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: levofloxacin / nsaids attending: chief complaint: shock major surgical or invasive procedure: patient had a tunnelled hd line placed on . . patient was intubated at osh, extubated - total of 11 days. history of present illness: 29 year-old male patient with a history of dm2, obesity, osa and pericarditis (6 months ago) who presented to on with chest pain, back pain, fevers, chills and shortness of breath for one day. his pain was described as sharp, worse with inspiration and on laying supine and relieved by sitting and leaning forward. he also reported diaphoresis and cough productive of green sputum. he had a similar episode 6 months prior to admission and was diagnosed with pna and "fluid accumulation around the heart". he was treated with nsaids at a hospital in . . his vital signs on presentation to the osh were: temp 103, bp 89/30, hr 116-138, rr 28, 97% on 2 l. his wbc was 15 (73 n, 11 l), cpk 253, (mb 21.5, index 8.5), trop i 2.88. glucose was 310. bili 4.2, alk phos 91, ast 416, alt 325, ldh 1130. cxr was negative for infiltrates, ecg with ste 1mm in i and avl, pr depression in i and avl. he received 2l ivf boluses, 1gm of ctx and 500mg of azithromycin. he was given a diagnosis of percarditis, treated with motrin 800mg tid, and admitted to teh icu. . an echo showed an ef 25%, global hk, dilated lv. there was no pericardial effusion and rv appeared normal size. dopamine was used for bp support and the patient was subsequently intubated for respiratory distress. he was found to be in dka with blood glucose in the 600's and ketones in the urine. 100mg of lovenox was given empirically and was transferred to for further management. . in the ccu, the patient was thought to be in either cardiogenic shock or septic shock from a pneumonia. he was continued on vancomycin, ceftriaxone, and azithromycin. renal, gi and id were consulted for renal failure, transaminitis (to ast 11,916) and septic shock of somewhat unclear etiology. renal did not feel that there is an acute need for hd at this point and agreed with ivf and pressors. infectious disease got a history of the patient recently removing dead rodents from an automobile fan and felt that atypical organisms were highly likely. they recommended changing azithromycin to doxycycline. hepatology felt the clinical picture was most consistent with shock liver. the patient is being transferred to micu per the request of id and given evolving septic shock. past medical history: 1. obesity 2. dm2 3. osa on bipap 4. h/o pericarditis 6 months ago social history: patient is married and has a 12 year-old daughter. works as a restaurant manager at fridays (contact with food). denies tobacco and reports rare etoh use. no hx of ivdu. recently moved to this area from (wooded area). no recent tick, bug or animal bites. no sick contacts. travel. his car recently had two large rodents removed from car fan. his wife previously worked in a nursing home, but hasn't in several months. family history: unknown physical exam: vs: tm 103.7 tc 101.4, bp 112/68 (88-122/62-88), hr 123 (125-150), rr 24 97% on vent: ac: tv: 700 x 24, fio2 0.4, peep 10 -> pip 35, plateau 29, abg 7.34/30/99, 7.32/28/130 cvp 23, co 8.5, ci 2.63, svr 687, mvo2 76 gen: morbidly obese young man intubated and sedated heent: ett in place, mmm neck: large neck but no jvd appreciated cv: tachycardic, regular rhythm, no m/r/g pulm: mechanical breath sounds appreciated, crackles at the bases bilaterally abd: obese, nabs, nt/nd ext: cool extremities, no c/c/e, 1+ dp and pt b/l neuro: intubated, sedated derm: no rashes noted. pertinent results: cxr (): ill-defined opacities are present in the left mid and lower zones consistent with pulmonary consolidation. cxr (): air bronchogram present in the left lower lobe suggesting lll pneumonia. increased opacification in the right lower zone c/w atelectasis rather than pneumonia abd us (): limited examination. echogenic liver consistent with fatty infiltration. other forms of liver disease, including more significant hepatic fibrosis or cirrhosis, cannot be excluded on the basis of this examination. patent left and middle hepatic veins and left portal vein. otherwise, extremely limited doppler examination of the liver. chest/abd ct (): moderate-sized bilateral pleural effusions. no acute abdominal pathology sinus ct (): no sinusitis. echo (): mild symmetric lvh. lv cavity moderately dilated. severe global left ventricular hypokinesis with ef 15-20%. no masses or thrombi are seen in lv. rv systolic function appears depressed. lv inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure echo : conclusions: there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild global left ventricular hypokinesis. ef 45%. there is no pericardial effusion. compared with the report of the prior study (images unavailable for review) of , the lvef has improved and the lv cavity size has normalized. b/l le us: conclusion: study is limited by body habitus, but there is no evidence of dvt in the left or right lower extremity. ct chest/abdomen : impression: 1. overall stable appearance of the chest, abdomen and pelvis. no ct evidence of pancreatitis. 2. stable bilateral lower lobe consolidations which could represent aspiration or atelectasis. 3. stable splenomegaly. brief hospital course: *shock: there was an initial concern for cardiogenic shock in the setting of possible pericarditis/myocarditis, ekg changes, elevated cardiac enzymes and echo showing ef 25%. however, fevers, elevated wbc count and low svr suggested more of a septic picture. additionally, his cardiac output was elevated (though difficult to use those numbers which were from cvp and not swan). shock was complicated by acute renal and hepatic failure, respiratory failure, relative adrenal insufficiency, cardiac depression and dka. source of septic shock was initially unclear and included multifocal pneumonia, pericarditis/myocarditis, atypical organism in setting of exposure to rodents. ?hanta virus vs. vs. mycoplasma? chest/abd ct without pathology. no sinusitis on sinus ct. in terms of bp, pt was appropriately switched from dopamine to levophed which was quickly titrated down, and discontinued more than a week before discharge. he remained hemodynamically stable throughout the remainder of his hospital course. he was treated with zosyn and vancomycin for a total of 13 days, and azithromycin for a total of 5 days. all blood and urine cultures showed no growth, he had negative serologies for chlamydia pneumoniae, b, leptospira, mycoplasma pneumoniae, hcv, hbv, influenza and parainfluenza,anca and . he was igg positive, but igm negative for ebv and cmv. he also tested positive for legionella antibodies and hepatitis. he was further tested positive for igm hantavirus, however the confirmatory for sin nombre virus was negative. a repeat serology was sent to the state lab and the results were still pending on discharge. he was afebrile, with stable blood pressures at discharge. . *fever: as above, the etiology of his septic shock was unclear. there was a suggestion of multifocal infiltrates on cxr suggesting possible pneumonia with bacterial pathogen. id was consulted and considered atypical organisms such as mycoplasma, chlamydia, legionella, leptospirosis and viral pathogens such as hepatitis, influenza, adeno, cmv, ebv, hiv, and hanta virus. legionella igg antibody returned with high titers of 256. this should be repeated at the end of (around 30th); a fourfold rise in titer confirms acute infection. he completed a 5 day course of doxycycline, followed by a 5 day course of azithromycin as it was thought the doxycycline may have contributed to his pancreatitis. he continued to run low grade fevers until . us of le were done bilaterally without evidence of dvt. his fevers were likely related to atelectasis, with possible contribution of pancreatitis (see below). they resolved on their own by . by the time of discharge he had completed a 13 day course of vancomycin and zosyn, as well as a 5 day course of azithromycin and was afebrile. he has scheduled follow-up with id and his hantavirus serologies will be followed at that visit. . *cardiomyopathy: echocardiogram on showed ef 15-20% in the setting of tachycardia (25% at the osh on ), although windows suboptimal. likely viral myocarditis (possible induced by b vs. adenovirus vs. hep c vs. cmv vs. echovirus vs. ebv) vs. sepsis-induced cardiomyopathy vs. restrictive pericarditis given recent episode of pericarditis and filling defect on echo. mvo2 73 and co normal, with good oxygenation, making primary cardiogenic shock somewhat less likely. his bp was stable and heart failure and fluid retention was treated with cvvh. original primary still unknown at this point, as all blood cultures remained negative and he tested negative for all above mentioned possible viruses. unclear if possible hantavirus infection could have been contributory and final results were still pending at discharge. repeat echo about a week into his hospital course demonstrated recovery of ef to 45% (on ), normal lv cavity size, and no pericardial effusion. he should follow-up with cardiology to deal with this issue as an outpatient and was given their number. . *acute renal failure: the patient's creatinine rose to 11.3 from a normal baseline. fena was less than 1% and his renal failure was felt to be a complication of his shock. his potassium gradually increased and his volume status worsened and he was started on cvvh on . he had improvement in his k, cr and acidosis. large volumes of fluid were removed with ultrafiltration. on he was changed over to hd. he remains hd dependent, and had a hd tunneled line placed on . initial anuria resolved and pt puts out small amounts of urine now. he will receive hd as an outpatient and will follow-up with nephrology for further treatment adjusments. . *acute hepatitis: the patient was admitted with markedly elevated lfts to an ast of 11,916. the height of his ldl () and the speed of the rise in lfts is suggestive of shock liver and not congestion. hepatology was consulted during his stay and agreed with this as the likely cause. his inr and lfts improved dramatically, confirming this diagnosis, steadily trending down over the course of his hospital stay. . *respiratory distress: the patient was intubated at the outside hospital in setting of respiratory distress and dka. there was no evidence of ards on imaging exams and he did well on the ventilator. he underwent a bronchoscopy on which showed scant secretions that were negative for organisms. he had bilateral lower lobe infiltrates on ct scan, and was started on vancomycin/zosyn, as well as doxycycline for atypical coverage, as above. he was eventually weaned to psv and then extubated on without complication after almost 2 weeks of intubation.his o2 saturation remained stable after extubation, 96-98% on ra, no drop in o2sat on ambulation. patient's respiratory status was stable on discharge. . *dka: the patient was admitted with elevated blood sugars, anion gap and trace ketones in urine. he was treated effectively with an insulin drip. he had a persistent anion gap which was felt to be secondary to his renal failure, as repeat ketone/beta hydroxybutyrate assays were negative. his sugars were well controlled on an insulin sliding scale. . *pancreatitis: he had low grade fevers even after about 9 days of antibiotics, and in search of a cause, his pancreatic enzymes were found to be elevated. an abdominal ct scan did not reveal radiographic evidence of pancreatitis. it was noted that the enzymes trended up shortly after restarting propofol for sedation, and that this had happened once previously. his amylase and lipase both began to trend down after propofol was discontinued again. there was a thought that doxycycline could also have contributed, and this was changed to azithromycin. once extubated, he denied abdominal pain, and his fevers resolved. after transfer to the floor his lipase and amylase steadily came down, pt was non-tender in epigastric area on exam and denied abdominal pain. . *splenomegaly: he was noted to have splenomegaly on both of his abdominal ct scans here. it is unclear if this has been present previously. ebv igg was positive but not igm. he had no hilar or mediastinal adenopathy making sarcoidosis less likely. he does not drink alcohol excessively. it's possible that he developed portal hypertension acutely in the setting of shock liver. he should likely have a repeat ct scan at some point in the future to re-evaluate the spleen. his cbc should be monitored periodically as well. on the floor he complained of transient luq pain on two occassions for which he did not require any treatment or further work-up. he should follow-up with his pcp for repeat ct and cbc monitoring. he has been set-up with a pcp, he did not have one previously, and is scheduled to see him on in clinic. . *hypertension/tachycardia/bigeminy: the patient had persistent tachycardia during the hospitalization, probably related to his fevers, as well as his body habitus/deconditioning. he was treated with beta blockers (labetalol drip peri-extubation, with transition to po metoprolol). he was noted to have ventricular bigeminy just after starting hd on . his bigeminy resolved with calcium supplementation (his free calcium was noted to be low). pt's blood pressures were well controlled on metoprolol. . *leg pain: pt developed leg swelling, discolorisation (red to purple), blisters (bloody and non-bloody), necrotic changes on toes and pain in both feet. these changes were most likely due to malperfusion, secondary to cardiogenic shock. his legs improved during his stay, though he still reported dull pain, 'pins and needles' in his feet. he did not require pain medication for that during the days prior to discharge. he will follow up with plastic surgery, and an appointment was scheduled for , for further evaluation and treatment. . *nausea: pt had waxing and waining episodes of nausea during the course of his hospital stay which were well controlled with prochlorperazine. on the day of discharge pt has some nausea and was treated with prochloperazine. medications on admission: 1. metformin cr 2gm daily 2. afrin 3. blood pressure medication, which he isn't taking . on transfer to micu 1. zosyn 2.25g iv q8h 2. doxycycline 50mg iv q12 (after 100mg loading dose) 3. vancomycin 1g iv daily 4. aspirin 325mg daily 5. lansoprazole 30mg ng daily 6. caco3 1g tid 7. acetaminophen 325mg-650mg q4-6h prn, do not exceed 2g/day 8. colace 100mg 9. fludrocort 0.05mg daily 10. hydrocort 50mg iv q6h 11. hep sq 12. senna 1 tab , prn discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) sc injection injection tid (3 times a day). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. insulin sliding scale please place the patient on an insulin sliding scale per the protocol of your institution 5. metoprolol tartrate 25 mg tablet sig: tablet po three times a day. 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 7. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 8. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po tid w/meals (3 times a day with meals). 9. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 10. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day). 11. prochlorperazine 10 mg iv q6h:prn 12. dolasetron mesylate 12.5 mg iv q8h:prn nausea 13. oxycodone 5 mg capsule sig: one (1) capsule po every hours as needed for pain. 14. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain: no more than 2 gm per day. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: septic shock acute respiratory distress shock liver pancreatitis acute renal failure cardiomyopathy diabetic ketoacidosis . secondary diagnosis: diabetes hypertension discharge condition: stable condition with low uop and dialysis dependent discharge instructions: you are being discharged to a rehabilitation facility. . please take all your medications as prescribed. . please call your doctor or return to the er if you have nausea, vomiting, chest pain, shortness of breath, abdominal pain, fevers, increased difficulty with urination, blood in your urine or other concerning symptoms. followup instructions: please follow up in plastic surgery clinic as below. please call 2-3 days prior to your appointment to give them your information. provider: surgery clinic phone: date/time: 2:30 . please follow-up with infectious disease. we have scheduled an apppointment for you with dr. on at 10 am, phone:. please call in prior to your appointment at the above mentioned number to check directions. . for your information: dr. , , primary care physician, in obesity, working at the clinic. if you are interested in seeing her please scheduled an appointment with her. her phone number is . procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis closed [endoscopic] biopsy of bronchus diagnostic ultrasound of other sites of thorax infusion of vasopressor agent diagnoses: pneumonia, organism unspecified other primary cardiomyopathies obstructive sleep apnea (adult)(pediatric) acute kidney failure with lesion of tubular necrosis acute and subacute necrosis of liver unspecified septicemia severe sepsis pulmonary collapse acute respiratory failure other specified cardiac dysrhythmias septic shock morbid obesity acute pancreatitis gangrene splenomegaly diabetes with other coma, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to