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: cough and fatigue major surgical or invasive procedure: aortic valvuloplasty history of present illness: mr. is an 88m with severe aortic stenosis, diastolic heart failure, moderate pulmonary hypertension, stage iv chronic kidney disease, and bronchiectasis with several months of cough w/ trace hemoptysis. he came to the ed today b/c his cough is occuring more frequently and continues to be blood tinged. he has midline chest pain associated with the cough without radiation. . he has chronic exertional cp and sob with ambulating 10 meters which he states is unchanged: this has been attributed to his severe as in the past. . in terms of his bronchiectasis (radiographically mild) and hemoptysis, he has been seen in pulmonary clinic. he had mac on an afb smear in the fall of which he refused treatment for and which did not appear on 3 serial afb smears in . differential for his hemoptysis includes bronchiectasis vs severe valvular dz w/ subsequently increased filling pressures. . in the ed vitals were 98.4, 173/96, 64, 18, 100% 3lnc. ekg unchanged. bnp elevated. cxr with stable effusion and no overt pulmoanry edema. he was given aspirin 325 x1 and lasix 20 iv as his jvp appeared elevated. past medical history: past medical history: 1. cardiac risk factors: - hypertension 2. cardiac history: - severe aortic stenosis (peak vel 5m/s, mean grad 72, 0.9 cm2) - diastolic heart failure (lvef 70-80%) - pulmonary hypertension (moderate, pasp >55) - moderate lvh (1.6cm) 3. other past medical history: - stage iv ckd (baseline cr~3) - gastritis - trigeminal neuralgia - bladder cancer - bph s/p turp - iron deficiency anemia (hct mid 30s) - vitamin b12 deficiency - rcc s/p nephrectomy - chronic mycobacterium avium intracellular infection positive sputum in (pulm follows) had three negative sputums in social history: patient lives alone in . he was lieutenant colonel in russian army during wwii, and his entire family killed in war. after end of war went to medical school and became a dermatologist and practiced for 43 yrs. he moved to the us 18 years ago to be near his sons, in /sf who are in computers. he no longer practices but enjoys going to dermatology grand rounds at and bimdc. he smoked until age 25. rare alcohol use. he denied illicits/herbals. family history: father died from lung ca at age 45, though he worked in a tobacco store. mother, siblings were all killed at a young age in wwii. he says his sons have no medical issues. physical exam: on admission: vs: 97.6, 162/82 (initially 188/92), 64, 20, 96% 2lnc general: nad. oriented x3. mood, affect appropriate. heent: ncat. perrl, surgical pupil, eyelid lag slightly more on right eye, eomi. neck: supple with jvd 5cm above clavicle at 90 degrees. cardiac: iii/vi crescendo systolic murmur heard over ao area, iii/vi hsm at lsb, normal s1, dull s2 no rubs or gallops lungs: + rhonci throughout, no wheeze, l>r slightly decreased bs at bases abdomen: + bs, soft, ntnd. extremities: mild trace le edema at ankles b/l. dp pulses +1 b/l. skin: no stasis dermatitis, ulcers, scars, or xanthomas. . at time of discharge: vs: 98.6, 136/69, 61, 20, 90% ra. general: nad. oriented x3. mood, affect appropriate. heent: ncat. perrl, surgical pupil, eyelid lag slightly more on right eye, eomi. neck: supple with jvd 5cm above clavicle at 90 degrees. cardiac: iii/vi crescendo systolic murmur heard over ao area, iii/vi hsm at lsb, normal s1, dull s2 no rubs or gallops lungs: + rhonci throughout, no wheeze, l>r slightly decreased bs at bases abdomen: + bs, soft, ntnd. extremities: mild trace le edema at ankles b/l. dp pulses +1 b/l. there is a large superficial ecchymosis of the r groin with no e/o hematoma. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: admission labs: wbc-6.7 rbc-3.90* hgb-11.6* hct-33.5* mcv-86 rdw-14.1 plt ct-339 neuts-69.3 lymphs-20.3 monos-6.0 eos-3.2 baso-1.2 pt-11.9 ptt-28.0 inr(pt)-1.0 glucose-111* urean-49* creat-2.8* na-140 k-4.1 cl-105 hco3-24 angap-15 . cardiac enzymes: 04:30pm blood ck-mb-notdone probnp-* 04:30pm blood ctropnt-0.04* 04:30pm blood ck(cpk)-54 11:09pm blood ck(cpk)-86 . ct head: no acute intracranial abnormality. in case of continued clinical concern for infarction, an mri can be obtained. ct abd/pelvis: 1. 8.0 x 4.6 x 5.8 cm hematoma in the right groin just deep to the femoral vessels with surrounding fat stranding. evaluation for active extravasation cannot be done due to lack of iv contrast. 2. multiple stable pancreatic cysts. echo: there is symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%); outflow tract obstruction cannot be excluded and is probably present. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are severely thickened/deformed. significant aortic stenosis is present (not quantified). mild (1+) aortic regurgitation is seen. the severity of aortic regurgitation may be underestimated due to the technically limited nature of this study. the mitral valve leaflets are mildly thickened. there is no pericardial effusion. compared with the prior study (images reviewed) of , no definite change. post aortic valvuloplasty echo: there is symmetric left ventricular hypertrophy. the left ventricular cavity is small. left ventricular systolic function is hyperdynamic (ef>75%). mild to moderate (+) aortic regurgitation is seen. the severity of aortic regurgitation may be underestimated. there is no pericardial effusion. . cxr: relatively stable pleural effusion as previously documented. there is improved aeration of the lung bases with only mild residual opacities remaining, likely atelectasis. . : right femoral u/s impression: no evidence of aneurysm in the right groin. no discrete organizing fluid collection also identified. the area of known hematoma is likely intramuscular and not well appreciated on this study brief hospital course: mr. is a 87 yo male with severe aortic stenosis, dchf with preserved ef, pah, ckd, htn, chronic cough/hemoptysis who presents with worsening cough and chest pain associated with cough. physical exam on admission was suggestive of mild fluid overload. . # cough/hemoptysis: acute worsening of chronic cough is main presenting symptom. pt previously grew out mac (untreated) and has been diagnosed with bronchiectasis and chronic lung disease. his presenting complaint of worsened cough with assoc cp was most suggestive of a bronchiectasis flare. patient was treated with ciprofloxacin for 7 days (he completed 3 days of his course at time of discharge). patient's cough was managed with tesalon pearls and robitussin with some symptomatic relief. . # chest pain: chest pain really only occurred in the setting of cough. he was noted to have a trop of 0.04 in setting of ckd which is consistent with his prior troponin. patient refused additional sets of enzymes, but his symptoms were felt to be very unlikely acs. he was discharged on aspirin, statin & metoprolol. . # chf: patient was gently diuresed with lasix until euvolemic. he should continue on a low dose of furosemide 20mg daily. he will need teaching regarding daily volume assessment and weights. . # aortic stenosis: patient underwent a valvuloplasty with a decrease in mean gradient from 45mmhg to 20mmhg. he was transferred to ccu post procedure for low blood pressures that were thought most likely due to vasovagal response. patient refusing aortic valve repair but may be eligible for core valve replacement clinical trial. # chronic renal failure: had renal cell carcinoma s/p nephrectomy in . creatinine at baseline prior to discharge 3.1 (on ) with baseline of 2.8. the patient refused further blood draws as inpatient. . # htn: controlled with metoprolol and amlodopine added . # iron deficiency anemia, b12 deficiency anemia: patient had hct drop after valvuloplasty from 35 to 30. last hct checked found to be relatively stable at 28.7. the patient refused further lab draws. patient stated that he understood that if we were unable to monitor hematocrit he could bleed, have a heart attack, and die. he was willing to take those risks because lab draws caused him pain. ct head, abd/pelvis were done to find source of bleed. ct abd/pelvis suggested hematoma but follow up ultrasound of right femoral area showed no evidence of hematoma or aneursym. of note, the patient did have a stable large ecchymotic area near the r inguinal area without evidence of hematoma at the time of discharge. . # bladder agents: continued finasteride & detrol. . # seizure d/o: continued trileptal. . code status: confirmed as full code this admission. medications on admission: albuterol sulfate - 90 mcg hfa aerosol inhaler - 2 (two) puffs inhaled twice a day as needed calcitriol - 0.25 mcg capsule - 1 (one) capsule(s) by mouth sunday,monday, wednesday, and friday finasteride - 5 mg tablet - 1 tablet(s) by mouth once a day furosemide - 20 mg tablet - 1 tablet(s) by mouth once every monday, wednesday, and friday as needed for . lidocaine - 5 % (700 mg/patch) adhesive patch, medicated - apply each knee once a day metoprolol succinate - 100 mg tablet sustained release 24 hr - 1 (one) tablet(s) by mouth once a day omeprazole - 20 mg capsule, delayed release(e.c.) - 1 (one) capsule, delayed release(e.c.)(s) by mouth once a day oxcarbazepine - 300 mg tablet - 2 tablet(s) by mouth daily as directed tolterodine - 4 mg capsule, sust. release 24 hr - 1 capsule(s) by mouth once a day acetaminophen - 325 mg tablet - 1 to 2 tablet(s) by mouth every six (6) hours as needed for pain aspirin - 81 mg tablet - 1 tablet(s) by mouth once a day back brace - misc - apply daily for back fracture and back pain cyanocobalamin - (prescribed by other provider) - dosage uncertain docusate sodium - 100 mg capsule - 1 (one) capsule(s) by mouth twice a day constipation ferrous gluconate - 325 mg tablet - 1 tablet(s) by mouth once a day discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation twice a day as needed for shortness of breath or wheezing. 2. calcitriol 0.25 mcg capsule sig: one (1) capsule po every other day (every other day). 3. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 4. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 5. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 7. oxcarbazepine 600 mg tablet sig: one (1) tablet po daily (daily). 8. ciprofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 4 days. disp:*4 tablet(s)* refills:*0* 9. aspirin 81 mg tablet sig: one (1) tablet po once a day. 10. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). tablet(s) 11. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 12. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 13. vitamin b-12 oral 14. detrol la 4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. 15. colace 100 mg capsule sig: one (1) capsule po twice a day. 16. lasix 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: of discharge diagnosis: primary diagnosis: severe aortic stenosis bronchiectasis . secondary diagnosis: acute on chronic diastolic heart failure discharge condition: stable, alert, ambulating with assistance. discharge instructions: you were admitted to the hospital with chest pain when you coughed and worsening fatigue. your chest pain was not due to a heart attack and is likely only caused by your cough. we tried to control your cough with cough medications and an antibiotic. . we think that your fatigue is due to a narrow aortic valve, or aortic stenosis and heart failure. you had a procedure called an aortic valvuloplasty. this enlarged your aortic valve and improved blood flow. your heart failure was treated with a medication called lasix. . we have made the following changes to your medication list: 1. ciprofloxacin 250mg by mouth once a day for 4 days 2. start atorvastatin 80mg by mouth once a day 3. start amlodopine 5mg by mouth once a day weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: please call dr. phone: to reschedule your eye appointment originally scheduled for at 10:30. provider: , md phone: date/time: 12:40 provider: , m.d. date/time: 12:00 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters percutaneous balloon valvuloplasty diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified acute on chronic diastolic heart failure aortic valve disorders other chronic pulmonary heart diseases chronic kidney disease, unspecified iron deficiency anemia, unspecified epilepsy, unspecified, without mention of intractable epilepsy personal history of malignant neoplasm of kidney bronchiectasis without acute exacerbation precipitous drop in hematocrit 

Answer: The patient is high likely exposed to