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: hemoptysis major surgical or invasive procedure: endotracheal intubatation flexible bronchoscopy rigid bronchoscopy history of present illness: 79 y.o f on coumadin for cva and afib on coumadin who presented to hospital yesterday after an episode of hemoptysis. at , she reportedly coughed up another 200 cc of bright red blood. she was satting well, but was tachypneic in the high 20s and noted to have patchy opacities on cxr. of note, her inr was 3.9 and she received 5mg of vitamin k and and 2u ffp. she was then med-flighted to for further management. . of note, the patient reportedly had been noted to have lung mass on cxr for which her pcp was in the process of setting up bronchoscopy. it is unclear how much this has been worked up already. . in the ed, she received another 5mg vitamin k and cxr was repeated which showed bilateral patchy opacities. labs were significant for an inr of 2.2, hct 36.8, wbc 12.0. electrolytes unremarkable with exception of slightly elevated bun of 25. no t/s sent. her access consisted of 2 16g and 1 18g. no fluids given and she was hd stable with vs: t: afeb hr: 67 100% 160/75 rr: 25 . on arrival to the icu, vs were afebrile, 170s/100s, 130s, rr 40, o2: 70s on nrb. pt had another 30cc of hemoptysis upon arrival to icu. she was in moderate respiratory distress with accessory muscle use, and complaining subjectively of shortness of breath. respiratory and anesthesia were subsequently called and she was intubated without complication. setting are ac o2 100%, tv 400 rr 18 peep 5 . review of systems: as above, pt was subjectively short of breath. remaineder of ros unable to be obtained past medical history: - cva in and (has gait instability but no other residual deficits) - afib on coumadin - hld - htn - trigeminal neuralgia - peripheral neuropathy - bronchiectasis (has been seen by a pulmonologist at but she cannot remember his name) social history: lives with her husband. independent in her adls. previously smoked for <1 year in her 20s. very rare etoh. no illicits. family history: no history of lung disease or malignancy. physical exam: admission exam: vitals: 170s/100s, 130s, rr 40, o2: 70s on nrb. general: alert, oriented, moderate respiratory distress, tachypneic heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: tachycardic, irregular, no murmurs appreciated. lungs: moderate resp distress, coarse breathsounds anteriorly abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding gu: no foley ext: cool, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, strength and sensation grossly intact discharge exam: vs: tm 98 bp 139-163/73-94 hr 70-82 rr 20-22 95%ra (97% 2l nc) gen: no acute respiratory distress, comofrtable lungs: scattered ronchi b/l heart: irreg irreg, no murmur abd: non tender, +bs ext: 1+ edema neuro: right arm and leg slightly weaker than left pertinent results: admission labs: 05:40am blood wbc-12.0* rbc-3.72* hgb-11.4* hct-36.8 mcv-99* mch-30.6 mchc-31.0 rdw-13.1 plt ct-235 05:40am blood neuts-88.1* lymphs-8.0* monos-3.2 eos-0.5 baso-0.2 05:40am blood pt-23.5* ptt-37.0* inr(pt)-2.2* 08:41am blood type-art temp-38.3 rates-18/ tidal v-400 peep-5 fio2-100 po2-154* pco2-66* ph-7.24* caltco2-30 base xs-0 aado2-493 req o2-83 intubat-intubated vent-controlled comment-98.9 axill 08:41am blood freeca-1.25 discharge labs: 07:15am blood wbc-9.1 rbc-3.57* hgb-11.1* hct-33.7* mcv-94 mch-31.0 mchc-32.9 rdw-14.4 plt ct-312 07:15am blood neuts-72.4* lymphs-13.1* monos-8.3 eos-5.9* baso-0.3 06:10am blood glucose-112* urean-16 creat-0.6 na-138 k-3.4 cl-98 hco3-33* angap-10 04:20am blood calcium-9.4 phos-2.0* mg-2.0 05:45am blood pt-14.5* inr(pt)-1.4* pertinent labs: 11:01am blood anca-negative b 11:01am blood -positive * titer-1:80 08:41am blood lactate-1.8 03:36am blood lactate-1.2 microbiology data: 02:35pm urine color-yellow appear-clear sp -1.018 02:35pm urine blood-sm nitrite-neg protein-30 glucose-neg ketone-40 bilirub-neg urobiln-neg ph-5.5 leuks-neg 02:35pm urine rbc-3* wbc-3 bacteri-few yeast-none epi-0 02:35pm urine castgr-1* casthy-3* 08:19 aspergillus antibody test result reference range/units aspergillus ab negative negative aspergillus fumigatus ab negative negative aspergillus flavus ab negative negative 09:44 aspergillus galactomannan antigen test result reference range/units aspergillus antigen 0.1 <0.5 result interpretation: an index <0.5 is considered to be negative. an index >=0.5 is considered to be positive. 09:44 ige test result reference range/units immunoglobulin e 31 <or=114 /l 3:45 pm bronchoalveolar lavage right lower lobe. gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): ~3000/ml commensal respiratory flora. yeast. ~1000/ml. isolates are considered potential pathogens in amounts >=10,000 cfu/ml. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): fungal culture (preliminary): yeast. aspergillus fumigatus. potassium hydroxide preparation (final ): test cancelled by laboratory. patient credited. this is a low yield procedure based on our in-house studies. if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). 3:00 pm sputum source: endotracheal. **final report ** gram stain (final ): pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): rare growth commensal respiratory flora. mold. 1 colony on 1 plate. urine culture - negative blood culture x3 - negative blood culture x2 - negative pathology: bronchial clot (1 jar), report date blood, fibrin, and inflammatory cells, no evidence of malignancy (bronchial clot). bronchial washings negative for malignant cells. numerous acute inflammatory cells and macrophages. ecg 6:02:50 am sinus rhythm. non-specific st junctional depression. no major change compared to the previous tracing. cxr : there are no previous studies available for a direct comparison. heart size is upper limits of normal. subtle density at the left retrocardiac area which may represent atelectasis or a developing infiltrate. rest of the lung fields are grossly clear. there are no signs for pulmonary edema or large pleural effusions. ct chest w/contrast 2:54 pm 1. pneumatized soft tissue density in the right mainstem bronchus with imaging characteristics suggestive of secretions. correlation with bronchoscopy findings and pathology results is recommended. 2. diffuse bilateral centrilobular ground-glass opacities with more confluent opacities in the left lung and bilateral bronchiectasis. confluent soft tissue density in bilateral hila with calcifications. differential diagnosis includes atypical mycobacterial infection, sarcoidosis, lymphoproliferative disorder, and less likely kaposis sarcoma. superimposed hemorrhage may also lead to ground glass opacities. 3. apparent tracheal wall thickening and inflammation. 4. dilated right atrium. coronary artery calcifications of indeterminate hemodynamic significance. 5. partially imaged superior endplate vertebral body compression deformity of l2. cxr ng tube tip is off the film, at least in the stomach. bilateral pleural effusions are slightly worse. there continues to be mild cardiomegaly. there is lower lobe volume loss/infiltrate slightly worse than before as well. rigid bronchoscopy 79 yo f with massive hemoptysis. rigid bronchoscopy with flexible bronchoscopy with removal of endobronchial thrombus and blood but with no active bleeding seen on the right sided airways. the rll had purulent secretions that were therapeutically suctioned. the rll basilar main bronchus had mild mucosal erythema that although unlikely to be the primary source of hemoptysis, it was cauterized empirically to minimize chance of recurrent bleeding. interestingly no gross bleeding form the rml/lingula where the bronchiectasis are located. likely source the rll probably bleeidng due to pneumonia + bronchitis + supratherapeutic inr. double lumen et tube exchanged to a single lumen et tube. no complications. brief hospital course: ms. is a 79y/o lady with history of afib (on warfarin), cva, and bronchiectasis who presented with respiratory failure from hemoptysis. she was intubated, and in the micu she underwent bronchoscopies to diagnose the cause: it is likely that this represented an acute exacerbation of her bronchiectasis in the setting of infection. she was stabilized and transferred to the medical floor where she remained stable and was discharged to rehab with plans to follow up with pulmonology. active issues #. hemoptysis: acute exacerbation of bronchiectasis in the setting of pneumonia. she presented with hemoptysis in the setting of inr 2.9; she was transfused 1u prbc and 4u ffp (both on day of admission). became hypoxic and was intubated; in the micu she underwent flexible bronchoscopy on which showed no endobronchial tumors, but fresh blood and thrombus in the left lung which was suctioned. the right middle segment thrombus was not intervened upon because it was thought that there was a lesion underneath in the right lung. epinephrine was instilled. it was felt that there was massive hemoptysis from the right lung and right main stem bronchus. two days later on she underwent rigid bronchoscopy with removal of the thrombus and blood; no active bleeding was seen in right side of the right lower lobe with purulent secretions removed. it was felt that the patient likely had pneumonia and bronchiectasis exacerbation. developed leukocytosis to 12.8 but never developed fevers. the bronchiectasis appeared more bacterial in nature; aspergillus was not likely to be a causative pathogen (see below). she completed a course of vancomycin/cefepime () and azithromycin (), with wbc decreasing to 9.1. after diuresis to optimize her oxygenation status, on she was able to be extubated without issues and she was weaned to room air on the medical floor. she was evaluated by physical therapy and was discharged to rehab. she should have chest pt for 15-30 minutes, 3-5 times a day, in addition to having the acapella flutter valve at the bedside. she will follow-up with dr. (who saw her as pulmonary consult) in a few weeks, with repeat ct scan to evaluate interval change including the nodular infiltrates on her ct here. #. aspergillus fumigatus in sputum: likely not pathogenic. patient is immunocompetent and it was felt that the aspergillus was likely not a pathogen. no evidence of allergic bronchopulmonary aspergillosis, particularly since she has not had a history of asthma, and her eosinophil count was quite low. aspergillus galactomannan test was negative, so less likely to have invasive aspergillosis and there is no need for voriconazole treatment per discussion with pulmonology. #. atrial fibrillation: s/p , on warfarin with new inr goal of 2.0-2.5. (a) rate she was continued on sotalol 80 . she went into afib with on micu day 6 so she received iv diltiazem and was transitioned to po diltiazem, which she is being discharged on as a new med. besides one self-limited episode of hemodynamically to hr 140's while on the floor, she had no more problems with and hr is 70-90 at the time of discharge. ***note: she is being discharged on diltiazem 60mg po qid; rehab providers can consider changing to diltiazem extended release 240mg daily instead, for ease of administration. (b) anticoagulation warfarin was initially held and inr reversed with ffp as above, and after discussion with pulmonology it was restarted on . no issues with re-bleeding. while her home warfarin dose is 5mg daily, she is being discharged on 4mg daily due to the risks associated with over-anticoagulation. inr is 1.4 at the time of discharge. ***note: she requires daily inr checks, and new goal inr is 2.0-2.5 to prevent risk of re-bleed.*** if she develops any more hemoptysis, one option is bronchial artery embolization by dr. (interventional pulmonology at ). #. ?aspiration: she has passed speech and swallow evaluation. while intubated, she was on tube feeds and upon extubation was evaluated by speech therapy who felt that she was an aspiration risk. she was re-evaluated on and was felt to be safe for a diet with observation; she did well and her ng tube was removed. on the day of discharge, she still reports coughing with eating but was re-evaluated by speech and swallow and was felt to be safe for a po diet. of note, it is felt that much of her chronic bronchiectasis might be related to aspiration, so if there is concern for aspiration in the future she should be re-evaluated with a speech and swallow evaluation. -discharge diet: regular. -meds one by one with water, crushed in puree if patient has difficulty. -tid oral care #. constipation: continues to have constipation. passing gas and abdominal exam benign. she is on colace, senna, and miralax. offer fleet enema if needed (she declined on this admission). inactive issues #. h/o cva: stable, chads2 is 4. no new neurologic deficits at this time (has chronic mild gait instability associated with right-sided weakness). her aspirin 81 mg was restarted once her hct remained stable. initially her warfarin was held but was restarted (please see above regarding warfarin and new inr goal). she understands the risks associated with subtherapeutic inr (specifically, cva) but she also agrees that the risks of a supratherapeutic inr are high given her recent hemoptysis. #. htn: stable. losartan initially held in the setting of bleed. patient became hypertensive once bleed resolved, so she was initially placed on captopril 37.5 tid, then was transitioned back to home dose losartan which she should continue as an outpatient. #. hypothyroidism: stable. continued levothyroxine. #. hyperlipidemia: stable. continued simvastatin. transitional issues #. code status: full code #. emergency contact: (husband/hcp) , (daughter) home, cell #. labs/studies pending at the time of discharge: final result of bronchoalveolar lavege (acid fast culture and fungal culture) #. diet: regular. if there is concern for aspiration in the future she should be re-evaluated with a speech and swallow evaluation. #. inr goal change: she requires daily checks of her inr with new goal 2.0-2.5 because of bleeding risk. if she develops any more hemoptysis, one option is bronchial artery embolization by dr. (interventional pulmonology at ). #. physical therapy: should include chest pt for 15-30 minutes, 3-5 times a day, in addition to having the acapella flutter valve at the bedside. #. follow-up: with dr. ( pulmonology). medications on admission: 1. losartan 50mg 2. k-dur 10meq daily 3. aspirin 81mg daily 4. simvastatin 20mg daily 5. furosemide 20mg po daily 6. levothyroxine 50mcg daily 7. warfarin 8. sotalol 80mg 9. tegretol 100mg prn pain discharge medications: 1. aspirin 81 mg po daily 2. diltiazem 60 mg po qid 3. furosemide 20 mg po daily 4. levothyroxine sodium 50 mcg po daily 5. losartan potassium 50 mg po bid 6. simvastatin 20 mg po daily 7. sotalol 80 mg po bid 8. warfarin 4 mg po daily 9. polyethylene glycol 17 g po daily:prn constipation 10. senna 1 tab po bid:prn constipation 11. docusate sodium 100 mg po bid 12. carbamazepine 100 mg po daily:prn occasional pain from neuralgia 13. k-dur *nf* 10 meq oral daily discharge disposition: extended care facility: care center - discharge diagnosis: primary: hemoptysis pneumonia atrial fibrillation constipation secondary: bronchiectasis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair (but hopes to regain mobility by working with pt; was ambulatory prior to this admission) discharge instructions: you came to the hospital because you were coughing up blood. you were intubated (had a breathing tube in) and underwent bronchoscopies (diagnostic procedure with a scope) that showed that the bleeding was probably from your known bronchiectasis as well as pneumonia in the setting of having thin blood from warfarin. we treated you by decreasing your dose of warfarin: your new inr goal is 2.0-2.5 given your risk of bleeding, and you should have daily inr checks. in addition, you were treated for pneumonia with a course of antibiotics. you were stabilized and extubated (breathing tube removed), and are being discharged to rehab to regain your strength. please use the acapella flutter valve throughout the day; also while you are at rehab you should have chest physical therapy. please follow up with dr. (pulmonology appointment listed below, including repeat ct scan prior to the appointment). note that while you were here, you were evaluated by speech and swallow therapy and have been cleared for a regular diet. if you feel that food is going down your windpipe please let your providers know. also note that while you were admitted you had an episode of atrial fibrillation with a fast heart rate; for this, you have been started on a new medication (diltiazem) and your heart rate is controlled. we made the following changes to your medications: 1. change warfarin dose to 4mg (rather than 5mg) with new inr goal of 2.0-2.5 2. start diltiazem for atrial fibrillation. 3. start medications you can take for constipation: docusate, senna, and miralax as needed. please take these meds if you are constipated. followup instructions: radiology: ct scan when: thursday at 11:30 am with: cat scan building: gz building (/ complex) campus: east best parking: main garage ***nothing to eat or drink for 3 hours before the ct. ok to take medications with water. please arrive 15 minutes early*** pulmonology department: pulmonary function lab when: thursday at 1:40 pm with: pulmonary function lab building: campus: east best parking: garage department: medical specialties when: thursday at 2:00 pm with: rn/dr. building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy injection or infusion of other therapeutic or prophylactic substance arterial catheterization closed [endoscopic] biopsy of bronchus endoscopic excision or destruction of lesion or tissue of lung diagnoses: pneumonia, organism unspecified abnormal coagulation profile unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation asthma, unspecified type, unspecified constipation, unspecified other and unspecified hyperlipidemia acute respiratory failure hypotension, unspecified long-term (current) use of anticoagulants other and unspecified special symptoms or syndromes, not elsewhere classified personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits dehydration unspecified hereditary and idiopathic peripheral neuropathy trigeminal neuralgia malnutrition of moderate degree dysphagia, unspecified bronchiectasis with acute exacerbation 

Answer: The patient is high likely exposed to