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: hypoxia major surgical or invasive procedure: right central venous line placement history of present illness: y.o. male with advanced dementia biba from nh with sudden onset sob, dyspneic. . pt is unable to provide history given end stage dementia. per ems records they were called to the pt's nh after he was noted to be hypoxic to 75% on ra. o2 sat increased only to 83-89% on 6l, thus pt was placed on a nrb mask. . in the ed initial vs were noted to be t102.4, hr 116, bp 124/89, rr 28, sat 75% on 15l. labwork was notable for leukocytosis of 11.3, hgb/hct 12.5/41. u/a showed large leuks, large bld, wbc >182, few bacteria. lactate was 3.6 with na 168, bun/cr 39/1.9. cxr was obtained and showed rml pna. pt was given zosyn/vanc for broad coverage for pna as well as uti. he was also placed on bipap given his hypoxia, given tylenol for a fever of 102. right ij was placed in the ed. . ros: unable to obtain past medical history: end stage dementia with delirium >10 yrs cva in with resultant aphasia and r sided weakness; tia cad chf -- icd 8 yrs ago tte in with ef 40-45%, +bubble study with small r --> l shunt recurrent uti's -- h/o ecoli and proteus with sensitivity to ctx, some resistant to cipro bph colon ca with colostomy placed ~45 yrs ago rectal ca with ap resection in vp tia recurrent aspiration pna's multiple admissions to with lgib, pna and uti in - social history: pt has been in and out of nursing homes since a major cva in and has recently been admitted to the va for hypernatremia. most recently, he comes from of where he was noted to be unable to keep up with his oral fluid intake. has a daughter who is hcp. family history: nc physical exam: admission physical exam 99.2 116 150/90 100% 4l nc gen: caucasian male laying down in bed, non verbal in nard heent: , pt does not track movements or follow commands to eval eomi cv: s1, s2, tachycardic 110, rrr resp: course bs, rhonchi over left and right mid thorax abd: no facial grimacing noted with abdominal palpation, + bs x 4, non distended, ostomy bag ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: pt is non verbal, does not follow commands. discharge physical exam 99.9 86 126/53 24 97%2 ra elderly m in no distress, awake and alert and responds to verbal stimuli but does not answer appropriately (only says "yes" over and over to any question posed) or follow commands. ctab with decreased bs's at l base s1/s2 very faint, difficult to auscultate but no gross murmurs abd soft nt nd no ble edema noted has very gross bue tremor noted, uanble to follow commands, non-conversant pertinent results: 06:47am blood wbc-7.3 rbc-2.98* hgb-8.7* hct-29.1* mcv-98 mch-29.3 mchc-30.0* rdw-15.8* plt ct-170 04:08am blood wbc-7.8 rbc-3.05*# hgb-9.0*# hct-29.4*# mcv-96 mch-29.4 mchc-30.5* rdw-15.6* plt ct-176 02:30am blood wbc-11.3* rbc-4.12* hgb-12.5* hct-41.0 mcv-100* mch-30.3 mchc-30.4* rdw-16.2* plt ct-267 02:30am blood neuts-69.5 lymphs-22.7 monos-4.1 eos-2.6 baso-1.1 11:32am blood urean-29* creat-1.7* na-154* k-3.7 cl-125* hco3-21* angap-12 04:08am blood glucose-133* urean-35* creat-1.9* na-157* k-3.7 cl-125* hco3-24 angap-12 11:39pm blood urean-37* creat-1.9* na-160* k-3.2* cl-129* 07:21pm blood urean-37* creat-1.9* na-164* k-3.5 cl-130* 03:00pm blood urean-34* creat-1.9* na-162* k-3.7 cl-132* 10:23am blood urean-33* creat-1.9* na-163* k-3.7 cl-133* 02:30am blood glucose-157* urean-39* creat-1.9* na-168* k-3.8 cl-132* hco3-23 angap-17 04:08am blood albumin-2.2* calcium-7.7* phos-1.9* mg-1.9 11:32am blood phos-1.5* mg-1.7 11:12am blood type-mix po2-43* pco2-39 ph-7.37 caltco2-23 base xs--2 11:12am blood lactate-3.3* 02:44am blood lactate-3.6* 11:12am blood o2 sat-75 02:15am urine color-dkamb appear-cloudy sp -1.020 02:15am urine blood-lg nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-lg 02:15am urine rbc-95* wbc->182* bacteri-few yeast-few epi-1 11:20am urine hours-random creat-170 na-19 k-83 cl-34 11:20am urine osmolal-514 11:20 am urine source: catheter. **final report ** urine culture (final ): yeast. 10,000-100,000 organisms/ml.. 2:21 am urine site: not specified top hold # 64392a . urine culture (preliminary): yeast. 10,000-100,000 organisms/ml.. time taken not noted log-in date/time: 6:45 am urine 0090a. **final report ** legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. (reference range-negative). performed by immunochromogenic assay. a negative result does not rule out infection due to other l. pneumophila serogroups or other legionella species. furthermore, in infected patients the excretion of antigen in urine may vary. blood culture pending x2 ekg baseline artifact. probable sinus tachycardia. left bundle-branch block with marked left axis deviation. no previous tracing available for comparison. suggest repeat tracing and clinical correlation. cxr findings: the tip of the right ij line is in the upper svc. there is a pacemaker in place. there is no pneumothorax. vascular congestion and mild interstitial edema indicate cardiac dysfunction despite normal heart size. bibasilar opacification, more at the left, is either atelectasis or pneumonia. blunting of the left costophrenic is most likely a small pleural effusion. impression: 1. mild pulmonary edema and small left pleural effusion. 2. possible bibasilar pneumonia, suspect aspiration. 3. right ij line ends in upper svc. no pneumothorax or other complication. findings: in comparison with the study of , there is continued enlargement of the cardiac silhouette with mild elevation of pulmonary venous pressure, small effusions, and bibasilar atelectatic change, more prominent on the left. the possibility of supervening pneumonia at the bases cannot be excluded in the appropriate clinical setting. right ij catheter and pacemaker devices remain in place. records obtained from : - ct head : low attenuation of periventricular white matter, volume loss sulcal and ventrular prominence, no acute abnml - ct l spin : djd, disc bulges - ct head : advanced chronic microvascular ischemic changes, atherosclerosis of ica - d/c summary for hypernatremia and uti -- admitted with fever 101, ams, serum na 171, ua with uti. free h2o deficit 10l, na was 150 and pt advanced to po food/water. given ctx x5 days for uti and pt defervesced. had troponin leak. palliative care consulted (severe baseline dementia, cva, no longer oriented. fully dependent on others for care, says very few words at baseline; comfort focused care suggested to family and "do not hospitalize" also suggested) - echo : mild hypertrophy of lv, severe inferior hk, 40-45%, dilated aortic root, 1+ mr, moderate lae, mod tr, pasp 36, - echo : 40-45%, lvh, mild , no signficant valvular disease, otherwise not much different from previous, again visualized r to l shunt brief hospital course: yom with h/o cva in with residual aphasia and weakness, end stage dementia with delirium, cad/chf, and multiple admissions to and the va for recurrent uti's and aspiration pna's who was admitted to micu green after being found hypoxic at of , now discharged back with plans for hospice care. 1. hypoxia: noted to be 75% at nh, 75% on 15l in the ed so placed on bipap and admitted to micu where he was able to be weaned to 4l nc by micu admission and ra by discharge. etiology is likely aspiration given h/o recurrent aspiration, bibasilar opacifications with suspicion of aspiration; also with some mild pulmonary edema (was not diuresed due to hyperna). pt weaned to ra without difficulty through admission. pt initially covered broadly with iv abx -- zosyn, vancomycine, levaquin. after discussion with palliative care, the hcp/daughter stated that it would be against goals of care for pt to be discharged with picc for continued iv therapy; she requested that the team find a suitable oral abx if pt able to take po. pt was switched to amoxicillin-clavulanate for 8 day course. of note, unable to obtain sputum cx but legionella urinary ag negative. of note, after receiving records from , pt has h/o recurrent admissions for aspiration pna's. 2. hypernatremia: na 168 on admission. recent h/o several admissions for hypernatremia, as recently as several weeks ago to the , in which pt was again hyperna to 170 which improved with ivf's. likely due to poor po intake given severe deficits from cva in 3/. pt was hydrated with hypotonic ivf's at an acceptable rate and na improved to 154 by discharge. should continue to attempt oral hydration if able from mental status perspective and recheck na if consistent with goals of care. 3. renal failure: pt with cr 1.9 on admission, down to 1.7 by discharge. his baseline was unclear, but cr noted to be 2.4 at the va on . 4. hct drop: hct 41 on admission was likely hemoconcentrated, and unclear his baseline. dropped to 29.4 after ivf's which was likely dilutional as no source of bleeding, and was stable thereafter. 5. dispo: palliative care met with the pt's daughter/hcp about the non-sustainability of recent management issues regarding the hyperna and it was decided to tranfer pt back to with hospice care. therefore, pt's cvl that was placed in the ed was removed. code: dnr/dni, discharged with plans for hospice care. medications on admission: medications at nursing home (per records): donepezil 10mg qhs finasteride 5mg dsaily memantine 10mg venlafaxine 37.5mg daily honey thick liquids fleet enema prn bisacodyl 10mg prn acetaminophen 650mg q6hrs prn mom prn discharge medications: 1. augmentin 875-125 mg tablet sig: one (1) tablet po twice a day for 6 days: stop abx on . tablet(s) 2. donepezil 10 mg tablet sig: one (1) tablet po hs. 3. finasteride 5 mg tablet sig: one (1) tablet po once a day. 4. memantine 10 mg tablet sig: one (1) tablet po twice a day. 5. venlafaxine 37.5 mg tablet sig: one (1) tablet po once a day. 6. fleet enema 19-7 gram/118 ml enema sig: one (1) rectal prn as needed for constipation. 7. bisacodyl 5 mg tablet sig: two (2) tablet po once a day as needed for constipation. 8. acetaminophen 650 mg tablet sig: one (1) tablet po every six (6) hours as needed for fever or pain. 9. milk of magnesia 400 mg/5 ml suspension sig: one (1) po once a day as needed for constipation. discharge disposition: extended care facility: senior healthcare of discharge diagnosis: primary: aspiration pna, hypernatremia secondary: altered mental status, dementia discharge condition: mental status: confused - always. activity status: bedbound. non verbal discharge instructions: you were admitted to the hospital after you were found to have breathing difficulties at your nursing home. your oxygen level was low so you were placed on a breathing mask and sent to the icu. you were not intubated per your and your family's wishes. whilst in the icu you were diagnosed with a pneumonia and given antibiotics. you were also give some fluids as you were dehydrated and your salt level was high. after discussion with your daughter who is your healthcare proxy it was decided you should go back to your nursing home with hospice care. the only change to your medication regimen is the addition of augmentin (amoxicillin-clavulanate) 875 mg po bid for 6 more days, to end on . followup instructions: none md procedure: venous catheterization, not elsewhere classified diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other persistent mental disorders due to conditions classified elsewhere pneumonitis due to inhalation of food or vomitus personal history of malignant neoplasm of large intestine automatic implantable cardiac defibrillator in situ personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits do not resuscitate status hyperosmolality and/or hypernatremia attention to colostomy personal history, urinary (tract) infection personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus 

Answer: The patient is high likely exposed to