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: lactose attending: chief complaint: low back pain, shortness of breath major surgical or invasive procedure: thoracentesis pigtail pleural catheter placement history of present illness: the patient is a 74m who presented to the ed with back pain. he has had three mechanical falls in the past two weeks. he has had difficulty ambulating secondary to pain. he denied fevers, chills, chest pain, cough or cold symptoms, nausea, vomiting, abdominal pain, and dysuria though does endorse worsened dyspnea. on arrival to the ed, he triggered for hypoxia to 88% which improved with supplemental oxygen. a head ct was negative, cxr showed pna in rll and ct torso showed a loculated effusion and compression fractures. he was started on vanc and zosyn and 1l ns. he was also given morpinge 4mg iv and percocet. spine was consulted for the compression fractures and recommended a tlso brace and an mri on a non-urgent basis. past medical history: bph anemia dyspepsia weight loss atrial flutter diagnosed in , s/p ablation in vitamin d deficiency dmii mds colonic adenomas h/o sigmoid diverticulitis. h/o basal cell carcinoma. h/o left hip fracture, status post orif in . social history: retired, lives with wife. denies any alcohol. is currently smoking tobacco pipes, 50y history. denies any other illicit drug use. family history: maternal aunt with diabetes. there is no family history of premature coronary artery disease, arrhythmias, or sudden death. physical exam: physical exam on admission: general - cachectic male appearing older than stated age heent - nc/at, perrla, eomi, sclerae anicteric, dry mucous membranes with poor dentition neck - supple, no thyromegaly, no jvd, no lymphadenopathy lungs - bronchial on right heart - pmi non-displaced, rrr, no mrg, nl s1-s2 abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps) skin - no rashes or lesions lymph - no cervical, axillary, or inguinal lad neuro - awake, a&ox3, cns ii-xii grossly intact physical exam on discharge - unchanged from above except for: heent - moist mm lungs - mild crackles and bronchial breath sounds in the right lung base. pertinent results: labs on admission: 08:21pm blood wbc-27.6*# rbc-3.48* hgb-9.2* hct-30.7* mcv-88 mch-26.3* mchc-29.8* rdw-17.3* plt ct-179 08:21pm blood neuts-85* bands-1 lymphs-3* monos-6 eos-0 baso-0 atyps-0 metas-2* myelos-2* nrbc-1* other-1* 08:21pm blood pt-13.3 ptt-27.4 inr(pt)-1.1 08:21pm blood glucose-140* urean-36* creat-1.1 na-139 k-4.2 cl-101 hco3-29 angap-13 08:21pm blood alt-35 ast-71* alkphos-373* amylase-51 totbili-0.3 03:43am blood totprot-6.1* albumin-2.3* globuln-3.8 calcium-10.6* phos-3.7 mg-2.0 03:43am blood pth-6* 08:26pm blood lactate-3.8* k-4.4 02:53am blood lactate-2.3* 04:42am pleural wbc-* rbc-1625* polys-97* lymphs-3* monos-0 04:42am pleural totprot-4.2 glucose-15 ld(ldh)-2507 05:44pm pleural wbc-* rbc-2500* polys-94* lymphs-2* monos-4* 05:44pm pleural totprot-3.1 glucose-2 ld(ldh)-2393 cholest-44 blood culture and : pending 2:40 am sputum source: expectorated. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): sparse growth commensal respiratory flora. 4:42 am pleural fluid gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (preliminary): no growth. anaerobic culture (preliminary): no growth. legionella antigen: negative 5:44 pm pleural fluid pleural fluid. gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (preliminary): no growth. anaerobic culture (preliminary): images: -cxr : small residual of right pleural effusion has remained stable since insertion of the pigtail pleural drain at the base of the lung. consolidation primarily in the right lower lobe, to a lesser degree anterior segment of the right upper and middle lobes is improving. infrahilar atelectasis in the left lower lobe, however, is worsening. heart size normal. normal pulmonary vasculature. no edema. no pneumothorax. -ct head : no acute intracranial process -cxr (): 1. no evidence of pneumothorax following right pigtail pleural catheter removal. 2. improving mass-like consolidation in right lower lobe consistent with pneumonia. 3. small pleural effusions, right greater than left. -abd us (): no evidence of gallstones or biliary dilatation. splenomegaly. ascites. ekg at admission: sinus tachy, lad, q waves v1-2 discharge labs: 03:07pm blood pth-7* 04:55am blood vitamin d dihydroxy-24 (nl) 06:56am blood parathyroid hormone related protein-negative 03:43am blood vitamin d 25 hydroxy- 27 06:25am blood wbc-5.6 rbc-3.04* hgb-7.8* hct-26.1* mcv-86 mch-25.8* mchc-30.0* rdw-18.1* plt ct-221 06:25am blood glucose-76 urean-16 creat-1.0 na-140 k-3.8 cl-103 hco3-32 angap-9 06:25am blood calcium-8.7 phos-2.7 mg-2.4 brief hospital course: 74 year old male with history of mds, weight loss of 70-80 pounds, multiple falls, diabetes mellitus, who presented for low back pain, found to have multifocal pneumonia and complicated parapneumonic effusion. #) pneumonia with complicated parapneumonic effusion/loculation: on admission to the micu he had a thoracentesis and 1l of cloudy non-purulent fluid was drained. he was initially covered broadly with vanc/zosyn/levofloxacin. on , he had an additional throacentesis with chest tube placement by ip. there was concern for aspiration versus community acquired pna. once legionella antigen was negative levofloxacin was discontinued. early in the hospitalization, he had occasional desaturations overnight which required oxygen via facemask. this was not occurring for the 5-6 days prior to discharge. at time of discharge, he had completed a 9 day course of antibiotics and will not need further antibiotics. clinically, his breathing was improved at discharge, he was maintaining good oxygen saturation on room air and there was no reaccumulation of the pleural effuion on repeat cxr. #) leukocytosis: persistent in the in the high 20's on admission, but decreased to normal range at the time of discharge. increased wbc likely secondary to his pneumonia. c. diff was negative x3. #) hypercalcemia: given unintentional weight loss of 70-80 lbs and smoking history, there is concern for malignancy. pth was appropriately low at 7. 1,25-oh-vitd was normal and pthrp was also negative. skeletal survey did not show evidence of lytic lesions, only suggestive of osteoporotic changes. he was given a dose of pamidronate 60mg on and his calcium level decreased to the normal range. a urine n-telopeptide was sent and was elevated, suggesting some process leading to increased bone turnover. paget's is another possible explaiantion given elevated alk phos and calcium, no evidence of paget's on skeletal survery per radiology. had a bone scan in which also did not show evidence of paget's. #) weight loss: psa was 0.5 in . per pt he had a normal colonoscopy last year. as mentioned above, no obvious cause despite negative pet/ct as well as negative bone marrow biopsy prior to admission. has follow-up with hematology/oncology arranged. #) pain control: he was treated with acetaminophen 1g q8h, toradol 15 mg iv q8h for three days, lidocaine patch, morphine sulphate prn, oxycodone prn. a tlso brace was placed. mri showed compression fracture in l1 and l2, recommended follow-up in 4 weeks. at discharge, pain well controlled only on prn tylenol and lidocaine patch, not requiring narcotics. #) dm: metformin was held and he was covered with insulin sliding scale. blood sugars remained well controlled during admission and he will be restarted on metformin at discharge. #) diarrhea: had diarrhea during this admission with 4-5 bms per day. c. diff was negative x3. it is thought that he had antibiotic-associated diarrhea which should improve at discharge now that he is off antibiotics. also encouraged yogurt to improve the diarrhea. #) code status during this admission: full code trnasitional issues: -follow-up mri in 4 weeks from to follow-up on lumbar compression fractures -ongoing work-up for weight loss and hypercalcemia, as described above -emailed pt's hemotologist who is aware of weight loss and has talked with pcp regarding concern for malignancy -received pamidronate 60mg iv on , would be due for this every month if ongoing therapy with bisphosphonates is desired medications on admission: lisinopril - (prescribed by other provider) - 5 mg tablet - one tablet(s) by mouth daily metformin - (prescribed by other provider) - 500 mg tablet - one tablet(s) by mouth twice a day pravastatin - (prescribed by other provider) - 20 mg tablet - one tablet(s) by mouth daily medications - otc aspirin - (prescribed by other provider) - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day calcium carbonate - (prescribed by other provider) - dosage uncertain cholecalciferol (vitamin d3) - (prescribed by other provider) - 1,000 unit tablet, chewable - one tablet(s) by mouth daily discharge medications: 1. miconazole nitrate 2 % powder sig: one (1) application topical three times a day: apply to buttocks. 2. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 3. metformin 500 mg tablet sig: one (1) tablet po twice a day. 4. pravastatin 20 mg tablet sig: one (1) tablet po once a day. 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day. 6. cholecalciferol (vitamin d3) 1,000 unit capsule sig: one (1) capsule po once a day. 7. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup sig: five (5) ml po every six (6) hours as needed for cough or chest congestion. 8. fleet enema 19-7 gram/118 ml enema sig: one (1) enema rectal once a day as needed for constipation. 9. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection three times a day. 10. duoneb 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: one (1) neb inhalation every four (4) hours as needed for shortness of breath or wheezing. 11. lidoderm 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) patch topical once a day: apply to l1-l2 area. 12 hours on, 12 hours off. 12. pamidronate 60 mg/10 ml (6 mg/ml) solution sig: sixty (60) mg intravenous once a month: last given . 13. aluminum-magnesium hydroxide 200-200 mg/5 ml suspension sig: five (5) ml po four times a day as needed for indigestion. 14. acetaminophen 650 mg tablet sig: one (1) tablet po every four (4) hours as needed for pain. discharge disposition: extended care facility: rehabilitation & care center - discharge diagnosis: primary: aspiration pneumonia lumbar compression fracture rib fractures hypercalcemia secondary: diabetes mellitus myelodysplastic syndrome discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , it was a pleasure taking care of you during your hospitalization at . you were admitted with low back pain, for which we found that you had a new compression fracture. orthapedics did not recommend surgery and instead placed you in a special type of brace. you also presented with shortness of breath and oxygen saturation. we discovered that you had a pneumonia, for which we treated you with two different intravenous antibiotics. we also placed a tube to drain some of the fluid that had accumalated in the pneumonia. at discharge, you were breathing more comfortably and do not need any more antibiotics after discharge. your calcium level was found to be elevated. we did not find a cause for this, although you have had an extensive work-up priot to this admission which also did not find a cause. you were given pamidronate and your calcium level improved, this medication should be given every month. you also had significant diarrhea, which was negative for the infection c. diff 3 times. it is likely related to the antibiotics, which we have stopped now. eating foods like yogurt can help improve your symptoms, and you should feel better now that the antibiotics are stopped. medication changes: start guaifenesin-dextromethorphan 5ml by mouth as needed for cough start pamidronate 60mg iv every month (last given ) start lidoderm patch 1 patch apply to l1-l2 area, on for 12 hours and off for 12 hours. start duonebs 1 nebulizer every 4 hours as needed for shortness of breath of chest tightness start miconazole powder 1 application to buttocks and groin three times daily followup instructions: pcp appointment to be arranged by rehab department: hematology/oncology when: friday at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: insertion of intercostal catheter for drainage thoracentesis diagnoses: thrombocytopenia, unspecified tobacco use disorder unspecified pleural effusion unspecified fall hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) myelodysplastic syndrome, unspecified other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus loss of weight cachexia alkalosis diarrhea closed fracture of one rib closed fracture of lumbar vertebra without mention of spinal cord injury hypercalcemia history of fall unspecified antibiotic causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to