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: chest pain major surgical or invasive procedure: coronary artery bypass grafting to four vessels. (left internal mammary artery->left anterior descending artery, saphenous vein graft(svg)->diagonal artery, svg->obtuse marginal artery, svg->posterior descending artery.); left atrial appendage ligation. history of present illness: mr. is a 76 year old male with chest pain, called ems which found st elevations in leads ii, iii, avf and diffuse depressions in other leads. he was transported directly to the catherization lab at gsmc with ongoing chest pain and st elevations. past medical history: atrial fibrillation (on coumadin) chronic obstructive pulmonary disease hypertension hyperlipidemia obesity glaucoma bronchitis myocardial infarction 30 y ago cholethiasis (by ct scan) right pericardial cyst (noted on ct ) peripheral artery disease social history: occupation: retired lives with wife : 2pks x 30y etoh: occasional family history: non-contributory physical exam: pulse: 81 sr resp: 14 o2 sat: 98% 4 l nc b/p right: 112/66 left: height: 5'8'' weight: 220 lbs general: skin: dry intact edema 2 + pitting in : perrla eomi neck: supple full rom short neck chest: lungs clear bilaterally heart: rrr irregular murmur - abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema varicosities: cannot assess neuro: grossly intact/ moves 4 ext pulses: femoral right: + left: + dp right: dop left: dop pt : left: radial right: + left: + carotid bruit right: - left: - pertinent results: carotid ultrasound 1. mild heterogeneous plaque in the right internal carotid artery with less than 40% stenosis. 2. significant heterogeneous plaque in the left internal carotid artery with 70-79% stenosis. this is a baseline examination at the . ===================================== echo pre-cpb:1. the left atrium is markedly dilated. moderate to severe spontaneous echo contrast is seen in the body of the left atrium. moderate to severe spontaneous echo contrast is present in the left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). a left atrial appendage thrombus cannot be excluded. 2. the right atrium is markedly dilated. mild spontaneous echo contrast is seen in the right atrial appendage. no atrial septal defect is seen by 2d or color doppler. 3. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is moderately depressed (lvef= 35-40 %). there is calcification of the inferior midventricular segment. 4. the right ventricular free wall is hypertrophied. the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. 5. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. trace aortic regurgitation is seen. 6. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. 7. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. post-cpb: on infusions of phenylephrine and epinephrine, av pacing, preserved biventricular systlic function compared with pre-bypass, lvef = 35-40%, mr remains mild, aortic contour normal post decannulation, no evidence of hematoma or dissection of aortic wall. ========================================= head ct scan: there is no intra- or extra-axial hemorrhage, shift of normally midline structures, edema, mass effect, or evidence of acute infarct. there is periventricular and subcortical white matter change as well as there is an old left basal ganglia infarct noted. there is no evidence of acute vascular territorial infarct. the mastoid air cells are hypoplastic bilaterally. the right maxillary sinus is opacified. ethmoid and sphenoid sinus opacification is also noted. the bony calvarium is intact. ======================================== , m 76 radiology report chest (pa & lat) study date of 5:30 pm , fa6a 5:30 pm chest (pa & lat) clip # reason: evaluate pulm edema final report pa and lateral chest on history: evaluate pulmonary edema after cabg. impression: mild pulmonary edema is almost resolved. moderate cardiomegaly and small bilateral pleural effusions persist. the study and the report were reviewed by the staff radiologist. dr. dr. approved: fri 2:57 pm =========================================== 08:56pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-tr 08:56pm urine rbc->50 wbc-* bacteria-few yeast-none epi-0-2 07:34pm glucose-103 urea n-23* creat-1.5* sodium-139 potassium-3.3 chloride-99 total co2-31 anion gap-12 07:34pm alt(sgpt)-14 ast(sgot)-16 ld(ldh)-269* ck(cpk)-51 alk phos-72 amylase-40 tot bili-0.7 07:34pm lipase-34 07:34pm ck-mb-notdone ctropnt-0.04* 07:34pm albumin-3.5 calcium-8.5 phosphate-3.2 magnesium-1.9 07:34pm %hba1c-6.6* 07:34pm tsh-2.6 07:34pm wbc-5.3 rbc-3.05* hgb-9.7* hct-29.5* mcv-97 mch-31.7 mchc-32.9 rdw-16.7* 07:34pm pt-25.1* ptt-56.2* inr(pt)-2.5* 07:34pm plt count-226 08:55am blood wbc-8.5 rbc-3.25* hgb-9.8* hct-30.2* mcv-93 mch-30.2 mchc-32.5 rdw-18.2* plt ct-224 08:55am blood pt-18.7* inr(pt)-1.7* 08:55am blood glucose-179* urean-30* creat-1.6* na-140 k-5.1 cl-99 hco3-30 angap-16 ======================================== 11:06 am urine source: catheter. **final report ** urine culture (final ): citrobacter freundii complex. ~/ml. identification and sensitivities requested per dr. # . this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. piperacillin available on request. sensitivities: mic expressed in mcg/ml citrobacter freundii complex | cefepime-------------- <=1 s ceftazidime----------- =>64 r ceftriaxone----------- 16 i ciprofloxacin--------- 2 i gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s ============================================== brief hospital course: mr. was admitted to the on for surgical management of his coronary artery disease. he was worked-up in the usual preoperative manner including a carotid ultrasound which showed mild heterogeneous plaque in the right internal carotid artery with less than 40% stenosis and significant heterogeneous plaque in the left internal carotid artery with 70-79% stenosis. plavix was allowed to washout of his system. the sleep service was consulted regarding his sleep apnea and cpap was recommended. on , mr. was taken to the operating room where he underwent coronary artery bypass grafting to four vessels with ligation of his left atrial appendage. please see dr operative note for further details. postoperatively he was taken to the intensive care unit for monitoring. he remained on pressors and intubated overnight. pressors were slowly weaned over the next few days. he remained intubated for a prolonged postoperative period due to hemodynamic instability as well as thick secretions impairing his ventilation/oxygenation status. by pod#7 mr. was weaned off all pressors and inotropes. he was treated with antibiotics for positive staph sputum culture and he was aggressively diuresed to optimize his potential for extubation. pod#13 ventilator weaning continued until an episode of flash pulmonary edema which required increased ventilatory support. during this postoperative period mr. was slow to wake up from sedation. his mental status improved enough, along with hemodynamic and ventilatory stability that he was successfully extubated. all lines and drains were removed in a timely fashion. over the next several days mr. remained in the cvicu due to his state of confusion, refusing medications and nutrition, requiring haldol and need for pulmonary management. sleep consult was called and cpap was initiated for obstructive sleep apnea. full anticoagulation was attained with coumadin for his rate controlled, chronic atrial fibrillation. beta-blocker, digoxin, aspirin and statin were initiated once blood pressure and heart rate would tolerate. nutrition was consulted due to poor intake and aspiration risk. speech and swallow evaluated oral and pharyngeal dysphagia with recommendations for nectar thickened/ground solid advancement of po intake and tube feeds over night. wound care was also consulted for skin impairments and heel ulcerations. by pod# 24 mr. continued to progress and was transferrd to the step down unit for further monitoring. the remainder of his postoperative course was slow but steady. given his flucuating waxing and mental status with visual hallucinations and agitation, the psychiatry service was consulted prior to discharge. eeg ruled out epileptiform activity and head ct scan showed no evidence of acute infarct. the head ct scan did reveal a chronic left basal ganglia lacunar infarct. given his delirium, it was recommended to continue haldol twice daily and prn, optimize non-psychopharm measures(frequent reorientation, emphasize sleep wake cycle, dimming lights at night) and minimize benozodiazepines, opiates and anti-cholinergics. a u/a was also check which was positive and the patient was started on bactrim. by pod# 35 he continued to progress and he was cleared for discharge to rehab for further increase in strength, endurance and conditioning. all follow up appointments were advised medications on admission: lasix 40 mg daily xalatan eye drops timoptic 0.5% one drop each eye prilosec 20 mg daily zocor 80 mg daily plavix 75mg daily cardizem cd 120 mg daily aspirin 81 mg daily lopressor 50 mg twice a day fluorouracil 5% cream every 8 hours topical combivent inhaler 2 puffs qid discharge medications: 1. carvedilol 12.5 mg tablet : one (1) tablet po bid (2 times a day). 2. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours) as needed for wheezing. 3. digoxin 125 mcg tablet : one (1) tablet po daily (daily). 4. simvastatin 40 mg tablet : one (1) tablet po daily (daily). 5. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 6. latanoprost 0.005 % drops : one (1) drop ophthalmic hs (at bedtime). 7. timolol maleate 0.5 % drops : one (1) drop ophthalmic daily (daily). 8. bisacodyl 10 mg suppository : one (1) suppository rectal daily (daily) as needed for constipation. 9. acetaminophen 325 mg tablet : two (2) tablet po q4h (every 4 hours) as needed for pain/fever. 10. magnesium hydroxide 400 mg/5 ml suspension : thirty (30) ml po hs (at bedtime) as needed for constipation. 11. aspirin 81 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po daily (daily). 12. lidocaine hcl 2 % gel : one (1) appl mucous membrane prn (as needed) as needed for pain. 13. warfarin 1 mg tablet : as directed to keep inr 2-2.5 tablets po daily (daily): target inr 2-2.5 patient to recieve 2mg on then as directed to keep inr 2-2.5. 14. insulin regular human 100 unit/ml solution : sliding scale injection qac&hs. 15. potassium chloride 20 meq tab sust.rel. particle/crystal : one (1) tab sust.rel. particle/crystal po bid (2 times a day): hold for k>4.5. 16. haloperidol 2 mg tablet : one (1) tablet po tid (3 times a day). 17. trimethoprim-sulfamethoxazole 160-800 mg tablet : one (1) tablet po bid (2 times a day) for 10 days. 18. furosemide 10 mg/ml solution : sixty (60) mg injection (2 times a day). 19. heparin, porcine (pf) 10 unit/ml syringe : as outlined below ml intravenous prn (as needed) as needed for line flush: heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. . discharge disposition: extended care facility: - discharge diagnosis: coronary artery disease s/p cabg postop delirium atrial fibrillation chronic obstructive pulmonary disease hypertension hyperlipidemia obesity glaucoma bronchitis myocardial infarction cholelithiasis peripheral artery disease cellulitis mrsa (nasal swab) discharge condition: good. discharge instructions: 1) monitor wounds for signs of infection. these include redness, drainage or increased pain. in the event that you have drainage from your sternal wound, please contact the at (. 2) report any fever greater then 100.5. 3) report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) no lotions, creams or powders to incision until it has healed. you may shower and wash incision. gently pat the wound dry. please shower daily. no bathing or swimming for 1 month. use sunscreen on incision if exposed to sun. 5) no lifting greater then 10 pounds for 10 weeks from date of surgery. 6) no driving for 1 month or while taking narcotics for pain. 7) call with any questions or concerns. 8)adjust warfarin for goal inr between 2.0 - 3.0. please arrange pt/inr followup with pcp prior to discharge from rehab. followup instructions: please follow-up with dr. in 1 month. ( please follow-up with dr. in 2 weeks. please call all providers for appointments. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery insertion of endotracheal tube (aorto)coronary bypass of four or more coronary arteries excision, destruction, or exclusion of left atrial appendage (laa) diagnoses: obstructive sleep apnea (adult)(pediatric) subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation other chronic pulmonary heart diseases peripheral vascular disease, unspecified unspecified glaucoma other and unspecified hyperlipidemia acute respiratory failure long-term (current) use of insulin old myocardial infarction long-term (current) use of anticoagulants other respiratory complications obesity, unspecified chronic obstructive asthma, unspecified pressure ulcer, heel delirium due to conditions classified elsewhere long-term (current) use of aspirin tricuspid valve disorders, specified as nonrheumatic pressure ulcer, unstageable unspecified congenital anomaly of heart 

Answer: The patient is high likely exposed to