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 known allergies / adverse drug reactions attending: chief complaint: hypoxic respiratory failure major surgical or invasive procedure: coronary catheterization history of present illness: 69 yo male with pmh of htn, dm ii, hld s/p mi s/p 2 ptca who presented to osh with cough, exertional dyspnea and icnreased edema x2 days and was found to have nstemi and was transferred to for cardiac catheterization. patient initially presented to on sun early am with 2 days of sob, diaphoresis and an inconsistent history of chest pain. according to his discharge summary a number of possible diagnoses were entertained and a variety of therapeutic interventions were implemented. intially he was felt to be hypervolemic, as a result he he was placed on bipap, nitro-paste and diuresed with partial resolution of his symptoms. his diuresis was apparently discontinued secondary to rising cr. he also had a cxr which showed a questionable infiltrate and fever to 102 on and was started on empiric treatment for cap with ceftriaxone and azithromycin. he was also noted to have an ekg showing st depressions 1-2mm in v5 and v6. trop on at 2200 was 0.524 he was started on asa, metoprolol and aotrvastatin and a heparin gtt and transferred to for lhc. . patient was taken to the cath lab at on the evening of ccu transfer. he underwent r and l heart cath which demonstrated a mildly elevated wedge ~16, mildly elevated pap, diffuse dis--90% mid lcx, 90% mid rca, 50-60% os/lm, lad diffuse disease, ef 45%, septal hypokinesis, 1+mr. . a was reccomenced and he was transferred to the floor for evaluation by ct . shirtly after arrival to the floor he became hypertenvie and tachycardic and quite agitated with concern for flash pulmonary edema. his oxygen saturations dropped to the mid 60's despite being on nrb. he was diaphoretic and agitated with notable agonal breathing. he was intubated and sedated on the floor and transferred to micu 6 under the care of the ccu team. . on arrival to the micu he was hypertensive on a nitro gtt, intubated and sedated with fentayl and propofol. his ekg on arrial demonstrated worseing st depressions in the lateral leads as well as 1mm elevation in avr. . he became hypotensive shortly after arrival to the icu with maps in the 50's and diaphoretic. his propofol and nitro gtt were discontinued and dopamine was initiated to maontin cardiac perfusion. ekg during hypotensive episode showed worsening elevation in avr and continued st depressions in lateral leads. his maps quickly rebounded to 70's and repeat ekg showed resolving changes. . he is currently intubated on fentanyl and midazolam. and off pressors. all told he was on dopamine for 30 min total. . unable to participate in ros secondary to intubation and sedation. . past medical history: 1. cardiac risk factors: diabetes, dyslipidemia, hypertension 2. cardiac history: - : none - percutaneous coronary interventions: angioplasty x2 in - pacing/icd: none 3. other past medical history: copd social history: - tobacco history: smoked 2.5 ppd x 36 years quit smoking in - etoh: denies (per osh dc summary) - illicit drugs: denies (per osh dc summary) family history: - limited and obtained from osh records. - mother: cad - father: brain cancer physical exam: admission physical examination: general appearance: well nourished, diaphoretic eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic, endotracheal tube placed cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: diffuse crackles) chest: coarse symmetric breath sounds bl abdominal: soft, distended extremities: right lower extremity edema: trace, left lower extremity edema: trace skin: not assessed neurologic: responds to: not assessed, movement: not assessed, sedated, tone: not assessed . discharge exam: general appearance: well nourished, on nasal cannula eyes / conjunctiva: perrl head, ears, nose, throat: poor dentition cardiovascular: (s1: normal), (s2: normal), no clear murmur peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (percussion: resonant : ), (breath sounds: rhonchorous: right > left), crackles bilaterally extremities: right lower extremity edema: absent, left lower extremity edema: absent skin: not assessed neurologic: attentive, not oriented (oriented x1), poor attention pertinent results: admission labs: 03:06am blood wbc-8.8 rbc-3.53* hgb-11.1* hct-34.0* mcv-96 mch-31.4 mchc-32.7 rdw-13.8 plt ct-215 03:06am blood pt-13.1* ptt-50.0* inr(pt)-1.2* 05:30pm blood glucose-166* urean-26* creat-1.4* na-137 k-3.3 cl-101 hco3-25 angap-14 05:30pm blood alt-30 ast-63* alkphos-38* amylase-46 totbili-0.4 03:06am blood ctropnt-1.34* 02:39pm blood ctropnt-1.56* 04:13am blood ck-mb-12* mb indx-1.3 ctropnt-1.32* 05:30pm blood albumin-3.2* cholest-117 05:30pm blood %hba1c-8.7* eag-203* 05:30pm blood triglyc-112 hdl-46 chol/hd-2.5 ldlcalc-49 10:43pm blood lactate-1.3 k-4.3 . relevant labs: 11:36pm blood alt-30 ast-53* ld(ldh)-382* ck(cpk)-690* alkphos-40 totbili-0.3 04:24am blood alt-28 ast-37 alkphos-92 totbili-0.2 11:04am blood ck-mb-24* mb indx-1.5 02:39pm blood ctropnt-1.56* 04:13am blood ck-mb-12* mb indx-1.3 ctropnt-1.32* 08:13am blood ck-mb-7 06:16pm blood ck-mb-13* mb indx-1.4 ctropnt-1.51* 11:36pm blood ck-mb-8 ctropnt-1.50* 05:30pm blood %hba1c-8.7* eag-203* 05:30pm blood triglyc-112 hdl-46 chol/hd-2.5 ldlcalc-49 . microbiology: blood culture , , , : negative mycolytic/afb cultures: pending urine culture , , , , , : negative c. diff , : negative urine legionella , : negative cryptococcal ag : negative 2:37 am stool consistency: soft source: stool. fecal culture (final ): no salmonella or shigella found. no enteric gram negative rods found. campylobacter culture (final ): no campylobacter found. viral culture (preliminary): no virus isolated. 3:24 pm bronchoalveolar lavage rul post segment. **final report ** gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): budding yeast with pseudohyphae. respiratory culture (final ): commensal respiratory flora absent. yeast. >100,000 organisms/ml.. viral culture of bronchial washings: negative imaging: cardiac cath: comments: 1. selective coronary angiography of this right dominant system revealed left main and triple vessel coronary artery disease. the lmca had a 50% ostial stenosis with partial ventricularization of the catheter pressure with engagement and a 50% distal lmca stenosis. the mid lad had a 50% stenosis. the lcx had 60% high rising om1, 90% tubular mid, and 50% om2 stenoses in addition to 95% diffuse disase in both branches of a large bifurcating om3. the rca had a 95% mid vessel and 40% distal stenosis. 2. resting hemodynamics demonstrated mildly elevated biventricular filling pressures with mean pcw 16mm hg and rvedp 12mm hg. mild pulmonary hypertension with mean pa 28mm hg. preserved cardiac index of 2.08 l/min/m2. mild systemic arterial hypertension with central pressure of 149/65 mm hg. final diagnosis: 1. left main and triple vessel cad. 2. mildly elevated biventricular filling pressures. 3. mild pulmarony hypertension. . carotid series: impression: 1. 40-59% stenosis of the right internal carotid artery. 2. 60-69% stenosis of the left internal carotid artery. echo: the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with mild hypokinesis of the basal inferior and inferolateral segments. the remaining segments contract normally (lvef = 45-50%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. no aortic regurgitation is seen. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild regional left ventricular systolic dysfunction, c/w cad. no clinically-significant valvular disease seen. mild pulmonary hypertension. ct head non-con: impression: no evidence of intracranial hemorrhage. ct torso non-con: impression: 1. consolidation in the posterior segment of the right upper lobe, compatible with pneumonia. additional bibasilar atelectasis and/or consolidation and small pleural effusions. 2. two 9-mm perifissural nodules in the right upper and right middle lobes, possibly infectious in etiology. 3. nonspecific small lymph nodes of the mediastinum and bilateral axilla; none meet pathologic size criteria; of unclear clinical significance. a follow-up chest ct is recommended after treatment to document resolution of the above findings. 4. calcified atherosclerotic disease of the aorta, coronary arteries, renal arteries, and splenic arteries. 5. diverticulosis. ruq u/s: conclusion: no evidence of liver or biliary disease. small right effusion noted. video swallow:trace aspiration with thin liquids and pureed solids. discharge labs: : wbc rbc hgb hct mcv mch mchc rdw plt ct 12.4* 3.05* 9.7* 31.1* 102* 31.8 31.2 17.2* 330 neuts bands lymphs monos eos baso atyps metas myelos 64.7 20.7 6.5 7.5* 0.5 red cell morphology hypochr anisocy poiklo macrocy microcy polychr basic coagulation pt ptt inr(pt) 13.2* 31.3 1.2* renal & glucose glucose urean creat na k cl hco3 angap 209*1 49* 1.1 145 4.1 106 29 14 enzymes & bilirubin alt ast ld(ldh) alkphos totbili 31 39 218 102 0.3 chemistry calcium phos mg 8.6 4.6* 2.2 brief hospital course: 69 yom with h/o htn, dm, hld, copd, initially p/w dyspnea and nstemi to osh, s/p cath at showing 3v cad, admitted to ccu while intubated for acute onset hypertension and tachycardia resulting in flash pulmonary edema. initial plan was for . course was complicated by vap and delerium. # respiratory status: patient was initially transferred from the floor to the ccu secondary to respiratory distress in the setting of flash pulmonary edema/hypertention/tachycardia as well as agitation. he was intubated on the floor prior to transfer to ccu. he was diuresed with iv lasix and responded well. he was extubated transiently but then, 2 days later, became agitated, hypertensive and had another episode of flash pulmonary edema. given tenuous respiratory status and extreme agitation, patient was re-intubated. barriers to extubation included ventilator associated pneumonia (see below) leading to v/q mismatch as well as delerium/agitation. pulmonary c/s was obtained, who recommended control of agitation and aggressive diuresis and then to attempt extubation. once sbps and delerium were better controlled (see below for more details), mr. was extubated successfully. due to concern that his episodes of flash pulm edema were due to ischemia, he was reintubated and taken to cath where stent was placed in the right coronary and the circumflex was angioplastied. lad was not as stenosed as previously thought so no action taken there. he was successfully extubated s/p cath but he continued to have poor respiratory status and seemed to be in a pattern where any activity or agitation (even just moving from bed to chair) caused hypertension and flash pulm edema. during these episodes he was placed on bipap and aggressive diuresis as well as nebulizer treatments were provided. he would subsequently stabilize to his baseline, though this was also poor and characterized by tachypnea and paradoxical abdominal wall movements with breathing. he had copious secretions so also did chest pt and deep suctioning. he was aggressively diuresed several liters daily and his respiratory status improved. he was satting well on 2-3l nc at the time of discharge to rehab. # mental status/delirium: patient significant delerium/agitation during the admission. worsened mental status, likely secondary to his respiratory distress in addition to underlying delirium. patient was treated with seroquel and responded well initially. however, when attempting to d/c propafol to assess mental status, patient remained sedated despite being off medications. patient was evaluated by neurology who said he likely needed more time for propafol to wear off. seroquel was stopped to limit sedation. since patient was on a heparin drip and with quite labile blood pressures, there was some concern for ich, so head ct was obtained. ct head was neg, with small areas of ischemia or watershed ischemia can be missed on ct. once propafol wore off, patient was awake, responsive, following commands. oriented to self, but not place or date. he improved to the point of being conversant, making jokes, and answering questions appropriately, but was still not oriented to place or time at the time of d/c to rehab. he failed a speech and swallow evaluation so required ng tube placement for feeding. if his mental status continues to improve, he should be evaluated again by speech and swallow at rehab and ng tube discontinued as early as possible to aid in recovery of mental status. # cad: patient was transferred from hospital with nstemi. he was taken to the cath lab at on the evening of ccu transfer. he underwent r and l heart cath which demonstrated a mildly elevated wedge ~16, mildly elevated pap, diffuse dis--90% mid lcx, 90% mid rca, 50-60% os/lm, lad diffuse disease, ef 45%, septal hypokinesis, 1+mr. was reccomenced and he was transferred to the floor for evaluation by ct . however, in the setting of complicated hospital course, ct declined operative intervention due to high mortality in patients with such poor mental status prior to intervention. decision was made after discussion with health care proxy and patient to proceed with a high risk pci. on , patient was taken to the cath lab. during the procedure, stented right coronary, angioplastied left circumflex, no action on left main (not as stenosed as previously appeared). prior to intervention, patient was on heparin drip and was plavix loaded. medical regimen currently includes plavix, aspirin 81mg, statin, beta blocker, abd ace-i. also started on lasix 60mg po qd once was adequately diuresed with goal of euvolemia. # ventilator associated pneumonia: patient was spiking fevers and with leukocytosis during the admission. cxr on suggests progression of infiltrate. no decubitus ulcer reported, urine cx neg, c.dif neg, so ruled those out as source of infection. patient was treated with vancomycin/cefepime for 14 days. he was also treated with flagyl given high risk and suspicion for aspiration. he remained febrile and with leukocytosis, thus infectious disease was consulted. they recommended to continue with current antibiotic regimen as well as a bronchoscopy. pulmonary was already following and performed a bronch which showed 1+ budding yeast. however, this was thought to be colonization and thus antifungal coverage was not initiated after discussion with id. bglucan was weakly positive at 81 (upper limit of normal is 80), did not treat. cryptococcal ag and urine legionella were negative. sputum cultures did not grow out any organism. he completed a 14 day course of abx coverage for hcap (chose 14 days due to long period of intubation and persistent fevers early in on hospital course). after completion of abx he did well and had no recurrence of fevrs and wbc count remained normal. he did continue to have a junky cough and chest pt was performed to help pt cough up secretions. would continue chest pt at rehab. # htn: patient had extremely labile and difficult to control blood pressures, with sbps rising to the 200s. he was transiently controlled on a nitro drip and then transitioned to high dose, multi drug oral regimen (doses attached) including hydralazine, carvedilol, isosorbide dinitrate, lisinopril and lasix. blood pressures were then well controlled. # aspiration risk: patient failed speech and swallow and video swallow on showed silent aspiration. ng tube kept in, nothing by mouth except small amount of ice chips. will need to be re-evaluated at rehab within 2-3 days and hopefully get ng tube out. # hypernatremia: patient was intermittently hypernatremic throughout the admission, likely in the setting of dehydration. gave free water flushes w/ meds through ng tube, responded well, and these were continued to maintain normal electrolyte status while on tube feeds. # : baseline 1.1. cr increased to peak of 1.9 during the admission. this wqas likely pre-renal from aggressive diuresis during flash pulmonary edema episodes and trended down when diuresis was held. monitored closely after dye load for cardiac cath, but cr did not trend up. his creatinine was 1.1 at the time of discharge. # dm: hba1c 8.7 on admission. placed on insulin ss and lantus, adjusted as needed throught the hospitalization. had large insulin requirement while on tube feeds. # hld: triglyc-112 hdl-46 chol/hd-2.5 ldlcalc-49. initiated atorvastatin 80mg. transitions of care: - chest ct in months to followup the following incidental findings which were attributed to his pneumonia 1.) two 9-mm perifissural nodules in the right upper and right middle lobes (thought to be infectious in etiology 2.) nonspecific small lymph nodes of the mediastinum and bilateral axilla; none meet pathologic size criteria; of unclear clinical significance but assumed to be infectious. - cardiology follow up: medical assistant will arrange - will need to be weighed daily, md if weight increases by 3 lbs in 1 day - repeat speech and swallow eval in days at rehab to see if pt can have ng tube removed medications on admission: fenofibrate 160mg qd lipitro 40mg qd diovan/hctz 160/25 daily advair 250/50 metformin 850 lopressor 25mg qid lasix 40mg qdaily amlodipine 5mg qd lantus 10u sc daily discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. acetaminophen 650 mg/20.3 ml solution sig: six y (650) mg po q6h (every 6 hours) as needed for pain/fever. 5. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for wheeze, dyspnea. 7. hydralazine 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). 8. carvedilol 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). 9. isosorbide dinitrate 20 mg tablet sig: two (2) tablet po tid (3 times a day). 10. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for rash. 11. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 12. multivitamin tablet sig: one (1) tablet po daily (daily). 13. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day. 14. furosemide 20 mg tablet sig: three (3) tablet po daily (daily). 15. lantus 100 unit/ml solution sig: ten (10) units subcutaneous at bedtime. 16. regular insulin sliding scale fingerstick q6h: 0-70mg/dl - proceed with hypoglycemia protocol, 71-100mg/dl - 0 units, 101-150mg/dl - 0 units, 151-200mg/dl - 4 units, 201-250mg/dl - 6 units, 251-300mg/dl - 8 units, 301-350mg/dl - 10 units, 351-400mg/dl - 12 units, >400mg/dl notify m.d. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: non st-elevation myocardial infarction hypertension diabetes dyslipidemia discharge condition: mental status: occasionally coherent level of consciousness: alert and interactive at most times activity status: out of bed with assistance discharge instructions: dear mr. , it was a privilege to provide care for you here at the hospital. you were admitted because you were short of breath, and were found to have a pneumonia and a heart attack. you received a coronary cath procedure, which found that you have narrowings in some of the blood vessels on your heart. you had a stent placed in one area and a balloon used to prop open a second area. you were intubated temporarily to help you breathe, and then successfully extubated. your medications were optimized and you were discharged to rehab. while you were here you had delirium, but this improved after you were extubated and your medications adjusted. multiple changes were made to your medications. please see the attached list for your new medication regimen. you do not need to take any other medications in addition to this unless your doctor tells you. followup instructions: cardiology follow up in weeks. attending will arrange and pt will be notified. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of endotracheal tube insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation arterial catheterization closed [endoscopic] biopsy of bronchus insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: other iatrogenic hypotension subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified other chronic pulmonary heart diseases personal history of tobacco use percutaneous transluminal coronary angioplasty status occlusion and stenosis of carotid artery without mention of cerebral infarction other and unspecified hyperlipidemia acute respiratory failure long-term (current) use of insulin old myocardial infarction candidiasis of lung other and unspecified special symptoms or syndromes, not elsewhere classified hypoxemia hyperosmolality and/or hypernatremia ventilator associated pneumonia occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction surgical or other procedure not carried out because of contraindication tachycardia, unspecified other alteration of consciousness acute edema of lung, unspecified encounter for therapeutic drug monitoring family history of other cardiovascular diseases 

Answer: The patient is high likely exposed to