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: amoxicillin attending: chief complaint: hypercarbic respiratory failure major surgical or invasive procedure: intubation. central venous catheter placement. history of present illness: the pt is an 80 yo male with h/o severe osa on 2l at home and colon cancer s/p colectomy who presents with ams, s/p 2 falls, slurred speech, visual hallucinations, and worsening pco2. the wife reports he's been having hallucinations for 1.5 wks. her husband reported seeing people in the room who were not there and was talking to these people. he also called 911 to ask the police to remove these people from his house. he's also had slurred speech for the past week. she reports he hit his head at 4am yesterday with a resulting periorbital hematoma. he put his weight on a table and the other end came up and hit him in the head. he then fell again tonight which was unwitnessed but his wife thinks he fell off the couch onto the rug. over the last few days, his c02 has been rising at his pcps office. wife says these sx are consistent with previous hypercarbic respiratory failure when he needed to be admitted to 2 yrs ago. . vitals on arrival to the ed were 98.2 100 142/83 16 96%. his abg showed ph 7.28 pco2 78 po260 and he was started on bipap. cxr was notable for mild pulm edema bilaterally. blood cx was sent but patient refused the 2nd of 2 blood cultures. the patient refused a foley to obtain a ua. labs in the ed were notable for trop 0.04, lactate 1.2, wbc 8.5, k+ 6.3, bun 26/creatinine 1.3, glc 212, ast 81, probnp 1185. his legs were notable for a cellulitis and he received vancomycin 1gram iv x1. the patient refused ct head, chest, spine, abd/pelvis. vitals prior to transfer were 97.8 75 131/108 rr15 94% on bipap with 5 peep and 30% fi02. . on arrival to the floor the patient was agitated and wanting to take off his c-collar. he was refusing to put on his cpap without administration of something for his anxiety. meanwhile he was satting 82% on 2l nc. he was given ativan 0.25mg iv. he was placed on bipap and sats dropped as low as 69% and later improvd to the 80s. he was intubated and started on propofol for sedation. past medical history: severe osa on 2l at home cpap at night colon ca s/p colectomy diabetes social history: no etoh, illicits, never smoker family history: non contributory physical exam: vs: bp: 152/63 hr:96 rr:19 o2sat 82% on nc gen: argumentative, a & o x3 heent: pupils equaal in size, generally can move eyes in all directions, mildly dry mm unable to appreciate jvd given body habitus resp: mildly decreased bs anteriorly cv: rr, s1 and s2 wnl, no m/r/g abd: + echymossus in upper abdomem, obese, distended, + surgical scars ext: + erythema and warmth of right leg, + chronic venous stasis changes in le bilaterally skin: extensive in inguinal creases bilaterally neuro: aaox3. moving all extremities, pupils equal in size pertinent results: admission labs: 01:00am wbc-8.5# rbc-4.20* hgb-12.8*# hct-39.2* mcv-93 mch-30.4 mchc-32.6 rdw-14.6 01:00am neuts-77.5* lymphs-15.3* monos-4.8 eos-1.5 basos-1.0 01:00am glucose-212* urea n-26* creat-1.3* sodium-136 potassium-6.3* chloride-98 total co2-31 anion gap-13 01:18am type-art o2 flow-2 po2-60* pco2-78* ph-7.28* total co2-38* base xs-6 intubated-not intuba . discharge labs: . microbiology: blood, urine, sputum cultures negative rpr: pending . ct head non contrast: impression: no evidence of acute intracranial pathological process. comment: there is a suggestion of minimal bilateral proptosis, without extraocular muscle abnormalities to suggest grave's disease. please correlate this observation clinically. . ct c-spine: ct chest: the pulmonary arterial tree is well opacified, and there is no evidence of pulmonary embolism. the aorta is normal in caliber without evidence of acute aortic syndrome. extensive calcifications of the aorta and coronary arteries are seen. within the lung parenchyma, there is bibasilar atelectasis and consolidation. the airways are patent to the segmental level. no pericardial effusion or measurable pleural effusion is seen. no pathologically enlarged lymph nodes are present. the patient is intubated with endotracheal tube approximately 4.6 cm above the carina. a nasogastric tube is in place with tip within the stomach. ct abdomen with contrast: within the abdomen, there is cholelithiasis, including a large stone measuring up to 5.5 x 5.3 cm within the gallbladder fundus, which was present on the prior examination, however, may be slightly increased in size. no evidence of gallbladder wall edema is seen. no choledocholithiasis is identified. the liver, kidneys, adrenal glands, spleen, and pancreas appear grossly unremarkable. loops of small and large bowel are of normal size and caliber. there is diffuse anasarca with some nonspecific diffuse stranding of the mesentery. again seen are extensive vascular calcifications. several retroperitoneal lymph nodes measuring up to 1.3 cm in short axis (500b:77) are present however these are non-specific. no free air is seen. the patient is status post right hemicolectomy. ct pelvis with contrast: again noted the patient is status post right hemicolectomy. there is diverticulosis of the sigmoid colon. the bladder is collapsed around a urinary catheter. there are prostatic calcifications. again noted is diffuse mild anasarca. no pelvic free air is seen. bone windows: no concerning osseous lesion is seen. bone islands in the left iliac bone and within the ribs are stable. impression: 1. no evidence of pulmonary embolism. bibasilar atelectasis and possible aspiration/consolidation. 2. cholelithiasis without evidence of cholecystitis. . cta chest : ct chest: the pulmonary arterial tree is well opacified, and there is no evidence of pulmonary embolism. the aorta is normal in caliber without evidence of acute aortic syndrome. extensive calcifications of the aorta and coronary arteries are seen. within the lung parenchyma, there is bibasilar atelectasis and consolidation. the airways are patent to the segmental level. no pericardial effusion or measurable pleural effusion is seen. no pathologically enlarged lymph nodes are present. the patient is intubated with endotracheal tube approximately 4.6 cm above the carina. a nasogastric tube is in place with tip within the stomach. ct abdomen with contrast: within the abdomen, there is cholelithiasis, including a large stone measuring up to 5.5 x 5.3 cm within the gallbladder fundus, which was present on the prior examination, however, may be slightly increased in size. no evidence of gallbladder wall edema is seen. no choledocholithiasis is identified. the liver, kidneys, adrenal glands, spleen, and pancreas appear grossly unremarkable. loops of small and large bowel are of normal size and caliber. there is diffuse anasarca with some nonspecific diffuse stranding of the mesentery. again seen are extensive vascular calcifications. several retroperitoneal lymph nodes measuring up to 1.3 cm in short axis (500b:77) are present however these are non-specific. no free air is seen. the patient is status post right hemicolectomy. ct pelvis with contrast: again noted the patient is status post right hemicolectomy. there is diverticulosis of the sigmoid colon. the bladder is collapsed around a urinary catheter. there are prostatic calcifications. again noted is diffuse mild anasarca. no pelvic free air is seen. bone windows: no concerning osseous lesion is seen. bone islands in the left iliac bone and within the ribs are stable. impression: 1. no evidence of pulmonary embolism. bibasilar atelectasis and possible aspiration/consolidation. 2. cholelithiasis without evidence of cholecystitis. . echo : the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). there is no ventricular septal defect. with normal free wall contractility. the diameters of aorta at the sinus, ascending and arch levels are normal. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are not well seen. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. . renal ultrasound (): unremarkable renal ultrasound, without hydronephrosis or evidence of obstruction. bladder not evaluated. . ct head ():. no evidence for hemorrhage or other acute intracranial process. 2. interval resolution of ethmoidal and left sphenoid air cell fluid, with residual sphenoid air cell mucosal thickening. brief hospital course: 8o yo male with h/o hypercarbic respiratory failure and osa who presents with hallucination . # hypercarbic respiratory failure: likely secondary to osa, obesity hypoventilation syndrome, and altered mental status. gas in the ed just after put on 2l was ph 7.28 pco2 78 po2 60. on arrival his 02 sat was as low as 69% on bipap. he was intubated and maintained on ac ventilation. he was diuresed, and sedation was slowly weaned but his mental status remained a barrier to extubation (i.e. he was agitatated when awake enough not to be apneic). he was on a precedex drip for several days, but this did not seem to affect his mental status. his sedation was weaned, and eventually he was extubated. upon extubation, he was mildly hypoxic and co2 in the 60s. cxr showed possible pneumonia. he was started on levofloxacin and vancomycin on (also covering cellulitis, as below). throughout the course of his hospitalization he intermittently required bipap. diuresis continued and eventually the patient only required bipap overnight with stability of blood gases during the day. after several family meetings, it was decided that pt would be dnr/dni and . he can continue night time cpap with bipap mode (psv) at rate of: (insp pressure=12 and exp pressure=6). pt may refuse this if he choses. . # ams: combination of hypercarbic respiratory failure, infection, and s/p fall with trauma to the head. pt with hallucinations and slurred speech per his wife. ct of the head was unremarkable for an acute process. ct c-spine showed only cervical spondylosis and spinal stenosis. he was maintained in his c-collar while intubated and sedated. mental status became a barrier to extubation, so precedex was tried for several days but did not affect his mental status. haldol also did nothing to calm him. he continued to require versed boluses. eventually this was weaned and he was extubated. psychiatry consultants recommended haldol while not taking po and seroquel when taking po. eventually the patient had seroquel dc'd given concerns that it was effecting his mental status and was ultimately switched to zyprexa standing and prn. he continued to be delirious. ct of head was repeated without acute intracranial process. neurology was consulted and felt that this presentation was consistent with toxic metabolic encephelopathy. they recommended checking folate, b12, rpr, all of which were wnl. on the days prior to discharge, pt was made and all medications, tubes, lines were stopped. he then improved and became more lucid, conversant, would answer questions appropriately. at time of discharge he was given zyprexa qhs as well as prn zyprexa and haldol as needed for agitation. he was also given thiamine in the event that his ams was contributed by a thiamine deficiency. in summary, his ams throughout hospitalization was thought to be due to multiple problems: hypercarbic resp encephalopathy, icu and hospital delerium, infection. he started to clear prior to discharge after lines, tubes, meds were d/c-ed. . # cellulitis: he was treated with vancomycin iv and levofloxacin. his cellulitis resolved but he still has chronic venous stasis changes in the lower legs. he completed a 7-day course. on , he was noted to have new lower extremity erythema. vancomycin and levofloxacin were restarted with resolution of cellulitis. . # goals of care: given his tenuous respiratory status prior to extubuation multiple family meetings were held to clarify the patient and family's wishes about contingencies post-extubation. the final decision, agreed upon by the patient's wife and daughter, was that the patient would not want further aggressive measures including no re-intubation and no tracheostomy. he values his independence highly. later in the hospital course the decision was made that the patient would be discharged to rehab with hospice care and plan on not returning to the hospital. pt was made dnr/dni/dnh/. *pt is dnr/dni *pt is "do not return to hospital" *pt is * give night-time bipap (as above) if pt agrees but he may refuse. . # pulm edema: pro bnp was as high as 1185. his echo showed an ef of 70-75%, moderate symmetric left ventricular hypertrophy, and they were unable to measure degree of pulm htn. he was diuresed with lasix gtt during the admission. . # new right bundle: this is compared to ekg 5 yrs ago. his enzymes were cycled and he was ruled out for a mi. . #dm: he was placed on an insulin sliding scale. . # renal failure: his fena was <0.5% suggesting a prerenal etiology. urine eos were negative. his medications were renally dosed. his creatinine returned to baseline 1.0. later, he again developed acute renal failure in the context of aggressive diuresis. creatinine continued to trend up after diuresis was stopped. it was observed that with higher maps the patient tended to have improved urine output. he was given a trial of levophed to determine if higher maps improved renal function. with levophed the patient's creatinine improved. levophed was stopped and creatinine remained stable. renal was consulted and felt that the patient pre renal etiology to explain his poor renal function. at time of discharge his cr ranged from 2.1-2.3 (baseline appears to be 1.0-1.3). . #cardiac/htn: pt's lisinopril and torsemide were held towards the end of hospitalization when pt made . they may be resumed at rehab if pt's mental status continues to improve and he agrees to take them. he was on torsemide 20mg daily and lisinopril 20mg daily. . # hypothyroidism: his ct of the head showed minimal bilateral proptosis and his tsh was normal. he was continued on his home levothyroxine 175mcg daily. . # bph: he was continued on his tamsulosin and finasteride. . #. psych history: per his pcp he was taking extra methylphenidate while at home as well as a sedative. his methylphenidate was discontinued. . # onchycomycosis: his terbinafine 250mg daily was hled given his elevated asts. . # in groin folds: he was treated with miconazole and his improved significantly. medications on admission: -torsemide 20mg daily -lisinopril 20mg daily -allopurinol 300mg daily -levothyroxine 175mcg daily -diphenoxylate-atropine 2 tabs qud prn diarrhea -tamsulosin 0.4 2 tabs daily -finasteride 5mg daily -methylphenidate 10mg daily -terbinafine 250mg daily discharge medications: 1. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed) as needed for rash. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 3. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 4. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation: prn. 5. budesonide 0.5 mg/2 ml suspension for nebulization sig: one (1) ml inhalation (2 times a day). 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for sob, wheezing. 7. ipratropium bromide 0.02 % solution sig: one (1) inhalation q4h (every 4 hours) as needed for sob, wheezing. 8. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po qhs (once a day (at bedtime)). 9. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po bid (2 times a day) as needed for agitation: prn. 10. haloperidol lactate 5 mg/ml solution sig: one (1) injection (2 times a day) as needed for agitation: prn (first try zyprexa). 11. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed). 12. levothyroxine 175 mcg tablet sig: one (1) tablet po once a day. 13. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: two (2) capsule, sust. release 24 hr po once a day. 14. finasteride 5 mg tablet sig: one (1) tablet po once a day. 15. thiamine hcl 250 mg tablet sig: one (1) tablet po once a day for 7 days: start on . 16. thiamine hcl 100 mg tablet sig: one (1) tablet po once a day: start on . discharge disposition: extended care facility: of discharge diagnosis: altered mental status hypercarbic respiratory failure hospital acquired pneumonia discharge condition: mental status: confused - always. (occasionally has lucid moments) of consciousness: and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: it was a pleasure providing care for your during your hospitalization. you were admitted to the hospital for confusion. the confusion was thought to be due to breathing difficulties (hypercarbic respiratory distress from your sleep apnea). you also likely had hospital induced and icu induced delerium. the following changes were made to your medications: your heart and blood pressure medications were temporarily stopped. you may resume them at rehab if your confusion continues to improve: -torsemide 20mg daily -lisinopril 20mg daily your thyroid medication was continued. -levothyroxine 175mcg per day your diphenoxylate-atropine was stopped for your prostate, the following meds were continued -tamsulosin 0.4mg 2 tabs daily -finasteride 5mg daily methylphenidate 10mg daily was stopped. terbinafine 250mg daily was also stopped. (all of the above medications that were held may be resumed as your mental status improves) please start: -thiamine. take 250mg once a day for the next 5 days. then take 100mg once a day thereafter -zyprexa at night if you agree, we also reccomend you continue your cpap at night: nasal bipap with psv mode of . followup instructions: should follow up with your primary care doctor after you leave rehab. procedure: 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 enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified toxic encephalopathy diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure other chronic pulmonary heart diseases hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, unspecified acute and chronic respiratory failure cellulitis and abscess of leg, except foot alkalosis right bundle branch block personal history of malignant neoplasm of large intestine do not resuscitate status hyperosmolality and/or hypernatremia venous (peripheral) insufficiency, unspecified candidiasis of skin and nails history of fall malnutrition of moderate degree conjunctivitis, unspecified dermatophytosis of nail obesity hypoventilation syndrome 

Answer: The patient is high likely exposed to