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: shortness of breath major surgical or invasive procedure: picc line placement history of present illness: 77m with hx of copd, recent admit for copd flare, arf (d/c ), afib, chf sent to ed from with severe shortness of breath and desaturation to 86%. pt states that this am, he woke up and was feeling well. he got up to go the bathroom but needed to take his oxygen off because it would not reach. when he got back from the bathroom, he was severely short of breath. he put his oxygen back on but it did not help. he states that he could hear himself wheezing. later, he again got up to go to the bathroom and had to take off his o2. once again, he became severely short of breath. this time, he sat in his chair because that makes his breathing better but his o2 does not reach to the chair. he felt very short of breath and for his nurse. his o2 sat was checked and found to be 86% on ra. nursing home notes state that pt has been coughing up blood tinged sputum. pt states he has a chronic cough productive of dark brown sputum. her cannot walk more than 3 feet without stopping to rest. he denies chest pain, palpitations. . in ed, cxr showed rul pneumonia and pt was given levaquin and nebs. past medical history: * copd: no pfts on record, on home o2 3l/m for past 2 weeks * interstitial lung disease * atrial fibrillation (formerly on coumadin; stopped during last admission) * chf: last echo with lvef >55%, 2+ mr, 3+ tr, mild av stenosis, severe pulm art htn * severe pulm art htn by echo * dm type ii * cri: baseline creat 1.6 * bph * known bladder mass since * ? lung mass * anemia social history: lives with his wife in a 2 story house but is now at a since recent hospitalization; smoked 150 pack-years, quit 7 years ago; formerly worked in a battery factory and may have been exposed to hazardous chemicals during this time; has a h/o asbestos exposure; no alcohol or illicit drug use. one daughter lives down the street. family history: father with cad. physical exam: temp 98.2, bp 130/60, hr 102, r 20, o2 94% 4l; wt 187lbs gen: nad, pleasant; moderate resp distress after moving about in bed; ao x 2 heent: eomi, mmm; +accessory muscle use with resp distress neck: no jvd, no bruit cv: tachy, irreg irreg; difficult to ascultate heart sounds due to breath sounds; no murmurs detected chest: diffuse exp wheezes with prolonged exp phase; crackles at bilateral bases abd: +bs, soft, mildly distended, nontendner; multiple bruises ext: venous stasis skin changes; 2+ dp skin: multiple abrasions on arms, abdomen, lower ext; on lle, 4cm area of raw skin; on rle, 3cm area of raw skin; on top of right foot, large area of raw skin, tender pertinent results: 02:28pm urine rbc-0-2 wbc-0 bacteria-rare yeast-few epi-0 02:28pm urine blood-mod nitrite-neg protein-neg glucose-250 ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 02:28pm urine color-yellow appear-clear sp -1.007 04:05pm plt count-278 04:05pm neuts-83* bands-2 lymphs-3* monos-9 eos-3 basos-0 atyps-0 metas-0 myelos-0 nuc rbcs-2* 04:05pm wbc-16.5*# rbc-3.14* hgb-9.3* hct-27.5* mcv-88 mch-29.8 mchc-33.9 rdw-18.6* 04:05pm ck-mb-4 ctropnt-0.05* probnp-969* 04:05pm ck(cpk)-144 04:05pm glucose-165* urea n-45* creat-1.5* sodium-138 potassium-5.0 chloride-98 total co2-29 anion gap-16 05:05pm lactate-1.2 . micro: - bcx () 4/4 bottles no growth (final) - sputum cx () contaminated with resp secretions - urine legionella ag negative (final) . cxr (): there is no significant interval change in multifocal patchy opacities bilaterally since multiple prior exams, including chest ct dated . the pulmonary vasculature is normal. there is no pneumothorax. tiny bilateral pleural effusions are slightly smaller than one day earlier. the cardiac silhouette, mediastinal and hilar contours are stable. the surrounding soft tissue and osseous structures are unremarkable. . ct-chest w/o contrast. impression: 1. poorly defined patchy and nodular airspace opacities seen bilaterally suggesting multifocal pneumonia. followup imaging following treatment to document resolution is recommended. 2. small bilateral pleural effusions, right greater than left. 3. pleural calcifications bilaterally, suggesting prior asbestos exposure. 4. diffuse coronary artery calcifications and atherosclerotic calcifications noted within the aorta. . echo : the left and right atria are moderately dilated. the estimated right atrial pressure is 16-20 mmhg. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. the right ventricular cavity is dilated. right ventricular systolic function is normal. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (area 1.2-1.9cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. the mitral regurgitation jet is eccentric. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. . ekg (): afib at 87 bpm, lad, flattened t waves in i, borderline ivcd with left bundyloid pattern; flipped t waves in avl; no st changes; overall unchanged from prior tracing . brief hospital course: 77-yo-man w/ copd, afib, diastolic chf, anemia, ckd, admitted with pna. he had recently been discharged after a copd exacerbation treated with steroids. he is status post micu stay for hypoxia/respiratory distress. . # hypoxia/resp distress: this was though to be multifactorial, due to pna, copd, and diastolic chf. his acute dyspnea that resulted in icu transfer was felt due to volume overload, and improved after diuresis with iv lasix. he was diuresed with iv lasix, treated with iv antibiotics (see below), and round the clock nebulizers. . # pna: this was multilobar, noted both on chest x-ray and non-contrast ct scan of the chest. blood cultures had no growth (final). initial sputum culture was contaminated and repeat grew oropharyngeal flora (not speciated). initially he was placed on levofloxacin, with vancomycin added 24 hours later. the pneumonia was complicated by chf and copd exacerbations, so his progress was slow. after 6 days of levofloxacin and 5 days of vancomycin, his coverage was broadened to zosyn instead of levofloxacin for presumed nosocomial pneumonia, acquired at the nursing home. vanco was continued. he remains afebrile and his wbc normalized. he should receive an additional 7 days of vancomycin and zosyn. he should follow up with dr. (his primary care physician) in weeks. . # copd: the patient has no pfts on record, but he has had a constant o2 requirement since his last discharge on of 3l nasal cannula. his copd was likely exacerbated by his pna. he was continued on advair and placed on a more extended prednisone taper (he should begin 20mg x 7 days on , tapered to 10mg daily for 7 days, then to 5mg daily x 7 days, then off). he should continue nebulizers, atrovent q6h and albuterol q4h). once his acute flair has improved, he should be referred for outpatient pfts. . # atrial fibrillation: the patient was rate controlled on diltiazem which was continued. coumadin was stopped during his last admission due to hematuria. he was continued on aspirin. b-blocker was not given as not to exacerbate his copd. . # dm type 2: the patient was diet controlled until his prior hospitalization in . since he has been on steroids, he has required insulin. his fingersticks should be checked four times a day. he should receive 20 units of nph insulin each morning and at bedtime, along with a sliding scale. his doses of insulin may need to be decreased as his steroids are tapered. . # cri: this is likely from htn and dm nephropathy. the patient was at baseline (creat ~ 1.6). his medications were renally dosed. he has an appointment with his nephrologist in as noted on the discharge paperwork. . # anemia - this is a combination of blood loss and chronic inflammation. his baseline hct 26-28. he had hematuria (see below) and received 4 units total of packed rbcs. his hct was stable post transfusion, and he is currently at baseline hct. he was noted to have guiac positive stools, and will need outpatient colonoscopy once his acute respiratory issues have improved sufficiently. he was started on iron supplements. . # hematuria: pt has known bladder mass and bph. urology was consulted during last admission, and recommended stopping his coumadin and outpt urology followup. urology was re-consulted for hematuria after foley insertion. they again recommended outpatient workup and cystoscopy. proscar was started as per urology and urine cytology sent (can be followed up by urology at the outpatient appointment.) the patient had continuous bladder irrigation and his urine cleared. bladder irrigation was stopped 36 hours prior to discharge and the patient's urine remained clear. on the day of discharge the foley was changed from a 3-way to an 18-french 2 way catheter. some hematuria was again noted but this was felt due to the trauma of foley replacement. he should follow up with urology on as previously scheduled. he can have a voiding trial in days as the catheter is no longer required for medical management. . # le wounds: the patient had skin ulcers on his lower extremities likely secondary to blisters and excoriation by patient. there was good perfusion on exam and no evidence of ulcer progression or superinfection. he was followed by the wound nurse were changed daily (wound gel and adaptic, covered with kerlix). the wound care should continue at rehab and his wounds monitored closely for sign of infection. . # fen: diabetic/cardiac diet. electrolytes were stable. . # prophylaxis: sc heparin, bowel regimen, diet . # full code . # communication: (wife) medications on admission: * ipraptropium * senna/colace * levalbuterol prn * prednisone 20mg until * furosemide 40 mg qmwf * aspirin 325 mg qd * lisinopril 2.5 mg qd * diltiazem hcl 240 qd * tamsulosin 0.4 mg qhs * insulin ss discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 2. albuterol sulfate 0.083 % solution sig: one (1) nebulized treatment inhalation q4h (every 4 hours). 3. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 5. diltiazem hcl 240 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 8. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 9. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 10. insulin nph human recomb 100 unit/ml cartridge sig: twenty (20) units subcutaneous qam. 11. insulin nph human recomb 100 unit/ml cartridge sig: twenty (20) units subcutaneous at bedtime. 12. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 13. furosemide 20 mg tablet sig: three (3) tablet po daily (daily). 14. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q6h (every 6 hours). 15. metolazone 2.5 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). 16. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 17. piperacillin-tazobactam na 2.25 gm iv q6h 18. vancomycin hcl 1000 mg iv q 24h 19. tamsulosin 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po hs (at bedtime). 20. prednisone 20 mg tablet sig: one (1) tablet po daily (daily) for 7 days: then decrease dose to 10mg x 7 days, then 5mg x 7 days, then off. 21. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 22. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for for pain with dressing changes. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: 1. pneumonia, nosocomial 2. copd (chronic obstructive pulmonary disease) 3. chf (congestive heart failure) . secondary: 1. bladder mass 2. diabetes 3. atrial fibrillation discharge condition: afebrile, breathing improved. stable. discharge instructions: please take all your medications as prescribed. you were admitted with pneumonia and need another week of iv antibiotics. you should continue to use oxygen (3l nasal cannula) at all times). . call your doctor or return to the hospital if you have fever, shortness of breath, chest pain, or any other concerning symptom. followup instructions: please call your primary doctor, dr. , for an appointment within 1-2 weeks. . you should follow up with your kidney doctor, dr. as noted below. you have an appointment with a urologist, dr. , on as noted below for work up of your bladder mass. . provider: , md phone: date/time: 10:15 provider: , m.d. phone: date/time: 9:00 procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified anemia, unspecified coronary atherosclerosis of native coronary artery unspecified pleural effusion congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) postinflammatory pulmonary fibrosis diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to