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: worsening angina major surgical or invasive procedure: urgent coronary bypass grafting x2 with a reverse saphenous vein graft from the aorta to the first diagonal coronary artery; reverse saphenous vein graft from the aorta to the left anterior descending coronary artery placement of picc line tracheostomy peg placement history of present illness: mr. is a 44 year old jehovah witness with known coronary artery disease s/p des of om lesion , grade 1 diastolic dysfunction, and chronic pericarditis who presented to outside hospital with increasing angina on exertion. cardiac catheterization at revealed significant lm disease. patient was deemed to be poor surgical candidate and was subsequently transferred to the for further evaluation and treatment. past medical history: - coronary artery disease, s/p inferior mi(stemi), s/p drug eluting stent to obtuse marginal - history of positive ppd, negative cxr - chronic pericarditis - hypertension - hyperlipidemia - type ii diabetes mellitus social history: originally from , lives with wife and 2 children. denies tobacco and etoh. family history: denies premature coronary artery disease physical exam: pulse: 87 bp: 102/77 rr: 25 o2 sat: 100% height: 74 inches weight: 86 kg general:a&ox3 skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema varicosities: none neuro: grossly intact pulses: femoral right: left: dp right: 2+ left:2+ pt : left: radial right: 2+ left:2+ carotid bruit none right: 2+ left:2+ pertinent results: echocardiogram: the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. there is moderate regional left ventricular systolic dysfunction with akinesis of the basal to mid inferolateral wall, hypokinesis of the anterolateral wall. overall left ventricular systolic function is mildly depressed (lvef= 45 %). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. chest cta: 1. acute pulmonary embolus in the left descending pulmonary artery, extending in the lingula, and basal truncus, involving more than half of the vessel lumen. no evidence of right heart strain. 2. no pneumonia. no evidence of active, or chronic granulomatous disease. lower extremity ultrasound: no evidence of deep vein thrombosis in either leg. carotid ultrasound: right ica with no stenosis. left ica with no stenosis. intraop tee: pre-cpb: 1. the left atrium is mildly dilated. no spontaneous echo contrast is seen in the left atrial appendage. no thrombus is seen in the left atrial appendage. 2. no atrial septal defect is seen by 2d or color doppler. 3. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is mildly depressed (lvef= 40 %). there is moderate lateral hypokinesis. 4. right ventricular chamber size and free wall motion are normal. 5. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. 6. there are three aortic valve leaflets. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. 7. the mitral valve appears structurally normal with trivial mitral regurgitation. the pericardium may be thickened. **prior to bypass, there was an episode of hypotension with ekg changes. tee showed severe hypokinesis of the anterior and anteroseptal walls, with an lvef of 10 %. cpr was initiated and the patient emergently placed on cardiopulmonary bypass.** post-cpb: on infusions of vasopressin, epi, norepinephrine, milrinone. in sinus rhythm. improved anterior wall on inotropic support, with lvef now 35%. mr remain trace. there is no change in the aortic contour post decannulation. head ct scan: 1. limited study due to patient motion. a small hypodensity in the right parieto-occipital lobe is of indeterminate age, likely chronic. no acute intracranial hemorrhage or acute major vascular territorial infarction. 2. marked paranasal sinus disease as above. eeg: this is an abnormal video eeg study because of severe diffuse background slowing and disorganization. these findings are indicative of severe diffuse cerebral dysfunction, which is etiologically non-specific. there were no epileptiform discharges or electrographic seizures. mri head/brain: 1. innumerable punctate foci of signal on the diffusion-weighted images, many of which are also bright on flair suggestive of multiple acute, likely embolic, infarcts. a more confluent area of flair signal abnormality in the right posterior temporal lobe could be another area of older infarct. 2. scattered punctate foci of susceptibility artifact could represent areas of microhemorrhage or calcification. abd ultrasound: limited view of pancreas. no evidence of cholelithiasis or intra-or extrahepatic biliary dilatation. radiology report video oropharyngeal swallow study 1:25 pm medical condition: 45 year old man s/p decannulation final report indication: evaluate for aspiration in patient with history of aspiration. findings: barium passes freely through the oropharynx without evidence of obstruction. the patient demonstrates a slow oral phase and weak swallow with weak pharyngeal muscle contraction. there is penetration and aspiration of thin barium without penetration or aspiration of nectar or thick barium. the patient does sense the aspiration and coughs appropriately. he has an increased residue in both the valleculae and piriform sinuses, which spills over in between swallows. for more details please see the speech and swalllow division note in omr. there is again noted an opacity projecting over the tracheal air column that likely represents an endoluminal lesion, possibly tracheal polyp or other mass lesion. recommend further evaluation with direct visualization or neck ct. impression: 1. aspiration of thin barium without aspiration of thick or nectar barium which represents some improvement from the prior study. 2. lesion projecting over the trachea that may represent tracheal polyp or other mass lesion. recommend further evaluation with dedicated ct of trachea or direct visualization for further evaluation. radiology report chest (pa & lat) study date of 10:26 am medical condition: 45 year old man with s/p cabg findings: in comparison with the study of , the lungs are now essentially clear except for some mild atelectatic changes at the left base. no vascular congestion. tracheostomy tube remains in good position, and the picc line again extends to the lower svc or cavoatrial junction. dr. admission 07:02pm blood wbc-6.9 rbc-4.41* hgb-12.6* hct-38.9* mcv-88 mch-28.5 mchc-32.3 rdw-15.0 plt ct-274 01:46am blood wbc-17.9* rbc-1.66* hgb-4.8* hct-15.9* mcv-96 mch-28.7 mchc-30.0* rdw-21.0* plt ct-515* 05:00am blood wbc-6.4 rbc-3.09* hgb-8.1* hct-27.0* mcv-87 mch-26.2* mchc-29.9* rdw-17.6* plt ct-544* 07:02pm blood pt-11.1 ptt-26.1 inr(pt)-0.9 01:46am blood pt-14.8* ptt-29.2 inr(pt)-1.3* 05:02am blood pt-15.7* inr(pt)-1.4* 07:02pm blood glucose-131* urean-17 creat-1.1 na-142 k-3.9 cl-105 hco3-28 angap-13 05:02am blood glucose-143* urean-24* creat-0.7 na-148* k-3.7 cl-114* hco3-29 angap-9 05:00am blood glucose-110* urean-15 creat-0.5 na-137 k-4.4 cl-100 hco3-30 angap-11 07:02pm blood alt-23 ast-27 ld(ldh)-143 alkphos-63 amylase-86 totbili-0.2 01:46am blood alt-426* ast-267* ld(ldh)-569* alkphos-588* amylase-478* totbili-0.4 09:45am blood alt-36 ast-33 ld(ldh)-259* alkphos-158* amylase-106* totbili-0.3 05:25am blood calcium-9.4 phos-4.2 mg-2.0 12:35pm blood albumin-2.7* calcium-8.4 phos-3.7 mg-2.5 discharge 07:35am blood wbc-5.0 rbc-3.93* hgb-10.3* hct-32.4* mcv-83 mch-26.1* mchc-31.7 rdw-17.1* plt ct-374 07:35am blood plt ct-374 06:13am blood pt-14.0* ptt-33.0 inr(pt)-1.2* 07:35am blood glucose-140* urean-25* creat-0.8 na-138 k-4.6 cl-101 hco3-30 angap-12 09:45am blood alt-36 ast-33 ld(ldh)-259* alkphos-158* amylase-106* totbili-0.3 07:35am blood mg-2.0 07:02pm blood %hba1c-8.3* eag-192* brief hospital course: mr. was admitted to the cardiac surgical service. given severe left main disease and unstable angina, he remained on integrilin and nitroglycerin. preoperative evaluation was notable for mildly depressed lv function and pulmonary embolus - see result section for additional details. after extensive discussion with the patient and his family about risks and benefits especially refusal of blood products, he agreed to proceed with surgical revascularization. on , dr. performed coronary artery bypass grafting surgery. operative course was notable for hypotensive cardiac arrest following induction of anesthesia. see operative note for additional details. following surgery, he arrived to the cvicu in critical condition, on multiple pressors. given labile hemodynamics, he required insertion of iabp. the iabp was eventually removed on postoperative day two, and inotropic support was gradually weaned over several days. given severe anemia and refusal of blood products, epogen was administered. initially unresponsive, neurology was consulted. head ct scan was unrevealing, and eeg showed no evidence of seizure activity. neurology initially attributed his severe obtundation to possible hypoxic-ischemic injury related to hypotensive cardiac arrest and persistently severe anemia. mri of brain was notable for multiple emboli and infarcts. given that there was no intervenable etiology of his unresponsiveness neuro initially signed off. due to prolonged ventilation, dobhoff feeding tube and picc line were placed. tracheostomy was eventually performed on , with subsequent peg placment on . mr. transferred from the icu to the floor on (pod #19). he intermittently spiked fevers which subsided and he was treated for staph pna. neuro was re-consulted to evaluated his bilateral leg weakness on . his leg weakness was believed to be due to low flow state and profound anemia with a hct of 9. no clinical diagnostic evidence was found to support an etiology for this persistant lower extremity immobility. over the course of his hopsital stay he slowly began moving his lower extremities and is now able to move his lower extremities and partial weight bear. he was eventually weaned from the vent to a trach collar and finally decanulated on .he was evaluated and followed throughout his hospital stay by speech and swallow pathologists for passy-muir valve trails and he had mutiple video swallow evaluations. he is presently taking po's and receiving cycled tube feeds at night which can be weaned off when taking adeq oral nutrition. his most recent video swallow revealed a tracheal lesion that radiologist recommend follow up for tracheal polyp vs mass. per dr., mr. should have follow up done with his referring physician. physical therapy and occupational therapy continued to work with mr.. he continues to make slow improvements toward regaining his lower extremity strength and functioning. diabetes service was consulted for glucose management. he remains in stable condition. dr. cleared mr. on pod# 67 from his original surgery, for discharge to rehabilitation. all follow up appointments were advised. medications on admission: aspirin discharge medications: 1. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 4. therapeutic multivitamin liquid sig: five (5) ml po daily (daily). 5. ranitidine hcl 15 mg/ml syrup sig: one (1) po daily (daily). 6. carvedilol 12.5 mg tablet sig: four (4) tablet po bid (2 times a day). 7. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 8. ferrous sulfate 300 mg (60 mg iron)/5 ml liquid sig: one (1) po tid (3 times a day). 9. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 10. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime). 11. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 12. diltiazem hcl 60 mg tablet sig: one (1) tablet po qid (4 times a day). 13. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 14. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po daily (daily) as needed for constipation. 15. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 16. ibuprofen 100 mg/5 ml suspension sig: four hundred (400) mg po q8h (every 8 hours) as needed for pain. 17. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 18. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 19. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 20. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 21. insulin glargine 100 unit/ml solution sig: forty (40) units subcutaneous once a day. 22. insulin regular human 100 unit/ml solution sig: sliding scale injection qac&hs. discharge disposition: extended care facility: discharge diagnosis: coronary artery disease s/p urgent coronary bypass grafting x2 with a reverse saphenous vein graft from the aorta to the first diagonal coronary artery; reverse saphenous vein graft from the aorta to the left anterior descending coronary artery. endoscopic vein harvesting of the left leg. s/p cardiac arrest s/p percutaneous endoscopic gastrostomy tube placement/percutaneous tracheostomy tube placement intra-op cerebral vascular accident anemia pneumonia past medical history: diabetes mellitus s/p inferior myocardial infarction(stemi) s/p des to lcx om1(90% stenosis) ppd+ negative cxr chronic pericarditis hypertension hyperlipidemia discharge condition: alert and oriented x3 upper extremities strengths, full range of motion lower extremities limited motion and generalized weakness. able to stand. incisional pain managed with ibuprofen incisions: sternal - healed, no erythema or drainage edema - none discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month until follow up with surgeon no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments: need updated appointment w/rh surgeon: dr. on tuesday at 2:30 pm 2a cardiologist dr. wednesday @ 8:00 am please call to schedule appointments with: primary care dr. in weeks ******please have tracheal lesion work up with referring/primary care physician******** **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery (aorto)coronary bypass of two coronary arteries insertion of endotracheal tube fiber-optic bronchoscopy fiber-optic bronchoscopy percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy implant of pulsation balloon diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled cardiac complications, not elsewhere classified percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia acute respiratory failure cardiac arrest old myocardial infarction other pulmonary embolism and infarction other specified diseases of pericardium iatrogenic cerebrovascular infarction or hemorrhage long-term (current) use of aspirin other staphylococcus pneumonia cerebral thrombosis with cerebral infarction 

Answer: The patient is high likely exposed to