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: methyldopa / atenolol / codeine / norvasc attending: chief complaint: hypercarbic respiratory failure major surgical or invasive procedure: endotracheal extubation (intubated at rehab facility) history of present illness: the patient is an 82 yo m with h/o copd (fev1 0.56 in ) and recent hospitalization for pneumonia, discharged from here to rehab on . today he was noted to be dyspneic. he was given nebs and an extra dose of steroids and an abg showed 7.3/79/126/39. he failed bipap and was intubated at and transferred here. in the ed, initial vs were: t 100.2 p 103 bp 123/87 r 17 o2 sat 100. patient was given cefepime, levo, 2l ns, nebs and propofol. . on review of records, he was achypneic to 24 on routine vitals today and yesterday. hypertensive this am to 179/95. overall net positive fluid balance over past week >3l. . on discussion with rn at , the patient has been non-compliant with bipap using it for several hours a night at the most. he was transfered to the more acute floor at last night for an acute worsening of dyspnea. an abg in the evening of showed 7.31/79/73/39. he was non-compliant with bipap. patient was mildly confused. no cough rn. no increased sputum. no fevers. again this morning, he appeared very short of breath. a series of abgs showed: 7.3/79/126/39 @0653 7.2/108/135/43 @0849 7.3/76/46/40 @1030 he was encouraged to wear the bipap but he was non-compliant and in fact was given the option of bipap or intubation and consented to the intubation. he was then intbutaed and given 5mg versed and total 10mg diazepam. he was also given 60mg iv methylpred @1400. . on arrival he is sedated and intubated but responds to verbal stimuli. he complains of pain and points to his lower abdomen. he confirms that pain is the bladder spasm pain. his family is present and states that he had been doing well but seemed much worse last night with labored breathing and audible wheezes and also lethargic. they are not aware of any precipitating events and are not aware if was aspirating. . of note, they also states that he had been dnr/dni but reversed code status for them. past medical history: -hypertension -chronic back pain -copd -hyperlipidemia -bph -gastritis -djd social history: lives alone and is independent with adls. he had a recent mechanical fall with left leg bruising. he quit smoking >40 years ago. he drinks socially. no illicits. family history: positive for pancreatic cancer in his brother, positive for diabetes in his mother, positive for cad in his father, positive for hypertension in his mother, positive for throat cancer in his mother, questionable stomach cancer in his sister. physical exam: on admission: gen: intubated, awake, opens eyes to voice, follows commands heent: perrla cv: nl s1/s2, no m/r/g, rrr chest: anterior vent sounds with rhonchi and rales abd: soft, nt/nd, bs+ ext: 1+ pitting edema to knees b/l . death exam: unresponsive to deep pain and sternal rub pupils fixed and unreactive no ausculated or visible breath sounds no palpable or ausculated pulses or heart rate x 60 seconds cool extremities with no palpable pulses pertinent results: on admission: ============= 01:19pm blood wbc-18.5* rbc-3.40* hgb-10.5* hct-33.2* mcv-98# mch-30.8 mchc-31.5 rdw-14.0 plt ct-145* 01:19pm blood neuts-94* bands-2 lymphs-1* monos-2 eos-0 baso-0 atyps-1* metas-0 myelos-0 01:19pm blood hypochr-1+ anisocy-occasional poiklo-normal macrocy-occasional microcy-normal polychr-normal 01:19pm blood pt-11.7 ptt-22.9 inr(pt)-1.0 01:19pm blood glucose-146* urean-33* creat-1.0 na-146* k-4.8 cl-106 hco3-35* angap-10 10:35pm blood ck(cpk)-13* 05:10am blood alt-18 ast-16 ck(cpk)-21* alkphos-53 totbili-0.4 01:19pm blood ctropnt-<0.01 10:35pm blood ck-mb-2 ctropnt-<0.01 05:10am blood ck-mb-2 ctropnt-<0.01 probnp-243 03:14am blood ck-mb-3 ctropnt-<0.01 10:35pm blood calcium-8.7 phos-2.5*# mg-1.5* 09:18pm blood d-dimer-1487* 05:10am blood caltibc-159* ferritn-245 trf-122* 08:05pm blood type-art rates-16/ tidal v-500 peep-10 fio2-50 po2-107* pco2-57* ph-7.43 caltco2-39* base xs-11 -assist/con intubat-intubated 01:33pm blood lactate-1.6 . on discharge: ============= 02:46am blood wbc-9.3 rbc-3.25* hgb-9.9* hct-30.3* mcv-93 mch-30.5 mchc-32.7 rdw-13.7 plt ct-110* 02:49pm blood glucose-98 urean-49* creat-1.1 na-139 k-4.6 cl-96 hco3-40* angap-8 02:46am blood calcium-9.3 phos-2.6* mg-1.9 10:50am blood type-art temp-35.9 rates-/30 tidal v-700 peep-5 fio2-40 po2-74* pco2-70* ph-7.38 caltco2-43* base xs-12 intubat-intubated 04:43pm blood type-art temp-36.6 rates-/29 tidal v-845 peep-5 fio2-50 po2-118* pco2-68* ph-7.40 caltco2-44* base xs-14 intubat-intubated vent-spontaneou 02:56am blood type-art temp-36.1 po2-96 pco2-75* ph-7.36 caltco2-44* base xs-13 intubat-intubated 02:59pm blood type-art temp-36.8 po2-81* pco2-74* ph-7.35 caltco2-43* base xs-10 intubat-not intuba . imaging: ======== cxr : the ng tube tip is in the stomach. the et tube tip is approximately 7 cm above the carina. there is no change in severe upper lung emphysema and multifocal bilateral consolidations. consolidation is better delineated on the ct chest obtained on . . cta : 1. no evidence of pulmonary embolism. 2. multifocal pneumonia. 3. moderately severe centrilobular emphysema. . echo : the left atrium is normal in size. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast at rest. there is mild symmetric left ventricular hypertrophy with normal cavity size. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). the right ventricular free wall is hypertrophied. right ventricular chamber size is normal. with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse or regurgitation. there is moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a prominent fat pad. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with preserved ejection fraction. right ventricular hypertrophy with preserved systolic function. at least moderate pulmonary hypertension. no intracardiac shunt by bubble study (only done at rest). . cxr : the et tube tip is 3 cm above the carina. the picc line tip is at the level of low svc. cardiomediastinal silhouette is stable. bibasal consolidations are unchanged as well as upper lung emphysema. overall no significant change since the most recent prior radiograph is noted. as compared to more remote radiographs from the appearance is unchanged as well. . brief hospital course: 82yo m with copd p/w hypercarbic respiratory failure and pneumonia who had a progressively declining clinical course and eventually expired after transitioning care to comfort measures only. . # hypercarbic respiratory failure ?????? patient was admitted intubated from rehab though previously dni, his code status was reversed after he was found hypoxic at his facility. he was ruled out for pe on admission and imaging revealed volume overload, multifocal pneumonia, and severe underlying emphysema. no evidence of acs on admission. patient was continued on vancomycin, cefepime, and levofloxacin for hcap coverage without improvement in radiographic or clinical status. he was diuresed with iv lasix and continued on prednisone 35mg daily. patient was extremely clear about his desire to remove the tube and was awake and alert while intubated. family expressed that patient has been consistent about these wishes even prior to this admission. given patient's prior and current wishes to be dnr/dni and overall poor prognosis, family decided to proceed with extubation. the patient expressed on repeated occasions that he wanted the tube removed and did not want to be reintubated under any circumstances. after the extubation, patient's clinical status deteriorated and after extensive discussion with the family, his care was transitioned to focus on comfort. he was started on a morphine gtt and all other measures were discontinued. patient expired later that same day, please see event notes below regarding the circumstances of his death. . attending icu death/event note: prior to extubation patient expressed clear wish to be extubated and did not want to be reintubated even if it meant he would die. family understood his wishes and agreed to respect them. patient extubated at midday with family present. initially did well but became progressively uncomfortable with labored breathing and obvious distress. morphine infusion begun to control breathlessness. other medications discontinued as family agreed to respect patient's wish to be comfortable. this evening bp and oxygen saturation progressively declined with bp by arterial line < 60 systolic for several hours. oxygen discontinued along with other measures not aimed at comfort. i was called at approx 1:30 because family was upset and questioning management. lengthy discussion with family regarding focus on comfort. emphasized that we had agreed that morphine would be used for comfort and that other measures would not be continued unless directed at his comfort. physicians and nurses all agreed mr. was unresponsive and feeling no pain. family remained upset, angry, questioning all care although they understood he was dying and his wishes were being respected. during this conversation mr. died and they were informed of his passing at 2:18. code purple called as family became increasingly angry and belligerent. . resident icu death/event note: patient was extubated this am and subsequently confirmed dnr/dni with family and patient. patient was very clear about not wanting the tube replaced even if his respiratory status worsened. post-extubation, patient became tachypneic to rr in the 40s and o2 sats dropped to high 80's on 5l nasal cannula. we discussed extensively with the family his goals of care and they decided to make him cmo. he was started on a morphine drip and ativan prn for comfort of breathing and antibiotic therapy was discontinued. patient was very comfortable and in no distress throughout the day on the morphine drip, his o2 sats drifted down to the 50-60s on nasal cannula and bp persisted at sbp 40-50s for several hours. at 2:16am patient expired with family present at bedside. several family members were extremely upset at time of death given concern for the nasal cannula being weaned down despite dropping o2 sats throughout the evening. they had expressed similar concerns throughout the day about his rehab facility, stating that "they were just going to let him die if we didn't undo his dni." attending and nurse manager were called to mediate, but the family became more argumentative and combative, threatening to " for killing father", and a code purple was called to control the situation. situation deescalated and family ultimately declined autopsy. patient was examined at bedside and pronounced at 2:16am. his pcp was notified by phone and email. case was not reported to the medical examiner. . medications on admission: nystatin swish/swallow 5cc q6 carbamaide peroxide drops 5 drops q12 r ear diphenhydramine 25 po daily (last dose 5/23) docusate sodium 100 q 12 ensure 1 can daily finasteride 5mg daily advair diskus 250 mcg-50 mcg twice a day hctz 12.5 mg daily combinebs q6h lip balm qid lisinopril 20 daily loperamide 4mg q4h prn (last given ) loratidine 10mg daily melatonin 5mg hs multivit with min daily pantoprazole 40 q24 saccharomyces 250 po tid saline nasal spray q8h senna/docusate 1 simvastatin 10 tamsulosin 0.4 hs triamcinolone orabase qid prn inner lip verapamil 240 sr prednisone taper. now on 5mg discharge medications: expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified arterial catheterization diagnoses: pneumonia, organism unspecified other chronic pain unspecified essential hypertension atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other and unspecified hyperlipidemia acute and chronic respiratory failure pneumonitis due to inhalation of food or vomitus alkalosis personal history of noncompliance with medical treatment, presenting hazards to health hyperosmolality and/or hypernatremia backache, unspecified family history of malignant neoplasm of gastrointestinal tract family history of malignant neoplasm of other respiratory and intrathoracic organs 

Answer: The patient is high likely exposed to