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: bactrim / sulfa (sulfonamide antibiotics) / seroquel / heparin agents attending: chief complaint: dyspnea/hypoxia major surgical or invasive procedure: : chest tube placement on left : ir fluoroscopy guided pigtail drain placement into loculated left pleural effusion history of present illness: mr. 53-year-old male with history of cad status post mi in ' with bypass, chronic systolic chf, ef of 30%-35%, hep c untreated with thrombocytopenia, history of ivdu, chronic pain on chronic methadone, status post history of laryngeal nerve injury, status post a history of multiple lower extremity orthopedic surgeries who presents with l-sided pleuritic chest pain and cough for 4 days. patient denies fevers but has been fatigues for the past week, coughing up "pus like" sputum that is occasionally streaked with blood. he has lost 14 lbs in 3 weeks with decrease in appetite. he denies night sweats but reports significant left sided pleuritic cp which has been progressing. . in the ed 100.0 134 113/56 20 95%. cxr: large l pleural effusion. given /ceftriax and morphine. labs notable for cr 1.3 and wbc 19 and lactate normal. 100.6 126 115/92 30 96% on 4l. given 1l fluids. . upon arrival to the icu, patient was endorsing sharp, left sided pleuritic cp with radiation to left shoulder and neck and to left side of abdomen. he took 2 nitros for this 5 days ago which did not provide relief of his pain. he endorses cough productive of yellow mucus but that is hurt to cough or move at all the left side. denied shortness of breath or palpitations. also endorsed chronic aspiration given previous c2 injury. he was febrile but denied feeling chilled on admission or at home. he also endorses right hip pain that has been progessing and limiting his walking. orthopedics had told him this was likely arthritis. . ros: (+) per hpi (-) denies night sweats, recent weight gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough. denied chest tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: -cad status post stemi in 07, lima to lad -chronic systolic chf, ef 30%-35%. most recent echo was from -hcv with possible cirrhosis, never treated -copd -htn -hl -hepatitis b with reported cleared infection -depression/anxiety/ptsd -chronic back pain -psoriasis -l3 spinal fusion -: l knee gun shot wound; : l knee total arthroplasty; -: l knee fusion -dm2, diet controlled -hep c genotype 1 cirrhosis -thrombocytopenia -history of cva with small left thalamic infarction -gerd/barrett's -history of question bph, -ptsd status post c2 injury with fall with subsequent surgery complicated by laryngeal nerve injury -recurrent aspiration pneumonitis -history of isolated mac in his sputum -history of mssa plus gbs tibial osteomyelitis /11 social history: recently noncompliant with medications. he lives at st has vna qd. smoking five cigarettes per day down from onepack, history of iv drug use, none in the last 16 years. denies alcohol. family history: mother died of lung cancer when he was three years old. father was murdered when he was 7. physical exam: vs: temp: 100.7 bp: 133/78 hr:124 rr:27 o2sat96%4l gen: pleasant but uncomfortable, in obvious distress in pain from left sided pain with rapid shallow breaths heent: perrl, eomi, anicteric, drymm, op without lesions, no supraclavicular or cervical lymphadenopathy, jvp to 8mmhg, no carotid bruits, no thyromegaly or thyroid nodules resp: poor inspiratory effort pain, but coarse bs at right base and decreased bs at left base anteriorly cv: tahcy regular, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, ttp in lower upper and lower quadrants, with involuntary guarding, no rebound, no masses or hepatosplenomegaly ext: no c/c/e, left knee is reconstructed and fused skin: no rashes/no jaundice/no splinters neuro: aaox3. cn ii-xii intact. 5/5 strength in upper extremites, lle 4+/5, rle . lle decreased sensation, otherwise intact. no pass-pointing on finger to nose. 2+dtr's biceps unble to elicit in lower ext . discharge exam: vitals: vss, breathing at 20 94 ra . gen: nad heent: ncat perrl mmms neck: no lad supple **pulm: no accessory muscle use, right lung field cta with basilar expiratory crackles, no wheezes or rhonci; left lung improving, still with bronchial bs and crackles chest wall: chest tube draining from left chest; chest tube draining yellow fluid cv: rrr nml s1/2 no m/r/g ab: +bs. non-tense distended abdomen, mildly ttp. fos. ext: no edema left knee: well healed scar skin: no lesions, no rashes neuro: grossly non-focal. pertinent results: admission labs: 10:10pm urine hours-random creat-48 sodium-44 potassium-17 chloride-35 10:10pm urine color-yellow appear-clear sp -1.046* 10:10pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-2* ph-6.0 leuk-neg 07:22pm pt-18.5* ptt-29.2 inr(pt)-1.7* 03:25pm glucose-85 urea n-23* creat-1.3* sodium-134 potassium-4.7 chloride-96 total co2-28 anion gap-15 03:25pm estgfr-using this 03:25pm alt(sgpt)-18 ast(sgot)-28 ld(ldh)-171 alk phos-84 tot bili-1.0 03:25pm tot prot-7.8 03:16pm comments-green top 03:16pm lactate-1.6 03:00pm ctropnt-<0.01 03:00pm wbc-19.7*# rbc-3.88* hgb-12.1* hct-34.6* mcv-89 mch-31.0 mchc-34.9 rdw-15.5 03:00pm neuts-91.4* lymphs-4.6* monos-3.4 eos-0.4 basos-0.2 03:00pm plt count-147*# . ekg: nsr at 129 bpm, lad, ni, q in avf, v1, v2, upsloping 1mm ste in v2, 2mm ste v3 with poor baseline, compared to prior elevated in v3 on new but may be related to lead placement. ischemic cannot be excluded. . imaging: cxr : prelim, left sided white out . bedside u/s: loculated pleural effusion . ct ab/p/ch c contrast: impression: 1. multiloculated large left pleural effusion with visceral and parietal pleural enhancement concerning for empyema. 2. mediastinal adenopathy, likely reactive. 3. cirrhosis. splenomegaly and evidence of umbilical vein recanalization, suggestive of portal hypertension. 4. left renal cyst. . ct-guided pigtail impression: moderate to large residual loculated left upper effusion now status post successful 8 french modified pigtail drain catheter placement into the pleural space. 165 ml of serosanguineous fluid was aspirated. the findings were discussed with caring resident, dr. , shortly after exam completion at approximately 5:15 p.m. via phone by dr. . system should be placed to suction overnight. . cxr: impression: ap chest compared to through :34 a.m.: the volume of residual left pleural effusion is smaller today than it was yesterday and a closer apposition of pleural surfaces may account for increase in pain. the pigtail catheter ends at the level of the carina. left lower lobe is essentially collapsed. less severe atelectasis at the right lung base is unchanged. no right pneumothorax. small volume of left apical pleural air is decreasing as that compartment fills with fluid. basal pleural tube also unchanged in position but difficult to localize on the single frontal view. . cxr pa-l: findings: in comparison with the study of , there again are areas of air-fluid levels in the lateral aspect of the left hemithorax, consistent with a complex hydropneumothorax. chest tubes remain in place. right lung remains essentially clear. . ct-ab/p/c wet read: jbre tue 3:18 am 1. no acute process of the abdomen or pelvis including no ascites, splenic infarct, abd abscess or diverticulitis. 2. significant fecal loading of the entire colon, increased from prior exams. 3. unchanged splenomegaly and left renal cyst. 4. since , significant interval decrease in size of the left empyema, but remaining lll opacity (atelectasis vs. pna). 5. stable rml opacity, likely atelectasis. 6. unchanged reactive mediastinal lap. . final read: 1. significant interval decrease in the size of the left-sided complex pleural effusion / empyema with thoracostomy tube placement. residual tethering of the left lower lobe is noted; however, there has been reasonable reexpansion of the left lung. 2. unchanged splenomegaly. the study and the report were reviewed by the staff radiologist. . ct-chest c contrast: impression: 1. interval marked decrease in size of loculated pleural collections, with no new fluid collections seen. a left pleural pigtail catheter and left thoracostomy tube are unchanged in position. there is residual moderate atelectasis at the left lung base. . cxr findings: low lung volumes result in bronchovascular crowding. the small left pleural effusion and left basilar atelectasis are unchanged from . the right lung is clear. a chest tube projects over the left hemithorax. a right picc ends in the mid svc. there is no pneumothorax. cervical spinal hardware is incompletely evaluated. impression: no change from . no pneumothorax. discharge labs: . 05:44am blood wbc-5.3 rbc-2.99* hgb-8.9* hct-26.8* mcv-90 mch-29.6 mchc-33.1 rdw-15.7* plt ct-145* 09:08am blood glucose-99 urean-11 creat-1.0 na-136 k-4.2 cl-101 hco3-30 angap-9 09:08am blood calcium-7.4* phos-3.6 mg-2.1 brief hospital course: 53 yom admitted to the icu with hypoxia due to aspiration pna associated empyema, now s/p chest tube and pigtail drain (removed) on ceftriaxone, who has a history of recurrent aspiration pneumonitis, mac isolated from his sputum, and copd in the setting thrombcytopenia, hcv, and chronic pain/heroine abuse on methadone. . active issues: . #empyema: patient presented with large located left-sided pleural effusion. thoracic surgery was consulted and placed a left-sided chest tube. pleural fluid studies were consistent with empyema. ir was consulted for drainage of a loculated effusion not drained by chest tube, with a pigtail catheter placed on . cultures of the pleural fluid showed strep anginosis. was treated initially with levofloxacin, then broadened to vanc/zosyn, then narrowed to ceftriaxone for a planned course of weeks. serial imaging as detailed above showed interval improvement in the empyema with serial injections of tpa and drainage by wall suction. vats was considered, with both liver and cardiology clearing the patient for surgery, but ultimately deferred due to the improvement with conservative management and with the patient's comorbidities making the risk to benefit ratio unfavorable. the pigtail was pulled before discharge. the patient was discharged on ceftriaxone with one chest tube in place and plans to follow-up with cardiothoracic surgery. . #pleuritic chest pain: the pain service consulted. the patient was initially managed on a dilaudid pca, which was transitioned to dilaudid po before transfer to the floor from the icu. breakthrough was managed with po dilaudid then transitioned to percocet the day before discharge. longacting pain control was provided by convertin the patient's daily methadone to q6h with an increase to 200mg total daily before being decreased back to once daily 155mg, the patient's baseline, before discharge. a fentanyl patch was started and uptitrated to 50mg. the patient was discharged with follow-up with the pain clinic. adjunctive pain management was provided with lidocaine patches, gel, and tizanidine, with little effect. . #constipation: the patient had marked abdominal pain on transfer to the floor from the icu. ct-abd showed no acute pathology other than constipation. the patient's symptoms improved with an aggressive bowel regimen, which included mag-citrate and methylnaltrexone every other day. . #acute renal failure: the patient presented with creatinine 1.3. his acute renal failure was felt to be secondary to volume depletion, and he was treated with iv fluids, bicarb and mucomyst after contrast study. lisinopril was held. the patient's urine output increased, and his renal function rapidly returned to . on , the patient's renal function worsened again, which was attributed to contrast nephropathy. cr returned to with supportive measures. . #methadone overdose: the patient was given his home dose of methadone 155mg daily twice; he was only prescribed for once daily dosing as documented in poe. fentanyl and percocet were stopped. he was ordered for naloxone but this was never given because he remained ao x 3 and sats remained stable. serial ekgs showed stable qtc peaking in 470s. he was discharged on his home dose of methadone, fentanyl patch, and percocet. the patient said that he did not refuse the second dose because he forgot receiving the first dose; he also noted that the morning prior he was almost given a second dose but refused it. . inactive issues: . #dm2: diet controlled at home. while inpatient, the patient was managed with an insulin sliding scale. insulin sliding scale was stopped on given lack of significant hyperglycemia. remained euglycemic. . #chronic pain: methadone was continued at the patient's home dose. the patient's acute left-sided pleuritic chest pain was managed as above. chronic pain service followed patient in-house. qtc remained ~ 460. . # copd: no e/o flare. was managed on ipratropium bromide neb 1 neb ih q6h and albuterol 0.083% neb soln 1 neb ih q6h:prn. . # hep c cirrhosis: was never encephalopathic this admission. maintained on lactulose tid. . # anemia: remained stable. . # thrombocytopenia, coagulopathy: working dx = cirrhosis related. remained stable. coagulopathy was corrected with vitamin k when the patient was under consideration for vats. . # chf: clinically euvolemic throughout admission. discharged in euvolemic condition. . # cad, htn: continued home regimen as detailed below. -metoprolol tartrate 25 mg po/ng (home dose 25mg succinate daily) -clonidine 0.3 mg po daily -aspirin 81 mg po/ng daily -simvastatin 40 mg po/ng daily -lisinopril 5mg daily . # psych issues: anxiety, ptsd, depression. continued home regimen as below. -clonazepam 1 mg po/ng tid:prn anxiety -doxepin hcl 300 mg po/ng hs . # gerd: stable. continued home regimen as below. -omeprazole 40 mg po daily . transitional issues: # chest tube: will be managed by the cardiothoracic surgical service with outpatient follow-up. # chronic pain: will be managed by the pain service with outaptietn follow-up. # methadone: will be overseen by new pcp . . medications on admission: clonazepam - (prescribed by other provider) - dosage uncertain clonidine - (prescribed by other provider) - dosage uncertain doxepin - (prescribed by other provider) - dosage uncertain lactulose - (prescribed by other provider) - 10 gram/15 ml solution - 30 ml by mouth daily as needed for prn for constipation lisinopril - 5 mg tablet - 1 (one) tablet(s) by mouth once a day methadone - (prescribed by other provider) - 40 mg tablet, soluble - 5 tablet(s) by mouth once a day total dose 170 mg daily metoprolol succinate - 25 mg tablet extended release 24 hr - 1 tablet(s) by mouth daily nitroglycerin - 0.4 mg tablet, sublingual - 1 tablet(s) sublingually every 5 mins as needed for angina call 911 if no relief after 3rd pill. nitroglycerin - (prescribed by other provider) - 0.4 mg tablet, sublingual - 1 tablet(s) sublingually q5 min x3 for chest pain as needed for prn omeprazole - (prescribed by other provider) - 40 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth daily oxycodone - 30 mg tablet - 1 capsule(s) by mouth once a day as needed for pain do note drink or drive under the influence of this medicaion. do not operate dangerous equipement. potassium chloride - (prescribed by other provider) - dosage uncertain promethazine - 50 mg tablet - 1 tablet(s) by mouth daily at bedtime for nausea simvastatin - 40 mg tablet - 1 tablet(s) by mouth daily tiotropium bromide - (prescribed by other provider) - 18 mcg capsule, w/inhalation device - 1 puff daily discharge medications: 1. clonazepam 1 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for anxiety . 2. clonidine 0.1 mg tablet sig: three (3) tablet po daily (daily). 3. doxepin 150 mg capsule sig: two (2) capsule po once a day. 4. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day) as needed for cirrhosis patient, prevent encephalopathy. 5. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 6. methadone 10 mg tablet sig: 15.5 tablets po daily (daily). 7. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 8. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tab sublingual once a day as needed for chest pain. 9. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 10. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 11. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) puff inhalation once a day. 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 13. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily) as needed for constipation. 16. magnesium citrate solution sig: three hundred (300) ml po daily (daily). 17. methylnaltrexone 12 mg/0.6 ml solution sig: twelve (12) mg subcutaneous every other day as needed for constipation for 2 weeks. 18. fentanyl 50 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 19. oxycodone-acetaminophen 5-325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 20. ceftriaxone in dextrose,iso-os 1 gram/50 ml piggyback sig: one (1) g intravenous q24h (every 24 hours) for 3 weeks: last day for total course of 5 weeks (day 1 ). 21. sodium chloride 0.9 % 0.9 % solution sig: one (1) flush injection prn (as needed) as needed for line flush: picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 22. chest tube to suction discharge disposition: extended care facility: - discharge diagnosis: primary: -empyema secondary: -chronic pain -opiate dependence on methadone maintenance discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance. discharge instructions: it has been a privilege to take care of you at . . you were hospitalized for a puss collection in your left chest called an empyema; the empyema was probably caused by aspiration pneumonia, which you have had in the past due to your vocal cord paralysis. the cardiothoracic surgeons saw you during this hospitalization, and placed a chest tube as well as a pigtail catheter; they injected enzymes into your chest to dissolve the pus. overtime the pus has drained from the chest cavity as seen by serial x-rays. the pigtail catheter was removed, but you are being discharged with the chest-tube in place; it will remain in place until you see your cardiothoracic surgeons in clinic after discharge. you are being discharged on intravenous antibiotics, which you will need to continue for several weeks. . the pain service saw you during this hospitalization. they started a number of new medications for your pain, but you are being discharged on your home dose of methadone, which is 155mg daily. . abdominal imaging was performed because you were experiencing abdominal pain. the imaging showed that you were very constipated. you are being discharged on anti-constipation medications. . no changes were made to your medications other than as detailed below. start: -ceftriaxone antibiotics until the prescription is complete. -fentanyl patch for pain -percocet as needed for pain -duonebs for shortness of breath, wheeze -magcitrate daily to prevent constipation -miralax to prevent constipation -colace to prevent constipation -compazine for nausea -methylnaltrexone to prevent constipation - this medication acts only on the intestine - it does not cause withdrawal, and you have been receiving it this hospitalization without any problems -aspirin to prevent heart disease . stop: -promethazine -potassium chloride followup instructions: department: thoracic surgery (in hematology/oncology suite) when: thursday at 4:00 pm with: , md building: sc clinical ctr campus: east best parking: garage department: pain management center when: friday at 10:30 am with: , md building: one place (, ma) campus: off campus best parking: parking on site your new pcp will be dr. . call the clinic at to make this appointment once you leave rehab. procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified thoracentesis diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension chronic hepatitis c without mention of hepatic coma 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 aortocoronary bypass status opioid type dependence, unspecified dysthymic disorder pneumonitis due to inhalation of food or vomitus old myocardial infarction chronic systolic heart failure empyema without mention of fistula poisoning by methadone accidental poisoning by methadone posttraumatic stress disorder 

Answer: The patient is high likely exposed to