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: patient recorded as having no known allergies to drugs attending: chief complaint: respiratory distress/failure major surgical or invasive procedure: ett intubation dobhoff tube picc line r ij cvl history of present illness: mr. is an 89 yo male with htn, mild dementia presenting with fever and hypoxia with 02 sats in the 80's at nh. noted to very fatigued and delirious at , with "acute respiratory distress". suctioned with large purulent sputum. 40 mg iv lasix given at 1700 hrs. nh reported mental status changes over 2 days. recent admission for delirium, shortness of breath, cough, fever to 102. found to be influenza positive. treated for superimposed bacterial infection with vanc and zosyn and completed course on . required micu stay given hypoxia and increased secretions. at time of discharge patient was requiring frequent suctioning, satting in the mid- to upper 90's on 3 - 4 l nc; breathing comfortably with an ng tube for feeding given failed speech and swallow. . in ed temp to 103, hr 101, rr 40's, 90% non rebreather. crackles bases. intubated with etomidate and succinylcholine. cr to 1.8 from baseline 0.7. hct to 22.8 baseline above 30. abg post intubation 7.33 47/106. right ij placed, bp ~110 systolic throughout stay. given concern for sepsis, right ij placed. ~3 l iv fluid given. ordered for 2 units prbc. admitted to the . past medical history: influenza a bph htn hx of hip fracture social history: patient lives at home with his wife. a nurse alliance sees the couple twice a week on mondays and wednesdays. he denies tobacco use and drug use,but does drink glasses of wine/day. family history: nc physical exam: 97.8, 108, 112/63, 74 100% ac fi02 50% rr 15, peep 5 gen: intubated elderly male with og tube heent: thick secretions noted in mouth. atramatic. no neck stiffness. peerl. difficult to assess jvp. rij with scant bleeding adjacent. cv: tachycardic, no murmurs noted resp: exp wheeze, crackles basilar. abd: hypoactive bowel sounds, non distended. no grimace to touch guaiac: negative in ed prior to arrival neuro: intubated, sedated. not responding skin: cool le, no mottling. 2+ dp,pt pulses pertinent results: 05:00pm blood wbc-26.7* rbc-2.64* hgb-8.3* hct-24.0* mcv-91 mch-31.4 mchc-34.6 rdw-15.5 plt ct-376 08:58am blood wbc-26.5* rbc-2.26* hgb-7.0* hct-21.3* mcv-94 mch-31.1 mchc-33.1 rdw-15.0 plt ct-426 05:55pm blood wbc-27.5*# rbc-2.43*# hgb-7.7*# hct-22.8*# mcv-94 mch-31.7 mchc-33.8 rdw-15.0 plt ct-694* 04:00am blood ret aut-6.5* 04:00am blood glucose-93 urean-46* creat-1.3* na-142 k-3.9 cl-110* hco3-24 angap-12 05:55pm blood glucose-132* urean-53* creat-1.8*# na-138 k-4.8 cl-102 hco3-26 angap-15 04:00am blood alt-21 ast-23 ld(ldh)-202 alkphos-60 totbili-0.9 dirbili-0.4* indbili-0.5 05:55pm blood alt-34 ast-31 ck(cpk)-40 alkphos-78 totbili-0.4 05:55pm blood lipase-41 08:58am blood ck-mb-3 ctropnt-0.05* 04:00am blood ctropnt-0.04* probnp-1687* 05:55pm blood ctropnt-0.05* 04:00am blood albumin-2.1* phos-2.9 mg-1.9 iron-22* 05:55pm blood albumin-2.8* calcium-8.6 phos-4.1 mg-2.4 08:58am blood hapto-238* 04:00am blood caltibc-137* ferritn-497* trf-105* 05:56pm blood type-art temp-37.2 rates-/17 fio2-50 po2-120* pco2-48* ph-7.36 caltco2-28 base xs-1 intubat-intubated vent-spontaneou 07:33am blood type-art temp-36.6 rates-/25 tidal v-495 peep-5 fio2-50 po2-86 pco2-47* ph-7.39 caltco2-30 base xs-2 intubat-intubated vent-spontaneou 02:16am blood type-art peep-5 po2-122* pco2-34* ph-7.48* caltco2-26 base xs-3 -assist/con intubat-intubated 07:38pm blood type-mix peep-5 po2-106* pco2-47* ph-7.33* caltco2-26 base xs--1 -assist/con intubat-intubated comment-green top 07:36pm blood peep-5 po2-395* pco2-43 ph-7.39 caltco2-27 base xs-1 intubat-intubated 06:13pm blood lactate-2.8* 05:56pm blood lactate-1.1 04:35am blood wbc-26.2* rbc-3.33* hgb-10.4* hct-30.4* mcv-91 mch-31.3 mchc-34.3 rdw-15.3 plt ct-375 04:04am blood wbc-13.1* rbc-3.28* hgb-10.1* hct-30.3* mcv-93 mch-30.9 mchc-33.4 rdw-14.6 plt ct-382 06:00am blood wbc-13.5* rbc-3.28* hgb-9.9* hct-31.2* mcv-95 mch-30.3 mchc-31.9 rdw-14.1 plt ct-611* 11:22am blood esr-62* 03:32pm blood ret aut-2.8 04:00am blood ret aut-6.5* 04:00am blood glucose-93 urean-46* creat-1.3* na-142 k-3.9 cl-110* hco3-24 angap-12 04:41am blood glucose-117* urean-26* creat-0.8 na-148* k-3.3 cl-106 hco3-37* angap-8 06:00am blood glucose-70 urean-20 creat-0.7 na-140 k-3.9 cl-104 hco3-28 angap-12 04:00am blood ctropnt-0.04* probnp-1687* 04:35am blood ck-mb-4 ctropnt-0.04* 03:32pm blood hapto-199 04:35am blood hapto-229* 04:00am blood caltibc-137* ferritn-497* trf-105* 11:22am blood anca-negative b 11:22am blood -negative 11:22am blood rheufac-13 07:33am blood type-art temp-36.6 rates-/25 tidal v-495 peep-5 fio2-50 po2-86 pco2-47* ph-7.39 caltco2-30 base xs-2 intubat-intubated vent-spontaneou 05:56pm blood type-art temp-37.2 rates-/17 fio2-50 po2-120* pco2-48* ph-7.36 caltco2-28 base xs-1 intubat-intubated vent-spontaneou 09:40am blood type-art temp-36.6 peep-5 po2-111* pco2-56* ph-7.42 caltco2-38* base xs-10 intubat-intubated 10:31am blood type-art po2-84* pco2-52* ph-7.44 caltco2-36* base xs-9 . micro: ------ 12:00 pm aspirate with swab. vic add on per dr. pg# at 1639. vic to r/o all respiratory virus. **final report ** viral culture (final ): herpes simplex virus type 1. confirmed by monoclonal fluorescent antibody.. direct influenza a antigen test (final ): negative for influenza a viral antigen. direct influenza b antigen test (final ): negative for influenza b viral antigen. . studies: -------- ct sinus/mandible/maxillofacial w/o contrast 4:44 pm findings: three axial series were obtained through the paranasal sinuses, two of which are significantly degraded by motion artifact. the third axial series and the coronal reformats are of diagnostic quality. the paranasal sinuses are clear. the bilateral ostiomeatal complexes are patent. nasoendotracheal and nasoenteric tubes are present with their tips out of view. the left mastoid is fully included in the field of view. the right mastoid is nearly completely included with a small portion of the lateral temporal bone not included. compared to the non-contrast head ct, , there has been interval increase in fluid within the bilateral middle ear cavities as well as worsening of opacification of bilateral mastoid air cells. there is no focal fluid collection or abscess identified and no evidence of bone destruction. impression: 1. no paranasal sinus disease. 2. compared to , interval worsening in amount of fluid within the bilateral middle ear cavities as well as worsening of bilateral mastoid air cell opacification without evidence of focal fluid collection, abscess, or bone destruction. findings could represent sterile effusions related to intubation, although otomastoiditis is possible. . chest (portable ap) 9:00 am single supine view of the chest at 9:20 a.m.: again seen are a right central venous catheter terminating at the cavo-atrial junction, and a post-pyloric nasogastric tube. multiple air space opacities through both lungs are unchanged, consistent with multifocal pneumonia. again, the heart is enlarged and the pulmonary vasculature is engorged. there are small bilateral pleural effusions. impression: no interval change in multifocal pneumonia with bilateral pleural effusions and congestive heart failure, but without frank edema . unilat up ext veins us right 5:24 pm findings: grayscale, color, and pulsed wave doppler son were performed on the right subclavian, axillary, brachial, basilic, and cephalic veins. right ij could not be evaluated due to dressing overlying the indwelling central venous catheter. echogenic noncompressible thrombus is seen within a portion of the cephalic vein, but only in the antecubital fossa. visualized portions of the cephalic vein more proximally demonstrate normal flow and compressibility. other visualized veins in the right upper extremity demonstrate normal flow, waveforms, and compressibility. no other intraluminal thrombus is identified. note is made of diffuse edema throughout the right arm. impression: superficial thrombosis of the right cephalic vein in the antecubital fossa. no evidence of deep venous thrombosis in the right upper extremity. . tte (): the left atrium is elongated. left ventricular wall thicknesses and cavity size are normal. there is regional left ventricular systolic dysfunction with mild focal hypokinesis of the apex and the mid to apical septum, anterior, and lateral walls. the remaining segments contract normally (lvef = 45-50 %). right ventricular chamber size and free wall motion are difficult to assess due to suboptimal technical quality, but are probably normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. impression: suboptimal image quality. regional left ventricular dysfunction consistent with coronary artery disease or other focal myopathic process. borderline pulmonary hypertension. resting tachycardia. compared with the prior study (images reviewed) of , left ventricular function appears more vigorous. resting heart rate is now faster. . knee (2 views) right port 2:28 pm findings: two views show no evidence of joint effusion. the bony structures are quite well maintained without evidence of narrowing or spurring. of incidental note is an intramedullary device in the femur. . ct head w/o contrast 7:09 pm findings: no evidence of acute hemorrhage, mass lesion, shift of normally midline structures, hydrocephalus or evidence of major territorial infarction. there is again noted moderate diffuse global cerebral atrophy. there is moderate-to-severe periventricular white matter hypoattenuation consistent with chronic microvascular infarction. the major intracranial cisterns are preserved. there is new opacification of the mastoid air cells bilaterally. the remaining paranasal sinuses visualized are clear. there has been a right orbital lens replacement. impression: 1. no evidence of acute hemorrhage or mass effect. 2. new opacification of the mastoid air cells which may be compatible with acute mastoiditis. 3. moderate-to-severe chronic periventricular white matter ischemia/infarction, unchanged. . ct pelvis w/contrast 7:10 pm ct abdomen with contrast: bibasilar opacities are present with associated small pleural effusions. nodular opacities are also noted within the parenchyma of the right and left lower lobes. bilateral calcific pleural plaque is present suggesting previous asbestos exposure. no pericardial effusion or cardiomegaly is present. evaluation of the upper abdomen is limited given streak artifact from arms within the field of view. there is a round hypoattenuated lesion within segment iv of the liver measuring 1.3 cm in greatest axial dimension, consistent with a simple cyst. an adjacent hypoattenuating lesion is too small to adequately characterize. the gallbladder is distended without definite intraluminal stone. a trace amount of ascitic fluid is present surrounding the liver. limited views of the pancreas suggest mild pancreatic ductal prominece and a probable 8 mm hypoattenuating lesion within the body (2:27). no gross abnormalities are detected within the adrenal glands, which are not well evaluated given artifact. there is a heterogenous appearence to the left kidney which may be secondary to considerable streak artifact in this region. an ng tube courses through the mediastinum with tip terminating in the stomach. ct pelvis with contrast: there is a mild amount of ascites within the pelvis. a rectal tube is present in the rectum. there is no small-bowel obstruction. a foley catheter is noted within the bladder with a small amount of intraluminal air. there is calcific atherosclerotic plaque within the descending abdominal aorta with a very mild aneurysmal dilatation in an infrarenal location measuring 2.6 cm in greatest axial dimension. the iliac vessels are tortuous. there is a large intramuscular hematoma in the anterior compartment of the right thigh. no arterial blush is identified to suggest active extravasation of contrast material. bilateral knee effusions are only partially imaged. there is a right femoral intramedullary rod with dynamic screw in the right femoral neck and head. coarse calcifications are detected in the region of the scrotum bilaterally. impression: 1. large intramuscular hematoma in the anterior compartment of the right thigh. 2. bibasilar consolidation with small pleural effusions. aspiration must be considered. 3. bilateral knee effusions. 4. small amount of ascitic fluid. 5. calcific atherosclerotic plaque within the descending abdominal aorta and iliac branches with very mild infrarenal aneurysmal dilatation. 6. suggestion of mild pancreatic ductal prominence and a rounded cystic lesion within the body. the differential includes a pancreatic cyst vs side branch ipmn. this region is considerably degraded by streak artifact and further evaluation is recommended in 3 months time. 7. subcutaneous edema in bilateral lower extremities. . chest (portable ap); -76 by same physician : supine portable ap chest radiograph is obtained. a new right ij central line is seen with its tip in the distal svc. endotracheal tube and ng tube are unchanged. the lungs are unchanged from prior study with stable multifocal pulmonary consolidation again noted. cardiomediastinal silhouette is stable. diffuse osteopenia is noted. no pneumothorax. impression: new right ij central line in good position. otherwise, no change. brief hospital course: 89 y/o male recent discharged after micu stay for influenza pneumonitis, representing with respiratory failure, fever, altered mental status & hct drop, concern for onogoing superimposed bacterial pneumonia. micu course: egd performed and upper gi tract clear without evidence of bleed. as it turns out, patient has large hematoma in right thigh. patient was seen by wascular surgery who recommended ace wrap. the patient's hematocrit stabilized after a total of 9 unitd prbcs. patient also had head ct on arrival secondary to mental status change. was found to have acute bilateral mastoiditis for which he was started on ceftriaxone. respiratory work-up was unrevealing though there was evidence of a a possible right lower lobe infiltrate, however, his primary pathology seemed to involve peripheral paranchyma suggestive of a possible interstitial lung disease. he does have a history of work in a shipyard and the ct was noted to be consist with asbestosis in the past. at first, he was treated with meropenem and linezolid for question of failure of previous antiibotics treatment (vanc/zosyn) during his last hospitalization (was d/c 3 days prior to this admission). #anemia: hct drop on adm from 31 to 22%. hemolysis labs wnl. pt received 9units prbcs, hct did not rise appropriately until after 3rd unit. hct finally went to 30, no e/o hemodynamic instability. guaiac negative from golytely bm, reported coffee grounds in ng lavage performed in ed, bile currently present when og suctioned, egd on showed clean upper gi tract without evidence of bleeding. colonosocpy not perfromed with guaiac negative schools and intubated. nursing noted swelling of right knee and right lower extremity. plain films of right knee negative. seen by rheum no blood on tap, no crystals. leni of right lower extremity revealed hematoma. vascular consulted recommended cta of rle. patient premedicated with acetylcysteine and and bicarb. scan showed large hematoma with no evidence of active extravation of contrast. after transfer to the floor, hematocrit remained stable, and thigh size improved with ace wraps. # respiratory failure/#likely aspiration pneumonia: etiology unclear, possibly aspiration versus inability to clear secretions causing respiration pneumonitis vs. acute flare up of what appears to be underlying interstital lung disease. respiratory viral screen positive for hsv 1, but felt to be an oral contaminant. cxr and prior ct seem consistent with underlying interstitial ling disease, making reserve lower. patient successfully extubated, transferred to floor. he required intermittent suctioning for thick secretions on transfer, but remained stable on 50% humidified face tent. subsequently transitioned to face mask and then nasal canula. he was maintained on ceftriaxone and then flagyl was later added for better anaerobic coverage. a course was completed. pt. continued to have delerium, inability to eat safely, ultimately, after many disucssions with family, pt. was sent home with hospice care. # mastoiditis/#leukocytosis: ceftriaxone therapy initiated, and impressive admission leukocytosis improved gradually, though remained elevated. he was not febrile while on the floor. #altered mental status/#dementia: delerium in the setting of acute illness, icu stay and intubation with associated sedating meds. upon transfer to floor, he interacted with tracking and unintelligible vocalization. he has a history of dementia, but prior to recent hospitalizations was ambulatory and interactive, although disoriented to all but self. he subsequently was quite lethargic with minimal interaction. later, he was alert again and more interactive, even recognizing his son and conversing, however, only intermittantly. he did not improve overall, and was sent home with hospice care. # arf: baseline creatinin 0.7. improved with hydration. premedicated with acetylcysteine and bicarb for cta with no bump in cr. # anasarca -- in the setting of fluid resucitation and acute illness. improved with gentle diuresis. right upper ext felt to be larger than left, so u/s doppler done with no evidence of dvt (only superficial clot). # flexible feeding tube placement -- placed by ir for nutrition and fluids on the day of transfer to the floor, . initiated on tube feeds without difficulty. family was informed this does not decrease his risk for aspiration. dobhoff tube fell out on when patient vomited small amount. . # goals of care prior to dobhoff tube falling out, overall goals of care discussed with family (sons and ). initial thought was to allow a course of antibiotics (at least one week more) and then re-assess. decision on peg deferred. however, after dobhoff tube came out, issue was revisited. palliative care also consulted. after much discussion, decision made to make patient dnr/dni, not pursue replacement of dobhoff or peg, but consider iv nutrition. immediately after this, decision made to make patient cmo. this was done on night of (including cessation of antibiotics). however, on morning of , patient was much more alert. decision then made to reverse cmo status, however keeping dnr/dni status and not pursuing aggressive measures. antibiotics were restarted. patient was also seen by speech/swallow. though at high risk for aspiration, family willing to take risk to allow patient to eat since patient seemed to want to eat. tpn also initiated for brief period of time to provide minimal nutrition. plan is to assess for any improvement in overall mental status and respiratory status and then re-assess goals of care. pt. subsequently aspirated again, and the above discussion and family meeting again done. family decided not to feed him, to pursue further parenteral nutrition and to complete his antibiotic course. he fluctuated from this point forward, with two episodes of mucous plugging with desaturations to the 60s, requiring invasive nasotracheal suctioning to clear the secretions. he slowly became more alert and interacitive, but was unable to comply with pt or speech evaluations. after numerous further dicussions with the patient's sons, palliative care and the medical team, the decision was made by the sons (and hcp son ) to send the patient home with hospice (no tpn, no saline, no abx, no picc line) with cmo status. the patient was discharged on to home with hospice. medications on admission: asa 81 mg metoprolol tartrate 25 mg vancomycin 750 mg ended zosyn 4.5 q 8 ended ipratropium bromide 0.02% q6 prevacid 30 mg daily senna colace oral dulcolax tylenol 325 mg q6 discharge medications: 1. morphine concentrate 20 mg/ml solution sig: 1-10 mg po q2h (every 2 hours) as needed for pain, increased secretions. disp:*60 ml* refills:*0* discharge disposition: home with service facility: hospice of the good discharge diagnosis: primary: possible aspiration pneumonia secondary: dementia secondary: 276.0 hypernatremia secondary: 383.9 unspecified mastoiditis secondary: 263.0 malnutrition, moderate secondary: 293.0 delirium, nos secondary: 600.01 bph w/ urinary obstruction secondary: 428.20 heart failure, (a3) chronic systolic secondary: thigh hematoma secondary: acute blood loss anemia discharge condition: vital signs stable discharge instructions: patient going home with hospice. followup instructions: provider: xray (scc 2) phone: date/time: 9:55 provider: , md phone: date/time: 10:15 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) acute respiratory failure pneumonitis due to inhalation of food or vomitus chronic systolic heart failure rash and other nonspecific skin eruption unspecified accident contusion of thigh hyperosmolality and/or hypernatremia malnutrition of moderate degree unspecified mastoiditis 

Answer: The patient is high likely exposed to