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: patient recorded as having no known allergies to drugs attending: chief complaint: respiratory failure major surgical or invasive procedure: intubation in the field. history of present illness: 73 year old man with history of copd, hyperlipidemia, htn who presents to the ed intubated by paramedics after they were called to his home for increasing sob. the details of the events leading up to his intubation are not clear. in discussion with friend , she reports that came to visit on at which time he was reportedly "doing well" in terms of his respiratory status. sometime after left, however, pt. called and told her he needed help as he could not breathe. it was at that time that ems was called. there is no ems record in paperwork from the ed, but per verbal report from ed resident, pt was so sob that he requested intubation when ems arrived to his home. although per verbal s/o there was report that he never picked up steroids that were prescribed on discharge, i am unable to find a record of steroids having been prescribed during his last admission and further upon discharge. he was intubated at home and was transferred to ed for further evaluation. . of note, he was admitted to the surgical service from /08 after presenting with abdominal pain/rectal bleeding and progressive sob. he was intubated in emergency room d/t increasing respiratory distress despite multiple nebs. ngt tubes was placed with coffee grounds and he reportedly had episodes of maroon stool egd was performed on which showed pyloric ulcers, but no e/o active bleeding. he had subsequent additional hct drop and egd was repeated on showing e/o recently bleeding pyloric ulcer. ulcer was injected with epi and endoclip was deployed unsuccessfully. he received a total of 8 units prbcs, 1 bag platelets, 1 unit ffp last on after which his hct remained stable without any further bleeding. he was continued on ppi and was treated for h. pylori. although his respiratory failure was attributed to copd exacerbation, it does not appear that he received steroids during his hospital stay. he was, however, extubated successfully and when ambulating with pt during last admission, he became sob with o2 sats dipping into the 80% and cta was positive for subsegmental pe and he was started on heparin gtt and transitioned to coumadin prior to discharge. . in the ed, initial vs were: t 100.0 p 120 bp 95/77 intubated and breathing at set rate of 16 o2 sat100% on ac (exact settings unclear). cta chest on prelim read showed no pe, pneumonia or edema; it showed unchanged pulmonary nodules. ua showed few bacteria, no squams, 6 wbcs, rbcs. he received 125mg iv solumedrol, 1g iv ceftriaxone and 500mg iv azithromycin x1. he received versed for sedation. he received a total of 6l ns. . review of sytems: unable to obtain given pt. is intubated/sedated. past medical history: 1. asthma/copd? 2. htn 3. hyperlipidemia 4. h/o prostate ca s/p radical prostatectomy with xrt in 5. colonic polyps 6. lichen simplex chronicus 7. h/o pud 8. +ppd 9. osteoarthritis social history: no tobacco use, no etoh, no illicit drug use. lives in an apartment alone, retired welder. family history: nc physical exam: general: intubated, sedated, pupils pinpoint and minimally reactive to light. heent: sclerae anicteric, mmm. lungs: clear anteriorly without wheezes, rales, rhonchi. cv: sinus tachy, no mrg appreciated. abdomen: +hypoactive bs. soft, no rebound/guarding. no hsm noted. ext: cool feet, but with palpable pulses. no edema. pertinent results: images: cta chest (prelim): no pe, pneumonia or edema. nodules unchanged from 9 days prior. . cta chest: 1. isolated subsegmental pulmonary embolism in the right lower lobe of uncertain clinical significance. 2. 5-mm left upper lobe pulmonary nodule for which a six-month followup chest ct is recommended per fleishner society guidelines. attention should be paid to two 1- mm pulmonary nodules in the right upper and right middle lobes at that time as well. 3. moderate to marked emphysema. 4. left posterior diaphragmatic defect with adjacent atelectasis . spirometry: moderate to marked obstructive ventilatory defect. fev1 of 0.96. compared to the prior study of there has been no significant change. . ekg: no clear ps, probable a. flutter at rate of 123. normal axis. frequent pvcs. biphasic tws in v5-v6. . tte: the left atrium and right atrium are normal in cavity size. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 0-5 mmhg. 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 descending thoracic aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the report of the prior study (images unavailable for review) of , at least mild pulmonary artery systolic hypertension is now detected (32-35mmhg). the remaining findings are similar with normal biventricular systolic function. : the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. there is mild to moderate regional left ventricular systolic dysfunction with severe hypokinesis of the distal half of the anterior septum and anterior walls, and apex. the remaining segments contract normally (lvef = 40-45 %). the right ventricular cavity is mildly dilated with focal hypokinesis of the apical free wall. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is a trivial/physiologic pericardial effusion. impression: suboptimal image quality. normal left ventricular cavity size with regional systolic dysfunction c/w cad. distal right ventricular hypokinesis. compared with the prior study (images reviewed) of , the regional left ventricular and right ventricular systolic dysfunciton is new and c/w interim ischemia (mid lad distribution). brief hospital course: 73 year old man with copd (fev1 0.96), htn, hyperlipidemia and recent gib from pud presents 2 days post discharge, intubated at home by paramedics after c/o increasing dyspnea. # respiratory failure likely related to copd exacurbation: history surrounding intubation and presentation is largely unknown as he does not come with ems paperwork and friend listed as contact is unaware of the details. it appears that he had been doing okay at home since his d/c on , but complained to his friend over the phone that he needed help d/t increasing sob (which prompted ems call). per verbal s/o from ed, he had been prescribed prednisone upon discharge on for copd exacerbation, but pt did not pick up prescription. he was intubated on presentation to the ed on last presentation as well presumably thought d/t copd exacerbation. was diagnosed with pe on last admission by cta on ("isolated subsegmental pulmonary embolism in the right lower lobe of uncertain clinical significance"). he was on heparin and discharged on coumadin for this finding and repeat cta on this presentation does not even comment on subsegmental pe on prelim read so seems very unlikely to be causing clinical presentation. no e/o volume overload nor of pneumonia on ct chest and unable to obtain hx re: cough/sputum production. the patient was given iv steroids which was subsequently trasitioned to oral prednisone with . he was continued on standing mdis and was given azithromycin. sputum and blood cultures were no growth to date. # hypotension: normally hypertensive at baseline. presented with sbps in the 90s where he has largely remained stable despite 6l ivfs. unclear etiology. infection suspected initially but his ua was unremarkable and his ct of chest without e/o infiltrate. no other signs of infection were evident. be partially med related (fentanyl/versed). his sbps improved during the hospitalization and remained stable without ivf. # pe: on cta chest showed small subsegmental pe for which he was heparinized then transitioned to coumadin for discharge. inr has been therapeutic and repeat cta today with prelim report showing no pe. goal inr per d/c summary was 2-2.5 given recent gib; inr currently 2.7. anticoagulation was continued during this admission. # positive cardiac biomarkers: with elevated ck and mb although neg mb index; troponin positive at 0.30. trop could be up in setting of pe, but pe on last admission seems so small (subsegmental) that it is unlikely to be the underlying cause of his hypoxia and positive trop. ekg did show probable a.flutter with rate in the 120s so demand ischemia possible. continued statin and asa; holding bb given relative hypotension. cardiology saw the patient and recomended outpatient follow up. # pud and recent ugib: serology positive for h. pylori. it appears that he was initiated on amoxacillin and clarithromycin on and thus, should have completed a full 2 week course at this time. we continued ppi and sucralfate # a. fib/flutter: ekg from shows a. fib. does not appear to have diagnsosis of this prior to that. chads2 score of with htn and age nearly >75. he is currently anticoagulated and inr is therapeutic. # lung nodule: 5-mm left upper lobe pulmonary nodule on ct chest for which a six-month recommended. medications on admission: will need verification as d/c summary completed 10 days prior to actual discharge so not clear exactly on what he was discharged. spiriva inhaled daily diltiazem sr 120 mg daily proair hfa 90 mcg/actuation aerosol inhaler 2 (two) puffs(s) q6h prn hydrochlorothiazide 25 mg daily lisinopril 10 mg daily (per omr list, 30mg per surgical d/c summary) omeprazole 40 mg flovent hfa 220 mcg/actuation aerosol inhaler 2 puffs serevent diskus 50 mcg/dose for inhalation 1 puff ih atrovent mdi prn atorvastatin 20mg hs coumadin 5mg daily sucralfate discharge medications: 1. warfarin 5 mg tablet : one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 2. amlodipine 5 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. guaifenesin 100 mg/5 ml syrup : 5-10 mls po q6h (every 6 hours) as needed. disp:*200 ml(s)* refills:*1* 4. lisinopril 20 mg tablet : two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 5. metoprolol tartrate 25 mg tablet : 1.5 tablets po tid (3 times a day). disp:*135 tablet(s)* refills:*2* 6. albuterol 90 mcg/actuation aerosol : inhalation four times a day. disp:*1 bottle* refills:*1* 7. spiriva with handihaler 18 mcg capsule, w/inhalation device : one (1) inhalation once a day. disp:*1 bottle* refills:*1* 8. ipratropium bromide 17 mcg/actuation aerosol : inhalation four times a day. disp:*1 bottke* refills:*2* 9. fluticasone 110 mcg/actuation aerosol : four (4) puff inhalation (2 times a day). disp:*1 bottle* refills:*2* 10. salmeterol 50 mcg/dose disk with device : two (2) disk with device inhalation q12h (every 12 hours). disp:*120 disk with device(s)* refills:*2* 11. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). disp:*60 tablet,rapid dissolve, dr(s)* refills:*2* 12. sucralfate 1 gram tablet : one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*2* 13. aspirin 325 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 14. atorvastatin 80 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 15. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. disp:*60 tablet(s)* refills:*0* 16. serevent diskus 50 mcg/dose disk with device : inhalation twice a day. disp:*1 bottle* refills:*2* 17. prednisone 10 mg tablet : 1/2-4 tablets po once a day for 14 days: take 4 tabs for 1 day, 2 tabs for 4 days, 1 tab for 4 days, tab for 4 days. disp:*18 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: chronic obstructive lung disease pulmonary embolism atrial fibrilation wall motion abnormalities on echo discharge condition: stable discharge instructions: you were admitted with an exacurbation of your copd. you required intubation for a brief period and were treated with antibiotics, steroids, neulizers and oxygen. you are being discharged on steroid medication (prednisone) as well as a medication to help with your cough (guainefesin). while you are on steroids, you should take sucralfate. you should continue albuterol, atrovent, serevent, flovent and spiriva. we also noted that your heart exhibited some abnormalities which we believe are a consequence of your rapid heart rate. we gave you medications to slow your heard down. we have arranged an appointment with a heart doctor on an outpatient basis. also we have scheduled for you to have a stress test to evaluate your heart. we made changes in your blood thining medication (coumadin) and you are to follow up with a nurse practitioner in the in order to have this medication monitored. also your visiting nurse can help with this. you should not take coumadin today because your level was slightly elevated. we gave you a new medication to take for your blood pressure (amlodipine) so now you should take metoprolol, lisinopril and amlodipine for blood pressure. please call your regular doctor or return to the ed if you experience shortness of breath, chest pain, palpitations, lightheadedness or any other symptom that concerns you. also be aware that the blood thining medication places you at risk for bleeding. followup instructions: provider: , md phone: date/time: 10:20 provider: clinical pharmacist phone: date/time: 1:00 provider: , md phone: date/time: 1:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnoses: abnormal coagulation profile subendocardial infarction, initial episode of care unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation personal history of malignant neoplasm of prostate atrial flutter other and unspecified hyperlipidemia acute respiratory failure long-term (current) use of anticoagulants personal history of venous thrombosis and embolism chronic obstructive asthma with (acute) exacerbation anticoagulants causing adverse effects in therapeutic use helicobacter pylori [h. pylori] peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction erythromycin and other macrolides causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to