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: glyburide / metformin / tamsulosin attending: chief complaint: shortness of breath. major surgical or invasive procedure: intubation. history of present illness: 84 year-old male with a history of type ii diabetes mellitus, chronic atrial fibrillation presented from nursing home after being noted to be hypoxic to low 90's and after suctioning revealed some bloody secretions. he was subsequently taken by ambulance to the emergency department and received lasix 80 mg iv en route. . in the emergency department, the patient was in atrial fibrillation with rvr (rate 140) and in respiratory distress. the patient also complained of abdominal pain in the left and right lower quadrants. temperature 99.8 rectally. blood pressure intially normal but then dropped to 60's systolic. a right femoral line was placed and the patient was started on intravenous fluids and levophed with improvement to systolics to 100's. . cardiology was consulted for frequent nsvt and recommended heparin drip out of concern for pulmonary embolus. the patient was guaiac negative and heparin gtt was started. the patient remained in respiratory distress and was intubated prior to cta given the inability to lay flat. the patient had a difficult airway and required fiberoptic guidance for intubation. post intubation blood gas was ph 7.31 pco2 54 po2 263 hco3 28. the cta was subsequently negative for pe but did show lower lobe infiltrates. surgery was consulted for the abdominal pain and recommended ct abdomen, which was unrevealing. the patient was started on vanc/levo/flagyl; heparin was discontinued. a diltiazem drip was attempted for control of rvr but the patient became hypotensive with this medication. . the patient was admitted to the micu. levophed was weaned quickly. the patient remained in atrial fibrillation with rates 90-110. blood pressures remained with systolics 110. the patient was extubated and maintained on oxygen per nasal cannula. the patient's antibiotics were changed to vanc/zosyn for treatment of pneumonia in this nursing home resident. . on transfer to the floor, he complained of cough occasionally productive of yellow sputum. he denied shortness of breath, chest pain, palpitations, abdominal discomfort. review of systems otherwise negative in detail. past medical history: 1. chronic atrial fibrillation, no longer on coumadin secondary to fall risk 2. coronary artery disease 3. diabetes type ii, diet controlled 4. hypertension 5. hypercholesterolemia 6. prostate cancer 7. legally blind 8. gout 9. incidental thyroid nodule 10. status post multiple mechanical falls social history: patient has been living in since last and was at rehbilitation. has pt services 2x/week and a homemaker 2x/week and all meals provided at center. he ambulates with walker. he is a retired accountant. he reports smoking "little bit" 60 years ago, denies alcohol/illicit drug use. per report has a girlfriend who allegedly he has been repeatedly calling at all hours in the night. family history: father had history of heart disease at unknown age, mother was healthy. physical exam: on admission to the micu: vs: t 97.1 bp 103/77 hr 90-110 vent: ac tv 550 rr 16 fio2 50% peep 5 o2 sat 98-100 on these settings. gen: obese elderly caucasian gentleman, sedated and tubated. neck: obese cv: irregularly irregular rhythm. heart sounds well audible no murmurs appreciated. lungs: cta anteriorly abd: soft, nt/nd, minimal bs. horizontal incision noted. extr: no edema, 2+ pulses. neuro: downgoing toes, squeezes hand to command when sedation is lightened. . on transfer to the floor: vs: t 97.8 ax bp 121/89 hr 80 rr 16 spo2 99% 2l nc gen: obese male lying in bed in nad. occ cough. neck: obese, unable to assess jvp cv: irregularly irregular rhythm. nl s1/s2. no murmurs appreciated. lungs: bronchial breath sounds diffusely with scattered expiratory wheezes abd: soft, nt/nd, + bs. extr: trace edema, warm. l picc line in place. pertinent results: labwork on admission: 11:00pm wbc-9.1 rbc-4.61 hgb-14.3 hct-42.1 mcv-91 mch-31.1 mchc-34.0 rdw-14.4 11:00pm plt count-164 11:00pm neuts-63.7 lymphs-28.0 monos-4.0 eos-3.5 basos-0.8 11:00pm glucose-188* urea n-24* creat-0.9 sodium-144 potassium-3.9 chloride-104 total co2-28 anion gap-16 11:10pm pt-12.2 ptt-24.8 inr(pt)-1.0 11:10pm ck-mb-4 ctropnt-<0.01 probnp-2194* . cta chest w&w/o c&recons, non-coronary impression: 1. no evidence of pulmonary embolism, edema, pneumonia, or significant pleural effusion. 2. bibasilar atelectasis, though superimposed infection cannot be excluded. no definite consolidations are seen at this time. 3. unchanged left thyroid nodule. 4. extensive atherosclerotic coronary calcifications. . ct abdomen w/o contrast impression: 1. no evidence of acute intra-abdominal pathology. 2. increasing bibasilar airspace opacities are concerning for pneumonia and possibly aspiration. 3. incidental note is made of multiple findings which are unchanged compared to , including: large calcified gallstone, multiple renal cysts, pancreatic calcifications consistent with chronic pancreatitis, infrarenal abdominal aortic aneurysm measuring up to 4 cm, aneurysmal dilatation of bilateral iliac arteries, sigmoid diverticulosis, and an enlarged prostate gland. . echocardiography the left atrium is dilated. the right atrium is markedly dilated. 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 50-55%). right ventricular systolic function is normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mitral regurgitation is present but cannot be quantified (probably at least mild to moderate). the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. the presence of atrial thrombus cannot be adequately assessed by transthoracic echocardiography. . bronchoscopy oozing from multiple sites, blood seeping down trachea from above. . chest port. line placement the patient was extubated in the meantime interval. the ng tube tip terminates in the stomach. the left picc line tip is in mid low svc. the patient is slightly rotated, which might explain the lll haziness . the heart size is enlarged, left atrium in particular. this might explain the left deviation of the ng tube .the lungs are otherwize clear no sizable pleural effusion is identified. . chest (portable ap) gradual improvement in left lower lobe consolidation. no new abnormality is detected. . labwork on discharge: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:45am 6.6 3.61* 11.2* 31.6* 87 31.1 35.5* 14.2 153 renal & glucose glucose urean creat na k cl hco3 angap 05:45am 107* 15 0.9 143 3.3 104 31 11 enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili 05:45am 20 18 45 0.7 brief hospital course: 84 year-old male with type ii diabetes and chronic atrial fibrillation not on anticoagulation who presents from nursing home with respiratory failure, hemoptysis, and brief episode of hypotension in the setting of atrial fibrillation with rapid ventricular rate. . 1. respiratory failure: likely due to aspiration pneumonia in the setting of atrial fibrillation with rapid ventricular rate. cta negative for pulmonary embolus but showed lower lobe infiltrates. the patient was intubated for hypoxia and for evidence of hemoptysis. he underwent bronchoscopy which demonstrated diffuse friability with oozing from multiple sites. the patient also had blood seeping down trachea from above and moderate tracheobronchiomalacia. the patient was a difficult airway requiring fibroscopic bronchscopy to assist with intubation. he was successfully extubated and weaned to a nasal cannula. the patient was diuresed prior to admission with lasix but echocardiogram during admission showed no definite evidence of systolic or diastolic heart failure. the patient was started on vancomycin and zosyn to complete a 14 day course for nosocomial pneumonia starting . the patient was given supportive care with standing xopenex and ipratropium nebulizers (albuterol was avoided given the history of tachycardia), oxygen as needed, and anti-tussives as needed. cultures from bronchoaveolar lavage were negative at the time of discharge. he was evaluated by speech and swallow and allowed a diet of soft solids and thin liquids. pt did have difficulty clearing his secretions and seemed to have some distress when coughing, because of this the pt was transferred to the micu the day prior to discharge. he was stable there with need for occasional suctioning. 02 saturations 93-95% on room air. bp also stable (range 110s-140s/60's-90's). it was felt that pt could be discharged from micu to rehab given his stability. pt needs to be suctioned when coughing to help clear secretions. . 2. hemoptysis: a focal source was never identified. bronchoalveolar lavage was performed as above. the patient was evaluated by ent given the difficulty passing ogt and ngt secondary to bleeding. ent believed that his hemoptysis was related to nasopharyngeal trauma from ngt attempts, however, per history bloody secretions came before ngt attempts. ent irrigated his nasopharynx with afrin and did anterior packing. his epistaxis resolved and his airway secretions became progressively less bloody. echocardiogram was also unrevealing for a source. . 3. atrial fibrillation: the patient was seen by cardiology in the ed for rapid atrial fibrillation. rate control attempted with diltiazem, however, unsuccessful due to hypotension. echocardiogram revealed dilated atria, lvef 50-55%, 1+ ar, moderate pulmonary hypertension. the patient has a history of chronic atrial fibrillation but is not anticoagulated at home secondary to multiple falls. the patient was on toprol xl as outpatient, and was given metoprolol in the icu once his blood pressure stabilized. the patient was given metoprolol three times daily and on return to the micu was titrated up to 125 mg tid. the patient was continued on aspirin. . 4. anemia: normocytic. the patient's hematocrit drifted down during admission likely due to dilution. the patient had no signs or symptoms of bleeding. baseline hematocrit is mid-to-high 30s, likely due to chronic disease. the patient was guaiac negative. further work-up deferred as an outpatient. . 5. thrombocytopenia: resolved. unclear etiology; nadir of platelets was 124. this may have been dilutional in the setting of fluid resuscitation. . 6. abdominal pain: resolved. the patient complained of abdominal pain on admission. there were no concerning physical examination findings. imaging was negative for an acute process as above. . 7. liver function test abnormalities: resolved prior to discharge. unclear etiology. imaging unrevealing as above. simvastatin and colchicine were initially held. simvastatin was restarted prior to discharge; colchicine can be restarted as needed as an oupatient. . 8. diabetes: diet-controlled. well-controlled during admission. the patient was continued on a diabetic diet with sliding scale insulin as needed. . 9. hypertension: the patient was transiently hypotensive on admission as above. the patient was started on metoprolol once stable as above. blood pressures remained well-controlled on the floor. . 10. coronary artery disease: no active issues during admission. the patient was continued on aspirin and beta-blocker. . 11. prostate cancer: the patient is discharged with foley in place. the patient was continued on finasteride. tamsulosin was held for transient hypotension and to allow up-titration of beta-blocker for atrial fibrillation as above; this medication can be restarted as needed as an outpatient. the patient is followed by urology as an outpatient. . 12. hyperlipidemia: the patient's liver function tests were initially abnormal on admission and simvastatin was held. the patient liver function tests subsequently normalized and simvastatin was restarted. the patient should follow-up with his primary care doctor . . 13. dementia/depression: no active issues. the patient was continued on aricept and fluvoxamine. . 14. gout: no active issues. the patient's colchicine was held in the setting of elevated liver function tests; this medication can be restarted as needed as an outpatient. medications on admission: 1. aspirin 325 daily 2. toprol xl 100 daily 3. simvastatin 20 mg daily 4. finasteride 5 mg daily 5. fluvoxamine 50 daily 6. colchicine 0.6 mg daily 7. aricept 10 mg daily 8. tamsulosin 0.4 mg daily 9. albuterol prn 10. tylenol prn discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. insulin lispro (human) 100 unit/ml solution sig: as per sliding scale subcutaneous asdir (as directed). 3. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 4. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day) as needed for constipation. 5. lactulose 10 g/15 ml syrup sig: fifteen (15) ml po q8h (every 8 hours) as needed for constipation. 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) tid (3 times a day). 7. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 8. donepezil 5 mg tablet sig: two (2) tablet po hs (at bedtime). 9. fluvoxamine 50 mg tablet sig: one (1) tablet po daily (daily). 10. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 11. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 12. xopenex 0.63 mg/3 ml solution sig: one (1) ml inhalation q8h (every 8 hours). 13. piperacillin-tazobactam 4.5 g recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 7 days: day 1= for 14-day course. 14. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) intravenous q 12h (every 12 hours) for 7 days: day 1= for 14-day course. 15. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) for 9 days. 16. dextromethorphan-guaifenesin 10-100 mg/5 ml liquid sig: five (5) ml po q6h (every 6 hours) as needed for cough: please give sugar-free syrup. 17. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous daily (daily) as needed: 10ml ns followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen qd and prn. inspect site every shift . 18. sodium chloride 0.9 % 0.9 % parenteral solution sig: ten (10) ml intravenous daily (daily) as needed: 10ml ns followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen qd and prn. inspect site every shift . 19. metoprolol tartrate 100 mg tablet sig: one (1) tablet po tid (3 times a day). 20. guaifenesin 100 mg/5 ml syrup sig: fifteen (15) ml po q6h (every 6 hours). 21. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 22. metoprolol tartrate 25 mg tablet sig: one (1) tablet po three times a day: total metoprolol 125 mg tid. 23. ipratropium bromide 17 mcg/actuation aerosol sig: five (5) puffs inhalation every 4-6 hours. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: 1. respiratory failure 2. aspiration pneumonia 3. atrial fibrillation with rapid ventricular rate 4. hemoptysis 5. anemia 6. thrombocytopenia 7. liver function test abnormalities . secondary: 1. chronic atrial fibrillation, no longer on coumadin secondary to fall risk 2. coronary artery disease 3. diabetes type ii, diet controlled 4. hypertension 5. hypercholesterolemia 6. prostate cancer 7. legally blind 8. gout 9. incidental thyroid nodule 10. status post multiple mechanical falls discharge condition: afebrile, vital signs stable. discharge instructions: you were admitted with respiratory distress and hemoptyis (coughing up blood). you were found to have a pneumonia and are on antibiotics for treatment. no clear source was found for the hemoptysis. . please contact a physician if you experience fevers, chills, chest pain, shortness of breath, palpitations, hemoptysis, abdominal pain, nausea, vomiting, diarrhea, or any other concerning symptoms. . please take your medications as prescribed. . please keep your follow-up appointments as below. . suctioning every 4 hours as needed for cough followup instructions: please call your primary care physician, . , at to schedule a follow-up appointment within two weeks of discharge. . previously scheduled appointments: provider: /urology urology cc3 (nhb) phone: date/time: 11:30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: thrombocytopenia, unspecified anemia, unspecified coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation acute respiratory failure pneumonitis due to inhalation of food or vomitus malignant neoplasm of prostate legal blindness, as defined in u.s.a. 

Answer: The patient is high likely exposed to