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: dyspnea major surgical or invasive procedure: intubation history of present illness: mr. is a 70 year old man with multiple medical problems including copd (2l home 02), dm2, gerd, htn, hld, cad s/p nstemi , recurrent pna, aaa, recent pneumothorax, chf (ef=20-25%), as (valve area of 0.9cm2 and valve gradient of 38) af on coumadin, who is transferred from icu to for increasing pulmonary edema and hypotension. . on , he presented to osh with sob, orthopnea, and pnd, similar to multiple admissions over the past years. admitted with a diagnosis of chf exacerbation (bnp>500) in the context of likely copd flare, then transferred to . cardiac cath/tte showed severe aortic stenosis (valve area of 0.9cm2 and valve gradient of 38). his cardiac output was also preserved, at 5.4l/min. cardiac surgery and pulmonary was consulted to comment on his candidacy for avr and he was deemed to be a poor open surgical candidate due to his existing comorbidities, but possibly for percutaneous valve replacement in the future. he was not aggressively diuresed, due to his preload dependence and he was discharged to rehab on his daily 10mg predisone after completing a 7-day taper. . the patient had a previous admission at nwh from was initially admittted because of severe dywspnea and concerns for an nstemi. at osh lab studies were notable for acardiac enzyme peak ck of 115 and mb of 10.7, with a peak troponin of 4.33. microbiology was notable for a urine culture which grew 2 types of pseudomonas, subswuqently changed foley. his sob was initally believed to be copd flare/pneumonia than chf. the patient improved on iv solumedrol. . on his most recent admission on , the patient noted that he woke up this am feeling sob. he was given an albuterol neb, which per pt worsened his sob. in osh ed he recieved adenosine 18 mg total which failed to break his tachypnea, and he was also noted to be tachycardic into the 150s; he also recieved iv lopressor and was transferred to icu where he was placed on bipap and given dilt 10 mg iv which hr down to 120s. the patient was given abx for possible pneumonia in the setting of elevated wbc to 26. patient given iv lasix. methylprednisolone, pantroprazole, and fluticasone/sealmeterol, tiotropium, insulin, vancomycin, imipenem-calastin. today the patient developed acture respiratory distress that was not responsive to iv lasix 80s or a lasix gtt; the team felt that his problem was likely cardiac and mechanical, he should be transferred to . . . upon arrival at , patient had an a line placed c sbp in the 140/70, noted tachypnia at 33, and face mask o2 at 12 l. hr 114. he appears uncomfortable with accewssory muscle use, and was transitioned to bipap. . past medical history: 1. cardiac risk factors: diabetes +, dyslipidemia +, hypertension + 2. cardiac history: -atrial fibrillation on coumadin -congestive heart failure. ef 20-25% -inferior nstemi -severe aortic stenosis (valve area 0.9) -cabg: n/a -percutaneous coronary interventions: n/a . 3. other past medical history: -chronic obstructive pulmonary disease, 2l home o2 -noninsulin dependent diabetes mellitus -questionable history of syncope -history of pulmonary embolus in -gerd -left femoral aneurysm repaired -aaa, infrarenal evaluated at 4.5cm on ct -recurrent pneumonia -lung nodules, stable -large pneumothorax requiring chest tube post-bronch social history: the patient is divorced. he is retired . he currently lives alone. he reports 5ppd and stopped 8 months ago. he reports rare alcohol use, however, reported daily alcohol use at the age of 20 for approximately ten years family history: mother died age 72 of a "neck spinal cord injury." no knowledge of father. grandmother thromboembolic cva. physical exam: vs: t 96.3 bp 140/80 hr= 114 rr= 32 o2 sat= 94% on bipap. general: tachypneic. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 14 cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. difficult to ascultate any murmur secondary to heavy breath sounds. lungs: no chest wall deformities, scoliosis or kyphosis. resp were labored with accessory muscle use. lungs are diffusely wheezy with crackles at the bases. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: cxr impression: ap chest compared to : extensive opacification in right lower lung probably due to pulmonary edema in the setting of chronic emphysema. previous pneumonia in the axillary subsegments of the left upper lobe appears to have improved but there may be bronchietasis in its wake. heart is top normal size. left pic line ends at the origin of the left brachiocephalic vein. no pneumothorax. small bilateral pleural effusions are present. . cxr et tube in standard placement. left pic line ends in the left brachiocephalic vein and a nasogastric tube passes into the stomach and out of view. heterogeneous opacification in the right mid and lower lung zone has improved, probably due to decreasing edema in the setting of severe emphysema, but the asymmetry still raises concern for extensive pneumonia particularly due to aspiration. volume loss in the left lower lobe is improving. small bilateral pleural effusions are presumed. no pneumothorax . cxr 1. worsening left lower lobe atelectasis and mild interval increase in size of bilateral pleural effusions, small on the right, small-to-moderate on the left. 2. resolving right pulmonary heterogenous opacity, either represents pulmonary edema or pneumonia. . cxr impression: stable left lower lobe atelectasis and small left pleural effusion. . cxr lines and tubes are stable. there are unchanged bilateral pleural effusions, left side worse than right. hazy left retrocardiac opacity is also seen. there is some coarsening of the interstitial markings; however, no overt pulmonary edema is identified. . cxr tracheal and nasogastric tube have been removed. there is a right ij central venous line with the distal lead tip in the mid svc. there is coarsening of the bronchovascular markings which has worsened since previous. these are more confluent within the right base. this may represent developing infiltrate or an element of pulmonary edema. there is unchanged left-sided pleural effusion. brief hospital course: # respiratory failure: patient presented with large right-sided infiltrates, pulmonary edema, and baseline end-stage copd on admission. on admission he failed bipap trial prompting intubation. he was aggressively diuresed with iv lasix gtt and then transitioned to iv lasix on . initial extubation postponed secondary to significant aggitation. successful extubation on with transition to bipap and then face mask. he continued to be aggitated off sedation, olanzapine was traded for haldol around the on while having cvl replaced and lying flat, developed significant dypsnea and increasing o2 requirement requiring re-intubation. repeat cxr consistent with right-sided pleural effusion and increase in pulmonary vascular markings consistent with likely flash pulmonary edema. patient was extubated several days later, and initally did well. after speaking with his health care proxy, his daughter, it was decided to make patient dnr/dni. 48 hours post-extubation, he continued to be dependent on bipap, looking increasingly uncomfortable. after speaking with patient's daughter, decision was made to take patient off bipap and make him cmo. he expired roughly 45 minutes after removal of bipap. . # pump: initially presented in acute on chronic chf with likely multifactorial etiology including depressed ef, critical as, and poor baseline contractility. aggressively diuresed with lasix gtt. it was determined that due to his multiple comorbidities, his increasing deconditioned status, as well as information gathered from family and friends stating he would not want to be institutionalized for a prolonged period of time, he would not be a candidate for valvuloplasty and/or percutaneous valve replacement. . # rhythm: presented with a history of atrial fibrillation on coumadin. coumadin was held and he placed on a heparin gtt. he became persistently tachycardic throughout hospilization, worsening with extubation and fever. on hd 5, ekg revealed atrial fibrillation with rvr that was unresponsive to iv metoprolol. he was loaded on a diltiazem drip and heparin gtt with heart rates persistently in the 130s and sbps in the 120-130s. on hd 5 he was put on amiodarone gtt. he was d/c cardioverted and remained in sinus rhythm until he expired. medications on admission: 1. glucotrol xl 10 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 2. mucinex 1,200 mg tab, multiphasic release 12 hr sig: one (1) tab, multiphasic release 12 hr po twice a day. 3. levalbuterol hcl 0.31 mg/3 ml solution for nebulization sig: one (1) nebulizer inhalation every 4-6 hours as needed for shortness of breath or wheezing. 4. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 5. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 6. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily) as needed for constipation. 8. proair hfa 90 mcg/actuation hfa aerosol inhaler sig: inhalation every 4-6 hours. 9. tylenol 325 mg tablet sig: two (2) tablet po every six (6) hours as needed for pain: not to exceed 4 grams daily. 10. alprazolam 0.25 mg tablet sig: one (1) tablet po bid (2 times a day). 11. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 12. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 13. cardizem cd 120 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po twice a day. 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po bid (2 times a day). 16. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) puff inhalation (2 times a day). 17. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 18. prednisone 10 mg tablet sig: one (1) tablet po once a day. 19. januvia 100 mg tablet sig: one (1) tablet po once a day. 20. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 21. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 22. warfarin 5 mg tablet sig: one (1) tablet po once a day. 23. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 24. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*3* 25. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*3* 26. outpatient lab work 27. outpatient lab work 28. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 29. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po twice a day. discharge medications: n/a discharge disposition: expired discharge diagnosis: primary: respiratory failure secondary: end-stage copd tertiary: aortic stenosis discharge condition: expired procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances atrial cardioversion diagnoses: congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation aortic valve disorders personal history of tobacco use other and unspecified hyperlipidemia acute and chronic respiratory failure cardiogenic shock intestinal infection due to clostridium difficile old myocardial infarction long-term (current) use of anticoagulants personal history of venous thrombosis and embolism do not resuscitate status abdominal aneurysm without mention of rupture hyperosmolality and/or hypernatremia ventilator associated pneumonia acute on chronic systolic heart failure pneumonia due to klebsiella pneumoniae 

Answer: The patient is high likely exposed to