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: patient recorded as having no known allergies to drugs attending: chief complaint: sob and abdominal pain major surgical or invasive procedure: retroperitoneal repair of a juxtarenal abdominal aortic aneurysm with an 18 mm dacron tube graft. exploration of right inguinal canal. right inguinal hernia repair. flexible gastroscopy, attempted percutaneous endoscopic gastrostomy tube placement -- abandoned. bed side swallow exam x 4 placement history of present illness: 89 yo m w hx cad, chf, af, prostate transfered from . initally presented for abdomnal pain, sob and was found to have aaa 7.5cm on abd ct done for abd pain. patient confirms orthpopnia, doe with mild movement. patient also complains of 2 weeks worseneing le edema with pain on the right lower calf. patient denies f/c/n/v/ since last admission. of note the patient travelled by plain from end of . also patient is s/p recent dc/ w/community aquired pna/uti s/p abx (ceftriaxone, azithro 6/10days). abd pain/diarrhea was worked up at that time all cultures were negative including c-diff. past medical history: 1. cad s/p cabg in at 2. chf w/ ef of 40% on tee in , 1+ ar, 2+mr 3. hypothyroidism 4. l thr 5. prostate ca s/p resection+xrt 6. afib s/p d/c cardioversion , on coumadin 7. gerd 8. hiatal hernia 9. oa 10. hypertension 11. dyslipidemia 1. aaa repair social history: widower, former furniture washer. smoked 3ppd until 20 years ago. no alcohol use. family history: not elicited physical exam: general: cachectic white male, nad nuero: pt slightly confused at times, but alert and oriented x 2, non focal heent: ncat, perrl, eomi neg lesions nares, oral pharnyx, auditory canal supple, farom, neg lyphandopathy, supraclavicular nodes lungs: cta b/l, with slight crakles at bases cardiac: rrr without murmers abd: soft, nttp, nd, pos bs, right inguinal hernia scar - healing well without redness, discharge, or , placed ext neg cyanosis, clubbing, edema fem 2 plus b/l, dopplerable pt/dp b/l pertinent results: video oropharyngeal swallow: study performed in conjunction with the speech and swallow division. varying consistencies of barium were given and video fluoroscopy was performed during all phases of swallowing. the patient had significant difficulty initiating the oropharyngeal phase of the swallow. no penetration or aspiration was identified, however, significant barium was retained within the valleculae, which could not be cleared with coughing. during the exam the patient continued to regurgitate barium and the esophagus was noted to be markedly dilated, tapering at the lower esophageal sphincter. a 13 mm barium tablet was administered, which became lodged within the valleculae, and could not be cleared. several attempts to pass the tablet were unsuccessful. eventually, the patient vomited the residual barium and the tablet, upon which the exam was terminated. impression: 1) no evidence of aspiration or penetration; however, significant difficulty initiating the oropharyngeal swallow with barium and barium tablet retained within the vallecula. see speech pathologist report. 2) significantly dilated esophagus tapering distally, suggesting the lower esophageal sphincter spasm. correlate clinically. echo findings: left atrium: marked la enlargement. elongated la. right atrium/interatrial septum: markedly dilated ra. left ventricle: mild symmetric lvh. mildly dilated lv cavity. overall normal lvef (>55%). aorta: moderately dilated aortic root. moderately dilated ascending aorta. aortic valve: mild as. mild to moderate (+) ar. mitral valve: moderately thickened mitral valve leaflets. moderate to severe (3+) mr. tricuspid valve: normal tricuspid valve leaflets. severe tr. moderate pa systolic hypertension. pericardium: no pericardial effusion. conclusions: 1.the left atrium is markedly dilated. the left atrium is elongated. 2.the right atrium is markedly dilated. 3.there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is normal (lvef>55%). 4.the aortic root is moderately dilated. the ascending aorta is moderately dilated. 5.there is mild aortic valve stenosis. mild to moderate (+) aortic regurgitation is seen. 6.the mitral valve leaflets are moderately thickened. moderate to severe (3+) mitral regurgitation is seen. 7.severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. 8. there is no pericardial effusion. 9. there is an echogenic density in the right ventricle consistent with a pacemaker lead. 9 renal u.s. port findings: the right kidney measures 12.4 cm. there is a 6 x 6.1 x 5.5 simple cyst at the upper pole. the right renal artery and vein are patent. doppler exam is technically limited, blood flow is detected at the upper pole, interpolar region, and lower pole. the left kidney measures 12.1 cm. limited doppler exam demonstrates blood flow throughout the kidney, but adequate waveforms could not be obtained due to respiratory motion. there are no stones in either kidney or evidence of hydronephrosis. the bladder is mildly distended with urine. impression: technically limited exam with blood flow detected in both kidneys. no evidence of hydronephrosis. ct abdomen w/o contrast; ct pelvis w/o contrast medical condition: 89 year old man with questionable sbo / incarcerated hernia reason for this examination: sbo incarcerated inguinal hernis; patient cannot get po contrast -- with achalasihernia abdomen with contrast: there are calcifications within the coronary arteries. calcified bilateral pleural plaques are consistent with asbestos exposure. there is a small right pleural effusion with bibasilar atelectasis. fine detail within the lung bases is limited by respiratory motion. within the limits of this unenhanced scan, multiple calcifications are seen within the liver and spleen, consistent with previous granulomatous disease. the pancreas is atrophic. several calcified gallstones are present within an otherwise unremarkable appearing gallbladder. there is no change in the appearance of multiple bilateral renal cysts, incompletely evaluated on this exam without intravenous contrast. the bowel is not well assessed without oral contrast material. a large infrarenal abdominal aortic aneurysm is noted measuring 6.7 x 8.0 cm, which is slightly larger than on the prior exam. the aneurysm sac contains mixed density material and some calcification. there is a 9 mm nonobstructing stone at the lower pole of the left kidney. pelvis with limited oral contrast: the bladder is distended. detail within the deep pelvis is limited by streak artifact from the patient's left metallic hip prosthesis. there is a wide based protrusion of abdominal contents into the right inguinal canal, but no evidence of bowel obstruction. similarly, within the lower left abdominal wall, there is a soft tissue density superficial to the musculature, which may or may not be connected to bowel, and is difficult to assess on this exam without oral contrast. this may represent a subcutaneous process or a hernia containing small bowel. bone windows: there are no suspicious lytic or sclerotic osseous lesions. multiplanar reformatted images redemonstrate the above findings and are of grade 4. impression: 1) difficult exam due to the lack of oral contrast. probable right inguinal hernia and possible hernia within the left abdominal wall versus a subcutaneous nodule or collection. 2) slight interval increase in size of infrarenal abdominal aneurysm sac. 3) coronary artery calcifications. 4) calcified pleural plaques consistent with asbestos exposure. 5) cholelithiasis. 6) 9 mm calcified stone at the lower pole of the left kidney, nonobstructing. ecg atrial fibrillation with a rapid ventricular response. ventricular premature beat. baseline artifact in lead v6. poor r wave progression with qs configuration in leads v1-v2 - could be due to lead placement or left axis deviation/ left anterior fascicular block but consider prior anteroseptal myocardial infarction. diffuse st-t wave abnormalities are non-specific but cannot exclude ischemia. clinical correlation is suggested. since the previous tracing of ventricular rate has increased and qrs voltage is less prominent. intervals axes rate pr qrs qt/qtc p qrs t 133 0 108 284/362.42 0 -46 175 radiology final report chest (portable ap) reason: hypotension, evaulate for chf portable chest a picc line is again noted terminating in the mid svc. there is no significant change in appearance of the chest since the prior chest x-ray of . pleural thickening at the left base is present. the heart is enlarged and there are post-cabg changes. the right lung is clear. impression: no change in the chest over the past four days. wbc rbc hgb hct mcv mch mchc rdw plt ct 6.6 3.41* 10.7* 32.1* 94 31.4 33.4 16.0* 244 pt ptt inr(pt) 21.3* 33.0 2.9 glucose urean creat na k cl hco3 angap 104 38* 0.8 139 4.5 108 27 9 brief hospital course: pt has thinned chart pt has had a difficult and complicated hospital stay. pt admitted on pt had retroperitoneal repair of a juxtarenal abdominal aortic aneurysm with an 18 mm dacron tube graft, with t10 epidural placed for post op pain mgmt. pt tolerated the procedure well. there were no complications. pt transfered to the pacu in stable condition. pt remained in the pacu untill . because the patient could not be extubated transfered to the sicu. immediatly post - op pt did exprience increase creatinine (2.6) , rapid a-fib, became febrile and had an increase in troponin. during his stay in the sicu, pt was tx for a multiple of problems experienced post op. - , sicu stay nephrology consult was obtained: arf secondary to atn in the setting of greater than 1 hr corvis clamp. creatinine followed. stable on dc. cardiology consult was obtained: chronic a - fib, tx with lopressor, anti - coagulation. lytes replenished, blood products replaced. pt extubated pt remained in the sicu for p/o confusion, not able to protect airway. aspiration precautions. hypernatremia tx with free water bolus's. increase bs - riss pt with increase fevers, found to have uti, tx with levoquin pt transfered to the - in the pt was treated for the above entities. pt also had difficulty swallowing. a kub was obtained. showed questionable alchalasia. pt experiencing blood from foley, with excessive clotting urology consult obtained: recommended flushes, check sensitivites for uti. no improvement from ab, sensitivities come back resistant to levo, ampicillan started, pt uti syptoms improve. pt failed multiple swallowing studies, dhft tube placed bedside. tf were started. pt pulls out dhft, goes to flouro for relacement of dhft, unable to place, eusophageal sphincter spasm. ppn started. gi consult was obtained: recommended egd / under flouro. pt goes to have placed experience rapid a-fib. procedure cancelled. pt has bout of ventricular ectopy. cardiology recommends amiodorone, c/w beta blockade. - pt rtansfered to the floor. a pt / casemanagement consult was obtained, recommended rehab. pt gets egd; recommended started on protonix, checked for h- pylori, need sesophageal manometry. picc placed for tpn. pt c/o abdominal pain, questionable incarcerated henia. general surgery consult obtained: pt recieves ct scan confirms the above diagnosis. pt taken to surgery. pt did not have incarcerated hernis, found to have an meshoma, a r inguinal herniorraphy was done. pt experiences sob / cxr obtained - pt found to have pnuemonia started back on levofloxacin for 7 day course pt recieves , tolerates the procedure well. pt iv meds are swithed over. 24 hours after the procedure the pt is starteed on tube feeds, coumadin is restarted for chronic a-fib. pt creatine is improved to 1.0 - rehab screening / pt is following. inr is monitered. heparin is dc'd when inr is at 2.0. pt improved. on discharge pt's tf by , has foley, ambulating with asst. is able to get oob to chair. inr 2.9, creat 1.0. medications on admission: asa lisinopril lasix atenolol warfarin levothyroxine kcl discharge medications: 1. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 2. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 3. levothyroxine sodium 88 mcg tablet sig: one (1) tablet po daily (daily). 4. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 6. atorvastatin calcium 10 mg tablet sig: one (1) tablet po daily (daily). 7. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 8. citalopram hydrobromide 20 mg tablet sig: 0.5 tablet po daily (daily). 9. hydromorphone hcl 2 mg/ml syringe sig: one (1) injection q4-6h (every 4 to 6 hours) as needed. 10. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 11. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 12. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 13. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 14. coumadin 2 mg tablet sig: one (1) tablet po at bedtime: inr goal 2 - 2.5. discharge disposition: extended care facility: discharge diagnosis: asymptomatic juxtarenal abdominal aortic aneurysm. psbo arf afib alchalasia - not diagnosed needs manometry as outpt. meshoma uti lll pnuemonia discharge condition: stable discharge instructions: keep wound c/d/i, maintenance follow inr for a-fib, goal is 2 - 2.5 foley to gravity - may dc when pt is able to ambulate to bathroom. bedside swallow study needs to be done, once pt is able to swallow may advance diet to solids and wean off tpn. followup instructions: follow up with dr two weeks. please call pt needs to have a manometer test for alchalasia. please schedule through gi as an outpt. call pt needs bedside swallow study at rehab, if he can not get, please call the number for gi and do as an outpt. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other gastroscopy other endoscopy of small intestine other esophagoscopy enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] other repair of abdominal wall resection of vessel with replacement, aorta, abdominal irrigation of other indwelling urinary catheter diagnoses: pneumonia, organism unspecified acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified unspecified protein-calorie malnutrition atrial fibrillation aortocoronary bypass status abdominal aneurysm without mention of rupture hyperosmolality and/or hypernatremia achalasia and cardiospasm abdominal or pelvic swelling, mass, or lump, right lower quadrant 

Answer: The patient is high likely exposed to