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: morphine attending: chief complaint: ruptured thoracoabdominal aneurysm major surgical or invasive procedure: - emergent salvage repair of ruptured thoracoabdominal aortic aneurysm with a 34-mm dacron tube graft using deep hypothermic circulatory arrest. - chest and abdomen exploration, removal of packs, chest closure. - abdomen closure/ feeding jejunostomy tracheostomy history of present illness: 59 m transferred from with ruptured taa. presented to osh with back pain - ct scan done-> intubated and transferred here.taken directly to or for surgery for ruptured taa. past medical history: hypertension social history: lives with fiance family history: unknown physical exam: pe: 120/65 hr 85 intubated, sedated rrr decreased bs on left soft nt, distended obese abdomen no edema, feet warm, 1+ pt and dp b/l pertinent results: admission: 11:45am fibrinoge-260 11:45am pt-13.8* ptt-29.3 inr(pt)-1.2* 11:45am plt count-405 11:45am wbc-21.4* rbc-3.30* hgb-9.6* hct-30.5* mcv-92 mch-29.1 mchc-31.5 rdw-13.0 11:53am glucose-366* lactate-3.4* na+-137 k+-5.5* cl--110 12:35pm glucose-358* lactate-4.1* na+-141 k+-4.8 cl--111 08:05pm alt(sgpt)-34 ast(sgot)-88* alk phos-37* tot bili-1.8* 08:05pm glucose-187* urea n-15 creat-1.2 sodium-152* potassium-3.7 chloride-114* total co2-31 anion gap-11 discharge: 02:58am blood wbc-10.1 rbc-3.05* hgb-8.7* hct-26.9* mcv-88 mch-28.5 mchc-32.3 rdw-15.2 plt ct-399 02:58am blood plt ct-399 02:58am blood pt-25.1* ptt-33.0 inr(pt)-2.4* 02:58am blood glucose-111* urean-53* creat-1.4* na-135 k-4.3 cl-103 hco3-24 angap-12 02:58am blood alt-82* ast-59* alkphos-131* amylase-100 totbili-1.1 02:58am blood albumin-2.8* calcium-8.5 phos-4.2 mg-2.3 cholest-99 03:13am blood %hba1c-6.0* eag-126* echo - this is a directed and limited study to assess the aorta. the patient was booked as a type a dissection. on placement of the tee, it is clear that there is no ascending dissection and no ai. the descending aorta and mediastinum are distorted by clot. it is not possible to discern an aortic lumen or to fairly assess the heart's fxn. it is possible to see the aortic valve well. no ai or ascending dissection seen. other intracardiac structures are too distorted to assess. tee was used to help place the venous cannula in the right atrium. aortic wire could not be seen. pre-cpb: the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. there is a small pericardial effusion. after circ arrest and cpb: there were several instances when the right heart ceased to function because the lungs were full of blood and he could not be ventilated. with frequent pulmonary lavage and high dose epi, we were able to regain some cardiac fxn. no ai was seen. after heroic resuscitation, he had good biventricular systolic fxn on moderate doses of norepi and epinephrine by infusion. the patient was taken to the icu for further care. echocardiography report , portable tte (complete) done at 3:07:53 pm final interpret md: , md echocardiographic measurements results measurements normal range left atrium - long axis dimension: 2.9 cm <= 4.0 cm left atrium - four chamber length: *6.8 cm <= 5.2 cm left atrium - peak pulm vein s: 0.5 m/s left atrium - peak pulm vein d: 0.6 m/s right atrium - four chamber length: *5.8 cm <= 5.0 cm left ventricle - septal wall thickness: 1.0 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 1.1 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 3.9 cm <= 5.6 cm left ventricle - ejection fraction: >= 55% >= 55% left ventricle - stroke volume: 59 ml/beat left ventricle - cardiac output: 5.00 l/min left ventricle - lateral peak e': *0.07 m/s > 0.08 m/s left ventricle - septal peak e': *0.04 m/s > 0.08 m/s left ventricle - ratio e/e': 13 < 15 aorta - sinus level: *4.0 cm <= 3.6 cm aorta - ascending: *4.3 cm <= 3.4 cm aortic valve - peak velocity: 0.9 m/sec <= 2.0 m/sec aortic valve - lvot vti: 13 aortic valve - lvot diam: 2.4 cm mitral valve - e wave: 0.7 m/sec mitral valve - a wave: 0.6 m/sec mitral valve - e/a ratio: 1.17 mitral valve - e wave deceleration time: 175 ms 140-250 ms tr gradient (+ ra = pasp): *38 mm hg <= 25 mm hg findings left atrium: elongated la. left ventricle: normal lv wall thickness, cavity size, and global systolic function (lvef>55%). suboptimal technical quality, a focal lv wall motion abnormality cannot be fully excluded. no resting lvot gradient. right ventricle: mildly dilated rv cavity. normal rv systolic function. aorta: moderately dilated aortic sinus. moderately dilated ascending aorta. aortic valve: normal aortic valve leaflets (?#). no as. no ar. mitral valve: normal mitral valve leaflets with trivial mr. tricuspid valve: normal tricuspid valve leaflets. mild to moderate +] tr. moderate pa systolic hypertension. pericardium: there is an anterior space which most likely represents a fat pad, though a loculated anterior pericardial effusion cannot be excluded. general comments: suboptimal image quality - poor echo windows. conclusions the left atrium is elongated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic root is moderately dilated at the sinus level. the ascending aorta is moderately dilated. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild -moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. impression: suboptimal image quality. pulmonary artery systolic hypertension. mild right ventricular cavity enlargement. dilated ascending aorta. these findings are c/w a primary pulmonary process (copd, bronchospasm, pulmonary embolism, obstructive sleep apnea, etc.). clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. electronically signed by , md, interpreting physician 17:47 chest (portable ap) study date of 7:25 am final report indication: 59-year-old male with thoracic aneurysm repair and fever. comparison: . chest, ap: mediastinal widening is roughly stable, measuring 14 cm in greatest transverse measurement. left lower lobe atelectasis is unchanged. the right lung is clear. there are no large pleural effusions. cardiac and hilar contours are normal. surgical clips are noted in the left upper quadrant. impression: 1. cardiomediastinal silhouette appears stable, but evaluation should ideally be performed by transesophageal echocardiography, ct, or mr. 2. no acute pulmonary process. the study and the report were reviewed by the staff radiologist. dr. ho dr. mr head w/o contrast study date of 2:42 pm medical condition:59 year old man s/p taa, chest/abd closure now blind reason for this examination: ischemic vs hemmorrhagic event final report:mri of the brain and mra of the head and neck clinical history: 59-year-old man status post taa, chest, abdomen closure, now blind. technique: mri of the brain was performed without the use of intravenous contrast. mra of the head was obtained utilizing time-of-flight technique (no intravenous gadolinium contrast). mra of the neck was performed both before and after the administration of intravenous gadolinium contrast, utilizing bolus triggering and subtraction technique. complex multiplanar reformatted images were obtained of the mra of the head and mra of the neck. mr brain: multiple foci of decreased diffusion are noted in the brain, the largest of which is in the right occipital lobe, with corresponding t2 and flair hyperintensity, consistent with acute infarcts. there is also gyriform t1-hyperintensity in the right occipital lobe, likely representing cortical laminar necrosis. additional smaller foci of decreased diffusion are noted in the frontal and the parietal lobes, bilaterally, with involvement of the left precentral gyrus. there is no mass effect, shift of midline structures, or evidence of a space-occupying lesion. there is no extra-axial fluid collection. scattered foci of susceptibility artifact are noted within the brain, which do not appear to correlate with these foci of decreased diffusion. the flow-voids of the major vessels are present. mild mucosal thickening is noted in the ethmoid air cells. fluid is noted layering in the nasal cavities and in the right maxillary sinus, likely related to the patient being intubated. there is also fluid within the mastoid air cells bilaterally, also likely related to the intubation. the visualized orbits and soft tissues are otherwise unremarkable. the bone marrow signal on the sagittal t1 image appears heterogeneous with foci of decreased t1 signal intensity. mra head: there is normal flow-related enhancement of the intracranial internal carotid arteries, the anterior, middle and posterior cerebral arteries, the anterior and posterior communicating arteries, the vertebral arteries, and the basilar artery. there is a slightly patulous basilar tip, with a prominence to the origin of the left superior cerebellar artery which may have an infundibular origin. otherwise, there is no evidence of a hemodynamically significant stenosis, dissection, or aneurysm (within the limitations of this mra technique). mra neck: image quality is degraded by patient motion and the timing of the contrast bolus injection. however, allowing for this limitation (and using both initial and delayed acquisitions), the common, internal and external carotid arteries demonstrate normal enhancement, without evidence of hemodynamically significant stenosis or dissection. the vertebral arteries are grossly normal in caliber and enhancement, again without evidence of hemodynamically significant stenosis. impression: 1. multiple acute infarcts, bilaterally, the largest of which is in the right occipital lobe. given that (by dwi, adc map and flair sequences) these lesions appear to be of the same age, the distribution as well as the history, these are likely embolic in nature, related to a single event. 2. a few foci of susceptibility artifact, appearently unrelated to the foci of acute infarction, may be represent prior microhemorrhage, perhaps related to underlying hypertension or, less likely, prior embolic disease or underlying cavernous malformations. 3. mra of head and neck is unremarkable, without evidence of hemodynamically significant stenosis, dissection, or aneurysm (within the limitations of the mra technique). 4. heterogeneous bone marrow signal with foci of t1-hypointensity in the bone marrow of the calvaria and the visualized spine. in a male patient of this age, this raises the possibility of a marrow-replacing process, and close correlation with laboratory data is recommended. the study and the report were reviewed by the staff radiologist. dr. dr. brief hospital course: mr. was transferred to the on for emergent repair of his ruptured thoracoabdominal aortic aneurysm. he was taken immediately to the operating room where he underwent an emergent salvage repair of ruptured thoracoabdominal aortic aneurysm with a 34-mm dacron tube graft using deep hypothermic circulatory arrest. please see operative note for details which included cardiac arrest x2. postoperatively he was taken to the intensive care unit for monitoring with an open chest. he remained intubated and sedated on pressors and inotropes. on , he returned to the operating room where he underwent exploration and chest closure. on he returned to the or for abd closure jp/ drain placement/ feeding jejunostomy placed at that time for nutritional support. neurology consult done . pressors slowly weaned. id consult obtained on for fever,leukocytosis, and recomendations for antibiotic management. multiple bronchoscopies were performed for secretions/ pulm. hemorrhage. developed intermittent a fib on and treated with amiodarone and cardioversion x4, has had several episode of going in and out of atrial fibrillation since that time. eeg done revealed severe encephalopathy for continuing neurologic deficits including bilat. le paralysis and right arm paralysis. mri revealed multiple acute infarcts, with the largest in the right occipital lobe. when the patient woke it was found that he had developed blindness. ophthalmology was consulted and stated that the patient likely had posterior ischemic optic neuropathy bilaterally due to hypotension, in addition to occipital infarcts. electrophysiology was consulted and recommended titration of beta blocker and observation of rhythm. tracheostomy was performed on . on bc were + for gpc treated with-iv vanco. coumadin was titrated for afib. with target inr being 2-2.5. his tube feeds have been at goal rate for past several weeks. by system: neuro: moves all extremities and follows commands. still not able to tolerate passy-muir so unable to assess orientation. at times becomes restless and agitated, has history of benzo use preoperatively and has responded well to prn ativan during post-op course. pulmonary: s/p tracheostomy on , has tolerated long periods of trach collar over past week however tires and has been on cmv or psv overnight to rest. continues to have moderate to large amount of secretions daily. cv: intermittant atrial fibrillation treated with bblockers and amiodarone and now in sinus rhythm. also anticoagulated for afib. hemodynamically stable since initial recovery from surgery. renal: arf in initial post-op period now largely resolved, never requiring hd. continues to be diuresed with lasix abdm: soft/nt/+bs. tube feeds at goal rate (novasource renal) ext: warm with palpable pulses, 1+ edema bilat id: +bc wcoag neg staph tx with vanco last level on 27.2-course completed wounds: thoracoabdominal wound healing well with exception of very small open area mid wound that is @1cm around and 1/2cm deep, no surrounding erythema. packed with dry gauze and covered w/dsd- medications on admission: benicar discharge medications: 1. ranitidine hcl 15 mg/ml syrup sig: one y (150) mg po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dryness. 4. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 5. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 6. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: six (6) puff inhalation q6h (every 6 hours) as needed for wheezes. 7. amiodarone 200 mg tablet sig: two (2) tablet po once a day: 400mg daily for 7days then 200mg daily. 8. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for groin yeast. 9. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 10. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 11. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. 12. clonazepam 1 mg tablet sig: one (1) tablet po bid (2 times a day). 13. lorazepam 1 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for agitation/anxiety. 14. insulin glargine 100 unit/ml solution sig: twenty (20) units subcutaneous once a day. 15. furosemide 20 mg tablet sig: one (1) tablet po twice a day. 16. warfarin 1 mg tablet sig: as directed tablet po once daily at 4 pm: 3mg on target inr 2-2.5 (received 5mg last 4 days) . 17. insulin regular human 100 unit/ml solution sig: sliding scale injection qac&hs. discharge disposition: extended care facility: hospital discharge diagnosis: type a aortic dissection with rupture s/p thoracoabdominal repair hypertension atrial fibrillation blindness respiratory failure s/p trach and g-j tube discharge condition: alert and responsive, at times agitated/restless moving all extremities, follows commands new blindness, needs assistance with ambulation and adl thoraco-abdominal wound healing well with exception of mid wound 1cm are that is about .5cm deep/packed with dry gauze and covered with dsd discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: surgeon dr. 1:00 pm please call to schedule appointments primary care dr. . ( in 2 weeks referral for a cardiologist needed from dr. and please make appt in weeks procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other enterostomy enteral infusion of concentrated nutritional substances other bronchoscopy other bronchoscopy exploratory laparotomy exploratory laparotomy arterial catheterization atrial cardioversion temporary tracheostomy other repair of chest wall resection of vessel with replacement, thoracic vessels closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus resection of vessel with replacement, aorta, abdominal delayed closure of granulating abdominal wound open chest cardiac massage hypothermia (systemic) incidental to open heart surgery diagnoses: pneumonia, organism unspecified anemia, unspecified unspecified pleural effusion urinary tract infection, site not specified unspecified essential hypertension acute and subacute necrosis of liver acute kidney failure, unspecified cardiac complications, not elsewhere classified atrial fibrillation pulmonary collapse other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure iatrogenic pneumothorax cardiac arrest alkalosis bacteremia intestinal infection due to clostridium difficile other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other specified disorders of biliary tract cerebral embolism with cerebral infarction hyperosmolality and/or hypernatremia staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus ventilator associated pneumonia urinary complications, not elsewhere classified profound impairment, both eyes, impairment level not further specified iatrogenic cerebrovascular infarction or hemorrhage ischemic optic neuropathy other accidents thoracoabdominal aneurysm, ruptured blister of trunk, without mention of infection blister of shoulder and upper arm, without mention of infection 

Answer: The patient is high likely exposed to