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: shortness of breath major surgical or invasive procedure: none this hospitalization history of present illness: mr. is a 52yo male with a past medical history of non-ischemic cardiomyopathy (lvef 30%-35%), insulin-dependent diabetes mellitus, hepatitis c infection, htn, hld, schizophrenia and depression who is presenting in acute respiratory distress after recent admission to the micu/gen med () for similar presentation. the patient reports that he was smoking crack cocaine earlier 2 days ago began to have chest pain and progressive shortness of breath over the past 2 days. he also reports worsening of productive cough (white sputum) which has been present since his discharge from the hospital on . he says that he felt that he never truly returned to his baseline after his last hospitalization. he says that he has had worsening orthopnea, with use of 3 pillows instead of his usual 2 last night. he denies edema, pnd. he denies fevers/chills or other uri sx, chest pain/pressure, pleuritic pain. he has had a vna and reports that his weight has decreased from 183 to 180, he has avoided salt in his diet and he has been fully compliant with this medications. he does think that the crack that he smoked 2 days ago had "less baking soda in it." the patient also does have a past medical history of mrsa pna requiring tracheostomy. . he also had admission from in which he was intubated and ct showed multifocal pneumonia. because the radiographic evidence of this pneumonia cleared quickly within 2 weeks, it was felt that this was crack lung as opposed to infectious. he was treated with broad spectrum abx and his respiratory status returned to baseline. during his admission , the patient was felt to have crack lung/hypersensitivity pneumonitis given parenchymal abnormality seen on chest ct, he was treated with one dose of methylprednisone 125mg but had hyperglycemia requiring insulin gtt and was thus not treated with steroids. he did not receive antibiotics. there may have been a component of chf during this presentation and the patient was treated with lasix gtt during this prior admission. . in the ed, initial vs were: rr 40s, o2 sat: 75% on nrb. the patient received nitro gtt, was placed on bipap with dramatic improvement. the patient was also treated with levofloxacin and vancomycin. he received lasix 40mg iv x1, aspirin and tylenol 1000mg po. blood cultures were obtained. . on arrival to the micu, the patient is still tachypneic but completing full sentences. he is alert, oriented and does not appear in acute distress. . review of systems: (+) per hpi. endorses headaches. endorses diarrhea which resolved 2 days ago. (-) denies fever, chills, night sweats, recent weight gain. denies sinus tenderness, rhinorrhea or congestion. denies wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: 1. cardiac risk factors: type ii diabetes, hyperlipidemia, htn 2. cardiac history: 3. other past medical history: - nonischemic dilated cardiomyopathy (-lvef 20%, lvd 6.4cm, mild rv dilation, borderline function, 1+ mr) - hepatitis c antibody positive - mrsa pneumonia (requiring trach) - copd - substance abuse (cocaine) - tobacco abuse - schizophrenia social history: - history of multiple incarcerations (>6 months in ) - lives with sister - walks w/ cane due to right sided foot drop - tobacco history: current smoker, 1 cig per day - etoh: denies - illicit drugs: crack cocaine three days ago family history: - father: pacemaker, deceased physical exam: admission exam: . vitals: t: 98.6 bp: 98/61 p:95 r: 31 18 o2: 100% cpap with fio2 100% and peep of 5 general: alert, oriented, no acute distress with cpap on heent: sclera anicteric, mmm, poor dentition, eomi, perrl neck: supple, jvp not able to be assessed, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops appreciated lungs: diffuse dry crackles, no wheezes. air movement throughout. no use of accessory muscles with cpap in place. abdomen: soft, minimal diffuse tenderness, mild distended, bowel sounds present, obese gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . discharge exam: . vitals: 98.8 98.7 115/68 100 20 94% 1l nc bg: 77-239 mg/dl i/os: 1300 | 1000 + brp (-0.5l los) general: appears in no acute distress. alert and interactive. able to speak in full sentences. heent: normocephalic, atraumatic. eomi. perrl. nares clear. mucous membranes moist. neck: supple without lymphadenopathy. jvd just above clavicle at 90-degrees. cvs: regular rate and rhythm, without murmurs, rubs or gallops. s1 and s2 normal. resp: faint breath sounds bilaterally with inspiratory crackles at bases; rhonchi in upper airways bilaterally. no wheezing. stable inspiratory effort. abd: soft, non-tender, non-distended, with normoactive bowel sounds. no palpable masses or peritoneal signs. extr: no cyanosis, clubbing; no peripheral edema, 2+ peripheral pulses neuro: cn ii-xii intact throughout. alert and oriented x 3. strength 5/5 bilaterally, sensation grossly intact. gait deferred. pertinent results: admission labs: . 09:30pm blood wbc-13.6* rbc-4.20* hgb-11.1* hct-35.4* mcv-84 mch-26.4* mchc-31.4 rdw-15.3 plt ct-333 09:30pm blood neuts-74.1* lymphs-18.8 monos-2.5 eos-4.2* baso-0.4 09:55pm blood pt-11.4 ptt-35.1 inr(pt)-1.1 09:30pm blood glucose-127* urean-12 creat-0.9 na-144 k-4.0 cl-108 hco3-26 angap-14 03:06am blood alt-19 ast-23 ld(ldh)-360* ck(cpk)-98 alkphos-65 totbili-0.4 03:06am blood albumin-3.1* calcium-8.5 phos-3.9 mg-1.4* 09:30pm blood asa-neg ethanol-17* acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 09:31pm blood lactate-2.2* 10:35pm blood lactate-1.2 05:07am urine cocaine-pos . discharge labs: . 07:25am blood wbc-6.4 rbc-3.55* hgb-9.2* hct-30.1* mcv-85 mch-26.0* mchc-30.7* rdw-15.1 plt ct-335 03:06am blood pt-12.6* ptt-32.4 inr(pt)-1.2* 06:55am blood glucose-112* urean-9 creat-0.8 na-143 k-4.3 cl-108 hco3-29 angap-10 06:55am blood calcium-8.9 phos-4.3 mg-1.8 . microbiology data: blood culture (x 2) - pending mrsa screen - negative urine legionella - negative . imaging: chest (portable ap) - in addition to a severe infiltrative abnormality, with probable confluence in the lung bases, there are many small discrete nodular opacities, which have grown appreciably since , probably entirely new since . pattern strongly suggests widespread infection, possibly septic emboli. heart is moderately enlarged, unchanged. at least small bilateral pleural effusions are presumed. brief hospital course: impression: 52m with a pmh significant for non-ischemic cardiomyopathy (lvef 30%-35%), insulin-dependent diabetes mellitus, hepatitis c infection, htn, hld, schizophrenia and depression with recent hospitalization for crack lung, who presented with acute hypoxic respiratory distress found to have bilaterally diffuse airspace opacification with suspected component of chf exacerbation, in the setting of recent illicit substance use. . # diffuse, bilateral lung opacification and acute respiratory decompensation - consistent with his prior hospitalizations, mr. was admitted with acute hypoxic respiratory failure requiring nippv in the setting of recent crack cocaine use, attributed to acute crack inhalation lung injury. in , he presented with a picture concerning for multifocal pneumonia, although his rapid resolution of symptoms without antibiotics was more consistent with hypersensitivity pneumonitis or crack lung. three days preceding admission, he notes crack cocaine use. he was admitted to the micu for respiratory monitoring and required a period of bipap use with improvement with symptomatic treatment, namely nebulizers and agressive respiratory therapy. he was not intubated during this admission. while he received a single dose of iv vancomycin in the ed, these were discontinued, and steroids were deferred given his similar presentation with rapid improvement in the past despite minimal intervention. his admitting cxr showed bilateral opacifications, despite a normal wbc and no fevers. a chest ct on prior admission showed marked diffuse bilateral airspace opacities, ground-glass in appearance, with confluent consolidation -- but subsequent cxrs noted rapid improvement despite limited therapy, supporting a crack lung or hypersensitivity etiology. over several days, his supplemental oxygen was weaned and he ambulated 100 feet without destaurations, maintaining his oxygen saturations in the 92-94% range on room air (which is his baseline). he had no cough or respiratory symptoms and he resumed all of his home medications. . # insulin-dependent diabetes mellitus - patient previously managed with lantus dosing (taking 40 units at home) - intermittently checks his glucose at home, has been under the 200 mg/dl range per the patient. last hba1c 7.4% in 11/. no evidence of retinopathy, renal failure (baseline creatinine 0.9-1.1) or neuropathy. we titrated his lantus to 50 units sc at nighttime for tighter glucose control. . # non-ischemic cardiomyopathy / chronic systolic heart failure - patient with known moderate global left ventricular hypokinesis (lvef = 30-35%), lvd 6.4-cm, mild rv dilation, borderline function, 1+ mr on 2d-echo from 12/. his respiratory decompensation was attributed to a pulmonary source predominantly. he was tolerating his home po lasix, and returned to room air with adequate oxygen saturations prior to discharge. we continued his lisinopril 10 mg po daily, metoprolol succinate xl 100 mg po daily, maintained his home dose of furosemide 40 mg po daily and kept him on a fluid restriction of 1500 ml daily. he was monitored with daily weights, monitored i/os, and his goal for diuresis was 0.5-1l daily. . # hypertension - managed as an outpatient with acei, beta-blocker. discharged on home regimen without changes. . # hyperlipidemia - we continued atorvastatin 20 mg po qhs. . # substance, tobacco abuse history - he has multiple prior episodes of relapse with resulting hospitalizations; patient notes mostly crack-cocaine use (2-3 days prior to admission) in lieu of alcohol use. lives with sister who is supportive and is a probation officer. we offered him a nicotine patch for tobacco use and provided smoking cessation counseling. social work consultation was provided and motivational support was offered; he may benefit from outpatient addiction program assistance, which he is strongly considering. he does not qualify for dual diagnosis admission since his psychiatric illness is compensated. . # hepatitis c infection - he has a history of positive hcv antibody documented in . no evidence of sequelae of chronic liver disease. liver synthetic function appears maintained (plt 424, albumin 2.8). lfts: ast 29 and alt 13 with t-bili 0.4 from prior lab studies. hiv negative, ama and smooth negative in . abdominal u/s in was normal. hcv viral load 20,101,696 iu/ml in 11/. will need follow-up as outpatient for afp, serial ultrasounds, candidacy for possible anti-viral therapy (likely poor candidate) given his hepatitis c infection. . transition of care issues: 1. social work consultation was provided and motivational support was offered; he may benefit from outpatient addiction program assistance given his substance abuse history. 2. has outpatient follow-up with primary care physician and pulmonology scheduled. 3. will need follow-up as outpatient for afp, serial ultrasounds, candidacy for possible anti-viral therapy (likely poor candidate) given his hepatitis c infection. 4. will also need outpatient pfts and pulmonology follow-up to evaluate for other underlying lung disease. medications on admission: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. 2. atorvastatin 20 mg tablet sig: one (1) tablet po at bedtime. 3. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 4. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 5. insulin lispro 100 unit/ml solution sig: units subcutaneous per sliding scale. 6. insulin glargine 100 unit/ml solution sig: forty (40) units subcutaneous at bedtime. 7. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. 8. lisinopril 10 mg tablet sig: one (1) tablet po once a day. 9. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 11. sertraline 50 mg tablet sig: 0.5 tablet po once a day. 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 13. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day. 14. codeine sulfate 30 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 15. seroquel 100 mg tablet sig: 0.5-1 tablet po at bedtime. discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. 2. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 3. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 4. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 5. novolog 100 unit/ml solution sig: units subcutaneous once a day: per insulin sliding scale. 6. lantus 100 unit/ml solution sig: fifty (50) units subcutaneous at bedtime. 7. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. 8. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 9. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 11. sertraline 50 mg tablet sig: 0.5 tablet po daily (daily). 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 13. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 14. codeine sulfate 30 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 15. quetiapine 100 mg tablet sig: 0.5-1 tablet po hs (at bedtime). discharge disposition: home with service facility: vna discharge diagnosis: primary diagnoses: 1. acute pulmonary syndrome (presumably related to crack-cocaine use) 2. acute on chronic exacerbation of non-ischemic cardiomyopathy . secondary diagnoses: 1. history of polysubstance abuse 2. insulin-dependent diabetes mellitus 3. hypertension 4. hyperlipidemia 5. positive hepatitis c antibody 6. chronic obstructive pulmonary disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: patient discharge instructions: . you were admitted to the internal medicine service at on cc7 regarding management of your acute respiratory issues. you were first admitted to the medical intensive care unit given concern for worsening heart failure in the setting of your illicit substance use, but this resolved with supportive therapy. you should avoid all illicit substance use in the future and take all necessary steps to obtain motivational assistance and substance abuse program assistance to promote healthy living. . please call your doctor or go to the emergency department if: * you experience new chest pain, pressure, squeezing or tightness. * you develop new or worsening cough, shortness of breath, or wheezing. * you are vomiting and cannot keep down fluids, or your medications. * if you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include: dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit, or have a bowel movement. * you experience burning when you urinate, have blood in your urine, or experience an unusual discharge. * your pain is not improving within 12 hours or is not under control within 24 hours. * your pain worsens or changes location. * you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. * you develop any other concerning symptoms. . changes in your medication reconciliation: . * upon admission, we added: none . * upon admission, we changed: we changed: lantus from 40 to 50 units subcutaneously in the evenings for better glucose control . * the following medications were discontinued on admission and you should not resume: none . * you should continue all of your other home medications as prescribed, unless otherwise directed above. followup instructions: department: pulmonary function lab when: thursday at 9:10 am with: pulmonary function lab building: campus: east best parking: garage . department: medical specialties when: thursday at 9:30 am with: , m.d. building: campus: east best parking: garage . department: pft when: thursday at 9:30 am ** please contact our registration department at to update your information.** . department: internal medicine when: friday at 10:45 am with: , md building: (, ma) campus: off campus best parking: free parking on site md procedure: drug detoxification diagnoses: other primary cardiomyopathies tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified viral hepatitis c without hepatic coma obstructive chronic bronchitis with (acute) exacerbation other and unspecified hyperlipidemia acute respiratory failure long-term (current) use of insulin chronic systolic heart failure cocaine dependence, continuous poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted poisoning by cocaine other specified allergic alveolitis and pneumonitis 

Answer: The patient is high likely exposed to