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: percocet / tylenol attending: chief complaint: progressive doe x 3 days major surgical or invasive procedure: picc line placement cpap history of present illness: 87 yom with h/o afib not on coumadin and scc on the face s/p resection, who presents with three days of progressive doe. he reports pink-tinged frothy sputum as well as chills, anorexia and rhinorrhea, though he denies fever, ha, arhtralgias/myalgias, chest pain, emesis and diarrhea. he says he "may have gained weight recently," though was at the doctor on and seemed to be doing well. he denies weight loss over the last several months. he also told the ed he had increased urinary output. . in the ed, vs were t 100.3, bp 139/70, hr 124 in afib, rr 16, 96% on nrb (85% ra, 95% 4lnc) on presentation. he was given asa 325 mg, ibuprofen 400 mg po, and levofloxacin 740 mg iv, ceftriaxone 1 g iv, and vanco 1g iv for cap. in the ed, bp was initially in the 120's on admission but then dropped to 84/43; it improved to the 110-120's with a ivf bolus. he got a total of ~2l betwen ivf and antibiotics. blood cultures were sent. abg was not done. there was concern for an element of chf with a bnp > , though he was not diuresed in the ed because of the concern for infection. . on arrival to the icu, t 96.0, hr 92, bp 122/49, 92-96% nrb. initially there was concern for volume overload and he was given lasix 20 mg iv. he also had some hemoptysis. past medical history: dm2 paroxysmal atrial fibrillation on anticoagulation cri- baseline cr 1.5 - 2.0 htn gout copd oa h/o gib (; found to have gastritis, ulcerations, no active bleeding, and angioectasia in colon) h/o hip fx s/p orif/im nail r hip, l hip unclear etiology, previously treated with regular transfusions, now on procrit, baseline 30 h/o pericardial effusion in setting of af with rvr, chf, pleural effusions () s/p turp for prostate enlargement and urinary retention h/o sigmoid colon ca s/p sigmoid colectomy right cheek scc s/p skin graft diastolic chf social history: patient denies tobacco or illicit drugs. he reports occasional alcohol consumption. (hcp) report recent falls. house with stairs between kitchen and bedroom. speaks multiple languages. family history: nc physical exam: vs on arrival to the icu: t 96.0, hr 92, bp 122/49, 92-96% nrb general: elderly, comfortable but appears somewhat sob, nad, speaking in full sentences heent: poor dentition, op clear, tacky mm lungs: end exp wheezes on right throughout; high pitched sounds, rhonchi, crackles throughout on left; some use of scm for breathing cardio: heart sounds difficult to hear over o2 and breath sounds; difficult to assess jvd with surgical scars and scm use abd: somewhat distended and obese, but soft, no fluid wave appreciated, nt ext: chronic woody changes of b/l le to mid-shin, + b/l symmetric skin: multiple sk's and ak's; large area of skin graft/post-surgery on left fronto-parietal foreheaad/head ms: left leg slightly shorter and externally rotated neuro: aa, ox3, speaking in full sentences, conversant, appropriate, resting tremor in l>r pertinent results: admission cxr (12/6/9): single upright frontal chest radiograph: there is near-complete opacification of the left hemithorax, with some residual aeration noted in the upper lung. air-bronchogram is the mid lung suggests a component of air-space consolidation with probable increased effusion. the right hemithorax is normally aerated. there is no pneumothorax. no large pleural effusion is noted on the right. the cardiomediastinal silhouette is incompletely assessed secondary to the left hemithorax opacification. there is unchanged calcification in the aortic knob. impression: interval near-complete opacification of the left hemithorax, compatible with a large left-sided pleural effusion and likely consolidation. . 12/7/9 echo: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate global left ventricular hypokinesis (lvef = 35 %). the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is a trivial/physiologic pericardial effusion. compared with the report of the prior study (images unavailable for review) of , biventricular systolic function is now seen. clinical implications: the left ventricular ejection fraction is <40%, a threshold for which the patient may benefit from an acei or . 12/7/9 ct chest: 1)diffuse dense left lung consolidation and collapse with extensive airway occlusion, likely due to infectious pneumonia and coexisting atelectasis from retained secretions. correlation with bronchoscopy may be helpful to clear secretions and to exclude a fixed endoluminal lesion. no definite hilar mass but assessment limited by absence of iv contrast. 2)focal consolidation in the right upper lobe also likely due to infection but attention to this area on follow up imaging recommended to ensure resolution. 3)coronary artery, aortic valve and mitral annulus calcification. 4)gallstones . cxr: there is slight improvement of the left lung consolidation although significant amount of consolidation is still involving most of the left lung with some minimal sparing of the lateral portion of the left lower lobe. the right upper lobe is entirely consolidated but the right lower lung appears to be relatively clear. there is potentially present left pleural effusion. there is no pneumothorax. multiple abnormalities might be further evaluated by chest ct if clinically warranted. . cxr: cardiomediastinal contours are unchanged with cardiac size top normal. multifocal consolidations have continuously improved. still they are greater on the right upper lobe and left lower lobe. if any, there is a small left pleural effusion. there is no pneumothorax. . cxr: left picc tip is in the proximal svc. cardiomediastinal contours are obscured by the lung abnormalities. multifocal consolidations are unchanged as does a left pleural effusion. there are lower lung volumes . there is no evident pneumothorax. . cxr: history: pneumonia, to evaluate for change. findings: in comparison with the study of , the patient has taken a somewhat better inspiration. the degree of left perihilar opacification, retrocardiac opacification, and perihilar opacification on the right is similar. there may be some increase in the right upper lobe opacification when compared to the prior study. picc line position is unchanged. negative blood cultures 12/7 negative urine legionella . : feces positive for c. difficile toxin by eia. . labs on day of discharge; wbc rbc hgb hct mcv plt ct 7.5 2.6 6.6 24.5 99 140* . glucose urean creat na k cl hco3 angap 172* 60* 1.1 143 4.6 109* 32 7* brief hospital course: mr. is an 87yom, with a pmh significant for afib not on coumadin and scc on the face s/p resection, who presented to the micu with complete white out of left lung. . #. unilateral pleural effusion: this was thought to be due to a pneumonia given the unilateral nature of the effusion; parapneumonic effusion as most likely diagnosis. given smoking history and degree to which whole lung is affected, post-obstructive pna (due to malignancy) was considered as a possibility too. less likely chf b/c of left-sided unilateral nature, although the pt appeared to have element of volume overload with peripheral edema and response to lasix. it seems of relatively short onset, given that the patient had a normal peat pcp's office four days prior to admission, per the pt. blood and sputum cultures and urine legionella were negative. ct and cxr's showed the significant effusion. the patient refused vats/surgery/thoracentesis, so no clear etiology was discovered. he was treated broadly with antibiotics (empirically), and there was progressive (albeit slow) improvement in patient's oxygenation (>90% on 2l nc at discharge), his physical exam, and his chest x-rays. he was treated empirically with vancomycin/cefepime/azithromycin for hospital-acquired pneumonia broad coverage. . on multiple occasions, patient had sob, increased rr and work of breathing, spo2 decreased - on those occasions, lasix was tried, in case chf was a component, in addition to morphine, haldol (sparingly, for anxiety/confusion), and nebs. we found that talking/anxiety was big contibutor to , tried to control that with reassurance. patient was placed on cpap on a few of these separate occasions, and tolerated it well, and was able to come back off of the cpap without repercussion. goal spo2 in low 90s which is finally acheived with 2l nc and off cpap for several days prior to dishcarge. . chemical pneumonitis is likely a component of the dypnea, as the pt's neighbor later reported that he had found no less than 2 dozen raid bombs on the patient's bedroom floor, which the patient had been setting off due to "bugs on the floor" (likely visual hallucinations). the pt completed 5 days of methylprednisolone course. . #. copd/asthma: as patient will now be long-term npo any non-inhaled meds had to be d/c'd and he was sent out on fluticasone inh and prn nebs. . #. afib: the pt went into afib went into rvr after his po meds (including metoprolol) were held. ultimately, scheduled iv metoprolol was begun with good rate control. he required diltiazem drip at two different time points during his hospitalization. one of those times, his heart rate went into the bradycardic range. on other occasions, he would just become bradycardic without an obvious trigger, but tolerated it without symptoms. he was in sinus rhythm at discharge. . given fall risk/history and questionable history of gi bleed, patient was not anticoagulated. he was originally on aspirin 325mg daily, but in the setting of melena (see below), that was stopped. this should be restarted . . #melena - patient had one large melanotic stool without cht drop or decompensation during his hospitaliation, thoguht to be due to c. diff infection. we held aspirin which should be restarted as below. his ppi was also increased to , and should be restarted at qd on the . . # agitation/disorientaion: patient quite classically sundowns, but responds well to redirection and zydis tab if necessary. he had apparently been having nightly visual hallucinations at home prior to this admission. . #. diabetes: held home po meds, used ssi. not an active issue. . # c.difficile infection: c. diff positive, started on flagyl morning of , should continue until . . #.contact: with the patient, has friends/ who are ( and ). they were updated frequently. . #. code: dnr, dni. palliative care was consulted, suggested morphine for discomfort/anxiety, and consider zydis as needed also (used very rarely during admission). . # access: picc (double-lumen). . # nutrition: started tpn through picc. we watched electrolytes closely, due to concern for refeeding syndrome given patient was not eating for many days prior. difficulty swallowing, concern for aspiration. po pills converted to iv form and non-essentials d/c'd. medications on admission: buproprion 75 mg combivent 2 puffs diltiazem 240 mg qd epo 10,000 sc qweek ferroud sulfate 325 mg qd fluticasone lasix 40 mg qd lisinopril 10 mg qd montelukast 10 mg qd mvi pantoprazole 40 mg qd rosiglitazone 2 mg qd discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. tablet, delayed release (e.c.)(s) 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 3. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 4. insulin lispro 100 unit/ml solution sig: see attached sliding scale unit subcutaneous asdir (as directed): see attached sliding scale. 5. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 6. albuterol sulfate 2.5 mg/0.5 ml solution for nebulization sig: one (1) inhalation every six (6) hours. 7. morphine 2 mg/ml syringe sig: one (1) injection q6h (every 6 hours) as needed for pain,. 8. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours): d 1 = , dc on for 14 day course after planned completion of cefepime. changed to iv as pt could not swallow pill . 9. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q12h (every 12 hours). 10. metoprolol tartrate 5 mg/5 ml solution sig: 7.5 mg intravenous q6h (every 6 hours). 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) treatment inhalation q6h (every 6 hours) as needed for wheezing/sob. 12. ipratropium bromide 0.02 % solution sig: one (1) treatment inhalation q6h (every 6 hours) as needed for wheezing/sob. 13. olanzapine 5 mg tablet, rapid dissolve sig: 0.5 tablet, rapid dissolve po bid (2 times a day) as needed for agitation. discharge disposition: extended care facility: discharge diagnosis: primary: 1) pneumonia, 2) respiratory distress, 3) c. dificile colitis, 4) atrial fibrillation secondary: 1) congestive heart failure, 2) type 2 diabetes, 3) chronic renal insuffiency, 4) squamous cell cancer, 5) iron deficiency anemia discharge condition: mental status: confused - majority of time, especially when hypoxic. difficult to understand speech hoarseness, face mask. generally alert and interactive. out of bed with assistance to chair or wheelchair discharge instructions: you were seen in the ed for difficulty breathing. you had a very large pneumonia and required a large amount of respiratory support in the micu at medical center for several weeks in the icu to maintain your oxygenation levels. overtime, you improved with iv antbiotics and iv steroids. while you were hospitalized, you developed an antibiotic-associated infection of the colon called clostridium dificile, which you will need to take antibiotics for 2 weeks after the treatment for your pneumonia is completed. during your stay in the icu, you became quite confused. we think this is due to your pneumonia, decreased oxygen levels in your blood, and being in an unfamiliar location. you can take a medication called zydis which disolves on your tongue when you get very confused or agiatated. your heart was evaluated while you were hospitalized and you do have congestive heart failure; because of your chf, pleae weigh yourself every morning, md if weight goes up more than 3 lbs. you were diuresed with iv lasix periodically during your hospitalization. additionally, your infection triggerred your heart to go into a rapid, abnormal rhythm, atrial fibrillation, during your hospitalization--this was treated with metoprolol iv. new medications: antibiotics: metronidazole (flagyl) 500 mg iv q8h (discontinue on for 14 day course, can be changed to po when patient is eating) vancomycin 500 mg iv q 24h start: , discontinue on for 14 day course. heart medications: metoprolol tartrate 7.5 mg iv q6h (hold for hr<60 sbp<90, patient can be started on metop 25mg po tid when taking po again) zydis 2.5mg fast melt can be uptitrated to a max of 5mg for agitation heparin 5000 units subcutaneous tid for anticoagulation combivent nebulizer treatments changed pantoprazole 40 mg po qday to pantoprazole iv 40mg (can be changed to po when pt taking pos). holding these medications in acute setting: rosiglitazone 2 mg qday buproprion 75 mg lasix 40mg po qday ferrous sulfate 325 mg po qday discontinued: diltiazem 240 mg po qday followup instructions: please follow up with your primary care physician . in weeks. you will need to call for an appointment. phone: . please see your cardiologist, dr. . date & time: tuesday, at 12:40pm location: , bldg , , ma phone: md procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances thoracentesis non-invasive mechanical ventilation diagnoses: pneumonia, organism 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 i through stage iv, or unspecified gout, unspecified atrial fibrillation chronic kidney disease, unspecified constipation, unspecified acute respiratory failure personal history of other malignant neoplasm of skin blood in stool intestinal infection due to clostridium difficile surgical or other procedure not carried out because of patient's decision hyperosmolality and/or hypernatremia empyema without mention of fistula delirium due to conditions classified elsewhere acute on chronic combined systolic and diastolic heart failure history of fall other acquired deformity of other parts of limb 

Answer: The patient is high likely exposed to