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: penicillins / sulfonamides / hytrin attending: chief complaint: "can't catch my breath after walking 20 feet or even button my pants!" major surgical or invasive procedure: paracentesis x2 history of present illness: 77yo m w/ copd with interstitial lung disease, pulm htn, severe cor pulmonale, and chronic renal disease who p/w worsening sob, increasing abdominal girth, and 20 lb wt gain for 2 weeks. pt reports feeling exhausted and "terrible." he is becoming short of breath after walking ~20-25 feet from the bathroom to the living room, having stop and catch his breath, which is unusual for him. at the same time, he was noted to have increasing weight--a gain of 20 lbs over 2 wks (198 -> 218 lbs). accordingly, he then developed "belly pain" and began having trouble buttoning his pants over his growing abd. because of these increasing symptoms, he was brought to the ed for further evaluation. of note, the pt has had a precipitous decline in his functional status since primarily due to symptoms of end-stage cor pulmonale from his severe pulm disease. in , pt developed similar symptoms of sob, abd distension, and wt gain and was hospitalized at for a total of 12 days. pt otherwise denies fever/chills, chest pain, palpitations, nausea/vomiting/diarrhea, headache/dizziness, or incontinence. past medical history: -- hypertension -- hyperlipidemia -- bph; s/p turp x2 -- gout -- impaired glucose tolerance -- interstitial lung disease with diminished dlco (thought to pulmonary fibrosis and emphysema as per pulmonary). b/l pleural thickening and honeycombing on ct. pt needs 2-3l, occasionally 4l, of continuous supp o2 at baseline, pt is able to ambulate independently w/o walker, cane, or assistance. -- end-stage cor pulmonale -- left ventricular diastolic dysfunction/heart failure -- obesity -- diabetes mellitus 2, diet controlled -- hiatal hernia -- sleep apnea -- r sided renal lesion -- ckd - baseline creatinine is 1.6-1.7 -- abdominal aortic aneurysm. -- constipation. -- hypothyroidism social history: lives at home with his wife of 50 years. stays on the of the house (can't climb stairs sob). has 6 children and 15 grandchildren-all healthy. was high school teacher for 7 yrs, elementary school principal for 12 yrs, and superintendent for 19 yrs. retired in and became a lobbyist for the retirees until 1/. quit smoking 20 yrs ago (1ppd x 20 yrs), rare etoh, no drug use. family history: non-contributory physical exam: tm 98.3, tc 96.3, hr 88 (50-80s), bp 100/67 (90-110s/40-60s), rr 20, 02 96% 4l (92-100%) admission wt 99.3kg, i/o: length of stay in micu -5.5l constitutional: pleasant elderly man sitting up in chair waiting for transfer. heent: nc/at. perrl. oral pharynx benign. cv: regular rate, irregular rhythm. loud p2. no m/r/g. pulm: b/l crackles up to mid lung fields. no wheezes. abd: severely distended, protuberant abd w/ significant fluid wave. soft yet slightly taut. nt. +bs extrem: mild clubbing present throughout b/l finger nails. mild r hand tremor at rest. b/l le 1+ pitting edema. skin: 2 scabs -- 1.5cm x 0.5cm and 0.5cm x 0.5cm at r inner leg. 1 broken blister w/ dried blood at l shin. l inner leg dried broken blister. dry, scaly skin w/ hyperpigmentation below mid-leg b/l. neuro: alert and oriented x 3. cn ii-xii intact. motor strength full () throughout b/l ue and le. mild r hand tremor at rest. only b/l biceps reflexes elicited, unable to elicit patellar, ankle, or triceps reflexes. downgoing toes b/l. proprioception intact at b/l toes. narrow-based gait. pertinent results: **********laboratory results********** 03:10pm blood wbc-7.4 rbc-4.50* hgb-11.8* hct-37.6* mcv-84 mch-plt ct-292 07:10am blood wbc-5.8 rbc-3.75* hgb-10.1* hct-31.3* mcv-84 mch-27.0 mchc-32.2 rdw-21.1* plt ct-274 03:10pm blood pt-16.5* ptt-26.7 inr(pt)-1.5* 03:10pm blood glucose-145* urean-44* creat-2.0* na-134 k-4.7 cl- 07:10am blood glucose-100 urean-36* creat-1.8* na-136 k-4.1 cl-94* hco3-30 03:10pm blood probnp-* 07:26pm blood digoxin-0.6* 03:13pm blood lactate-3.1* 07:46pm blood lactate-2.7* 4:11 pm peritoneal fluid. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. 3:10 pm blood culture venipuncture #1. blood culture, routine (final ): no growth. 3:25 pm blood culture venipuncture #2. blood culture, routine (final ): no growth. 11:38 am urine source: catheter. urine culture (final ): enterococcus sp.. >100,000 organisms/ml.. _______________________________________________________ enterococcus sp. | ampicillin------------ <=2 s nitrofurantoin-------- 64 i tetracycline---------- =>16 r vancomycin------------ <=1 s echocardiography at 2:01:13 pm the right atrium is markedly dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 10-20mmhg. normal left ventricular systolic function. the right ventricular cavity is dilated with severe global free wall hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. there is no mass/thrombus in the right ventricle. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is trivial mitral regurgitation. the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. the tricuspid valve leaflets fail to fully coapt. severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. the pulmonic valve leaflets are thickened. significant pulmonic regurgitation is seen. there is no pericardial effusion. impression: severe right ventricular dilation and hypokinesis with severe tricuspid regurgitation. right ventricular pressure/volume overload. severe pulmonary hypertension. no evidence of intracardiac shunt. single ap upright radiograph of the chest: there is a right lower lobe opacity in comparison with multiple prior studies, likely represents epicardial fat exaggerated by lordotic technique and patient rotation. with the exception of this, there are no focal consolidations. there is no pulmonary edema. there is no pleural effusion or pneumothorax. heart size is enlarged, stable. impression: no acute cardiopulmonary process. study date of 9:00 am right upper quadrant ultrasound: the liver echotexture is normal. there is no focal liver lesion or intrahepatic biliary ductal dilatation. the main portal vein is patent with the appropriate direction of flow, though flow is noted to be pulsatile. the heparic veins are also dilated. the gallbladder is normal without evidence of stones. the common duct is not dilated, measuring 2 mm. the pancreas is not visualized. the spleen is normal in size, measuring 8.5 cm. a moderate to large amount of ascites is seen in all quadrants. impression: probable passive hepatic congestion related to right-sided heart failure, particularly in light of relatively pulsatile blood flow in the portal vein. normal liver echotexture and spleen size. large amount of ascites. brief hospital course: mr. is a 77 year-old male with copd/interstitial lung disease, pulmonary hypertension, severe cor pulmonale, and chronic kidney disease who presented with exacerbation of cor pulmonale, worsening sob and 20 lb wt gain. in the , pt experienced hematemesis x 2. o2 sat of 80s on 4l nc and then 94-96% on nrb. pt was placed on bipap 10/5 and received 40 mg iv lasix x 2. lactate was 3.1 on admission, bnp , trop slightly above baseline of 0.02 to 0.04. pt was initially admitted to medicine for further treatment of his r-sided hf. on arrival to the medical , the patient was hypoxic w/ o2 sats in low 70s, bp 131/86, dyspneic at rr 44, tachy w/ hr of 92, as well as vomited 50cc of bloody contents upon arrival to the floor. he transferred to the micu for further monitoring and management. in the micu, pt was gently diuresed w/ iv lasix. a 4l paracentesis was performed. he became hypotensive (bp into the 70s-80s systolic) following the paracentesis. for this, he received total of 75g albumin over 2 days. once patient's vitals stabilized, he was transferred to the floor for further management. on the general medicine floor, the following issues were managed as described below. ## pulmonary fibrosis: pt has severe interstitial pulmonary disease refractory to treatment. it has led to severe pulmonary hypertension and end-stage cor-pulmonale. he requires given prior side effects of hypotension, tachycardia, and dizziness with a trial of sildenafil in the past (), no sildenafil was attempted during this hospital stay. patient was maintained on prn inhalers and continued on oxygen regimen increased from home dose of 4l. patient was also placed on cpap overnight. continued outpatient pulmonary follow-up with dr. will be needed. ## cor pulmonale: chronic. echo shows severe right ventricular dilation and hypokenesis w/ severe tricuspid regurgitation, as well as right ventricular pressure/volume overload. this is thought to be secondary to severe pulmonary fibrosis/pulmonary hypertension. there is no evidence of intracardiac shunt on echo. his right ventricular failure has led to hepatic congestion -> ascites -> b/l le edema. he was treated with aggressive diuresis as well as paracentesis x2. net total weight/fluid loss at the end of the hospital stay was approximately 20 lbs. discharge weight 87kg (day prior had been 92kg, before 2l paracentesis). patient was discharged with lasix 80 mg po bid with increased oxygen requirement at 5l nc satting between 90-94%. he goal 02 sat is >93%. ## hypotension: pt is relatively hypotensive at baseline with sbp typically 90-110. however, following his first paracentesis of 4l his bp did drop into the 70s-80s. he remained asymptomatic despite this drop in blood pressure. his blood pressure responded to albumin. of note, he underwent a 2nd therapeutic paracentesis of 2l and his blood pressure tolerated the lower volume tap. ## chylous ascites: the fluid was chylous in nature w/ high tg's. the cause of ascites secondary to hepatic congestion related to rh failure. abdomen remained significantly protuberant with dramatic fluid wave on exam despite paracentesis. patient received therapeutic paracentesis x 2. ## hematemesis: patient had episode of hematemesis on admission, though no subsequent episodes. he was evaluated by the gi service. egd was discussed but the patient preferred to hold on the procedure since there was no recurrence of following admission. his hct remained relatively stable in the low to mid-30s. given no further evidence of bleend and the patient's request to decrease the number of pills taken daily, protonix was discontinued during the latter half of the hospitalization. ## lv diastolic hf: echo showed 55% lv systolic function. ## insomnia: patient initially complained of insomnia, which was treated with home dose of 10 mg po ambien. ## hypothyroidism: clinically stable with complaints of cold intolerance but no other symptoms or signs of hypothyroidism. patient was maintained on home dose of levothyroxine. ## code: dnr/dni medications on admission: allopurinol 100 mg po qd lipitor 10 mg po qd bipap - 11cm inspiratory and 7 cm expiratory along with 4 l/min 02 cyclosporine 0.05 % 1 dropperette in the r eye fluoxetine 10 mg po qd lasix 80 mg po tiw, 60 mg qiw lactulose 10 gram qd or prn constipation levothyroxine 12.5 mcg po qd metoprolol tartrate 12.5 mg po bid prilosec 20 mg po qd prn gastric upset oxygen 4 liters/min continuously (recently increased from 3l nc) spironolactone 25 mg po qod digoxin 125 mcg qod (started ) verapamil recently discontinued () discharge medications: 1. oximeter please provide a pulse oximeter for use at home. goal oxygen saturations >95%. 2. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 3. fluoxetine 10 mg capsule sig: one (1) capsule po daily (daily). disp:*30 capsule(s)* refills:*0* 4. levothyroxine 50 mcg tablet sig: 0.25 tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. disp:*30 tablet(s)* refills:*0* 6. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours). 7. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day. disp:*30 tab sust.rel. particle/crystal(s)* refills:*0* 8. lasix 80 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary: pulmonary fibrosis, pulmonary hypertension, cor pulmonale, hypotension secondary: hypothyroidism, hematemesis, hepatic congestion, left ventricular diastolic heart failure, possible urinary tract infection, chylous ascites, insomnia discharge condition: stable. discharge weight 87kg (day prior had been 92kg, before 2l paracentesis) discharge instructions: you were admitted with shortness of breath, worsening edema, and weight gain of 20 lbs. this was due to your severe lung disease, which has caused heart failure. during your hospital stay, fluid was drained from your abdomen twice and you received lasix to removed additional fluid from your body. -you should take lasix 80 mg twice daily at home. this dose may need to be increased if you start gaining weight again. -you have also been prescribed potassium pills because your potassium levels have been low. -you should no longer take metoprolol, verapamil, spironolactone or digoxin. -you have been given a pulse oximeter. it is important that you check your oxygen levels when you are walking or exerting yourself to be sure that your oxygen level is above 90%. otherwise, while resting, you should monitor your oxygen saturation every 6 hours. -please keep your supplemental oxygen on at all times with a goal oxygen saturation > 93%. please use bipap every night. -weigh yourself every morning, call your primary care provider or pulmonary specialist, dr. , if weight > 3 lbs. please adhere to a diet of < 2 grams of sodium per day as well as fluid restriction of < 1.5 l per day. -please take all of your medications as prescribed. if you develop any shortness of breath, weight increase, ascites, chest pain, increased abdominal girth, worsened edema, severely low blood pressure, dizziness, blood in your stool, or any other symptoms of concern, please call your primary care physician or pulmonary specialist or proceed to the nearest emergency department. followup instructions: please follow-up with your physicians after discharge. the following appointments have been scheduled. provider: , md on at 11:50am phone: ( fax: ( provider: function lab phone: date/time: 8:40 place: , ***please arrive at 8:30am to undergo pulmonary function tests. . provider: , m.d. phone: date/time: 9:00 place: , procedure: percutaneous abdominal drainage diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified acute on chronic diastolic heart failure chronic kidney disease, unspecified other and unspecified hyperlipidemia acute respiratory failure postinflammatory pulmonary fibrosis other emphysema hemorrhage of gastrointestinal tract, unspecified chronic pulmonary heart disease, unspecified other noninfectious disorders of lymphatic channels 

Answer: The patient is high likely exposed to