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: naprosyn attending: chief complaint: transfer for urgent cardiac catheterization major surgical or invasive procedure: cardiac catheterization central venous line placement (subclavian) history of present illness: mr. is a 76 year-old man with a history of dm, htn, hl but no known cad, who initially presented to an osh with shortness of breath on who is now being transferred with a stemi. per the osh records (no history could be obtained from the patient as he is intubated): presented on with two weeks of cough and dyspnea. seen by his pcp and was given tylenol with codeine. on the day of admission, had worsened sob and cough with white sputum. no fevers. also with chest pain, reportedly from coughing. noted to have arf (scr of 1.5 on admit) with a lactate of 1.6. ck and troponin were negative. bnp was 386. cxr showed rll pna and he was treated with levaquin. on hd#2, at 7pm, noted by to be sob and wheezing. o2 sat <80% and placed on nrb after which time he became unresponsive with reported right eye gaze and questionable weakness of the rue. an abg was done and showed 7.03/106/297 (on nrb) and he was intubated. soon after, bp 220/113 with a hr of 114. labs later returned with a ck of 186, mb 10.2, trop t 0.495. ecg showed sinus tach. aspirin then increased to 325 and atorvastatin 80 given. a head ct was ordered before heparin was administered. at 4:30am on day of transfer patient was hypotensive with ecg showing ?stemi. neosynephrine was started. he is transferred to for urgent cardiac catheterization, on neo, insulin, and heparin gtts. cardiac catheterization at showed: two vessel coronary artery disease. diastolic dysfunction with severely elevated filling pressures. stenting of mid lad with two overlapping bms. past medical history: 1. cardiac risk factors: (+) diabetes (+) dyslipidemia (+) hypertension 2. cardiac history: -cabg: none. -pci: none. -pacing/icd: none. 3. other past medical history: - diverticulosis - history of colon polyps - osteoarthritis social history: lives at home alone. quit smoking 15 years ago, prior to that smoked ppd x18 years. denied etoh and illicit drug use. family history: non contributory physical exam: general: intubated and sedated. heent: ncat. sclera anicteric. pupils constricted. neck: difficult to assess jvp with central line in place. cardiac: rrr, nl s1-s2, no mrg lungs: vented resp were unlabored. diffuse wheezes anteriorly. abdomen: +bs, soft/nt/nd. extremities: wwp, no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: 2+ dps bilaterally. pertinent results: laboraotyr studies: 07:51am blood wbc-10.5 rbc-3.43* hgb-11.0* hct-31.6* mcv-92 mch-32.0 mchc-34.9 rdw-13.2 plt ct-217 04:21am blood wbc-14.5* rbc-3.31* hgb-10.5* hct-30.0* mcv-91 mch-31.9 mchc-35.1* rdw-13.3 plt ct-194 06:21am blood wbc-9.4 rbc-3.33* hgb-10.3* hct-29.8* mcv-90 mch-31.1 mchc-34.7 rdw-13.3 plt ct-186 07:51am blood neuts-87.8* lymphs-10.4* monos-1.2* eos-0.6 baso-0 07:51am blood pt-15.1* ptt-68.6* inr(pt)-1.3* 06:21am blood pt-21.7* ptt-150* inr(pt)-2.1* 07:51am blood glucose-174* urean-29* creat-1.4* na-139 k-4.5 cl-106 hco3-23 angap-15 06:21am blood glucose-112* urean-27* creat-1.1 na-142 k-3.6 cl-102 hco3-30 angap-14 11:10am blood ck(cpk)-262* 03:00pm blood ck(cpk)-511* 10:01pm blood ck(cpk)-714* 04:21am blood ck(cpk)-644* 11:10am blood ck-mb-19* mb indx-7.3 ctropnt-0.36* 03:00pm blood ck-mb-50* mb indx-9.8* ctropnt-0.64* 10:01pm blood ck-mb-80* mb indx-11.2* ctropnt-1.24* 04:21am blood ck-mb-71* mb indx-11.0* ctropnt-2.02* 11:10am blood calcium-7.8* phos-2.8 mg-2.2 cholest-246* 07:51am blood albumin-3.6 06:21am blood calcium-8.6 phos-3.7 mg-2.1 07:51am blood vitb12-352 07:51am blood %hba1c-6.2* 11:10am blood triglyc-113 hdl-45 chol/hd-5.5 ldlcalc-178* 09:55am blood type-art po2-113* pco2-56* ph-7.28* caltco2-27 base xs--1 02:10pm blood type-art po2-100 pco2-46* ph-7.43 caltco2-32* base xs-4 03:12pm blood type-art temp-37.3 rates-/15 peep-5 fio2-40 po2-105 pco2-53* ph-7.31* caltco2-28 base xs-0 intubat-intubated 05:52am urine color-straw appear-clear sp -1.022 05:52am urine blood-sm nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 05:52am urine rbc-10* wbc-1 bacteri-none yeast-none epi-0 05:52am urine castgr-4* casthy-28* microbiology: swab respiratory culture-pending; gram stain-no organisms; fungal culture-pending blood culture blood culture, routine-pending blood culture ( myco/f lytic bottle) blood/fungal culture-pending; blood/afb culture-pending blood culture blood culture - pending catheter tip-iv pending aspirate nasal sinus gram stain- gram stain (final ): 2+ (1-5 per 1000x field): squamous epithelial cells. 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture and fungal cultures - pending. catheter tip-iv wound culture-negative sputum gram stain-final; respiratory culture-preliminary {aspergillus species}, sparse growth; oropharyngeal flora blood culture blood culture, routine-pending blood culture blood culture, routine-pending urine urine culture-negative mrsa screen mrsa screen-negative catheter tip-iv negative imaging/studies: ecg 12.17: artifact is present. sinus rhythm. there are tiny r waves in the anterior leads consistent with possible prior anterior infarction. there is st segment elevation in the lateral and anterolateral leads with st segment depression in the inferior leads consistent with acute myocardial infarction. clinical correlation is suggested. c. catheterization : final diagnosis: 1. stemi. 2. two vessel coronary artery disease. 3. diastolic dysfunction with severely elevated filling pressures. 4. successful stenting of the mid lad with two overlapping bms. cxr 12.17: impression: ap chest reviewed in the absence of prior chest radiographs: heterogeneous peribronchial infiltration in the lower lungs, right greater than left could be due to asymmetric edema, but alternatively, given the presence of partially calcified pleural thickening along the right lower costal margin could be due to overlying pleural abnormality. upper lungs are clear, and free of either vascular congestion or edema. there is no layering pleural effusion. heart size is normal. et tube in standard placement, an ascending pulmonary floatation catheter tip projects over the left pulmonary artery at the origin of the descending portion, nasogastric tube passes into the stomach and out of view and a right subclavian line can be traced as far as the low right atrium. no pneumothorax. ecg : sinus rhythm. st segment elevation in the anterior and anterolateral leads with terminal t wave inversion and more modest st-t wave changes in the remaining leads consistent with evolving myocardial infarction. compared to the previous tracing evidence of evolution is now present. clinical correlation is suggested. echo : the left atrium is elongated. a small secundum atrial septal defect is present. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. small secundum asd. cxr : frontal chest radiograph: the endotracheal tube and swan-ganz catheter have been removed. a left subclavian central venous line tip terminates in distal svc. there is no pneumothorax. the cardiomediastinal silhouette is stable. bibasilar opacities likely represent atelectasis and are unchanged. cta head/neck: 1. no evidence of acute infarct, vessel cutoff or intracranial hemorrhage. final read pending reformats. 2. left maxillary opacification and mass effect mass causes dehiscence of the medial wall. consideration includes inverting papilloma but squamous cell cancer or infectious process cannot be excluded. appearance is unchanged from study performed . chest ct: preliminary - no focal consolidation to suggest aspergillus pneumonia. brief hospital course: 76m with htn, dm, hl, but no known cad, presented to osh w/ pna and arf, now transferred to ccu w/ stemi. s/p bms x2 to mid-lad 90% stenosis. 1. cad. pt w/ stemi, admitted to ccu on s/p bms x2 to mid-lad for 90% stenosis. on cath, fick co 6.73, ci 3.20. anatomy also w/ proximally occluded rca w/ robust collaterals. ecg pos cath showing ste in v2-v6 w/ biphasi tw in same leads. his cks peaked at 714, mb 11.2 on and troponin at 2.02 on . on patient was started on asa 325, plavix 75 and high dose statin. patient was also started on lopressor 12.5 tid. patient was continued on this regimen until when he was extubated. he was started on captopril 12.5mg tid for elevated bps and mi on . after extubation, patient denied cp or shortness of breath. throughout this time he was continued on heparin gtt for anterior wall mi and was transitioned to coumadin. he was trasferred to the floor on . he remained symptom free through hospital stay to discharge. at time of discharge his medications included metoprolol xl 50 mg qd and lisinopril 10. the patient was started on coumadin for prophylaxis of possible thrombus formation after mi. his inr was therapeutic at 2.6 on discharge. 2. pneumonia. noted on cxr from osh w/ rll infiltrate, and started on levofloxacin at osh, for cap. he was continued on this regimen while intubated. patient remained afebrile throughout ccu stay. as respiratory status and oxygenation improved and pt was extubated, repeat cxr showed bibasilar opacities consistent w/ atelectasis. sputum cx did not grow organisms w/ exception of aspergillus species. patient will complete a 7day course of levofloxacin the day after discharge. 3. aspergillus positive sputum cx & left maxillary sinus opacification with dehiscence of medial sinus wall. significance of aspergillus on sputum culture was unclear. pt. is diabetic and received solumedrol at osh and one dose of prednisone for copd exacerbation while at , but is not frankly immunocompromised. ct chest was obtained that did not show changes consistent w/ infiltrative aspergillus. sinus cultures were negative/pending at time of discharge. id was consulted who did not feel that the findings were consistent w/ invasive aspergillosis. ct at osh and cta at showed opacification found in l maxillary sinus with mass effect mass and dehiscence of the medial sinus wall. this was felt to be unlikely an infectious process, but was felt to be more likely a neoplastic one by id. ent was consulted and felt the process was not related to the respiratory failure/copd exacerbation. a cx sample was obtained. patient was recommended to follow up w/ ent as an outpatient for further workup. 4. hypercarbic respiratory failure. pt. was intubated at osh for co2 >100 on abg, treated w/ duonebs, levofloxacin and solumedrol iv for copd exacerbation. pco2 was 56 on admission and pt was found to have diffuse wheezes on exam. he was started on ipratropium and xopenex nebs stadning and prn. levofloxacin was continued. he received one dose of 20 mg iv lasix. respiratory status improved w/ abg of 105/53/7.31/28 and patient was successfully extubated on . he remained somewhat somnolent post extubation, abg pco2 was 46, however this improved significantly by w/ pt being a&o x3, communicating clearly. by day of discharge he was sating well in the mid 90's on ra. he contineud to be treated with xopenex tid and atroven q6h for copd flare. 5. left facial droop and hemiparesis. on day of extubation patient was noted to have a left facial droop, le hyperreflexia, upgoing left toe and lle lue weakness, however patient was somnolent and could not cooperate w/ a full motor exam. given osh report of r gaze deviation and these findings, cva or ich was suspected. heparin gtt was temporarily held. cta of heach and neck did not show flow limiting lesions, ich or lesions consistent w/ cva. carotid u/s showed 60-69% r ica stenosis, 40-59% l ica stensosis. pt's symptoms and exam improved on , w/ slight l nasolabial fold flattening remaining on exam. it was felt that this may have been a tia or possible localized symptoms that may occur in patient's w/ encephalopathy. anticoagulation was restarted and patient was arranged for op neurology follow up. 6. congestive heart failure, diastolic, acute. pt. w/o symptoms of hf on exam or hx, however w/ slight suggestion of hf on initial xr. he received one dose of lasix 20mg prior to extubation. echo showed lvef > 55% and mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. pt was continued on metoprolol and started on acei for htn. at time of discharge his medications included metoprolol xl 50 mg qd and lisinopril 10. 7. acute renal failure. creatinine on arrival to osh elevated to 1.5, no baseline was available. this improved to 1.1 by . u/a was consistent w/ pre-renal etiology, however possible ckd given hx of htn and dm. no proteinuria on ua. patient was started on acei during admission (see above) for htn and renal protection. on discharge his arf had resolved and his cr had decreased to 1.0. 8. diabetes. on po metformin at home, was on insulin gtt at osh icu. while hospitalized, his home metformin was held. patient was started on lantus and riss for tight blood sugar control. fasting bg ranged between 124 - 188, but improved to 112 on lantus 15u and riss. he was discharged back on his home metformin. 9. depression. pt was continued on home celexa. medications on admission: aspirin 81mg daily lisinopril 10mg daily simvastatin 80mg daily metformin 500mg daily citalopram 40mg daily tylenol prn discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*11* 2. simvastatin 80 mg tablet sig: one (1) tablet po once a day. 3. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 4. citalopram 40 mg tablet sig: one (1) tablet po once a day. 5. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 6. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 7. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 8. levofloxacin 750 mg tablet sig: one (1) tablet po once a day for 1 days. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 11. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) neb inhalation tid (3 times a day). 12. guaifenesin 100 mg/5 ml syrup sig: ten (10) ml po q6h (every 6 hours) as needed for cough. 13. metformin 500 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: of discharge diagnosis: primary- st elevation myocardial infarction respiratory failure pneumonia transient ischemic attack secondary- hypertension diabetes hyperlipidemia discharge condition: hemodynamically stable, afebrile discharge instructions: you were admitted to as a transfer from for a heart attack and respiratory failure (you were intubated). while at you underwent a cardiac catheterization with placments of stents to open flow in the blood vessels of your heart. you were also treated with medications for your heart attack. you were also treated for pneumonia and chronic obstructive pulmonary disease exacerbation with antibiotics and medications to help you breathe better. with this regimen, you heart condition and your breathing improved significantly. you were started on multiple new medications and you should continue to take these as you leave the hospital. please see below for detailed list of new medications. after you were extubation, it was noticed that you had weakness which quickly resolved. neurology evaluated you and did not feel that you had a stroke, however this may have been a transient ischemic attack (a mini-stroke). you will need to follow up with neurology. in addition, you were also found to have changes in your left sinus that may be concerning for a mass. you were evaluated by infectious disease and head and neck specialists who felt that you should follow up for this mass as an outpatient with your ent doctor. changes to your medications: 1. you were started on plavix 75 mg daily. it is very important that you take this medication every day and do not miss a dose. 2. you were started on coumadin 5 mg daily. you will need to have blood work checked to ensure that you anticoagulation is at an appropriate level. 3. you were started on pantoprazole 40 mg daily to decrease the risk of stomach bleeding on anticoagulation. 4. you were started on toprol xl 50 mg daily. 5. you were started on xopenex nebs three times daily and atrovent nebs every 6 hours to treat your copd exacerbation. 6. you will need to take one more day of levofloxacin to finish treatment for the pneumonia. otherwise continue your outpatient medications as prescribed. should you experience any fevers, chills, weight loss, nightsweats, chest pain, shortness of breath, cough, swelling in your legs, dizziness, visual changes, weakness, difficulty walking or any other symptoms concerning to you, please call your primary care physician or go to the nearest emergency room. followup instructions: please follow up with your primary care doctor, dr. (). an appointment was made for you on at 11:40 am. please follow up with ent within the next 1-2 months for workup for the sinus mass which was found on ct. it is very important that you see your ent doctor for this. an appointment was made for you to follow up with neurology () on at 1 pm. his office is located in the building on the . if you cannot keep any of the above appointments, please call to reschedule. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery 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 personal history of tobacco use depressive disorder, not elsewhere classified other and unspecified hyperlipidemia acute respiratory failure swelling, mass, or lump in head and neck acute diastolic heart failure acute myocardial infarction of unspecified site, initial episode of care unspecified transient cerebral ischemia asbestosis 

Answer: The patient is high likely exposed to