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 58 year old man with insulin dependent diabetes, end stage renal disease on hemodialysis, cad, congestive heart failure with ejection fraction of 30 to 35 percent, copd, who presented to the emergency room with fever, shortness of breath and fatigue for one to two days. the patient is status post admission through with progressive shortness of breath and bilateral pleural effusions (status post thoracentesis at that time with 2 liters off each side) and status post admission through for transition of peritoneal dialysis to hemodialysis. by wife's report, the patient had a temperature to 102 degrees at home with cough, increasing shortness of breath, but no sputum production. the patient was also noted to be confused, somnolent and agitated at times. the patient had hemodialysis on the day prior to admission without incident. he has intermittent hypotension after hemodialysis. he does not make any urine. the patient is on the transplant list for a kidney. review of systems is negative for diarrhea, emesis, nausea, pain. the patient has baseline poor p.o. intake with worsening over the last day. the patient is on home oxygen per wife's report that is new since last admission. oxygen requirement is 4 to 5 liters nasal cannula. he has never been intubated. in the emergency room the patient was treated with ceftriaxone, tylenol, 10 units of insulin and a 500 cc bolus that was repeated to 2 1/2 liters. the patient was also consented for a left internal jugular central line which was placed in the emergency room. levophed was started in the emergency room for low blood pressure. prior to insertion of central line, right sided thoracentesis was performed without complications. transudative fluid 1400 cc was removed. the patient had increasing agitation in the emergency room and was intubated for airway protection as well as hypercarbia. his initial blood gas was 7.30/42/61 on 6 liters nasal cannula. after intubation blood gas was 7.28/46/120, lactate 1.8. past medical history: diabetes since with nephropathy, retinopathy, neuropathy. end stage renal disease on hemodialysis since . the patient was on peritoneal dialysis prior to that. coronary artery disease three vessel disease on cardiac catheterization. hyperlipidemia. status post cva in with no residual effects. anemia. gastroparesis. copd. bilateral cataracts. depression/anxiety. migraines. hypertension as well as hypotension following hemodialysis. toxic shock with staph aureus in . the patient's primary care is dr. . the physician is . . the patient's cardiologist is dr. . the patient's pulmonary doctor is dr. . allergies: demerol, erythromycin, reglan all cause nausea and vomiting. social history: the patient lives with wife. quit tobacco 25 years ago with a 40 pack year history. no alcohol or drug use. medications on admission: insulin 15 units nph q.a.m., 5 units nph and 5 regular at bed time; cardizem 120 mg only if blood pressure is over 140/90; florinef 0.1 mg t.i.d. taken when blood pressure is low following hemodialysis; atenolol 25 mg q.day; domperidone 10 mg two to four times a day if eating; effexor xr 37.5 mg b.i.d.; trental 400 mg b.i.d.; diatx one time a day; plavix 75 mg one time a day; tincture of opium drops 36 drops with water; neurontin 300 mg take two tabs at supper; procrit 6500 units two times per week at dialysis; aspirin 325 mg q.day; vitamin e q.day; trazodone 50 mg p.o. q.h.s.; lipitor 10 mg q.h.s. please note that the patient covers himself with sliding scale insulin throughout the day in addition to his standing nph and regular dosing. physical examination: temperature 98.2, blood pressure 124/74, pulse 73, respirations 14. vent settings pressure support/simv fio2 100 percent, respiratory rate 14, peep 5, sat 98 percent, pressure support 5. in general, the patient is sedated, appears older than stated age. heent pupils are equal, round, and reactive to light and accommodation. mucous membranes dry. neck engorged ej. supple neck, no rigidity. left ij in place. chest decreased breath sounds at bases, anteriorly clear. cardiovascular regular rate and rhythm, no murmurs, rubs or gallops. abdomen soft, nontender, no hepatosplenomegaly, normoactive bowel sounds. extremities right heel ulcer with minor erythema, no malodor, no drainage. dry skin. good pulses. neuro sedated. laboratory data: on admission to the intensive care unit white blood cells 15.1, hematocrit 36.8, platelets 269, 78 neutrophils, 13 bands, 1 lymphocyte, 7 monocytes. sodium 135, potassium 5.4, chloride 96, bicarbonate 23, bun 41, creatinine 5.3, glucose 468, anion gap 24. lactate 2.5. blood gas 7.30/42/61. alt 24, ast 23, alka phos 177, total bili 0.3. pleural fluid obtained in the emergency room shows total protein 2, glucose 373, ldh 148, amylase 28. corresponding serum ldh 263, serum total protein 5.1. cortisol stim test went from 53.9 to 60. chest x-ray shows right upper lobe infiltrate and bilateral pleural effusions. followup chest x-ray after thoracentesis is negative for pneumothorax. followup chest x-ray after line placement shows left internal jugular line in svc. ekg normal sinus rhythm, rate 75, old q waves 2, 3, v3, flattened sts that are old consistent with ekg in . hospital course: 1. respiratory failure. the patient was intubated for airway protection due to increased agitation and intolerance of bipap in the emergency room. the patient's mental status continued to decline in the emergency room. the patient was quickly changed to pressure support and was extubated within 24 hours of intubation. 2. pneumonia. the patient has a new right upper lobe infiltrate on x-ray along with increased white count with left shift. the patient was treated with ceftriaxone, levofloxacin and vancomycin for broad coverage. blood cultures and pleural fluid cultures were obtained and were negative to date at the time of this dictation. urine culture was not obtained due to lack of urine output. sputum culture was also not obtained due to inability to obtain sample. the patient's clinical status improved and his antibiotic regimen was tailored to levaquin upon transfer to the medical floor. 3. sepsis. the patient was initiated on the sepsis protocol during his icu admission. central venous pressure monitoring indicated pressures ranging from 11 to 18. svo2 monitoring ranged from sats of 50 to 70. the patient was initially on levophed, but was quickly weaned off with good pressures and was restarted on metoprolol within 48 hours of icu course. 4. pleural effusions. effusions are transudative and are consistent with congestive heart failure. these were tapped upon admission with worry that they were parapneumonic, however, this was ruled out. further chest x-rays showed reaccumulation of fluid, however, the patient did not have significant shortness of breath and these were not retapped. 5. coagulopathy. the patient's coagulation studies were increased to an inr max of 2.5. a dic panel was checked as well as lfts which were normal. this was thought to be likely due to malnutrition and the patient was started on three days of vitamin k with correction of his inr to normal. 6. end stage renal disease. the patient was seen by the renal service during admission and had two hemodialysis sessions during his icu course. the patient was started on calcium acetate as well as aluminum hydroxide to decrease his elevated phosphate. the patient was maintained on midodrine as well as florinef for hypotension during dialysis. the patient received epogen at dialysis as well. 7. diabetes mellitus. the patient was maintained on a sliding scale with q.i.d. checks. an insulin drip was never needed. he was continued on half of his regular nph dosing while npo. 8. hypotension. this was resolved within 24 hours and pressors were stopped. an a-line was placed in the right upper extremity and was discontinued within 24 hours of placement. 9. coronary artery disease. the patient's enzymes were cycled and negative except for a small troponin leak which is not surprising in the setting of sepsis and renal failure. the patient's ekg was unchanged. he was continued on plavix and aspirin. 10. anemia. the patient received epogen at hemodialysis. 11. nutrition. the patient was started on tube feeds during intubation and was quickly transitioned to a p.o. diabetic diet upon extubation. 12. depression. the patient was continued on venlafaxine and was given trazodone q.h.s. 13. prophylaxis. the patient was continued on lansoprazole and heparin as well as colace. 14. code status. code status was discussed with the patient and his wife. is a full code. disposition: the patient was seen stable for transfer to a regular medical floor and is awaiting a bed at the time of dictation on . please see addendum to this discharge summary. it is of note that the patient has a right permcath for his hemodialysis which was not mentioned above. it is also of note that the family has requested a congestive heart failure consult upon transfer to the floor. this will be communicated to the team. transfer medications: 1. trazodone 50 mg q.h.s. 2. florinef 0.1 mg t.i.d. 3. levofloxacin 250 mg p.o. q.four to eight hours day five. 4. aluminum hydroxide 30 mg q.i.d. times one day for hyperphosphatemia. 5. midodrine 5 mg q.hemodialysis. 6. metoprolol 12 1/2 mg b.i.d. 7. vitamin k 10 mg q.day, day three out of three. 8. haldol p.r.n. 9. calcium acetate 1334 mg t.i.d. 10. colace. 11. lansoprazole 30 mg q.day. 12. bisacodyl. 13. heparin 5000 subcu t.i.d. 14. venlafaxine 37.5 mg q.day. 15. plavix 75 mg q.day. 16. aspirin 325 mg q.day. 17. insulin nph 12 units q.a.m., 6 units q.p.m. plus sliding scale. followup: please see addendum to this discharge summary for completion of hospital course. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis thoracentesis non-invasive mechanical ventilation other transfusion of whole blood diagnoses: pneumonia, organism unspecified congestive heart failure, unspecified unspecified septicemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure hemorrhage of gastrointestinal tract, unspecified diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled nutritional marasmus acute pericarditis in diseases classified elsewhere 

Answer: The patient is high likely exposed to