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: tetracycline / doxycycline attending: chief complaint: asymptomatic major surgical or invasive procedure: - 1. repair of thoracoabdominal aortic aneurysm with a 28-mm vascutek multibranched graft with separate anastomoses to the celiac artery, superior mesenteric artery, right and left renal arteries. the graft is a vascutek gelweave graft (catalog number , lot number , serial number ).2. aortobi-iliac graft with a 24 x 12 hemashield graft. - exploratory laparotomy, evacuation of hematoma and suture repair of bleeding right graft to common iliac artery anastomosis. - left lower extremity four compartment fasciotomy. - exploratory laparotomy - 1. placement of gastrojejunostomy tube. 2. abdominal wall closure. 3. open tracheostomy. history of present illness: this is a 57 yo male s/p aortic dissection repair in followed distal arch repair via left thoractomy in . he recently presented to the in for a subdural hematoma following a fall. this was managed conservatively by the neurosurgery service. cta at that time revealed a large thoracic/abdominal aortic aneurysm with associated dissection. the dissection extended distally from the area that was previously repaired in . vascular surgery was consulted and they did not recommend surgery at that time but arranged for him to be seen as an outpatient by both vascular and cardiac surgeons. he was seen in for surgical discussion and planning presents today for preadmission testing for surgery tomorrow. currently, he denies chest, abdominal and back pain and is feeling well. past medical history: past medical history: - thoracoabdominal aneurysm with chronic type b dissection - hypertension - recent history of subdural hematoma s/p fall(improved on past ct scan) - history of elevated psa(normal now per patient) - left eye sclera scar from trauma past surgical history: s/p aortic dissection repair at (median sternotomy) s/p arch replacement at (left thoractomy) social history: last dental exam: no recent exam lives with: wife(in ) occupation: pastor tobacco: denies etoh: denies family history: no premature coronary artery disease physical exam: pulse: 85 resp: 20 o2 sat: 100% bp right: 138/94 left: 130/84 general: wdwn male in no acute distress skin: dry intact - well healed sternotomy and thoracotomy scars. axillary and left groin incisions also noted and well healed. significant scar noted on right neck from bite. heent: perrla eomi , sclera anicteric, op benign. obvious left scleral scar neck: supple full rom no jvd chest: lungs clear bilaterally heart: rrr nl s1-s2, soft i/vi systolic ejection murmur abdomen: soft non-distended non-tender bowel sounds + ventral and small umbilical hernia noted extremities: warm , well-perfused edema: trace bilateral le varicosities: none neuro: grossly intact, no focal deficits, mae, gait steady. pulses: femoral right: 2 left: 2 dp right: 2 left: 2 pt : 2 left: 2 radial right: 2 left: 2 carotid bruit right: none left: none pertinent results: echo pre bypass no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. a patent foramen ovale is present. a small amount of intermittent left-to-right shunt across the interatrial septum is seen at rest. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is mild global left ventricular hypokinesis (lvef = 40-45 %). right ventricular free wall function is borderline normal. the descending thoracic aorta is markedly dilated and tortuous. there are simple atheroma in the descending thoracic aorta. a mobile density is seen in the descending aorta consistent with an intimal flap/aortic dissection. there is flow in the false lumen. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. post bypass the patient is on infusions of epinephrine, norepinephrine, and nitroglycerin and is in sinus rhythm. left ventricular function is globally improved (lvef=50-55%). mild aortic regurgitation and mild mitral regurgitation remain. the descending aortic graft which measures approximately 2.8-2.9 cm in diameter is seen with good flow. proximal ascending aorta is intact. ct of spine 1. no obvious intraspinal pathology. evaluation of the spinal canal is markedly limited without intrathecal contrast. if there is clinical concern for cauda equina or cord compression, mri should be performed. 2. lines and tubes as described with changes of recent aortic surgery. 3. bilateral lower lobe atelectasis/consolidation ultrasound the left internal jugular vein demonstrates fairly extensive thrombus inferiorly, which is incompletely occlusive. this is essentially unchanged since the prior study without propagation or interval lysis. the left subclavian vein appears normal with normal color flow and respiratory variation. ct scan 1. bilateral lung infiltrates worse on the right that are consistent with aspiration or infection. left pleural effusion and atelectasis. 2. marked inflammatory change throughout left chest wall and anterior abdominal wall, and findings that suggest extravasation of oral contrast from the stomach into the base of the anterior wall incision consistent with enterocutaneous fistula. there may be tracking of oral contrast into the chest wall as well. 3. free fluid is seen in the abdomen and retroperitoneum without evidence of organized fluid collections. 4. postoperative changes associated with thoracoabdominal aaa repair, not well evaluated on this noncontrast examination mri spine there is no evidence of hematoma within the spine seen in the lumbar region. evaluation of the conus is slightly limited but no abnormal signal or compression seen. paraspinal soft tissues are unremarkable. there is no significant disc bulge or herniation. brief hospital course: mr. was admitted to the on for surgical management of his thoracoabdominal aortic aneurysm. he was taken to the operating room where he underwent a repair of his thoracoabdominal aortic aneurysm with a 28-mm vascutek multibranched graft with separate anastomoses to the celiac artery, superior mesenteric artery, right and left renal arteries and an aortobi-iliac graft with a 24 x 12 hemashield graft. please see operative note for details. postoperatively he was taken to the intensive care unit for monitoring. he was noted to be hypotensive following his surgery, hematocrit down to 19 from 29 preop in first hour post-op, transfused 5 units of blood to a hct of 23 and ultimately was returned to the operating room on for a re-exploration for bleeding with evacuation of hematoma and suture repair of the bleeding right graft to common iliac artery anastomosis. please see operative note for additional details. post-operatively, the mr. was hemodynamically stable. his cr was elevated to 3.2 but urine output was stable. a renal consult was obtained indicating no need for dialysis but close monitoring. he was intubated, sedated and paralyzed in the icu with a chest tube, ngt and jp drain. on physical exam, b/l leg edema had developed and was worsening. he was taken back to the or on for another washout of the abdomen along with a patch closure and four compartment fasciotomy for to prevent compartment syndrome. he remained intubated and sedated but it was observed that he was unable to move his legs when off of the sedation. a ct and mri of spine were negative for hematoma or ischemia. the rest of his hospitalization, by systems: neuro: mr. was intubated, sedated and paralyzed immediately post-operatively. early in his post-op course (hd 4), he was noted to not be moving his legs when lifted off of sedation. a ct and mri of spine were negative for hematoma or ischemia. he continued to have some sensation in his lower extremities but no motor function. neurology was consulted amd eventually he was determined to have spinal cord infarct despite negative imaging. his sedation was decreased and he was awake, alert, oriented and conversing during his last week of admission. renal: mr. cr bumped to 3.2 post-operatively. renal was consulted. in the setting of aaa repair and labs indicative of rhabdomyolysis, he was thought to have acute tubular necrosis. both creatinine and cpk trended upwards initially (cr peaked 5.6, then to 2.0 on discharge; cpk peaked to 50,000s on then downward to on ). he was managed with both fluids and lasix drip diuresis. discharge creatinine 1.8. resp: mr. was on a ventilator post-op on cmv. his lung exam was benign until hd 6 with the note of some crackles at the bases b/l. sputum cultures were ultimately obtained and antibiotics started (see id section). on hd 10, his o2 sats dropped on vent, a cxr showed near-total left sided lobar collapse prompting bedside bronchoscopy which resulted in improvement. he was bronched again on hd 11 and received a tracheostomy with the g-j/abdominal closure procedure by general surgery. additional bronchoscopy on hd 13 showed copious secretions on left side but therafter started to show signs of clinical improvement. continued fever spikes led to a chest ct on hd 16 consistent with infection/aspiration. he continued to have bronchs as needed throughout his hospitalization and continued to improve clinically. cxr on showed improvement respiration. he was discharged on 6 days of po ciprofloxacin. cv: received initial transfusion post operatively. received another unit of prbcs on hd 11 for a hct of 24.1 to which he responded appropriately. gi: mr. was initially kept npo with an ngt and eventually (one week into hospitalization) started on tube feeds. on hd 11 with abdominal closure, g-j tube was placed, started on tube feeds gradually advanced to goal. his lfts started to trend upwards, with tbili peaking to 5.0 on . ruq ultrasound was negative for cholecystitis, tbili returned to when checked on . he was started on po intake with thin liquids/ground solids on . id: mr. started to spike low grade fevers while on the ventilator starting about 1 week into his hospitalization. he was started empirically on vancomycin and zosyn and sputum culture growed enterobacter cloacae, pan-sensitive, for which antibiotics were continued and ciprofloxacin was added to the mix on and stopped on . sputum cultures from sample on grew yeast. since patient continued to spike fevers through the multi-antibiotic therapy, decision was made to add fluconazole to the treatment. blood cultures remained negative. wounds: upon re-exploration the abdominal wound was kept open for inability to close. general surgery was consulted and involved with the surgery and placement of a patch abdominal. he was taken back to the or on for abdominal closure. lle fasciotomy site was managed with wet dressings until vac application on hd 9. vac sponge was replaced every three days and the wound was deemed appropriate for closure attempt on . the medial incision was closed with horizontal matress sutures. the lateral incision was too tight for closure at this time and was instead fitted with sutures for a partial closure and packed with moist gauze. on day of discharge, patient is aaox3, nad, conversing, tolerating po intake during the day with tube feeds at night, afebrile, wbc 11.3, cr 1.8. medications on admission: enalapril 10mg daily, fluticasone nasal spray, norvasc 10mg daily, labetolol 600mg four times daily, cozaar 50mg twice daily, minoxidil 10mg daily, claritin 10mg twice daily, prilosec prn discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for temperature >38.0. 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. docusate sodium 50 mg/5 ml liquid sig: po bid (2 times a day). 4. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po daily (daily) as needed for constipation. 5. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily). 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 7. bisacodyl 10 mg suppository sig: one (1) suppository rectal every other day (every other day). 8. ranitidine hcl 15 mg/ml syrup sig: one (1) po daily (daily). 9. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 10. sertraline 50 mg tablet sig: two (2) tablet po daily (daily). 11. clonazepam 0.5 mg tablet sig: two (2) tablet po bid (2 times a day). 12. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 13. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: 5-10 mls po q4h (every 4 hours) as needed for pain. 14. hydralazine 10 mg iv q6h:prn sbp>180 15. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 6 days. 16. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 17. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 18. ascorbic acid 500 mg/5 ml syrup sig: one (1) po daily (daily). 19. multivitamin tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: - thoracoabdominal aneurysm with chronic type b dissection - hypertension - recent history of subdural hematoma s/p fall(improved on past ct scan) - history of elevated psa(normal now per patient) - left eye sclera scar from trauma discharge condition: stable discharge instructions: 1. please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage 2. please no lotions, cream, powder, or ointments to incisions 3. each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart 4. no driving for approximately one month and while taking narcotics 5. please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: please call to confirm follow-up appointments in 10 days-2 weeks from discharge. cardiac surgeon: dr. phone: ( vascular surgeon: dr. phone: ( general surgeon: dr. ( cardiologist: ( please call to schedule appointments with your primary care dr. 1-2 weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery other revision of vascular procedure other intubation of respiratory tract temporary tracheostomy fasciotomy resection of vessel with replacement, thoracic vessels closed [endoscopic] biopsy of bronchus other gastroenterostomy without gastrectomy reopening of recent laparotomy site resection of vessel with replacement, aorta, abdominal bronchoscopy through artificial stoma delayed closure of granulating abdominal wound other suture of muscle or fascia peritoneal lavage diagnoses: pneumonia, organism unspecified hypocalcemia acute kidney failure with lesion of tubular necrosis unspecified essential hypertension iron deficiency anemia secondary to blood loss (chronic) atrial flutter pulmonary collapse alkalosis surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other complications due to other vascular device, implant, and graft other specified complications of procedures not elsewhere classified precipitous drop in hematocrit rhabdomyolysis aneurysm of iliac artery embolism and thrombosis of iliac artery thoracoabdominal aneurysm, without mention of rupture nontraumatic compartment syndrome of abdomen nontraumatic compartment syndrome of lower extremity acute venous embolism and thrombosis of internal jugular veins dissection of iliac artery vascular myelopathies 

Answer: The patient is high likely exposed to