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: sulfonamides / a.c.e inhibitors / angiotensin receptor antagonist / keflex attending: chief complaint: change in mental status major surgical or invasive procedure: intubation central venous catheter placement thoracentesis bronchoscopy history of present illness: pt is a 72 yo m myelofibrosis, h/o c.diff, h/o delirium who presented to ed for ams, fever. on the day of presentation, pt was received his regularly scheduled interferon for myelofibrosis, then started to complain of nausea, vomiting, and diarrhea, as well as shortness of breath. he was then found to be nonresponsive at , where he resides, thus brought to the ed. pt denied any chest pain/pressure. per family, pt may have eaten an old . in the ed, he was initially 98% on ra, then became hypoxic to 82%. he was placed on 100% non-rebreather with o2 sats in low 90s. ohter vs were: 105rectal 92 98/45, 32, 86%ra 92?nrb, lactate 4.8 (ua negative, cxr with bilateral hazziness but no specific infiltrate). patient was given tylenol, 6l ns, vanc/dex/zosyn/ceftriaxone. repeat vs were 100.8, 60, 101/38, 95% 15l fmask. . on admission to the micu pt was alert and oriented to self and place only. he was somewhat combative, trying to pull off the mask. he was hypoxic to low 90s on nonrebreather, and abg was 7.26/44/98. anesthesia was called and intubated the patient uneventfully. arterial line was placed in the left wrist. rij was placed. he required dopamine and levophed to maintain his map>60. ep was called to increase his v-pacing to 90 to increase cardiac output. past medical history: idiopathic myelofibrosis - anemia associated with ckd & fe deficiency - pvd with recurrent le venous stasis ulcers - paf s/p - chf (ef 45% in ) - htn - hyperlipidemia - hypothyroidism - bph - depression - h/o chronic c. diff - diverticulitis - recurrent delirium social history: currently lives in the . retired trial lawyer. history of tobacco usage but quit smoking in , history of heavy alcohol usage and quit in . married but currently seperated. has 9 children. family history: mi - father who died at 56y cad, parkinson's disease, renal failure - brother as - mother etoh abuse - mother, brother bipolar d/o - daughter physical exam: icu admission exam: vitals: t94.2axillary 98.6rectal 60hr, 93/46, 90-92% on nrb general: alert, oriented x 2 (self and place). diaphoretic heent: sclera slightly icteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: coarse crackles bilaterally cv: v-paced at 60. normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, mildly distended, quite tender to palpation diffusely, most in llq. ext: warm, well perfused, 2+ pulses radial and femoral, non-palpable dp and pt, no clubbing, cyanosis or edema pertinent results: pleural fluid chemistry protein 1.6 glucose 109 ld(ldh): 96 pleural fluid wbc 30 rbc 14 poly 40 lymph 11 mono 28 10:10pm pt-18.9* ptt-29.3 inr(pt)-1.7* 10:10pm plt smr-normal plt count-427# 10:10pm wbc-21.7*# rbc-4.85 hgb-13.0* hct-43.9 mcv-91 mch-26.9* mchc-29.7* rdw-18.0* 10:10pm neuts-67 bands-3 lymphs-12* monos-7 eos-3 basos-1 atyps-0 metas-5* myelos-2* nuc rbcs-4* 10:10pm albumin-3.9 calcium-9.7 phosphate-2.9 magnesium-1.9 10:10pm ctropnt-0.10* 10:10pm ck-mb-2 10:10pm glucose-138* urea n-27* creat-1.6* sodium-134 potassium-6.1* chloride-98 total co2-23 anion gap-19 10:20pm hgb-13.9* calchct-42 10:30pm urine -neg nitrite-neg protein-tr glucose-neg ketone-tr bilirubin-sm urobilngn-4* ph-5.0 leuk-neg 10:30pm urine rbc-0-2 wbc- bacteria-many yeast-none epi- 12:48am ck-mb-5 probnp-* 12:48am ctropnt-0.19* 12:48am ck(cpk)-206* 12:48am glucose-116* urea n-27* creat-1.4* sodium-138 potassium-3.8 chloride-108 total co2-18* anion gap-16 12:54am lactate-3.0* 01:48am hgb-11.8* calchct-35 o2 sat-97 01:48am lactate-2.1* 01:48am type-art po2-98 pco2-44 ph-7.26* total co2-21 base xs--6 01:55am pt-21.3* ptt-34.9 inr(pt)-2.0* 01:55am plt count-371 . cxr : perihilar opacities reflecting airspace pulmonary edema. likely right pleural effusion. ct head : no evidence of mass lesion. no acute intracranial process. ct torso : 1. large right pleural effusion which is causing compressive atelectasis of the posterior right upper and right lower lobes. 2. new moderate left pleural effusion causing compressive atelectasis of the posterior left upper lobe and complete atelectasis of the left lower lobe. 3. cecal and ascending colonic wall thickening, consistent with colitis. 4. colonic diverticulosis without evidence of diverticulitis. 5. unchanged ascites. cxr : endotracheal tube and nasogastric tube have been removed. the left picc line is now seen extending to at least the cavoatrial junction. the distal tip is not well seen. right pleural effusion has decreased slightly, now moderate. left lower lobe collapse or effusion persists. cardiac size is top normal in size. dense retrocardiac opacity persists. aortic arch calcifications and are unchanged. all microbiologic data no growth to date. c diff negative x 3. sputum culture negative. echo the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated with mild global hypokinesis and septal dysnchrony (lvef = 40 %). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (area 1.3 cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild to moderate pulmonary artery systolic hypertension. there is a small circumferential pericardial effusion. cxr post r thoracentesis findings: interval decrease in right pleural effusion following thoracentesis, with residual small to moderate effusion remaining and no evidence of pneumothorax. associated improvement in parenchymal opacity at the right lung base. previously noted left pleural effusion is difficult to assess due to exclusion of left costophrenic sulcus from the radiograph, but there is at least a small residual left effusion remaining as well as persistent left retrocardiac opacification. brief hospital course: # respiratory failure: in the , pt was hypoxic to low 90s on non-rebreather, likely due to septic shock. differential diagnosis at first included pneumonia, pulmonary edema from chf, and ards. cxr showed diffuse haziness bilaterally and chronic pleural effusion r>l. he was intubated and sedated on admission and ventilator settings were per ardsnet protocol. he was given multiple antibiotics on admission (see below), which would cover pneumonia. he underwent bronchoscopy which showed scant secretions and normal anatomy. bal fluid was sent for gram stain and cultures, which were negative. urine legionella antigen was also negative. at the time of transfer to the floor, he was continued on ceftriaxone for presumed pneumonia even though cultures were negative. the patient was transitioned to precedex on due to intolerance of fentanyl/versed. this intolerance should be noted for future reference. he was weaned from the ventilator and extubated on , and on transfer to the floor, was maintaining his o2 saturation on room air. due to persistant dyspnea, mr. thoracentesis, which resulted in significant improvement in his resporatory distress. # septic shock/fever: unclear source. admission differential diagnosis included meningitis (altered mental status, high fevers), c. diff (pt has h/o c. diff colitis, currently has abdominal pain and high wbc count), and pneumonia. vancomycin/zosyn/ceftriaxone/decadron given in the ed; ampicillin (listeria), acyclovir (hsv), and flagyl (pt h/o c. diff) given on admission to icu. although stool cultures were negative for c.diff, given the patient's history and ct findings consistent w/ colitis, he was treated with po vancomycin for c.diff. he was also treated with ceftriaxone for presumed pneumonia. plan is for a total of a 10 day course of ceftriaxone with vancomycin to continue for 2 additional weeks thereafter. he received stress dose steroids for 48 hours given his inappropriate cortisol stim. they were stopped as his clinical condition improved. it could be conceivable that his symptoms were from a viral syndrome or possibly related to his interferon treatment. ifn was held while hospitalized and should not be restarted without the input of dr. & dr. of hematology # cardiac: on day of admission, troponins trended 0.10->0.19->0.26. differential included demand ischemia and acs. cardiac cath 3 years ago at showed no flow limiting lesions per patient. he was given 325mg asa but heparin was not started due to high inr. he was continued on asa 81 mg. his echo showed an ef of 40%. after aggressive hydration in icu, mr. was diuresed with iv lasix. he was also continued on beta blockers. due to ace-i allergy (anaphylaxis), hydralazine was started. . # change in mental status: pt has tendency to become delirious during acute illnesses. ms gradually cleared during admission. his head ct on admission did not show any evidence of mass lesion or acute intracranial process . # idiopathic myelofibrosis: pt was continued on hydroxyurea but interferon was held as per hem onc recs. pt will see them post discharge at which time the decision regarding restarting ifn will be made. . # paf with : pt was seen by ep and they adjusted settings to increase v-pacing to 90. settings subsequently decreased to 70 post-extubation. . # htn: continued metoprolol. started on hydralazine. . # elevated liver enzymes: likely related to hypoperfusion of the liver; trended down throughout hospital course but have not fully returned to . . # hypothyroidism: continued levothyroxine . # bleeding after heparin injection subq: pt had subcutaneous oozing after heparin shots. hence heparin was held. pt was given compression dressing and the bleeding stopped. . # fen: swallow eval showed that pt has mild to moderate dysphagia. hence he was started on soft (dysphagia) diet and nectar thick liquids. thin liquids were removed from his diet. he will need repeat swallow eval in days. . # ppx: heparin was held due to subcutaneous oozing and pt was given pnumoboots for dvt ppx. he was also on h2 blockers. . # code: full . # coommunication: with wife who is hcp. () medications on admission: - levothyroxine 125mcg daily - toprol xl 25mg daily - seroquel 25 mg tablet - tablet(s) by mouth twice daily. 50 mg in am, 75 mg at bedtime. - allopurinol 100mg daily - simvastatin 10mg daily - pentoxifylline 400mg tid - danazol 200mg - hydroxyurea 500mg alternating with 1000mg every other day - albuterol prn 100mg daily - cymbalta 60mg daily - lasix 40mg vs 80mg qod - vit c 500 mg tablet - 1 tablet(s) by mouth daily - vit b - vit d3 (400 for 7 weeks - ending ) - mvi - fe 325mg daily - asa 81mg daily - , colace, fleets, bisacodyl, mom - epogen ,w,f - albuterol sulfate - 1 vial neb every 4 hours prn - famotidine - 20 mg tablet daily - interferon alfa-2b - 6 million unit/ml solution - 3.0 million units subcutaneously every monday, wednesday, and friday - lidocaine - (prescribed by other provider) - 5 % (700 mg/patch) adhesive patch, medicated - apply to lower back for 12 hours on, 12 hours off. - oxycodone - 5 mg tablet - 1 tablet(s) by mouth q 6 hrs as needed for pain - prochlorperazine maleate - (prescribed by other provider) - 5 mg tablet - one tablet(s) by mouth twice a day as needed for nausea - trazodone - (prescribed by other provider) - 50 mg tablet - one half tablet(s) by mouth at hs as needed for insomnia - acetaminophen - (prescribed by other provider) - 325 mg tablet - two tablet(s) by mouth every 6 hours as needed for fever, pain - b complex vitamins - (otc) - capsule - 1 capsule(s) by mouth daily . discharge medications: 1. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 2. vancomycin 250 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 2 weeks. 3. hydroxyurea 500 mg capsule sig: one (1) capsule po daily (daily). 4. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 5. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 6. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 7. hydralazine 10 mg tablet sig: two (2) tablet po q6h (every 6 hours). 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for sob/wheezing. 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. ceftriaxone in dextrose,iso-os 1 gram/50 ml piggyback sig: one (1) intravenous q24h (every 24 hours): last day = . 11. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 12. dextromethorphan-guaifenesin 10-100 mg/5 ml liquid sig: mls po q6h (every 6 hours) as needed for cough. 13. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. 14. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po tid (3 times a day) as needed for agitation. 15. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. discharge disposition: extended care facility: discharge diagnosis: septic shock pneumonia pleural effusions discharge condition: fair. afvss discharge instructions: you were admitted to the hospital with very low pressure and difficulty breathing. we never found the source of your illness, but have treated you for a presumed diagnosis of pneumonia and c diff colitis. thankfully, after intensive medical care in the icu you improved. you will need to finish a 14 day course of oral vancomycin and finish a 10 day course of ceftriaxone (another antibiotic). dr. and dr. will need to decide at your next appointment whether to continue with the interferon treatments. we also drained fluid from your lung (a thoracentesis) which helped your shortness of breath. if you have fever >100.4, diarrhea, difficulty breathing, loss of consciousness or any other concerns then please seek medical attention. followup instructions: provider: , md phone: date/time: 10:00 provider: , md phone: date/time: 10:00 provider: , m.d. phone: date/time: 10:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube thoracentesis closed [endoscopic] biopsy of bronchus removal of other device from thorax diagnoses: anemia in chronic kidney disease other and unspecified noninfectious gastroenteritis and colitis congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other chronic pulmonary heart diseases pulmonary collapse acute respiratory failure septic shock intestinal infection due to clostridium difficile iron deficiency anemia, unspecified cardiac pacemaker in situ acute on chronic systolic heart failure diverticulosis of colon (without mention of hemorrhage) other acute and subacute forms of ischemic heart disease, other bacterial pneumonia, unspecified myelofibrosis with myeloid metaplasia 

Answer: The patient is high likely exposed to