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: lasix / paxil / allopurinol / lipitor attending: chief complaint: shortness of breath major surgical or invasive procedure: bronchoscopy to evaluate the position of the trach. trach removal and removal history of present illness: pt is a 75 yo man w/ copd, htn, recent complicated ccu admit () with nstemi, intubation, pea arrest at cardiac cath, iabp, tracheostomy, h influenza pna, mrsa pneumonia tx w/ , placement, avm/gi bleed, who presents from hospital with acute resp distress, hypoxia. most of history obtained from chart and patient's son, who is at his bedside. patient reports he was in his usoh, doing well at rehab until last night, when he acutely became sob w/ increased secretions. he was noted to have sats in the 70's on his 2l and was placed on a non rebreather with improvement in sats to 100%. they were unable to suction from his trach and he was sent to the ed for evaluation. of note, his trach was capped last week and he has been on a nasal cannula at 2l since that time w/o incident. also of note, pt has been eating well independently and has not been used. patient denies any known aspiration event and has been eating w/o incident for many days. he denies fevers but does report a "cold sweat" last night. he also says he has felt fatigued over the last few days. denies diarrhea/chest pain/ abd pain/ headaches. has some chronic urinary incontinence and foley was just d/c'd last week. he has been urinating on his own since then. pt had some bloody secretions and feels he has been able to cough up his mucous well until this am. has a strong gag per patient. on pt has had a petechial rash on his legs that was thought to be due to lasix or paxil. it was biopsied by dermatology at -- much improvement over last few days. * in ed, mild hypoxia (91% ra, tachy 120's, low grade temp), rec'd 1 g vanco, 500 mg iv flagyl, albuterol/atrovent, ct surgery called for eval of trach. vss, sats improved w/ ventimask. abg at 7.2/85/107 (on nrb??- unsure) * patient was then sent to floor and abx coverage switched to vancomycin/ zosyn. he went to or procedure for replacement of trach and hours later developed hemoptysis and hypoxia down to mid 80's requiring suctioning and nc to 10l and trach mask. despite the latter patient's oxygenation did not improve. they called a micu consult for evaluation of hypoxia. once micu team arrived to floor patients sats had increased to low 90's, tachy to 100-120's, blood pressure 120's/70's, rr to 30's but with abdominal breathing and respiratory retractions. cycled cardiac enzymes ruled patient in for nstemi. patient was then transferred to icu. * icu course: pt hypoxic and in respiratory distress on presentation to icu. pt initially coved with vanc/zosyn for pna, however these were d/c'ed after culture results. underwent a bronchoscopy to evaluate for the location of trach, it was in ant. mediastinum. replaced under video. also revealed 3 polypoid lesions in lll which were biopside.pt eventually coughed it out and trach was removed and remained stable with weaning of o2 down to 3l/min (baseline 1.5cc/min). cardiac pt was continued on asa/statin/bb and was started on acei . pt was transferred to the floor and remained stable. he had no further c/o sob. past medical history: 1.nstemi - cardiac cath w/ 3vd: distal lm 50%, lcx 60%, om2 90%, om1 80%, no intervention, dropped bp at end of cath w/ pea arrest---> resuscitated w/ epi/pressors 2. ef 35% 1-2+mr echo (had flash pulm edema on last admit) 3. copd on home oxygen (2l for years) dr. is pulm fev1 590 cc by report- no pft's here 4. h/o pneumothorax 5. depression 6. iabp on last admit- was evaluated by ct surgery for cabg but was thought not to be a surgical candidate given mmp 7. arf on last admit - cr 1.7, now 0.98 8. gib-- avm on last admit at hepatic flexure- s/p embolization by ir (after 4 bleeding scans, c scope, push enteroscopy,etc) required 15 units of prbc's on last admit social history: married with two children. tobacco: 2 ppd x 25 years, quit 35 years ago. no etoh. family history: non-contributory physical exam: exam from on admission to the floor. pe: t 98.4 bp 100/48 p 81 r 27 sat 97% 3l gen: nad lying comfortably in bed heent: nc/at, eomi, perrl,mmm, nc in place neck: jvp difficult to asses, supple. trach site with dressing with scant serosang. secretions. chest: wheezes apically, decreased breath sounds at bases. prolonged expiratory phase. cv: distant hs, regular abd: obese, non tender, tube in place. extrm: , macular petechial-like rash over dorsal aspect of ble, no edema 2+dp 1+pt pulses bilaterally. neuro: intact mental status; alert and oriented x 3, able to give clear history when asked, moving all extremities. pertinent results: 07:10am blood wbc-10.9 rbc-3.73* hgb-10.6* hct-33.6* mcv-90 mch-28.5 mchc-31.6 rdw-14.7 plt ct-422 07:10am blood neuts-89* bands-1 lymphs-1* monos-8 eos-0 baso-1 atyps-0 metas-0 myelos-0 07:10am blood pt-12.3 ptt-27.0 inr(pt)-1.0 07:10am blood glucose-155* urean-13 creat-0.8 na-141 k-4.8 cl-99 hco3-33* angap-14 07:26pm blood ck-mb-39* mb indx-21.4* ctropnt-0.29* 03:45am blood ck-mb-33* mb indx-22.8* ctropnt-0.35* 09:55pm blood type-art o2 flow-10 po2-78* pco2-70* ph-7.32* calhco3-38* base xs-6 intubat-not intuba ## right leni : no evidence of deep vein thrombosis ## cxr : probable bilateral pleural effusions with multifocal patchy opacities that may represent fluid overload pattern in this patient with background emphysema. infection cannot be excluded. 07:10am blood wbc-8.5 rbc-3.54* hgb-9.9* hct-31.7* mcv-90 mch-28.1 mchc-31.3 rdw-14.6 plt ct-443* 07:10am blood glucose-90 urean-15 creat-0.8 na-142 k-4.7 cl-97 hco3-41* angap-9 05:00am blood ck-mb-notdone ctropnt-0.63* 08:00pm blood ck-mb-notdone ctropnt-0.42* 11:55am blood ck-mb-notdone ctropnt-0.31* brief hospital course: 75 yo man w/ complicated recent pmh including pea arrest, prolonged intubation w/ trach, mrsa/h influenza pna, gi bleed, here w/ multilobar pneumonia. pt sent to unit secondary to hypoxia and respitory distress earlier. in the unit pt received nebs and respiratory support. pt remained stable in the unit and was sent to floor. 1. resp distress: baseline for pt is 2l o2 at home with copd. he was initially treated empirically for possible mulifocal pna (asp, cap, vent-assoc pna), however pt remained afebrile and sputum culture (a good specimen) grew only sparse staph aureus. pt believed to be colonized only and antibiotics were stopped in micu. more likely etiology is cardiac given nstemi and chf. pt presented with trach, which upon examination during bronchoscopy was found to be in the mediastinum and was removed. resp status improved after trach removal. pt transferred from micu satting well on 4lnc with serovent qid. -lactate 1.5 and hd stable, which is reassuring. pt remained stable satting above 92% on 4l nc on the floor -hypoxia resolved after bronch and removeal of trach. -chest pt -home o2 -no indication for abx. were d/c;d in micu. * 2. copd: nebs prn, on chronic steroids (5 mg). pt will be sent home with prednisone 5mg, serovent, albuterol and salmeterol. * 3. cad: on bb, asa, statin. pt s/p nstemi this admission now cp free. continue to afterload reduce with captopril 6.25mg tid. will followup with dr. in mid for likely therapeutic cath. * 4. chf: euvolemic on exam, ef 35%. currenrtly euvolemic. on bb and acei. * 5. hemoptysis: in setting of bronch now resolved. * 6. gibleed: has h/o avm but hct stable for now. hct stable. on ppi. * 7. fen: d/c'ed on day of discharge. will go home on heart healthy po diet. * 8. dispo: patient being discharged to home with wife and daughter present. pt evaluated him and pt ok to go home with services. will need home o2, and chest pt. medications on admission: 1. allopurinol 100 mg qd 2. asa 325 mg qd 3. voltaren eye drops 4. finasteride 5 mg qd 5. lasix 20 mg --d/c 6. lansoprazole 30 qd 7. metoprolol 50 mg tid 8. pravachol 80 mg qd 9. prednisone 5 mg qd 10. flomax 0.4 mg 11. trazodone 50 mg qhs 12. remeron 7.5 mg qd 13. bacitracin to g tube 14. tylenol prn 15. lorazepam prn 16. hydrocortisone cream to his feet tid 17. insulin humalin sliding scale discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. diclofenac sodium 0.1 % drops sig: one (1) ophthalmic once a day (). 3. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 4. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. pravastatin sodium 20 mg tablet sig: four (4) tablet po hs (at bedtime). tablet(s) 6. toprol xl 50 mg tablet sustained release 24hr sig: two (2) tablet sustained release 24hr po once a day. disp:*90 tablet sustained release 24hr(s)* refills:*2* 7. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 8. tamsulosin 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po bid (2 times a day). 9. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime). 10. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). 11. hydrocortisone 1 % cream sig: one (1) appl topical tid (3 times a day). 12. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day). disp:*120 tablet, chewable(s)* refills:*2* 13. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). disp:*qs tablet(s)* refills:*2* 14. salmeterol xinafoate 50 mcg/dose disk with device sig: one (1) disk with device inhalation q12h (every 12 hours). disp:*60 disk with device(s)* refills:*2* 15. albuterol 90 mcg/actuation aerosol sig: one (1) inhalation q4-6h:prn. disp:*qs 1* refills:*2* 16. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). disp:*qs 1* refills:*2* 17. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 18. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day) as needed. 19. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: copd nstemi arf gibleeding discharge condition: stable discharge instructions: please continue to take all your medications as directed. please return to the ed if you experience any chest pain or shortness of breath. call pcp or return to ed if you have fevers, chills. followup instructions: please follow up with your pcp . .. please call ent to setup an appt for your ears. md, procedure: closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified other specified forms of chronic ischemic heart disease attention to tracheostomy attention to gastrostomy 

Answer: The patient is high likely exposed to