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: patient recorded as having no known allergies to drugs attending: chief complaint: respiratory distress major surgical or invasive procedure: intubation and mechanical ventilation history of present illness: 64 y/o gentleman with asthma has complained of sob since sunday. he has had productive cough. pcp prescribed azithromycin which the patient has taken in the last two days. today his sob acutely worsened. he took inhalers/nebs today without any effect. called ems. his symptoms are typical of his asthma exacerbation. patient was taken to hospital. . in hospital patient was found to be lethargic, cyanotic and unable to speak. he was assessed to be in status asthmaticus. he was intubated. ? difficult intubation. . transfer from hospital as there was not any icu beds available. in ed her vitals were t 99.8 bp 124/96 hr 94 rr 19 92% oxygen saturated with unclear settings. difficulty ventilating him adequately in ed. patient received propofol gtt, vecuronium, asa 325 x1, ceftriaxone 2 gram iv x 1, and azithromycin 500 mg x 1. . on arrival to the micu patient was intubated, sedated and on paralytics. most of the history was obtained from his wife and from the chart. no fever, chills, nightsweats, chest pain, abdominal pain, nausea, vomitting, diarrhea, dysuria, bleeding. no known sick contacts. past medical history: - asthma, never intubated in the past, last hospitalization 4 years ago, has been on prednisone for most of the last one year, ranging from 10 mg to 40 mg daily - hypertension - hypercholesterolemia - h/o wct in , clean coronaries, ep study where avnrt was induced with both left bundle branch block pattern and right bundle branch block pattern. abnormality was successfully ablated social history: lives with wife. employed as an engineer. no tobacco/etoh. family history: wife was unable to recall. physical exam: gen: sedated and paralyzed heent: mmm, dried blood inside the mouth heart: s1s2 rrr lungs: ctab in anterior lung fields abdomen: soft ntnd ext: wwp, no edema, dp 2+ b/l neuro: limited by sedation/paralytics at time of discharge: general: awake, alert caucasian male in nard pulmonary: globally diminshed but clear cardiac: s1 s2, no murmurs, rubs or gallops appreciated abdomen: soft, non-tender, non-distended, normoactive bowel sounds, extremities: lue extremity noted to have 2+ edema, + edema noted in b/l le skin: bruises noted over upper extremities. neurologic: alert, oriented x 3. able to relate history without difficulty. 3+ grip strength b/l pertinent results: imaging: cta chest: there are no pulmonary artery filling defects to suggest pulmonary embolism. additionally, there are no secondary signs of embolism, including no evidence of right-sided heart strain. minimal atherosclerotic calcifications involve the thoracic aorta, which is tortuous; however, there is no acute aortic pathology identified including no aortic dissection. atherosclerotic calcifications also involve the coronary arteries. there is no pericardial or pleural effusion. scattered prominent hilar and mediastinal lymph nodes measure up to approximately 9 mm in short axis. in the lungs, diffuse bilateral tree-in- opacities are associated with a few more focal small ground glass opacities. a small amount of atelectasis is noted at the right lung base. an endotracheal tube appears appropriately positioned with secretions noted in the distal trachea and bronchi. although this exam is not tailored to evaluate abdominal organs, limited evaluation of the upper abdomen is performed. a nasogastric tube terminates in the proximal stomach. a 6.2 cm exophytic cyst projects anterior from the interpolar region of the right kidney, partially imaged. fullness of the left renal collecting system is only partially imaged. impression: 1. no pulmonary embolism or acute aortic pathology. 2. diffuse bilateral tree-in- opacities consistent with a small airways infection or inflammation. aspiration should also be considered in the setting of airway secretions. 3. fullness of the left renal collecting system is only partially imaged. dedicated ultrasound to look for frank hydronephrosis can be performed as clinically indicated. lue venous ultasound:() indications: 64-year-old woman with asthma and asymmetric left upper extremity edema with picc line. question dvt. impression: no deep vein thrombosis. chest x-ray (): reason for examination: evaluation of dobbhoff tube placement. portable ap chest radiograph was compared to . the dobbhoff tube tip is in proximal stomach. the left picc line tip is at the cavoatrial junction. cardiomediastinal silhouette is unchanged. minimal retrocardiac atelectasis seen on the left, and the rest of the lungs are unremarkable. minimal pleural effusion cannot be excluded, especially on the left. the study and the report were reviewed by the staff radiologist =================== 05:18am blood wbc-6.2 rbc-3.51* hgb-10.7* hct-31.0* mcv-88 mch-30.4 mchc-34.4 rdw-14.9 plt ct-223 03:59am blood wbc-9.3 rbc-3.48* hgb-10.5* hct-30.6* mcv-88 mch-30.3 mchc-34.5 rdw-15.0 plt ct-212 06:50pm blood hct-31.0* 03:37am blood wbc-10.9 rbc-3.56* hgb-11.0* hct-30.9* mcv-87 mch-31.0 mchc-35.7* rdw-14.7 plt ct-202 04:41pm blood hct-29.9* 10:19am blood hct-29.4* 03:58am blood wbc-8.4 rbc-3.54* hgb-10.7* hct-31.2* mcv-88 mch-30.2 mchc-34.3 rdw-14.8 plt ct-190 11:14am blood hct-33.7* 03:21am blood wbc-12.1* rbc-3.86* hgb-11.9* hct-33.9* mcv-88 mch-30.8 mchc-35.1* rdw-14.5 plt ct-209 04:01am blood wbc-12.7* rbc-4.17* hgb-12.5* hct-37.0* mcv-89 mch-29.9 mchc-33.7 rdw-14.4 plt ct-218 04:37am blood wbc-15.4* rbc-3.82* hgb-11.6* hct-34.2* mcv-90 mch-30.5 mchc-34.1 rdw-14.2 plt ct-206 03:27am blood wbc-15.6* rbc-3.50* hgb-10.8* hct-31.5* mcv-90 mch-30.8 mchc-34.3 rdw-14.0 plt ct-226 03:51am blood wbc-12.6* rbc-3.55* hgb-10.9* hct-32.3* mcv-91 mch-30.7 mchc-33.7 rdw-13.7 plt ct-229 03:19am blood wbc-10.7 rbc-3.33* hgb-10.6* hct-30.7* mcv-92 mch-31.9 mchc-34.5 rdw-13.7 plt ct-235 03:29am blood wbc-9.7 rbc-3.28* hgb-10.5* hct-30.4* mcv-93 mch-32.0 mchc-34.5 rdw-13.9 plt ct-228 03:44am blood wbc-8.9 rbc-3.43* hgb-10.7* hct-31.3* mcv-91 mch-31.2 mchc-34.2 rdw-14.1 plt ct-203 04:24am blood wbc-10.8 rbc-3.76* hgb-11.4* hct-34.0* mcv-90 mch-30.3 mchc-33.6 rdw-14.3 plt ct-197 04:10am blood wbc-9.5 rbc-3.90* hgb-11.8* hct-35.1* mcv-90 mch-30.4 mchc-33.7 rdw-14.4 plt ct-200 05:46am blood wbc-10.3 rbc-4.20* hgb-13.1* hct-37.5* mcv-89 mch-31.2 mchc-35.0 rdw-14.5 plt ct-234 05:18am blood glucose-114* urean-15 creat-0.6 na-146* k-3.5 cl-113* hco3-24 angap-13 03:59am blood glucose-102 urean-14 creat-0.7 na-144 k-3.3 cl-111* hco3-26 angap-10 03:37am blood glucose-106* urean-17 creat-0.6 na-145 k-3.5 cl-112* hco3-24 angap-13 03:58am blood glucose-116* urean-20 creat-0.6 na-148* k-3.4 cl-113* hco3-25 angap-13 03:21am blood glucose-95 urean-22* creat-0.7 na-144 k-3.3 cl-106 hco3-27 angap-14 04:01am blood glucose-91 urean-25* creat-0.6 na-142 k-3.7 cl-101 hco3-31 angap-14 04:37am blood glucose-103 urean-25* creat-0.6 na-141 k-3.2* cl-93* hco3-40* angap-11 09:35pm blood glucose-144* urean-14 creat-0.8 na-140 k-4.6 cl-101 hco3-34* angap-10 03:44am blood ld(ldh)-195 03:33pm blood ck(cpk)-119 05:29am blood ck(cpk)-186* 09:35pm blood ck(cpk)-250* 03:33pm blood ck-mb-7 ctropnt-0.04* 05:29am blood ck-mb-9 ctropnt-0.06* 09:35pm blood ctropnt-0.16* 09:35pm blood ck-mb-10 mb indx-4.0 05:18am blood calcium-8.3* phos-2.6* mg-2.1 03:59am blood calcium-7.9* phos-2.8 mg-2.1 03:37am blood calcium-7.7* phos-2.6* mg-2.1 03:37am blood triglyc-100 03:51am blood triglyc-108 04:10am blood triglyc-157* 04:37am blood theophy-<0.8* ======= microbiology: 4:33 pm mini-bal bronchial lavage-mini test.. gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): oropharyngeal flora absent. pseudomonas aeruginosa. 10,000-100,000 organisms/ml.. of two colonial morphologies. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 4 s ceftazidime----------- 4 s ciprofloxacin---------<=0.25 s gentamicin------------ 2 s meropenem-------------<=0.25 s piperacillin---------- 8 s piperacillin/tazo----- 8 s tobramycin------------ <=1 s immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. less than 2 ml received interpret negative results with caution. fungal culture (preliminary): no fungus isolated 3:58 am blood culture negative pending x 1 blood culture, routine (final ): no growth x 2 brief hospital course: 64 y/o gentleman with asthma, hypertension and hypercholesterolemia presents with acute respiratory failure. # respiratory failure: patient presented with severe asthma exacerbation, requiring intubation and mechanical ventilation. initially, he required paralysis in order to maintain ventilator synchrony. he was placed on respiratory precautions while a viral illness was ruled out; a rapid viral screen was negative for influenza, parainfluenza, adenovirus, and rsv infection. at time of admission, he was started on ceftriaxone and azithromycin as empiric coverage for a community-acquired bacterial pneumonia. he was treated with high-dose solumedrol and continuous bronchodilatory mdi's in effort to reduce his airway resistance. a pan-sensitive pseudomonas organism was subsequently cultured from a sputum sample obtained at the time of his presentation. on , his antibiotic coverage was changed to levofloxacin and zosyn for double-coverage of pseudomonas. his ventilator settings were managed to allow permissive hypercapnea, and remained stable but without improvement. the differential for the trigger for his asthma exacerbation was broadened, and a mini-bal was performed on with sample sent for fungal culture and pcp . ldh was 195, making pcp less likely. fungal markers were sent. the pt was eventually extubated and transferred to the floor where he completed his 2 week course of levofloxacin and zosyn. prior to discharge pt was saturating adequately on 2l nasal canula with fluticasone, albuterol, montelukast, albuterol inhalers. pulmonary team were also consulted prior to transfer and recommended a slow prednisone taper of 1. 40mg prednisone once a day x 5 days (starting ) 2. 30mg prednisone once a day x 5 days (starting ) 3. 20mg prednisone once a day, he should be continued on this dose until he is seen by his outpatient pulmonary physician . at , office number: . unfortunately dr. was not available at time of discharge to set up appointment, he was e-mailed with details of the pt's discharge and his transition to for rehab. per dr. clinic he will call the rehab for the appointment needed in 4 weeks time. # steroid prophylaxis: after discussion with pulmonary prior to discharge pt was started on pcp prophylaxis with bactrim as well as calcium and vitamin d. # demand ischemia: during admission pt was noted to have an elevated troponin level of 0.16 (which trended down) with negative ck and ck mbs. he was briefly anticoagulated on a heparin gtt due to initial concern for cardiac ischemia; however, this was later attributed to demand and heparin gtt was discontinued. he was started on asa 81 mg for primary cardiac prevention and was continued on his home statin. the asa was stopped when concern for possible contribution of the asa to his reactive airways. # gib: during his icu stay the pt was noted to have brbpr. he had been maintained on a ppi during his entire course. the hct dropped but stabilized and transfusion was deferred at family request. gi was consulted but given that the hct stabilized no emergent intervention was needed. gi saw pt prior to discharge and recommended an outpatient endoscopy once pt has completed rehab. # myopathy: after extubation, the pt had a profound muscle weakness, possibly related to steroids. he failed a video swallow on and a dobhoff was placed. pt/ot worked with the pt and recommended rehabilitation. at time of discharge pt still unable to raise his extremities against gravity but showed improvement with grip strength (), internal/external roation of the upper extremities (), able to move toes and internally/externally rotate lower extremities (). # hypertension: pt has a history of hypertension for which prior to discharge he was maintained on cardizem 30mg four times a day. # oral candidasis: pt was noted to have oral candidiasis was started on nystatin swish and swallow. medications on admission: advair 500/50 flovent 220 mcg spiriva not anymore singulair 10 mg once a day cardizem 180 mg daily albuterol nebs prn discharge medications: 1. montelukast 10 mg tablet : one (1) tablet po daily (daily). 2. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day). 3. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 4. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day) as needed. 5. polyvinyl alcohol 1.4 % drops : 1-2 drops ophthalmic prn (as needed). 6. albuterol 90 mcg/actuation aerosol : 1-2 puffs inhalation q4h (every 4 hours) as needed for wheezing. 7. fluticasone-salmeterol 500-50 mcg/dose disk with device : one (1) disk with device inhalation (2 times a day). 8. fluticasone 110 mcg/actuation aerosol : two (2) puff inhalation (2 times a day). 9. diltiazem hcl 30 mg tablet : one (1) tablet po qid (4 times a day). 10. insulin regular human 100 unit/ml solution : one (1) unit injection asdir (as directed): per sliding scale whilst on prednisone. 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation q2h (every 2 hours) as needed for wheezing. 12. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day). 13. prednisone 10 mg tablet : per taper tablet po once a day: please take 40mg once a day starting from to . starting from to please wean down to 30mg once a day. from on please take 20mg once a day. 14. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr twice a day. 15. bactrim ds 160-800 mg tablet : one (1) tablet po qmon,qwed,qfri. 16. vitamin d 400 unit tablet : two (2) tablet po once a day. 17. calcium 500 500 mg (1,250 mg) tablet : one (1) tablet po three times a day. discharge disposition: extended care facility: - discharge diagnosis: primary: asthma exacerbation secondary: hypertension, hyperlipidemia discharge condition: stable, afebrile discharge instructions: you were transferred to this hospital after having an asthma exacerbation that required you to be on a ventilator. whilst you were in the hospital your breathing was maintained on the ventilator in the icu until you were able to breathe for yourself. you were then extubated and your breathing improved to the point that you only needed nasal cannula oxygen. during your hospitalization we noted that you were weak after being very sick, you were seen by physical and occupational therapy who recommended you go to a rehab facility to help gain your strength. whilst in the hospital we also noted that your blood level decreased, you were seen by the gi specialists. please take your medications as prescribed. if you experience any fevers, chills, worsening breathing please return to the ed. followup instructions: we will let your pulmonary doctor know that you are going to rehab. if you do not hear from him within the next week please call his office. please make an appointment with your pcp . in three weeks time procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances insertion of other (naso-)gastric tube diagnoses: hyperpotassemia hypocalcemia pure hypercholesterolemia unspecified essential hypertension adrenal cortical steroids causing adverse effects in therapeutic use acute respiratory failure pneumonia due to pseudomonas hemorrhage of gastrointestinal tract, unspecified toxic myopathy hyperosmolality and/or hypernatremia asthma, unspecified type, with (acute) exacerbation asthma, unspecified type, with status asthmaticus 

Answer: The patient is high likely exposed to