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: no known allergies / adverse drug reactions attending: chief complaint: hypotension and weakness major surgical or invasive procedure: none this hospitalization history of present illness: 72m history of non-insulin-dependent diabetes, dementia, coronary peripheral vascular disease, poor historian, but complains of generalized weakness and fatigue of unclear chronicity as well as an episode of "passing out" in a seated position. he denies chest pain, dyspnea, abdominal pain, vomiting, diarrhea, headache, cough, dysuria, but again is a somewhat poor historian. ems found him with a heart rate of 40, and unable to obtain a blood pressure, but he was awake and alert. he reports several days of constipation. . on arrival, the patient was bradycardic at 40, and hypotensive with systolic blood pressure 70. awake, alert, oriented x2. neuro nonfocal. abdomen soft, nontender, nondistended. patient refused rectal exam. ekg shows sinus bradycardia. he was given 2 l of iv fluid without change in blood pressure. in response to 0.5 mg atropine, his heart rate improved to 60, but without blood pressure improvement. dopamine at 5 mics per kilogram per minute did not improve blood pressure. increase to 10 mics per kilogram per minute, went into atrial fibrillation rate 130, same blood pressure, dopamine discontinued. started on low-dose levophed with improvement in blood pressure. placed right ij central line, sterile, a portable chest x-ray confirms okay to use. a foley was palced for urine and he got one dose of hydrocortisone, unasyn, and vancomycin and was admitted to the micu for further management. . on arrival to the unit he is alert and oriented and mentating clearly on 0.1 of levophed. . past medical history: peripheral vascular disease degenerative joint disease dementia type 2 diabetes mellitus pontine cva paroxysmal atrial fibrillation carotid artery disease . surgical history: right carotid endarterectomy fem-fem bypass graft social history: patient lives in an facility in the . patient is unemployed and derives income from social security. pt currently smokes cigarettes and has for 25 years, but denies alcohol or illicit drug. family history: non-contributory physical exam: admission exam: . t 97.6 hr 53 bp 110/50 (on 0.1mcg/kg/min norepinephrine)rr 20 o2 sat 100% general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . discharge exam: . vitals: 98.6 98.3 115/76 88 18 99% ra i/os: | 2400 (2l) general: appears in no acute distress. alert and interactive. heent: normocephalic, atraumatic. eomi. perrl. nares clear. mucous membranes moist. neck: supple without lymphadenopathy. jvd at base of clavicle at 30-degrees. cvs: regular rate and rhythm, ii/vi systolic crescendo-decrescendo murmur heard best at rusb, without rubs or gallops. s1 and s2 normal. resp: decreased breath sounds at bases minimally, bilaterally without adventitious sounds. no wheezing, rhonchi or crackles. stable inspiratory effort. abd: soft, non-tender, non-distended, with normoactive bowel sounds. no palpable masses or peritoneal signs. extr: no cyanosis, clubbing or edema, 2+ peripheral pulses gu: active bleeding from urethral meatus has subsided with clot visible at opening. uncirumsized. no source of bleeding identified. neuro: cn ii-xii intact throughout. alert and oriented x 3. dtrs 2+ throughout, strength 5/5 bilaterally, sensation grossly intact. gait deferred. pertinent results: admission labs: . 01:50pm blood wbc-11.3* rbc-4.46* hgb-13.3* hct-39.4* mcv-88 mch-29.8 mchc-33.7 rdw-13.6 plt ct-158 01:50pm blood neuts-74.4* lymphs-19.8 monos-3.7 eos-1.5 baso-0.6 05:15pm blood pt-20.1* ptt-34.1 inr(pt)-1.9* 01:50pm blood glucose-157* urean-18 creat-1.1 na-140 k-4.8 cl-111* hco3-20* angap-14 01:50pm blood alt-15 ast-22 alkphos-52 totbili-0.2 01:50pm blood albumin-3.2* calcium-8.1* phos-4.1 mg-2.1 08:43pm blood tsh-0.27 08:43pm blood free t4-1.3 08:43pm blood cortsol-29.3* 02:16pm blood lactate-3.2* 08:55pm blood lactate-2.4* 12:09pm blood lactate-1.7 . discharge labs: . 05:40am blood wbc-7.6 rbc-3.73* hgb-11.0* hct-32.4* mcv-87 mch-29.4 mchc-33.9 rdw-13.7 plt ct-133* 05:40am blood neuts-71.4* lymphs-21.0 monos-5.7 eos-1.6 baso-0.3 05:40am blood pt-13.0* ptt-28.1 inr(pt)-1.2* 05:40am blood glucose-114* urean-15 creat-0.8 na-145 k-3.7 cl-111* hco3-28 angap-10 05:40am blood calcium-8.5 phos-3.4 mg-2.0 . urinalysis: clear, negative for le, negative for nitr, no protein . microbiology data: blood culture (x 2) - pending mrsa screen - negative . imaging: chest (portable ap) - the heart size is normal. the hilar and mediastinal contours are within normal limits. there is bronchovascular crowding secondary to poor inspiratory effort, however, no focal consolidation, pleural effusion, or pneumothorax is seen. . abdomen u.s. (complete) - non-aneurysmal mid and distal aorta. no abdominal free fluid. evaluation of the proximal aorta is limited due to overlying bowel gas. pancreas not evaluated due to overlying bowel gas. diffuse increased echogenicity of the liver which may be secondary to fatty infiltration. more severe forms of liver disease including hepatic fibrosis and cirrhosis cannot be excluded on this examination. . 2d-echo - the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef > 55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. suboptimal image quality. normal biventricular cavity sizes with preserved global biventricular systolic function. no structural cardiac cause of syncope identified. brief hospital course: impression: 72m with a pmh significant for non-insulin-dependent diabetes (on oral agents), dementia, coronary artery disease, peripheral vascular disease, carotid artery disease (s/p r cea with 100% occlusion of the l cca/ica), cva (right pontine), paroxysmal atrial fibrillation (on coumadin) with reportedly chronic low blood pressure attributed to his pvd who presents following a near-syncopal event who was found to be hypotensive and bradycardic. . # hypotension - the patient initially presented with blood pressures 70/palp. he has had a past medical history of hypotension, with multiple recordings of systolics in the 90-100 mmhg range in the medical record. he was maintained on levophed gtt briefly and then was stabilized for the medical floor, requiring a short micu stay. the patient initially presented with near-syncope, but he maintained baseline mental status throughout his hospitalization. given this elevated lactate, and his elevated creatinine and his leukocytosis, there was concern for sepsis inducing hypovolemia. however, he did not appear hypovolemic on exam and orthostatic vital signs were negative; he also maintained normal urine output. the patient was initially treated with broad spectrum antibiotics, but these were discontinued as it was thought that infection was unlikely. his thyroid and adrenal function were noted to be normal. an infectious work-up, endocrine work-up and cardiology evaluation were all normal. following volume resuscitation, his blood pressure in both arms was noted to be discordant. vascular surgery noted left subclavian artery pvd which contributed to this discrepancy and his right blood pressure was reassuring. we resumed his home acei and beta-blocker following discovery of his unilateral hypotension. . # urethral bleeding, hematuria - the patient self-removed his foley catheter on overnight with the balloon inflated. active bleeding was noted at the urethral meatus following the incident, which resolved with pressure. urine output remained stable, with minimal clotting noted. urology was notified and recommended close monitoring without intervention as long as he continue to make urine. the hematuria had largely improved, but not completely resolved, prior to discharge. . # bradycardia, prolonged qt interval - the patient presented with sinus bradycardia noted on ekg and telemetry with a prolonged qtc in the 500s - cardiology noted this to be physiologic in the setting of bradycardia. his electrolytes were optimized, he remained without symptoms and his av-nodal blocking agents were slowly resumed. we did discontinue donepezil given its known qt effects. a 2d-echo was reassuring. cardiology noted he did not require further outpatient follow-up. . # leukocytosis - admitted with leukocytosis to 11.3 without fevers or clinical evidence of infection. cxr reassuring, u/a negative and culture data unrevealing. his leukocytosis resolved prior to discharge. . # paroxysmal atrial fibrillation - history of atrial fibrillation. ekg showing sinus bradycardia on admission. home medication includes coumadin, chads-2 score of 3. we slowly resumed his metoprolol without issue and he had no issues with rapid ventricular rates or rhythm disturbance this admission. his inr was 1.2 on discharge and he will resumed coumadin 4 mg po daily with inr monitoring as an outpatient. . # diabetes mellitus, type 2 - managed on oral hypoglycemics at baseline. no history of hba1c in our records. lipid profile reveals elevated triglycerides to 222 (ldl 51, hdl 33, cholesterol 128 in ). no evidence of retinopathy, neuropathy or nephropathy (creatinine 0.9). we resumed his glipizide on discharge. . # dementia - appears to be mentating at his baseline. holding donepezil given qtc effect and vasotonic effects. . transition of care issues: 1. will need monitoring of blood pressure daily. do not check left arm pressures given his known left arm peripheral vascular disease. his right arm should be used for bp checks. 2. patient self-removed his foley catheter with an inflated balloon and had significant hematuria with clot following this. this has improved significantly, and he continues to make adequate urine. if he bleeds, hold pressure. his hematocrit and blood pressure remain stable despite these issues. if you think clot is obstructing and he is unable to urinate, that would warrant more urgent urology evaluation. scheduled urology follow-up not required. 3. patient discharged with inr 1.2 on and will continue on coumadin 4 mg po daily. will need inr check on with results faxed to pcp for dose adjustment. 4. at the time of discharge, blood culture from was pending without growth to-date. 5. donepezil discontinued given qt prolonging effects. does not need formal cardiology follow-up. 6. follow-up scheduled with vascular surgery given left subclavian artery pvd, as well as follow-up ultrasound for known carotid disease. medications on admission: home medications (confirmed with patient) 1. acetaminophen 500 mg po bid prn pain 2. cyanocobalamin 1000 mcg inj every month 3. docusate sodium 100 mg po bid 4. donepezil 10 mg po daily 5. diltiazem 180 mg er po daily 6. glipizide 5 mg er po daily 7. hydrocodone-acetaminophen 5/500 mg po bid prn pain 8. lisinopril 10 mg po daily 9. metoprolol 25 mg po bid 10. simvastatin 80 mg po daily 11. warfarin 4 mg po daily (sun, tues, thurs, sat) 12. warfarin 5 mg po daily (mond, wed, fri) 13. aspirin 81 mg po daily 14. ferrous sulfate 325 mg po bid 15. glucosamine 1500 mg po daily 16. multivitamin 1 tablet po daily 17. omeprazole 20 mg po ec daily discharge medications: 1. acetaminophen 500 mg tablet sig: one (1) tablet po twice a day as needed for fever or pain. 2. cyanocobalamin (vitamin b-12) 1,000 mcg/ml solution sig: one (1) ml injection once a month. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. glipizide 5 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 5. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 6. metoprolol succinate 25 mg tablet extended release 24 hr sig: 0.5 tablet extended release 24 hr po daily (daily). disp:*30 tablet extended release 24 hr(s)* refills:*1* 7. simvastatin 80 mg tablet sig: one (1) tablet po once a day. 8. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm: based on inr monitoring with goal inr . 9. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 10. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day. 11. glucosamine 500 mg tablet sig: three (3) tablet po once a day. 12. multivitamin tablet sig: one (1) tablet po once a day. 13. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 14. outpatient lab work please have your pt/inr checked given your anticoagulation needs on and your primary care physician will adjust your coumadin dosing as needed. , fax discharge disposition: home with service facility: vna discharge diagnosis: primary diagnoses: 1. left subclavian artery peripheral vascular disease 2. sinus bradycardia with qt-prolongation 3. gross hematuria . secondary diagnoses: 1. peripheral vascular disease 2. degenerative joint disease 3. dementia 4. diabetes mellitus, type 2 5. history of pontine cerebrovascular accident 6. paroxysmal atrial fibrillation 7. carotid artery disease discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: patient discharge instructions: . you were admitted to the internal medicine service at on cc7 regarding management of you low blood pressure and low heart rate. your blood pressure improved with administration of iv fluids. you were also noted to have discordant blood pressures in your right and left arms, with prior vascular studies showing some stenosis in your left subclavian artery. you should only have blood pressures drawn in your right arm. you were also evaluated by cardiology and we optimized your medication list. you had a foley catheter which was removed traumatically and you had some bleeding issues which resolved on their own. you can expect your bloody urine to improve over the next several days. . please call your doctor or go to the emergency department if: * you experience new chest pain, pressure, squeezing or tightness. * you develop new or worsening cough, shortness of breath, or wheezing. * you are vomiting and cannot keep down fluids, or your medications. * if you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include: dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit, or have a bowel movement. * you experience burning when you urinate, have blood in your urine, or experience an unusual discharge. * your pain is not improving within 12 hours or is not under control within 24 hours. * your pain worsens or changes location. * you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. * you develop any other concerning symptoms. * excessive bleeding with urination or inability to urinate. . changes in your medication reconciliation: . * upon admission, we changed: changed: metoprolol tartrate 25 mg by mouth twice daily to metoprolol succinate xl 12.5 mg by mouth daily changed: lisinopril from 10 mg to 2.5 mg by mouth daily . * the following medications were discontinued on admission and you should not resume: discontinue: vicodine discontinue: diltiazem discontinue: donepezil . * you should continue all of your other home medications as prescribed, unless otherwise directed above. followup instructions: name: jiyin , nurse practitioner location: address: 545a centre st, , phone: you will be seen at home by np within several days of your discharge. if you have any questions, you can call the number listed above. . department: vascular surgery when: thursday at 10:00 am building: lm campus: west best parking: garage . department: vascular surgery when: thursday at 10:30 am with: , md building: lm bldg () campus: west best parking: garage md procedure: venous catheterization, not elsewhere classified diagnoses: tobacco use disorder diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation constipation, unspecified other specified cardiac dysrhythmias other late effects of cerebrovascular disease long-term (current) use of anticoagulants other specified peripheral vascular diseases gross hematuria leukocytosis, unspecified long qt syndrome dementia, unspecified, without behavioral disturbance chronic hypotension other specified disorders of urethra 

Answer: The patient is high likely exposed to