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 75-year-old male with a history of coronary artery disease, status post multiple myocardial infarctions in the past, status post right nephroureterectomy on for a transitional cell carcinoma, who presented on the day of admission to with worsening lower extremity edema and exertional dyspnea since discharge. the patient awoke on the morning of admission with acute dyspnea and presented to where his electrocardiogram revealed new lateral st depressions of 2 mm in v5 through v6 which was initially read as left ventricular hypertrophy with strain, and he had an initial creatine kinase of 40 with a negative troponin, but an oxygen saturation of 85% on room air. the patient was given lasix 120 mg intravenously, nitroglycerin, morphine sulfate, given 100% nonrebreather, and his oxygen saturation improved to 100%. he was diuresed and sent to the . on review of the patient's history, he admits to having frequent bologna sandwiches and can soups and was unaware of their sodium content. at , the patient had a blood pressure of 130/54, pulse of 72, respiratory rate of 26, and an oxygen saturation of 100% on 50% venturi mask with electrocardiograms that revealed 1-mm st depressions in v5 through v6. the patient was admitted to the c-med service, and several hours later suffered acute worsening dyspnea with 5/10 chest pain, and diaphoresis, and an electrocardiogram that showed st depressions in ii and f as well as v4 through v5, with a rate of 120, and a blood pressure of 150/90. the patient was given intravenous nitroglycerin, morphine, lasix, and heparin. he was taken to the catheterization laboratory where he had a pulmonary artery pressure of 62/30 and wedge of 35. he was found to have a left main coronary artery with a 40% distal lesion, left anterior descending artery with a 50% proximal lesion, left circumflex with a 50% middle lesion, second obtuse marginal and third obtuse marginal were totally occluded, right coronary artery with a 70% proximal lesion. an echocardiogram revealed global hypokinesis, left ventricular ejection fraction of 20%, and mild-to-moderate mitral regurgitation. the patient was transferred to the coronary care unit for observation, diuresis, and afterload reduction in the setting of 3-vessel disease and left ventricular dysfunction. past medical history: 1. coronary artery disease; status post myocardial infarction in , as well as a non-q-wave myocardial infarction in . 2. first-degree anterior vesicular block. 3. congestive heart failure with an ejection fraction that was markedly depressed by not quantified on a recent outside hospital echocardiogram. 4. history of prostate cancer. 5. history of colon cancer, status post right hemicolectomy. 6. type 2 diabetes mellitus. 7. chronic obstructive pulmonary disease without a history of intubation or hospitalizations. 8. hypertension. 9. peripheral vascular disease, status post left femoral-popliteal in with known carotid artery disease with a right internal carotid artery of 80%. 10. transitional cell bladder cancer, status post right nephroureterectomy on . 11. postoperative confusion. 12. chronic renal insufficiency (with a bowel sounds creatinine of 2 to 2.5). 13. anemia of chronic disease. allergies: iodine which causes anaphylaxis. medications on admission: lopressor 50 mg p.o. b.i.d., nph 15 units subcutaneous q.12h., clonidine 0.15 mg p.o. q.o.d. alternating with 0.3 mg p.o. q.o.d., allopurinol 100 mg p.o. q.d., lipitor 20 mg p.o. q.d., enteric-coated aspirin 325 mg p.o. q.d., lasix 120 mg p.o. q.d., multivitamin, trazodone 25 mg p.o. q.d., protonix 40 mg p.o. q.d. social history: the patient has a 100-pack-year smoking history. he quit smoking 14 years ago. the patient is married. his wife is his primary caretaker. his health care proxy is his daughter, . has four daughters and one son. physical examination on presentation: the patient's temperature was 97.4, pulse of 94, blood pressure of 140/69, respiratory rate of 21, 100% on 100% nonrebreather. on general examination, the patient was a pleasant elderly man in mild respiratory distress. head, eyes, ears, nose, and throat examination revealed pupils were equally round and reactive to light and an oropharynx was that clear and moist. neck examination revealed elevated jugular venous pressure to 10 cm of water. chest examination revealed crackles up to one-third of the lung fields bilaterally. the patient had fair movement. cardiovascular examination revealed distant heart sounds, a regular rate and rhythm. no third heart sound or fourth heart sound appreciated, and a soft 3/6 systolic blowing murmur heard at the left lower sternal border radiating to the apex. abdominal examination revealed no hepatosplenomegaly, normal bowel sounds, with a nontender and nondistended abdomen. extremity examination revealed 2+ edema. pertinent laboratory data on presentation: the patient had a white blood cell count of 10.5, hematocrit of 25.3, platelets of 195. the patient's creatinine was 2.5. the patient's creatine kinase was 39 with a troponin of 0.6. radiology/imaging: an echocardiogram status post catheterization revealed the patient had an ejection fraction of 15% to 20%, severe global left ventricular hypokinesis, and a normal right ventricle. there was 2+ mitral regurgitation. hospital course: the patient is a 75-year-old male with a history of diabetes, coronary artery disease, congestive heart failure, and chronic renal insufficiency who presented with a congestive heart failure exacerbation. 1. cardiovascular: from a coronary artery disease standpoint, the patient had 3-vessel disease with 40% left main lesion, 50% left anterior descending artery lesion, a 40% first diagonal lesion, a circumflex lesion with a 60% to 70% midvessel stenosis, a 70% proximal right coronary artery lesion, and a totally occluded first obtuse marginal. no intervention was performed on the patient's first catheterization. within 48 hours of the patient being in the coronary care unit, the patient developed an episode of bradycardia, hypotension, and hypoxic arrest requiring intubation and the use of pressors. in this setting, the question arose of possible ischemic mitral regurgitation in addition to viable myocardial compromise by rate-related ischemia. the patient was taken to cardiac catheterization four days later, at which point he received stents to his right coronary artery and first obtuse marginal. he was maintained on aspirin and plavix. from a myocardium standpoint, the patient had a right heart catheterization on presentation which showed elevated left-sided filling pressures with a mean pulmonary capillary wedge pressure of 37 mmhg. the patient initially required levophed and dopamine which was able to be weaned off within the first 24 hours after intubation. the patient was then started on afterload reduction with hydralazine and then nitrates. from a rhythm standpoint, the patient presented in normal sinus rhythm but then developed intermittent wenckebach until nine days into the admission when the patient developed atrial flutter without rapid ventricular response. the patient was anticoagulated and chemically cardioverted with ibutilide. the patient was eventually stabilized on a heart failure regimen that included hydralazine and isordil. 2. pulmonary: from a pulmonary standpoint, the patient was initially intubated for hypoxic respiratory failure secondary to flash pulmonary edema in the setting of known poor systolic function. the patient also had renal insufficiency in the setting of recent right nephroureterectomy. the patient was intubated for progressive hypoxia. he was started on continuous venovenous hemofiltration, and then the patient's clinical status improved. he was extubated two days later. twenty four hours later, the patient became progressively lethargic, developing ventilatory failure as well as hypoxemia, and the patient was once again reintubated. the patient was able to be extubated within approximately three days of intubation. the patient was once again extubated, and within 48 hours was reintubated for hypoxic respiratory failure. at that point, pulmonary was consulted and felt that the patient's multiple reintubations had to do with poor cardiac status limiting increase cardiac output and stress response to mild episodes of respiratory compromise including mucous plugging and aspiration. multiple meetings were held with the family regarding goals of care, and at all times they wished to pursue reintubation and resuscitation with the exception if the patient were to require long-term ventilatory care. they were amenable to tracheostomy and percutaneous endoscopic gastrostomy tube placement if needed. the patient was successfully extubated and did well status post third extubation. 3. infectious disease: the patient had presented with a low-grade temperature and possible right lower lobe infiltrate. he was empirically started on levaquin and flagyl. subsequent cultures grew only pan-sensitive enterococcus in his urine. the patient completed a 10-day course of levofloxacin and ampicillin for a urinary tract infection. when the patient experienced his decompensation status post initial extubation, he was started on vancomycin and ceftazidime for a possible line-related sepsis and ventilatory-associated pneumonia. this was continued for approximately seven days. after the patient's second extubation, he was found to have progression of a right lower lobe consolidation and was restarted on ceftazidime, vancomycin, and ciprofloxacin. this was to cover ventilatory-related pneumonia. the patient had a right femoral internal jugular tip which had grown out methicillin-resistant staphylococcus epidermitis for which he received a single dose of gentamicin. the patient was continued on coverage for ventilatory-associated pneumonia for 10 days; after which his antibiotics were discontinued. he had a normal white blood cell count at that time and was afebrile. 4. renal: the patient developed progressive oliguria in the setting of known chronic renal insufficiency within the first 48 hours of presentation. his acute renal failure was felt to be secondary to acute tubular necrosis from hypotension. the patient subsequently underwent two cardiac catheterizations which also were felt to have contributed to dye-associated nephropathy. the patient was initially started on continuous venovenous hemofiltration with excellent results and excellent control of his volume status. the patient was then started on hemodialysis. over the course of the admission, the patient did not have significant improvement in urinary output averaging about 600 cc per day. although possible renal recovery was not excluded, it appeared to the renal service that the patient would remain on prolonged hemodialysis. the patient had a perm-a-cath placed for durable hemodialysis access. 5. hematology: the patient presented with a low hematocrit which was initially thought secondary to chronic anemia. the patient had been anticoagulated for several of his catheterizations and after stent placement. he exhibited significant bleeding around lines and had multiple clot suctions in his endotracheal tube. anticoagulants were held. the patient was evaluated for dic, which laboratories were found to be normal. his hematocrit eventually stabilized. he was transfused with blood products to maintain a hematocrit of greater than 30. 6. gastrointestinal: the patient presented with borderline nutritional compromise. he was provided tube feeds through nasogastric tube. when the patient was extubated, he was evaluated for his swallowing and was found to aspirate significantly at the bedside. the patient was re-evaluated after his third extubation with video swallowing and was also found to have marked aspiration. after discussion with the family, a peg-j placement was elected. the patient underwent this procedure without difficulty. he will receive tube feeds until it is felt that his swallowing capacity may be re-evaluated. 7. ear/nose/throat: the patient complained of difficulty hearing after his second extubation. this was thought to be possibly secondary to drug effect; although the only ototoxin he received was gentamicin, and he had only received one dose of this. the patient had marked cerumen impaction on examination, and upon removal of the cerumen the patient's hearing improved slightly. after the patient's third extubation it appeared that his hearing had improved. he will likely need formal audiologic testing and possible hearing aide. 8. psychosocial: the patient remained full code throughout the admission. multiple discussions were held with the daughters and with the patient. he felt strongly that his daughters should make the decision for him regarding his health care. his daughters felt that he would want aggressive respiratory and ventilatory efforts as long as he was not to remain on machines indefinitely. condition at discharge: condition on discharge was good. discharge followup: the patient was discharged with followup with primary care physician's (dr. ) office within one week of discharge. discharge status: the patient was to be discharged to acute rehabilitation for ongoing conditioning and management of pulmonary hygiene. note: the remainder of this dictation will be dictated as an addendum as the patient approaches discharge. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using a single catheter insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis angiocardiography of right heart structures right heart cardiac catheterization diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery mitral valve disorders acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified atrial flutter acute respiratory failure 

Answer: The patient is high likely exposed to