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: reason for micu admission: respiratory distress s/p intubation in ed major surgical or invasive procedure: endotracheal intubation rij central line placement history of present illness: this is an 85 year old man with pmh significant for htn, chf, chronic kidney disease who presents with repiratory distress. he had been hospitalized multiple times recently at , beginning in with a mechanical fall then re-presented that month with pneumonia. in he returned with a dvt in the right common and deep common femoral veins and chf exacerbation, as well as troponin elevations and a bibasilar pneumonia. . he now presents following a fall at home. per his wife and notes, he was at home for the last three days following discharge from rehab. he was reportedly sitting in a chair at home, then fell off the chair. his wife found him on the ground, awake and talking, and called ems to get him to for evaluation. he did not have any obvioud trauma. his wife says he noted chest heaviness and heart racing earlier in the day, and had seemed short of breath since discharge from rehab. . in the ed, he was noted to be in respiratory distress, tachypnic to 35, and o2 sat was 80%. his extremities were cool. he denied chest pain, nausea, vomiting, incontinence, fevers, chills, palpitations. due to his respiratory distress, code status was confirmed and the patient was intubated. antibiotics were started with vancomycin, levofloxacin, and flagyl, then blood cultures were sent. cxr was felt to not have a striking pneumonia. ct angiogram was considered but not done due to elevated creatinine, and vq scan was also considered. he got 1.8 liters of fluid and was empirically started on heparin because his inr was 1.8, then transferred to the micu. past medical history: 1. htn 2. ckd: baseline around 2.3 3. bipolar disorder - on lithium previously 4. hyperlipidemia 5. prostate surgery many years ago - indication not specified 6. patient reports hospitalization in 's for mi but does not know details. 7. urinary incontinence 8. mi () and a recent nstemi in /06 9. dvt 10. chf with ef 30-40% with multiple hypokinetic walls 11. uti's 12. anemia 13. possible reactive airway disease with response to prednisone 14. hematuria 15. pneumonia social history: patient lives with his wife of > 60 years in an senior facility in . has 2 grown children, one is and one in . remote history of tobacco. no alcohol. family history: non-contributory physical exam: v: t101.2 100/50 p85 98% ac 500x18 100% gen: intubated, sedated, in no distress heent: pupils small, reactive neck: jvp elevated at 30 degrees resp: lungs with crackles diffusely bilaterally cv: irreg irreg, normal s1s2 no murmurs abd: soft ntnd +bs ext: cool extremities, 2+ pitting edema bilaterally neuro: sedated. pertinent results: ekg: atrial fibrillation at rate of 98, st depressions in v5 and v6, likely j point elevation in v2/v3. lvh. wide qrs - interventricular conduction abnormality. . radiology final report bilat lower ext veins port 9:13 am bilat lower ext veins port reason: swollen legs and hypoxia medical condition: 85 year old man with swollen les and hypoxia. reason for this examination: ?dvt doppler ultrasound study of both lower limb veins clinical details: evaluate for deep venous thrombosis. findings: right and left lower limb veins are patent and compressible with phasic venous flow and increased venous return with augmentation demonstrated on doppler. conclusion: 1. no right or left lower limb deep venous thrombosis. the study and the report were reviewed by the staff radiologist. dr. dr. approved: mon 1:34 pm . cardiology report echo study date of patient/test information: indication: congestive heart failure. weight (lb): 182 bp (mm hg): 103/58 hr (bpm): 103 status: inpatient date/time: at 13:11 test: portable tte (complete) doppler: full doppler and color doppler contrast: definity tape number: 2006w000-0:00 test location: west micu technical quality: adequate referring doctor: dr. dr. measurements: left atrium - long axis dimension: *4.9 cm (nl <= 4.0 cm) left atrium - four chamber length: *6.3 cm (nl <= 5.2 cm) right atrium - four chamber length: *6.3 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: *1.2 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: *1.3 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 5.4 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 4.5 cm left ventricle - fractional shortening: *0.17 (nl >= 0.29) left ventricle - ejection fraction: 15% to 20% (nl >=55%) aorta - valve level: 2.8 cm (nl <= 3.6 cm) aorta - ascending: 2.9 cm (nl <= 3.4 cm) aortic valve - peak velocity: 1.4 m/sec (nl <= 2.0 m/sec) mitral valve - e wave: 1.2 m/sec mitral valve - e wave deceleration time: 142 msec tr gradient (+ ra = pasp): *30 mm hg (nl <= 25 mm hg) interpretation: findings: left atrium: mild la enlargement. elongated la. right atrium/interatrial septum: moderately dilated ra. left ventricle: mild symmetric lvh. normal lv cavity size. severe global lv . severely depressed lvef. no lv mass/thrombus. right ventricle: normal rv wall thickness. normal rv chamber size. normal rv systolic function. . aorta: normal aortic root diameter. normal ascending aorta diameter. aortic valve: mild to moderate (+) ar. mitral valve: mildly thickened mitral valve leaflets. mild mitral annular calcification. moderate (2+) mr. tricuspid valve: moderate tr. borderline pa systolic hypertension. pericardium: no pericardial effusion. conclusions: 1. the left atrium is mildly dilated. the left atrium is elongated. the right atrium is moderately dilated. 2.there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is severe global left ventricular . overall left ventricular systolic function is severely depressed. no masses or thrombi are seen in the left ventricle. intrinsic lv function likely more depressed given the mitral and aortic regurgitation. 3. right ventricular chamber size is normal. right ventricular systolic function is normal. 4. mild to moderate (+) aortic regurgitation is seen. 5.the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. 6.moderate tricuspid regurgitation is seen. 7.there is borderline pulmonary artery systolic hypertension. 8.there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the mr is now worse and the anterior, inferior and inferolateral walls are more hypokinetic with a marked decrease in overall lv function. electronically signed by , md on 16:28. physician: , . () . radiology final report chest (portable ap) 7:50 pm chest (portable ap) reason: r/o chf medical condition: 85 year old man with reason for this examination: r/o chf indication: evaluate for chf. comparison: . ap chest radiograph study is limited by patient breathing. cardiomegaly appears unchanged. mediastinal and hilar contours appear unchanged. increased opacities at the lower lobes bilaterally are seen. there is slight increase in the pulmonary vascularity suggesting mild chf. impression: increased lower lobe opacity bilaterally consistent with aspiration or pneumonia. mild chf. the study and the report were reviewed by the staff radiologist. dr. . dr. approved: mon 10:35 am . 10:27 am sputum site: endotracheal source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs and clusters. 3+ (5-10 per 1000x field): gram positive rod(s). respiratory culture (preliminary): ? oropharyngeal flora. staph aureus coag +. heavy growth. gram negative rod(s). rare growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | . bcx ngtd brief hospital course: a/p: 85 year old man with recent history of chf, pneumonia, dvt in , admitted with acute shortness of breath requring intubation in ed. . 1. respiratory failure - ddx includes chf, pe, pneumonia. initially with cool extremities suggestive of cardiogenic shock but was found to be guaiac positive with falling hct. was on anticoagulation for le dvt; suspect he was anemic, developed af, then went into heart failure/pulm edema and resp failure and then had an nstemi. electively intubated in ed for hypoxia and tachypnea. bilateral pleural effusions on cxr, not tappable via us . patient was extubated without complication. pe not excluded but patient will need long-term anticoagulation anyway for his past dvt and af. tte showed depressed ef 15-20%, + ar, 2+mr/tr worsened mr of ant/inf/inflt walls (prior ef 30-40%). amiodarone and digoxin were started; amiodarone dosing should be changed to 400mg qd on . levo, flagyl and vanco were initially started, then levo/flagyl d/c'd. vancomycin continued for coag-positive staph aureus in sputum (sensitivities still pending at time of discharge); he should complete a full week (through ) of vancomycin (1g q48 hrs, hold for trough>15). his central line should be removed after the last dose of vancomycin. . 2. gib - guaiac positive with melena . no clear h/o gibs but has been on anticoagulation as an outpt for recent deep vein thrombosis involving the right common femoral and deep femoral veins . no ng lavage performed since hct stable on and pt was just extubated. patient received 2 units prbc for chronic anemia and drifting hct and was maintained on protonix q12 with slow advancement of diet to clears once hct stable. pt seen by gi; bleeding thought to be from ulcer/gastritis in setting of anticoagulation, and egd/colonoscopy deferred until pt's respiratory status stabilizes and risk/benefit ratio is more favorable. he should stay on protonix and can restart his coumadin, and he only needs to follow-up with gi if he develops more bleeding. . 3. a fib - pt had a fib on last ekg but otherwise no evidence of previous a fib by reports. could be contributing to chf picture by reducing the atrial kick. tee negative for thrombus/effusion and ef 15-20% + ar, 2+ mr/tr and worsened mr, inf/ant/infolateral . loaded w/iv amiodarone on po maintenance; dose should switch to 400mg po qd on . a digoxin level should be checked within a few days with adjustment of dosage as necessary. coumadin should be restarted and inrs checked, with goal . . 4. elevated troponins with likely nstemi. last nstemi was started on asa/plavix no stent/intervention. no h/o stents/intervention. has cardiac disease and was on medical management. ck peaked at 193 on admission and have been downtrending. tropt peaked at 0.82 . continue asa, statin, cont acei and titrate up as tolerated. loaded with digoxin (renally dosed for crcl 31). he does not need to be on plavix as he has no stents. . 5. h/o htn - hold hydralazine, isordil for now and titrate up acei . 6. chronic kidney disease at recent baseline of 2.6-3.0. likely has reduced forward flow in the setting of severe chf. weaned o2 keeping sat>93%. diuresed with iv lasix based on clinical status by day, with close monitoring of cvp and uop. . 7. h/o r le dvt in - anticoagulation held in setting of given guaiac positive stools. bilateral lenis this admission neg for dvt . 8. anemia - mcv 97. send iron studies consistent with acd likely also component of iron deficiency. threshold hct<28 to transfuse. . 9. h/o bipolar disorder - continue valproate. . 10. proph - held anticoagulation until hct stable, will restart coumadin . pneumoboots, ppi , bowel regimen, hob>30 degrees, oob to chair/pt consult . 11. fen - start clears and advance as tolerated . 12. access - rij ; unable to get piv on so ij left in place; line should be pulled as soon as vancomycin is done with placement of picc or piv as necessary . 13. code status - full . 14. communication - with wife and son . 15. dispo - transferred to per family wishes medications on admission: acetaminophen 325 mg tablet po q4-6h aspirin 325 mg po daily divalproex 125 mg po qam, 250 mg po hs furosemide 40 mg po daily clopidogrel 75 mg po daily atorvastatin 80 mg po daily metoprolol tartrate 75 mg po tid hydralazine 50 mg po q6h isosorbide dinitrate 10 mg po tid ipratropium inhalation q6h (every 6 hours) as needed. senna 8.6 mg po bid docusate sodium 100 mg po bid pantoprazole 40 mg po q24h calcium acetate 1334 mg po three times a day: with meals. coumadin 4 mg po qd discharge medications: 1. acetaminophen 160 mg/5 ml solution sig: five (5) ml po q4-6h (every 4 to 6 hours) as needed. disp:*100 ml* refills:*0* 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. disp:*30 tablet(s)* refills:*0* 3. docusate sodium 150 mg/15 ml liquid sig: ten (10) ml po bid (2 times a day). disp:*600 ml* refills:*2* 4. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. calcium acetate 667 mg capsule sig: two (2) capsule po tid (3 times a day). disp:*180 capsule(s)* refills:*2* 7. depakote 125 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po qam. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 8. depakote 250 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po qpm. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 9. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. captopril 12.5 mg tablet sig: 0.5 tablet po tid (3 times a day): hold for sbp<100. disp:*45 tablet(s)* refills:*2* 11. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) gram intravenous q48h (every 48 hours): 7 days total (through ); last dose given at 6am; hold if trough > 15. disp:*15 gram* refills:*2* 12. amiodarone 200 mg tablet sig: three (3) tablet po daily (daily): for 1 week (last dose ), then decrease dose to 400mg po qd. disp:*60 tablet(s)* refills:*2* 13. amiodarone 400 mg tablet sig: one (1) tablet po once a day: first dose . disp:*30 tablet(s)* refills:*2* 14. coumadin 4 mg tablet sig: one (1) tablet po once a day: inr goal . disp:*30 tablet(s)* refills:*2* 15. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* discharge disposition: extended care facility: - discharge diagnosis: acute respiratory failure gi bleed / blood loss anemia chf cri (baseline 2.6-3.1) atrial fibrillation guiac-positive stool nstemi anemia of chronic disease bipolar disorder discharge condition: good discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1500ml take all medications as directed. followup instructions: provider: , surgery (nhb) date/time: 10:30 call dr. at for an appointment 2 weeks after you leave the hospital procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube transfusion of packed cells diagnoses: subendocardial infarction, initial episode of care unspecified essential hypertension iron deficiency anemia secondary to blood loss (chronic) atrial fibrillation asthma, unspecified type, unspecified mitral valve insufficiency and aortic valve insufficiency chronic kidney disease, unspecified rheumatic heart failure (congestive) acute respiratory failure old myocardial infarction unspecified gastritis and gastroduodenitis, with hemorrhage bipolar i disorder, most recent episode (or current) unspecified 

Answer: The patient is high likely exposed to