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: ace inhibitors attending: chief complaint: respiratory distress major surgical or invasive procedure: right internal jugular central line placement flexible bronchoscopy endotracheal intubation history of present illness: pt is a 65 yo vietnamese male w/ a pmh sig for non-small cell endobronchial lung ca s/p rmsb stent (), copd, cri, recent admission for respiratory distress requiring intubation, and chest tube placement x 2 in , who presented to an osh on @ ~1730 with significant tachypnea and tachycardia, requiring 5 l nc to keep sats above 95%. the patient's respiratory status continued to decline and he was placed on bipap and treated with morphine, iv lasix, steroids, ceftriaxone, and azithromycin. the patient's respiratory distress did not resolve and after obtaining an abg of 7.17/74/226, the patient was transferred to for further management. in the ed at , the patient's mental status declined and his hypercarbia worsened considerably with an abg 7.09/121/140 on bipap. shortly after the results of this blood gas were obtained the patient was intubated. he became hypotensive with sbp<60 post-intubation. he was given 1400cc of fluid and started on levophed after a central line was placed in his right femoral vein. his bp subsequently improved to map>60. the patient was further resuscitated with 4 l of ivf in the ed before being transferred to the micu for further medical management. past medical history: 1.non-small cell lung ca dx in s/p rmsb stent , on palliative chemo/radiation therapy. carboplatin q3weeks with 2 weeks off and xrt qweek. 2.htn 3.copd 4.tuberculosis 10 yrs ago tx??????ed in 5.? h/o dvt 6.cri (baseline cr 1.7) 7.chronic b/l le pain and paraesthesia 8.hyperlipidemia 9.anisocoria 10.asthma fev1 0.7 l 11.ef 64%, mild mr, mild diastolic dysfxn 12.h/o mssa pna in social history: pt denies tob or etoh use. family history: gm w/ lung ca. physical exam: vitals on presentation to ed temp 102.4, hr 96, bp 117/72, rr 16 sats 100% on ac fio2 0.5, 500/16 peep 5 gen: intubated, sedated heent: r pupil 2mm reactive, l pupil 4mm reactive, anicteric sclera, mmm, no jvd, no bruits, no lad pulm: coarse rhonchi bilaterally with poor airmovement throughout, prolonged expiratory phase, insp/exp wheezes cv: sinus tachycardia, nl s1/s2 no m/r/g abd: scaphoid, soft, non-distended, +bs ext: no c/c/e skin: no rash physical exam on discharge vs: t 98.7 bp 100s-110s/70s-80s p 80s-100s r 16 96% ra gen: pleasant, cachectic appearing, nad, walking in halls with walker pulm: ctab, occasional rales that clear easily with cough cv: rrr, nl s1/s2, no murmurs appreciated abd: soft, nt/nd, +bs ext: no edema pertinent results: echo study date of conclusions: 1.technically difficult study. 2. the left atrium is normal in size. 3.left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50-55%). 4.right ventricular chamber size is normal. right ventricular systolic function is borderline normal. 5.the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. 6.the mitral valve leaflets are structurally normal. no mitral regurgitation is seen. 7.there is an anterior space which most likely represents a fat pad, though a loculated anterior pericardial effusion cannot be excluded. there is no evidence of rv compression. cxr : compared to the prior film of , the patient has been extubated and the lines have been removed. heart size is normal. extensive scarring is present in both upper lobes with upward retraction of both hila. pleural thickening is present over the right lung apex and there is shift of the trachea to the right. all of these findings are unchanged since the prior film of . similarly, the tenting of both hemidiaphragms and pleural thickening in the right costophrenic angle are unchanged. no pneumothorax and no new lung lesions. 08:50pm blood wbc-25.7*# rbc-4.56* hgb-12.2* hct-38.2* mcv-84 mch-26.8* mchc-32.0 rdw-14.5 plt ct-371 08:50pm blood neuts-93* bands-4 lymphs-1* monos-2 eos-0 baso-0 atyps-0 metas-0 myelos-0 08:50pm blood pt-12.3 ptt-30.6 inr(pt)-1.0 08:50pm blood glucose-223* urean-18 creat-2.1* na-137 k-4.4 cl-94* hco3-29 angap-18 08:50pm blood alt-15 ast-27 ld(ldh)-392* ck(cpk)-80 alkphos-71 totbili-0.3 08:50pm blood lipase-17 08:50pm blood albumin-4.1 calcium-8.6 phos-4.8*# mg-1.8 uricacd-8.3* 05:54am blood cortsol-86.6* 09:58pm blood type-art po2-140* pco2-121* ph-7.09* calhco3-39* base xs-2 12:10am blood glucose-233* lactate-3.1* na-138 k-3.9 cl-110 09:58pm blood freeca-1.20 05:55am blood wbc-4.0 rbc-3.30* hgb-8.8* hct-28.1* mcv-85 mch-26.7* mchc-31.3 rdw-17.4* plt ct-98* 05:54am blood neuts-96.3* bands-0 lymphs-1.6* monos-1.3* eos-0.5 baso-0.3 05:55am blood plt ct-98* 05:55am blood glucose-102 urean-30* creat-1.2 na-141 k-4.1 cl-108 hco3-26 angap-11 04:00am blood alt-19 ast-15 ld(ldh)-195 alkphos-47 totbili-0.3 05:55am blood albumin-3.1* calcium-8.2* phos-3.9 mg-1.9 05:30am blood caltibc-155* ferritn-520* trf-119* 04:00am blood vanco-11.4* bronchoalveolar lavage: 12:48 pm bronchoalveolar lavage gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): oropharyngeal flora absent. staph aureus coag +. rare growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ 8 i levofloxacin---------- 4 i oxacillin------------- 0.5 s penicillin------------ =>0.5 r legionella culture (final ): no legionella isolated. immunofluorescent test for pneumocystis carinii (final ): pneumocystis carinii not seen. poor quality specimen. sensitivity of detection be adversly affected. interpret results with caution. fungal culture (final ): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. acid fast culture (pending): pending at time of discharge 12:48 pm rapid respiratory viral screen & culture rapid respiratory viral antigen test (final ): positive for respiratory syncytial viral antigen. culture confirmation pending. specimen screened for: adeno,parainfluenza 1,2,3 influenza a,b and rsv. this kit is not fda approved for direct detection of parainfluenza virus in specimens; interpret parainfluenza results with caution. reported by phone to dr. 11:35am . viral culture (preliminary): no virus isolated so far. brief hospital course: 1. respiratory distress: the patient's respiratory status was complicated by a number of factors including his underlying copd, diastolic heart failure, lung ca, and suspected infection. the patient has significant co2 retention at baseline with paco2 50-70 and a baseline compensatory metabolic alkalosis with hco3 in the low 30s. the patient was initially intubated in the setting of hypercarbia and impending respiratory failure. he was started on standing albuterol/atrovent mdi's as well as stress dose steroids. on he underwent flexible bronchoscopy with bal at the bedside which demonstrated significant airway edema, thick white secretions but no obstruction. the patient's rms stent was patent. the bal fluid was positive for rsv antigen but no virus was isolated. the gram stain, fungal, afb, and legionella cultures were all negative. due to the patient's poor airway compliance, significant bronchospasm, and anxiety, he developed autopeep on the ventilator calculated to be ~15. this degree of autopeep made it almost impossible for him to trigger the ventilator on pressure support. therefore, the patient's sedation was increased using both fentanyl and propofol in order to decrease the respiratory rate while still on ac and decrease his autopeep. once the patient's autopeep was down to <=5 he was started on ps 16/8. the following day he was able to tolerate ps of and eventually weaned to 5/0. he was successfully extubated on . he remained stable from a respiratory standpoint following extubation, initially requiring a face mask, then oxygen via nasal cannula. he continue to improve with albuterol and atrovent nebulizers and was breathing progressively more comfortably over the next few days on the floor with no significant oxygen need. 2. question of pna: patient's underlying respiratory distress thought secondary to underlying sepsis pna aspiration vs. mssa pna. the patient was placed on vanc/levo/flagyl for empiric coverage of gp/gn/anerobes. he was febrile on admission, but afebrile throughout remainder of icu stay. blood cx drawn on admission and on follow up were negative. of note, rsv antigen was detected in his sputum. the patient's antibiotics were continued until extubation and then discontinued. pt continued to improve and follow up chest x ray showed on showed no new lung lesions. pt was maintained off antibiotics and did not worsen from a respiratory standpoint. 3. sepsis: hypotension likely related to septic shock on admission. patient initially received 4 l of ivf in the ed and 2 l of ivf after arrival to the micu. he initially required pressure support with levophed, but this was weaned off within the first 24 hours. an echo was performed which showed no evidence of pericardial effusion, a normal la, and an ef of 50-55%. he was bolused for low cvp throughout the first several days of his hospital stay such that by the patient was over 13 l positive, but did not show any signs of peripheral edema. the patient was thought to be profoundly intravascularly depleted sepsis, poor nutritional status and poor po intake. he was given lasix 20mg iv x 1 on and subsequent auto-diuresis with additional medication. although he was initially hypotensive, the patient's hr and bp slowly increased such that his hr was in the 90's with sbp>150. he was started on diltiazem which was quickly titrated to 120mg qid for heart rate control. as he improved clinically, the diltiazem was decreased and pt was sent home on 60mg po qid. pt was somewhat tachycardic to 110s on the floor, but this seemed to be more in the immediate post-albuterol nebulizer setting, as well as due to dehydration, as below. pulse taken spaced out from nebs was more in the 80s-90s. 4. copd: severe underlying disease/possible exacerbation in the setting of rsv bronchiolitis complicated the patient's respiratory status. he was maintained on standing albuterol/atrovent treatments and given iv steroids that were changed to po prednisone after extubation. the patient was maintained on a slow prednisone taper due to his severe disease, and was also sent home with albuterol and atrovent nebulizers. 5. acute renal failure: the patient's cr on presentation was 2.1. this improved over the course of his hospital stay to his baseline cr of 1.2, which remained stable over the rest of his hospitalization. 6. non-small cell lung ca: the patient's oncologist was made aware of his admission to the hospital. she met with the family and confirmed the patient's code status as full. prior to admission the patient had received carboplatin treatment. 7. thrombocytopenia: on admission, the patient's platelets were 371. they declined slowly to a nadir of 44. the patient had no signs of bleeding. thrombocytopenia was felt most likely secondary to medication administration (likely secondary to carboplatin, which he received prior to admission; there was also concern over contribution from vancomycin or levaquin, which were discontinued). an hit antibody was sent which was negative. pt's platelets remained stable over the course of the rest of his stay and had even begun to recover, reaching 98 on the day of discharge. this favors the possibility of a drug-induced effect, most likely bone marrow suppression due to carboplatin. 8. cachexia/malnutrition: pt had poor po intake after he was extubated and began to recover. his mental status improved, but he became transiently hypernatremic and required free water repletion. he was started on megace, and uptitrated to 800mg daily, which he said resulted in improved appetite. however, he was still with poor po intake on discharge, which is thought to be due to his malignancy. he was sent out on amitriptyline, which is covered by free care. during the hospitalization, and likely due to poor po intake, pt was dehydrated, with hypernatremia, relative hypotension to sbp 90s, tachycardia to 110s, and a contraction alkalosis. this improved with iv hydration but will likely continue to be problem. 9. hyperglycemia: pt's glucose was often in the 200s. the reasons were thought to be multifactorial, most notably in the setting of infection and then with steroids. he was covered on an insulin sliding scale. however, due to the fact that the steroids will be tapered over the next 1-2 weeks, patient was not given any antihyperglycemic agents for home use. he should have his glucose rechecked by his new primary care physician. 10. mental status: pt required haldol and increased sedation while in the icu, even needing a sitter temporarily. after extubation, his mental status improved, though he was markedly confused over the first 1-2 days. a depression screen revealed no evidence of depression, and pt was back to his baseline per family members. medications on admission: 1. robitussin ac 2. megestrol acetate 3. protonix 40mg qam 4. metoprolol 25mg 5. cozaar 50mg qam 6. gabapentin 100mg tid 7. lipitor 20mg qam 8. prochloperazine 10mg q8prn discharge medications: 1. albuterol sulfate 5 mg/ml nebu soln sig: one (1) nebulizer inhalation every four hours as needed for shortness of breath or wheezing. disp:*180 vials* refills:*2* 2. ipratropium bromide 0.02 % solution sig: one (1) nebulizer treatment inhalation every four (4) hours as needed for shortness of breath or wheezing. disp:*180 vials* refills:*2* 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. atorvastatin calcium 20 mg tablet sig: one (1) tablet po qam (once a day (in the morning)): for cholesterol lowering. disp:*30 tablet(s)* refills:*2* 5. diltiazem hcl 60 mg tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*2* 6. prednisone 20 mg tablet sig: one (1) tablet po daily (daily) for 2 days: take on (wed), (thurs). disp:*2 tablet(s)* refills:*0* 7. prednisone 10 mg tablet sig: one (1) tablet po once a day for 3 days: take on (fri), (sat), (sun). disp:*3 tablet(s)* refills:*0* 8. prednisone 5 mg tablet sig: one (1) tablet po once a day for 3 days: take on (mon), (tues), (wed). disp:*3 tablet(s)* refills:*0* 9. prednisone 1 mg tablet sig: one (1) tablet po once a day for 3 days: take (thurs), (fri), (sat). disp:*3 tablet(s)* refills:*0* 10. amitriptyline hcl 25 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: health vna discharge diagnosis: primary: 1. non-small cell lung cancer 2. hypercarbic respiratory failure 3. tachycardia 4. chronic obstructive pulmonary disease 5. rsv antigen positive 6. septic shock, resolved 7. chronic kidney disease secondary: 1. thrombocytopenia, likely chemotherapy-induced 2. hypertension 3. peripheral neuropathy 4. cachexia with poor oral intake 5. history of tuberculosis, treated over 10 years ago 6. hyperlipidemia 7. history of melena 8. anisocoria discharge condition: stable, tolerating po, breathing well. cough has improved with decreased sputum production; patient is able to ambulate well without assistance. discharge instructions: please follow up with dr. , your new pcp, take all of your medications as instructed. you are on a prednisone taper, which means that the doses will change every couple of days. please look at the instructions carefully and take the proper dose on the specific dates noted. please measure your blood pressure at home. the vna will talk about arranging for you to have a blood pressure cuff at home. if you have shortness of breath, chest pain, or any other symptom that is concerning to you, please call your primary care doctor or go to the nearest emergency room. followup instructions: provider: , md where: phone: date/time: 1:50 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus transfusion of packed cells infusion of vasopressor agent diagnoses: acute kidney failure, unspecified unspecified septicemia severe sepsis obstructive chronic bronchitis with (acute) exacerbation acute and chronic respiratory failure pneumonitis due to inhalation of food or vomitus cachexia septic shock methicillin susceptible pneumonia due to staphylococcus aureus hyperosmolality and/or hypernatremia unspecified hereditary and idiopathic peripheral neuropathy diastolic heart failure, unspecified malignant neoplasm of main bronchus personal history of tuberculosis acute bronchiolitis due to respiratory syncytial virus (rsv) 

Answer: The patient is high likely exposed to