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: levofloxacin attending: chief complaint: cc: sob major surgical or invasive procedure: no major surgical or invasive procedures. history of present illness: hpi: 64 yo male with hx of cad s/p nstemi, severe copd with multiple intubations on chronic steroids, who p/w onset of sob over several hours. one day prior to admission, pt reports that he had been sitting in bed and noted the gradual progression of sob over several hours. denies sudden onset sob, cp, pleuritic pain, orthopnea, pnd, inc le edema. states that it feels like a copd flare. +occ cough, unchanged from chronic pattern. +yellow sputum, unchanged in frequency or character. took ipratroprium/albuterol nebs x10, without improvement and decided to come to the ed. . in ed, 108, 140/90, 23, 88% ra. durintg time in room, bp dropped to 97/69, rec'd 1.5l ns w/ subsequent improvement in bp. rec'd cipro 250 mg. also rec'd solumdrol 125, and underwent bipap while in ed. past medical history: pmh: 1. copd on 4 l o2 at home and s/p multiple admissions and intubations for flares-fev1 .47(19%) fev1/fvc 36% on 4l home 02, and bipap qhs. 2. hypertension 3. hyperlipidemia 4. cad s/p nstemi () with cath normal 5. chronic low back pain l1-2 laminectomy from accident at work 6. steroid induced hyperglycemia 7. left shoulder pain for several months 8. cataract 9. gerd 10. chronic indwelling urethral catheter. social history: married with six children. lives at home in with wife. retired mechanic. exposed to a lot of spray paint. former smoker. quit 25 years ago. 20 pack year history. occassional etoh quit marijuana 3 years ago. denies iv drug use. activity limited due to prior spine and current shoulder problems. family history: mother with asthma and father with cancer physical exam: pe: 97.1, bp 123/43, 92, 18, 99% 4l nc well appearing male, not utilizing acc mm, breathing comfortably in nad. perrl. op clr, mmm 6cm jvp regular s1,s2. no m/r/g. lca b/l. +inc expiratory time. +bs. soft. nt. nd. no le edema. pertinent results: ekg: 85bpm, nl axis, nl interval, non-specific ivcd, unchanged. . cxr ap upright portable chest x-ray: the study is limited secondary to patient's positioning. the right costophrenic angle is not seen. the cardiac silhouette is normal in size. the aorta is tortuous. there is stable overinflation of bilateral lung fields, with flattening of the cardiac silhouette, and bilateral hemidiaphragms. hyperlucency bilaterally and symmetrically is consistent with diffuse emphysema. the imaged lung fields are otherwise clear, with slight stable scarring at the left lung base. there is no pneumothorax, and the pulmonary vasculature is normal. impression: 1. no acute cardiopulmonary process. 2. underlying diffuse bilateral emphysema. . 5:09 pm urine **final report ** urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with fecal contamination. . 1:05 pm urine site: catheter **final report ** urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with fecal contamination. . blood cx: negative . 02:35pm urine color-yellow appear-hazy sp -1.016, blood-lg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-mod; rbc-* wbc->50 bacteria-many yeast-none epi-0-2 trans epi-0-2 glucose-114* urea n-16 creat-0.8 sodium-141 potassium-3.8 chloride-101 total co2-29 anion gap-15, calcium-9.0 phosphate-4.5 magnesium-1.7, wbc-14.0* rbc-4.52* hgb-12.2* hct-37.8* mcv-84 mch-27.1 mchc-32.3 rdw-15.4, neuts-67.9 lymphs-24.3 monos-4.3 eos-3.2 basos-0.4, plt count-333 brief hospital course: a/p: 64 yo male with htn, severe copd with fev1 20%, on home oxygen 4l and chronic steroids, with multiple prior intubations, admitted with copd flare and hypotension. . 1) shortness of breath: the patient's presentation was consistent with a copd flare. there was no new infiltrate on chest x-ray, and there was no change in the consistency/amount/frequency of his sputum production. pulmonary embolism is highly unlikely. it was felt there was no indication for antibiotics. we continued his steroids at prednisone 60mg po qd, and discharged the patient on a taper over 10 days. we continued albuterol and ipratropium bromide nebulizer treatments, scheduled. the pt was started on fluticasone and salmeterol inhalers, and he will use these as an outpatient. he did not have to go on bipap. at discharge, he was able to walk around the icu five times. he reports this is his baseline. he will follow up with dr. , his pulmonologist in the next 2 weeks. . 2) the pt had one episode of sbp in the 90s in the ed. he was asymptomatic. we considered a normal variation in bp, and could not r/o mild volume depletion given insensible losses vs adrenal insufficiency as pt is on steroid taper. we recommend cortstim on the pt as an outpatient. we continued steroids for copd flare. our goal was for map<60 and uop<30cc/hour, supported with fluid boluses if need be, however he did not require this. he was with stable vs throughout his stay. no more episodes of hypotension. he was placed on his high blood pressure medications while in the . . 3) the pt's urine cultures came back positive for >3 colony types, consistent with fecal contamination. urology felt that this was likely colonization, given he has a chronic indwelling catheter. the catheter was changed on , and urology recommended macrodantin for 3 day course given the cath change. the pt is to follow up with dr. at for potential transurethral needle ablation of the prostate for benign prostatic hyperplasia. . 4) pt has history of anemia in past, unclear when his last colonoscopy was. will have pt follow up with pcp as outpatient to schedule colonoscopy. stools were guiaic negative. . 5) coronary artery disease- no current evidence of angina. we continued his ace inhibitor//statin. . 6) code status- full. medications on admission: meds: 1.aspirin 325 mg qd 2.atorvastatin calcium 10 mg qd 3.calcium carbonate 500 mg qd 4.cholecalciferol (vitamin d3) 400 unit qd 5.senna 8.8 mg/5 ml 6.sertraline 50 mg qd 7.albuterol sulfate 0.083 % neb q4hours 8.ipratropium bromide nebq4hours 9.multivitamin qd 10.lisinopril 5 mg qd 11.prednisone 30mg qd on taper(down from 40mg on ) 12.percocet discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*2* 2. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*4* 3. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*3* 4. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed: please see your primary care physician for refills of this medication. . :*30 tablet(s)* refills:*0* 5. salmeterol 50 mcg/dose disk with device sig: one (1) disk with device inhalation q12h (every 12 hours). :*1 disk with device(s)* refills:*2* 6. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*2* 7. cepacol 2 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed). :*30 lozenge(s)* refills:*0* 8. verapamil 240 mg tablet sustained release sig: one (1) tablet sustained release po q24h (every 24 hours). :*30 tablet sustained release(s)* refills:*2* 9. nitrofurantoin macrocrystal 50 mg capsule sig: one (1) capsule po qid (4 times a day) for 2 days: to complete a 3 day course. . :*8 capsule(s)* refills:*0* 10. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*2* 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). :*30 tablet, delayed release (e.c.)(s)* refills:*2* 12. albuterol sulfate 0.083 % solution sig: one (1) nebulizer inhalation every six (6) hours. :*120 nebulizer* refills:*2* 13. ipratropium bromide 0.02 % solution sig: one (1) nebulizer treatment inhalation q6h (every 6 hours). :*120 nebulizer treatment* refills:*2* 14. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). :*qs mdi* refills:*2* 15. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): for constipation. :*60 capsule(s)* refills:*2* 16. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed: for constipation. :*60 tablet(s)* refills:*2* 17. prednisone 10 mg tablet sig: see instructions tablet po once a day for 7 days: take 4 tab po qd for 1 day, then 3 tab po qd for 2 days, then 2 tab po qd for 2 days, then 1 tab po qd for 2 days. . :*16 tablet(s)* refills:*0* discharge disposition: home with service facility: medical services discharge diagnosis: 1. chronic obstructive pulmonary disease flare/exacerbation 2. chronic indwelling urethral catheter 3. benign prostatic hypertrophy 4. hypertension 5. hyperlipidemia 6. coronary artery disease 7. chronic lumbago 8. gastroesophageal reflux disease discharge condition: stable discharge instructions: if you experience worsening shortness of breath, coughing and sputum production increased in quantity or quality, please report to the emergency room immediately. if you notice that you are requiring more inhalers or oxygen than normal, please come to the er. please follow up with your physicians (see information below). please take all of your medications. followup instructions: 1. provider: , md phone: . date/time: you will be called by , rn from dr. office regarding a time in the next two weeks for you to come in. 2. provider: , md phone: date/time: 9:30 am. 3. provider: , .d. phone: date/time: 11:30 4. please follow up with dr. at , urology, for evaluation for your transurethral needle ablation of the prostate. 5. provider: , m.d. phone: date/time: 11:00 procedure: non-invasive mechanical ventilation insertion of indwelling urinary catheter diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension long-term (current) use of steroids obstructive chronic bronchitis with (acute) exacerbation other and unspecified hyperlipidemia hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) hypotension, unspecified old myocardial infarction bladder neck obstruction lumbago pain in joint, shoulder region 

Answer: The patient is high likely exposed to