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: mr. is a 55-year-old male with end stage insulin dependent diabetes mellitus with triopathy who presents after complaints of progressive shortness of breath with sudden onset, developing on . he ultimately came to the emergency room on where work-up included a chest x-ray that showed cardiomegaly, cephalization, vascular engorgement with bilateral ct angle blunting consistent with pulmonary edema. ultimately given this presentation, he was admitted to the c-med service where he was put on a rule out protocol. his troponin i did peak at 37. his cks, however, remained negative. his preoperative hematocrit was noted to be 28 with platelet count of 152,000 and a white blood cell count of 11,000. his bun and creatinine were 37 and 1.4 with baseline creatinine of 1.3 to 1.5. cardiac catheterization that was carried out on revealed trace mr, left ventricular ejection fraction of 35%. the left main coronary artery was non diseased, however, the lad had diffuse disease with a 70% mid lad lesion and another serial lesion on the lad at 80% distally. the left circ at the level of the om1 had a 95% stenosis at the origin and the right coronary artery was diffusely diseased with 90% distal stenosis with thrombus. given his significant three vessel coronary artery disease and mild to moderate systolic dysfunction, he was admitted to the c-med service, placed on telemetry, given diuresis and beta blockade and ultimately referred to the cardiothoracic surgery service of dr. . the patient was evaluated by dr. on . at this time he was already on heparin for the positive troponin and three vessel disease. he was pain free at that time. his jvd and pulmonary compromise with pulmonary edema were resolving. he was transfused for a hematocrit of 24 on hospital day #2 and given one unit of packed cells followed by lasix. past medical history: his other preoperative history included a past medical history of insulin dependent diabetes with peripheral neuropathy, questionable history of gastroparesis. he has severe peripheral vascular disease. he has chronic lower extremity leg ulcers on the left. he has had coronary artery disease, hypertension, degenerative joint disease including bilateral hips. he has history of chf, has had a gunshot wound in the past. past surgical history: significant for right below the knee amputation as well as a left transmetatarsal amputation. allergies: penicillin. social history: significant for previous tobacco history, greater than 30 pack year as well as he lives alone and is a veteran. his physical activity at baseline is wheelchair bound. he has had no history of tia, cva or gi bleed. hospital course: ultimately dr. felt the patient was appropriate to go to the or. he went for a three vessel coronary artery bypass graft on . grafts included a lima to the lad, a left saphenous vein graft to the om1 and a left saphenous vein graft to the pda. the patient tolerated the procedure well. intraoperative tee revealed an ejection fraction of 30-40%. post-operatively out of the or he was maintained on epinephrine, aprotinin, levophed, an insulin drip and propofol for sedation. he was brought to the cardiac surgical care recovery unit where his postoperative labs were noted to have a hematocrit of 30, normal coagulation parameters, inr of 1.2, ptt 33, potassium was noted to be 4.4, bun and creatinine at this time were 63 and 1.5. he was started on levaquin and flagyl not only to cover his lower extremity leg ulcers, but also to cover some viscous pulmonary secretions that were noted. he was extubated on postoperative day #1 and was maintained on a non rebreather. he was satting at 93% with gases of 7.26, 63, 167, 31 and 0. given the tenuous nature of his gases, he had serial abgs followed on postoperative day #1, was given aggressive pulmonary toilet. he was started with diuresis. his aspirin was started and his neo-synephrine was weaned. his insulin drip was maintained at 5 units per hour and he was normoglycemic. by postoperative day #2 the patient remained in the cardiac surgical care recovery unit. he was on levaquin and flagyl, his perioperative vancomycin dose was finished at his third dose, insulin drip was titrated to 6 units to maintain normoglycemia. he was started on prophylaxis with zantac as well as stool softeners with colace. his oral diet was a diabetic , 1800 kilocalories with cardiac diet as well. his day #2 labs included a hematocrit of 23 for which he was ultimately transfused two units. this was thought to be secondary to small oozing that was in his chest tube. bun and creatinine were 69 and 1.8. after his volume being repleted as well as his transfusion being completed, he was continued on progressive pulmonary toilet and diuresis. by postoperative day #3 the patient was deemed appropriate for discharge to the floor. he was maintained on chest tube suction because of high chest tube output, his sanguineous discharges on the first two days changed to more serosanguineous and his hematocrit was stable at 30 on postoperative day #3. bun and creatinine were noted to be 71 and 1.9. he was changed to a q day lasix regimen instead of and lopressor was started as well as adding on a full dose aspirin. consultation was obtained for assistance with the patient's diabetic management. he was tolerating his diet although he was complaining at this time of intermittent regurgitation. this was felt to be due secondary to his probable underlying gastroparesis and autonomic neuropathy from his end stage diabetes. consequently the patient was started on reglan which had satisfactory results and eliminated the majority of the patient's complaints of nausea and regurgitation. of note, on postoperative day #3 the patient's foley was removed, however, he failed to void in 9 hours post foley removal and after attempts by the house officer and nursing staff to insert a foley catheter, these failed, urology consultation was obtained. the patient had his catheter inserted by the urology service who felt that he probably failed to void secondary to retention issues of the post-operative state with narcotic use and his autonomic neuropathy and perhaps small degree of benign prostatic hypertrophy. foley was instructed to stay in until which time the chest tube is removed so that once his pain requirements became less he would use less narcotic and as a consequence have less urinary sphincter tone. by postoperative day #4 the patient was undergoing transfers with physical therapy, was out of bed to a chair, tolerating it well. he was noted to go into atrial fibrillation with rapid ventricular response to the 110's. this was easily treated and controlled with lopressor and he was started on amiodarone, converted to normal sinus rhythm after approximately 12 hours of therapy. by postoperative day #5 the patient was in sinus rhythm, was afebrile, tolerating his diet without complaints. he had a foley catheter and chest tube at this time. by postoperative day #6 his chest tubes were removed, chest x-ray showed a small left effusion with pneumothorax, normal cardiac silhouette, no focal infiltrate was identified. he additionally had foley catheter removed at midnight prior to discharge. labs prior to discharge were notable for hematocrit of 35, bun and creatinine of 64 and 1.6. his exam was notable for temperature of 98.3, pressure of 90/50, pulse rate of 64 and sinus. on exam he has a stable sternum with staples in place, no erythema or drainage. heart was regular with no murmur or rub or gallop. lungs with decreased breath sounds at the bases with crackles bilaterally. left lower extremity was noted to have trace edema. saphenous vein harvest was well approximated, intact, no drainage or erythema were present. he did have a macular rash in the inguinal regions that was felt to be intertrigonal, likely secondary to candidiasis. ultimately patient was accepted to rehab facility where he will undergo aggressive rehabilitation regimen to get him back to his baseline of being wheelchair bound. his activity restriction will include no pushing off with his arms as he is dependent on his upper extremities for mobility. this cannot be utilized for 30 days so his sternal wound be allowed to adequately heal. additionally he will be put on subcu heparin for dvt prophylaxis. he should be continued with an aggressive pulmonary rehabilitation effort including incentive spirometry, coughing and deep breathing, nebulizers as needed. follow-up will include seeing dr. in 30 days from the time of discharge. he is to see his pcp weeks from the time of discharge and the rehabilitation facility will be able to evaluate his wounds. discharge medications: lopressor 12.5 mg po bid, lasix 20 mg po q a.m., k-dur 20 meq po q day, colace 100 mg po bid, aspirin 325 mg po q day, eucerin cream to the left foot , protonix 40 mg po q day, heparin 5000 units subcu , mycostatin powder to the affected skin area, flagyl 500 mg po q 8 should be completed by , levaquin 500 mg po q day to be completed by . both of these antibiotics were given for presumed pulmonic infection. blood cultures and sputum cultures taken on postoperative day #1 ultimately never revealed an organism. percocet po q 4-6 hours prn and amiodarone taper including 400 mg po tid times 7 days, then change to 400 mg po bid times 7 days, then change to final regimen of 200 mg po q day times 14 days, then stop. reglan 10 mg po q 6 hours as well as nph 40 units q a.m., nph 30 units q p.m. and sliding scale insulin as directed by the clinic. condition on discharge: stable, sinus rhythm, afebrile, to go to rehab facility at . discharge diagnosis: 1. coronary artery disease. 2. unstable angina. 3. status post three vessel coronary artery bypass graft including lima to lad, saphenous vein graft to om1 and saphenous vein graft to the pda. 4. postoperative urinary retention. 5. phimosis. 6. postoperative atrial fibrillation with rapid ventricular response, now in sinus, rate controlled. 7. peripheral vascular disease. 8. insulin dependent diabetes mellitus with peripheral neuropathy, likely triopathy. 9. hypertension. 10. congestive heart failure. 11. degenerative joint disease. , m.d. dictated by: medquist36 procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters (aorto)coronary bypass of two coronary arteries angiocardiography of left heart structures left heart cardiac catheterization diagnostic ultrasound of heart other esophagoscopy diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified acute posthemorrhagic anemia candidiasis of other urogenital sites atrial fibrillation retention of urine, unspecified urinary complications, not elsewhere classified atherosclerosis of native arteries of the extremities with ulceration diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to