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: hypotension, respiratory distress major surgical or invasive procedure: multi lumen - 09:09 am arterial line - 05:30 pm midline placed - trach placement - history of present illness: 53 yom w/ a h/o severe copd s/p prolonged hospitilation for copd flare, s/p trach and 1.5 years trach / vent dependent due to pna and ards / copd flare now s/p trach removal 3-5 days ago presents w/ respiratory distress and hypotension. ems was called mainly due to increased secretions and hypoxia however his hypoxia had resolved when ems had arrived, on a different o2 sat monitor he was in the 90s on room air rather than in the 60s as they were initially called for. . the patient is unable to converse but is able to answer yes or no questions. upon questioning he is able to say that he has had a cough for at least months, over the past few weeks it is worsening, not in frequency but it is more productive. he has not felt short of breath but does have some orthopnea. he has no functional capacity at baseline. he denies any pain anywhere, no chest pain, no abdominal pain. he denies any lightheadedness. he feels generally well and states he feels fine. . labile blood pressures despite 3.5 liters of fluid now but intermittently with sbps in the 80s. . patient initially refused any medical care and seemed to have capacity. patient has schizoaffective disorder, psych was called and he was more delierious at that time and he was not answering questions and therefore deemed uncapable. . vbg drawn and increased co2 so a thought was co2 narcosis, but w/ supplemental o2 3l nc and mental status improved but not co2. . rec'd levo / vancomycin zosyn, 3.5 liters of fluid as above and decadron 10mg iv x 1. afebrile. past medical history: past medical history: - chronic vent/trach/peg for hypercarbic respiratory failure at the beginning of , ?reportedly due to copd exacerbation - severe copd, home o2 dependent in the past - per rehab admission note, questionable old granulomatous lung disease with calcified hilar lad - remote l cva with residual right sided weakness - new onset generalized tc seizures on per rehab neuro note, thought to be post-cva and metabolic abnormalities (on transfer from rehab on keppra, depakote) - diabetes mellitus, on 16u lantus at rehab and riss - depression - schizophrenia, on effexor and risperdal - past h/o etoh abuse - gerd - afib/sinus tach - pseudomonas pna resistant to cephalosporins and quinolones - tte: lvef 50-60% w/dilated right ventricular cavity and depressed right ventricular systolic function - h/o diverticulitis - h/o questionable old granulomatous lung disease with calcified hilar lad. social history: divorced. former smoking. h/o etoh abuse. was living at a rehab facility prior to admission. family history: non-contributory physical exam: tmax: 37.3 ??????c (99.1 ??????f) tcurrent: 37.3 ??????c (99.1 ??????f) hr: 110 (70 - 111) bpm bp: 131/69(92) {78/40(54) - 137/69(92)} mmhg rr: 25 (7 - 25) insp/min spo2: 97% gen: well-appearing, well-nourished, no acute distress heent: eomi, perrl, sclera anicteric, no epistaxis or rhinorrhea, mmm, thrush neck: no jvd, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline, trach inplace cor: tachycardic, no m/g/r, normal s1 s2, radial pulse 1+ r and 2+ l pulm: lungs diminshed air movement bilaterally but patient has poor inspiratory effort, he is in no respiratory distress, no paradoxical breathing or accessory muscle use, diffuse ronchi bilaterally abd: soft, nt, nd, +bs, no hsm, no masses ext: no c/c/e, no palpable cords neuro: alert, upon yes / no questioning aox 1 only. cn2-10 and 12 normal, cn11 on r impaired. r arm 4/5 weakness of grip, bicep, tricep, wrist flex / extend, deltoid . lue stregnth to all modalities. rle able to move toes but otherwise unable. lle stregnth to dorsiflex / plantarflex, quad, hamstring. pertinent results: 04:13am blood wbc-8.1 rbc-3.30* hgb-9.6* hct-28.9* mcv-88 mch-29.0 mchc-33.0 rdw-15.3 plt ct-360 04:07am blood neuts-87.4* lymphs-6.6* monos-5.0 eos-0.9 baso-0.1 04:13am blood pt-13.4 ptt-23.5 inr(pt)-1.2* 04:13am blood glucose-123* urean-8 creat-0.3* na-143 k-3.8 cl-102 hco3-35* angap-10 04:00am blood alt-7 ast-20 alkphos-49 amylase-61 totbili-0.2 04:13am blood calcium-8.4 phos-3.7 mg-1.9 04:11am blood caltibc-251* hapto-204* ferritn-193 trf-193* 12:06am blood cortsol-0.9* 04:07am blood valproa-52 04:57am blood type-art temp-37.9 rates- tidal v-600 peep-5 fio2-40 po2-69* pco2-55* ph-7.43 caltco2-38* base xs-9 -assist/con intubat-intubated 10:17am blood lactate-1.0 cxr portable (): the tracheostomy tube tip is approximately 3 cm above the carina. no significant change in the right lung consolidation, bilateral pleural effusion, and perihilar vascular engorgement is demonstrated compared to the prior study. the right internal jugular line was removed in the meantime interval. cxr portable (): interval removal of tracheostomy tube. there is persistent collapse of the right middle and lower lobes. right-sided pleural effusion is seen. there is no pneumothorax. the cardiac silhouette cannot be evaluated due to opacities from collapsed lung. the trachea is deviated to the right and unchanged. brief hospital course: 53m with copd and history of chronic respiratory failure; s/p recent trach removal at rehab and here w/ increased secretions; now s/p replacement of trach and continued labile bp of unclear etiology. #. hypercarbic respiratory failure: trach replaced on admission - had been removed 5 days prior to admission. chest radiograph with white out of right middle and lower lung fields ??????improved on discharge. mucus plugging was high on differential. possible pneumonia hidden within white out. sputum culture grew pseudomonas and staph aureus ?????? unclear if this was colonizer or actual infection. copd exacerbation also on differential given considerable wheezing on admission. initially treated with vancomycin, ceftaz, and tmp-smx (given history of stenotrophomonas). as no clear indication of active pneumonia (afebrile, slightly elevated wbc count which may be due to steroid therapy, and + culture thought to be colonizers), was started on treatment with short course of ceftaz for bronchitis. tobramycin, which was initially added for double coverage of pseudomonas, and vancomycin were discontinued. ceftaz day 4 on ; midline placed for additional 3 days of administration. - steroids initially increased and tapered to home dose on discharged (hydrocortisone 20mg po qam, 5mg po qpm) - needs aggressive sunctioning for continued considerable secretions - staying on vent may be best option given patient??????s level of discomfort off of vent - flovent started for severe copd #. hypotension: occasionally pressured dropped to maps in 50s. thought initially to be related to adrenal insufficiency. no evidence of autopeep, hypovolemia, sepsis, or autonomic insufficiency. has history of adrenal insufficiency, now on high dose steroids. on discharge decreased steroid dose to home regimen as above. # schizoaffective d/o vs. schizophrenia: per psych patient did not have capacity to refuse medical care on admission. continued effexor, risperdal and depakote. valproic acid level within normal range on . # seizures: tonic-clonic seizures in past, thought to be related to previous cva and 'toxic metabolic disturbances' upon previous admissions. continued keppra 250mg po bid. continued valproic acid as above. # dm: blood glucose range 120-180 - lantus increased to 12u qhs + ssi. # fen: - tube feeds via peg tube # access: - midline placed - arterial line, central line removed # code: full code - social work involved and attempted to contact patient??????s healthcare proxy/guardian to assess goals of care. unable to contact - will follow-up with this. patient reports different goals of care, but as above was deemed incompetent to make such a decision. medications on admission: docusate sodium 100mg po bid senna 8.8 mg/5 ml- 10 ml po qhs latulose prn dulcolax 10 mg pr prn heparin sc tid acetaminophen 325 mg po q6hrs prn folic acid 1 mg po daily risperidone 2 mg po bid divalproex 875mg po tid venlafaxine 75 mg po bid keppra 250mg po bid nexium 40 mg po daily combivent 2 puffs q4hrs prn atrovent nebs prn albuterol nebs prn hydrocortisone 5mg po qpm hydrocortisone 20mg po qam insulin lantus 10uqhs, humalog ss oxycodone 5mg po q6hrs prn mvi daily discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 2. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 3. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 4. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 5. risperidone 2 mg tablet : one (1) tablet po bid (2 times a day). 6. therapeutic multivitamin liquid : one (1) tablet po daily (daily). 7. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed. 8. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day) as needed. 9. valproic acid (as sodium salt) 250 mg/5 ml syrup : eight y five (875) mg po q8h (every 8 hours). 10. chlorhexidine gluconate 0.12 % mouthwash : one (1) ml mucous membrane (2 times a day). 11. albuterol 90 mcg/actuation aerosol : four (4) puff inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 12. ipratropium bromide 17 mcg/actuation aerosol : two (2) puff inhalation qid (4 times a day). 13. insulin glargine 100 unit/ml solution : twelve (12) units subcutaneous at bedtime. 14. hydrocortisone 20 mg tablet : one (1) tablet po qam (once a day (in the morning)). 15. hydrocortisone 5 mg tablet : one (1) tablet po qpm (once a day (in the evening)). 16. azithromycin 250 mg tablet : one (1) tablet po qmowefr (monday -wednesday-friday). 17. fluticasone 110 mcg/actuation aerosol : two (2) puff inhalation (2 times a day). 18. pantoprazole 40 mg recon soln : one (1) recon soln intravenous q24h (every 24 hours). 19. ceftazidime 1 gram recon soln : one (1) recon soln intravenous q8h (every 8 hours): last dose in evening on . 20. keppra 250 mg tablet : one (1) tablet po twice a day. 21. insulin regular human 100 unit/ml cartridge : sliding scale per home regimen injection qachs. 22. effexor 75 mg tablet : one (1) tablet po twice a day. discharge disposition: extended care facility: hospital discharge diagnosis: chronic vent/trach/peg for hypercarbic respiratory failure with acute exacerbation severe copd hypotension depression diabetes mellitus discharge condition: on pressure support; bed bound; hemodynamically stable discharge instructions: patient was admitted on with hypercarbic respiratory failure and hypotension. trach was replaced, and patient maintained on mechanical ventilation (pressure support). changes to medication regimen: - ceftazidime for additional 4 days - total 7 days therapy, ending - azithromycin qmwf for chronic secretions, airway inflammation - lantus increased to 12u qhs - fluticasone patient also needs: - frequent suctioning for secretions. - to be maintained with trach. - intermittent ekgs given risk of prolonged qt on risperdal + azithromycin. - referral to endocrinology for further management of adrenal insufficiency. followup instructions: at rehab facility procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances arterial catheterization temporary tracheostomy closed [endoscopic] biopsy of bronchus diagnoses: esophageal reflux congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled depressive disorder, not elsewhere classified acute and chronic respiratory failure other late effects of cerebrovascular disease chronic systolic heart failure epilepsy, unspecified, without mention of intractable epilepsy glucocorticoid deficiency gastrostomy status other diseases of trachea and bronchus other disorders of muscle, ligament, and fascia foreign body in main bronchus schizophrenic disorders, residual type, chronic obstructive chronic bronchitis with acute bronchitis 

Answer: The patient is high likely exposed to