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: codeine / compazine / penicillins / metformin / heparin agents / ativan attending: chief complaint: lethargy major surgical or invasive procedure: none history of present illness: mr. is a 53 y.o. m with severe copd (1-3 l nc followed by ), trach for tracheomalacia, h/o pseudomonas and mrsa pnas, hepatitis b and diabetes, admitted for lethargy from his nursing home. the patient states that yesterday he noted much more sleepiness and that it is hard to wake up. he feels extremely tired. he endorses a worsening cough with mucus that feels stuck in his throat. he is unable to cough up a lot of sputum. he also notes tremors that have occurred since yesterday. this has not happened before, and usually affects the upper extremities. he endorses chronic abdominal pain that he did not continue to describe to me. denies fever, chills, chest pain, diarrhea. recently admitted to from to for respiratory distress. noted to have thickened secretions and cxr with evidence of bilateral collapse and possible lll infiltrate. he was started on meropenem and vancomycin for h/o mrsa and mdr pseudomonas in sputum. he was started on high dose corticosteroids and standing nebs with q1 hour suctioning. picc line was placed. he was attempted to be weaned to po prednisone but he did not feel comfortable, so was d/c with iv solumedrol. he was also on vent for his symptoms. in the ed, initial vs: t 97.1 hr 106 bp 110/80 rr 20 100% labs drawn and significant for hypernatremia of 147. abg 7.3/84/53/43. fs 212. blood cultures x 2 drawn. ekg with sinus tachycardia, no acute st/twi. cxr with lll. given vancomycin 1 gm iv x 1, albuterol and ipratropium nebs x 1. patient refusing to be attached to ventilator in ed as he "feels okay." review of systems: (+) per hpi (-) denies fever, chills, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation. past medical history: 1) severe o2-dependent copd, recently on l continuous o2 at home 2) tracheal stenosis s/p stent, stent removal, dilatation, and tracheostomy insertion - 3) diabetes mellitus. 4) osteoporosis. 5) hepatitis b. 6) vertebral compression fractures (details unknown). 7) left 3rd finger amputation for osteomyelitis 8) history of intravenous drug use. 9) multi-drug resistant pseudomonas infection, + mrsa sputum 10) pud hx of ulcers 11) chronic right hemidiaphragm elevation/paralysis social history: mr. lives in the nursing home. he quit using heroin about eight years ago, but has an approximately 20 year history. he quit drinking more than seven years ago. he quit smoking approximately one to two ears ago and has a 60 pack year history. he smoked two packs per day for many years. he tested hiv negative in the past. he used to work as a dog groomer. he did work in construction in the past, but does not know of any asbestos exposure. he denies tuberculosis exposure. family history: non-contributory. physical exam: vital signs: 98.3 104 113/78 18 94% 2 l nc gen: chronically appearing, sleepy male with trach heent: eomi, anicteric, op - no exudate, no erythema, no cervical lad chest: poor inspiratory effort, no wheezes, no rhonchi cv: tachy, no m/r/g abd: nd, soft, slightly tender to palpation periumbilically ext: no c/c, + pitting edema; erythematous and warm to touch bilateral shins neuro: sleepy but answering questions appropriately derm: erythematous and warm skin over shins bilaterally pertinent results: admission labs: 12:10am wbc-10.0 rbc-4.35* hgb-11.1* hct-36.9* mcv-85 mch-25.5* mchc-30.0* rdw-13.7 12:10am neuts-82.1* lymphs-11.2* monos-6.3 eos-0.3 basos-0.1 12:10am plt count-347 12:10am pt-11.7 ptt-24.7 inr(pt)-1.0 12:10am calcium-9.8 phosphate-2.9 magnesium-2.1 12:10am glucose-97 urea n-16 creat-0.7 sodium-147* potassium-3.9 chloride-103 total co2-40* anion gap-8 12:17am lactate-1.3 01:45am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-8.0 leuk-neg 01:45am urine color-straw appear-hazy sp -1.010 12:22am type-art po2-53* pco2-84* ph-7.30* total co2-43* base xs-11 12:22am lactate-0.9 06:54am wbc-10.0 rbc-3.70* hgb-10.0* hct-30.7* mcv-83 mch-26.9* mchc-32.4 rdw-14.7 06:54am plt count-288 06:54am free t4-1.3 06:54am tsh-0.17* 09:09am blood type-art po2-150* pco2-63* ph-7.37 caltco2-38* base xs-8 05:18am blood type-art po2-47* pco2-92* ph-7.27* caltco2-44* base xs-11 12:22am blood type-art po2-53* pco2-84* ph-7.30* caltco2-43* base xs-11 . admission cxr: recurrent left lower lobe atelectasis. chronically collapsed right lower lobe. . repeat cxr impression: no significant interval change in bilateral atelectasis, right greater than left, and moderate-sized right pleural effusion and small- to moderate-sized left pleural effusion. . repeat cxr impression: similar radiographic examination of the chest with bibasilar atelectasis / collapse and bilateral pleural effusions. . discharge labs: 07:15am blood wbc-13.7* rbc-4.10* hgb-10.7* hct-34.3* mcv-84 mch-26.2* mchc-31.3 rdw-14.8 plt ct-380 07:15am blood glucose-106* urean-11 creat-0.6 na-143 k-4.3 cl-99 hco3-37* angap-11 . microbiology: 5:51 am sputum source: expectorated. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. 1+ (<1 per 1000x field): budding yeast. respiratory culture (final ): sparse growth oropharyngeal flora. pseudomonas aeruginosa. sparse growth. . blood culture x 2: pending urine culture: negative urinalysis: negative brief hospital course: 1. lethargy/copd: elevated pco2 at admission, patient connected to ventilator the night of admission, but disconnected am . it is possible his hypercarbia is related to his capped tracheostomy and/or a component of sleep apnea related to his underlying tracheobronchomalacia and hemi-diaphragm paralysis. since his disconnection from the ventilator, his tracheostomy has remained uncapped at night with trach collar, and he has continued on 1-3l nasal cannula. it is possible that he may have a component of obesity/hypoventilation syndrome. his primary pulmonologist recommended an outpatient sleep study, which has been ordered. the pt will be contact with an appointment. cxr showed questionable infiltrate, and pt was started on empiric meropenem/vancomycin for presumed tracheobronchitis. sputum culture grew only sparse pseudomonas, and pt is likely colonized given his history of multi-drug resistant pseudomonas and mrsa. hence, picc order and antibiotics were discontinued prior to discharge. pt remained afebrile throughout his stay. pt was initiated on prednisone 30mg po daily (), and steroids were tapered by 5mg daily to ultimately 20mg daily at discharge. per primary pulmonologist, dr. , pt will continue on 20mg daily for a least one week, and dose should then be decreased to alternating 20mg/15mg daily as tolerated. pt was placed on standing ipratropium nebs q6h, and albuterol nebs q4 prn. he has an appointment in to follow-up with dr. , but he will be contact with an earlier appointment. pt should keep his trach uncapped for a scheduled period of time each night (e.g. 11pm-6am) with overlying trach collar. blood cultures x 2 are pending and should be followed up. . 2. hyperglycemia: most likely steroid-induced. blood sugars remained between 120s-160s. kept on humalog ssi. 3. chronic pain: back pain was controlled on oxycodone prn. home lidocaine patch was discontinued as pt said it was ineffective. . 4. depression: continue citalopram. . 5. chronic steroid use: continue ppi, bactrim on mwf, vitamin d and calcium. . 6. hypernatremia: appears euvolemic, may be secondary to central di hypoxia/infection. trended and improved. normalized at discharge. . 7. bilateral le edema: likely secondary to venous stasis; chronic in nature. patient reports this is at his baseline. plase keep le's elevated at all times. . 8. sinus tachycardia: baseline hr is in the 100s per patient, he remained at this level during icu and floor stay. asymptomatic. . fen: no ivfs / replete lytes prn / regular diet ppx: pneumoboots (no heparin sq due to allergy), bowel regimen prn, ppi due to steroid use access: piv code status: full - confirmed with pt medications on admission: calcium carbonate 500 mg po daily prilosec 20 mg po bid ammonium chloride 490 mg po tid oxycodone 5 mg po q4 hours prn mild pain oxycodone 10 mg po q4 hours prn sever pain humulin r sliding scale tyelnol 325-650 mg po q6 hour prn pain diamox 250 mg po bid albuterol sulfate 2.5 mg/0.5 ml q 4 hours asa 325 mg po daily vitamin d 1000 units po daily celexa 20 mg po daily lasix 40 mg po daily atrovent nebs q4 hours lidocaine patch 5% daily to back mirapex 0.25 mg po qhs prednisone 40 mg po daily senna 8.6 mg po bid bactrim ds 800-160 1 tab po mwf miralax 17 gm po tu/thurs/sat lactulose 10 gm/15 ml 30 ml po qid prn mylanta 30 ml q6 hour prn albuterol q2 hour prn magnesium citrate 300 ml po daily prn kenalog 0.1% ointment to dry areas mom 30 cc po q8 pm dulcolax 10 mg pr fleet enema pr prednisone taper in the midst of 35 mg x 5 days (end date ) followed by 30 mg x 5 days, 25 mg x 5 days, 20 mg indefinitely. acetylcysteine 10% 200 mg daily prn discharge disposition: extended care facility: rehabilitation & nursing center - discharge diagnosis: primary: copd exacerbation hypercarbic respiratory distress . secondary: copd chronic back pain hx of mrsa and multi-drug resistant pseudomonal pulmonary infection hepatitis b discharge condition: good, hemodynamically stable with sinus tachycardia in the 90s-100s, satting mid-90s on 2l nasal cannula, afebrile discharge instructions: you were admitted for lethargy and elevated co2 levels. this was likely related to your capping of your tracheostomy at night, as well as possible some sleep apnea. you will be having a sleep study as outpatient. you will also be continuing a prednisone taper. please try to keep your tracheostomy uncapped at night for a specific period of time (e.g. 11pm-6am) with an overlying trach collar. . the following changes were made to your medications: + miconazole powder + docusate for constipation + prednisone 20mg po daily x 1 week, followed by alternating days of 20mg and 15mg po daily stop lidocaine patch as you felt it was ineffective for your pain . if you experience any worsening sob, lethargy, fever, chills, increasingly productive cough, pain, nausea, confusion, chest discomfort, palpitations, or have any other concerns, please your md or return to the ed. followup instructions: provider: . phone: date/time: 8:30 you will be contact by dr. office for an earlier appointment as well as for an outpatient sleep study. please make sure the doctors at your nursing home follow-up your pending blood cultures. . please follow-up with your pcp, . within 1 month. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified replacement of tracheostomy tube diagnoses: obstructive sleep apnea (adult)(pediatric) diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled obstructive chronic bronchitis with (acute) exacerbation acute respiratory failure other specified cardiac dysrhythmias osteoporosis, unspecified hyperosmolality and/or hypernatremia other malaise and fatigue viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta venous (peripheral) insufficiency, unspecified other diseases of trachea and bronchus 

Answer: The patient is high likely exposed to