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: pneumonia major surgical or invasive procedure: bronchoscopy history of present illness: the patient is an 89yo male with pmh notable for copd, afib, dm, h/o pna requiring intubations, and h/o bronchomalacia transfered to intubated from hosptial. per report pt was discharged yesterday from mvh for pneumonia. today he had dyspnea, called ems and was taken to mvh ed where he was treated for ?copd and chf exacerbations with azithromycin, solumedrol, and lasix. pt was placed on bipap but did not improve and thus was intubated. per report, he had a neg d-dimer and a leukocytosis of 19 (but on prednisone). in the ed, initial bp was 110s/70s, but it soon dropped to 70s/50s. pt had received 1.5l ivf prior to arrival. in the ed, he was started on levophed, which was quickly titrated off (bp 100s/60s). he received an additional 1l in ed. ultrasound showed compressible svc. he received vanc/cefepime in the ed. labs here notable for wbc 12.1, inr 3.2, cr 1.3, and lactate 2.4. cxr showed bibasilar opacities. ekg showed fib or flutter at 59. unable to obtain additional history due to intubated pt. past medical history: -?chf -?copd -atrial fibrillation -dm -h/o repeated pneumonias -tracheobronchomalacia social history: lives on . former diary farmer. distant smoking hx. denies etoh or illicit drug use. family history: no family hx tbm, physical exam: physical examination t low bp 102/65 hr 83 rr 15 o2 sat 100% general: intubated, non responsive heent: peerl but sluggish neck: supple cv: distant heart sounds, regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation anteriorly, no wheezes, rales, ronchi abdomen: large midline well healed scar, soft, non-distended, bowel sounds present, no palpable organomegaly, no tenderness to palpation, no rebound or guarding gu: + foley ext: cool, dopplerable pulses, no clubbing, cyanosis or edema neuro: non responsive, perrl upon discharge: unchanged except for the following general: well-appearing, no acute distress lungs: b/l rhonchi throughout pertinent results: admission labs: 06:33pm wbc-12.1* rbc-4.74 hgb-14.9 hct-44.1 mcv-93 mch-31.4 mchc-33.8 rdw-13.8 06:33pm neuts-96.9* lymphs-1.6* monos-1.3* eos-0.1 basos-0.1 06:33pm pt-33.3* ptt-32.0 inr(pt)-3.2* 06:33pm plt count-206 06:33pm glucose-285* urea n-46* creat-1.3* sodium-139 potassium-5.8* chloride-104 total co2-25 anion gap-16 06:33pm alt(sgpt)-38 ast(sgot)-35 alk phos-49 tot bili-1.0 06:33pm lipase-42 06:33pm albumin-3.2* calcium-7.9* phosphate-3.4 magnesium-2.6 06:33pm ck-mb-5 ctropnt-0.05* probnp-986* 06:39pm type-art rates-14/ tidal vol-500 peep-10 o2-100 po2-244* pco2-42 ph-7.42 total co2-28 base xs-3 aado2-423 req o2-74 -assist/con intubated-intubated 09:58pm lactate-1.4 na+-138 k+-4.2 cl--108 06:33pm urine blood-neg nitrite-neg protein-neg glucose-70 ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 06:32pm lactate-2.4* 06:33pm urine color-straw appear-clear sp -1.010 discharge labs: imaging: cardiovascular report ecg study date of 6:24:14 pm atrial fibrillation with controlled ventricular response rate of 59 beats per minute. right bundle-branch block. non-specific st segment changes in the inferolateral leads. no previous tracing available for comparison. cardiovascular echo the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). there is no ventricular septal defect. rv with normal free wall contractility. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mitral regurgitation is present but cannot be quantified. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. chest (portable ap) study date of impression: 1. et tube below the clavicles. recommend repeat film to better assess position. 2. bibasilar opacities which may be atelectasis; however, infection cannot be excluded. possible small left pleural effusion. ct trachea w/o c w/3d rend study date of impression: 1. severe tracheobronchomalacia with areas of complete collapse of the trachea as well as severe narrowing of the left and right main stem bronchi. 2. complete obstruction of left lower lobe bronchus causing collapse of the left lower lobe, which is most likely chronic. recommend bronchoscopy for further evaluation. 3. consolidation at the right lower lobe with bronchiectasis which may be atelectasis vs. pneumonia or aspiration. 4. multiple nodules for which follow up with ct in 3 months is recommended. nodule with halo of ground glass in the right lower lobe may be infectious in nature. 5. small bilateral pleural effusions. 6. large thyroid goiter arising from the left lobe of the thyroid causing focal mild compression on the trachea. brief hospital course: 89yo m pmhx bronchomalacia, afib, recent osh admission for pna, who re-presented 1d after discharge w dyspnea and hypoxia requiring intubation, bronch and ct c/w bronchomalacia, e/o ongoing infection versus mucus plugging. active issues =========================== # tracheobronchomalacia: mr. was transferred from for hypoxic respiratory failure. he was recently d/c'd from osh where he was treated for a ?candidal pneumonia and copd exacerbation. he was discharged on diflucan, prednisone, and levofloxacin. he then represented to osh for hypoxic respiratory failure and transferred to after intubation. upon admission to micu, he had cxr showed possible bilateral pleural effusions, but pneumonia, especially in the retrocardiac space cannot be ruled out. wbc is elevated but unclear whether this is due to prednisone vs infectious process. chf is unlikely given preserved lv function. d dimer negative at osh. a bronchoscopy was performed which revealed airways that were convoluted with sputum and mucous plugs. the patient was extubated on without complication. a ct trachea was performed which showed severe tracheobronchomalacia with complete collapse of the trachea on expiration and severe narrowing of the mainstem bronchi; secretions in airways with complete obstruction of left lower lobe bronchus causing collapse of the left lower lobe, likely choronic; consolidation at right lower lobe which may be atelectasis, infectious or aspiration; multiple sub-centimeter nodules for which follow up in 3 months is required. on , interventional pulmonology unsuccesfully tried to place y stent. thoracics was consulted and did not believe that tracheobronchoplasty would help alleviate patient's symptoms. he was treated medically with mucolytics, flutter valve, and nebulizers as well as cpap as needed that helped improved his symptoms. pulmonology was consulted and pfts during hospitalization did not illustrate reactive airway pattern or reversibility with bronchodilators. he was treated for hospital acquired pneumonia as outlined below. upon discharge, his symptoms greatly improved, with o2 saturation high 90s on ra with minimal coughing. . #hospital acquired pneumonia: evidence of rll infiltrate on ct scan. with his recent treatment for community acquired pneumonia at osh. he was treated for hospital acquired pneumonia with 8day course of vancomycin/cefepime/flagyl. #dysphagia: pt complained of dysphagia for liquids/solids s/p extubation. he had never had dsyphagia previously. speech and swallow evaluated him and believed it was secondary to tracheal irritation. he was not aspirating and no restrictions on his diet was made. # hypotension: unclear etiology. possibly hypovolemia vs sepsis vs medication induced (propofol). pt was only on levophed very briefly. most likely hypovolemia, possibly severe sepsis. he was fluid responsive to only 2.5l of fluid recussitation. echo revealed normal ef without significant valvular dysfunction and only small pericardial effusion. the patient recovered and remained normotensive in the icu. . # hypothermia: hypovolemia vs severe sepsis in setting of hypotension. pt was fluid responsive, lactate now normal s/p ivf. the patient was given a warming blanket and bolus of warm saline, and returned normothermia. . # : thought to be most likely secondary to pre-renal as cr trended down to 0.9 upon discharge with ivf. # a. fib: rate controlled with diltiazem with hr in 70s. anti-coagulated with coumadin. he came in with supratherapeutic inr of 3.2, which was reversed with vitamin k in preparation for bronchoscopy. . #elevated lactic acid: slight elevation at 2.4 thought to be secondary to hypovolemia which improved with ivf. chronic problems: ================================== #htn: treated with home losartan. transional issues: =========================== - pulmonary nodules in rll will need to be followed up in 3 months by ct. - mr. had supratherapeutic inr upon admission. may need to adjust his home coumadin dosing. medications on admission: preadmission medications listed are correct and complete. information was obtained from patientpharmacy. 1. prednisone 20 mg po daily as part of an 8 day steroid taper from 60mg to 0. 2. fluconazole 200 mg po bid rx on for a total of an 8 day course 3. diltiazem extended-release 240 mg po daily 4. tiotropium bromide 1 cap ih daily 5. losartan potassium 100 mg po daily 6. warfarin 7.5 mg po daily16 discharge medications: 1. warfarin 5 mg po days (mo,we,th,fr,sa) 2. warfarin 7.5 mg po days (,tu) 3. cefepime 2 g iv q8h rx *cefepime 2 gram every eight (8) hours disp #*18 gram refills:*0 4. diltiazem extended-release 240 mg po daily 5. losartan potassium 100 mg po daily 6. tiotropium bromide 1 cap ih daily 7. vancomycin 1000 mg iv q 12h rx *vancomycin 1 gram 1000mg q12h x 3days every twelve (12) hours disp #*9 gram refills:*0 8. mucinex *nf* (guaifenesin) 1,200 mg oral reason for ordering: requiring mucolytics rx *mucinex 1,200 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*0 9. metronidazole (flagyl) 500 mg iv q8h rx *metronidazole 500 mg 500mg q8h x3 days every eight (8) hours disp #*3 gram refills:*0 10. benzonatate 100 mg po tid rx *benzonatate 100 mg 1 capsule(s) by mouth three times a day disp #*30 capsule refills:*0 discharge disposition: home with service facility: nursing association discharge diagnosis: tracheobronchomalacia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you at hospital. you were transferred here from because you were having trouble breathing. here at you were found to have a condition called tracheobronchomalacia, which is a floppy airway that does not stay open all the time. this causes you to have trouble bringing up phlegm making you cough. the way to treat this is by giving you medications to thin the mucous with mucinex and other medication to help with the cough called benzonatate. you were also being treated with a pneumonia with 3 antibiotics. you will continue these antibiotics for three days after you leave the hospital. please continue all of the medications you were taking at home (except for fluconazole and prednisone as they are no longer needed); in addition you will be taking the medications we have outlined above. followup instructions: name: , p. location: medical services address: , , phone: appointment: monday 7:45am *the office said that if you dont want to come in this early to just give them a call and they will fit you in elsewhere. department: pulmonary function lab when: tuesday at 11:40 am with: pulmonary function lab building: campus: east best parking: garage department: medical specialties when: tuesday at 12:00 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other intubation of respiratory tract other intubation of respiratory tract central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) unspecified pleural effusion congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified atrial fibrillation paroxysmal ventricular tachycardia acute respiratory failure long-term (current) use of insulin unspecified disorder of kidney and ureter other diseases of trachea and bronchus goiter, unspecified shock, unspecified other diseases of respiratory system, not elsewhere classified dysphagia, unspecified other nonspecific abnormal finding of lung field 

Answer: The patient is high likely exposed to