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: respiratory failure and difficult weaning from ventilation after hernia repair. major surgical or invasive procedure: picc line placement arterial line placement history of present illness: history of present illness, in brief: 41-year-old male with past medical history of patent foramen ovale s/p closure, pe on lovenox, diastolic chf, copd, pulmonary hypertension, on home o2 at 4l nc (although patient states he was on room air prior to admission) initially presented to hospital with 10/10 periumbilical pain associated with nausea, vomiting, worse in the right lower quadrant. at that time he was found to have an incarcerated hernia on imaging and admitted for open repair of strangulated incisional hernia with mesh placement, with some strangulated bowel requiring resection (end to end connection). after the procedure he was transfered to the icu, where he was not able to be extubated for 2 days and apparently developed aspiration pneumonia which was treated with antibiotics (levofloxacin and metronidazole). he developed atrial flutter after which he required both face mask and nasal cannula to maintain oxygen saturations above 90% and required cardioversion. patient had difficulty being weaned of venti-face mask with fio2 of 50% with 5l nc. pulmonary was consulted and thought that the patient had severe pulmonary hypertension and recommended transfer to tertiary care facility for further pulmonary care. surgically, patient has recovered and is tolerating a regular diet, passing flatus and having normal, soft bowel movements. patient was transferred to for severe pulmonary hypertension with continued elevated o2 requirements. the patient immediately triggered on the floor with an sao2 of 88% on 50% venti-face-mask and a temperature of 101.1. he was given iv lasix 80mg, nebs, heparin drip continued, vancomycin and zosyn for hap/vap/aspiration pna, blood and urine cultures obtained and micu consulted and subsequent transfer initiated. in the micu the patient was maintained on a face mask. he had an a-line placed and a tte with bubble study, which showed a septal occluder device in place without evidence of atrial septal defect of patent foramen ovale. mild symmetric left ventricular hypertrophy with systolic function of ef>75%. right ventricular cavity is dilated with borderline depressed free wall motion. there is severe pulmonary artery systolic hypertension. the patient was started on a lasix drip and acetazolamide. a picc line was placed and a cta was performed which showed possible chronic pulmonary emboli and patchy ground glass opacities and enlarged lymph nodes. the facemask was reduced from 50% to 40% with stable sao2s. the lasix drip was stopped with continued diuresis by the patient. his sotalol was decreased to 40mg , however, hr increased to 130s and he continued his 80mg dosing. the patient was deemed to be stable for general medical floor treatment and was transferred. review of systems: (+) per hpi, bilateral lower extremity swelling, flatus, bm, sob (-) denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain, chest pressure, palpitations, or weakness. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: past medical history: - congenital birth defects with patent foramen ovale s/p closure at - mild developmental delay - hypertension - diabetes mellitus type 2 - h/o recurrent pe while on anticoagulation (coumadin and aspirin - has also been on plavix but developed hemoptysis) - h/o paradoxial cva from shunt (s/p repair) in - diastolic chf - copd - pulmonary hypertension diagnosed - no vasodilator challenge, no right heart cath since pfo closure, no pulmonologist - home o2, 4l nc (although patient reports being on ra) - aflutter with rvr perioperativly. past surgical history: - splenectomy in due to trauma - strangulated hernia s/p repair with bowel rescection social history: patient lives at home with his parents. - tobacco: denies - alcohol: social, occasional - illicits: denies family history: non-contributory, denies family history of pulmonary hypertension. physical exam: general: male, alert, oriented, sitting in chair with only nasal cannula in no apparent distress heent: sclera anicteric, mmm, oropharynx without lesions, perrl, eomi neck: supple, jvp not elevated, no lad lungs: crackles bilateral through lower , good air movement, without wheeze cv: rr, nl rate, without murmurs, rubs or gallops, s1, split s2 abdomen: soft, nt, nd, +bs (some tenderness around surgical incision site), incision c/d/i, inferior incision with serosanguinous drainage with overlying clean, sterile dressing, no rebound, no guarding gu: foley in place ext: warm, well perfused; 2+ dp pulses, trace bilateral lower extremity pitting edema neuro: aox3, cn ii-xii grossly intact, grossly intact, ambulates without difficulty pertinent results: 10:45pm wbc-16.9* rbc-3.65* hgb-10.2* hct-32.0* mcv-88 mch-27.9 mchc-31.8 rdw-18.1* 10:45pm neuts-79.0* lymphs-14.3* monos-5.1 eos-1.4 basos-0.3 10:45pm pt-20.4* ptt-39.6* inr(pt)-1.9* 10:45pm albumin-2.6* calcium-8.2* phosphate-3.0 magnesium-1.3* 10:45pm alt(sgpt)-163* ast(sgot)-23 ld(ldh)-214 alk phos-55 tot bili-1.0 10:45pm probnp-3223* 10:45pm glucose-65* urea n-14 creat-1.0 sodium-141 potassium-3.9 chloride-102 total co2-30 anion gap-13 cxr: lung volumes are low, exaggerating the heart size. pulmonary and mediastinal vessels are dilated but there is no pulmonary edema. small left pleural effusion may be present. tee: the left atrium is elongated. a septal occluder device is seen across the interatrial septum. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef>75%). the right ventricular cavity is dilated with borderline depressed free wall motion. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. cta chest: 1. tiny filling defects in the distal subsegmental branches of the pulmonary arteries bilaterally as detailed above with an eccentric distribution, the imaging findings of which are consistent with chronic pulmonary emboli; however, the chronicity of this finding cannot be definitively ascertained due to which an acute process is not entirely excluded. 2. bilateral patchy ground-glass opacities predominantly in the upper lobes, left greater than right, stable since , could represent an inflammatory/infectious process. 3. mediastinal adenopathy, stable since . consideration to pet/ct should be given for further evaluation. 4. increased size of main pulmonary artery measuring 3.7 cm consistent with pulmonary arterial hypertension. 5. small hiatal hernia. 6. small amount of fluid in the left upper quadrant of the abdomen with nonvisualization of spleen, correlate for history of splenectomy. 7. mild fatty infiltration of liver. ruq u/s: anterior abdominal wall paramedian fluid collections at the superior aspect of the incisional scar measuring up to 7.6 cm on the right and 7.4 cm on the left. brief hospital course: 41m with pulmonary hypertension, history of recurrent pe, diastolic chf, and s/p pfo closure, initially admitted to osh for strangulated hernia, with persistent hypoxia likely secondary to pulmonary hypertension. #. respiratory distress: the patient has been persistently hypoxic. initially he required 5l nc and 50% facemask to maintain sao2 of above 92% and was sent to the micu. the likely etiology was pneumonia, volume overload and pulmonary hypertension. the pneumonia was treated with an 8 day course of vancomycin and zosyn. the patient was placed on a lasix drip with aggressive diuresis. finally the patient was treated for pulmonary hypertension (as below). the patient improved with diuresis and was transferred to the floor on 3l nc and 35% fm. the patient did well initially but then developed increased sputum and an increase oxygen requirement and was transferred to the micu. there he was given another 8 day course of vancomycin and zosyn and was aggressivly diuresed. the patient returned to the floor on 3l nc during the day and 40% fm overnight. he has remained on this oxygen level with sao2 > 92 percent. the patient continued to have a cough with mimimal sputum production. he had chest pt, acapella valve and incentive spirometry. the patient was discharged with home oxygen. #. pulmonary hypertension: the patient has severe pulmonary hypertension. the likely etiology is from chronic thromboembolic disease which was worsened from volume overload. the patient was started on sildenafil, which was uptitrated to 100mg tid. the patient had daily ambulatory o2 sats. he was continued on coumadin and aspirin with an inr goal of . will need follow up with a pulmonologist as an outpatient and a pulmonary hypertension specialist. he may also warrant evaluation for lung transplantation in the future. #. abdominal wound: due to recent repair of encarcerated hernia and bowel resection. the abdominal wound is open and draining serosangiunous fluid at the distal edge of the wound. surgery has evaluated the wound and states that it does not appear to be infected and to continue daily dressings with gauze. the patient will need to follow as an outpatient with a general surgeon. #. leukocytosis: unclear source. the patient was treated multiple times for hap/vap. also worrisome for intraabdominal pathology around wound site. the patient remained afebrile and clinically did not look infected. cxr showed no evidence of pneumonia. no evidence of infection on recent cultures. #. atrial flutter: the patient had a cardioversion at the outside hospital. had one episode in the micu which resolved with sotalol and digoxin. he is maintained on these two medications and should be followed by a cardiologist as an outpatient. #. dm type ii: the patient was maintained on an insulin sliding scale. #. gerd: continued ppi. medications on admission: medications upon discharge at : - perceocet q4 prn pain - lovenox 160mg sc qd - glipizide 5mg po daily - nexium 40mg po daily - zocor 20mg po daily - metformin 850mg po bid - lasix 80mg po bid - digoxin 0.125mg po daily - sildenafil 20mg po tid - sotalol 80mg po bid - levaquin 500mg po daily (stop date ) - albuterol nebulizer prn - coumadin 4mg po daily - aspirin 325mg po daily on hold - plavix 75mg daily on hold . medications upon transfer to cc7: -enoxaparin sodium 90 mg sc q12h -aspirin 81 mg po/ng daily -insulin sc (per insulin flowsheet) sliding scale & fixed dose -sotalol 80 mg po bid -trazodone 25 mg po/ng hs:prn insomnia -furosemide 40 mg iv bid -warfarin 3 mg po/ng daily16 -simvastatin 20 mg po/ng daily -vancomycin 1000 mg iv q 24h -morphine sulfate 2 mg iv q6h:prn pain -polyethylene glycol 17 g po/ng daily:prn constipation -pantoprazole 40 mg po q24h -sildenafil 20 mg po tid -digoxin 0.125 mg po/ng daily -ipratropium bromide neb 1 neb ih q4h -albuterol 0.083% neb soln 1 neb ih q4h -acetaminophen 500 mg po/ng q6h:prn fever, ha, pain -ipratropium bromide neb 1 neb ih q6h:prn sob wheeze -albuterol 0.083% neb soln 1 neb ih q2h:prn sob -piperacillin-tazobactam 4.5 g iv q8h discharge disposition: home with service facility: home health care discharge diagnosis: primary diagnosis: 1. pulmonary hypertension 2. ventilator associated pneumonia secondary diagnosis: discharge condition: . mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: you were admitted to the hospital from hospital after an abdominal surgery. at that time you were found to be hypoxic and requiring oxygen. you were transferred to and were taken to the intensive care unit for further monitoring. you were given iv antibiotics for a pneumonia. you were also diuresed to get rid of extra fluid that built up on your lungs. with antibiotics and aggressive diuresis your oxygenation improved. you were continued on oxygen therapy and your previous medications. you will need to follow up with a pulmonologist as an outpatient as it appears you have pulmonary hypertension. for further evaluation and management of your pulmonary hypertension it is very important for you to go to your appointments. the following medications were changed: 1. you were started on viagra 100mg three times per day 2. your plavix was stopped 3. your aspirin was changed to 81mg daily 4. your lasix was decreased to 20mg twice per day followup instructions: appointment #1 dr - surgical follow-up at 4:30 , , ma . appointment #2 md: , np (works with dr specialty: primary care date/ time: at 11am location: , , ma phone number: . appointment #3 md: dr with dr specialty: pulmonology date/ time: at 3:30 for a breathing test and the 4pm with the doctor. location: , bldg, , medical specialites phone number: procedure: venous catheterization, not elsewhere classified arterial catheterization diagnoses: esophageal reflux congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified atrial fibrillation acute on chronic diastolic heart failure atrial flutter hypopotassemia diaphragmatic hernia without mention of obstruction or gangrene other and unspecified hyperlipidemia acute and chronic respiratory failure alkalosis long-term (current) use of insulin primary pulmonary hypertension long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits other postprocedural status ventilator associated pneumonia other abnormal blood chemistry mild intellectual disabilities nonspecific abnormal electrocardiogram [ecg] [ekg] essential thrombocythemia chronic pulmonary embolism 

Answer: The patient is high likely exposed to