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: bactrim attending: chief complaint: shortness of breath major surgical or invasive procedure: intubation history of present illness: mr. is a 72 yo m with copd and stage 1 lung ca who presented to with cough and dyspnea at rest. bipap was attempted but failed, he desaturated, showed signs of fatigue, was intubated and transfered to the icu. he had a new lbbb on ekg but cardiac enzymes were negative and so cardiology thought lbbb was copd exacerbation and pna. he was initially treated with ceftriaxone and levofloxacin for pna. he received a bal which revelaed to organisms but was significant for blood. abx regimen changed to include vancomycin because of concern for necrotizing pna caused by kleb or staph. peep was lowered and his lbbb resolved, cardiac markers continued to be negative. while in icu his hct dropped from 35->27, guiac was negative. he received 20mg lasix yesterday and was negative 1l, overall during icu admission he was positive 2l. he has been in and out of a.fib with rvr into 120s which responded to iv lopressor. ekg revealed t-wave inversions in iii and avf, but again cardiac enzymes continued to be negative. vancomycin course completed but he will be on ceftriaxone for 2 more days. of note, patient was extubated , has been saturating in low 90s on ra, at times requiring 2l nc and/or face mask. he is also being viral screened and is on droplet precautions. past medical history: 1. cns lymphoma - followed by -dx'd by biopsy on - b-cell cd20+ cns lymphoma -tx'd w/methotrexate high dose iv and intrathecal -relapse tx'd w/induction rituxan and temozolomide immunotherapy -completed 12 cycles of maintenance temozolomide chemotherapy 2. polymyalgia rheumatica 3. stage i seminoma in the right testicle treated with orchiectomy and irradiation in 4. waldenstrom's macroglobulinemia - per notes stable. his serum igm from was 432 (range 20-230). + hypogammaglobulinemia 5. squamous cell carcinoma of the skin: followed by s/p electron-beam irradiation for squamous cell carcinoma to his right neck and mid-back from to . 6. bronchiectasis and granulomatous lung mass: , m.d. 7. neurocognitive dysfunction: stable on ritalin la and namenda. 8. low testosterone on adrogel 9. s/p dvt, ivc placement on lovenox therapy 10. bovine atrial valve replacement 3 yrs ago at social history: patient lives with his wife and son. manages auto dealership. he has >60 pkyr smoking history, quit 20 yrs ago. he ~30yrs ago he previously was a heavy drinker but now drinks one to two alcoholic drinks a month. he denies illicit drug use. his only exposure history is that related to radiation that he had for his squamous cell and seminoma. family history: father died of colon cancer at the age of 80. mother died of cva at the age of 94. no family history of lung cancer. physical exam: general: alert, oriented, no acute distress, using accessory muscles to breath heent: sclera anicteric, perrl, mmdry, oropharynx clear neck: supple, jvd flat, no lad lungs: diffuse rhonchi throughout r>l, crackles and wheezes at the left base cv: rrr, loud s1, nl s2, no murmurs, rubs, gallops abdomen: +bs, soft, non-tender, distended, no rebound tenderness or guarding, no organomegaly gu: + foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: a&ox3, cn 2-12 intact discharge pe: ****** vs******* gen: well nourished male, laying in bed, pleasant and in good humor. he is aox3, comfortable but appears to be in some respiratory distress. heent: scar and noticeable deformity over r parietal bone where omaya reservoir placed. perrl. mmm. no lad. no jvd. neck supple. no cervical, supraclavicular, or axillary lad. cards: heart sounds difficult to appreciate because of diffuse. heart sounds rr s1, s2 clear and of good quality. no murmurs/gallops/rubs appreciated pulm: on 1l ns saturating in mid 90s. on auscultation he has diffuse inspiratory stridor, coarse rhonchi throughout r>l and end expiratory wheezes r>l. crackles not appreciated on exam. using accessory muscles. there is a large radiation scar over r upper back. abd: bs+, soft, nt, nd, no rebound/guarding, no hsm, no sign extremities: wwp, no edema. dps, pts 2+. skin: there are many ecchymoses throughout neuro: cns ii-xii intact. 5/5 strength in u/l extremities. dtrs 2+ bl. sensation intact to lt, gait deferred. pertinent results: admission labs: 09:30pm wbc-8.3 rbc-4.83 hgb-13.9* hct-42.1 mcv-87 mch-28.7 mchc-32.9 rdw-15.8* 09:30pm neuts-87.2* lymphs-8.7* monos-1.9* eos-1.7 basos-0.5 09:30pm glucose-177* urea n-34* creat-1.2 sodium-140 potassium-4.2 chloride-102 total co2-26 anion gap-16 09:36pm lactate-2.1* 09:36pm po2-45* pco2-54* ph-7.30* total co2-28 base xs-0 comments-green top 10:20pm type-art o2-50 po2-89 pco2-38 ph-7.40 total co2-24 base xs-0 intubated-not intuba 10:45pm urine rbc-1 wbc-<1 bacteria-none yeast-none epi-0 10:45pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 10:45pm urine color-yellow appear-clear sp -1.020 ce trend: 09:30pm blood ctropnt-<0.01 03:15am blood ck-mb-3 ctropnt-<0.01 04:22pm blood ck-mb-4 ctropnt-<0.01 11:36pm blood ck-mb-4 ctropnt-<0.01 01:01am blood ck-mb-3 ctropnt-<0.01 discharge labs: ************** results: cxr: bilateral pleural effusions, right greater than left are probably unchanged allowing the difference in positioning of the patient. cardiomediastinal contours are unchanged. patient is status post right upper lobectomy. there is no evident pneumothorax. left lower lobe opacities consistent with pneumonia are unchanged. opacities in the left mid lung are worsening likely due to another focus of infection. right lower lobe opacity has worsened, most likely due to worsening large area of atelectasis. sternal wires are aligned. patient is status post aortic valve replacement. brief hospital course: mr. is a 72 yo m with copd and stage 1 lung ca who presented to with cough and dyspnea at rest. bipap was attempted but failed, he desaturated, showed signs of fatigue, was intubated and transfered to the icu. he had a new lbbb on ekg but cardiac enzymes were negative and so cardiology thought lbbb was copd exacerbation and pna. he was initially treated with ceftriaxone and levofloxacin for pna. he received a bal which revelaed no organisms but was significant for blood. abx regimen changed to include vancomycin because of concern for necrotizing pna caused by kleb or staph. peep was lowered and his lbbb resolved, cardiac markers continued to be negative. while in icu his hct dropped from 35->27, guiac was negative. he was in and out of a.fib with rvr into 120s which responded to iv lopressor in icu. ekg revealed t-wave inversions in iii and avf, but again cardiac enzymes continued to be negative. vancomycin/ceftriaxone/levofloxacin course completed (3day/5d/5d). he was extubated . on the floor he was weaned off oxygen and continuous o2 monitoring until he was mid 90s on 1l with only occasional desat with exertion. # respiratory failure/hypoxia: came to the floor s/p intubation for increasing respiratory distress and fatigue while on bipap. respiratory failure was likely cap given left shift, infiltrate seen on cxr and increasing respiratory distress. necrotizing pna caused by kleb or staph could not be r/o in light of bloody bal. pseudomonas less likely without bronchiectasis and no prior history of resistant organisms or recent hospitalizations. nasopharyngeal viral studies were negative, blood cultures were negative and sputum cultures unremarkable. he completed a course of prednisone and iv vanc/ceftriaxone/levoflox. a/a nebs for copd with relief of wheezes. he was afebrile during admission, without a leukocytosis and without s/s of pna. day before discharge he had worsening wheezes and occasional desats. although cxr showed ? new opacities in mid lung, he was afebrile, there was no change in cough character and recently completed abx -- therefore, repeat abx course deferred. he was weaned down to 1l nc with only occasional desats. the patient was able to ambulate around the floor multiple times a day and stated that he felt significantly improved. patient knows to call with any pulmonary changes #episode of afib: associated w/ twi in iii and avf and a rbbb. pt has h/o aflutter and rbbb is seen on ekg from . asymptomatic. trops and ck-mbs have been negative x5. he was kept on full dose aspirin (325) as he was treated as an outpatient per family coumadin was not started in past because ?bleeding while on it in past. restarted on dilt in addition to metoprolol per outpatient regimen. he converted into a. flutter but had some hypotensin and bradycardia. dilt reduced to 120mg instead of 360mg and he tolerated that better.ritalin was also decreased on discharge. discussed plan with cardiology, who agreed. #anemia: hct from 42 on admission to 35 and then to 29. there was no clear source of bleeding, guaic negative, but he was having some bloody secretions previously (bal)and a slow pulmonary bleed might be contributing. he was hemodynamically stable for duration of admission except for duol nodal blocker effect and his h/h remained stable. # acute kidney injury: seems to be resolved in icu, likely pre-renal in setting of infection. resolved with ivf boluses. will continue to monitor #copd: we continued home regimen a/a nebs (see above. he was discharged on symbicort, and spiriva with as needed albuterol. #htn: well controlled, we continued home meds metoprolol and dilt but went down on dilt as above. #history of dvt: legs appeared symmetric without pain. dvt filter in place. aspirin and pneumoboots continued. heparin was not started because of dropping h/h and history of bloody secretions. transitional issues: - ?opacity in left mid lung on cxr after abx course without clinical signs of infection:if he does show new signs of pna or clinical status changes he should be covered with vanc/cefepime for hap/pseudomonas. - pt asked to follow up with cardiology for ass titrating his bp/nodal blocking meds - pt to f/u with dr. r.e decreasing ritalin to 40 from 55 and history of mental status changes when off of ritalin. consider using provigil instead for less cardiac irritation. -reassess need for home oxygen and titration of copd medications as tolerated. medications on admission: albuterol sulfate 90 mcg hfa aerosol inhaler 2 puffs inh q6h prn sob alendronate 35 mg tablet one tablet(s) by mouth one tab weekly budesonide-formoterol 160 mcg-4.5 mcg 2 puffs inh citalopram 40 mg tablet daily diltiazem hcl 360 mg capsule, er daily fluticasone 50 mcg spray, 2 spray(s) each nostril daily gabapentin 300 mg capsule 1 capsule(s) by mouth evening levothyroxine 25 mcg tablet once a day namenda 10 mg tablet by mouth twice a day nr methylphenidate 20 mg tablet er 2 tablet(s) by mouth daily nr methylphenidate 5 mg tablet 2 tablet(s) by mouth metoprolol tartrate 50 mg tablet by mouth twice daily pantoprazole 40 mg tablet, delayed release by mouth daily rivastigmine 1.5 mg capsule 3 capsule(s) by mouth qam, 2 caps qpm rosuvastatin 40 mg tablet by mouth daily nr testosterone 50 mg/5 gram (1 %) gel 25 mg transdermally daily tiotropium bromide 18 mcg capsule inh once a day aspirin 325 mg tablet by mouth daily cholecalciferol (vitamin d3) 2,000 unit capsule 2 capsules daily nr multivitamin . allergies: bactrim discharge medications: 1. home oxygen please provide home oxygen at 2-3l continuous 2. citalopram 20 mg tablet : two (2) tablet po daily (daily). 3. gabapentin 300 mg capsule : one (1) capsule po hs (at bedtime). 4. levothyroxine 25 mcg tablet : one (1) tablet po daily (daily). 5. memantine 10 mg tablet : one (1) tablet po bid (2 times a day). 6. metoprolol tartrate 50 mg tablet : one (1) tablet po bid (2 times a day). 7. rivastigmine 1.5 mg capsule : three (3) capsule po qam (). 8. rivastigmine 3 mg capsule : one (1) capsule po qpm (). 9. rosuvastatin 20 mg tablet : two (2) tablet po daily (daily). 10. aspirin 325 mg tablet : one (1) tablet po daily (daily). 11. cholecalciferol (vitamin d3) 1,000 unit tablet : four (4) tablet po daily (daily). 12. multivitamin tablet : one (1) tablet po daily (daily). 13. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 14. senna 8.6 mg tablet : two (2) tablet po bid (2 times a day) as needed for constipation. 15. docusate sodium 100 mg capsule : two (2) capsule po bid (2 times a day). 16. bisacodyl 10 mg suppository : one (1) suppository rectal hs (at bedtime) as needed for constipation. 17. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 18. magnesium hydroxide 400 mg/5 ml suspension : thirty (30) ml po q6h (every 6 hours) as needed for constipation. 19. methylphenidate 20 mg tablet extended release : two (2) tablet extended release po dailyam (). disp:*30 tablet extended release(s)* refills:*0* 20. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed for wheezing, sob. 21. diltiazem hcl 120 mg capsule, extended release : one (1) capsule, extended release po daily (daily). disp:*15 capsule, extended release(s)* refills:*0* 22. symbicort 160-4.5 mcg/actuation hfa aerosol inhaler : two (2) puffs inhalation twice a day. 23. spiriva with handihaler 18 mcg capsule, w/inhalation device : one (1) capsule inhalation once a day. discharge disposition: home with service facility: discharge diagnosis: copd exacerbation secondary to pneumonia atrial fibrillation / atrial flutter stage 1 lung cancer cns lymphoma dvts 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: dear mr. , it was a great pleasure treating you during your hospitalization. you were admitted to for respiratory distress. you were treated for a copd exacerbation secondary to pneumonia. you did not do well with non-invasive respiratory therapy initially and had to be intubated. after a stay in the icu where you were treated with steroids and antibiotics you were transfered to the omed team after extubation for treatment of penumonia. you were treated with vancomycin, ceftriaxone and levofloxacin. your breathing improved but you still required supplemental oxygen. the following changes to your medications were made: - diltiazem reduced to 120mg po daily - ritalin reduced to 40mg po daily - no other changes were made to your home medications, please continue to take your home medications as prescribed. - please see your outpatient cardiologist to titrate your diltiazem followup instructions: department: cardiac services when: wednesday at 1 pm with: , np building: sc clinical ctr campus: east best parking: garage department: when: wednesday at 2:40 pm with: , md building: (, ma) campus: off campus best parking: on street parking department: pulmonary function lab when: monday at 10:40 am with: pulmonary function lab building: campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube non-invasive mechanical ventilation closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified acidosis polymyalgia rheumatica acute kidney failure, unspecified atrial fibrillation personal history of malignant neoplasm of bronchus and lung obstructive chronic bronchitis with (acute) exacerbation other malignant lymphomas, unspecified site, extranodal and solid organ sites acute respiratory failure personal history of malignant neoplasm of testis other dependence on machines, supplemental oxygen macroglobulinemia 

Answer: The patient is high likely exposed to