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: dilantin / keppra / seroquel attending: chief complaint: hypoxic respiratory failure, ards major surgical or invasive procedure: intubation tracheostomy peg tube placement history of present illness: 56 year old male with a hx of cva (good functional recovery) admitted on to hospital with fevers, cough w/ hemoptysis, sob x 2 and hypoxemia, tachypnea, and elevated wbc. he was intubated shortly after arrival for hypoxemia. family members were diagnosed with strep throat prior to his admission, and he had some dust exposure while cleaning the roof of his house before admission. ct on showed diffuse bilateral airspace infiltrate, increased at the bases, no evidence of pe. he has been on >80% fio2 for the past 2 weeks, currently on 100% fio2 with a peep of 15. saturations today () have been in the mid 80s to low 90s. first bronch complicated by pneumothorax,and was + for pseudomonas. second bronch complicated by post-bronch desats to mid80s, and showed 9900 wbc 87%p. recent imaging showed bilateral alveolar interstital infiltrates, slightly improved compaged to . he was started on gentamycin and cefepime at the outside hospital, on arrival here we have switched him to gent/. of note he also experienced some high fevers starting (105 f). past medical history: cva seizure disorder chronic leg pain htn hyperlipidemia depression copd eczema cea in s/p bilateral inguinal hernia repair social history: lived at home with family. works in automotive and motorcycle repair. quit smoking a few years ago. h/o alcoholism, sober x6yrs. no other drug use. family history: no h/o seizures, early stroke or mi physical exam: general: sedated, does not respond to tactile or auditory stimuli heent: sclera anicteric, perrl neck: supple, jvp not elevated cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: crackles in b/l anterior lung fields abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge exam: vitals: 98.2, 103, 115/79, 22, 96% trach mask 12l, 50% fio2 general: occasionally verbal, responds to stimuli, moves four extremities heent: sclera anicteric, perrl cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear in b/l anterior lung fields abdomen: soft, non-distended, bowel sounds present, no hepatosplenomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission results 09:42pm type-art po2-64* pco2-46* ph-7.35 total co2-26 base xs-0 09:42pm lactate-1.1 09:42pm o2 sat-88 09:42pm freeca-1.14 08:36pm type-art temp-36.8 peep-15 po2-62* pco2-49* ph-7.41 total co2-32* base xs-4 intubated-intubated 08:06pm type- temp-37.4 po2-38* pco2-62* ph-7.37 total co2-37* base xs-7 intubated-intubated 07:56pm glucose-86 urea n-74* creat-1.0 sodium-146* potassium-4.4 chloride-104 total co2-32 anion gap-14 07:56pm estgfr-using this 07:56pm ck(cpk)-10* 07:56pm ck-mb-1 ctropnt-<0.01 07:56pm calcium-10.2 phosphate-4.1 magnesium-2.1 07:56pm wbc-20.0* rbc-2.71* hgb-8.3* hct-26.5* mcv-98# mch-30.7 mchc-31.3 rdw-15.1 07:56pm neuts-70 bands-8* lymphs-10* monos-5 eos-0 basos-0 atyps-1* metas-2* myelos-4* 07:56pm hypochrom-3+ anisocyt-normal poikilocy-normal macrocyt-1+ microcyt-normal polychrom-occasional stippled-occasional 07:56pm plt smr-high plt count-532* 07:56pm pt-13.3* ptt-30.1 inr(pt)-1.2* discharge labs: 04:01am blood wbc-20.9* rbc-3.05* hgb-9.3* hct-27.4* mcv-90 mch-30.5 mchc-34.1 rdw-14.5 plt ct-425 04:15am blood neuts-73* bands-0 lymphs-13* monos-8 eos-3 baso-1 atyps-1* metas-1* myelos-0 04:55am blood pt-13.5* ptt-39.7* inr(pt)-1.3* 04:01am blood glucose-103* urean-27* creat-0.7 na-136 k-3.8 cl-95* hco3-33* angap-12 04:01am blood calcium-10.6* phos-4.5 mg-2.1 10:02am blood type-art temp-38.1 fio2-50 o2 flow-15 po2-75* pco2-50* ph-7.42 caltco2-34* base xs-6 micro ucx negative bcx-negative imaging cxr: et tube, chest tube, ng tube seen. bilateral parenchymal opacities, left more than right, constant in severity in extent. no pleural effusions. icu labs cxr : widespread infiltrative pulmonary abnormality is still present, but has improved generally in the right lung and in the left upper lung since . that component of the abnormality was probably recoverable pulmonary edema. what remains may be the residual of diffuse alveolar damage, in the right lung, and pneumonia in the lingula and left lower lobe. pleural effusion is minimal, if any. there is no pneumothorax. cxr : upper lobe could represent fibrotic stage of ards given the fact that they are not resolving and where largest abnormalities were present on . echo : the left atrium is normal in size. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. echo the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. the pulmonary artery systolic pressure could not be determined. bilateral lower extremity dopplers: impression: no evidence of a right or left lower extremity dvt. abdominal u/s: impression: 1. left-sided nephrolithiasis as described above. 2. stable right kidney calyceal diverticulum or cyst. 3. normal caliber of the abdominal aorta. ct chest w/out contrast: impression: interval decrease in consolidative opacities bilaterally, with likely conversion into fibrotic stage of ards or progressed preexisting fibrotic lung disease with patchy ground glass opacities with increased interstitial septal thickening, subpleural reticular and cystic changes with traction bronchiectasis and apical right greater than left honeycombing. no findings to suggest infection. ct sinus/mandible/maxillofacial w/out contrast: impression: 1. moderate mucosal thickening of the sphenoid sinuses with secretions. minimal opacification of the right mastoid air cells. 2. remote right occipital infarction with ex vacuo dilatation of the right lateral ventricle, better assessed on the head ct of the same date. ct head w/out contrast: impression: 1. limited study due to extensive motion artifact. within this limitation, subtle area of hypodensity in left mca distribution may be artifactual or reflect left mca infarction. correlation with clinical exam is recommended. 2. remote right occipital infraction with associted ex vacuo dilatation of the right lateral ventricle 3. prominent sulci and ventricles, significantly progressed since exam. ct torso w/out contrast: impression: 1. mildly distended gallbladder, clinical correlation suggested. 2. no other acute intra-abdominal pathology identified. 3. mild mediastinal lymphadenopathy again noted. 4. persistent findings of bibasilar predominant peripheral reticular opacities in the lungs, history of ards, without evidence of acute pneumonia. ct abd/pelvis: impression: 1. no acute intra-abdominal or intrapelvic process. specifically, no acute hematoma detected. 2. severe bibasilar consolidations and edema, reflective of known history of ards. mri head w/ and w/o contrast: impression: 1. pachymeningeal enhancement and bilateral areas of punctate enhancement at the expected locations of perivascular spaces, new since prior exam. the above findings may represent infectious, or inflammatory process, alternatively, central hypotension is a consideration in the setting of recent lumbar puncture. there are no associated areas of restricted diffusion to suggest microabscesses or septic emboli. 2. encephalomalacia of the right occipital lobe and associated ex vacuo dilatation of the occipital of the right lateral ventricle, represents sequelae remote infarction. no evidence of acute infarction. eeg impression: this is an abnormal continuous icu eeg monitoring study because of moderate to severe diffuse background slowing and disorganization. this is suggestive of moderate to severe diffuse cerebral dysfunction which is etiologically non-specific. there are abundant right hemispheric sharp waves that have maximal amplitude at parietal-temporal regions p4, t4. at times, they become pseudo-periodic in prolonged runs. these findings are indicative of a highly potentially epileptogenic area in the right posterior quadrant. however, toward the end of the study, the sharp waves become less frequent and there is improvement in the background activity to hz theta. compared to the prior day's recording, the frequency of the sharp wave has slightly decreased with improvement of background activity. cxr findings: in comparison with the study of , there is little overall change. again, there is prominence of interstitial markings consistent with the patient's known idiopathic pulmonary fibrosis. vague suggestion of some more coalescent opacifications at the left base, which could possibly represent a developing consolidation in the appropriate clinical setting. brief hospital course: icu course 56 yo male with past medical history notable for ipf, htn, hld, copd, cva , transfered from hospital on for continued management of his hypoxic respiratory failure / ards. . # hypoxic respiratory failure: the patient originally presented with respiratory failure, possible secondary to pneumonia, which became ards and required intubation using ards net protocol and aprv. during his hospital stay he developed positive sputum cultures for pseudomonas, possibly a ventilator associated infection, or an infection that caused his initial presentation. chest ct on revealed improvement in the bibasilar consolidations with a progression of his ards into the fibrotic stage. patient was treated with a course of ciprofloxacin which ended on . as patient was unable to be weaned from ventilator, tracheostomy was performed on without complication. subsequently he developed trach leak requiring an upsizing of the trach. subseqently he developed increasing oxygen requirements and ventilator support with changes in sputum consistency. he grew mrsa and citrobacter in his sputum and was treated with vancomycin and cipro for 10 days. he was able to be weaned off the ventilator and tolerated trach mask well. he was fitted for a passy-muir valve on . he developed mild pulmonary edema on and was started on lasix 20mg iv daily, which was changed to 40mg po daily at the time of discharge. . # status epilepticus: he has a known underlying seizure disorder; however, patient had a recurrence of his seizures due to withholding of usual antiseizure medications, and pharmacological clearance of benzodiazepines (received prolonged continuous high dose). he was treated with versed, valproate, and licosamide. eeg showed continued bilateral eleptiform discharges, slowed background, but no frank seizures. head ct without contrast revealed no new seizure focus area. mri revealed pachymeningeal enhancement and bilateral areas of punctate enhancement at the expected locations of perivascular spaces, new since prior exam with the changes thought to be secondary lumbar puncture. versed was tapered once valproate was therapeutic. head mri on showed no evidence of acute intracranial process. patient discharged on valproate 750mg q6, lacosamide 200 mg and neurontin 600 po tid. he will follow up with his outpatient neurologist and the neurology service was involved in his care throughout his course. . # anemia: he developed a moderate anemia during this hospitalization, without clinical evidence for active bleeding. this was likely multifactorial due to dilution, acute illness and phlebotomy. however, given recent peg tube placement, there was concern for retroperitoneal bleed. he was transfused to maintain hct >24. abd/pelvis ct showed no evidence of peg-related bleeding or retroperitoneal hemorrhage. his hct remained stable for the remaineder of his course. . # coag negative staph bacteremia (intravascular catheter related)- bacteremia thought to be secondary picc line infection. the picc was removed and sent for culture, which was negative. echo showed no vegetations. he was treated with vancomycin for 10 days as above. . # leukocytosis: at the time of discharge, pt had a persistent leukocytosis of unclear origin. all blood, urine, csf cultures were negative at the time of d/c and c diff was negative x2. sputum culture positive for staph aureus was felt to be commensal given his prolonged hospitalizaton, lack of infiltrate on cxr and stable respiratory status. he received a 10d course of vancomycin for a likey line infection immediately prior to sputum culture result. . # altered mental status: the patient was sedated for mechanical ventilation, and was also likely altered due to his seizure prodrome, post-ictal state, and slow clearance of narcotics. he also has an underlying prior cva, which contributed to his altered mental status. a head ct without contrast revealed no evidence for new cva. lumbar puncture was negative for infection. . # fevers: he was repeated cultured and only positive cultures are as above in sputum and blood. csf was negative for infections. at the time of discahrge, he had been afebrle for several days without localizing s/sx of infection. . # electrolyte abnormalities: he developed a hypovolemic hypernatremia during this hospitalization, which was treated with fluid resuscitation and free water boluses as needed. he also had hypokalemia due to nutritional depletion, and was repleted to a goal of 4 daily. . # acute renal failure: he developed acute kidney injury, which was attributed in part to aminoglycosides and atn with a peak cr of 3.3. his renal function improving slowly with avoidance of nephrotoxic medications. at the time of discharge his cr was 0.6. . # diastolic heart failure - he received diuresis at osh. during course as he was hypotensive, he required fluid boluses. through the rest of his admission, he was kept in even fluid balance with lasix 20mg iv daily. he was discharged on lasix 40mg po qday. . transitional issues ======================== -neurology follow up -thoracic surgery follow up , p. md medications on admission: medications on transfer : versed 1-2mg prn insulin lispro ss lasix 20mg iv q6hr solumedrol 80mg protonix 40mg iv bid ventolin q2hr gent 400mg iv qday cefepime 2g iv q12 fentanyl gtt propofol gtt colace 100mg miconazole pdr lisinopril 10mg qday zoloft 150mg qday metoprolol 25mg senna 10mg qday combivent 4puffs q4hrs valproic acid 500mg q8hrs zocor 40mg qday asa 81mg qday neurontin 900mg tid heparin sq5000 q8hrs discharge medications: 1. aspirin 81 mg po daily 2. docusate sodium 100 mg po bid 3. senna 1 tab po daily 4. sertraline 150 mg po daily 5. valproic acid 750 mg po q6h 6. gabapentin 600 mg po tid 7. amlodipine 10 mg po daily hold for sbp < 100 8. hydroxyzine 25 mg po q6h:prn itching 9. lacosamide 200 mg po bid 10. lansoprazole *nf* 30 mg oral daily reason for ordering: on ng tube 11. lidocaine 5% patch 1 ptch td daily apply to lower back. 12. miconazole powder 2% 1 appl tp :prn rash 13. oxycodone liquid 5 mg po q6h:prn pain 14. polyethylene glycol 17 g po daily 15. acetaminophen 650 mg po q6h:prn pain please do not exceed 4g total daily 16. artificial tears preserv. free 1-2 drop both eyes prn dry eyes 17. heparin 5000 unit sc tid 18. furosemide 40 mg po daily hold for sbp<100 19. atorvastatin 10 mg po daily 20. albuterol 0.083% neb soln 1 neb ih q2h:prn sob or wheeze 21. metoprolol tartrate 25 mg po bid hold for hr <60, sbp <100 22. ipratropium bromide neb 1 neb ih q6h discharge disposition: extended care facility: - - discharge diagnosis: acute respiratory failure ards ventilator associated pneumonia acute renal failure discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: mr. : it was a pleasure taking care of you at . you were transferred here from hospital because you had a very bad pneumonia with a bacteria called pseudomonas that required you to have a breathing tube and antibiotics. you were intubated for a long time requiring a tracheostomy tube, which is a tube at the base of your neck for breathing. you were also unable to eat and required a feeding tube through your stomach. additionally, you had seizures while you were here and we made adjustments to your seizure medicines which you can see on your medication sheet. also, you developed a second pneumonia which we treated with antibiotics. during your hospital course, you had acute kidney failure, which resolved by the time you were discharged. followup instructions: department: neurology when: wednesday at 2:30 pm with: drs. & building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of endotracheal tube enteral infusion of concentrated nutritional substances other lavage of bronchus and trachea percutaneous [endoscopic] gastrostomy [peg] arterial catheterization arterial catheterization temporary tracheostomy closed [endoscopic] biopsy of bronchus replacement of tracheostomy tube central venous catheter placement with guidance diagnoses: hyperpotassemia anemia, unspecified acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified personal history of tobacco use depressive disorder, not elsewhere classified other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure hypotension, unspecified iatrogenic pneumothorax cardiac arrest personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits hyperosmolality and/or hypernatremia ventilator associated pneumonia accidents occurring in residential institution chronic diastolic heart failure other alteration of consciousness pseudomonas infection in conditions classified elsewhere and of unspecified site other tracheostomy complications epilepsia partialis continua, without mention of intractable epilepsy physical restraints status surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation foreign body in other specified parts bronchus and lung 

Answer: The patient is high likely exposed to