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 / clindamycin / keflex / amiodarone / levaquin / iodine attending: chief complaint: dyspnea major surgical or invasive procedure: none history of present illness: mr. is a 84m with pmh pvd, cad s/p pm, aaa repair, tia, antithrombin iii deficiency who was transfered from today with abdominal distension and shortness of breath. this morning the pt was found by his daughter to be tachypneic, sob, and anxious so she took him to . according to the pt these symptoms have been progrevisively worsening over the past 2 weeks. at the osh his bnp was 890 and he received lasix. his inr was found to be 4.5. he was also given 250 cc ns. cxr showed "peripheral rul infiltrate/atelectasis and probable insult to peripheral lll/pleura." ct scan at the osh revealed a small fat containing umbilical hernia with minimal fat stranding concerning for incarceration. he was transfered to because he normally gets his care here. according to the patient's daughter and notes the patient was recently admitted for weakness and difficulty ambulating. he was found to have sob, dehydration and hypokalemia from increased diuretic use, and abdominal distension. his kub showed fecal loading in the rectum so he was given milk of magnesia and mg citrate. per report from his daughter after his discharge from this hospitalization he was able to pass a large bm with gas for a few days but then becamse progressively weaker and more constipatied. his abdomen then became distended (his belly 3 x as big as usual) and after that he developed worsening shortness of breath. she also states he has not been taking in good po. the pt lives alone in with 24 hr home health aid. . ros: the daughter notes the pt has had + constipaiton, poor po intake, and sob. his baseline lung exam is dry rhales worse on right and he has low bp in the low 90s. his ms baseline is a and o x 3. the pt (and daughet) denies fevers, chest pain, diahrrea. his hernia is old. he denies dysuria. per the daughter the ua perfromed in was clean, but the foley was traumatic. past medical history: - non-hodgkin's lymphoma, , s/p chop, complete remission, followed by dr. . - chronic systolic chf, ef 30-35% , history of cardiotoxicity secondary to adriamycin, followed by dr. artery disease - history of myocardial infarction - s/p aicd, -v pacer ( icd in sync 7289 placed in pacer vvir mode 70-110) - history of tia with aphasia - hypothyroidism - hypercholesterolemia - history of lle dvt, secondary to antithrombin iii deficiency - status post aaa repair () - history of hemicolectomy secondary to clostridium difficile / induced toxic megacolon - history of group g beta-streptococcus le cellulitis and bacteremia () - history of mild cognitive dementia - severe tophaceous polyarticular gout social history: he currently lives alone in an apartment in , ma. his daughter is np and his hcp. she lives on the same street and sorts his medications. at baseline the patient is able to walk with a walker. tobacco: stopped several years ago. etoh: none illicits: none family history: non-contributory physical exam: vitals: t: 96.7 p: 70 bp: 88/54 r: 32 sao2: 96% 2 l nc general: awake, alert, nad. heent: nc/at, eomi without nystagmus, no scleral icterus noted, mmm, no lesions noted in op neck: supple, elevated jvp to ear pulmonary: + course rhales throughout cardiac: rrr, difficult to appreciate heart sounds due to overwhelming rhonchi abdomen: distended, hyperactive bs, ventral reducible hernia, nontender to palpation, no guarding, no masses or organomegaly noted, no stool in rectal vault but able to get brown stool on glove. extremities: 2+ radial, dp pulses b/l, 2+ edema to knees bilaterally, crhonic venous stasis changes lymphatics: no cervical, supraclavicular, lymphadenopathy noted. skin: dry skin with diffuse scaling, erythematous macular, blanching rash on upper back, chest, and arms, multiple echymosis on hands/arms neurologic: -mental status: alert, oriented x 2 (states the year is , when asked again, states , can not remember where he lives but knows he is at . not able to provide history without difficulty although able to confirm he has been sob for a few weeks. -motor: normal bulk, strength and tone throughout. no abnormal movements noted. pertinent results: 02:40pm blood wbc-12.4*# rbc-3.69* hgb-12.8* hct-38.0* mcv-103* mch-34.7* mchc-33.8 rdw-18.7* plt ct-158 02:40pm blood neuts-86.2* lymphs-6.3* monos-7.2 eos-0.2 baso-0.2 02:40pm blood pt-60.7* ptt-37.4* inr(pt)-6.9* 05:50am blood fibrino-639* 05:50am blood fdp-0-10 02:40pm blood glucose-104* urean-34* creat-1.4* na-133 k-4.7 cl-100 hco3-24 angap-14 02:40pm blood ld(ldh)-241 ck(cpk)-37* 02:40pm blood ck-mb-3 ctropnt-0.12* probnp-7940* 02:40pm blood calcium-8.9 phos-3.8 mg-1.8 05:50am blood d-dimer-991* 02:40pm blood digoxin-0.4* echo : the left atrium is moderately dilated. the right atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy. there is moderate regional left ventricular systolic dysfunction with akinesis of the inerior and inferolateral walls. there is mild hypokinesis of the remaining segments (lvef = 30%). the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a very small pericardial effusion. impression: moderate regional left ventricular systolic dysfunction, c/w cad. mild aortic regurgitation. mild mitral regurgitation. mild pulmonary hypertension. compared with the report of the prior study (images unavailable for review) of , the findings appear similar. kub : findings: air filled, mildly distended loops of large bowel are present. there is a large amount of stool within the descending and sigmoid colon and the rectal vault. non-dilated loops of small bowel are unremarkable. there is no acute fracture or dislocation. the patient is status post aortobiiliac arterial stent grafting. multiple metallic clips are present within the lower quadrant. pacer wires are present in the included views of the chest, with leads terminating within the coronary sinus and right ventricle. there is no free air. impression: 1. large amount of stool within the distal colon and rectal vault. 2. mildly distended loops of large bowel. cxr 2/25/0: chest, ap and lateral views: there is an aicd overlying the left chest wall, with leads terminating in the right atrium and ventricle, similar in appearance to prior study. the lung volumes are low, with accentuation of the cardiomediastinal contours and bronchovascular structures. moderate cardiomegaly is stable. there is mild vascular congestion that is similar in appearance to prior study, without evidence of consolidation. there is no pleural effusion of pneumothorax. impression: stable cardiomegaly, with mild vascular congestion. ct from : wet read: 4:40 pm tiny fat containing umbilical hernia with additional tiny ventral wall defects. no evidence of incarcerated bowel. small perihepatic free fluid, decreased from . contracted gallbladder with numerous gallstones. emphysema with suggestion of mild fluid overload. final report indication: rule out incarcerated hernia, shortness of breath, chf. comparison: . technique: a non-contrast ct of the torso was obtained at on at 10:41 a.m., and submitted for consultation. the images available include axial, coronal, sagittal images of the torso. ct chest without iv contrast: a pacer overlies the left chest wall. the heart and pericardium are without pericardial effusion. atherosclerotic calcifications of the coronary arteries are noted. there are also atherosclerotic calcifications of the aortic arch. few scattered mediastinal lymph nodes are not enlarged by ct size criteria. there is centrilobular emphysema. diffuse hazy ground-glass opacities throughout the lungs may relate to exhalation during the study or edema. in addition, a relative crescentic shape of the trachea could reflect relate to the expiratory phase or underlying tracheomalacia. slight prominence of the interlobular septa may relate to mild fluid overload. bibasilar opacities likely reflect dependent atelectasis. there is no pleural effusion. ct of the abdomen without iv contrast: a small amount of perihepatic free fluid is decreased in extent from . the liver, gallbladder, and adrenal glands are unremarkable. the pancreas is fatty atrophied, without a focal lesion. the left kidney is normal in appearance. the right kidney is markedly atrophic, which is similar in appearance to prior study. the gallbladder appears contracted, with high-density contents, which may reflect stones. a surgical clip is seen within the left upper quadrant of the abdomen. the small bowel is unremarkable. there is sigmoid diverticulosis, without evidence of diverticulitis. incidentally noted is a relatively high riding cecum, similar in appearance to prior study. there is a small fat-containing umbilical hernia with the neck of the hernia measuring up to approximately 10 mm. additional small defects in the left abdominal wall (2:86), and (2:90) are also noted, which are fat-containing. there is no evidence for an incarcerated hernia. there is evidence of an aortic endograft stent, extending into both iliac arteries. assessment of the vasculature is limited without intravenous contrast. small scattered lymph nodes within the retroperitoneum with stranding are grossly similar in appearance to ct of the pelvis without iv contrast: the urinary bladder is collapsed with a foley catheter present. rectum and prostate are unremarkable. a small fat-containing right inguinal hernia is noted. surgical clips are seen within the left inguinal region. osseous structures: there are multilevel degenerative changes of the thoracolumbar spine, most severe at l3-4, with loss of disc height, endplate sclerosis, and marginal osteophytes. impression: 1. small fat-containing umbilical hernia, with additional tiny ventral wall defects as detailed, without evidence of bowel herniation or incarceration. 2. small amount of perihepatic free fluid, which is decreased in size from . 3. collapsed gallbladder, containing high-density contents, likely reflective of numerous stones. 4. evidence of an aortic endograft stent, with limited assessment without iv contrast. 5. emphysema, with suggestion of mild fluid overload. 6. sigmoid diverticulosis without evidence of diverticulitis. brief hospital course: micu course: (to be incorporated into final discharge summary) patient was transferred to the micu on for administration of neostigmine. he received 2 mg iv of neostigmine, resulting in large bowel movement and softening of his abdomen. his kub showed improved bowel distention. he was transferred back to the floor. . his ua was positive for uti and so he was given aztreonam, as he has a history of pseudomonas uti's and has many antibiotic allergies. . on the floor the patient was tachypneic to 32 and was on 6 l nc. this was turned down to 2 l and he maintained sats at 96%. he appeared labored in breathing and uncomfortable, but denied pain. # hypoxia/tachypnea: in the ed: the patient's vitals were 97.9 104/65 75 100% 2l. he had rales of the way up his chest bilaterally. he was given aspirin, lasix 40mg iv x1 and duonebs. the patient was transferred to the medical floor on 6 l nc but this was turned down to 2 l and he maintained saturations of 96%. the patient was tachypneic to the low 30s and he looked uncomfortable. his cxr showed no pleural effusion, but his ct showed emphysema with suggestion of mild fluid overload. his jvp was elevated to his ear and lower extremities showed 2+ edema to knees bilat. bnp was grossly elevated at 7940, however his bnp was elevated above 7000+ for all prior lab values except for one checked 2 weeks ago that was 5000. his creatinine was elevated above baseline at 1.4. it was unclear if the patient was having an acute systolic chf exacerbation or abdominal distention from constipation that was causing splinting and tachypnea. because his bp was in the high 80s (basline is low 90s) he was not diuresed aggresively. an echo was obtained which showed ef of 30% and similar findings compared to prior echo in . the patient underwent an aggressive bowel regimen (see below) which was initially unsuccessful. on hd #2 he became tachypneic ____? # abdominal distention: the pt had been having constipation for the past two weeks prior to admission. he had a distended abdomen on exam (stating his abdomen was three times his normal size), but denied pain. it was thought that his distention might be causing his dyspnea/tachypea. on rectal exam there was no stool in the vault for manual dissempaction. however, kub showed significant stool in the distal colon and rectal vault. he was given fleets and lactulose enema, senna, and colace with no bowel movement by hd #2. he was given lactulose and ___ # leukocytosis: on presentation the pt was afebrile but had an elevated wbc count. he received aztreonam in the ed for uti on ua (pt has many allergies to antibiotics). urine and blood cultures were taken but did not grow any organisms. the patient remained afebrile and his white count trended down. # bacteruria: the patient's daughter stated that the ua performed at the osh the day of admission was clean, followed by traumatic foley insertion. here at the patient's ua showed few bacteria, wbcs and rbcs. he had an elevated white count with 86% neutrophils so he was started on aztreonam for uti. this antibiotic was selected given his multiple antibiotic allergies and the fact that he had pseudomonas in his urine in . however, his urine culture ended up not growing anything so the aztreonam was stopped. # chf: as above, it was unclear if the patient was volume overloaded from acute chf exacerbation. his home dose lisinprol, digoxin, and torsemide were continued. # antithrombin iii deficiency: the patient normally takes coumadin 2 mg alternating with 4 mg at home for his hypercoagulopathy. his inr was found to be supratheraputic at 6.9. his coumadin was held. his inr trended down and was __ on discharge. # hypothyroid: the patient was continued on levothyroxine 200 mg daily with 300 mg on sunday # cad: the patient's statin and ace inhibitor were continued. he has an allergy to beta blockers and is on coumadin #) code status: full code (confirmed with daughter) #)communicaiton: daughter # dispo: the patient lives at home and has 24 home health *****micu course a code blue was called at about 4:30 am on . the patient was found down and without pulses on routine check. code was started, pt. found to be in v tach and shocked once. his pacemaker was found to then be firing at about 80 bpm. he was transferred to the icu. his pupils were fixed and he was not responsive. after discussion with the family, he was made comfort measures only. care was withdrawn and he expired at 1804. family was at the bedside. medications on admission: torsemide 40 po bid potassium supplement 40 mg levoxyl 100 ug po once a day m,t,w,th,f,s (200 mg on sunday) lisinopril 1.25 mg po daily 400 mg po allopurinol q day 0.6 mg colchicine qod 0.125 mg dig q t,th,sat,sun 40 mg lipitor q hs coumadin 2 mg alternating with 4 metolazone 2.5 mg (last dose 2 weeks ago) discharge medications: pt. expired discharge disposition: expired discharge diagnosis: primary diagnosis: cardiac arrest actue systolic chf exacerbation constipation secondary diagnosis: antithrombin iii deficiency hypothyroidism cad discharge condition: pt. expired followup instructions: pt. expired procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances insertion of endotracheal tube cardiopulmonary resuscitation, not otherwise specified automatic implantable cardioverter/defibrillator (aicd) check diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation hypopotassemia paroxysmal ventricular tachycardia constipation, unspecified other malignant lymphomas, unspecified site, extranodal and solid organ sites cardiac arrest long-term (current) use of anticoagulants paralytic ileus automatic implantable cardiac defibrillator in situ hypoxemia primary hypercoagulable state hypovolemia acute on chronic systolic heart failure flatulence, eructation, and gas pain diverticulosis of colon (without mention of hemorrhage) chronic respiratory failure gouty tophi of other sites, except ear 

Answer: The patient is high likely exposed to