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 / levaquin / biaxin attending: chief complaint: tracheal obstruction major surgical or invasive procedure: bronchoscopy history of present illness: 38 y/o male with pmhx significant for type 1 diabetes, history of jail time, who initially presented at with 10 days of chest tightness, mylagias, couging, fever, and wheezing, as well as shortness of breath. at osh patient was being treated for cap and started on azithromycin and ceftriaxone. patient had cxr done at osh which showed diffuse reticular nodular opacities involving bilateral lungs. ct chest at osh was reported to show diffuse ground glass opacification and diffuse adenopathy. there was also adenopathy that was compressing the trachea, given this concern for airway obstruction patient was intubated and transferred to for further management. he was ruled out for mi with negative cex3 and negative ekg past medical history: type 1 diabetes asthma diabetic nephropathy fractures fibula h/o mrsa pna social history: smokes 1ppd for many years, no drug or etoh history, history of jail time family history: nc physical exam: pe: t 97.8 bp 110/48 hr 102 rr 16 o2sat 97% ac 450x14 peep 5 fio2 60 7.21/70/80 gen: patient intubated, sitting up in bed, gagging on tube heent: perrl, eomi, ett tube in place neck: no lad appreciated lungs: diffuse ronchi throughout cardiac: tachy, rr s1/s3 abdomen: soft nt +bs ext: no edema neuro: awake pertinent results: 03:55pm neuts-55 bands-14* lymphs-19 monos-8 eos-4 basos-0 atyps-0 metas-0 myelos-0 04:15pm type-art rates-14/ tidal vol-450 peep-5 o2-60 po2-80* pco2-70* ph-7.21* total co2-30 base xs--1 intubated-intubated vent-controlled . ct chest : findings: endotracheal tube is in place, with tip terminating just above the level of the aortic arch. the trachea is abnormal in size and contour. the trachea is enlarged with coronal diameter of 2.8 cm. additionally, it has a lunate configuration with elevated coronal to sagittal ratio. during expiration, there is excessive collapsibility of the tracheal lumen, resulting in reduction of cross-sectional area from 149 mm2 to 53 mm2. this likely underestimates the degree of collapsibility because it was not performed as a dynamic expiratory scan. dense consolidation is present throughout both lower lobes with homogeneous increased density with prominent air bronchograms. more heterogeneous lung opacities are present within the anterior, nondependent portions of the lungs, including the upper lobes, middle lobe and lingula. these areas demonstrate peribronchiolar ground-glass opacities, areas of consolidation, and centrilobular/tree-in- opacities. enlarged lymph nodes are present within the mediastinum, measuring up to 13 mm within the right paratracheal and precarinal regions. additionally, there is diffuse stranding throughout the mediastinal fat, likely due to edema. the heart size is normal. there is no pericardial effusion. small bilateral pleural effusions are present. within the imaged portion of the upper abdomen, there is a trace amount of ascites. the remaining imaged portion of the upper abdomen is unremarkable on this unenhanced ct which was not specifically tailored to evaluate the abdominal organs. diffuse anasarca is present throughout the chest and abdominal wall soft tissues. impression: 1. enlarged, lunate trachea configuration with associated tracheomalacia. severity of tracheomalacia is likely underestimated on this end-expiratory scanning sequence. 2. diffuse bilateral lung parenchymal abnormalities, including peribronchiolar opacities in the upper and mid lungs and extensive confluent consolidation in the lower lobes. the findings are most consistent with diffuse infection complicated by ards. a component of hydrostatic edema is also possible, particularly given the presence of diffuse anasarca and bilateral pleural effusions. . echo : conclusions: the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50%). the right ventricular cavity is dilated. right ventricular systolic function is borderline normal; there are echolucent areas in the basal and midventricular segments of the right ventricular free wall; the apical segment of the right ventricular free wall appears thin. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: status post cardiac arrest; dilated hypocontractile right ventricle; consider arrhythmogenic right ventricular cardiomyopathy . cta : impression: 1. no evidence of pulmonary embolus. 2. redemonstration of multifocal parenchymal opacities. some of the right lung opacities appear to have progressed, while others in the left upper lobe, appear slightly better than on . 3. bilateral lower lobe consolidation, unchanged. unchanged bilateral pleural effusions. 4. severe tracheobronchomalacia. suggestion of bronchiectasis in multiple areas, difficult to assess given the presence of intubation/positive-pressure ventilation. . tte : no evidence for intracardiac (right-to-left) shunt identified. . portable abdomen 11:11 am bowel gas pattern is unremarkable and there is no evidence of free air on this portable film. possible nlargement of the liver silhouette may represent hepatomegaly or a prominent riedel's lobe. surrounding osseous structures are unremarkable. impression: no evidence of ileus or obstruction. . chest (portable ap) 12:45 am impression: ap chest compared to through 9. small bilateral pleural effusion has increased, with new fissural components. atelectasis or consolidation at the left base has improved since and atelectasis at the right lung base, which has been difficult to assess all along appears to have improved, restricted to the posterior basal segment. heart size is normal. no pneumothorax. tracheostomy tube and right subclavian line in standard placements. no pneumothorax. . ct chest w/o contrast 2:35 pm there is dense collapse and consolidation of the dependent aspects of both lung bases, right greater than left. there is minimal improvement in the aeration of the left lower lobe. patchy nodular airspace opacification is again noted involving the right upper lobe, left upper lobe and the aerated portions of the left lower lobe. this has not significantly changed from the prior examination. small bilateral pleural effusions are again noted which have slightly improved from the prior examination. as previously described there is evidence of tracheomalacia. a tracheostomy tube appears in the mid trachea. no pericardial effusion is present. limited unenhanced images through the upper abdomen are unchanged. impression: dense collapse and consolidation of lung bases eith minimal improvement in the aeration of the left lower lobe. patchy nodular airspace disease throughouth the lungs relatively unchanged consistentwith multilobar pneumonia and ards. . 9:47 am chest, upright ap portable: comparison is made to five days earlier and to a more recent ct from . patient is status post tracheostomy. a picc line terminates at the cavoatrial junction. cardiac and mediastinal contours are unremarkable. there are no effusions or pneumothorax. patchy bilateral alveolar opacities are somewhat more extensive than before. impression: worsening patchy bilateral, predominantly basilar, parenchymal opacities. brief hospital course: 38 y/o m with dm type 1, history of jail time who presented to osh with what was thought to be cap, found to have ground glass opacification and diffuse adenopathy on chest ct s/p intubation for airway obstruction, development of ards. . ## respiratory failure/ards - the patient was admitted with respiratory failure due to ards from pna. of note, pt hiv and tuberculosis negative. he could not be consented in house given intubation and current sedation. the patient was treated per ards net protocol. he was started on broad spectrum antibiotics, which initially included vancomycin and ceftazidime. pt was proned to aid in ventilation. he required paralytics as he was quite agitated and needed them to tolerate proning. he underwent bal which grew mrsa. (pt initially treated w/ vanco, and later linezolid as pt had positive screen for vre). patient seemed to improve over a week or so, no longer needing ards protocol/proning. he then subsequently decompensated and became more hypoxic, possibly from volume overload. this persisted despite attempts at aggressive diuresis. thus, he underwent cta which was negative for pe but showed some progression of prior opacities (along w/ stable b/l effusions). based on his vent settings it appeared as if his ards might be worsening. because of this, he was restarted on paralytics, placed on ards protocol again with proning. pt was aggresively diuresed (as he was over 20lb up since admission). with diuresis & abx, pt slowly improved. proning was discontinued during the second week of . he was gradually weaned off the vent. pt went for tracheostomy w/ surgery. eventually transitioned to trach mask alone. (of note, on admission and on ct scan there was question of possible tracheomalacia/obstruction. this was not seen on pt's bronchoscopy.) abg's demonstrate no marked hypercarbia. tolerating trach mask well on 0/35 fio2. off abx for pneumonia, stable on trach mask. treated with abx. . ## pna: pt had been treated with ctx & azithro at osh. his coverage was broadened to ceftazidime & vanco following admission to . pt's bal grew mrsa (?colonization vs pathogen). id was consulted. they felt that pt did not have typical mrsa pna picture as cx had low mrsa colony count and imaging showed lymphadenopathy and ards/multifocal pneumonia. id recommended extensive workup for other causes, including legionella, erhlichia, tuleremia, chlamydia, mycoplasma, and babesia, all of which were negative. pt received 16 days of ceftazidime and 14 days of linezolid and doxycycline, the latter of which was added for empiric tularemia tx. pt defervesced and white count decreased with above treatment. off antibiotics for pneumonia at the time of discharge to rehab. with slight worsening appearance of opacities on chest x-ray, still concern for tularemia or other pathology not covered/ -follow up on tularemia abx, blood cx -follow up appointment with id . ## pulm edema: likely ards plus component of fluid overload following aggressive fluid resuscitation. pt was aggressively diuresed w/ lasix lasix gtt--this was stopped on . pt was given lasix bolus prn. cxr shows resolving effusions/edema. lasix was given prn, and as cxr demonstrated possible fluid overload 40 iv lasix given. patient net + 5 liters at time of discharge. lasix to be given as needed if signs of overload, clinical and imaging studies demonstrate need. . ## sedation: pt required enormous doses of sedatives to keep him calm and prevent him from removing lines/self-extubating. he required paralytics on top of sedatives for this and to tolerate the proning. weaning sedation proved very difficult. methadone was started to help wean off iv fentanyl and other sedatives. then, fentanyl patch initiated, in attempt attempt to wean methadone and prevent opiate withdrawal. fentanyl patch decreased, use methadone prn and then dc'd; used haldol prn agitation. final regimen at time of discharge included fentanyl patch at 150 mcg to be decreased as tolerated: clonipine 3 mg tid, to be weaned as tolerated slowly, morphine 1-2 mg q 2 for agitation pain, ativan as needed, and standing haldol to be decreased to prn as needed. . ## pea arrest: on the night of admission the patient had pea arrest, with cpr for 2-5 minutes. the patient responded to epi and atropine. the cause was likely respiratory as prior to the event the patient had oxygen sats in the 70's. the patient required fluids and pressors and eventually was weaned off pressors. . ## hypotension: thought to be primarily from sepsis, although high peep and large doses of propofol likely also contributed. his stim was negative. as his infection was treated and propofol weaned, he was able to be weaned off levophed. once of sedatives, and ventilator, bp increased and pt was hypertensive during weaning off narcotics and sedation. . ## anemia: the patient had a slow drop in his hematocrit. required occasional transfusions. thought to be due to infection, renal failure and dilutional effect. guaiac negative. epo was started per renal recommendation. discontinued several days prior to dc as felt anemia related to renal failure which was resolving in addition to acute illness. stable at time of discharge, guiac negative. . ## arf: atn from hypotension/contrast nephropathy. muddy brown casts on ua. feurea 65%. this slowly resolved. however, renal function again worsened in setting of aggressive diuresis. renal followed patient while in house. once diuresis slowed and pressors discontinued, pt's renal function improved. not worsened with diuresis and close to baseline at the time of discharge. . ## hsv: facial vesicular rash, swab-no virus isolated. day 13/14 on day of discharge. . ## hyponatremia/hypernatremia: likely hypervolemic hyper-na+, diurese & volume restrict. resolved. hypernatremia ensued later in the course, treated with free water flushes, which resolved after several days as well. . ## hypothermia- axillary, possibly related to propofol, infection, narcotics. resolved at the time of discharge. . ## diffuse adenopathy - noted on admission. this could be reactive secondary to infection as mentioned above. given history of jail time patient with risk factor for tuberculosis. ppd placed at osh which was negative. other differential could be hiv, though this was also negative at osh. other concern would be malignant such as lymphoma. still require ln biopsy if this does not resolve w/ tx of pna. at time of discharge no inguinal lymphadenopathy palpated, likely reactive secondary to infection. . ## dm type 1 - the patient's sugars were closely followed and was treated intermittently with insulin drip and when off the drip glargine and ssi according to his finger sticks. stable on glargine and sliding scale at the time of discharge. . ## ppx: heparin sc, ppi, bowel regimen ## code: full ## fen: on tpn then transitioned tubefeed tf. peg placed by surgery. patient receiving tube feeds at goal via the peg tube with minimal residual. diuresed as needed, but not grossly fluid overloaded at the time of discharge to the rehab facility. ## access: picc line ##comm: mother medications on admission: lantus 20u qhs humalog sliding scale combivent advair 250/50 . meds on transfer: lantus 12 units duonebs q4 via neb mucinex 2 tabs azithromycin 500mg q24 ceftriaxone 1g q24 advair 250/50 discharge medications: 1. albuterol 90 mcg/actuation aerosol : four (4) puff inhalation q6h (every 6 hours). 2. ipratropium bromide 17 mcg/actuation aerosol : six (6) puff inhalation qid (4 times a day). 3. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 4. acetaminophen 160 mg/5 ml solution : one (1) po q4-6h (every 4 to 6 hours) as needed. 5. polyvinyl alcohol 1.4 % drops : 1-2 drops ophthalmic prn (as needed). 6. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 7. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 8. senna 8.6 mg tablet : one (1) tablet po twice a day as needed for constipation. 9. bisacodyl 10 mg suppository : one (1) suppository rectal daily (daily) as needed. 10. clonazepam 1 mg tablet : three (3) tablet po tid (3 times a day). 11. lactulose 10 g/15 ml syrup : thirty (30) ml po q8h (every 8 hours) as needed. 12. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 13. fentanyl 100 mcg/hr patch 72 hr : one (1) transdermal q72h (every 72 hours): 125 mcg patch. 14. acyclovir 400 mg iv q8h d# 1 15. lorazepam 0.5-1 mg iv q4h:prn agitation 16. haloperidol 5 mg iv tid 17. morphine sulfate 1-2 mg iv q2h:prn hold for sedation and rr<10 18. insulin glargine 100 unit/ml cartridge : twelve (12) units subcutaneous at bedtime: in addition to iss, see attached table. discharge disposition: extended care facility: radius discharge diagnosis: primary: ards pneumonia acute renal failure narcotic withdrawal/agitation dm i anemia hsv hypotension hypernatremia hyponatremia . secondary: asthma diabetic nephropathy h/o mrsa pneumonia fibula fracture discharge condition: stable discharge instructions: you were admitted with ards, and had a long hospital stay -continue all medications, neb treatments. -wean narcotics as tolerated -acyclovir x 2 days, to complete 14 day course -follow up with infectious disease -follow up on pending tularemia antibody and blood culture data -cxr, abx and diuresis as needed -trach and peg tube placement followup instructions: please follow up with pcp from rehab facility . please follow up with infectious disease, discussion of tularemia and review of cx and antibiotic data. 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 percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus transfusion of packed cells cardiopulmonary resuscitation, not otherwise specified injection or infusion of oxazolidinone class of antibiotics infusion of vasopressor agent diagnoses: anemia in chronic kidney disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere tobacco use disorder acute kidney failure with lesion of tubular necrosis unspecified septicemia severe sepsis infection with microorganisms resistant to penicillins asthma, unspecified type, unspecified acute respiratory failure cardiac arrest long-term (current) use of insulin methicillin susceptible pneumonia due to staphylococcus aureus rash and other nonspecific skin eruption pressure ulcer, heel enlargement of lymph nodes delirium due to conditions classified elsewhere diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled other and unspecified diseases of the oral soft tissues 

Answer: The patient is high likely exposed to