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: the patient is a 68-year-old gentleman with a significant cardiac history with coronary artery disease (status post coronary artery bypass graft), hypertension, congestive heart failure, hyperlipidemia, and diabetes mellitus who presented with worsening congestive heart failure of several months in duration with new onset chest pressure. the patient was in his usual state of health until three days prior to admission when he began to experience increasing shortness of breath at rest and with exertion. however, the patient was still able to walk his dog for approximately one half of a mile per day. no paroxysmal nocturnal dyspnea. no orthopnea. minimal bilateral lower extremity edema at baseline. the patient had one episode of chest pressure (his anginal equivalent) with exertion three days prior to admission which resolved after one hour. on the day prior to admission, the patient had a second episode of chest pressure, substernal, and without radiation. no associated nausea, vomiting, or palpitations. mild diaphoresis and lightheadedness. the patient took one sublingual nitroglycerin, and his pain score went down to 7/10, and he presented to the emergency department for evaluation. in the emergency department, the patient's chest pressure was relieved with aspirin, heparin, nitroglycerin, and integrilin. he also received metoprolol intravenously. he did continue to be short of breath despite receiving 80 mg of lasix intravenously on arrival. the initial electrocardiogram showed sinus tachycardia with a left bundle-branch block and left atrial abnormality, without any significant changed when compared to the previous tracing of . his initial creatine kinase was 326 with a troponin t of 0.31. of note, the patient denies fevers or chills. he has a slight cough with sputum. he is not on a low diet. no recent dietary indiscretion. past medical history: 1. coronary artery disease. (a) status post coronary artery bypass graft in ; left internal mammary artery to left anterior descending artery, saphenous vein graft to right coronary artery, and saphenous vein graft to diagonal. (b) persantine mibi on demonstrated a dilated left ventricle, partially reversible moderate perfusion defect in the anterior left ventricular wall, with moderate fixed deficits at the septal/inferior walls, global and left ventricular hypokinesis with an ejection fraction of 21%. 2. congestive heart failure; heart association class ii. an echocardiogram on with depressed left ventricular systolic function with an ejection fraction of 20%. 3. insulin-dependent diabetes mellitus. 4. hypertension. 5. hyperlipidemia. 6. onychomycosis. 7. status post appendectomy. 8. anemia with leukocytosis. 9. chronic obstructive pulmonary disease; last pulmonary function tests in with a mixed obstructive/restrictive deficit. medications on admission: 1. lisinopril 40 mg by mouth once per day. 2. lipitor 20 mg by mouth once per day. 3. cardura 2 mg by mouth q.h.s. 4. celexa 40 mg by mouth once per day. 5. coreg 12.5 mg by mouth q.a.m. 6. digoxin 0.25 mg by mouth every day. 7. lasix 80 mg by mouth once per day. 8. lumigan 0.03% drops q.h.s. 9. timoptic 0.25% drops both eyes q.a.m. 10. excedrin by mouth as needed. 11. nph insulin 95 units subcutaneously q.a.m. and 90 units subcutaneously at dinner. family history: family history was noncontributory for coronary artery disease. social history: the patient is a retired painter. he has been married times 44 years. he has a 60-pack-year history of tobacco; he quit 15 years ago. occasional alcohol use. no intravenous drug use. physical examination on presentation: physical examination on admission revealed his temperature was 98.4 degrees fahrenheit, blood pressure was 133/64, his heart rate was 107, his respiratory rate went from 40 to 24, and his oxygen saturation was 95% on 2 liters. in general, an elderly gentleman in no apparent distress. head, eyes, ears, nose, and throat examination revealed normocephalic and atraumatic. pupils were equal, round, and reactive to light and accommodation. extraocular movements were intact. the neck was supple. no lymphadenopathy. no thyromegaly. cardiovascular examination revealed a regular rate. normal first heart sounds and second heart sounds. no murmurs, rubs, clicks, or gallops. pulmonary examination revealed decreased breath sounds at the bases bilaterally. no rales or wheezes. the abdomen was obese, soft, nontender, and nondistended. normal active bowel sounds. no hepatosplenomegaly or masses. extremity examination revealed 2+ pitting edema bilaterally to the knees. neurologic examination revealed alert and oriented times three. cranial nerves ii through xii were grossly intact. pertinent laboratory values on presentation: initial laboratories revealed creatine kinase was 326, ck/mb was 14, troponin t was 0.25, and mb index was 4.3. his white blood cell count was 7.8, his hematocrit was 33, and his platelets were 281. sodium was 135, potassium was 4.2, chloride was 99, bicarbonate was 28, blood urea nitrogen was 24, creatinine was 1.1, and blood glucose was 303. prothrombin time was 13.8, partial thromboplastin time was 25.2, and his inr was 1.3. pertinent radiology/imaging: a chest x-ray demonstrated cardiomegaly with pulmonary vasculature redistribution and a new lingular opacity (pneumonia versus asymmetric pulmonary edema), and a small calcified granuloma in the right upper lobe (as previously demonstrated). brief summary of hospital course by issue/system: the patient was admitted to the c-med service, placed on telemetry, and continued on his outpatient cardiac medications, as well as a nitroglycerin, heparin, and integrilin drips. 1. congestive heart failure issues: at baseline, the patient had been on 2 liters nasal cannula of home oxygen. his oxygen requirement remained stable while in house on 3 liters nasal cannula. he was saturating at 97%. an echocardiogram was performed on which demonstrated an ejection fraction of 20% with global hypokinesis; consistent with prior examination. the patient was continued on digoxin 0.25 mg by mouth once per day and lasix 80 mg intravenously once per day. daily weights and strict ins-and-outs were monitored. on the day of discharge, the patient no longer had edema of the lower extremities. he was saturating at 100% on 2 liters with his lungs clear to auscultation bilaterally. 2. coronary artery disease issues: the patient ruled in by enzyme criteria; however, his electrocardiogram continued to be unchanged with a left bundle-branch block at baseline. there was consideration of catheterization during this inpatient stay; however, given the patient's complications with gastrointestinal bleeds, as well as his reluctance to undergo this procedure, this was deferred. the patient underwent a chemical stress mibi on ; during which time he had no anginal symptoms or interpretable electrocardiogram changes. by verbal report, the nuclear portion of this study demonstrated fixed defects in the anterior/inferior walls with an ejection fraction of 20% and left ventricular cavity enlargement. 3. anemia/gastrointestinal bleed issues: the patient had an episode of melena on the morning of . he denied bright red blood per rectum, hematemesis, coffee-grounds emesis, nausea, vomiting, or abdominal pain. he had never had symptoms of gastrointestinal bleeding in the past. a nasogastric lavage demonstrated no active upper gastrointestinal bleed, and his vital signs remained stable with a stable hematocrit at 29.8. two large-bore intravenous lines were placed, and the patient was transfused a total of three units of packed red blood cells with 80 mg of intravenous lasix prior to this transfusion. he was also started on protonix 40 mg intravenously twice per day. the integrilin, heparin, and aspirin were held. a gastroenterology consultation was obtained, and an esophagogastroduodenoscopy was recommended and performed on the morning of . this demonstrated gastritis. nevertheless, due to the patient's gastrointestinal bleeding he was transferred to the medical intensive care unit because of concern over the initial hematocrit drop from 33 to 26 with a question of potential retroperitoneal bleed. on , when he was transferred to the medical intensive care unit, an abdominal and pelvic computed tomography without contrast was obtained which demonstrated some cholelithiasis without evidence for cholecystitis, and no evidence of retroperitoneal bleed. an anemia workup was continued, and iron studies demonstrated an elevated ferritin and decreased total iron-binding capacity suggesting likely anemia of chronic disease with acute anemia secondary to gastritis superimposed. the patient remained stable and was transferred back to the c-med service on the evening of . for the duration of his inpatient course, the patient's hematocrit remained stable at 32.7, and he did not experience subsequent episodes of melena or hematemesis. of note, the aspirin, heparin, and integrilin continued to be held (this contributed to the unwillingness to perform cardiac catheterization during this inpatient stay). 4. pneumonia issues: on admission chest x-ray, the patient was noted to have a lingular infiltrate that was felt to be new compared to prior studies. of note, the patient's white blood cell count was 7.8, but he did spike to 102.3 degrees fahrenheit on . thus, it was felt that the chest x-ray infiltrate was consistent with pneumonia, and he was started on levofloxacin 500 mg once per day for a 10-day course. the patient's chest x-ray gradually improved during his inpatient stay. on the day of discharge, his temperature was 99.6 with a white blood cell count of 13.3. of note, his maximum white blood cell count had been 13.9. the patient had been afebrile for 48 hours prior to discharge. 5. diabetes mellitus issues: the patient was placed on an insulin sliding-scale with four times per day fingersticks. his glucose remained within normal limits during this hospital course. 6. mental status change issues: the patient was minimally agitated during his medical intensive care unit stay. it was felt that this was likely baseline dementia with superimposed intensive care unit delirium. he did have a recent head computed tomography which showed no acute event. of note, his mental status was much improved upon transfer to the floor. discharge disposition: the patient was discharged on . his vital signs were stable. he was saturating at 100% on 2 liters nasal cannula. his creatine kinase levels had been dropping from 187 to 108 with a troponin of 0.31. he was asymptomatic. condition at discharge: condition on discharge was stable. discharge diagnoses: 1. acute non-st-segment myocardial infarction. 2. pneumonia. 3. coronary artery disease. 4. gastrointestinal bleed. medications on discharge: 1. lipitor 20 mg by mouth once per day. 2. celexa 20 mg by mouth by mouth twice per day. 3. doxazosin 2-mg tablets one tablet by mouth once per day. 4. timolol eyedrops 0.25% one both eyes q.a.m. 5. levofloxacin 500-mg tablets one tablet by mouth once per day (for a 10-day course with day one being on ). 6. lisinopril 40 mg by mouth once per day. 7. digoxin 250-mg tablets one tablet by mouth once per day. 8. carvedilol 12.5 mg by mouth twice per day. 9. protonix 40-mg tablets one tablet by mouth twice per day. discharge instructions/followup: 1. the patient was instructed to follow up with dr. in the medical building, suite b, on at 11 a.m. (telephone number ). 2. the patient was instructed to follow up with dr. in the building, on at 12:10 p.m. (telephone number ). 3. the patient was advised to call 911 or present to the nearest emergency department with symptoms of chest pressure, shortness of breath, jaw discomfort, palpitations, or diaphoresis. 4. the patient was advised to resume all outpatient medications; aside from aspirin. , m.d. dictated by: medquist36 d: 08:42 t: 14:08 job#: procedure: other endoscopy of small intestine injection or infusion of platelet inhibitor diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified other specified cardiac dysrhythmias unspecified gastritis and gastroduodenitis, with hemorrhage 

Answer: The patient is high likely exposed to