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: respiratory failure major surgical or invasive procedure: tracheostomy tube placement central line placement transesophageal echocardiogram history of present illness: 36m with history of obesity, osa, and cocaine use who presented to osh with difficulty breathing and is now transferred to micu at after intubation for hypercarbic hypoxic respiratory failure. . according to the patient's girlfriend, he has apparently had a problem with fluid retention (primarily noted as enlarging pannus and inner thighs) which has gotten worse over the past two weeks. he saw his pcp one week ago and was told to double his lasix dose. over the past week he was noted by his girlfriend to be sleepy and confused. she has also noticed that his breathing has seemed more difficult and louder over the past several days, though she denies frank wheezing. he was brought into the ed at in . there, he denied fevers, cough, n/v though reported wheezing at home and "congestion". he is also supposed to be using bipap, but has not been using it frequently. no prior hospitalizations for dyspnea. his family reports a 15-year history of drug problems and has recently been using cocaine. . at the osh ed, he had bp 152/76 hr 104 rr 32 89-90% nrb. he was given bipap, lasix 80mg iv, an inch of nitro paste, 125mg solumedrol, rocephin 2g iv, and azithromycin 500mg iv. the patient could not tolerate bipap in the ed and had an abg of 7.17/109/62. he was intubated with 40mg etomidate, 200mg succinylcholine and ativan. post-intubation, abg was 7.27/81/137. tox screen was negative. he is transferred to for further evaluation. past medical history: 1. obesity 2. osa 3. substance abuse, cocaine/crack 4. htn 5. "heart problems" 6. arthritis social history: patient lives with his girlfriend in . he is a trucker, but is "off for the season". has a 15-year history of drug use, including crack and cocaine. has been in rehab in the past, but signed himself out. he drinks approximately a six-pack and a nip or two in a night, previously drank more. no smoking. family history: htn in father. diabetes, obesity, cad, ca. physical exam: vitals: t 98.7 bp 137/59 hr 103 95% on ac 1.0 600x18 peep 10 gen: morbidly obese man, intubated and sedated, minimally responsive to painful stimuli heent: pupils 2mm and reactive bilaterally, moist mucous membranes neck: short and thick, supple, could not visualize jvp lung: coarse breath sounds bilaterally with inspiratory and expiratory wheezes chest: round crusted papules across chest cor: tachycardic, regular rhythm, no m/r/g appreciated abd: obese abdomen, large panus, soft non-distended, nabs ext: no clubbing or cyanosis, trace edema present in bilateral les up to knees neuro: sedated, responsive to painful stimuli pertinent results: admission labs: 04:35pm glucose-155* urea n-18 creat-0.8 sodium-139 potassium-4.6 chloride-95* total co2-36* anion gap-13 04:35pm alt(sgpt)-41* ast(sgot)-25 ld(ldh)-399* ck(cpk)-278* alk phos-63 tot bili-0.4 04:35pm ck-mb-5 ctropnt-<0.01 04:35pm albumin-4.0 calcium-8.6 phosphate-3.8 magnesium-1.9 04:35pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 04:35pm neuts-78* bands-5 lymphs-9* monos-7 eos-0 basos-1 atyps-0 metas-0 myelos-0 nuc rbcs-2* 04:35pm wbc-7.6 rbc-4.31* hgb-11.5* hct-37.2* mcv-86 mch-26.6* mchc-30.8* rdw-16.0* 04:35pm hypochrom-1+ anisocyt-1+ poikilocy-normal macrocyt-occasional microcyt-occasional polychrom-1+ 04:35pm plt count-189 04:35pm pt-13.8* ptt-28.8 inr(pt)-1.3 04:00pm urine hours-random total co2-<5 04:00pm urine bnzodzpn-pos barbitrt-neg opiates-neg cocaine-pos amphetmn-neg mthdone-neg . discharge labs : cbc: 8.1 > 8.1/26.7 < 433 . chem 7: 142 / 103 / 15 -------------< 118 4.0 / 30 / 0.8 . ca: 8.3 mg: 2.3 p: 3.8 . pt: 14.6 ptt: 65.2 inr: 1.5 . pertinent studies: bilateral lower extremity ultrasound: grayscale and doppler ultrasound of the left and right common femoral, superficial femoral, and popliteal veins was performed. although this study was limited due to patient body habitus, flow and appropriate doppler waveforms, and compressibility, and augmentation was seen within all of these vessels. no intraluminal thrombus is identified. impression: no evidence of right or left lower extremity dvt. . tee: conclusions: no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers, though saline contrast injection was suboptimal due to long transit time to the heart. there is mild regional left ventricular systolic dysfunction with mild hypokinesis of the septum. right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. trivial mitral regurgitation is seen. there is no pericardial effusion. impression: no intracardiac shunt. mild septal hypokinesis. . vq scan: interpretation: ventilation images were obtained with tc-m aerosol in only 3 views, limited by the patient body habitus. perfusion images were obtained in the same 3 views. there is mild heterogeneity demonstrated with matched perfusion and ventilation.the patient is noted to be intubated. impression: limited study. no obvious evidence for pulmonary embolism. . ruq u/s: findings: focused ultrasound of the gallbladder was performed. the gallbladder is filled with echogenic material consistent with sludge, similar to the prior study. there is no gallbladder wall edema. the gallbladder is not tensely distended. no pericholecystic fluid is identified. impression: sludge-filled gallbladder without evidence for cholecystitis. the overall appearance is similar to the prior study. brief hospital course: # hypercarbic hypoxic respiratory failure: pt has a history of osa and presented to the osh with dyspnea, confusion and hypercarbia on abg, which prompted his intubation, he was then transferred to for futher care. etiology of respiratory failure was most likely pe worsened by obesity hypoventilation and chf. patient had negative lenis and an indeterminate vq scan (unable to obtain ct scan due to size/weight), but given significant risk factors, high a:a gradient, persistent elevated oxygen requirements after 10 l diuresis, and marked improvement of oxygenation after anticoagulation, pe was ultimately felt to be the primary cause of his respiratory failure. he is currently in the process of uptitrating coumadin for goal inr of . given his high peep requirements, a prolonged wean was anticipated and the patient had a trach placed in the or. he continues to receive albuterol and ipratropium mdis prn and has the head of the bed elevated as much as tolerated to relieve the weight on his lungs. he was weaned from iv sedation and currently has a fentanyl patch, lorazapam via dophoff, and haldol 50 mg po tid with prns for agitation - qt interval has been 0.22-0.35. he will continue on lasix via dophoff for further diuresis. he continues to wean from the ventilator and is currently on ps of 15, peep of 14 and fio2 of 50% with oxygen saturation 91-95%. . # fevers: early in his hospital course he completed a course of zosyn for ventilator associated pneumonia and associated septic shock during his first week of hospitalization. during his second week of his hospitalization he developed approximately one week of fevers up to 103.7. etiology of the fevers was unclear, during these fevers he had multiple sets of blood/urine/sputum cultures with no growth, bal with ngtd, he had no localizing symptoms, normal tsh, ruq u/s x 2 not consistent with acalculous cholecystitis, and he was unable to be further imaged due to his size. a sputum culture from grew pansensitive acenitobacter which was felt to be colonization and he was not started on any new antibiotics as his fever had improved and he was clinically well when the culture results returned. fevers may have been due to drug fever from reglan and erythromycin with delayed clearance leading to fevers 3 days after the medications were stopped. he was afebrile for 36 hours prior to discharge. **cultures pending at discharge: c. dif toxin, bal fluid culture from , blood cultures from and , line tip cx from ** . # elevated cpk: patient's cpk was found to be elevated with a peak of on , the levels were trended and decreased to 1189 on . etiology unclear, nms was felt to be unlikely given no muscle rigidity associated with his fevers. renal function was preserved. would recommend follow up with pcp to recheck cpk in weeks to ensure it has normalized. . # htn: patient's outpatient medications were held on admission. he was started on captopril 12.5 tid for bp control with good results. . # arf: patient's cr was elevated on admission, recovered to baseline with hydration, then he developed arf again in the setting of hypotension and septic shock. he has since returned to a his baseline of cr 0.8 at discharge. . # fen: patient is currently on tube feeds via dophoff, promote with fiber at 100 cc/hr. patient had brief hypernatremia which resolved with increase fluid boluses and switch to promote tube feeds. . # anemia: pt had a decrease from his initial hct of 36, attributed to frequent labs and blood cultures. it has since been stable in the range 26-28. stools were guaiac negative. . # ppx: heparin gtt for pe treatment and dvt prophylaxis. ppi. bowel regimen - currently held given loose stools. . # full code . # access: l picc placed on medications on admission: lasix 40mg albuterol prn clonidine 0.1mg procardia 30mg daily naproxen 500mg paxil discharge medications: 1. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4h (every 4 hours) as needed. 2. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for yeast overgrowth. 5. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 6. cyanocobalamin 500 mcg tablet sig: two (2) tablet po daily (daily). 7. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 8. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). 9. lansoprazole 30 mg susp,delayed release for recon sig: one (1) po daily (daily). 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 11. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 12. artificial tear ointment 0.1-0.1 % ointment sig: one (1) appl ophthalmic prn (as needed). 13. insulin lispro (human) 100 unit/ml solution sig: as directed subcutaneous asdir (as directed): per insulin flowsheet. 14. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed. 15. warfarin 5 mg tablet sig: one (1) tablet po daily (daily): goal inr . 16. trazodone 100 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 17. captopril 12.5 mg tablet sig: one (1) tablet po tid (3 times a day). 18. fentanyl 50 mcg/hr patch 72hr sig: one (1) patch 72hr transdermal q72h (every 72 hours): may titrate patch to off as needed for pain. 19. lorazepam 1 mg tablet sig: 1-2 tablets po q8h (every 8 hours) as needed. 20. haloperidol 10 mg tablet sig: five (5) tablet po tid (3 times a day): please check qtc daily, md if > 450 before administering. . 21. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day) as needed. 22. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 23. heparin (porcine) in d5w 100 unit/ml parenteral solution sig: titrate intravenous infusion: titrate to ptt 60-80. discontinue 1 day after inr range 2-3. 24. haloperidol lactate 5 mg/ml solution sig: 5-15 mg injection q4h (every 4 hours) as needed for agitation. 25. lasix 40 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: discharge diagnosis: hypercarbic respiratory failure hypoxic respiratory failure cannot rule out chronic pulmonary emboli alcohol dependence hypertension hypernatremia obstructive sleep apnea morbid obesity b12 deficiency ventilator associated pneumonia with pan-sensitive acinetobacter colonization septic shock hyperthermia, likley reglan reaction discharge condition: ventilated through trach tube with 15 of pressure support, 12 of peep, 50% fio2. afebrile. oriented to himself and place. non-verbal due to high peep. discharge instructions: please discharge to rehab at in . please wean from ventilator per protocol. if the patient has fevers, chills, chest pain, uncontrolled fevers, shortness of breath, or other concerns, please return to the ed or call your pcp. followup instructions: with your pcp, , phone , fax , in weeks after discharge from rehab. please follow up with the pulmonary clinic 2-3 weeks after discharge from rehab. call ( for an appointment. procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances temporary tracheostomy closed [endoscopic] biopsy of bronchus pulmonary artery wedge monitoring other nonoperative respiratory measurements diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia cocaine abuse, unspecified other b-complex deficiencies acute and chronic respiratory failure septic shock morbid obesity hyperosmolality and/or hypernatremia other and unspecified alcohol dependence, unspecified other pulmonary embolism and infarction rhabdomyolysis alcohol withdrawal sleep related hypoventilation/hypoxemia in conditions classifiable elsewhere 

Answer: The patient is high likely exposed to