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: lovastatin attending: chief complaint: fever major surgical or invasive procedure: none history of present illness: this is an 80 y/o cantonese-speaking male with pmh significant for esrd on hd, dm ii, atrial fibrillation, cad, who presented from hemodialysis on with a reported fever of 105.7. the patient only complained of fatigue and weakness, starting yesterday morning. at around 2pm , he began feeling very tired at hd and was having chills so ems was called. per ems, the patient was hypotensive during transport but upon arrival to the ed, was hypertensive to the 170's systolic. . in the ed, initial vs were t 102.3, bp 174/60, hr 102, rr 16, sao2 88%/ra. due to the temperature, sepsis protocol was initiated. r ij was placed because he has poor access. cxr and head ct were unremarkable. ua showed many bacteria but was otherwise unremarkable. the patient reported symptoms of a headache and neck stiffness during his ed course, however lp was negative. prior to the lp, he received vancomycin 1 gm, ctx 2 gm iv, ampicillin 2gm iv. he also received 10 mg dexamethasone and a random cortisol level was sent which was normal (=8). his sbp trended down from the 160's to 90's-100's while in the ed and he received a total of 3 l ivf. his o2 requirement increased from 2 l nc -> 4 l nc and his svo2 ranged from 91-97. his cvp was documented from (after approximately 2 l ns). he also received 325 mg asa and 2 mg iv morphine for his headache. he was admitted to the micu for further management. of note, the patient has had prior admissions for fever (101-102) in and which after a thorough work-up, was attributed to gouty flares and improved with a steroid taper. he recently saw his rheumatologist 1 week ago, who increased his allopurinol from 200 to 300 mg daily due to acute flares through the prior dose and increased the patient's steroid taper. . in the micu, he was continued on vancomycin and ceftriaxone. ampicillin was discontinued given low likelihood of meningitis. he remained hemodynamically stable and did not require fluids. his steroid dose was increased to 32mg methylprednisolone daily, per discussion with his outpatient rheumatologist dr. . during the afternoon of , he became dyspneic and wheezy with elevated jvp and mild increase in chf on cxr. he was felt to be volume overloaded volume resuscitation and was sent to hd for ultrafiltraion, 2.3 l was taken off. he was transferred to the floor in stable condition and continued on the antibiotics. his urine cx grew out likely >100,000 enterococcus. . this morning on the floor at 6:30 am, the patient triggered for a hr in the 160's and mild respiratory distress. he received 5 mg iv metoprolol and neb treatments with improvement in his hr to the 110's and resolution of his respiratory distress. around 7:30 am, he was noted to be tachypneic in the 40's, extremely wheezy, tachycardic to the 160's (a fib with rvr), and hypertensive to the 190's systolic. he was hypoxic and placed on a nrb, with improvement of his sao2 to the 90's. abg on the nrb was 7.33/51/73. he was felt to have gone into flash pulmonary edema and he received a total of 200 mg iv lasix with 225 cc uop, 1.5 mg iv morphine, 10 mg iv hydral, 5 mg iv dilt, 10 mg iv metoprolol, and 1" nitropaste. he was initiated on bipap on the floor and abg was 7.44/38/305. he received 25 mg metoprolol po x 1 upon arrival to the micu for persistent tachycardia in the 140's. past medical history: 1. cad - reported as single vessel disease s/p catheterization in following ett-mibi demonstrating an inferolateral perfusion defect. mid lcx was stented with a drug eluting stent with successful rescue of the om1 with balloon angioplasty. also has history of catheterization more than 20 years ago. 2. diabetes mellitus type ii - for more than 30 years. his blood glucose levels are usually 97-100. his most recent hba1c was 6.6 in . has nephropathy and proteinuria, as well as mild distal neuropathy. 3. atrial fibrillation - paroxysmal atrial fibrillation diagnosed in . on long-term anticoagulation. 4. hypertension 5. history of gi bleed - history of gastric ulcers. presumed lower gi bleed on . 6. chronic renal insufficiency - probable diabetic nephropathy. baseline creatinine 2.7. has seen been seeing dr. for possible initiation of peritoneal dialysis. 7. sleep apnea 8. musculoskeletal problems: (a) bilateral severe carpel tunnel (b) polyneuropathy of hands (c) right flexor tendon nodules/ contracture (d) oa of dips, pips, and 1st cmc (e) gout - recent admission in for gout flair. (f) pseudogout. (g) osteopenia social history: mr. is cantonese speaking. he lives with his wife. has a remote 20-year history of tobacco smoking. he quit 20 years ago. no alcohol or illicit drug use. performs most adls at baseline. family history: both parents deceased. father had diabetes. he has 2 children who are well and no siblings. physical exam: vs: tc 98.7, bp 91/44, hr 120-130, rr 19-20, sao2 96%/4l nc general: elderly asian male in nad, lying comfortably in bed heent: nc/at, perrl, eomi. +dentures. mmm, op clear neck: supple, +right ij cvl in place chest: crackles and expiratory wheezes to the apices cv: irregularly tachycardic, s1 s2 normal, sm at the base abd: soft, nt/nd, nabs, no hsm ext: no c/c/e, several ecchymosis over the upper extremities; left av fistula with palpable thrill and bruit - no erythema, tenderness or swelling neuro: non-focal, moving all extremities. pertinent results: imaging: cxr - heart size is at the upper limits of normal. mild interstitial prominence is noted, which may be related to mild chf. no pleural effusions are seen. bowel gas pattern in the upper abdomen is unremarkable. . cxr - chf has mildly increased compared to yesterday. there is mild blunting of the left costophrenic angle indicating pleural fluid. . cxr - worsening pulmonary edema with haziness of the right base . ekg - afib with rvr, no ischemic changes noted brief hospital course: mr. is an 80 y/o cantonese-speaking male with pmh significant for esrd on hd, dm ii, atrial fibrillation, cad, who presented from hemodialysis on with a reported fever of 105.7. the patient only complained of fatigue and weakness, starting the morning prior to admission. at around 2pm , he began feeling very tired at hd and was having chills so ems was called. per ems, the patient was hypotensive during transport but upon arrival to the ed, was hypertensive to the 170's systolic. . in the ed, initial vs were t 102.3, bp 174/60, hr 102, rr 16, sao2 88%/ra. due to the temperature, sepsis protocol was initiated. r ij was placed because he has poor access. cxr and head ct were unremarkable. ua showed many bacteria but was otherwise unremarkable. the patient reported symptoms of a headache and neck stiffness during his ed course, however lp was negative. prior to the lp, he received vancomycin 1 gm, ctx 2 gm iv, ampicillin 2gm iv. he also received 10 mg dexamethasone and a random cortisol level was sent which was normal (=8). his sbp trended down from the 160's to 90's-100's while in the ed and he received a total of 3 l ivf. his o2 requirement increased from 2 l nc -> 4 l nc and his svo2 ranged from 91-97. his cvp was documented from (after approximately 2 l ns). he also received 325 mg asa and 2 mg iv morphine for his headache. he was admitted to the micu for further management. of note, the patient has had prior admissions for fever (101-102) in and which after a thorough work-up, was attributed to gouty flares and improved with a steroid taper. he recently saw his rheumatologist 1 week prior to admission, who increased his allopurinol from 200 to 300 mg daily due to acute flares through the prior dose and increased the patient's steroid taper. . in the micu, he was continued on vancomycin and ceftriaxone. ampicillin was discontinued given low likelihood of meningitis. he remained hemodynamically stable and did not require fluids. his steroid dose was increased to 32mg methylprednisolone daily, per discussion with his outpatient rheumatologist dr. . during the afternoon of , he became dyspneic and wheezy with elevated jvp and mild increase in chf on cxr. he was felt to be volume overloaded volume resuscitation and was sent to hd for ultrafiltraion, 2.3 l was taken off. he was transferred to the floor in stable condition and continued on the antibiotics. his urine cx grew out likely >100,000 enterococcus, sensitive to ampicillin, so vanco/ctx was discontinued and the patient was treated with augmentin. . on the floor, the patient triggered for a hr in the 160's and mild respiratory distress. he received 5 mg iv metoprolol and neb treatments with improvement in his hr to the 110's and resolution of his respiratory distress. later that morning, he was noted to be tachypneic in the 40's, extremely wheezy, tachycardic to the 160's (a fib with rvr), and hypertensive to the 190's systolic. he was hypoxic and placed on a nrb, with improvement of his sao2 to the 90's. abg on the nrb was 7.33/51/73. he was felt to have gone into flash pulmonary edema and he received a total of 200 mg iv lasix with 225 cc uop, 1.5 mg iv morphine, 10 mg iv hydral, 5 mg iv dilt, 10 mg iv metoprolol, and 1" nitropaste. he was initiated on bipap on the floor and abg was 7.44/38/305. he received 25 mg metoprolol po x 1 upon arrival to the micu for persistent tachycardia in the 140's. the patient again went to hd for ultrafiltration with resolution of his respiratory symptoms. he was slowly weaned off o2 onto room air and on he was transferred back to the floor. he remained stable on the floor with no signs or symptoms of respiratory distress. # respiratory distress - mr. respiratory distress was likely due to flash pulmonary edema, in the setting of fluid resusitation, afib with rvr, leading to the respiratory event. he was treated as outlined above. . # atrial fibrillation with rvr - mr. has a known history of atrial firbrillation, for which he is on coumadin. his atrial fibrillation was likely exacerbated due to volume overload/pulmonary edema. he was initially rate controlled with iv dilt and iv metoprolol. ekg without ischemic changes. his po metoprolol dose was increased to 20mg . he takes coumadin for anticoagulation. his coumadin was held for 2 days due to a supratherapeutic inr, likely secondary to antibiotic therapy. on his day of discharge, mr. heart rate was well-controlled and he had been restarted on his home coumadin regimen. #uti - my. was initially treated broadly due to concern for urosepsis. the urine culture grew out enterococcus, sensitive to ampicillin. he was treated with augmentin for 7 days total. on his day of discharge, he had one additional day of augmentin. . # gout - mr. has history of gout and pseudogout. he has had two admissions this year with fever felt to be secondary to gout flares. he was started on methylprednisolone 32 mg to treat a gout flare. per rhematology, his steriods were tapered quickly -> 24mg x 2days, 16mg x 2days, 12mg x 2days, 8mg. 8mg methylprednisolone is his home dose. he continued allopurinol 300 mg daily. he will follow up with rhematology as scheduled. . # esrd - mr. has esrd secondary to diabetes. he has on hemodialysis tuesday, thursday, and saturday. renal followed the patient throughout his hospitalization. during this admission, he was emergently hemodialyzed twice. . # diabetes - patient continued lantus with humalog sliding scale. . # htn - mr. continued metoprolol and imdur. mr. was discharged home with vna on hospital day #7 in stable condition. he will follow up on tuesday, for hemodialysis as scheduled. medications on admission: 1. allopurinol 300 mg daily 2. asa 81 mg daily 3. atorvastatin 10 mg daily 4. renal caps 1 tab daily 5. coumadin 2.5 mg 2d/wk, 1.25mg 5d/wk 6. folic acid 1 mg daily 7. levemir insulin 16 units qhs 8. novolog insulin sliding scale 9. imdur 30 mg daily 10. levothyroxine 75 mcg daily 11. methylprednisolone 8 mg daily 12. lopressor 25 mg 13. ntg sl prn 14. protonix 40 mg daily . discharge medications: 1. allopurinol 100 mg tablet sig: three (3) tablet po daily (daily). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 4. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. levothyroxine 50 mcg tablet sig: 1.5 tablets po daily (daily). 7. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 8. amoxicillin-pot clavulanate 500-125 mg tablet sig: one (1) tablet po daily (daily) for 1 days: please take after hemodialysis. disp:*1 tablet(s)* refills:*0* 9. methylprednisolone 2 mg tablet sig: six (6) tablet po daily (daily) for 2 days: please take 12mg on and on . disp:*12 tablet(s)* refills:*0* 10. methylprednisolone 8 mg tablet sig: one (1) tablet po daily (daily): start this medication on . . 11. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 12. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). disp:*30 tablet(s)* refills:*0* 13. nitroglycerin sublingual 14. coumadin 2.5 mg tablet sig: one (1) tablet po 2days/week: take 2.5mg 2days per week. 15. coumadin 2.5 mg tablet sig: 0.5 tablet po 5days/week: take 1.25mg 5days per week. 16. levemir 100 unit/ml solution sig: sixteen (16) units subcutaneous at bedtime. 17. novolog 100 unit/ml solution subcutaneous discharge disposition: home with service facility: caregroup vna discharge diagnosis: primary: flash pulmonary edema urinary tract infection gout flare secondary: diabetes atrial fibrillation end stage renal disease htn cad h/o gib discharge condition: stable discharge instructions: - you were treated for a urinary tract infection with augmentin. you only need to take it for one more day. take augmentin after hemodialysis tomorrow (). - you were treated for a gout flare with steriods. you are currently on a steriod taper. you will take methylprednisolone 12mg tomorrow () and then following day (). then starting on , you should take methylprednisolone 8mg (your home dose). - you should continue to take your coumadin (blood thinner). you should take 1.25mg 5 days per week and 2.5mg 2 days per week. this is the same regimen that you were on before. - we increased your blood pressure medication, lopressor to 37.5mg two times per day. - you treated for pulmonary edema with lasix and hemodyalysis. - continue all your other medications as listed below. please call your doctor immediately for chest pain, difficulty breathing, abdominal pain, fever>100.4, or any concerns. followup instructions: 1. please follow up with renal for hemodialysis as scheduled. 2. please follow up with your pcp, . , at 9:30am, #. 3. please follow up with rhematology as needed. your next scheduled appointment is at 08:30a with dr. . procedure: spinal tap incision of lung hemodialysis injection of antibiotic central venous pressure monitoring diagnoses: end stage renal disease coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified other pulmonary insufficiency, not elsewhere classified atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes personal history of tobacco use percutaneous transluminal coronary angioplasty status sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of insulin unspecified sleep apnea long-term (current) use of anticoagulants acute on chronic systolic heart failure diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled septicemia due to gram-negative organism, unspecified personal history of peptic ulcer disease 

Answer: The patient is high likely exposed to