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: history of present illness: the patient is a 70-year-old male with a history of chronic obstructive pulmonary disease, status post intubation on and coronary artery disease who presented to with hypoxia and hypercarbia requiring intubation, as well as hypotension requiring pressors. the patient presented several times this year to the emergency department for chronic obstructive pulmonary disease exacerbation, only once requiring intubation (). the patient usually responds well to steroids, antibiotics and bronchodilators. at baseline, the patient is functional and is not oxygen dependent. during his medical intensive care unit admission, stress echocardiogram and cardiac catheterization were performed to rule out ischemia as a cause of low o2 saturations. the stress echocardiogram showed anterior abnormalities and the cardiac catheterization showed mild to moderate coronary artery disease with no flow limiting lesions; normal filling pressures, left ventricular ejection fraction equal to 55%. on this admission, the patient states that he had had fevers the night prior to admission and increased wheezing and shortness of breath over the past week due to the "hot weather." on the night prior to admission, the patient became very short of breath without relief from his albuterol and atrovent nebulizers. the patient denies any chest pain, hemoptysis, paroxysmal nocturnal dyspnea, orthopnea, peripheral edema. on the date of admission, the patient was playing cards with friends, had an episode of nausea and vomiting which was followed by the patient being found outside gasping for air and asking for oxygen. ems arrived on the scene and his o2 saturation was 70%. the patient was unable to speak, and he was diaphoretic. in the emergency department, his o2 saturation was 84% on nonrebreather with respiratory rate equal to 44. blood pressure 120/palp and heart rate equal to 132. the patient was then intubated. the patient then proceeded to seize after receiving lidocaine/versed/succinylcholine/etomidate and resolved spontaneously. patient was given albuterol/atrovent nebulizers treatment, as well as solu-medrol 125 mg intravenous times one, fentanyl, and 750 cc of normal saline intravenously in the emergency department. his chest x-ray showed congestive heart failure. his electrocardiogram showed a left bundle branch block which was intermittently seen on prior electrocardiograms during his admission. his arterial blood gases was equal to 6.29/87/502 after intubation. his blood pressure dropped to 68/palp and the patient was then begun on levophed 4 mg/kg/minute and was transferred to the medical intensive care unit. initial laboratories on admission include: white blood cell count 12.9, 58% neutrophils, 32% lymphocytes, 6% monocytes and 3% eosinophils. hematocrit equal to 47.1, platelet count 304,000, pt equal to 14.4, ptt 31.9, inr 1.4. electrolytes: sodium was 143, potassium 4.9, chloride 103, bicarbonate 24, bun 15, creatinine 1.1, glucose 192. repeat arterial blood gas was 7.17/54/363. all cks were less than 200. all ck-mbs were less than 10 and initial troponin was less than 0.3. urinalysis was negative. past medical history: 1. chronic obstructive pulmonary disease - pfts in were: fvc equal to 85% expected, fev1 equal to 52% expected and fev1/fvc equal to 60% expected. these pfts were improved with bronchodilators. 2. coronary artery disease - ejection fraction equal to 55% in , 1+ mitral regurgitation, hypokinetic basal half of the anterior septum and anterior wall on stress echocardiogram, cardiac catheterization showed 40% occlusion of the mid left anterior descending, 40% occlusion of the mid circumflex, 20% occlusion of the left main with a normal proximal left anterior descending and normal septal branches. 3. hypothyroidism. 4. depression. 5. question of hepatitis. medications on admission: 1. aspirin 325 mg q.d. 2. levoxyl 125 mcg q.d. 3. serevent. 4. albuterol/atrovent. 5. flovent. 6. protonix 40 mg po q.d. 7. folate 1 mg po q.d. 8. paxil 20 mg po q.d. allergies: penicillin causes edema. social history: in the chart, it is documented that the patient smoked tobacco one pack per day times 40 years, however, he tells me he only smoked for about 4-5 years while in the service. he denies alcohol use now. there is documented abuse in the past. the patient is a retired police officer. physical examination on admission: temperature 97. heart rate 131. blood pressure 118/61 (off pressors). oxygen saturation was 100% on assist control with fio2 of 60%, total volume 600 and rate of 12. in general, the patient is sedated and intubated. head, eyes, ears, nose and throat: pupils are constricted bilaterally, both reactive, right pupil approximately 1 mm, left was approximately 3 mm. lungs: severe expiratory wheezes throughout the chest anteriorly. heart: tachycardiac with a normal s1, s2, no murmurs, rubs or gallops. abdomen was soft, nontender, nondistended, positive for hepatomegaly with the liver being felt 3 cm below the costal margin. extremities had poor capillary refill. no cyanosis, clubbing or edema. 2+ dorsalis pedis and posterior tibial pulses. neurological exam: the patient is moving all extremities spontaneously. hospital course: the patient was admitted to the medical intensive care unit team to be intubated for his acute respiratory failure, as well as the hypotension which initially required pressors. as per the medical intensive care unit teams evaluation, the patient likely experienced acute respiratory failure in the setting of rate related diastolic heart failure with likely demand ischemia, possibly related to increased use of his albuterol. the patient rapidly responded to positive pressure ventilation and peep, however, remaining tachycardiac while maintaining stable blood pressure after being weaned from all pressors. he was extubated on and did extremely well. he did require three, one liter boluses for systolic blood pressures in the 70s. he was found to be prerenal as per fena calculation 0.11% and the patient received d5 normal saline at 150 cc an hour for a low urine output on , which is about 20 cc per hour throughout the day. the patient's urine output picked up to 40 cc per hour with hydration. follow-up chest x-ray on showed clear lungs, no effusions and no congestive heart failure. the patient began to have improved po intake with significantly increased urine output. by system: 1. pulmonary: the patient is currently saturating well on room air at 97% at rest and 93% with ambulation. the patient was begun on a prednisone taper at 60 mg q.d. times three, 40 mg q.d. times three, 20 mg q.d. times three and 10 mg q.d. times three for a total of 12 days. he received intravenous steroids while in the medical intensive care unit and was transitioned to prednisone when transferred to the regular medicine floor. the patient was begun on singulair 10 mg po q.d. his mdi regimen was restarted with serevent 2 puffs b.i.d., flovent 4 puffs b.i.d., atrovent 4 puffs q.i.d. and albuterol only 1-2 puffs q. 4 hours prn. the patient should not use albuterol nebulizers as he gets anginal symptoms and tachycardic secondary to those nebulizers and likely becomes ischemic due to demand. 2. cardiac: the patient's troponin was found on to be 1.4. this is likely related to his episode of congestive heart failure. the patient denies any chest pain at this time. the patient's hypotension improved throughout his stay with hydration. the patient's lipid profile looks good, therefore, there is no need to start a statin for his cholesterol level. the patient continued on his aspirin. it was decided not to start a beta-blocker due to the patient's significant bronchoreactivity. possibly consider beginning a calcium channel blocker as an outpatient, as the patient's blood pressure tolerates. the patient has never been on a cardiac regimen at all, so possibly consider cardiology consult as an outpatient. 3. endocrine: the patient was begun on a regular insulin sliding scale due to the steroid taper. his fingersticks remained within normal limits. this continued on . the patient's tsh was found to be low at 0.15. free t4 and t3 were sent and are still pending. albeit, in the setting of acute illness, the patient will be discharged on slightly lower dose of levoxyl then he was getting previously and will follow-up with his primary care physician regarding this issue. the patient will be discharged on levoxyl 100 mcg po q.d. as opposed to his dose he is currently taking which is 125 mcg po q.d. 4. psychiatric: the patient has a history of depression and anxiety. the patient had been taking paxil 20 mg po q.d. until about a week prior to admission when he ran out of his prescription. the patient was restarted on paxil during his stay. 5. hematology: the patient's hematocrit trended down from 47.1 on admission to 34.3 at time of discharge. rectal exam showed guaiac negative stools. this is likely dilutional as the patient was hydrated aggressively due to his hypotension. this should continue to be followed up by his primary care provider upon discharge. 6. infectious disease: the patient was started on levofloxacin 500 mg po q.d. for a ten day course for treatment of the chronic obstructive pulmonary disease exacerbation/bronchitis. sputum showed moderate oropharyngeal flora, likely not a good sample. blood cultures have been negative to date. 7. fluid, electrolytes and nutrition: the patient is currently on a cardiac diet as tolerated and we are encouraging po intake. the patient is doing well with this at time of discharge. condition on discharge: improved. good. discharge status: to home without services. discharge diagnoses: 1. chronic obstructive pulmonary disease exacerbation with associated hypotension/resolved. 2. chronic obstructive pulmonary disease. 3. coronary artery disease. 4. hypothyroidism. 5. depression. 6. question hepatitis. medications on discharge: 1. enteric coated aspirin 325 mg po q.d. 2. singulair 10 mg one tablet po q.d. 3. levofloxacin 500 mg po q.d. times six more days to complete a ten day course. 4. prednisone taper. patient has completed the 60 mg times three days, so the patient is discharged with 40 mg po q.d. times three days, 20 mg po q.d. times three, then 10 mg po q.d. times three. 5. serevent mdi 2 puffs b.i.d. 6. flovent 110 mcg mdi 4 puffs inhaled b.i.d. 7. atrovent mdi 4 puffs inhaled q.i.d. 8. albuterol mdi 1-2 puffs inhaled q. 4 hours prn. 9. paxil 20 mg po q.d. 10. levoxyl 100 mcg po q.d. 11. folate 1 mg po q.d. 12. protonix 40 mg po q.d. follow-up: the patient should follow-up with his primary care provider, , in one to two weeks. the patient is also seen by his pulmonary specialist, dr. , and dr. . the patient should also follow-up with them within the next one to two weeks for follow-up of this hospitalization. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube arterial catheterization diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation hypotension, unspecified 

Answer: The patient is high likely exposed to