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: penicillins / olanzapine attending: chief complaint: afib chf exacerbation major surgical or invasive procedure: cardioversion right internal jugular catheter history of present illness: this is a 74 year old man with history of chf who was intially admitted to hospital with atrial fibrillation and chf exacerabtion and is now transfered to for further management. history was obtained from patient and medical records since the patient could not address many aspects of his presentation. on he presented to his pcp with shortness of breath and weight gain. at the time his weight was 251 lb (aproximately 25 lb increase) and he was noted to have worsened lower extremity edema. on this visit he was also noted to be in atrial fibrilation with a ventricular rate of 130 bpm (most recent ecg in is reported as sinus). at that time he was on diltiazem 240 mg daily, furosemide 40 mg daily and lisinorpil 20 mg daily. his furosemide was increased to 40 mg twice daily and he was started on metoprolol succinate 50 mg daily. for unclear reasons his lisinopril was discontinued. on he presented to his pcps office again with symptoms of shortness of breath and was found to have atrial fibrillation with a rate of 150. he was refered for admission at hospital. there he was initially treated with diltiazem, metoprolol, digoxin and heparin ggt. acs was ruled out with cardiac enzymes and ecg. he was also given intravenous furosemide boluses for management of his chf exacerabtion. on he desaturated and he developed rapid ventricular response. a code was called without cpr administration. the patient was transfered to the icu. he was intubated and placed on furosemide ggt. he was started on digoxin and his diltiazem ggt was continued. acetazolamide was also started. he was extubated on and he has done well on 4l nc since then (02 sat 98%). his admission weight was 279 lb, which improved to 250 lb with diuresis. a tte on showed ef55% with septal hypokinesis as well as severe mr (with limited windows). repeat tte on confirmed severe mr with two separate jets tracking up. lenis were negative bilaterally. his urine output ranged from 100 to 300 ml/hr??. his hospitalization course at has been complicated by delirium with disorientation and combativeness. he developed hypokalemia in the setting of diuresis and although sputum cultures grew gnr (? e. coli) he has been afebrile without cxr changes suggesting pna. . on arrival to the ccu, he reported only intermittent cough that is non-productive and buttock pain at the site of his sacral ulcerations. he denied shortness of breath, chest pain, nausea, vomiting, diarrhea, fevers, chills. he is a poor historian and could not comment further on prior history. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . past medical history: htn chf copd ?cva obesity social history: -tobacco history: quit 40 yrs ago -etoh: no -illicit drugs: no -wife deceased, former truck driver, lives alone . family history: nc physical exam: admission pe: vs: t=99.8 bp=125/56 hr=110 rr=22 o2 sat= 94% on 15l fm general: obese male in nad. oriented x2, drowsy but arousable. mood, affect appropriate. inattentive on questioning. heent: ncat. sclera anicteric. perrl, eomi. mmm. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: rij in place, cvp transduced at 15. cardiac: pmi located in 5th intercostal space, midclavicular line. tachy, irreg, irreg, normal s1, s2. unable to appreciate m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. decreased bs b/l with few inspiratory crackles at the bases. abdomen: obese, soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. no sacral edema. skin: 4 sacral decubitus/periscrotal ulcers - stage two, two unstagable. no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ pertinent results: 04:01pm glucose-104 urea n-21* creat-1.1 sodium-141 potassium-4.0 chloride-100 total co2-34* anion gap-11 04:01pm estgfr-using this 04:01pm calcium-9.0 magnesium-2.9* 04:01pm vit b12-845 folate-17.1 04:01pm %hba1c-5.9 04:01pm digoxin-1.2 04:01pm hct-38.0* 04:01pm ptt-74.9* 08:19am blood wbc-9.0 rbc-4.64 hgb-13.3* hct-39.9* mcv-86 mch-28.6 mchc-33.4 rdw-14.7 plt ct-304 08:19am blood plt ct-304 08:19am blood pt-13.0 ptt-27.4 inr(pt)-1.1 08:19am blood glucose-98 urean-13 creat-0.8 na-144 k-4.6 cl-103 hco3-35* angap-11 05:17am blood alt-28 ast-22 ld(ldh)-226 alkphos-75 totbili-0.5 08:19am blood calcium-9.4 phos-3.2 mg-2.3 04:01pm blood vitb12-845 folate-17.1 02:20pm blood %hba1c-5.9 12:25am blood triglyc-192* hdl-23 chol/hd-8.3 ldlcalc-129 02:30pm blood type-art po2-64* pco2-63* ph-7.38 caltco2-39* base xs-8 02:30pm blood lactate-1.4 : inr 1.1 cxr - : findings: in comparison with the study of , there is little overall change. continued moderate cardiomegaly with mild engorgement of pulmonary vessels. progressive clearing of the left basilar atelectasis and effusion. elevation of the right hemidiaphragm persists with atelectatic streaks in the right lower zone. echo: : no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is normal free wall contractility. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. trace aortic regurgitation is seen. there is moderate/severe mitral valve prolapse. there is partial mitral leaflet flail. an eccentric, anteriorly directed jet of severe (4+) mitral regurgitation is seen. there is no pericardial effusion. brief hospital course: atrial fibrillation: apparently new onset since , however his most recent ecg prior to this was in . also pt is a poor historian. this was likely precipited by his chf exacerbation. after a tee revealed no clot, he was dc cardioverted. he was rhythm control with an amiodarone load and rate controlled with metoprolol. he was anticoagulated with heparin gtt (chads 2, note unclear h/o cva), and once he was determined not to be a current surgical candidate bridging with warfarin was undertaken. titrate to inr 2.0 - 3.0. . decompensated diastolic/systolic lv dysfunction: on presentation at osh, nearly euvolemic here. the exact etiology of the exacerbation was not known. the most concerning precipitant is worsening mitral regurgitation, although may be precipitated by dietary or medication noncompliance or gut edema and poor absorbtion. tte showed preserved systolic function. given his severe mr there is a component of systolic dysfunction as well given his ef<60. no baseline tte was available to determine progression of his lv dysfunction. his weight decreased by aprx 30 lb with furosemide gtt, and he was stabilized on his diuresis regimen with furosemide 60mg po qd. afterload reduction with a goal sbp<120 was acheived with bb and acei (lisinopril). there was some element of co2 retention with sedation, normalized now. as goal o2 sat is 88-90%, pt was weaned off o2 on day of discharge. . mitral regurgitation: most likely this is a chronic process. a history of rhd is not reported. no evidence of ischemic disease at osh to suggest acute mr mm rupture, but he has not been evaluated in past. tee shows no intracardiac thrombus. tee revealed partial posterior mitral leaflet with severe eccentric mitral regurgitation. patient was seen by ct surgery and deemed not to be a candidate at this time given ams, hypercarbia, deconditioning. dr. was contact and he decided to postpone cardiac catheterization until a time more proximal to his surgery. we will look into the mitral valve clip placement trial as a possible therapeutic alternative, though this was not immediately obvious as an option. . preventative medicine- his lipid panel revealed(tc-190, ldl-130, tg-192, hdl??????23) his a1c-5.9 was. . delirium: most evenings mr became disoriented and occasionally combative in the setting of acute illness. likely icu delirium vs. toxic metabolic cause exacerbated by sundowing. mr poorly to zydis. per sister, patient is independent at baseline. we attempted to regulate his sleep and wake cycle with seroquel qhs. rpr, b12, folate were all wnl. . medications on admission: home meds confirmed with outpt pharmacy: metoprolol succinate 50 mg daily furosemide 40 mg twice daily diltiazem 240 mg daily 20 meq kcl po daily - on transfer amio ggt 20cc/hr lopressor 5 mg q4 iv heparin gtt lasix 20 mg gtt digoxin 250mcg iv daily aspirin 325mg po acetazolamide 250 colace 100mg omeprazole 40mg daily potassium miconazole topical tid insulin ss albuterol/ipratropium nebs qid reglan prn ativan prn bisacodyl prn discharge medications: 1. furosemide 40 mg tablet sig: 1.5 tablets po once a day. 2. lisinopril 10 mg tablet sig: 1.5 tablets po daily (daily). 3. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 4. heparin (porcine) in d5w intravenous 5. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: titrate to inr 2.0 - 3.0. 6. metoprolol tartrate 50 mg tablet sig: one (1) tablet po twice a day. 7. lamisil at 1 % cream sig: one (1) topical twice a day. 8. potassium chloride 20 meq packet sig: one (1) packet po once a day. 9. aspirin 81 mg tablet sig: one (1) tablet po once a day. 10. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 13. quetiapine 25 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for aggitation. 14. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) vial inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 15. ipratropium bromide 0.02 % solution sig: one (1) vial inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. vial 16. outpatient lab work please check inr daily until > 2.0 discharge disposition: extended care facility: - discharge diagnosis: acute on chronic diastolic congestive heart failure atrial fibrillation with rapid ventricular response acute delerium mitral regurgitation chronic obstructive pulmonary disease onychomycosis and tinea pedis hypertension discharge condition: alert, oriented x2, delerium is clearing 1 assist to chair, able to take a few steps. discharge instructions: you had an acute exacerbation of your congestive heart failure and needed to be treated with furosemide intravenously and with increased pill doses. weigh yourself every morning, md if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. adhere to 2 gm sodium diet. you also had atrial fibrillation, an irregular heart rhythm that increases your risk of stroke. you were started on coumadin to prevent strokes and will stay on a heparin iv drip until the coumadin is therapeutic. you also became delerious in the hospital because you were sick. this should clear slowly once you get better. followup instructions: primary care: , phone: date/time: please make an appt after you get out of rehabilitation . cardiology: , a. phone: date/time: monday at 10:30am. procedure: diagnostic ultrasound of heart other electric countershock of heart diagnoses: mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation personal history of tobacco use pressure ulcer, lower back personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits obesity, unspecified pressure ulcer, heel delirium due to conditions classified elsewhere pressure ulcer, stage i pressure ulcer, stage ii acute on chronic combined systolic and diastolic heart failure dermatophytosis of foot dermatophytosis of nail 

Answer: The patient is high likely exposed to