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 a 59 year old male with a history of hypertension, diabetes, mellitus, hypercholesterolemia, coronary artery disease, congestive heart failure and chronic obstructive pulmonary disease who presented to an outside hospital on , two days prior to transfer, with shortness of breath times two weeks. the patient had been seen by his primary care physician and treated with solu-medrol dose pak and bactrim and had had a chest x-ray consistent with question of pneumonia. the patient had had increasing shortness of breath and on arrival to the emergency room for further evaluation complained of some productive cough. the patient was noted to have elevation of his cardiac enzymes and the patient was treated with heparin initially and integrilin added when the troponins were noted to be elevated at the outside hospital. the patient became more short of breath, failed noninvasive positive pressure ventilation (nppv) and required intubation. after intubation, the patient's blood pressure transiently dropped and dopamine was started to improve his pressures. the patient, however, became tachycardiac and flipped into atrial fibrillation. the patient was treated with lopressor and digoxin intravenously and changed to neo-synephrine with good blood pressure control. the patient was also receiving propofol for division. as well the patient received an insulin drip. foley catheter was placed with some difficulty by the urologist at the outside hospital and noted to have some blood-tinged urine. of note, the patient's intubation was very difficult. the patient was transferred to for further evaluation. on transfer to the the patient's propofol was changed to ativan for sedation. the patient's insulin drip was discontinued. the patient continued to be on neo-synephrine, heparin and integrilin drips for control. on arrival the patient was sedated with some ativan on transfer and this was changed to a drip. at the outside hospital the patient also had a pneumonia which was treated with levaquin. past medical history: 1. diabetes mellitus; 2. hypertension; 3. hypercholesterolemia; 4. coronary artery disease; 5. congestive heart failure; 6. chronic obstructive pulmonary disease; 7. peripheral neuropathy. allergies: penicillin. home medications: lescol 80 mg p.o. q.d.; lisinopril 20 mg p.o. q.d.; albuterol inhaler; medrol dose pak; bactrim; lasix 20 b.i.d.; metformin 500 b.i.d.; actos; insulin 70/30 62 q. am, 68 units q. pm ? unclear family history: history of coronary artery disease. review of systems: at the outside hospital the patient denied fevers, chills, and had some shortness of breath and cough. physical examination: temperature 98.7, blood pressure 124/68, 138 kg. the patient was sating 100%, central venous pressure 12, fingersticks of 94. the patient was ventilated on assist control 650 times 12/100% fio2 with pips of 36, plateaus of 27 and a positive end-expiratory pressure of 5%. in general, this was an obese man in no apparent distress. endotracheal tube was in place and he was sedated. head, eyes, ears, nose and throat: the patient was normocephalic, atraumatic. pupils equal, round and reactive to light, oropharynx clear. neck: obese, no lymphadenopathy, right subclavian was in place. lungs: decreased breathsounds at the bases, bibasilar crackles noted. cardiovascular: the patient had distant heartsounds, irregular, atrial fibrillation. abdominal: the patient was very obese, distended, nontender with decreased bowel sounds. extremities: 2+ pitting edema. neurological: the patient was not responding to verbal tactile stimuli and moving all four extremities well. laboratory data: pertinent for white count of 10.9 with differential of 75% polys, 16% lymphs, and 6% monos, hematocrit of 30.5, platelets 533. bicarbonate 24, creatinine 1.5, bun 51, inr 1.1. calcium 8.4, magnesium 1.5, albumin 2.3, alkaline phosphatase 295, total bilirubin 0.2, alt 23, ast 20. creatinine kinase 170, mb 6, troponin 0.22. urinalysis greater than 50 red blood cells, white blood cells, occasional bacteria. electrocardiogram: atrial fibrillation with a rate of 84, regular rate and rhythm, t wave inversions in v1 to v4, depressions in v3 and . depression in v4 to v5, not significantly changes from the outside hospital. chest x-ray: question of congestive heart failure and left retrocardiac opacity. arterial blood gases: 7.44/pco2 42, po2 212 on the current vent settings, as described above, lactate 0.8. hospital course: 1. respiratory failure - the patient was maintained on ventilator given his hospital course for multifactorial respiratory failure in the setting of chronic obstructive pulmonary disease flare, congestive heart failure on examination and x-ray and pneumonia on x-ray. the patient was maintained on a ventilator, assist control and subsequently weaned off of pressure support as tolerated. 2. congestive heart failure - the patient was thought to be in congestive heart failure contributing the respiratory failure. unclear etiology, whether this was due in the setting of acute coronary syndrome with a troponin leak versus atrial fibrillation with history of hypertension. the cardiology team was consulted regarding the care of this patient and they felt that the troponin leak was not due to acute coronary syndrome but was instead due to sepsis versus demand ischemia in this patient with atrial fibrillation. the patient was subsequently started on lasix drip with improvement of his diuresis on hospital day #6, after several attempts at diuresis, and the patient subsequently had significant diuresis with both the lasix drip and acetazolamide that was initiated for his worsening alkalosis. 3. chronic obstructive pulmonary disease - the patient had significant wheezing on examination, history of chronic obstructive pulmonary disease and question of asthma. the patient was started on intravenous steroids and tapered to p.o. by hospital day #6. around-the-clock nebulizers and with metered dose inhalers, atrovent and albuterol, were started for the remainder of his hospital course with the improvement of his wheezing. 4. pneumonia - the patient had evidence of left retrocardiac opacity on chest x-ray on admission. the patient was started on levofloxacin for a total 10 day course and also was subsequently continued to spike on hospital day #3 and ceftazidime was added for events of associated pneumonia given the temperature spike. the patient remained afebrile throughout the remainder of the course with a decrease in his white blood cell count. 5. troponin leak - the patient had positive enzymes at the outside hospital and here. creatinine kinase was trended. there was consideration of acute coronary syndrome but the electrocardiogram showed no dynamic changes since outside hospital films. again cardiology was consulted as above and they felt this troponin leak was not due to acute coronary syndrome. the patient, however, was maintained on aspirin, statin, during this admission. once the patient was off of pressors, beta blocker was started as was the ace inhibitor. the patient was initially on integrilin on transfer to the hospital here and this was discontinued after cardiology's recommendation that this was not likely to be acute coronary syndrome. 6. hypotension - the patient initially presented with sepsis-like picture and the patient was maintained on neo-synephrine for pressure support, subsequently weaned off on hospital day #3 with improvement of his mean arterial pressures to greater than 50 degrees. 7. atrial fibrillation - the patient resolved spontaneously on hospital day #2 from his atrial fibrillation and was in normal sinus rhythm for the remainder of his hospital course. it was felt that this was new and possibly due to paroxysmal atrial fibrillation and question side effect of dopamine as per outside hospital records. the patient was maintained on beta blocker once off pressure for rate control and maintained on telemetry without further event. the patient was not on heparin in the setting of genitourinary bleed. 8. acute renal failure - the patient had elevation of bun and creatinine, slightly resolved with intravenous fluids and subsequently improved with hydration. however, slight bump on hospital day #4 was likely due to worsening congestive heart failure at which point lasix drip was initiated with improvement of his renal status. there is a question of hyperperfusion as a cause compounded with acute tubular necrosis. this was also in the setting of complete, continued bleeding from the bladder from traumatic foley catheter. the patient was maintained on continuous bladder irrigation for removal of clots with the assistance of urology's recommendation and care. 9. decreased hematocrit - in the setting of genitourinary bleed, and heparin and integrilin on transfer to the hospital after traumatic foley catheter placement, the patient was consented for blood type and screen and received packed red cells during this hospital admission for maintained of his hematocrit. by hospital day #5, the patient's hematocrit was stable with resolution of the genitourinary bleed. 10. fluids, electrolytes and nutrition - the patient was maintained on tube feeds during his hospital administration while intubated. 11. code status - the patient was full code. communication was with the family, wife . 12. prophylaxis - the patient was maintained on pneuma boots for deep vein thrombosis prophylaxis and proton pump inhibitor for gastrointestinal prophylaxis. disposition: to be determined by the next intern who will dictate the remainder of this hospital course in the medicine intensive care unit. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: pneumonia, organism unspecified acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified septicemia atrial fibrillation acute on chronic diastolic heart failure acute respiratory failure alkalosis chronic obstructive asthma, unspecified 

Answer: The patient is high likely exposed to