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: lipitor attending: chief complaint: shortness of breath, requiring nrb major surgical or invasive procedure: thoracentesis history of present illness: male with h/o cad, htn, chf presented with gradually increasing sob/doe over past few months and for the past week has worsened to the point where he could not put on his socks/adl's. at baseline, he walks about 1 block before getting short of breath. in addition, he notes that for the past few weeks, he has been experiencing some chest pressure, which is worse when lying flat. he saw his cardiologist in the week before admission, noted to have chf on cxr, pcp called him to increase his lasix dose from 60 to 80 ; however, he was noted to have no significant increase in urine output. on the morning of admission, he saw his pcp and was sent to ed. . ed course: he was given 40mg iv lasix to which he did not respond. he was subsequently given 100mg iv lasix, to which he had good urine output. . ros: +orthopnea, no sick contacts, no fever, chills, nausea, vomiting. he does note an occasional mild non-productive cough. he denies any large, salty meals, no palpitations, no pleuritic chest pain, no lightheadedness, dizziness. past medical history: cad s/p cabg y ago htn dmii dmii nephropathy turp rectal bleeding social history: no tob/ etoh or ivdu patient never married, no children. he lived with his brother in an apartment until recently when his brother died. does have 2 friends who help him at home with meds, etc. family history: not elicted physical exam: in the icu on admission: vs- 95.4 127/75 48-69 24 99%nrb gen- lying in bed, breathing slightly labored using abd muscles heent- mmm, perrl, conjunctivae normal, sclerae anicteric neck- jvp at 8cm cv- bradycardic, regular, iii/vi systolic murmur at llsb chest- sternum separated, poor airflow, rare rhonchi and crackles abd- +bs, soft, nt, nd ext- 1+ pitting edema 1/4 up tibia bilaterally neuro- oriented x 3 skin- seborheic keratosis, no rashes msk- deferred pertinent results: 06:45am blood wbc-9.7 rbc-3.38* hgb-10.3* hct-31.2* mcv-92 mch-30.4 mchc-33.0 rdw-15.8* plt ct-349 07:10am blood wbc-8.4 rbc-3.50* hgb-10.4* hct-32.2* mcv-92 mch-29.7 mchc-32.3 rdw-15.8* plt ct-338 06:38pm blood neuts-84.6* lymphs-8.5* monos-6.5 eos-0.4 baso-0.1 01:00pm blood neuts-79.9* lymphs-12.7* monos-6.9 eos-0.3 baso-0.2 11:00am blood pt-13.9* ptt-61.1* inr(pt)-1.2* 07:25am blood pt-14.1* ptt-34.9 inr(pt)-1.2* 06:45am blood glucose-62* urean-111* creat-3.1* na-144 k-4.4 cl-106 hco3-22 angap-20 06:55am blood glucose-119* urean-131* creat-3.5* na-138 k-3.8 cl-95* hco3-29 angap-18 06:38pm blood glucose-159* urean-87* creat-3.6* na-140 k-4.5 cl-102 hco3-24 angap-19 01:00pm blood glucose-209* urean-80* creat-3.2* na-140 k-4.8 cl-103 hco3-23 angap-19 04:45am blood ck(cpk)-67 01:00pm blood ck-mb-notdone probnp-* 01:00pm blood ctropnt-0.28* 06:47pm blood ck-mb-13* mb indx-16.0* ctropnt-0.30* 04:45am blood ck-mb-12* mb indx-17.9* ctropnt-0.34* 06:45am blood calcium-9.2 phos-4.5 mg-2.3 04:45am blood albumin-4.2 calcium-9.8 phos-4.8* mg-2.6 iron-45 cholest-161 04:45am blood caltibc-273 vitb12-1026* folate-greater th ferritn-155 trf-210 04:45am blood triglyc-94 hdl-52 chol/hd-3.1 ldlcalc-90 06:55am blood osmolal-338* 07:10am blood osmolal-332* pleural fluid: 01:54pm ph-7.54* comment-pleural fl 12:58pm pleural wbc-125* rbc-950* polys-17* lymphs-19* monos-2* meso-14* macro-48* 12:58pm pleural totprot-1.6 glucose-190 ld(ldh)-93 12:58 pm pleural fluid gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (preliminary): no growth. anaerobic culture (pending): pleural fluid cytology - pending 01:44am urine color-straw appear-clear sp -1.010 01:44am urine blood-lge nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 01:44am urine rbc-89* wbc-2 bacteri-none yeast-none epi-0 01:44am urine casthy-2* 08:14pm urine color-straw appear-clear sp -1.015 08:14pm urine blood-lge nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-mod 08:14pm urine rbc-0-2 wbc- bacteri-few yeast-none epi-0 08:14pm urine amorphx-occ 09:12am urine hours-random creat-54 na-36 10:29am urine hours-random urean-415 10:29am urine osmolal-352 8:14 pm urine **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. trimethoprim/sulfa sensitivity testing confirmed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s imipenem-------------- <=1 s levofloxacin----------<=0.25 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- =>128 r piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s echo: conclusions: the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. there is mild regional left ventricular systolic dysfunction with mid antero-septal hypokinesis. the right ventricular cavity is mildly dilated. right ventricular systolic function is borderline normal. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload and superimposed conduction delay. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. the tricuspid valve leaflets are mildly thickened. severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the report of the prior study (images unavailable for review) of , the severity of mitral and tricuspid regurgitation has increased. the degree of pulmonbary hypertension detected has also increased. overall regional lvef may appear better, however, intrinsic forward ef may be reduced secondary to valvular regurgitation. chest, pa and lateral: bilateral pleural effusions likely slightly worse when compared to the previous exam. there is an increased retrocardiac left lower lobe collapse. there are increased perihilar interstitial opacities consistent with slight worsening in chf. there is unfolding of the aorta with wall calcifications. the cardiac contour remains enlarged. impression: 1. slight worsening of interstitial pulmonary edema. 2. slight increase in size of bilateral pleural effusions with left lower lobe atelectasis. approved: fri 3:21 pm cardiology report ecg study date of 4:15:42 pm since the previous tracing of there is a regular supraventricular rhythm. this is possibly sinus with first degree a-v block, although a junctional rhythm cannot be entirely excluded. other than rhythm, there is no significant change compared to the previous tracing of . tracing #1 read by: , b. intervals axes rate pr qrs qt/qtc p qrs t 66 0 148 434/447 0 98 116 ct chest without iv contrast: there are moderate-sized bilateral pleural effusions, left greater than right. there is associated atelectasis of the left lower lobe. the combination of the left- sided pleural effusion and left lower lobe atelectasis apparntly accounts for the retrocardiac opacity seen on chest x- ray. the patient is status post median sternotomy with no evidence of sternal wires. there are extensive atherosclerotic coronary artery and aortic wall calcifications. there are dense calcifications involving the mitral annulus. the airways are patent down the segmental bronchi. there is no significant intrathoracic lymphadenopathy. imaging of the upper abdomen shows multiple cystic renal lesions, which appear unchanged dating back to , compatible with multiple hyperdense renal cysts. the adrenal glands are nodular and prominent, without evidence of focal mass. there are tiny gallstones. a small amount of fluid is seen anterior to the liver. impression: moderate-sized bilateral pleural effusions. left lower lobe collapse. the combination of the pleural fluid and left lower lobe collapse account for the retrocardiac left lower lobe opacity on chest x-ray. approved: mon 9:40 pm cxr: impression: 1. improved chf with resolving perihilar haziness. 2. slight improvement in left lower lobe opacity, corresponding to a combination of atelectasis and effusion on recent ct. 3. slight decrease in small right pleural effusion. approved: 4:07 pm cxr: history of shortness of breath. there is cardiomegaly with pulmonary vascular engorgement and probable small left pleural effusion consistent with chf. in addition, there is opacity at the left base obscuring the left hemidiaphragm likely due to a combination of atelectasis/consolidation in the left lower lobe and left pleural effusion. impression: chf with atelectasis/consolidation left lower lobe and left pleural effusion. the left basilar opacity is possibly slightly increased since yesterday's film of . approved: mon 9:56 pm brief hospital course: chf (systiolic and diastolic) exacerbation was felt to be the mostly likely cause of his progressive dyspnea given radiographic findings, elevated bnp, and physical exam. the chf may have been triggered by the bradycardia/junctional escape rhythm seen on ekg. nstemi also had a non-stemi with elevated troponins. started initially on heparin gtt for one night; given his dnr/dni status, he preferred noninvasive medical management only. repeat echo revealed worsening mr , and it was felt that a large component of his symtpoms of failure were due to poor forward flow. he was started on an acei for afterload reduction and he was gently diuresed daily. chest ct was obtained to further evaluate retrocardiac opacification for malignancy, pneumonia. ct revealed atelectasis and pleural effusions. it was decided not to tap the effusions in the icu given his clinical improvement. new atrial flutter: was noted with a slow rate in the 60s ventricular and 150's atrial. this is new compared to ekgs in . cardiology/ep felt that he would not benefit from pacer at this time, and nothing active to do for the atrial flutter. specifically ep recs: "no pacer at this point but could consider if clinically improves. age and comorbidities make biv not indicated. could have eps for flutter but too sick for this now and would likely necessitate pacer". after stabilization of chf and mi the patient was tranferred to the floor from the icu. due to overdiuresis, the bun went upto >130. after few ivf boluses and holding lasix, bun decreased. patients renal function was almost at baseline for him. low dose lasix was restarted. the continuing need for lasix and the dose should be determined by pcp in response to his symptoms. # uti: patient had a foley catheter in for the first few days of admission. he developed a burning sensation with urination, urine culture revealed e.coli and he was started on ciprofloxacin for 7 day course for complicated uti. # pleural effusions: 2 days prior to discharge, the patient developed dyspnea requiring oxygen. not much improvement with nebs. cxr showed a large left pleural effusion and retrocardiac infiltrate. given the concern that this could have been a parapneumonic effusion, thoracentesis was performed. pleural fluid was serous yellow in colour and a transudate suggestive of chf or renal failure. 1300 ml of fluid was drained and cytology was sent for and pending at discharge. #pneumonia, bacterial - ciprofloxacin (for uti) was changed to levofloxacin to complete the 14 day course. with rx of pneumonia and thoracentesis, hypoxia and dyspnea both resolved. . # dm: patient had hx of diabetes, type ii on prandin at home. after initial insulin, started on home regimen. . # acute on chronic renal failure: has ckd from diabetes. baseline creatinine 3.5 in 11/. all meds were dosed renally. due to overdiuresis, the bun went upto >130. after few ivf boluses and holding lasix, bun decreased. patient's renal function was almost at baseline for him. low dose lasix was restarted. as stated above, the continuing need for lasix and the dose should be determined by pcp in response to his symptoms. . # anemia: hct baseline is ~30. likely chronic renal disease. he is normocytic. iron studies, b12, folate were normal suggesting anemia of chronic disease (most likey renal disease) . # gerd: continued ppi . # code: dnr/dni to be discharged to . medications on admission: asa 325 qd procardia 90 cr qd protonix 40 qd nitro prn cozaar 100 mg qd lasix 80 metoprolol 25 lisinopril 5 mg qd prandin 2mg qbreakfast, 1mg qdinner discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 5. losartan 50 mg tablet sig: two (2) tablet po daily (daily). 6. nifedipine 90 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). 7. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 8. repaglinide 2 mg tablet sig: one (1) tablet po daily (daily). 9. repaglinide 0.5 mg tablet sig: two (2) tablet po dinner (dinner). 10. albuterol sulfate 0.083 % solution sig: one (1) inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 11. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 12. insulin lispro (human) 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed). 13. levofloxacin 250 mg tablet sig: one (1) tablet po q48h (every 48 hours) for 10 days. 14. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: congestive heart failure (systolic and diastolic) coronary artery disease non st-elevation mi atrial flutter acute on chronic renal failure pneumonia, bacterial urinary tract infection (e.coli) discharge condition: stable discharge instructions: the doctor at the rehab will take care of your further medical needs. please make a follow up appointment with your primary doctor in next 10 days. your medications have been changed. please refer to the details attached. return to the emergency room or call your doctor if you notice increasing shortness of breath, cougf, fever, chest pain or any other symtpoms concerning to you. followup instructions: make a follow up appointment with your doctor in the 7 to 10 days. , d. . (to follow cytology results of pleural fluid) procedure: thoracentesis diagnostic ultrasound of other sites of thorax diagnoses: other primary cardiomyopathies anemia of other chronic disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere subendocardial infarction, initial episode of care esophageal reflux mitral valve disorders unspecified pleural effusion urinary tract infection, site not specified acute kidney failure, unspecified aortocoronary bypass status other chronic pulmonary heart diseases diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes atrial flutter hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hypoxemia diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled legal blindness, as defined in u.s.a. acute on chronic combined systolic and diastolic heart failure bacterial pneumonia, unspecified 

Answer: The patient is high likely exposed to