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: shortness of breath, increased oxygen requirement major surgical or invasive procedure: endotracheal tube placement central venous line arterial line history of present illness: mr. is a 76 male admitted to micu with acute worsening of baseline shortness of breath since this morning. he is a 76 year old male with pulmonary fibrosis on 2l of oxygen at night and with exertion, cad recently admitted with presumed idiopathic pulmonary fibrosis exacerbation started on steroid taper and discharged to pulmonary rehab now transferred from osh ed with acute onset of air hunger and feeling of suffocation since this morning which prompted him to increase his usual supplemental oxygen to 4lnc. reports he had been feeling much improved until awakening this morning with acute onset of sob. also reports cough productive of yellow blood tinged sputum and subjective fevers and chills with temp to 102 at osh and post-tussive emesis x 3. at osh, vs 104/57 hr 130 rr35 85%ra->100% nrb. abg on 100% 7.47/32/73/23. wbc 18. he received ceftriaxone, azithro, solumedrol 125mg iv, protonix 40mg, compazine 10mg and tylenol 1g with subsequent improvement in symptoms. . this presentation similar to previous admission 1 month ago except sob much more severe. denies current leg pain but did have right calf cramping this am when at osh ed x 2 hours now resolved. denies chest pain, palpitations, myalgias, sick contacts, n/v/d, abdominal pain, dysuria. . in our ed, initial vs were: 98.4 70 98/58 20 95%nrb with desats to 88% on 6l. patient was given vancomycin 1g iv and 1l ns for tachycardia, prerenal azotemia. cxr consistent with new rml/rul infiltrate and he was admitted to micu. wbc 14.7 and lactate 1.1. . on the floor, he feels much better, is requesting diet and reports sob back to baseline but is unsure which intervention has helped him. past medical history: cad angioplasty and stenting of the distal lcx spinal stenosis idiopathic pulmonary fibrosis colonic adenomas inguinal hernia hyperlipidemia diverticulosis gerd meralgia paresthetica hypertension bph social history: patient lives alone and has daughter who lives nearby. farsi-speaking, recently visited family in 2 months prior. patient has a 25 pack-year history and quit over 35 years ago. no alcohol. no pets. no vna services but daughter check on patient and lives nearby. he is separated from his wife. has four children and two grandchildren, with two of his children living in the area. formerly worked in iron furniture factory. family history: non-contributory physical exam: on admission vitals: t: bp: p: r: 18 o2: general: alert, oriented x 3 but does not recall details of transfer, tachypneic but appears comfortable, using accessory muscles, speaking in full sentences heent: sclera anicteric, mm dry, oropharynx clear neck: supple, jvp 6cm, no lad lungs: bibasilar dry crackles with coarse wet crackles/rhonchi with egophony right mid lug field. no wheezes cv: distant. regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, + clubbing. 2+ pulses, no cyanosis or edema on discharge general: alert, oriented x 3, farsi speaking heent: sclera anicteric, mm dry, oropharynx clear neck: supple, without jvp, no lad lungs: bibasilar dry crackles without crackles, rhonchi or wheezes cv: distant. regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, + clubbing. 2+ pulses, no cyanosis or edema pertinent results: labs on admission: wbc-14.7* rbc-4.05* hgb-13.4* hct-39.0* mcv-96 rdw-16.3* plt ct-175 neuts-96.4* lymphs-1.7* monos-1.0* eos-0.8 baso-0.2 pt-13.3 ptt-21.9* inr(pt)-1.1 glucose-145* urean-24* creat-1.2 na-132* k-4.0 cl-98 hco3-23 angap-15 alt-19 ast-30 ld(ldh)-394* ck(cpk)-61 alkphos-69 totbili-0.6 albumin-3.1* calcium-8.0* phos-4.2 mg-2.2 blood lactate-1.1 . labs throughout stay: 02:14am blood wbc-7.6 rbc-2.88* hgb-9.5* hct-28.1* mcv-98 mch-33.2* mchc-34.0 rdw-15.5 plt ct-167 03:43am blood glucose-132* urean-42* creat-0.8 na-137 k-4.3 cl-104 hco3-28 angap-9 03:12am blood type-art temp-36.7 po2-71* pco2-36 ph-7.50* caltco2-29 base xs-4 intubat-not intuba . other labs: 07:44pm blood ck-mb-notdone ctropnt-0.05* probnp-146 02:56am blood ck-mb-notdone ctropnt-0.05* 11:36am blood ck-mb-notdone ctropnt-0.02* . micro: urine culture negative urine legionella antigen negative blood culture x 2: no growth to date 4:02 pm urine no growth 10:50 am mini-bal gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. . other studies: cxr: ill-defined areas of opacity in the right upper and right mid lung zones which could represent developing pneumonia or alternatively represent atelectasis from lower lung volumes compared to previous studies. clinical correlation is recommended. ble u/s: no evidence of deep vein thrombosis in either leg. brief hospital course: this is a 76m with ipf recently admitted with presumed ipf exacerbation now a/w acute worsening sob, hypoxemia, fever, possible right infiltrate consistent with health care pneumonia vs exacerbation of ipf. . # respiratory failure: the likely cause was due to ipf exacerbation vs pneumonia. the patient presented with sob, increased oxygen requirement associated with fever, chills and leukocytosis. the patient had a cxr which was concerning for pneumonia or worsening of fibrotic lung disease. the patient was treated for health care associated pneumonia with cefepime, ciprofloxacin and vancomycin for an 8 day course. he was also given steroids and oral nac for his interstitial pulmonary fibrosis. the patient subsequently desaturated while ambulating and required intubation for hypoxemic respiratory failure. he was intubated for 7 days and extubated after diuresis. post extubation the patient was maintained on high flow oxygen mask with continued diuresis, however, he was not able to tolerate significant weaning of his oxygen. post extubation the patient developed leukocytosis and sputum production which was again suspicious for pneumonia. the patient was empirically treated with zosyn and ciprofloxacin for a 14 day course which started . . # sedation: at the time of intubation, the patient was maintained on propofol, versed, and fentanyl with daily wakenings. the patient required paralytics due to dysynchrony from the ventilation. these were quickly discontinued. sedation was easily weaned prior to extubation. . # leukocytosis: the patient had leukocytosis on admission which was either secondary to steroids or infection. the patient's fevers resolved early in his admission and cultures were not revealing of an etiology. the patient was treated multiple courses of antibiotics for possible health care associated pneumonia. no cultures were positive during his stay. leukocytosis resolved during his admission. . # hypotension: the patient became hypotensive with sbps to 80's with a hr in the 50's and low uring output. the patient was given ivf and the hypotension resolved. . # bradycardia: the developed bradycardia to hr 30s while he was sedated. the likely cause of the bradycardia was fentanyl. following weaning of fentanyl the bradycardia resolved. he maintained good urine output with warm extremities during his episodes of bradycardia. . # normocytic anemia: hct was 39 atthe time of admission. this decreased to the low 30's. the likely etiology was hemoconcentration from dehydration with underlying anemia of chronic disease from ipf. there was no signs of acute bleed throughout his stay, all stool was guaiac negative. labs for hemolysis are pending, b12 and folate were within normal limits. . # htn: initially the patient was hypotensive and his imdur was held. after extubation the patient became hypertensive. he was restarted on his home medications. . # high tube feed residuals and constipation: the patient had high tube feeds during his stay. a kub was done which was negative for obstruction. the patient was given a bowel regimen with resolution of his residuals. . # anxiety/agitation: the patient has a history of anxiety. he was treated with lorazepam 0.5 mg q6h prn with good effect. . # ipf: methylprednisolone was started at 180 mg iv daily and tapered to 40mg iv daily for ipf exacerbation. the patient had improvement of his clinical picture, however, without complete return to his prior baseline. he was started on bactrim prophylaxis and continued on his po nac regimen. . # hematuria: the patient had blood in multiple ua, with negative leukocyte esterase and nitrite. multiple urine cultures were sent, all of which were negative. the likely etiology was mechanical injury in the setting of a foley. . # hyponatremia: at the time of admission, his hyponatremia was likely hypovolemic hyponatremia given dry appearance on exam. he was given ivf ns, with improvement of sodium to normal range. . # cad: continued asa, plavix, and imdur with holding parameters. . # gerd: changed home ppi to h2 blocker. . # fen: following intubation, he was maintained with tube feeds. after extubation, his diet was advanced to a thickened liquids, medications crushed in puree, which he has tolerated well. a swallow re-evaluation is recommended before advancing diet. hyperglycemia was managed with insulin sliding scale. . # prophylaxis: subcutaneous heparin, h2 blocker as per above. . # social: a family meeting was held with the patient and his children through farsi interpreter to describe that his ipf had likely progressed and it was unclear if his functional status would significantly improve. the family did not wish to reconsider full code status at that time. . medications on admission: 1. aspirin 325 mg daily. 2. atorvastatin 40 mg. 3. plavix 75 mg daily. 4. isosorbide mononitrate 60 mg daily in the morning. 5. nac 600mg po tid 6. currently prednisone 10mg po bid. discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. disp:*qs tablet, delayed release (e.c.)(s)* refills:*0* 2. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*qs tablet(s)* refills:*2* 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*qs tablet(s)* refills:*2* 4. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day): take if no bowel movement for 1 day. disp:*qs * refills:*2* 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*qs tablet(s)* refills:*0* 6. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for if no bm in 1 day: take if no bowel movement for 1 day. disp:*qs ml(s)* refills:*0* 7. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). disp:*qs tablet(s)* refills:*2* 8. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. disp:*qs ml(s)* refills:*0* 9. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*qs tablet(s)* refills:*2* 10. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*qs tablet sustained release 24 hr(s)* refills:*2* 11. hydrocodone-acetaminophen 5-500 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for cough. disp:*qs tablet(s)* refills:*0* 12. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. disp:*qs ml(s)* refills:*0* 13. ipratropium bromide 0.02 % solution sig: one (1) inhalation q4h (every 4 hours) as needed for wheeze. disp:*qs * refills:*0* 14. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for wheeze. disp:*qs * refills:*0* 15. acetylcysteine 20 % (200 mg/ml) solution sig: three (3) ml miscellaneous q8h (every 8 hours). disp:*qs ml* refills:*2* 16. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 17. lorazepam 0.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety. disp:*qs tablet(s)* refills:*0* 18. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 19. ondansetron 4 mg iv q8h:prn nausea 20. methylprednisolone sodium succ 20 mg iv bid start: 21. piperacillin-tazobactam 4.5 g iv q8h 22. ciprofloxacin 400 mg iv q12h discharge disposition: extended care discharge diagnosis: hypoxemic respiratory failure idiopathic pulmonary fibrosis hypotension leukocytosis constipation bradycardia anxiety hypertension bradycardia hematuria hyponatremia secondary: normocytic anemia cad gerd discharge condition: fair. interval increase in oxygen requirement from 2 l nasal cannula to high flow oxygen, with stable oxygen saturation. discharge instructions: you were admitted to for shortness of breath and fevers. you developed low levels of oxygen in your blood and you were placed on a ventilator to support your breathing. it is likely that your difficulty of breathing was from a worsening of your idiopathic pulmonary fibrosis or an infection. you were treated with antibiotics and steroids and were able to be taken off the ventilator. you are still requiring an oxygen mask to get enough oxygen into your blood. you are being transferred to icu for continued care of your respiratory distress. . after discharge, you should continue solumedrol as directed by your pulmonologist, dr. . you were started on antibiotics named cefepime and ciprofloxacin. you will take these for 12 more days. you should continue taking your bactrim as well. all other discharge medications should be taken as directed. . please attend your follow up appointments as listed. . after discharge from , please contact your pulmonologist or present to an emergency department if you develop worsening shortness of breath, fevers, increasing sputum production, chest pain or any other symptoms that you find concerning. followup instructions: provider: , md phone: date/time: 1:45 provider: , .d. phone: date/time: 1:40 provider: , m.d. phone: date/time: 11:00 md 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 arterial catheterization diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension hyposmolality and/or hyponatremia percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia anxiety state, unspecified acute respiratory failure other specified cardiac dysrhythmias other constipation other and unspecified special symptoms or syndromes, not elsewhere classified unspecified accident injury to bladder and urethra, without mention of open wound into cavity spinal stenosis, unspecified region other specified hypotension diverticulosis of colon (without mention of hemorrhage) leukocytosis, unspecified personal history of colonic polyps cough 

Answer: The patient is high likely exposed to