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: sob major surgical or invasive procedure: intubated history of present illness: mr. is a 88 yo m w/ as, chf here with incr sob, chest congestion and cough productive of blood tinged sputum x1 day. pt was visited by vna on who also found him to have o2 sat 80s on ra, a slight wheeze and who supplied him with supplemental oxygen. this relieved his symptoms. no fever, cp. cxr with pna, u/a with uti, trop indeterminate with baselinee cr 2.9, bnp lower than baseline. pt was originally on facemask in the ed with sats mid 90s with tachypneic to 30s. he was at first wheezy but later was rhonchorous. around 2am, vitals were p79 bp153/70 r24 o2 sat 97% on fm 15l. just prior to planned transfer to the icu, pt experiences resp decompensation. he was intubated with succinylcholine, etomodate, fentanyl and midazolam and soon after dropped his pressures ? incr intrathoracic pressure with as and was started on levo, placed rij. in total in the ed, he got 6mg of midazolam and 200mcg fentanyl. he was also bolused with total 1l fluid. he also recieved asa 325mg, azithromycin 500mg iv, ceftriaxone 1gm iv, lasix 20 iv and urojet. . on arrival to the icu, the pt is intubated and sedated. past medical history: past medical history: 1. cardiac risk factors: - hypertension 2. cardiac history: - severe aortic stenosis (peak vel 5m/s, mean grad 72, 0.9 cm2) - diastolic heart failure (lvef 70-80%) - pulmonary hypertension (moderate, pasp >55) - moderate lvh (1.6cm) 3. other past medical history: - stage iv ckd (baseline cr~3) - gastritis - trigeminal neuralgia - bladder cancer - bph s/p turp - iron deficiency anemia (hct mid 30s) - vitamin b12 deficiency - rcc s/p nephrectomy - chronic mycobacterium avium intracellular infection positive sputum in (pulm follows) had three negative sputums in social history: patient lives alone in . he was lieutenant colonel in russian army during wwii, and his entire family killed in war. after end of war went to medical school and became a dermatologist and practiced for 43 yrs. he moved to the us 18 years ago to be near his sons, in /sf who are in computers. he no longer practices but enjoys going to dermatology grand rounds at and bimdc. he smoked until age 25. rare alcohol use. he denied illicits/herbals. family history: father died from lung ca at age 45, though he worked in a tobacco store. mother, siblings were all killed at a young age in wwii. he says his sons have no medical issues. physical exam: on admission to icu: on transfer to floor: afebrile, hr 67 bp 132/57 sat 97/2l general: nad, alert, unclear level of orientation : mmm neck: rij, no jvd appreciated cards: rrr, blowing systolic murmur across precordium resp: mostly clear, sparse crackles abdomen: soft, nt/nd, +bs, no r/g extremities: trace edema pertinent results: labs on admission: 11:30pm blood wbc-7.4 rbc-3.27* hgb-9.5* hct-29.5* mcv-90 mch-28.9 mchc-32.1 rdw-14.5 plt ct-356 11:30pm blood neuts-67.2 lymphs-23.2 monos-5.2 eos-3.5 baso-0.9 11:30pm blood plt ct-356 11:30pm blood glucose-129* urean-54* creat-2.9* na-137 k-4.8 cl-105 hco3-22 angap-15 11:30pm blood ck(cpk)-42* 11:30pm blood ck-mb-notdone probnp-* 06:12am blood calcium-7.3* phos-4.4 mg-2.2 11:37pm blood lactate-1.0 12:05am urine color-straw appear-clear sp -1.012 12:05am urine blood-sm nitrite-neg protein-75 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-mod 12:05am urine rbc-* wbc->50 bacteri-mod yeast-none epi-0-2 labs on transfer to floor: 02:59am blood wbc-7.4 rbc-3.26* hgb-9.7* hct-28.4* mcv-87 mch-29.8 mchc-34.2 rdw-14.7 plt ct-312 02:59am blood plt ct-312 02:59am blood glucose-96 urean-42* creat-2.9* na-141 k-4.2 cl-106 hco3-24 angap-15 02:59am blood calcium-9.0 phos-3.9 mg-2.1 06:13am blood vanco-21.6* micro: 11:40 pm blood culture x2: no growth. 6:38 am sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): rare growth commensal respiratory flora. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): final report ** respiratory viral culture (final ): no respiratory viruses isolated. culture screened for adenovirus, influenza a & b, parainfluenza type 1,2 & 3, and respiratory syncytial virus.. detection of viruses other than those listed above will only be performed on specific request. please call virology at within 1 week if additional testing is needed. respiratory viral antigen screen (final ): respiratory viral antigen test is uninterpretable due to the lack of cells. refer to respiratory viral culture for further information. reported by phone to 11:55am. urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. 12:05 pm urine leg added to acc#0048k. **final report ** legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. (reference range-negative). performed by immunochromogenic assay. a negative result does not rule out infection due to other l. pneumophila serogroups or other legionella species. furthermore, in infected patients the excretion of antigen in urine may vary. 1:09 pm urine source: catheter. **final report ** urine culture (final ): no growth. imaging: chest (portable ap) 10:16 pm ap upright radiograph of the chest: there is increasing faint opacity in the left mid lung, suggestive of an infectious process. there is a large retrocardiac hiatal hernia. there is bibasilar atelectasis. a small left pleural effusion is also new. there is no pneumothorax or pulmonary edema. cardiac silhouette is mildly enlarged in size, unchanged. impression: 1. left mid lung pneumonia. a followup radiograph to document resolution is recommended. small left pleural effusion. 2. large hiatal hernia. chest (portable ap) 2:39 pm ap single view of the chest has been obtained with patient in sitting semi-upright position. analysis is performed in direct comparison with the next preceding similar study obtained 10 hours earlier during the same day. the patient remained intubated, the tube in unchanged position. the same holds for the previously described right internal jugular approach central venous line. on previous chest examinations observed perivascular haze (, 3:44 hours and , 4:57 hours) has regressed, thus less evidence of chf. no new parenchymal infiltrates are identified. no pneumothorax has developed. observed that patient was difficult to examine and left lateral chest wall is not completely included in image field. impression: improvement of pulmonary congestive pattern in comparison with next preceding chest examinations. echo : the left atrium is mildly dilated. there is asymmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. left ventricular systolic function is hyperdynamic (ef 80%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is a mild resting left ventricular outflow tract obstruction. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). mild to moderate (+) aortic regurgitation is seen. the severity of aortic regurgitation may be underestimated. the mitral valve leaflets are moderately thickened. there is no mitral valve prolapse. an eccentric, anteriorly directed jet of mild to moderate (+) mitral regurgitation is seen. due to the eccentric nature of the regurgitant jet, its severity may be significantly underestimated (coanda effect). the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. compared with the findings of the prior study (images reviewed) of , the left ventricle is slightly less hyperdynamic, and the cavity is slightly larger. brief hospital course: # respiratory failure: pt p/w pna on cxr and increased work of breathing in ed for which he was intubated. pt was felt to be volume overloaded and extubated successfully after diuresis. breathing comfortably on room air at time of discharge. # pneumonia complicated by sepsis: hypotensive in ed in setting of pna and +ua and required levophed initially. after treatment with antibiotics, we were able to wean levophed quickly. pt was broadly covering with vancomycin and zosyn. urine culture was mixed flora c/w contamination and reculture showed no growth. sputum was obtained by bal and was negative for bacteria and acid fast bacilli. blood cultures were also checked on admission and were no growth. on discharge pt is day for his pneumonia treatment (however, he will not require any additional vancomycin doses as he gets vancomycin q48h and got vanc on the day of discharge). # hemoptysis: pt has had longstanding occasional sm volume hemoptysis. this is felt to possibly be mac (isolated from prior bal specimen), however, decision was made not to treat. pt also has pulmonary nodules that will require f/u in . # pulm nodules noted : pt had 4mm pulm nod noted on ct chest in . pt to get repeat ct chest at 6 mos (). -please order pt for ct chest for # ckd: cr remained at baseline of ~2.8. pt's calcitriol was recently increased and was continued at current dose of 4x daily. # diastolic chf with acute exacerbation: diuresed aggressively in the micu and then placed back on home regimen of 20 lasix m,w,f. currently euvolemic s/p diuresis prior to extubation. pt was continued on atorvastatin and aspirin. per pt's cardiologist, ideal bp is 140-150, lasix held for sbp <140. # severe as: s/p valvuloplasty . pt likely still somewhat preload dependent. per pt's cardiologist, ideal bp is 140-150, lasix held for sbp <140. # aspiration: initial concern for aspiration, s/sw evaluated after intubation with poor results, on re-evaluation pt had improved and was able to tolerate normal diet and thin liquids. . # anemia: pt had recent iron studies, b12, folate. repletion continued. per pt's nephrologist, pt likely has some anemia ckd. medications on admission: atorvastatin - 80 mg daily calcitriol - 0.25 mcg capsule sunday,monday, wednesday, and friday finasteride - 5 mg daily furosemide - 20 mg monday, wednesday, and friday prn lorazepam - 0.5 mg qhs prn metoprolol succinate - 100 mg daily omeprazole - 20 mg daily oxcarbazepine - 600 mg daily tolterodine - 4 mg, sust. release daily acetaminophen - 325 -650mg q 6 prn pain aspirin - 81 mg daily cyanocobalamin docusate sodium - 100 mg ferrous gluconate - 325 mg daily discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. cyanocobalamin 100 mcg tablet sig: 0.5 tablet po daily (daily). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 5. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 6. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 7. calcitriol 0.25 mcg capsule sig: one (1) capsule po 4x/week (,mo,we,fr). 8. oxcarbazepine 600 mg tablet sig: one (1) tablet po daily (daily). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. lasix 20 mg tablet sig: one (1) tablet po m,w,f: hold for sbp <140. 11. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 12. tolterodine 4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. 13. acetaminophen 325 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for pain. 14. toprol xl 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day: please hold for sbp <140. 15. piperacillin-tazobactam 2.25 gram recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 2 days: last dose in the evening. discharge disposition: extended care facility: of discharge diagnosis: primary: 1. pna 2. respiratory failure 3. sepsis secondary: 1. severe as 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: it was a pleasure taking care of you during your admission at . you were admitted for pneumonia. you had a breathing tube in and needed medicines to raise your blood pressure. you improved with antibiotics. please get a current medication list from your rehab when you are discharged. in brief, your toprol was decreased from 100mg daily to 50mg daily. your lorazepam was stopped. followup instructions: *** please arrange for f/u with pt's pcp (dr within 1 week of discharge*** (phone number below) please transport pt to the following appointments: department: sleep unit neurology when: thursday at 11:00 am with: , m.d. building: campus: east best parking: garage department: when: tuesday at 12:00 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage department: medical specialties when: wednesday at 11:00 am with: , rn building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified anemia in chronic kidney disease congestive heart 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 acute on chronic diastolic heart failure aortic valve disorders acute respiratory failure personal history of malignant neoplasm of bladder other diseases of lung, not elsewhere classified personal history of malignant neoplasm of kidney disseminated due to other mycobacteria 

Answer: The patient is high likely exposed to