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: penicillins attending: chief complaint: fatigue major surgical or invasive procedure: none history of present illness: 68m with h/o cad s/p stent in the in and one episode of pna several years ago admitted recently with pna treated with po levoflox but now re-presenting with fevers and fatigue. per patient he was in his usoh until sunday when he developed severe fatigue. he says this was how he felt with his last bout of pna. he had a dry cough but is not sure if he also had fevers because he didnt have a thermometer. he was admitted here with a cap and treated with one dose of levofloxacin iv and then switched to po levofloxacin and sent home. over the last few days he has not felt any better and every time the tylenol wears off he feels even worse. mostly he has fatigue. the cough is non-productive but it does hurt him to cough. he denies myalgias. he had one episode of diarrhea this morning but otherwise no gi complaints although he has not been able to drink or eat much. today he was feeling even worse and he took his temperature and it was 103 so he decided to come to the ed. in the ed admission vitals: 101.9 130 132/90 24 100% 3l. hpi was as above in the ed and otherwise ros negative in ed. cxr in ed looks like persistent rll pna consistent with evolving pna. ecg was sinus tachycardia to 126bpm. 2l ns brought hr down to 90s. he received vanc/ctx/azithro and although he reports a pcn allergy with hives he tolerated the ctx well. vs on transfer were: temp 98.4, hr 92, 109/68, rr22 96 on 2l. (94 on ra). . on the floor, patient reports severe fatigue and dry cough. he reports the one episode of "explosive" diarrhea but none since. no other changes in bowel or bladder function. no sick contacts. recent travel. never smoker. no tuberculosis risks but never had a ppd. . review of systems: (+) per hpi (-) denies recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied denied nausea, vomiting, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. past medical history: (per omr and patient) -cad- s/p mi with stent in (type of stent not known - placed in where he was stationed at the time) -hyperlipidemia -pud - bleeding ulcer in (cauterized endoscopically per pt) -gastric hamartoma social history: (per omr and confirmed with patient) retired army colonel and army pilot. works in while son is attending college, but lives with wife in and plans to return there in near future. drank up to one bottle of wine per night up to several months ago, when he quit cold and has abstained ever since. life-long non-smoker. family history: ( per omr) father deceased in his 70s - mother deceased in her 70s - heart failure one brother - schizophrenia one sister-epilepsy two biological sons - both healthy physical exam: vitals: t:96.9 p:93 bp118/83 r: 20 o2: 96 on 2l nc general: alert, oriented, no acute distress heent: sclera anicteric, dry mm, lungs: wheezing in rll and rml. left side clear but poor inspiratory effort coughing with deep breaths cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: a+ox3 discharge: pertinent results: 10:25pm lactate-3.2* 08:14pm urine color-yellow appear-hazy sp -1.013 08:14pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 08:14pm urine rbc-<1 wbc-2 bacteria-few yeast-none epi-0 08:14pm urine amorph-occ 08:14pm urine mucous-rare 08:10pm glucose-197* urea n-19 creat-1.3* sodium-130* potassium-3.9 chloride-95* total co2-24 anion gap-15 08:10pm calcium-7.8* phosphate-3.1 magnesium-2.6 03:36pm lactate-2.7* 03:15pm glucose-155* urea n-21* creat-1.5* sodium-131* potassium-4.2 chloride-93* total co2-25 anion gap-17 03:15pm calcium-8.7 phosphate-1.8* magnesium-2.6 03:15pm wbc-11.2*# rbc-4.89 hgb-16.4 hct-45.1 mcv-92 mch-33.5* mchc-36.3* rdw-14.0 03:15pm neuts-85.3* lymphs-9.2* monos-4.5 eos-0.2 basos-0.7 03:15pm plt count-105* micro: blood, sputum cultures . . . urine legionella negative cdiff . . . images: portable cxr: rll pna impression: 1. right lower lobar pneumonia with a small amount of adjacent pleural effusion. no large obstructing mass is seen, although post-treatment imaging can be considered if there is a concern for malignancy. 2. nonspecific ground-glass opacity within the right upper lobe, likely reflecting mild inflammatory change. 3. mild left atelectasis with a trace amount of pleural effusion. 4. small pericardial effusion. 5. splenomegaly, incompletely imaged. brief hospital course: # pna: failed po levoquin and curb65 score high enough to be re-admitted. likely had resistent bacterial pna and needs rx with iv antibiotics for longer prior to switching to po. he was treated with vanc/ctx/azithro and then switched to vanc/meropenem/gent/azithro at the recommendations of id when he continued to have hypoxia and fevers. a ct showed no abscess or fluid collection. he underwent bronchoscopy which revealed clear airways but blood-tinged fluid on bal. blood, urine, and sputum cultures had no growth. urinary legionella was negative. his antibiotics were eventually tailored to meropenem, gentamicin, vancomycin prior to transfer out of micu and doses increased according to levels. his oxygenation requirements decreased and he was transferred out of the micu. he was treated with mucinex and codeine as well as nebs prn for symptom control. his final antibiotic regimen was vanc to be continued for 5 more days, gentamycin to be continued for two more days and ciprofloxacin to be continued for 2 more days. he completed a course of azithromycin as well as meropenem. ppd was negative. # hyponatremia: likely to either the pna or dehydration from poor po intake. improved with ivf. discharge sodium 138. # renal insufficiency: likely pre-renal fever and dehydration from poor po intake. improved with ivr. discharge creatinine 0.8. # tachycardia: likely dehydration from fever and poor po intake. resolved with ivf. # diarrhea: likely adr from abx but could be cdiff or legionella which would explain both the lung and gi findings. urinary legionella was negative and cdiff negatiee as well. diarrhea resolved. # cad: stable. ace inhibitor and statin held in the setting of acute illness. restarted on time of discharge. # gerd: continued home nexium # code: confirmed full # emergency contact: wife: transitions of care: - multiple cultures and serologies pending and will be followed up by the infectious disease department at his follow up appointment. they should call him within 48 horus with this appointment and if they do not call he should call them. he was discharged to rehab with these instructions. - the picc line needs to be removed when the antibiotics are finished. medications on admission: (per d/c summary and confirmed with patient) 1. levofloxacin 750 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 6 days. disp:*6 tablet(s)* refills:*0* 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 4. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 5. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 6. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 7. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup sig: five (5) ml po q6h (every 6 hours) as needed for cough. disp:*90 ml(s)* refills:*0 discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 3. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 4. simvastatin 40 mg tablet sig: one (1) tablet po once a day. 5. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*90 capsule(s)* refills:*2* 6. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po at bedtime as needed for cough: do not drive while taking this medication as it will make you sleepy. disp:*200 ml(s)* refills:*0* 7. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 5 days. disp:*10 gram* refills:*0* 8. gentamicin 40 mg/ml solution sig: five hundred (500) mg injection q24h (every 24 hours) for 2 days. disp:*1000 mg* refills:*0* 9. ciprofloxacin 750 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 days. disp:*4 tablet(s)* refills:*0* 10. picc removal please remove picc line after course of iv antibiotics are finished in 5 days. discharge disposition: extended care facility: - discharge diagnosis: community acquired pna hyponatremia acute renal failure dehydration discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital with pneumonia and dehydration. you were given iv fluids and iv antibiotics. your pneumonia got better. you should continue your medications as prescribed. medication changes: start vancomycin for 5 more days start: gentamycin for 2 more days start: ciprofloxacin for 2 more days start: guaifensin with codeine qhs as needed for cough start: benzonatate as needed for cough followup instructions: you will need the picc line removed after you are finished with your antibiotics in 5 days. this can be done at the rehab facility. pcp : thursday, at 4:40pm with: ,md location: center address: , , phone: infection disease appointment: pending phone: ** this department is working on getting you a follow up appointment for this hospitalization. if you havent received a call from them within 48hours from your discharge please call them at the above number for an appointment within 10 days from your discharge do 12-bdu procedure: closed [endoscopic] biopsy of bronchus diagnoses: thrombocytopenia, unspecified esophageal reflux acute kidney failure, unspecified unspecified septicemia hyposmolality and/or hyponatremia percutaneous transluminal coronary angioplasty status sepsis other and unspecified hyperlipidemia old myocardial infarction diarrhea tachycardia, unspecified splenomegaly bacterial pneumonia, unspecified unspecified antibiotic causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to