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: hemoptysis major surgical or invasive procedure: bronchoscopy history of present illness: this is a 72 year-old male with a history of afib on coumadin, htn and recent bronchitis who was transferred from osh ed with several episodes of hemoptysis (frank blood and large clots) for pulmonary evaluation. . pt was in usoh until today when he noticed an episode of hemoptysis this afternoon at home. he went to ed for evaluation and continued to have multiple episodes of frank hemoptysis and clots. he was hd stable. cxr did not show any acute finding. inr was 2.4 and hct was 49. pt was transferred to for pulmonary evaluation. . of note, pt had severe bronchitis about three weeks ago that resolved on its own. no h/o cancer or smoking. also denies brbpr, tarry stools or vomiting. also no changes in his coumadin dose. no sick contacts. bleeds. . in the ed, his vs were t97.7, 115, 148/79, 18, 100%ra. lung exam with b/l rales. he was guaiac negative. ekg with afib, no acute changes. cxr without acute process. inr was 2.7. hct stable at 44.3. wbc 16.9 with left shift but no bands. pt coughed up a total of approximately 50-75cc of blood (frank blood and clots) which eventually subsided after one large clot. 2 large bore ivs were placed. interventional pulmonary was contact who decided to reverse his inr and perform bronchoscopy in am. pt received 10mg iv of vitamin k and 2u of ffp and was admitted to the icu for further monitoring. . ros: the patient denies any bleeds, fevers, chills, weight change, nausea, vomiting, abdominal pain, diarrhea, melena, hematochezia, chest pain, shortness of breath or dysuria. past medical history: - atrial fibrillation x 20 yrs, on coumadin - htn - ppm (per pt, for difficult to control afib; no h/o heart block); placed 9 yrs ago at - anxiety - depression social history: lives at home with wife. denies any etoh, cigarette smoking or ivdu. family history: no lung diseases. physical exam: vitals: t: 97.6 bp: 138/75 hr: 107 rr: 20 o2sat: 95% ra gen: wdwn male in no acute distress heent: eomi, perrl, sclera anicteric, no epistaxis, dry mm, op clear, dry blood around lips neck: no jvd, supple cor: irregularly irregular, no m/g/r, normal s1 s2 pulm: coarse bs b/l, dry inspiratory crackles at bases b/l abd: soft, nt, nd, +bs, no hsm, no masses ext: no c/c/e, good pulses neuro: alert, oriented x3. moves all 4 extremities. skin: no jaundice, cyanosis or ecchymoses. maculopapular rash with hives over chest and left temporal area on his head. pertinent results: studies: ecg: afib at 102, nl axis, prolonged pr, nonspecific st changes . cxr : single portable ap upright chest radiograph is reviewed without comparison. cardiomediastinal silhouette is unremarkable, allowing for lordotic positioning. streaky linear opacity at the left base most likely represents atelectasis. there is no pneumothorax. no pleural effusion is seen, although the extreme right costophrenic sulcus is excluded. impression: borderline cardiomegaly, no definite evidence of pulmonary edema. . ct chest w/o contrast : 1. multifocal airspace abnormality, most pronounced in the anterior segment of the left upper lobe could be spontaneous pulmonary hemorrhage with aspiration, aspiration of blood from the upper aerodigestive tract or some combination of pneumonia and hemorrhage with aspiration. dr. and i discussed these findings, at the time of dictation. she recounted bronchoscopic findings of a bleeding site in the left upper lobe bronchus, where i seen only mild thickening of the posterior wall. . . labs: wbc-16.9* hgb-15.7 hct-44.3 mcv-85 plt ct-285 neuts-92.5* bands-0 lymphs-5.8* monos-1.4* eos-0.1 baso-0.1 wbc-12.4* hgb-12.6* hct-37.5* mcv-89 plt ct-257 pt-27.2* ptt-30.5 inr(pt)-2.7* pt-15.1* inr(pt)-1.3* glucose-184* urean-20 creat-0.9 na-137 k-4.2 cl-102 hco3-26 glucose-94 urean-21* creat-0.9 na-142 k-4.1 cl-108 hco3-26 calcium-8.8 phos-2.4* mg-2.2 . 12:41am urine color-yellow appear-clear sp -1.009 12:41am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirub-neg urobiln-neg ph-7.0 leuks-neg . micro: blood cx- coag neg staph blood cx- no growth blood cx- no growth urine legionella- negative viral culture- negative (rrv uninterpretable) bronchial washings- gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram positive cocci in clusters. 1+ (<1 per 1000x field): gram negative rod(s). respiratory culture (final ): sparse growth oropharyngeal flora. . . bronchial washings- negative for malignant cells bronchial washings- atypical cells. rare cluster of atypical epithelial cells of undetermined significance. numerous pulmonary macrophages and inflammatory cells. bronchial brushings- atypical. scattered clusters of highly atypical epithelial cells in a background of many benign bronchial cells (see note). note: most of the atypical cells appear to be multinucleated and have very prominent nucleoli. while these may represent highly reactive cells, a malignancy cannot be entirely excluded. . . brief hospital course: this is a 72 year-old male with a history of afib on coumadin, htn and recent bronchitis who was transferred from osh ed with several episodes of hemoptysis (frank blood and large clots) for pulmonary evaluation. . # hemoptysis: in setting of coumadin. most likely due to pulmonary source. less likely gi or ent source given abscence of signs or symptoms to suggest these. in addition, pt had recently suffered from severe bronchitis predisposing to hemoptysis. ddx of massive hemptysis include bronchiectasis, tuberculosis and lung abscess, none of which are likely here. also no h/o cancer. inr was reversed in the ed with vitamin k and 2u ffp. patient had bronch on which showed an oozing lul lesion. bal cytology was negative, however brushings did reveal atypical cells. ct chest revealed multifocal airspace opacity most notable in the lul-- ddx: spontaneous pulmonary hemorrhage with aspiration, aspiration of blood from the upper aerodigestive tract or some combination of pneumonia and hemorrhage with aspiration. he was treated empirically with levofloxacin for possible cap. plan was for repeat bronchoscopy 4 weeks after discharge. the patient was instructed to hold aspirin and coumadin until instructed by his outpatient physicians. . # wbc elevation: wbc was 9.4 at osh ed. here wbc of 16.9 with mild left shift, trended down to 12.4 by day of discharge. no bands. likely in setting of stress reaction and recent bronchitis. possibly pulmonary infection currently given active hemoptysis. he was treated empirically with levofloxacin, as noted above. ua and urine legionella negative. sputum culture was contaminated however culture from bal revealed only sparse op flora. blood culture from with 1/4 coag neg staph, however this cleared by the following day. he received iv vancomycin for this while in the hospital. . # rash: developed maculopapular rash with hives shortly after arrival to icu. located over left temporal area (about 5cm) and across chest. discontinued final cc's of ffp. benadryl and sarna lotion prn. resolved. there was a question that this may have been a reaction to vitamin k. . # afib: pt remained rate controlled with dig and bb. during this admission. he was on coumadin for anticoagulation, however this was held in the setting of hemoptysis, as above. . # htn: normotensive. he was continued on his home medication regimen. . # depression/anxiety: continued nortryptiline and klonopin. . medications on admission: atenolol 50 daily digoxin 250 mcg daily nortryptiline 25 daily coumadin 10 mg total per week (2 mo, 2 tue, none wed, 2 , none fri, 2 sat, 2 sun) asa 81 daily nifedipine sr 30 daily klonopin 0.5 tid . discharge medications: 1. atenolol 25 mg tablet sig: two (2) tablet po daily (daily). 2. digoxin 250 mcg tablet sig: one (1) tablet po daily (daily). 3. nortriptyline 25 mg capsule sig: one (1) capsule po hs (at bedtime). 4. levofloxacin 750 mg tablet sig: one (1) tablet po once a day for 3 days. disp:*3 tablet(s)* refills:*0* 5. nifedipine 30 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). 6. benzonatate 100 mg capsule sig: two (2) capsule po tid (3 times a day) as needed. disp:*30 capsule(s)* refills:*0* 7. robitussin cough-congestion 10-200 mg/5 ml syrup sig: ten (10) ml po every six (6) hours as needed for cough: sugar-free. disp:*1 bottle* refills:*0* . discharge disposition: home discharge diagnosis: primary: hemoptysis . secondary: atrial fibrillation, hypertension . discharge condition: vital signs stable. no further hemoptysis. . discharge instructions: you were admitted to the hospital for coughing up blood. bronchoscopy showed that you were bleeding from the left upper lobe of the lung. this may have been related to your recent bronchitis or there is a small chance that it could represent something more concerning like a cancer. the pulmonary doctor who performed your bronchoscopy will call you next week with the results of your bronchoscopy. you will need a repeat bronchoscopy in 4 weeks. you have been given a prescription for an antibiotic called levofloxacin which you should take for 3 more days. . you should not take coumadin or aspirin until you see dr. . . please take all other medications as prescribed. . if you develop fever >101, chest pain, shortness of breath, or have another episode of coughing up a large amount of blood, you should return to the emergency room. . followup instructions: call your pcp, . , to schedule a follow-up appointment within the next 2 weeks. telephone . . you will need a repeat bronchoscopy in 4 weeks. you can schedule this with dr. when he calls you to report the results of your bronchoscopy. telephone number (. . procedure: closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus diagnoses: unspecified essential hypertension atrial fibrillation dysthymic disorder long-term (current) use of anticoagulants cardiac pacemaker in situ other diseases of lung, not elsewhere classified rash and other nonspecific skin eruption hyperosmolality and/or hypernatremia 

Answer: The patient is high likely exposed to