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: no known allergies / adverse drug reactions attending: chief complaint: shortness of breath major surgical or invasive procedure: intubation via trach history of present illness: 65m with severe copd p/w tachypnea. he was at home and sneezed and his trach cap flew off. he initially had difficulty finding it and called who referred him to 911. when ems arrived he had found it but was tachypneic so they brought him to ed. he has been short of breath lately but he denies feeling sob except when he is moving too fast, he says that doctors telling to move slower. got trach placed in . ekg in ed was sinus tach. was tachypneic to 50 in ed so put on and then appeared comfortable. his trach was changed. vs prior to transfer: 87, 109/59, 95% on 35% fio2. was satting 87-88 got 4l ivf for borderline high 80s pressures after being put on the vent, he had a similar reaction after intubation in . got cefepime/vanc in addition to azithromycin and methylprednisolon in the ed. norepinephrine was about to be started but his pressure came up and it was immediately stopped. he denies any worsening cough, progressive sob, fevers, rhinorrhea, n/v/d, chest pain. he says that he has been compliant with all of his medications including his advair, tiotropium and albuterol. past medical history: - copd: fev1 23% predicted, home 1.5-2l o2 at night only - secondary pulmonary hypertension (51-66 mm hg on echo ) - schizophrenia - hx gi bleeding - mental retardation - pulmonary hypertension - s/p tonsillectomy - s/p trach social history: lives in , unknown if alone. on disability since for mental health issues. has home nurse visit every morning and evening. reports ~50 pack-year smoking denies current smoking. denies any etoh/drug use. family history: non-contributory physical exam: vitals: t: 98.7 bp: 108/62 p: 74 r: 40 o2: 91% on 2l nc general: alert, oriented, no acute distress, able to speak w/ trach cap on. : sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: significantly decreased bilaterally with extremely prolonged expiratory phase and scattered wheezing. cv: regular, distant heart sounds abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. passing flatulence on exam. gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, mild cyanosis, no edema pertinent results: admission labs: 08:20am blood wbc-12.3* rbc-4.86 hgb-14.3 hct-45.6 mcv-94 mch-29.4 mchc-31.3 rdw-12.9 plt ct-354 08:20am blood neuts-85.6* lymphs-10.0* monos-3.0 eos-1.0 baso-0.4 08:20am blood pt-13.3 ptt-31.6 inr(pt)-1.1 08:20am blood glucose-145* urean-14 creat-1.0 na-140 k-4.5 cl-96 hco3-38* angap-11 08:35am blood type-art o2 flow-4 po2-57* pco2-58* ph-7.38 caltco2-36* base xs-6 intubat-not intuba comment-nasal cardiac biomarkers: 08:20am blood ctropnt-<0.01 05:26pm blood ck-mb-2 ctropnt-<0.01 studies: chest (portable ap) study date of 8:09 am findings: the lung volumes are normal. there is no pleural effusion, pneumothorax, or focal consolidation. the hilar and mediastinal silhouettes are unchanged. the heart is of normal size. the pulmonary vasculature appears prominent. left basal scarring and atelectasis appears unchanged. in comparison to exam, there is increased retrocardiac opacity. the trachostomy tube terminates 8.5 cm above the carina. impression: interval increase of the retrocardiac opacity, which may represent atelectasis. however, superimposed infection cannot be entirely excluded. lateral views may aid in further evaluation, if clinically indicated. microbiology: 9:30 am sputum tracheostomy. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs and chains. 4+ (>10 per 1000x field): gram positive rod(s). respiratory culture (preliminary): moderate growth commensal respiratory flora. streptococcus pneumoniae. moderate growth. respiratory viral antigen screen (final ): negative for respiratory viral antigen. specimen screened for: adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. refer to respiratory viral culture for further information. 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. brief hospital course: 65 yo m w/ severe copd s/p trach p/w hypoxia and respiratory distress. 1. hypoxia: at presentation his sats were in the low 90s on home o2 of 2l. in the ed his abg did not suggest acute worsening of hypoventilation. his worsening respiratory status was thought to be secondary to a copd exacerbation given his improved oxygenation with pressure support initially. while on pressure support he was hypotensive and was resuscitated with 4l of ns. he was initially tachycardic and it resolved after resuscitation and was normotensive prior to off of positive pressure. he had a flu swab sent, which returned negative, with a culture sent from the same sample. on chest x-ray, he had a retrocardiac opacity, and in the setting of his hypoxia and tachypnea, he was started on levofloxacin and ceftiaxone for pneumonia. when he arrived in the icu, he was on ps and pulling tidal volumes of 150. he was switched to ac 450 with a peep of 10 and fio2 of 30%. he was started on solumedrol 60mg iv q8h and written for tamiflu which was discontinued when his flu came back negative. he was also given nebulizers and continued on inhaled steroids. because of his history of mrsa he was started on vanco, which was dc'd when his cultures came back positive for strep pneumoniae. he was treated with levofloxacin for a 5 day course which he finished and ceftriaxone/cefpodoxime for a 7 day course. his steroids were tapered from solumedrol to prednisone. calcium and vitamin d were started on the day of discharge. follow-up: - finish cefpodoxime 200mg po bid until - steroid taper: prednisone 40mg until , then 30mg until , then 20mg until , then 10mg until . 2. apnea: while here, the patient had apneic episodes while in house which was thought to be central in nature. he will not tolerate a cpap mask at night, and would likely need to be ventilated at night for these episodes. follow-up: - please perform a sleep study to assess for central sleep apnea - please arrange for home ventillation if necessary at night based on the sleep study results for central apnea 3. hypotension: initially hypotensive and tachycardic. however this resolved with fluids as above as well as removal of positive airway pressure. he remained hemodynamically stable and normotensive for the remainder of his stay. 4. arf: his baseline creatinine appeared to be around 0.6-0.7 and was 1.0 on admission to the icu. this was likely a pre-renal azotemia secondary to dehydration. he was fluid resucitated with 4l ns as above. 5. schizophrenia: olanzapine was held initially for his inability to tolerate being off the vent to take pos and was added back to his regimen when he tolerated po medications. 6. diarrhea: patient began experiencing diarrhea on the day of discharge. he was afebrile, without an increase in his wbc. a c. diff was sent. - follow-up on c. diff toxin transition issues: c. diff toxin was pending at the time of discharge. mr. needs a sleep study to evaluate for central sleep apnea, and may require further intervention based on the results of that study. medications on admission: 1. zyprexa 7.5 mg tab 1 tablet(s) by mouth once a day 2. multivitamins with minerals tab 1 tablet(s) by mouth once a day 3. advair diskus 500 mcg-50 mcg/dose for inhalation 1 puff(s) inhaled twice a day 4. spiriva with handihaler 18 mcg & inhalation caps 1 capsule inhaled once a day 5. aspirin 81 mg tab, delayed release1 tablet(s) by mouth once a day 6. tylenol 325 mg tab 1 tablet(s) by mouth every four (4) hours as needed for fever or pain 7. proair hfa 90 mcg/actuation aerosol inhaler 2 puffs(s) inhaled twice a day and q 4 hours prn wheeze 8. famotidine 20 mg tab 1 tablet(s) by mouth every twelve (12) hours 9. prednisone 20 mg tab 2 tablet(s) by mouth daily (daily) . taper as directed. 10. colace 100 mg cap 1 capsule(s) by mouth once a day discharge medications: 1. olanzapine 7.5 mg tablet : one (1) tablet po once a day. 2. multivitamin tablet : one (1) tablet po once a day. 3. fluticasone-salmeterol 500-50 mcg/dose disk with device : one (1) disk with device inhalation (2 times a day). 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : two (2) puff inhalation every four (4) hours as needed for wheezing. 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation q2h (every 2 hours) as needed for wheezing for 10 days. 6. ipratropium bromide 0.02 % solution : one (1) neb inhalation q6h (every 6 hours) as needed for sob/wheeze for 10 days. 7. tiotropium bromide 18 mcg capsule, w/inhalation device : one (1) cap inhalation daily (daily). 8. aspirin 81 mg tablet : one (1) tablet po once a day. 9. tylenol 325 mg tablet : one (1) tablet po every six (6) hours as needed for pain. 10. cefpodoxime 100 mg tablet : two (2) tablet po q12h (every 12 hours) for 3 doses. 11. prednisone 10 mg tablet : four (4) tablet po as directed per taper below: take 40mg (4 tabs) until , take 30mg (3 tabs) until , take 20mg (2 tabs) until , and take 10mg (1 tab) until . discharge disposition: extended care facility: - discharge diagnosis: primary: pneumonia copd exascerbation 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: mr. , it was a pleasure taking part in your care. you were admitted to for difficulty breathing, low oxygen, and low blood pressure. you were found to have pneumonia with a bacteria called streptococcus pneumoniae, and were treated with antibiotics. you were also given iv fluids because you were dehydrated. you were admitted to the medical intensive care unit, and you required mechanical ventilation through your trach to help rest you as well as to keep your oxygen level appropriate. throughout your stay, your oxygen level improved and you were able to be kept off the ventilator for long periods of time. the following changes were made to your medications: - continue cefpodoxime 200mg by mouth twice a day through - continue prednisone according to the following taper: 40mg until 30mg until 20mg until 10mg until - use ipratropium and albuterol neublizers as needed for shortness of breath, and wheezing please take all medications as prescribed. please follow-up at your appointments below. followup instructions: please arrange to follow-up with your primary care doctor at the appointment below. department: when: tuesday at 10:20 am with: , m.d. building: campus: east best parking: garage md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours replacement of tracheostomy tube diagnoses: acute kidney failure, unspecified obstructive chronic bronchitis with (acute) exacerbation other chronic pulmonary heart diseases unspecified schizophrenia, unspecified acute and chronic respiratory failure hypotension, unspecified pneumococcal pneumonia [streptococcus pneumoniae pneumonia] unspecified intellectual disabilities mechanical complication of tracheostomy 

Answer: The patient is high likely exposed to