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: beta-blockers (beta-adrenergic blocking agts) attending: chief complaint: sudden onset dyspnea major surgical or invasive procedure: intubation x2 days; history of present illness: mr. is a 77yo m with htn, hl, copd, and newly diagnosed nsclc , now s/p his first round of chemotherapy. he was transferred to the ed in the midst of a rbc transfusion when he developed sudden shortness of breath that was interpreted as a possible transfusion reaction. . he appears to have severe copd caused by an extensive smoking history. he has poor exercise tolerance which has only worsened in the preceding months. any exertion, including walking down the street, can cause increased rr and profound sob. albuterol can help stop these episodes. he has been pursed-lip breathing for years. he recently underwent tte evaluation of his exercise intolerance, at which point a relatively large pericardial effusion with tamponade physiology was seen. he was admitted to the ccu - and underwent pericardiocentesis, which revealed malignant cells. he recently underwent his first chemo session with taxol for nsclc. his oncologist is dr. at . . his fatigue and poor exercise tolerance persisted. he was found to be anemic to 25 and subsequently was brought to 7 for blood transfusion. midway through the transfusion, he developed worsening sob and increased rr. he thinks this episode was similar to his usual bouts of breathlessness, and he admittedly was upset with how long the transfusion was taking. fearing a transfusion reaction, he was brought to the ed for further evaluation. . in the ed, he was found to be tachycardic and tachypneic. received 20mg iv lasix and underwent bipap trial, which was poorly tolerated. of note, he continued to saturate in the upper90s on 3-4lnc, though remained tachypneic. a bedside echo was done which showed no pericardial effusion per the ed read. he was transferred to the micu for concern of increased wob. vs prior to transfer were 97.9 108 150/80 36 99/4l. . on arrival to the micu, his intial vs were 96.5, 107, 153/63, 95 3lnc. he continues to purse-lip breath. he describes frequent episodes similar to his breathlessness on transfusion, which often pass after coughing or spitting. he otherwise feels well aside from fatigue. he notes no recent couging or cold-like smpyotms, no sore throat, fevers, chills, chest pains or pressure. he has lower extremity edema but no pnd, orthopnea. no recent f/c. in the midst of our interview, he had the urge to urinate and abruptly stood to use his urinal- he developed respiratory distress with saturations dipping to the 80s and tachypnea to 50. this episode resolved with supplemental 02. he felt it was similar to the events surrounding his infusion. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - non-small cell lung cancer - squamous cell carcinoma, s/p mohs - colonic polyps, last colonoscopy 1 year ago - copd - gastritis - h/o gout - h/o nephrolithiasis - hypertension - hyperlipidemia social history: lives with his wife in . retired hardware store owner. has two boys, both live in , and one grandson. - tobacco history: 97.5 pack-year history, still smokes 1.5 ppd - etoh: 1 glass of wine/night - illicit drugs: denies family history: - no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death - mother: chronic leukemia, died at age 89 - father: h/o mi, pancreatic cancer, died at age 69 physical exam: admission exam: vitals: 96.5, 107, 153/63, 95 3lnc general: alert, oriented, pursed-lip breathing in the 30s heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: diffuse wheezing heard throughout anterior and posterior lung fields. fair air movement. no crackles or rhonchi. cv: tachycardic, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. abdominal musculature used in exhalation. gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema at the time of his discharge, the patient's vital signs were stable and he had o2 sats of 96% on 2l nc. while he continued to have wheezes with fair air movement on lung exam, there were no basilar crackles. there was no edema or elevation of the jvp. the foley had been removed. pertinent results: admission labs: 08:23pm urine hours-random urea n-679 creat-97 sodium-71 potassium-81 chloride-86 08:23pm urine color-yellow appear-clear sp -1.013 08:23pm urine blood-sm nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 08:23pm urine rbc-2 wbc-1 bacteria-none yeast-none epi-<1 08:23pm urine granular-2* hyaline-14* 08:23pm urine mucous-rare 06:36pm lactate-1.3 06:30pm glucose-124* urea n-30* creat-1.5* sodium-141 potassium-4.5 chloride-104 total co2-25 anion gap-17 06:30pm estgfr-using this 06:30pm ld(ldh)-395* ck(cpk)-115 tot bili-0.8 06:30pm ctropnt-1.00* 06:30pm ck-mb-5 probnp-* 06:30pm iron-83 06:30pm wbc-3.2*# rbc-2.79*# hgb-9.1*# hct-25.2*# mcv-90# mch-32.7* mchc-36.2* rdw-20.8* 06:30pm neuts-22* bands-2 lymphs-47* monos-19* eos-7* basos-1 atyps-0 metas-0 myelos-2* nuc rbcs-3* 06:30pm hypochrom-1+ anisocyt-1+ poikilocy-2+ macrocyt-1+ microcyt-1+ polychrom-1+ spherocyt-1+ schistocy-2+ bite-1+ acanthocy-1+ 06:30pm plt smr-low plt count-132* 06:30pm pt-17.8* ptt-26.5 inr(pt)-1.6* notable labs: 05:15am blood fdp-40-80* 06:30pm blood ctropnt-1.00* 04:41am blood ck-mb-6 ctropnt-0.99* 05:24pm blood ck-mb-5 ctropnt-0.65* 06:30pm blood caltibc-257* hapto-<5* ferritn-590* trf-198* 06:36pm blood lactate-1.3 ekg : sinus tachycardia. left axis deviation. right bundle-branch block. probable small r waves in leads ii, iii and avf but consider prior inferior myocardial infarction. st-t wave abnormalities. low precordial voltage. compared to the previous tracing of the rate is faster. st-t wave abnormalities are more prominent. precordial voltage is less prominent. clinical correlation is suggested cxr : 1. moderate enlargement of the cardiac silhouette, similar compared to the prior pet-ct. 2. dilated and tortuous ascending thoracic aorta. 3. patchy opacities within the lung bases, which could reflect atelectasis, infection, or aspiration. 4. known spiculated nodule in the right upper lobe is better appreciated on the recent pet ct. tte : the left atrium is elongated. the right atrium is markedly dilated. the estimated right atrial pressure is 5-10 mmhg. the estimated right atrial pressure is at least 15 mmhg. left ventricular wall thicknesses and cavity size are normal. there is mild global left ventricular hypokinesis (lvef = 40-45 %). right ventricular chamber size is normal. with borderline normal free wall function. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a very small pericardial effusion. impression: mild global left and right ventricular hypokinesis. mild to moderate mitral regurgitation. mild to moderate aortic regurgitation. very small pericardial effusion. moderate pulmonary hypertension. compared with the prior study (images reviewed) of , biventricular function is now impaired. valvular regurgitation is now apparent (previous study was focused). pulmonary hypertension is identified. . labs on discharge: 09:45am blood wbc-7.0 rbc-3.15* hgb-9.8* hct-31.2* mcv-99* mch-31.2 mchc-31.6 rdw-20.8* plt ct-135* 09:45am blood plt ct-135* 09:45am blood glucose-131* urean-45* creat-1.3* na-143 k-3.7 cl-99 hco3-34* angap-14 09:45am blood calcium-8.9 phos-3.2 mg-1.8 brief hospital course: mr. is a 77yom with copd, htn, hld, and a recent hospitalization for cardiac tamponade who presents from 7 transfusion unit with acute sob during transfusion. 1. acute hypoxic respiratory failure: --pneumonia and acute systolic chf: he developed acute shortness of breath early into his blood transfusion which he was receiving for anemia. transfusion reaction/trali was initially suspected though he lacked severe pulmonary edema or hypoxia to support this diagnosis. he was admitted to the micu due to apparent increased wob, and was briefly tried on bipap in the ed despite normal saturations. tamponade was ruled out with us in ed. he initially was stable on room air with saturations in the 90s upon admission to the icu. he related numerous similar episodes of shortness of breath at home and related a progressive worsening of his overall respiratory status and exercise stamina over the preceding months. his cxr showed mild edema and rll haziness. widespread wheezing prompted treatment for copd exacerbation. he decompensated quickly in the unit after getting agitated during a foley adjustment. he desaturated to the 70s-80s and had an increased wob refractory to nebs, lasix, and nrb. he was urgently intubated. the cause of his decompensation was felt to be multifactorial. he had a trop of 1.00 on admission with flat ck/mb, but new lad-distributed twi on ekg, and new onset systolic dysfunction with ef to 40-45% on tte (new since last month). a cardiac event could have potentially caused his deterioration and chf exacerbation. pneumonia was possible based on his rll infiltrate, and he was treated for hcap with vanco/cefepime/levaquin. sputum culture revealed commensal resp flora and sparse gnr. he was started on nebs and steroids for possible copd exacerbation as well,though these were quickly tapered due to suspicion for more of a chf etiology. he was aggressively diuresed. he was extubated on and transfered to the floor on . . on the floor he was initially saturating in the 90's on 4l nc. he continued to be diuresed gently with po and occasional iv lasix. his oxygen was weaned as tolerated with a goal of 02 sat of 92%. his steroids were discontinued on as the etiology of his sob was thought to be related to pulmonary edema and a possible pneumonia rather than a copd exacerbation. his vancomycin was discontinued based on sputum data and cefepime and levaquin were continued until further speciation was available. his nebulizers were continued throughout his hospital stay. on the day prior to discharge, cefipime was discontinued as the patient had remained afebrile and without leukocytosis; prednisone was also discontinued since copd flare appears to not have been the primary etiology of sob and his symptoms were resolving. pt was consulted and worked with the patient on improving functional status. he was discharged home with home pt services, home 02, and cardiac telemonitoring. . 2)nstemi: his troponin elevation to 1.00 is without any similar mb or ck elevation. he had some nonspecific lateral t wave changes, but no chst pain or pressure to suggest acs. tte revealed new onset systolic dysfunction with ef 45-50%. cardiology was consulted, who felt that the chemotherapy (taxol/cisplatin) is not likely to blame and that he had a recent mi. based on ekg and echo data, there was a possible partial occlusion in the lad and that the patient may benefit from elective cathetrization. however, based on the absence of symptoms and the comorbidities in the patient, oncology, medicine and the patient's family were in agreement with medical management. on the patient had an 8 beat run of v-tach. an ekg was essentially unchanged and troponins showed a continued downward trend. . 3. anemia: hct to 25 of unclear source, though inflammatory disease from malignancy or myelosupression from chemo are both possible. though his hematrocrit trended downwards in the days prior to discharge, a transfusion was not thought to be necessary by cardiology (goal 25). . 4. non small cell lung cancer: currently undergoing taxol chemo; will resume as outpatient. atrius oncology service followed while the patient was in house. 5. hypertension: the patient had recently been taken off his dose of 20 mg linisnopril qam due to low blood pressures. based on his new diagnosis of chf, lisinopril was restarted at a dose of 10 mg qam; his blood pressures remained stable with systolics greater than 110 while in house. . 6. gout: allopurinol and colchicine were continued, this was not an active issue on this admission. medications on admission: 1. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). 2. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q4-6 hours as needed for sob, wheezing. 4. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 5. allopurinol 100 mg tablet sig: two (2) tablet po once a day. 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). discharge medications: 1. allopurinol 100 mg tablet sig: 1.5 tablets po daily (daily). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. beclomethasone dipropionate 80 mcg/actuation aerosol sig: one (1) spray inhalation twice a day. 4. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) capsule inhalation once a day. disp:*30 capsules* refills:*2* 7. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: puff inhalation every four (4) hours as needed for shortness of breath or wheezing. 8. lisinopril 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 9. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 10. home oxygen 1-4 liters per minute continuous oxygen via nasal cannula : 99 months diagnosis: copd 11. lasix 20 mg tablet sig: two (2) tablet po once a day. disp:*60 tablet(s)* refills:*0* 12. levofloxacin 750 mg tablet sig: one (1) tablet po every other day for 1 doses. disp:*1 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: congestive heart failure, possible pneumonia, copd, non-small cell lung cancer, anemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker). discharge instructions: dear mr. , it was a pleasure participating in your care at . you were admitted to the medical icu after presenting to the emergency department for acute onset shortness of breath during a blood transfusion. a reaction to the blood transfusion itself was ruled out. a chest xray showed possible signs of a pneumomia and you were started on broad spectrum antibiotics. it is possible that yoru copd was contributing to your shortness of breath and you were also given a steroid as well as your usual inhalers. in the micu you had a second acute episode of shortness of breath that was not responsive to oxygen. because of your worsening respiratory status you were intubated (given a breathing tube). laboratory results and an ekg suggested that you may have had a heart attack prior to the hospitalization. an echo cardiogram showed that you had a new onset of congestive heart failure (chf). it is likely that your shortness of breath was due to too much volume backing up in your lungs. you were given lasix to help reduce the volume in your lungs and your respiratory status improved to the point that you were extubated (breathing tube was removed) two days after you were intubated. cardiology was consulted to help with your care and suggested the possibility of a cardiac cathetrization to look at the vessels of your heart. however, along with your oncolgy team, it was determined to be best to try to manage your heart disease with medical management. due to your continued improvement you were transferred to the general medical floor where we continued to monitor your respiratory status and give you lasix to manage your fluid balance. your steroids were stopped on the medical floor and the medicines for your pneumonia were narrowed to treat the most likely organism. your regular inhalers were continued. we followed your blood counts throughout your stay and it was not deemed necessary to transfuse additional blood at this time. you will return home with home nursing, oxygen, and physical therapy services. you should keep your oxygen saturation bewteen 88-92% and should use 3l of oxygen when active. you will also have cardiac telemonitoring to assist with monitoring your daily weights and blood pressures. the results of this will automitically be sent to dr. office. you should resume the medicines you were previously taking at home with the following changes: start: lisinopril 10 mg qd (daily) start: lasix 20 mg po (by mouth) qd start: atorvastatin 80 po qd start: spiriva 1 puff (twice daily) continue: levofloxacin 750 mg x1 dose () followup instructions: please follow up with the appointments below after your discharge from the hospital: name: , np specialty: internal medicine when: tuesday at 9:30am location: - address: , , phone: dr. is out of the office next week so you will see his nurse at this visit. name: , md specialty: hematology/oncology when: thursday at 1:30p location: address: , , phone: name: , pa specialty: cardiology when: wednesday at 11:30am location: address: , , phone: you will see dr. physicians assistant at this visit. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube central venous catheter placement with guidance diagnoses: anemia of other chronic disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension gout, unspecified obstructive chronic bronchitis with (acute) exacerbation dysthymic disorder other and unspecified hyperlipidemia acute respiratory failure personal history of other malignant neoplasm of skin long-term (current) use of other medications antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use malignant neoplasm of other parts of bronchus or lung acute systolic heart failure raynaud's syndrome personal history of colonic polyps bacterial pneumonia, unspecified antineoplastic chemotherapy induced anemia malignant pleural effusion 

Answer: The patient is high likely exposed to