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: dyspnea major surgical or invasive procedure: arterial line placement central line placement intubation history of present illness: 85 m with history of htn, hypercholesterolemia, pvd, lung ca s/p right pneumonectomy presenting with increasing sob x several days and dry cough with fever at home. denies cp/palpitations. no n/v/d. . on arrival to ed, initial vitals 97.2 100 106/52 20 86% and triggered for an o2 sat of 86%. patient was placed on a nrb with o2 sats up to 100%, but rr continued to rise to 30-40. initial cxr showed noew opacity in left base compatible with pna. started on ceftriaxone and levofloxacin for presumed pna. patient was subsequently intubated for increasing respiratory distress and elevated lactate. other notable labs were trop of 0.16, bnp of , cr of 1.7 up from baseline of 0.8, wbc of 18.6 with left shift. ekg st at 112 with new rbbb. cardiology consulted given trop elevation and felt likely secondary to demand ischemia and hypoperfusion, recommended treatment with asa, but no further intervention. after intubation, sbps dropped to 60s, started on peripheral levophed and left ij cvl was placed in ed. on transfer to micu, patient's most recent vitals were bp 96/48, 99, 99% on fio2 60%, peep 8 on levophed 0.15. given 3l ns down in ed. . on arrival to the micu, patient is intubated and sedated. vital signs are bp 99/58, p 117, rr 17, o2 sat 97% intubated. no further history is able to be obtained. past medical history: htn, bph s/p turp, pleural pulmonary tuberculosis, lung ca s/p right pneuomnectomy, pvd, prostate ca s/p xrt social history: divorced. employed as custodian. former heavy smoker, quit in 's ?90's. lives alone. has a daughter who is in good health. family history: non contributory physical exam: admission exam vitals: bp 99/58, p 117, rr 17, o2 sat 97% intubated general: intubated, sedated, in nad heent: perrl, ett in place, ngt in place neck: supple, jvp not elevated, no lad cv: sinus tachycardia, normal s1 + s2, no murmurs, rubs, gallops lungs:crackles at left base on anterior exam, absent breathsounds on right abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley in place draining concentrated urine ext: cool extremities bilaterally with 2+ radial and dp pulses bilaterally, no appreciable edema, right foot with small 1cm circumference nonhealing ulcer on dorsum, no surrounding erythema, no significant drainage neuro: intubated and sedated pertinent results: admission labs: 10:45pm blood wbc-18.6*# rbc-4.92 hgb-14.4 hct-43.9 mcv-89 mch-29.3 mchc-32.9 rdw-14.9 plt ct-112* 10:45pm blood neuts-87* bands-9* lymphs-2* monos-2 eos-0 baso-0 atyps-0 metas-0 myelos-0 10:45pm blood hypochr-normal anisocy-normal poiklo-normal macrocy-normal microcy-normal polychr-normal 12:00am blood pt-19.3* ptt-33.0 inr(pt)-1.8* 10:45pm blood glucose-185* urean-43* creat-1.7* na-127* k-5.8* cl-85* hco3-18* angap-30* 10:45pm blood ck-mb-12* mb indx-1.2 probnp-* 10:45pm blood ctropnt-0.16* 03:43am blood ck-mb-13* mb indx-1.8 ctropnt-0.22* 02:44pm blood ck-mb-15* mb indx-2.8 ctropnt-0.36* 10:05pm blood ck-mb-12* ctropnt-0.31* 03:43am blood calcium-7.5* phos-4.1 mg-1.9 03:43am blood hbsag-negative hbsab-positive hbcab-positive 01:30pm blood hiv ab-negative 03:43am blood hcv ab-negative 10:50pm blood lactate-10.6* 04:04am blood o2 sat-68 03:58am blood freeca-1.08* . urine 01:20am urine color- appear-hazy sp -1.014 01:20am urine blood-tr nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-2* ph-5.0 leuks-neg 01:20am urine rbc-2 wbc-3 bacteri-few yeast-none epi-1 01:20am urine castgr-16* casthy-8* 01:20am urine mucous-rare 10:12am urine hours-random urean-428 na-less than k-45 cl-16 10:12am urine osmolal-375 . microbiology: . 11:00 pm blood culture # 2. **final report ** blood culture, routine (final ): no growth. 1:20 am urine **final report ** urine culture (final ): no growth. 1:47 pm bronchoalveolar lavage gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram positive cocci. in pairs and in short chains. smear reviewed; results confirmed. respiratory culture (final ): no growth, <1000 cfu/ml. legionella culture (final ): no legionella isolated. potassium hydroxide preparation (final ): test cancelled by laboratory. patient credited. this is a low yield procedure based on our in-house studies. if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): no mycobacteria isolated. 1:47 pm rapid respiratory viral screen & culture respiratory viral culture (final ): no respiratory viruses isolated. culture screened for adenovirus, influenza a & b, parainfluenza type 1,2 & 3, and respiratory syncytial virus.. detection of viruses other than those listed above will only be performed on specific request. please call virology at within 1 week if additional testing is needed. respiratory viral antigen screen (final ): less than 60 columnar epithelial cells; specimen inadequate for detecting respiratory viral infection by dfa testing. interpret all negative results from this specimen with caution. negative results should not be used to discontinue precautions. refer to respiratory viral culture results. recommend new sample be submitted for confirmation. reported to and read back by 10:30am. viral culture: r/o cytomegalovirus (preliminary): no cytomegalovirus (cmv) isolated. cytomegalovirus early antigen test (shell vial method) (final ): negative for cytomegalovirus early antigen by immunofluorescence. refer to culture results for further information. 5:07 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. smear reviewed; results confirmed. respiratory culture (final ): commensal respiratory flora absent. stenotrophomonas (xanthomonas) maltophilia. moderate growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ stenotrophomonas (xanthomonas) maltophilia | trimethoprim/sulfa---- <=1 s ecg's: cardiovascular report ecg study date of 10:50:22 pm sinus tachycardia. right bundle-branch block. non-diagnostic repolarization abnormalities. compared to the previous tracing of right bundle-branch block and sinus tachycardia are now present. tracing #1 cardiovascular report ecg study date of 8:53:20 am sinus rhythm with atrial premature depolarizations. compared to the previous tracing the heart rate is reduced. otherwise, no significant change. tracing #2 cardiovascular report ecg study date of 10:53:32 pm atrial fibrillation with a rapid ventricular response. right bundle-branch block. diffuse st-t wave changes. compared to the previous tracing of the rhythm is atrial fibrillation with a rapid ventricular response. other findings are similar. tracing #1 cardiovascular report ecg study date of 2:01:58 am sinus rhythm with atrial premature beat. right bundle-branch block. non-specific lateral t wave changes. compared to the previous tracing sinus rhythm is now present. tracing #2 cardiovascular report ecg study date of 6:15:10 am atrial fibrillation with rapid ventricular response. right bundle-branch block. diffuse non-specific st-t wave changes. q-t interval is prolonged. compared to the previous tracing of the rhythm is now atrial fibrillation and the ventricular response is rapid. cardiovascular report ecg study date of 10:43:48 am sinus rhythm with atrial premature depolarizations. right bundle-branch block. non-diagnostic repolarization abnormalities. compared to the previous tracing of the cardiac rhythm is now sinus mechanism. imaging: radiology report chest (portable ap) study date of 10:36 pm impression: left basal pneumonia. followup radiograph four weeks after treatment is recommended. radiology report chest (portable ap) study date of 11:15 pm impression: satisfactory position of endotracheal tube with findings of left basal pneumonia. , portable tte (complete) done at 10:04:10 am final there is mild symmetric left ventricular hypertrophy. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the overall left ventricular ejection fraction is severely depressed (lvef = 25 %) secondary to ventricular interaction with a pressure and volume overloaded right ventricle. the right ventricular cavity is dilated with severe global free wall hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the ascending aorta is mildly dilated. 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. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen (may be significantly underestimated due to the technically suboptimal nature of this study). significant pulmonic regurgitation is seen. there is no pericardial effusion. radiology report chest (portable ap) study date of 12:44 am the et tube tip is 7 cm above the carina. the ng tube tip is in the stomach. left internal jugular line tip is most likely in the left brachiocephalic vein. there is additional interval progression of left middle lower lung consolidation. no pneumothorax is seen. small amount of pleural effusion cannot be excluded. radiology report chest (portable ap) study date of 1:09 am portable ap radiograph of the chest was reviewed in comparison to prior study obtained several minutes earlier. currently, the left internal jugular has been advanced with its tip most likely at the superior svc. the rest of the findings did not change in the short interim. radiology report cta chest w&w/o c&recons, non-coronary study date of 2:51 am impression: 1. multifocal left pneumonia and parapneumonic effusion. 2. stable right pneumonectomy changes. 3. no evidence of pulmonary embolism. probable pulmonary hypertension. 4. left adrenal adenoma. radiology report chest (portable ap) study date of 4:32 am impression: ap chest compared to through 17: large pneumonia in the left lung has increased in extent since , accompanied by increasing pleural effusion, of indeterminate volume. the patient has had right pneumonectomy. et tube is in standard position. left jugular line ends in the upper svc. no left pneumothorax. radiology report chest port. line placement study date of 2:56 pm impression: right-sided picc line in the right atrium, should be withdrawn 4 cm for more optimal positioning in the low svc. increasing left basilar pneumonia. radiology report chest (portable ap) study date of 2:21 am multifocal pneumonia in the left lung is unchanged. the left apex is still clear. patient is status post right pneumonectomy with white out of the right hemithorax. the cardiomediastinal silhouette cannot be evaluated, is obscured by pleural and parenchymal abnormalities. et tube is in standard position. ng tube tip is in the stomach. right picc tip is probably in the mid svc. radiology report chest (portable ap) study date of 4:43 pm findings: as compared to the previous radiograph, the previous feeding tube has been removed and replaced by a dobbhoff catheter. the catheter is in the mid esophagus. it should be advanced by at least 20 cm to ensure position within the stomach. the patient has also received a tracheostomy tube and the endotracheal tube has been removed. normal position of this device. radiology report chest (portable ap) study date of 8:46 pm findings: as compared to the previous radiograph, there is unchanged appearance of the left lung, with a known extensive left pneumonia. the monitoring and support devices are constant. also constant is the appearance of the post-pneumonectomy chest on the right. radiology report chest (portable ap) study date of 1:11 pm findings: comparison is made to previous study from . there is a tracheostomy tube, which is unchanged in position and appropriately sited. there is again seen complete whiteout of the right lung. there is a dobbhoff tube whose tip is in the fundus of the stomach. there is an airspace opacity in the left mid and lower lung fields consistent with known pneumonia. this is slightly more dense than on the prior study. there are no pneumothoraces. cxr 7:15 am impression: worsening extensive left lung consolidation. minimal aerated left upper lobe. brief hospital course: primary reason for hospitalization: patient is an 85yo male with htn, hypercholesterolemia, pvd, and lung ca s/p pneumonectomy who presented with respiratory failure and shock, and found to have pneumonia. he initially presented with increasing sob x 1 week with associated dry cough and fever. he was quite ill from the time of presentation with respiratory distress, for which he required intubation, as well as hypotension requiring vasopressors. cxr was consistent with pna. initial bal showed gram positive cocci and he completed a course of antibiotics for cap. he improved and was successfully weaned off all pressors, however, after initial improvement, patient had recurrent fevers, leukocytosis, and worsening cxr. bronchoscopy was concerning for necrotizing pna. patient was started on treatment for vap with cipro, vanc, cefepime however sputum culture showed stenotrophomonas (xanthomonas) maltophilia and antibiotics were tailored to sensitivities. the patient's respiratory status remained tenous from the start, he underwent tracheostomy placement on . he continued on cmv with increased minute ventilation. he had intermittent difficulty tolerating ventilation with intermittent agitation requiring increasing sedation. he later developed increasing bloody secretions worsened by anticoagulation for afib. his warfarin was stopped and he was given 2mg of vitamin k. fio2 and peep requirements subsequently increased with some transient improvement with suctioning. overall, patient's respiratory status continued to deteriorate, requiring fio2 100%, appearing increasingly uncomfortable despite increases in sedating medications. the patient's clinical status was discussed with his hcp who ultimately chose to gradually withdraw aggressive medical care over several days. on , per family/hcp request, the ventilator was withdrawn. patient was kept comfortable with iv pain medications, and he expired at 10:20 pm. the family refused autopsy. . the patient's course was complicated by the following: # acute respiratory failure see above. . # septic shock hypotensive on admission requiring vasopressors, improved with volume and treatment of underlying infection. ultimately weaned off pressors, though transiently required them for trach procedure . as patient was transitioned to comfort care did not further address hypotension. # acute kidney injury patient developed atn, likely from poor perfusion while initially septic. from initial presentation and volume boluses, patient remained volume up for length of stay and required lasix diuresis. his creatinine intially normalized, however, renal dysfuction gradually insued with associated electrolyte abnormalities. as patient was transtioned to comfort measures, laboratory studies were no longer monitored. # afib with rvr patient with intermittent afib. he received amiodarone 1mg/min x 6 hours then 0.5 mg/min for 18 hours however amio d/c??????d on as patient was in sinus rhythm and lfts were rising. he remained in sr thereafter. metoprolol was held metoprolol in setting of hypotension, and warfarin was ultimately discontinued in the setting of airway bleeding. # anemia and thrombocytopenia: related to hemodilution in the setting of large amount of iv fluids, marrow suppression in setting of acute infection, and gradual blood loss from pulmonary process. # foot ulcer his wound was evaluated by vascular surgery who felt it was stable and not the cause of his sepsis. medications on admission: asa 81 hctz 25 pravastatin 40 percocet 1 tab qhs discharge medications: n/a discharge disposition: expired discharge diagnosis: respiratory failure discharge condition: expired md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy arterial catheterization arterial catheterization temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified hyperpotassemia thrombocytopenia, unspecified anemia, unspecified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation personal history of malignant neoplasm of prostate personal history of malignant neoplasm of bronchus and lung other chronic pulmonary heart diseases personal history of tobacco use systolic heart failure, unspecified ulcer of other part of foot 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 and chronic respiratory failure long-term (current) use of insulin septic shock do not resuscitate status hyperosmolality and/or hypernatremia ventilator associated pneumonia accidents occurring in residential institution other disorders of neurohypophysis atherosclerosis of native arteries of the extremities with ulceration personal history of tuberculosis acquired absence of organ, lung 

Answer: The patient is high likely exposed to