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, fever, respiratory failure major surgical or invasive procedure: intubation aline placement ij line placement x 2 bronchoscopy esophageal balloon placement history of present illness: this is a 55 yo m with h/o htn who initially presented to an osh 2 days ago complaining of fevers, sob and now is being transferred in the setting of respiratory failure. history is obtained from osh records and pt's family. per osh d/c summary, pt was being conservatively treated for uri sxs 5 days prior to presentation to osh with ? unknown abx, cefclor, promethazine, and codeine but did not feel better and thus was admitted to on . at the time, he was reportedly complaining of subjective fevers, chills, rigros, sore throat, shortness of breath, and cough without hemoptysis. no diarrhea, abd pain, n/v, myalgias. . on presentation to osh, febrile to 104.3, o2 sat 91% on ra --> 96% 4l nc, rr 18. wbc 4.7 with 86.3% neutrophils, plts 106k, na 128, cr 1.2, hco3 29. cxr revealed multi-focal pna (l>r). flu swab negative. sputum cx, urine legionella, hiv still pending. he was placed on respiratory isolation for r/o tuberculosis for unclear reasons other than his history of being from . he was treated with iv vancomycin, ceftriaxone, azithromycin and bactrim (added on ). however, on am of transfer, pt noted to desat from 97% on 2-3l nc to 77%, requiring nrb. pt also noted to be tachypneic with rr in 30s, febrile to 101-102 in spite of tylenol. abg 7.44/35/71/24 on nrb. cxr revealed nearly complete white out of left lung. . upon arrival to the , the pt is intubated and not responsive to sternal rub. past medical history: htn hypercholesterolemia social history: works as school bus driver. married and lives at home with wife. etoh, illicits, ivda, tobacco per osh d/c summary. moved to usa from 20 years ago. no other known recent tuberculosis risk factors. family history: no family contacts with known tuberculosis. otherwise non-contributory physical exam: 98.1 149/91 92 20 97ra glucose 148 gen: appears weak, but comfortable, non-toxic. nad. heent: clear op, mmm neck: no lad. cv: rrr, no mrg, +2 pulses chest: cta b, good ae. abd: +bs, soft, nt/nd ext: no edema, well perfused neuro: cn2-12 grossly intact, no focal defecits. msk: profound generalized weakness, slowly improving daily. unable to feed self, able to sit forward in chair, but unable to sit up in bed from lying position. strength 3/5 diffusely. pertinent results: labs on admission: 03:32pm blood wbc-3.5* rbc-3.76* hgb-11.5* hct-32.8* mcv-87 mch-30.6 mchc-35.1* rdw-13.3 plt ct-119* 03:32pm blood neuts-79* bands-10* lymphs-9* monos-1* eos-0 baso-0 atyps-1* metas-0 myelos-0 03:32pm blood pt-13.8* ptt-36.9* inr(pt)-1.2* 03:32pm blood wbc-3.5* lymph-10* abs -350 cd3%-43 abs cd3-150* cd4%-34 abs cd4-120* cd8%-10 abs cd8-33* cd4/cd8-3.62* 03:32pm blood glucose-204* urean-13 creat-0.8 na-131* k-4.8 cl-100 hco3-25 angap-11 03:32pm blood alt-76* ast-201* ld(ldh)-1794* ck(cpk)-5948* alkphos-51 amylase-74 totbili-0.3 03:32pm blood lipase-64* 03:32pm blood albumin-2.8* calcium-6.8* phos-2.7 mg-2.3 . micro: bal: gnrs pcp- hiv - negative, hiv viral load negative cryptococcal ag- negative toxo ab- negative c. diff- negative cmv ab and viral load- negative legionella negative beta glucan and galactomannan- negative viral resp culture- negative echinococcus antibody igg- negative mycoplasma- negative hsv - igg + for hsv1, igm - neg ehrlichia- negative histoplasmosis- pnd entamoeba- pnd hanta virus- neg leptospira- pnd lcm- pnd q-fever- negative . reports- . echo- the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion . ct torso impression: 1. extensive multifocal pulmonary consolidations with areas of ground-glass opacity, together suggestive of extensive infection. 2. hepatic hypodensity as above, most likely a cyst. 3. large amount of fluid seen throughout the colon, with further characterization not possible on this non-contrast study . leni impression: no dvt of either lower extremity . cxr : impression: 1. ng tube tip in stomach. 2. multifocal pneumonia with slight improvement in left upper lobe aeration. . abd us: impression: 1. gallbladder sludge with no evidence of cholecystitis. 2. left hepatic cyst unchanged from that described on ct done on the same day. . ct cap: impression: 1. extensive multifocal pulmonary consolidations with areas of ground-glass opacity, together suggestive of extensive infection. 2. hepatic hypodensity as above, most likely a cyst. 3. large amount of fluid seen throughout the colon, with further characterization not possible on this non-contrast study. . discharge labs: 06:00am blood wbc-9.3 rbc-3.55* hgb-10.8* hct-32.9* mcv-93 mch-30.5 mchc-32.9 rdw-15.5 plt ct-329 06:00am blood neuts-63.9 lymphs-22.6 monos-6.2 eos-6.7* baso-0.6 03:32pm blood wbc-3.5* lymph-10* abs -350 cd3%-43 abs cd3-150* cd4%-34 abs cd4-120* cd8%-10 abs cd8-33* cd4/cd8-3.62* 06:00am blood glucose-93 urean-17 creat-0.8 na-136 k-3.8 cl-101 hco3-24 angap-15 04:05am blood alt-61* ast-30 alkphos-84 totbili-0.6 06:15am blood calcium-8.8 phos-3.2 mg-2.0 10:45am blood anca-negative b 10:45am blood -negative 04:07am blood hiv ab-negative brief hospital course: 55 m w htn, who originally presented to osh w fever/sob, and was subsequently transferred to in hypoxic respiratory failure in the setting of multi-focal pna. . # acute hypoxic respiratory failure: pt required intubation before transfer to . he had prolonged fevers without identifable cause. required high peep requirement while on vanc/zosyn/levo. he had a multifocal pna on cxr and required proning to increase oxygenation. he had a low cd4 count despite negative hiv test at and osh. there was concern also for pcp and he was also treated with steriods and bactrim. bactrim was later stopped and then later restarted. steriods were stopped and then restarted and later tapered. differential included cap vs interstitial inflammatory process (acute interstial pna, acute eosionphilic pna) vs vasculitis. vasculitis less likely with no hemorrhage on bronch on , and negative , anca, and anti-gbm. infectious work-up showed: hiv 1 and 2 negative, pcp negative, and glucactomanna negative, legionella antigen negative, viral culture negative, blood cultures negative, toxo negative, cmv negative, ehrlichia negative, mycoplasma negative. urine culture yeast only. neg hep c/b. met hb normal. had a dose of caspo on , was discontinued following discussion with id. echinococcus, lcm, hanta virus, and entamoeba negative. due to high levels of peep initally bal and bronch were not able to be completed until . cx from bal grew a small amount of yeast and was negative for pcp and virus; afb was negative as well. id closely followed the patient. he was treated with vancomycin, zosyn, levo. also had azithro, flagyl (stopped with negative c. diff), bactrim, doxycycline, and micafungin. during also had et complication of a partial extuabation with cuff above vocal cords, then was corrected. 2 days later had rupture of balloon and et tube exchanged. xray with findings of pneumomediastinum, thoracics evaluated pt, otherwise stable and though to be secondary to high peep. patient was gradually weaned off the vent over the course of the next couple days and was extubated on without complication. on , antibiotics were discontinued. pt was transferred to the floor stable, on room air, and on tube feeds due to failed swallow study on . on the floor, patient remained afebrile with stable pulmonary status. he was continued on a slow prednisone taper, as it is unclear if steroids in the icu were responsible for some of his improvement in the icu. on his prednisone was decreased from 10 mg to 7.5 mg, with plans to decrease dose by 2.5 mg every 5 days until off. # hypertension: has hx of htn at baseline. intially bp meds held. later in course bp was elevated. he was give sedation as needed and treated with prn hydral and metoprolol. bp was labile, and was increased as sedation was weaned. pt required propofol, versed, and fentanyl to prevent agitation. . pt was started on metoprolol and later low dose lisinopril was added for improved bp control. please follow up on his blood pressure and titrate medications as necessary. please note that his blood pressure may improve as his prednisone dose decreases. please check lytes, bun/cr in 5 days to ensure tolerating lisinopril. . # arf: developed acute renal failure but had adequate uop. fena consistent with pre-renal, however was third spacing. given blood as neede. renally dosed meds. . renal failure improved, and normalized by the time of discharge. . # hypernatremia: developed hypovolemia hyponatremia. improved with free water boluses as needed. . # constipation/diarrhea: initially had consiptiaon, then later had diarrhea after po contrast and bowel meds. c. diff negative x 3. diarrhea later improved. had a flexiseal placed. abd ct without obstruction of evidence of acute process. diarrhea resolved. . # diabetes: had elevated blood sugars elevated, that were more elevated with steriod treatments. was placed on ssi intiailly then changed to insulin gtt. on the floor, he was treated with sq insulin, but did not reliably require insulin. please follow glucose levels, and consider starting metformin if remains elevated. . # elevated ldh, ck: had what appeared to be rhabomyolisis. ck to . given ivf and monitored uo. ck improved. . # hyperkalemia: with renal failure and rhabo had developed elevated k to >6. no ekg changes. was treated with kayexalate and insulin. improved once bms started. resolved by time of discharge. . # anemia: unclear cause, but likely marrow suppression due to acute illness. hemolysis labs negative. . # pancytopenia: initially thrombocytopenic at osh but has progressively developed leukopenia and anemia. low cd4, but with negative hiv testing. unclear cause. cell counts improved. . # weakness: pt was noted to have profound generalized weakness, initially unable to sit up in bed, feed self, or lift arm above shoulder. pt worked with pt with gradual but signif improvement. the profound weakness is thought to be due to an icu myopathy from prolonged intubation/sedation. pt will be discharged to for inpatient rehab. medications on admission: home medications: atenolol 25 mg daily cefaclor 250 mg po tid promethazine tsp qid . medications on transfer: vancomycin 1 gm iv q12h (last dose 1200) ceftriaxone 1 gm iv q24h (last dose 6/4 1400) azithromycin 250 mg iv q24h (last dose 6/4 1800) bactrim 350 mg iv q6h (last dose 1000) albuterol neb q1h prn albuterol neb q6h prn ipratropium neb q6h prn lidocaine sl ntg 0.4 mg prn maalox 30 ml q2-4h prn milk of magnesia 10 ml daily prn docusate 100 mg prn atenolol 25 mg daily tylenol 1gm q6h prn benzonatate 100 mg tid prn pantopraozle 40 mg daily hydrocone syrup 5 ml q4h prn propofol 150 mg iv x 1, vecuronium 10 mg iv x 1, ativan 4 mg iv x 1 and then 2 mg iv x 1 with intubation discharge medications: 1. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 2. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 3. prednisone 5 mg tablet sig: as dir tablet po once a day: 7.5 mg po q day x 4 days, then 5 mg po q day x 5 days, then 2.5 mg po q day x 5 days, then d/c. 4. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily): please check lytes, bun/cr in 5 days. note: started on . 5. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain or fever. discharge disposition: extended care facility: - discharge diagnosis: # acute respiratory failure/multifocal pneumonia; unclear etiology (presumed infectious) # ards # icu myopathy/profound weakness # hypertension # anemia discharge condition: stable discharge instructions: you were admitted for an acute respiratory failure that required prolonged intubation. extensive laboratory workup was performed, but no definative diagnosis was able to be made, however we suspect that this was due to an infectious etiology. you were treated with antibiotics, and are now only being treated with a slow taper of prednisone. after your icu stay, you were profoundly weak, and will require inpatient rehab to help you regain your strength. followup instructions: recommend a slow prednisone taper for his respiratory failure of unclear etiology. pt's prednisone was decreased from 10mg to 7.5 on , and recommend decreasing by 2.5 mg every 5 days until off. . pt was started on lisinopril on for hypertension. please note that this may improve once off of prednisone. please follow up lytes/bun/cr in 5 days to ensure tolerating well. titrate prn. . pt will need aggressive pt. patient is highly motivated. . recommend monitoring patient off of insulin, and if persistently hyperglycemic, consider starting metformin. . he should follow up with his primary care physician in approx 2 weeks. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube arterial catheterization closed [endoscopic] biopsy of bronchus injection or infusion of oxazolidinone class of antibiotics diagnoses: pneumonia, organism unspecified acidosis anemia, unspecified pure hypercholesterolemia unspecified essential hypertension acute kidney failure, unspecified hyposmolality and/or hyponatremia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure hypotension, unspecified diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled other specified disorders of biliary tract mechanical complication due to other implant and internal device, not elsewhere classified hypoxemia diarrhea accidents occurring in residential institution rhabdomyolysis other specified disorders of liver dysphagia, unspecified 

Answer: The patient is high likely exposed to