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: admitted to micu s/p intubation for hypoxic respiratory failure. major surgical or invasive procedure: endotracheal intubation, central venous catheter placement, arterial line blood pressure monitor placement history of present illness: mr. is a year old rehab resident with history of chf, htn, cri, who developed shortness of breath this morning - circumstances are somewhat unclear as he had no report with him from heb reb. he was supposedly in his usual state of health when he was noted by staff this morning to be tachypneic, with rr in the 40s and o2 sat 70%. at the time his hr was also noted to be in the 20s. he was placed on a nrb with sats improving to 80s, and given atropine with improvement of hr to 40s. he was transported to ed. given 40 mg iv lasix by ems who noted 4+ le edema and rales of the way up lung fields. . on arrival to the ed his vitals were hr 28, bp 134/39, rr 30, o2 sat 73% on ra, 92% on nrb. though he is dnr, he agreed to intubation in the ed. he was intubated with etomidate, succinylcholine. he was given 3 mg atropine with increase of hr to 40s. he was also given glucagon and calcium for suspected bb vs ccb toxicity in the setting of an elevated creatinine. he was started on a dopamine drip for hr support (bp stable over 100 systolic prior). he also received 2 l ns, 2 amps of sodium bicarb for a hyperchloremic non-gap acidosis, and mucomyst for the possibility of a cta which he didn't have. lastly, they gave him ceftriaxone and azithromycin for question of lll pna. . labs were notable for a bnp of 1789, lactate 2.6. his k was 5.5, with widened qrs on ekg and he received calcium gluconate, insulin, d50. . on arrival to micu patient with temp of 103.8 rectal, on dopamine drip at 8 with decreasing maps when drip decreased. past medical history: 1) htn 2) cri: baseline cr 2.0-2.2 3) h/o chf (unknown ef) 4) rectal cancer s/p resection 5) anemia: baseline hct 33-35 6) gout 7) psoriasis social history: lives at rehab with wife. moved to us from 12 years ago. former textile worker. no tobacco or alcohol use family history: mother died of stomach cancer physical exam: gen: mildly overweight caucasian male, intubated and sedated, appearing comfortable. heent: anicteric sclerae, pearl. neck: could not evaluate jvp secondary to body habitus. cor: rr, normal rate, distant heart sounds. chest: b/l gynecomastia. no spider angiomata. lungs: rales at bases b/l from anterior auscultation. abd: hypoactive bowel sounds, soft, nd, no facial grimacing with palpation, no guarding. extr: large - approx. 10 cm in longest dimention - area of desquamation on lateral aspect of l upper arm, erythematous with serosanguinous drainage, no frank pus. hyperpigmented plaques on le b/l, warm, mildly erythematous. 2-3 cm ulceration on rle without exudate. genitals: no scrotal edema or erythema. pertinent results: cxr: impression: suboptimal study. apparent right-sided pleural effusion and ill-defined left lower lung zone opacity. . ekg on arrival: sinus bradycardia at 46 bpm with 1st degree av block (pr 280 ms), twi in v1-v3 which are old, rbbb (old). . ekg after dopamine: 61 bpm, unclear if buried in previous beat, vs. nodal rhythm. axis identical. . echo : the left atrium is mildly dilated. the inferior vena cava is dilated (>2.5 cm) c/w increased right atrial pressure. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional systolic function is normal. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is a minimally increased gradient consistent with mild aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: preserved global and regional biventricular systolic function. mild aortic valve stenosis. moderate pulmonary artery systolic hypertension. mild aortic regurgitation. . 03:32am blood wbc-20.0*# rbc-4.05* hgb-9.8* hct-32.3* mcv-80* mch-24.1* mchc-30.2* rdw-21.8* plt ct-200 03:32am blood neuts-80* bands-8* lymphs-5* monos-6 eos-1 baso-0 atyps-0 metas-0 myelos-0 03:55am blood wbc-25.7* rbc-4.43* hgb-10.4* hct-34.2* mcv-77* mch-23.4* mchc-30.4* rdw-22.9* plt ct-257 02:30pm blood plt ct-188 02:30pm blood pt-13.5* ptt-40.2* inr(pt)-1.2 02:30pm blood fibrino-572* 02:30pm blood ret aut-1.0* 02:30pm blood glucose-219* urean-82* creat-3.1* na-144 k-5.3* cl-117* hco3-13* angap-19 03:55am blood glucose-72 urean-86* creat-3.0* na-148* k-3.2* cl-120* hco3-15* angap-16 03:32am blood alt-72* ast-58* ld(ldh)-232 ck(cpk)-176* alkphos-312* totbili-0.3 02:30pm blood ck-mb-notdone ctropnt-0.12* probnp-1789* 09:30pm blood ck-mb-notdone ctropnt-0.14* 03:32am blood ck-mb-9 ctropnt-0.16* 04:32pm blood ck-mb-12* mb indx-5.4 ctropnt-0.15* 09:30pm blood hapto-162 02:30pm blood tsh-3.9 02:30pm blood t4-4.3* 03:32am blood cortsol-15.2 12:30pm blood cortsol-20.1* 01:04pm blood cortsol-21.8* 03:17pm blood po2-362* pco2-31* ph-7.24* calhco3-14* base xs--12 brief hospital course: a/p: year old male with htn, cri, chf though ef undocumented, here with hypoxic respiratory failure, bradycardia, hypotension, fever, uti, and acute on chronic renal failure. . 1) hypoxic respiratory failure: thought to be possibly multifactorial with component of chf and possible lll pna. small l pleural effusion on cxr, and possibly mild chf, though poor film. bnp 1800. pe was in differential, however given his acute on chronic renal failure ed did not do cta. decided to not do given no right heart strain on echo. covered for nosocomial pna c vanco/zosyn * 10 d course. failed multiple sbt trials of sedation limited by low respiratory rate. was extubated successfully 3 days prior to expiration and noted to have good o2 sats on face tent. also noted to have paradoxical abdominal movement with chest movement thought related to weakened diaphragm/deconditioning. noted to have marked rhonchi and significant difficulty clearing secretions. . 2) hypotension: patient seems to have become hypotensive only after intubation, likely from decreased venous return and sedating meds. was not hypotensive even in setting of hr 30. however, given t 103.8, uti and ?pna, tachypnea, met criteria for sepsis. place central venous line with cvp and svo2 monitor, bolused fluids. treated c hydrocortisone/fludricortisone * 7 d inappropriate stim test. over course of hospitalization, developed hypertension on dopamine drip; treated with hydralazine given persistent bradycardia. weaned dopamine off though noted to have decrease in uop c bradycardia; d/w team extensively re: flow vs. pressure in maintaining perfusion of kidneys. pt over course of hospitalization was able to maintain hr off dopamine. . bradycardia: appeared to be a chronic issue, with hr 40s on last admission a month ago. at that time, bb was held. he has been getting metoprolol and amlodipine at rehab. likely progression of sick sinus syndrome, also with av nodal conduction disease. unclear whether or not patient symptomatic as bp adequate prior to admission. spoke to cards re: pacer. they were reluctant to place pacer now given other issues (tenous resp. status, infxn). resolved over course of hsopitalization. . 4) uti: positive ua. uctx + for citrobacter/coag+staph. tx c 10 d course zosyn. pt. remained afebrile. . 5) acute on chronic renal failure: chronic renal failure presumably secondary to hypertension, now with acute creatinine elevation, likely secondary to hypoperfusion either in the setting of sepsis or poor forward flow. thought initially to be prerenal though persistence of elevated creatinine warranted further workup, urine electrolytes sent, noted to have + urine anion gap. renal consult called but pt. made cmo prior to interventions/further w/u. . 6) metabolic acidosis: hyperchloremic, non-gap, likely secondary to volume expansion with normal saline at first but then noted to have persistence of metabolic acidosis non gap even with fluid repletion c lr; see above. . 7) troponin elevation: in setting of elevated bnp and cri with superimposed arf, likely from cardiac stretch with impaired clearance. ck-mb most sensitive in setting of renal failure, and wnl, therefore low concern for acute coronary syndrome. also, ekg unchanged from baseline. repeat enzymes negative . 8) anemia: irone deficiency. chronic, appears to be slightly below baseline. last ferritin in very low (21). treated with iron supplements. . 9) hyperglycemia: patient with elevated finger stick in ed. no history of dm. started on riss with qid fs for tight glycemic control; then started on insulin gtt for tight sugar control . 10) code status: patient requested intubation in ed. pt. family alternated between full code and dnr/dni - thought initially to keep full code and intubate only if pt. undergoing a process that was reversible. after approx. 1 week of hospitalization and worsening resp. status (inability to protect airway) and unlikely possibility of regaining previous quality of life, pt. was made cmo by family. . - pt. made cmo by family. developed increasing secretions, worsening paradoxical abdominal movement with respiration, hypoxia, started on sedation. soon developed respiratory failure presumed hypoventilation/v/q mismatch and expired. medications on admission: allopurinol 100 mg qhs amlodipine 10 mg qday bethanechol 25 mg po tid calcitriol 0.5 mcg po qday epo 100 mcg sc q week colace 100 mg lasix 20 mg qday metoprolol 25 mg po qday kcl 20 meq qhs prednisolone 1% drops to r eye simethicone 80 mg po bid simvastatin 10 mg po qhs tamsulosin 0.4 mg po qhs tobramycin/dexamethasone ointment to r eye qhs acetaminophen 1000 mg po q6 hours prn maalox 30 ml prn senna 2 tabs qhs prn fluocinonide 0.05% ointment tp qday to hands discharge medications: none discharge disposition: expired discharge diagnosis: primary 1. bradycardia 2. sepsis 3. hypotension 4. acute renal failure 5. urinary tract infection discharge condition: expired discharge instructions: expired followup instructions: expired procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization infusion of vasopressor agent diagnoses: acidosis acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis aortic valve disorders hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute and chronic respiratory failure septic shock iron deficiency anemia, unspecified sinoatrial node dysfunction hyperosmolality and/or hypernatremia 

Answer: The patient is high likely exposed to