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: hypotension major surgical or invasive procedure: none history of present illness: 83m with hx of copd, afib who was sent to the er from house after he was found to be tachypneic to the 40s. per nurse house, pt normally keeps to himself and is generally healthy except for his breathing. she states that his physician has been trying to get him to wear o2 but he has refused. pt states that over the past two weeks, he has been having loose stools and crampy, squeezing abdominal pain. he has been eating normal meals but his pain worsens after eating. he describes some nausea but has not had any emesis. pt states his breathing has felt fine until the last day when it started to feel labored, associated with productive cough. . in the , pt found to be hypotensive to 50s/30s with hr in the 40s, rr in the 40s, 100% on nrb. of note, he had taken his 200mg of toprol xl in the am. he was given glucagon 1mg iv x 1 with no improvement in hr. he was then started on dopamine which improved both hr and bp. this was titrated up to 25mcg to maintain maps in the 60s. he was then given ceftriaxone and vancomycin to cover for pna. he was given solumedrol, albuterol and atrovent nebs to cover for copd flare. and he was given 10mg of lasix for possible chf but also had received 2l of ns earlier. he was then admitted to the icu. past medical history: * htn * copd, unknown fev1 * chf, ef unknown * afib * spinal stenosis * anemia * hx of pneumonia * hx of pvd social history: 2-3ppd x 48yrs, lives in house; not married, no children; nephews are very involved family history: nc physical exam: exam: temp 98.4, bp 110/40, hr 67, r 15, o2 94-98% on 4l gen: nad, pleasant, ao x 3 heent: mm dry, eomi, left pupil 4mm and reactive, right pupil 2mmand reactive neck: jvd to 8cm cv: regular chest: crackles at bilateral bases but otherwise clear abd: hypoactive bowel sounds, nontender, soft, nondistended, no rebound ext: feet cool; 2+ pitting edema, nonpapable and nondopplerable pulses; dopplerable popliteal pulses, 1+ radial pulse; fingers blue neuro: cn 2-12 intact, 5/5 strength bilaterally pertinent results: ** admit labs ** wbc-13.6* hct-31.2* neuts-85.7* lymphs-9.8* monos-3.9 eos-0.4 basos-0.1 plt count-294 inr(pt)-1.2* . probnp-* . glucose-135* urea n-43* creat-1.9* sodium-136 potassium-5.0 chloride-98 total co2-24 . alt(sgpt)-2191* ast(sgot)-2076* ld(ldh)-2325* alk phos-101 amylase-505* tot bili-0.8 lipase-19 . lactate-4.4* --> 4.8 --> 3.3 . abg: type-art po2-221* pco2-53* ph-7.21* on 100% nrb . cxr: heart size is at upper limits of normal. the aorta is calcified and tortuous. pulmonary vasculature is unremarkable. there is a left lower lobe opacity and small left pleural effusion. left lower lobe opacity could represent atelectasis; however, pneumonia cannot be excluded. . echo: the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . ruq u/s: 1. patent hepatic vasculature. 2. unremarkable liver echotexture. 3. trace ascites. 4. simple-appearing cyst of the mid left kidney. . brief hospital course: 83m with hx of copd, afib now in icu for hypotension found to have abdominal pain and elevated lfts . # shock: volume depletion vs sepsis vs adrenal insufficiency or combination. volume depletion likely due to 2 weeks of loose stools and decreased po intake. sepsis also likely given lactate of 4.8, possible pneumonia and possible intra-abd source. adrenal insufficiency was impossible to test given that pt received solumedrol in ed. cardiogenic shock not likely given lack of ekg changes and negatige enzymes and tte showed preserved systolic function. patient was given fluids and started on dopamine to maintain maps>60. steroids were changed to decadron to perform stim test but initial level was 40 so stim was not performed. steroids were d/c'd. pt was weaned off dopamine on hospital day #2 and bps remained stable. bb was resumed for rate control and verapamil was restarted. sbps remained 120s-140s. . # sepsis: possible sources include lung, urine, abdomen. cxr with possible infiltrate so started levaquin/flagyl. ua was clean and urine culture was negative. blood cultures remain negative. pt remained afebrile with elevated wbc count, attributed to possible pna and steroids. his wbc should be followed in rehab to make sure it is trending down. . # transaminitis: alt and ast equally elevated to the on admission. ddx of this includes right heart failure (which may explain elevated bnp), shock liver, viral hepatitis (which could explain pt's abd pain, nausea, diarrhea), med related (he is on 650mg standing tylenol tid), budd chiari. no hx of etoh abuse. ruq us was normal without evidence of clot and tylenol level was neg. patient's hepav ab was positive, igm is pending. we will continue to hold his statin and she should not be on standing tylenol. his lfts should also be trended to make sure they are trending down. . # abd pain/diarrhea: stool was sent for e. coli 0157 given h/o diarrhea and arf. c diff also sent. patient's diarrhea resolved as did his abdominal pain. as above, his abd u/s was negative. it may be secondary to hepatitis a but igm was pending on time of discharge. . # tachypnea/copd: likely that pt has an underlying pneumonia causing an exacerbation of his underlying copd. he was given standing nebs along with oxygen. his breathing improved dramatically over the first few hours of his hospital stay. he should continue on albuterol and atrovent inhalers. he also should continue to wear oxygen at rest and with ambulation. he was started on advair. he may benefit from an outpatient pulmonary appointment along with pfts. he may also need additional medications including tiotropium. . # chf: by report only. echo was normal with preserved funciton. bnp elevated to 18,000 on admission but appeared dry on exam so he improved with fluids. he was continued on his beta blocker after bp normalized. . # afib: patient was in nsr on admission and converted to a-fib while in micu with hr 100's-120's. he is not anticoagulated likely due to fall risk. he is rate controlled with beta blocker and verapamil. . # arf: baseline is unknown. urine lytes showed fena of 0.9% indicating pre-rernal etiology verses acute tubular necrosis from hypotension. creatinine peaked at 2.8 from 1.9 on admission and is now trending down. this should be followed and medications adjusted for creatinine clearance. . # glucse intolerance: pt was covered with insulin sliding scale but required none. . # code: pt is dnr/dni, confirmed with pcp . # comm: nephew , ; pcp medications on admission: * asa 81mg qd * hctz 25mg qd * toprol xl 200mg qd * prilosec 20mg qd * mvi * verapamil 180mg qd * colace 100mg * cilostazol 50mg * tylenol 650mg tid * motrin 600mg tid * lipitor 10mg qd * neurontin 100mg qhs * mom * albuterol * atrovent discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. toprol xl 200 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. 3. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 4. multi-vitamin tablet sig: one (1) tablet po once a day. 5. verapamil 180 mg tablet sustained release sig: one (1) tablet sustained release po once a day. 6. colace 100 mg capsule sig: one (1) capsule po twice a day. 7. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*2* 8. atrovent 18 mcg/actuation aerosol sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. 9. levofloxacin 250 mg tablet sig: one (1) tablet po q48h (every 48 hours) for 3 days. 10. flagyl 500 mg tablet sig: one (1) tablet po three times a day for 3 days. 11. advair diskus 250-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day. discharge disposition: extended care facility: center discharge diagnosis: primary diagnosis: 1. sepsis 2. community acquired pneumonia 3. transaminitis hepatitis a verses shock liver 4. diarrhea, ? hepatitis a 5. acute renal failure acute tubular necrosis . secondary diagnosis: 1. copd 2. atrial fibrillation discharge condition: good, afebrile and oxygenating well on 3l discharge instructions: take all medications as prescibed and go to all follow-up appointments. your oxygen level is low so you should wear oxygen at home. you will need to take the levaquin and flagyl (antibiotics for your pneumonia) for 3 more days. your liver function was slightly lower than normal so you should avoid taking tylenol while it recovers. please avoid both tylenol and motrin given your liver and kidney disease. return to the er or call your pcp if you experience any dizziness, shortness of breath, abdominal pain, diarrhea, nausea or vomiting. followup instructions: you have an appointment with dr. on at 3:30pm. if you want to cancel this, please call . you will need to have your creatinine and liver function tests checked on friday and monday to make sure they are improving. procedure: infusion of vasopressor agent diagnoses: pneumonia, organism unspecified acidosis mitral valve disorders acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension unspecified septicemia severe sepsis atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation septic shock volume depletion, unspecified 

Answer: The patient is high likely exposed to