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 attending: chief complaint: productive cough, shortness of breath major surgical or invasive procedure: placement of picc line history of present illness: 61 y/o male with history of right lung non small cell cancer, s/p right upper lobe lobectomy, severe copd, and a history of mrsa and psuedomanous pna who presents from ed to icu with hypoxia and possible pna. he recently had a 3 week hospitalization for copd exacerbation and treated for a pneumonia with bactrim (for mrsa) and levaquin (for pseudomonas). he was discharged on but continued to feel sob and was readmitted several days later where he grew out pseudomonas resistant to ciprofloxacin. workup also included a cxr which showed a question of interstitial process and cta was negative for pe but did reveal bilateral patchy infiltrates in middle and lower lobes bilaterally c/w pneumonia. pt was treated with vancomycin and ceftaz during this hospital course, and was discharged on prednisone taper. . he was doing well at home until 1 week pta when he reports onset of fevers to 101, weakness, sob, pleuritic cp, cough. denies any arm or jaw pain, diaphoresis, nausea, palpitations. ros + for photophobia, dizziness with some balance loss, but no loss of consciousness over this time period as well. pt therefore presented to hospital. he remained clinically stable throughout his course at mvh - afebrile, bp 110s-130s/60s-70s, hr 60s-80s, rr 18-24 and sats of 93% on 3l -> 93% on 2l. his pulmonologist (dr. was contact and recommended transfer to for possible bronchoscopy to figure out why he is having recurrent copd flares. on arrival here, he states that his breathing feels comfortable. past medical history: 1. non-small cell lung cancer, s/p r upper lobectomy, partial r fifth rib resection c/b chronic pain. no chemo or radiation. 2. copd w/ severely reduced dlco, fev1, and fev1/fvc ratio 3. h/o mrsa and pseudomonas pna 4 uc - s/p multiple surgeries, most recently in late 80s. s/p total colectomy and ileostomy 5. steroid induced hyperglycemia 6. pfo 7. h/o cardiomegaly 8. h/o depression social history: married, 2 daughters, lives on the . not current smoker, quit in w/ dx of lung cancer, 40 pack-yr history. occasional etoh use. worked as a paiting contractor, retired after lung cancer surgery. family history: f died of lung cancer; m died of alzheimer's. has 3 sisters, all older than him, healthy physical exam: vitals - t 95.9, hr 95, bp 107/58, rr 20, o2 97% on high flow face mask general - awake alert, sitting up in bed, mask on, nad heent - perrl, eomi, dry mm cvs - slightly tachycardic, no noted m/r/g lungs - diffuse insp and exp wheezes, scattered coarse rhonci at bases, bronchial breath sounds on right middle airfield abd - tense, non-tender, ileostomy in place ext - no le edema b/l pertinent results: admission labs: 10:15pm blood wbc-9.3 rbc-3.40* hgb-10.0* hct-28.8* mcv-85 mch-29.4 mchc-34.6 rdw-15.4 plt ct-280# 10:15pm blood neuts-80* bands-10* lymphs-3* monos-6 eos-0 baso-0 atyps-0 metas-1* myelos-0 nrbc-1* 10:15pm blood pt-16.1* ptt-31.4 inr(pt)-1.5* 10:15pm blood glucose-262* urean-65* creat-2.8*# na-129* k-4.1 cl-87* hco3-24 angap-22* 05:39am blood alt-122* ast-155* ld(ldh)-347* alkphos-118* amylase-64 totbili-0.5 05:10am blood alt-79* ast-52* ld(ldh)-311* alkphos-115 totbili-0.4 04:14am blood alt-14 ast-1 ld(ldh)-255* alkphos-108 totbili-0.3 05:39am blood lipase-12 05:10am blood lipase-13 05:39am blood albumin-2.5* calcium-7.7* phos-6.6*# mg-2.1 04:14am blood caltibc-160* ferritn-1317* trf-123* 08:26am blood hbsag-negative hbsab-negative igm hbc-negative igm hav-negative 08:26am blood hcv ab-negative 01:59am blood type-art po2-110* pco2-40 ph-7.38 caltco2-25 base xs-0 intubat-not intuba 10:31pm blood lactate-2.4* pertinent labs/studies: . chest (portable ap) 10:10 pm impression: 1. new right middle lung opacification most consistent with newly developing pneumonia given acuity of onset (1 month). 2. underlying chronic obstructive pulmonary disease, status post right thoracotomy. . : portable cxr - impression: minimal worsening of right pneumonia, superimposed upon severe emphysema. it is difficult to exclude a component of necrotizing infection. persistent air collection at right apex, likely due to a postoperative pneumothorax, unchanged since recent radiograph, but worse when compared to older studies from . . : echocardiogram conclusions: 1. the left ventricular cavity size is normal. overall left ventricular systolic function cannot be reliably assessed. 2. the mitral valve leaflets are mildly thickened. the mitral valve is not well seen. 3. there is no obvious vegetations seen, but the cardiac valves are not well seen. . . microbiology: sputum source: expectorated. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs and clusters. 1+ (<1 per 1000x field): budding yeast. 1+ (<1 per 1000x field): gram negative diplococci. respiratory culture (final ): oropharyngeal flora absent. staph aureus coag + moderate growth. pseudomonas aeruginosa. sparse growth. yeast. sparse growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | pseudomonas aeruginosa | | cefepime-------------- 2 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s =>16 r imipenem-------------- 8 i levofloxacin---------- =>8 r meropenem------------- 8 i oxacillin------------- =>4 r penicillin------------ =>0.5 r piperacillin---------- 8 s piperacillin/tazo----- 8 s rifampin-------------- <=0.5 s tetracycline---------- <=1 s tobramycin------------ =>16 r vancomycin------------ <=1 s . blood cultures: to : no growth . urine: : no growth : no growth . stool: : c. diff - negative discharge labs: . 05:25am blood wbc-8.2 rbc-3.03* hgb-9.5* hct-25.7* mcv-85 mch-31.4 mchc-37.1* rdw-16.6* plt ct-179 05:25am blood glucose-118* urean-22* creat-0.7 na-134 k-3.6 cl-95* hco3-30 angap-13 05:25am blood calcium-8.3* phos-3.2 mg-1.6 brief hospital course: 61 y/o m w/ h/o nsclc s/p rul lobectomy, severe copd, recurrent pna over past couple months, with righ sided pna (mrsa/pseudomonas) and severe hypoxia requiring significant o2 suppplementation. . 1. pna with severe hypoxia: had right multilobar pna with mrsa/pseudomonas growing from sputum, with wbc count of 9,000 and bandemia as high as 22%, elevated anion gap, and elevated lactate to 2.4. also has poor underlying lung function from copd (fev 1.2l in ) and h/o right upper lobe lobectomy. patient was initially treated with high flow face mask of 15 l at 40% with additional nc with saturations varying from 88 to 98%, but with continued frequent coughing which causes desaturations. the patient has since decreased his oxygen requirement to venti amsk at 12 lpm with o2 sats rangin 89 to 97%. the patient continues to cough and is draining sputum well with transition from dark brown thick sputum to thinner grey/clear sputum. the patient had one episode small volume blood tinged sputum on attributed to inflammation from underlying pna. the patient is currently being treated with linezolid for a planned 21 day course for mrsa as well as ceftazidime, again for a planned 21 day course for pseudomonas. amikacin was added for syndergy and to avoid resistance with a planned 14 day course (ending dates specified on discharge meds). the patient will be discharged with need for continued o2 suppplementation to keep sats >90% and <94% with o2 weaning as possible. the patient will continue to require ongoing chest pt and physical therapy as well. . 2. copd: has h/o copd on montelukast, spiriva, advair, flovent, prednisone 10mg at home with pft's showing fev of 1.2 l (42% predicted), fev1/fvc ratio of 42 (59% predicted), 6 l tlc, and elevated residual volume (193% predicited). he was given advair, monteleukast, prednisone 60 mg daily tapered down to 30 mg daily as well as atrovent nebulizers. the patient is followed by dr. , his outpatient pulmonolgist with whom he should continue to be followed after discharge. . 3. anxiety: patient was experiencing a significant amount fo anxiety during this admission, likely at least partly attributable to his air hunger. the patient was maintained on clonopin with hold parameters with ativan rescues as needed. . 4. acute renal failure: patient presented with arf with cr to 2.8 which resolved rapidly with fluids down to baseline of 0.7. . 5. chest pain: had right sided chest pain, which is diffuse and pleuritic, likely due to pna. treated with mssr 45 mg and iv morphine for breakthrough pain. . 6. abdominal pain: patient has been experiencing ongoing abdominal pain for a few days. a kub showed a non-obstructive bowel gas patterns and the patient's ostomy continues to drain well. the patient has good appetite without nausea/vomiting. c. diff was negative x 1. the patient did have an elevated amylase/lipase, now trending down. pain did not radiate to back and again patient was tolerating po well without any exacerbation of pain. the patient's symptoms are exacerbated with coughing and are likely secondary to musculoskeletal strain from frequent coughing. treating pain as above with ms sr 45 with rescue doses. . 6. transaminitis: presented with elevated liver enxymes which trended down to normal. hepatitis panel negative for hep b or c. . 7. h/o lll nodule and several other areas of focal scarring: should be followed with serial ct scans in the future by outpatient providers. . 8. h/o right upper lobe lung ca: not active currently. sputum for cytology was negative for malignant cells. no history of chemo or radiation. . 9. h/o thrush: likely related to inhaled staeroids. continued his outpt nystatin. . 10. steroid induced hyperglycemia: treated with 70/30 insulin at am dose of 40 and pm dose of 22. . 11. anemia: labs consistant with anemia of chronic disease. also was guaiac positive. needs to be followed in the future. he is s/p colectomy for ulcerative colitis. . 12. ulcerative colitis: s/p colectomy and ileostomy. not on any medications for uc. . code: full . communication: wife (h) (c) , daughter ( medications on admission: montelukast 10 mg po daily tiotropium bromide 18 mcg daily flovent 110 2 puffs prednisone 10mg daily mucinex 600mg tid multivitamin po daily fluticasone-salmeterol 250-50 mcg benzonatate 100 mg po tid senna 8.6 mg po bid prn docusate sodium 100 mg po bid prn nexium 40 mg twice a day. morphine 30 mg tablet sustained release po q12h morphine 15mg ir po q8hr prn nystatin 100,000 unit/ml suspension sig: five (5) ml po qid discharge medications: 1. hexavitamin tablet sig: one (1) cap po daily (daily). 2. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. nystatin 100,000 unit/ml suspension sig: 100,000 mls po qid (4 times a day). 4. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. 5. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. lorazepam 0.5 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for anxiety. 8. acetylcysteine 20 % (200 mg/ml) solution sig: one (1) ml miscell. q4-6h (every 4 to 6 hours) as needed. 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 10. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 11. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 12. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day): continue until patient is regularly ambulatory, than may d/c. 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 14. ipratropium bromide 0.02 % solution sig: one (1) inhalation inhalation q4h (every 4 hours) as needed. 15. clonazepam 0.25 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po three times a day: hold for rr < 16. 16. guaifenesin 600 mg tablet sustained release sig: two (2) tablet sustained release po bid (2 times a day). 17. morphine 15 mg tablet sustained release sig: three (3) tablet sustained release po q12h (every 12 hours). 18. linezolid 600 mg/300 ml parenteral solution sig: six hundred (600) mg intravenous q12h (every 12 hours) for 5 days: first dose: continue for total of 21 day course last dose: . 19. ceftazidime-dextrose (iso-osm) 2 g/50 ml piggyback sig: two (2) grams intravenous q8h (every 8 hours) for 7 days: first dose: continue for total of 21 day course last dose: . 20. amikacin 250 mg/ml solution sig: one (1) gram injection q24h (every 24 hours) for 3 days: first dose: continue for total 14 day course last dose: . 21. dolasetron 12.5 mg/0.625 ml solution sig: 12.5 mg intravenous q8h (every 8 hours) as needed for nausea /vomiting. 22. morphine 2 mg/ml syringe sig: two (2) mg injection q4h (every 4 hours) as needed for breakthrough pain. 23. prednisone 10 mg tablet sig: three (3) tablet po daily (daily): continue for 1 week. wean as possible over following 2 to 3 weeks to 10mg daily as possible. 24. insulin nph-regular human rec 100 unit/ml (70-30) suspension sig: see instructions units subcutaneous once a day: please provide 40 units qam 22 units qhs. 25. insulin lispro (human) 100 unit/ml solution sig: one (1) unit subcutaneous four times a day: please provide humalog sliding scale with meals and at bedtime per provided sliding scale in addition to standing insulin 70/30 . discharge disposition: extended care facility: northeast - discharge diagnosis: primary: mrsa/pseudomonas pneumonia copd exacerbation abdominal pain steroid induced hyperglycemia anxiety . secondary: history of non small cell lung ca s/p pneumonectomy ulcerative colitis anemia discharge condition: fair. patient with ongoing o2 requirement above baseline. symptomatically improved, hemodynamically stable. discharge instructions: 1. please take all medications as prescribed . 2. please keep all outpatient appointments . 3. please return to the hospital for symptoms fevers/chills, worsening respiratory status, shortness of breath, chest pain, or any other concerning symptoms followup instructions: 1. please follow up with your pcp, . on discharge. please call his office at to make an appointment . 2. please follow up with your pulmonologist within one week of discharge from your rehab facility. please call his office to schedule an appointment. procedure: venous catheterization, not elsewhere classified non-invasive mechanical ventilation transfusion of packed cells injection or infusion of oxazolidinone class of antibiotics diagnoses: thrombocytopenia, unspecified other specified disorders of pancreatic internal secretion adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified personal history of malignant neoplasm of bronchus and lung infection with microorganisms resistant to penicillins obstructive chronic bronchitis with (acute) exacerbation anxiety state, unspecified pneumonia due to pseudomonas bacteremia methicillin susceptible pneumonia due to staphylococcus aureus retention of urine, unspecified nonspecific abnormal findings in stool contents ileostomy status abdominal pain, generalized epistaxis painful respiration 

Answer: The patient is high likely exposed to