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: penicillins attending: chief complaint: cc: shortness of breath/anasarca/acute renal failure reason for micu transfer: hypercarbia, somnolence major surgical or invasive procedure: picc line history of present illness: mr is a 38 year old man with poorly controlled type 1 diabetes (c/b nephropathy, neuropathy and retinopathy), hypertension, hyperlipidemia, question of coronary artery disease and prior polysubstance abuse, presenting from clinic for dyspnea and weight gain, being transferred from the floor for hypercapnea and somnolence. . briefly, patient has been residing at for treatment of osteomyelitis. he was seen at clinic earlier on the day of admission for worsening weight gain, renal failure and shortness of breath. he was found to have increased creatinine from baseline and was sent to ed for further evaluation. . in the ed, vital signs were initially: 98% ra, 63, 12, 141/88. patient was admitted to the medical service where he was noted to be very somnolent and witnessed to have acute desaturation event to 70's on supplemental oxygen. episode is described by team as "excessive sleepiness" at time of interview, where he was falling asleep in mid sentence while aswering questions. patient had no complaints at the time of desaturation, no convulsions or apneic episodes were witnessed. . given concern for hypercapnea and somnolence, patient had arterial blood gas which revealed ph 7.42 pco2 58 po2 177. overall assessment is that he needed bipap for apneic episodes while remainder of workup was performed. . review of progress notes reveals patient completed 8 weeks of vancomycin and ciprofloxacin on for r toe osetomyelitis. he is now on suppression dose doxycycline. he developed anasarca and was treated with escalating doses of diuretics including 120mg po lasix + metolazone resulting in worsening renal function. past medical history: #. healing osteomylitis (coagulase negative staph and pseudomonas) - arthroplasty r hallux - s/p 8 weeks iv vancomycin, followed ciprofloxacin #. diabetes mellitus - diagnosed at age 2, poorly controlled - last a1c = 9.4 () - complicated by neuropathy, nephropathy, and blindness #. polysubstance abuse - previous use of heroine, cocaine #. hypertension #. history of coronary artery disease - he reports three mis in the past: the first at age 20yo associated with steroids and bdp abuse, the second at age 28 associated with anxiety, and a third at age 34 associated with cocaine use. - per osh records, he had a cath at a different hospital that demonstrated clean coronary arteries. #. venous stasis dermatitis #. legally blind - s/p vitreoectomies #. chronic renal insufficiency, stage 3 - proteinuria - follows with dr. - baseline creatinine 2.3-2.8 #. bipolar disorder - follows with dr. at #. anxiety disorder, nos #. hypercholesterolemia #. hyperparathyroidism, secondary (renal disease) social history: the patient lives with his mother and brother. his mother is his healthcare proxy and administers all of his medications. the pt admits to using heroin and cocaine in the past, but states he currently does not use either. he does currently smoke marijauna frequently. he denies alcohol. smoked 1 ppd x 4 months, but quit smoking. pt is on methadone 150 mg a day which he gets from habbitt opco. family history: no history of kidney disease, dm or gout. no history of cad in parents. brother with substance abuse; maternal grandmother with hypertension, lung ca, cardiovascular dz physical exam: vs: af, 138/87, 61, 20, 97 ra gen: the patient is in no distress and appears comfortable skin: no rashes or skin changes noted heent: difficult to assess jvd, neck supple, no lymphadenopathy in cervical, posterior, or supraclavicular chains noted. chest: lungs remarkably clear to auscultation. cardiac: regular rhythm; nl s1, loud p2. abdomen: no apparent scars. distended, and soft without tenderness extremities: marked 3+ edema to thighs, warm without cyanosis. r index toe with skin breakdown, blister, negative bone probe. neurologic: alert and appropriate. cn ii-xii grossly intact. bue , and ble both proximally and distally. no pronator drift. reflexes were symmetric. downward going toes. pertinent results: labs on admission: 12:50pm blood wbc-8.2 rbc-3.62* hgb-9.8* hct-29.6* mcv-82 mch-27.2 mchc-33.2 rdw-15.0 plt ct-327 12:50pm blood neuts-82.3* lymphs-10.8* monos-4.0 eos-2.5 baso-0.4 12:50pm blood pt-11.4 ptt-31.7 inr(pt)-0.9 12:50pm blood glucose-73 urean-95* creat-4.1*# na-128* k-4.1 cl-85* hco3-34* angap-13 12:50pm blood ck(cpk)-417* 12:50pm blood calcium-9.0 phos-5.2* mg-3.6* 07:13pm blood tsh-4.0 07:10am blood anca-negative b 07:10am blood rheufac-7 07:10am blood -negative 07:10am blood hiv ab-negative 07:15pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 06:36pm blood type-art po2-177* pco2-58* ph-7.42 caltco2-39* base xs-11 . labs on discharge: 06:10am blood wbc-6.3 rbc-3.70* hgb-9.8* hct-31.1* mcv-84 mch-26.5* mchc-31.7 rdw-14.4 plt ct-274 06:10am blood plt ct-274 06:10am blood glucose-437* urean-64* creat-2.9* na-130* k-4.2 cl-86* hco3-34* angap-14 06:25am blood ck(cpk)-113 06:10am blood calcium-8.9 phos-3.6 mg-2.4 . cxr: impression: no acute cardiopulmonary abnormality. . echo : the left and right atria are moderately dilated. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: normal biventricular cavity sizes with preserved global and regional biventricular systolic function. mild pulmonary artery systolic hypertension. biatrial enlargement. . compared with the prior study (images reviewed) of , the findings are similar. . renal ultrasound : impression: unremarkable renal ultrasound. brief hospital course: 38 year old man with poorly controlled diabetes, hypertension, chronic renal failure, presenting with worsening edema/anasarca, shortness of breath, found to be in acute renal failure and severe somnolence on arrival. . # altered mental status: patient was admitted to the medical service where he was noted to be very somnolent and witnessed to have acute desaturation event to 70's on supplemental oxygen. the episode was described by team as "excessive sleepiness" at time of interview, where he was falling asleep in mid sentence while aswering questions. patient had no complaints at the time of desaturation, no convulsions or apneic episodes were witnessed. given concern for hypercapnea and somnolence, patient had arterial blood gas which revealed ph 7.42 pco2 58 po2 177. overall assessment involved bipap for apneic episodes while remainder of workup was performed. his medications were adjusted with a decrease in pregabalin from 75mg tid to 25mg tid and decrease in methadone to 100mg. his mental status improved back to baseline by the am. he was continued on cpap at night daily. . # anasarca/volume overload: ddx included proteinuria vs. liver disease vs. on vs. cardiac disease, specifically from pulmonary hypertension, as there was evidence from prior tte that patient had mild-moderate pulmonary artery hypertension. unlikely to be liver disease, given only minimal evidence of synthetic dysfunction. in addition, degree of proteinuria was only minimal to explain 20-40 lb weight gain. patient was also on a calcium channel blocker previously, which may have been a slight contributor. however, suspect primary etiology to be cardiac disease, or right heart failure, given elevated rv pressures and elevated pulmonary artery pressures. patient underwent tte at on showing estimated end systolic rv pressure > 35mmhg. ddx for right sided heart failure included hiv, osa, polysubstance abuse, and rheumatologic causes. workup included negative hiv testing, negative anca, negative rheumatoid factor, and negative . patient did have evidence of prior polysubstance absuse, including cocaine and methamphetamine, which can contribute to r heart failure. he was also noted to have an episode of somnolence with an acute desaturation event, which may be related to apnea. he was set up with a sleep clinic appointment for osa evaluation as an outpatient. he was informed to eliminate any drug use, which may be contributing. he was decreased on his lyrica from 75 mg tid to 25 mg tid, since it may have contributed to his presentation as well. after iv lasix diuresis for three days, patient had returned to his dry weight and had lost approximately 15 liters of fluid. his bun/cr also returned to . repeat tte here showed slightly improved pa/rv pressures. patient was discharged on home regimen of 80 mg po lasix. . # acute renal failure on stage iv : patient with chronic diabetic nephropathy, however with acute decompensation. it is possible that osa is causing severe increase in pulmonary pressures leading to decreased forward flow, however other causes of renal failure were considered. ddx included obstruction (however renal ultrasound was negative), intrinsic renal failure (although ain and/or atn were unlikely given bland urine sediment). of note, after aggressive iv diuresis, patient's bun and cr returned to (discharge values 64 and 2.9, respectively). . # diabetes type 1: known to be poorly controlled. insulin dose adjusted in setting of arf and hypoglycemic episode on one morning. patient continued on ssi. have arranged for close follow-up with pcp to adjust bg regimen as needed. . # bipolar disorder: continued home regimen of lamictal and abilify . # h/o polysubstance abuse: continued methadone. . # hypertension: patient was continued on prior medications, as notes. his blood pressure was well controlled on discharge. . # osteomyelitis: s/p 8 week treatment with vancomycin and ciprofloxacin for osteomyelitis. continued home regimen of doxycycline for suppressive therapy. patient was seen by , and they noted healing heel ulcers as well as healing right 5th digit blister. they recommended wet to dry dressings on discharge. of note, patient has follow-up arranged with dr. . . # anemia of iron deficiency and : hct remainded at baseline. patient continued his home iron regimen. . # cardiac: pt reported mi, normal angiogram , subsequent ett-mibi osh which showed a small anterior mixed defect. . # dispo: discharge to home with pcp, , sleep clinic follow-up. he is to obtain chemistry 10 panel and fax results to dr. . medications on admission: lyrica 75 mg po tid clonidine 0.1 mg qid methadone 150 mg po q daily amlodipine 10 mg po q daily lamictal 100 mg po bid furosemide 80 mg q day clonazepam 1 mg po tid calcitrol 0.25 mg po q day saline nasal spray simvastatin 40 mg po q day carvedilol 25 mg po bid aspirin 81 mg po q day docusate 100 mg po bid vit d 400 u po bid abilify 20 mg po q day mag plus 15 ml po q4 prn indegestion chloride hydrate 1000 mg prn insomnia saline nasal spray glargine 30 u q hs doxycycline 100 mg po q day ascorbic acid 5-00 mg po tid discharge medications: 1. outpatient lab work please obtain chemistry 10 panel on and have results faxed to . dr. will review these results. 2. pregabalin 25 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*30 capsule(s)* refills:*2* 3. lamotrigine 100 mg tablet sig: one (1) tablet po bid (2 times a day). 4. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. clonazepam 1 mg tablet sig: one (1) tablet po tid (3 times a day). 6. calcitriol 0.25 mcg capsule sig: one (1) capsule po once a day. 7. simvastatin 40 mg tablet sig: one (1) tablet po once a day. 8. carvedilol 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 11. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 12. aripiprazole 10 mg tablet sig: two (2) tablet po daily (daily). 13. doxycycline hyclate 100 mg capsule sig: one (1) capsule po daily (daily). disp:*30 capsule(s)* refills:*2* 14. methadone 10 mg tablet sig: fifteen (15) tablet po daily (daily): prescribed by alternate provider at methadone clinic. 15. ascorbic acid 500 mg tablet sig: one (1) tablet po three times a day. 16. insulin glargine 100 unit/ml solution sig: twenty (20) units subcutaneous at bedtime. disp:*1 vial* refills:*2* 17. humalog 100 unit/ml solution sig: as per sliding scale sheet units subcutaneous before breakfast, lunch, and dinner as per sliding scale. disp:*1 vial* refills:*2* discharge disposition: home discharge diagnosis: primary: - acute right heart failure. - pulmonary artery hypertension. - anasarca. . secondary: - diabetes mellitus type i. - stage iv - neuropathy, retinopathy, and blindness - substance abuse - bipolar disorder type i - hypertension - osteomyelitis right big toe. - anemia of iron deficiency and - pt reported mi, normal angiogram , subsequent ett-mibi osh which showed a small anterior mixed defect. discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - independent discharge instructions: you were admitted to for worsening weight gain and shortness of breath. you were noted to have some acute kidney injury and your total body volume overload was felt to be from high blood pressure in your lungs (pulmonary hypertension). this is likely from multiple causes including obstructive sleep apnea, prior drug use, and potentially high dose lyrica. you were given iv lasix and you were discharged when your weight had returned to baseline. you will likely require a sleep study on discharge. it will be critical for you to continue cpap to keep the fluid from re-accumulating. the sleep study should be arranged by your primary care doctor, and can be discussed at next visit. in addition, you were seen by the team for your heel ulcers and your right 5th digit ulceration. they recommended wet to dry dressings on discharge, and have arranged for a follow-up appointment, as noted below. . new medications/medication changes: - decrease lyrica to 25 mg three times a day - continue cpap at night - wet to dry dressing changes to right 5th digit . please seek medical attention for worsening volume overload, progressive shortness of breath, fevers, worsening drainage from your heel/toe ulcer, chest pain, abdominal pain or distension, or any other concerns. please discuss outpatient sleep study with your primary care doctor. followup instructions: we have made an appointment with your primary care doctor, dr. , on at 11:45 am. please call if you need to re-schedule. . we have made an appointment for you at sleep clinic on at 1 pm with dr. . it will be at . please call if you need to reschedule. . provider , dpm phone: date/time: 10:10 () . you will obtain a chemistry 10 laboratory blood draw and have these results faxed to dr. as noted below. procedure: venous catheterization, not elsewhere classified diagnoses: anemia in chronic kidney disease obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery pure hypercholesterolemia tobacco use disorder congestive heart failure, unspecified acute kidney failure, unspecified chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other chronic pulmonary heart diseases opioid type dependence, continuous anxiety state, unspecified long-term (current) use of insulin old myocardial infarction iron deficiency anemia, unspecified secondary hyperparathyroidism (of renal origin) hypoxemia personal history of noncompliance with medical treatment, presenting hazards to health acute diastolic heart failure bipolar i disorder, most recent episode (or current) unspecified diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with renal manifestations, type i [juvenile type], uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], uncontrolled legal blindness, as defined in u.s.a. background diabetic retinopathy ulcer of heel and midfoot venous (peripheral) insufficiency, unspecified other specified disorders of skin cannabis abuse, unspecified chronic osteomyelitis, ankle and foot 

Answer: The patient is high likely exposed to