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: betadine attending: chief complaint: sudden onset mid back pain radiating to groins, left >right major surgical or invasive procedure: none history of present illness: 34 year old morbidly obese man with a history of htn, chronic renal insufficiency presented to the ed after developing sudden onset mid back pain radiating to groins, left >right. patient states that he was drinking a bottle of water at the time. he denies dizziness or headache. denies shortness of breath, chest pain, nausea or emesis. on presentation to the ed patient was found to have systolic blood pressure in 215-230 range in acute on chronic renal failure. past medical history: - hypertension with hypertensive urgency x 1 in past - chronic renal insufficiency with baseline cr 1.5 - acute disseminated encephalomyelitis - per records, diagnosed at , p/w photophobia and was sore from his l-ear to his scapula; s/p craniotomy with biopsy and 5 week hospital stay, recovered completely, no neurological symptoms since - bacteremia - , per patient from eczema skin wound. hospitalization for group g streptococcal bactermia. - eczema - childhood asthma--has not been on inhalers in years - allergic rhinitis - rotator cuff injury . allergies: betadine--rash social history: social history is significant for the presence of current tobacco use: 1-2ppd x 10 years. patient denies alcohol abuse, though he indiciates there have been times when he had to cut back on his drinking. he works as a bartender. +tattooes done by a friend, reports they are done under sanitary conditions. denies ever abusing iv drugs or cocaine. lives with roommates. family history: there is a family history of premature coronary artery disease: mother with cad in her 40s. father and sisters healthy. mother has dm that resolved after gastric bypass. denies other family h/o dm, htn, or cad. physical exam: physical exam: 98.4 vs bp: 149/74 84 20 99%ra wt. 145 kg gen: obese african american male, appears somewhat uncomfortable with movement. appropriate. heent: dry mucus membranes. sclera anicteric. neck: supple. normal rom. symmetric pulses without carotid bruits. cv: regular rate and rhythm. distant heart sounds. no murmur appreciated. chest: distant but clear. abd: obese, soft, ntnd, no hsm or tenderness. ext: 1+ edema bilaterally. multiple areas of hypopigmentation. feet warm and well perfused. good capillary refill. pulses: car fem dp pt : 2+ 1+ 2+ dop left: 2+ 1+ 2+ palp pertinent results: 06:40am blood wbc-10.3 rbc-3.39* hgb-10.8* hct-31.7* mcv-94 mch-31.7 mchc-34.0 rdw-13.4 plt ct-198 04:36am blood wbc-11.7* rbc-3.50* hgb-10.8* hct-32.2* mcv-92 mch-31.0 mchc-33.6 rdw-13.8 plt ct-159 01:08am blood wbc-11.0 rbc-3.72* hgb-11.4* hct-34.1* mcv-92 mch-30.5 mchc-33.3 rdw-13.8 plt ct-149* 05:52am blood wbc-12.1* rbc-3.51* hgb-11.2* hct-32.4* mcv-92 mch-31.8 mchc-34.5 rdw-13.7 plt ct-149* 12:34am blood wbc-10.4 rbc-3.65* hgb-11.6* hct-33.8* mcv-93 mch-31.9 mchc-34.4 rdw-13.9 plt ct-136* 08:34pm blood hct-35.7* 05:05pm blood hct-37.5* 08:43am blood wbc-14.0* rbc-4.00* hgb-12.6* hct-36.5* mcv-91 mch-31.6 mchc-34.6 rdw-13.9 plt ct-144* 12:30am blood wbc-15.9*# rbc-4.56* hgb-14.2 hct-41.2 mcv-90 mch-31.1 mchc-34.4 rdw-14.5 plt ct-176 06:40am blood plt ct-198 04:36am blood plt ct-159 01:08am blood plt ct-149* 05:52am blood plt ct-149* 12:34am blood plt ct-136* 12:34am blood pt-13.1 ptt-36.9* inr(pt)-1.1 08:43am blood plt ct-144* 08:43am blood pt-13.3 ptt-36.1* inr(pt)-1.1 12:30am blood plt ct-176 12:34am blood fibrino-321# 06:20am blood glucose-88 urean-34* creat-3.0* na-141 k-4.0 cl-106 hco3-27 angap-12 06:40am blood glucose-83 urean-31* creat-2.8* na-144 k-3.9 cl-106 hco3-26 angap-16 04:36am blood glucose-115* urean-31* creat-3.0* na-140 k-4.7 cl-105 hco3-26 angap-14 01:08am blood glucose-104 urean-36* creat-3.5* na-142 k-3.7 cl-106 hco3-26 angap-14 05:52am blood glucose-108* urean-34* creat-3.6* na-139 k-3.3 cl-102 hco3-25 angap-15 12:34am blood glucose-116* urean-29* creat-2.8* na-138 k-3.6 cl-104 hco3-23 angap-15 08:34pm blood urean-29* creat-2.9* 08:43am blood glucose-98 urean-29* creat-2.7* na-138 k-3.1* cl-102 hco3-25 angap-14 12:30am blood glucose-96 urean-32* creat-2.9* na-139 k-3.6 cl-101 hco3-23 angap-19 04:36am blood alt-15 ast-32 ld(ldh)-467* alkphos-52 amylase-80 totbili-0.7 05:52am blood ld(ldh)-234 totbili-0.7 12:34am blood alt-11 ast-17 ck(cpk)-320* alkphos-56 amylase-71 totbili-0.6 04:55pm blood ck(cpk)-487* 05:52am blood hapto-122 08:43am blood tsh-3.0 04:36am blood hcg-less than 04:36am blood afp-1.8 12:30am blood holdblu-hold 12:48am blood lactate-1.0 06:54pm blood lactate-0.9 final report scrotal ultrasound. findings: the right testicle measures 3.4 x 2.6 x 3.8 cm. the left testicle measures 3.0 x 2.1 x 3.9 cm. there is normal arterial and venous flow seen within both testes. there is a small right-sided hydrocele. within the left testicle, there are multiple punctate microcalcifications identified. a hypoechoic lesion measuring 2 x 2 mm is identified and does not contain microcalcifications. within the head of the left epididymis, there is a 3 x 5 mm hypoechoic lesion consistent with a simple cyst. an additional cyst is seen within the left epididymis tail. the right epididymis is unremarkable. impression: 1. no evidence of abnormal vascular flow. 2. small right-sided hydrocele. 3. left testicular microcalcifications. 4. 2 x 2 mm hypoechoic lesion within the left testicle. follow up in 3 months is reccomended. these findings were communicated directly to at the time of review. the study and the report were reviewed by the staff radiologist. ct abdomen and pelvis . findings: the left kidney measures 10.4 cm. the right kidney measures 10.9 cm. there is no mass, hydronephrosis, or stones. there is wall-to-wall color flow of the right and left main renal arteries. the resistive indices of the right main renal artery ranges from 0.77 to 0.86, with resistive indices in the lower and upper poles of 0.76. the resistive indices in the left main renal artery is 0.79. resistive indices in the upper left and lower poles of the left kidney are 0.79 and 0.62 respectively. impression: 1. no evidence of hydronephrosis. 2. appropriate flow within the main renal arteries with symmetric resistive indices bilaterally. the study and the report were reviewed by the staff radiologist. cta chest, abdomen, and pelvis on findings: there is an intimal flap seen within the aortic arch originating at the level of the right common carotid artery and crossing the ostia of the left common carotid and left subclavian arteries extending through the thoracic aorta through the abdomen beyond the bifurcation into the external iliac vessels. thrombus is seen within both external iliac vessels, extending minimally into the left common femoral artery. the true lumen supplies both hypogastric arteries as well as the left renal artery and a portion of the celiac trunk and sma. both true and false lumens are well opacified proximally, and the right renal artery is well opacified. the phase of contrast administration is very early, and there is poor enhancement of both kidneys, but no differential enhancement is evident. bibasilar consolidation is seen, possibly due to aspiration. an endotracheal tube terminates proximal to the carina. an orogastric tube extends to the gastric antrum. spleen is homogeneous in attenuation, as is the pancreas. the adrenal glands are normal in morphology. liver reveals no abnormalities on early arterial phase imaging. there is no ascites. no bowel wall thickening. impression: 1. type a aortic dissection originating at the level of the right common carotid and extending to the bilateral external iliac arteries, with thrombus seen within these vessels. there is likely hypoperfusion of the right kidney which is supplied by the false lumen; however, early arterial phase imaging precludes evaluation of the renal parenchyma. 2. bibasilar pulmonary consolidations. radiology report mr thoracic spine w/o contrast study date of 11:21 am final report mri of the thoracic and lumbar spine without gadolinium. gadolinium could not be administered due to low egfr. history: back pain. comparison is made with prior c-spine study from . sched chest (pa & lat) final report findings: pa and lateral chest radiographs are reviewed without comparison. cardiac silhouette is unchanged. thoracic aorta is mildly tortuous, but also unchanged. pulmonary vascularity is normal. lungs are clear. there is no pleural effusion or pneumothorax. note is made of bilateral gynecomastia. impression: no acute intrathoracic process. unchanged cardiomediastinal contours. cardiology report ecg study date of 3:59:18 am sinus rhythm. left atrial abnormality. non-specific t wave inversions in leads i, avl and v4-v6. minimal st segment depression in lead v6. st-t wave abnormalities are non-specific but might be related to left ventricular hypertrophy. compared to the previous tracing of upward bowing of st segment elevations in lead v2-v4 is no longer present. portable tee (complete) done conclusions no spontaneous echo contrast is seen in the left atrial appendage. no thrombus is seen in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level, which is likely within normal limits for the patient's size. a mobile density is seen in the distal aortic arch consistent with an intimal flap/aortic dissection; there is no dissection or significant enlargement of the ascending aorta. the right and left coronary artery origins are visualized in their customary positions with normal appearance of the ostia. a linear density is seen in the descending aorta consistent with an intimal flap/aortic dissection. there is flow in the false lumen. the dissection flap likely extends into the distal abdominal aorta, which cannot be visualized with tee. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no pericardial effusion. impression: type b (debakey type iii) aortic dissection originating at the level of the distal aortic arch with propagation into the descending thoracic aorta. no evidence of ascending aortic enlargement or aortic rupture. no aortic regurgitation or pericardial effusion. normal biventricular function. no significant valvular disease. t-spine; l-spine (ap & lat) clip # findings: two views of the thoracic spine and two views of the lumbar spine are reviewed without comparison. there is no fracture. vertebral body and intervertebral disc space heights are normal. mild degenerative changes are seen in the lower lumbar spine, with degenerative loss of disc space height at l4-5, and moderate anterior osteophyte formation. small anterior osteophytes are seen at multiple levels in the thoracic spine. visualized bowel gas pattern is normal. impression: no fracture. brief hospital course: 34m h/o severe hypertension and hypertension nephropathy, presenting to the ed on after experiencing an acute onset of mid-thoracic back pain while drinking a bottle of water. the pain radiated down into his groin bilaterally, l>r, with subjective left leg numbness in his left heel, which resolved. he denied ha, dizziness, or visual changes. he denied cp, sob, n/v. in the ed his initial vs were: t: 98.3f, bp: 182/87, hr: 87, rr: 16, sao2: 98% ra. he admits that he ran out of bp meds 3 weeks ago. his exam was notable for slight ttp at t8-9, normal neuro exam, normal testicular exam with no hernia. ecg demonstrated nsr at 87 bpm, notched p-waves (old), lvh (old), biphasic t-waves in lateral leads (new). his bp rose to a peak of 226/143 with hr 95, which was managed initially with labetalol 20mg iv boluses. back pain was difficult to control with 2 tabs percocet, 4mg iv morphine x 3 and 1mg iv dilaudid. he had wbc 15.9, 87% pmn. he was in acute on chronic renal failure with bun/cr of 32/2.9 from baseline creatinine 1.5. he received 3l ns. ck was in 700s with negative -mb fraction. urinalysis was negative for infection, though with spot protein of 100, which is more than baseline. cxr was clear, with no evidence of mediastinal widening. plain films of l- and t-spine unremarkable. decision made to avoid cta to r/o aortic dissection due to compromised renal function. mri was attempted, but patient could not tolerate due to anxiety and discomfort. patient was admitted to micu servcie for hypertension management and for tee. bp control switched to esmolol, bp was 153/89 at time of transfer. cards fellow aware. tee showed debakey type 2 aortic dissection, involving aortic arch and extending all the way down to bifurcation. no ascending aortic involvement. normal lvf, no valvular problems, no pericardial effusion. vascular service was consulted- patient transferred to vascular surgery/dr. service and ct surgery/dr. consulted. in the micu bp control was difficult to attain, patient was intubated and sedated for better bp control and possible emmergent surgery. bp was aggressively controlled with titrating nitro and esmolol drips with target bp 100-120. surgery discussion was deffered. hd2 still with elevated bp remains on esmolol and nitro drips. cpap on the vent. pulses present throughout. given morphine for pain control. restarted home antihypertensives. started clonidine patch, in an attempt to wean off iv antihypertensives. creatinine 2.8->2.9. pain med switched to percocet and valium. hd3 remains intubated, sedated. bp in good control with current meds.cta showed-type a aortic dissection originating at the level of the right common carotid and extending to the bilateral external iliac arteries, with thrombus seen within these vessels. there is likely hypoperfusion of the right kidney which is supplied by the false lumen; however, early arterial phase imaging precludes evaluation of the renal parenchyma. serial hct followed. creatinine 2.9. renal consulted for persistently rising creatinine-likely contrast nephropathy. hd4 po labetolol increased, able to wean off nitro drip. weaned from vent and extubated. transfer to vicu deferred secondary to c/o testicular/groin pains- us abdomen/testicles- showed 2 x 2 mm hypoechoic lesion within the left testicle. follow up in 3 months is reccomended. hd5 bp well controlled on labetolol, clinidine but still requiring hydralazine iv prn. afebrile. urology consulted for testicular mass- recommeded to obtain tumor/ca markers afp, bhcg, ldh and lfts- recommends repeat us in 6 wks. fu with dr. . transferred to vicu. hd6 good bp control. creatinine peaked at 3.6->2.8. renal following. dispo to home plan. social work consult for insurance/med procurement issues. medical consult for long term bp management-recs to wean down labetolol to 800 mg from 1000 mg. hd7 dispo plan for home tomorrow. appointment arranged with new pcp (dr. at the on for bp management. hd8 renal and dr. in to see patient and make new medication recs. lasix and lisinopril restarted. labetolol decreased to . norvasc continued. hydralazine and isorsorbide discontinued. clonidine changed to po for freecare coverage. patch d'ced and clonidine to be started on saturday. all medications and plans fully discussed with patient. patient will have blood pressure monitored at clinic and cr checked there tomorrow. cr results will be sent to dr. . medications on admission: labetalol 600 mg lisinopril 40 mg qd lasix 80 mg discharge medications: 1. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed. 2. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily): refill from , md phone:. disp:*60 tablet(s)* refills:*1* 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily): refill from , md phone:. disp:*30 tablet(s)* refills:*1* 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed: refill from , md phone:. disp:*60 capsule(s)* refills:*0* 5. furosemide 80 mg tablet sig: one (1) tablet po bid (2 times a day): refill from primary , md phone: . disp:*60 tablet(s)* refills:*1* 6. labetalol 200 mg tablet sig: four (4) tablet po bid (2 times a day): refill from , md phone:. disp:*240 tablet(s)* refills:*1* 7. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily): refill from , md phone:. disp:*60 tablet(s)* refills:*1* 8. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 9. clonidine 0.1 mg tablet sig: one (1) tablet po tid (3 times a day): start saturday . disp:*90 tablet(s)* refills:*1* 10. outpatient lab work please draw cr on . fax results to dr. (nephrologist) fax:( phone( discharge disposition: home discharge diagnosis: type b aortic dissection pmhx: htn, cri, acute disseminated encephalyomyelitis, s/p craniotomy w/bx, bacteremia - per patient from eczema skin wound, hospitalized for group g strep bactermia; h/o anemia and g6pd deficiency, lvh discharge condition: stable discharge instructions: - you were admitted at the for type b aortic dissection. - it is important that you keep your systolic blood pressure blelow 140. - take all your medications as prescribed. - go to the emergency room if you experience the same type of pain that you had before. - refrain from engaging in heavy lifting or strenous activities otherwise you should be able to do most activities of daily living. - eat a healthy well balanced diet. - follow-up with dr. as scheduled. followup instructions: you will need to have your blood pressure and cr checked at 10am and your blood pressure checked again on monday at health center at , (fax ). you should continue with weekly blood pressure checks until you visit with dr. . primary care follow up group , md phone: date/time: 1:30 (/). it is very important for you to keep this appointment as you will have close follow up of your medications and blood pressure. vascular follow up you will have a follow up in 1 month with vascular surgery dr. phone on at 1130am 5b (). you will also have a ct scan of your torso just prior to your appointment. cat scan phone: date/time: 10:15. radiology , . renal follow up dr. , phone: . his secretary will call you to fit you in for an appointment in the next week weeks. please call his office if you do not here from them. you will need your creatinine/kidney test closely followed. urology follow up urology provider: . phone: date/time: 11:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnostic ultrasound of heart insertion of endotracheal tube diagnoses: tobacco use disorder acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified morbid obesity dissection of aorta, thoracoabdominal hydrocele, unspecified other specified disorders of male genital organs 

Answer: The patient is high likely exposed to