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: shortness of breath major surgical or invasive procedure: central line placement history of present illness: this is an 87-year-old man with colon cancer who presents with several months of shortness of breath, dyspnea on exertion, and leg edema. he was initially noted to have a right pleural effusion back on when his cardiologist ordered a chest ct scan. he was seen today in the oncology clinic for evaluation of this possible malignant effusion, and he was noted to be hypoxic in the mid to high 80's on room air and he desaturated to 81% with ambulation. he was referred to the ed. he states that he has actually had slowly progressive dyspnea over the past year or more, and that he has also had leg edema for that same time period. he has noticed a recent worsening, but more with fatigue, poor appetite, and decreased ability to ambulate the same distances he was able to do before. he cannot go up stairs. he has not had any urinary symptoms, abdominal pain, fevers, or chills. he has had a midly productive cough. he has brown stools, but occasionally sees a little blood. past medical history: 1) sick sinus syndrome and bifascicular block s/p pacemaker 2) paroxysmal atrial fibrillation not on coumadin, svt and atrial flutter status post ablation 3) cataracts. declined surgery 4) echo : mild-to-moderate mitral regurgitation, ra and la 5) bph s/p turmp 6) b/l edema with skin changes 7) hard of hearing 8) hx of guiaic positive stools/gi bleeding 9) osteoarthritis 10) osteoporosis 11) subclinical hypothyroid state as per record 12) hx of syncope 13) renal insufficiency 14) right pleural effusion social history: lives alone. former smoker with 35-pk-yrs. no longer drinking alcohol, formerly had a couple of drinks a week. family history: brother had marrow stem cell transplant at age 82 sister died from heart attack. also had an unknown cancer. mother died from an unknown cancer. neice has unknown cancer. physical exam: t 98.0, hr 70, bp 120/81, rr 16, o2 sat 88-93% on 3-4l nc gen: alert and oriented. nad. heent: supple neck. anicteric sclera. slightly dry mm. no cervical lad. cv: rrr, ii/vi systolic murmur at llsb lungs: decreased bs and + dullness at right base. some coarse bs at the left base. abd: soft, mildly protuberant. nontender. ext: chronic venous stasis changes in both legs with 1+ bilateral pitting edema of the legs. neuro: a+o. non-focal. pertinent results: ct abd: 1. no definite evidence of central venous thrombosis although the opacifications of the veins is suboptimal. 2. probable "apple core" lesion in the hepatic flexure of the colon, which may be the area of suspected cancer. please correlate with other history. 3. new patchy opacity in the left lower lobe could represent aspiration or developing pneumonia. 4. large right-sided pleural effusion with associated lower lobe atelectasis, similar in appearance to the prior study. 5. bilateral kidney cysts, the largest of which are simple fluid attenuation. 6. enlarged prostate with central calcifications cxr: two views are compared with radiographs dated and the recent chest ct. there is cardiomegaly with pulmonary vascular congestion and blurring and interstitial edema, as before. the moderately large layering right pleural effusion is not much changed. the moderately severe centrilobular emphysema and several bilateral upper lobe pulmonary nodules are better appreciated on the cross-sectional study. cxr : impression: pa and lateral chest compared to through . small bilateral pleural effusions have both decreased since , but severe right basal atelectasis has worsened. top normal heart size unchanged. transvenous right atrial and right ventricular pacer leads are unchanged in their respective positions. upper lungs clear. no pneumothorax. cxr : impression: slight improvement in pleural effusions and left lower lobe atelectasis, but persistent right middle and lower lobe atelectasis. cxt : impression: stable unchanged bilateral small-to-moderate pleural effusions and persistent unchanged left lower lobe atelectasis and right middle and lower lobe atelectasis. vq scan: impression: stable unchanged bilateral small-to-moderate pleural effusions and persistent unchanged left lower lobe atelectasis and right middle and lower lobe atelectasis. glucose-97 urea n-26* creat-1.3* sodium-145 potassium-4.8 chloride-108 total co2-31 anion gap-11 wbc-4.9 hct-34.1* mcv-93 plt 225 (neuts-69.6 lymphs-19.0 monos-8.6 eos-2.3 basos-0.5) brief hospital course: 87 y/o male w/ multiple medical problems including untreated colon ca, bph, severe phtn, admitted from clinic w/ hypoxia of 81% on room air, transferred from floors w/ worsened hypoxia, hypotension, fevers, and leukocytosis consistent with urosepsis due to prolonged manipulation and trauma during foley insertion. patient grew our ceftriaxone sensitive e.coli and treated for a 2 week course with ceftriaxone. patient s/p continuous bladder irrigation with resolution of his hematuria. patient required pressors initially but was successfully weaned. patient was hypoxic at baseline with known transudative pleural effusions requiring tap on . etiology likely heart failure. hospital course by problem: hypoxia: - patient w/ significant dyspnea for last few months, had been seen in oncology clinic to work up possible malignant pleural effuions. etiology of the effusions unclear. had 2 pleural tap while in the hospital, the first one with over 1l fluid, and the second one with 1.2l of fluids removed. both taps c/w transudate, w/ negative cytology. tte showed severe phtn and rv diastolic dysfunction w/ fluid overload. no wml or ekg abn to suggest imi. high suspicion of pe in this cancer patient, but still does not explain etiology of effusions. degree of effusions seemed disproportionate to degree of rv diastolic hf. patient also has centrolobular emphysema on ct scan in the past. patient transferred to the oncology medical unit from the icu.. he was aggressively diuresed with iv lasix with drastic improvement of lower extremity edema. mild to moderate pulmonary effussions persistent on follow up cxrs. the etiology of the initial edema is likely heart failure related. he is being discharged with persistent oxygen requirement that has been weaned down from 5-6l nc to 2-3l nc, and will go home on this. the oxygen reqirement is likely multifactorial and related to heart failure, copd, and ? pe causing rll persistent effussion and atelectasis. - no cta to arf, v/q scan not an option to effusions - no empiric anticoagulation h/o gi bleed - pleurodesis not a good option given transudative etiology - vq scan indeterminent because of persistent stable effusion, atelectasis and underlying emphysema. . # septic shock: - acute sepsis from gu source in setting of prolonged urologic manipulation during foley insertion. patient intitially w/ fevers and leukocytosis. - was on vanc/zosyn/cipro for double coverage to intial growth of gnr from ucx. sensitivities back, cipro/vanc d/c??????d and zosyn switched to ctx on , continued through . - hypotension w/ infection and concominant diursesis. started on neo/levo/vaso for pressors, subsequently d/c??????d and pressures stable. . # hematuria/bph: patient with tramautic foley insertion as above. he is s/p cbi with resolution of hematuria. pt transferred from icu to oncology floor with foley catheter. pt failed voiding trial on , and foley resinserted on . he has an outpatient follow appointment made with urology for several days after discharge. continue terazosin . # diarrhea: patient with multiple, loose bowel movements. c diff negative x6. likely antibiotics related diarrhea given multiple abx for sepsis. treated with imodium prn, now without diarrhea. . # paf, sick sinus syndrome: on amiodarone at home, no rvr. continue home dose, currently in sinus. not anticoagulated given fungating colon ca. # colon ca: fungating mass dx in , patient declined treatment. was in clinic to evaluate pleural effusions. no malignant cells on cytology. while palliative resection was one therapeutic option given pencil thin stools, patient declining further work up /treatment. stools guaiac positive. . # arf: acute on chronic. worsened cr of 1.1 on admission, 2.4 now and stable. pre renal from septic shock/ diuresis vs atn from hypotension. renal u/s r/o??????d post-renal obstruction. not that cbi complete, will monitor urine output. medications on admission: amiodarone 200 mg--1 tablet(s) by mouth daily aspirin 81 mg--1 tablet(s) by mouth daily lasix 20 mg--2 tablet(s) by mouth daily metoprolol succinate 25 mg--1 tablet(s) by mouth daily terazosin 5 mg--1 capsule(s) by mouth daily tylenol 650 mg daily mvi discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 4. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 5. terazosin 5 mg capsule sig: one (1) capsule po once a day. 6. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever. 7. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 8. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) inhalation q6h (every 6 hours). 9. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 10. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnosis: 1. hypoxia 2. urosepsis 3. urinary retention 4. acute exacerbation of congestive heart failure 5. pneumonia 6. copd 7. diarrhea . secondary diagnosis: - sick sinus syndrome discharge condition: stable, no shortness of breath, requiring 3l o2 for sats >90%. discharge instructions: you were admitted to the hospital with shortness of breath. this was thought most likely due to lung disease from smoking, heart failure, atelectasis (collapsed lung), fluid in your lung, and pneumonia. we treated you for pneumonia with antibiotics, we also removed fluid from your lungs and this has not re-accumulated, and we have treated you with diuretics (water pills) to help remove fluid from your lungs. your breathing has improved significantly, although you are still requiring 3l of oxygen. we would recommend that you continue to use 3l of oxygen. . while you were here, you also developed a very serious blood infection related to your bladder. you were treated with antibiotics in the intensive care unit and you recovered very well from this infection. . please continue to take all your medications as prescribed. the following changes have been made: - nebulizer treatments: you should take albuterol and ipratroprium nebulizers every 6 hours - oxygen: you should use at least 3l of oxygen for daily activity . if you have symptoms of worsening fevers, chills, night sweats, chest pain, abdominal pain, light-headedness, pain or burning with urination, shortness of breath, or worsened lower extremity swelling, please seek immediate medical attention. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet followup instructions: please follow up with urology on thursday at 9:45am in 3. follow up with your pcp , . in weeks. procedure: venous catheterization, not elsewhere classified thoracentesis diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) severe sepsis chronic airway obstruction, not elsewhere classified atrial fibrillation acute on chronic diastolic heart failure chronic kidney disease, stage iii (moderate) cardiogenic shock septic shock primary pulmonary hypertension retention of urine, unspecified septicemia due to escherichia coli [e. coli] malignant neoplasm of other specified sites of large intestine bacterial pneumonia, unspecified 

Answer: The patient is high likely exposed to