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: penicillins / lansoprazole attending: chief complaint: hemoptysis major surgical or invasive procedure: intubation history of present illness: pt is a 78 yo male with p-anca vasculitis, history of interstitial lung disease, recent d/c from at the end of who presents with frank hemoptysis, transfer from an osh. pt was admitted to from when he presented with chills, wt loss, muscle cramps, night sweats. he was found to be in arf with creatinine of 2.7, crp 113, esr >100, mildly elevated transaminases in the lower 100s, ck 785. he was found to have a positive p anca (mpo specificity, negative pr3). renal biopsy had "evidence of fibrinoid necrosis of the small/medium vessels. this was consistent with a pauci-immune vasculitis of the medium vessels. "(per d/c summary. no report in computer). pt was started on prednisone (60mg qday) and received one dose of cytoxan. this admission was also complicated by anemia and hematuria. patient was seen in both rhematology and renal clinic yesterday and looked and felt well per report. today, he presented to hospiatl by ems from home when he had a sudden onset of difficulty breathing and frothy hemoptysis (per nw note). he was only able to answer in one word answers, tachycardic in the 140s, and hypertensive to 190/110. sao2 was 50s per report (ambulance tx) and pt was having frank hemoptysis or brb (150-200 cc) and pt was emergently intubated. he was given 5 mg versed, 20 etomidate, 120 mg succinylcholine prior to intubation. abg at nwh was 7.34/37/180 on an fio2 of 100%. labs were notable for potassium 5.5, bun/cr of 86/3.8, lactate of 3.6, wbc of 28.2. he was also give protonix 40 mg iv and 1 gram of iv solumedrol. he received 3.375 mg iv zosyn, 1 gram of iv vancomycin. patient was then transferred to . in the ed at , vs on arrival were: t: 99.0 hr: 80, bp: 146/83; rr 18; o2: 94-97%ra. past medical history: 1. interstitial lung disease- diagnosed four years ago with restrictive pattern on pfts. 2. bladder cancer-transitional cell, low grade 3. htn 4. gerd 5. hyperlipidemia 6. 4 mm subpleural chest nodule 7. p-anca vaculitis as above. social history: per last d/c summary (cannot obtain info from pt now as he is intubated). no smoking. 6 drinks/week. no drugs. retired stock broker. family history: sister with crohns physical exam: vs: t: 97.5; hr: 72; bp: 125/73; rr: 17; o2: 98 on ac 500/16/80/13 gen: intubated, sedated though can follow commands. does not open eyes. heent: pupils reactive 3-->2. ett in place. neck: no lad cv: rrr s1s2. no m/r/g lungs: posteriorly: bronchial breath sounds throughout though good aeration. there are dry crackles scattered bilaterally. abd: soft, nondistended. no grimaces to palpation back: no lesions. ext: trace edema pitting b/l. dp 1+ b/l. neuro: intubated, sedated though arousable. can squeeze hands, wiggle toes. dorsiflexion strength is intact. biceps, brachio, patellar reflexes. pertinent results: ekg: sinus rhythm at 85. normal axis. normal intervas. no acute st=t wave changes. upsloping of st in v2, v3, nonspecific. . radiology: cxr ap -marked progression to diffuse parenchymal opacities. differential includes severe infectious etiology including pcp in immunocompromised patient, pulmonary hemorrhage with asymmetric diffuse alveolar edema felt less likely. mild over distention of endotracheal tube balloon cuff. labs on admission: 08:19pm blood freeca-1.04* 03:13pm blood lactate-2.5* 12:31am blood type-art temp-36.2 rates-/4 tidal v-500 peep-13 fio2-50 po2-129* pco2-36 ph-7.46* caltco2-26 base xs-2 intubat-intubated vent-controlled 02:45pm blood crp-29.1* 02:45pm blood wbc-16.5* rbc-3.97* hgb-11.7* hct-37.3*# mcv-94 mch-29.4 mchc-31.3 rdw-17.8* plt ct-204 02:45pm blood neuts-95.4* bands-0 lymphs-2.1* monos-2.1 eos-0.4 baso-0 echo the left atrium is mildly dilated. the estimated right atrial pressure is mmhg. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a fat pad. cxr there has been interval progression of diffuse parenchymal opacities involving majority of the lung fields bilaterally with scattered air bronchograms and without evidence of overt cardiac enlargement or pleural effusions. endotracheal tube is approximately 6 cm from the carina and there is mild over distention of the balloon cuff. orogastric true terminates within the stomach fundus. there is no evidence of a pneumothorax and the hemidiaphragms are well visualized. cxr endotracheal tube terminates approximately 3.9 cm above the carina. a right subclavian line terminates at the level of the mid superior vena cava. a dobbhoff tube courses below the diaphragm and out of view of the film. right lung opacity may demonstrate more confluence today with persistent left retrocardiac and perihilar opacity with air bronchograms. low lung volumes are noted bilaterally and there is no evidence of pneumothorax. left costophrenic angle is cut off on this film; however, a right-sided effusion likely persists. cardiomediastinal silhouette is unchanged. compared with the prior there is massive increase in the amount of air within the stomach. brief hospital course: pt is a 78 yo male with a history of interstitial lung disease, newly diagnosed p-anca vasculitis presented with respiratory failure from hemoptysis. he received plasmapheresis, pulse dose steroids, and cytoxan. now s/p extubation, episode of aflutter s/p cardioversion. 1. respiratory failure- patient intubated with likely pulmonary hemorrhage secondary to vasculitis (capillary alveoli leak) on admission. he was bronched on hd 3 which did not show active bleeding. he was treated broadly for possible infection with vancomycin, levaquin, and flagyl (14 day course) as well as the fact that blood is a nidus of infection. he had pressure support trial on hd2 and was extubated on hd3, failing extubation and had to be reintubated 8 hours later. his abg showed good ventilation and it was purely hypoxic failure and tiring out. based on bnp >assay, cxr, and physical exam, it was thought that fluid overload played a large part in the failed extubation. he was diuresed aggressively. a repeat echo did not show any wall motion abnormalities and enzymes checked showed an elevated troponin but not thought to be ischemia. rebronch on hd 7 showed no active hemorrhage and patient was successfully extubated on hd 8. he continued to need aggressive suctioning (including nasally) as he was having large mucus plugs. on he became neutorpenic with increased secretions. he was started on vancomycin and aztreonam. on during a change in his central line developed respiratory distress with profound hypoxia. was intubated. bronchoscopy showed coupious secretions throughout. after meeting with family, given overall poor prognosis and patients prior voiced wishes, care was withdrawn. patient was extubated and expired within in minutes. 2. anca positive non-eosinphilic vasculitis with hemoptysis- microangiopathic vasculitis vs. wegeners vs. other. he had respiratory failure as above. he was treated with three courses of plasmapheresis (hd1, hd3, hd4) and with pulse dose steroids on admission (1 gram of solumedrol x 3 days). the solumedrol was tapered down and po prednisone was started on hd 13. anca levels per lab were decreased from last admission; antimyeloperoxidase ab on 76--> values of 14. pt received his second dose of cytoxan on (560 mg/m2 -1000 mg) with mesna and prehydration. secondary to steroids, bactrim prophylaxis was started which was changed to atovaquine when pt had thrombocytopenia (see below). renal, rheumatology,and transfusion medicine were all heavily involved in patients care of above. 3. aflutter- history of aflutter on last admission. patient had his toprol xl changed to metoprolol tid. on hd 8 he had aflutter to the 170s, hemodynamically stable treated with a diltiazem drip. he was cadioverted on hd 10 and was in sinus from then. he was initially dig loaded but this was stopped post-cardioversion. he was started on amiodarone gtt at the time of cardioversion and was on an amiodarone taper. 4. renal failure- followed by renal. creatinine remained relatively stable, though bun increased. medications were renally dosed for creatinine clearance of 15-20. pholo and epogen were started. bun rose steadily to mid 140s. 5. hypertension. patient with known hypertension. his metoprolol was uptitrated to 75 tid and amlodipine and hydralazine were started. 6. hypernatremia- intermittent hypernatremia to upper 140s likely from decreased po intake when failed s&s. he got free water boluses via dobhoff and d5w ivf as needed. 7. pt with overall weakness post extubation. overall normal neurological exam though with decreased strength. cpk was checked and normal. head ct was negative for an acute event (evidence of encephalomalcia from trauma from boating accident 20 years ago). 8. thrombocytopenia- nadir 65 on hd 7. pt's bactrim was switched to atovaquine. hit ab was sent and negative. platelets improved. however dropped again secondary to cytoxan and was low at the time of death. 9. f/e/ pt failed a s&s study on hd 10 and a dubhoff was placed the next day. medications on admission: prednisone 60 mg po qday cyanocobalamin 500 mcg po qday chlorphenirmaine 4 mg po qday citalopram 10 mg po qday bactrim ds qmonday, wednesday, friday protonix 40 mg po qday epoetin 10,000 qweek ferrous sulfate 325 po qday toprol xl 75 mg po qday asa 325 mg po qday discharge medications: none discharge disposition: expired discharge diagnosis: pneumonia discharge condition: expired discharge instructions: none followup instructions: none procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy atrial cardioversion therapeutic plasmapheresis transfusion of packed cells injection or infusion of cancer chemotherapeutic substance diagnoses: pneumonia, organism unspecified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified atrial flutter other and unspecified hyperlipidemia acute respiratory failure postinflammatory pulmonary fibrosis antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use personal history of malignant neoplasm of bladder hyperosmolality and/or hypernatremia arteritis, unspecified foreign body in larynx 

Answer: The patient is high likely exposed to