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: duricef / gentamicin / aminoglycosides attending: chief complaint: sob, abdominal pain major surgical or invasive procedure: right colectomy history of present illness: pt is a 46 y/o m with hx of esrd on hemodialysis, dm, htn, cad and recent diagnosis of svt who presents with sob. pt normally has hd on mwf. this am, he missed his hd because he was taking care of his sister's children. over the course of the day he gradually became more short of breath and decided to come to the ed. pt denies any dietary indiscretion. he also tries to watch his fluid intake but reports that he has more difficulty with this. he estimates that kilos of fluid are removed at each dialysis session. pt denies cp. . of note, pt reports that he has had "a cold" since . he was treated with a course of biaxin with some improvement, but that he has had worsening cough and fatigue again since the end of that treatment. he reports temperatures around 99, without chills. he also reports coughing up greenish-brown sputum. he reports that the rest of the family is suffering with similar symptoms. . he reports feeling extremely tired, especially since his toprolol xl dose was increased to 200mg. he denies cp. he does complain of abdominal discomfort in the epigastric area, but says this pain is not new for him. he had a egd and colonoscopy in the past which was normal according to the pt. he also reports diarrhea but says that he has had diarrhea off and on for "a long time". the diarrhea recently worsened, so he took immodium with some relief. he reports that the diarrhea is liquidy but not watery and that he has been going to the bathroom up to 7-8 times per day, at its maximum, but its now improving. he does still make urine, approximately 1 l per day. . in the , pt had cxr consistent with fluid overload. he was given lasix 80mg iv and started on a nitro drip to titrate bp to 110-130. he was also given calcium gluconate for his hyperkalemia. he was sent for hd where he began to feel decreasing sob. past medical history: 1. cad s/p drug eluting stent to mid-lcx in for single vessel disease; echo showed ef of 55%, bicuspid aortic valve with moderately thickened leaflets but without discrete vegetation (cannot exclude). mild-moderate aortic regurgitation. mild mitral regurgitation. 2. dm - 25 years, requiring insulin, complicated by retinopathy, neuropathy and nephropathy 3. esrd on hd mwf (for 2-3 years) 4. htn 5. hyperlipidemia 6. charcot foot s/p l distal 2nd mtp and proximal phalanx resection 7. chronic anemia 8. osa - does not use his bi-pap machine because he does not like the way it feels 9. endocarditis in 10. s/p cholecystectomy . carpal tunnel bilat 12. rotator cuff injury bilat s/p rotator cuff surgery . l4-l5 disc herniation 14. bilateral hearing loss secondary to gentamicin 15. hx of mrs neg staph 16. gerd 17. severe as and elevated r and l sided pressures. 18. splenic infarct social history: lives at home with his fiancee, his 2 children, his mother and his brother. etoh - occasionally tob - none family history: dm in mother, father, brother; heart disease in mother who has hx of cabg in early 50s, a-fib and is s/p ablation physical exam: vitals - t 98.2 hr 95 bp 128/93 rr 31 sao2 99% ra general - obese man, sleepy, sitting up, in bed, nad heent - mmm, clear op chest - increased work of breathing, using accessory muscles, speaking in complete sentences, good air movement bilat, crackles bilaterally of the way up, few expiratory wheezes bilaterally, coarse upper airway sounds cv - jvp at ear lobe, rrr, iii/vi crescendo-decrescendo murmur, over rusb, radiating into axilla abd - large, soft, non-tender, non-distended, -hsm extrem - 2+ pitting edema bilat, pedal pulses present bilat, no ulcers or sores on feet, l. charcot foot neuro - somnolent, falling asleep mid-sentence, answers questions appropriately with arousal pertinent results: on admission 10.1#>38.4*<130* diff 75*n 3b 16*l 3m 1e 1b pt 13.3 inr1.2 esr 15 134/7.3*/93*/22/87/13.2/291 ca 7.4* mg 1.6 phos 8.2* alt 29 ast 23 ck 482* amylase 151* tbili 0.4 . studies: ap upright portable chest x-ray: the cardiac silhouette is enlarged. there is bilateral hilar fullness in pulmonary vascular distribution and interstitial edema. consistent with moderate/severe volume overload. . ct abdomen/pelvis : subtle pericolonic stranding in the cecum, ascending colon, thought likely to reflect an infectious etiology. as the patient has some subtle colonic thickening here, a tumor with microperforation is considered, although thought less likely. . echo : ef 25-30%, new pan-wall motion abnormalities brief hospital course: # sob: the pt's shortness of breath is most likely related to fluid overload since he developed the sob after missing his scheduled hd. on exam, the pt appeared to be working hard to breathe, crackles were heard in both lower lung fields and the pt had an elevated jvp and lower extremity edema. the cxr was consistent with fluid overload. there were a few expiratory wheezes bilaterally, indicating a component of reactive airway disease likely exacerbated by a respiratory tract indection. the pt reported that he has had a cough productive of greenish-brown sputum since . he also reports that the rest of the family is suffering with similar symptoms. after dialysis the pt was only mildly short of breath. he was also treated with albuterol and then atrovent for presumed reactive airways disease. by the morning after admission, the pt reported that his sob had resolved. . # afib with rvr: the pt has had several recent er visits for paroxysmal afib with rvr. prior episodes were well controlled with metoprolol. on the evening of admission, the pt was noted to have a low blood pressure of 70/40 with a heart rate of 119. the pt was mentating normally throughout the episode. he did not complain of any cp, sob, light headedness or dizziness. an ekg showed afib with rvr, in addition to anterior ischemia. the patient's afib did not repond to 2 iv doses of 5mg metorpolol, but it did responded to diltiazem 2x 10mg iv. the pt's heart rate came down to the mid 80s to mid 90s. the pt's low bp responded to iv fluids and was 100-110s/60-70s after the pt received 1.5l of fluid during the episode of rvr. the pt spontaneously converted to sinus rhythm the following morning. pt had no further episodes of afib. his toprol dose was reduced to 100mg qd and diltiazem 60mg po qid was added. three sets of cardiac enzymes were stable and did not suggest any myocardial infarction. the pt's ekg after converting back to sinus rhythm showed no persisting evidence of infarction. lfts and tsh were sent in case pt would need to be started on amiodarone. lfts and tsh were normal. pfts should be done as an outpatient before pt starts amiodarone. pt will follow up with his cardiologist, dr. , on monday and to get home monitoring to determine how frequently he has episodes of afib. . # abdominal pain - on , after dialysis pt began to complain of crampy abdominal pain. he had 3 normal bowel movements and then developed non-bloody diarrhea. overnight he vomited once, non-bloody, non-bilious. on the morning of the pt spiked a temperature to 102.2. pt's labs showed a wbc of 17.8. the pt's pain became worse over the morning. pt was extremely tender in the right upper and lower quadrants. his abdomen was soft, but he did have some voluntary guarding. pt was made npo and had an upright axr which showed no free air but was limited due to pt's body habitus. pt was evaluated by surgery who recommended a ct abdomen which showed mild stranding around the cecum and mild wall thickening???? pt's history is concerning for ischemic bowel in the context of atrial fibrillation with possible clot vs hemoconcentration after hemodialysis with decreased flow. the pt has a known hx of afib, but he was not on tele when the abdominal pain developed.other possible causes were infectious causes, including gastroenteritis and c. difficile colitis. pt had no known sick contacts and had a very focal abdominal exam, and a high wbc, so gastroenteritis seemed unlikely. stool cultures and c. diff toxin were sent. the first c. diff was negative. other possible causes included appendicitis, a right sided diverticulitis or another bowel abscess. there was no evidence of any of these processes on ct. surgical consultation was obtained. the patient was not felt to have an acute abdomen on the evening of but was placed on intravenous antibiotics with a plan for serial exams. the patient developed worsening abdominal pain a fever and was taken to the operating room on for a right colectomy. a focal area of necrosis was found in the ascending colon without gross fecal contamination. post-operatively the patient was taken intubated to the sicu where he weaned off neosynephrine within 18 hours. hemodialysis was performed on and the patient was extubated. he persisted with tachycardia and low-grade fever over the next 2 days. cardiology consultation was obtained and they did not feel that the patient was having myocardial ischemia/infarction. his aspirin and beta-blockers were continued perioperatively. on pod#3, the patient was noted to become tachycardic shortly after a r ij cvl change over wire and subsequently arrested. acls protocol was performed but the patient expired after 40 minutes of resuscitation efforts. the patient's family was notified and they agreed to a post-mortem examination. . # lethargy - pt was extremely lethargic on presentation. he was falling asleep mid-sentence, but did answer questions appropriately when he was arroused. possible causes of pt's lethargy include a component of prolonged infection, the possible contribution of medications especially b blocker and gabapentin, and a contribution of pt's severe and untreated osa. pt reported that he has tried bipap in the past and that he does not like the way it feels. pt was councelled that his osa is putting added strain on his heart and that he should consider giving bipap another try. the pt noted that he has felt more tired since his metoprolol dose was increased dueing his last admission. the pt's metoprolol dose was decreased from 200mg qd to 100mg qd and diltiazem was added for further rate contol. after the b blocker dose was decreased, the patient was much more alert. . # dm: pt continued his outpatient regimen of 42u of 70/30 at bedtime and in the morning. he was also covered with an issc while he was in house. no acute issues. . # hyperkalemia: pt was noted to have k of 7.7 on admission. pt was asymptomatic with this k. pt received calcium gluconate in the ed. after dialysis pt's k has been medications on admission: on discharge 1. fenofibrate micronized 145 mg tablet sig: one (1) tablet po daily. 2. aspirin 325 mg tablet sig: one (1) tablet po daily 3. gabapentin 300 mg capsule sig: one (1) capsule po tid 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily 5. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 6. folic acid 1 mg tablet sig: one (1) tablet po daily. 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h. 8. tamsulosin 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po hs. 9. cyanocobalamin 500 mcg tablet sig: one (1) tablet po daily 10. pyridoxine 100 mg tablet sig: one (1) tablet po daily 11. calcium acetate 667 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 12. topiramate 100 mg tablet sig: 1.5 tablets po hs 13. testosterone 1 % (50 mg) gel in packet sig: one (1) gel transdermal qday (). 14. meclizine 12.5 mg tablet sig: two (2) tablet po bid 15. hydromorphone 2 mg tablet sig: 2-3 tablets po q4-6h as needed. 16. insulin nph-regular human rec 70-30 unit/ml suspension sig: forty two (42) units subcutaneous twice a day. current (as above, plus the following meds) 17. metoprolol xl 200 mg po daily 18. heparin 5000 unit sc tid 19. albuterol puff ih q6h:prn 20. insulin sliding scale discharge medications: none discharge disposition: home discharge diagnosis: fluid overload due to missing hemodialysis session paroxysmal atrial fibrillation coronary artery disease s/p stenting right colectomy for likely embolic ischemia of right colon cardiac arrest .................... diabetes mellitus complicated by retinopathy, neuropathy and nephropathy end-stage renal disease on hemodialysis severe aortic stenosis discharge condition: expired discharge instructions: none followup instructions: none procedure: insertion of endotracheal tube hemodialysis pericardiocentesis other incision of pleura open and other right hemicolectomy diagnoses: end stage renal disease congestive heart failure, unspecified atrial fibrillation aortic valve disorders hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease ventricular fibrillation acute vascular insufficiency of intestine diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to