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: lasix attending: chief complaint: cough and malaise major surgical or invasive procedure: 1. none history of present illness: 87m with recent admission for pna here with increasing productive cough. pt was admitted with a rml pneumonia. pt was treated with 7-day course of levofloxacin. pt reported that he felt better when he went home, but 2-3 days later, felt increasing fatigue and increasing cough productive of yellow and then green-yellow sputum. pt states he is sore from coughing but denies cp. denies frank sob. denies n/v/abd pain, no fevers/chills at home. does not use o2 at baseline. pt denies any blood in sputum. denies any difficulty eating or swallowing at home. . in the , pt was noted to be tachypneic but satting well on 3-4l nc. as pt was subtherapuetic on coumadin, he was sent for ct angio to r/o pe. when he returned from ct scanner, was tachypneic to 40s, hypoxic to 90s on nrb, bp in 240s. was transiently placed on a ntg gtt, and bp dropped into 170s. chest ct showed multifocal pna. initial abg 7.29/57/173 on nrb, lactate 1.5. in the , pt rec'd ns x2l, ceftazidime 2g ivx1, vancomycin 1g ivx1, albuterol nebs x2, robitussin with codeine, tylenol 1g, ntg gtt. . in the micu, he was treated with vancomycin, azithromycin, and zosyn for pneumonia refractory to levofloxacin. his o2 requirement was weaned down. however, on hospital day 2, he developed hypertension with acute shortness of breath; this was treated with a ntg gtt. isosorbide dn was added to his bp regimen replace the ntg. . because of his dyspnea and tight, wheezy lung exam, he was started on steroids for copd exacerbation, although he does not carry a history of copd. a short course followed by short taper was planned to treat the copd. he was then able to wean down from a face mask to nasal cannula. past medical history: bladder cancer- originally diagnosed and treated with conservative mgmt, recurred in in ny, s/p chemo/xrt, s/p intravesical bcg/ifn x6 completed , recurrent tumors on cystoscopy, s/p transurethral resection peptic ulcer disease dvt- dvt occured spontaneously, dvt 35y ago in postop setting (varicose vein stripping),on coumadin since cri- etiology unclear, baseline creatinine 1.3-1.5 spinal stenosis (low back pain and b le pain) left hernia repair. venous stripping surgery. left cataract repair. social history: patient denies any history of smoking or alcohol consumption. he is currently a retired post-office worker. he lives in with his wife and has a son in the area. family history: non-contributory physical exam: vs: 99.7 145/67 107 46 97% 5l nc gen: well appearing, hard-of-hearing, nad heent: perrl, eomi, mm dry, op clear cv: tachy, regular, nl s1/s2, no m/r/g pulm: diffusely rhonchorous with scattered wheezes, dtp at l lung field superiorly; no e->a change abd: soft, nt/nd, +bs, no masses ext: no c/c/e pertinent results: ekg: 101bpm, nsr, no st/t wave changes, nl axis, nl r wave progression . cxr : multifocal pulmonary opacities in the right mid and both lower lung regions show interval improvement with residual confluent opacity most prominent in the right middle lobe. vascular engorgement and perihilar haziness have also improved. impression: improving multifocal pneumonia and likely resolving superimposed interstitial edema. . tte : normal ef, no valvular disease . cxr : 1.improving right middle lobe airspace opacity likely representing resolving pneumonia. 2. 7-mm right lower lobe nodular opacity seen on a single view. further characterization of this finding with repeat pa and lateral chest radiographs is recommended following resolution of the right middle lobe consolidation. . ct angio : multifocal pna, cannot see pe but limited exam (patient movement) . micro: blcx x2: 1/4 bottles w/coag negative staph negative for influenza a and b brief hospital course: 87m with recent pna on levofloxacin, now with worsening multifocal pneumonia. had episode of respiratory difficulty overnight requiring numerous interventions including lasix (although cxr afterwards showed no signs of chf), albuterol nebs, nitro for afterload reduction, and finally bipap . # respiratory distress/multifocal pneumonia - patient readmitted for multifocal pna that did not respond to levofloxacin as an outpatient. it was thought that the patient either did not receive long enough treatment with levofloxacin or possibly that the patient's pneumonia was resistant to levofloxacin. alternatively, it was considered that the patient could have a secondary infection superimposed on his prior pneumonia. the patient was started on zosyn/vanco to cover broadly given progression of symptoms and radiographic appearance of pna as well as azithromycin to cover atypicals. he was admitted to the micu given his oxygen requirement and respiratory distress. in the micu, the patient had two episodes of tachypnea to the 40s. the first episode of sudden tachypnea and increased o2 requirement was thought to be mucous plugging. the patient had a second episode of respiratory distress with rr 40s and was given bipap with improvement of rr 20-30. the patient did not require intubation in the micu. the patient was started on iv solumedrol for wheezing thought to be consistent with copd/reactive airways disease. a tte perfomed showed no evidence of valvular disease with ef > 55%. his cta showed multifocal pneumonia but no evidence of pe (although it was somewhat limited study due to patient motion). he did not require endotracheal intubation. his pneumonia and respiratory status began to improve on the vanc/zosyn. additionally, the patient was found to have significant wheezing on exam thought to be consistent with a component of copd/reactive airways disease. although the patient does not have known copd, he was started on iv steroids for presumed reactive airways disease contributing to his severe respiratory distress. he was started on solumedrol iv and then subsequently switched to prednisone. he also received nebulizer treatments and his wheezing has improved during his hospital course. he will complete iv antibiotics and a prednisone taper after discharge at the rehab macu. upon discharge, he was requiring 2-3l nasal cannula to maintain saturation of 96%. on room air, the patient's oxygen saturation was 90%. . # hypertension - patient's hypertension to sbps 240s in the ed were thought to be likely from catecholamine surge in the setting of possible early sepsis. he was transiently put on a nitro gtt which improved his sbps to 160s-170s and was transitioned to isosorbide dn and metoprolol after it was clear that he was no longer septic. his antihypertensive regimen can be further uptitrated as necessary in the outpatient setting. . # anemia: patient found to have new anemia with hct 30-32. stool guiacs x 2 were negative. hemolysis labs were sent with no evidence of hemolysis. . # bladder ca - patient was found to have recurrent bladder cancer on a recent cystoscopy. he is s/p transurethral resection . there are no acute issues at this time. his ua was noted to have many rbcs which is not seen in prior uas but pt has known bladder ca. the patient will need further followup as an outpatient with his urologic oncologist. currently no acute issues at this time. ua was noted to have many rbcs which is not seen in prior uas but . # ckd - no acute issues. renally dose meds. the patient's baseline cr ranges between 1.3-1.6. . # h/o dvt - the patient's coumadin was stopped in the icu in the event a procedure was necessary and he was bridged with a heparin gtt. upon discharge, his inr was 2.2 and heparin gtt was no longer needed. goal inr 2.0-3.0 . # fen/gi - heart healthy diet . # ppx - tolerating po medications on admission: ultram 50mg q4-6h prn toprol xl 25mg daily celexa 20mg daily levofloxacin 250mg daily (last day ) guaifenesin edecrin 25mg daily coumadin 2.5mg daily discharge medications: 1. piperacillin-tazobactam 2.25 g recon soln sig: one (1) recon soln intravenous q6h (every 6 hours) for 7 days. 2. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours) for 7 days. 3. tramadol 50 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 4. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. 5. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 6. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 7. isosorbide dinitrate 10 mg tablet sig: two (2) tablet po tid (3 times a day). 8. azithromycin 250 mg capsule sig: one (1) capsule po q24h (every 24 hours) for 4 days. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. prednisone 20 mg tablet sig: three (3) tablet po daily (daily) for 3 days. 11. prednisone 20 mg tablet sig: two (2) tablet po daily (daily) for 3 days: start after 60mg x 3 days is completed. 12. prednisone 20 mg tablet sig: one (1) tablet po daily (daily) for 3 days: start after 40mg x 3 days is completed. 13. warfarin 1 mg tablet sig: three (3) tablet po hs (at bedtime). 14. toprol xl 25 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. 15. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 16. insulin sliding scale please continue insulin sliding scale while patient is on prednisone taper. see attached sliding scale. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: 1. multifocal pneumonia . secondary: 1. bladder cancer 2. pud 3. dvt , on coumadin 4. ckd - basline cr 1.3-1.5 5. spinal stenosis 6. l henia repair 7. venous stripping 8. hard of hearing discharge condition: 1. stable, patient clinically improved. patient is stable but still with o2 requirement and wheezing on exam. patient will benefit from close follow up with macu. discharge instructions: 1. please take all medications as prescribed. you were started on antibiotics for your pneumonia (vancomycin, zosyn and azithromycin) . 2. please keep all outpatient appointments . 3. please return to the hospital for symptoms of worsening dyspnea, chest pain, nausea/vomiting, chest pain, or any other concerning symptoms followup instructions: please follow up with your pcp, . after discharge from your rehab admission. please call his office at to make an appointment within one to two weeks after discharge from rehab. md procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified anemia, unspecified congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified acute respiratory failure long-term (current) use of insulin diarrhea asthma, unspecified type, with (acute) exacerbation peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction spinal stenosis, lumbar region, without neurogenic claudication malignant neoplasm of other specified sites of bladder 

Answer: The patient is high likely exposed to