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: patient recorded as having no known allergies to drugs attending: chief complaint: acute hypoxemic respiratory failure major surgical or invasive procedure: thoracentesis and placement of pig-tail catheter in right thorax history of present illness: 78m myelofibrosis, anemia requiring transfusions, zenkers diverticulum, hx of aspiration pna requiring intubation ()presenting with acute hypoxia in setting of large right sided pleural effusions. . of note the pt was recently admitted to hospital on following a fall at home during which he had a work-up for head trauma and syncope. ecg at that time revealed rbbb and lafb. hct of 20.7, ct head without acute intracranial pathology. cxr revealed right sided atelectasis vs pna. the pt was treated for a right facial laceration and admitted. the pt states he received 2 blood transfusions ans was discharged home from the osh after approximately 2 days. no discharge summary currently available. . the pt states that over the past few days he has noted worsening right sided pain that radiates to his chest. worse with inspiration . no palpitations. denies fevers, but admits to chills. no diaphroses. the pt has had stable 1 pillow orthopnea and has doe upon walking up one flight of stairs. the pt today presented to his pcp where he was noted to have a bp of 80/p and subsequently brought to the ed. . upon arrival to the ed 97.9 93/37 70 19 94% (02 not listed). the pt was continued to complain of back pain. ed exam was notabable for absent bs on right. cxr with low lung volumes on right. ct chest revealed effusion on right with mild ascites. no signs of acute bleed. . the pt received vancomycin 1mg iv, levofloxacin 750mg iv x1, azreonam 1gm ivx1 for suspected right sided pna in setting of question pcn allergy. a piv 18g and 20g were placed. the pt received 2l of ns and 1l of d5w with 3 amp of bicarb. uop of 250cc. . the pt was seen by interventional pulmonary that who performed a bedside ultrasounded throacentesis during which 1200cc of serosanginous fluid was drained. initial ph 7.08, pleural ldh of 468 indicative of an exudative process thus a pigtail catheter was placed. follow-up cxrs without evidence of pneumothorax. . vitals prior to transfer hr 70 122/58 16 100% on 12l nrb. . . review of systems: (+)ve: chills, chest pain, orthopnea, 1 episode of brbpr 3 weeks ago. (-)ve: fever, night sweats, loss of appetite, fatigue, palpitations, rhinorrhea, nasal congestion, cough, sputum production, hemoptysis, dyspnea, paroxysmal nocturnal dyspnea, nausea, vomiting, diarrhea, constipation, hematochezia, melena, dysuria, urinary frequency, urinary urgency, focal numbness, focal weakness, myalgias, arthralgias past medical history: # myelofibrosis - bone marrow bx , 20q deletion, jak-2 mutation # chronic anemia: requiring blood transfusions mf # aspiration pna () with hypoxemic respiratory failure requiring intubation (unconfirmed location - per osh records) # zenker's diverticulum - hx of aspiration events # significant macular degeneration and cataracts # depression # pruritis # mild symmetric lvh # moderate pulmonary htn () # ?bph (per osh records) social history: he does not smoke and denies any alcohol abuse. he lives alone, independent of adls, although declining. he is a retired english professor . interest in . family history: mother deceased - ca physical exam: t=97.3 bp=120/44 hr=75 rr=18 98 6l general: pleasant, ill cachectic appearing m in nad heent: right facial laceration. right purulence from conjunctiva. mild conjunctival pallor. no icterus. dry mm. neck: supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . jvp= flat lungs: clear on left anteriorly. clear superiorly on right anteriorly. right pigtail catheter in place. abdomen: nabs. soft, nt, mild distension, +hepatosplenomegaly. extremities: no edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. skin: no rashes/lesions, ecchymoses. neuro: no asterxis. a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. + reflexes, equal bl. normal coordination. gait assessment deferred psych: listens and responds to questions appropriately, pleasant . exam as of vitals: 96.5 101/49 85 18 95%2lnc pain: over sacrum and r chest wall access: piv and lue double lumen picc gen: thin man, cachectic, weak heent: mm dry cv: rrr, no m chest: r chest tube site dry with dressing resp: +bibasilar crackles, no wheezing abd; soft, thin, nontender, +sm ext; r>l edema (new over past 2days) neuro: a&ox3, grossly nonfocal skin: sacral decub stage ii with dressing, l 4th toe hyperemic but good distal pulse, area of erythema with darker and irregular border over r hip, pruritic for patient, not clear cellulitis, ?fungal psych: calm, pleasant pertinent results: discharge day labs: other pertinent labs: ua : 6-10wbc, few bacteria, ucx neg ua : 21wbc, +casts, mod le, few bac, neg nitrites, 18rbc, ucx neg . : una 10, ucreat 98, uurea 875 : repeat urine lytes: fena 0.7 . bc ngtd x2 . pleural fluid cx ntd pleural fluid: wbc 2550 with 89%pmns, ldh 468, ph 7.08 pleural fluid cytology: neg for malignancy sputum cx upper flora . . imaging/results: ekg: rbbb, lafb . : cxr large right pleural effusion, with consequent lower and middle lobe collapse. . cxr ; two views of the chest demonstrate a large right-sided pleural effusion with atelectasis/consolidation of the right lower lobe. left lung is clear. a chest tube is present at the right lung base. there is little interval change with prior studies. hila and mediastinum within normal limits . cxr (post pigtail removal) there is a small right lower lobe pneumothorax. small bilateral pleural effusions, left greater than right, are unchanged. bibasilar consolidations and right middle lobe opacities are unchanged, as is faint right upper lobe opacity. cardiomediastinal contours are normal. . ct chest w and w/o contrast 1. marked decrease in size of now small complex loculated right pleural effusion. the tip of the catheter remains within the pleural cavity, but the formed pigtail is extrathoracic in location with adjacent subcutaneous emphysema and soft tissue swelling. 2. slight increase of small simple left pleural effusion. persistent pneumonia with component of coexisting atelectasis of both lower lobes but improved aeration of the right upper and right middle lobes. nonspecific ground-glass opacities are noted within the right middle and lower lung which may be related to infection or reexpansion pulmonary edema. 3. unchanged hypoattenuating hepatic and splenic lesions as described. many of the hepatic lesions are clearly simple cysts. there is stable hepatosplenomegaly with sequelae of portal hypertension. 4. known zenker's diverticulum. . ct chest noncontrast 1. decreased right pleural effusion, now moderate in size, status post right pleural pigtail catheter placement. small left pleural effusion. 2. multifocal pneumonia involving nearly the entire right lung, and large portions of the left lower lobe. 3. unchanged hepatosplenomegaly. 4. unchanged appearance of probable zenker's diverticulum. . ct c/a/p c contrast: 1. large right pleural effusion with resultant compressive atelectasis or the right lung. 2. hepatosplenomegaly. 3. ascites. 4. splenic hypodensity, not fully characterized, possible hamartoma or hemangioma. 5. nodularity of the left adrenal gland, but no distinct nodule. this finding should be correlated clinically and if indicated, with serum biochemical markers. 6. collection of fluid and gas at the thoracic inlet in the region of the esophagus, a finding which predisposes the patient to possible aspiration and should be clinically correlated. . renal us ; 1. no hydronephrosis or nephrolithiasis. 2. unchanged renal cysts and prostatic enlargement. . . labs: hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 12:27pm 6.5 2.73* 8.6* 24.7* 91 31.6 34.9 17.5* 93* source: line-picc 05:04am 5.7 2.51* 7.9* 23.0* 92 31.5 34.4 17.4* 70*1 source: line-picc 08:00am 4.9 2.51* 7.8* 22.8* 91 30.9 34.0 17.5* 68*2 source: line-left picc line 06:45am 5.1 2.48* 7.6* 22.7* 92 30.6 33.5 17.4* 66*1 source: line-left picc line 04:06am 5.1 2.25* 6.9* 21.5* 96 30.5 31.9 18.0* 59*3 source: line-picc 05:00am 5.4 2.50* 7.4* 23.0* 92 29.6 32.2 17.8* 72*3 source: line-picc 08:47am 5.4 2.59* 7.8* 24.1* 93 30.2 32.4 17.9* 107*1 source: line-picc line 08:00am 6.0 2.68* 8.1* 25.0* 93 30.0 32.2 17.8* 113*1 05:50am 6.9 2.68* 8.0* 24.9* 93 30.0 32.2 17.9* 132*3 06:45am 7.1 2.77* 8.4* 25.6* 92 30.2 32.7 18.0* 1511 06:45am 9.3 3.09* 9.4* 28.9* 93 30.3 32.5 18.1* 1711 10:55am 12.2*# 3.17* 9.3* 29.6* 93 29.4 31.6 18.2* 187 06:10am 7.3 2.65* 8.0* 24.2* 91 30.2 33.1 18.5* 1703 01:00pm 10.9# 3.11*# 9.0*# 28.5*# 92 28.8 31.5 18.4* 203 06:00am 6.9 2.20* 6.5* 20.8* 95 29.6 31.2 18.5* 1753 05:40am 6.1 2.30* 6.8* 21.8* 95 29.7 31.3 18.8* 185 05:55am 7.4 2.35* 6.9* 22.1* 94 29.3 31.2 18.5* 205 05:20am 13.8*# 2.72* 8.1* 25.7* 95 29.9 31.6 18.7* 2081 08:35am 28.2* 02:53am 7.9 2.49* 7.4* 24.0* 97#4 29.8 30.9* 18.8* 1511 11:16pm 8.5 2.92* 8.8* 30.2* 104*#4 30.3 29.2* 18.7* 1531 02:00pm 12.8*#1 2.98*# 9.1*# 28.1*# 94 30.6 32.4 19.3* verified by smear large forms present verified verified differential neuts bands lymphs monos eos baso atyps metas myelos 06:45am 80.7* 11.8* 4.8 2.6 0.1 source: line-left picc line 08:47am 82.8* 0 11.2* 4.7 1.2 0 source: line-picc line 02:00pm 86* 3 4* 7 0 0 0 0 0 red cell morphology hypochr anisocy poiklo macrocy microcy polychr ovalocy 02:00pm 3+ 2+ 2+ 1+ 1+ occasional 2+ basic coagulation (pt, ptt, plt, inr) pt ptt plt smr plt ct inr(pt) 12:27pm low1 93* source: line-picc 05:04am very low2 70*3 3+ source: line-picc 08:00am very low4 68*5 3+ source: line-left picc line 06:45am 66*3 source: line-left picc line 06:45am 16.5* 37.3* 1.5* source: line-left picc line 04:06am very low 59*6 source: line-picc 05:00am very low 72*6 source: line-picc 08:47am low7 107*3 2+ source: line-picc line 08:00am low8 113*3 05:50am low 132*6 05:50am 15.7* 1.4* 06:45am 1513 06:45am normal 1713 2+ 10:55am normal9 187 06:10am normal 1706 01:00pm normal10 203 1+ 01:00pm 15.9* 33.9 1.4* 06:00am normal 1756 1+ 05:40am 185 05:55am normal11 205 1+ 05:20am normal 2083 05:20am 17.0* 39.8* 1.5* 02:53am 1513 02:53am 19.0* 39.2* 1.7* 11:16pm normal 1533 2+ 02:00pm 17.4* 35.8* 1.6* 02:00pm normal low few large platelets very low with large forms verified by smear very low large forms present large forms present verified low occ large forms low large plts seen normal occ large forms normal many large platelets normal mod. large plts chemistry renal & glucose glucose urean creat na k cl hco3 angap 08:38am 317*1 41* 0.8 137 4.7 105 26 11 source: line-picc 05:04am 103*1 38* 0.7 138 4.0 105 27 10 source: line-picc 08:00am 125*1 30* 0.8 138 3.7 106 28 8 source: line-left picc line 06:45am 126*1 29* 0.8 140 3.7 109* 28 7* source: line-left picc line 04:06am 134*1 30* 0.9 137 3.4 106 23 11 source: line-picc 05:00am 111*1 34* 0.9 137 4.3 110* 23 8 source: line-picc 08:47am 111*1 35* 1.1 140 4.2 111* 25 8 source: line-picc line 08:00am 881 40* 1.3* 142 4.4 113* 24 9 05:50am 891 48* 1.4* 143 4.7 112* 25 11 03:30pm 188*1 51* 1.7* 142 5.5* 112* 23 13 06:45am 971 56* 1.6* 142 5.8* 112* 23 13 06:45am 1001 44* 1.5* 143 5.7* 111* 28 10 10:55am 163*1 35* 1.2 140 5.0 109* 27 9 06:10am 891 28* 0.8 143 4.4 112* 28 7* 01:00pm 129*1 29* 0.9 141 4.6 109* 26 11 06:00am 117*1 30* 0.9 140 4.0 110* 27 7* 05:40am 117*1 34* 0.8 138 3.6 107 28 7* 05:55am 1001 44* 1.1 141 3.9 108 25 12 05:20am 107*1 39* 1.2 139 4.2 106 27 10 added b12 @ 08:08am on 02:53am 134*1 36* 1.2 142 4.3 108 27 11 02:00pm 145*1 39* 1.5* 139 4.9 106 26 12 added pon cpis at 1500 if fasting, 70-100 normal, >125 provisional diabetes estimated gfr (mdrd calculation) estgfr 06:45am using this1 source: line-left picc line 10:55am using this2 02:00pm using this3 added pon cpis at 1500 using this patient's age, gender, and serum creatinine value of 0.8, estimated gfr = >75 if non african-american (ml/min/1.73 m2) estimated gfr = >75 if african-american (ml/min/1.73 m2) for comparison, mean gfr for age group 70+ is 75 (ml/min/1.73 m2) gfr<60 = chronic kidney disease, gfr<15 = kidney failure using this patient's age, gender, and serum creatinine value of 1.2, estimated gfr = 59 if non african-american (ml/min/1.73 m2) estimated gfr = 71 if african-american (ml/min/1.73 m2) for comparison, mean gfr for age group 70+ is 75 (ml/min/1.73 m2) gfr<60 = chronic kidney disease, gfr<15 = kidney failure using this patient's age, gender, and serum creatinine value of 1.5, estimated gfr = 45 if non african-american (ml/min/1.73 m2) estimated gfr = 55 if african-american (ml/min/1.73 m2) for comparison, mean gfr for age group 70+ is 75 (ml/min/1.73 m2) gfr<60 = chronic kidney disease, gfr<15 = kidney failure enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili 08:38am 9 9 51 0.5 source: line-picc 03:00pm 9*1 06:00am 8*1 02:00pm 7 6 54 0.7 added pon cpis at 1500 verified by replicate analysis new reference interval as of ;upper limit (97.5th %ile) varies with ancestry and gender (male/female);whites 322/201 blacks 801/414 asians 641/313 other enzymes & bilirubins lipase 02:00pm 12 added pon cpis at 1500 cpk isoenzymes ck-mb ctropnt 03:00pm 2 <0.011 06:00am 2 <0.011 02:00pm 0.012 added on tnt at 1459 02:00pm 2 added pon cpis at 1500 <0.01 ctropnt > 0.10 ng/ml suggests acute mi ctropnt > 0.10 ng/ml suggests acute mi chemistry totprot albumin globuln calcium phos mg uricacd iron 08:38am 7.7* 2.3 source: line-picc 08:00am 7.6* 3.7 2.1 source: line-left picc line 06:45am 7.2* 3.5 2.1 source: line-left picc line 04:06am 7.1* 3.0 2.1 source: line-picc 05:00am 7.3* 2.7 2.1 source: line-picc 08:47am 7.6* 3.2 2.3 source: line-picc line 08:00am 7.6* 3.0 2.2 05:50am 2.3* 7.6* 3.9 2.3 03:30pm 7.8* 4.7* 2.3 06:45am 7.8* 4.9* 2.3 06:45am 8.1* 4.6* 2.2 10:55am 7.8* 3.4 2.1 06:10am 8.0* 2.6* 2.1 01:00pm 8.0* 2.6* 2.1 05:40am 2.5* 7.9* 2.4* 2.1 05:55am 8.1* 3.2 05:20am 8.0* 4.3 2.3 added b12 @ 08:08am on 02:53am 2.8* 7.3* 3.7 2.1 hematologic vitb12 05:20am 672 added b12 @ 08:08am on lipid/cholesterol cholest triglyc 05:00am 501 source: line-picc ldl(calc) invalid if trig>400 or non-fasting sample antibiotics vanco 05:30pm 26.2* random . . brief hospital course: 78 year old male (retired english professor) with h/o myelofibrosis/anemia (transfusion dependent, dx ), longstanding zenker's diverticulum with chronic aspiration and recurrent aspiration pneumonias admitted on with the same. . 1. aspiration pneumonia: patient was initially admitted to the with significant rll pna with pleural effusion and hypotension. hypotension resolved with ivf and he was transferred to floor. he underwent thoracentesis with resultant exudative fluid, and a chest tube was placed with resultant drainage of 3l of fluid and removal of the catheter on . he received a ten day course of levofloxacin/clindaymycin. at the time of discharge he had normal oxygen saturations on room air. . 2. chronic aspiration: patient failed speech and swallow evaluation several times. dobhoff tube placement was unsuccessful, a picc was placed on , and tpn was started. the plan is for endoscopic repair of his zenker's diverticulum by dr.. dr office will call rehab to schedule a pre-operative visit. . 3. anemia myelofibrosis: patient received intermittent transfusions to maintain a hct>22 (is also transfusion dependent as an outpatient). folate supplementation was continued. he is followed for this issue by his hematologist, dr.. . 4. thrombocytopenia: platelet count began to trend down during the last week of hospitalization, thought to be increased splenic congestion in the setting of volume overload while on tpn. there was also concern that his antibiotics were contributing. after completing antibiotics and undergoing diuresis with lasix 20mg iv as needed, his platelet count began to trend up, and on the day of discharge was 103. . 5.acute renal failure: patient noted to have arf on admission, which improved with ivfs to cr=0.8. however, he once again developed arf on (peak creat 1.7) likely from volume depletion as well, which again improved with hydration. renal us was within normal limits. . 6. sacral decubitus ulcer: patient has a stage ii sacral ulcer and was getting wound care and turning frequently. . pcp: . hematologist: dr. ent: dr. medications on admission: combivent folic acid ferrous sulfate discharge disposition: extended care facility: for the aged - macu discharge diagnosis: aspiration pneumonia c/b parapneumonic pleural effusion zenker's diverticulum with chronic aspiration moderate to severe malnutrition sacral decub stage ii myelodysplastic syndrome and anemia, transfusion dependent discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - requires assistance or aid (walker or cane) discharge instructions: you were admitted with a recurrent aspiration pneumonia and pleural effusion which required drainage with a chest tube. you were briefly in the icu. you were treated with antibiotics with improvement in your symptoms and completed these on . the chest tube had some trouble draining but we were able to fix this with tpa and it drained about 3l of fluid and your breathing improved. the cause of your pneumonia is due to recurrent aspiration, in part due to your large zenker's diverticulum. dr. office will contact you to arrange a pre-opertive visit to discuss repair of the diverticulum. a picc line was placed for tpn, which is iv nutrition. our hope is that this will make your nutrition status better so you can recover from the surgery. you also required occasional blood transfusions to keep your hematocrit above thirty. your platelet count dropped to a low of 59, but was increasing at the time of discharge. this was thought to be due to splenic congestion due to volume overload. . please take all medications as prescribed. it is very important to use your incentive spirometer and work with physical therapy going forward. followup instructions: please follow up closely with your pcp as soon as possible: pcp: , r. . you will be contact by dr. to arranged for your endoscopic surgery for zenker's procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent thoracentesis diagnoses: thrombocytopenia, unspecified unspecified pleural effusion acute kidney failure, unspecified other chronic pulmonary heart diseases hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) acute respiratory failure pneumonitis due to inhalation of food or vomitus pressure ulcer, lower back other ascites anemia in neoplastic disease pressure ulcer, stage ii nutritional marasmus myelofibrosis with myeloid metaplasia diverticulum of esophagus, acquired 

Answer: The patient is high likely exposed to