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: history of present illness: the patient is a 66-year-old male with a history of coronary artery disease (status post coronary artery bypass graft), type 2 diabetes, hypertension, and paroxysmal atrial fibrillation who presented with fever, weakness, and hyperglycemia. the patient was at from visiting his daughter who is currently an inpatient when he developed increased fatigue and weakness. on checking his blood sugars, they were in the 400s, at which time he presented to the emergency department with a fever of 103. he denied any chest pain, shortness of breath, nausea, vomiting, diarrhea, melena, or bright red blood per rectum. he was initially hemodynamically stable in the emergency department, but his blood pressure subsequently fell to the 70s and 80s. he was volume resuscitated with 6 liters of normal saline without affect. a right internal jugular triple lumen catheter was placed in the emergency department, and levophed and neo-synephrine were initiated for blood pressure support. the patient was admitted to the medical intensive care unit for further management. past medical history: 1. coronary artery disease; status post myocardial infarction in treated at that time with percutaneous transluminal coronary angioplasty, followed by a 4-vessel coronary artery bypass graft in . 2. diabetes; on insulin. 3. hypertension. 4. paroxysmal atrial fibrillation; treated with coumadin. 5. congestive heart failure (with an ejection fraction of 30%). 6. beta-thalassemia trait. allergies: no known drug allergies. medications on admission: aspirin, coumadin, lisinopril, pravachol, pletal, lasix, zaroxolyn, 70/30 insulin, neurontin, and allopurinol. social history: the patient is married. he denies the use of tobacco. he drinks alcohol only occasionally. physical examination on presentation: examination on admission revealed temperature was 103, heart rate was 124, blood pressure was 88/40, respiratory rate was 18, and oxygen saturation was 96% on room air. in general, he was lethargic. oriented times three. he appeared acutely ill. pertinent physical findings revealed that his oropharynx was dry. his neck was supple with jugular venous pulsation approximately 10 cm. his lungs sounded clear to auscultation bilaterally (by report). his heart examination was regular with normal first heart sounds and second heart sounds. a 2/6 systolic ejection murmur at the left upper sternal border. his abdominal examination was unremarkable. his extremities revealed trace pedal edema with chronic venous stasis dermatitis bilaterally and erythema of the left lower extremity around the medial malleolus which was also warmer than surrounding skin. neurologic examination revealed that he was alert and oriented times three. cranial nerves ii through xii were intact. otherwise, neurologic examination was nonfocal. pertinent laboratory values on presentation: laboratories on admission revealed white blood cell count was 21.7 (with a differential of 77 polys, 6 bands, 8 lymphocytes, and 7 monocytes), hematocrit was 31.7, and platelets were 210. chemistry-7 was remarkable for a blood urea nitrogen of 59 and creatinine of 1.6. blood sugar was 314 on admission. liver function tests were checked and were within normal limits. initial set of cardiac enzymes done in the emergency department revealed creatine kinase was 250, with a mb fraction of 7, and a troponin of 2.4. coagulations revealed prothrombin time was 19.7 and an inr of 2.6. urinalysis on admission revealed a specific gravity of 1.017, with a small amount of blood, and a glucose measurement of 1000. pertinent radiology/imaging: electrocardiogram on admission revealed a sinus rhythm with a right bundle-branch block at a rate of 108, with st depressions in v4 through v6. a chest x-ray on admission showed cardiomegaly without infiltrate or signs of congestive heart failure. hospital course by issue/system: 1. infectious disease issues: presumably septic, the patient was admitted to the medical intensive care unit where he was initially treated with vancomycin and levofloxacin after having been started on oxacillin in the emergency department for presumed cellulitis of the left lower extremity. his hemodynamic instability improved rather quickly, and his antibiotics were changed to unasyn; although a source of his sepsis was still unknown. with the patient afebrile without any signs of hemodynamic instability or obvious source of infection, the unasyn was discontinued; allowing any present infection to present itself. after the discontinuation of the antibiotics, the patient remained afebrile with no signs of obvious infection, and antibiotics were not re-initiated. blood cultures throughout this admission were negative to date at the time of this dictation. 2. hypotension issues: hypotension again presumed to be sepsis. the patient was treated initially with levophed and neo-synephrine. further volume resuscitation was held given his high likelihood of the complication of congestive heart failure. pressors were weaned over the subsequent 24 hours, and by the second hospital day the patient was off all pressors and was maintaining his blood pressure. 3. cardiovascular system: in the setting of the patient's hypotension, he developed electrocardiogram changes and had cardiac enzymes measured with a peak troponin of 49.3 and a creatine kinase of 334. ultimately, the electrocardiogram did not develop t waves, and the patient was diagnosed and treated medically for a non-q-wave myocardial infarction. he was not treated with heparin because he was fully anticoagulated with coumadin; however, he was continued on aspirin. once his blood pressure tolerated, his ace inhibitor was restarted. he was also begun on lopressor when his blood pressure allowed. with the aggressive volume resuscitation upon admission, the patient did experience congestive heart failure which was treated with his outpatient doses of lasix and zaroxolyn once his blood pressure was able to tolerate this. a full set of lipids was checked which revealed a total cholesterol of 127, high-density lipoprotein was 56, low-density lipoprotein was 56, and triglycerides were 77. therefore, his pravachol dosing was not changed. for his atrial fibrillation, his coumadin was continued at his outpatient dose at 7 mg daily with his inr maintained appropriately. with diuresis, the patient's heart failure improved to his baseline 4. renal insufficiency issues: upon admission, the patient's creatinine was 1.6. this was felt to be due to prerenal azotemia. with hydration upon the initial resuscitation, his creatinine improved to 1.4. subsequently, with the complication of his congestive heart failure, his creatinine worsened again to 1.7. however, with diuresis his creatinine got as low as 1.2; which was likely his baseline. 5. left knee pain issues: on hospital day three, the patient developed the acute onset of left knee pain with focal tenderness on the lateral side of the knee with an apparent effusion within the knee. concern was raised for a septic joint given the likelihood of his recent bacteremia. however, on further probing of the patient's past medical history it was found that he has a history of gout in that knee and had been on allopurinol prior to admission. the patient was treated empirically for gout with colchicine, and rheumatology was consulted regarding the possibility of an arthrocentesis in the setting of an elevated inr to rule out a septic joint. rheumatology did tap the left knee and aspirated 0.5 cc of joint fluid which was sent for culture; on which there was no growth at the time of this dictation. following 24 hours of treatment with colchicine, the patient's symptoms improved dramatically, and his walking improved. the patient was to be treated with colchicine 0.6 mg p.o. three times per day for a total of three days followed by 0.6 mg p.o. once per day for approximately four weeks; at which time he was to follow up with his orthopaedist in and likely restart his allopurinol at that time. 6. endocrine system: the patient was continued on 70/30 insulin with the addition of a regular insulin sliding-scale. initially, due to decreased oral intake as well as a strict diabetic diet, he was requiring less insulin than he did at home. however, ultimately because of continuing elevated fingersticks his insulin was returned to his outpatient doses. discharge diagnoses: 1. sepsis of unknown etiology. 2. non-q-wave myocardial infarction. 3. chronic renal insufficiency with acute renal azotemia. 4. gout. 5. congestive heart failure. medications on discharge: 1. aspirin 325 mg p.o. once per day. 2. pravachol 40 mg p.o. q.h.s. 3. lisinopril 20 mg p.o. once per day. 4. coumadin 7 mg p.o. once per day. 5. lasix 80 mg p.o. once per day. 6. zaroxolyn 2.5 mg p.o. once per day (to be taken one half hour prior to lasix). 7. toprol-xl 50 mg p.o. once per day. 8. neurontin 300 mg p.o. three times per day. 9. colchicine 0.6 mg p.o. three times per day (through ) followed by 0.6 mg p.o. once per day (for four weeks). 10. pletal 100 mg p.o. twice per day. 11. 70/30 insulin 50 units subcutaneously q.a.m. and 30 units subcutaneously q.p.m. 12. tylenol p.o. as needed. 13. multivitamin one tablet p.o. once per day. condition at discharge: condition on discharge was stable. discharge instructions/followup: 1. the patient was instructed to follow up with dr. (his orthopaedist) in three to four weeks regarding further treatment of his gout. 2. in addition, the patient was to follow up with his primary care physician in the next one to two weeks. discharge status: the patient was discharged with plans for home physical therapy upon return to in approximately to days. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified arthrocentesis diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia atrial fibrillation other shock without mention of trauma cellulitis and abscess of leg, except foot unspecified disorder of kidney and ureter 

Answer: The patient is high likely exposed to