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: sulfa or amoxicillin attending: chief complaint: hypoxia major surgical or invasive procedure: r ij placement history of present illness: 87yo male w/ ischemic cardiomyopathy with an ef of 45% s/p ppm/aicd placement in for av block, htn, and possible sarcoidosis who presents with two days of shortness of breath. presents with worsening breathing since yesterday. family reports a mechanical fall onto bottom yesterday. has not been altered since. just worse breathing over course of 24-48 hours. no fevers, chest pain or worsening pedal edema. was at clinic for foley placement with urology for urinary retention and noted to be tachypneic, breathing in the 30s. sent here for further eval. has been off of metoprolol b/c of hypotension. . he has had multiple recent admissions. on admission from to , patient presented with acute onset shortness of breath with productive of whitish sputum without fever or leukocytosis, felt to be consistent with bronchiectasis flare. sxs resolved overnight so pt was discharged on ciprofloxacin to be completed on . to he was admitted for hyopxia that improved while on bipap. that time he was found to have a dvt and was presumed to have a pe, started on lovenox bridge to coumadin. treated for pna with vanc/cefepime, then levofloxacin. . in the ed, initial vs were: 97.8 120 110/70 28 100% 10l. crackles at l lung base, mild wheeze. afebrile. portable cxr looked okay. bnp up to 939. pressures into 80s, responded to 500ccs of fluid. tachycardic to 130s, down to 110 with fluid. ua negative. down to venti mask, dipped down to 90 with nasal cannula. ordered for vanc/zosyn. full code. prior to transfer, patient became hypotensive to the 80s. a cvl was placed, given 1l ns and started on levophed. cta looked like aspiration pneumonia. . on arrival to the micu, patient denies pain. per his wife he is 'not himself'. he is exasperated with being in the hospital. past medical history: bradycardia - with primary av block s/p aicd and pacer placement recurrent urethral strictures childhood infection mild systolic dysfunction - ef of 40-45% on echo in chronic , congestion and hoarseness with referral forpossible sarcoidosis. chronic sinusitis. osteoarthritis. right knee surgery. repeated hypoxia episodes from ?bronchiectasis flares social history: denies smoking, alcohol use, recreational drug use. lives at home with wife. family history: father died of cva; sister has . physical exam: admission physical exam: general: alert, oriented, no acute distress though mildly tachypneic heent: sclera anicteric, dry mucous membranes, oropharynx clear, eomi, perrl neck: supple, jvp flat, no lad cv: tachycardic but regular, normal s1 + s2, slight systolic murmur loudest at apex. no rubs, gallops lungs: diffusely rhonchurus with good air movement abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. 1+ pitting edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation . discharge physical exam: vitals: 98.1/98.1 132/60 61-109 20 96-99% 2l general: elderly m who appears short of breath, aaox3 heent: perrl, eomi, dry mms, eyes closed neck: supple, no jvd cardiac: rrr s1 s2 no r/m/g lungs: ctab. no c/w/r. : sntnd +bs no hsm extrem: 2+ pulses ble, no c/c/e skin: bruises on bue pertinent results: admission labs: wbc-12.2* rbc-3.61* hgb-11.5* hct-32.9* mcv-91 mch-31.7 mchc-34.9 rdw-14.6 neuts-87.5* lymphs-5.9* monos-3.8 eos-2.3 basos-0.5 pt-32.7* ptt-44.1* inr(pt)-3.2* probnp-939* ctropnt-0.07* glucose-107* urea n-19 creat-1.3* sodium-133 potassium-3.9 chloride-94* total co2-30 anion gap-13 lactate-1.6 urine: blood-sm nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg rbc-18* wbc-5 bacteria-none yeast-none epi-<1 abg: type-art temp-36.7 po2-184* pco2-49* ph-7.42 total co2-33* base xs-6 intubated-not intuba comments-ventimask . discharge labs: wbc-8.5 rbc-3.24* hgb-10.1* hct-30.9* mcv-95 mch-31.2 mchc-32.7 rdw-14.4 plt ct-223# pt-27.1* inr(pt)-2.6* glucose-90 urean-13 creat-0.9 na-137 k-4.9 cl-103 hco3-22 angap-17 calcium-9.1 phos-2.5* mg-2.1 . other pertinent labs: tsh-0.44 free t4-1.4 cortsol-35.2* . cta chest with/without reconstruction (): 1. peribronchovascular ground-glass and more consolidative opacities in the left lower lobe are concerning for aspiration pneumonitis/pneumonia. 2. predominantly central bronchial wall thickening bilaterally is likely related to chronic aspiration or bronchitis. 3. stable right middle lobe pulmonary nodule, as described above. . chest x-ray (): there is a left-sided pacemaker with dual leads, which is stable. there is a right ij central venous line with the distal lead tip at the cavoatrial junction, stable. there has been poor inspiration since the previous study, with crowding of the pulmonary vascular markings. there is prominence of the vasculature consistent with moderate pulmonary edema. there is a developing left retrocardiac opacity which may represent areas of confluent edema versus developing consolidation. closer attention to this area is recommended on subsequent exams. . ekg (): tachycardia at 125bpm with pr 196 . echo: the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with inferior and infero-lateral hypokinesis. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the level. 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. the mitral valve leaflets are elongated. there is mild bileaflet mitral valve prolapse. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , no major change. brief hospital course: 87 yo m with h/o ischemic cardiomyopathy (ef 45%) s/p ppm/aicd placement in for av block, htn, and possible sarcoidosis with h/o numerous recent admissions for dyspnea who was admitted with dyspnea, hypoxemia and hypotension, found to have pneumonia. . #.pneumonia: patient with recurrent admissions for hypoxemia/pneumonia over the past several months. chest ct revealed peribronchovascular ground-glass and more consolidative opacities in the left lower lobe concerning for aspiration pneumonitis/pneumonia. no pulmonary embolism detected. he was initially treated with vanco/zosyn while in micu, then narrowed to zosyn due to suspicion for aspiration pneumonia. he was then further narrowed to po augmentin. video swallow study showed some risk for aspiration, but no aspiration events, making aspiration pneumonia less likely. given the above as well as concern for possible augmentin allergy (rash), antibiotic was switched to levoquin to cover for cap. although he is at risk for hcap, he remained afebrile with normal wbc count and clinically improving on levoquin. he will complete 7 day antibiotic course. of note, his oxygen sats were in the high 90s on room air for the most part while on the floor, but he desatted to 86% on ambulation and appeared more comfortable when using 2l supplemental oxygen. therefore he was discharged with supplemental oxygen for comfort. he refused rehab placement, and insisted on going . he will receive home pt to address deconditioning, and is recommended to continue regular diet but with close observation during meals as he tends to be inattentive while eating which puts him at risk for aspiration. . #.hypoxia: likely pneumonia (see above). patient also has chronic and congestion for which etiology has been potentially considered to be sarcoidosis in past. chest ct did show changes c/w chronic bronchitis. he received prn nebs during hospitalization. also received fluids and lasix held while in micu, so considered volume overload as an etiology; home lasix 40mg po daily was restarted on transfer to the floor with excellent urinary output response. he was weaned to room air before transfer to the floor, and was generally satting in high 90s on room air while on the floor, with occasional desats as noted above. discharged with home oxygen because of episodic desaturation. . #.history of dvt/pe: patient was continued on warfarin. inr was initially subtherapeutic to 1.8 (no e/o pe on cta chest) so warfarin was increased to 3.5mg daily. inr will be followed by his pcp, drawn by vna. . #.code status: while patient was in micu, he initially expressed desire to be made dnr/dni and potentially transition to do not hospitalize. on transfer to the floor, this conversation was re-initiated and on further discussion patient clarified that he did indeed want to be dnr/dni, but that he would want all other therapeutic measures to be taken were he to become sick again. a family meeting including the palliative care and social work teams was held to discuss code status. healthcare proxy is his wife ; she was present for and involved in all discussions. his pcp was by email and encourage to further this discussion with patient and his hcp. medications on admission: 1. finasteride 5 mg daily 2. furosemide 40 mg daily 3. metoprolol tartrate 12.5mg 4. rosuvastatin 20 mg daily 5. potassium chloride 20 meq tablet qod 6. sertraline 25 mg daily 7. tamsulosin 0.4 mg qhs 8. aspirin 81 mg tablet daily 9. multivitamin daily 10. calcium carbonate 200 mg calcium (500 mg) 11. aleve 220 mg prn pain 12. terazosin 5 mg qhs 13. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for nasal congestion. 14. ofloxacin 0.3 % drops qid 15. fluticasone 50 mcg/actuation nasal spray daily 16. levofloxacin 750 mg until 17. warfarin 4 mg as instructed 18. lovenox 110mg daily until yesterday 20. albuterol sulfate 2.5 mg /3 ml (0.083 %) nebs q6hrs 21. guaifenesin 50 mg/5 ml q6hrs prn discharge medications: 1. outpatient lab work please check inr on and fax to dr. at . 2. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 6. levofloxacin 750 mg tablet sig: one (1) tablet po daily (daily) for 5 days: first day = last day = . disp:*5 tablet(s)* refills:*0* 7. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm. 8. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 9. rosuvastatin 40 mg tablet sig: one (1) tablet po once a day. 10. sertraline 25 mg tablet sig: 0.5 tablet po daily (daily). 11. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po twice a day. 12. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day). 13. ofloxacin 0.3 % drops sig: three (3) otic four times a day. 14. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). 15. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation every four (4) hours as needed for wheeze/sob. 16. guaifenesin 50 mg/5 ml liquid sig: one (1) po every six (6) hours as needed for . 17. home oxygen please dispense home oxygen continuously at 2 liters/min. = 99. diagnosis = pneumonia discharge disposition: home with service facility: family & services discharge diagnosis: 1. pneumonia 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 participating in your care at . you were admitted to the hospital with difficulty breathing and low blood pressure. you were found to have pneumonia, and were started on antibiotics. your symptoms improved, but you will be discharged with supplemental oxygen in case you feel short of breath in the future. while you were here, you also clarified that should you become much sicker in the future, your wishes are not to be intubated or to receive cpr or defibrillation (electrical shock) to restart your heart. . please attend the follow-up appointment listed below with your primary care doctor to follow up on this hospitalization. . we made the following changes to your medications: (1) started levoquin 750mg by mouth daily for 7 days (first day = , last day = ) (2) decreased warfarin to 2mg by mouth daily (dose will be adjusted based on your inr blood test, to be followed by dr. (3) stopped your metoprolol tartrate 12.5mg by mouth twice daily -- please discuss with dr. whether this should be restarted. (4) stopped potassium chloride followup instructions: department: when: friday at 2:00 pm with: , md building: (, ma) campus: off campus best parking: on street parking this appointment replaces the one scheduled for due to your hospitalization. the appointment above is a longer appointment. department: rheumatology when: thursday at 2:00 pm with: , md building: lm bldg () campus: west best parking: garage department: cardiac services when: friday at 11:30 am with: device clinic building: sc clinical ctr campus: east best parking: garage procedure: central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified congestive heart failure, unspecified unspecified septicemia sarcoidosis hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) sepsis other specified forms of chronic ischemic heart disease other shock without mention of trauma chronic systolic heart failure long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ do not resuscitate status hypovolemia bronchiectasis without acute exacerbation benign essential hypertension bacterial pneumonia, unspecified chronic pulmonary embolism chronic venous embolism and thrombosis of unspecified deep vessels of lower extremity 

Answer: The patient is high likely exposed to