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: shortness of breath major surgical or invasive procedure: bronchoscopy () picc line placement () history of present illness: 82 yo m with h/o copd, as s/p avr, afib, right nephrectomy for rcc, colon ca s/p colectomy admitted with cough and shortness of breath. patient had a recent admission - for community acquired pneumonia right middle and lower lobe, pleural effusion drained 800ccs (transudative) and melena (no scope due to respiratory status, discharged on h. pylori treatment). ct torso demonstrated right pre-bronchial and pretracheal mild adenopathy with narrowing or part opacification of the right lower lobe bronchus that could suggest mass. on patient followed up at outpatient gi appointment found to have temp 100.2 with persistent sob and cough. cxr showed rll consolidation and smaller pleural effusion. patient was given one dose of levofloxacin, but antibiotics held as infection felt less likely. leni demonstrated new thrombosis in branch of popliteal vein. cta done to r/o pe demonstrated rll and rml consolidation recurrence associated retrocrural and extrapleural adenopathy suspicious for malignancy. pulmonary consulted and recommended bronch to evaluate airways and biopsy node (done today). during admission patient also had a slowly drifting down hct - gi consulted and prep was attempted however not completed. patient developed abdominal pain from partially obstructed ventral hernia whic was reproducible, followed by surgery and improved on repeat imaging. patient started spiking temperatures - work up involved blood cx, urine cx, c. diff, repeat ct scan which only revealed rll/rml opacities. id consulted and suspected post-obstructive pneumonia that may have been partially treated and recommended bronch bal. bronchoscopy demonstrated diffuse tbm, thickened mucosa of rml and rll, performed bal and brushings rll of superior segment as well as ebus tbna (transbronchial needle aspiration). patient was given versed and fentanyl. around 10 pm night float was called for acute respiratory distress. patient 65% on 4 l (following procedure on 4 l, baseline 2 l), bp 120/60, hr 105, rr 34. he was given 40 mg laisx and cxr demonstrated white out right lung concerning for atelactasis/mucus plugging. abg on 4 l 7.32/58/53. respiratory suctioned thick sputum. patient continued to be in respiratory distress and consequently transferred to the micu for care. repeat cxr and abg improved 7.31/56/70 (fio2 70%). past medical history: 1. congestive heart failure - echo () with mild symmetric lvh with normal cavity size and global systolic function (lvef>55%). mild mr; moderate tr - cath () with dilated left ventricle with significant generalized hypokinesis and a global ejection fraction of 28% (while the patient is in atrial flutter). 2. copd- moderate to severe per dr. (pcp) 3. hypertension 4. s/p avr for aortic stenosis 5. atrial fibrillation, cardioversion () 6. s/p splenic artery aneurysm resection/splenectomy () 7. gerd 8. history of rcc s/p left nephrectomy () 9. history of colon cancer status post colostomy () 10. history of b12 deficiency 11. history of itp social history: lives with his wife in . he quite smoking in . 30 etoh per week. retired electrician. id note at from documents he had been ppd negative and without tuberculosis risk factors; he confirms he has not been exposed to anyone with tuberculosis to his knowledge. no animal contacts. was in the navy many years ago with travel to and but not to or . no prison exposure. limited travel outside in recent years. family history: noncontributory. physical exam: vitals: 97.1, 104, 111/64, 20, 98/ 70% face tent with 5l/nc heent: sclera anicteric, mm slightly dry, oropharynx clear neck: supple, jvp flat, no lad lungs: crackles in rml/rll, diffuse wheezing cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: large hernia, positive bowel sounds, soft, very mild diffuse tenderness, no rebound tenderness or guarding ext: warm, well perfused, 2+ pulses, 2+ pitting edema b/l r>l pertinent results: admission labs ======================================================= 05:30pm blood wbc-7.8 rbc-3.03* hgb-9.4* hct-29.5* mcv-97 mch-31.1 mchc-32.0 rdw-17.1* plt ct-254 05:30pm blood neuts-66.7 bands-0 lymphs-22.7 monos-9.8 eos-0.7 baso-0.1 05:30pm blood pt-15.2* ptt-38.5* inr(pt)-1.3* 05:30pm blood glucose-101* urean-20 creat-1.8* na-136 k-4.7 cl-102 hco3-26 angap-13 07:50am blood alt-13 ast-28 ld(ldh)-214 alkphos-54 totbili-0.5 06:03am blood calcium-8.1* phos-2.9 mg-1.9 iron-24* 06:03am blood caltibc-96* vitb12-331 folate-13.8 ferritn-458* trf-74* 10:36pm blood type-art po2-53* pco2-58* ph-7.32* caltco2-31* base xs-1 intubat-not intuba discharge labs ======================================================= 03:38am blood wbc-25.1*# rbc-2.90* hgb-8.7* hct-27.3* mcv-94 mch-30.0 mchc-31.8 rdw-17.1* plt ct-192 06:40am blood wbc-13.0* rbc-2.72* hgb-8.5* hct-27.2* mcv-100* mch-31.1 mchc-31.1 rdw-17.3* plt ct-211 06:16am blood neuts-82.5* lymphs-6.4* monos-10.3 eos-0.2 baso-0.5 06:40am blood pt-23.2* ptt-93.1* inr(pt)-2.2* 06:40am blood glucose-129* urean-17 creat-1.4* na-140 k-3.7 cl-108 hco3-26 angap-10 06:40am blood calcium-7.5* phos-3.1 mg-1.8 07:50am blood ck-mb-notdone ctropnt-0.13* 05:52pm blood ck-mb-notdone ctropnt-0.08* microbiology ======================================================= 5:12 pm bronchoalveolar lavage rll bal. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (preliminary): commensal respiratory flora absent. staph aureus coag +. 10,000-100,000 organisms/ml.. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations rifampin should not be used alone for therapy. staph aureus coag +. 10,000-100,000 organisms/ml.. second morhphology. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _______________________________________________________ staph aureus coag + | staph aureus coag + | | clindamycin----------- =>8 r =>8 r erythromycin---------- =>8 r =>8 r gentamicin------------ <=0.5 s <=0.5 s levofloxacin---------- =>8 r =>8 r oxacillin------------- =>4 r =>4 r rifampin-------------- <=0.5 s <=0.5 s tetracycline---------- 4 s 2 s trimethoprim/sulfa---- <=0.5 s <=0.5 s vancomycin------------ <=0.5 s fungal culture (preliminary): no fungus isolated. nocardia culture (preliminary): no nocardia isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): reports ======================================================= unilat lower ext veins right study date of nonocclusive thrombus in a branch of the right popliteal vein only. no evidence of dvt in any other region of the left lower extremity. cta chest w&w/o c&recons, non-coronary study date of 1. rll and rml consolidation, given recurrence in the same region and associated retrocrural and extrapleural adenopathy, is suspicious for malignancy, correlation with either fdg pet or tissue sampling is recommended. 2. unchanged lobulated left splenectomy bed soft tissues, could represent regenerated splenic tissue, however, local rcc recurrence is not excluded. 3. patchy lll opacity, could be atelectasis, however, metastatis is not excluded and attention on followup is recommended. 4. coronary and atherosclerotic aortic calcifications. 5. no evidence of pulmonary embolism or acute aortic syndrome. portable tte (complete) done the left atrium is markedly dilated. the right atrium is markedly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is mild regional left ventricular systolic dysfunction with inferior hypokinesis. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is moderately dilated. a bioprosthetic aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , regional lv systolic dysfunciton is now appreciated. ct abdomen / pelvis w/o contrast study date of 1. partial colonic obstruction at the right anterior abdominal wall hernia with transverse colon herniated within. it appears that only the anterior wall of the transverse colon is in the hernia but there is torquing of the colon such that the large amount of fluid within the cecum, ascending colon, and proximal transverse colon cannot cross through the torqued transverse colon distal to the hernia. no evidence of bowel compromise at this time. 2. small amount of ascites. unchanged appearance of splenules. left nephrectomy with hypodense lesions in right kidney, as before unchanged. 3. abdominal aortic aneurysm up to 5.5 cm incompletely assessed without intravenous contrast. 4. unusual soft tissue within the presacral space may represent abnormal lymph nodes, however, this is uncertain. attention on followup in three months is recommended, preferably using mri. 5. urinary bladder containing contrast from cta chest more than two days ago suggests some renal insufficiency. small urinary bladder diverticulum. chest (portable ap) study date of in comparison with the study of , there is increased opacification involving the right mid and lower lung zones. this is consistent with increasing pleural effusion and underlying compressive atelectasis. there is again enlargement of the cardiac silhouette with evidence of pulmonary vascular congestion. postoperative widening of the mediastinum is again seen. bronchial brushings procedure date of negative for malignant cells. tbna 11 r procedure date of negative for malignant cells. bronchial epithelial cells. brief hospital course: 82 yo m with h/o copd, as s/p avr, afib, right nephrectomy for rcc, colon ca s/p colectomy. recent admission for pna, re-admission for shortness of breath and fevers. transferred to the micu for hypoxia following bronchoscopy. # acute respiratory distress: patient with shortness of breath worse than baseline upon admission on . then acutely decompensated post-bronchoscopy. based on chext x-ray and recent bronchoscopy most likely mucus plugging worsened by underlying effusion, atelactasis and possible post-obstructive pneumonia. patient has known dvt, but based on significant findings on cxr and current anticoagulation unlikely pe. patient febrile on admission which could be related to recent bronchoscopy, however due to rising leukocytosis, was broadly covered. patient never complained of chest pain to suggest acs and troponins were stably elevated. his acute worsening was thought to be less likely congestive heart failure as cxr findings unilateral and symptoms acute in onset. as below, patient was continued on antibiotics. he was also positioned on left side for improved oxygenation his respiratory status improved with chest pt, use, vibrating vest therapy and acapella therapy. he should continue all these therapies as aggressive pulmonary toilet upon transfer in to the macu. bal results as above. started on advair and spiriva for copd component. # fevers with leukocytosis: during admission, patient was noted to have frequent febrile episodes. initial evaluation included persistant rll/rml opacities. he also had numerous negative blood cultures, urine culture and c. diff x 1. most likely etiology is post-obstructive pneumonia. his fevers resolved with initiation of antibiotics post-broncoscopy on . he was treated broadly for post-obstructive pneumonia with vancomycin, cefepime and flagyl. on his bal studies came back as above with one s.aureus with preliminary findings of intermediate sensitivity to vancomycin. given this, he was transitioned to linezolid. on discharge, he is on day 4 of a total 21 day course of antibiotics. if patient looks markedly improved with decreased oxygen requirements and improved chest x-ray, would consider decreasing course to 14 days. given linezolid, patient will need weekly cbc checks. additionally, please call the microbiology department at ( on , , to follow-up additional studies. # ventral hernia: patient with longstanding ventral hernia. some concern during admission that there be an element of incarceration and ct scan demonstrated partial colonic obstruction. repeat ct scan with overall improvement. upon discharge, hernia easily reduced and without any abdominal pain. # recent gastroentestingal hemorrhage: hct relatively stable with mild intermittent drops. no melena during this admission. given that patient is a high colonoscopy perforation risk due to colonic distension, gi did not perform any endoscopy. he was continued on iv pantoprazole . he was transfused a total of 2u prbc during this admission, the last one on . # dvt: patient with popliteal branch dvt as above. initially placed on a heparing drip and then transitioned to lovenox / warfarin. the day of discharge his inr was therapeutic at 2.2. would recommend daily inr checks for several days given newly on warfarin and newly therapeutic the day of discharge. please elevate the leg as able to decrease swelling and minimize pain. # chronic diastolic chf (ef>55%): with echo results as above concerning for new lv dysfunction. lasix and beta blocker held in the setting low blood pressure. could consider restarting and oral intake improves. # copd: moderate to severe. initially started on nebulizer therapy prn. started on advair and spiriva while inpatient. patient should follow-up with pulmonary as an outpatient for continued management. # atrial fibrillation: rate controlled. off coumadin temporarily given recent gi bleeding. chads2 score is 3 and bioprosthetic valve. echo showed no evidence of thrombus. restarted on anticoagulation as above. also continued on digoxin. while inpatient, metoprolol was held for lower blood pressures in the setting of poor po intake. could consider restarting this as an outpatient if need further rate control and blood pressure tolerates it. # gerd: stable. continued on pantoprazole. # chronic kidney disease: baseline approximately 1.6. elevated to 2.0 on but resolved to 1.4 upon discharge. all medications were renally dosed. # abdominal aortic anuerysm: stable, per vascular surgery will follow-up with dr. as outpatient. # tachycardia: initially attribued to atrial fibrillation with holding of his beta blocker. other considerations included hypovolemia or secondary to infection (pneumonia). given poor oral intake, he was given maintenance fluid and heart rate improved from 120s to low 100s. need further ivf while in macu if oral intake poor. # history of itp: platelets trended and stable during admission. access: picc placed , please discontinue after completion of antibiotic course. line care per general protocols. patient was a full code during his hospital stay. medications on admission: 1. digoxin 125 mcg po daily 2. atrovent 2puff daily 3. albuterol 1puff q4 prn 4. pantoprazole 40 mg daily 5. recently held: warfarin, lasix, metoprol 6. recently completed: flagyl and amoxicillin x 14 days for h. pylori discharge medications: 1. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm. 7. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours) for 18 days. 8. cefepime 2 gram recon soln sig: one (1) recon soln injection q24h (every 24 hours) for 18 days. 9. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q12h (every 12 hours). 10. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 18 days. 11. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) neb inhalation q4hrs prn () as needed for sob, wheezing. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: pneumonia secondary: atrial fibrillation, copd, aortic stenosis discharge condition: good, afebrile, vital signs stable, o2 sats 94% on face tent, ambulates out of bed to chair with assistance, aox3 discharge instructions: you were admitted to hospital on . you had initially presented to a gi appointment where you were found to have a fever, and findings concerning for a pneumonia. you were subsequently sent to the hospital where you were evaluated with a procedure called a bronchoscopy. after this procedure, you were admitted to the medical intensive care unit after the levels of oxygen in your blood were noted to drop. while in the icu, you received a thorough evaluation and multiple treatments for pneumonia. on your condition had improved and you were discharged to the rehab macu for continued physical therapy. . the following changes have been made to your outpatient medication regimen: -started cefepime 2g iv q24 hours. last day of dosing will be -started linezolid 600 mg po/ng, q12h. last day of dosing will be . - started metronidazole 500 mg iv q8h. last day of dosing will be . -started fluticasone salmeterol 250/50, 1 inh -started tiotropium bromide 1 cap inh qd -started senna, 1-2 tabs qd, prn constipation -started docusate 100 mg prn, constipation - stopped lasix - stopped metoprolol - started xoponex nebs, 1 neb q4h prn wheezing or shortness of breath - stopped albuterol nebs - continue digoxin 0.125 mg qd - continue pantoprozole 40 mg qd - continue coumadin 2.5 mg qd, until instructed to change the dose by a physician . please continue regular respiratory treatments with chest pt, use of a cough assist device and acapella device. . it was a pleasure participating in your medical care. followup instructions: please make an appointment to follow-up with dr. from the department of pulmonology at . their office is closed today so an appointment has not been made for you. please call their office at to an appointment within the next 1 month. . you should call your primary care doctor an appointment and discuss this hospitalization with them. your primary care doctor is listed as . please call her office at to an appointment in the next 1-2 months. . you will need to have your inr checked daily to ensure that it remains safely in a therapeutic range. please have your inr checked daily at rehab and physicians can adjust your warfarin level appropriately. . please have a cbc (blood counts) checked weekly to ensure that your hematocrit is stable. . you have the following appointment scheduled with the gastroenterology appointment. provider: , md phone: date/time: 2:00 procedure: venous catheterization, not elsewhere classified closed [endoscopic] biopsy of bronchus biopsy of lymphatic structure diagnoses: pneumonia, organism unspecified anemia, unspecified esophageal reflux congestive heart failure, unspecified acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure personal history of tobacco use chronic kidney disease, unspecified personal history of malignant neoplasm of large intestine nausea alone heart valve replaced by transplant abdominal aneurysm without mention of rupture enlargement of lymph nodes personal history of malignant neoplasm of kidney incisional ventral hernia with obstruction other diseases of trachea and bronchus acute venous embolism and thrombosis of unspecified deep vessels of lower extremity paroxysmal tachycardia, unspecified 

Answer: The patient is high likely exposed to