusion of packed cells diagnoses: anemia, unspecified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease anxiety state, unspecified acute respiratory failure disorders of phosphorus metabolism unspecified sleep apnea chronic obstructive asthma, unspecified accidents occurring in residential institution enlargement of lymph nodes chronic diastolic heart failure hypercalcemia paroxysmal supraventricular tachycardia personal history of tuberculosis benzodiazepine-based tranquilizers causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to