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: hypotension major surgical or invasive procedure: left femoral line history of present illness: 76 yo m with esrd on hd, cad, aaa repair, aflutter, avr, copd, transferred from hospital with sepsis. and weak. he was dialysed 5 times in the past 1 week as patient had gained around 9 kg. he also noted to have diarrhea, decreased po intake. he also complained of left flank pain for the last 1-2 weeks. on the morning od admission, he felt really weak and slumped to the ground. his daughter checked his bp which was sbp of 30's. he was immediately taken to . in the ems, his sbp was in 60's. at , he got fluid boluses and was started on pressors. they tried scl but were not successful. he was then transferred to for further management. in the ed, he got a fem line (under sterile precautions) and was started intially on neo and then switched to levo. his ua was dirty, he had leukocytosis and elevated cks. he also received vanc, cefepime. past medical history: atrial fibrillation/atrial flutter cad s/p cabg thoracic ascending aortic aneurysm s/p avr htn ckd - on hd mwf s/p pacer s/p aaa repair ??????01 af ?????? s/p cardioversion ??????03 copd hypothyroid carotid stenosis possible renal artery stenosis kyphosis asthma asbestosis restless leg social history: patient lives with his wife and one of his 3 children. he quit smoking 40 years ago (), smoked for 18 years. retired salesman. asbestos exposure in submarines 50 yrs ago. denies any etoh, no ivdu. family history: no h/o dm, htn, no cancer mother died of heart disease at 90 physical exam: vitals: 97.8, 91/71, 66, 14, 100%/3l nc gen: alert, oriented, in no acute distress heent: furrowed tongue, mild glossitis neck: thick neck, no jvd appreciable heart: s1/s2, many ectopic beats, 3/6 sem at lusb lungs: bilateral wheezes, no crackles abdomen: tense, no tenderness/guarding/rigidity, normoactive bs flank: no tenderness ext: no edema neuro: no focal deficits pertinent results: 05:20pm blood ck(cpk)-1598* 02:18am blood ck(cpk)-1143* 05:57pm blood ck(cpk)-696* 02:18am blood ck-mb-24* mb indx-2.1 ctropnt-0.30* 05:20pm blood cortsol-29.1* 12:25am blood cortsol-39.1* 01:00am blood cortsol-44.5* 05:20pm wbc-19.5* rbc-3.34* hgb-11.2* hct-33.6* mcv-101* mch-33.5* mchc-33.3 rdw-17.9* 05:20pm glucose-76 urea n-41* creat-5.1*# sodium-138 potassium-5.5* chloride-102 total co2-24 anion gap-18 . ekg: aflutter with 4:1 block, no acute st-t wave changes . chest xray: overall improvement in the congestive heart failure seen in early . likely there is still a mild degree of pulmonary edema. stable appearance to the mediastinum. . lue u/s : 1. nonvisualization of left upper extremity veins with multiple collateral vessels identified, suggestive of a chronic obstruction. this can be further evaluated with an mr examination. 2. no evidence of deep venous thrombosis in the right upper extremity. 3. fistula graft within the left forearm which is widely patent, however, it appears to be anastomosed to arterial vessels. no venous flow is noted within the region of the fistula graft anastomoses. . echo : 1.the left atrium is mildly dilated. the right atrium is moderately dilated. 2.there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef>75%). 3. right ventricular chamber size is normal. 4.a bioprosthetic aortic valve prosthesis is present. the aortic prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. trace aortic regurgitation is seen. 5. the mitral valve leaflets are mildly thickened. there is severe mitral annular calcification. moderate to severe (3+) mitral regurgitation is seen. 6. severe tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. 7.there is no pericardial effusion. compared with the findings of the prior report (images unavailable for review) of , the mr significantly. an accurate assessment of the aorta could not be made on the present study. . fistulography l arm: angiography of the arterialized l brachial vein showed an occluded l subclavian vein. the l subclavian vein was occluded. the procedure was abandoned in favor of surgical intervention. final diagnosis: 1. thrombosed l av fistula 2. occluded l subclavian vein . hd catheter exchange by ir: uneventful exchange of right ij dialysis catheter, as above. the tip of the catheter, which was removed, was sent for cultures. the line is ready to use. . left fistula ligation without any major complications. brief hospital course: 76 yo m with esrd on hd, cad, aaa repair, aflutter, avr, copd with hypotension from urosepsis vs overdialyzing, requiring micu stay. he was transiently on pressors. broad spectrum antibiotics were started in the icu, as well as a heparin gtt for aflutter and l ue clot. he was transferred to the floor with stable bp, off pressors, on vancomycin and cefepime. . 1) hypotension: ? line sepsis vs. pneumonia vs hypovolemia aggressive hd and decreased po intake. cortstim test was negative for adrenal insufficiency. likely sources of infection are hd catheter, pna, less likely urine. off levophed gtt after 24h, bp was stable, then transferred to floor. patient received iv fluids as needed. vancomycin (started ) and cefepime (started ) were continued. a total course of 21 days should be given. multiple blood and urine cultures from through came back negative. hd catheter cultures were sent off on and also came back negative. pt was hemodynamically stable on discharge and afebrile. . 2) cad s/ cabg: pt developed elevation of troponin to 0.3 (from 0.14 from ), cpk elevated to 1598 although no elevation of ck-md index. ekg no evidence of any acute st-t wave changes. this could represent demand ischemia in the setting of sepsis, hypotension. cardiac enzymes were cycled x3 and remained stable. pt was continued on lipitor. asa was held on heparin gtt. pt was continued on toprol xl with holding parameters once his blood pressure was stable after transfer from the icu. an echo from to assess lv function showed ef of 75%, but mr. p appointment with cardiologist dr. should be scheduled for 1-2 weeks after discharge. . 3) atrial flutter: his rate was controlled in 4:1 bloc. it was therefore unlikely that this was contributing to the hypotension. pt was continued on his bb. anticoagulation was started. a heparin gtt was initiated which was discontinued shortly pior discharge since he went for an av fistula ligation. he also developed guaiac positive stools on two occasions during his hospital stay. the first time, the heparin gtt has been held transiently (see below). the second time, coumadin was just started at 3mg qhs and was held as well for guaiac positive stools. a hematocrit should be checked at rehab. it should be decided after further hematocrits whether anticoagulation with coumadin is being continued as an outpatient. . 4) l ue clot: present since fistula operation in . the patient was on a heparin gtt for the majority of his hospital stay. however, the drip has been discontinued shortly prior discharge. a fistulogram on was performed and showed a large clot that could not be cleared during the procedure. transplant surgery ligated the fistula on without any major complications. swelling of his arm improved soon thereafter. an outpatient followup appointment has been scheduled by transplant surgery in order to follow up on his ligated av fistula. . 5) esrd: pt received routine hd on m/w/f or as needed. pt was continued on nephrocaps and phoslo. hd catheter was exchanged over wire on by ir. hd catheter tip was sent for culture and came back negative. he should resume his regular outpatient hd. vancomycin should be given with hemodialysis. levels should be checked prior each vanco dose. . 6) anemia: likely secondary esrd. iron studies consistant with acd. hct baseline of 34-40. hct was trending down to 31. pt received epo with hd and dose was increased on . . 7) guaiac positive stools: pt had guaiac pos stool on . heparin gtt was transiently held and pt was briefly on ppi iv bid, but repeat hct remained stable at a lower baseline. one unit of prbc were transfused on . the heparin drip was restarted but discontinued shortly prior discharge for an av fistula ligation. coumadin was started after the procedure at 3mg qhs but was held as well because of another guaiac positive stool. a hematocrit should be checked at rehab. it should be decided after further hematocrits whether anticoagulation with coumadin is being continued as an outpatient. it is recommended that the patient is undergoing an outpatient gi workup for this gi bleed. . 8) dizziness: the patient developed intermittent, mild dizziness when moving. these symptoms appeared shortly prior discharge. one likely diagnosis would be bppv among others, and should be further worked up as an outpatient. his vs remained stable. . 9) htn: continued bb after transfer to the floor. . 10) copd: continued nebs. xopenex (levalbuterol) to be considered if tachycardic. . 11) hypothyroid: continued levothyroxine; initial elevated ck could be from hypothyroidism. tsh was 64, free t4 was 0.57 while patient was still in the icu. synthroid dose was increased from 75 mcg to 100 mcg daily. patient was discharge on this higher dose. . 12) ppx: heparin gtt (for majority of hosptial stay), one dose of coumadin, held after guaiac positive stools, heparin sc for the remainder, pneumoboots, protonix, hob elevation . 13) fen: heart healthy diet . 13) access: l femoral line discontinued on , hd catheter, picc, piv . 15) code: dnr/i medications on admission: asa 81 mg carbidopa-levodopa 10-100 mg tablet tid atorvastatin 40 mg qd morphine 15 mg fluticasone-salmeterol 250-50 mcg/dose metoprolol succinate 25 mg tablet sr qd pantoprazole 40 mg ipratropium bromide q6h docusate sodium 100 mg ropinirole 1 mg nephrocaps qd levothyroxine 75 mcg qd discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 4. carbidopa-levodopa 10-100 mg tablet sig: one (1) tablet po tid (3 times a day). 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) inhalation every six (6) hours as needed for shortness of breath or wheezing. 7. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 8. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 9. metoprolol succinate 25 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 13. ropinirole 1 mg tablet sig: one (1) tablet po bid (2 times a day). 14. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) intravenous qhd (each hemodialysis) for 10 days: started . complete 21 day course. check vanco level prior each hd. 15. cefepime 1 g recon soln sig: one (1) recon soln intravenous q24h (every 24 hours) for 8 days: started . complete 21 day course. 16. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous daily (daily) as needed. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: 1. ? sepsis 2. atrial flutter 3. l upper extremity clot . secondary diagnosis: 1. cad s/p cabg 2. hypertension 3. copd 4. hypothyroid discharge condition: afebrile. hemodynamically stable. tolerating po. discharge instructions: please call your primary doctor or return to the ed with fever, chills, chest pain, shortness of breath, nausea/vomiting, spontaneous bleeding or any other concerning symptoms. . please take all your medications as directed. your coumadin has been held. . please keep you follow up appointments as below. followup instructions: please follow up with your primary care doctor (, m. ) as needed. please schedule a followup appointment with dr. () in weeks from now. . from transplant surgery has scheduled an oupatient appointment for you. her phone number is . the appointment is: provider: , md phone: date/time: 9:10 . vancomycin and cefepime to be continued until 21 day course is completed or for one week after discharge. vancomycin levels should be checked prior each hemodialysis. . *******patient had guaiac positive stools during hospitalization. outpatient gi workup is necessary.********his hematocrit should be checked at rehab. his last hct at discharge was 26.5.********* coumadin (3mg qhs) was started during the hospitalization but has been held prior discharge. it should be decided as an outpatient when to restart.********* procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified hemodialysis venous catheterization for renal dialysis arteriography of other specified sites removal of arteriovenous shunt for renal dialysis infusion of vasopressor agent phlebography of other intrathoracic veins using contrast material diagnoses: end stage renal disease congestive heart failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified aortocoronary bypass status atrial flutter other specified forms of chronic ischemic heart disease infection and inflammatory reaction due to other vascular device, implant, and graft heart valve replaced by transplant asbestosis other complications due to renal dialysis device, implant, and graft fitting and adjustment of cardiac pacemaker hypotension of hemodialysis swelling of limb profound impairment, one eye, impairment level not further specified 

Answer: The patient is high likely exposed to