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: penicillins attending: chief complaint: dyspnea major surgical or invasive procedure: endotracheal intubation tracheostomy peg placement history of present illness: 76 yo male with a history of end-stage pulmonary sarcoidosis who presents with increased shortness of breath over last 24hrs, tachycardia, general fatigue x 1 week. similar prior presentations, felt to be related to sarcoidosis. denies any increase in cough or sputum production, fevers, chills or sweats. no abdominal pain, nausea, vomting or diarrhea. past medical history: 1. pulmonary sarcoidosis with pumonary fibrosis, dx , s/p lung bx 2. bph 3. hypercholesterolemia 4. orthostatic hypotension 5. l eye ptosis since birth 6. glucose intolerance 7. chronic encephalomalacia secondary to head trauma while playing ice hockey in 8. h/o "tummy tuck" remotely social history: retired from import/export business in plumbing. ran his own business. only out of country travel was to bermuda years ago. smoking hx 1-1/2 ppd x 15 yrs, quit . no etoh or drugs. lives alone. brother and his familiy live in . family history: mother died at y.o. hx , father died at 75 yo, stroke/cerebral hemorrhage. patient has 2 brothers, healthy. married, no children physical exam: pe on admission: gen: tachypnic appearing male heent: , ptosis on left, anicteric, dry mucous membranes, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: rhonchorous diffusely, poor air movement, using accessory muscles of neck and abdomen to assist with ventilation cv: tachycardic, no murmurs abd: nd, +b/s, soft though muscles contracted 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. . exam on discharge gen: awake and alert w/trach in place, sitting up in bed, thin frail-appearing man heent: perrla. eomi. cv: rrr, no m/g/r lungs: diffuse coarse inspiratory and expiratory sounds. expiratory wheezing more prominent on right lung fields. : soft nondistended and nontender ext: no edema, + peripheral pulses bilaterally neuro: grossly intact, writing notes to communicate pertinent results: admission labs 11:30am blood wbc-13.6*# rbc-4.83# hgb-15.2# hct-45.7# mcv-95 mch-31.5 mchc-33.3 rdw-13.0 plt ct-247 11:30am blood neuts-91.1* lymphs-5.6* monos-2.7 eos-0.3 baso-0.4 11:30am blood glucose-107* urean-15 creat-0.8 na-143 k-3.8 cl-101 hco3-31 angap-15 11:30am blood ctropnt-<0.01 07:56pm blood ck-mb-3 ctropnt-<0.01 06:19am blood ck-mb-3 07:56pm blood calcium-7.1* phos-2.6* mg-1.4* 07:56pm blood cortsol-29.8* 11:33am blood lactate-2.1* k-3.7 . pertinent labs 04:42am blood wbc-7.0 rbc-3.36* hgb-10.5* hct-31.6* mcv-94 mch-31.2 mchc-33.2 rdw-13.1 plt ct-196 03:02am blood wbc-9.1 rbc-3.56* hgb-10.8* hct-32.5* mcv-91 mch-30.4 mchc-33.3 rdw-12.7 plt ct-341 02:44am blood wbc-9.3 rbc-3.08* hgb-9.5* hct-28.4* mcv-92 mch-30.9 mchc-33.5 rdw-13.3 plt ct-399 04:20am blood wbc-9.5 rbc-3.81* hgb-11.9* hct-35.9* mcv-94 mch-31.3 mchc-33.2 rdw-13.8 plt ct-449* 04:06am blood plt ct-323 02:44am blood plt ct-399 06:07am blood pt-12.7 ptt-24.9 inr(pt)-1.1 04:20am blood pt-12.7 ptt-24.9 inr(pt)-1.1 04:23pm blood glucose-86 urean-18 creat-0.4* na-139 k-3.5 cl-94* hco3-39* angap-10 03:01am blood glucose-87 urean-21* creat-0.4* na-146* k-3.7 cl-106 hco3-38* angap-6* 04:07am blood glucose-78 urean-19 creat-0.4* na-145 k-3.8 cl-98 hco3-40* angap-11 04:20am blood glucose-101* urean-16 creat-0.5 na-148* k-3.9 cl-100 hco3-43* angap-9 03:01am blood alt-33 ast-24 ld(ldh)-162 alkphos-98 totbili-0.2 03:44am blood type-art temp-36.8 rates-/25 peep-5 fio2-40 po2-163* pco2-59* ph-7.33* caltco2-33* base xs-3 intubat-intubated vent-spontaneou 04:34pm blood type- temp-37.5 rates-/12 tidal v-320 peep-5 fio2-30 po2-48* pco2-66* ph-7.43 caltco2-45* base xs-15 intubat-intubated vent-spontaneou 03:36am blood type- temp-38.2 rates-/28 tidal v-400 peep-5 fio2-30 po2-32* pco2-59* ph-7.41 caltco2-39* base xs-8 intubat-intubated vent-spontaneou 12:07am blood type-art po2-127* pco2-73* ph-7.39 caltco2-46* base xs-15 intubat-intubated . microbiology 12:00pm urine blood-mod nitrite-neg protein-150 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg 03:34pm urine blood-tr nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg 02:12pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-sm . blood cultures (): no growth urine culture (): no growth sputum (): gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): sparse growth commensal respiratory flora. direct influenza a antigen test (final ): negative for influenza a. direct influenza b antigen test (final ): negative for influenza b. blood cultures (): no growth blood cultures (): no growth blood cultures (): no growth cxr (): aside from slightly lower lung volumes, there is no significant interval change in the appearance of the end-stage sarcoidosis as previously documented. . cxr (): comparison with the previous study done . there are extensive parenchymal and pleural changes consistent with end-stage sarcoidosis as before. an endotracheal tube and nasogastric tube remain in place. allowing for differences in technique, there is no significant change. no significant interval change. . cxr (): previously questioned retrocardiac nodular infection has cleared, presumably representing secretions resolved from a region of cystic lung. in all other respects the radiographic appearance of these severely scarred and bronchiectatic lungs, as well as bilateral pleural abnormalities are unchanged over the long-term. there are no findings to suggest acute pneumonia or pulmonary edema. brief hospital course: 76 yo male with end stage sarcoidosis presenting with dyspnea. . # hypercarbic respiratory failure: pt presented to the er with increased shortness of breath over 24hrs, tachycardia, and generalized fatigue. similar prior presentations were felt to be related to sarcoid flares. cxr showed end stage pulmonary fibrosis but no other abnormalities. it was felt his sx likely represented pneumonia in setting of severe underlying fibrotic lung disease. pt was unable to sustain high minute ventilatory rate, evidenced by a rising pco2 and thus required emergent intubation shortly after arrival to icu. the patient was treated for presumed pneumonia with levofloxacin and meropenem given leukocytosis and dyspnea. infectious work-up including multiple blood cultures and viral cultures were negative. the patient was not given steroids since it was felt that his sx were related to an infectious process rather than a flair of his sarcoid lung disease. the patient was made dnr after talking with the son. ip consult was sought for trach placement given the patient's inability to wean off the ventilator with subsequent placement of tracheostomy and peg on and respectively. pt tolerated trach mask well. he was transferred to the floor on . later that afternoon he was noted to desat into the 50's with increased work of breathing and was requiring high levels of nursing care. he was transferred back to the micu where he again experienced agitation and increased work of breathing. he was placed back on the vent on ps overnight and tolerated this well and eventually was able to transition to trach mask throughtout the day and night. clinical decompensation attributed to mucus plugging. # chronic orthostatic hypotension: pt normotensive on admission to icu. his home medications of midodrine and fludricortisone were continued while admitted. # agitation: the patient had issues with agitation especially at night. geriatrics was consulted and a regimen of seroquel was initiated as well as efforts to limit lines and to orient him frequently. his mental status waxed and waned and he fell out of bed twice but sustained no injuries. by his delirium had improved on a regimen of seroquel to 12.5 mg , seroquel 25 mg qhs and seroquel 25mg prn. upon readmission to the micu, however, he again became significantly agitated and required iv haldol in addition to his scheduled seroquel. ekg the following morning did not show any eveidence of prolonged qt. per geriatric recommendations the pt's seroquel was increased to 50mg qhs and his sundowning improved. qtc was noted to 419 on discharge dose of seroquel. . the patient was on subq heparin for dvt prophylaxis and ppi for stress ulcer prophylaxis. communication was with the patient and his , () . code status was dnr/dni, confirmed with hcp. . # malnutrition: he failed swallowing test twice with concern for aspiration. peg tube was placed and his tube feeds were advanced to goal rate of 35 cc/hr. medium chain trigylcerides were added for coloric help. . follow up at rehab 1. sundowning: increase his schedule dose of seroquel and qhs. his qtc on current dose is only 419. please check ekg after increasing his dose to ensure there is no significant qtc prolongation. medications on admission: 1. fludrocortisone 0.1 mg daily 2. tamsulosin 0.4 mg hs 3. docusate sodium 100 mg as needed for constipation 4. midodrine 1.25 mg po bid 5. acetaminophen 1000 mg po q6h as needed for pain discharge medications: 1. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 2. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 3. senna 8.8 mg/5 ml syrup : one (1) tablet po bid (2 times a day). 4. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 5. midodrine 2.5 mg tablet : 0.5 tablet po bid (2 times a day). 6. beclomethasone dipropionate 80 mcg/actuation aerosol : one (1) inhalation (2 times a day). 7. fludrocortisone 0.1 mg tablet : one (1) tablet po daily (daily). 8. quetiapine 25 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for anxiety. 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 10. quetiapine 25 mg tablet : 0.5 tablet po bid (2 times a day). 11. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed for thrush. 12. acetylcysteine 20 % (200 mg/ml) solution : one (1) ml miscellaneous q4h (every 4 hours). 13. oxycodone-acetaminophen 5-325 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for pain. 14. ipratropium-albuterol 18-103 mcg/actuation aerosol : six (6) puff inhalation q4h (every 4 hours) as needed for wheezing. 15. quetiapine 25 mg tablet : two (2) tablet po qhs (once a day (at bedtime)). 16. acetaminophen 500 mg tablet : two (2) tablet po q8h (every 8 hours). 17. medium chain triglycerides 7.7 kcal/ml oil : one (1) ml po bid (2 times a day). discharge disposition: extended care facility: - - discharge diagnosis: primary diagnosis 1. hypercarbic respiratory failure 2. pneumonia 3. sarcoidosis 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: you were admitted because you had shortness of breath which was thought to be due to a pneumonia in setting of your underlying sarcoidosis. you were treated with antibiotics called meropenem and vancomcyin. you needed help with mechanical ventilation to breathe. a tracheostomy was performed as you required prolong ventilatory support. you were removed off of mechanical ventilation and were breathing on trach collar mask prior to transfer to rehab. . followup instructions: department: pulmonary function lab when: wednesday at 3:40 pm with: pulmonary function lab building: campus: east best parking: garage department: medical specialties when: wednesday at 4:00 pm with: , m.d. building: campus: east best parking: garage department: pft when: wednesday at 4:00 pm md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy diagnoses: pneumonia, organism unspecified pure hypercholesterolemia personal history of tobacco use sarcoidosis hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) acute and chronic respiratory failure postinflammatory pulmonary fibrosis other and unspecified special symptoms or syndromes, not elsewhere classified do not resuscitate status accidental fall from bed drug-induced delirium other abnormal glucose lung involvement in other diseases classified elsewhere orthostatic hypotension mixed acid-base balance disorder other severe protein-calorie malnutrition other conditions of brain late effects of other accidents dysphagia, oropharyngeal phase benzodiazepine-based tranquilizers causing adverse effects in therapeutic use congenital ptosis 

Answer: The patient is high likely exposed to