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: cough, fever, hypotension, tachycardia major surgical or invasive procedure: central venous access, history of present illness: 89 year old male with recent gastrointestinal bleeds attributed to gastric ulcer, status post mechanical aortic valve replacement on coumadin, chronic kidney disease, history of nstemi in , who presented from rehab with fevers and anemia. of note, patient has a history of gi bleeds of unknown etiology, so receives periodic transfusions at rehab. earlier this week, he was noted to have hct of 21. he was given 2u prbcs over 2 days on and . on he had a t 101.8 with dry, non productive cough. on morning of admission, t 99.6, hr 96 bp 80/60 rr 24. 95% on ra. he became tachycardic with hr 147 and was transferred to . . in the ed, initial vs were: t 97.9 p 147 bp 89/57 rr 32 o2 99% on ra. patient became febrile to t 101, bp in 70s, hr in 150s. this persisted for 2 hours despite 1.5l iv fluids. there was some delay in transfusing the patient given crossmatching requirements. once the patient received 1u prbcs, bp normalized, as high as 160s. hr came down to 100s. patient was notably guaiac negative. a ct abdomen was performed to eval for mesenteric ischemia, which was negative. the patient was given vanc, levo, flagyl empirically with concerns for sepsis. a r ij was placed in the ed. . after receiving 1.5l ivfs and 1u prbcs, patient sounded slightly fluid overloaded on exam. he was given 40mg iv lasix, and put out 400cc urine. . vitals prior to transfer were hr 105, bp 117/54 rr 22 o2 100% on 5l nc. . on the floor, patient says that he feels weak. denies pain. but cannot provide further history. . review of systems: (+) per hpi (-) denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain. past medical history: # listeria endocarditis s/p avr, suppressive amoxicillin stopped due to hemolytic anemia, previously on prednisone # hx recent gi bleeds: colonoscopy : noted normal colon, hemorrhoids # aortic mechanical valve, last inr 2.0 # gerd: egd with non-bleeding ulcers in esophagus and stomach # anemia from gi bleed of gastric ulcer vs. hemolytic anemia from avr # ckd 1.6-2.0 # cad s/p nstemi # h/o likely diastolic chf on diuretics # hyperlipidemia # hypertension # depression since death of his brother # prostate ca- s/p radiation # bladder/bowel incontinence # right lateral malleolus stage 1 pressure ulcer social history: he was born in ny and has been a book binder all of his life. he moved to to be closer to his son. does not smoke or drink currently. he was just transferred to rehab, but also lived at the . his brother recently died. he requires a significant degree of assistance in all his adls and iadls. family history: non contributory. physical exam: vitals: t: 102.1 bp: 93/60 p:99 r: 30 o2:99% on 4l general: a+ox1. mouth breathing, intermittently at rate of 40, though denies dyspnea. heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, though difficult to assess given r ij, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley present ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs on admission: 11:50am blood wbc-1.7*# rbc-1.86*# hgb-6.5* hct-21* mcv-115*# mch-34.8*# mchc-30.4* rdw-15.6* plt ct-102*# 11:50am blood pt-27.6* ptt-52.0* inr(pt)-2.7* 08:16pm blood fibrino-462* 08:16pm blood ret man-5.6* 08:16pm blood glucose-138* urean-27* creat-1.5* na-139 k-3.5 cl-105 hco3-23 angap-15 11:50am blood alt-11 ast-28 ld(ldh)-283* ck(cpk)-22* alkphos-36* totbili-0.7 11:50am blood ctropnt-0.02* 08:16pm blood calcium-7.2* phos-3.4 mg-1.7 11:50am blood hapto-<5* 03:22am blood tsh-4.8* 12:03pm blood glucose-113* lactate-1.7 na-137 k-3.4* cl-108 calhco3-23 labs on discharge: 04:21am blood wbc-3.5* rbc-2.26* hgb-7.9* hct-24.8* mcv-109* mch-34.7* mchc-31.7 rdw-19.4* plt ct-101* 04:21am blood pt-34.9* ptt-82.8* inr(pt)-3.6* 04:21am blood glucose-80 urean-28* creat-1.4* na-144 k-3.0* cl-111* hco3-21* calcium-6.9* phos-2.7 mg-1.8 01:07pm blood type-art po2-115* pco2-34* ph-7.42 caltco2-23 microbiology: blood cx: pending urine cx: pending studies: interstitial abnormality in the right lung including a central bronchial cuffing and basal septal thickening is probably pulmonary edema though heart is normal size and there is no pleural effusion. the patient has had a cardiac valve replacement, probably aortic. brief hospital course: 89 yom with history of gi bleeds, presenting with anemia, hypotension, tachycardic episode in the ed, concerning for septic shock. . # hypotension, tachycardia: patient had sbps in 70's, with hr in 150's, along with documented fever at rehab and in the ed, initially concerning for septic shock. the most likely source was thought to be pneumonia given tachypnea and fevers; however, there was no clear initial infiltrate on chest x-ray. ct abdomen was performed evaluating for additional source of infection but was negative. patient was started on vancomycin and zosyn for hcap and tamiflu for possible h1n1 infection. a nasal pharyngeal aspirate was obtained for flu and was negative. tamiflu was discontinued. urine legionella ag was also obtained and was negative. cardiac enzymes were cycled, trended upward and rapidly declined without mb fraction change, attributed to likely demand ischemia. patient received 1 unit of prbc's for demand ischemia. patient was transiently started on pressors for bp support but was quickly weaned off on day 2. by day 3, bp was stable 110's and patient remained in nsr in 80's. echo was performed to evaluate aortic valve which was unremarkable. . # macrocytic anemia: hct 21. patient has h/o of melanic stools, though with recent colonoscopy, egd, and capsule study without obvious source. guaiac negative in the ed. other etiologies that were entertained included hemolysis mechanical valve vs. auto-immune process, vs. mds. initial haptoglobin was < 5. patient also had h/o hemolysis amoxacillin. patient initially presented with pancytopenia which was felt to result from mds. spep, upep were performed. coombs test was performed and was possitive, suggesting auto-immune process. . # aortic mechanical valve: patient on coumadin as outpatient which was held for concern of bleeding. at the time of discharge, inr remained therapeutic and coumadin remained held. . # respiratory status: patient hypoxic in the ed in the setting of iv fluids and prbcs. cxr was consistent with mild fluid overload. patient was tachypneic, though denied discomfort. jvp not obviously elevated, no crackles on exam. abg in ed within normal limits. patient was diuresed with several boluses of iv lasix with good output. patient maintained good oxygen sats and was saturating at 96% on ra at the time of discharge. . # cad s/p nstemi: cp free. however hypotension and tachycardia could be in the setting of new ischmic event. cardiac enzymes were cycled. troponins initially increased but quickly decreased not accompanied by mb fraction. this was thought to have resulted from demand ischemia. patient was continued on outpatient statin and metoprolol. . medications on admission: 1. simvastatin 80 mg po daily 2. metoprolol tartrate 12.5 mg po daily 3. omeprazole 20 mg po daily 4. vitamin d 1,000 unit po daily 5. calcium carbonate 650 mg (1,625 mg) po bid 6. ferrous sulfate 325 mg (65 mg iron) po daily 7. bisacodyl pr pod 8. warfarin 3.5 mg po daily 9. tylenol 325mg po q6h prn pain, fever 10. synthroid 50mcg po daily discharge medications: 1. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 2. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain, fever. 4. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for wheezing. 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 8. docusate sodium 100 mg capsule sig: one (1) capsule po daily (daily) as needed for constipation. 9. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours) for 5 days. 10. piperacillin-tazobactam 2.25 gram recon soln sig: one (1) recon soln intravenous q6h (every 6 hours) for 5 days. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary - pneumonia secondary - autoimmune hemolytic anemia (coomb's +) discharge condition: patient was alert and oriented, conversant, comfortable, saturating at 96% on ra. discharge instructions: mr. , you were admitted to the hospital for low blood levels, fever and hypotension concerning for a serious infection. we do not believe that you are bleeding from anywhere at this time. instead, we believe your blood levels may be low as a result of an auto-destructive process. we also discovered that you likely have a lung infection. this will require several days of iv antibiotics. followup instructions: you will continue your treatment at a rehab facility. after discharge from the rehab facility, you should follow up with your primary care provider for further evaluation. procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified congestive heart failure, unspecified unspecified septicemia severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of malignant neoplasm of prostate acute on chronic diastolic heart failure chronic kidney disease, unspecified other and unspecified hyperlipidemia septic shock old myocardial infarction long-term (current) use of anticoagulants autoimmune hemolytic anemias 

Answer: The patient is high likely exposed to