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: amoxicillin attending: chief complaint: transfer for respiratory failure major surgical or invasive procedure: bronchoscopy *2 history of present illness: mr. is a 51 yo man with a diagnosis of pulmonary alveolar proteinosis who presents in transfer from for treatment of pneumonia and respiratory failure. per h&p from osh, the patient was in his usual state of health until when he developed uri symptoms, dyspnea, cough, fever and chills. he presented to the hospital today and was found to have a large lll/lingular pneumonia on chest x-ray. he was afebrile on admission there with rr 49, hr 143, bp 111/75. he was started on iv linezolid and levofloxacin and admitted to the icu. o2 sat on arrival to the icu was 88% on fio2 70%. abg was 7.48/33/51. his rr increased to 50, his hr remained 130s and his temp increased to 100.4, and he was intubated at that time. he was placed on ventilator support - assist control, tidal volume 600, fio2 100% and rr 12. he was placed on a propofol drip for sedation. he was suctioned for thick yellow brownish-colored sputum, blood-tinged. gram stain showed <10 epis, 1+ gram positive cocci. bp dropped to 89/40 and he received a ns bolus and started on neosynephrine. repeat abg was 7.43/39/222. high a-a gradient of 442. he was transferred to for further management. upon arrival to the icu, the patient was intubated, sedated, on neo gtt. central line and r radial a-line placed. bronchoscopy performed showing large mucus plug on the left. on transfer to the floor, he felt that his shortness of breath had improved, but was still requring supplemental oxygen. he reported feeling tired, but was improved since his admission past medical history: - pulmonary alveolar proteinosis, diagnosed by open lung bx -follow-up 11/08 per osh report almost complete resolution of infiltrates - ibd s/p colon resection and colostomy - hashimoto's thyroiditis - hx of sinus surgery social history: occasional etoh use, does not and has never smoked. married, two children. works as a mechanical engineer in an office setting. has no known exposure to asbestos. mother grew up on a farm in and patient would visit often as a child. no known exposure to any chemicals or solvents. married with two children/ family history: father deceased - kidney ca. mother is alive and healthy physical exam: vs: t: 99.4 hr: 91 bp: 102/60 rr: 16 o2: 98% on fio2 100%, peep 5 gen: intubated sedated heent: peerl, mm dry neck: supple, no lad, no jvd heart:rrr, nl s1/2, no murmurs lung: clear breath sounds b/l anteriorly abd: colostomy with midline scar extrem: warm, no edema, 2+ dp, radial pulses skin: no rashes neuro: no clonus, toes downgoing pertinent results: ekg: sinus rhythm at 88 with pvc. nl intervals, nl axis, j point elevation in lateral leads, changed from prior hematology 09:45pm blood wbc-10.3 rbc-3.79* hgb-11.7* hct-35.6* mcv-94 mch-31.0 mchc-33.0 rdw-13.9 plt ct-241 03:04am blood wbc-13.0* rbc-3.16* hgb-9.7* hct-29.2* mcv-93 mch-30.6 mchc-33.0 rdw-14.5 plt ct-237 04:08am blood wbc-11.2* rbc-3.13* hgb-9.7* hct-29.2* mcv-93 mch-31.0 mchc-33.2 rdw-14.2 plt ct-381 08:40am blood wbc-9.4 rbc-3.64* hgb-10.8* hct-33.8* mcv-93 mch-29.6 mchc-31.9 rdw-14.6 plt ct-677* 02:36am blood neuts-92.1* lymphs-4.7* monos-2.5 eos-0.5 baso-0.2 coags 03:04am blood pt-13.9* ptt-30.3 inr(pt)-1.2* chemistry 09:45pm blood glucose-114* urean-23* creat-1.4* na-141 k-3.7 cl-107 hco3-23 angap-15 02:36am blood glucose-100 urean-16 creat-0.9 na-146* k-3.2* cl-112* hco3-26 angap-11 08:40am blood glucose-80 urean-7 creat-0.9 na-137 k-4.8 cl-106 hco3-22 angap-14 08:40am blood calcium-8.8 phos-2.8 mg-2.2 lfts 09:45pm blood alt-14 ast-39 ld(ldh)-303* alkphos-60 totbili-1.6* cardiac enzymes 03:16am blood ck(cpk)-53 11:00am blood ck(cpk)-435* 03:16am blood ck-mb-notdone ctropnt-<0.01 11:00am blood ck-mb-5 ctropnt-<0.01 06:00pm blood ctropnt-<0.01 endocrine/iron 05:11am blood caltibc-133* ferritn-749* trf-102* 03:04am blood tsh-1.4 03:04am blood t4-2.1* t3-44* calctbg-0.95 tuptake-1.05 t4index-2.2* free t4-0.44* 11:00am blood cortsol-11.9 03:23am blood lactate-1.6 urine: u/a: negative glucose, small bili, neg ketones, neg nitrates, trace blood, negative leuk esterase, protein >=300, wbc, 3+ bacteria, 1+ amorphous crystals influenza antigen screen - negative culture data: bal: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): sparse growth commensal respiratory flora. fungal culture (preliminary): mold. bal: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): rare growth commensal respiratory flora. fungal culture (preliminary): no fungus isolated. legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. blood and urine cultures at negative to date ct chest - impression: confluent consolidation involving nearly the entire left lung with either bronchocentric or vascular dissemination to the right lung with assoicated mediastinal and hilar lymphadenopathy most suggestive of infection. alternatively, consolidative forms of bronchoaleveolar carcinoma or lymphoma could have a similar appearance. review of the outside ct from and shows near resolution of previous extensive ground glass opacity, diagnosed as pulmonary alveloar proteinosis which may be idiopathic or related to inhalational exposure. extensive mediastinal soft tissue and lymphadenopathy. brief hospital course: 51 yo man with ibd, pulmonary alveolar proteinosis who presented from with pneumonia and respiratory failure. # respiratory failure/pneumococcal pneumonia: in the setting of an acute pulmonary process, this was initially attributed to bacterial pneumonia, likely community acquired, supported by intial gpc's on sputum at . however, pcp and nocardia were also considered given known diagnosis of pap and labs were sent accordingly. cxr demonstrated unilateral disease, not c/w pap flare and more concerning for an acute process. patient was intubated and intially started on an ards type ventilation with low tidal volumes. patient was also underwent bronchoscopy with aspiration of large, thick mucus cast. legionella ag was sent and was negative. the patient was initially started on vancomycin and aztreonam. he was subsequently switched to levaquin after cultures (blood and sputum) from returned possitive for streptococcus pneumoniae. on , patient grew agitated in the evening and self-extubated. he was maintained with adequate saturations on highflow facemask. patient's mental status rapidly improved over the next several days. his cxr also rapidly improved with increased oxygenation of the rl fields. f/u of the nocardia culture was negative to date and pcp smear was never done in the lab. on transfer to the floor, his oxygen requirement was initially 4l. levaquin was continued. he had no acute events on the floor, and o2 saturation was 94% on ra on day of discharge. physical therapy evaluated him during his admission and recommended further visits. he still had dyspnea on exertion so home oxygen was arranged for him. follow-up: pcp 1 week (their office will contact patient to arrange appointment) and repeat chest imaging in weeks. # acute renal failure - on transfer, patient had elevated creatinine of 1.4, given 3l ns bolus in setting of hypotension and pressors. responded appropriately. discharged with creatinine 0.8-0.9. # hypotension - patient experienced hypotension prior to transfer from osh. he was transferred to on a neosynephrine (phenylephrine) drip. chem-7 showed elevated creatinine which likely indicated pre-renal state. responded to 3l ns bolus and pressors were discontinued. patient maintained normal blood pressure for rest of admission. # pulmonary alveolar proteinosis - not an acute issue during admission, however, may have been contributing factor to his illness. instructed patient to follow-up with his pulmonologist within 4 weeks of discharge. # hypothyroidism - tsh within normal limits. continued home dose of levoxyl. medications on admission: - levothyroxine - 200mcg po daily discharge medications: 1. oxygen o2 at 2 to 4 l continuous, pulse dose for portability. 2. levothyroxine 100 mcg tablet sig: two (2) tablet po daily (daily). 3. levofloxacin 750 mg tablet sig: one (1) tablet po once a day for 5 days. disp:*5 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: 1. pneumonia 2. respiratory failure 3. hypotension 4. acute renal failure secondary diagnosis: 1. pulmonary alveolar proteinosis 2. hypothyroidism discharge condition: hemodynamically stable. tolerating po intake. stable on oral antibiotics. discharge instructions: you were transferred to from for further management of your pneumonia. when you arrived, you were sedated and had a tube down your throat to help you breathe. you also needed medication to help your body maintain your blood pressure. after recieving iv fluids, the medication to help you maintain your blood pressure was discontinued. you pulled the breathing tube out of your mouth while in the intensive care unit, however it was not inserted. oxygen was required for most of your hospitalization to help you breath. antibiotics were continued while you were in the hospital. please complete your course of antibiotics after discharge. it is important that you follow-up with your pcp and your pulmonologist after discharge. you were given both a flu and pneumococcal vaccine prior to discharge to help prevent flu and pneumonia. oxygen has been arranged for you to have at home. it is intended to be used during exertion for the next 2-3 days or at anytime that you are experiencing shortness of breath. changes in medication start levofloxacin 750 mg by mouth daily for 5 days continue levothyroxine 200 mcg by mouth daily if you experience fever > 101, worsening shortness of breath, chest pain, pain when you breathe, coughing up blood, nausea or vomitting, headaches, confusion or any other symptom that concerns you, please contact your pcp or go to the nearest emergency room for evaluation. followup instructions: please follow-up with your pcp within one week of discharge. dr. is no longer at the practice site your prevoiusly went to and they stated your new pcp is . . dr. nurse will contact you to arrange an appointment. additionally, you should follow-up with your pulmonologist within 4-6 weeks for evaluation. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube arterial catheterization other intubation of respiratory tract other intubation of respiratory tract diagnoses: acute kidney failure, unspecified unspecified acquired hypothyroidism unspecified disease of pericardium acute respiratory failure hypotension, unspecified pneumococcal pneumonia [streptococcus pneumoniae pneumonia] foreign body accidentally entering other orifice foreign body in main bronchus pulmonary alveolar proteinosis 

Answer: The patient is high likely exposed to