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: bactrim attending: chief complaint: respiratory failure major surgical or invasive procedure: - endotracheal intubation, mechanical ventilation, subsequent extubation - bronchoscopy history of present illness: mr. is a 63 year-old male smoker with a history of severe copd on home (4l), dchf, and dm2 who presents from home with dypnea and respiratory failure. he was recently discharged on after being admitted for a copd exacerbation (3 day hospital stay) and was sent to rehab. he did well at rehab and arrived home yesterday. since this morning, per his wife, he began feeling increasingly dyspneic and fatigue and had fevers; he has a chronic productive cough at baseline which was unchanged. he then called ems after finishing dinner with his family. of note, his daughter has cystic fibrosis and is "coming down with a cold." no pets at home. . he was noted by ems to be dyspneic and received nebs without improvement. he desatted with a nrb and was intubated en route to ed. . in the ed, vital signs were initially: 103.4 rectal 96 109/53 99% on vent settings of cmv 550 x 16, peep 8, fio2 100%. a cxr demonstrated a rll infiltrate. he was given 2.5l ivf, vanc, ceftriaxone, and levoflox and admitted to the . past medical history: 1. severe copd: followed by dr. , on prednisone and home (4l nc) at baseline, recently he has been having monthly admissions for copd: 's : fev1 19%, fev1/fvc 43% 2. chronic systolic chf: tte lvef>55%, although patient denies this 3. gastritis/gerd 4. h/o sbo 5. tobacco abuse: previous 5ppd, now cigs/day 6. diabetes mellitus type 2 7. diverticulosis 8. c6-c7 hernitation 9. b12 deficiency- on monthly injections 10. obesity with possible osa, but pt refuses sleep study or cpap 11. psoriasis 12. hypertension 13. glaucoma 14. recent lle cellulitis social history: home: lives with his wife and his son. his has cystic fibrosis and is currently hospitalized for respiratory infection. his wife has recently started a new job and is under a great deal of stress. tobacco: previous heavy smoking history of 5 ppd, states he recently quit smoking during hospital admission etoh: previous history of heavy etoh, now rarely drinks drugs: denies family history: mother - died of lung cancer in 60s father - died of lung cancer in 60s sister- died of lung cancer in 50s physical exam: vs: 103.4 rectal 96 109/53 99% on ac, fio2 100%, 550 x 16, peep 10 gen: intubated, cushingoid skin: no rashes or skin changes noted heent: obese neck, unable to appreciate jvd, no lymphadenopathy in cervical, posterior, or supraclavicular chains noted. chest: + b/l rhonchi, no wheezes cardiac: regular rhythm; no murmurs, rubs, or gallops. abdomen: obese, no hepatosplenomegaly extremities: no peripheral edema neurologic: intubated, arousable, unable to assess strength pertinent results: admission labs: abg ph 7.27 pco2 83 po2 235 hco3 40 basexs 7 na:142 k:4.4 cl:100 glu:207 lactate:0.6 pt: 11.8 ptt: 21.1 inr: 1.0 145 93 61 ------------< 223 4.8 39 1.7 freeca:1.08 lactate:2.3 ph:7.22 ck: 53 mb: notdone trop-t: pnd ca: 8.3 mg: 2.9 p: 2.9 serum asa, etoh, acetmnphn, benzo, barb, tricyc negative 14.4 >--< 229 34.2 cbc on : 9.7 > 31 < 76 studies: cxr : patchy opacities bilaterally which could be consistent with multifocal pneumonia and/or aspiration. possible overlying pulmonary edema. trace right pleural effusion. cxr : relatively symmetric ground-glass opacification in the lower lung zones is most likely pulmonary edema. heart is normal size. the mediastinal veins are distended. left jugular vein ends in the upper svc. lung bases are excluded from the examination. upper pleural margins show no abnormality, but some pleural effusion could be present. ekg: artifact is present. sinus tachycardia. probably normal tracing. compared to the previous tracing there is no significant change. brief hospital course: mr. is a 63 year-old male smoker with a history of severe copd on home (4l), dm2, and diastolic heart failure who presented to the icu from home (after a brief stay at rehab following recent hospitalization) with dyspnea and respiratory failure. due to worsening respiratory effort he was intubated in the field, transported to the emergency department and admitted to the icu. . 1. hypoxic/hypercapneic respiratory failure: his respiratory failure was felt to be secondary to pneumonia complicated by copd exacerbation. mr. has history of multiple copd exacerbations and pneumonia episodes in past, for which he has been intubated, and he continues to smoke. he presented to the icu on , intubated with abg consistent with chronic respiratory acidosis. he was started on empiric vancomycin and zosyn for hospital-acquired pneumonia (given recent hospitalization and rehab stay) as well as azithromycin for atypical coverage. his antibiotics were eventually switched to levaquin after a bronchoalveolar lavage culture grew stenotrophomonas maltophilia that was sensitive to levaquin. he was started on tamiflu empirically, and had a flu swab that later returned negative and his tamiflu was discontinued. he was extubated on without complication. he was initially on high dose solumedrol iv which was transitioned to prednisone 60 mg po daily. per dr. (outpatient pulmonologist), he should continue this dose of prednisone until he his seen in clinic. he completed a 9 day course of levaquin for his hospital acquired stenotrophomonas pneumonia. at time of discharge patient is requiring albuterol nebs q3h and ipratropium nebs q6h to prevent acute exacerbation. patient would also likely benefit a great deal by bipap. he was seen by respiratory therapy on the medical floor and started on intermittent bipap. recommend continuing to offer bipap for intermittent relief and throughout night. smoking cessation (reportedly has not smoked since hospital admission) was congratulated and abstinence encouraged. patient is scheduled to follow up with dr. in clinic on to address prednisone taper. . 2. acute renal insufficiency: mr. has a baseline creatinine of 0.7 which was elevated on admission to 1.7. his creatinine trended downward (1.0) during his hospital course in response to iv fluid. the underlying etiology for arf on presentation was felt to be pre-renal in the setting of pneumonia. with later diuresis on the medicine floor for volume overload his creatinine fell to 0.8. suggesting his diastolic dysfunction is a considerable contributor to compromised renal function. . 3. hypertension: after receiving iv fluids and high dose steroids for his pneumonia and copd, he became hypertensive. he was restarted on his home amlodipine which was increased to 10mg po daily. he was also restarted on lisinopril 40 mg po daily and lasix 60 mg po daily (discontinued on previous admission in setting of arf). . 4. diastolic chf: patient appeared volume overloaded on presentation to the medicine floor. lasix was restarted and patient was diuresed > 3 l. renal function improved with diuresis. continue antihypertensive regimen as listed about. recommend compression stockings and leg elevation to reduce lower extremity edema. . 5. sinus tachycardia: persists throughout admission. likely secondary to frequent albuterol nebs and respiratory distress. if tolerated attempt to decrease frequency of albuterol nebs to decrease tachycardia and allow greater diastolic filling. . 6. code status: patient stated that he no longer would like to be intubated on . however, he would not like this to take effect until he has discussed this with his family. he plans to meet with his family on to notify them of this change. please verify code status with patient after his family discussion. medications on admission: medications at home (per last d/c summary): 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) nebs q2h prn 2. ipratropium bromide 0.02 % nebs q6h (every 6 hours) 3. amlodipine 5 mg tablet sig: one (1) tablet po daily 4. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h prn 5. metformin 500 mg tablet sig: two (2) tablet po bid 6. pantoprazole 40 mg tablet po q12h 7. simvastatin 5 mg tablet po daily (daily) 8. tamsulosin 0.4 mg capsule, sust. release 24 hr po hs 9. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs 10. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 11. ferrous sulfate 325 mg (65 mg iron) one (1) tablet po daily 14. atovaquone 750 mg/5 ml suspension sig: 1500 (1500) mg po daily 15. alendronate 70 mg tablet sig: one (1) tablet po qmon 16. calcium carbonate 500 mg tablet, chewable (1) tablet po tidac 17. cholecalciferol (vitamin d3) 400 unit tablet sig: 1 tablet 18. senna 8.6 mg tablet sig: 1-2 tablets po hs (at bedtime) prn 19. multivitamin tablet sig: one (1) tablet po daily (daily). 20. albuterol sulfate 2.5 mg /3 ml (0.083 %) neb q4h 21. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h 22. fluticasone-salmeterol 500-50 mcg/dose disk: 1 disc prn 23. insulin lispro 100 unit/ml solution sig: sliding scale. 24. triamcinolone acetonide 0.1 % ointment: 1 appl prn psoriasis 25. clobetasol 0.05 % ointment (1) appl topical prn psoriasis 26. lorazepam 0.5 mg tablet sig: 1-2 tablets po hs (at bedtime) prn 27. prednisone 20 mg po daily (daily) 28. glipizide 5 mg tablet sig: 0.5 tablet po daily (daily). 29. spiriva with handihaler 18 mcg capsule: one (1) inhalation daily discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid prn as needed for constipation. 2. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 4. simvastatin 10 mg tablet sig: 0.5 tablet po daily (daily). 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. alendronate 70 mg tablet sig: one (1) tablet po qmon (every monday). 7. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tidac (3 times a day (before meals)). 8. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 9. atovaquone 750 mg/5 ml suspension sig: 1500 (1500) mg po daily (daily). 10. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 11. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 12. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 14. prednisone 20 mg tablet sig: three (3) tablet po daily (daily). 15. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for congestion. 16. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 17. clobetasol 0.05 % ointment sig: one (1) appl topical (2 times a day) as needed for psoriasis. 18. furosemide 20 mg tablet sig: three (3) tablet po daily (daily). 19. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 20. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q3h (every 3 hours). 21. insulin see humalog sliding scale. check fsbs qachs. half dose while npo. 22. lisinopril 40 mg tablet sig: one (1) tablet po once a day: hold if sbp < 100. discharge disposition: extended care facility: - discharge diagnosis: copd hypertension diastolic chf diabetes mellitus discharge condition: patient on home requirement of 4l/min nc, ambulation is severely limited by respiratory distress, patient requires assistance/supervision with all ambulation, tolerates po diet and medications. discharge instructions: you presented to the emergency department by ambulance in respiratory failure. you required intubation during your transport. you were admitted to the icu and found to have pneumonia and an exacerbation of your severe copd. you were treated with antibiotics, and steroids and improved. you were extubated and transferred to the medicine floor. there you continued to receive antibiotics, steroids, and frequent breathing treatments. your lasix was restarted to remove extra fluid and to help your breathing and your leg swelling. you were discharged back to rehabilitation center where you will continue your diuresis and respiratory therapy. the following changes were made to your medications: 1) increase amlodipine to 10 mg by mouth daily 2) restart furosemide (lasix) 60 mg by mouth daily 3) restart lisinopril 40 mg by mouth daily followup instructions: please follow up with dr. on at 4 pm in the pulmonary clinic located at . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: acidosis anemia of other chronic disease obstructive sleep apnea (adult)(pediatric) esophageal reflux pneumonia due to other gram-negative bacteria tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension long-term (current) use of steroids acute kidney failure, unspecified unspecified septicemia severe sepsis acute on chronic diastolic heart failure unspecified glaucoma other b-complex deficiencies acute respiratory failure disorders of phosphorus metabolism displacement of cervical intervertebral disc without myelopathy long-term (current) use of insulin septic shock morbid obesity diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled chronic obstructive asthma with (acute) exacerbation hypovolemia other psoriasis diverticulosis of colon (without mention of hemorrhage) other dependence on machines, supplemental oxygen personal history of methicillin resistant staphylococcus aureus 

Answer: The patient is high likely exposed to