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: codeine / streptokinase / iodine attending: chief complaint: left total knee replacement major surgical or invasive procedure: left total knee replacement history of present illness: 57-year-old male with a past medical history significant for severe bilateral arthritis s/p r tkr in ; cad s/p mi (remote); recurrent dvt and pe and atrial fibrillation, on coumadin; hypertension; chf, diastolic and systolic; obstructive sleep apnea, on bipap; severe copd on 4l home o2; history of heavy tobacco abuse; systemic lupus now in remission; diabetes; hepatitis c; colon cancer (resected); and peripheral neuropathy. he is being admitted for an elective left total knee replacement, but given his complex medical problems, it was felt he should be admitted to medicine pre-operatively. when he had his right tkr in he was transferred to medicine post-op for management of fluid overload and anticoagulation. he had a copd exacerbation that was treated with abx. his current surgery was supposed to be done , but when admitted pre-op was found to have pna, treated with ceftriaxone and cefpodoxime. surgery was rescheduled to . . on review of systems here he denies cough, fever, chills, vomiting, constipation, orthopnea, increased dyspnea on exertion or dysuria. he does use 4l home o2, but has no change in his requirements. he has chronic knee pain and neuropathy for which he takes methadone every 6 hours. past medical history: - type ii diabetes - sle diagnosed - cad s/p mi in - chronic afib on coumadin - hep c s/p interferon - copd w/ fev1 60% - diastolic chf w/ ef 50% in - seizure d/o - s/p tia in - colon cancer s/p resection w/o chemo - s/p splenectomy - hyperlipidemia - hypertension - neuropathy on methadone - osa on home cpap social history: vet, lives with wife, daughter, son and granddaughter. quit smoking in after 80 pack-year history. history of drug abuse clean since . both patient and wife deny that he uses any etoh; pt states it is because he has hx of hepatitis c. family history: no known family history because pt did not know his parents. physical exam: vs - temp 97.1 f, bp 128/78, hr 112, r 24, o2-sat 96% ra general - obese man w/ mild dyspnea off o2, comfortable, appropriate heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple, no thyromegaly, no jvd, no cervical lad. lungs - cta bilat with occasional cough on deep inspiration, resp unlabored, no accessory muscle use heart - irregularly irregular, no mrg, nl s1-s2 abdomen - obese, soft/nt/nd, no masses or hsm. extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps) skin - no rashes or lesions neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout, cerebellar exam intact, steady gait with slight limp from left knee pain pertinent results: labs during hospital course: : blood wbc-13.4* rbc-3.49* hgb-9.9* hct-30.6* mcv-88 mch-28.5 mchc-32.5 rdw-14.8 plt ct-344 05:40am blood wbc-14.4* rbc-3.90* hgb-11.1* hct-34.2* mcv-88 mch-28.5 mchc-32.4 rdw-14.6 plt ct-347 05:47pm blood wbc-17.7*# rbc-3.55* hgb-10.4* hct-32.0* mcv-90 mch-29.1 mchc-32.3 rdw-14.9 plt ct-276 : blood wbc-22.2* rbc-3.75* hgb-10.5* hct-32.2* mcv-86 mch-28.1 mchc-32.7 rdw-15.0 plt ct-261 : blood wbc-21.2* rbc-3.14* hgb-8.8* hct-27.0* mcv-86 mch-28.1 mchc-32.8 rdw-15.3 plt ct-219 : blood wbc-18.7* rbc-2.82* hgb-8.4* hct-24.9* mcv-88 mch-29.6 mchc-33.5 rdw-15.1 plt ct-234 10:35am blood hct-25.0* 05:35am blood wbc-16.1* rbc-2.76* hgb-7.9* hct-24.0* mcv-87 mch-28.5 mchc-32.9 rdw-15.2 plt ct-300 06:00am blood wbc-15.0* rbc-2.86* hgb-8.3* hct-25.2* mcv-88 mch-28.9 mchc-32.8 rdw-15.0 plt ct-377 05:50am blood pt-14.9* ptt-25.7 inr(pt)-1.3* 06:00am blood pt-17.3* ptt-25.4 inr(pt)-1.5* 05:50am blood glucose-88 urean-24* creat-1.3* na-141 k-3.8 cl-97 hco3-33* angap-15 05:40am blood glucose-118* urean-19 creat-1.0 na-144 k-3.5 cl-98 hco3-35* angap-15 10:22am blood glucose-164* urean-18 creat-1.1 na-141 k-3.4 cl-98 hco3-34* angap-12 04:49pm blood glucose-132* urean-19 creat-1.3* na-143 k-3.6 cl-100 hco3-35* angap-12 05:35am blood glucose-164* urean-14 creat-1.1 na-138 k-3.5 cl-96 hco3-31 angap-15 06:00am blood glucose-164* urean-11 creat-1.0 na-136 k-3.5 cl-97 hco3-31 angap-12 05:55am blood glucose-138* urean-14 creat-1.1 na-136 k-3.6 cl-95* hco3-32 angap-13 05:35am blood glucose-141* urean-21* creat-1.2 na-139 k-3.5 cl-97 hco3-31 angap-15 06:00am blood glucose-139* urean-19 creat-1.1 na-140 k-3.8 cl-97 hco3-32 angap-15 04:49pm blood alt-16 ast-25 ld(ldh)-187 ck(cpk)-58 totbili-0.4 05:55am blood ld(ldh)-188 totbili-0.9 04:49pm blood lipase-55 05:35am blood ggt-178* 05:50am blood calcium-8.4 phos-4.9* mg-2.0 06:00am blood calcium-8.3* phos-3.1 mg-2.0 05:55am blood hapto-410* 04:49pm blood tsh-1.8 04:49pm blood free t4-1.3 05:54pm blood type-art temp-39.4 rates-/14 po2-42* pco2-54* ph-7.33* caltco2-30 base xs-0 intubat-not intuba comment-cpap with 11:31pm urine color-yellow appear-clear sp -1.011 11:31pm urine blood-mod nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-neg 11:31pm urine rbc-18* wbc-3 bacteri-none yeast-none epi-0 07:14pm urine color-yellow appear-clear sp -1.013 07:14pm urine blood-mod nitrite-neg protein-75 glucose-neg ketone-tr bilirub-neg urobiln-neg ph-5.0 leuks-neg 07:14pm urine rbc-* wbc-0-2 bacteri-mod yeast-none epi-<1 07:14pm urine castgr-* micro: blood cultures (, , ): negative till date urine cultures (, , ): no growth imaging: pre-op ecg (): atrial fibrillation with single wide complex beat, possibly ventricular. st-t wave abnormalities. since the previous tracing of the wide complex beat is new. pre-op cxr (): findings: comparison made to . moderate cardiac enlargement is unchanged, without evidence of increased pulmonary vascularity, or pulmonary edema. lungs are clear. there is no pleural effusion or pneumothorax. impression: unchanged cardiomegaly. . knee film final report left knee clinical information: total knee replacement. findings: three views of the left knee are compared to the prior study from . these demonstrate interval placement of total left knee arthroplasty in near anatomic alignment without hardware complication at this time. surgical staples are present. there are post-surgical changes in the soft tissues. small joint effusion is present. dr. approved: 9:36 pm . : lower extrem u/s: negative for dvt (prelim report) . cxr (): there is interval improvement of pulmonary edema with still present right perihilar opacity as well as minimal left perihilar opacity, most likely representing residue of the infection. attention on the subsequent study is recommended to exclude the possibility of developing infection. cardiomegaly is unchanged. mediastinal silhouette is stable. no appreciable pleural effusion is present, although note is made that the left costophrenic angle was excluded from the field of view. there is no pneumothorax. cxr (): findings: in comparison with the study of , there is continued enlargement of the cardiac silhouette with minimal elevation of pulmonary venous pressure. the perihilar opacities persist, most likely representing residual of infection. impression: no evidence of acute pneumonia or pleural effusion. brief hospital course: 57yo man with extensive past-medical history including chf, copd, afib on coumadin and history of difficult peri-operatively in the past, admitted pre-operatively in preparation for left tkr. #. left total knee replacement: prior to the surgery, warfarin was discontinued and heparin gtt was started. the patient was sent to surgery on for left total knee replacement. there were no complications during the surgery. post-operatively the patient's recovery in the pacu was complicated with fevers to 103, rigors, elevated hrs to 110s and sbp to 180s with brief o2 desaturation to 70s that returned to the low 90s about 7 hours post-operatively. there was a question of whether the etiology was sepsis vs. withdrawal (benzo/etoh - there was no history of etoh recently per patient and wife) vs. neuroleptic malignant syndrome vs. pe. pe did not seem likely as the patient did not show signs right heart strain on ecg. as a result the patient was transferred to the micu where esmolol was started and the patient's bp/hr improved. labs were sent and the patient was placed on ciwa scale, on which he consistently had a score of 0. once the patient was stabilized, the patient was sent back to the floor where he continued to have fevers to 101. pan-cultures were sent, all of which have been negative to date. no antibiotics were started, and the patient defervesced on his own. the fevers were thought to be due to possibly a combination of post-operative fevers and atelectasis. the patient had a drop in his hct from his baseline of 32. hemolysis labs were done, which were negative, and the surgical site did not indicate a hematoma. subsequently, the patient's hct began to rise with hct on discharge of 25.2. the patient's hct will need to be monitored during rehabilitation, and transfusion may be required if the patient's hct falls below 24. the patient is on long-standing methadone. for adequate pain control post-operatively, the patient was started on dilaudid 1mg q6prn. . #. diastolic chf: the patient takes high doses of furosemide at home tid. the patient has had difficulty peri-operatively with fluid overload in the past, thus careful monitoring of his fluid was done during this surgery. post-operatively he appeared euvolemic. at discharge, his home dose of lasix was re-started, which he seemed to tolerate well. his home medications of carvedilol and isosorbide were continued. captopril dose was reduced in half to 6.25 tid from 12.5 tid. the patient may be up-titrated to his home dose of captopril in the outpatient setting. . #. afib/history of pe & dvt/anticoagulation: the patient suffers from paroxysmal atrial fibrillation and also has a history of pe and dvts. the patient's warfarin was stopped 1 day prior to admission. on admission he was started on heparin gtt, which was discontinued on the day of surgery. post-operatively heparin gtt was restarted and continued while the patient was bridged to coumadin. the patient was discharged on his home dose of coumadin on 17.5mg. at discharge, the patient had inr of 1.5, and as a result the patient was started on lovenox 100mg . lovenox should be discontinued once the patient reaches his goal inr of which should be checked at his rehab. . #. diabetes: during the hospital course, the patient's metformin and glipizide were held and the patient was started on a humalog insulin sliding scale. at discharge, the patient was restarted on metformin and glipizide. he should have his sugars checks at the rehab. . #. hypertension the patient was continued on home doses of carvedilol and isosorbide dinitrate. captopril was reduced in half as stated above. the captopril may be up-titrated to his home dose in the outpatient setting. #. copd: at baseline, the patient is on 4l of 02 at home. the patient required the same amount of 02 during the hospital course and the patient's home nebulizers and bronchodilators were continued. . #. obstructive sleep apnea: the patient suffers from sleep apnea, and had brought his home bipap machine, which he used during the course of his hospital stay. . #. insomnia: the patient suffers from insomnia and was continued on his home dose of tanazidine and oxazepam. . #. sle: the patient suffers from sle, and was continued on his home dose of plaquenil. . patient was full code during this admission, and his wife was the main person of contact. medications on admission: albuterol sulfate - 90 mcg hfa aerosol inhaler - puffs(s) by mouth every four (4) to six (6) hours as needed for cough/wheezing captopril - 12.5 mg tablet - 0.5 (one half) tablet(s) by mouth three times per day carbamazepine - 200 mg tablet - 2 tablet(s) by mouth three times a day carvedilol - 25 mg tablet - 2 tablet(s) by mouth twice a day fluticasone - 50 mcg spray, suspension - 1 spray(s) nasal twice a day fluticasone-salmeterol - 250 mcg-50 mcg/dose disk with device - 1 puff po twice a day furosemide - 80 mg tablet - 2 tablet(s) by mouth in am;1 @ noon; 2 tabs in pm glipizide - 5 mg tablet - 1 tablet(s) by mouth once a day hydroxychloroquine - 200 mg tablet - 1 tablet(s) by mouth twice a day ipratropium-albuterol - 0.5 mg-2.5 mg/3 ml solution for nebulization - 1 solution(s) inhaled every six (6) hours isosorbide dinitrate - 40 mg tablet - 1 tablet(s) by mouth three times a day metformin - 1,000 mg tablet - 1 tablet(s) by mouth twice a day metformin - 500 mg tablet - 1 tablet(s) by mouth at bedtime methadone - 10 mg tablet - 1 tablet(s) by mouth every six (6) hours as needed for pain fill on or after nitroglycerin - 0.4 mg/dose spray, non-aerosol - 1 as needed as needed for chest pain omeprazole - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth once a day oxazepam - 30 mg capsule - 1 capsule(s) by mouth at bedtime potassium chloride - 20 meq tab sust.rel. particle/crystal - 1 tablet by mouth three times a day pregabalin - 100 mg capsule - 1 capsule(s) by mouth three times a day simvastatin - 80 mg tablet - 1 tablet(s) by mouth at bedtime tizanidine - 4 mg capsule - 1 capsule(s) by mouth at bedtime warfarin - 5 mg tablet - 5 tablet(s) by mouth 17.5 mg daily 3 tabs of 5 mg + (1) 2.5 mg tab medications - otc aspirin - 325 mg tablet - 1 tablet(s) by mouth once a day blood sugar diagnostic - strip - use twice a day for diabetes monitoring discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours) as needed for shortness of breath. 2. carbamazepine 200 mg tablet sig: two (2) tablet po tid (3 times a day). 3. carvedilol 12.5 mg tablet sig: four (4) tablet po bid (2 times a day). 4. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. hydroxychloroquine 200 mg tablet sig: one (1) tablet po bid (2 times a day). 6. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 7. methadone 10 mg tablet sig: one (1) tablet po q6h (every 6 hours). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. pregabalin 25 mg capsule sig: four (4) capsule po tid (3 times a day). 10. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 11. tizanidine 2 mg tablet sig: two (2) tablet po hs (at bedtime). 12. oxazepam 15 mg capsule sig: two (2) capsule po hs (at bedtime) as needed for insomnia. 13. isosorbide dinitrate 20 mg tablet sig: two (2) tablet po tid (3 times a day). 14. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 15. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 16. captopril 12.5 mg tablet sig: 0.5 tablet po tid (3 times a day). 17. furosemide 80 mg tablet sig: two (2) tablet po qam/qpm (). tablet(s) 18. furosemide 40 mg tablet sig: three (3) tablet po noon (at noon). 19. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. tablet(s) 20. metformin 500 mg tablet sig: one (1) tablet po at bedtime. 21. glipizide 5 mg tablet sig: one (1) tablet po once a day. 22. enoxaparin 120 mg/0.8 ml syringe sig: one (1) subcutaneous q12h (every 12 hours): please discontinue once inr is and only continue coumadin. 23. warfarin 10 mg tablet sig: one (1) tablet po once daily at 4 pm. 24. warfarin 7.5 mg tablet sig: one (1) tablet po daily at 4pm. 25. hydromorphone 2 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for pain: please do not take this medicine if you are driving or operating heavy machinery. 26. aspirin 325 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: hospital - discharge diagnosis: primary: left total knee replacement secondary: atrial fibrilation systolic & diastolic congestive heart failure chronic obstructive pulmonary disease diabetes type ii hypertension hyperlipidemia obstructive sleep apnea systemic lupus erythematosis discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:bedbound discharge instructions: you were admitted because you needed medical evaluation prior to your left total knee replacement. after the surgery you experienced fevers and were transferred to the icu to get stabilized. once you were brought back to the floor, you continued to have fevers, but they subsided. an infection was not thought to be the cause of your fevers and you did not need antibiotics. by discharge you were not having fevers and you were feeling better. you were also restarted on all your home medications at home dosages. your pain was in control. . weigh yourself every morning, md if weight goes up more than 3 lbs. . we made the following changes to your medications: - please take captopril 6.25 three times a day (instead of 12.5 three times a day) - please stop taking your daily potassium for now until your labs are rechecked at rehab - please continue taking coumadin per your home dose - please take lovenox injections 110mg twice a day until your inr is - please take dilaudid as needed every 6 hours for pain . please take all medications as prescribed. please followup with all appointments. please do not hesitate to return to the hospital for any concerning symptoms at all. . followup instructions: the following are appointments that you have in the future. please follow-up with all appointments. . please schedule a follow up appointment with orthopedics, ( in the next 2 weeks or after you have completed physical therapy. . provider: , : date/time: 1:40 provider: , phone: date/time: 6:20 provider: . phone: date/time: 1:00 do 12-bjm procedure: non-invasive mechanical ventilation total knee replacement diagnoses: systemic lupus erythematosus obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery tobacco use disorder congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation acute on chronic diastolic heart failure pulmonary collapse old myocardial infarction unspecified disorder of kidney and ureter long-term (current) use of anticoagulants other respiratory complications personal history of malignant neoplasm of large intestine epilepsy, unspecified, without mention of intractable epilepsy personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation unspecified hereditary and idiopathic peripheral neuropathy insomnia, unspecified osteoarthrosis, localized, not specified whether primary or secondary, lower leg postprocedural fever 

Answer: The patient is high likely exposed to