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: patient recorded as having no known allergies to drugs attending: chief complaint: sob major surgical or invasive procedure: thorocentesis history of present illness: 77 y/o male w/ h/o rheumatic heart dz s/p mechanical mvr/avr, afib (s/p vvi ppm); cad s/p stenting; h/o chf with preserved ef 55%; s/p recent admit to for 7 wks (work up for valve leakage included tte, tee, mri showing 2+ mr e; s/p cath x 2 with stenting of rca and lad; s/p vvi pacemaker for chronic afib) who was discharged and then readmitted with sob and resp failure, aggressively diuresed with natrecor and laxis and dc to rehab on . now readmitted with increased sob and weight gain (148 on , 153 on , goal is 132). unable to diurese at rehab despite increasing bumex to 3mg on . increaed edema, decreased sats. in ed: decreased bp to 60s systolic (usually 90s) and somnolent. recieved 250 bolus and dopamine gtt. abp 7.19/82/94 placed on bipap. had temp to 101 in ed and recieve 1gm vanco. k was 6.2 and recieved 10 units of insulin/d50/2gm cal glu. rt fem cvl placed. cxr showed worse right pleural effusion aas compared to previous. pt transferred to floor, abg 7.16/87/61 and decided to intubate after extensive discussion with family about code status. past medical history: 1. cad - s/p cath :stenting of the rca with 3 overlapping cypher - : rotational atherectomy, ptca and stenting of the lad/lcx. 2. mvr/avr 3. chf - ef >55% 2+mr , rv dysfunction, moderate pulmonary htn 4. paf s/p vvi pacemaker 5. cri 6. mds 7. chronic mechanical hemolysis 8. hx. of perirectal abscess s/p surgery social history: no hx of etoh or tobacco, lives at home alone, widower. children are very involved in his care. family history: non-contributory physical exam: vitals: t= 99.8, hr = 60-89, bp = 82/45 on dopa of 5, rr = 20 , sao2 = 100% on ac 500, rate 18, peep 8. fio2 50%. weight 153 lbs general: uncomfortable, mild distress, intubated heent: normocephalic and atraumatic head, no nuchal rigidity, anicteric sclera, moist mucous membranes. neck: no thyromegaly, no lymphadenopathy, no carotid bruits. chest: chest rose and fell with equal size, shape and symmetry, lungs with decreased breath sounds, left greater than right. cv: pmi appreciated in the fifth ics in the midclavicular line- hyperdymanic, afib, mechanical s1 and s2. iii/vi systolic murmur, ii/iv diastolic murmur abd: normoactive bs, nt and nd. no masses or organomegaly back: no spinal or cva tenderness. ext: no cyanosis, no clubbing. 2+ symetric edema with 2+ dorsalis pedis by doppler pulses bilaterally integument: no rash neuro: solmnmelent but answer questions yes, no. communicates with family. cn ii-xii symmetrically intact, perrla. pertinent results: cxr: findings: a single ap supine image. comparison study taken 3 hours earlier. the ett has been withdrawn slightly and its tip is now 3 cm above the carina in good position. the ng line is well positioned in the lower portion of the stomach. the heart shows fairly marked enlargement, predominantly left ventricular. there is evidence of prior cardiac surgery but the prosthetic valves are not clearly defined. there is also evidence of cabg procedure with some cardiovascular clips and sternal sutures noted. the aorta is slightly calcified and unfolded. the pulmonary vessels show fairly marked upper zone redistribution. there is a moderate sized right sided pleural effusion. these findings are consistent with left heart failure. the severity of the cardiac decompensation is not significantly changed since the prior study. an external electrode overlies the inferior aspect of the cardiac silhouette. a pacemaker overlies the left shoulder region with a single electrode extending into the apex of the right ventricle. impression: 1) evidence of prior surgery. there is now left ventricular decompensation of moderate severity associated with a right sided effusion. the ett is now in good position. brief hospital course: 1. respiratory failure: when the aptient was admitted, he was placed on bipap, however continued to have decreased pao2 and was acidotic and hypercarbic. therefore he was intubated and remained intubated until when he was successfully extubated/ the patient's respitary failure was though to be due to a combination of chf, a large pleural effusion and possibly a pna. he was aggressively diuresed, and his plueral effusion was tapped and found to be transudative, and he was placed on broad spectrum antibiotics. the iv antiobiotics were switched to po levofloxacin. repeat cxr showed increased right pleural effusion compared to the cxr after the thoracentesis. however, pt continued to breath comfortably on room air. pt also got flu vaccine during his stay. 2. decompensated chf: the patient came in with a weight of 69.4kg and his dry weight is 60kg. the patient later admitted to drinking a large amount of water in rehab and being constantly thirsty. historically the patient responds best to natrecor with dopamine. he was started on dopamine and natrecor for diuresis and lasix iv bolsues were added as needed. as his urine output fell, he was started on a lasix drip. once he was close to his dry weight, natrecor was stopped and he was switched to po zaroxyln and lasix prn. he was eventually switched converted to standing po bumex 2 mg po bid and achieved his ideal wt of 60 kg and remained stable. once pt was off dopamine tolerating bp, toprol xl was started. lisinopril was re-started as well. these medications were administered at bedtime since his sbp drops to 80's with these meds. standing po bumex was started (2 mg ). pt achieved his ideal dry weight of 60.5 kg at one point, but wt returned to 63.5 kg which was thought to be secondary to sodium retention from the prednisone he took for gout flare. his discharge weight was 62.8 kg. he was discharged with toprol 12.5 mg po qhs, lisinopril 1.25 mg po qhs, bumex 2 mg po bid. pt is very sensitive to acei and drops his bp in 80's, so it is given at bedtime. it is emphasized that his baseline bp is in the 80's-low 100's, and no medications should be held for sbp of high 80's or 90's. toprol and lisinopril should be spaced 2 hr apart. pt will be followed at clinic. 3. cad: the paitent is s/p rca stenting on for reversible inferior wall defect. his asa and plavix were continued and carvediol and lisinopril were initially held for low sbp. as above, after diuresis and improved cardiac output, pt was started on toprol and lisinopril. 4. rhythm: chronic afib s/p vvi pacer . pt was initially started on digoxin for rate control while he was hypotensive and on dopamine gtt. but it was switched to toprol later for rate control. coumadin was held for thoracentesis but re-started. 5. chronic anemia mechanical hemolysis mds, and anemia of chronic disease. he was initially continued on iron and folate, but the epo was given 10,000 units qmwf which is half of what he was getting on last admission to keep his hct stable. his hct slowly drifted down, so the epo was increased to 20,000 units qmwf with good response. his hct remained stable at 29-30. pt will be discharged with epo 20,000 qmwf and iron supplement. 8.cri: the paitent's baseline is 1.2. he had a bump up to 3.0 on admission. his creatinine improved to his near baseline after aggressive diuresis to improved the cardiac output. 9.mechanical valve: pt was on coumadin which was held initiallya and bridged with heparin gtt for procedures. coumadin was re-started with goal of inr 2.5-3.5. inr was 3.5 on discharge. 10. gout: pt developed a severe left foot pain localized at tarsal area. the area appeared erythematous and tender to palpation. pt responded well to prednisone 30 mg x 3 days. pt was given additional 15 mg x 3 days. he will be followed by outpatient clinic and decide whether he needs to be on long term prophylaxis. pt's uric acid was 10.6. gout flare may have been triggered by chronic mechanical hemolysis, chronic diuresis, and cri. 11. fen: pt needs to be on 2gm sodium diet, cardiac diet, and fluid restriction of 1.5 l. pt needs to be weighed daily and be reported to md if he has more than 1 kg of weight gain, so his medications could be adjusted. medications on admission: plavix 75, folic acid 1, atrovent, lipitor 20, asa 81, remeron 15, no aldactone (was not supposed to start this in rehab given labile k), ranitidine 150, epogen qmwf, cravediolol 3.125 , lisinopril 5 (was supposed to be taking 3.75), bumex 2 increased to 3 on , coumadin 13mg. discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. atorvastatin calcium 20 mg tablet sig: one (1) tablet po daily (daily). 7. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 8. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 9. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 10. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 11. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 12. zolpidem tartrate 5 mg tablet sig: 1-2 tablets po hs (at bedtime). 13. epoetin alfa 20,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). 14. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po bid (2 times a day). 15. metoprolol succinate 25 mg tablet sustained release 24hr sig: 0.5 tablet sustained release 24hr po hs (at bedtime): please give 2 hrs before lisinopril hold for sbp<90, hr<55. 16. bumetanide 2 mg tablet sig: one (1) tablet po bid (2 times a day). 17. warfarin sodium 5 mg tablet sig: two (2) tablet po daily (daily): please have inr checked frequently. 18. warfarin sodium 1 mg tablet sig: three (3) tablet po once a day: please base the dosing on inr level. goal 2.5-3.5. 19. prednisone 10 mg tablet sig: 1.5 tablets po daily (daily) for 2 days. 20. lisinopril 2.5 mg tablet sig: 0.5 tablet po hs (at bedtime): take 2 hrs after toprol. discharge disposition: extended care facility: - discharge diagnosis: chf exacerbation pneumonia gout a-fib cad discharge condition: stable, pt near his ideal weight, breathing on room air. discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1.5 l patient was instructed to take all of the medications as instructed. pt needs to be weighed daily and needs to report to md (dr. or md at the rehab and have his medications be adjusted accordingly. pt needs to restrict the fluid intake to 1.5 l/day. pt should have his inr checked until it is at a stable level between 2.5-3.5, and have the coumadin dose adjusted accordingly. followup instructions: provider: , m.d. where: cardiac services phone: date/time: 3:30 provider: , md where: lm phone: date/time: 10:00 provider: , m.d. where: cardiac services phone: date/time: 11:30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube thoracentesis non-invasive mechanical ventilation injection or infusion of nesiritide diagnoses: pneumonia, organism unspecified hyperpotassemia anemia of other chronic disease congestive heart failure, unspecified acute kidney failure, unspecified gout, unspecified atrial fibrillation heart valve replaced by other means acute respiratory failure hypotension, unspecified unspecified disorder of kidney and ureter 

Answer: The patient is high likely exposed to