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: prednisone attending: chief complaint: transfer from osh major surgical or invasive procedure: 1. intubation and ventilator use history of present illness: 34 yo male with bipolar affective disorder who was admitted on to osh for 4th pneumonia since . pt initially presented to osh with 3day history of weakness, productive cough (yellow sputum), sob, and pleuritic chest discomfort. in , pt was afebrile, wbc 26, o2 sat 76% on ra, po2 39 on ra, with diffuse bilateral interstitial infiltrates on cxr. pt was given cefuroxime and iv bactrim in ed and admitted to the icu on 100% non-rebreather. pt developed increasing respiratory distress requiring intubation (). he also became hypotensive requiring neo-synephrtine. blood cultures at osh have been negative and pt has been treated with cefriaxone, levaquin, and vancomycin since admission. of note, pt is s/p bronch and bal at osh; he was found to be pcp negative, viral/fungal/bacterial cultures were pending. * per patient's wife, pt recently started new psych med (strattera). depression has not been well-controlled, thus increase in meds in the last year. wife reports that pt occasionally awakens from sleep with coughing and sometimes nausea/vomiting. she wonders if this may be related to psych meds. * ros per wife significant only for doe at baseline, which may have worsened in the last week. pt has gained weight recently. otherwise has felt well since . pt was transferred to for further management. past medical history: bipolar disorder hx of elbow surgery hx kidney stones recurrent pneumonias (, , ) crohn's disease social history: married with 2 children works as a house painter (wears respirator) no recent travel smokes pack/day denies alcohol denies ivdu abused ephedrine four months ago family history: non-contributory physical exam: vs: t98.7, p85, 116/63, rr17, 100% on ac 70% 500/10, rate set 15 gen: sedated, intubated, unresponsive heent: perrl, ett in place, ngt in place, mmm neck: supple, large, no lymphadenopathy chest: decreased breath sounds at bases, crackes at l base and anteriorly, no wheezes cvs: rrr, no m/g/r abd: obese, distended, hypoactive bowel sounds ext: right fem line in place. warm. 2+ pedal pulses pertinent results: 08:48pm wbc-12.3* rbc-3.65* hgb-11.0* hct-33.9* mcv-93 mch-30.0 mchc-32.3 rdw-15.0 08:48pm plt count-274 08:48pm neuts-78.8* lymphs-15.6* monos-2.5 eos-2.9 basos-0.3 08:48pm pt-12.7 ptt-24.7 inr(pt)-1.0 * 08:48pm glucose-92 urea n-8 creat-0.6 sodium-142 potassium-4.3 chloride-108 total co2-25 anion gap-13 08:48pm albumin-3.5 calcium-8.4 phosphate-4.3 magnesium-2.2 * 08:48pm alt(sgpt)-29 ast(sgot)-21 ld(ldh)-363* alk phos-96 amylase-33 tot bili-0.3 08:48pm lipase-14 * 08:48pm cortisol-10.9 08:48pm lithium-0.3 * 08:48pm urine color-straw appear-hazy sp -1.024 08:48pm urine blood-lge nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 08:48pm urine rbc->50 wbc-0-2 bacteria-few yeast-none epi-0-2 09:35pm lactate-0.5 * 09:35pm type-art temp-36.9 rates-15/3 tidal vol-500 peep-10 o2-70 po2-149* pco2-48* ph-7.34* total co2-27 base xs-0 -assist/con intubated-intubated * 09:35pm freeca-1.22 * 04:06am blood pep-no specifi igg-695* iga-194 igm-122 ife-no monoclo * portable cxr: portable ap chest: an et tube is identified, with its tip 4.8 cm above the carina. an ng tube is also seen. the tip courses below the diaphragm. the heart size is normal allowing for position. there is diffuse wide spread air space consolidation in both lungs, consistent with prior history of pneumonia. the mediastinum cannot be assessed due to the patient's consolidation and because this is a supine film. impression:widespread airspace consolidation consistent with pneumonia. * portable cxr: findings: compared to the film from the prior day, the et tube has been removed. there is an ng tube in the stomach. the bilateral lower lobe infiltrates are still present but are less confluent. overall, there is improved aeration compared to the prior film but infiltrates are still present. there is hazy bilateral vasculature which suggests that there may be an element of fluid overload as well. * brief hospital course: icu course: pt was thought to have aspiration pneumonia especially since he has a history of awakening at night with cough/nausea/vomiting in setting of multiple psychiatric medications. his respiratory failure was thought to be from ards. his sputum culture grew out gram negative rods. ceftriaxone and vancomycin were discontinued after one day. he was maintained on levofloxacin. pt remained afebrile. pt was weaned from the ventilator and extubated on . * floor course () 1. pneumonia/ards/respiratory failure: on transfer, pt was stable from respiratory standpoint. he denied sob or cough. he had an o2sat of 94% on ra. lungs were clear with minimal crackles at the left base. pt was continued on levofloxacin, with which he was discharged to complete a 7 day course. pt was kept on aspiration precautions. pt was seen by speech and swallow who found no signs of aspiration on bedside swallowing evaluation. ambulatory sat was noted to be in mid-90's. pt was discharged on floor day 2 in stable condition with instructions to follow-up with pulmonary as an outpatient regarding etiology of recurrent pneumonia. * 2. ileus: pt had decreased stool while in the icu, but had bm on the floor. likely resolved ileus. * 3. gerd: pt has history of gerd symptoms, likely resulting in aspiration. he was continued on protonix. he was instructed to consider outpatient ph manometry. * 4. bipolar: mood was stable. pt was continued on outpatient psych meds. he was instructed to follow-up with outpatient psychiatrist to review psych medications for increased risk of gerd/decreased lower esophageal sphinctor tone. * 5. fen: he was continued on aspiration precautions * 6. prophylaxis: he was continued on ppi, heparin sc tid. medications on admission: effexor 150mg qam, 225mg qhs zoloft 100mg qam neurontin 800mg abilify 75mg qpm risperdal 4mg straterra 15mg qam lithium 300mg protonix 40mg qd discharge medications: 1. gabapentin 400 mg capsule sig: two (2) capsule po bid (2 times a day). disp:*120 capsule(s)* refills:*2* 2. risperidone 2 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 3. venlafaxine hcl 75 mg tablet sig: two (2) tablet po qam (once a day (in the morning)). disp:*60 tablet(s)* refills:*2* 4. venlafaxine hcl 75 mg tablet sig: three (3) tablet po qpm (once a day (in the evening)). disp:*90 tablet(s)* refills:*2* 5. sertraline hcl 100 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). disp:*30 tablet(s)* refills:*2* 6. aripiprazole 30 mg tablet sig: 2 1/2 tabs tablets po at bedtime. disp:*90 tablet(s)* refills:*2* 7. strattera 10 mg capsule sig: 1 tab capsule po once a day. disp:*60 capsule(s)* refills:*2* 8. lithium carbonate 300 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 9. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 10. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 3 days: take for 3 days. disp:*3 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: aspiration pneumonia discharge condition: stable discharge instructions: elevate head of the bed to at least 30 degress by putting a brick or bed raiser on the two legs at the head of the bed. follow up with psychiatrist and primary care physician as stated below followup instructions: follow up with pcp on as scheduled. follow up on following issues: 1. further work-up of recurrent pneumonias 2. follow-up chest x-ray 3. consider ph manometry study 4. coordinate with psych doc on altering psych medications follow up with psychiatrist to consider the possible effects of psych medications on reflux symptoms. have psych doc and pcp coordinate any possible medication changes. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: esophageal reflux tobacco use disorder regional enteritis of unspecified site pneumonitis due to inhalation of food or vomitus paralytic ileus personal history of urinary calculi bipolar i disorder, most recent episode (or current) unspecified 

Answer: The patient is high likely exposed to