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: sulfa(sulfonamide antibiotics) attending: chief complaint: bowel obstruction, copd, pna, nstemi major surgical or invasive procedure: s/p diverting colonostomy and lysis of adhesions on at history of present illness: 81yom with copd, parkinsons disease, asbestosis who presented to on with abdominal pain, distension, and cough, whose course was complicated by pna and nstemi, now being transferred to with hemodynamic instability. . the patient had reported difficulty moving his bowels, abdominal pain, and distension for 2 days prior to presentation to on . he had a leukocytosis of 12 with left shift of 80% pmn, 5% bands. he also reported upper respiratory symptoms with recent cxr showing only evidence of abestosis and had completed a course of zithromax. he was determined to have a bilateral lower lobe pna and was started on levofloxacin and then broadened to vanc/zosyn, and was given duonebs and methylprednisolone 40mg iv. he was also diagnosed with bowel obstruction and after three days of conservative management with ngt, enemas, ivf, he underwent an exploratory laparotomy with lysis of adhesions on and ?colectomy with diverting transverse loop colostomy. he had an ngt placed and was started on tpn for nutrition. post-op, he had a lateral wall nstemi believed to be due to demand ischemia, and a tte on showed a new diagnosis of severe aortic stenosis with normal ef. he was started on a heparin gtt. he was also found to be in an acute chf exacerbation with pulmonary edema on cxr, and was placed on a non-rebreather. he was subsequently diuresed with lasix 20-40 mg iv and had multiple episodes of hypotension. during his stay at , the patient's blood pressure and volume status was difficult to manage and he was intermittently on phenylephrine and neosynephrine. he has intermittently been on bipap and was weaned to a venti-mask the day of transfer. . additionally, the patient was also found to be anemic with a hct ranging from 30-40, and was given 1 unit prbc. he was also found to have an elevated d-dimer and underwent leni's which were negative for dvt. . on arrival to the micu, the patient was in moderate respiratory distress on a venti-mask and was also very anxious. he complained of abdominal pain at his colostomy and recent surgical site, but otherwise denied other pain. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. 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, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. . past medical history: - copd - asbestosis - severe aortic stenosis (valve area 0.7cm2) - dyslipidemia - diverticulosis - parkinson's disease - bipolar disorder - history of exploratory laparotomy - s/p bilateral knee replacement - s/p s/p diverting colonostomy and lysis of adhesions at on social history: - tobacco: denies current use. prior smoker. - alcohol: denies current use. - illicits: denies. married and lives with wife. retired shipyard worker and merchant seaman. family history: nc. physical exam: vitals: not listed general: alert, oriented, moderate respiratory distress heent: sclera anicteric, mmm, oropharynx clear, eomi neck: supple, jvp ~13-14 cm cv: regular rate, tachycardic, normal s1 + s2, no murmurs or extra heart sounds appreciate in the setting of diffuse rhoncherous upper airway noises throughout lungs: use of accessory muscles with labored breathing. tachypneic. diffuse rhonchorous upper airway noises throughout. crackles at bases bilaterally. minimal wheezes bilaterally. abdomen: soft, tender at midline surgical site, ostomy pink and intact, mild to moderately distended, hypoactive bowel sounds gu: foley in place ext: warm, well perfused, equal thready dp pulses b/l, no clubbing, cyanosis, trace pitting edema neuro: non-focal discharge: t98.1 bp 123/50 103-123/50-61, p 70s-80s, 96% ra, 24 h i/o . general: alert, oriented, appears quite comfortable with breathing heent: sclera anicteric, mmm, oropharynx clear, eomi neck: supple, jvp 10 cm cv: regular rate and rhythm, normal s1, inaudible s2, parvus et tardus, late peaking systolic murmur with radiation to carotids l>r vs carotid bruit, murmur heard across precordium lungs: mildly tachypneic. diffuse rhonchorous airway noises throughout. crackles at bases bilaterally. minimal wheezes bilaterally. abdomen: soft, tender at midline surgical site, ostomy pink and intact, mild to moderately distended, positive bowel sounds gu: no foley ext: warm, well perfused, equal thready dp pulses b/l, no clubbing, cyanosis, edema resolved neuro: non-focal pertinent results: osh labs : 131 96 30 -------------- 87 3.6 29 0.5 . ca 7.3, mg 2.0, phos 3.1 . ast 31, alt 5, tbili 0.5, albumin 1.9, tp 4.3 . 10.3 11.0 ------ 261 29.8 . pt 12.1, inr 0.96, ptt 24.6 . troponin i 0.52 . micro: bcx at : ntd peritoneal tissue: negative . images: cxr osh : chf has improved, decreased vascular congestion and pulmonary edema. smaller pleural effusions. atelectasis at the lung bases. ngt remains in position. . lenis : no dvt. . kub : large amount of feces in the right colon. several top normal air-filled dilated small bowel loops. small amount of air in the left colon. no definite free air. dense pleural calcifications noted. . ct abdomen/pelvis : modest hiatal hernia. patchy bibasilar airspace process - bibasilar atelectasis or subsegmental consolidations. extensive calcified pleural plaques. colonic dilation (transverse colon 8cm) to the dital colon with marked stool burden and associated physiologic small bowel obstruction. marked dilation of small bowel loops suggestive of obstructive pattern. no discrete transition zone. distal sigmoid diverticulosis without diverticulitis. small left inguinal hernia. . tte : ef 50-55%. preserved systolic function. borderline inferior wall hypokinesis. la enlargement. severe aortic stenosis (valve area 0.72 cm2, mean gradient 33mmhg). mild aortic regurgitation. mildly thick mitral valve with mitral annular calcification and mild mr. moderate tr. . admission labs at : 10:00pm blood wbc-15.5* rbc-4.85 hgb-13.4* hct-40.8 mcv-84 mch-27.7 mchc-32.9 rdw-15.2 plt ct-423 10:00pm blood neuts-86.0* lymphs-7.8* monos-4.5 eos-1.2 baso-0.5 04:10am blood hypochr-normal anisocy-1+ poiklo-1+ macrocy-normal microcy-1+ polychr-normal ovalocy-1+ ellipto-occasional 10:00pm blood pt-11.3 ptt-28.5 inr(pt)-1.0 10:00pm blood glucose-107* urean-38* creat-0.7 na-138 k-4.6 cl-101 hco3-29 angap-13 10:00pm blood alt-9 ast-43* ld(ldh)-278* alkphos-59 totbili-0.4 10:00pm blood albumin-3.5 calcium-8.9 phos-4.3 mg-1.9 10:00pm blood triglyc-66 07:40am blood vanco-12.9 04:06am blood digoxin-0.5* 09:50pm blood type-art temp-36.4 o2 flow-12 po2-71* pco2-50* ph-7.37 caltco2-30 base xs-1 intubat-not intuba 09:44am blood type-art temp-36.6 rates-/13 fio2-40 po2-88 pco2-47* ph-7.44 caltco2-33* base xs-6 intubat-not intuba vent-spontaneou 09:50pm blood lactate-0.7 04:22am blood freeca-1.06* at discharge: 08:04am blood wbc-8.7 rbc-3.67* hgb-10.4* hct-30.7* mcv-84 mch-28.4 mchc-34.0 rdw-16.3* plt ct-493* 08:04am blood glucose-161* urean-9 creat-0.8 na-139 k-4.0 cl-102 hco3-31 angap-10 micro: 10:00 pm mrsa screen source: nasal swab. **final report ** mrsa screen (final ): no mrsa isolated. 9:40 pm urine source: catheter. **final report ** urine culture (final ): no growth. urine legionella: neg blood cultures: ngtd =============== studies/images: =============== ecg study date of 10:51:48 pm supraventricular tachycardia. consider atrial flutter with 2:1 block. there are also two wide complex beats which may be ventricular. st-t wave abnormalities. no previous tracing available for comparison. clinical correlation is suggested. intervals axes rate pr qrs qt/qtc p qrs t 147 0 124 318/470 0 -13 152 # ct abd and pelvis with oral contrast on : findings: coronary and aortic annulus calcifications are seen. calcifications of the pericardium are seen. pleural plaques are seen. bilateral basilar atelectases are identified. abdomen: the liver is with no gross pathology. the gallbladder is within normal limits. there is no intra- or extra-hepatic biliary duct dilatation. calcifications of the spleen are seen. the pancreas is with no gross pathology. both kidneys are unremarkable. no stones or hydronephrosis are seen within the kidneys. the patient is status post colectomy with diverting double-barrel colostomy. diverticulosis is seen in the sigmoid colon without signs of diverticulitis. the small bowel is unremarkable. no signs of bowel obstruction are seen. no peritoneal lymphadenopathy is seen. there are no signs of retroperitoneal hematoma. note is made to a small fluid collection with small gas bubble within it along the incision line. the collection is anterior to the peritoneum and measures 25 x 58 mm (2, 47). atherosclerotic changes are seen along the course of the aorta. pelvis: foley catheter is seen within the urinary bladder, which is not fully distended. the prostate is within normal limits. small amount of fluid is seen in the presacral region. osseous structures: degenerative changes are seen in the spine with no concerning lytic or osteoblastic lesion. impression: 1. no evidence of hematoma. 2. post operation fluid collection along the incision line, as described. echo : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is critical aortic valve stenosis (valve area <0.8cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the function of the distal segments appears normal on the current study. estimated aortic valve area is slightly less. the other findings are similar. brief hospital course: 81yom with copd, parkinsons disease, asbestosis who presented to on found to have lbo s/p loop colostomy, course complicated by pna and vasopasm vs aborted stemi from thrombus or embolus w/ newly found severe as transferred to with hemodynamic instability now stable. echo results show mostly apical hypokinesis c/w possible stress induced cardiomyopathy now resolved. . #. respiratory distress: patient presented profoundly volume overloaded with labored breathing, elevated jvp ~13-14cm and crackles bilaterally, hypertension in the 180's systolic at admission which is consistent with fluid overload. also with evidence of multifocal pneumonia on ct chest from osh initially treated with levofloxacin then broadened to vanc/zosyn for which he completed an 8 day course. respiratory status significantly improved with diuresis, initially on lasix gtt then transitioned to boluses. he then had persistent hypotension for which lasix drip was held. he was maintained euvolemic off lasix with breathing back to baseline. pt with very mild swelling of extremities but given pt's preload dependence for blood pressure, further diuresis was held. . #. aborted mi vs vasospasm: patient had vasospasm or transient thrombotic/emobolic event post-op, causing i and avl st elevation with reciprocal lead depression seen on osh ekg. this resolved on further ekgs and the echo does not show focal deficits in this distribution. pt was given heparin at that time. most likely patient has stable cad with an acute event that spontaenously resolved given the very mild troponin elevation at osh and echo findings. pt had no chest pain, trops trended down, ekg unremarkable for ischemia while here. medical management was continued for stable cad, including aspirin 81 mg daily, atorvastatin 80 mg daily, and toprol 12.5 mg. pt should be considered for lhc/rhc with vasodilator trial for aortic valve eval, vessel evaluation, ?primary pulmonary hypertension given severe lung disease. . # acute on chronic systolic and diastolic chf from stress induced cardiomyopathy: pt initially grossly volume overloaded thought to be from diastolic failure secondary to aortic stenosis. echo on showed mild regional left ventricular systolic dysfunction with mostly apical hypokinesis, at least moderate pulmonary hypertension, and moderate diastolic dysfunction. pt responded well to lasix but became hypotensive with continued diuresis and this was held with restoration of blood pressure with gentle fluid boluses. on repeat echo before discharge regional wall motion abnormalities resolved. notably, pt did have i and avl st elevation which does not correspond with apical hypokinesis. most likely pt had a stress induced cardiomyopathy which may have exacerbated hypotension and volume overload on top of his diastolic dysfunction. the patient was tolerating metoprolol well at time of discharge. captopril was tried during hospitalization, but pt became hypotensive; most likely from too much afterload reduction for patient's aortic stenosis. . #. aortic stenosis: patient with severe aortic stenosis with valve area 0.8cm2. developed pulmonary edema and diastolic failure from this. management discussed above. cardiology follow-up as outpatient with possible cath and surgical avr evaluation if indicated. given severe lung disease and high pulmonary artery pressures on echo, would consider vasodilator trial as well if pvr high. . # hypotension: thought to be from severe as leading to significant pre-load dependence, stress-induced cardiomyopathy, multifocal pna, possible medication effects (seroquel and lorazepam). overdiuresis led pt to became hypotensive and episodes of hypotension also seemed to correlate with administration of seroquel for the patient's bipolar disorder. thus, patient was placed on haldol. pt's blood pressures were in the 110s-120s at discharge with maintanence of euvolemia as well as improvement in heart function on repeat echo. . #. atrial flutter: patient with evidence of 2:1 aflutter at 150 bpm for less than 48 hours, which resolved. most likely this was stress related. rates at that time controlled with metoprolol and digoxin. there was no need for anticoagulation given the event was <48 hours and pt had no recurrence. pt was continued on metoprolol for chf and cad and digoxin was stopped. . #. rue swelling: patient with rue swelling concerning for thrombus. rue us neg for dvt . #. parkinson's disease: - continue carvidopa-levodopa per home regimen . #. bipolar disorder: d/c??????ed seroquel given oversedation and hypotension. psych was consulted and recommended starting patient on haldol 1mg , however given hypotension this was decreased to 0.5mg . pt did well on this regimen. we retried seroquel before discharge, but this again resulted in hypotension, thus the patient was maintained on haldol. will need outpatient psych followup. . # s/p large bowel obstruction: patient presented to ohs with abd distention and was found to have ? large bowel obstruction. he had diverting colonostomy and lysis of adhesions on at . he now has a colostomy that has been draining liquid brown stool. he had a repeat abd ct with oral contrast on . our surgery team was consulted and he has possible lower l colon obstruction, past the stoma, concerning for malignancy. he will need to have a colonoscopy either from his rectum or from the stoma (if it is done from the stoma) he will need be at least 3 weeks post op. he is tolerating his diet well. staples were removed here, but retention sutures to be removed in 30 days from surgery by surgeons at . . # anemia: labs c/w mix of anemia of chronic disease and , but predominant acd likely given lower serum iron, low tibc and transferrin, and normal ferritin. would tend to expect high ferritin but possibly normal from and possible given left colonic obstruction/mass. . # code: full (confirmed with pt) . transitional: 1) the surgeons at who did your colostomy. they should remove the sutures a month from the surgery and decide how they would like to proceed with the colostomy 2) gi doctors who will need to perform a colonoscopy for concern of lower left colon obstruction 3) your pcp . who is aware of these health issues 4) cardiology who will you for aortic valve repair as well as coronary disease 5) lung doctors your copd and absestosis 6) neurology for your parkinsons 7) psychiatry for bipolar medications on admission: home medications: ( records) - guaifenesen/codeine 5ml qid prn cough - oxybutynin 10 mg daily - neurontin 600 mg tid - combivent 2 inhalations qid - ventolin 2 inhalations qid prn - senokot 2 tabs qhs - docusate 200 mg qhs - seroquel xr 600 mg qhs - carbidopa/levodopa 25/100 mg 2 tabs tid - clonazepam 0.5 mg po daily . transfer medications: - metoprolol 25 mg po tid - atorvastatin 80 mg po qhs - aspirin 325 mg daily - vancomycin - zosyn 3.375 iv q6h - seroquel 400 mg qhs - digoxin 0.125 mg po daily - lactobacillus 1 tab - pantoprazole 40 mg iv daily - insulin regular sc sliding scale - tylenol 650 mg po prn - albuterol/ipratropium nebs q4h - docusaete 200 mg qhs - senna 10 ml qhs - carbidopa/levodopa 2 tabs tid po - clonazepam 0.5 mg po daily - oxybutynin 10 mg po daily - albuterol inhaler prn - gabapentin 600 mg po with meals - guaifenesin/codeine 5 mg qid prn - zofran 4 mg iv q6h prn - fentanyl iv - phenyleprhine gtt - norepinephrine gtt - heparin iv gtt - tpn discharge medications: 1. oxybutynin chloride 10 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 2. neurontin 600 mg tablet sig: one (1) tablet po three times a day. 3. combivent 18-103 mcg/actuation aerosol sig: two (2) inh inhalation four times a day. 4. xopenex hfa 45 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 unit* refills:*2* 5. senna 8.6 mg tablet sig: two (2) tablet po at bedtime. 6. docusate sodium 100 mg capsule sig: two (2) capsule po at bedtime. 7. carbidopa-levodopa 25-100 mg tablet sig: two (2) tablet po tid (3 times a day). 8. clonazepam 0.5 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 9. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 11. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*0* 13. toprol xl 25 mg tablet extended release 24 hr sig: 0.5 tablet extended release 24 hr po once a day. disp:*30 tablet extended release 24 hr(s)* refills:*0* 14. haloperidol 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: home with service facility: homecare discharge diagnosis: primary: aortic stenosis, pneumonia, hypotension, coronary vasospasm vs aborted stemi, acute systolic and diastolic heart failure secondary: parkinson's, bipolar discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to for low blood pressure in the setting of a pneumonia and severe aortic stenosis. you had a recent surgery at for a large bowel obstruction after which you developed many complications including pneumonia, heart failure, low blood pressure, and a small heart attack. you were treated with antibiotics, diuretics, and medications to help improve your heart function. it will be very important for you to follow up with your outpatient providers as you have many medical conditions that need follow up. this includes: 1) the surgeons at who did your colostomy. they should remove the sutures a month from the surgery and decide how they would like to proceed with the colostomy 2) gi doctors who will need to perform a colonoscopy for concern of lower left colon obstruction 3) your pcp . who is aware of these health issues 4) cardiology who will you for aortic valve repair as well as coronary disease 5) lung doctors your copd and absestosis 6) neurology for your parkinsons 7) psychiatry for bipolar the following changes were made to your medication: stop seroquel as this medication seemed to be tied to low blood pressure. this can be tried again when you are healthier at the discretion of your psychiatrist and primary care physician start haldol for bipolar disorder start atorvastatin for coronary artery disease start xoponex inhaler for copd stop albuterol inhaler (if xoponex is not covered by your insurance, then it is okay to continue using albuterol instead) start toprol for coronary artery disease start aspirin for coronary artery disease start multivitamin followup instructions: **it is recommended you schedule a follow up with your primary care physician 1 week of discharge.** the following appointments were made for you: department: cardiac services when: friday at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: pulmonary function lab when: thursday at 2:40 pm with: pulmonary function lab building: campus: east best parking: garage department: pft when: thursday at 3:00 pm department: medical specialties when: thursday at 3:00 pm with: rn/dr. building: sc clinical ctr campus: east best parking: garage md, procedure: parenteral infusion of concentrated nutritional substances central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation aortic valve disorders atrial flutter other and unspecified hyperlipidemia paralysis agitans hypotension, unspecified alkalosis acute myocardial infarction of unspecified site, initial episode of care bipolar disorder, unspecified asbestosis diverticulosis of colon (without mention of hemorrhage) colostomy status acute on chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to