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: shortness of breath/fevers/ha major surgical or invasive procedure: ip service thoracentesis history of present illness: pcp: : , o. location: internal medicine associates address: , , , phone: fax: . date/time: : 4:00 am . history obtained with the assistance of a speaking rn 84m with h/o recurrent pleural effusions s/p pigtail catheter placement, vats with talc pleurodesis. his thoracoscopy was complicated by a right pneumothorax requiring a chest tube. he also has ckd, dm, as and presents with a ha x 24 hours but resolved on presentation to the ed. he also here with soboe and fever to 101.2 on presentation. he felt febrile so she took his temperature which was 99.3. he then took 1 gm of tylenol. even though per the ed he presented with worsening sob per pt he did not have difficulties breathing, solely a headache. no visual changes. no slurred speech. on 3l nc. cxr c/w pna. s/p l us guided thoracentesis 4 days ptp which produced clear serosanguinous fluid. he felt very weak and tired after his thoracentesis and there was no change in his breathing. not on oxygen at home. his breathing improved dramatically after his recent surgery such that he was able to climb stairs without difficulty. he is not very active at home but he is able to walk from one room to another. 101.2 83 207/89-> bp improved without intervention 18 94 meds given: azithromycin and ceftriaxone, fluids given: radiology studies:, consults called. ivf (dry on exam, increased creatinine) cx and abx (ceftx, azithro) - admit medicine + 10 pt crit drop- guiac negative in ed. rsided pna and l pleural effusion. ivf, cultures before abx. 99f 70 162/68 17 99% 2l 02 . ros: -constitutional: wnl weight gain 8 lb fatigue/malaise fever chills/rigors nightweats anorexia -eyes: wnl blurry vision diplopia loss of vision photophobia -ent: wnl dry mouth oral ulcers bleeding gums/nose tinnitus sinus pain sore throat -cardiac: wnl chest pain palpitations le edema orthopnea/pnd doe -respiratory: wnl sob pleuritic pain hemoptysis cough -gastrointestinal: wnl nausea vomiting abdominal pain abdominal swelling diarrhea- constipation hematemesis hematochezia melena -heme/lymph: wnl bleeding bruising lymphadenopathy -gu: wnl incontinence/retention dysuria hematuria discharge menorrhagia dribbling with urination -skin: wnl rash pruritus -endocrine: wnl change in skin/hair loss of energy heat/cold intolerance -musculoskeletal: wnl myalgias arthralgias back pain -neurological: wnl numbness of extremities weakness of extremities parasthesias dizziness/lightheaded vertigo confusion headache -psychiatric: wnl depression suicidal ideation -allergy/immunological: wnl seasonal allergies all other ros negative. . past medical history: htn dm2 cri, baseline creatinine 2.5-3.0 hypothyroidism gerd antral ulceration with gi bleeding diverticulosis proctitis pancreatitis bph colon polyps dperession as chronic anemia . psh: right vats, talc pleurodesis, and pleural biopsise on . s/p colectomy social history: lives with wife and 1 of his daughters. from republic, worked on farm there, last visit . denies tobacco, alcohol, drug use. - no visual aides - no dentures - independent of adls - continues to drive, no memory problems, no falls, walks without cane or walker. grandaughter daughter is hcp family history: sister and mother had stomach cancer. daughter has cad s/p pcix3. physical exam: 97.8, 181/83l , 181/81, 64, 20, 88-89% ra, 96% 2l general: thin, chronically ill appearing male in nad. nourishment: at risk grooming: ok mentation: alert, speaks in full setences eyes:nc/at, eomi without nystagmus, no scleral icterus noted ears/nose/mouth/throat: mmm, no lesions noted in op neck: supple, no jvd or carotid bruits appreciated respiratory: lungs cta bilaterally without r/r/w cardiovascular: rrr, nl. s1s2, no m/r/g noted gastrointestinal: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. genitourinary: skin: no rashes or lesions noted. no pressure ulcer extremities: no c/c/e bilaterally, 2+ radial, dp and pt pulses b/l. lymphatics/heme/immun: no cervical, supraclavicular, axillary or inguinal lymphadenopathy noted. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. -cranial nerves: ii-xii intact -motor: normal bulk, strength and tone throughout. no abnormal movements noted. -sensory: no deficits to light touch throughout. -cerebellar: no nystagmus, dysarthria, intention or action tremor, dysdiadochokinesia noted. fnf and hks wnl bilaterally. -dtrs: 2+ biceps, triceps, brachioradialis, patellar and 1+ ankle jerks bilaterally. plantar response was flexor bilaterally. no foley catheter/tracheostomy/peg/ventilator support/chest tube/colostomy * physical exam on discharge: patient now has good breath sounds on the left, but still has rhoncherous breath sounds on the right. no le edema. jvp 6. pertinent results: 01:22am lactate-0.7 11:20pm glucose-179* urea n-55* creat-2.9* sodium-136 potassium-3.6 chloride-105 total co2-23 anion gap-12 11:20pm estgfr-using this 11:20pm wbc-10.8 rbc-3.31*# hgb-8.5*# hct-25.8*# mcv-78* mch-25.6* mchc-32.9 rdw-17.4* 11:20pm neuts-82.4* lymphs-13.1* monos-4.2 eos-0.2 basos-0.1 11:20pm plt count-223 11:20pm pt-13.2 ptt-30.8 inr(pt)-1.1 . procedure date tissue received report date diagnosed by dr. ,dr. /stu previous biopsies: pleural fluid (1 vial) slides referred for consultation. egd diagnosis: pleural biopsies (a): granulation tissue with acute and chronic inflammation; organizing fibrinous exudate. some degree of atypicality is seen, probably reactive. polarizable material present. no malignancy identified. . pleural pleural analysis wbc rbc polys lymphs monos eos meso macro other 09:39am 275* 185* 6* 53* 27* 9* 1* 4*1 09:34am 505* 30* 34* 16* 0 17* 31* 2*2 10:30am 50* 3* 4* 56* 0 1* 6* 30* 3*3 atypical cells, refer to cytology reviewed by , md mesothelial cells,favor reactive refer to cytology reviewed by on atypical cells,refer to cytology reviewed by ,md on pleural chemistry totprot glucose creat ld(ldh) 09:39am 3.0 156 108 09:34am 4.1 116 2.3 151 10:30am 1.8 92 74 other body fluid other body fluid ph 10:06am 7.451 09:48am 7.421 pleural fluid brief hospital course: the patient is an 84 year old male with htn, dm, recurrent pleural effusions who presented with new hypoxemia(not on home o2) primary diagnosis: 482.9 pneumonia, bacterial nos secondary diagnosis: 786.05 shortness of breath secondary diagnosis: 780.60 fever, unspecified secondary diagnosis: 799.02 hypoxemia secondary diagnosis: 428.32 heart failure, (b3) chronic diastolic the patient was found on admission to have fever and new infiltrate on the right. this was in addition to the recurrent pleural effusion that had formed on the left, even after being drained just a few days before. with both problems he had significant resp comprimise and went to the icu. there he was given broad spectrum antibiotics after having a rising wbc's and recurrant fever with cap therapy. his fever improved and the fluid was drained. he is now down to 2l by nc. he will need to complete 10 days of broad abx therapy(until ). his vancomycin b/c of his renal function was dosed once, with vanc levels checked daily and given again for level <20(first dose lasted >72hrs). he will also need close monitoring of his i/o's to make sure he stays even and gets iv lasix if needed. he was previously on 40 mg of lasix prior to admission and the effusion returned. we are not entirely sure that this effusion is from chf, so even if his volume status is maintained it may return. if his o2 worsens he should get cxr's to monitor that left lung. he will need f/u with the interventional pulmonary clinic 2 weeks after discharge. they will be scheduleing him an appt the day after discharge. he will also need pulm rehab as he lives up 2 flights of stairs. . secondary diagnosis: 585.4 chronic kidney disease, stage iv (15-29) acute renal failure- b/l 2.4 now increased to 2.9. will need monitoring frequently. pls avoid nephrotoxins and dose vancomycin by level. . secondary diagnosis: 424.1 aortic stenosis-insufficiency moderate aortic valve stenosis (valve area 1.0-1.2cm2). the patient may be preload dependent so euvolemia is difficult but important to maintain. . secondary diagnosis: 401.1 hypertension, benign when ill, the patient had all his hypertension meds held. we recommend restarting his bb the night of discharge and the nifedipine if needed. . secondary diagnosis: 249.40 secondary diabetes mellitus with renal manifestations, not stated as uncontrolled, or unspecified -stopped o/p dm meds and using only insulin. had to add nph for better control . secondary diagnosis: 600.90 hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (luts) -continued flomax. . secondary diagnosis: 530.11 gastroesophageal reflux disease (gerd) continue o/p ppi . code status: full code, discussed with patient/family on admission. . hcp is (dtr) medications on admission: 1. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po bid (2 times a day). 2. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 3. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 4. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 7. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 8. polyethylene glycol 3350 17 gram/dose powder sig: one (1) scoop po once a day. disp:*1 can* refills:*2* 9. nifedipine 60 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). recently discontinued. 10. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 11. enalapril maleate 20 mg tablet sig: one (1) tablet po daily (daily). 12. lasix 20 mg po bid 13. rosiglitazone 4 mg tablet sig: one (1) tablet po bid (2 times a day). discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) dose injection tid (3 times a day): to stop when ambulating. 2. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 5. nph insulin human recomb 100 unit/ml cartridge sig: five (5) units subcutaneous twice a day. 6. insulin aspart 100 unit/ml cartridge sig: sliding scale subcutaneous ac&hs. 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q4h (every 4 hours) as needed for sob or wheezing. 8. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for sob or wheezing. 9. nifediac cc 60 mg tablet sustained release sig: one (1) tablet sustained release po once a day. 10. piperacillin-tazobactam 2.25 gram recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 5 days: until . 11. vancomycin 1,000 mg recon soln sig: one (1) dose intravenous level <20. 12. furosemide 10 mg/ml solution sig: forty (40) mg injection qdaily to if i/o are positive or weight +>3lbs. 13. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. 14. metoprolol tartrate 50 mg tablet sig: one (1) tablet po twice a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnosis: 518.81 respiratory failure, acute secondary diagnosis: 424.1 aortic stenosis-insufficiency secondary diagnosis: 401.1 hypertension, benign secondary diagnosis: 585.4 chronic kidney disease, stage iv (15-29) secondary diagnosis: 530.11 gastroesophageal reflux disease (gerd) secondary diagnosis: 428.32 heart failure, (b3) chronic diastolic secondary diagnosis: 250.82 diabetes type ii, uncontrolled w/ complications secondary diagnosis: 482.9 pneumonia, bacterial nos discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: patient being transferred to facility followup instructions: with clinic in 2 weeks(appt to be made 1 day after discharge) also need f/u with pcp upon discharge(he has been updated on the hospital course). procedure: thoracentesis diagnoses: acidosis nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere anemia, unspecified esophageal reflux unspecified pleural effusion congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortic valve disorders depressive disorder, not elsewhere classified chronic kidney disease, unspecified acute respiratory failure other specified cardiac dysrhythmias dehydration diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diverticulosis of colon (without mention of hemorrhage) chronic diastolic heart failure bacterial pneumonia, unspecified 

Answer: The patient is high likely exposed to