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: lisinopril attending: chief complaint: shortness of breath major surgical or invasive procedure: endotracheal intubation history of present illness: mr. is an 88 yo m with h/o dchf, copd, dm2, ckd presents with acute shortness of breath. . per family, patient had become increasingly short of breath at home over the last few days. this morning he felt so short of breath that he insisted on coming to the ed. also complaining of burning chest pain. has been taking meds as prescribed, reports "maybe a few pounds" of weight gain in the last few weeks. per records, his dry weight is about 200 lbs and upon admission his weight was 218 lbs. . of note, the family denies that he has been having increasing symptoms of pnd, orthopnea, peripheral edema, weight gain, increasing amounts or change in quality of his daily sputum, recent illness. . on arrival to the ed, vs were rr 30, hr 80s, sbp 180, spo2 67% on ra. on exam, he was tachypneic, tight breathing with expiratory wheezes, giving one word answers to questions. given nebulizers and solumedrol. cxr showed pulmonary edema. started on ntg drip, given asa. started on bipap, but vomited. place on nrb, but only satting up to 80. intubated for hypoxia, given etomidate and succ. stopped ntg, started propofol gtt, given 4 midaz bolus. given 20 iv lasix and azithro/ceftraixone. vent settings on transfer 550/16/5/100. vs on transfer 100.8 81 99/ra 16 115/48. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or 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: 1.) mild obstructive pulmonary disease: last pfts , fev1 1.24 2.)? coronary artery disease: stress test negative, but frequent atrial irritability. mibi revealed normal myocardial perfusion. 3.)diastolic congestive heart failure: lvef = 65%, e/e' > 15, mr 4.)hyperlipidemia 5.)chronic renal insufficiency: baseline creatinine 1.2-1.4 6.)diabetes mellitus, type 2 7.)gerd: on high dose ppi, h/o h.pylori gastritis 8.)gynecomastia 9.)hypertension 10.)constipation 11.)left knee osteoarthritis 12.)pulmonary nodule 13.)atrial ectopy- had atrial tach and apcs seen by zimmetbaum- thought secondary to his lung disease. 14.) chronic sinusitis 15.)dysphagia 16.)peripheral neuropathy 17.)sexual dysfunction 18.)elevated psa 19.)cataract surgery .)dyslipidemia 21.)s/p right eye injury and blindness since childhood social history: 40 pack year somking history but stopped in . never used alcohol/illicits. he lives with his wife in a senior home and has sons in the area. previously, he worked as a longshoreman, worked in a hardware store, and worked in a security. originally from , moved to and met his wife in . has 8 living children, many grandchildren and a few great-grandchildren. family history: reviewed and not contributory physical exam: admission physical exam: vitals: t: 98.8, bp: 140/63, p: 75, r: 18 o2: 99% vented general: intubated, sedated heent: perrla, oropharynx clear and moist neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, + sem murmur best at left sternal border without radiation to the carotids or axillae lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . discharge physical exam: vitals: afebrile, vss, o2 sats mid 90s on 2l o2 (on o2 at baseline) cv: regular rate and rhythm, normal s1 + s2, + sem murmur best at left sternal border without radiation to the carotids or axillae lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi ext: no cyanosis, no edema pertinent results: admission labs: 12:40am blood wbc-7.2 rbc-3.87* hgb-9.6* hct-30.4* mcv-79* mch-24.9* mchc-31.7 rdw-18.1* plt ct-330 12:40am blood neuts-88.6* lymphs-7.9* monos-2.3 eos-1.1 baso-0.2 11:10pm blood pt-12.0 ptt-34.0 inr(pt)-1.1 11:10pm blood glucose-158* urean-21* creat-1.4* na-138 k-4.2 cl-98 hco3-28 angap-16 05:59am blood alt-10 ast-17 ld(ldh)-243 alkphos-103 totbili-0.5 11:10pm blood probnp-1530* 11:10pm blood ctropnt-<0.01 11:01am blood ck-mb-2 ctropnt-<0.01 05:59am blood calcium-9.0 phos-2.9 mg-1.5* 12:36am blood type-art peep-5 po2-151* pco2-53* ph-7.36 caltco2-31* base xs-3 intubat-intubated 12:36am blood hgb-9.8* calchct-29 o2 sat-99 12:36am blood lactate-2.4* 11:00pm urine color-straw appear-clear sp -1.005 11:00pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg . micro: , 12/5 blood cultures ngtd urinary legionella antigen negative . imaging: cxr comparison: . findings: single frontal view of the chest demonstrates interval increase of bilateral fluffy perihilar and infrahilar opacities as well as obscured and prominent cardiac silhouette, compatible with moderate congestive heart failure. there is persistent opacity involving the cardiophrenic angles. supervening pneumonia and or aspiration cannot be excluded in the appropriate clinical setting. small effusions cannot be excluded. there is no pneumothorax. atherosclerotic calcifications are seen in the aortic arch. impression: 1. findings compatible with moderate congestive heart failure, with interval worsening since . 2. supervening lower lobe infection and/or aspiration cannot be excluded in the appropriate clinical setting. . cxr: findings: in comparison with the study of , there is continued enlargement of the cardiac silhouette with decreasing pulmonary vascular congestion. confluent lower lobe opacities are consistent with regions of pneumonia, especially at the right base. the endotracheal and nasogastric tubes have been removed. . labs on discharge: . 06:07am blood wbc-8.5 rbc-4.07* hgb-10.0* hct-31.9* mcv-79* mch-24.7* mchc-31.4 rdw-17.5* plt ct-340 06:07am blood glucose-114* urean-26* creat-1.2 na-140 k-3.9 cl-97 hco3-35* angap-12 06:07am blood calcium-8.7 phos-4.0 mg-2.0 brief hospital course: this is an 88 year old male with a history of copd and diastolic chf who is admitted with 1 day of shortness of breath and intubated in the ed for hypoxia found to have chf exacerbation and community acquired pneumonia. . # chf exacerbation: on admission, patient was in severe respiratory distress requiring intubation in the ed for hypoxia. cxr demonstrated fluid overload. bnp was elevated only mildly, to 1530. per family and patient, he did not make any diet changes and was compliant with medications, thus cause of exacerbation is unclear. however, he was up 18 lbs from his dry weight. acs was ruled out as a cause of chf exacerbation with 2 sets of neg cardiac enzymes. patient responded well to diuresis with lasix 40mg iv and was transitioned to lasix 40mg po qd and finally to home dose of lasix 20mg po qd. on discharge, patient was at his dry weight of 200 lbs. symptom control with albuterol and ipratroprium nebs. continued diltiazem, losartan for bp control. on discharge, patient was set up with vna services as well as telemonitoring for daily weights. . # pneumonia: on admission, cxr consistent with a bilateral pneumonia given the fluffy bases which have a slight nodularity. this could be consistent with a bacterial or viral illness. however, he did not initially have leukocytosis and his family denied recent increase in sputum, fevers, muscle aches, or generalized illness. urine legionella was negative. patient was treated for cap with ceftriaxone/azithromycin. patient was then transitioned to levofloxacin 750mg po qd and was discharged with a prescription to complete a 7 days course of antibiotics. . #cad: continue statin, asa for cad primary prevention . # chronic obstructive pulmonary disease (copd): history of non-compliance with his advair due to costliness and also trouble getting his oxygen at home. continued albuterol/ipratroprium, advair when extubated. because he was not wheezing on exam and his cxr was more consistent with volume overload than hyperinflation, the steroids that were started in the ed were not continued in the icu. . # chronic kidney disease: admission creatinine was at baseline. . # diabetes mellitus, type 2 (dmt2): maintained on sliding scale. . # gerd: continued ppi . transitional issues: - full code medications on admission: albuterol sulfate - 90 mcg qid albuterol sulfate - 2.5 mg/3 ml neb q6h citalopram - 20 mg daily diltiazem hcl 240 mg daily erythromycin - 5 mg/gram ointment right eye at bedtime fluticasone - 50 mcg spray nasal fluticasone-salmeterol - 250 mcg-50 mcg/dose furosemide - 20 mg daily glipizide - 10 mg ipratropium bromide - 0.2 mg/ml neb q6 losartan - 50 mg daily lovastatin - 10 mg daily omeprazole - 40 mg daily pioglitazone 15 mg daily ranitidine hcl - 300 mg bedtime aspirin - 81 mg daily discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) inhalation four times a day. 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 3. citalopram 20 mg tablet sig: one (1) tablet po once a day. 4. erythromycin 5 mg/gram (0.5 %) ointment sig: one (1) ophthalmic at bedtime: apply to right eye. 5. fluticasone 50 mcg/actuation spray, suspension sig: one (1) nasal twice a day. 6. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 7. glipizide 10 mg tablet sig: one (1) tablet po twice a day. 8. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 9. losartan 50 mg tablet sig: one (1) tablet po once a day. 10. lovastatin 10 mg tablet sig: one (1) tablet po once a day. 11. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 12. pioglitazone 15 mg tablet sig: one (1) tablet po once a day. 13. ranitidine hcl 300 mg tablet sig: one (1) tablet po at bedtime. 14. diltiazem hcl 240 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po once a day. 15. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 16. levofloxacin 750 mg tablet sig: one (1) tablet po once a day for 1 days. disp:*1 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis acute diastolic heart failure exacerbation pneumonia . secondary diagnosis chronic obstructive pulmonary disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , . you were admitted to the hospital because you were having difficulty breathing. we think that you had an exacerbation of your chronic heart failure. you were treated by removing fluid from your lungs with furosemide (lasix) at higher doses than you take at home. you also had a breathing tube in to breathe for you. the tube was removed and you did very well. you were also found to have a pneumonia which was treated with antibiotics. you will need to finish taking the antibiotics at home. . the following changes were made to your medications: -start levofloxacin 750mg; take it once on sunday, . it is very important that you keep all of the follow-up appointments listed below. . it is also very importan that you weigh yourself every morning, md if weight goes up more than 3 lbs. . it was a pleasure taking care of you in the hospital! followup instructions: department: when: wednesday at 10:40 am with: fern, rnc building: sc clinical ctr campus: east best parking: garage department: when: tuesday at 10:40 am with: , m.d. building: sc clinical ctr campus: east best parking: garage department: pulmonary function lab when: monday at 11:40 am with: pulmonary function lab building: campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: anemia, unspecified esophageal reflux mitral valve disorders 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 obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure chronic kidney disease, unspecified constipation, unspecified other and unspecified hyperlipidemia acute respiratory failure unspecified hereditary and idiopathic peripheral neuropathy diseases of tricuspid valve osteoarthrosis, unspecified whether generalized or localized, lower leg bacterial pneumonia, unspecified profound impairment, one eye, impairment level not further specified 

Answer: The patient is high likely exposed to