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: shortness of breath major surgical or invasive procedure: right-sided thoracentesis history of present illness: pt is a 77 y.o. male with h/o rheumatic heart disease s/p mechanical mvr/avr, afib (s/p vvi ppm); cad s/p x 2 with stenting of rca and lad; h/o chf with preserved ef 55%; 2+mr around leakage around mechanical valve, recently discharged for severe chf requiring natrecor, lasix and dopamine drips, chronic anemia, mds, and more recent d/c for fall and arf admitted to hospital on . * pt presented to with hypoxia and change in mental status from rehab. at rehab, pt with a 7 lb weight gain over week prior to admission, with attempted increase in bumex to compensate for weight gain. on day of admission, pt with increasing somnolence and o2 sat 80s on room air --> 92% on 2l. +sob. also, in the week prior to admission, pt's remeron was doubled secondary to depression. additionally, pt's daughter said that pt had slurred speech week pta and called her saying nonsensicle things, which is unusual for him (of note remeron doubled around that time). * at hospital pt found to be in hypercarbic respiratory failure with pco2 71. pt placed on bipap and transferred to icu. he was maintained on bipap, and diuresed on a natrecor drip, lasix drip, and dopamine for bp support . pt ruled out by cardiac enzymes and ekg for mi. repeat echo done to rule out showed ef 60% and functioning mechanical valves. on cxr pt with loculated effusion that was tapped on c/w transudative process per d/c summary. he was started to be treated to a cap but this was stopped secondary to decreased suspicion with abx d/cd (do not know which abx). pt presented with arf to 2.4 peak but down to 1.2 upon transfer. additionally, pt's coumadin was held there as pt got thoracentesis and he was bridged on a heparin gtt. pt also found to be c. diff positive and started on flagyl . pt was transferred to for further care. * today, pt feels well. no sob or cp. breathing "is pretty good." pt tells team that he has been compliant with low sodium diet and there have been no recent medication changes. past medical history: 1. cad - s/p cath with 3vd: 99% distal lad, 60% lcx at origin of prior ptca, rca 50% distal with 70% rpl. prior lad and rca stents widely patent. :stenting of the rca with 3 overlapping cypher - : rotational atherectomy, ptca and stenting of the lad/lcx. last stress --> moderate to severe, fixed perfusion defect of all three segments of the inferior and inferolateral walls extending into the apex (fixed compared to partially reversible in ). 2. mvr/avr - complicated by 2+mr 3. chf - ef >55% 2+mr , rv dysfunction, moderate pulmonary htn 4. paf s/p vvi pacemaker 5. cri baseline cr 1.5-1.7 6. mds 7. chronic mechanical hemolysis 8. hx. of perirectal abscess s/p surgery 9. gout 10. hemorrhoidal bleeding social history: no etoh or tobacco. was living alone at home (widower) prior to recent hospitalizations. two daughters heavily involved in care. physical exam: t: 98.3; bp: 102/48; p: 71; rr: 14; o2: 100 3l gen: elderly male speaking in full sentences in nad. heent: perrla; eomi; sclera anicteric. neck: jvd to earlobe cv: ii/vi systolic murmur at apex radiating to axilla. also with mechanical click s2. irregularly irregular rhythm. lungs: decreased b/s b/l l>r. rales scattered mid-lower left lung fields. abd: soft, mildly distended, llq with small few cm hard object (has been there always per pt). nontender. ext: + pitting edema b/l. neuro: cn ii-xii tested and intact. perrla; eomi; facial muscles equal and strong. tongue midline without fasciculation. scm and shoulder shrug strong. palate elevation equal and symmetrical. ms upper and lower. reflexes: brachio/biceps . patellar 1 b/l. brief hospital course: 1. chf- on the floor, he failed to diurese to natrecor and lasix, with dopamine for bp support. he was still fluid overloaded on exam, but was becoming hypotensive to low 70s-upper 60s. he was transferred to the ccu for invasive hemodynamic monitoring. initially, his pa pressures were 70s/30s, with a wedge of 23. his co was 7 with an svr of 469. he was placed on natrecor, vasopressin, lasix, and dopamine. this was changed in the am to vasopressin, lasix, and levophed, as given his low svr and low-grade temp it was felt he had some septic physiology. since he was also clearly volume overloaded, he was given diuril to augment diuresis with lasix, which was effective. he had a large pleural effusion, which was tapped on and was c/w transudate. the patient was ultimately controlled with levophed and a lasix drip alone which were both successfully weaned off. his management was optimized with diuril 250 mg daily, lasix 100 mg , digoxin 0.125 mg qod given his renal dysfunction, and spironolactone 50 mg daily. he was not placed on an ace-i or beta-blocker given his relative hypotension with systolic blood pressures in the high 80s and 90s - which is his baseline blood pressure. 2. cad- the patient was continued on a statin, plavix and asa. the patient ruled out at osh by enzymes. he was not placed on a beta-blocker given his low blood pressure. * 3. rhythm- the patient has a history of atrial fibrillation and was monitored on telemetry with no issues. given his initial rate in the 120s, digoxin was initiated for better rate control and he remained stable thereafter. he was placed on coumadin after his swan was discontinued and a heparin drip to bridge to coumadin. his goal inr is 2.5 to 3.5 as he also has 2 prosthetic valves. * 4. c. diff- the patient was diagnosed with c. diff at the osh. he was continued on metronidazole 500 tid for 10 days treatment ( 1st dose). he had no further episodes of diarrhea. * 4. cri- baseline creatinine 1.5-1.7. his creatinine ranged from 1.7-1.9 during his stay. * 5. anemia- secondary to mechanical hemolysis mds and anemia of chronic disease. he was continue on iron/folate and transfused one unit during his stay. the patient was restarted on epoetin 20,000 mwf. his baseline hct is 29-30. he is also guaiac negative. our goal hct for him is to transfuse for hct <27 as his hematocrit drops within a few days post transfusion regardless. his hematocrit remained stable otherwise throughout his stay. * 6. nosocomial pneumonia - the patient was presumed to have a nosocomial pneumonia and placed on zosyn for a 7 day course. he remained afebrile thereafter. 7. co2 retention - the patient's co2 remained in the 40s. pulmonary followed the patient and believed the patient would benefit from an outpatient sleep study and pfts to assess for obstructive sleep apnea. he was at first treated with diamox which had little effect on his serum bicarbonate and was thus, discontinued. it is important that his potassium is checked frequently and maintained above 4.0 to ensure his bicarbonate does not rise further. medications on admission: asa 325 qday bumex 3 mg qam, 2 mg qpm lovenox sc 30 mg qhs zocor 80 mg po qhs toprol xl 25 mg po qday coumadin 5 mg po qday tramadol 25 mg tid ambien 5 mg qhs prn arinef 100 mg sc qweek remeron 30 mg qday folic acid 1 mg po qday senna 2 tabs qhs colace 100 mg iron sulfate 325 tid pepcid 20 * medications upon transfer: diuril 500 (30 min prior to lasix) lasix 20 iv bid coumadin 5 mg qhs protonix 40 mg qhs asa 81 mg qday colace 100 heparin drip 700 units/hour discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). 3. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 4. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 5. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po bid (2 times a day). 6. epoetin alfa 20,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). 7. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 8. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 9. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 10. digoxin 125 mcg tablet sig: one (1) tablet po every other day (every other day). 11. furosemide 20 mg tablet sig: five (5) tablet po bid (2 times a day). 12. chlorothiazide 250 mg tablet sig: one (1) tablet po daily (daily). 13. spironolactone 25 mg tablet sig: two (2) tablet po daily (daily). 14. warfarin sodium 2 mg tablet sig: three (3) tablet po hs (at bedtime). 15. heparin sod (porcine) in d5w 100 unit/ml parenteral solution sig: one (1) intravenous asdir (as directed). discharge disposition: extended care facility: - discharge diagnosis: diastolic congestive heart failure atrial fibrillation h/o rheumatic heart disease with aortic and mitral valve replacement resolved clostridium difficile diarrhea discharge condition: stable. discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet followup instructions: provider: clinic where: cardiac services phone: date/time: 9:30 provider: , m.d. where: cardiac services phone: date/time: 10:00 procedure: venous catheterization, not elsewhere classified thoracentesis non-invasive mechanical ventilation arterial catheterization injection or infusion of nesiritide diagnoses: pneumonia, organism unspecified unspecified pleural effusion acute kidney failure, unspecified atrial fibrillation other chronic pulmonary heart diseases rheumatic heart failure (congestive) acute respiratory failure hypotension, unspecified mechanical complication due to heart valve prosthesis blood in stool surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation urinary incontinence, unspecified mixed acid-base balance disorder 

Answer: The patient is high likely exposed to