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: ventricular fibrillation arrest major surgical or invasive procedure: icd placement history of present illness: 69 yo man with a history of cad s/p ptci () & cabg (), s/p pacer for junctional bradycardia(), afib on coumadin, and esrd on hd (being evaluated for renal tx), who is transferred from good hospital for evaluation for icd placement after ventricular fibrillation arrest. of note, pt gets most of his cardiac care at as well. . mr. initially presented to hospital on after falling off of commode at his nursing home. he reportedtly fell asleep, fell off commode, and sustained head trauma. he was awake & talking after fall and was brought to osh ed, where he went into v-fib arrest. according to osh records, he was defibrillated once, and developed wide complex tachycardia. he was then given iv amio bolus as well as dopamine for apparent hypotension. he was intubated and a head ct was obtained, which was negative for ich. he was admitted to osh icu. in icu, amiodarone was discontinued. cardiac enzymes were negative. cxr was concerning for possible pna ("basilar densities") as well as chf. of note, his wbc was elelvated at 14, though it is unclear if he was ever febrile. he was not given abx for pna. sputum grew pseudomonas. he was given ceftriaxone for uti (gnr on g-stain). for his chf, he received urgent dialysis on with removal of 2.1kg. two attempts were made to wean pt off the vent using cpap however pt was continued on vent due to "inadequate" blood gases. past medical history: coronary artery disease - s/p multiple pci/stents. known cath and lad stent in (3 vessel disease, systemic systolic arterial hypertension, moderate lv systolic heart failure, nl lv diastolic function, and successful ptca of the lpl). cabg - cabg x 3 (left internal mammary artery to left anterior descending artery, saphenous vein graft to obtuse marginal branch, saphenous vein graft to right coronary artery.) history of multiple mi's - most recent ischemic cardiomyopathy, ef 30-40% in mild-mod mr ar pacemaker insertion (), dddr peripheral vascular disease end-stage renal disease on hemodialysis since right brachicephalic av fistula tunnelled dialysis catheter diabetes mellitus type ii - now insulin dependent hypertension elevated cholesterol neuropathy s/p appendectomy s/p bilateral lower extremity orif social history: no current tobacco use. there is no history of alcohol abuse. separated from wife; has 4 grown kids. close w/ son, . hcp. recently in rehab/nursing home. family history: there is no family history of sudden death. extensive family history of cardiac disease including early mis (50s) and multiple family members with diabetes. mother died at age 58 due to cerebral hemorrhage and also had h/o dm2. father died at age 65 of a cerebral hemorrhage and also had h/o dm2. brother died at age 74 due to complications of dm1. physical exam: vs t97.7, p76, bp 126/64, rr 18, o2 sat: 95% on 2l nasal cannula gen: thin male in no apparent distress heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with no jvd. cv: tachycardic, rregularly irregular heart rate. no murmurs appreciated. chest: bilateral crackles halfway up; otherwise clear to auscultation. no chest wall deformities, scoliosis or kyphosis. abd: soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: trace edema in bilateral lower extremities. wasting of limbs. skin: pilonidal cyst in sacral area pulses: right: 1+ dp left: 1+ dp pertinent results: 08:15pm blood ck(cpk)-86 03:59am blood ck(cpk)-63 10:03pm blood ck(cpk)-41 06:15am blood ck(cpk)-34* 08:15pm blood ck-mb-notdone ctropnt-0.15* 10:03pm blood ck-mb-notdone ctropnt-0.30* 06:15am blood ck-mb-notdone ctropnt-0.26* 08:15pm blood glucose-181* urean-40* creat-4.5* na-143 k-4.9 cl-108 hco3-23 angap-17 ekg on admission - prob a fib, rate avg ventric respons 110s-150s. lad. lvh. st seg depression 1-2mm in v5-6 (old). poor rwave progression. . cxr at - pulm congestion and bibasilar densities. . tte at - ef 14%. severe global hypokinesis of the lv, mod reduced rv global systolic fxn, mod-sev ar, mod-sev mr. . 2d-echocardiogram performed on (at ) ef 55%, left atrium moderately dilated, rv chamber size and function normal. ra cavity nl with pacemaker wire visualized. aortic valve leaflets mildly thickened without as and mild ar, miral valve with mild to moderate mr, tricuspid valve with mild regurg. rvsp 41 mmhg, rap 5 mmhg and moderate pulmonary hypertension. mild pr, no pericardial effusion. borderline lv hypertrophy. . ett performed on demonstrated : 1) small severe predominantly fixed apical perfusion defect which has significantly improved since . 2) global hypokinesis, most severe at the apex, estimated ef of 38%. brief hospital course: s/p ventricular arrythmia: pt was transferred after ventricular tachycardia requiring cradioversion. the most likely etiology is structural heart disease vs scar rather than acute ischemia/infarction given negative ce at osh. pt underwent pacemaker interrogation which confirmed the vtach event and is now s/p icd placement. pt had been loaded with amiodarone at osh in setting of ventricular tachycardia and has been continued amiodarone 200mg daily. pt was transitioned to carvedilol 25mg . pt will need follow up with ep for ep investigation and testing of icd device after 4wks of therapeutic anticoagulation. . respiratory failure: pt was transferred s/p endotracheal intubation in setting of ventricular tachycardia. pt was noted to have a fever on admission and cxr from osh was read as "bibasilar infiltrates". repeat cxr showed possible right sided opacity and pt was started on cefepime due to a sputum that was positive for pseudomonas and enterobacter, pan sensitive. pt was weaned and extubated on . pt completed a ten day course of cefepime for and required aggressive diuresis for pulm edema and right sided pleural effusion. pt was sating well on room air and denying any ongoing shortness of breath despite residual moderate right sided pleural effusion. . syncope: pt initally presented to the osh after fall while on commode. it is unclear if there was any loc. however, the ventricular tachycardia event in the osh ed raises suspicion for arrythmogenic cause of syncope. pt did sustain a head trauma during fall. however, ct scan of head was negative and neuro status remained stable in house. there have been no further ventricular arrythmias noted on telemetry and pt had an icd lead placed prior to discharge. pt will need to return for ep follow up and icd investigation after 4wks of anticoagulation. . cad: pt with h/o mis of cabg & ptci. there were no signs of active ischemia on ekg or by enzymes. trop trend: 0.15->0.30->0.26, though cks/mb fraction were not elevated, suggesting possible demand ischemia from chf/recent arrest in setting of renal failure. patient was continued on asa, carvedilol, ace i, and statin. . cardiomyopathy: pt with a history cad s/p mi with baseline depressed ef. tte in revealed ef of 30-40%. pt had an echo done on that revealed a worsened ef of 15-20%. pt will need a follow up echo given that these images were performed after cardioversion and function may improve somewhat over the next months. . atrial fibrillation: pt developped parosymal atrial fibrillation in post cabg setting() and has been maintained on coumadin since that time. pt was rate controlled with beta blocker and amiodarone. digoxin was discontinued and pt was transition to carvedilol 25mg . pt was anticoagulated with heparin gtt in house and should resume coumadin on . pt will need inr monitoring on and every three days there after. . end stage renal disease: pt has been on hemodialysis since and has been evaluated for transplant. pt presented with acute systolic heart failure and required aggressive hd to remove additional fluid. on it was noted that patient had not urinated for two days despite normal habit of urinating twice daily. overnight patient urinated 200cc and was restarted on on his home dose of flomax with resolution of oliguria. . thrombocytopenia: pt has chronic history of low platelets in the 100 to 150 range. pt had a hit ab sent during last admission that was negative. platelets were monitored in house and remained in the low 100s, on the day of discharge platelet count of 90. pt will need follow up cbc in 2-3days to ensure stability. . diabetes: pt was maintained on lantus 10u qhs with additional coverage with sliding scale insulin. . diarrhea: pt was complaining of multiple loose stools but remained afebrile with normal white count. c. diff toxin was negative times two. diarrhea occurred in the setting of pureed diet and seemed to resolve after pt was advanced a regular diet per speech & swallow recommendations. . pilonidal cyst: the patient reported increased pain secondary to a pilonidal cyst and was started on a standing dose of oxycodone for pain control. pt states he will pursue drainage of cyst as an outpatient. medications on admission: amiodarone - 200mg qd escitalopram - 10mg qd esomeprazole qd, dose? furosemide - 20mg qd? isosorbide 30mg sr qd lactulose - 20g qd metoprolol tartrate - 50 tid sevelamer hcl - 400 qd simvastatin 80mg qd tamsulosin 0.4 qd warfarin - dose? ascorbic acid 500bid aspirin 81 qd docusate 100 insulin nph & regular - 68 units qam/38 units qpm discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 2. escitalopram 10 mg tablet sig: one (1) tablet po daily (daily). disp:*qs tablet(s)* refills:*0* 3. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). disp:*qs capsule, sust. release 24 hr(s)* refills:*2* 4. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. disp:*qs * refills:*0* 5. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*qs tablet(s)* refills:*2* 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed. disp:*qs * refills:*0* 7. carvedilol 25 mg tablet sig: one (1) tablet po bid (2 times a day): hold if sbp < 100 or hr < 60. disp:*60 tablet(s)* refills:*0* 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 9. simvastatin 80 mg tablet sig: one (1) tablet po once a day. 10. sevelamer hcl 400 mg tablet sig: one (1) tablet po once a day. 11. lactulose 20 gram packet sig: one (1) po once a day. 12. insulin nph & regular human 100 unit/ml (70-30) cartridge sig: one (1) 68 subcutaneous qam. 13. insulin nph & regular human 100 unit/ml (70-30) cartridge sig: one (1) 38 subcutaneous qpm. 14. ascorbic acid 500 mg tablet sig: one (1) tablet po twice a day. 15. outpatient lab work please draw cbc, pt, inr, tsh, free t4 on and forward results to rehab md. 16. outpatient lab work please draw pt/inr on monday, and every 3days adjustment recommendations. 17. keflex 500 mg capsule sig: one (1) capsule po once a day for 3 days: on dialysis days, please take after dialysis. 18. pulmonary function tests please schedule pulmonary function tests within 2-3 weeks. the telephone number is (. forward the results to dr. office (ph# ). 19. aspirin 81 mg tablet sig: one (1) tablet po once a day. 20. warfarin 2 mg tablet sig: one (1) tablet po at bedtime. 21. oxycodone 5 mg tablet sig: 1-2 tablets po every six (6) hours for 5 days. discharge disposition: extended care facility: rehabilitation discharge diagnosis: primary: respiratory failure hospital acquired pneumonia ventricular arrythmia s/p icd placement atrial fibrillation acute systolic heart failure with an ef of 25-30% . secondary: esrd on hemodialysis cad s/p cabg pilonidal cyst discharge condition: stable and asymptomatic on discharge with appropriate follow-up. discharge instructions: you were admitted after having an arrhythmia and respiratory failure requiring intubation. you had a defibrillator placed for your arrhythmia and have been treated for pneumonia and volume overload that contributed to your respiratory problem. . you were started on the following medications: carvedilol 25mg po bid for heart failure and rate control. lisinopril 5mg po daily for blood pressure. oxycodone 5 mg po q 6hr for the pain from the pilonidal cyst. . the following medications were changed: aspirin was increased from 81 to 325mg daily. isosorbide was discontinued. coumadin was stopped and now restarted at 3 mg daily pending inr in two days. furosemide was discontinued. . please make sure you follow up with your doctors . . if you experience any chest pain, chest pressure with jaw or arm pain, difficulty breathing, or any other concerning symptoms, please call 911 or come to the er. followup instructions: you have a follow up appointment scheduled with dr. on monday at 1pm. . you have an appointment with device clinic. phone: date/time: 3:00 please check cbc and pt/ptt/inr on monday and forward to dr. office. thank you. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified hemodialysis thoracentesis implantation or replacement of automatic cardioverter/defibrillator, total system [aicd] diagnoses: thrombocytopenia, unspecified end stage renal disease diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation aortocoronary bypass status percutaneous transluminal coronary angioplasty status paroxysmal ventricular tachycardia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) acute respiratory failure pneumonia due to pseudomonas retention of urine, unspecified acute on chronic systolic heart failure fitting and adjustment of cardiac pacemaker pilonidal cyst without mention of abscess 

Answer: The patient is high likely exposed to