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: penicillins attending: chief complaint: hypoglycemia, change in mental status major surgical or invasive procedure: none history of present illness: mr. is a 71 year old morbidly obese male with a pmh of multiple cardiovascular risk factors including htn, hl, dm2 on insulin, ongoing cocaine use, with known s/p stents to lad and rca, prior stroke with residual right sided weakness, and multiple pulmonary co-morbidities including copd, osa, chronic diastolic and systolic chf (ef 50%), and pulmonary hypertension who was found down in apartment today by family. on ems arrival, his blood sugar and it was 61. no iv access able to be obtained in the field, so he got 2mg of im glucagon en route. also reportedly had some respiratory distress so got nebulizers as well. in the ed, initial vs were: 97.3 70 121/73 26 90%ra. on exam, he was agitated and in extremis, then very lethargic, but quickly improved with bipap, much more communicative. no abg was obtained. fingerstick was notable for hypoglycemia to 64. he was given 1 amp d50, on re-check was fsg 67, so received 2nd amp. mental status improved with these interventions. labs showed wbc count of 4.9, normal creatinine 1.0, ck 86, tn 0.02. u/a was dirty. urine tox positive for cocaine. ekg showed nsr with 1st degree block with prolonged , twi in i,avl, and precordial leads, all stable from prior tracings. ct head was not performed due to rapid improvement in mental status with the other interventions. cxr showed possible vascular congestion, no focal consolidation. blood and urine cultures were sent, and he was given 20mg lasix for congested cxr, and 750mg levofloxacin "for uti", and was admitted to the icu given ongoing use of bipap. access is 2 pivs, 20g and 18g. on arrival to the floor, he is not on bipap but rather on o2 via nasal cannula. the patient's fsg is 46, but he is alert and oriented x3, appropriate. the patient is somewhat unclear on what happened but he does report poor po intake for 1 week with some diarrhea last week. he has been using his long acting insulin consistently. no fevers or chills, but he endorses a cough for the last month and some dysuria and occasional hematuria. he denies chest pain but states that he is short of breath with minimal exertion, which is his baseline. he notes le edema "on and off." has been using his baseline 2 pillows. no dietary indiscretions or medication nonadherence. he admits to cocaine use at a party over the weekend. of note the patient was admitted in for ams and hypoglycemia. he has also had multiple er visits for hypoglycemia, usually improved with juice and crackers. he had a similar admission for lethargy and ams that was improved after hypoglycemia resolved. past medical history: # pcis: s/p cath in with 2 vessel dz. - lad proximal stenosis involving the origin of d1 (50%). - rca was diffusely diseased with a mid 70% stenosis after am and 80% stenosis, s/p 2 cypher stents overlapping in the rca. stent to plad, to rca # mitral regurgitation # chf: ef 45-50%, diastolic and systolic failure # severe hypertension # pulmonary hypertension # +ppd (15mm) cxr negative # impotence # narcotics contract: for pain from hip fracture # hip fracture # back pain: several mris in the past. # htn # dmii: followed at # copd # osa # pud # gastric mass- noted # gerd- h. pylori +, s/p four drug tx. # glaucoma # prostate disease # elevated d-dimer: (received 5 ctas over 2-3 years) social history: he has blister packs that are prepared by . he gets around on a scooter. lives alone in senior housing in a handicapped apartment. wife passed away . retired and chef at and previously in the navy. has 9 children (5 sons, 4 daughters),who help him out with his finances and groceries as well as vna services. - tobacco: 80 pack year smoking history, still about 1ppd. - alcohol: a beer or less a day - illicits:history of cocaine abuse, last positive u/a for cocaine was 12/. patient admits cocaine use this past weekend. family history: father - in his 50s mother died last at years old physical exam: admission physical exam vitals: t: 95.0 bp: 121/98 p:61 r: o2: 97% on 4l general: morbidly obese, alert, oriented, no acute distress heent: anicteric, corneal clouding, pupils pinpoint, unable to visualize op due to habitus neck: obese, jvp unable to determine lungs: upper airway congestive sounds clear to auscultation bilaterally, no wheezes, rales, ronchi cv: distant hs, rrr, normal s1 + s2, no m/r/g abdomen: obese, soft, non-tender, non-distended, bs present, no rebound tenderness or guarding ext: warm, well perfused, 2+ pulses, 1+ edema neuro: a+o x 3, non focal exam pertinent results: admission labs 03:21am blood wbc-5.4 rbc-4.32* hgb-13.4* hct-41.1 mcv-95 mch-31.0 mchc-32.7 rdw-14.4 plt ct-284 03:21am blood glucose-219* urean-15 creat-1.2 na-138 k-3.9 cl-99 hco3-35* angap-8 04:30pm blood ck(cpk)-63 03:21am blood calcium-8.5 phos-3.1 mg-1.9 labs at discharge 05:15am blood wbc-4.3 rbc-4.47* hgb-13.4* hct-42.3 mcv-95 mch-30.0 mchc-31.6 rdw-14.2 plt ct-316 05:58am blood glucose-179* urean-13 creat-1.0 na-139 k-4.1 cl-98 hco3-35* angap-10 05:15am blood calcium-8.6 phos-2.9 mg-2.0 10:25am urine blood-mod nitrite-neg protein-500 glucose-neg ketone-tr bilirub-neg urobiln-4* ph-7.0 leuks-sm 10:25am urine rbc-* wbc-21-50* bacteri-few yeast-none epi-0-2 blood culture pending 10:25 am urine site: catheter **final report ** urine culture (final ): gram negative rod(s). ~7000/ml. staphylococcus species. ~1000/ml. ct head findings: there is no evidence of acute hemorrhage, edema, mass effect, or major vascular territory infarction. the -white matter differentiation is preserved. confluent areas of bilateral hypodensity in the subcortical and periventricular white matter likely represents sequelae of small vessel ischemic disease. prominence of the ventricles and sulci represents a mild degree of generalized atrophy. there are calcifications of the bilateral carotid siphons. as compared to the prior examination, fluid within the left maxillary sinus appears new. there is mild ethmoid air cell mucosal thickening. no concerning osseous lesion is seen. impression: 1. no acute intracranial process. 2. mucosal thickening in the ethmoid air cells and fluid within the left maxillary sinus could represent acute sinusitis. cxr portable upright chest radiograph: the study is limited by respiratory motion and patient's inability to lift his head for the radiograph, thus obscuring the lung apices and the thoracic inlet. the cardiac silhouette is moderately enlarged, unchanged. the thoracic aortic contour remains tortuous. no overt pulmonary edema is seen. ill-defined airspace opacity in the right lung base was present previously. no definite large pneumothorax or pleural effusion seen. no displaced fracture noted. gas is seen within a relatively distended stomach. impressions: little change since with ill-defined opacity in the right lung base, which could represent infection, aspiration, or atelectasis. brief hospital course: 71 year old male with h/o dm2 on insulin and multiple presentations for hypoglycemia and ams, also with , osa, copd, found down in his house with hypoglycemia and altered mental status, +coccaine, initially admitted to icu. he was easily weaned to 4l then 2l there without ams. he was initially refractory to d5 boluses so he was started on a d10 gtt which was stopped early in the morning on once fs normalized to 100-150s. . # altered mental status: was most likely due to hypoglycemia. illicit drug (cocaine) use likely contributed as well. however, the differential also included co2 retention/narcosis from his morbid obesity and osa. his uti may have contributed as well. no reason to suspect cns infection (no wbc count, no fever, no meningismus, rapid improvement), and no trauma or anticoagulation to prompt initial head ct. improved rapidly and resolved with treatment of hypoglycemia and uti. as patient was still not completely oriented to date while on the floor, and the nursing staff was concerned about his mental status, a ct head was done which did not show an acute process. # hypoglycemia: likely due to poor po intake in the setting of continued doses of insulin, and cocaine use (prolonged use of sympathomimetics can result in hypoglycemia). started on d10 drip until stable and > 200. tolerated oral intake without difficulty. was monitored closely on q1h fingersticks until improved and then transitioned to qachs. was consulted and recommended changes to his insulin therapy. strict dosing and prevention of errors was stressed with the patient and he was scheduled with nursing to assist. # uti - u/a appeared infected in ed. no prior positive cultures to guide therapy. started on ciproflocaxin 7 day course, 1st day . # cocaine use: initially held beta blocker setting of continued cocaine use. social work was consulted. # chronic systolic and diastolic chf: given 20mg iv lasix in ed for volume overload seen on cxr. initially held beta blocker setting of continued cocaine use. once improved, was restarted on home lisinopril and beta-blocker. continued home lasix and low na diet. # hyperkalemia - 5.3 in ed, but on a hemolyzed sample. ekg without peaked t waves. resolved on repeat check. . # copd: followed by dr. . did not appear acutely exacerbated. continued home advair and spiriva as well as 2l of oxygen. # : in comparison to previous ekgs, twi were not different/new. could be more prominent in setting of hypoglycemia and recent cocaine use. also prolonged, likely in setting of cocaine use. on previous admissions, gradually normalized to 430s. continued plavix and aspirin while holding beta blocker. cardiac enzymes without acute rise. # s/p mca cva: per pcp notes, has residual right sided weakness, primarily in his leg and with writing, but this was not appreciated on exam. continue asa and plavix. # osa: not on home cpap. continued on cpap prn. # back/hip pain: on percocet at home. # htn: resumed medications in step-wise fashion after clinical improvement. # glaucoma: continued latanoprost. # gerd: continued omeprazole (of note, on plavix, omeprazole interaction). # communication: daughter , er # code: full (discussed with patient in icu) medications on admission: amlodipine 5 mg daily atorvastatin 80 mg tablet daily carvedilol 25 mg tablet twice a day clopidogrel 75 mg tablet once a day fluticasone-salmeterol 500 mcg-50 mcg 1 inhaled puff twice a day furosemide - 80 mg tablet - one tablet(s) by mouth once a day insulin glargine - 100 unit/ml solution - 45 units per day as per the once a day insulin lispro - 100 unit/ml solution - use as directed before meals four times a day per sliding scale ipratropium-albuterol 18 mcg-103 mcg (90 mcg)/actuation aerosol - 2 puffs inhaled four times a day as needed for shortness of breath latanoprost - dosage uncertain lisinopril - 40 mg tablet - 1 tablet(s) by mouth daily nitroglycerin - 0.4 mg tablet, sublingual - 1 tablet(s) under tongue every 5 min as needed for chest pain up to 3 tablets omeprazole - 20 mg once a day oxycodone-acetaminophen - 5 mg-325 mg tablet - 1 tablet(s) by mouth three times a day as needed for pain polyethylene glycol 3350 - 17 gram (100 %) powder in packet - 1 powder(s) by mouth once a day as needed for constipation tiotropium 18 mcg capsule 1 capsule inhaled once a day aspirin, buffered - 325 mg tablet - 1 tablet(s) by mouth daily docusate sodium - 100 mg capsule - 1 capsule(s) by mouth senna - 8.6 mg tablet - 1 tablet(s) by mouth twice a day ferrous sulfate - 325 mg (65 mg iron) tablet - 1 tablet(s)daily. discharge medications: 1. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. carvedilol 25 mg tablet sig: one (1) tablet po twice a day. 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. furosemide 40 mg tablet sig: two (2) tablet po daily (daily). 7. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: two (2) puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. 8. latanoprost ophthalmic 9. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 11. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet sublingual q5min as needed for chest pain: up to 3 tablets. call your doctor if your use this medication. 12. percocet 5-325 mg tablet sig: one (1) tablet po three times a day as needed for pain. 13. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 14. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 15. aspirin, buffered 325 mg tablet sig: one (1) tablet po daily (daily). 16. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 17. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 18. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 19. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 doses: continue through . disp:*7 tablet(s)* refills:*0* 20. insulin please see attached sliding scale and insulin schedule discharge disposition: home with service facility: vna discharge diagnosis: primary: -hypoglycemia -cocaine use secondary: -dm discharge condition: alert and oriented x 3 ambulating with assistance discharge instructions: you were admitted to because of confusion. this was caused by low blood sugars. your low blood sugars were caused by using cocaine and taking too much insulin. while you were here, you had to stay in the intensive case unit. your insulin regimen was changed. you were also treated for a urine infection. while you were here some of your medications were changed: - start cipro until you finish the pills on the prescription for infection. - change your insulin scale to the one attached. take all of your other previous medications as prescribed by your doctor. please be sure to be careful when following your new insulin regimen and make sure your follow-up with your doctors as listed below. weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: department: when: friday at 8:00 am with: , m.d. building: sc clinical ctr campus: east best parking: garage name: , nurse educator when: ,, 10am location: diabetes center address: one place, , phone: name: , when: wednesday, , 1:30pm location: diabetes center address: one place, , phone: procedure: venous catheterization, not elsewhere classified non-invasive mechanical ventilation diagnoses: hyperpotassemia obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery esophageal reflux mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified other chronic pulmonary heart diseases unspecified glaucoma percutaneous transluminal coronary angioplasty status cocaine abuse, unspecified other and unspecified hyperlipidemia long-term (current) use of insulin other late effects of cerebrovascular disease morbid obesity pain in joint, pelvic region and thigh backache, unspecified diabetes with other specified manifestations, type ii or unspecified type, uncontrolled peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms impotence of organic origin abdominal or pelvic swelling, mass, or lump, unspecified site chronic combined systolic and diastolic heart failure muscle weakness (generalized) 

Answer: The patient is high likely exposed to