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: respiratory distress major surgical or invasive procedure: endotracheal intubation and extubation bronchoscopy history of present illness: mr. is an 86 yo m with a h/o cad s/p cabg x 4 , t2dm, bladder ca s/p turb in , s/p cea in transfered from an osh for hypoxic respiratory failure. . he had been at home from rehab for 1 week, after which he developed abdominal distention with a high grade sbo. at admission, he was noted to have malnourishment/weight loss. he was admitted to the icu and placed on ng decompression. he was thought to have a rll infiltrate with cough, and treatment for pna was started. he responded to ng decompression initially, but then worsened. on , he had a partial small bowel resection, lysis of adhesions, and re-anastomosis. after extubation, his hypoxia worsened and he developed a productive cough, which was thought to be due to chf vs pneumonia. his mental status was also noted to worsen. he has been receiving nebs and antibiotics, and he has been diuresed and improved with suction. . his post operative course was complicated by atrial fibrillation, treated with metoprolol and with a cardizem drip. his course also significant for leukopenia/thrombocytopenia and grossly bloody hematuria which has resolved. he has also been hyperglycemic with fs in the low 200s. his bps have been stable by report. by report, he had a tte with a normal lvef. his creatinine was 0.9-1.1. he was started on tpn since his pod#1. up to the time of this admission to the icu, he has had no return of bowel function. . for pneumonia, he was treated with flagyl, azithromycin, continued from his preop ceftriaxone. he was seen by id who felt he had a low likelihood of pna and suggested stopping antibiotics. over the last 2-3 days prior to his transfer, his oxygenation and tachypneia had worsened. on the day of transfer, he was satting 100% on nrb, and was changed to 9l face tent. his abg was 7.46/51/138, and his cxr showed b/l fluffy infiltrates. his vitals on the morning of transfer were: t 99.4, hr 96, rr 20, 114/49. at that time he still had no return of bowel function. . on arrival to the icu floor, he was tachypneic with use of accessory muscles and parodoxical abdominal breathing. he was able to tell us his name, and confirmed that he would want to be intubated and pain or shortness of breath. past medical history: opcabgx4 coronary artery disease prostatism, s/p turp, ~ , benign per patient bladder cancer, s/p trans ureteric resection, ~ carotid stenosis, s/p cea hyptertension diabetes social history: prior electrician. from (greek is 1st language), has lived in us for 57 years. married. had been at rehab of . lives with wife. previously, independent with adl's. no smoking. rare etoh. family history: he has no family history of early myocardial infarction, arrhythmia, cardiomyopathies, or sudden cardiac death. mother died of diabetes. father unknown. brother died at 81 of ami, kidney disease. physical exam: on admission: t: 37.4 ??????c (99.4 ??????f) hr: 102 bp: 126/53(71) rr: 21 spo2: 94% general appearance: no(t) well nourished, thin cardiovascular: (s1: normal), (s2: normal), tachycardic peripheral vascular: (right radial pulse: not assessed), (left radial pulse: not assessed), (right dp pulse: not assessed), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (breath sounds: rhonchorous: diffusely) abdominal: mildly firm, dressing in place, nt extremities: right lower extremity edema: trace, left lower extremity edema: trace skin: not assessed, black right 5th toe on discharge: t: 36.1 ??????c (97 ??????f) hr: 90 bp: 153/63(96)mmhg rr: 21 spo2: 99% general: extubated, lying in bed in nad, conversing heent: dobhoff in place lungs: rales diffusely (improved from yesterday), upper airway secretion sounds. cv: tachy, regular rhythm, normal s1 + s2. abdomen: soft, nondistended, nontender, abdominal wound bandaged. gu: no foley ext: no edema. r foot wrapped with dressing clean and dry pertinent results: on admission: wbc-4.2 rbc-3.32* hgb-10.5* hct-30.6* mcv-92 mch-31.8 mchc-34.5 rdw-14.9 plt ct-106* neuts-67 bands-1 lymphs-16* monos-14* eos-0 baso-0 atyps-2* metas-0 blood pt-15.4* ptt-28.5 inr(pt)-1.3* glucose-265* urean-28* creat-0.9 na-134 k-4.2 cl-94* hco3-31 angap-13 art po2-92 pco2-47* ph-7.46* caltco2-34* base xs-8 freeca-1.08* microbiology: blood cx: no growth. blood cx: no growth. sputum: gram stain showed gp cocci in clusters, culture showed sparse commensal respiratory flora. urine cx: yeast, 10,000-100,000 organisms/ml. imaging: cxr impression: bilateral patchy alveolar infiltrate. a part of this at least is due to fluid overload, however, an underlying infectious infiltrate cannot be excluded. ct chest s contrast impression: 1. mild widespread pulmonary edema could be cardiogenic or noncardiogenic accompanied by small layering nonhemorrhagic and pericardial effusions. mild soft tissue edema suggests total body volume or salt overload. 2. multifocal consolidation should be considered pneumonia until proved otherwise. abd xray impression: dilated small bowel. cxr impression: improvement of pulmonary edema. on discharge: ================================================= - 03:27am blood wbc-5.5 rbc-3.39* hgb-10.2* hct-30.1* mcv-89 mch-30.1 mchc-33.9 rdw-15.6* plt ct-233 - 03:27am blood pt-12.6 ptt-32.1 inr(pt)-1.1 - 03:27am blood glucose-82 urean-41* creat-1.2 na-139 k-3.7 cl-100 hco3-31 angap-12 - 03:27am blood calcium-8.4 phos-4.8* mg-2.1 cxr: widespread ground-glass opacification of both lungs, left lower lobe atelectasis or consolidation improving. small pleural effusions have not changed over the past several days. right subclavian or picc line ends close to the superior cavoatrial junction. no pneumothorax. tte: the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with basal to mid inferior and inferoseptal hypokinesis. there is no ventricular septal defect. right ventricular chamber size is normal. with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. impression: regional lv systolic dysfunction consistent with cad. no significant valvular abnormality. moderate pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , the function of the basal to mid inferior and inferolateral walls is hypokinetic on the current study. the estimated pulmonary artery pressure is more elevated. brief hospital course: mr. is a 86 yo m with cad cabg x 4, t2dm, bladder ca s/p turb, s/p cea transferred from osh after admission for sbo s/p exlap/sb resection reanastomosis () for hypoxic respiratory failure. # hypoxic respiratory failure: the differential diagnosis for his respiratory failure included multifocal pna, ards, and chf. he underwent bronchoscopy to obtain better cultures as previous sputums had been insufficient. blood and urine cultures were sent, and they were ultimately negative except for yeast in the urine cx. he was started on treatment for possible hcap with vancomycin and cefepime and eventually transitioned to levofloxacin. on hd2 a ct chest w/o contrast was obtained which showed ground glass oppacities and likely multifocal pna. he was also treated for pulmonary edema likely fluid overload, and was diuresed aggressively for several days with a lasix gtt, during which he had tachypnea and agitation during his sbt's. he was put on standing seroquel to treat his agitation. he was extubated on , and his lasix drip was stopped and he was given several boluses of lasix with good urine output. his cr remained stable at 1.2. # atrial fibrillation: on admission he was on a diltiazem drip, but had converted to sinus rhythm. he was continued on metoprolol and did not have afib for the remainder of his stay. # sbo s/p resection: surgery was consulted to help with wound and bowel planning. they reported that the surgical wound was clean and abdominal exam was benign other than mild distention, and they were not concerned for intraabdominal process at the moment. on hd2, his hct was 21.6 and he was transfused 2 units of prbc on hd8 he was found to have guaiac + stools but his hct remained stable. he was given tpn and was eventually restarted on tube feeds. he was kept on a bowel regimen and began making regular nonbloody bowel movements. his speech and swallow evaluation on , and a dobhoff was placed and it was recommended that he receive po medications crushed with applesauce and not have regular food pending intensive swallow therapy at rehab. #htn: while intubated, he had labile bps with sbp ranging 80s-180s. periods of hypotension mostly occurred while sleeping. bp lability improved after extubation. he was restarted on his lisinopril and amlodipine, and was given hydralazine as needed for sbp>160. on day prior to discharge, bp was in low normal range and amlodipine was discontinued. this may need to be restarted in the future. # agitation: he developed some agitation on d6 and he was started on prn then standing seroquel which was continued with improvement of symptoms. this was changed to qhs:prn prior to discharge. #diabetes: he was mantained on an iss as well as insulin glargine at night (up to 25 units qhs) but was not discharged on glargine. # cad s/p cabg : he had ce neg x 1 and an ekg without evidence of ischemia. he was continued on his regular asa 81mg and metoprolol. # s/p bladder cancer: he had mild hematuria intermittently during admission foley trauma. foley was removed prior to discharge with successful void. transitional issues: -f/u nutrition and remove dobhoff as able -continued speech/swallow -monitor blood sugars and restart glargine as needed -monitor volume status and start lasix as needed -monitor bps and restart amlodipine as needed -f/u with surgery medications on admission: 1. acetaminophen 325 mg tablet sig: two (2) tablet po tid (3 times a day) as needed for pain/fever. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. glyburide 5 mg tablet sig: one (1) tablet po bid (2 times a day). 6. metformin 500 mg tablet sig: one (1) tablet po daily (daily). 7. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 8. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 9. lisinopril 10 mg tablet sig: three (3) tablet po daily (daily). 10. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 11. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day). 12. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 13. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed). 14. atorvastatin 80 mg tablet sig: one (1) tablet po daily discharge medications: 1. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: five (5) ml po q4h (every 4 hours) as needed for pain: discontinue if level of pain decreases. . 2. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day). 3. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 5. glyburide 5 mg tablet sig: one (1) tablet po twice a day. 6. metformin 500 mg tablet sig: one (1) tablet po once a day. 7. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 8. ranitidine hcl 15 mg/ml syrup sig: ten (10) ml po daily (daily). 9. lisinopril 20 mg tablet sig: 1.5 tablets po daily (daily). 10. amiodarone 200 mg tablet sig: one (1) tablet po twice a day. 11. clopidogrel 75 mg tablet sig: one (1) tablet po once a day. 12. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. 13. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: four (4) puff inhalation q4h (every 4 hours) as needed for wheezing for 1 months. 14. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for not having bowel movements. 15. quetiapine 25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed for agitation. discharge disposition: extended care facility: - discharge diagnosis: hypoxemic respiratory failure small bowel obstruction failure to thrive discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: after you had your bowel surgery at an outside hospital, you were transferred here to the because you had trouble breathing and were intubated. you had fluid in your lungs and were treated with diuretics to remove the fluid. you were also treated with antibiotics for the possibility of a pneumonia. your condition improved and you were stable after your breathing tube was removed, and you can be discharged to your rehab facility. the following changes were made to your medications: new: 1. oxycodone-acetaminophen 5-325mg/5ml solution, five (5) ml by mouth every 4h prn pain 2. albuterol sulfate 90mcg/actuation inhaler, 4 puff inhalation q4h as needed for wheezing/shortness of breath 3. senna 8.6mg tablet, 1 tab by mouth twice a day as needed for not having bowel movements. 4. quetiapine 25mg tab, 1 tab by mouth once a day at bedtime, as needed for agitation. discontinued: 1. acetaminophen 325 mg tablet, 2 tablet po tid (3 times a day) as needed for pain/fever 2. amlodipine 10mg po daily changed: none. followup instructions: please make and keep your follow up appointment with your surgeon who performed your abdominal surgery in weeks. . please also follow up with your primary care doctor after leaving rehab. md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified other iatrogenic hypotension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled cardiac complications, not elsewhere classified atrial fibrillation aortocoronary bypass status alkalosis personal history of malignant neoplasm of bladder other and unspecified special symptoms or syndromes, not elsewhere classified nonspecific abnormal findings in stool contents gross hematuria adult failure to thrive acute edema of lung, unspecified benign essential hypertension 

Answer: The patient is high likely exposed to