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: no known allergies / adverse drug reactions attending: chief complaint: increasing dyspnoea major surgical or invasive procedure: none history of present illness: this is a 78 year old male with a history of congestive heart failure and ef of 20%, who is now presenting with increasing dyspnea. he says that over the past 2-3 days, he has had increasing dyspnea. denies orthopnea or pnd. also states his urine output has decreased, with associated poor po intake. he went to see his pcp given his symptoms. his pcp noted his blood pressure to be 80s systolic. he also has a history of chronic kidney disease with a baseline creatinine of 1.5, which has now worsened to 2.1. he recently had a cardiac catheterization in , with bms to the mid-lad lesion. in the ed, he continued to have lower blood pressures, with systolic around 90. he was not dizzy or lightheaded; no fluids were given in the setting of likely pulmonary edema. an ekg showed no new changes; troponin was obtained which was at baseline. on the floor, he was saturating at 100% on 2 l. he denied orthopnea, pnd, or shortness of breath (was at baseline). did endorse continued leg swelling that he feels is above his baseline. past medical history: -chf, systolic: with last echo showing ef 20%, , global hypokinesis -3 v cad, 40% proximal stenosis of lad, 80% mid, 40% long mid to distal and 80% diagonal stenosis s/p ptca of mid lad stenosis () -cardiomyopathy, unclear cause -, cr baseline of 1.4-1.6 -anemia (baseline hct 35): fe 34, tibc 229, ferritin 616 in 06 -hypertension -ra on chronic steriods -gout -ed -sz in setting of etoh withdrawal -osteopenia -gerd -osteoarthritis -right olecranon bursitis -shingles social history: he lives alone. he is retired, but had worked in a candy factory. also was a minister who performed ceremonys. his daughter feels that he is isolated and depressed at home. also unclear if he was taking all of his medicines. he quit smoking over 30 years ago. hx of excessive alcohol use in the past, but patient reports no alcohol use in the last year. denies drug use daughter is best contact. also has a daughter that has requested not get pt information. family history: the patient has eight sisters apparently healthy. one daughter with arthritis of the knees age 50. three children, one with metastatic cancer. his sister died from heart disease physical exam: at discharge vs: 97.5, 105/76, 81, 20, 96% ra gen: black male, lying in bed in no apparent distress heent: anicteric cards: nl s1/s2 rrr, jvd to ear ( tr) pulm: lungs clear, no rales or wheezes abd: soft, nontender, nondistended ext: no peripheral edema, pulses palpable skin: has open area on ant shaft of penis with white discharge. pertinent results: 07:41pm blood wbc-8.0 rbc-5.03# hgb-13.8* hct-44.4# mcv-88 mch-28.4 mchc-32.1 rdw-19.9* plt ct-134* 07:41pm blood pt-16.5* ptt-29.4 inr(pt)-1.5* 07:41pm blood glucose-108* urean-47* creat-2.1* na-129* k-5.0 cl-95* hco3-20* angap-19 07:41pm blood ck(cpk)-92 07:41pm blood calcium-9.0 phos-3.4 mg-2.0 . other labs 07:15am blood alt-38 ast-25 alkphos-110 totbili-2.1* dirbili-1.4* indbili-0.7 07:41pm blood ck-mb-4 probnp-* 07:41pm blood ctropnt-0.08* 08:35am blood probnp-* 07:15am blood vitb12-greater th folate-10.3 ferritn-163 07:41pm blood osmolal-284 07:35am blood tsh-2.1 07:35am blood free t4-1.8* 06:37pm blood lactate-3.1* 03:11pm blood lactate-3.5* 11:01am blood lactate-2.4* 08:58am blood lactate-2.8* 07:48am blood lactate-3.0* 07:52am blood lactate-3.1* . . urine . 05:30pm urine hours-random urean-460 creat-72 na-63 k-32 cl-57 05:30pm urine osmolal-387 05:30pm urine casthy-0-2 05:30pm urine rbc-0-2 wbc-0-2 bacteri-rare yeast-none epi-0-2 05:30pm urine blood-neg nitrite-neg protein-25 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 05:30pm urine color-yellow appear-clear sp -1.011 12:57pm urine color-yellow appear-clear sp -1.013 12:57pm urine blood-neg nitrite-neg protein-25 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 12:57pm urine rbc-0-2 wbc-0-2 bacteri-rare yeast-none epi-0-2 12:57pm urine casthy-* . . radiology chest (portable ap) study date of 11:34 am \ findings: as compared to the previous radiograph, there is unchanged cardiomegaly with small bilateral pleural effusions. unchanged retrocardiac atelectasis. no newly appeared focal parenchymal opacity suggesting pneumonia. . . cardiology: . ecg study date of 5:49:54 pm normal sinus rhythm. intraventricular conduction delay with a qrs duration of 114 milliseconds. low voltage in the limb leads. poor r wave progression. left atrial abnormality. prior inferior wall myocardial infarction and possible anterior wall myocardial infarction. compared to the previous tracing of no diagnostic interval change. intervals axes rate pr qrs qt/qtc p qrs t 85 176 114 420/463 28 -51 126 . tte (complete) done at 11:03:01 am conclusions the left atrium is moderately dilated. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thicknesses and cavity size are normal. there is severe global left ventricular hypokinesis with mild apical dyskinesis (lvef = 20 %). no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size is normal with moderate global free wall hypokinesis. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal biventricular cavity size with severe global biventricular systolic dysfunction c/w multivessel cad or other diffuse process. pulmonary artery hypertension. moderate to severe tricuspid regurgitation. increased pcwp. compared with the prior study (images reviewed) of , the left ventricular cavity is smaller and the estimated pulmonary artery systolic pressure is lower. the other findings are similar. liver ultrasound:findings: gallstones.unremarkable liver, with normal doppler findings. discharge labs : 07:50a na: 128 cl:89 bun:44 glucose:100 k:4.6 bicarb:25 creat:1.9 estgfr: 34/42 ca: 9.3 mg: 2.2 p: 3.4 alt: 67 ap: 121 tbili: 2.5 ast: 31 hct: 42.9, hgb: 13.9, plt: 127, wbc: 8.8 brief hospital course: # cardiomyopathy/chronic systolic congestive heart failure: ef of 20%. unclear of acute exacerbation but likely that pt was failing at home and poor memory impaired adherance to medication regimen. lisinopril was stopped at his last admission due to hyperkalemia and aldactone has been held. weight 143 pounds on admission with 3-4+ peripheral edema and sob. cxr showed small bilateral effusions. pt was aggressively diuresed with milrinone and furosemide intravenously and weight on discharge is 121 pounds. he was converted to torsemide po as this medicine works better with intestinal edema which is common in right sided failure. his jvd is elevated because of severe tr. on exam, he appears dry with no peripheral edema, clear lungs and no o2 requirement. echo showed normal biventricular cavity size with severe global biventricular systolic dysfunction c/w multivessel cad or other diffuse process in addition to pulmonary artery hypertension, moderate to severe tricuspid regurgitation and increased pcwp. compared with the prior study of , the left ventricular cavity was smaller and the estimated pulmonary artery systolic pressure was lower. the other findings were similar. he should have daily weights and close monitoring of his fluid status. . # renal failure: baseline creatinine has worsened, possibly in setting of dehydration (clinically appears dry) and recent diuresis increases in addition to poor po intake. he has been hyponatremic since admission, thought to be intially wet, then dry. would continue to limit po fluid to 1500cc/day. will need close monitoring of electolytes. follow up with dr. on who can mke a decision about resumeing lisinopril or aldactone. . # hyperbilirubinemia: on was noted to have a bilirubin 2.1. there were no other localising signs and this is felt likely hepatic congestion given his significant chf. ruq ultrasound showed stones and sludge but no signs of inflammation or obstruction. . # hypotension: baseline sbp 80's-90's. pt is not symptomatic typically. if pt becomes orthostatic, would push po fluids before ivf. . # persistent disorientation: continued to be disoremted in time and will perseverate. tsh/ca normal. difficult to know if this is close to baseline for him as he likely has an element of alcoholic dementia due to his years of alcoholism. previous normal b12 and folate in . had cognitive evaluation with mmse 14 ace-r 37.5/100 with global dysfunction mostly affecting verbal fluency, memory and language although pretty severaly affected across the board his daughter states that he is forgetful at home and has been struggling to care for himself. also an element of isolation and depression. should have geripsych evaluation at rehab to re-evaluate now that his medical condition has improved. he will need social service evaluation for appropriate placement after discharge . # hyponatremia - likely in setting of diuretic regimen. is also intravsscularly dry. started torsemide and having furosemide boluses with na remained relatively static. currently 127. pt should frequent monitoring and fluid restriction of 1500cc/day. . # penile ulcer: hypopigmented non-tender ulcer on foreskin on vertal aspect of penis was noted on . noted dysuria and a ua was sent and was negative with negative ucx. rpr was also negative. it did not look to be hsv and culture negative. he was seen by wound care who recommended aquaphor ointment. . # chronic anemia: likely secondary to . stable. . # cad s/p ptca: presentation inconsistent with angina. no new or concerning ekg changes. troponins at baseline. will continue asa, clopidogrel, carvedilol, and pravastatin. . # rheumatoid arthritis: stable. continue home hydroxychloroquine, leflunomide, and prednisone. . # gout: no sign of flare. restarted allopurinol at home dose. . medications on admission: 1. aspirin 81 mg tablet sig: one (1) tablet po once a day. 2. alendronate 70 mg tablet sig: one (1) tablet po once a week. 3. allopurinol 100 mg tablet sig: two (2) tablet po once a day. disp:*60 tablet(s)* refills:*2* 4. carvedilol 12.5 mg tablet sig: one (1) tablet po twice a day. 5. clopidogrel 75 mg tablet sig: one (1) tablet po once a day. 6. hydroxychloroquine 200 mg tablet sig: one (1) tablet po twice a day. 7. leflunomide 10 mg tablet sig: one (1) tablet po once a day. 8. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 9. pravastatin 40 mg tablet sig: one (1) tablet po once a day. 10. prednisone 10 mg tablet sig: one (1) tablet po once a day. 11. calcium carbonate-vitamin d3 500 mg(1,250mg) -400 unit tablet sig: one (1) tablet po once a day. 12. furosemide 40 mg daily 13. aldactone 25 mg daily discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. alendronate 70 mg tablet sig: one (1) tablet po once a week: start on fridays. 3. allopurinol 100 mg tablet sig: two (2) tablet po daily (daily). 4. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). 5. clopidogrel 75 mg tablet sig: one (1) tablet po once a day. 6. hydroxychloroquine 200 mg tablet sig: one (1) tablet po bid (2 times a day). 7. leflunomide 10 mg tablet sig: one (1) tablet po daily (). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 9. pravastatin 40 mg tablet sig: one (1) tablet po once a day. 10. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). 11. calcium 600 + d(3) 600-400 mg-unit tablet sig: one (1) tablet po twice a day. 12. torsemide 20 mg tablet sig: one (1) tablet po daily (daily). 13. petrolatum ointment sig: one (1) appl topical tid (3 times a day) as needed for wund care ulcer: apply to open area on penis . 14. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for puritis. discharge disposition: extended care facility: of discharge diagnosis: acute on chronic systolic congestive heart failure hyponatremia acute on chronic kidney injury altered mental status coronary artery disease discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted with acute on chronic systolic congestive heart failure or fluid overload. you needed to be on 2 intravenous medicines, milrinone and furosemide to take off the extra fluid. weigh yourself every morning, call dr. at if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. your weiht at discharge is 121 pounds (55kg) . we made the following changes in your medicines: 1. stop taking furosemide, start torsemide instead to keep the fluid off 2. stop aldactone 3. decrease carvedilol to 6.25 mg twice dialy 4. use aquaphor dressing twice daily to open area on your penis 5. use sarna lotion as needed for itchy skin followup instructions: department: cardiac services when: wednesday at 11:40 am with: , m.d. building: campus: east best parking: garage department: cardiac services when: monday at 3:00 pm with: dr. building: sc clinical ctr campus: east best parking: garage procedure: central venous catheter placement with guidance diagnoses: other primary cardiomyopathies anemia in chronic kidney disease coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified long-term (current) use of steroids acute kidney failure, unspecified hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified percutaneous transluminal coronary angioplasty status other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified hypotension, unspecified osteoarthrosis, unspecified whether generalized or localized, site unspecified rheumatoid arthritis acute on chronic systolic heart failure disorder of bone and cartilage, unspecified chronic passive congestion of liver other specified disorders of penis 

Answer: The patient is high likely exposed to