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: altered mental status major surgical or invasive procedure: 1. intubated on & extubated 2. : ipsilateral first order catheter placement, unilateral extremity angiogram, abdominal angiogram. 3. : 1. right below knee popliteal. 2. posterior tibial artery bypass with reverse saphenous vein graft. 3. intraoperative angioscopy and valve lysis. history of present illness: mr. is a 65 yo m with a h/o uncontrolled dmii, esrd on pd, cad, chf w/ an ef of 25% and waldenstrom's macroglobulinemia who presents with altered mental status x 1 day. patient was discharged tuesday night following admission for sbp and foot infection; family states that he was slightly confused at time of discharge. wife states that he was disoriented and unable to eat or drink during the day on wednesday. per family, he was unable to perform pd as usual. wife states that he was requiring constant supervision and that she was afraid he would fall. she called daughter who states that he was somnolent, unable to complete a sentence, and unable to stand. wife denies any fevers or rigors at home. daughter reports that he has been increasingly somnolent with incoherent thoughts since last week. . in ed, hr 74, bp 101/65, rr 21, spo2 100% on nrb. a cxr and ct head were performed. blood, urine, and peritoneal fluid were sent for culture, and he received a dose of vancomycin and zosyn. given his somnolence, patient was intubated in ed for airway protection. he received normal saline 2 l, asa 325 mg pr, vancomycin 1 g, and zosyn 4.5 g. following intubation, blood pressure dropped to 78/50 and levophed gtt was initiated. . past medical history: waldenstrom's macroglobulinemia, diagnosed 8-9 years ago, started on chemotherapy in . status post 7 cycles of rituxan, vincristine, cyclophosphamide, and prednisone. hypertension. diabetes mellitus, poorly controlled. history of possible renal failure and neuropathy from diabetes. coronary artery disease status post left anterior descending angioplasty x 2 in 12/89 and . chronic renal insufficiency secondary to diabetes mellitus, hypertension, and renal atrophy. history of atrophy of one kidney. hypercholesterolemia. sleep apnea, using cpap at home gout. gerd. history of gallstones. status post arthroscopic procedure to his right knee approximately 5-7 years ago for torn cartilage. social history: the patient denies tobacco use. he has not drunk alcohol for the last 2 months and he states that he quit in order to lose weight. prior to that, he was drinking alcoholic beverages per day. he is married and he states that his wife is an alcoholic. he is semi-retired. he used to be the director of human relations and vice president of hospital. the patient was also a lawyer and does a small amount of law practice on the side. he has 4 grown children who are healthy. family history: the patient's father died of colon cancer at age 55; mother is alive in her late 80s with hypertension, status post cabg for an mi, and with history of stroke. physical exam: pe: vitals: 98.2 97.6 80 122/70 20 95% nad. a&ox3. anicteric. mmm. no bruits. rrr. ctab. soft. nt. nd. pd cath llq. multiple b/l heal fissures and ischemic ulcers with dry eschar on digits and right lateral midfoot, largest b/t 1&2 digits on r. also lesions on l foot. +paronychia right medial hallux. erythema of the forefoot and lateral foot on the r. some dependent rubor of b feet. sensation and motor intact. pulses: car rad fem pt dp r +2 +1 +1 tri mono l +2 +1 +1 tri tri mono labs: 137 95 41 / ------------ 157 3.6 28 8.6 \ ca: 8.2 mg: 1.8 p: 5.6 \ 8.3 / 6.6 ---- 282 /25.7 \ pertinent results: 04:05am blood wbc-7.4 rbc-2.56* hgb-7.8* hct-23.7* mcv-93 mch-30.4 mchc-32.9 rdw-15.4 plt ct-304 07:10am blood wbc-6.8 rbc-2.63* hgb-7.7* hct-24.3* mcv-92 mch-29.3 mchc-31.7 rdw-16.0* plt ct-253 04:05am blood pt-16.6* ptt-32.0 inr(pt)-1.5* 04:05am blood glucose-169* urean-47* creat-8.9* na-135 k-3.7 cl-96 hco3-27 angap-16 07:10am blood glucose-118* urean-58* creat-8.4* na-134 k-3.9 cl-93* hco3-30 angap-15 02:23pm blood ck(cpk)-67 06:04am blood ck(cpk)-82 09:55pm blood ck(cpk)-124 02:23pm blood ck-mb-5 ctropnt-0.52* 06:04am blood ck-mb-7 ctropnt-0.53* 09:55pm blood ctropnt-0.65* 06:37am blood probnp-* 04:05am blood calcium-8.2* phos-6.2* mg-1.6 06:37am blood cortsol-23.7* 04:05am blood vanco-17.7 10:03pm blood lactate-4.7* 02:36pm blood lactate-1.2 10:35 pm blood culture venipuncture #2. blood culture, routine (preliminary): gram positive coccus(cocci). in pairs and clusters. aerobic bottle gram stain (final ): gram positive cocci in pairs and clusters. echo the left atrium is mildly dilated. the right atrium is moderately dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = 20-30 %). there is no ventricular septal defect. the right ventricular cavity is dilated with depressed free wall contractility. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the findings of the prior report (images unavailable for review) of , the left ventricle is more dilated. the mitral regurgitation is reduced. cxr : a single portable image of the chest was obtained and compared to the prior examination dated demonstrating no significant interval change. an enlarged cardiac silhouette associated with pulmonary vascular congestion is again seen. there is a left retrocardiac opacity likely secondary to underlying atelectasis, difficult to exclude pneumonia. no new focal opacities are seen. the right central venous line is grossly unchangedand terminates within the expected region of the cavoatrial junction. the endotracheal tube and nasogastric tube had been removed in the interim. brief hospital course: 65 yo m with a h/o uncontrolled dmii, esrd on pd, cad, chf w/ an ef of 20-30% and waldenstrom's macroglobulinemia who presents after recent discharge with altered mental status x 1 day and continuing chronic bilateral lower extremity ischemia. . #) altered mental status: etiology unclear, but hyperviscosity secondary to waldentrom's is unlikely given serum viscosity of 1.3 (nl 1.4-1.8). after careful review, it appears patient has been experiencing increasing lower extremity pain and has self increased pain medication dosing. after metabolic etiologies were excluded, it appears both altered mental status and hypercarbic respiratory arrest were medicaiton induced. patient was re-evaluated by podiatry regarding foot ulcers, as these seem to be the source of his severe pain. for details, please see under foot ulcers below. . #) hypotension: on adm, pt met 1 of sirs criteria (afebrile, hr 74, wbc 7.9, rr 21) but required levophed for bp support following intubation. only definitive culture data is ?????? bottles + for gpcs. essentially unchanged echo and ce flat. septic shock was still most likely etiology pt hypotension on admission. no evidence of sepsis or infection in our system. patient was quickly weaned off pressors and was transferred to the floor, where he has been normotensive. . #) foot ulcers: as above, these are likely cause of severe pain. patient has known severe vascular disease with prior superficial femoral artery angioplasty. podiatry re-evaluated case and requested doppler studies of lower extremities, which confirmed severe disease. vascular surgery was consulted and decided to perform angiogram which revealed severe occlusive disease of the right lower extremity. after discussion with patient, he decided to undergo femoral-popliteal bypass. patient was transferred to vascular surgery after procedure. . #) esrd: we continued pd, per renal recs. goal to run net negative. . #) cardiac: (a) vessels: pt p/w mild troponin leak, likely due to demand ischemia in setting of sepsis and renal disease. patient remained asymptomatic and serial ecg's showed return to baseline. . (b) chronic systolic heart failure: severe global left ventricular hypokinesis with relative preservation of apical systolic function suggestive of non-ischemic etiology; echo essentially unchanged with lvef 20-30%. we resumed ace-i and beta-blocker, patient tolerated them well . c) atrial fibrillation: pt noted to be in a.fib with hr in low 100s on , with return to sinus rhythm. . #) anemia: likely esrd. - continue procrit . #) dm2: poorly controlled, hba1c>13%. patient maintained on sliding scale insulin. . #) osa: pt with h/o osa on cpap, but has not been using for months now - will monitor overnight & apply supplemental oxygen prn - encourage family to bring in home machine . #) waldenstrom's macroglobulinemia: serum viscosity essentially stable, no acute issues . prophylaxis: # dvt: heparin sc tid # stress ulcer: ppi . # code status: patient remained full code during this admission. . =========================================== vascular surgery: pt was transferred to the vascular surgery service on following a right popliteal to posterior tibial artery bypass with right saphenous vein graft. there were no complications intraoperatively and the patient tolerated the procedure well. he was extubated in the or and transferred to the pacu for recovery. ultimately he was transferred to 5 for recovery. . pod1 the patient was seen by the renal service and recommendations were made to continue his peritoneal dialysis at 1.5% dextrose, cc volume, q6hrs, with po kcl 15meq . pt was seen by pt/ot and declined evaluation on this day. . pod2 pt passed a single guaic (+) bm. pt was seen by the clinic and home insulin dosing was adjusted. pt was seen and evaluated by pt/ot and recommendations were made for rehab. pt was also seen by ot and recommendations were again made for rehab. . pod3 pt with a k of 3.4 (down from 3.6) and was given a single dose of 40meq kcl po per renal consult service. pt will continue current peritoneal dialysis, insulin, and home medication regimen at rehab. medications on admission: toprol xl 25 mg allopurinol 75 mg daily levothyroxine 75 mcg daily nexium 40 mg daily niaspan er 500 mg daily icap humulin r 5 units humulin n 30 units qam, 25 units qpm lipitor 20 mg daily lisinopril 20 mg daily iron 65 mg daily asa 81 mg daily effexor xr 150 mg daily lorazepam 1 mg qhs ambien 10 mg qhs procrit 6000 units qweek fosrenol 100 mg tid w/ meals discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 2. allopurinol 300 mg tablet sig: 0.25 tablet po daily (daily). 3. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 5. niacin 500 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (). 6. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po daily (daily) for 7 days. 7. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 8. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. venlafaxine 75 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po daily (daily). 11. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed for nausea. 12. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for prn insomnia. 13. epoetin alfa 10,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). 14. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 15. lanthanum 500 mg tablet, chewable sig: two (2) tablet, chewable po tid w/meals (3 times a day with meals). 16. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 17. humulin r 5 units 18. humulin n 30 units qam, 25 units qpm discharge disposition: extended care facility: hospital discharge diagnosis: 1. altered mental status 2. dmii 3. esrd on pd 4. cad s/p angioplasty ' & ' 5. chf with lvef of 25% 6. htn 7. pvd 8. hypercholesterolemia 9. obstructive sleep apnea 10. gerd 11. gout 12. hypothyroidism 13. waldenstrom's macroglobulinemia 14. chronic bilateral lower extremity ischmia s/p right -pt bypass with reversed svg discharge condition: stable, to rehab discharge instructions: please report to the er for temperature greater than 101.0f, increasing confusion, persistent fever/chills, nausea and/or vomiting, increasing pain to your wound sites and/or drainage, bleeding, or foul smell, increasing redness to wound site or obvious signs of infection. followup instructions: provider: , m.d. phone: date/time: 1:40 . provider: . , phone: please follow up with him in 2 weeks. please call to schedule an appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnostic ultrasound of heart insertion of endotracheal tube arteriography of femoral and other lower extremity arteries other (peripheral) vascular shunt or bypass arteriography of other intra-abdominal arteries peritoneal dialysis diagnoses: other iatrogenic hypotension anemia in chronic kidney disease end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified gout, unspecified atrial fibrillation percutaneous transluminal coronary angioplasty status hypopotassemia pulmonary collapse hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure long-term (current) use of insulin chronic systolic heart failure altered mental status atherosclerosis of native arteries of the extremities with gangrene family history of malignant neoplasm of gastrointestinal tract chronic total occlusion of artery of the extremities diabetes with renal manifestations, type ii or unspecified type, uncontrolled family history of other cardiovascular diseases poisoning by other specified analgesics and antipyretics accidental poisoning by other specified analgesics and antipyretics macroglobulinemia diabetes with peripheral circulatory disorders, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to