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: this is an 84-year old gentleman with a long history of tobacco use, hypertension, hypercholesterolemia in family history until about eight months ago when he noticed the requirement of needing more frequent sublingual nitroglycerin for increasing chest pain. at 1:00 a.m. on , while at rest in bed, he developed substernal chest pain radiating to his left shoulder with shortness of breath. he took four sublingual nitroglycerins with minimal relief. the pain kept him awake throughout the night. at 6:00 a.m. he took eight nitroglycerins without relief and also tried his albuterol inhaler. he called his daughter and she activated the emergency system and he was brought to at 9:00 a.m. at , his electrocardiogram showed anterior st elevations with lateral t-wall inversions and reciprocal inferior st depressions. he was given aspirin, heparin, aggrastat, and nitroglycerin. he was transferred to . at , he underwent emergent cardiac catheterization, results to follow. past medical history: 1. hypertension. 2. angina. 3. hypercholesterolemia. 4. aortic stenosis. 5. asthma. 6. peptic ulcer disease, status post gastrectomy 30 years ago. 7. colon cancer, status post colectomy with radiation therapy 4 years ago. 8. peripheral vascular disease with history of bilateral lower extremity claudication. allergies: none known. medications on admission: albuterol, aspirin, norvasc, isosorbide dinitrate, lovastatin and sublingual nitroglycerin. family history: he had a strong family history of coronary artery disease including myocardial infarction in one brother. social history: he had a smoking history of 20 pack years, but he quit 30 years ago. he was somewhat active, walking about an hour a day. laboratory data on admission: white count 12.1. hematocrit 34.5. platelet count 242. sodium 141. k 4.2. chloride 111. co2 14. bun 29. creatinine 1.4 with blood sugar of 169. his cks were in the 230 to 1244 range with mbs of 25 and 180 which indexed to 10.9 and 16.5, ruling him in for myocardial infarction. hospital course: at cardiac catheterization at , he had elevated filling pressures with an 80% posterior descending artery lesion, a left main left anterior descending 95% lesion, and diffusely diseased diagonal 1. they did place a stent in the left main proximal left anterior descending lesion and a balloon was placed and patient was transferred into the ccu. he was started on plavix, heparin, aggrastat, and captopril and he was referred to cardiothoracic surgery. he was seen by dr. from cardiac surgery for evaluation in this acute myocardial infarction period. on his exam, his pressure was 110/52 with a heart rate of 80. his head, eyes, ears, nose and throat exam was negative. he had no carotid bruits. he had a systolic injection murmur. his lungs had crackles on the right side. he had a healed median infraumbilical scar and no masses. his abdomen was soft and nontender. he had an intraaortic balloon pump in place in his right groin. his distal pulses were present on doppler. his chest x-ray showed some pulmonary edema. his blood gas that day was 7.41/98/30/20 with a base excess of -3. his white count had dropped to 9.4, with a hematocrit of 30, a k of 3.8, a bun of 30 and creatinine of 1.5. he appeared to be still evolving his myocardial infarction. his left ventricular end-diastolic pressure was 40 with pulmonary artery pressures of 58/42. his ejection fraction was 20% with an aortic valve area of 0.9 cm squared. the mean gradient of 14 at a peak of 23 as well as a calcified ascending aorta. all of these results were found on his echocardiogram which confirmed the presence of aortic stenosis and myocardial dysfunction. he continued to be stabilized in the ccu over the next couple of days for his evolving myocardial infarction. he had a ct scan of the chest which showed some midcalcification of the ascending aorta most prominently anteriorly and calcifications near the aortic valve. it also showed moderate bilateral pleural effusions with some loculation on the left and probable asbestosis. please refer to the ct chest report. he was seen by clinical nutrition as he awaited surgery with the balloon pump in the ccu. he received a swan-ganz in the ccu as his medical issues were addressed. on he underwent aortic valve replacement with a 20 mm - bioprosthetic valve and a coronary artery bypass grafting times 4 with a left internal mammary artery to the left anterior descending, a vein graft to the posterolateral sequential to the ramus intermedius, and a vein graft to the posterior descending artery by dr. . he was transferred to the cardiothoracic intensive care unit in stable condition on a levophed drip at 0.05 mics per kg per minute, a milrinone drip at 0.5 mics per kg per minute and a propofol drip at 30 mics per kg per minute. on his first postoperative day, he had decreased urine output. he received fluid and lasix with a minimal response. his creatinine rose to 1.8, his hematocrit was 30 and a white count of 8.7. his lactate was 1.6. he remained on the balloon pump. intubated on levophed, insulin, milrinone, neo-synephrine and propofol. his intra-aortic balloon pump was removed on the afternoon of the second day. renal was asked to see the patient who determined that he was probably in acute renal failure from several factors, being prerenal, intrarenal with the possibility of interstitial nephritis and probable acute tubular necrosis. this was discussed with dr. . their recommendations were followed. over the course of the next several days, the patient was seen by physical therapy. he continued to have problems with urine output. on his second postoperative day, his creatinine rose to 2.3 with a rising white count of 14.9. he remained intubated and sedated with a blood pressure of 100/50 and a t-max of 99.1 on dopamine, levophed, milrinone, neo-synephrine and propofol. he was also seen by a vascular surgeon because, after his balloon removal that afternoon, there was a question of whether or not he lost his pulse. he did have a slightly cool left foot with some mottling of the toes, with with the possibility of having showered small emboli to the vessels in the left foot during placement or removal of the balloon. this was discussed with dr. of vascular surgery with the recommendation to anticoagulate him, and he remained on the heparin drip. he was followed every day by vascular. he was seen by renal. he continued to have slight improvement in his urine output. he did remain intubated but was following commands. he was on continuous positive airway pressure on postoperative day 3 remaining again on his inotropic and pressor support. he was seen again by nutrition. the patient was extubated on the 13th. the milrinone was off, the neo-synephrine was off. there were some casts and sediment with white blood cells in his urine. amiodarone had been added in. he was being paced in the 88 to 118 range with the blood pressure ranging from 80/42 to 137/66. he remained extubated. his heparin was turned off. his white count was 11.0 on postoperative day 4. his acute renal failure continued to be followed by renal. he continued to be followed by vascular. he was started on phoslo to increase his phosphate. he had some increased sputum production which was blood tinged. he remained on dopamine. heparin was restarted. his creatinine continued to rise on postoperative day 5 to 4.1 with a white count of 8.5, k of 5.0, bun of 67. he had been restarted on levophed to help keep his pressure up, which was approximately 109/49 at the time of exam. he remained on heparin at vascular's recommendation. his platelet count continued to drop on the heparin, dropping to 34 on postoperative day 5. he was reintubated. he was seen by case management for a follow-up. he was started on levofloxacin. he was on amiodarone and lopressor for his atrial flutter. he had some deterioration in the status of his left foot. he continued on his tube feeds and remained intubated in the intensive care unit. he continued to evolve multiple issues over the next several weeks which included a rising white count, failure to wean off the ventilator, decreasing breath sounds, requirements for levophed and dopamine. he had a long and protracted stay in the intensive care unit. on the day of dictation, he is postoperative day 91. he developed respiratory complications and renal complications. he ultimately received total parenteral nutrition for feeding. he required going back to the operating room for wound dehiscence and a sternal debridement on by dr. and dr. . please refer to the operative note. a large vac dressing was placed over the wound. he was followed daily by the renal service and vascular service saw him daily over the course of the first month. his dopamine remained on, although it was turned down early on to renal dose only to help his urine output and keep his blood pressure stable. the plan was for him to get a peripheral bypass when he was fully stabilized and recovered. he was followed often by physical therapy, but given his decreased platelet count, he was unable to receive chest physical therapy. in the first month or so, his creatinine stayed in the 4 range. on , he was extubated and put on bilevel positive airway pressure and the total parenteral nutrition was started. he was reintubated later in the day on the 19th. the recommendations from renal continued to be followed as well as from vascular. although he was intubated, he did remain alert and the plan was to do tracheostomy which was done on the 22nd percutaneously. he had multiple line placements over the course of the next several weeks, including subclavian and ultimately quinton catheter placement. patient was unable to receive a flap from plastic surgery after his sternal debridement due to multiple infections and processes that were going on including his difficulty with respiratory and renal. their plan was to do a skin graft and on he did ultimately receive that split-thickness skin graft from the right thigh to his chest wound. he also received a placement of jejunostomy tube and placement of a quinton permcath to his left chest wall for management of his renal failure and his open chest wall for coverage and infectious prevention. he was unable to receive his flap due to his multiple infectious issues. those procedures were done on . he also had gastrointestinal consult who followed him for elevated total bilirubin in late . he was started on antibiotics also in , levaquin for question of sepsis and development of cholestasis and jaundice. his ast rose to 84 with an alt of 48. his total bilirubin rose to 11.0 with an indirect bilirubin of 0.9. his albumin continued to drop in late as low as 1.6 which also was another reason why plastic was unwilling to take him for a flap. his heparin was discontinued and he remained on dopamine and neo-synephrine. in late he also received a hematology consult to rule out hemolysis given his increased bilirubin. the recommendation was that it was not a hemolytic picture, but one of a more cholestatic one. while he was transferred to the surgical intensive care unit and received an infectious disease consult in late , he had been restarted on vancomycin and levofloxacin to also cover the possibility of sepsis and abdominal process. multiple lines were re-wired and re-sited. he was also started on zosyn. ultimately he cultured out over the course of the next couple of months with klebsiella from his chest wound, methicillin resistant staphylococcus aureus in his sputum, and yeast from multiple sites including respiratory and urinary. at the present time, he has no bacteria in his blood stream, blood cultures have been negative. he ultimately had a ddd pacemaker placed by cardiology after an asystolic arrest in early . the wires are internal, but the pacer generator itself is external due to his skin graft and infection of his open chest. it was elected not to reimplant this, that this could be done as an outpatient when the patient recovered out in rehabilitation and was off all antibiotics with no infectious issues so it is externally on his chest. the patient remains ventilator dependent and is usually on a tracheal collar during the day and rested on the ventilator at night. efforts were made over the course of several weeks prior to the skin grafting of his chest to get him to the point where he could nutritionally tolerate and, from an infectious point of view, tolerate having a surgical flap placed over his open chest and ultimately he was unable to achieve this and did receive a skin graft in . , m.d. dictated by: medquist36 procedure: (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization other enterostomy hemodialysis temporary tracheostomy other skin graft to other sites open and other replacement of aortic valve with tissue graft local excision of lesion or tissue of bone, scapula, clavicle, and thorax [ribs and sternum] implant of pulsation balloon other lysis of peritoneal adhesions initial insertion of single-chamber device, rate responsive diagnoses: thrombocytopenia, unspecified acute kidney failure with lesion of tubular necrosis other postoperative infection congestive heart failure, unspecified aortic valve disorders acute myocardial infarction of anterolateral wall, initial episode of care cardiogenic shock mediastinitis 

Answer: The patient is high likely exposed to