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: no known allergies / adverse drug reactions attending: chief complaint: sob major surgical or invasive procedure: right chest tube thoracostomy right video-assisted thoracoscopic surgery and decortication of lung. history of present illness: 52m ho testicular ca, ulcerative colitis, recently admitted to the osh icu for necrotizing pna x 5 days, did not require intubation but was on non-rebreather, who was discharged 2 days ago and since then has been having worsening dyspnea, malaise, sob, fever 101.8. pt initialy reported to ed and then transfered to ed. . in detail, pt reports 1 mo he had emesis and felt feverish, sluggish, malaise. the following week he had chest pain down his right side that reminded him of his prior stone in the common bile duct in . he saw a gi doctor who considered biliary colic. following day he felt worse and had fever and reported to osh hospital where he was diagnosied with a pneumonia and treated initialy with clinda and then switched to 4 days of zosyn and vanco. received total of 5 days of levoflox. cta was negative for pe but did reveal necrotizing pna in rul, pna in rll and lll, right sided effusion (this is all per wife who is rn). he was put on non-rebreather to maintain sats in 90s. he was discharged 2 days ago and felt a little better. today he felt worse, recurrent pleuritic cp, fevers and reported to osh. . while at ed he was given zofran for some nausea and then sent to ed. . in the ed, initial vs were: 90% ra, 139/83, rr 30, 91 hr, t 98.4 triggered for requiring 6l nc for sat in low 90s, rr 30s. access 18g given morphine, albuterol neb, ipratropium neb, zofran, zosyn 4.5g and plans to give vanco. given 1 l ns. blood cx drawns. labs: lactate 0.9, wbc 14, hct 40, plt 599. cxr:rml and rll opacity and effusion transfer vitals: 94% on 6l nc, 132/71, rr 22, hr 87, t 98.4 pt transfered to micu for resp distress in setting of pneumonia. . on arrival to the micu, pt is comfortable but diapharetic. denies any dyspnea or cough. ros positive for 16 ib weight loss since pna, night sweats for a few weeks, no cough whatsoever. has intermitten diarrhea from uc but has been having more episodes in setting of antibiotics lately. some blood in stool. past medical history: common bile duct stone sp ercp with stone removal ?biliary colic- getting outpatietn workup sciatica- gabapentin and tizanidine htn ulcerative colitis- mesalamine prn testicular ca renal cysts several lumbar spine surgeries complciated with e coli infection social history: 35+ smoking history, quit years ago, no drugs. he does not smoke, drink, or use any drugs. he is married. he has two children. he continues to work at stop & shop. family history: positive for cerebral aneurysm in his father as well as lung cancer in his mother. physical exam: vitals: t:99.6, hr 80, bp 133/69, 96% on 4l general: alert, oriented, diapharetic but no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: crackles in bases bilaterally, decreased breath sounds in right lower base abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: a+o x3 pertinent results: admission labs: 09:20pm blood wbc-14.6* rbc-4.72 hgb-13.5* hct-40.2 mcv-85 mch-28.6 mchc-33.6 rdw-13.0 plt ct-599*# 09:20pm blood neuts-77* bands-1 lymphs-8* monos-4 eos-8* baso-0 atyps-0 metas-2* myelos-0 03:55am blood pt-14.5* ptt-28.4 inr(pt)-1.4* 09:20pm blood glucose-119* urean-25* creat-1.2 na-140 k-4.3 cl-104 hco3-27 angap-13 03:55am blood alt-53* ast-35 ld(ldh)-204 ck(cpk)-34* alkphos-121 amylase-22 totbili-0.3 03:55am blood ck-mb-1 ctropnt-<0.01 04:46pm blood ck-mb-1 ctropnt-<0.01 09:20pm blood calcium-9.3 phos-4.3 mg-2.1 03:55am blood caltibc-177* ferritn-858* trf-136* 03:55am blood hiv ab-negative 12:14pm blood po2-81* pco2-48* ph-7.41 caltco2-31* base xs-4 cxr (): moderate cardiomegaly, new since , with large right and small left pleural effusions, central vascular congestion, and mild interstitial edema, concerning for cardiac decompensation. . tte (): the left atrium is mildly dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the estimated cardiac index is normal (>=2.5l/min/m2). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is moderately dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild-moderate pulmonary artery hypertension. there is a small to moderate sized pericardial effusion anterior to the right atrium (#37). the effusion appears loculated - ?pericardial cyst. impression: small/moderate loculated anterior pericardial effusion c/w ? pericardial cyst. normal biventricular cavity sizes with preserved global and regional biventricular systolic function. dilated ascending aorta. pulmonary artery hypertension. . cta chest (): 1. no pulmonary embolism or aortic pathology identified. 2. large right loculated simple appearing pleural effusion without areas of rim enhancement or complex density to suggest superimposed infectious process. significant amount of adjacent pulmonary parenchymal collapse is identified in all right lobes particularly the right lower lobe. 3. hypodensity in the lateral aspect of the collapsed right lobe likely due to pneumonia. 4. evidence of right heart strain with enlarged right ventricle and straightening of the interventricular septum. . 11:42 am pleural fluid right pleural fluid. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (preliminary): no growth. fungal culture (preliminary): no fungus isolated. 11:50 am abscess right pleural abscess. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (final ): no growth. anaerobic culture (preliminary): no growth. fungal culture (preliminary): no fungus isolated. 12:15 pm tissue pleural tissue right lung(intra pleural). gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. tissue (final ): no growth. anaerobic culture (preliminary): no growth. fungal culture (preliminary): no fungus isolated. brief hospital course: 52 m with htn and uc who was recently admitted to icu with necrotizing pneumonia, presented again with persistent sob, fevers and a para pneumonic effusion. . # pneumonia with para pneumonic effusion started on vancomycin, cefepime and levofloxacin the micu. ct scan showed a para pneumonic effusion on the lower right lobe. drained 1.7l by paracentesis while in the micu, with fluid showing an exudative pathology. chest tube remained in place and on suction. on he underwent a right vats decortication and tolerated the procedure well. he returned to the pacu in stable condition and maintained stable hemodynamics. he has 3 chest tubes in place for drainage. his pain medications required many adjustments but he was able to cough and deep breath and use his incentive spirometer effectively. his port sites were dry and healing well and his oxygen was weaned off easily. the infectious disease service also followed him during his stay and antibiotics were switched to vancomycin, ceftriaxone and flagyl for empiric coverage. he remained afebrile with a wbc down to 12k. his intraop cultures remained negative except for a pleural tissue culture which grew rare gram positive rods. the id team reviewed the cultures but felt that it was most likely a contaminent. they recommended completing a 3 week course of flagyl and levaquin and they will follow him in their out patient clinic in a few weeks. after an uneventful recovery he was discharged to home on and will follow up in the thoracic clinic in 2 weeks. medications on admission: citalopram - 20 mg tablet - 1 tablet(s) by mouth daily gabapentin - 800 mg tablet - 1 tablet(s) by mouth three times a day hydrochlorothiazide - 25 mg tablet - 1 tablet(s) by mouth once a day ibuprofen - 800 mg tablet - 1 tablet(s) by mouth three times a day standing mesalamine - 1,000 mg suppository - 1 suppository(s) rectally at bedtime prn diarrhea (last taken 1 mo ago) omeprazole - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth qam tizanidine - 4 mg tablet - 2 tablet(s) by mouth three times a day as needed for muscle spasm medications - otc multivitamin - tablet - 1 tablet(s) by mouth once a day discharge medications: 1. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 2. gabapentin 400 mg capsule sig: three (3) capsule po q8h (every 8 hours). 3. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. oxycodone 5 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*40 tablet(s)* refills:*0* 7. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours). 8. tramadol 50 mg tablet sig: two (2) tablet po qid (4 times a day). disp:*60 tablet(s)* refills:*2* 9. colace 100 mg capsule sig: one (1) capsule po twice a day. 10. senna 8.6 mg tablet sig: two (2) tablet po at bedtime as needed for constipation. 11. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for wheezing. disp:*1 inhaler* refills:*0* 12. levofloxacin 750 mg tablet sig: one (1) tablet po daily (daily): thru . disp:*16 tablet(s)* refills:*0* 13. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours): thru . disp:*50 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: empyema. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: * you were admitted to the hospital for lung surgery and you've recovered well. you are now ready for discharge. * continue to use your incentive spirometer 10 times an hour while awake. * check your incisions daily and report any increased redness or drainage. cover the area with a gauze pad if it is draining. * your chest tube dressing may be removed in 48 hours. if it starts to drain, cover it with a clean dry dressing and change it as needed to keep site clean and dry. * you will continue to need pain medication once you are home but you can wean it over a few weeks as the discomfort resolves. make sure that you have regular bowel movements while on narcotic pain medications as they are constipating which can cause more problems. use a stool softener or gentle laxative to stay regular. * no driving while taking narcotic pain medication. * take tylenol 650 mg every 6 hours in between your narcotic. if your doctor allows you may also take ibuprofen to help relieve the pain. * continue to stay well hydrated and eat well to heal your incisions * shower daily. wash incision with mild soap & water, rinse, pat dry * no tub bathing, swimming or hot tubs until incision healed * no lotions or creams to incision site * walk 4-5 times a day and gradually increase your activity as you can tolerate. call dr. office if you experience: -fevers > 101 or chills -increased shortness of breath, chest pain or any other symptoms that concern you. followup instructions: department: hematology/oncology when: thursday at 3:30 pm with: , md building: sc clinical ctr campus: east best parking: garage please report 30 minutes prior to your appointment to the radiology department on the of the clinicla center for a chest xray. department: infectious disease when: tuesday at 11:00 am with: , md building: lm bldg () campus: west best parking: garage department: when: monday at 8:10 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: insertion of intercostal catheter for drainage thoracoscopic decortication of lung diagnoses: sciatica unspecified essential hypertension other chronic pulmonary heart diseases personal history of tobacco use depressive disorder, not elsewhere classified pneumonitis due to inhalation of food or vomitus ulcerative colitis, unspecified examination of participant in clinical trial empyema without mention of fistula 

Answer: The patient is high likely exposed to