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: history of present illness: the patient is a 71 year old man with a past medical history as described below, who initially presented to an outside hospital on , with confusion, fatigue, fevers and palpitations. he was transferred to the following day for further evaluation of hypotension and decreased urine output. at the outside hospital, he was also noted to be in atrial fibrillation and atrial flutter and had an elevation in his cardiac enzymes. chest x-ray and ct angiogram at the time were negative. upon transfer, the patient was started empirically on vancomycin and ceftriaxone as treatment for meningitis given his change in mental status. mri of the head was performed which showed an old cerebellar infarction and micro-angiopathic changes, but no acute infarction. lumbar puncture was performed which was negative. ct scan of the chest without contrast was done initially because of the patient's acute renal failure and it showed only small bilateral pleural effusions. the patient continued to be hypoxic however, with an increased a:a gradient. the patient had been anti-coagulated with lovenox at the outside hospital because of his atrial fibrillation, however ct angiogram was performed again to rule out pulmonary embolism. prior to the ct angiogram being done, the patient experienced a significant episode of hematemesis for which the heparin drip was stopped. ct angiogram was eventually done which showed a left anterior segmental pulmonary embolism. bilateral lower extremity non-invasive studies were done which were negative for deep vein thrombosis and the patient was restarted on the heparin drip. later that evening, on , the patient became acutely hypoxic with o2 saturations in the 70s; his skin was mottled. he was noted to be in atrial flutter at a rate of 150 with a blood pressure initially of 180/90. the arterial blood gases at that time showed ph of 7.26, pco2 of 40 and a po2 of 51. the patient was intubated for respiratory failure. his temperature at that time was noted to be 102.0 f. subsequently, the patient became hypotensive with systolic blood pressures in the 80s which responded to aggressive volume resuscitation. a transesophageal echocardiogram was done to evaluate for right ventricular thrombus, and revealed dilatation of the right ventricle and mild global hypokinesis but no intramural thrombus. as the patient's blood pressure improved on intravenous fluids, lysis of his pulmonary embolism and likely recurrent massive pulmonary embolus was deferred. in the setting of this acute stress, the patient had a non-st elevation myocardial infarction with a peak troponin of 3.2. he remained hemodynamically stable and anti-coagulated on heparin which was again complicated by a gastrointestinal bleed in which the patient had significant amounts of melena. nasogastric lavage was performed which was negative. the patient was transfused two units of packed red blood cells and his hematocrit improved to 31.2 from a nadir of 28.0. gi was consulted at the time and esophagogastroduodenoscopy was deferred. the patient's stool continued to be occult blood positive from that time on, but he had no further frank melena. the patient was extubated on and was rather tachypneic and wheezy immediately thereafter but responded very well to nebulizers. following extubation, the patient was total body overloaded from his aggressive volume resuscitation, approximately 13 liters for length of stay and was diuresed aggressively between one and two liters per day, which he tolerated well. the patient was transferred to the medical service on . past medical history: 1. coronary artery disease status post coronary artery bypass grafting in at hospital. 2. post-polio syndrome. 3. gout. allergies: no known drug allergies. medications at the time of transfer from the intensive care unit: . protonix 40 mg intravenously twice a day. 2. lopressor 25 mg p.o. q. day. 3. heparin drip with a goal ptt of 60 to 65 because of the patient's gastrointestinal bleeding. 4. tylenol p.r.n. 5. zocor 40 mg q. day. 6. captopril 6.25 mg three times a day. 7. lasix 20 mg intravenously q. day. 8. albuterol and atrovent nebulizers p.r.n. 9. allopurinol 100 mg p.o. q. day. physical examination: at the time of admission, the patient was afebrile at 98.8 f., heart rate was 76; blood pressure 136/66; respiratory rate 20 and he was saturating 100% on a face tent at 15 liters per minute. intake and output on the day of transfer were 1000 in and over 3000 out. in general, he complained only of fatigue, but he was in no acute distress and was alert and oriented times three. examination of his neck revealed no jugular venous distention. his heart examination was regular without murmur, although telemetry revealed a rhythm of atrial flutter. his lung examination at the time revealed diffuse expiratory wheezing. his abdominal examination was benign. extremity examination revealed two plus peripheral edema throughout. laboratory: at the time of transfer, white blood cell count was 6.9, hematocrit 29.7, platelets 214. ptt was 84.3. chem-7 was unremarkable. hospital course on medical firm: 1. pulmonary embolism: the patient was continued on his heparin drip with a goal ptt as listed above. coumadin initiation was delayed for a couple of days while the gastrointestinal and cardiology services consulted considering procedures to correct his atrial flutter and gastrointestinal bleeds respectively. ultimately, coumadin was begun at 5 mg q. day and the patient's inr slowly increased. he was changed to 7.5 mg q. day at the time of discharge. his respiratory status improved dramatically over 24 to 48 hours and was weaned to room air with saturations of 93 to 94%, while ambulating. he had very rare short bursts of pleuritic chest pain on the left side. ekg was checked at one of these occasions which was unchanged from the previous and the pain was only fleeting with no elevations of cardiac enzymes. for his wheezing, he received albuterol and atrovent nebulizers on a p.r.n. basis which responded very well. as the patient's gastrointestinal bleeding was stable, he was anti-coagulated and will be continued on anti-coagulation therapy for a minimum of six months. 2. fever: the patient initially presented to the outside hospital with fevers and continued to have fever to 102.0 f., at . a thorough work-up was done including lumbar puncture as listed above and various viral serologies at the recommendation of the infectious disease consultation. because the patient is from area, numerous etiologies were thought plausible and the patient was ruled out for both influenzae both a and b, cmv, lyme disease, ebv, both igg and igm were checked with the igg positive, histoplasma and ehrlichia and rsv, all of which were negative. blood cultures and urine culture were all negative as well. it was felt that the patient either had a viral syndrome to explain his fever or that the fever was due to the pulmonary embolism itself. no antibiotics were given after the day of admission after the lumbar puncture was done and was found to be negative. 3. non-st elevation myocardial infarction: this was felt to be due secondary to demand in the setting of atrial flutter in the rate of 150s and massive pulmonary embolism. the patient was already anti-coagulated on heparin. aspirin was held, however, because of his gastrointestinal bleeding. the patient was started on captopril which was titrated to 25 three times a day at the time of discharge and converted to lisinopril 10 mg for decreased pill burden at the time of discharge. in addition, he was started on lopressor which was titrated to 50 mg twice a day and converted to atenolol once daily, again, for decreased pill burden. he was continued on his outpatient doses of zocor. 4. gastrointestinal: the patient did not have either esophagogastroduodenoscopy or colonoscopy this admission because of the ongoing need for anti-coagulation as well as his high o2 requirements earlier on in the hospital course. the patient was continued on a proton pump inhibitor twice daily and the patient will follow-up with gastroenterology within a short time after he discontinues anti-coagulation for both esophagogastroduodenoscopy and colonoscopy. 5. atrial flutter: it is unclear if the atrial flutter / fibrillation, preceded the pulmonary embolism in which the patient had a cardiac embolic event or if the pulmonary embolism led to the irregular heart rhythm. regardless, the patient was rate controlled with beta blocker and anti-coagulated already for his pulmonary embolism. cardiology was consulted regarding the treatment of his atrial flutter and it was felt while he was adequately rate controlled, that there was no need for acute intervention. the patient will follow-up with electrophysiology in approximately one month for follow-up ekg and possible intervention at that time. it is possible that with treatment and resolution of his pulmonary embolism, the patient may convert back to sinus rhythm on his own, which is why no acute intervention was done. 6. hematologic: again, the patient was managed on a heparin drip with a low goal ptt range of 60 to 65, with initiation of coumadin titrated up to 7.5 mg q. day. the patient will follow-up with his primary care physician, . , for inr checks, upon returning to . because of his falling hematocrit in the setting of his gastrointestinal bleed, the patient was transfused two units of packed red blood cells on . in addition, because of a slow decrease in his hematocrit over the subsequent three days, the patient was transfused one further unit of packed red blood cells on . following that blood transfusion, the patient's hematocrit remained stable between 33 and 35, requiring no further blood transfusions. 7. volume overload: following the patient's hypotensive episode and aggressive volume resuscitation, he was ultimately approximately 13 liters positive for length of stay in the medical intensive care unit. once stabilized, he was begun on 20 mg of intravenous lasix daily, which produced dramatic results of anywhere from 1.5 to 4 liters of diuresis daily. the patient's anasarca resolved over a period of three to four days with no peripheral edema at the time of discharge. his electrolytes were managed and repleted on a p.r.n. basis throughout this time. 8. rheumatologic: the patient was continued on his outpatient dose of allopurinol. code status: the patient was a full code throughout his hospitalization. discharge diagnoses: 1. pulmonary embolism. 2. non-st elevation myocardial infarction. 3. gastrointestinal bleed. 4. new atrial fibrillation / flutter. discharge medications: 1. allopurinol 100 mg p.o. q. day. 2. simvastatin 40 mg p.o. q. day. 3. atenolol 50 mg p.o. q. day. 4. coumadin 7.5 mg p.o. q. day to be adjusted based on inr at primary care physician's discretion. 5. lisinopril 10 mg p.o. q. day. 6. protonix 40 mg p.o. twice a day. 7. sarna lotion. disposition: the patient is discharged to home with visiting nurses association services for physical therapy. discharge instructions: 1. the patient is to follow-up with his primary care physician upon return to for measurements of inr and dosing adjustments of his coumadin. 2. in addition, he is to follow-up with his cardiologist in approximately one month for further management of his atrial flutter. 3. the patient will arrange follow-up with gastroenterology after his course of coumadin is complete for esophagogastroduodenoscopy and colonoscopy. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung diagnostic ultrasound of heart other esophagoscopy insertion of endotracheal tube arterial catheterization gastric lavage diagnoses: acidosis subendocardial infarction, initial episode of care acute kidney failure, unspecified atrial flutter acute respiratory failure hemorrhage of gastrointestinal tract, unspecified other pulmonary embolism and infarction late effects of acute poliomyelitis 

Answer: The patient is high likely exposed to