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: addendum: see attached. chief complaint: dyspnea, hemoptysis major surgical or invasive procedure: tracheostomy central venous line hemodialysis catheter placement picc line placement central venous catheter history of present illness: history of present illness: 51 year old male with a history of copd (on continuous home oxygen 4-6l/min), moderate restrictive lung disease, osa on cpap, morbid obesity, chronic dvt (on coumadin) and anxiety with complaints of dyspnea and hemoptysis, found to be profoundly hypoxic. short of breath for 3 days, coughing yesterday. when ems arrived, the patient was apparently able to answer the door, sat was 50 on room air (ran out of o2). nrb to 80's. he reported subjective fevers. he denied chest pain. he also was describing vague neck pain. per the health care proxy, the patient's oxygen tank exploded on sunday, creating a cloud of dust and debris. the police and fire dept came to the house and recommended that the patient and his mother evacuate, but the patient chose to stay home. . in the ed, initial vs were: 96.6 96 127/71 28 95% on nrb. on exam, he was in obvious respiratory distress with mild crackles. a cxr showed ?volume overload. his labs were notable for an inr of 10, an abg of 7.34 71 92 on nrb. patient was given a dose of methylprednisolone, albuterol nebs, which he did not tolerate well. he was also started on bipap with a full facemask, which he also didn't tolerate well. bp was initially in the mid 90's, but at one point dropped lower possibly to the 70's, so he also received 1l fluid. bipap was then stopped, and he was restarted on nrb, currently satting in mid-high 80's, at a rate of 20's-30's. he was taken for cta to rule out pe, and not reversed downstairs out of concern for overshooting without knowing if there was a pe present. ffp was ordered but not given. . upon arrival to the micu, respiratory failure, was intubated, arteial line and central venous line were placed after receiving 4 units ffp and 10iv vitamin k. 3l of ns were given and dopamine was started initially through a peripheral iv. . review of systems: (+) per hpi (-) denies chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: copd oxygen dependent obstructive sleep apnea anxiety morbid obesity chronic lle dvt social history: patient lives with his elderly mother. denies any history of tobacco, etoh, or drug use. he uses a motorized chair for most mobility. family history: noncontributory physical exam: on admission vitals: t: 95.1 bp: 97/63 p: 92 r: 26 o2: 98% on nrb with grunting general: alert, severe respiratory distress with grunting and screaming heent: sclerae anicteric, mmm, oropharynx clear neck: supple, jvp not elevated but with brisk upstroke, no lad lungs: poor air movement throughout with diffuse rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops. loud p2. abdomen: soft, obese, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. no rash, trace to 1+ edema on discharge: afebrile, blood pressure 90s/50s by aline, heart rate 60, oxygenation 98% on ventilator cmv peep 5, fio2 40%, tv 550, f 25. general: alert to voice, interactive, nad heent: ncat, no scleral icterus, mmm, trach in place with ulceration on left side of trach. no jvd pulm: coarse b/l breath sounds anteriorly, no wheezes, bl symmetric chest wall expansion cv: rrr w/o mgr abd: obese, w/ g-tube in place. soft. ntnd. +bs. ext: warm, well perfused, trace b/l pitting edema. no clubbing or cyanosis. pertinent results: on admission 09:18pm type-art temp-35.7 peep-31 o2-70 po2-138* pco2-57* ph-7.39 total co2-36* base xs-8 intubated-intubated 09:18pm lactate-1.6 09:03pm glucose-132* urea n-8 creat-0.6 sodium-145 potassium-3.6 chloride-105 total co2-32 anion gap-12 09:03pm calcium-8.3* phosphate-3.3 magnesium-1.9 06:34pm type- po2-52* pco2-71* ph-7.34* total co2-40* base xs-8 06:34pm o2 sat-82 06:32pm type-art po2-139* pco2-64* ph-7.35 total co2-37* base xs-7 06:32pm lactate-1.1 06:06pm pt-19.9* ptt-35.0 inr(pt)-1.8* 06:06pm urine color-straw appear-clear sp -1.021 06:06pm urine blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.0 leuk-neg 06:06pm urine rbc-10* wbc-4 bacteria-none yeast-none epi-0 04:50pm type-art po2-97 pco2-71* ph-7.31* total co2-37* base xs-5 04:50pm lactate-0.9 03:10pm type-art po2-90 pco2-89* ph-7.23* total co2-39* base xs-6 02:08pm type-art temp-35.1 rates-28/ o2-80 po2-115* pco2-100* ph-7.16* total co2-38* base xs-3 aado2-352 req o2-64 -assist/con intubated-intubated 01:11pm type-art temp-35.3 rates-26/ tidal vol-520 peep-8 o2-80 po2-75* pco2-107* ph-7.13* total co2-38* base xs-2 aado2-385 req o2-68 -assist/con intubated-intubated 01:11pm lactate-0.6 01:11pm o2 sat-88 11:53am type-art po2-91 pco2-105* ph-7.12* total co2-36* base xs-1 11:53am o2 sat-93 11:46am glucose-146* urea n-11 creat-0.7 sodium-143 potassium-3.4 chloride-103 total co2-34* anion gap-9 11:46am calcium-8.5 phosphate-3.6 magnesium-2.0 11:46am wbc-9.4 rbc-4.38* hgb-10.3* hct-35.3* mcv-81* mch-23.5* mchc-29.1* rdw-17.4* 11:46am plt count-193 11:46am pt-34.3* ptt-44.4* inr(pt)-3.5* 08:12am type-art rates-/24 po2-92 pco2-71* ph-7.34* total co2-40* base xs-8 intubated-not intuba 08:12am type-art rates-/24 po2-92 pco2-71* ph-7.34* total co2-40* base xs-8 intubated-not intuba 07:53am comments-green top 07:53am lactate-2.7* 07:45am glucose-153* urea n-10 creat-0.7 sodium-143 potassium-3.1* chloride-102 total co2-29 anion gap-15 07:45am estgfr-using this 07:45am alt(sgpt)-13 ast(sgot)-22 ld(ldh)-266* alk phos-61 tot bili-0.5 07:45am lipase-22 07:45am ctropnt-<0.01 07:45am ck-mb-3 probnp-250* 07:45am wbc-7.6 rbc-4.54* hgb-10.7* hct-36.3* mcv-80* mch-23.6* mchc-29.6* rdw-17.3* 07:45am neuts-81.7* lymphs-10.4* monos-5.5 eos-2.1 basos-0.3 07:45am plt count-178 07:45am pt-86.6* ptt-52.4* inr(pt)-10.5* on discharge 02:36am blood wbc-8.1 rbc-2.91* hgb-7.7* hct-26.1* mcv-90 mch-26.5* mchc-29.6* rdw-20.3* plt ct-109* 02:36am blood neuts-81.9* lymphs-10.8* monos-5.2 eos-1.6 baso-0.3 05:37am blood neuts-85* bands-2 lymphs-2* monos-6 eos-4 baso-0 atyps-0 metas-0 myelos-1* nrbc-1* 05:37am blood hypochr-3+ anisocy-2+ poiklo-1+ macrocy-1+ microcy-1+ polychr-occasional schisto-occasional stipple-occasional tear dr 02:36am blood plt ct-109* 02:36am blood pt-28.0* ptt-46.4* inr(pt)-2.7* 02:00am blood fibrino-477* 02:01am blood ret aut-1.9 02:36am blood glucose-85 urean-41* creat-2.5* na-139 k-3.5 cl-104 hco3-27 angap-12 03:51am blood amylase-86 02:00am blood alt-12 ast-24 ck(cpk)-49 alkphos-58 amylase-115* totbili-0.3 02:00am blood ld(ldh)-424* 03:51am blood lipase-40 02:36am blood phos-5.7* mg-2.0 02:49am blood type-art po2-124* pco2-70* ph-7.25* caltco2-32* base xs-1 other studies urine culture: parapsilosis. >100,000 organisms/ml.. . , c. diff negative , and blood cultures: no growth to date , , , , , , , : no growth 9:13 pm sputum site: endotracheal gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). respiratory culture (final ): oropharyngeal flora absent. pseudomonas aeruginosa. moderate growth. of three colonial morphologies. pseudomonas aeruginosa | cefepime-------------- 16 i ceftazidime----------- 16 i ciprofloxacin--------- =>4 r gentamicin------------ 2 s meropenem------------- =>16 r piperacillin---------- =>128 r piperacillin/tazo----- =>128 r tobramycin------------ <=1 s other studies: cta: 1. technically limited study, with no evidence of central pulmonary embolism though evaluation to the segmental and subsegmental branches is limited. 2. severe centrilobular emphysema with new superimposed widespread airspace consolidation involving the entire lung fields, predominantly with most significant involvement involving the bilateral lower lobes, for which the differential includes infectious etiologies, hemorrhage, or edema. echo: the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size is mildly increased with free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. ct abd/pelvis w/: 1. enlargement of the right iliacus muscle from hematoma formation. there is no evidence for active or arterial extravasation within this hematoma. would recommend clinical correlation with instrumentation of the patient's right groin. no other hematomas identified. 2. improved appearance but still persistently markedly distorted lung bases with severe emphysematous and bullous changes. extensive subcutaneous emphysema in the anterior chest wall, demonstrating improvement. 3. soft tissue density material in the anterior right hemithorax may be a small area of resolving hemothorax as there is also an additional small locule of air on the most nondependent portion of the right anterior hemithorax. 4. no abnormal findings in the pancreas, gallbladder, or liver. 5. marked colonic fecal loading. no bowel obstruction. gallbladder u/s: no gallstones. no sludge identified on this ultrasound. no evidence of cholecystitis and no biliary dilatation seen. ble u/s: no evidence of dvt. ct head w/o: no intracranial hemorrhage or edema. unchanged moderate mucosal thickening of the sphenoid sinuses. renal u/s: markedly limited exam; no evidence of hydronephrosis or abnormal echogenic areas to suggest the presence of a fungus ball as questioned. : ct abd/pelvis study limited due to lack of iv contrast. no large fluid collections seen. enlargement of the right iliacus muscle, with similar appearance compared to prior study, likely hematoma. : cxr: the tracheostomy tip is 7.3 cm above the carina. the double-lumen central venous catheter line terminates at the level of mid svc. cardiomediastinal silhouette and widespread extensive parenchymal consolidations are grossly unchanged with questionable minimal improvement at the level of the left perihilar area. overall, the findings are more extensive than on , but overall unchanged since . brief hospital course: brief hospital course: 51 y/o male with a history of severe mixed obstructive and restrictive disease presents with hemoptysis, and hypoxic and hypercarbic respiratory failure. #1 hypoxic and hypercarbic respiratory failure: the initial insult was inhalation injury from oxygen tank explosion on top of severe underlying bullous emphysematous lung disease. ardsnet ventilation conducted given suspicion for . he was empirically covered for cap. on , patient developed subcutaneous emphysema, likely due to bleb rupture. this severely progressed into pneumomediastinum and subcutaneous emphysema propagating down both arms and into the chest. improved by cxr. continuing to follow with serial cxr. thoracics followed patient's care as well. trached and peged on . currently patient is on cmv assist with psv trial today. receiving albuterol and ipratroprium. patient's home prednisone was stopped and could be restarted once pseudomomas infection treated and cleared. #2 resistant pulmonary pseudomonas: the patient recently grew resistant pseudomonas on his sputum, sensitive to tobramycin and gent only. colistin sent to outside lab. he is currently on tobramycin day and id is following, redosing by level given dialysis. has a tobramycin level pending on discharge day and dosing will occur by torbamycin level. patient current on day tobra course, which may be shortened to 10 day course if pending sputum from is negative for pseudomonas. patient will need daily tobramycin levels with goal level >2. #3 sedation - patient transitioned from versed/fentanyl to propofol with goal of trach mask. however, patient failure sbt. the patient still had pain and anxiety with fentanyl patch and boluc (propofol had to be d/c'd for pancreatitis picture). increased to fentanyl drip on possibly for short term pain control pancreatitis, with drip now dc'd. currently requiring methadone, fentanyl patch, needs more for dressing changes with standing clonazepam for anxiety. #4 hypotension - likely in the setting of decreased preload with peep. was on dopamine via peripheral access. was switched to levophed for improved ionotropy and then slowly weaned off.currently off pressors, maintaining maps in 60s. #5 pancreatitis: elevated amylase/lipase on , likely propofol. stopped propofol, made npo, given pain control. amylas /lipase levels resolved. . #6 constipation - pt had constipation, without bm for 2 weeks. gi consulted. pt was placed on senna, colace, lactulose, soap suds enema, gastrografin enema, and golytely with resolution of stool backup to r colon. patient on a standing bowel regimen with no constipation and rectal tube in place. #7 persistent funguria with parapsilosis: the patient was on fluconazole, treated him for 14 days, last day . he was on amophtericin bladder washes which now dc'd given negative urine cultures. #8 thrombocytopenia: etiology unknown. decreased over last week, down to 103 today, being monitored closely. heparin dc'd as inr at goal of 2.0, will continue warfarin. will need to be followed. #9atrial fibrillation: while in the micu the patient developed intermittent a. fib. he was rate controlled with metoprolol and is in nsr now. is anticoagulated on warfarin. #10 renal failure: likely ain and atn from medication and hypotension. getting hd on mwf. kidneys starting to recover, remains at risk of nephrotoxicity on tobramycin. patient remains off spironolactone and lasix. #11 acute blood loss anemia: the patient had gi bleeding, bleeding from his trach site, and a retroperitoneal bleed found on ct. his heparin gtt was temporarily stopped. his goal hct is > 28. he was tranfused with prbcs when necessary to maintain that hematocrit. his hematocrits have been stable so his heparin gtt was restarted to continue bridge to warfarin. inr now therapeutic, heparin dc'd. hct has been stable, still restarting coumadin from heparin. #12 h/o dvt: ble u/s do not show dvt. restarted warfarin . currently on warfarin only after being bridged with heparin. continuing to monitor coags. #13 skin breakdown: wound care consulted for trach site ulceration and right buttocks wounds. care to continue per wound consult recommendations. # g-tube: ulceration around g-tube site. needs g-tube dressing site change q2-3 weeks. last dressing was placed . # social - after discussion with brother and family pt's brother states that pt had expressed desire to live and therefore wants everything done. full code. medications on admission: citalopram 20 mg tablet fluticasone 50 mcg/actuation spray furosemide 20 mg tablet daily omeprazole 20 mg capsule, delayed release(e.c.) prednisone 4 mg daily spironolactone 25 mg tablet daily tiotropium bromide 18 mcg capsule, w/inhalation device daily warfarin 12.5mg daily discharge medications: 1. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours). disp:*qs mdi* refills:*2* 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-20 puffs inhalation q4h (every 4 hours). disp:*qs mdi* refills:*2* 3. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane (2 times a day). disp:*60 ml(s)* refills:*2* 4. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). disp:*qs * refills:*2* 5. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). disp:*qs * refills:*2* 6. senna 8.8 mg/5 ml syrup sig: five (5) ml po bid (2 times a day). disp:*300 ml(s)* refills:*2* 7. polyethylene glycol 3350 100 % powder sig: one (1) po daily (daily). disp:*qs * refills:*2* 8. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 9. sodium chloride 0.9% and heparin. flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline and heparin daily and prn. 10. pantoprazole 40 mg po q24h 12. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 13. fentanyl 100 mcg/hr patch 72 hr sig: two (2) patch 72 hr transdermal q72h (every 72 hours). disp:*qs patch 72 hr(s)* refills:*2* 14. methadone 5 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 15. warfarin 2.5 mg tablet sig: three (3) tablet po once daily at 4 pm. disp:*90 tablet(s)* refills:*2* 16. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day). disp:*2700 ml(s)* refills:*2* 17. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for rash/puritis. disp:*qs * refills:*0* 18. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 19. clonazepam 1 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 20. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 21. beclomethasone dipropionate 80 mcg/actuation aerosol sig: one (1) inhalation twice a day. disp:*qs mdi* refills:*2* discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: inhalation lung injury hypoxic and hypercarbic respiratory failure pseudomonas pneumonia acute renal failure requiring hemodialysis gastrointestinal bleed atrial fibrillation acute blood loss anemia persistant funguria hypotension pancreatitis constipation secondary: copd anxiety chronic lle dvt discharge condition: fair. afebrile, blood pressure 90s/50s by aline, heart rate 60, oxygenation 98% on ventilator cmv peep 5, fio2 40%, tv 550, f 25. discharge instructions: you were admitted to the hospital due to very low levels of oxygen in your blood. you need to be placed on a ventilator to support your breathing and allow your body to get enough oxygen. it is likely that your oxygen tank exploding damaged your lungs and contributed to the need the ventilator. you needed a tracheostomy and feeding tube because you have been unable to get off the ventilator. you also developed a bad pneumonia that is being treated with antibiotics through a special intravenous line called a picc. on your anticoagulation for your history of chronic deep vein thrombosis, you developed a gastrointestinal bleed which has resolved and you have tolerated being restarted on your coumadin. you do have a right iliacus hematoma from this episode. you also developed kidney failure which was treated with dialysis while your kidneys had a chance to recover. you are currently on day of tobramycin for pseudomonas. your dosage needs to be changed based on the level of tobramycin in your blood and whether or not you receive hemodialysis. followup instructions: provider: , .d. phone: date/time: 2:30 provider: /dr. phone: date/time: 11:00 provider: , rn, cs phone: date/time: 10:00 md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube fiber-optic bronchoscopy fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances venous catheterization for renal dialysis venous catheterization for renal dialysis percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy closed [endoscopic] biopsy of bronchus bronchoscopy through artificial stoma diagnoses: thrombocytopenia, unspecified obstructive sleep apnea (adult)(pediatric) abnormal coagulation profile acute kidney failure with lesion of tubular necrosis acute posthemorrhagic anemia unspecified septicemia severe sepsis unspecified acquired hypothyroidism candidiasis of other urogenital sites atrial fibrillation acute respiratory failure septic shock morbid obesity long-term (current) use of anticoagulants paralytic ileus pressure ulcer, buttock pressure ulcer, lower back other constipation other diseases of lung, not elsewhere classified personal history of venous thrombosis and embolism anticoagulants causing adverse effects in therapeutic use hemorrhage of gastrointestinal tract, unspecified hyperosmolality and/or hypernatremia ventilator associated pneumonia intravenous anesthetics causing adverse effects in therapeutic use acute pancreatitis hemoperitoneum (nontraumatic) pseudomonas infection in conditions classified elsewhere and of unspecified site emphysematous bleb pressure ulcer, stage ii other tracheostomy complications interstitial emphysema unspecified injury of lung without mention of open wound into thorax accident caused by explosion of gas cylinders 

Answer: The patient is high likely exposed to