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: no drug allergy information on file attending: chief complaint: dyspnea major surgical or invasive procedure: none history of present illness: the patient is a 66 year old male with multiple medical problems including diabetes, copd on oxygen at baseline, hypertension and hyperlipidemia who presented to the diabetes clinic this afternoon complaining of increased fatigue, shortness of breath and cough for the past three weeks. he also has been experiencing lightheadedness and blurry vision intermittently. the patient also experienced an episode of hypoglycemia this morning (finger stick of 25) which he treated with juice and glucose with rapid resolution. given his symptoms this am in diabetes clinic, he was advised to present to the ed. . he denies chest pain and worsening cough. he does report increased shortness of breath but has not needed to increase his home oxygen use. he denies fevers, chills. he has a cough at baseline which is non-productive and non-purulent and may be slightly more productive over the past few weeks. he has lost 15 lbs over three months when his lasix dose was increased. he denies any recent medication changes, or dietary changes. he denies hemoptysis. he denies any recent periods of immobility, long distance travel. no recent sick contacts. . in the ed the patient was found to be afebrile, hypoxic with an o2 sat of 84% on 100% o2, and hypotensive with a bp of 83/60 and hr 92. his hypotension resolved with iv fluids. an ekg was performed which revealed a right bundle branch block and there was concern for anterioseptal st-depression. cardiology was consulted who did not feel that he was experience an acute coronary event. he did recieve aspirin 325, and was started on a heparin and nitroglycerine gtt. first set of troponins came back negative. initial chem7 revelaed a serum potassium of 6.4 on an non-hemolyzed specimen and he received insulin, sodium bicarbonate, calcium gluconate, dextrose and kaexylate. past medical history: 1. dm2 (complicated by nephropathy, neuropathy) 2. ckd (proteinuria) 3. htn 4. hyperlipid 5. copd, home o2 3-4l nc 6. depression 7. anxiety 8. morbid obesity 9. obstructive sleep apnea social history: single, lives in . currently not working. used to smoke 5 packs per day, currently smokes cigarettes daily. no alcohol use, no ilicits family history: sons had in 30s and 40s, mother and father had in older age. history of cancer but unknown type. physical exam: vitals: t: 98.2 hr: 87 bp: 119/62 rr: 22 02: 98% on non-rebreather mask gen: alert and oriented, mild-respiratory distress heent: perrl, eomi, pharynx clear and without exudates neck: jvp ~ 12 cm cv: distant heart sounds, rrr, no murmurs or gallops appreciated resp: decreased breath sounds throughout, no wheezes or ronchi appreciated gi: obese, soft, non-tender, non-distended, + bs gu: foley in place draining clear yellow urine ext: wwp, 1+ pulses bilaterally, 1+ pitting edemas to shins, no clubbing or cyanosis neuro: grossly intact rectal: guaiac negative per ed pertinent results: admit labs 04:38pm blood wbc-10.5 rbc-4.99 hgb-13.8* hct-44.2 mcv-89 mch-27.7 mchc-31.2 rdw-17.4* plt ct-148* 04:38pm blood neuts-75.4* lymphs-17.2* monos-5.8 eos-0.9 baso-0.7 04:38pm blood hypochr-3+ anisocy-1+ microcy-1+ 04:38pm blood pt-39.8* ptt-37.7* inr(pt)-4.5* 05:30pm blood glucose-190* urean-29* creat-1.3* na-134 k-6.4* cl-95* hco3-36* angap-9 05:30pm blood ck(cpk)-153 05:30pm blood ck-mb-6 ctropnt-<0.01 probnp-5032* 04:30am blood ck-mb-6 ctropnt-<0.01 04:38pm blood lactate-5.8* k-8.7* 05:14pm blood lactate-4.2* k-6.4* 12:32pm blood o2 sat-87 . discharge labs 04:16am blood wbc-8.9 rbc-4.89 hgb-13.5* hct-41.0 mcv-84 mch-27.7 mchc-33.1 rdw-16.9* plt ct-132* 04:16am blood pt-14.7* ptt-23.5 inr(pt)-1.3* 04:16am blood glucose-80 urean-22* creat-0.8 na-141 k-4.0 cl-99 hco3-39* angap-7* 04:16am blood calcium-9.4 phos-3.2 mg-2.2 . imaging . cxr: suspected bilateral hilar enlargement and bilateral consolidations, suggesting infectious process as a more likely diagnosis. . ct-pa: 1. bibasilar posterior patchy consolidations representing multifocal pneumonia versus aspiration versus aspiration pneumonia. mild atelectasis. associated prominence of lymph nodes is probably reactive, however, follow-up scan after appropriate clinical interval recommended to ensure resolution. 2. evidence of mild fluid overload. no pleural effusions. 3. no pulmonary embolism or aortic dissection. 4. radiopaque gallstone with calcification in gallbladder wall which may reflect porcelain gallbladder. please correlate. 5. left kidney scarring with calcification. 6. left adrenal adenoma. . tte 1.the left atrium is mildly dilated. 2.there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). 3.the right ventricular cavity is markedly dilated. right ventricular systolic function appears depressed. there is abnormal diastolic septal motion/position consistent with right ventricular volume overload. 4.the aortic valve is not well seen. no aortic regurgitation is seen. 5.the mitral valve is not well seen. no mitral regurgitation seen. 6.the estimated pulmonary artery systolic pressure is normal. 7.there is no pericardial effusion. 8. bubble study for shunt was performed bubble study with cough was recorded but not at rest or with valsalva. reported to be negative by fellow and echo technician present. brief hospital course: the patient is a 66 year old male with multiple medical problems including diabetes, copd on oxygen at baseline, hypertension and hyperlipidemia who presented to the diabetes clinic complaining of increased fatigue, shortness of breath and cough for the past three weeks. pt was admitted to the micu for management of respiratory distress with hypercarbic hypoxia. the following issues were addressed during this admission: . # hypoxemia: we originally considered cardiac versus primary respiratory etiologies for his hypoxia. there was no evidence of ischemia per routine cycling of cardiac markers. additionally, clinical exam, tte, and cxr failed to reveal significant evidence of chf, and ct-pa was negative for pe. physical exam and cxr findings appeared most consistent with an exacerbation of copd, possibly compounded by underlying cardiac disease. accordingly, pt began a one week course of azithromycin, started high dose iv steroids, combivent nebs, home-dose flovent/advair/spiriva, and was placed on bipap for improved ventilation/oxygenation. pt showed rapid improvement in his respiratory status. as pt continued to improve, his steroids were transitioned from iv to po with subsequent taper, and mask ventilation was transitioned to nasal cannula w/o issue. at discharge, pt had returned to his clinical baseline, with mildly increased o2 requirement vs. baseline (currently spo2 >88% on 6 l nc). pt was discharged on prednisone taper, azithromycin, home resp meds, with recommendation for close pcp/pulmonology f/u. pt noted that he understood and agreed with this plan. . # diabetes: continued to follow during admission, adjusting insulin dosing as needed in the face of inflammation and steroid use. pt will continue to f/u with as an outpatient as he tapers off of the prednisone. . # hypertension: bp was well-controlled on home meds (toprol xl 50 mg, norvasc 5 mg, lisinopril 20 mg); lasix, diovan, and spironolactone were held during this admission due to thickened resp secretions suggesting the need for hydration. pt will f/u with his pcp for further management. . # hyperkalemia - resolved with withdrawal of agents with a tendency to induce hyperkalemia (spironolactone). . # a-fib - chronic coumadin for anticoagulation, toprol for rate control; inr 1.3 at discharge, so returned to home-dose coumadin schedule (initially altered due to inr 4.5 on admission). pt instructed to f/u with pcp for inr check this week. . # chronic kidney disease: stable at baseline, admission cr 1.3 improved rapidly with fluid resuscitation. . # hyperlipidemia - continued lipitor 80 mg daily and niaspan 500 mg daily. . # depression, anxiety - continued home xanax prn, zoloft 50 mg . . # fen: renal, diabetic, heart healthy diet. continued to replete electrolytes as needed. . # prophylaxis: dvt (on coumadin, daily ambulation), gi (ppi). medications on admission: gabapentin 300 mg tid nph 30 units in am, 10 units in pm toprol 50 mg diovan 160 mg daily niaspan 500 mg qhs potassium chloride 10 mg qid lipitor 80 mg daily glyburide 5 mg (2 in am, 2 in pm) coumadin 8 mg daily lisinopril 20 mg daily lasix 40 mg daily norvasc 5 mg daily zoloft 50 mg centrum silver mvi daily xanax 0.5 mg x daily prn spironolactone 25 mg daily spiriva daily advair 500/50 1 puff albuterol 2 puffs qid oxygen 4-5 l at baseline discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q4-6h (every 4 to 6 hours) as needed. 2. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. sertraline 50 mg tablet sig: one (1) tablet po bid (2 times a day). 5. hexavitamin tablet sig: one (1) cap po daily (daily). 6. alprazolam 0.25 mg tablet sig: two (2) tablet po tid (3 times a day) as needed. 7. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 8. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 9. albuterol sulfate 0.083 % solution sig: one (1) inhalation q2h (every 2 hours) as needed. 10. niacin 500 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). 11. azithromycin 250 mg capsule sig: two (2) capsule po q24h (every 24 hours) for 1 days: last dose 10/30. 12. metoprolol succinate 50 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). 13. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 14. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 15. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 16. prednisone 20 mg tablet sig: two (2) tablet po daily (daily) for 4 days: last dose 11/1. 17. warfarin 4 mg tablet sig: two (2) tablet po daily (daily). 18. prednisone 20 mg tablet sig: one (1) tablet po once a day for 2 days: start . disp:*2 tablet(s)* refills:*0* 19. prednisone 20 mg tablet sig: .5 tablet po once a day for 2 days: start . disp:*1 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary 1. copd exacerbation 2. pneumonia 3. a-fib secondary 1. dm2 (complicated by nephropathy, neuropathy) 2. chronic proteinuria 3. htn 4. hyperlipidemia 5. obstructive sleep apnea discharge condition: improved discharge instructions: you were diagnosed with a copd exacerbation, likely due to infection. please complete your antibiotic regimen as instructed, finish your prednisone taper as prescribed, take all medications as instructed, and follow up with your primary physician(s) within the next week to reevaluate your condition and adjust medications as needed. of note, your coumadin level (inr) was lower than therapeutic and will need to be addressed by your primary care provider (the physician that manages your coumadin dosing). also, please continue to follow up with for management of your diabetes. finally, we highly recommend that you quit smoking asap given your lung disease, hypertension and diabetes. followup instructions: please call to schedule an appointment with your primary care doctor within the next week for a reevaluation and manaagement of your coumadin level. please call to schedule an appointment with your primary pulmonologist for reevaluation of your copd. md, procedure: non-invasive mechanical ventilation diagnoses: nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes chronic kidney disease, unspecified paroxysmal ventricular tachycardia dysthymic disorder other and unspecified hyperlipidemia hypotension, unspecified pneumonitis due to inhalation of food or vomitus alkalosis diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled right bundle branch block morbid obesity hypoxemia diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled benign neoplasm of adrenal gland chronic pulmonary heart disease, unspecified 

Answer: The patient is high likely exposed to