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: hypercarbic respiratory failure major surgical or invasive procedure: intubation and mechanical ventilation. history of present illness: mr. is a 60yo man with a history of severe aspiration pna after egd in leading to a prolongued icu course here complicated by respiratory failure, , ards, sepsis, icu myopathy, and 2 subsequent readmissions for hap in , trach and ventilator dependent until , recently discharged from rehab 3 weeks ago, now presenting with 1-2 weeks of progressive fatigue, lethargy and weakness. prior to this, he had been doing well at home for appoximately 1 week. the patient recently established care with dr. in who found him to be slowly recovering, still requiring 2l nc home oxygen as well as bipap 15/5 qid x 15 minutes for hypercarbia pco2 in 60s attributed to weakness and chronic left lower lobe collapse. over the last 1-2 weeks, his family has noted a gradual decline in his mental status where he has been eating and drinking less with increased confusion and fatigue and decreased exercise tolerance. he and family deny increased dyspnea, or change in chronic dry cough. he has not been able to bring up any secretions. reports some mild chills but denies fever, cp, palpitations, melena, hematochezia. . . in the ed, initial vs were: 98.2 100 143/82 98%4l 93%2l. patient was given 1l ns, vancomycin 1gm iv once, zosyn 4.5gm iv once and 2l ns. ecg with new twi in v1-v2. cxr stable with left lower lobe collapse and atelectasis. cta negative for acute change or pe. abg 7.26/95/97. prior to transfer: 103 bp 130s/80s. 95%3l. . on the floor, he reports that he feels better with increased strength but unable to state what has helped. he states he has been using his bipap qid as directed. . review of systems: (+) per hpi (-) denies fever, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. 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: chronic respiratory failure as below. spirometry shows fev1 and vital capacity 0.4 and 1.12 (13% and 28% of predicted). dlco is 4.5 (17% of predicted). dldivided by alveolar volume is 75% of predicted. - septic shock (no bacteremia, but had pansensitive klebsiella and ecoli in sputum) - - dic - ards - gastritis h/o h. pylori (treated with triple therapy). patient with admission in with acute ugib, found to have chronic active h. pylori s/p tx with prevpac. - severe iron deficiency anemia - remote pancreatitis s/p partial pancreatectomy (in 20s, unclear etiology) - hypothyroidism - hyperlipidemia - lyme disease treated in - anxiety - r pneumothorax s/p ct, now resolved. - rij clot - thrombocytopenia (? vancomycin and/or dic) social history: has lived in rehab since discharge from until 3 weeks ago. has since discharge began to walk with pt, but continued to loose weight despite increasing caloric intake. family is devastated by lack of progress. retored accoutnant. - tobacco: never - alcohol: wine glasses/night (prior to the ) - illicits: no drug use. family history: no fh of pulmonary disease or neuromuscular disease physical exam: vitals:98.2 100 143/82 98%4l 93%2l general: alert, occasionally somnolent during exam but arousable. oriented x 3 to hospital, date, self, president. no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp 8cm, no lad. tracheostomy scar well healed lungs: coarse rhonchorous bs b/l r>l with overall decreased bs and dullness at left base. no wheezes, rales cv: regular rate and rhythm, normal s1 + s2 with prominent s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: aaox3 as above. no pronator drift ues. 5/5 strength , able to lift off bed and maintain against resistance. + asterixis pertinent results: admission labs 11:35pm glucose-91 na+-145 k+-4.8 cl--94* tco2-38* 10:23pm glucose-107* lactate-1.2 k+-6.2* 10:20pm glucose-105* urea n-27* creat-1.0 sodium-141 potassium-6.8* chloride-98 total co2-39* anion gap-11 10:20pm estgfr-using this 10:20pm estgfr-using this 10:20pm alt(sgpt)-22 ast(sgot)-44* alk phos-82 tot bili-0.1 10:20pm lipase-31 10:20pm ctropnt-less than 10:20pm calcium-9.4 magnesium-2.2 10:20pm wbc-10.1 rbc-3.87*# hgb-12.7*# hct-38.4*# mcv-99* mch-32.7* mchc-32.9 rdw-12.2 10:20pm neuts-85.0* lymphs-6.5* monos-6.3 eos-2.0 basos-0.2 10:20pm plt count-173 10:20pm pt-13.0 ptt-23.0 inr(pt)-1.1 . discharge labs 03:31am blood wbc-8.7 rbc-2.45* hgb-8.0* hct-23.9* mcv-98 mch-32.6* mchc-33.5 rdw-12.2 plt ct-141* 04:16am blood wbc-10.5 rbc-2.44* hgb-7.9* hct-24.4* mcv-100* mch-32.5* mchc-32.6 rdw-12.2 plt ct-162 10:19pm blood hct-25.0* 03:35am blood wbc-8.6 rbc-2.58* hgb-8.6* hct-25.1* mcv-97 mch-33.2* mchc-34.2 rdw-12.0 plt ct-137* 03:31am blood neuts-75.1* lymphs-13.5* monos-7.8 eos-3.5 baso-0.1 09:40pm blood neuts-93.6* lymphs-4.7* monos-1.6* eos-0.1 baso-0.1 03:31am blood plt ct-141* 04:16am blood plt ct-162 04:16am blood pt-13.4 ptt-26.1 inr(pt)-1.1 09:40pm blood plt ct-156 03:31am blood glucose-104* urean-30* creat-0.9 na-140 k-4.0 cl-102 hco3-36* angap-6* 04:16am blood glucose-92 urean-31* creat-0.9 na-140 k-4.4 cl-103 hco3-35* angap-6* 03:35am blood glucose-147* urean-21* creat-0.8 na-140 k-4.4 cl-105 hco3-31 angap-8 09:40pm blood glucose-171* urean-19 creat-0.8 na-139 k-4.3 cl-105 hco3-32 angap-6* 03:17am blood glucose-79 urean-15 creat-0.8 na-142 k-4.4 cl-102 hco3-39* angap-5* 03:09am blood alt-16 ast-20 ld(ldh)-161 alkphos-64 totbili-0.2 10:20pm blood lipase-31 10:20pm blood ctropnt-less than 03:31am blood calcium-8.6 phos-2.1* mg-1.9 03:35am blood calcium-9.0 phos-4.0# mg-2.1 03:09am blood vitb12-705 folate-greater th 03:09am blood tsh-0.24* 06:21am blood vanco-17.1 05:58pm blood vanco-21.9* 03:51am blood type-art temp-36.9 rates-25/25 tidal v-280 peep-5 fio2-40 po2-111* pco2-69* ph-7.35 caltco2-40* base xs-9 intubat-intubated 10:32pm blood type-mix ph-7.31* 10:26pm blood type-art temp-36.7 rates-25/25 tidal v-300 fio2-40 po2-118* pco2-70* ph-7.34* caltco2-39* base xs-9 -assist/con intubat-intubated 09:42am blood type-art temp-37.8 rates-25/ peep-5 fio2-40 po2-68* pco2-77* ph-7.32* caltco2-42* base xs-9 intubat-intubated 10:30pm blood type-art temp-36.8 rates-23/ tidal v-360 peep-5 fio2-40 po2-118* pco2-81* ph-7.28* caltco2-40* base xs-8 intubat-intubated vent-controlled 06:10pm blood type-art temp-36.6 rates-23/ tidal v-360 peep-5 fio2-40 po2-101 pco2-79* ph-7.28* caltco2-39* base xs-6 intubat-not intuba 10:32pm blood lactate-0.4* 09:42am blood glucose-91 lactate-0.5 04:32am blood lactate-0.5 10:32pm blood o2 sat-69 10:26pm blood o2 sat-98 06:10pm blood o2 sat-97 04:04pm blood o2 sat-77 10:32pm blood freeca-1.30 05:00pm blood freeca-1.31 . micro data respiratory culture (preliminary): commensal respiratory flora absent. due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. yeast. sparse growth. pseudomonas aeruginosa. sparse growth. pseudomonas aeruginosa. sparse growth. second morphology. pseudomonas aeruginosa. sparse growth. third morphology. gram negative rod #4. rare growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | pseudomonas aeruginosa | | amikacin-------------- 16 s 16 s cefepime-------------- 16 i 8 s ceftazidime----------- 16 i <=1 s ciprofloxacin--------- =>4 r =>4 r gentamicin------------ =>16 r =>16 r meropenem------------- =>16 r 1 s piperacillin/tazo----- =>128 r <=4 s tobramycin------------ =>16 r =>16 r . blood cultures pending . no mrsa isolated. . negative for legionella serogroup 1 antigen . urine cx- no growth blood cx.-no growth . reports ekg sinus rhythm. p wave and t wave abnormalities in lead v2 are most likely due to lead placement. compared to the previous tracing of no significant change other than change in lead placement of lead v2 . ct head no acute intracranial pathological process. if there is concern for subtle mass or acute brain ischemia, mri is more sensitive, if no contraindication to mri is present. . cxr as best can be compared across modalities, the appearance of the radiograph currently is relatively stable compared to the ct scan demonstrating a moderate-to-large left pleural effusion, left lower lobe collapse, and scattered parenchymal opacities, particularly in the left apex and in the right middle lobe. bronchiectasis is also noted anteriorly in the right lung as well. . cta of chest impression: 1. no filling defect in the pulmonary arteries to suggest pulmonary embolus. 2. bilateral multifocal scarring, ground-glass opacities, and traction bronchiectasis could be sequela of prior ards. 3. prominent lymph nodes in the mediastinum and right hilum, stable to prior. 4. persistent left lower lobe collapse with associated small left pleural effusion which appears slightly loculated. endobronchial lesion is not seen on ct; however, narrowing of second and third level bronchi is suggested and bronchoscopy can be considered. . echo the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. the right ventricular cavity is mildly dilated with borderline normal free wall function. there is abnormal septal motion/position. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the rv is now more dilated. . cxr comparison is made with prior study from nine hours earlier. there is new total collapse of the left lower lobe. there are no other acute interval changes, no pneumothorax. . comparison is made with prior study performed a day earlier. small right apical pneumothorax has minimally decreased in size. et tube tip is 6.2 cm above the carina. ng tube tip is out of view below the diaphragm. right ij catheter tip is in the lower svc. cardiomediastinal silhouette is unchanged. left lower lobe collapse is persistent. multifocal consolidations in the upper lobes bilaterally, left worse than right and in the right middle lobe are grossly unchanged. left pleural effusion have minimally increased. . reason for this examination: any evidence of pneumothorax? worsening? wet read: jxkc wed 10:53 am previously seen right pneumothorax is not clearly seen on this study. stable lll collapse. final report history: possible pneumothorax on prior chest x-ray with additional desaturations this morning, evaluate for any evidence of pneumothorax. comparison: at 3:33 a.m. and at 6:09 p.m. chest, single ap upright view: no definite pneumothorax is identified with the previously seen right pneumothorax not clearly visualized. there has been no other short interval change. the endotracheal tube tip terminates 7 cm from the carina. the ng tube is in stomach and the right internal jugular venous catheter terminates in the svc. left lower lobe collapse is persistent, with a left pleural effusion unchanged in size. opacities in the left upper lobe and right mid and lower lung are stable. impression: 1. no pneumothorax identified with the previously seen right apical pneumothorax not clearly visualized. 2. stable-appearing left lower lobe collapse and left pleural effusion . brief hospital course: micu course . 60 year old gentleman with chronic hypercarbic respiratory failure recently discharged from rehab who initially presented with fatigue, lethargy and acute on chronic hypercarbic respiratory failure and who progressed to worsening hypercarbia and clinical deterioration including hypotension and respiratory distress requiring intubation. . # hypercarbic respiratory failure: acute on chronic (given extensive hx including ards,malnutrition, deconditioning). he had ct evidence of left lower lobe collapse which was somewhat chronic in nauture but was placed on broad antibiotics with cefepime, vancomycin, and cipro. sputum cultures grew pseudomonas with interediate sensitibity to cefipime which he was on and full sensitivity to amikacin. as he remianed febrile and hypotensive we had planned intitiation of amikcacin but then goals of care evolved to cofort as below. . # bradycardia: episodes of brady to 20s-30s. likely due to high vagal tone and possible contribution form changes in intrathoracic pressure exacerbated by left lower lung collapse and ynamic right apical ptx. notably after small right apical ptx seen on one cxr, it resolved on plain films and ct has been planned to evaluate but goals of care evolved. #shock- infectious as most likely source. attempted to fluid resuscitate to optimal cvps. continue broad coverage abx for pna, until patient was made dnr and eventually had comfort care implemented after a family meeting. . # depression/anxiety: continue celexa, remeron, prn ativan, held standing klonopin to avoid altering mental status . #. gastritis: continued ppi . #. hypothyroidism: continued levothyroxine, check tsh . #. h/o c diff: continued lactinex, avoid empiric antibiotics if possible . # macrocytic anemia: hct initially 38 on admission; has been stable in mid 20s but now at 23. continued iron supplements. . patient's family convened and made decision for comfort measures only after discussions with dr and dr . patient was started on a morphine drip and extubated at approximately 5:30 pm. family was at bedside and patient's clinical status quickly deteriorated, though he appeared comfortable on the morphine drip. noticed asystole on telemetry and went to see patient. he was unresponsive. no visible chest rise or respirations. there were no heart sounds or breath sounds on auscultation. there was no palpable carotid pulse. pupils were fixed and dilated and corneal reflexes were absent. time of death was 6:04 pm. medications on admission: acetazolamide - (prescribed by other provider) - 500 mg capsule, sustained release - 125 mg by mouth once a day on mon wed & fri only albuterol sulfate - (prescribed by other provider) - 2.5 mg/3 ml (0.083 %) solution for nebulization - 1 neb every four (4) hours as needed citalopram - (prescribed by other provider) - 40 mg tablet - 1 tablet(s) by mouth once a day clonazepam - (prescribed by other provider) - 1 mg tablet - 1 tablet(s) by mouth three times a day levothyroxine - (prescribed by other provider) - 150 mcg tablet - 1 tablet(s) by mouth once a day lipase-protease-amylase - (prescribed by other provider) - 6,000 unit-,000 unit-,000 unit capsule, delayed release(e.c.) - 1 capsule(s) by mouth three times a day with meals lorazepam - (prescribed by other provider) - 0.5 mg tablet - 1 tablet(s) by mouth every eight (8) hours as needed for for anxiety metoprolol tartrate - (prescribed by other provider) - 50 mg tablet - 12.5 mg by mouth twice a day mirtazapine - (prescribed by other provider) - 15 mg tablet - 1.5 tablet(s) by mouth once a day nocturnal oximetry - - measure sats during sleep on 2l/min 02 omeprazole - (prescribed by other provider) - 40 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth once a day tiotropium bromide - (prescribed by other provider) - 18 mcg capsule, w/inhalation device - 1 inhalation once a day ferrous sulfate - (otc) - 325 mg (65 mg iron) tablet - 1 tablet(s) by mouth three times a day lactobacillus acidoph & bulgar - (prescribed by other provider) - 1 million cell tablet, chewable - 1 tablet(s) by mouth twice a day multivitamin - (prescribed by other provider; otc) - capsule - 1 capsule(s) by mouth once a day mucinex 600mg po bid discharge medications: patient passed away discharge disposition: expired discharge diagnosis: patient passed away discharge condition: patient expired. discharge instructions: patient expired. followup instructions: patient expired. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances diagnoses: unspecified pleural effusion unspecified protein-calorie malnutrition severe sepsis unspecified acquired hypothyroidism pulmonary collapse other and unspecified hyperlipidemia acute and chronic respiratory failure pneumonia due to pseudomonas septic shock iron deficiency anemia, unspecified personal history of venous thrombosis and embolism do not resuscitate status hypovolemia bronchiectasis without acute exacerbation unspecified gastritis and gastroduodenitis, without mention of hemorrhage mixed acid-base balance disorder septicemia due to pseudomonas 

Answer: The patient is high likely exposed to