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: no known allergies / adverse drug reactions attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: 66m with severe copd, chronically trached (capped), on 2l o2 at baseline who presents with tachypnea. the patient was found to be tachypneic and diaphoretic at his group home. when ems was called he was 82% on 2l, and came up to 99% on nrb. denied chest pain, abdominal pain, headache. . . notably, he had a recent micu admission from for copd exacerbation and pneumonia. sputum cultures grew out strep pneumoniae, and the patient was treated with ceftriaxone and levofloxacin. he was discharged on a steroid taper. . in the ed, initial vs were: 97.2 91 151/77 32 100% 15l nrb. exam was notable for coarse rales on the l, green sputum around the trach site, and accessory muscle use. ekg was without st segment changes. blood cultures and a sputum culture were sent. cxr was obtained. patient was given albuterol nebs x3, ipratropium nebs x3, prednisolone 125mg iv x1, wtihout much relief. he was also given vancomycin 1g, levofloxacin 500mg, and ceftriaxone 1g. respiratory was called, and the patient was ventilated. vitals prior to transfer were t98 hr 91 bp 133/52 99% on facemask, awaiting mechanical ventilation. with onset of mechanical ventilation and sedation (2mg iv midazolam), the patient briefly became hypotensive to 60s/40s. he was found to be autopeeping at 15. he received 2l iv fluids, and was briefly taken off the ventilator, with resolution of hypotension. bps prior to transfer were 95-112/56-58. he was started on 0.15 peripheral levophed. . . . on the floor, the patient is resting comfortably. he denies any chest pain. he has had chills overnight, and only felt badly yesterday. he states that 2 days ago, he felt completely well. denies cough or sputum production. . review of systems: (+) per hpi (-) denies fever, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - copd: fev1 23% predicted (), fev1/fvc 28% predicted () home 2l o2. trach placed in . - secondary pulmonary hypertension (tr gradient 51-66 mm hg on echo ) - schizophrenia - hx gi bleeding - mental retardation - s/p tonsillectomy - s/p trach social history: lives in , unknown if alone. on disability since for mental health issues. has home nurse visit every morning and evening. reports ~50 pack-year smoking denies current smoking. denies any etoh/drug use. family history: non-contributory physical exam: admission exam: vitals: t: 97.6 bp: 121/77 p: 63 r: 16 o2: 100% on ac fio2 of 100%, peep 5, vt 400 rr 16 general: alert, oriented, trach in place. no acute distress : sclera anicteric, mmm, oropharynx clear. trach in place, with purulent secretions around trach site. neck: supple, jvp not elevated, no lad lungs: poor air movement. faint end expiratory wheezes. no crackles or rhonchi. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema at discharge, same as above except: : trach in place and capped, no secretions lungs: moderate air entry, minimal wheezes pertinent results: admission labs: 07:20am plt count-318 07:20am neuts-74.5* lymphs-20.7 monos-3.9 eos-0.6 basos-0.3 07:20am wbc-13.9*# rbc-4.32* hgb-13.1* hct-40.6 mcv-94 mch-30.3 mchc-32.3 rdw-13.3 07:20am ctropnt-0.01 07:20am estgfr-using this 07:20am glucose-156* urea n-48* creat-1.0 sodium-149* potassium-4.5 chloride-100 total co2-48* anion gap-6* 07:37am freeca-1.19 07:37am lactate-0.9 07:37am type- rates-/40 o2-100 po2-192* pco2-101* ph-7.27* total co2-48* base xs-14 aado2-440 req o2-74 intubated-not intuba comments-green top 08:30am urine mucous-few 08:30am urine hyaline-4* 08:30am urine rbc-2 wbc-3 bacteria-none yeast-none epi-0 08:30am urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 08:30am urine color-yellow appear-clear sp -1.022 10:58am urine gr hold-hold 10:58am urine hours-random 11:27am type-art rates-/16 tidal vol-400 peep-5 o2-70 po2-223* pco2-78* ph-7.26* total co2-37* base xs-5 -assist/con intubated-intubated 05:00pm pt-13.1 ptt-26.5 inr(pt)-1.1 05:00pm plt count-270 05:00pm wbc-10.6 rbc-3.92* hgb-11.8* hct-36.7* mcv-94 mch-30.0 mchc-32.0 rdw-13.5 05:00pm calcium-7.9* phosphate-2.3* magnesium-1.7 05:00pm glucose-203* urea n-35* creat-0.8 sodium-141 potassium-4.7 chloride-103 total co2-32 anion gap-11 discharge labs: micro: blood culture x 2: ngtd sputum culture : 7:43 am sputum sputum via tracheostomy. **final report ** gram stain (final ): pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive rod(s). respiratory culture (final ): heavy growth commensal respiratory flora. gram negative rod(s). sparse growth. gram negative rod #2. sparse growth. urine culture : negative urine legionella : negative influenza a + b : negative sputum culture : 4:41 pm sputum source: endotracheal. **final report ** gram stain (final ): this is a corrected report (). reported to and read back by dr. , r () on at 15:09. >25 pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. previously reported () as:. >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive rod(s). 3+ (5-10 per 1000x field): gram positive cocci in pairs. 2+ (1-5 per 1000x field): gram positive cocci in clusters. 2+ (1-5 per 1000x field): gram negative rod(s). respiratory culture (final ): sparse growth commensal respiratory flora. imaging: cxr : cardiac contour is unremarkable. bilateral hilar prominence is stable. there is no focal consolidation within the lungs concerning for pneumonia. there is slight prominence and haziness of the pulmonary vasculature. no pleural effusion or pneumothorax. tracheostomy is in place. impression: minimal central vascular engorgement with minimal pulmonary vascular congestion. stable hilar prominence. brief hospital course: mr. is a 66 yo m with a history of severe copd, chronically trached, who presents with hypoxia and tachypnea likely due to a copd exacerbation. active problems: 1. dyspnea/tachypnea/acute respiratory failure: he presented with hypoxia and tachypnea, with desaturations to 82% at his rehab that rebounded with nrb. he has severe underlying copd and had recently undergone micu treatment of pneumonia within the past month. he was placed on vanco/levaquin/ceftriaxone for suspected hcap. copd was aggressively managed with iv steroids, standing ipratroprium and albuterol nebulizers, and the above antibiotics. cxr revealed no sign of infiltrate. he was placed on mechanical ventilator for elevated aad02 and co2 retention. he ruled out for flu and legionella. his sputum culture from revealed a polymicrobial gram stain with gram negative and positive rods, and gram positive cocci in pairs and chains, however the culture revealed only sparse growth of commensal respiratory flora. vancomycin and ceftriaxone were stopped on , and he will continue a 8 day course of levofloxacin based on previous culture data growing strep pneumo from last hospitalization. he came off the vent on and tolerated pressure support. his trach was capped , which he tolerated well, though he rested on pressure support overnight per the primary teams recommendation given his severe copd. he may need nightly resting on the vent, though this decision may depend on his performance at rehab as his trach is capped for longer periods. it may also be wise to consider nocturnal bipap. he will complete a ten day steroid taper. he completed 5 days of levaquin on . 2. acute hypotension: he became hypotensive to 60s/40s upon starting sedation and mechanical ventilation on admission. he received ivf x2l and was placed on levophed gtt, which was weaned during his second hospital day. he maintained his blood pressures thereafter. 3. chronic obstructive pulmonary disease: severe, with fev1/fvc 28% on 2l home 02. exacerbated, as above. benefit from nightly resting on pressure support. inactive problems: 4. schizophrenia: no issues, continued zyprexa 7.5mg pending tests at discharge: blood cultures x 2 transitional care issues: - prednisone taper as follows: 40mg daily through , then 30mg x3 days, 20mg x3 days, 10 mg x2 days, 5mg x 2 days. - consideration for nightly rest on vent or bipap medications on admission: 1. zyprexa 7.5 mg tab 1 tablet(s) by mouth once a day 2. multivitamins with minerals tab 1 tablet(s) by mouth once a day 3. advair diskus 500 mcg-50 mcg/dose for inhalation 1 puff(s) inhaled twice a day 4. spiriva with handihaler 18 mcg & inhalation caps 1 capsule inhaled once a day 5. albuterol inhaler 2 puffs q4h prn wheezing 6. aspirin 81 mg po daily 7. tylenol 325 mg po q6h prn pain discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : 1-2 puffs inhalation every four (4) hours as needed for wheezing. 2. olanzapine 5 mg tablet : 1.5 tablets po twice a day. 3. prednisone 10 mg tablet : per schedule below tablet po once a day: 4 tabs/day through , then 3 tabs/day for 3 days. 2 tabs/day for 3 days. 1 tab/day for 2 days. 0.5 tab/day for 2 days, then stop (10 days total taper). disp:*22 tablet(s)* refills:*0* 4. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 5. tiotropium bromide 18 mcg capsule, w/inhalation device : one (1) capsule, inhaled inhalation once a day. 6. advair diskus 500-50 mcg/dose disk with device : one (1) inhalation twice a day. 7. tylenol 325 mg tablet : one (1) tablet po every six (6) hours as needed for pain. 8. multivitamin with minerals tablet : one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses: acute respiratory failure secondary to exacerbation of chronic obstructive pulmonary disease. secondary diagnoses: schizophrenia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , you were admitted to the hospital with difficulty breathing, which was likely caused by worsening of your copd, and maybe a pneumonia. we treated you with strong antibiotics, nebulizer treatments, and steroids, and you improved. you also were placed on a mechanical ventilator to help rest your breathing muscles, which also helped you recover. you may find that nightly rest on a ventilator may be beneficial to you, though this possibility may be further explored at rehab. the following changes were made to your medications - start prednisone, in a tapered fashion as included with your medication list please continue all other meds as previously prescribed it was a pleasure caring for you, mr. . followup instructions: please call your pcp, . , at when you return from rehab to follow up. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: pneumonia, organism unspecified other iatrogenic hypotension long-term (current) use of steroids obstructive chronic bronchitis with (acute) exacerbation other chronic pulmonary heart diseases personal history of tobacco use unspecified schizophrenia, unspecified acute respiratory failure unspecified intellectual disabilities attention to tracheostomy other dependence on machines, supplemental oxygen other sedatives and hypnotics causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to