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: penicillins attending: chief complaint: respiratory failure. major surgical or invasive procedure: intubation history of present illness: hpi: 67 yo m w/pmhx sx for copd and tobacco use who presented to an osh today after a neighbor found him to be very dyspneic. per report, pt had been sick for three weeks with weakness and fever, with a productive cough with yellow sputum production, chills, sore throat, nasal congestion, and difficulty breathing. he also noted chest pressure. per family friend, patient had lost 20 lbs over this time course, and was using only vaporub for relief, and tylenol pm for sleep. . patient was brought today to the osh by his girlfriend. report, patient had temperature to 101, with hr 120s, with o2 sats of 96% on 6l, with progressively increasing tachypnea and cyanosis on presentation to the osh. patient was intubated at osh for hypercarbic respiratory failure thought to be pneumonia. his abg was initially 7.19/110/278 on a nonrebreather, then 7.24/96/67 on 2l nc prior to intubation. patient was also noted to have a leukocytosis with wbc of 24, with left shift and 1% bandemia, and a cxr which per report showed a lll pna. with the intubation patient received propofol, which resulted in hypotension, for which he was started on dopamine. at the osh, patient also received one dose of levofloxacin. a subclavian line was placed as well. patient was also noted to have dark emesis/hemoptysis with ngt placement, and protonix was started. . in the ed, patient had repeat cxr performed. his initial bps were 70/50s. a fast scan was performed, and was negative. he was transitioned off propofol and dopamine and started on levophed. patient has received 4l ivf as well, as well as ctx/azithromycin, and dexamethasone 10 mg x 1 dose. . ros: unable to obtain as patient intubated. past medical history: copd tobacco use alcoholism abdominal hernia depression social history: lives at home. has a girlfriend. no family nearby. smoked for many years. quit one year ago. extensive alcohol use - drinking beer recently. marijuana use in the past. family history: mother with cva, died of hip fracture. father with mi in 80s. physical exam: pe: vs: 97.1 bp 117/96 hr 98 rr 18 100% o2 sat on a/c 550x20 fio2 0.40 peep 5 gen: intubated, sedated. heent: mm dry. et tube in place. no scleral icterus. hrt: distant heart sounds. no mrg. lungs: no wheezes. poor air movement throughout. no rales or rhonchi. abd: soft/nt/nd. no fluid wave. no organomegaly. ext: cool. 1+pulses. neuro: intubated and sedated. pupils equally reactive. reflexes symmetric. withdraws to pain. pertinent results: 07:00pm urine mucous-few 07:00pm urine granular-0-2 hyaline-21-50* 07:00pm urine rbc-* wbc-* bacteria-few yeast-none epi- trans epi-0-2 07:00pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-sm urobilngn-neg ph-5.0 leuk-tr 07:00pm urine color-yellow appear-clear sp -1.017 07:00pm ret aut-0.9* 07:00pm fibrinoge-474* 07:00pm pt-20.2* ptt-31.6 inr(pt)-1.9* 07:00pm hypochrom-1+ anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 07:00pm neuts-77* bands-0 lymphs-8* monos-11 eos-1 basos-0 atyps-1* metas-2* myelos-0 07:00pm urine bnzodzpn-pos barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg . ct chest/abd/pelvis: impression: 1. densely calcified pancreas, consistent with chronic calcific pancreatitis. 2. poorly-defined multifocal patchy, nodular opacities seen distributed throughout the lungs bilaterally, with upper lobe predominance. findings are nonspecific but could be of infectious or possibly inflammatory etiology. 3. emphysema. 4. enlarged left adrenal gland, incompletely evaluated on this single-phase study. 5. small low attenuation lesion seen within the left kidney, possibly representing cyst but too small to characterize by ct. 6. low attenuation lesion seen in the anterior subcutaneous soft tissue, possibly representing sebaceous cyst. clinical correlation recommended. 7. no definite evidence malignancy identified on this study, however, this study was only performed with a single phase of contrast, limiting assessment for more subtle lesions, especially within the liver. . liver and gallbladder ultrasound: liver is of normal echogenicity and echotexture and no focal lesions are identified. no intra- or extra-hepatic bile duct dilatation. the cbd measures 4 mm and is normal. all the hepatic vessels are patent including the hepatic arteries, portal veins, and hepatic veins. the gallbladder is normal without evidence of stones. . ct chest: findings: as compared to the prior study, there has been interval worsening of the multifocal areas of peribronchial consolidation in the upper lobes bilaterally. mild peribronchial infiltration in the lingula, right middle lobe, and lower lobes, and two more discrete nodular focal opacities in the right lower lobe (3a: 44) are unchanged. bibasal posterior subsegmental atelectasis are new. a focal area of consolidation in the superior segment of the left lower lobe posteriorly is new. the airways are patent through the segmental level. there has been interval increase in size and number of multiple mediastinal lymph nodes, for instance, an 11-mm right lower paratracheal lymph node was 9 mm previously; a 9-mm left lower paratracheal lymph node was 6 mm in the past. bilateral mildly enlarged hilar lymph nodes are stable. cardiac size is normal. dense calcification is seen in the right brachiocephalic artery. there is no pericardial effusion. a small layering left pleural effusion is new. there are no bone findings of malignancy. in the upper abdomen, the liver, gallbladder, spleen, and right adrenal gland are unremarkable. the left adrenal gland remains enlarged measuring up to 26 mm. dense calcifications through the pancreas are again noted. previously described small cortical lesions in the kidneys are not seen on this nonenhanced study. there is a trace of ascites. diffuse increase in density of the mesentery and subcutaneous fat in the abdomen could be due to anasarca. the 25 x 30 mm low-attenuation oval-shaped lesion in the anterior subcutaneous abdominal wall is unchanged. impression: worsening multifocal pneumonia. brief hospital course: 67 yo with h/o copd, alcoholism, prsented to osh with several weeks of fever, productive cough, hemoptysis and weight loss. in the osh intubated for hypercarbic resp failure and transferred here. he got solumedrol and levaquin. he self-extubated but did well and was transferred to floor. despite improvement he still had a leukocytosis with immature forms. a chest ct was notable for diffuse bronchiolitis. of note a tracheal aspirate grew aspergillus. patient had multiple afbs sent that remained negative (cultures can be followed up later but no growth now) and negative ppd so taken off tuberculosis precautions. patient hiv negative, hcv negative, hbv negative. patient started empirically under the guidance of id and pulmonary on voriconazole. also given albuterol/atrovent nebs. also given 10 days of levofloxacin empirically. patient also had persistent diarrhea with multiple negative c diffs. . # pneumonia: seen by pulmonary and id. believe to have aspergillous bronchiolitis. started on voriconazole and began to improve. unclear how long course should be. should be seen by id consult at and can contact id group here at for further discussion. cont pulmonary pt. with concern for cirrhosis (although none seen on ultrasound) should get weekly lfts (have been normal here). recommend repeat ct scan chest in 3 weeks to watch progression of disease. . # copd: patient breathing improved significantly once started on steroids. cont advair and nebs prn. steroid taper now on discharge. close follow up with pulmonary. . # alkalosis: patient has mixed acid-base with metabolic alkalosis (contraction) with chronic respiratory acidosis. bicarb on discharge is 38. should get repeat checks and continue to encourage oral fluid intake aggressively, especially with diarrhea. can give lomotil prn for diarrhea. . # melena: patient with episode here. with question of liver disease might still consider outpatient egd, especially if repeat bleeding. should get screening colonoscopy. . # leukocytosis: improved with treatment but should continue to monitor. . # adrenal gland: possibly enlarged on ct scan. should consider repeat imaging as outpatient. . # chronic pancreatitis: found to have calcifications of pancreas on ct scan without elevation amylase/lipase. started on creon empirically. likely alcohol related. continue to monitor as outpatient. . #. communication. patient with close friend . need to contact pcp, . , north central human services, , ma in am. medications on admission: inhalers prn discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. hexavitamin tablet sig: one (1) cap po daily (daily). 5. acetaminophen 325 mg tablet sig: one (1) tablet po q8h prn (). 6. cepacol 2 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed). 7. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 8. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane tid (3 times a day). 9. zolpidem 5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed. 10. voriconazole 200 mg tablet sig: one (1) tablet po q12h (every 12 hours). 11. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 12. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 13. insulin lispro (human) 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed): use with fingersticks qachs with sliding scale. 14. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 15. amylase-lipase-protease 33,200-10,000- 37,500 unit capsule, delayed release(e.c.) sig: one (1) cap po qidwmhs (4 times a day (with meals and at bedtime)). 16. prednisone 5 mg tablet sig: as directed in taper tablet po once a day for 9 days: take 4 tabs daily for 4 days, then 2 tabs daily for 3 days, then 1 tab daily for 3 days then stop. 17. diphenoxylate-atropine 2.5-0.025 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. discharge disposition: extended care facility: discharge diagnosis: aspergillos bronchiolitis steroid induced hyperglycemia copd exacerbation melena chronic pancreatitis with calcifications discharge condition: good discharge instructions: you have a history of copd. you appear to have developed an aspergillus bronchiolitis. you are getting treated for this but will need close infectious disease and pulmonary follow up. you are also being treated with steroids for your copd flare. . you have had intermittent diarrhea here and have become dehydrated. you need to continue to be aggressive with your fluid intake. . you had an episode of melena (blood in your stool). this may have been stress related but if it recurs you will need to get an endoscopy. if you have not had a colonoscopy in the last 5 years we recommend that for routine screening as well. . you were found to have heavy calcifications in your pancreas suggestive of possible chronic pancreatitis. you were started on creon with meals. this can be reevaluated as an outpatient. followup instructions: you need to establish a primary care doctor and have regular appointments. you should seen both a pulmonary and infectious disease doctor in the next 2-3 weeks. they can contact our staff here with detailed questions. dr. from infectious disease (() and dr. from pulmonary ((). procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnoses: acidosis tobacco use disorder obstructive chronic bronchitis with (acute) exacerbation depressive disorder, not elsewhere classified acute respiratory failure hypotension, unspecified blood in stool diarrhea chronic pancreatitis aspergillosis other and unspecified alcohol dependence, continuous acute bronchiolitis due to other infectious organisms 

Answer: The patient is high likely exposed to