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 / watermelon / almond oil attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: mr. is a 32 yo m w/hx of dm type i, esrd on hd who presents with shortness of breath and hypoxemia. patient has been in usual state of health. on thursday morning he noticed he was more short of breath. went to hd yesterday and completed session w/o events (w/ 1.6l ultrafiltration). unfortunately, yesterday afternoon/evening developed progressive shortness of breath worst when lying flat. no reported fevers, chills, night sweats, productive cough or other complaints. no sick contacts, recent travel. to patient feels similar to previous admission in when he had dyspnea related to volume overload. . in the ed, initial vs were: t99.4 hr 98 bp 185/108 rr18 100. initial impression was for pulmonary edema in setting of diastolic dysfunction and hypertensive urgency. was given oral medications/home regimen for treatment of bp. ct chest performed that excluded pe, and showed stable ground glass opacities. read of ct chest concerning for infection rather than volume overload, and patient was covered in ed with vanco. zosyn held given pcn allergy. renal contact who saw patient and planning hd on arrival to floor. . prior to transfer to the icu, patient's vs were: hr 91, 153/86 100% nrb, rr 20. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - htn - dm i since age 19, seen at . complicated by nephropathy, gastroparesis, and possibly retinopathy. recent admissions for dka and hypoglycemia. - esrd/ckd: thought to be related to htn and longstanding diabetes. now on hemodialysis t/th/sat. does make urine. has been listed on kidney/pancreas transplant wait list since 4/. - anemia: thought to be combination of iron deficiency and ckd, now on epo with dialysis - depression - s/p appendectomy social history: states that he previously drank heavily (30-40 drinks/week) but has not used alcohol since . +h/o tobacco use, quit in , relapsed, quit last year and denies tobacco currently. denies other drugs. neg ppd . lives with girlfriend. family history: no fh of pancreatitis. diabetes and heart trouble in grandfather. physical exam: vitals: t: bp: p: r: 18 o2: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi 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: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs on admission: 03:34am plt count-299 03:34am neuts-64.7 lymphs-25.1 monos-7.1 eos-2.4 basos-0.7 03:34am wbc-8.1 rbc-3.73* hgb-11.1* hct-33.1* mcv-89 mch-29.7 mchc-33.5 rdw-14.9 03:34am k+-5.1 03:34am comments-green top 03:34am ck-mb-2 03:34am ctropnt-0.24* 03:34am ck(cpk)-187 03:34am glucose-289* urea n-19 creat-5.9* sodium-131* potassium-7.8* chloride-94* total co2-29 anion gap-16 09:00am urine rbc-* wbc- bacteria-few yeast-none epi-0 09:00am urine blood-tr nitrite-neg protein-500 glucose-1000 ketone-neg bilirubin-neg urobilngn-neg ph-8.0 leuk-neg 09:00am urine color-straw appear-clear sp -1.015 09:00am urine cocaine-neg amphetmn-neg 09:00am urine hours-random 11:54am type-art po2-92 pco2-44 ph-7.47* total co2-33* base xs-7 12:42pm albumin-3.4* calcium-9.1 phosphate-4.2 magnesium-1.7 12:42pm ck-mb-2 ctropnt-0.24* 12:42pm lipase-19 12:42pm alt(sgpt)-21 ast(sgot)-22 ld(ldh)-269* ck(cpk)-74 alk phos-88 tot bili-0.3 12:42pm glucose-188* urea n-18 creat-6.9* sodium-137 potassium-4.1 chloride-97 total co2-30 anion gap-14 . microbiology: blood cx : ngtd (not final at discharge) urine cx : neg legionella urine ag neg . images/studies: . cxr : portable upright chest x-ray: there is increased opacity in the bilateral lungs, which appears more severe at the right base. this is diffuse and nonfocal, and suggests a diffuse airspace process. there is no pleural effusion. there is no pneumothorax. the cardiac contour is enlarged and globular, in keeping with known pericardial effusion. the mediastinal contour is otherwise unremarkable. the visualized bones and the upper abdomen demonstrate no acute abnormality. impression: 1. enlarged cardiac silhouette, in keeping with known pericardial effusion. 2. new diffuse airspace opacities, which appears more severe than right. lack pleural effusions argue against volume overload, and a diffuse infectious process is considered more likely. other etiologies, including hemorrhage, are not excluded. . cta : findings: the aorta is normal in caliber and configuration, with no evidence for acute aortic syndrome. there is adequate opacification of the pulmonary arterial tree, with no evidence of filling defect to suggest pulmonary embolus. the main pulmonary artery is again enlarged, suggesting pulmonary artery hypertension. there is a moderate pericardial effusion, similar in size to prior study. the heart is otherwise unremarkable. prominent prevascular and pretracheal mediastinal nodes are again noted. in the lungs, there are diffuse ground-glass, somewhat nodular opacity, seen predominantly in the lower lobes with relative sparing of the apices. this is improved compared to . more consolidative processes at the bases have improved. while there is slight septal thickening, suggesting that a component of this may represent pulmonary edema, the lack of effusion argues against attributing this strictly to volume overloada, and infectious etiologies remain strong consideration. the trachea and central airways are patent to the subsegmental level, without endobronchial lesions identified. the esophagus appears normal. there is no acute abnormality identified in the upper abdomen. bone windows: there are no suspicious lytic or sclerotic osseous lesions. impression: 1. no evidence for acute aortic syndrome or pulmonary embolism. 2. extensive ground-glass, nodular opacities throughout both lungs, most predominant in the lower lobes, remain most concerning for infection. other diagnostic considerations include pulmonary edema (given history of renal failure and htn) or pulmonary hemorrhage. findings are improved. there is prominent pretracheal and prevascular lymph nodes again present, possibly reactive. 3. moderate pericardial effusion, stable. 4. prominent main pulmonary artery, again suggestive of pulmonary hypertension. brief hospital course: mr. is a 32 y/o m w/ dm, esrd on hd, htn who presents with acute onset dyspnea and hypertensive urgency. . # dyspnea/hypoxemia: the patient was admitted to the micu given his respiratory distress. the most likely cause was felt to be hypertension precipitating diastolic dysfunction and pulmonary edema. there was likely a significant component of volume-overload to this presentation as blood pressure, respiratory status and oxygen requirement decreased post-hemodialysis with removal of >3l fluid. a cta demonstrated ground glass opacities with possible infectious etiology so he was initially covered with broad spectrum antibiotics. blood cultures negative, urine legoinella negative, and clinical status improved with fluid removal so antibiotics stopped on day 2. the patient was weaned rapidly from non-rebreather to room air post-dialysis, and did not require supplemental oxygen for the remainder of his hospitalization. . # malignant hypertension: his blood pressure was acutely controlled on a nitroglycerin drip with rapid transition to control on home medications and removal of fluid with hemodialysis. hydralazone was discontinued, as it was felt that it could be contributing to his complaints of fatigue and depression. lisinopril was titrated up from 20 mg to 30 mg daily, and the remainder of his antihypertensive medications were continued at home doses. . # esrd: the renal team was consulted on arrival and hemodialysis was started on the day of admission with removal of 3.3l of fluid. the next day 400ml were taken off and hemodialysis was stopped early due to an episode of chest pain. his home medications were continued. he received epogen and zemplar with hd. . # type 1 diabetes uncontrolled with complications: last a1c 7.5 in . the patient was continued on his home regimen of lantus 15 units daily, and humalog sliding scale. . # r-arm pain: thought to be possibly related to av graft as having elevated venous pressures during session, and some clot retrieved at start of session. did thrombose graft and had thrombectomy in past month. however, the pain was worse with movement and could also be musculoskeletal. the graft functioned well during dialysis. . # chest pain: the patient described left sided chest pain that was worse with inspiration and reproducible with palpation. ekg was unchanged. cardiac enzymes were cycled with normal ck and slightly elevated but unchanged troponins. this was thought to be due to demand related ischemia in the setting of esrd. cta on admission was negative for pulmonary embolism. . # failure to thrive/weight loss: felt most likely to be secondary to depression. the option of starting an ssri was discussed with the patient, and he declined. he was also followed by social work during this admission. medications on admission: hydralazine 25mg po tid lisinopril 20mg po qday calcium acetate 667mg tablets - 2 tablets tid with meals -> not taking reglan 5mg po tid - not eating well so using sporadically vitamin d 5,000 iu po qday x 2 weeks -> not taking currently calcitriol 0.25mg daily -> not taking amlodipine 10mg po qday toprol xl 200mg po qday laisx 80mg po qday po qday glargine 15 units sc qam humalog sliding scale as below < 50 0 15 51 100 0 0 0 0 0 101 150 0 0 0 0 0 151 200 0 0 0 0 0 201 1 300 4 0 4 4 2 301 350 6 0 6 6 4 351 400 8 0 8 8 6 > 8 all insulin doses in units discharge medications: 1. calcium acetate 667 mg tablet : two (2) tablet po three times a day: with meals. 2. metoclopramide 10 mg tablet : 0.5 tablet po tid w/ meals (). 3. vitamin d 50,000 unit capsule : one (1) capsule po once a week. 4. calcitriol 0.25 mcg capsule : one (1) capsule po once a day. 5. amlodipine 5 mg tablet : two (2) tablet po daily (daily). 6. metoprolol succinate 100 mg tablet sustained release 24 hr : two (2) tablet sustained release 24 hr po daily (daily). 7. furosemide 40 mg tablet : two (2) tablet po daily (daily). 8. lisinopril 30 mg tablet : one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. lantus solostar 300 unit/3 ml insulin pen : fifteen (15) units subcutaneous qam. 10. humalog 100 unit/ml solution : asdir subcutaneous four times a day: please follow sliding scale. discharge disposition: home discharge diagnosis: primary diagnoses: pulmonary edema hypertensive urgency diabetes mellitus type i - poorly controlled, with complications esrd on hemodialysis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you have severe hypertension, and were admitted to the hospital for low oxygen. we think that your lungs became filled with fluid because of an episode of severe hypertension. it is very important to take all of your blood pressure medications and continue with dialysis. if you decide to stop either of these treatments, it is likely that you will become very ill and possibly die. . we made the following changes to your home medications: -stop hydralazine -increase lisinopril to 30 mg daily please take all of your other medications as prescribed. followup instructions: please call your kidney doctor, , within 1-2 weeks. tel . please also call your pcp, . to see him within weeks. tel . department: advanced vasc. care cnt when: wednesday at 2:00 pm with: , md building: (, ma) campus: off campus best parking: free parking on site department: transplant when: monday at 2:40 pm with: , md building: lm campus: west best parking: garage procedure: hemodialysis diagnoses: hypertensive chronic kidney disease, malignant, with chronic kidney disease stage v or end stage renal disease anemia in chronic kidney disease end stage renal disease abdominal pain, unspecified site renal dialysis status depressive disorder, not elsewhere classified loss of weight long-term (current) use of insulin iron deficiency anemia, unspecified other abnormal blood chemistry diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled adult failure to thrive background diabetic retinopathy diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled gastroparesis diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled mixed acid-base balance disorder pain in limb 

Answer: The patient is high likely exposed to