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: history of present illness: the patient is a 76 year old russian speaking man with multiple medical problems including type 2 diabetes mellitus and chronic renal insufficiency, progressed to end stage renal disease, hypertension and peripheral vascular disease, who was in his usual state of health until , when he presented with chronic abdominal pain of two days. this pain was associated with shortness of breath and diaphoresis. he was admitted to the medical service for further evaluation. past medical history: 1. type 2 diabetes mellitus. 2. benign prostatic hypertrophy. 3. impotence. 4. herniated l4-l5 disc. 5. tobacco history. 6. world war ii abdominal blast wound surgery. 7. carotid artery disease. 8. dizziness. 9. chronic renal insufficiency progressing to end stage renal disease with a left hand fistula. 10. constipation. 11. hypertension. 12. claudication. allergies: no known drug allergies. medications on admission: 1. lasix 60 mg q.d. 2. glipizide 10 mg b.i.d. 3. lipitor 10 mg q.d. 4. avandia 2 mg q.d. 5. epogen 4000 units subcutaneous three times a week. 6. aspirin 325 mg q.d. 7. colace p.r.n. 8. dulcolax p.r.n. 9. lactulose p.r.n. 10. nifedipine 120 mg q.d. 11. pletal 50 mg b.i.d. physical examination: on arrival, temperature 96.3, blood pressure 140/60, respiratory rate 30, saturating 92%. in general, an elderly man in no acute distress. head, eyes, ears, nose and throat - the pupils are equal, round, and reactive to light and accommodation. extraocular movements are intact. the neck examination revealed no lymphadenopathy. the neck is supple. cardiovascular regular rate and rhythm, s1 and s2. lung examination revealed bilateral rales. abdominal examination revealed midline scar, left lower quadrant tenderness. extremity examination - bilaterally 2+ lower extremity edema. neurologic examination - awake, alert and oriented times three. cranial nerves ii through xii are intact. laboratory data: on discharge, white count 12.6, hematocrit 30.1, platelets 286,000. electrolytes revealed sodium 136, potassium 5.4, chloride 100, bicarbonate 16, blood urea nitrogen 88, creatinine 8.3 predialysis on . magnesium 2.6, phosphorus 7.6. video swallow on , shows no evidence of aspiration but mild rescue with all consistencies. this study was obtained prior to tracheostomy placement. prostate ultrasound shows bilateral benign prostatic hypertrophy with no abscess. peripheral zone calcification of uncertain etiology. hida scan on , shows no evidence of acute cholecystitis. last chest x-ray on , shows small bilateral effusions which are stable since . the lateral decubitus bilateral films show no significant layering. abdominal ct on , shows no evidence of diverticulitis or obstruction. appendix is not identified. there is a distended gallbladder with gallstone but no gallbladder thickening. there is a left adrenal soft tissue mass with attenuation not typical for adenoma although statistically probably an adenoma. bilateral pleural effusions. there is enlarged left pectinate muscle, likely a hematoma. there is a small hyperattenuation focus in the bladder, may be a bladder stone or prostate gland. cardiac catheterization on , shows right dominant system with left main and three vessel coronary artery disease. resting hemodynamics reveal normal left and right sided filling pressures with calculated cardiac index of 2.3 liters per minute per meter square. there is no gradient across the aortic valve. microbiology data - last line culture which was positive shows coagulase negative staphylococcus on , with a groin quinton line which was removed. urine culture shows no growth. c. difficile assay is negative. blood cultures are negative. cultures for gonorrhea and chlamydia are negative. bronchoscopy in , shows clean lungs and all segments without any secretions. hospital course: the patient was admitted initially to the medical service for rule out myocardial infarction protocol after his episode of shortness of breath and diaphoresis. his initial evaluation included renal service evaluation for his emanate dialysis and cardiology evaluation for non q wave myocardial infarction. his cardiology evaluation led to a cardiac catheterization recommendation which showed left main disease with three vessel coronary artery disease with normal systolic function. given this, he was referred to the cardiothoracic service for coronary bypass. the patient received a coronary bypass on , with the following grafts: saphenous vein graft to left anterior descending. saphenous vein graft to om1. saphenous vein graft to om2. saphenous vein graft to posterior descending artery. the patient's postoperative course was extensively complicated with multiple issues. he required intubation three times for persistent respiratory failure which eventually required a tracheostomy tube placement. for nutritional support, he received percutaneous endoscopic gastrostomy tube placement. his issues are being summarized by systems in the following section. on discharge, however, he is on ventilator with a tracheostomy, on dialysis with a permacath access and on tube feeds with percutaneous endoscopic gastrostomy tube. 1. cardiovascular - the patient was taken to the operating room for coronary bypass on , at which time he received a four vessel coronary artery bypass graft. his cardiac performance after the operation throughout hospitalization has remained stable. his rhythm has been in sinus in the 70s with stable blood pressure, being controlled with lopressor, captopril and norvasc. during his respiratory distress episodes, he received rule out myocardial infarction protocol which was negative. on discharge, he is on norvasc, lopressor, captopril and aspirin and is in sinus rhythm. 2. neurological - the patient is reportedly to be alert and oriented prior to his operation, however, there is question of some baseline dementia. after his coronary bypass, he received intubation three times for respiratory distress. at third intubation, he required sedation with ativan while he awaited multiple procedures including tracheostomy, permacath access placement and percutaneous endoscopic gastrostomy tube placement. after being weaned from an ativan drip, he is awake and more responsive, more and more every day. on discharge, he is moving all four extremities. he is not on any sedation or pain medication and is communicative by signs. he is not on any neurological medication, however, responds well with ativan, a small dose p.r.n. should sedation be required. 3. renal - the patient presented to the hospital with chronic renal failure requiring likely dialysis. given his high creatinine and almost no urine output, he has been requiring dialysis throughout his hospitalization. his left av fistula which he had prior to his coronary bypass was found to be low flow and tenuous. for his access, he has been dialyzed through temporary quinton catheters throughout the hospitalization, but prior to discharge has received permanent right ij permacath for further dialysis. on discharge, his dialysis catheter is functioning well. he receives dialysis every two to three days per hemodialysis service. specifications are with the hemodialysis team at . his renal medications include nephrocaps, phoslo, epogen and heparin with dialysis. he has been treated with vancomycin renally dosed for his previous quinton catheter line infection. on discharge, he is afebrile. infectious disease - the patient was reintubated postoperative his coronary bypass on day two for presumed respiratory distress. further evaluation showed a left lower lobe infiltrate. initial gram stain showed gram positive cocci and pmns for which he was treated with quinolone and clindamycin for a complete course of pneumonia. cultures were, however, oropharyngeal flora. his pneumonia has resolved which was evident with bronchoscopy performed in early . on discharge, he is afebrile and oxygenating and ventilating well on a ventilator with small bilateral pleural effusions. the patient has also had two episodes of line catheter tips growing coagulase negative staphylococcus, likely staphylococcus epidermidis. for this, he has been treated for ten days of vancomycin dosed renally per routine vancomycin levels. at discharge, he has finished his vancomycin course and is being discharged without any temporary lines and without any antibiotics. gastrointestinal - the patient presented to the hospital with history of constipation and on preoperative films was shown to have stool in the colon. after the coronary bypass, he continued to remain constipated and required a general surgery consultation. abdominal ct showed no intra-abdominal process, however, showed constipation. since then, he has received a clean out with golytely and after that he receives colace through his gastrostomy tube. on discharge, he is having bowel movements at least once every one or two days. there was also a question of gallbladder infection as raised by infection disease, however, further studies showed no evidence of cholecystitis. this was shown with studies including hida scan. hematology - the patient's hematocrit has been fluctuating in the high 20s and 30s requiring approximately three units of blood throughout his postoperative course, all given during dialysis. nutrition - the patient due to his prolonged hospitalization and intubations has had intermittent nutrition for which he received percutaneous endoscopic gastrostomy tube placement. he is at goal on his tube feeds which are nephro with 60 grams of promod at 45 cc per hour. the nephro tube feeds are three quarter strength. he is being followed by nutrition service. he is on prevacid, vitamin c and zinc. diabetes mellitus - the patient's diabetes mellitus has been controlled with sliding scale insulin through his hospitalization. genitourinary - the patient was shown to have some urethral discharge for which he received genital cultures which were negative including negative for gonorrhea and chlamydia. his rpr test was also negative. urology evaluation included a prostate ultrasound which showed prostatic hypertrophy but no abscess or any other malignant process that could be seen. in summary, the patient presented to the hospital with multiple comorbidities including end stage renal disease, poor respiratory function and coronary disease. his evaluation showed three vessel coronary disease with left main disease and required a coronary bypass. postcoronary bypass course has been for respiratory failure which shows poor respiratory compensation for acidosis likely from his end stage renal disease. this has required tracheostomy tube placement for difficulty weaning from a respirator, percutaneous endoscopic gastrostomy tube placement for poor nutrition and required nutritional support and permanent dialysis catheter placement for nonfunctioning left av fistula and persistent hemodialysis needs. on discharge, he is alert and responsive. he is in bed for multiple days. he is on ventilator at pressure support of 10 with cpap at 35% of fio2 with normal arterial blood gases. he is moving all four extremities and has clean, dry and intact incisions. his access includes a right ij permacath. he is being discharged to rehabilitation for ventilator weaning. discharge medications: 1. aspirin 81 mg per gastrostomy tube q.d. 2. norvasc 10 mg per gastrostomy tube q.d. 3. lopressor 25 mg per gastrostomy tube b.i.d. 4. captopril 50 mg per gastrostomy tube t.i.d. 5. phoslo two tablets per gastrostomy tube q.i.d. 6. epogen 12,000 units with dialysis. 7. heparin 5,000 units subcutaneous b.i.d. 8. ativan 0.5 mg intravenous q6hours p.r.n. 9. colace 100 mg per gastrostomy tube b.i.d. 10. nephrocaps one per gastrostomy tube q.d. 11. prevacid elixir 15 mg per gastrostomy tube q.d. 12. vitamin c 50 mg per gastrostomy tube q.d. 13. zinc 220 mg per gastrostomy tube q.d. 14. insulin sliding scale: for 150-200 give three units, 201-250 given six units, 251-300 give nine units, 301-350 give twelve units. 15. albuterol mdi two puffs q4hours p.r.n. 16. tube feeds three quarter strength nephro with 60 grams promod at 45 cc per hour. allergies: no known drug allergies. follow-up: dr. in two to four weeks. follow-up with hemodialysis as required. disposition: to acute rehabilitation. discharge diagnoses: 1. coronary artery bypass graft times four. 2. end stage renal disease on hemodialysis. 3. respiratory failure on ventilator with tracheostomy. 4. percutaneous endoscopic gastrostomy tube for nutrition. 5. noninsulin dependent diabetes mellitus. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery angiocardiography of left heart structures left heart cardiac catheterization coronary arteriography using a single catheter insertion of endotracheal tube (aorto)coronary bypass of four or more coronary arteries venous catheterization for renal dialysis temporary tracheostomy diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified acute respiratory failure infection and inflammatory reaction due to other vascular device, implant, and graft diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to