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 attending: chief complaint: hypotension major surgical or invasive procedure: rij placement history of present illness: 63 yo m w bipolar disorder, htn, iddm2, le ulcers, chf (ef = 20%) and prior cva presenting from his pcps office after being section 12'd in the setting of hypotension. the patient is a very poor historian but reports that he has had shortness of breath productive of thick sputum over the past 3-4 days. he denies any hemoptysis. he has also had substernal chest pressure associated with diaphresis although without radiation. he is unable to characterize further or describe in what setting this chest discomfort occurs. he also endorses poor po intake but denies fevers, chills, nightsweats. he reports that his friend is dying of hcv and lung cancer and he is inside of him. he states that he would not have gone to the doctor's but his vna was concerned about his le ulcers. the patient does also endorse increased le pain. he was sent into the ed from his pcps on a section 12 with sbps in the 70s, and was admitted to the icu. . upon arrival to the ed, his vs were: 99.1 65/47 73 98% ra. exam was notable for a cantancerous male with left sided crackles and le ulcers. labs were notable for a creatinine 1.7, trop 0.02 and an inr 1.6. a cxr was c/f left sided pna. given hypotension, a fast exam was done and the patient was given 1l ns bolus. after fluid bolus the patient become sob w abg 7.34/50/177 and was placed on cpap with reported improvement. fast exam showed free fluid so a ct a/p was done. this showed likely cirrhosis, ascites and arf. the patient was given vanc and zosyn. an ekg was done and showed a rbbb reportedly unchanged from prior. a rij was placed and the patient was started on a levophed gtt. vs prior to transfer 77 97/65 18 100% cpap 6 fio2 40. . upon arrival to the floor, the patient reports feeling much improved. he says that he lived with the devil for years and he should have never let the devil into his home. he states that the devil took his foot off. past medical history: iddm2 prior cva htn bipolar disorder afib on coumadin cad w cabg *4 in , mi in his 40s pvd chf w ef 25-30%, moderate to severe pulmonary htn on tte in tremor diabetic neuropathy with resultant transmetatarsal amputation of the left foot osteomyelitis and right foot ulcer tobacco abuse social history: the patient reports smoking an unknown quantity of tobacco since he was 22 years old. he reports that he is a recovering alcoholic and does not do any recreational drugs. he is unwilling to provide any further history. family history: unable to obtain. physical exam: vitals: t 98.6 bp 98/60 rr20 hr 76 o2 sat 95% ra weight 92.9 kg general: nad. oriented x3. mood, affect appropriate. heent: sclera anicteric. cardiac: rrr lungs: resp were unlabored, no accessory muscle use. crackles at bases bilaterally abdomen: soft, nt, nd.bs present extremities: bilateral erythema, skin changes in lower extremities, erythema with skin peeling pertinent results: admission labs wbc-9.1 rbc-3.63* hgb-10.1* hct-32.1* mcv-88 mch-27.8 mchc-31.5 rdw-16.2* plt ct-163 neuts-81.4* lymphs-11.0* monos-4.4 eos-2.7 baso-0.5 pt-17.6* ptt-30.5 inr(pt)-1.6* glucose-174* urean-38* creat-1.7* na-134 k-4.3 cl-98 hco3-28 angap-12 ctropnt-0.02* ck-mb-3 ctropnt-<0.01 probnp-6317* albumin-3.3* calcium-8.1* phos-3.9 mg-2.1 digoxin-0.8* lithium-0.6 asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg type-art rates-/34 po2-177* pco2-50* ph-7.34* caltco2-28 base xs-0 intubat-lactate-2.0 k-4.1 reports ct a/p:impression: 1. cirrhosis and splenomegaly. 2. mild simple ascites and marked body wall edema. 3. delayed bilateral renal contrast excretion; recommend close monitoring of renal function as contrast induced nephropathy is a concern. 4. 4-cm infrarenal aaa. 5. bilateral adrenal fullness, likely reactive hyperplasia. 6. diverticulosis without diverticulitis. tte:the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. there is severe global left ventricular hypokinesis with near akinesis of the inferior wall and mild dyskinesis of the aneurysmal apex (lvef = 25 %). cardiac index is depressed (<2.0l/min/m2). no masses or thrombi are seen in the left ventricle. right ventricular chamber size is mildly increased with focal hypokinesis of the apical free wall. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: biventricular cavity enlargement with global and regional systolic dysfunction c/w diffuse process (multivessel cad, toxin, metabolic, etc.), pulmonary artery hypertension. moderate to severe mitral regurgitation. moderate tricuspid regurgitation. dilated ascending aorta. cxr:chest, ap: examination is suboptimal due to underpenetration. changes of cabg are seen, with median sternotomy wires and mediastinal clips. mild cardiomegaly is present. other than some retrocardiac atelectasis, the lungs are clear. there is no pneumothorax or pleural effusion. impression: mild cardiomegaly. no consolidation. ruq u/s: impression: 1. cirrhosis, splenomegaly, and ascites. 2. partially distended gallbladder with wall thickening. this is likely reactive, given absence of symptoms is less worrisome for acute cholecystitis. brief hospital course: 63 yo m w bipolar disorder, htn, iddm2, le ulcers, chf (ef = 20%) and prior cva presenting from his pcp's office with hypotension, recent cough/sob and chest pressure as well as increased le ulcer pain. brief hospital course by problem #. hypotension. the etiology of his initial hypotension was unclear, however it improved with diuresis, suggesting possible cardiogenic shock. per review of clinic notes, he also has history of low sbp 80s-90s at baseline so likely was not too far from baseline and had low reserve. hypotension improved with diuresis and antibiotics for question of pneumonia, and he was weaned off levophed . it was also possible that he took more of his home antihypertensives given his confusion and delirium with mania on initial presentation. his blood pressures were monitored and were stable with sbp 90-120. he was kept on a low salt diet. on discharge, he was started on lasix po 60 mg once a day, lisinopril at home dose, and coumadin. will ask patient to f/u with pcp and have inr checked. per outpatient records, patient is on coumadin for afib ( score of 2 for dm and chf) . #. sob/cough in the setting of systolic chf. the patient may have had bronchitis although unlikely to have pna with a clear xray and lack of need for oxygen aside from in the setting of what sounds like acute pulmonary edema after receiving a fluid bolus. he was started on levofloxacin/ceftriaxone for presumed cap; changed levofloxacin from iv to po ; after which he remained afebrile and wbc normalized with no sx of pna. levofloxacin 750 mg po/ng discontinued on and ceftriaxone 2 gm iv q24h discontinued . he was kept on ipratropium bromide neb 1 neb ih q4h and albuterol 0.083% neb soln 1 neb ih q4h until discharge. he was weaned off of oxygen. . # chest discomfort in the setting of known cad. ekgs: sinus rhythm. baseline artifact. right bundle-branch block. prior inferior myocardial infarction. compared to the previous tracing of right bundle-branch block is now recorded. trended cardiac enzymes which were negative. he was kept on metoprolol at home dose as well as statin at home dose and aspirin. #hit: platelet count decreased by 50% from admission to . on , heparin discontinued and hit antibodies ordered. he was re-started on coumadin. discharge inr 1.4. hit antibodies pending. . # le ulcers/ possible cellulitis. vancomycin given in icu admission due to concern for cellulitis (pt had leukocytosis on admission). exam demonstrates skin changes consistent with chronic changes secondary to stasis and volume overload. white count normalized . discontinued vancomycin . wound care consulted and followed patient during hospital course. patient remained afebrile. . # ascites ct, asterixis in exam, elevated inr, low albumin. likely cirrhosis. uncertain history regarding alcoholism/hepatitis exposure. no para given too little fluid and unlikely to have sbp. records obtained from pcp, comment on liver disease. hepc rna was negative. patient was started on lactulose 30 ml po/ng tid titrate to 4 bms daily. patient will need outpatient liver f/u. . # arf. unclear baseline although normal in . likely pre-renal physiology vs ckd in the setting of dm. : cr 1.0; 6/26:0.9, 6/27:1.1. per ct , delayed bilateral renal contrast excretion; recommend close monitoring of renal function as contrast induced nephropathy is a concern. urine culture negative, urine tox (-), urine lytes: urea 385, na 24, k28, cl17, uric ac 34.5, osm 323. he was restarted on digoxin and lisinopril on . . # iddm. he was maintained on home (slightly decreased dose of 40 units) and sliding scale. he was kept on a diabetic diet. blood sugars were well-controlled during hospitalization, mostly 100-150s. will discharge on 40 units once a day and ssi. . # delusions/paranoia: patient with known bipolar disorder. psychiatry was consulted and recommended risperdal 2mg qhs and 0.5 mg po qam as well as lithium carbonate 300 mg po bid. daily lithium levels were normal. tsh was 1.7. will discharge patient on the increased dose of risperdal. . # bph. continue finasteride 5 mg po daily. . # aaa. 4 cm aaa on ct. patient will need outpatient f/u. have asked patient to see pcp for /u. . #social. social work consulted: coordinated hcp( , ). pt consulted. . ## communication: patient (: ) # code: full code, would not want to be intubated>7 days; hcp form signed and will be nephew in nc with as alternate #weight on discharge: 92.9 medications on admission: (per outpatient records): 65u qam lasix 80mg po bid warfarin unclear dosing kcl 10meq daily humalog 6u qmeal metoprolol sr 25mg po daily finasteride 5mg po daily lisinopril 5mg po daily mvi simvastatin 40mg po daily digoxin 125mcg daily risperdol 0.5mg q am, 1mg qpm omeprazole 20mg daily lithium 300mg po bid metolazone 2.5mg as directed discharge medications: 1. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*125 tablet(s)* refills:*2* 2. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. lithium carbonate 300 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). disp:*60 tablet sustained release(s)* refills:*2* 7. risperidone 0.5 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). disp:*30 tablet(s)* refills:*2* 8. risperidone 2 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 9. outpatient lab work please have inr and chem 7 monitored on tuesday, 10. 100 unit/ml solution sig: 40 units subcutaneous once a day. disp:*1 vial* refills:*2* 11. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 12. lasix 20 mg tablet sig: three (3) tablet po once a day. disp:*90 tablet(s)* refills:*2* 13. insulin regular human 100 unit/ml (3 ml) insulin pen sig: ssi subcutaneous at meals and bedtime: please take insulin according to sliding scale at meals and bedtime. disp:*1 vial* refills:*2* 14. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 15. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day). disp:*2700 ml(s)* refills:*2* 16. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: hypotension heart failure le ulcers/cellulitis cirrhosis acute renal failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the hospital for hypotension. you were treated with fluids and pressors. you had ulcers in your legs and cellulitis. you were treated with wound care and antibiotics. you had shortness of breath which was treated with antibiotics and nebulizer breathing treatments. please make the following changes to your medications: decrease lasix 80 mg twice a day to 60 mg once a day until instructed to change your dosing by your primary care provider. 65 units once a day to 40 units once a day. increase risperdal 1 mg at bedtime to 2 mg at bed time. stop metolazone. start coumadin 5 mg once a day followup instructions: please have your blood drawn by wednesday to have your inr and kidney function monitored. . please make an appointment to see a liver doctor. who: call: ( . please keep your previously scheduled appointments as listed below: . surgery: dr. tuesday at 10 am. primary care: dr. thursday at 11 am. phone: . psychiatry: dr. at noon. phone: . procedure: venous catheterization, not elsewhere classified diagnoses: thrombocytopenia, unspecified mitral valve disorders congestive heart failure, unspecified alcoholic cirrhosis of liver acute kidney failure, unspecified other and unspecified alcohol dependence, in remission chronic airway obstruction, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes hypotension, unspecified cellulitis and abscess of leg, except foot long-term (current) use of anticoagulants abdominal aneurysm without mention of rupture acute on chronic systolic heart failure bipolar disorder, unspecified ulcer of other part of lower limb venous (peripheral) insufficiency, unspecified 

Answer: The patient is high likely exposed to