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: resp distress major surgical or invasive procedure: right internal jugular central venous line- removed before discharge endotracheal intubation right arm picc history of present illness: 83m w/ h/o cad s/p remote silent mi and pci in ' in , reported chf, pe in on anticoagulation/ivc filter now admitted to micu for further management of resp failure after transfer from osh for evaluation of gas in region of gallbladder. records are limited but apparently recently d/c'd from osh for treatment of recurrent pna (for which completing course of abx) when apparently felt presyncopal/?fall w/o loc/head trauma when walking in bathroom. later, began to note increased doe, pnd, orthopnea w/ le edema. no definite wg or cp. chronic cough productive of reddish sputum. evaluated at osh where noted to be hypoxic on 4 liters but o/w hemodymically stable. labs notable for flat ck and troponins, bnp of 877 and no definite leukocytosis. cxr w/ reported bilateral patchy consolidation and pleural effusions confirmed by ct w/o evidence of thromboembolic disorder. films thought to be worse than prior cxr c/w pna. ct also noted incidental gas in region of gallbladder fossa. pt diuresed nearly 2.5 liters w/ minimal improvement in oxygen requirements so transferred to for furhter evaluation. at , remained afebrile, marginal pressures and cxr w/ bilateral patchy alveolar infiltrates. labs notable for troponin of 0.18 and bnp in xcess of 7k. ecg w/ lbbb. developed increased tachypnea in the setting of tachycardia and relative htn w/ abg 7.29/52/105. received 120iv lasix, nitro gtt but ulitmately placed on bipap. received ceftriaxone and zithro. lft wnl and u/s negative for abscess in the biliary tract. past medical history: reported chf cad s/p remote silent mi and pci in ' () htn pe on anti-coagulation and filter (unclear of reason why developed pe) recent pna ( and then again ) s/p lap choley in setting of cholecystitis aaa repair in ' w/ repair of lle aneurysm as well s/p left shoulder rotator cuff repair bph throat cancer s/p resection in social history: lives w/ family in , remote tobacco (quit 25 y/a), no etoh, ivda basia (daughter) family history: n/c physical exam: t 98.8, bp 133/77, hr 86, rr 20, 94% on 4l gen: elderly male, comfortable on bipap, answering questions heent: pupils reactive, eomi. dry mucus membranes, jvp at 8 cm at 45 degrees cv: faint heart sounds, s1 + s2 normal, regular, no m/r/g pulm: bibasilar rales from base abd: midline vertical scar well healed, + bs, soft , diffuse tenderness, mostly llq, no cvat ext: + dp pulse. + le edema neuro: moving all extremities, ms equal bilaterally. pertinent results: admit labs: ========== wbc-9.1 hgb-11.8* hct-35.2 plt ct-236 neuts-83* bands-0 lymphs-6* monos-11 eos-0 baso-0 atyps-0 metas-0 myelos-0 pt-23.7* ptt-30.2 inr(pt)-2.4* glucose-69* urean-29* creat-1.0 na-138 k-3.8 cl-102 hco3-24 angap-16 alt-39 ast-46* ck(cpk)-43 alkphos-54 amylase-14 totbili-0.9 totprot-5.6* calcium-7.8* phos-4.3 mg-2.0 . cardiac enzymes: ================ 01:20pm blood ck-mb-notdone ctropnt-0.18* probnp-7937* 08:05pm blood ck-mb-notdone ctropnt-0.20* 03:28am blood ck-mb-notdone ctropnt-0.17* . %hba1c-5.6 triglyc-61 hdl-29 chol/hd-4.0 ldlcalc-74 . radiology: liver u/s impression: 1. right pleural effusion. 2. no abnormal fluid collection within the gallbladder fossa. 3. no evidence of focal hepatic mass or intra- or extrahepatic biliary ductal dilatation in the visualized portions of the liver. . cxr 1. acute pulmonary edema. its somewhat atypical appearance suggests the possibility of underlying emphysema. 2. superimposed pneumonia is also possible and cannot be excluded. . chest cta 1. no evidence of pulmonary embolism. 2. moderate layering bilateral pleural effusions with associated atelectasis with bilateral patchy areas of ground-glass opacity as well as areas of interlobular septal thickening consistent with pulmonary edema/volume overload. in addition, there are multiple bilateral patchy areas of consolidation involving all lobes of the lungs worrisome for superimposed infectious process. 3. extensive atherosclerosis including atherosclerosis of the coronary arteries. . echo: ============ conclusions: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated with severe regional systolic dysfunction including akinesis of the inferior wall and basal half of the anterior septum and anterior walls. the remaining segments are hypokinetic. the basal inferolateral wall contracts best. no masses or thrombi are seen in the left ventricle. e/e' is >15 c/w elevated lvedp. right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated. the ascending aorta is mildly dilated. the aortic valve leaflets are moderately thickened but no aortic stenosis is present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. mild to moderate (+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: left ventricular cavity enlargement with severe regional dysfunction c/w multivessel cad (or other diffuse process). increased lvedp. mild-moderate mitral regurgitation. pulmonary artery systolic hypertension. . discharge labs: 05:36am blood wbc-9.7 rbc-3.71* hgb-10.8* hct-32.8* mcv-88 mch-29.0 mchc-32.8 rdw-16.9* plt ct-285 05:36am blood plt ct-285 05:36am blood pt-18.0* ptt-120.7* inr(pt)-1.7* 05:36am blood glucose-145* urean-15 creat-0.8 na-142 k-4.2 cl-108 hco3-26 angap-12 05:36am blood calcium-8.1* phos-2.9 mg-2.0 05:36am blood vanco-16.9* 07:00am blood digoxin-0.5* brief hospital course: 83 y/o m w/ cad, chf, dm, recurrent pna admitted to icu with hypoxic respiratory failure. brief hospital course outlined below. . the patient was admitted to the icu and intubated for hypoxic respiratory failure. the cause of his hypoxia was felt to be largely secondary to chf exacerbation with volume overload. there was also a suspected component of aspiration pneumonia with thick purulent secretions noted by endotracheal suctioning. for his volume overload, he was diuresed aggressively with iv lasix, which he tolerated well. for his pneumonia, he was treated broadly with vancomycin, ceftaz, flagyl with gradual improvement of his oxygen requirement and reduction of secretions. he will complete his antibiotic course on . he was weaned of ventilatory support by and was quickly weaned down to nasal cannula with maintenance of oxygen saturation >97%. . given his history of pe, he was continued on heparin iv anti-coagulation and transitioned to coumadin on . . in order to evaluate his cardiac function, an echo was performed which confirmed systolic heart failure with an ef of 20-25% in the setting of 2+ mr. was maintained on a medical regimen of b-blocker, ace-i, digoxin and daily lasix (see medication list for discharge doses) . of note, initial imaging studies revealed evidence of gas in gall bladder wall. however repeat imaging did not confirm this finding and liver function tests remained stable throughout. no further evaluation was performed on this hospitalization. medications on admission: levaquin 500 qd, lisinopril 5 qd, coreg 3.125, 6.25, lasix 20 qd, glyburide 2.5qd, warfarin 7.5 qhs discharge medications: 1. colace 100 mg capsule sig: one (1) capsule po twice a day for 1 months. disp:*60 capsule(s)* refills:*0* 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for 1 months. disp:*60 tablet(s)* refills:*0* 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 4. digoxin 125 mcg tablet sig: half tablet po once a day. disp:*15 tablet(s)* refills:*2* 5. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4-6h (every 4 to 6 hours) as needed for 1 months. disp:*2 inh* refills:*0* 6. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation q4-6h (every 4 to 6 hours) as needed for 1 months. disp:*2 inh* refills:*0* 7. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). disp:*45 tablet(s)* refills:*2* 8. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. glyburide 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. atorvastatin 10 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 12. warfarin 2.5 mg tablet sig: two (2) tablet po qhs. disp:*60 tablet(s)* refills:*2* 13. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 1 days. disp:*3 tablet(s)* refills:*0* 14. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 1 days. disp:*2 gram* refills:*0* 15. tamsulosin 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po hs (at bedtime). disp:*30 capsule, sust. release 24hr(s)* refills:*2* 16. heparin (porcine) in d5w 100 unit/ml parenteral solution sig: 1300 (1300) units intravenous per hour: please check ptt every eight hours and adjust heparin drip as follows. goal ptt 70-100. if ptt <70, increase rate by 100units/hr. if ptt >100, please stop drip for one hour and restart at 100 units less per hour. please stop once inr is between 2 and 3. disp:*qs units* refills:*0* 17. ceftazidime-dextrose (iso-osm) 2 g/50 ml piggyback sig: two (2) gram intravenous q8h (every 8 hours) for 2 days. disp:*12 gram* refills:*0* 18. picc care picc care per protocol 19. outpatient lab work please check ptt every 8 hours while on heparin. please check pt/inr every day while on coumadin until inr is . once coumadin dose is at goal based on inr of , check inr three times per week. 20. blood sugar monitoring please check fingerstick glucose qachs. glyburide can be increased to 5mg qd if blood sugars are consistantly high. discharge disposition: extended care facility: hospital of & islands - discharge diagnosis: congestive heart failure (ef 20-25%) hospital acquired pneumonia discharge condition: stable discharge instructions: you were treated for exacerbation of congestive heart failure. this was a severe exacerbation that required intubation and mechanical ventilation. in order to help prevent another episode, it is very important that you follow a low sodium diet and restrict fluid intake to 2 liters per day. it is also important to follow your weight daily. please call your physician for change in weight >3lb. also call for any shortness of breath, chest pain, palpitations or other concerns. it is important that you take all medicines as outlined below. you will complete your course of antibiotics tomorrow for treatment of pneumonia as outlined below. followup instructions: please follow-up with your primary physician . 1 week after discharge from rehab. please be sure to schedule an apoointment with your cardiologist to have your cardiac medication regimen adjusted as necessary. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation arterial catheterization transfusion of other serum diagnoses: pneumonia, organism unspecified anemia, unspecified congestive heart failure, unspecified unspecified essential hypertension systolic heart failure, unspecified other specified forms of chronic ischemic heart disease acute respiratory failure hypotension, unspecified personal history of venous thrombosis and embolism diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled other and unspecified coagulation defects personal history of malignant neoplasm of larynx 

Answer: The patient is high likely exposed to