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: shortness of breath major surgical or invasive procedure: bronchoscopy history of present illness: 78 m c hx of bronchiectasis, s/p r sided lobectomy who p/w dyspnea while at rehab. underwent l tkr () for osteoarthritis at nebh. postoperatively, required hospitalization () at nebh for dyspnea/hypoxia attributed to pneumonia and was treated with 10 day course of ceftriaxone/azithromycin. over the last 2-3 days, has had worsening dyspnea with exertion and productive cough c whitish-clear sputum. at baseline, pt. able to walk upto 1 flight of stairs; recently developing dyspnea with movement. this afternoon, while at rehab, pt. developed significant dyspnea while walking to bathroom and ambulance called. . in the ed, the pt. hypoxic to mid 80s while on 5l n/c. o2 sats in mid 90s on nrb. ekg c new rbbb. underwent cxr c/w l sided pna. cta chest done to exclude pe (no pe noted). received levofloxacin and piperacillin-tazobactam in ed and admitted for hcap. past medical history: 1. bronchiectasis - diagnosed in chronic cough. underwent r lower lobectomy with improvement of symptoms. 2. htn 3. hypercholesterolemia 4. gout 5. mitral valve prolapse 6. osteoarthritis 7. depression 8. hemachromatosis - undergoes phlebotomy every other month 9. subacute bacterial endocarditis - c septic emboli 10. cva 11. restless legs syndrome . psh: 1. tonsillectomy in 2. right lobectomy for bronchiectasis in 3. laminectomy in 4. craniotomy for unruptured cerebral aneurysm 5. right total hip replacement in 6. l3-l5 laminectomy in 7. left tkr social history: smoked 22 years, 1.25 ppd. quit at age 37. drinks a cup of wine each night. no drugs. lives with his wife. 2 grown daughters. worked as a cpa in the . served in the air-force in the usa in the early . no recent travel outside the country. family history: brother died of complications copd in 70s physical exam: vs- 98.1, 86, 145/79, 95% nrb, rr 20-30 gen- elderly man appears fatigued with nrb over face, able to have conversation heent- no elevation of jvp, anicteric sclerae, dry mm lungs- scattered crackles b/l lung fields heart- rrr, s1, s2, + sm c/w mr - soft, nd, nt, bs+ extre- wwp, no edema. 10 cm linear scar over midline l knee, well healed. no erythema/cords/swelling over l leg neuro- a*o*3, moving all extremities pertinent results: admission labs 06:30pm blood wbc-9.9 rbc-4.11* hgb-13.9* hct-40.0 mcv-97 mch-33.7* mchc-34.6 rdw-15.5 plt ct-304 06:30pm blood neuts-80.4* lymphs-12.1* monos-6.1 eos-0.9 baso-0.3 06:30pm blood plt ct-304 06:51pm blood pt-14.1* ptt-30.6 inr(pt)-1.2* 06:26pm blood esr-109* 06:30pm blood glucose-126* urean-18 creat-0.8 na-135 k-4.7 cl-97 hco3-27 angap-16 06:30pm blood ck(cpk)-36* 03:14am blood alt-23 ast-23 ld(ldh)-348* alkphos-119* totbili-1.1 06:30pm blood ck-mb-notdone ctropnt-<0.01 03:14am blood ctropnt-<0.01 probnp-914* 03:14am blood calcium-9.1 phos-3.6 mg-2.1 02:11am blood osmolal-271* 12:05pm blood anca-negative b 12:44pm blood type-art temp-36.9 po2-81* pco2-42 ph-7.46* caltco2-31* base xs-5 intubat-not intuba aspergillus-negative b glucan-negative anti gmb-negative . micro legionella urine antigen-negative blood, urine cultures-no growth bal-no growth c.diff negative times three . imaging ct chest 1. mixed changes since prior study, with several areas of improved ground- glass opacity seen bilaterally, unchanged donsolidative opacity in the left lower lobe, and increased consolidation in right lower lobe. findings are most suggestive of an acute infection superimposed on a chronic interstitial fibrotic lung disease. in the absence of infectious symptoms, acute exacerbation of chronic interstitial pneumonia should also be considered especially if the patient has experienced worsening dyspnea in the past month without other contributing factors. 2. the underlying nature of patient's chronic interstitial fibrotic lung disease is difficult to assess in the setting of acute superimposed changes. given the bronchovascular involvement and hyperlucent nodules, chronic hypersensitivity pneumonitis should be considered. other diagnostic considerations include usual interstitial pneumonitis (uip) and a fibrotic sybtype of nonspecific interstitial pneumonitis (nsip). 3. findings suggestive of pulmonary arterial hypertension . 4. saber-sheath configuration of the trachea, finding often seen in copd. 5. increased gallbladder distention compared to prior study. if clinically indicated, this could be further evaluated with ultrasound. . ct head no ct evidence for acute intracranial process. . cta chest 1. no pulmonary embolism to proximal subsegmental level. more distal branches obscured by respiratory motion. 2. multifocal airspace opacities, predominantly basilar and peripheral, though some appear to follow airways. this could represent pneumonia, especially with superimposed dense consolidation and effusion at the left base. the peripheral interstitial opacity better seen in the right lung could also represent an interstitial process such as uip/ipf. 3. small left pleural effusion. 4. coronary artery calcifications. echo the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). diastolic function could not be assessed. there is no ventricular septal defect. right ventricular chamber size and free wall motion 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. there is no mitral valve prolapse. an eccentric, anteriorly directed jet of mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion.. brief hospital course: 78 man with history of bronchiectasis, recent left knee replacement and treatment for community acquired pneumonia presents with hypoxic respiratory failure. . # hypoxic respiratory failure: initially concerns included healthcare acquired pneumonia given his recent bout with pneumonia one week ago (treatedw ith ceftriaxone and azithro, unclear if his symptoms really subsided), pe given his recent knee surgery. a chest cta was done in the ed that did not show pe but did show some fibrotic process. he had a cxr in the ed that showed lll consolidation and treatment for healthcare acquired pneumonia with vancomycin and zosyn were started. his increasing oxygen requirement was concerning and he was intubated. he met ards criteria and ards net vent settings were used. initially there was some concern for acute on chronic congestive heart failure as a cause of his respiratory distress, diuresis did not improve his symptoms, bnp was not elevated and echo was unimpressive. in addition he had a bronchoscopy and bal, from which no organsisms were isolated. studies looking at goodpasture, and aspergillus were negative. a repeat ct chest was done for concern of the fibrotic changes on his inital ct. the diagnosis of acute ipf was considered likely as he had not improved on antibiotics. steroids were started with minimal improvement in his ventilator requirements. nac was also started without effect. after being intubated for over 7 days, tracheostomy was raised with his family. as he stated previously that he would not want to be maintained on a tracheostomy his code status was changed to cmo after extubation on . he passed away after approximately one hour, family present. . # hypotension: his blood pressure decreased to map 60 after intubation, thought to have been medications given during intubation v. peep impeding venous return. pt may have also been septic from pneumonia. pt was given fluid to maintain cvp 18, and was on pressors for 2 days. he was weaned off pressors and then became hypertensive, home propanolol and amlodipine were restarted with good effect. . # arf: pt had a hypotensive episode on , which likely led to pre-renal/atn. urine lytes revealed a fena of <0.1%, una <10, no casts on sed, urine eos neg. with fluids, cr trended down to 1.0 (baseline). . # hyperglycemia: aafter initiation of high dose steroids his blood sugar levels increased, likely steroids. he was started on low dose glargine in addition to a sliding scale which provided adequate glucose control. . # hypernatremia: two days after initiating tube feeds his serum sodium became elevated, likely secondary to decreased free water intake, improved with increased free water boluses. . # rbbb: he has an old ekg from with rbbb. this appears to be intermittent, likely pulmonary disease. there is no evidence for pe on cta. pt has been ruled out by ces x3. . #anisocoria-pt was noted to have uneven pupils on hd 3, concern for ich given anticoagulation with lovenox but given unstable clinical status head ct was delayed. on head ct was normal, also family stated he has had this for some time. . # l tkr-initially anticoagulated on enoxaparin, held for suspected ich, then held for arf. he was anticoagulated with heparin sc. pt was attempted initally but pt could not participate oxygen desaturation. . # gout held colchicine secondary to arf . # coronary artery disease: no known hx based on previous notes. - continued asa and atorvastatin medications on admission: nitroglycerin 1-inch b.i.d. for hypertension azithromycin 500 mgs q twenty-four hours for ten days (started ) ceftriaxone one gram iv for ten days daily (started ) vicodin one tablet p.o. q six hours for pain. enoxaparin 40 mgs subcutaneously daily until ambulating milk of magnesia 30 mls q.h.s. p.r.n. colace 100 mgs p.o. b.i.d. tylenol 650 mgs p.o. q four hours p.r.n. fever or pain. mirapex 0.25 mgs p.o. daily, zoloft 50 mgs p.o. daily, protonix 40 mgs p.o. daily, multivitamins one tablet p.o. daily. lipitor 5 mgs p.o. daily, propranolol 40 mgs p.o. daily, aspirin 325 mgs p.o. daily, losartan 50 mgs p.o. daily, colchicine 0.6 mgs p.o. daily, discharge medications: none discharge disposition: expired discharge diagnosis: respiratory failure secondary to acute idiopathic pulmonary fibrosis discharge condition: expired discharge instructions: you were admitted with low oxygen and shortness of breath. you were treated for a pneumonia in the medical icu. your low oxygen required you to be intubated. you had a chest ct scan that showed likely ipf. you were started on steroids but did not improve significantly. after a prolonged intubation a family discussion was initiated and goals of care were addressed. as per your family you did not wish to be maintained on a tracheostomy tube and your breathing tube was removed. followup instructions: none procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified other iatrogenic hypotension coronary atherosclerosis of native coronary artery pure hypercholesterolemia mitral valve disorders unspecified essential hypertension adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified gout, unspecified acute respiratory failure right bundle branch block postinflammatory pulmonary fibrosis personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits encounter for palliative care hyperosmolality and/or hypernatremia other abnormal glucose anisocoria 

Answer: The patient is high likely exposed to