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: hypotension, worsening oxygen requirement major surgical or invasive procedure: dialysis history of present illness: mr is a 65 year old male with a history of diastolic chf (ef > 60%), cad s/p cabg in and stemi with three stents placed, esrd on hemodialysis s/p failed transplant and known chronic bilateral pleural effusions with associated trapped lung who presented on with worsening dyspnea on exertion. . the patient has had worsening dyspnea on exertion for approximately one month. he presented to center on at which times he was diagnosed with a posterior stemi and underwent thrombectomy to the pda, and three vision stents to the pda. his procedure was complicated by ventricular fibrillatoni arrest which requierd 2 shocks. peak troponin i was 21 and ck 657. he was subsequently transferred to for persistent dyspnea on exertion. he was admitted to this hospital from to . during that admission he was noted to have persistent large pleural effusions but was not considered a candidate for pleurex catheter placement given his need for aspirin and plavix. rheumatology evaluation was negative. his effusions were felt to be secondary to his diastolic heart failure and volume overload from chronic hemodialysis. he was started on digoxin and underwent scheduled dialysis and was discharged home. . he returned on with persistent shortness of breath without recurrent chest pain. he underwent his regularly scheduled dialysis on friday but on returning home could not climb the steps to his home. his dyspnea resolved within about 5 minutes but then returned. he initially presented to where he received plavix, cefepime and vancomycin and was transferred to for further evaluation. reportedly he had a low grade fever at . . in the ed, initial vitals were t: 97.9, bp: 100/64, hr 68, rr 18, o2 96% 2l. exam was notable for decreased breath sounds at the bases. troponin was elevated at 6.23. bnp was elevated at . there was initially concern for pulmonary embolism but the patient refused heparin gtt and cta. he was admitted to as an nstemi and for doe. . on arrival to the floor, patient was comfortable. he denied lower extremity edema, orthopnea or paroxysmal nocturnal dyspnea. he was not experiencing palpitations. his nephrologists have been aggressively dialyzing him for his pleural effusions and he was at his dry weight. although he endorsed a low grade fever in the emergency room he otherwise denied fevers, chills, nausea, vomiting, diarrhea, constipation, abdominal pain or dysuria since discharge. . since admission he has had a persistent oxygen requirement ranging from 2 to 4 l nasal canula. antibiotics were discontinued on admission. he underwent echocardiogram on which showed improvement of his ejection fraction to 60%, diastolic dysfunction and moderate pulmonary hypertension. he underwent right sided thoracentesis on complicated by the development of a small basilar pneumothorax. 600 cc serosangionous fluid was removed and fluid studies were consistent with transudate. he underwent hemodialysis on and with blood pressures ranging from 90s to 100s systolic. he was evaluated by thoracic surgery for potential vats decortication and pleurodesis and was felt not to be a surgical candidate. . he first triggered at on for hypotension and hypoxia with blood pressure of 88/64 and o2 sats of 86% on 3l. t max was 99.9. cxr showed reaccumulation of right sided pleural effusion. blood cultures were drawn. he triggered again on for hypotension to the 60s systolic and somnolence. abg at that time was 7.31/58/79 on 4l nasal canula. ekg showed normal sinus rhythm, normal axis, qtc 485, twf ii, iii, avf, twi v1-v3, compared to prior dated twi were more prominent. he had a right ej 18 g placed and received 2 l normal saline bolus and was transferred to the micu. he did not receive antibiotics prior to micu transfer. . on arrival to the micu he was persistently hypotensive to the 70s. peripheral dopamine is currently running at 20 mcg/kg/min with blood pressures in the 70s systolic. he has received a total of 4l normal saline. he had a left sided subclavian line placed. he had a stat echocardiogram which was unchanged from prior study dated . past medical history: past medical history: diastolic congestive heart failure: ef 60% coronary artery disease s/p 7-vessel cabg in stemi s/p vision stent x 3 on complicated by vfib arrest requiring 2 shocks atrial fib/ s/p ablation , recurrence in on coumadin upper gi bleed , pill esophagitis and - tear recurrent candidal esophagitis. esrd on hd, failed renal transplant in . recurrent squamous cell skin cancer, ? related to immunosuppression basal cell carcinoma diverticulitis. home o2 2l nc chronic bilateral pleural effusions . past surgical history: renal biopsy appendectomy left av fistula placement 30 years ago. skin resections for ca social history: social history is notable for his being married. he has 2 grownchildren. he lives with his wife. is a retired automation engineer. he does not drink alcohol. he smoked cigars for about a year years prior. he had tried marijuana 45 years ago. no other illicit drug use. he was exposed to second hand smoke as a child. although he states that he is still working in a pharmaceutical plant. he does have a dog at home. he lives in . family history: family history is notable for a brother with a deep venous thrombosis (dvt) at age of 67 physical exam: physical exam: vitals: t: 96.6 hr: 63 bp: 86/44 rr: 15 o2: 100% on 4l general: somnolent, responds to questions appropriately, oriented x 3, cachectic heent: nc/at, perrl, eomi without nystagmus, no scleral icterus noted, mm dry, no lesions noted in op neck: supple, jvp 12 cm pulmonary: diminished breath sounds bilaterally with dullness to percussion and trace crackes bilaterally cardiac: regular rate and rhythm, normal s1 and s2, no murmurs, rubs or gallops, well healed mid line cabg scar abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no c/c/e bilaterally, 2+ radial, dp and pt pulses b/l. left groin at site of catheter access is w/o hematoma or bruit but with minor bruising. fistua on left arm with + thrill and bruit, no le edema, dry scabs on le. lymphatics: no cervical, supraclavicular, or lymphadenopathy noted. skin: 1 cm hard bumps across legs, multiple areas of brusing, multiple areas of skin grafts pertinent results: 09:30am ck(cpk)-23* 09:30am ck-mb-notdone ctropnt-5.07* 01:28am comments-green top 01:28am lactate-1.0 01:15am glucose-84 urea n-24* creat-4.4* sodium-140 potassium-4.7 chloride-97 total co2-32 anion gap-16 01:15am ck(cpk)-24* 01:15am ctropnt-6.23* 01:15am ck-mb-4 probnp-* 01:15am digoxin-1.2 01:15am wbc-6.4 rbc-3.44* hgb-9.8* hct-31.7* mcv-92 mch-28.6 mchc-31.0 rdw-17.4* 01:15am neuts-77.8* lymphs-11.3* monos-9.7 eos-0.7 basos-0.5 01:15am plt count-239 01:15am pt-17.6* ptt-30.9 inr(pt)-1.6* imaging: cxr : upright radiograph of the chest: there has been no significant interval change with persistent bilateral pleural effusions and bibasilar opacities. cardiomediastinal silhouette is largely obscured by the pleural effusions and the basilar opacities; however, grossly unchanged. median sternotomy wires and mediastinal clips are unchanged. impression: no significant changes since , with persistent bilateral pleural effusions. echo : conclusions the left atrium is dilated. ef>60%. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic arch is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is a small pericardial effusion. impression: mildly dilated lv with mild symmetric lvh and preserved systolic function. diastolic dysfunction. mild mitral regurgitation. moderate pulmonary artery systolic hypertension. echo : conclusions the left atrium is dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no ventricular septal defect. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. no significant valvular abnormality seen. compared with the prior study (images reviewed) of , no change. cxr : findings: new left subclavian vascular catheter terminates in the proximal to mid superior vena cava, directed towards the lateral wall of this vessel. there is no evidence of pneumothorax. otherwise, no relevant changes since the recent radiograph performed a few hours earlier. cxr : large bilateral pleural effusions, greater on the left side are unchanged. there is mild worsening in moderate pulmonary edema. bibasilar consolidations, greater on the left side, are unchanged. cardiomediastinal silhouette is obscured by parenchymal opacities. sternal wires are aligned. brief hospital course: brief hospital course, by problem: 65 year old male with a history of diastolic chf (ef > 60%), cad s/p cabg in and stemi with three stents placed, esrd on hemodialysis s/p failed transplant and known chronic bilateral pleural effusions with associated trapped lung who was admitted to the hospital with nstemi in the setting of a recent stemi with stent placement. his hospital course was complicated by admission to the micu for refractory hypotension and worsening oxygen requirement. he was subsequently transferred to the medicine service for further evaluation. # shock: most likely etiology was thought to be septic shock during refractory hypotension. he required initially dopamine and levophed. most likely etiology would be pneumonia although blood stream infection was considered. patient was ablee to be liberated from dopamine fairly rapidly after micu admission. he had a repeat cardiac echo on which was compared to his admission cardiac echo on which did not appear to be cardiogenic shock. patient on low dose prednisone and random cortisol yesterday was 11.5. his blood pressures improved on vanco and zosyn and he was weaned off levo without complications. he was continued on a course of vanco and zosyn for hap. his cultures both at as well as continued to be negative. he was initially started on stress dose steroids and then tapered appropriately. on he was completely off pressors with stable blood pressure. hemodialysis was reinitiated and he tolerated it well. he was called out to the floor. blood pressures were stable after transfer. # pleural effusions/hypoxia: from admission, patient with increasing dyspnea and hypoxia thought most likely related to restrictive disase in setting of chronic pleural effusions and trapped lung. with abx treatment, his oxygen requirement was weaned down to 3l by nasal cannula and dyspnea is resolved. stable resp status off pressors. serial arterial blood gases were followed. given his need for aspirin and plavix, in addition to the loculations of the left pleural effusion, interventional pulmonary and thoracics did not think he was a surgical candidate. he was scheduled close follow up with both ip and pulmonary. #coronary artery disease: s/p recent posterior mi with pci and three vision stents complicated by vfib arrest requiring shocks. currently chest pain free. new echocardiogram without evidence of post-mi complications. ekg with new twi but no st segment changes. repeat cardiac enzymes with flat cks. he was continued on asa, plavix and his statin through his hospital course but his antihypertensives were held after he became hypotensive, and restarted (carvedilol and isosorbide). # chronic diastolic congestive heart failure: he was continued on carvedilol (at lower dose, prescription provided) once his blood pressures could tolerate them. digoxin was discontinued during this hospitalization, with the thought that it might be worsening his heart failure. aggressive fluid removal via hd was attempted but was not particularly successful. he was discharged on home oxygen. # atrial fibrillation: patient was put on heparin gtt as well as asa/plavix through his hospital course. his anticoagulation was initially discontinued, and warfarin was restarted on . he was then restarted on coumadin on (2mg daily). digoxin was discontinued as above. he should have his inr checked at his appointment with his primary care physician on tuesday. # esrd on hd s/p failed transplant: hd started back on once he was liberated from pressor requirement. his prednisone was continued. he was continued on sevelamer and fluconazole. approximately 3-3.5l were taken off with each dialysis session on , and . # gout: stable. patient continued on home allopruinol 100mg po. # recurrent esophagitis. he was treated with fluconazole without complications. # depression: continued on citalopram, increased to 30mg daily. medications on admission: allopurinol 100 mg po daily coreg 37.5 mg po daily citalopram 30 mg po daily epogen with dialysis fluconazole 100 mg po daily hydralazine 50 mg tid isosorbide dinitrate 40 mg po tid omeprazole 20 mg home oxygen 2l pravastatin 80 mg daily prednisone 2.5 mg daily sevelamer 800 mg po tid prometazine 12.5 mg po daily temezepam 15 mg po qhs:prn coumadin 2 mg po daily plavix 75 mg po daily digoxin 125 mcg q tuesday and saturday aspirin 325 mg daily discharge medications: 1. home oxygen home oxygen @ 2-4 liters per minute via nasal cannula conserving device for portability 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day): do not take the morning of hemodialysis. disp:*30 tablet(s)* refills:*2* 5. pravastatin 20 mg tablet sig: four (4) tablet po daily (daily). 6. isosorbide dinitrate 10 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 7. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. sevelamer hcl 400 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 10. fluconazole 100 mg tablet sig: one (1) tablet po q24h (every 24 hours). 11. citalopram 20 mg tablet sig: 1.5 tablets po daily (daily). disp:*45 tablet(s)* refills:*2* 12. allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). 13. promethazine 25 mg tablet sig: 0.5 tablet po q8h (every 8 hours) as needed for nausea. 14. temazepam 15 mg capsule sig: two (2) capsule po hs (at bedtime) as needed. 15. warfarin 2 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: , discharge diagnosis: acute on chronic diastolic congestive heart failure lvef 55% esrd on hd s/p failed renal transplant htn bilateral pleural effusions discharge condition: stable, sat low 90's on 2l nasal cannula discharge instructions: you were admitted with chest pain and difficulty breathing. you were found to have suggestion of another heart attack. you also had large amounts of fluid around and in your lungs. your blood pressure became very low and you required a stay in the medical intensive care unit. since then, we have been able to remove fluid from your body through dialysis, and you are going home with home oxygen. your medications have been changed: - your carvedilol has been cut in half (to 12.5mg twice daily) - your citalopram has been increased (to 30mg daily) - your hydralazine has been discontinued - your prednisone has been increased to 5mg daily - your isosorbide dinitrate has been decreased to 20mg three times a day - you should continue taking 2mg warfarin daily and have dr. recheck an inr - your digoxin was discontinued. . you must continue your aspirin and plavix until instructed to stop by your cardiologist. you should continue dialysis three times weekly, and keep all of your follow up appointments as scheduled. if you develop worsening shortness of breath, chest pain, palpitations, abdominal pain, nausea, vomiting, or other concerning symptoms, please seek medical attention immediately. . followup instructions: primary care: dr. phone: date/time: 12:00 cardiology: dr. phone: date/time: 2:30 interventional pulmonology: clinic interventional pulmonary (sb) phone: date/time: 10:00 pulmonology: dr. & dr. phone: date/time: 4:00 md, procedure: venous catheterization, not elsewhere classified hemodialysis thoracentesis arterial catheterization diagnoses: coronary atherosclerosis of native coronary artery unspecified pleural effusion congestive heart failure, unspecified unspecified septicemia severe sepsis coronary atherosclerosis of autologous vein bypass graft hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases depressive disorder, not elsewhere classified chronic kidney disease, unspecified pneumonitis due to inhalation of food or vomitus septic shock accidents occurring in other specified places surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation complications of transplanted kidney other esophagitis candidal esophagitis acute myocardial infarction of other lateral wall, initial episode of care 

Answer: The patient is high likely exposed to