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: history of present illness: this is an 82-year-old male with coronary artery disease, status post recent catheterization in with critical as, atrial fibrillation, gerd who presented on to an outside hospital with increased shortness of breath, exertional dyspnea, and cough with bloody sputum. the patient was found to have a right lower lobe infiltrate at that time and a white blood count of 19.2 consistent with pneumonia and worsening of chronic renal insufficiency. bun and creatinine of 6.5 and 3.2. baseline creatinine was known to be 2.4-2.5. the patient was given 1 dose of ceftriaxone and 5-day course of azithromycin plus a 14-day course of levofloxacin. white blood count was , the patient was started on empiric flagyl. sputum culture was without significant growth, but chest x-ray was questionable for new left-sided infiltrate. however, clinically the patient improved and was discharged home on . at home, the patient was with progressive increasing dyspnea, reports of subjective fevers, chills, and sweats. denies nausea or vomiting. no choking or palpitations. the patient still with mild blood-tinged sputum, but decreased production overall. denied pleuritic pain, questionable history of diarrhea with mild abdominal pain, but no constipation. the patient states he is taking all medications at home. shortness of breath was reported to be at rest, and the patient re-presented to the outside hospital today. white count was found to be 18. chest x-ray showed left lower lobe infiltrate, hematocrit of 28.7. in the emergency department, the patient's vitals were found to be temperature of 98 degrees, heart rate of 48, blood pressure of 80/60, and 88 percent on room air. the patient was placed on nonrebreather with o2 saturations 99 percent. an abg at this time was 7.42, 20, and 57. lactate from outside hospital was pending. the patient was given 600 cc bolus of normal saline without effect and was subsequently started on dopamine and blood pressure improved to 110/60. a left ij was placed at the outside hospital, and the patient was also given a dose of lasix 40 mg x 1, vancomycin 1 g x 1, and imipenem 500 mg. the patient was sent to for presumed sepsis. at , the vitals found to be temperature of 97 degrees, heart rate 66, blood pressure 68/16, respiratory rate 24, and 99 percent on nonrebreather. the patient was given 5 liters of iv fluid. dopamine was continued. levophed was initiated to maintain blood pressure. the patient was given 500 mg of levofloxacin and 500 mg of flagyl. hematocrit was found to be 25.7 (baseline of 31). the patient was given 2 units of packed red blood cells, a line was placed. an abg at this time showed ph of 7.30, pco2 of 26, and pao2 of 77, and lactate was 1.4. chest x-ray was repeated showing left lower lobe infiltrate. kub was performed secondary to nonspecific abdominal pain showing no free air and 1 dilated loop of bowel. the patient was transferred to the micu for further care. past medical history: cad, status post catheterization in with stent in the right coronary artery with brachytherapy. status post recatheterization in with re-stent of right coronary artery with a cypher stent. critical as with valve area of 0.85 square centimeters. atrial fibrillation on coumadin. gerd. chronic renal insufficiency with baseline creatinine of 2.4- 2.5. hypertension. pvd. anemia secondary to chronic renal insufficiency. question of copd with bronchospasm, recently on a steroid taper. allergies: no known drug allergies. medications on admission: 1. nph 6 units in the morning and 5 units at night with humulin insulin sliding scale while on steroid taper. 2. digoxin 0.125 mg q.d. 3. coumadin 2 mg q.d. 4. lopressor 25 mg q.i.d. 5. singulair 10 mg q.d. 6. nitro patch 0.6 mg q.12 hours. 7. aspirin 81 mg q.d. 8. protonix 40 mg q.d. 9. allopurinol 75 mg q.d. 10. plavix 75 mg q.d. 11. simvastatin 20 mg q.d. 12. cardizem 120 mg q.d. 13. flagyl 500 mg t.i.d. until . 14. prednisone 20 mg on a taper. social history: the patient lives at home with his wife, on high functional baseline, walks with a cane. tobacco, has a 30-pack-year history, but quit 20 years ago. drinks alcohol occasionally. physical examination: in the micu, temperature 96.4 degrees, heart rate 58, blood pressure 105/37, breathing 99 percent on a 100 percent nonrebreather. the patient is an elderly male in mild acute distress, dyspneic with speech, and pale appearing. the pupils were equal, round, and reactive to light. dry mucous membranes. no lymphadenopathy. heart was regular. s1 and s2 appreciated. harsh crescendo and decrescendo murmur at the right upper sternal border. questionable holosystolic murmur at the apex. lungs with crackles at the bases bilaterally. abdomen with good bowel sounds, soft, distended, and tympanitic. unable to appreciate hepatosplenomegaly. there were no masses. extremities with trace to 1 plus lower edema bilaterally. pulses were palpable bilaterally. evidence of ecchymosis on the upper extremities, but no rash. neurologically oriented x 3. cranial nerves ii through xii intact. moving all extremities in bed. sensation intact. the patient is mentating appropriately. labs at presentation: white count 18.5, hematocrit 25.7, platelets 134, bun 97, creatinine of 3.0, and glucose is 183. radiographic studies: ekg showed atrial fibrillation with left axis, 2-mm st depressions in v2-v6, t-wave inversions in 1 and avl. again, chest x-ray showed left lower lobe infiltrate. hospital course: sepsis, likely secondary to left lower lobe pneumonia, but consider an additional abdominal process. the patient was started on broad spectrum antibiotics, given iv fluids, given 4 mg of dexamethasone in the setting of recent steroid use. the patient was currently mentating well. urine output was stable. during hospital course, the patient was started on vancomycin, zosyn, and given a 5-day course of azithromycin. the patient subsequently developed a drug reaction rash to the zosyn and was started on imipenem. the patient received a 5-day course of azithromycin, 10-day course of vancomycin, and 10-day course of imipenem. micro data remained negative. the patient continued to spike temperatures. the patient was given fluconazole for evidence of yeast in the urine as well as sputum. this was the only organism that was evident in moderate growth; however, this was thought to be secondary to re-colonization after use of broad spectrum antibiotics. again, the patient's micro data remained negative during entire hospitalization. however, the patient persisted to have hypotension, which was fluid responsive; however, the patient was showing marked signs of volume overload. the patient was ultimately started on caspofungin and received 3 days of caspofungin. the patient remained afebrile, but again had issues with hypotension. during this course, the patient underwent swan-ganz catheter placement to determine overall fluid status. at this time, cvp was noted to be 12, ra pressures 47/7 and pa pressures 47/20, and respiratory wedge was found to be 14 with a mean wedge of 18. cardiac index at this time was 2.91 and cardiac output 7.1, svr 585, and svo2 of 67. physiology was concerning for sepsis. therefore, fluid boluses were used to maintain blood pressure. the patient was initiated on dopamine and subsequently levophed in the emergency department. however, during the hospital course, the patient was transitioned from these pressors over to dobutamine and vasopressin with improvements in mixed venous saturations. at the time of death the patient still remained pressor dependent with no signs of improvement. of note, xigris was considered early in hospital presentation, however, due to concerns for bleeding as well as anticoagulation, this was felt not to be a safe option for the patient as well as the patient met significant exclusion criteria for use. hypoxia/pneumonia. the patient initially had a large aa gradient, which was likely secondary to pneumonia. there was some concern for aspiration. however, given the patient's functional status thought to be less likely, again, the patient was started on broad spectrum antibiotics. urine legionella antigen was checked and found to be negative. the patient's respiratory status remained stable for the next few hours after admission. however, the patient was ultimately intubated for increasing hypoxia and hypocapnia. the patient's pao2 to fio2 was suggestive of ards. the patient was placed on the ardsnet protocol for ventilation with lung protective strategies. the patient remained stable on the ventilator without significant issues in oxygenation. there were episodes where patient appeared to have increased work of breathing. for this, ventilator settings were adjusted. throughout his course, respiratory status remained stable. a broncho with bal was performed; however, all microbiology remained negative. abdominal pain. this was thought to be secondary to diarrhea, but the patient has already completed a 7 out of 14- day course of flagyl. a ct scan was obtained showing no significant abdominal pathologies. the stool was checked for c. diff and found to be negative. after intubation, it was difficult to assess further abdominal pain. however, lfts, amylase, and lipase remained stable. the patient did have episodes of diarrhea; however, all were negative for c. difficile. acidosis. initially, the patient presented with an anion gap acidosis, which resolved quickly. this was thought initially to be due to diarrhea. the nonanion gap metabolic acidosis was subsequently thought to be due to renal failure as well as aggressive saline infusion. lactated ringers was used for further volume resuscitation. renal. the patient's creatinine remained stable and had improved to baseline. iv fluids were used to maintain central venous pressures. the patient's urine output also remained stable. however, given the need for large amounts of volume for resuscitation, the patient developed signs of volume overload. however, again, urine output remained stable. cardiovascular. ischemia. st depression in the anterior leads were thought to be demand ischemia in the setting of decreased blood pressure, anemia, and aortic stenosis. enzymes were cycled. the patient was transfused to maintain a hematocrit above 30 and the patient was continued on aspirin and plavix especially in the setting of recent stent. pump. the ef was noted to be around 60 percent. an echo was rechecked, showing again the ef of 60-65 percent with severe as. cardiac status remained stable during the hospitalization. rhythm. the patient had evidence of rate-controlled atrial fibrillation on coumadin. the patient's coumadin was withheld and initiated on heparin. the patient's antihypertensives were held secondary to hypotension. the patient's rhythm remained stable during hospitalization. the patient's clinical status continued to deteriorate despite aggressive measures. the patient was treated with broad spectrum antibiotics, given aggressive fluid resuscitation as needed. other sources of the infection were entertained. however, no further sources of infection could be identified. sepsis and respiratory failure were all attributed to the patient's multifocal nosocomial pneumonia. there was some concern that the patient may have developed a ventilator associated pneumonia. surveillance cultures and sputum cultures remained negative. legionella antigen was checked again, which was negative. in the setting of ventilator acquired pneumonia, the patient had been on imipenem. however, there may have been some resistance to imipenem, as the patient continued to be febrile with evidence of septic physiology. for that, the patient was started on caspofungin. however, the patient's infection persisted because of persistently poor clinical course and no signs of improvement despite all aggressive measures. the family opted to change code status to do not resuscitate and on , the family requested the care be withdrawn. on , the patient expired. discharge diagnoses: community acquired and hospital acquired pneumonia. hypoxia. acute respiratory distress syndrome. sepsis. hypotension (pressor dependent). atrial fibrillation. gastroesophageal reflux disease. acute renal failure/chronic renal insufficiency. peripheral vascular disease. anemia. critical aortic stenosis. coronary artery disease. dr., 12-761 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis arterial catheterization closed [endoscopic] biopsy of bronchus pulmonary artery wedge monitoring transfusion of packed cells diagnoses: pneumonia, organism unspecified acidosis hyperpotassemia acute kidney failure, unspecified unspecified septicemia chronic airway obstruction, not elsewhere classified aortic valve disorders hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure 

Answer: The patient is high likely exposed to