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 63 year old male with a history of hypertension and colon cancer status post hemicolectomy who is status post a nine foot fall from the cab of his truck on . the patient was reportedly down for about two hours before help arrived and has had changes in mental status since his fall. he was originally seen at the hospital where he was admitted and found to have a left scalp abrasion that was sutured, a left clavicle fracture, left rib fractures and a head ct scan that did not show any evidence of intracranial hemorrhage. his next ct scan was also negative for fracture. the pain was controlled there with percocet and he was cleared by physical therapy for discharge home with a creatinine of 2.4 at discharge. at home, however, he was unable to carry out his activities of daily living, became short of breath and was brought to an outside hospital emergency room where his ck was noted to be 2456 and he was noted to have a troponin t of 2.4, creatinine of 3.5, and had an o2 saturation of only 81% on five liters nasal cannula. an echocardiogram was carried out which showed an ejection fraction of 40 to 45% and an arterial blood gas at the outside hospital showed a ph of 7.32, with pco2 of 48 and a po2 of 50. a chest ct scan demonstrated right upper lobe and right lower lobe consolidation consistent with bronchopulmonary pneumonia thought to be secondary to aspiration pneumonia. no pneumothorax was seen. again, a head ct scan was negative. given the patient's white blood cell count elevation, infiltrate and hypoxia, he was given one gram of ceftriaxone, aspirin for positive cardiac enzymes and morphine sulfate for pain and was transferred to for further care. on admission to the , the patient was alert and intermittently oriented. the patient received in the emergency department aspirin, flagyl and further morphine sulfate for pain. the patient was noted to have unequal blood pressures in his arms and a transthoracic echocardiogram was carried out to rule out dissection. the transthoracic echocardiogram demonstrated no evidence of aortic or thoracic dissection and showed mile regional left ventricular systolic dysfunction with posterior and apical hypokinesis. past medical history: 1. hypertension times three years. 2. colon cancer status post hemicolectomy in . 3. prostate cancer status post prostatectomy. 4. remote history of hepatitis b approximately 25 years ago. medications on admission: 1. accupril 40 mg q. day. allergies: no known drug allergies. social history: the patient lives alone; he is separated from his wife. has two supportive daughters. has smoked approximately two to three packs per day times 50 years. has occasional ethanol. denies any intravenous drug use. he is a trucker and was independent before his fall. physical examination: on admission, vital signs with temperature of 98.0 f.; blood pressure 122/65; pulse 102; respiratory rate 20; o2 saturation 84% on room air and increased to 97 to 100% on a nonrebreather. in general, the patient was found lying in bed guarding his left side in mild distress. heent: pupils equally round and reactive to light. extraocular muscles are intact. oropharynx is clear. the patient wears dentures. neck with no lymphadenopathy. chest with diffuse rales and rhonchi on the right; clearer on the left but dullness is present at the left base. ecchymoses are present over the left anterior chest wall and he is tender to palpation on the left side of his chest. abdomen soft, nontender, slightly distended, positive bowel sounds. midline well healed scar. extremities with no edema, clubbing or cyanosis. two plus dorsalis pedis and radial pulses bilaterally. neurological examination: the patient is awake, oriented to person, occasionally to place, occasionally to time. cranial nerves ii through xii are intact. strength is five plus in all regions. laboratory: on admission, white blood cell count 22.1, hematocrit 40.5, platelets 298. sodium 138, potassium 5.2, chloride 103, bicarbonate 24, bun 41, creatinine 3.4 and glucose is 117. ck is 2427, with an mb of 133 and a troponin t of 3.41. ekg demonstrates normal sinus rhythm with normal axis and intervals and chamber size. there are no st or t wave changes. chest x-ray demonstrates minimally displaced rib fractures within the fifth, sixth and seventh left ribs posteriorly as well as a depressed fracture of the left clavicle which is displaced inferiorly by the width of the bone. there is no pneumothorax. mild congestive heart failure is evidenced by vascular engorgement. lungs are otherwise clear. hospital course: the patient was initially admitted to the medical intensive care unit. the patient was begun on antibiotics for presumed aspiration pneumonia and was placed on aspirin, beta blockers, given the elevated cardiac enzymes on admission. the patient's o2 saturations initially stabilized on therapy for presumed aspiration pneumonia and the patient was transferred to the floor. however, on the day of transfer, the patient had a further episode of hypoxia and hypotension with a drop in his systolic blood pressure to the 80s. the patient was bolused with a total of two liters of normal saline with improvement of his systolic blood pressure to 100 to 105 and the patient was transferred back to the medical intensive care unit for further management. on readmission to the medical intensive care unit, he had an o2 saturation of 80% on six liters via nasal cannula. he was transferred to a 50% face mask where his arterial blood gas was found to be 7.34/44/55. the patient demonstrated increasing agitation and required 50 mg of haldol for sedation. hospital course by systems: 1. pulmonary: the patient's hypoxia was most likely secondary to aspiration pneumonia as well as fluid overload. he was diuresed with intravenous lasix with improvement of his respiration. he was continued on a 14 day course of levofloxacin and flagyl for presumed aspiration pneumonia. the patient's respirations further improved with chest pt and he was transitioned back to nasal cannula and finally room air. the patient was able to maintain adequate room air o2 saturations. 2. cardiac: the patient was noted to have nonspecific inferior st depressions with t wave inversions, that were 1 mm in v4 through v6 in the setting of sinus tachycardia. on another occasion, the patient was noted to have t wave inversions in iii and avf with 1/ depressions in v4 and v5. on a further occasion, the patient was noted again in the setting of sinus tachycardia to have depressions in v4 through v6. the patient was monitored on telemetry and was noted to undergo atrial fibrillation at a rate of 140 on the with v4 through v6 st depressions of 1 mm. telemetry demonstrated further intermittent episodes of atrial fibrillation with rates up to 160 and a possible ten beat run of ventricular tachycardia. transesophageal echocardiogram demonstrated trace mitral regurgitation, trace tricuspid regurgitation, mildly depressed ejection fraction with posterior / apical hypokinesis and no evidence of dissection. furthermore, the transthoracic echocardiogram demonstrated left ventricular hypertrophy with mild global hypokinesis. the patient's ck was 2427 on admission and peaked at 2551 on the , after which point it trended downward to 575 on the . his ck mb was 133 on admission and declined consistently throughout his hospitalization. his ck mb was 5 on the . his troponin t was 3.41 on admission and increased to a maximum of 5.22 on the . his elevated cardiac enzymes were thought to be primarily due to renal failure in the setting of rhabdomyolysis as well as demand ischemia in the setting of tachycardia. the patient was begun on high dose beta blocker for rate control of his atrial fibrillation and nonsustained ventricular tachycardia. he was begun also on aspirin. he was anti-coagulated with heparin for prophylaxis of his atrial fibrillation. persantine mibi was carried out on the and did not demonstrate any significant ischemic st segment changes. there was no evidence of fixed or perfusion defects on nuclear study. diffuse hypokinesis and depressed ejection fraction of approximately 30% was noted. the patient was initially taken to the cardiac catheterization laboratory on the , but was unable to undergo the procedure at that time secondary to mental status changes and the cardiac catheterization was deferred to a later date. the patient was noted to have intermittent episodes of hypotension during subsequent hospitalization and his beta blockers and ace inhibitor doses were titrated. 3. renal: the patient was noted to have an elevated creatinine of 3.4 on admission. it was difficult to ascertain the patient's baseline creatinine level as he is not per report had blood work done recently prior to this admission; however, on admission to the hospital, shortly after his fall, he was noted to have an elevated creatinine of 2.6. his creatinine steadily declined during the course of his hospitalization from the maximum of 3.4 on admission to a baseline of between 2.2 and 2.4. renal ultrasound was carried out on the and revealed diffusely increased echogenicity of the renal parenchyma bilaterally consistent with chronic parenchymal disease. the left kidney is atrophied. overall, the study was consistent with arterial vascular disease. no hydronephrosis or proximal hydroureter was seen on the study. 4. psychiatric: the patient was noted to have intermittent episodes of delirium. a psychiatric consultation was obtained. a neurological consultation was also obtained. the patient's change in mental status were characterized by confusion that appeared to have a temporal component to it, with confusion occurring at its greatest at night time. at times, the patient was noted to have paranoid delusions. however, he never demonstrated any clear auditory or visual hallucinations. he required intermittent haldol for sedation. an ammonia level was checked and was found to be 27. a ct scan of the head was obtained and did not demonstrate any evidence of intracranial hemorrhage. the patient's mental status was significant improved on the and at the time of this dictation, the patient is alert and oriented times three and had a normal mini-mental status examination. 5. endocrine: the patient was found to be significantly hypothyroid. he had a tsh of 38 on the . repeat tsh on the 19th revealed a level of 45. the patient was begun on levothyroxine at 12.5 micrograms per day. his repeat tsh and thyroid studies will be carried out four weeks after this was initiated. , m.d. dictated by: medquist36 procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart (aorto)coronary bypass of one coronary artery arterial catheterization aortography arteriography of renal arteries diagnoses: other iatrogenic hypotension subendocardial infarction, initial episode of care congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation pneumonitis due to inhalation of food or vomitus delirium due to conditions classified elsewhere rhabdomyolysis 

Answer: The patient is high likely exposed to