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: sulfa (sulfonamide antibiotics) / vasotec / ranitidine attending: chief complaint: abdominal pain fever major surgical or invasive procedure: cardiac catheterization intubation and mechanical ventilation abdominal fluid drainage history of present illness: 67-year-old male with history of stroke s/p gastrostomy, cad s/p cabg (),htn,dm ii presented to ed w/ fever associated with left upper quadrant abdominal pain. all history was obtained through wife as pt was intubated when he arrived to the unit. wife reported that pt began feeling unwell ~1 week ago, with increasing weakness and gait instability. over the course of the past week, pt has complained of increasing luq pain, worse with inspiration, no association with food. pain was described as sharp, only lasting for short period of time. wife denied any nausea, vomiting or diarrhea; he has been constipated with last bowel movement about 3 days ago. his wife also notes increasing urinary accidents over the past week and she was concerned that he had a urinary tract infection. he was also noted to have a cough, but no chest pain, no shortness of breath. of note, wife also reports that pt had dental work done on wednesday, routine cleaning, for which he took prophylactic antibiotics. initial work-up in the ed included unremarkable ct abd and normal cxr. pt had a fever of 101 and was given 2l ns and started on vanc/zosyn. pt began suddenly dyspneic in ed. he was tachypnea to 40 87% ra, and received 2 l. bradycardic to 37 x 1 min, then improved spontaneously. event was associated with a bm. pt placed on nrb o2 sat 99%. was a=ox3 at this point. on exam he was rhonchorous and and had b/l crackles. repeat cxr notable for pulmonary edema. pt continued to be tachypneic to 40 r/min and was intubated. an ekg at this time showed ekg showed elevations iii, avr, diffuse ischemia - in setting of hypoxemic to 80s, tachycardic to 100s. trop was .15. he was started on hep ggt, given asa 625, and admitted to ccu. pt was not started on clopidogril as he has a known mutation preventing metabolization. he is not a candidate for prasugrel with prev stroke. on transfer, he is febrile to 102.8. past medical history: 1. cardiac risk factors: (+)diabetes, (+)dyslipidemia (ldl 52 hdl 33 ), (+)hypertension 2. cardiac history: -cabg: cad s/p cabg in (svg--->large bifurcating ramus, svg---> first diagonal, svg--> posterior descending, lima---> left anterior descending) -percutaneous coronary interventions: -pacing/icd: 3. other past medical history: dmii with a1c of 6.5 however microalbuminuria ckdiii due to dmii and htn pvd s/p r and l sfa stent osa - non-compliant with cpap s/p r knee replacement psoriasis hpl htn social history: he owned and ran several companies including a party store and a shoe store. his wife is now trying to these off. he lives in with his wife. smoked until the 80s and then quit. he occassionally drinks but not to excess and does not use illegal drugs. does not restrict his diet. family history: his father died at 72 from coronary artery diseas, his mother at 83 from cad and cancer (type unknown). he has 2 sisters, 1 of whom has issues related to diabetes and blood pressure. he has children who are healthy. physical exam: admission exam: tm/tc:98/98 hr:56-60 bp:124-161/57-86 rr:18 02 sat: 96% 2l general: pt indtubated and sedated heent: ncat. sclera anicteric. l pupil >r, equally reactive. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp appreciated cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. diffuse rhonchi with scattered wheezing. crackles b/l. abdomen: soft, nt,nd. no hsm or tenderness. no abdominial bruits. extremities: 1+ b/l tibial edema. tibial skin shiny, without hair. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ dp 1+ pt 1+ discharge exam: 97.1 50-57 18 110-151/56-72 general: wdwn male, sitting up in chair nad heent: ncat. sclera anicteric. l pupil >r, equally reactive. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp wnl cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. diffuse rhonchi with scattered wheezing. decreased breath sounds b/l. abdomen: soft, nt,nd. no hsm or tenderness. no abdominial bruits. extremities: 1+ b/l tibial edema. tibial skin shiny, without hair. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ dp 1+ pt 1+ pertinent results: admission labs: 07:20pm plt count-259 07:20pm neuts-79.3* lymphs-12.8* monos-6.2 eos-1.5 basos-0.2 07:20pm wbc-10.6 rbc-3.94* hgb-10.4* hct-33.0* mcv-84 mch-26.3* mchc-31.4 rdw-14.3 07:20pm albumin-3.6 calcium-8.9 phosphate-2.8 magnesium-1.8 07:20pm probnp-1698* 07:20pm ctropnt-0.15* 07:20pm lipase-48 07:20pm alt(sgpt)-26 ast(sgot)-26 alk phos-86 tot bili-0.4 07:20pm estgfr-using this 07:20pm glucose-149* urea n-22* creat-1.2 sodium-139 potassium-4.4 chloride-102 total co2-28 anion gap-13 07:25pm lactate-1.3 09:15pm urine mucous-rare 09:15pm urine rbc-1 wbc-1 bacteria-few yeast-none epi-1 09:15pm urine blood-neg nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 09:15pm urine color-yellow appear-clear sp -1.019 02:05am ck-mb-3 probnp-1765* 02:05am ctropnt-0.08* 02:05am ck(cpk)-102 02:09am lactate-2.0 03:00am type-art temp-39.3 rates-18/ tidal vol-450 peep-5 o2-60 po2-97 pco2-47* ph-7.34* total co2-26 base xs-0 -assist/con intubated-intubated vent-spontaneou 04:44am o2 sat-96 04:44am type-art temp-37.8 rates-18/ tidal vol-450 peep-5 o2-50 po2-97 pco2-51* ph-7.33* total co2-28 base xs-0 -assist/con intubated-intubated 05:04am pt-19.4* ptt-62.7* inr(pt)-1.8* 05:04am plt count-252 05:04am wbc-12.6* rbc-3.64* hgb-9.6* hct-30.5* mcv-84 mch-26.3* mchc-31.3 rdw-14.5 05:04am albumin-3.1* calcium-7.7* phosphate-2.8 magnesium-1.7 05:04am ck-mb-7 ctropnt-0.24* 05:04am alt(sgpt)-24 ast(sgot)-30 ld(ldh)-230 ck(cpk)-128 alk phos-76 tot bili-0.6 05:04am glucose-235* urea n-20 creat-1.1 sodium-136 potassium-4.0 chloride-102 total co2-24 anion gap-14 09:01am o2 sat-97 09:01am type-art temp-37.8 rates-20/ tidal vol-550 peep-5 o2-50 po2-131* pco2-37 ph-7.46* total co2-27 base xs-3 -assist/con intubated-intubated 12:30pm ck-mb-19* mb indx-8.7* ctropnt-0.60* 12:30pm ck(cpk)-218 03:00pm ptt-57.8* 06:18pm hgb-8.7* calchct-26 o2 sat-98 06:18pm glucose-145* k+-3.7 06:18pm type-art rates-/16 po2-270* pco2-36 ph-7.48* total co2-28 base xs-4 -assist/con intubated-intubated 07:00pm magnesium-1.7 07:00pm ck-mb-12* mb indx-6.9* ctropnt-0.60* 07:00pm ck(cpk)-173 07:00pm urea n-21* creat-1.2 sodium-139 potassium-3.9 chloride-103 total co2-25 anion gap-15 . cardiac catheterization : comments: 1. coronary angiography in this right dominant system demonstrated multi-vessel disease. the lmca was patent with mild plaquing. the lcx was a small (2.0-2.25 mm) vessel that was heavily calcified, tortuous, and severely diffusely diseased from origin to distal. it was supplied by collaterals to the distal rca breanches. the ri had a 100% cto proximally with delayed filling and possible appearance of competitive flow versus scissoring of its proximal vessel. the rca had a 100% cto proximally with minimal r to r collaterals. 2. venous conduit angiography revealed the svg-rca, svg-ri, and svg-diagonal grafts to be flush occluded. 3. arterial conduit angiogrpahy revealed the lima-lad graft to be patent and the distal lad to be severely diffusely diseased with total occlusion distal to the anastamosis. 4. supravalvular aortography was performed and confirmed no filling of the vein grafts. 5. resting hemodynamics revealed markedly elevated left and right-sided filling pressures consistent with severe diastolic dysfunction. there was moderately elevated pulmonary arterial pressure. preserved cardiac output and index. final diagnosis: 1. severe native three-vessel coronary artery disease. 2. occlusion of the three vein grafts. 3. patent lima with severe post-anastamosis lad disease. 4. markedly elevated left and right-sided filling pressures. 5. moderate pulmonary hypertension. 6. preserved cardiac output and cardiac index. . admission ekg: sinus rhythm @94bpm w/ ste in ii, iii, avf, q waves in inferior leads, st depression in i, avl, lvh brief hospital course: 67-year-old male with history of stroke, s/p gastrostomy/traumatic gastrostomy tube removal requiring surgical repair, cad s/p cabg (), htn, dm ii presented to ed w/ fever associated with luq pain. ed course complicated by acute respiratory distress and intubation. additional workup showed (+) trop and inferior lead st elevation. . # respiratory distress: most likely secondary to flash pulomary edema in setting of interval change in cxr and acute decompensation after fluid was given in the ed. most likely not pna in setting of clear admission cxr. pe also considered but pt has low criteria. patient was diuresed with iv lasix, and pulmonary edema resolved. he was extubated on and remained on lasix drip and supplemental o2 initially, both of which were eventually weaned, as his respiratory status improved. . # ecg changes: ecg changes and elevated troponin were likely secondary to demand ischemia in the setting of respiratory distress. pt does have baseline st elevatations in inferiors leads secondary to old infart. on admission, diffuse st depressions in lateral leads more consistent with demand ischemia. pt was a poor candidate for stent with inability to take plavix due to known mutation preventing metabolization and with inability to take prasugrel due to previous stroke. echo showed mild symmetric left ventricular hypertrophy with regional systolic function c/w cad (proximal rca distribution). right venticular free wall hypokinesis. mild-moderate mitral regurgitation with probable papillary muscle dysfunction. compared with the prior study from , the left ventricular dysfunction is more extensive, right ventricular dysfunction and mitral regurgitation are new c/w interim ischemia/infarction. cardiac catheterization showed 3-vessel disease with no lesions amenable to revascularization. he was treated medically. he was initially placed on heparin drip, but this was stopped on when cardiac enzymes were trending down. he was initially put on ticagrelor, aspirin, and initally labetolol and later metoprolol. given history of large hemorrhagic stroke on dual antiplatelets, ticagrelor was discontinued. he was d/c on aspirin 325mg daily. . # intraabdominal abscess: pt previously (on past admission) had peg but removed it when delirious and had secondary sepsis and abd infection requiring gastrectomy. on this admission, he continued to have abdominal pain, and on , gi was consulted. repeat ct showed two fluid collections in the anterior abdomen adjacent to the stomach and a left subphrenic abscess. the subphrenic abscess was drained by ir with ct-guided drainage of 20cc of pus. the anterior abdominal collection which was thought to be a hematoma had resolved by the time of the drainage. the abscess drainage was sent for culture and will be followed up upon discharge. we will d/c with zosyn to complete a 14 day course. if the culture shows bacteria not optimally treated with zosyn we will call rehab and recommend changing antibiotics. patient to be seen by id as an outpatient. . # unsteady gait: per wife, patient has had increasing weakness and gait instability worse than baseline over the last several days. on exam, pt's pupils are not symmetric, which, according to the report of the patient and his wife, has been present since his stroke 14 months ago. the weakness and gait instability were consistent with the patient's deficits following his stroke. these improved udirng his hospital stay. he likely had unmasking of prior deficts in the setting of systemic illness that resolved with the resolution of the systemic illness. . # dm ii: patient well controlled on metformin at home with recent a1c of 6.3. home meds held during admission in favor of iss. . # ckd: baseline cr around 1 with microalbuminuria in past, most likely secondary to dmii. hi creatinine bumped to 1.4 2 days after his cardiac catheterization. we avoided nephrotoxins. on discharge, his creatinine was 1.3. . #htn: treated with losartan and amlodipine at home. we initially held antihypertensives as pt was normotensive and sedated with concern for underlying infection. once stabilized, losartan was re-initiated. amlodipine 10mg daily. in addition, he was d/c with carvedilol 25mg po bid and furosemide 60mg daily. . #hld: we continued home atorvastatin. . ## transitional issues: - asymmetric bladder wall thickening. consider outpatient urine cytology and consider cystoscopy - left adrenal nodule: there is a 2.1 x 2.4 cm heterogeneously enhancing nodule within the left adrenal gland with indeterminate attenuation characteristics (:60). the nodule has increased in size since the prior examination when it measured 1.7 x 1.8 cm. though this nodule was previously characterized as an adenoma, the increasing size and heterogenous enhancement pattern are concerning. further evaluation with mr of the abdomen is recommended for further characterization (2:17). . - code: full code - emergency contact: wife medications on admission: 1. losartan potassium 100 mg po daily 2. labetalol 200 mg po bid 3. fish oil (omega 3) 1000 mg po daily 4. metformin xr (glucophage xr) 500 mg po daily do not crush 5. fluticasone propionate nasal 2 spry nu daily 6. amlodipine 10 mg po daily 7. atorvastatin 80 mg po daily 8. furosemide 40 mg po daily 9. sildenafil *nf* 100 mg oral prn ed 10. omeprazole 20 mg po daily 11. potassium chloride 10 meq po tid duration: 24 hours hold for k > 12. aspirin 325 mg po daily 13. cetirizine *nf* 10 mg oral daily 14. citalopram 20 mg po daily 15. trazodone 50 mg po hs:prn insomnia 16. ascorbic acid 500 mg po bid discharge medications: 1. amlodipine 10 mg po daily 2. aspirin 81 mg po daily 3. fluticasone propionate nasal 1 spry nu daily 4. furosemide 60 mg po daily 5. losartan potassium 100 mg po daily 6. trazodone 100 mg po hs insomnia 7. acetaminophen 325-650 mg po/pr q6h:prn fever 8. carvedilol 25 mg po bid hold for sbp < 100, hr < 60 9. oxycodone (immediate release) 5-10 mg po q4h:prn pain 10. polyethylene glycol 17 g po bid hold for loose stools 11. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 12. cetirizine *nf* 10 mg oral daily 13. citalopram 20 mg po daily 14. fish oil (omega 3) 1000 mg po daily 15. metformin xr (glucophage xr) 500 mg po daily do not crush 16. omeprazole 20 mg po daily discharge disposition: extended care facility: rehabilitation center - discharge diagnosis: primary - intra peritoneal phlegmon/abscess - non st elevation myocardial infarction - diabetes type 2 - hemorrhagic stroke history discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mr. , thank you for chosing . you were admitted for abdominal pain and a fever. you had difficlty breathing which required intubation and support from a breathing machine. you also had decreased blood flow to your heart resulting in a mild heart attack. imaging of your abdomen showed a fluid collection which is the likely cause of your abdominal pain and fever. you were given antibiotics and the radiology doctors performed a procedure that drained the fluid collection. the fluid is being tested to determine the type of bacteria present and this will help us determine what antibiotics you need to continue. . it is very important that your weigh yourself every day at home in the morning before breakfast and call dr. if your weight increases more than 3 pounds in 1 day or 5 pounds in 3 days. you may need to go up on your furosemide if this is the case. followup instructions: needs id and cv follow up. . department: suite b when: thursday at 4:30 pm with: , , dpm g: (, ma) campus: off campus best parking: free parking on site department: neurology when: tuesday at 3:00 pm with: , m.d. building: campus: east best parking: garage department: neurology when: tuesday at 2:30 pm with: , m.d. building: campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of endotracheal tube percutaneous abdominal drainage central venous catheter placement with guidance diagnoses: obstructive sleep apnea (adult)(pediatric) subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery other postoperative infection congestive heart failure, unspecified coronary atherosclerosis of autologous vein bypass graft hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other chronic pulmonary heart diseases peripheral vascular disease, unspecified abnormality of gait other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) acute respiratory failure other late effects of cerebrovascular disease other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation acute on chronic systolic heart failure knee joint replacement peritoneal abscess diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled acute edema of lung, unspecified other acute and subacute forms of ischemic heart disease, other 

Answer: The patient is high likely exposed to