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: penicillins attending: chief complaint: dyspnea major surgical or invasive procedure: endotracheal intubation mechanical ventilation history of present illness: mr. is a 38 year old man with h/o osa on cpap, htn, hld, anxiety, who was transferred from an osh s/p intubation for hypercarbic respiratory failure. patient presented to the osh yesterday with worsening shortness of breath. per the patient's girlfriend, the patient has been ill for the past 2-4 weeks. he has seen several doctors and was with bronchitis and uri, given albuterol inhaler and steroid taper. three days prior to admission, he had to leave from work because he was feeling ill. two days ago, he was having difficulty breathing while walking around the mall with his girlfriend. finished the prednisone taper the day prior to presentation. yesterday, the patient was increasingly short of breath at rest, so his girlfriend dropped him off at the ed. in the osh ed, patient was initially satting 72% on ra, up to 98% with 3lnc. initial cxr showed cardiomegaly, but otherwise was unremarkable. the patient was awaiting bed availability/admission to cards for further evaluation of cp and sob with ekg showing twi in inferolateral leads and st depressions in v2-5. he was noted to be obtunded this am while satting 99-100% on cpap/fio2 75% and could not be aroused. abg done at that time showed ph 7.05, pco2 170, po2 99. he was intubated at this point - intubation was difficult to anatomy and required 2 operators. post-intubation cxr with diffuse air-space disease, concerning for ards vs pulmonary edema, with no clear consolidations. flu swab was negative per osh. patient was given a dose of levaquin, duonebs, iv solumedrol, vecuronium, started on propofol gtt, and transferred to ed via . patient was bolused with fentanyl during the flight because sedation noted to be light. in the ed, patient noted to be agitated on propofol gtt, so was bolused propofol 50mcg. initial gas 7.38/68/68 on 100% fio2. labs notable for wbc 14. repeat gas 7.51/47/75 on 100% fio2 and peep 5. bedside echo showed no e/o rhs. cta chest prelim read with no e/o large pe. sedation changed from propofol to midazolam given decreased bp in the ed. also re-dosed with vecuronium prior to the cta chest. patient was given vanc, flagyl (in addition to levaquin that he received at the osh). also given a dose of tamiflu. blood and urine cultures drawn, flu swab sent. vitals prior to transfer: hr 60 bp 115/88 rr 24 o2sat 100% on mechanical ventilation. on the floor, the patient is intubated and sedated. fio2 now down to 50% with increased peep to 12. review of systems: unable to assess +weight gain recently per girlfriend past medical history: sleep apnea on cpap, does not use it every night gerd htn hld anxiety arthritis (hips) back pain obesity social history: lives with his girlfriend . at 's. - tobacco: past use - alcohol: none - illicits: none family history: patient was adopted physical exam: admission exam: vitals: t: 98.3 bp:157/105 p: 63 r: 24 o2: 96% on ventilator general: intubated, sedated heent: pinpoint pupils, sclera anicteric, ett and og tube in place neck: supple, jvp not elevated, no lad lungs: crackles at bases bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: distended, firm, hypoactive bowel sounds gu: foley in place ext: warm, well perfused, 2+ pulses, 2+edema b/l, cracked thick calluses on b/l feet neuro: sedated discharge exam: vitals: t98.5f, bp120/82, hr:80, rr:18, o2sat: 93&ra general: nad, breathing comfortably on room air heent: oropharynx clear lungs: ctab gu: foley removed neuro: alert, nonfocal exam otherwise uncanged from admission pertinent results: admission labs: 01:05pm blood wbc-14.0* rbc-5.11 hgb-13.4* hct-44.9 mcv-88 mch-26.2* mchc-29.9* rdw-14.1 plt ct-238 01:05pm blood neuts-92.2* lymphs-4.4* monos-3.1 eos-0.2 baso-0.1 01:05pm blood pt-12.4 ptt-21.0* inr(pt)-1.0 01:05pm blood urean-30* creat-1.2 na-141 k-5.2* cl-96 hco3-37* angap-13 01:05pm blood alt-88* ast-27 ld(ldh)-264* ck(cpk)-146 alkphos-51 totbili-0.7 01:05pm blood ck-mb-8 01:05pm blood ctropnt-0.06* 01:05pm blood albumin-4.0 calcium-8.7 phos-3.4 mg-2.2 12:57pm blood type-art rates-24/ tidal v-500 fio2-100 po2-68* pco2-68* ph-7.38 caltco2-42* base xs-11 aado2-589 req o2-95 -assist/con intubat-intubated 12:57pm blood lactate-2.8* urine: 01:05pm urine color-yellow appear-clear sp -1.014 01:05pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg 01:05pm urine rbc-3* wbc-1 bacteri-few yeast-none epi-1 transe-<1 01:05pm urine casthy-3* other pertinent studies: tsh 2.4 discharge labs: 04:47am blood wbc-6.9 rbc-5.68 hgb-14.8 hct-46.0 mcv-81* mch-26.1* mchc-32.3 rdw-15.0 plt ct-200 04:47am blood glucose-96 urean-21* creat-1.2 na-133 k-4.6 cl-94* hco3-30 angap-14 04:47am blood calcium-9.4 phos-3.6 mg-2.3 micro: bcx: blood culture, routine (final ): no growth. ucx: no growth. rsv screen: respiratory viral culture (final ): no respiratory viruses isolated. culture screened for adenovirus, influenza a & b, parainfluenza type 1,2 & 3, and respiratory syncytial virus.. detection of viruses other than those listed above will only be performed on specific request. please call virology at within 1 week if additional testing is needed. respiratory viral antigen screen (final ): negative for respiratory viral antigen. specimen screened for: adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. refer to respiratory viral culture for further information. mrsa screen: no mrsa isolated. studies: cxr: 1. intubated patient with the tip of the endotracheal tube 2.3 cm from the carina; this might be withdrawn for optimal positioning. 2. low lung volumes with left greater than right basilar opacities, likely atelectasis, though infection cannot be excluded. cxr : findings: bilateral lung volumes are low. right lower lung atelectasis has improved, but there is new minimal fluid in the right minor fissure. increased retrocardiac density reflecting left lower lung volume loss is unchanged. both upper lungs are clear. endotracheal tube and orogastric tube are in standard position. no evidence of pleural effusion. the study and the report were reviewed by the staff radiologist. ct chest: impression: 1. no evidence of pe or acute aortic injury. 2. bilateral opacification may represent aspiration versus pneumonia in the current clinical setting versus bibasilar atelectasis associated with lower airway inflammation. some tree-in- appearance, especially within the right lung may represent reactive/small airway disease or an infectious process involving small airways. tte : conclusions the left atrium is normal in size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is a small inferolateral pericardial effusion without evidence of hemodynamic compromise. impression: normal biventricular cavity sizes with preserved global and regional biventricular systolic function. small inferolateral pericardial effusion. pft'w: mild mixed obstructive and restrictive defect, decreased mips and meps, final interpretation pending. discharge abg: 02:19pm blood type-art po2-71* pco2-46* ph-7.44 caltco2-32* base xs-5 brief hospital course: primary reason for hospitalization: mr. is a 38 year old man with h/o osa, htn, hld, who was transferred from with hypercarbic respiratory distress, s/p intubation, and presented to the micu. he was started on levofloxacin for pneumonia, and cpap at night for obstructive sleep apnea. he was evaluated by physical therapy, with recommendations for rehabilitation. . #. hypercarbic/hypoxic respiratory failure: patient with initial hypoxia on presentation to the osh ed, with quick improvement on 2-3lnc. he then acutely decompensated while on fio2 75% on cpap. given his underlying sleep apnea, he may have been over oxygenated, causing the patient to lose his respiratory drive and become obtunded. could also have component of obesity hypoventilation as well. there was also concern for chf, as patient had had several weeks of increasing le edema. twi and st changes on ekg suggest possible coronary event, but ck remain flat at this time. tte showed intact systolic function. given concern for viral infection, he was initially started on oseltamivir, but this was discontinued once viral screen returned as negative. he treated with levofloxacin, with planned 7-day course. his oxygenation and mental status improved after intubation, but he required very high peeps. he diuresed well with iv lasix in the micu. his viral antigen screen was negative for flu, so oseltamivir was stopped. sputum cultures were negative. he was extubated on . osh records of a sleep study were obtained showing severe sleep apnea. he endorsed a history of severe daytime sleepiness prior to admission. he was started on nighttime cpap. on transfer to the floors, pulmonary was consulted. he had pft's which showed mild mixed obstructive and restrictive defect. abg showed mildly elevated co2. mip's were low, but no evidence of skeletal weakness otherwise. . #. chest pain: on admission, patient had t-wave inversions and st depressions inferolaterally, mildly improved since initial osh ekg. trop and ck flat at osh. trop 0.06 here, but ck/mb remained flat. troponin leak was likely due to fluid overload and respiratory failure. he had no more chest pain on the medicine floors. . #. acute renal failure: cr 1.6 at osh, improved to 1.2 here on admission. creatinine was trended, and was 1.2 on the day of discharge. lisinopril was initially held, but was restarted prior to discharge. transitional issues: 1. code: full 2. medical management: - start cpap at night 3. pending studies: - final pft's interpretation pending at time of discharge 4. follow-up: - pulmonary as an outpatient - sleep as outpatient - repeat sleep study as outpatient - repeat pft's as an outpatient in weeks medications on admission: omeprazole 20mg po bid lisinopril 10mg po daily ibuprofen 500mg po bid prednisone - s/p pred taper for bronchitis albuterol inhaler ammonium lactate lotion discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml ml injection tid (3 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 5. ipratropium bromide 0.02 % solution sig: one (1) treatment inhalation q6h (every 6 hours) as needed for sob/wheezing. 6. cpap machine to be used nightly. auto-set 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) treatment inhalation q6h (every 6 hours) as needed for sob/wheezing. 8. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. 9. lisinopril 5 mg tablet sig: two (2) tablet po daily (daily). 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 11. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 12. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 13. acetaminophen 325 mg tablet sig: 1-2 tablets po every six (6) hours: do not take more than 4 grams per day. discharge disposition: extended care facility: hospital - discharge diagnosis: primary: hypoxic, hypercarbic respiratory failure secondary: obstructive sleep apnea discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , you were admitted to the hospital for shortness of breath and confusion and were found to have a low blood oxygen level and a high blood carbon dioxide level. these required you to be intubated to help you breathe and you stayed in the icu. your breathing improved and we were able to take you off the ventilator and eventually back to room air. we feel that your obstructive sleep apnea plays a role in why this happened, but we will have to sort out the exact cause for this event with a pulmonologist and sleep specialist. in the hospital we did lung function tests and blood tests. these showed that your level of carbon dioxide was slightly high but improved and that your lungs show slight impedement of air movement both in and out. this could be related to your acute illness and should be followed up with repeat testing in weeks and with evaluation as an oupatient with a sleep pulmonologist and a general pulmonologist. please make the following changes to your medications: 1. start taking acetaminophen 325-650mg by mouth every 6 hours as needed for pain. do not exceed 4gm per day. 2. stop taking ibuprofen 3. start taking benzonatate 100mg by mouth three times daily as needed for cough 4. start heparin 5000 units by subcutaneous injection 3 times daily while in a healthcare facility 5. start senna 8.5 mg. take 1 tab by mouth twice daily as needed for constipation 6. start docusate 100mg by mouth twice daily 7. start bisacodyl 10mg rectally daily as needed for constipation 8. start ipratropium bromide nebulizer treatment every 6 hours as needed for shortness of breath 9. start albuterol nebulizer treatment every 6 horus as needed for shortness of breath 10. start using your cpap machine nightly. auto-set please take other medications as prescribed and dispose of old or expired medications properly. md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) esophageal reflux congestive heart failure, unspecified unspecified essential hypertension acute on chronic diastolic heart failure pulmonary collapse other and unspecified hyperlipidemia anxiety state, unspecified acute respiratory failure obesity, unspecified other chronic nonalcoholic liver disease 

Answer: The patient is high likely exposed to