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 / codeine / pork derived (porcine) attending: chief complaint: shortness of breath. major surgical or invasive procedure: 1.) placement of left internal jugular central venous line 2.) placement of arterial line 3.) endotracheal intubation history of present illness: mr. is a 56 year-old man with end-stage copd on 2l home o2 (fev1 19% predicted, baseline pco2 50s), cad s/p cabg and bare metal stent, with recent hospitalizations (>10 in the past year) presenting with shortness of breath, dyspnea on exertion, increased oxygen requirement to 3.5l, and worsened cough productive of green sputum x 4 days. his symptoms have been gradually worsening so that he feels short of breath even at rest, whereas at baseline he can walk one block without rest. he is a current smoker (a few cigarettes per day) but has recently decreased his tobacco use. he also endorses a chronic history of intermittent left-sided chest pain that lasts for seconds to minutes while at rest, occurs once each day, and last occurred in the emergency department. the pain radiates to his left ribs and shoulder blade; he does not take nitroglycerin for it. he denies any current chest pain. he denies any symptoms of fevers/chills, night sweats, no abdominal pain or diarrhea, no urinary symptoms, no difficulties swallowing. he denies seasonal allergies, sick contacts, symptoms of edema or increased dietary sodium intake. compliance with medications is difficult to assess, as patient is unable to identify medications and states he is taking those listed per computer system. of note, the patient was recently seen in copd clinic with dr. , who reduced his prednisone dose from 60 to 40 mg qday and prescribed doxycycline to be used prn for copd exacerbation symptoms as a preventative measure to hospitalization. it is unclear if the patient has taken the doxycycline at home. he was also seen in the ed for cellulitis of his left elbow, for which he was treated with a planned 7-day bactrim and clindamycin course and subsequent course of bactrim prophylaxis, the clindamycin was discontinued a day later at urgent care due to minimization of risk of c. diff. his most recent dose of bactrim was a prophylactic dose, although the 7-day period for treatment is not completed. mr. states that his left elbow is infected as a result of chronically leaning on it in bed. in the emergency department, initial vital signs were: 96.5 103 162/74 24 94%. his serum laboratory values were significant for a wbc of 13 with 85% neutrophils, no bands. ekg demonstrated prominent, peaked p waves with poor r wave progression (also present on ekg). troponin was negative x1. blood cultures were taken and cxr demonstrated no pneumonia by preliminary read. he received duonebs x3, iv methylprednisolone, and a dose of iv azithromycin. he also received 4 mg iv morphine for chronic low back pain, s/p orthopedic surgery for spinal stenosis. past medical history: 1.) copd on 2l home o2 overnight 2.) cad s/p mi and cabg; pci : patent lima to the lad, rima to the rca, bms placed in the rca distal to rima; cath : widely patent lima and rima grafts; patent distal rca stent and known occluded native lad and rca. nuclear stress nuclear perfusion stress: no anginal symptoms or ischemic st segment changes. 4.) thoracic aortic anuerysm s/p repair 5.) tobacco abuse; 1ppd since age 21 6.) hypercholesterolemia 7.) hypertension 8.) history of head trauma in from mva with post-traumatic grand mal seizure, now off anti-epileptics 9.) neurogenic claudication 10.) s/p spinal stenosis surgery , previously on 10 mg oxycodone qday for pain, recently violated narcotics contract social history: patient lives with his sister-in-law and her young children. endorses 30 pack-year tobacco history, now smokes 1 pack q2weeks. has previous history of 16-30 beers/day, states he has not had alcohol in 2 years. denies history of ivdu. family history: family history of cad, with death of mother at age 59 of mi, father at age 61 of mi, cousin at age 41 of mi, uncle at age 41 of mi. has sister with severe copd; brother died of throat cancer. physical exam: admission physical exam vs: 97.0 107/61 72 16 98% on 2l; pain: in low back. general: man appearing older than stated age with cushingoid habitus, lying in bed without tripode position, breathing with pursed lips. heent: cushingoid facies. oropharynx clear. neck: no jvd appreciated. shotty anterior cervical lymphadenopathy. chest: limited air movement with inspiratory: expiratory ratio of 1:4. diffuse inspiratory and expiratory rhonchi. no fremitus, egophony, or dullness to percussion appreciated. no pain to palpation over anterior chest. heart: regular rate and rhythm without murmurs, gallops, or rubs. no accentuated second heart sound. abdomen: abdomen is soft, non-tender, and non-distended. +bs. msk: no spinal point tenderness. skin: multiple ecchymoses on his skin and arms. no pitting edema in lower extremities. 2 mm wound ulceration through sub-cutaneous tissue with no surrounding erythema or fluctuance. access: 20g iv in r wrist discharge physical exam vs: 98.1 100/52 57 20 92-98% on 2l general: man appearing older than stated age with cushingoid habitus, lying back in bed without tripoding, breathing with pursed lips with increased work of breathing. heent: cushingoid facies. oropharynx clear. neck: no jvd appreciated. shotty anterior cervical lymphadenopathy. chest: limited air movement with inspiratory: expiratory ratio of 1:4. diffuse inspiratory and expiratory rhonchi. no fremitus, egophony, or dullness to percussion appreciated. no pain to palpation over anterior chest. heart: regular rate and rhythm without murmurs, gallops, or rubs. no accentuated p2. abdomen: abdomen is soft, non-tender, and non-distended. +bs. msk: no spinal point tenderness. skin: multiple ecchymoses on his skin and arms. no pitting edema in lower extremities. left elbow stage 3 pressure ulcer; right elbow stage 1 pressure ulcer. access: none. pertinent results: admission labs: 11:45am blood glucose-101* urean-9 creat-0.6 na-134 k-6.5* cl-95* hco3-26 angap-20 11:45am blood calcium-8.8 phos-4.0 mg-1.9 11:45am blood wbc-13.0* rbc-5.28 hgb-13.8* hct-44.0 mcv-83 mch-26.1* mchc-31.3 rdw-16.4* plt ct-203 01:27pm blood ck(cpk)-22* 11:45am blood ctropnt-<0.01 09:35pm blood ctropnt-<0.01 discharge labs: 06:30am blood glucose-93 urean-17 creat-0.7 na-141 k-4.0 cl-91* hco3-44* angap-10 06:30am blood calcium-9.6 phos-3.6 mg-1.9 06:30am blood wbc-9.0 rbc-4.13* hgb-10.6* hct-34.0* mcv-83 mch-25.6* mchc-31.0 rdw-15.6* plt ct-209 imaging: admission cxr: 1. no acute cardiopulmonary process. 2. hyperinflated lungs, compatible with the patient's history of copd. microbiology: 3:57 pm sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram negative rod(s). respiratory culture (final ): commensal respiratory flora absent. pseudomonas aeruginosa. sparse growth. piperacillin/tazobactam sensitivity testing confirmed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 16 i ceftazidime----------- 4 s ciprofloxacin--------- 1 s gentamicin------------ 8 i meropenem------------- =>16 r piperacillin/tazo----- 32 s tobramycin------------ <=1 s acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): no mycobacteria isolated. brief hospital course: this patient is a 56 year-old man with history of severe copd (fev1 19%) on home oxygen, with history of cad s/p mi with cabg and bms, admitted for copd exacerbation, intubated and transferred to micu for hypercarbic respiratory failure, readmitted to floor with trigger for hypoxemia/hypercarbia/respiratory distress. after family discussion , patient decided to go home on hospice and was medically stablized for discharge home to . #) copd exacerbation: the patient presented with increased sputum production and dyspnea with poor air movement and signs of expiratory limitation on exam. he had no infiltrate and pneumonia was not thought to be a primary process. he has a history of multiple previous admissions for copd exacerbations and his symptoms were consistent with previous episodes. on presentation he received 125 mg iv methylprednisolone x1 followed by 60 mg of prednisone po daily as well as azithromycin and increased frequency of inhalers. he failed to improve significantly and on hospital day two was intubated for hypoxic and hypercarbic respiratory failure and unresponsiveness (just prior to this episode he received one additional dose of methylprednisolone 125 mg iv*1). after his intubation he was transferred to the micu where he received standing ipratroprium and albuterol mdis, had his antibiotics switched to levofloxacin and continued on prednisone 60 mg po daily. he was extubated after four days and after his extubation was switched from levofloxacin to ciprofloxacin given his sputum culture grew only pseudomonas and no gram positive organisms (cxr never showed a clear infiltrate); and 7-day course completed during hospitalization. prednisone taper initiated on day 8 from 60 mg to 40 mg per the patient's pulmonologist, dr. . patient was discharged on standing prednisone (40 mg qday), standing albuterol/ipratropium mdis (2 puffs 4hr); he could not tolerate nebulizers. he was continued on prophylactic tmp/sulfa for pcp prophylaxis given his degree of immunosuppression. he required 2l nc at rest with increased o2 requirement of 4l nc with exertion; this should be titrated prn for goal o2sat 89-94%. #) hypoxic and hypercarbic respiratory failure: the patient failed to improve after his first two days of standard copd therapy and continued to be wheezy with limited air movement. on the morning of his third hospital day he received two mg of iv morphine for his chronic back pain. of note, this was significantly less than he had previously received for pain. shortly after receiving this he was noted to be slumped over and minimally responsive. he received naloxone 2g with minimal improvement. a code blue was called am for respiratory distress and need for intubation but the patient never stopped breathing or became pulseless. he was successfully ventilated with bag mask and no significant period of hypoxia was noted. he was intubated secondary to work of breathing and altered mental status. arterial blood gas could not be successfully obtained until after the code though a vbg afterwards demonstrated pco2 of 162. he was intubated with significant issues with autopeep and refractory hypoxemia though eventually improved with bronchodilator therapy and considerable steroids. acidemia in the 7.3 range was tolerated given the patient's chronic hypercarbic respiratory failure. eventually, the patient was extubated successfully on , with respiratory distress later in the day attributed to flash pulmonary edema. he received nippv with considerable improvement and remained off nippv after the evening of . afterwards his oxygen requirement remained at 2 l to saturate around 93-98% at rest. of note, when not compliant with nasal cannula or with exertion, patient has desaturations as low as 64%, which responded to non-rebreather and shovel mask with humidified oxygen. throughout his admission he remained hypercarbic, with baseline pco2 in 80s and serum bicarbonate in mid-40s. #) shock: the patient developed hypotension after his intubation and required phenylephrine for refractory hypotension after fluids and despite an adequate cvp. this was thought to be a combination of cardiogenic shock, due to his high amounts of autopeep increasing intrathoracic pressure and diminishing venous return, as well as a component of distributive shock due to the propofol he initially received for sedation after intubation. he remained normotensive to hypertensive from forward. #) hypertension: the patient was hypertensive after his extubation, which was thought to be part of the cause of his acute hypoxia and flash pulmonary edema. he was treated transiently with labetalol 10 mg iv *1 then restarted on his home metoprolol and lisinopril with controlled blood pressures. #) pain control: the patient has chronic low back pain and a history of a narcotics contract through though he violated his contract . at admission he was treated with standing tramadol, acetaminophen, and lidocaine patch. after complaining of chest pain (with no ekg changes and negative troponins x2), he received 2x 4 mg iv morphine as well as 1x 2 mg iv morphine . shortly after receiving this last dose of iv morphine he experienced hypercarbic respiratory arrest, not responsive to 2 g narcan and thought to be unrelated to the event. after his extubation he complained of back pain and was treated with morphine ir with reasonable pain control. when he returned to the floor, he initially received continued standing tramadol, acetaminophen, and lidocaine patch. as this was inefficacious and decision was made for patient to enter hospice care at home, he was transitioned to ms contin with po morphine elixir 10-20 mg q4hr prn pain and dyspnea and standing acetaminophen. #) elbow wound: the patient has an elbow wound that is s/p a 7-day course of ds tmp/sulfa for presumed cellulitis of left elbow wound shortly prior to hospital admission. no signs of active skin infection were noted during this hospitalization, but patient has a left elbow stage 3 decubitus ulcer and right elbow stage 1 decubitus ulcer secondary to leaning on the elbow in bed. he received a wound care consult, and wound was kept sterile and dry. plan for wound care in hospice on discharge. #) cad: in discussion with patient, decision made to continue all of his previous outpatient cardiac medications. this can be readdressed as his condition evolves. #) end of life discussions: a care connection meeting was held with mr. and his sister-in-law/hcp (present via conference call) to discuss goals of care and a safe plan for discharge. mr. ultimate goal is to return home (with and her children) and to be comfortable. we discussed that going home with hospice would best help him and his family achieve his goals of care, and that he would be able to receive morphine for both management of his chronic pain and dyspnea. hospice has arranged supplies such as a hospital bed and wheelchair at home. he would not be required to be home bound. he does understand that he needs to wear his oxygen at all times and increase the amount with exertion. both mr. and were in agreement with this plan. was especially supportive and cited her willingness to do whatever she could to keep him comfortable and take care of him at home. based on this discussion, he was full code in the hospital (if respiratory failure not reversible, would only want to be intubated long enough for family to say goodbye) but expresses preferences consistent with being made dnr/dni upon discharge home with hospice. dnr/dni form was reviewed and signed with the patient in agreement. if he develops respiratory distress, the plan would be to call hospice first. mr. and understand that this is a continual conversation and can be readdressed with his hospice team and providers as his condition evolves. medications on admission: aspirin - (prescribed by other provider) - 325 mg tablet - 1 tablet(s) by mouth daily (daily) steroids: prednisone - 10 mg tablet - 4 tablet(s) by mouth daily continue until instructed to taper fluticasone-salmeterol - (prescribed by other provider; not taking per patient) (not taking as prescribed) - 500 mcg-50 mcg/dose disk with device - 1 disk(s) inhaled twice a day antibiotics: sulfamethoxazole-trimethoprim - (prescribed by other provider) - 800 mg-160 mg tablet - 1 tablet(s) by mouth qmowefr ( -wednesday-friday) albuterol sulfate - 0.63 mg/3 ml solution for nebulization - 1 neb inh q6 hours as needed for shortness of breath furosemide - (prescribed by other provider) - 40 mg tablet - 1 tablet(s) by mouth daily (daily) ipratropium bromide - (prescribed by other provider) - 0.2 mg/ml (0.02 %) solution - 1 solution(s) inhaled every six (6) hours ipratropium-albuterol - 18 mcg-103 mcg (90 mcg)/actuation aerosol - 2 puffs po every four hours as needed as needed for shortness of breath use when not able to use nebulizer lisinopril - 20 mg tablet - 1 tablet(s) by mouth once a day metoprolol succinate - (prescribed by other provider) - 100 mg tablet extended release 24 hr - 1 tablet(s) by mouth daily o2 at 2l/min continuous, for portability pulse dose system - - qd with any activity once a day omeprazole - (prescribed by other provider) - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth once a day simvastatin - (prescribed by other provider) - 40 mg tablet - 1 tablet(s) by mouth once daily at bedtime tramadol - 50 mg tablet - 0.5 - 1 tablet(s) by mouth - tid as needed for severe pain trazodone - 50 mg tablet - 1 tablet(s) by mouth at bedtime as needed for insomnia calcium carbonate - (otc) - 200 mg (500 mg) tablet, chewable - 1 tablet(s) by mouth three times a day cholecalciferol (vitamin d3) - (prescribed by other provider) - 400 unit tablet, chewable - 2 tablet(s) by mouth once a day ferrous sulfate - (prescribed by other provider) - 325 mg (65 mg iron) tablet - 1 tablet(s) by mouth once a day for iron discharge medications: 1. please evaluate and admit to . 2. prednisone 20 mg tablet sig: two (2) tablet po once a day. disp:*60 tablet(s)* refills:*0* 3. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. disp:*15 tablet(s)* refills:*0* 4. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po mwf (-wednesday-friday). disp:*12 tablet(s)* refills:*0* 5. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*0* 6. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 7. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours). disp:*5 inhaler* refills:*2* 8. ms contin 15 mg tablet extended release sig: one (1) tablet extended release po twice a day as needed for pain, discomfort, shortness of breath. disp:*60 tablet extended release(s)* refills:*1* 9. morphine concentrate 100 mg/5 ml (20 mg/ml) solution sig: 0.5-1 ml po q4h:prn as needed for pain, discomfort, shortness of breath. disp:*60 ml* refills:*1* 10. nicotine 22 mg/24 hr patch 24 hr sig: one (1) patch transdermal once a day. disp:*30 patches* refills:*0* 11. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*0* 12. senna 8.6 mg tablet sig: one (1) tablet po bid:prn as needed for constipation. disp:*60 tablet(s)* refills:*0* 13. lisinopril 20 mg tablet sig: one (1) tablet po once a day. 14. simvastatin 40 mg tablet sig: one (1) tablet po at bedtime. 15. calcium carbonate 500 mg calcium (1,250 mg) tablet sig: one (1) tablet po three times a day. 16. ergocalciferol (vitamin d2) 400 unit tablet sig: two (2) tablet po once a day. 17. ferrous sulfate 325 mg (65 mg iron) capsule, extended release sig: one (1) capsule, extended release po once a day. 18. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 19. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 20. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 21. home o2 2l nc at rest at all times, increase to 4l nc with exertion. titrate to goal o2sat 89-94%. discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: chronic obstructive pulmonary disease exacerbation secondary diagnoses: - very severe copd (fev1 19%) on home o2 - cad s/p mi and cabg discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. o2 saturation at rest with 5l: 92-93%; o2 saturation on ra: 75-88%; o2 saturation with exertion: 64-85% discharge instructions: you were admitted to the medicine service of because of worsening breathing symptoms, increased need for supplemental oxygen at home, and cough with green sputum. in the hospital your breathing symptoms became much worse and you required a breathing tube and were managed in a specialized unit of the hospital, the medical intensive care unit. you received steroid medications, antibiotics, and nebulized medications to improve your breathing. we also gave you iv and oral pain medications to help you manage your pain. during your hospitalization, we had a discussion with you and your health care proxy, in which you decided that the best option for future care would be to go home with a hospice service (beacon), which would best support you and provide for your comfort at the end of your life. we made the following changes to your medications: 1.) we added oral morphine elixir, 10-20 mg every 4 hours as needed for pain. 2.) we added ms contin, a long-acting type of oral morphine, 15 mg twice a day. 3.) we stopped your ultram. it is important that you review these medication changes with your primary care physician. followup instructions: please follow up with your primary care physician after discharge to review the medication changes that were made in the hospital. you can call to schedule a visit. the following appointments have been previously scheduled: department: spine center when: at 12:20 pm with: dr. building: campus: east best parking: garage department: pulmonary function lab when: thursday at 8:40 am with: pulmonary function lab building: campus: east best parking: garage department: medical specialties when: thursday at 9:00 am with: , m.d. building: campus: east best parking: garage md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: anemia, unspecified esophageal reflux pure hypercholesterolemia tobacco use disorder urinary tract infection, site not specified unspecified essential hypertension long-term (current) use of steroids hyposmolality and/or hyponatremia obstructive chronic bronchitis with (acute) exacerbation aortocoronary bypass status percutaneous transluminal coronary angioplasty status acute respiratory failure pneumonia due to pseudomonas other shock without mention of trauma alkalosis cardiogenic shock old myocardial infarction family history of ischemic heart disease personal history of venous thrombosis and embolism do not resuscitate status lumbago intravenous anesthetics causing adverse effects in therapeutic use pressure ulcer, elbow insomnia, unspecified tricuspid valve disorders, specified as nonrheumatic other dependence on machines, supplemental oxygen pressure ulcer, stage iii personal history of methicillin resistant staphylococcus aureus 

Answer: The patient is high likely exposed to