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: sudden onset shortness or breath major surgical or invasive procedure: cardiac catheterization coronary artery bypass graft x 4 (left internal mammary artery to left anterior descending, saphenous vein graft to diagonal, saphenous vein graft to obtuse marginal "y" graft, saphenous vein graft to posterior lateral branch) history of present illness: mr. is a 68 year-old man with esrd on hd, cad, copd. he was in his usual state of health on when he was seated in a chair and he had sudden onset shortness of breath without chest pain or palpitations. he was admitted to hospital on . there he was intubated for hypoxic respiratory failure. he was briefly hypotensive in the peri-intubation period, thought to be secondary to propofol vs. sepsis. for the latter he was treated briefly with vancomycin and zosyn. also under consideration was that he may have aspirated secondary to benzodiazepine overdose. he was also treated for a copd exacerbation with steroids and nebulizers. he was subsequently thought to have had flash pulmonary edema secondary to a primary cardiac event, as below. . on his initial ekg, he had precordial st elevations and t-wave inversions inferiorly that were thought to be rate related. he was hypotensive and having an upper gi bleed, so treatment of acute mi including , beta , statin, acei were with-held. he was transferred to the icu wihere ekg showed resolution of the st elevation; however, troponin rose to 4.8. cardiology was consulted and agreed that no treatment options for acs were available as he was not stable for catheterization, anticoagulation was contraindicated (gi bleed), beta could not be given because of hypotension, and his esrd precluded acei. . on the second hospital day, the patient became tachycardic to the 130s and desatruated to 88% on 2l. ekg showed st depressions v5/v6. he was given 5 mg iv lopressor in decrease in hr to the low 100s as well as 1 mg iv ativan. cardiology was again consulted, and he was given po metoprolol such that hr decreased to the 90s over hours. cxr showed increased pulmonary edema. renal was consulted, and he received 80 mg iv furosemide with diuresis of 250 cc and improvement to 98% o2 sat on 2l. ekg 3 hours later showed resolution of st depressions and resolution of sinus tachycardia. cardiac enzymes were again cycled. troponin i increased to 1.22 8 hours after and subsequently fell. ck was flat. at no point did he experience chest pain. . upon review of the case, the cardiology consulting service felt that he because he had inducible ischemia that seemed to be rate dependent, he was a candidate for non-urgent catheterization. his beta , 81 mg, and statin were restarted prior to transfer. echo showed ef 35-45% with mild lv mild hypokinesis, moderate concentric lvh, and moderate mitral regurgitation. . his course was complicated by bright red blood in the ng tube at the time of intubation. hct dropped from 48 on admission, to 35 after agressive fluid resuscitation. it was subsequently stable for several days . for his esrd he underwent hd tuesday and thursday and was maintained net negative. past medical history: - end-stage renal disease on hd tues, thurs and sat at in wellingon circle - stroke without residual deficits, s/p right carotid endarterectomy - chronic obstructive pulmonary disease - coronary artery disease with two past mis ( and )? of cath previously - anxiety - tobacco abuse - etoh abuse: patient states no etoh use in the past 10 years - peptic ulcer disease - benzodiazepine abuse - s/p iatrogenic cardiac arrest social history: social history: he was a custodian at , currently retired. -tobacco history: he has smoked a ppd x 50 years -etoh: he states he quit etoh 10 years ago -illicit drugs: denies family history: not obtained physical exam: physical examination: 69" 160# vs: t=96, bp=111/85, hr=83, rr=20, o2 sat=95% on 3l general: comfortable appearing man heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 7 cm cardiac: regular, no murmurs lungs: lungs with bibasilar expiratory rhonchi abdomen: soft, ntnd. no hsm or tenderness. normoactive bowel sounds extremities: l arm fistula with palpable thrill, feet cool skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: cardiac cath: 1. selective coronary angiography of this right dominant system with a ramus branch revealed severe two vessel disease. the lmca had mild plaquing but was free of critical stenoses. the lad was heavily calcified and diffusely diseased with mild tapering of the proximal vessel and diffuse disease extending from d1 and culminating in a 90% stenosis just before the small d3 branch with post-stenotic dilatation. s1 had a moderate origin stenosis. the d1 branch was diffusely disease with a 60% stenosis in the mid-vessel. there were septal collaterals to the distal rca system. the moderate caliber lcx was diffusely diseased, and it was difficult to quantitate the reference vessel diameter. it supplied small diffusely diseased om branches with distal av groove collaterals to the distal rca. the ramus branch was a modest caliber but patent vessel. the rca was totally occluded serially in the proximal vessel after some severe disease and reconstituted distally (rca, rpl1, rpl2, and rpda) via vasa and left to right collaterals. 2. resting hemodynamics revealed normal right heart filling pressures with a mean ra of 6 mmhg and moderate-severely elevated left heart filling pressures with a mean pcwp of 19 mmhg and lvedp of 26 mmhg. there was mild pulmonary arterial hypertension with a pasp of 31mmhg. the cardiac index was preserved at 3.7 l/min/m2 (using an assumed oxygen consumption). 3. left ventriculography was deferred. echo: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated with mild to moderate regional left ventricular systolic dysfunction including hypokinesis of the basal half of the inferior and inferolateral walls, distal septum and apex. the apex is not aneurysmal (lvef 40%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is a trivial/physiologic pericardial effusion. impression: mild symmetric left ventricular hypertrophy with cavity dilation and regional dysfunction c/w multivessel cad. mild-moderate aortic regurgitation. moderate mitral regurgitation. dilated ascending aorta. ct of head: scattered hypodense foci in bilateral occipital lobes and bilateral cerebellar hemispheres, most consistent with acute/subacute embolic infarcts, superimposed on more chronic infarction. as the patient is unable to tolerate mri secondary to presence of epicardial pacer leads, serial ct examinations could be performed to assess possible evolution. mri of head: innumerable foci of slow diffusion with associated t2/flair signal hyperintensity scattered throughout the bilateral cerebral and cerebellar hemispheres. findings are consistent with acute-subacute infarcts of multiple etiologies, including embolic infarcts, watershed infarction, and hypoxic injury. brief hospital course: a 68 year-old man with a history of coronary artery disease, recently admitted to osh for hypoxic respiratory failure and found to have ekg changes in the setting of tachycardia, and currently transferred to for consideration of possible catheterization. . # coronaries/post-op: patient had st changes prior to transfer in the setting of tachycardia that may have been demand related. it's less difficult to tease out whether the ischemia was primary or secondary, but the st elevations and elevated troponin were worrisome. troponins were trending down prior to transfer. ck have not been elevated. medical management of cad including , statin, beta were continued. he underwent cardiac catheterization which showed lad with 50-60% tubular stenosis with focal 90% lesion in mid-vessel, lcx with diffuse disease, and a totally occluded proximal rca with filling distally via collaterals. given 3-vessel cad, cardiac surgery was consulted for consideration of cabg. he underwent coronary artery bypass graft on without incidence. please see operative report for surgical details. transferred to cvicu for invasive monitoring in stable condition. patient remained intubated due to unresponsiveness. ct/mri revealed multiple infarcts. chest tubes and epicardial pacing wires were removed per protocol. multiple attempts to wean patient from ventilator failed d/t neuro status and a tracheostomy was placed . tubes feeds were given throughout post-op course for nutrional support and peg was planned for placement on but not performed secondary to patient having fevers and increased wbc. peg tube was eventually placed on . . #stroke: on post-op day one sedation was weaned and although patient would open eyes, there was no movement in extremities or response to commands. stat ct and neuro consult were preformed. ct finding were most consistent with acute/subacute embolic infarcts, superimposed on more chronic infarction. neurology felt in addition to embolic infarcts, there was watershed and ischemic hypoperfusion bilaterally. they felt prognosis of recovery was poor. patient eventually regained very limited movement in extremities and response to commands. right pupil larger than left and blinks eyes to questions. . # pump: chronic systolic congestive heart failure with ef 35-40% on recent echo with evidence of lv wall hypokinesis. per osh records, he has a history of flash pulmonary edema in the setting of hypertensive urgency 03/. he also seems to have had flash pulmonary edema this admission at the other hospital, possibly triggered by a cardiac event, as above. on admission to , exam and cxr were indicative of euvolemia. . # recent hypoxic respiratory failure: his o2 sat was normal on room air upon transfer to . post-operatively patient was unable to be weaned from ventilator and required tracheostomy. . # copd exacerbation: the patient denied a history of copd, although this is noted on his osh records. he does have a 50 pack-year smoking history, and he was on combivent and tiotropium as an outpatient. he was being treated at the osh for copd exacerbation with nebulizers and steroids. on admission he was not sob, wheezing, or hypoxic. a brief steroid taper was completed. he did not require nebulizer treatments. pfts done as part of the pre-operative work-up showed fev 179% predicted with fev1/fvc 114% predicted. . # esrd: cause was unknown. tues/thurs/sat dialysis was continued upon admission but changed to mon/wed/friday dialysis after surgery. renal followed patient throughout post-op course. . # anxiety and substance abuse: patient had a history of anxiety disorder and benzodiazepine over-use. he was supposed to discontinue lorazepam as an outpatient, per notes from outside hospital. however, he has been receiving lorazepam on transfer and was actively withdrawing on arrival to , with visual hallucinations and tremors. he was started on a ciwa with diazepam. he required 10 mg diazepam every 4 hours, and his hallucinations abated. diazepam was decreased to 5 mg every 4 hours, and he continued to score high on the ciwa on subjective measures such as anxiety. he also was quite demanding about receiving the diazepam. the psychiatry consulting service saw him to assist with addiction and anxiety issues. at their recommendation, diazepam with ciwa was stopped, and outpatient dose of lorazepam resumed. sertraline was also restarted. he could not receive seroquel because of borderline long qt at baseline. psych consult was performed post-op and stated no acute psych issues and to continue with neuro/medical management. . # gi: patient had upper gi bleed with coffee ground ng output at osh. he has a history of pud but no prior bleeds according to him. hct on transfer is stable from osh (35 on transfer) and remained stable. post-op patient was incontinent of stool and urine and remained that way upon discharge. . #infectious disease: urine with citrobacter. sputum with coag positive staph. his wbc remained elevated during post-op fluctuating between 10.5 and 22.8. he received vanco/cipro during post-op. cipro d/c'd after repeat urine culture negative. . #nutrition: tubefeeding: nutren pulmonary full strength, goal rate:50 ml/hr. peg tube placed . on dr. felt mr. was ready for discharge to a rehabilitation facility. medications on admission: sertraline 25 mg daily, spiriva, albuterol prn, 325 mg qam, colace 100 mg , folate 1 mg daily, simvastatin 80 mg qhs, lorazepam 1.5 mg tid, lopressor 12.5 mg tid, seroquel 25 mg q6h prn, zantac 150 mg po bid, senna daily discharge medications: 1. sertraline 25 mg tablet : one (1) tablet po once a day. 2. spiriva with handihaler 18 mcg capsule, w/inhalation device : one (1) capsule inhalation once a day. 3. docusate sodium 100 mg tablet : one (1) tablet po bid (2 times a day). 4. folic acid 1 mg tablet : one (1) tablet po daily (daily). 5. lorazepam 1 mg tablet : one (1) tablet po three times a day as needed for anxiety. 6. senna 8.6 mg capsule : one (1) capsule po once a day. 7. aspirin 325 mg tablet : one (1) tablet po daily (daily). 8. metoprolol tartrate 25 mg tablet : three (3) tablet po tid (3 times a day). disp:*270 tablet(s)* refills:*2* 9. insulin regular human 300 unit/3 ml insulin pen : per sliding scale subcutaneous every six (6) hours. disp:*qs * refills:*2* 10. atorvastatin 80 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. heparin (porcine) 5,000 unit/ml solution : one (1) injection injection tid (3 times a day). disp:*90 injection* refills:*2* 12. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). disp:*30 tablet,rapid dissolve, dr(s)* refills:*2* 13. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : drops ophthalmic prn (as needed) as needed for dry eyes. disp:*qs * refills:*0* discharge disposition: extended care facility: & rehab center - discharge diagnosis: coronary artery disease s/p coronary artery bypass graft x 4 non-st elevation myocardial infarction end-stage renal disease chronic obstructive pulmonary disease anxiety stroke (no deficits) peptic ulcer disease tobacco and benzodiazipine abuse iatrogenic cardiac arrest s/p carotid endarterectomy right discharge condition: good discharge instructions: no lotions, creams or powders to any incision shower daily and pat incisions dry call for fever greater than 100.5, redness, drainage, or weight gain of 2 pounds in 2 days or 5 pounds in one week no lifting greater than 10 pounds for 10 weeks seroquel was stopped (please do not take this medication without discussing it with dr. .) adhere to 2 gm sodium diet. followup instructions: see dr. in weeks see dr. in weeks see dr. (cardiac surgeon) in 4 weeks please call to make appointments. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters intraoperative cardiac pacemaker diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances hemodialysis percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy debridement of nail, nail bed, or nail fold debridement of nail, nail bed, or nail fold debridement of nail, nail bed, or nail fold debridement of nail, nail bed, or nail fold debridement of nail, nail bed, or nail fold debridement of nail, nail bed, or nail fold debridement of nail, nail bed, or nail fold debridement of nail, nail bed, or nail fold debridement of nail, nail bed, or nail fold debridement of nail, nail bed, or nail fold diagnoses: end stage renal disease renal dialysis status subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified atherosclerosis of aorta obstructive chronic bronchitis with (acute) exacerbation aortic valve disorders hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease anxiety state, unspecified anoxic brain damage surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure cerebral embolism with cerebral infarction drug withdrawal urinary incontinence, unspecified hypotension of hemodialysis quadriplegia, unspecified iatrogenic cerebrovascular infarction or hemorrhage peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms acute on chronic combined systolic and diastolic heart failure alcohol abuse, in remission sedative, hypnotic or anxiolytic dependence, unspecified other specified diseases of nail cortical blindness 

Answer: The patient is high likely exposed to