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: shortness of breath , cough major surgical or invasive procedure: r chest tube placement r vats, decortication, biopsy of cavitary lesion history of present illness: 84 yo m from w/ mmp incl copd, macronodular pulmonary amyloidosis, cad, htn, aaa, htn presenting with several days cough and dyspnea, including increasing difficulty with activities of daily living. he also has some dyspnea at rest. he has a cough that started ~10 days pta, productive of greenish-brown sputum, no hemoptysis. he has had no fevers. he denies chest pain or abdominal pain. . he is followed by dr. for his pulmonary amyloidosis and copd. he was seen in pulmonary clinic 2 days pta for evaluation of these symptoms. a cxr showed increased nodularities and pathcy infiltrate. a ct of the chest was done which showed significant increase in size and number of pulmonary nodules with new cavitation, as well as loculated pleural effusion. the patient was started on augmentin. consideration was for semi-urgent vats. on the morning of admission, the patient "looked bad" to his daughter, and his vitals were noted to be 80/50, hr 120, rr 32, o2 88ra. at this time, the patient was transferred urgently by ambulance to . . at , noted to be afebrile with bp 94/48 and satting 90% on ra. notable lab results were a wbc of 31.4, cr of 4.3 and a k of 6.5. the patient was transferred to ed for continuity of care. . in the ed, the patient was afebrile. his blood pressures were in the 80s-90s systolic, with a nadir of 68/45. other vs include rr 18-22, hr 80s-90s, sat 94-96% 6l fm. his lactate was 2.5. he was pan cultured and started on vanco, ceftriaxone and flagyl. a ct abdomen/pelvis was done to r/o leaking aaa as cause of his hypotension, and a bedside fast exam was negative. a cxr showed loculated pleural effusion. dr. placed a 28fr ct in r chest wall with return of pus. the patient was then transferred to the micu for further care. he recieved a total of 2350 ivf, and had 800 uop + 60cc from the ct. past medical history: 1. copd followed by dr. . his fvc is 3.27 or 75% of predicted, fev1 is 0.8 which is 30% of predicted, and his fev1-fvc is 24% which is 39% predicted. 2. coronary artery disease with one vessel disease of the right coronary with collaterals, status post catheterization in . 3. hypertension. 4. hypercholesterolemia. 5. bilateral renal artery stenosis. 6. abdominal aortic aneurysm status post repair with aortobi-iliac bypass graft , complicated by trilobar pneumonia, high-grade four out of four bottles staphylococcus bacteremia, enterococcus urinary tract infection associated with the bacteremia. 7. peripheral disease, status post bilateral stents and bypasses. 8. atrial fibrillation/flutter status post ablation. 9. macronodular pulmonary amyloidosis diagnosed with biopsy in . 10. positive lupus anticoagulant. 11. anterior neck mass, questionable etiology. 12. hx clostridium difficile. 13. s/p bronchoscopy in , complicated by right pneumothorax. past surgical history: status post abdominal aortic aneurysm repair in , status post bilateral femoral-tibial bypass in and . family history: his father died at the age of 58 of an myocardial infarction. his mother had unknown malignancy physical exam: vs- 98.4 hr 77 bp 98/47 rr 17 sat 98% 6l nc gen- elederly, nad, chronically ill appearing, a+o x 3 skin- warm, dry heent- mm dry, perrl, no jvd, op clear cor- rrr. no m/r/g pulm- bilateral basilar dullness, reduced bs throughout. ct in place, intact in r cw, draining serosanguinous fluid. abdomen- soft, nt, nd extr- + edema, pulses intact, not hyperdynamic neuro- grossly intact, patient appropriately follows commands. pertinent results: studies. cxr - 1. loculated right pleural effusion with lucencies within it consistent with air. 2. nodular and parenchymal opacities predominantly in the right middle and right lower lung zones seen on the prior ct examination of . the differential diagnosis again includes infectious process, unusual manifestation of the patient's known pulmonary amyloidosis, wegner's disease, and malignancy cannot be excluded. . abd/pelvis ct - 1. no evidence of increase in the size of the abdominal aortic aneurysm. no evidence of aneurysmal leak. 2. extensive consolidative opacity in the right lung base, primarily appearing pleural, which has increased in size over the past two days, and contains small cystic spaces. this is most concerning for an infection. clinically correlate. . chest ct - significant interval increase in size and development of new nodules, several of which are now cavitary. the overall appearance is most worrisome for a superimposed infectious process, possibly septic, particularly given pleural reaction, loculated pleural fluid and adjacent opacities in the right lower lobe. this appearance may also be unusual manifestation of the patient's known pulmonary amyloidosis. the differential diagnosis radiographically would also include wegner's or other disease, rheumatoid or low-grade lymphoma. lung cancer would also be included in differential. . echo 1. the left atrium is mildly dilated. 2. 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 normal (lvef>55%). 3. the aortic valve leaflets are mildly thickened. mild aortic regurgitation is seen. 4. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. 5. compared with the findings of the prior report (tape unavailable for review) of , there has been no significant change. . ct abd/pelvis : impression: 1. no evidence of increase in the size of the abdominal aortic aneurysm. no evidence of aneurysmal leak. 2. extensive consolidative opacity in the right lung base, primarily appearing pleural, which has increased in size over the past two days, and contains small cystic spaces. this is most concerning for an infection. clinically correlate. 3. likely cholelithiasis without evidence of cholecystitis. 4. simple-appearing cysts in the right kidney. . ct chest : impression: stable appearance of multiple cavity nodules in both lungs likely representing an infectious process, possibly septic. the differentials include , rheumatoid or low-grade lymphoma. lung cancer should also be included in the differential. interval increase in the size of right-sided pleural effusion status post chest tube placement. this effusion now has multiple air bubbles, which could be secondary to the chest tube placement. however, a secondary superimposed infection cannot be excluded. brief hospital course: 84 yo m w/ mmp incl. copd, macronodular pulmonary amyloidosis, others transferred from osh w/ dyspnea, low sats, hypotension; rescently found to have worsening pulmonary infiltrates/pleural effusions. . #resp distress - likely due to baseline copd/amyloidosis with superimposed acute infection, loculated effusion with pus drainage at time of chest tube placement. after drainage remained stable from respiratory standpoint, oxygenative well on ra. chest tube without any evidence of air leak, approximately 100cc output, trailing off on second day. - pleural fluid s/w exudate, cx pending, no orgs on gs - cont vanco/zosyn empirically. - to or for decortication once renal function and coagulopathy improved. (see below) . #hypotension - pt w/ hx hypertension. no aaa on abd ct, neg fast. resolved with ivf by the second hospital day, lactate trended down . #coagulopathy - on coumadin for hx aflutter. no recent dose changes. poor po intake per family. given vitamin k x3 days with resolution of coagulopathy. . #arf - baseline cr 1.1-1.2 (last 1.2 in ). cr 4.4 on admission, back to baseline with some ivf. . #copd - fev1/fvc 31 (50%) pred, fvc 3.00 (74% pred), fev1 0.92 (37%pred). treated wtih albuterol/atrovent nebs prn, fluticasone . #a.flutter - hx a flutter s/p ablation. currently in sr. on coumadin prophylaxis, hold in preparatino for surgery. . #hyperchol - cont lipitor . #dm/igt - hold metformin in hospital. fsbs qid, hiss. . #htn - hold lisinopril, lasix for sbp<100. . #fen- cardiac/renal diet, ivf at 100cc/hr, follow lytes, replete prn. npo p midnight if going to or. . #ppx - pneumoboots, ppi . #access- 18g piv l forearm, 20g piv r ac. consider central access if cont to be hypotensive . #code status - dnr/dni - temporarily reversed for immediate perioperative course. . #communication - daughter is hcp (. daughter . addendum: patient went to operating room on for right vats/decortication and biopsy of cavitary lesion. the patient recovered well post-operatively. chest tubes were removed on post op day 3 and 4 with no complications. the patient was screened for a rehabilitation center and deemed fit for discharge on post op day 5. per id recommendations, will be discharged on po levoflox and complete a 2 week course of antibiotics. medications on admission: azmacort two puffs atrovent two puffs qid lipitor 40 mg qd lasix 40 mg qd lisinopril 5 mg qd coumadin 5 mg qd mvi qd tramadol 50mg prn metformin 500 mg qd ranitidine 150 qd foradil two puffs qd discharge disposition: extended care facility: rehab & nursing center - discharge diagnosis: empyema, right lower lobe infiltrate discharge condition: stable discharge instructions: the patient to call dr. office at if developing chest pain, shortness of breath, inability to swallow, fever, chills, nausea, vomiting, diarrhea, redness or drainage from the incisions. if you are unable to reach the thoracic service, please go to the emergency room. followup instructions: please call dr. office to schedule a follow-up appointment, and to arrange a chest xray before the appointment (phone number above). procedure: insertion of intercostal catheter for drainage decortication of lung closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus open biopsy of lung transfusion of other serum diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified essential hypertension acute kidney failure, unspecified severe sepsis atrial flutter atherosclerosis of renal artery long-term (current) use of anticoagulants chronic obstructive asthma, unspecified abdominal aneurysm without mention of rupture dehydration empyema without mention of fistula lung involvement in other diseases classified elsewhere 

Answer: The patient is high likely exposed to