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: acute on chronic respiratory distress major surgical or invasive procedure: intubation history of present illness: 65m with severe copd (fev1/fvc 23% of predicted) on home 02, schizophrenia, pulmonary htn (51-66mmhg on tte)the pt presents from his group home after he was noted to be lethargic with oxygen sats in the 70s. history is unable to be obtain from the patient and no contact information was available for contact. ems report "pt was found lying in bed having difficulty breathing but stating he didnt want to go." per report usual o2 sats are in the 80s. pt was noted there to have bilaterally upper airway wheezes and decreased breath sounds at the bases. there the pt was not noted to have jvd. . in the ed, initial 96.5 72 124/84 28 97. initial exam notable for letharic but speaking and audible wheezing. labs notable for initial abg 7.19/109/100. wbc 9.7, na 147 hco3 36, trop 0.01. patient underwent cxr with question r lower infiltrate. the patient received combivent nebs, azithromycin 500mg, ceftriaxone 1gm, solumedrol 125mg. the patient also underwent a non-contrast head ct. ecg nsr 74, twi in ii, iii, avf, v2-v6. the patient then underwent repeat abg in the ed following an hour of bipap 7.31/64/153. the pt continued to remain lethargic and was subsequently intubated. past medical history: 1) copd: fev1 23% predicted, home 1.5-2l o2 at night only 2) secondary pulmonary hypertension (51-66 mm hg on echo ) 3) schizophrenia 4) hx gi bleeding 5) mental retardation 6) pulmonary hypertension 7) s/p tonsillectomy social history: lives in with brother and brother-in-law. on disability since for mental health issues. has home nurse visit every morning and evening. reports ~50 pack-year smoking and has now cut down to 3 cigs/day. denies any etoh/drug use. family history: patient unable to provide. physical exam: vitals: t: bp: p: r: 18 o2: general: intubated sedated, moving all extremities : perrla, 1mm neck: jvp to ear on right elevated, no lad lungs: mild bilateral wheezes cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley ext: cool lower extremities, 1+ dp pertinent results: labs at admission: 09:38am blood wbc-9.7 rbc-4.73 hgb-14.4 hct-44.9 mcv-95 mch-30.4 mchc-32.1 rdw-14.0 plt ct-239 09:38am blood neuts-76.9* lymphs-16.8* monos-3.9 eos-1.7 baso-0.7 09:38am blood pt-13.2 ptt-33.4 inr(pt)-1.1 09:38am blood plt ct-239 09:38am blood glucose-137* urean-26* creat-1.0 na-147* k-4.5 cl-105 hco3-36* angap-11 01:15pm blood glucose-151* urean-27* creat-1.2 na-143 k-4.7 cl-103 hco3-35* angap-10 09:38am blood alt-18 ast-23 alkphos-57 totbili-0.4 01:15pm blood ck(cpk)-45* 09:38am blood ctropnt-0.01 01:15pm blood ck-mb-4 ctropnt-<0.01 09:38am blood albumin-4.3 01:15pm blood calcium-8.1* phos-3.6 mg-2.0 09:50am blood lactate-0.8 k-4.3 09:50am blood lactate-0.8 k-4.3 ___________________________________________________ imaging: cta impression: 1. no pulmonary embolism or aortic dissection. 2. persistent severe emphysema with mild ground-glass opacities and interstitial septal thickening involving the posterior right upper lobe segment and apical posterior left upper lobe segment abutting the major fissures. this is nonspecific and may represent underlying aspiration pneumonitis/pneumonia. 3. near two-year stability to multiple pulmonary nodules which do not warrant further followup. stable mediastinal and hilar lymph nodes. 4. mosaic attenuation of the lung parenchyma likely related to severe underlying emphysema as well as air trapping from unchanged tracheobronchomalacia, most severely involving the bronchus intermedius. 5. mild dilatation to the main right and left pulmonary arteries well as right atrium/ventricle, which may reflect underlying pulmonary arterial hypertension. echo impression: the left atrium is normal in size. 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%). the right ventricular free wall is hypertrophied. the right ventricular cavity is dilated and the free wall may be hypokinetic (not fully viusalized). the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no pericardial effusion. cxr impression: the cardiac silhouette and mediastinum is within normal limits. there has been improved aeration at the streaky opacities at the lung bases. no pulmonary edema or pleural effusions are identified. there are no pneumothoraces. ___________________________________________________ blood gases: 01:14pm blood type-art po2-56* pco2-63* ph-7.46* caltco2-46* base xs-17 comment-nasal 01:14pm blood type-art po2-56* pco2-63* ph-7.46* caltco2-46* base xs-17 comment-nasal 11:44pm blood type- po2-80* pco2-90* ph-7.37 caltco2-54* base xs-21 03:45pm blood type-art temp-35.6 po2-146* pco2-55* ph-7.25* caltco2-25 base xs--3 intubat-not intuba comment-simple fac 09:05pm type-art temp-36.7 rates-12/ tidal vol-550 peep-5 o2-40 po2-117* pco2-53* ph-7.41 total co2-35* base xs-7 -assist/con intubated-intubated ___________________________________________________ labs at discharge: 04:04am blood wbc-10.1 rbc-4.58* hgb-13.7* hct-43.1 mcv-94 mch-30.0 mchc-31.9 rdw-13.6 plt ct-257 04:05am blood neuts-92.0* lymphs-4.5* monos-2.5 eos-0.7 baso-0.3 04:04am blood glucose-112* urean-27* creat-0.6 na-142 k-3.7 cl-97 hco3-40* angap-9 04:24am blood type- temp-36.1 rates-/30 tidal v-200 peep-5 fio2-24 po2-44* pco2-73* ph-7.41 caltco2-48* base xs-16 intubat-not intuba vent-spontaneou 01:14pm blood type-art po2-56* pco2-63* ph-7.46* caltco2-46* base xs-17 comment-nasal 04:24am blood lactate-0.9 brief hospital course: 65m with copd exacerbation and acute on chronic hypercarbic respiratory failure . # acute on chronic hypercarbic hypoxemic respiratory failure : pt with known severe copd, pc02>100 on arrival which initially improved on bipap. pt was afebrile without leukocytosis. precipitating factors may have included cap, viral uri. patients with large a-a gradient on arrival. lethargy prompted intubation in the ed after he was given ativan for agitation. he was then extubated on to bipap. he received iv diuretics, iv steroids which were transitioned to po prednisone on and completed 5 day course of azithromycin for copd exacerbation. he was initially treated with ceftriaxone as well for 3 days but this was discontinued when there was no clear evidence of pneumonia. he continued to have waxing course requiring long duration of bipap especially at night, frequent nebs, suctioning as well as morphine iv for agitated respiratory distress. dni status was confirmed with pt and family several times. bipap was then weaned over the course of next several days and daily steroid dose was decreased. on day of discharge, he was sating in low-mid 90s on 1l nc. he had only required 2 hours of bipap the day prior for increased work of breathing which was much decreased from prior requirements. he may still require bipap at night for fatigue. at time of discharge, he demonstrates abdominal breathing and tachypnea with rr high 20s but he states breathing is much improved and is alert and awake and his pco2 is at his baseline in the mid 60s. home tiotropium and advair held while he is receiving albuterol and ipratropium nebs and po prednisone. plan is for 7 more days of prednisone which could be adjusted based on pulmonary status. . # acute change in ms: patient noted to be lethargic on arrival. this was initially in the setting of pco2>100. unclear from ed course whether patients ms improved following bipap. ct head without acute ich. pt subsequently became more alert and oriented as his respiratory status improved. on day of discharge he was somnolent but able to converse appropriately when aroused. . # hypotension: patient initially with sbp 124 on arrival to the ed. following intubation and sedation with propofol,his sbp has dropped to 90s. pt with questionable pna on cxr but without fever, tachycardia or leukocytosis, and thus did not meet sirs criteria. his bp remained stable during the micu course. blood and sputum cx were negative. . # twis: ecgs with twis inferolaterally. troponins negative. echo lvef>55% with thickened lv and dilated, possibly hypokinetic rv. stable during micu course. # schizophrenia: he was continued on his home medication zyprexa. medications on admission: albuterol mdi famotidine 20mg advair 500-50 zyprexa 7.5mg tiotropium 18mcg asa 81mg tylenol 325 colace mvi discharge medications: 1. aspirin 81 mg tablet sig: one (1) tablet po once a day. 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q2h (every 2 hours) as needed for sob. 3. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours). 7. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 8. olanzapine 5 mg tablet sig: 1.5 tablets po daily (daily). 9. prednisone 20 mg tablet sig: three (3) tablet po daily (daily) for 7 days. 10. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 11. morphine 5 mg/ml solution sig: 1-2 mg injection q4h (every 4 hours) as needed for anxiety/agitation. 12. insulin lispro 100 unit/ml solution sig: units subcutaneous asdir (as directed): see attached. only needed while patient continues on prednisone. discharge disposition: extended care facility: - discharge diagnosis: copd exacerbation discharge condition: hemodynamically stable, on nasal cannula with intermittent bipap, o2 in low-mid 90s on nasal cannula at rest. he does exhibit slightly labored breathing with the use of accessory muscles. alert and oriented, able to converse appropriately, he is able to take po medication and meals. he is not currently ambulating. discharge instructions: you were admitted to the hospital with difficulty breathing from your copd. you did not have any evidence of infection or pneumonia. you were initially on a breathign machine for approximately 2 days but we took you off the breathing machine and your breathing slowly improved with steroids and breathign treatments. you intermittently required a mask to help you with your breathing but the time you required the mask improved greatly over the course of your stay in the icu. please follow up with your primary care doctor . please take all of your medications as prescribed and please do not resume smoking cigarettes. this is extremely important for your health, especially while you are on oxygen. we made the following changes to your medications: 1. we added albuterol nebs q6hours and q2 hours as needed 2. we added ipratropium nebs q6 hours and stopped your tiotropium while you are receiving nebs 3. we added prednisone 60mg po daily x 7 more days 4. we added morphine as needed for sob 5. we added insulin for hyperglycemia to 200s while you were on prednisone 6. we added a nicotine patch to help you with quitting smoking 7. we added a bowel regimen for constipation followup instructions: please follow-up with your pcp . when you leave the rehab facility. name: , , mph location: address: , 1, , phone: fax: md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube arterial catheterization diagnoses: tobacco use disorder atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation other chronic pulmonary heart diseases unspecified schizophrenia, unspecified anxiety state, unspecified acute and chronic respiratory failure hypotension, unspecified unspecified intellectual disabilities 

Answer: The patient is high likely exposed to