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: levofloxacin attending: chief complaint: shortness of breath, with acute respiratory distress major surgical or invasive procedure: endotracheal intubation, subsequent extubation history of present illness: 87 y/o m with hx of dchf, htn, hl, copd and recent cva who is presenting with acute worsening of several days of dyspnea. of note, the patient's wife died in the week prior to admission, and per report, he went to his pcp who noticed he wasn't taking very good care of himself. he prescribed benzos for presumed anxiety due to the recent death. he has been intermittently complaining of "flu-like" symptoms with cough, low grade fevers, some shortness of breath to his family. today his family went to visit and he was weak and lethargic and then developed acute shortness of breath that was very different from the last few days. his daughter said she could hear audible wheezing. ems was called, and his bps were noted to be in the 200s. his rr was in the 40s and he was placed on ems cpap. he received 2 slng en route. . in the ed, inital vitals were 99.7, 94, 142/90, 32 and 89% on cpap. he was given nitro gtt, solumedrol, albuterol and azithromycin/ceftriaxone. he also received lorazepam for some anxiety as he was aggitated and pulling at his mask. he did have a fever in the ed, received tylenol for the fever. he is currently on bipap. . on arrival to the floor, he is somnulent, not answering question. he barely moved while having an abg. he does awak to loud voice and touch. he is breathing at a normal rate and seems to be tolerating the bipap mask well. he was subsequently admitted to the icu, and later transferred back to the medical service. past medical history: 1. diastolic heart failure (echo : mild lvh, ef 70%; exercise stress test : normal myocardial perfusion, ef 60%, suboptimal (hr 58% predicted), 8min exercise, uninterpretable ekg, no angina, decreased hr and bp response to exercise) 2. chronic lung disease (copd, also mild restrictive disease on pfts , though suboptimal study, unclear etiology; on home o2, sat 87% w/ambulation) 3. hyperlipidemia (: tc 169, tg 73, hdl 63, ldl 91, not on statin) 4. hypertension 5. bph s/p turp in 6. pbc (+ama, dx in , on nadolol for mild esophageal varices) 7. gerd 8. esophageal spasm 9. dysphagia (egd : esophageal dysmotility, gastric polyp, mucosal bridge) 10. gout/pseudogout (treated with colchicine in past, recent tap revealed pseudogout) 11. pericardial effusion and tamponade in 12. anemia (per chart review, due to iron deficiency, baseline hct 30-32) 13. mild dysarthria/garbled speech. chronic per report of patient's wife and daughter. 14. cva and seizure in - incidental 6 m pica aneurysm social history: no etoh, 40+ pack-year history tobacco, quit in ', lives with grandson and wife who is wheel-chair bound and whom he takes care of. has one biological daughter and two adopted daughters who help take care of himself (daughter is healthcare proxy). his wife died the week prior to this admission and he has been doing poorly since then. family history: mother and father both had htn and died after falls; biological daughter is healthy. physical exam: on admission: gen: pleasant, comfortable, nad heent: perrl, eomi, anicteric, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: wheezes throughout, poor air movement cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. no pass-pointing on finger to nose. 2+dtr's-patellar and biceps . on discharge: patient comfortable. 92-93% on 2-3l (baseline) patient with non-tender, soft abdomen with slight distention. no rebound or guarding. ext: no edema pertinent results: on admission: 01:25am blood wbc-7.6 rbc-4.34* hgb-13.7* hct-43.3 mcv-100* mch-31.5 mchc-31.6 rdw-15.0 plt ct-165 08:19am blood wbc-16.3*# rbc-4.07* hgb-12.8* hct-40.1 mcv-99* mch-31.6 mchc-32.0 rdw-15.2 plt ct-128* 08:19am blood pt-18.4* ptt-47.7* inr(pt)-1.7* 12:40am blood glucose-139* urean-26* creat-1.3* na-134 k-5.1 cl-101 hco3-24 angap-14 08:19am blood alt-28 ast-46* ck(cpk)-97 alkphos-189* totbili-0.3 12:40am blood probnp-3222* 08:19am blood calcium-9.0 phos-4.4 mg-2.2 . blood and urine cultures: negative . imaging: cxr: mild pulmonary edema with a more confluent opacity in the right lower lobe which may represent pneumonia. repeat radiographs after treatment of pulmonary edema could be useful. . ct-a impression: 1. no evidence of pulmonary embolism. 2. moderately extensive bibasilar pneumonia with less extensive right upper lobe consolidation. given the dependent location of these consolidations, aspiration is a possibility. 3. emphysema and evidence of pulmonary arterial hypertension. on discharge: cdiff toxin positive on . wbc decr to 14.6k on day of discharge. brief hospital course: 87 y/o m with hx of dchf, copd, and pbc who presented with acute respiratory decompensation. the cause was new pneumonia leading to copd exaccerbation. also had mild component of dchf. he was in the icu and intubated. he did well with intubation, was subsequently extubated without complications and improving. # hypercarbic respiratory failure: multifactorial from copd flare and presumed pneumonia, as well as underlying chf. he initially presented and was somnulent. he was placed on bipap and his pco2 improved. he was on and off bipap over three days with treatment of pna, copd and his dchf. on the third day, he had acute hypoxemia after a turn and was intubated briefly and transferred to the icu. he had a cta to rule out pe which was negative. he was treated for empirical coverage of hospital-acquired pneumonia with vanco, cefepime and azithro. he completed his course in the hospital and was transferred from the icu to the medical floor after extubation. he was on high dose steroids for 7 days with a tapered plan. the taper started from going to 60 mg pred to 50 mg pred with a plan for 10 mg decrease in dose every three days. we also started spiriva for his copd, in addition to prn nebulizers. # acute diastolic chf exacerbation: he was diuresed during the icu portion of his course, for acute chf which developed following volume resuscitation. once his dry weight was achieved, we restarted him on half his recent home dose of lasix at 40 mg daily, which was stable for several days prior to discharge and kept the patient euvolemic. the patient's lisinopril was increased to 20 mg daily. he was euvolemic on discharge and stable on room air at rest. he should be monitored as an outpatient and see if he requires adjustments to his outpatient diuretic regimen. . # pneumonia: s/p treatment as above with 8 days vanco/cefepime and 5 days of azithromycin. . # c diff: he developed a new leukocytosis on , with time course inconsistent with steroid response given that he was on a taper at that time. ua and cxr unconcerning for infection; blood cx ngtd at time of discharge. although he did not have diarrhea or severe abdominal symptoms, c diff was suspected given recent antibiotic use. he tested positive for c diff and was started on po flagyl. a baseline kub was obtained and showed evidence of stool without concern for toxic megacolon, but did show significant stool in the colon. he remained afebrile and his white count trended down, and we suggested continuing flagyl for 2 weeks total (starting on ). . # htn: hypotensive initially, but never reqired pressors. as his bp recovered, was converted to captopril (given it was short acting). on d/c he was switched back to lisinopril. his discharge dose was 20 mg daily (up from 10 mg daily). he was also continued on his nadolol for varices. . # coagulopathy: ptt elevated to 93 on , then to 145 even after changing sq heparing to . it is likely from excessive dose of heparin subcutaneous, and we added heparin to his allergy. lfts unremarkable except mild increase in ap. we stopped his heparin and just kept him on pneumoboots. coagulopathy thought to be related to pbc as below. . # pbc: stable lfts except coagulopathy as dicussed above. continued nadalol. . # s/p cva: no neuro deficits. continued aspirin and zonisamide for seizure ppx. . # goals of care: while he was intubated, we discussed what he would want. he was clear at first that he was ok with intubation prior to the event, but while intubated, he stated he wanted to be dnr/dni. . # addendeum re communication: the cdiff result and recommendations were discussed with the md (dr to be assuming his care at the rehab facility on the day following discharge by the writer. we noted concern that his exam and labs be monitored closely, given the ongoing prednisone treatment and recent cdiff diagnosis. medications on admission: # albuterol sulfate 90 mcg/actuation hfa aerosol inhaler two (2) puff inhalation every six (6) hours as needed for shortness of breath or wheezing. # ascorbic acid 500 mg tablet one (1) tablet by mouth daily (daily). # aspirin 81 mg tablet, chewable one (1) tablet, chewable by mouth daily (daily). # ferrous sulfate 300 mg (60 mg iron) tablet one (1) tablet by mouth daily (daily). # fluticasone 110 mcg/actuation aerosol two (2) puff inhalation twice a day. # furosemide 40 mg tablet one (1) tablet by mouth twice a day. # ipratropium bromide 17 mcg/actuation hfa aerosol inhaler two (2) puff inhalation four times a day. # lisinopril 10 mg tablet one (1) tablet by mouth daily (daily). # nadolol 20 mg tablet one (1) tablet by mouth daily (daily). # omeprazole 20 mg capsule, delayed release(e.c.) two (2) capsule, delayed release(e.c.) by mouth twice a day. # prednisolone acetate 1 % drops, suspension one (1) drop ophthalmic three times a day. # zonisamide 100 mg capsule three (3) capsule by mouth at bedtime. discharge medications: 1. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*1 device* refills:*2* 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. zonisamide 100 mg capsule sig: three (3) capsule po qhs (once a day (at bedtime)). 4. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 5. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 6. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. 7. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 8. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 2 weeks: day 1 =. continue until . disp:*40 tablet(s)* refills:*0* 10. prednisone 10 mg tablet sig: four (4) tablet po once a day for as below days: take 40 mg on and . then take 30 mg on , . then take 20 mg on , . then take 10 mg for , , . disp:*26 tablet(s)* refills:*0* discharge disposition: extended care facility: discharge diagnosis: primary diagnosis: 1. pneumonia 2. copd exaccerbation 3. acute on chronic diastolic chf discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: abulatory - requires some assistance at times. mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure caring for you at the . you were admitted to the hospital with respiratory distress. you had a new pneumonia. the pneumonia caused your underlying lung disease (copd) to get worse. unfortunately you required a breathing tube for a brief period of time. after treating you with antibiotics and steroids, your breathing improved and we were able to take your breathing tube out. you did well after that and will need to complete a steroid taper to help your breathing. in the hospital, you were evaluated by physical therapy and it was determined that you would benefit at a rehabilitation center. you were also found to have a gastrointestinal infection called clostridium difficile for which you will be treated with an antiobiotic for 2 weeks. . we made these changes to your medications: we started spiriva we started prednisone taper we increased lisinopril dose to 20 mg daily we started flagyl 500 mg three times a day for 2 weeks starting we decrease your lasix to 40 mg once a day . please continue your other home medications. your follow-up information is listed below. followup instructions: the following appointments have been made for you: department: when: thursday at 11:30 am with: dr. location: post clinic building: sc clinical ctr south campus: east best parking: garage this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up. department: dermatology when: monday at 11:30 am with: , md building: sc clinical ctr campus: east best parking: garage department: neurology when: monday at 2:30 pm with: drs. & building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: pneumonia, organism unspecified esophageal reflux congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other and unspecified hyperlipidemia acute respiratory failure hypotension, unspecified intestinal infection due to clostridium difficile personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits biliary cirrhosis 

Answer: The patient is high likely exposed to