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: palpitations, dizziness major surgical or invasive procedure: central line placement arterial line placement picc line placement cardiac catheterization icd placement history of present illness: mr. is a 60m h/o dilated cardiomyopathy, hypertension presents after episode palpitations, dizziness at home. he had just finished a large meal and was drinking a 'few' rum and cokes when he developed a fluttering in his chest, weakness, and lightheadness. he denies any chest pain, nausea, shortness of breath, or diaphoresis. upon ems arrival he was in a rapid wide complex tachycardia near 300 bpm presumed vt. per report, he was hypotensive and cardioverted x1 into sinus rhythm. he was given amiodarone 150 mg iv (infiltrated), then started on an amiodarone iv drip. on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. he had been feeling well prior to this episode but does not occasional similar short lived palpitations that last <1min and spontaneously resolve. all of the other review of systems were negative. cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. his weight has been stable recently, and notes mainly weight loss over the past months. in the ed, initial vitals were 98.4 94 103/66 12 99. he has remained asymptomatic with stable vital signs. ecg upon arrival with lbb and frequent pvcs. past medical history: 1. cardiac risk factors: - diabetes, - dyslipidemia, + hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: none -pacing/icd: none 3. other past medical history: dilated cardiomyopathy (diagnosed ) alcohol social history: married, small business owner. -tobacco history: never. -etoh: drinks per day, sometime more -illicit drugs: denies. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: general: wdwn. breathing comfortably. oriented x3. anxious. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 8 cm. cardiac: pmi laterally displaced and diffuse. irregular. normal s1, s2. systolic murmur at apex. no rubs or gallops. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. mild wheezes, no crackles or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: admission labs : 11:00pm wbc-11.6* hgb-14.2 hct-42.3 plt ct-202 11:00pm neuts-86.2* lymphs-8.0* monos-4.7 eos-0.7 baso-0.3 11:00pm pt-12.4 ptt-22.4 inr(pt)-1.0 11:00pm glucose-128* urean-31* creat-1.5* na-138 k-3.9 cl-102 hco3-21* angap-19 11:00pm ck(cpk)-165 11:00pm ck-mb-5 11:00pm calcium-9.6 phos-2.4* mg-1.8 . urine: 02:02pm color-yellow appear-clear sp -1.015 02:02pm blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-0.2 ph-5.0 leuks-tr 02:02pm rbc-21-50* wbc-21-50* bacteri-few yeast-none epi-0 05:01am bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg ---------------- discharge labs: 06:25am blood wbc-21.6* rbc-3.57* hgb-10.1* hct-30.7* mcv-86 mch-28.4 mchc-33.0 rdw-13.6 plt ct-538* 06:25am blood neuts-88.2* lymphs-4.5* monos-6.1 eos-1.1 baso-0.1 04:40am blood pt-14.2* inr(pt)-1.2* 06:25am blood glucose-99 urean-21* creat-1.2 na-135 k-4.4 cl-102 hco3-22 angap-15 06:47am blood alt-46* ast-33 ld(ldh)-284* alkphos-83 amylase-259* 06:47am blood lipase-552* 06:25am blood calcium-9.0 phos-3.2 mg-2.0 ---------------- micro: bcx - all negative ucx - all negative sputum cx - negative ---------------- studies: tte (): the left atrium is markedly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is severely dilated. there is severe global left ventricular hypokinesis (lvef = 10-15%). the estimated cardiac index is depressed (<2.0l/min/m2). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: dilated left ventricle with severe global systolic dysfunction and a low cardiac index. mild to moderate aortic regurgitation. moderate mitral regurgitation. mild pulmonary hypertension. . tte (): the left atrium is moderately dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity is severely dilated. there is moderate to severe global left ventricular hypokinesis (lvef = 30). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is moderately dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the left ventricle, while still hypocontractile and markedly dilated, is significnatly improved in terms of ejection fraction and stroke volume. . cxr (): cardiomegaly and moderate pulmonary edema . abdomen us (): 1. patent hepatic veins and portal vein. 2. coarse liver echotexture may represent diffuse hepatic disease and cirrhosi and/or fibrosis can not be excluded on this study. 3. 1-cm echogenic lesion in the right lobe of the liver may represent hemangioma. correlation with prior imaging is recommended. in case of underlying liver disease and/or concern for hepatic malignancy this lesion can be followed with mri in 6 months. 4. 7-mm left renal angiomyolipoma. . ct chest/abdomen/pelvis (): impression: 1. bibasilar consolidations with nodular opacities within the lungs. these findings are likely related to a multifocal pneumonia vs. aspiration pneumonia. 2. cardiomegaly, enlargement of the main pulmonary artery and interstitial thickening, likely on the basis of fluid overload. 3. extensive mediastinal and hilar adenopathy, as described above. also noted are calcifications within the lymph nodes. diagnostic considerations include an acute on chronic process. patient may have had a history of prior granulomatous process such as histoplasmosis. this lymphadenopathy is larger than usually seen as reactive to pneumonia and given the degree of adenopathy, malignancy is a concern. therefore, biopsy of one of the hilar and mediastinal lymph nodes may be warranted. these may be accessible vs. transbronchial biopsy. . cardiac cath (): comments: 1. coronary angiography in this left dominant system demonstrated single vessel disease. the lmca was without angiographically apparent disease. the lad had a 80% calcified lesion in the mid vessel and 40-50% more distally. there were mild luminal irregularities in the rest of the lad as well as the lcx. the rca was without significant disease. 2. resting hemodynamics revealed normal right and left heart filling pressures with preserved cardiac index at 2.4 l/min/m2. there was mild pulmonary artery hypertension with pasp 33 mmhg. the systemic and pulmonary vascular resistances were normal. there was no significant pressure gradient across the aortic valve. there was systemic arterial normotension. there was no evidence of constrictive or restrictive physiology and no evidence of intracardiac shunt by oximetry. 3. successful ptca and stenting of the lad with a 2.5x24mm endeavor stent that was postdilated to 3.0mm in its length and 3.25mm in the mid portion. final angiography revealed 10-20% residual stenosis, no angiographically apparent dissection and timi iii flow (see ptca comments). final diagnosis: 1. single vessel coronary artery disease. 2. successful pci of the lad. . cxr (): the position of the icd device is unchanged. irregular linear opacities in both the right and left lung are again noted. no pneumothorax is present. no failure is seen. brief hospital course: 60m with history of nonischemic cardiomyopathy admitted with wide complex tachycardia. 1. rhythm: admitted in cardiogenic shock s/p cardioversion for wide complex tachycardia, likely vt, near 300bpm. started on amiodarone gtt for load and transitioned to po amiodarone. remained in normal sinus rhythm with frequent ectopy which some nsvt. once hypotension had resolved, ectopy improved with discontinuation of dobutamine and uptitration of b-blocker. amiodarone was discontinued on for transaminitis and elevation of pancreatic enzymes. on , he had an episode of monomorphic vt. during the first one, the patient was hemodynamically unstable and terminated with lidocaine 100mg and did not require shock. he was started on a lidocaine drip. the drip was d/c on and he was restarted on amiodarone 400mg . amiodare was briefly discontinued secondary to a transient rise in liver enzymes and pancreatic enzymes. after an episode of nsvt, amiodarone was restarted without complication. he underwent icd placement on without complication. patient will require follow up of lfts, tfts, and pfts as an outpatient secondary to new amiodarone use. 2. coronaries: although patient has multiple risk factors for cad, including htn, hl, dm, and chf; he had refused a cardiac catheterization in the past so had unknown anatomy. upon admission, ekg was without symptoms concerning for acs and serial cardiac enzymes were negative. patient maintained on asa 325 and atorvostatin. a b-blocker was initiated and increased to toprol 75mg daily. the patient underwent cath and 2 endeavor drug-eluting stents were placed in lad. of note, patient will require plavix 75mg for ideally at least 1 year and will require asa indefinately. 3. hypoxia: upon hospitalization, acute respiratory failure from respiratory acidosis requiring intubation. initial etiology felt to be secondary to flash pulmonary edema with cxr showing bilateral diffuse infiltrates. subsequently developed increase in left retrocardiac opacity by cxr, increased sputum, fevers and leukocytosis felt to be related to vap. started on empiric antibiotic coverage with vancomycin, zosyn and ciprofloxacin on . repeat sputum cultures and blood cultures were negative. once pressors had been weaned, patient was aggressively diuresed with lasix drip. patient was able to be extubated without complication on . he continued to have high oxygen requirements with frequent desaturations that resolved with suctioning and positioning. despite successful diuresis, cxr continued to show diffuse bilateral inflitrates. ct torso showed bibasilar consolidations with nodular opacities within the lungs, consistent with multifocal vs aspiration pna; extensive mediastinal and hilar lad with calcifications - reactive vs malignancy. antibiotics were changed to vancomycin, meropenem on due to persistent fevers and ct findings and concern regarding occult resistant organizm in lungs. his white count then trended downwards. stool samples were negative for c diff. pulm was consulted, and felt that he was too high risk for bronch and that his lymph nodes were most likely reactive. antibiotic coverage was narrowed to meropenem for full 10 day course. hypoxia resolved over course of hospital stay and by time of discharge, patient was saturating well on room air both at rest and with ambulation. of note, the patient will require follow up ct scan of lungs approximately 6 weeks following discharge from hospital to ensure resolution of pulmonary nodules. 4. fever, leukocytosis ?????? admitted with wbc of 11.6 in setting of wide complex tachycardia s/p cardioversion. as noted above, patient subsequently developed fever and increased leukocytosis to 17.6, that was attributed to a ventilator associated pneumonia with symptoms of increased secretions and left retrocardiac opacity. started empiracally on broad spectrum antibiotics: vancomycin/ zosyn/ ciprofloxacin. initially, patient clinically improved and wbc normalized. however, on patient became febrile again wbc trended up, peaking at 21. evaluation for fever of unknown origin revealed mild transaminitis and elevated lipase but abdominal exam benign, ruq abdomen and ct scan abdoman were negative for acute process. blood, sputum, urine, stool cultures were unremarkable. most likely etiology of fever felt to be unresolved pneumonia with resistant organism. antibiotic coverage was switched to vancomycin and meropenem, and subsequently narrowed to meropenem for full 10 day course. while patient defervesced, wbc remained consistently elevated, and was rising on the day of discharge. patient developed gout flare during the same time. ua was negative. cxr was clear, and patient finished meropenem just a day prior. this new leukocytosis was attributed to gout flare, and patient was discharged with close lab monitoring. on the day of discharge, urine culture and c.diff were sent. the results were pending on discharge. if they are positive, patient will be contact to start antibiotics. 5. rue superficial thrombophlebitis: pt found to have occlusive thrombus in cephalic vein on rue u/s, patient was initially started on heparin drip due to arm swelling. however, he developed persistent substantial hematuria. since the patient did not have a rue dvt the heparin drip was discontinued. 6. transminitis/pancreatitis: patient complained of right abdominal and flank pain and the lfts and lipase were elevated. his symptoms quickly resolved. the initial concern was that the patient's transaminitis and pancreatitis was secondary to drug effect. his amiodarone was discontinued. his lfts quickly trended down. there was no evidence of a cholestatic pattern, ruq u/s with dopplers showed no acute pathology. 7. anemia: the patients hematocrit dropped initially; most likely dilutional due to fluid and medications given. no evidence of active bleeding. he did have some hematuria related to heparin later on. he did not require transfusion. his hct was 30 on discharge. 8. pump: the patient was found to have a dilated cardiomyopathy with ef 20% on initial echo on 3 pressors. he had a known cardiomyopathy but had refused outpatient evaluation. it was initially unclear if his cardiomyopathy was ischemic, alcoholic, vs idiopathic cmy. although cardiac catheterization did reveal some cad, it is likely that dilated cardiomyopathy was not fully explained by atherosclerotic burden. a repeat echo a week later showed ef 30%, markedly dilated lv, restrictive filling abnormality with elevated left atrial pressure. he was treated with lasix, metoprolol, spironolactone and lisinopril when blood pressure allowed. 9. ams: repeat episodes of delirium at night initially thought to be secondary to alcohol withdrawal, but then attributed to icu psychosis and systemic illness/ fevers. unlikely to be cns infection given non-focal neuro exam, no meningeal signs. the patient had paradoxical activation with ativan. he was given seroquel and qhs and all attempts were made to normalized day-night cycles. his mental status eventually cleared. medications on admission: carvedilol 6.25 mg lisinopril diuretic asa discharge medications: 1. outpatient lab work please check chem-7, cbc and lft's on and call results to dr. at 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*11* 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. metoprolol succinate 50 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po once a day. disp:*45 tablet sustained release 24 hr(s)* refills:*2* 8. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. spironolactone 25 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. cephalexin 500 mg capsule sig: one (1) capsule po q8h (every 8 hours) for 2 days. disp:*6 capsule(s)* refills:*0* 11. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for heartburn. 12. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day) for 2 weeks. disp:*56 tablet(s)* refills:*0* 13. amiodarone 400 mg tablet sig: one (1) tablet po once a day: decrease dose to 400 mg daily after you have finished two weeks of 400 mg twice daily. disp:*30 tablet(s)* refills:*2* 14. colchicine 0.6 mg tablet sig: one (1) tablet po once a day for 7 days. disp:*7 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: ventricular tachycardia hypertension acute on chronic systolic congestive heart failure discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: mr. , you had a dangerous heart rhythm called ventricular tachycardia and required shocks by the emt's. you were admitted and found to have congestive heart failure and a likely pneumonia. there were multiple enlarged lymph nodes found on the chest ct scan. you will need to have that repeated in 6 weeks to see if this is resolving and may need a biopsy. your liver function tests were elevated but are decreasing now. this may have been because of the cardiac arrest versus your alcohol intake. you cannot drink any more alcohol, it is harming your heart and possibly your liver. your right arm has a superficial clot in your cephalic vein, this does not need treatment. because your heart is weak, you will need to watch yourself for fluid overload that could include swelling in your legs, trouble breathing or fatigue. . please weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. . your white count was rising when you were discharged. this is most likely due to your gout flare. urine culture and stool studies were pending on discharge. we will call you if these studies turn out positive. in the mean time, please have your blood counts checked on monday, . . medication changes: 1. stop taking carvedilol and indapemide 2. start metoprolol succinate to lower your heart rate 3. decrease the lisinopril to 5 mg daily 4. increase aspirin to 325 mg daily for one year 5. start plavix every day for one year, do not stop taking this medicine for any reason unless dr. tells you to. 6. start taking spironolactone to help your heart work better 7. start cephalexin 500 mg capsule three times a day to prevent an infection at the icd site for 2 days 8. start taking thiamine, a b vitamin. 9. stop taking all of your supplements except for folic acid, calcium carbonate, and your multivitamin. 10. start amiodarone, a medicine to prevent ventricular tachycardia. you will take 400 mg twice daily for one week, then decrease the dose to 400 mg daily therafter. followup instructions: cardiology: dr. phone:( date/time: monday at 3:40 pm. . primary care: , r phone: date/time: please make an appt to be seen in 4 weeks to be seen. . electrophysiology: , md phone: date/time: at 1:40pm. device clinic: clinical center, , , , , phone: date/time: 11:30 radiology: - repeat chest ct scan to assess lymphadenopathy. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization implantation or replacement of automatic cardioverter/defibrillator, total system [aicd] insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: pneumonia, organism unspecified other primary cardiomyopathies anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis paroxysmal ventricular tachycardia acute respiratory failure cardiogenic shock phlebitis and thrombophlebitis of superficial veins of upper extremities acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to