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: benzodiazepines / terazosin hcl / iodine attending: chief complaint: chf exacerbation and respiratory failure requiring intubation. major surgical or invasive procedure: endotracheal intubation with mechanical ventilation picc placement, removal right subclavian line hemodialysis bronchoscopy history of present illness: the patient is a 79 year old polish speaking man with a history of diastolic chf (ef 65% in ), atrial fibrillation (refusing anticoagulation), htn, dm, cri who presented with pitting edema and shortness of breath on . per nursing home notes, patient's weight had increased 15 pounds from his baseline (dry weight 265). prior to early , patient's urine output was approximately 3-4 liters per day, but had dropped to less than one liter per day, despite lasix dose of 60mg not changing. . in the ed, diuresis was tried with 120mg iv lasix and 250mg diuril. a copd flare was suspected and iv solumedrol 80mg and azithromycin 500mg was started. levofloxacin 250 mg iv was added for a positive ua. as the patient's abg was 7.25/70/242, bipap was started and the patient was transferred to the micu. past medical history: -atrial fibrillation: not on anticoagulation because of lack of adherence -coronary artery disease: refused catheterization -chf (diastolic dysfunction with last ef 65% on echo , dry wt 125kg) -cri (baseline cr 2.7) -bph -htn -dm (diet controlled) -osa - pulmonary htn, requiring supplemental night oxygen and bipap before intubation -anemia (baseline hematocrit 23-27) social history: married, lives with daugther. wife lives at . polish speaking but understands some english. per pt's daughter (who is researcher at ) no tobacco, alcohol or other drugs; stopped smoking 40yrs ago (smoked a lot while being captain on a ship) at rehab 2 months prior to admission. prior captain on a ship. currently lives in . family history: no family history of seizures or strokes. mother died from complications of renal failure. physical exam: in micu: temp 96.3, bp 102/54; rr 21; o2 93% on 5lnc (off bipap) gen: increased work of breathing using abdominal accessory muscles on exhalation, responds to commands and moves all 4 extremities. heent: perrla, ncat, mm dry neck: very full, unable to assess jvp, moves neck freely cor: irreg irreg, s1s2, no r/g/m pulm: bilateral wheezes, tight sounding throughout lung fields, no crackles abd; obese, +abd muscle use with each expiration, unable to assess hsm, nt, decreased bs skin: venous stasis changes in ble, no rashes ext: bilateal le pitting 2+ edema up calves, w/w/p, weakly +dp pulses bilaterally . on transfer to medicine floor: t:98.6 bp:100/70 hr:80 rr:24 o2saturation:99% on 4l gen: obese man laying in bed. appears older than stated age. not responsive to voice or sternal rub, but responded only to deep suctioning. heent: no conjunctival pallor. no icterus. slightly dry mucous membranes. ngt in place. neck: supple. could not appreciate any cervical or supraclavicular lymphadenopathy. cv: irregularly irregular rate and rhythm. normal s1 and s2. no murmurs, rubs or appreciated. lungs: on anterior chest examination, decreased breath sounds in lower lung fields, bilaterally. abd: hypoactive bowel sounds in all four quadrants. soft. distended. ext: warm and well perfused. no clubbing. no lower extremity edema, bilaterally. 2+ dorsalis pedis and radial pulses, bilaterally. neuro: somnolent. could not perform detailed neurological examination. pertinent results: admission labs: 11:07pm type-art po2-242* pco2-70* ph-7.25* total co2-32* base xs-1 intubated-not intuba 11:07pm k+-5.6* 11:07pm freeca-1.04* 09:20pm urine color-straw appear-clear sp -1.011 09:20pm urine blood-lg nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 09:20pm urine rbc-21-50* wbc-* bacteria-few yeast-none epi-0-2 09:20pm urine hyaline-0-2 06:07pm glucose-142* urea n-114* creat-4.7*# sodium-135 potassium-5.9* chloride-99 total co2-28 anion gap-14 06:07pm ck(cpk)-15* 06:07pm ck-mb-notdone ctropnt-0.03* probnp-* 06:07pm calcium-7.6* phosphate-7.3*# magnesium-3.1* 06:07pm wbc-6.5 rbc-2.27* hgb-8.0* hct-24.5* mcv-108*# mch-35.2* mchc-32.7 rdw-18.7* 06:07pm neuts-77.1* lymphs-10.4* monos-10.4 eos-1.8 basos-0.2 06:07pm hypochrom-3+ anisocyt-2+ macrocyt-3+ 06:07pm plt count-158 . . microbiology: bronchalveolar (): citrobacter urine cx (): enterococcus, sensitive to ampicillin urine cx (): negative tests for mrsa(, ) and vre (): negative test for vre (): enterococcus, but sensitive to vancomycin and ampicillin blood cx (, ): negative catheter tip (): pending . hematocrit: remained in the 20's. initially 24, increased to 29. reticulocyte count: 2.2 on . wbc: 6.5 on admission, increased to 14.8 on , and 11.4 on transfer. creatinine: 4.7 on , and increased to 5.0. following temporary dialysis, 2.3. urea ranged between 114-->154-->117. na: elevated to 151 on , but trending down to 144 on . troponin: 0.06 on . bnp: on . blood gases: on .25/242/70. hypercarbic to 89, requiring intubation between . on transfer on .36/119/54. . studies: chest xray(): very limited radiograph, small bilateral pleural effusions and mild pulmonary edema cannot be excluded. pa and lateral radiographs with improved suspension of respiration is recommended, if feasible. . chest xray(): there has been interval placement of a right ij cvl with the tip extending to the cavoatrial junction. cardiomegaly is stable. perihilar interstitial opacities have improved in the interval, compatible with improving pulmonary edema. there are likely bilateral pleural effusions, although the study of limited secondary to patient's body habitus. . chest xray(): 1. standard et tube placement. 2. cardiomegaly with no evidence of congestive heart failure on the current chest radiograph. bilateral atelectasis right more than left, right pleural effusion. . chest xray(): 1. persistent failure and bilateral pleural effusions. 2. tip of the nasogastric tube not visualized, but below the level of the diaphragm. . picc placement (): successful placement of a 40-cm 4 french single lumen picc via the right brachial vein. the tip is in the central superior vena cava. the line is ready for use. . brain mri (): no evidence of acute infarct. moderate brain and medial temporal atrophy. moderate small vessel disease. . temporary catheter placement(): uncomplicated ultrasound and fluoroscopically guided temporary dialysis catheter placement via the right internal jugular venous approach with the tip in the right atrium. . chest xray : impression: improvement in the appearance of the previously described cardiac failure and bilateral pleural effusions. . abdominal ct: 1. malpositioned foley catheter; the balloon is inflated within the penile urethra. 2. moderate left hydroureteronephrosis to the level of the left ureteovesicular junction without a clear obstructing lesion. no stones are identified within the ureter or bladder. 3. no evidence for diverticulosis or diverticulitis. . echo: conclusions: 1.the left atrium is moderately dilated. the left atrium is elongated. the right atrium is markedly dilated. 2.there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef>75%). 3. right ventricular chamber size is normal. right ventricular systolic function is normal. 4.the ascending aorta is mildly dilated. the aortic arch is mildly dilated. 5.the aortic valve is not well seen. no aortic regurgitation is seen. 6.the mitral valve leaflets are moderately thickened. 7.there is no pericardial effusion. . labs on discharge: wbc: 5.3 hct: 27.6 plt: 265 na: 138 k: 4.2 bun: 32 cr: 2.7 ca: 8.1 mg: 2.2 p: 4.1 brief hospital course: mr. is a 79 year old man with a history of diastolic chf, atrial fibrillation, htn, dm, cri who presented with chf exacerbation requiring intubation and subsequently developed citrobacter pna. after extubation, he was unresponsive to voice and sternal rub. on he began responding to questions and following commands. he remained alert, conversant, breathing comfortably on ra. . #) respiratory failure: on admission, the patient's abg was 7.25/70/242, bipap was started and the patient was admitted to the micu. concern for aspiration was noted on , so an ngt was placed on . unasyn was started on for presumed right lower lobe pneumonia. patient was bronched on and large secretions were noted in the right and left lower lobes. with worsening hypercarbia, patient was intubated on . respiratory failure was felt to be secondary to chf. meropenem and vancomycin were added for broader antibiotic coverage. on , citrobacter, sensitive to meropenem, was isolated. patient was extubated on , requiring 4l supplemental oxygen. he had initially been given methylprednisolone 40mg iv q8 for question of a copd flare. he was switched to po prednisone and tapered over the course of his admission. he was slowly weaned down to room air and maintained oxygen saturations of 94-100%. on the patient was transferred to the floor. the patient received tube feedings without incident. his ng tube was d/c'd on and could not be replaced after 4 attempts. speech and swallow evaluated the patient on and felt he would be able to tolerate medications and ice chips. they were reconsulted on as the patient's mental status was improving. he completed a 14 day course of meropenem as above on . he continued to saturate well on ra, requiring 2l nc at night. cpap was attempted, however the patient refused and repeatedly removed his mask. he was given nebulizers as needed for wheezing. his lung exam at discharge was clear to auscultation bilaterally. . #) renal failure: mr. creatinine at baseline is approximately 2.6. on admission the patient's creatinine was 4.7 and peaked at 5.0. the acute renal failure was likely due to decreased intravascular repletion in setting of chf. his woresning renal function led to increased fluid retention which caused worsened cardiac congestion. he was placed on temporary dialysis for several days. dialysis was initiated on and discontinued on due to hypotension and tachycardia. on transfer to the floor, he was able to generate sufficient urine output with lasix. on the patient triggered for hypotension and his lasix was held. his foley was removed on , with resultant good urine output. ins and outs were difficult to obtain secondary to his incontinence and a foley catheter was eventually replaced. his creatinine remained approximately at his baseline. a small dose of lasix 20mg po was restarted on . his medications were dosed appropriately for his creatinine clearance. . #) chf: patient's original chf flare exacerbated by acute renal failure, causing increased fluid retention. he was treated with lasix gtt and nesiritide and even required hemodialysis for management of his volume status. the diuresis was effective and the patient was eventually extubated and was able to be weaned off of oxygen satting well on room air. his lower extremity edema resolved. his dry weight was known to be 265 lbs. on his weight was repeated and he was at approximately his dry weight. his beta blocker was continued and once his bp stabilized it was titrated up to his outpatient dose. while he was on lower doses of beta blocker he was noted to have breakthrough tachycardia at night, heart rates to the 140s at night. he remained asymptomatic during these episodes and his heart rate quickly returned to . however, once his beta blocker was titrated back to outpatient dose, these episodes did not recur. . #) left hydronephrosis: on the patient was noted to be hypotensive and complaining of abdominal pain. an abdominal ct was done which revealed a malpositioned foley catheter with the balloon inflated within the prostatic urethra and moderate left hydroureteronephrosis to the level of the left ureteovesicular junction without a clear obstructing lesion. the foley catheter was repositioned with good urine return and he was given a three day course of ciprofloxacin. he was seen by urology who recommended a catheter for 1-2 weeks until performance status improves, renal imaging in months to document resolution of the hydronephrosis and follow up with dr. . . #) episodes of hypotension: he triggered for hypotension on pm. labs and cxr were normal, other vital signs were stable. ekg w/ some deepened st depressions in i, avl, v5,v6 and flattened t waves in v3, v4. he was noted to be in afib and was put back on telemetry and his cardiac enzymes were cycled and did not change from his baseline mild elevation. he was already on asa, bblocker. it was felt that this may be related to finally getting up after long hospitalization (pivoted w/ pt 1 hr prior to event), but given his history, 24-36 hrs of "gas pain", and tenderness on abd exam, looked for infectious etiology. blood cultures and urine cultures remained negative. abdominal ct with hydronephrosis and traumatic foley placement as above. . #) mental status: on , in anticipation of extubation, patient's sedatives were weaned. at that time the patient was noted to have altered mental status, left-sided weakness. on transfer to the floor he was only responsive to deep suctioning. an mri was done on which did not reveal any evidence of acute infarct. the neurology team was consulted and felt that his mental status changes were likely toxic metabolic superimposed on an atrophic/ susceptible brain. initially it was felt that the changes were related to medication as he received ativan on for mri scan, and benzodiazepines are known to cause confusion in this patient. however, as his mental status did not resolve for several days the etiology was felt more likely to be increased uremia (renal failure versus steroid) vs. hypernatremia. he was started on d5w to help decrease sodium level. on he began responding to yes/no questions and following commands. his mental status continued to improve with improving renal function and improvement of his hypernatremia. on the day of discharge the patient was speaking both english and polish, was oriented x 3 and was able to express his desire to go home. at that time his na was within normal limits and his kidney function had improved. . #) cad: patient has refused cardiac catheterization in past. he had a hypotensive episode in the micu requiring phenylephrine and had an additional episode of hypotension (sbp 89) while on the floor. troponins measured on and were negative (0.05-0.06). he was maintained on his aspirin and beta blocker as above. he was not given an ace-inhibitor due to his renal function. this can be addressed as an outpatient. his lipid panel was checked on . there was no evidence of hypercholesterolemia, so statin not needed. the panel was repeated on and were notable for elevated triglycerides. no new medication was instituted at this admission, however follow up testing is recommended. . #) anemia: patient's hematocrit has remained stable during admission, although he required two units of packed red blood cells on . macrocytic anemia most likely due to patient's chronic kidney disease or due to bone marrow stimulation from epogen. he was continued on ferrous sulfate and epogen 8000 qm,w,f. . #) bph: the patient's foley was removed on . he was initially restarted on flomax and finasteride was added the following day. however, the foley was replaced on after he began complaining of abdominal pain and a bladder scan revealed >400cc urine in the bladder. in addition he had episodes of hypotension and as he had a foley catheter in place, flomax was discontinued for the possible effects it would have on his blood pressure. . #) diabetes: he was maintained on an insulin sliding scale for the majority of his hospitalization. during his stay in the icu, required insulin gtt for four days. on , patient weaned from insulin gtt and started on sliding scale insulin. his blood sugars remained moderately well controlled with dietary modifications. . #) uti: on admission, patient noted to have a uti. started on a 7 day course of ampicillin for pansensitive enterococcus. subsequent antibiotic modifications for presumed pneumonia provided effective coverage. . #) fen: mr. was initially given tube feedings which were continued until his ng tube was removed on . after a failed attempt at replacement, he did not receive nutrition for 3 days. speech and swallow evaluated the patient multiple times during this admission. he was initially restarted on po meds and ice chips, however as his mental status improved he was advanced to pureed foods and prethickened liquids. on he was delivered the incorrect meal tray and ate a without difficulty. he will need to be reevaluated by speech and swallow in the near future as he likely can eat solid foods. . #) prophylaxis: as patient was not ambulating, he was maintained on subq heparin and scd boots. he was placed on a ppi and given a bowel regimen. was called and it was determined that mr. has received neither his flu shot nor his pneumovax vaccinations. he will be given these prior to discharge. medications on admission: haloperidol 2.5 mg iv hs:prn anxiety heparin 5000 unit sc tid acetaminophen (liquid) 650 mg po q4-6h:prn hydralazine hcl 25 mg po q6h albuterol 6 puff ih q4h insulin sc (per insulin flowsheet) aspirin 325 mg po daily ipratropium bromide mdi 6 puff ih q4h bisacodyl 10 mg pr hs:prn lactulose 30 ml po q8h:prn calcium acetate mg po tid w/meals meropenem 500 mg iv q24h docusate sodium (liquid) 100 mg po bid epoetin alfa 8000 unit sc qmowefr methylprednisolone sodium succ 40 mg iv q8h ferrous sulfate 325 mg po daily metoprolol 25 mg po bid hold for sbp < 100, hr < 55 finasteride 5 mg po daily pantoprazole 40 mg iv q24h fluticasone propionate 110mcg 2 puff ih fluoxetine hcl 20 mg po daily tamsulosin hcl 0.4 mg po hs discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. epoetin alfa 4,000 unit/ml solution sig: one (1) inj injection qmowefr (monday -wednesday-friday). 3. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 4. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed. 5. docusate sodium 150 mg/15 ml liquid sig: fifteen (15) ml po bid (2 times a day). 6. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 7. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 8. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 9. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 11. pantoprazole 40 mg iv q24h 12. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 13. albuterol sulfate 0.083 % solution sig: one (1) neb ih inhalation q4h (every 4 hours) as needed. 14. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 15. simethicone 80 mg tablet, chewable sig: 0.5-1 tablet, chewable po qid (4 times a day) as needed for gas. 16. acetaminophen 325 mg tablet sig: two (2) tablet po q4-6h (every 4 to 6 hours) as needed for pain. 17. ipratropium bromide 0.02 % solution sig: one (1) neb ih inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 18. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 19. insulin sliding scale 20. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). discharge disposition: extended care facility: house discharge diagnosis: chf, diastolic (ef 75% on echo respiratory failure chronic renal insufficiency atrial fibrillation citrobacter pneumonia bph hypertension diabetes mellitus, type 2, diet controlled obstructive sleep apnea anemia left hydronephrosis, traumatic foley toxic metabolic encephalopathy coronary artery disease discharge condition: stable. the patient remains hemodynamically stable. discharge instructions: you were admitted for congestive heart failure. you had fluid in your lungs which made it difficult for you to breathe. you needed to be mechanically ventilated during this time. the fluid was removed from your lungs by putting you on hemodialysis and through different medications. you are now able to breathe on your own. you were also treated for a pneumonia which you developed while in the hospital. as you have heart failure, you should weigh yourself every morning, and call your doctor if weight > 3 lbs from baseline. you should also adhere to a 2 gm sodium diet it is important that you continue to take all of your medications as prescribed. if you begin to experience any chest pain, difficulty breathing, dizziness, lightheadedness, abdominal pain or any other concerning symptoms please call 911 or your doctor immediately. followup instructions: you have the following appointments: 1. dr. , , on thursday at 230. building, . 2. , : at on 850. you will need additional renal imaging, a renal ultrasound, in months. you will need a cxr in days of discharge to rule out silent aspiration as your diet was advanced on . procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis non-invasive mechanical ventilation closed [endoscopic] biopsy of bronchus transfusion of packed cells injection or infusion of nesiritide infusion of vasopressor agent diagnoses: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery pneumonia due to other gram-negative bacteria acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified toxic encephalopathy diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation other chronic pulmonary heart diseases chronic kidney disease, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure acute diastolic heart failure hyperosmolality and/or hypernatremia hydronephrosis hypotension of hemodialysis mechanical complication due to urethral (indwelling) catheter 

Answer: The patient is high likely exposed to