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 failure major surgical or invasive procedure: intubation, picc line placement history of present illness: 76 yo m tranferred from intubated with pneumococcal pneumonia. patient developed malaise and anorexia starting then cough, congestion, and dypnea starting . he was admitted to with hypoxia and a r sided infiltrate. initially was hypotensive to the 70's, hypoxic to 80's on nrb, with a wbc of 40k. he required 10 l of ivf for resucitation hypotension and oligouria. he was intubated after a short attempt at mask ventillation. urine pneumococcus antigen was positive and sputum grew pan-sensitive pneumococcus. his antibiotics were then switched from ctx/azith to pcn. he has had poor mental recovery despite decreased sedation for the last two days of his hospitalization. head ct and lp were wnl. transferred to for further work up. on pt had a short episode of atrial fibrillation documented on ecg which resolved with iv dilt. since being transferred to he has been in sinus rhythm. past medical history: recent gi bleed - admitted to ; capsule endoscopy with angioectasia of the duodenum, colon and small intestine nhl s/p chemo in remission x 13 years niddm hypothyroidism fe def anemia hyperlipidemia h/o systolic murmur - aortic sclerosis h/o rheumatic fever in childhood arthritis social history: lives at home with his wife, retired. former smoker, quit 35 years ago. no etoh or illicits family history: nc physical exam: physical exam on admission (icu) vs - 100.5, tm = 101.2 118/77 75 resp - ps 22/8 fio2 50% rr 18 o2 sat 98% gen - intubated, sedated heent - mm dry, perrl neck - supple, no lad, no thyroid nodules felt cor - rrr, sounds obscured by lung sounds chest - ronchi r>l abd - soft, non-distended, +bs ext - w/wp, 1+ edema bilat, 2+ dp neuro - perrl, + gag reflex pertinent results: laboratory studies on admission: wbc-16.2* hgb-9.1* hct-30.8* mcv-77* rdw-20.0* plt count-210 neuts-85* bands-0 lymphs-5* monos-8 eos-0 basos-2 atyps-0 metas-0 myelos-0 pt-16.0* ptt-28.2 inr(pt)-1.5* hbsag-negative hbs ab-negative hbc ab-negative hcv ab-negative calcium-7.7* phosphate-2.7 magnesium-2.2 iron-14* alt(sgpt)-102* ast(sgot)-48* alk phos-175* amylase-84 tot bili-0.8 lipase-285* glucose-119* urea n-24* creat-0.8 sodium-149* potassium-3.9 chloride-110* total co2-35* abg: po2-87 pco2-46* ph-7.49* total co2-36* base xs-10 intubated-intubated laboratory studies on discharge: wbc-11.1* hgb-10.4* hct-35.1* mcv-80* rdw-21.4* plt ct-829* glucose-135* urean-14 creat-0.8 na-137 k-4.6 cl-100 hco3-28 angap-14 ekg: sinus rhythm. normal ecg. compared to the previous tracing of no significant change radiology chest ct: dense multifocal opacities are seen within the right lung and left lung base consistent with multifocal pneumonia. no cavitary lesion is detected. there are small bilateral pleural effusions, right greater than left. note is made of calcified aortic valve which may suggest aortic stenosis and can correlate with echocardiography if warrented. no filling defect is identified within the pulmonary arteries. there are multiple prominent mediastinal nodes the largest of which is a right paratracheal node measuring 18 x 9 mm. enlarged lymph nodes are also seen within the left axilla, the largest measures 2.0 x 1.2 cm. the left lobe of the thyroid is enlarged and measures 3.0 x 3.5 cm. et tube is present. diffuse atherosclerotic calcification is seen within the aorta and coronaries. visualized upper abdomen demonstrates cholelithiasis. ng tube is curled within the stomach. ruq u/s: limited evaluation of the right upper quadrant demonstrates a liver with normal echogenicity without focal lesion. there is no intra- or extra-hepatic biliary dilatation. a decompressed gallbladder is present containing multiple stones. there is no pericholecystic fluid or gallbladder wall edema to suggest cholecystitis. portal vein is patent with hepatopetal flow. note is made of renal cyst at the upper pole. mri of head with and without contrast: there is opacification of the mastoid sinus air cells as well as scattered areas of mucosal thickening in the ethmoid sinuses. there is an air-fluid level in the nasopharynx. these findings are all consistent with intubation. there is no midline shift, mass effect or hydrocephalus. there are scattered foci of increased t2 signal within the periventricular and subcortical white matter of both cerebral hemispheres most consistent with chronic microvascular ischemic changes. there is no area of slow diffusion to indicate an acute infarct. there are no enhancing abnormalities. impression: no evidence of an acute infarct or enhancing abnormalities. tiny amounts of chronic microvascular ischemic change. transthoracic echocardiogram: the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 5-10 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). regional left ventricular wall motion is normal. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the ascending aorta is mildly dilated. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are moderately thickened. no masses or vegetations are seen on the aortic valve. there is mild aortic valve stenosis (area 1.2-1.9cm2). mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the pulmonary artery systolic pressure could not be determined. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. ct neck: no fluid collections are identified within the neck. enlargement of the left lobe of the thyroid is unchanged compared to four days prior. lung windows of the apices partially image patient's known multifocal opacities on the right. bone windows reveal no acute fractures or dislocation. no spondylolisthesis is identified. tiny avulsion injuries off the posterosuperior aspect of the c4 and c5 vertebral bodies appear old. scattered calcifications of the anterior longitudinal ligament and ligamentum flavum are also observed. vertebral body heights appear preserved. cxr pa/lat: pa and lateral views of the chest are obtained at 13:42 hours and compared with the prior radiograph of . the cardiomediastinal silhouette is unchanged. again seen is bilateral interstitial edema which appears to be slightly increased since the previous examination. patchy opacities at the right base and right midlung persists. new opacity developing in the left mid lung zone and in the right upper lobe. brief hospital course: 76 year old male tranferred from intubated with pneumococcal pneumonia and resuscitated septic shock. 1) pneumococcal pneumonia/respiratory failure: the patient was admitted to the intensive care unit intubated. he was initially covered with vancomycin/zosyn, subsequently changed to penicillin alone, and completed a 14 day course. his ventilation was managed per ards-net protocol and he was extubated on and transferred to the general medical floor on . his respiratory status remained stable on the floor and, at time of discharge, he was 96% on room air. this is the patient's second severe pneumonia within the last 2 years, despite multiple pneumococcal vaccines; his primary care physician is planning further as an outpatient to determine what, if anything, is predisposing him to recurrent pneumonias. he was evaluated by the speech and swallow service, who recommended soft solids and pureed solid diet to prevent aspiration. 2) change in mental status: following extubation, the patient remained significantly altered in terms of mental status. a neurology consult was obtained, and he underwent a repeat lp with negative cultures and negative hsv pcr. an mri of his head did not reveal an acute abnormality (see results section). metabolic work-up, uncluding tsh, electrolytes, rpr, and vitamin b12, was unrevealing. the patient's change in mental status, which gradually improved over the course of his hospital stay, was likely due to delirium in the setting of acute illness (pneumonia, recent intubation). he will require continued occupational therapy as an outpatient. 3) transaminitis: the patient underwent a right upper quadrant ultrasound which was unremarkable (with the exception of stones). hepatitis b and c panels were negative. was mildly positive at 1:40 (outpatient follow-up). his transaminitis, which resolved over the course of his hospital stay, may have been due to mild shock liver in the setting of sepsis. 4) type ii diabetes well-controlled: the patient was started on an insulin gtt in the icu. he was subsequently transitioned to lantus with a humalog sliding scale. he can likely be transitioned back to his oral regimen at his rehabilitation facility 5) iron deficiency anemia: the patient has undergone a recent extensive work-up for gi bleeding sources. he was restarted on iron supplements on discharge. 6) hypothyroidism/thyroid nodules: the patient will continue on levothyroxine. on his chest and neck ct, the left lobe of the thyroid was noted to be enlarged, measuring 3.0 x 3.5 cm. outpatient thyroid ultrasound may be considered at the discretion of his pcp. 7) lymphadenopathy: the patient's chest ct revealed prominent mediastinal and left axillary lymph nodes (see results section). these may be related to the patient's known extensive pneumonia, but outpatient follow-up is recommended once he recovers from his acute illness, particularly given the patient's history of non-hodgkins lymphoma. 8) generalized weakness: following extubation, the patient was noted to be generally weak in all 4 extremities. a neurology consult was obtained, who felt this could be secondary to deconditioning versus icu-related myopathy. his strength markedly improved over the course of his hospital stay and, at time of discharge, the patient was working well with physical therapy. 9) left foot redness: the patient was noted to have a rash involving his distal left foot; this was patchy, not painful/pruritic, and not cellulitic appearing. he was started on miconazole powder for possible fungal infection. this should continue to be monitored as an outpatient. full code medications on admission: iron supplements levothyroxine zetia - 10mg daily glucotrol sr - 5mg daily avandia - 2mg daily metformin - 1000mg discharge medications: 1. insulin glargine 100 unit/ml solution sig: twelve (12) units subcutaneous at bedtime. 2. insulin lispro (human) 100 unit/ml solution sig: sliding scale subcutaneous before each meal and at bedside: if fs <150 give 0 units, if 151-200 give 2 units, if 201-250 give 4 units, if 251-300 give 6 units, if 301-350 give 8 units, if 351-400 give 10 units, if >400 give 12 units and md . 3. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 4. levothyroxine 150 mcg tablet sig: one (1) tablet po once a day. 5. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 6. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) neb inhalation q6h (every 6 hours) as needed. 7. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 8. nexium 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 9. zetia 10 mg tablet sig: one (1) tablet po once a day. 10. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day): to left foot. 11. iron sulfate 325 mg daily discharge disposition: extended care facility: northeast discharge diagnosis: primary: streptococcal pneumonia secondary: change in mental status, thrombocytopenia, type ii diabetes well-controlled, anemia, hypothyroidism discharge condition: stable discharge instructions: you were admitted with a severe pneumonia 1) please follow-up as indicated below. 2) please come to the emergency room if you develop fevers, chills, shortness of breath, or other symptoms that concern you. followup instructions: please call your primary care physician . () to schedule an appointment 1 week after your discharge from the rehabilitation facility. md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung parenteral infusion of concentrated nutritional substances diagnoses: diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute and subacute necrosis of liver severe sepsis unspecified acquired hypothyroidism personal history of tobacco use other and unspecified hyperlipidemia other malignant lymphomas, unspecified site, extranodal and solid organ sites acute respiratory failure septic shock other generalized ischemic cerebrovascular disease iron deficiency anemia, unspecified rash and other nonspecific skin eruption pneumococcal septicemia [streptococcus pneumoniae septicemia] pneumococcal pneumonia [streptococcus pneumoniae pneumonia] enlargement of lymph nodes delirium due to conditions classified elsewhere arthropathy, unspecified, site unspecified debility, unspecified 

Answer: The patient is high likely exposed to