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: augmentin attending: chief complaint: shortness of breath major surgical or invasive procedure: bronchoscopy history of present illness: 66 yo male history of copd, crohn's on remicade/imuran, and multiple admissions for pna who presents from interventional clinic with increasing sob and hemoptysis over the past week. he was in his usual state of health until , when he fell on his bathroom floor and fractured multiple ribs on his left side. in , he reports a left sided pneumonia treated initially with moxifloxacin, and then by a double course of levofloxacin. he has felt sob since , and has noticed hemoptysis with thicker mucous production since . it initially was very small amounts of dark blood. ht has since progressed to 1/2-1 tsp at a time 10-12 times per day now bright red. he has also noticed thick sputum mixed with blood. he was referred to pulmonary at where a ct scan was done in . he reports there was something at the left base (lll ggo) and follow up was requested with pulm there in one month. he had another ct scan in which revealed similar findings. . he reports worsening sob, doe, and hemoptysis since at which point his daughter in law referred him to . he had his first ip consult today and was unable to get to it requiring assitance and a wheelchair. he states his o2 sat was low 80s on room air. he reports some air hungery, but denies fevers, chills, weight loss, and chest pain. he reports worsening doe, now unable to climb one flight of stairs. he notes that he is only coughing to get up a thick bought of mucous. . in the ed, initial vs were 98.8 102 144/92 16 93% 4l. labs including cbc, chem7, trop, and bnp were obtained. ekg, cxr, and ct chest were obtained. he was given one dose of levofloxacin 750mg iv and admitted to the floor. . currently, he reports being nervous. he denies sob and reports decreased coughing now that the oxygen is in place. he has had no further sputum production or hemoptysis since the ed. . review of systems: +cough, sob, doe -fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, brbpr, melena, hematochezia, dysuria, hematuria. past medical history: crohns on infliximab (q6weeks)/azathioprine - started / -ppd negative prior ankylosing spondylitis h/o bilateral pnas in , and requiring icu admits. social history: brother is a podiatrist at and a big supporter. lives alone, is divorced, has one son and one daughter. daughter in law is rn here at . occupation retired since previous worked in commercial real estate and as a loan officer for mortgages. smoking history: 1ppd/35 years, quit . alcohol: currently drinks one beer and oz vodka/day. drugs: no illicits. independent with adl's including driving. family history: brother is healthy. mother d.100. father d. 62, leukemia, emphysema. uncle d.63, mi. physical exam: vs - 97.2 140/68 114 18 94% on 4l 75kg general - well-appearing in nad, comfortable, appropriate heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple, no thyromegaly, no jvd, no carotid bruits lungs - bibasilar crackles l>r, rhonchi at left base to mid left lung heart - pmi non-displaced, tachycardic, no mrg, nl s1-s2 abdomen - +bs, soft/nt/nd, protuberant abdomen, no fluid wave, no rebound/guarding, large midline abdominal hernia extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps) skin - no rashes or lesions lymph - no cervical lad neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout pertinent results: admission labs: 04:00pm blood wbc-3.5* rbc-4.12* hgb-14.5 hct-42.1 mcv-102* mch-35.1* mchc-34.4 rdw-14.9 plt ct-178 04:00pm blood pt-10.5 ptt-32.3 inr(pt)-1.0 04:00pm blood glucose-90 urean-12 creat-0.9 na-140 k-4.0 cl-102 hco3-25 angap-17 09:00pm blood calcium-9.0 phos-3.0 mg-1.2* 03:58pm blood lactate-2.7* pertinent labs: antihistone antibody: < 1.0 b-glucan: < 31 06:22am blood esr-51* 05:25am blood ld(ldh)-379* totbili-0.5 05:25am blood vitb12-1438* folate-greater th hapto-<5* 09:16am blood anca-negative b 06:22am blood -positive * titer-1:160 06:22am blood crp-11.4* 09:16am blood c3-87* c4-26 micro: bal: immunoflourescent test for pneumocystis jirovecii (carinii) (final ): positive for pneumocystis jirovecii (carinii). gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. 2+ (1-5 per 1000x field): gram positive rod(s). 2+ (1-5 per 1000x field): gram negative rod(s). escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s induced sputum: (bal), , acid fast smear: no growth imaging: cxr: cardiac size is top normal. there is no pneumothorax or pleural effusion. diffuse bilateral lung opacities have minimally improved in the right upper lobe. there are no other interval changes. cta chest: interval progression of diffuse ground-glass and reticular opacities and reactive mediastinal lymph nodes. this may represent diffuse pulmonary hemorrhage superimposed on emphysema, drug reaction, or atypical infection. interstitial lung disease (such as nsip), although associated with ankylosing spondylitis, is considered less likely given the rapid progression since 9/. discharge labs: 07:00am blood wbc-2.9* rbc-3.49* hgb-12.0* hct-34.5* mcv-99* mch-34.3* mchc-34.7 rdw-14.2 plt ct-185 07:00am blood glucose-96 urean-18 creat-1.2 na-129* k-4.8 cl-98 hco3-23 angap-13 07:00am blood calcium-9.2 phos-3.4 mg-1.9 brief hospital course: 66 yo male with history of copd and crohn's disease on immunomodulators who presented with sob and hemoptysis, found to be hypoxic with pcp on bronchoscopy. active medical problems: 1. hemoptysis/ dyspnea: patient presented with hemoptysis x months with diffuse ground glass opacities and mediastinal lymphadenopathy on ct scan. symptoms were most likely secondary to pcp pneumonia as identified on bal. in addition, patient had evidence of a superimposed gnr pneumonia identified as fluroquinolone- resistent e.coli. he also has significant underlying lung disease with severe copd which likely contributes to hypoxemia. differential diagnosis also includes interstitial lung disease (associated with crohns disease or medications) or malignancy. limited rheumatologic evaluation showed positive , negative anca and normal complement levels. hemoptysis almost completely resolved after bronchoscopy and initiation of bactrim/ prednisone. dyspnea improved with antibiotics, steriods, nebulizers around the clock and supplemental oxygen. at time of discharge, patient required continuous oxygen with significant desaturation to low 90% with ambulation. of note, patient may require long term supplemental oxygen for underlying copd. he will need repeat ct scan in 4 weeks to assess for resolution of pulmonary parenchymal abnormalities. - cont treatment for pcp (see below) - cont treatment for ecoli pna with cefpodoxime x 1 day - cont nebs atc with home tiotropium - provide supplemental o2 - f/u ct scan in 4 weeks and pulmonary appointment 2. pcp : patient found to have pcp pneumonia on bal, at risk given immunosuppression with infliximab and azathioprine. patient met criteria for steriod course given partial pressure of oxygen <70 mmhg, alveolar-arterial (a-a) oxygen gradient >35 mmhg, and hypoxemia. he was started on steriod taper and a course of bactrim for 21 days. as above, patient will need a repeat ct scan in 4 weeks to ensure resolution of ct findings. in addition, he will stop infliximab treatment until further conversation with gastroenterologist given risks of immunosuppression. 3. hyponatremia: through hospital course, patient was noted to develop euvolemic hyponatremia with urinalysis/ urine lytes consistent with siadh with sodium wasting and inappropriately high osmolality. etiology felt to be due to underlying lung pathology from pcp and should resolve with treatment of above. patient was placed on a 2 l fluid restriction with sodium stabilizing at 129 on discharge. sodium should be trended as an outpatient. - trend sodium weekly - continue 2l fluid restriction 4. macrocytic anemia: slowly downtrending hct through hospital course likely multifactorial from: acute illness, repeat blood draws, hemoptysis, dilution and longterm azathioprine use causing bone marrow suppression. of note, patient may have low grade hemolysis given elevated ldh (may be caused by pcp) and low haptoglobin. smear was negative and there was no evidence of dic or ttp. folate and vitamin b12 levels were supraphysiologic levels. - repeat hct as oupatient medical problems 5. crohn's disease: currently well controlled with 1 bm daily on infliximab/ azathioprine. patient continued on home dose of azathioprine while in house and told to hold further infusions of infliximab until further evaluation by outpatient provider. 6. copd: patient with history and radiographic evidence of advance copd, not on supplemental oxygen at baseline. he was placed on standing nebs with home long acting b-agonist to optimize respiratory status. 7. leukopenia: extends as far back as and is likely related to azathioprine use worsened by acute illness. transitional issues: hypoxia: - treat pcp and pna as above - continue nebulizers - supplemental o2 - ct scan and pulmonary follow up hyponatremia: - 2l fluid restriction - trend weekly crohn's disease: - cont azathioprine - hold infliximab anemia/ leukopenia: - follow cbc medications on admission: albuterol sulfate - 90 mcg hfa aerosol inhaler azathioprine 50mg daily infliximab q6weeks tiotropium bromide guaifenesin vitmain b12 1000mg daily? vitamin d 1000mg daily mvi discharge medications: 1. azathioprine 50 mg tablet sig: one (1) tablet po daily (daily). 2. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po daily (daily). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. omega-3 fatty acids capsule sig: one (1) capsule po daily (daily). 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours). 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q2h (every 2 hours) as needed for shortness of breath. 7. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 8. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: two (2) tablet po q6h (every 6 hours) for 18 days: end day . 9. prednisone 20 mg tablet sig: two (2) tablet po daily (daily) for 5 days: days - . 10. prednisone 20 mg tablet sig: one (1) tablet po once a day for 5 days: - . 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours): please continue until stop prednisone (last day ). 12. cefpodoxime 200 mg tablet sig: one (1) tablet po twice a day for 1 days. 13. ipratropium bromide 0.02 % solution sig: one (1) inhalation every six (6) hours. 14. cyanocobalamin (vitamin b-12) 500 mcg tablet sig: two (2) tablet po daily (daily). 15. outpatient lab work please repeat cbc and bmp in 1 week (on ) and send results to rehab physician on call or pcp for review discharge disposition: extended care facility: green nursing & rehab center - discharge diagnosis: primary diagnosis: pneumocystis carinii pneumonia escherichia coli pneumonia syndrome of inappropriate adh leukopenia secondary diagnosis: copd crohns disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent: requires oxygen discharge instructions: mr. , you were admitted to the hospital because you were coughing up blood. you had a bronchoscopy and you were found to have pneumonia caused by pneumocystis carinii and ecoli. you were started on antibiotics and steriods and your symptoms improved. although your symptoms improved significantly, you were still requiring oxygen on your discharge from the hospital. while you were in the hospital you were also found to have a low sodium level in your blood which was likely caused by inappropriate secretion of the hormone, adh. this condition should resolve once your lungs heal but for the time being, you should restrict your fluid intake to less than 2 liters daily. please make the following changes to your medication regimen: start prednisone according to the following taper: - prednisone 40mg daily x 5 days ( - ) - prednisone 20mg daily x 11 days ( - ) start bactrim ds 2 tablets every 6 hours for 21 days ( - ) start cefpodoxime for 1 additional day start albuterol and ipratroprium nebulizers every 6 hours while you are still experiencing significant shortness of breath stop your remicade until you have an appointment with dr. please continue to take all of your other medications as previously prescribed it was a pleasure taking care of you during this hospitalization followup instructions: department: radiology when: tuesday at 8:45 am with: cat scan building: cc clinical center campus: west best parking: garage please do not eat anything 3 hours before your exam. you will need to follow up with dr. on tuesday after you have a ct scan of your lung. please call to schedule an appointment. you should also call your gastroenterologist, dr. , to schedule an appointment and discuss changing your medication regimen for crohn's disease. phone number: procedure: closed [endoscopic] biopsy of bronchus diagnoses: personal history of tobacco use regional enteritis of unspecified site pneumocystosis other emphysema pneumonia due to escherichia coli [e. coli] hypoxemia enlargement of lymph nodes other disorders of neurohypophysis unspecified deficiency anemia leukocytopenia, unspecified other drugs and medicinal substances causing adverse effects in therapeutic use unspecified diseases of blood and blood-forming organs ankylosing spondylitis 

Answer: The patient is high likely exposed to