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 a -year-old russian speaking man with a history of copd on home o2, bronchiectasis, hypertension, chf with an ef of 20-25% with 2+ mr , cad, who presents with increased shortness of breath, lower extremity edema for 1-2 weeks with acutely increased shortness of breath and tachypnea on the night before admission. the patient measured his blood pressure at home and it was elevated to 200/100. he became anxious over this elevated blood pressure and his dyspnea worsened. he denied chest pain, palpitations, fever, chills, or rash. denied any dietary noncompliance. he reports that he has not taken his lasix for "months", and he also reports that his duoneb had recently been d/c'd and he was on atrovent alone. ems was called, who found him to have a respiratory rate of 20, heart rate of 107, blood pressure of 200/100, and satting 89% on 2 liters with basilar wheezes. in the emergency department, he was started on a nitro drip and given 40 iv of lasix with initially good urine output of 1 liter for a presumed chf exacerbation. he, however, then subsequently developed increasing tachypnea and he was started on bipap for increasing pco2 respiratory distress with decreasing respiratory rate. abg on face mask before bipap was instituted was 7.20/112/62. ekg showed tachycardia with afib versus aflutter, and was therefore admitted to the icu for further management. past medical history: 1. copd on home o2 of 2 liters and in , he had a fev1 of 0.98. 2. right lung nodule. 3. chf: echocardiogram in showed an ef of approximately 20% with 2+ mr and 2+ tr. 4. cad. 5. hypertension. 6. benign prostatic hypertrophy. 7. hypothyroidism. 8. depression. 9. constipation. 10. diverticulosis. 11. colonic polyps. 12. spinal stenosis. 13. hiatal hernia. 14. elevated left hemidiaphragm status post trauma in . allergies: no known drug allergies. medications on admission: 1. albuterol. 2. flomax 0.4 q.d. 3. thyroxine alternating 75 and 50 q.d. 4. serevent. 5. zantac 150 q.d. 6. theophylline 400 q.d. 7. colace 200 b.i.d. 8. flovent 880 b.i.d. 9. atrovent. 10. losartan 75 b.i.d. 11. zoloft 25 q.d. 12. multivitamin. family history: noncontributory. social history: russian speaking gentleman, lives with his wife. a 40 pack year tobacco history and no alcohol abuse. physical examination: temperature 97.0, heart rate 106, blood pressure 126/69. in general, he was awake and alert, and answered questions appropriately through an interpreter. neck examination: jugular venous pressure was obscured by the bipap mask. lung examination: he had decreased breath sounds throughout with absence of breath sounds at the left base. no wheezes and few basilar crackles. cardiovascular is tachycardic with frequent ectopy. he had a normal s1, s2 and positive s3. his abdomen is soft and nontender. he had 3+ pitting edema to the knees bilaterally. laboratories on admission: white count 6.2, hematocrit 37.9, platelet count 191. differential on that white count was 73% neutrophils, 17% lymphocytes. coags with pt 12.5, ptt 26.3, inr 1.0. chem-7: sodium 137, potassium 4.6, chloride 93, bicarb 40, bun 16, creatinine 0.8, glucose 115, calcium 9.4, magnesium 1.7, phosphorus 3.1. ck was 100, mb 7, troponin-t 0.02. abg: 7.20/112/62 on 50% face mask. ekg: sinus tachycardia, left axis deviation, right bundle branch block, t-wave flattening in iii and l. chest x-ray showed cardiomegaly, elevated left hemidiaphragm, asymmetric pulmonary edema. assessment: this is a -year-old man with history of copd and chf, admitted with respiratory distress, hypoxia, and hypercapnia. history and physical were consistent with chf exacerbation. hospital course: 1. chf: in the sicu, the patient was diuresed with good effect with improvement of his o2 saturations and decreasing shortness of breath. he was rapidly weaned from by bipap back to face mask and finally to nasal cannula. additionally, his home medications of losartan and metoprolol were continued. 2. orthostatic hypotension: the patient had intermittent episodes of orthostatic hypotension likely secondary to overdiuresis with lasix in treating his chf. also possibly secondary to initial titration of his cardiac medicines. therefore while in-house, the lasix was held and losartan was decreased to 12.5 mg q.p.m. from his initial dose 75 b.i.d. 3. atrial fibrillation: patient was found to be in atrial fibrillation while he was in the hospital, which is a new diagnosis for him. echocardiogram was performed: moderately dilated left and right atria and left ventricular ejection fraction of 30% with near akinesis of the inferior septum and inferior walls and mild hypokinesis of everything else including rv. the rv was also dilated. examination of the valves revealed trace ai, 1+ mr, and 2+ tr with moderate pulmonary arterial hypertension of 48+ ra. a small pericardial effusion was noted and the patient was in-fact in atrial fibrillation. rate control of atrial fibrillation was achieved with beta blockers, which were initially titrated up, but then used to be decreased secondary to the patient's orthostatic hypotension. nevertheless, the patient remained in excellent rate control. anticoagulation was not begun secondary to the patient's hematuria as well as concern over his advanced age and possible fall risk. still need to be further addressed as an outpatient. 4. hematuria: the patient developed hematuria while he was in the icu likely secondary to traumatic foley insertion due to due his enlarged prostate from his benign prostatic hypertrophy. the hematuria cleared while the patient was in-house. however, it was felt that coumadin should not be started until it is absolutely certain that the hematuria had fully resolved. urology was consulted during the patient's stay in the sicu, and their assistance is greatly appreciated. 5. possible pneumonia or bronchitis: patient remained afebrile while he was in hospital, however, his sputum was initially brown. he therefore received a total of seven days of levofloxacin for treatment of possible pneumonia or bronchitis. 6. copd: patient's outpatient inhalers as well as oxygen were continued for his copd in addition to nebulizer treatments prn. his copd remained stable while he was in the hospital, and his oxygenation status remained at baseline once his chf exacerbation had been treated. 7. the patient's other medical problems namely cad, hypothyroidism, benign prostatic hypertrophy, and depression were stable while the patient was in-house, and his outpatient medicines were continued. 8. weakness: the patient had significant deconditioning due to his poor functional status at home for several weeks prior to admission in addition to his prolonged hospital stay. physical therapy was consulted, and felt that the patient would benefit greatly from home pt. discharge condition: improved. patient ambulates and maintained o2 saturations over 88% on 2 liters of nasal cannula oxygen. discharge status: to home with vna services for blood pressure monitoring as well as home physical therapy. discharge diagnoses: 1. congestive heart failure exacerbation. 2. atrial fibrillation. 3. orthostatic hypotension. 4. chronic obstructive pulmonary disease. 5. right lung nodule. 6. coronary artery disease. 7. hypertension. 8. benign prostatic hypertrophy. 9. hypothyroidism. 10. depression. 11. hematuria, resolved. discharge medications: 1. tamsulosin 0.4 mg p.o. q.h.s. 2. colace 200 b.i.d. 3. levothyroxine 75 mcg q.d. 4. salmeterol one puff q.12h. 5. sertraline 25 mg q.d. 6. ranitidine 150 mg q.d. 7. multivitamin. 8. aspirin 325 p.o. q.d. 9. albuterol 1-2 puffs q.6h. prn. 10. senna one tablet b.i.d. 11. combivent two puffs q.6h. 12. toprol xl 12.5 mg q.d. 13. losartan 12.5 mg p.o. q.p.m. 14. flovent 220 mcg/puff four puffs b.i.d. followup: the patient is to have followup with vna services for blood pressure and oxygen saturation monitoring. additionally, he needs to followup with a colleague of his pcp, . this week. an appointment was made with dr. on . she will check on his blood pressure as well as on his weight and volume status to determine if his lasix needs to be restarted. he had been on 20 p.o. q.d. additionally, whether or not the patient needs to be started on his anticoagulation for his atrial fibrillation needs to be addressed given the recent hematuria and his physical status. he is also to followup with dr. in urology for his hematuria and his benign prostatic hypertrophy. there is an appointment scheduled for . , m.d. dictated by: medquist36 procedure: non-invasive mechanical ventilation diagnoses: unspecified acquired hypothyroidism atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation mitral valve insufficiency and aortic valve insufficiency hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) rheumatic heart failure (congestive) acute bronchitis orthostatic hypotension 

Answer: The patient is high likely exposed to