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: chf and nstemi major surgical or invasive procedure: intubation x2 hemodialysis esophagogastroduodenoscopy history of present illness: events / history of presenting illness: mr is a 81 yo man with h/o transitional cell ca of the bladder s/p nephrectomy in , type i diabetes, hypertension, cri (baseline cr 3.5), hypertension, hyperlipidemia who began having uri symptoms with cough productive of thick sputum last friday. he underwent radiation to a skin cancer on his cheek and has thereafter had very dry mouth and thick sputum he has been unable to cough up. he denies any fevers, chills, night sweats, weight-loss, or sick contacts but does report paroxysms of shortness of breath and one episode of dark red hemoptysis this morning. sunday evening he found himself breathing very uncomfortably with significant orthopnea. he denies nausea, diaphoresis, or chest pain. he presented to hospital at 3am on monday where his initial vitals were t 98.7, hr 88, rr 18, sao2 85% ra and 95% on 2l n/c, bp 151/72 with hr 85. cxr showed rt-sided infiltrate so he was started on ctx and azithromycin to treat community-acquired pneumonia. ekg initially showed nsr with rate 85 and no ischaemic changes. his hypoxia quickly worsened to requiring 100% nrb and was noted on cxr to possible pulmonary edema with bnp of 1259. he was treated with lasix without good result. he subsuquently ruled in for mi with ck peak of 211 and ck-mb of 8.5. he later went into rapid atrial fibrillation with heart rates in the 130's-140's and was subsequently placed on a diltialzem and heparin drip. he was also noted to have acute renal failure with cr of 3.5 up from his baseline of 2.8. . on review of symptoms, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, joint pains, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. . *** cardiac review of systems is notable for mild chest pressure earlier this morning chest pain. at baseline he has no dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . past medical history: past medical history: type i diabetes transitional cell carcinoma s/p right nephroureterectomy and bcg therapy cri, baseline cr 2.8 (dr. primary nephrologist) htn hypercholesterolemia h/o a.fib/flutter s/p cholecystecomy s/p achilles tendon rupture . cardiac risk factors: diabetes, dyslipidemia, hypertension. no history of cardiac catheterization social history: social and family history: former smoker, quit 35 years ago. owns his own company that makes teflon that coats coronary stents. family history: has no fh early coronary disease. physical exam: physical examination: vs: t 98.6, bp 140/83, hr 95, rr 22, 93 o2 % on 100% nrb gen: wdwn elderly male in moderate respiratory distress. oriented x3. mood, affect appropriate. pleasant. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple, jvp difficult to assess due to habitus. cv: pmi located in 5th intercostal space, midclavicular line. irregular rhythm, tachycardic, normal s1, s2. no s4, no s3. chest: no chest wall deformities, scoliosis or kyphosis. moderate respiratory distress, coughing. loud ronchi heard throughout with -basilar crackles and scattered crackles throughout rt lung. abd: obese, soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; dp pulses not palpable but feet warm left: carotid 2+ without bruit; femoral 2+ without bruit; dp pulses non-palpable, but feet warm pertinent results: osh admission ekg: nsr with rate 86, normal axis, borderline lae, possible q in v1-2. no st of t wave changes. . ekg on transfer demonstrated coarse atrial fibrillation with ventricular rate of 120, normal axis, no hypertrophy, normal intervals. non-spesific diffuse st depression and twi. possible q wave in v1 and avr. . . . echo. the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the aortic valve leaflets (3) are mildly thickened. there is mild aortic valve stenosis (area 1.2-1.9cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. compared with the report of the prior study (images unavailable for review) of , there has been interval development of mild aortic stenosis and left ventricular hypertrophy (aortic valve velocity not evaluated on prior study). elevated left ventricular filling pressures are now present. estimated pulmonary artery pressures could not be assessed on the current study. the rhythm is now atrial fibrillation with a rapid ventricular response. . ett performed at hospital (records not available) on demonstrated: he exercised for 3 min and 39 sec on a protocol achieved a maximal heart rate of 94% with no angina or ischemic ekg changes there may have been a subtle inferior wall defect thought to be artifact. ef 65%. . cxr. . impression: new right upper lobe and right lower lung pneumonia possibly aspiration pneumonia with likely involvement of the left lower lung also. . egd .impresion:the previously noted mucosal abnormality on the incisura was not noted on this exam. otherwise normal egd to duodenal bulb . cxr comparison is made to the prior examinations dated and . the right-sided double lumen central venous catheter is stable in position. the cardiac silhouette is within normal limits. there is improvement of the vascular engorgement and asymmetric pulmonary edema noted on the prior examinations. the left retrocardiac opacity persists, likely reflects a small-to-moderate effusion and atelectasis, difficult to exclude pneumonia . complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:38am 12.4* 2.86* 9.2* 26.8* 94 32.0 34.1 15.9* 389 differential neuts bands lymphs monos eos baso atyps metas 06:30am 61.8 29.6 7.5 0.8 0.3 basic coagulation (pt, ptt, plt, inr) pt ptt plt smr plt ct inr(pt) 06:38am 389 chemistry renal & glucose glucose urean creat na k cl hco3 angap 06:38am 127* 32* 3.0* 138 4.1 100 30 12 brief hospital course: briefly, this is a 81ym with medical history including transitional cell ca s/p nephrectomy, htn, type i diabetes mellitus, cri (baseline cr approximately 2.8), who was initially admitted to for nstemi in the setting of afib with rvr. he had presented to an osh with uri-like symptoms one month ago and been treated for cap with a course of azithromycin. he subsequently decompensated into afib with rvr and when he presented to the tn was elevated over 2 and he had prominent airspace opacities on cxr. the patient was admitted to the ccu for hypoxia assumed to be secondary to pulmonary edema and mrsa pneumonia requiring intubation. the patient was transferred to micu care given hemodynamics consistent with sepsis, and eventually initiated on hd for worsening volume status and renal function. the patient was eventually successfully extubated although noted to develop hypoxia previously while awaiting hd over the weekend, and has now completed 14 day course of vanc for mrsa pna. his course has been further complicated by gib of an uncertain source while on asa, with egd showing abnormal gastric mucosa and esophagogastric erosions. asa was initially d/c'd. additionally, he also had very labile and poorly controlled blood glucose. . on , while on medical floor, the patient developed hyperglycemia into the 600s, uncontrolled with nph, and sob for 2-3 hours, with oxygen sats dropping to 88% even on supplemental oxygen. due to this hypoxia and hyperglycemia he was transferred to the micu for insulin gtt, hd, and closer monitoring. hypoxemia has responded to one session of hd with 2kg of ultrafiltration. he was taken off insulin gtt on and placed on lantus 40 and riss. at this lantus dose his bs dropped to 61 and 1 amp glucose was given; that evening lantus was lowered to 35u recs and morning labs showed bs = 41. the insulin was then sequentially lowered to 30, then 24, the following nights recs. . . . cardiac-- # rhythm. patient was initially admitted for atrial fibrillation with rvr to 140s, which required esmolol gtt and diltiazem gtt. he converted back to nsr with few recurrent episodes of afib, and is now back in afib. he has not reached target hr but well tolerates high hrs (90-110) and drops sbp when rate control is very aggressive. although he was initially anticoagulated with heparin gtt this was discontinued for gi bleed on . - we held asa for risk of bleed, and started asa after his repeat egd which showed normal gastric mucosa. - current rhythm afib on high-dose metoprolol and verapamil, with sbp maintained in the 110s-130s and hr ranges from 80s-90s. we changed his metoprol and verapamil to long-acting forumulations the morning of discharge. he is currently toprol xl 200 mg po and verapamil long acting 120 mg po. metoprolol can be titrated up as he was previously on metoprolol 100 mg tid. -he did not come into the hospital on coumadin, but recommended that he follow up with his pcp regarding initiation of anticoagulation. he had a regular rate and rhythm on morning of discharge. . # pump. recent echo with preserved ef. volume overload was present in setting of arf, he has had 12# taken off during the course of hospitalization. - hd on mon/wed/fri schedule . # hypoxia. hypoxia during hospitalization was secondary to volume overload and later mrsa pna (see below). volume has responded well to hd. currently not hypoxic and off of o2. required intubation during first ccu stay and was extubated, then reintubated during following micu stay, stabalized, and sent to the floor, extubated. - continued hd on mon/wed/fri schedule per above . # hyperglycemia. labile and high blood sugars required insulin gtt and micu transfer. the team was following. at discharge on lantus 18 u with sliding scale. his blood sugars ranged 142-291 on day of discharge. . . # pneumonia. resolved. patient had mrsa pneumonia, initially treated with levo/flagyl, now s/p 14 days vancomycin/zosyn without evidence of infection. - we continued chest pt, incentive spirometry -he had a low grade temp and a slightly elevated wbc, a repeat cxr showed showed a l retrocardiac opacity that most likely was a small effusion with atelectasis, but could not exclude pneumonia. it was unchanged from pervious week's cxr. blood cultures are pending. . # recent gi bleed. hct stable at last check. endoscopy (egd) during admission to ccu revealed no active bleeding, but the presence of abnormal mucosa, possible hematoma. repeat egd showed normal esophagus to duodenum. previously noted mucosal abnormality was not there. we stopped asa initially but restarted after the repeat egd. we continued his ppi. . # arf. patient with chronic renal failure secondary to hypertensive and diabetic nephropathy as well as s/p nephrectomy for tcc. on admission, patient was in acute on chronic renal failure and was oliguric. impression was patient had pre-renal arf from poor forward flow in setting of afib - hd was inititated on mon/wed/fri . # low grade temperature --?aspitation pneumonia/pneumonitis. increase in wbcs. he denied fever, cough, sob, diarrhea, dysuria. repeat cxr showed no change from previous weeks study. slight retrocardiac opacity that could not exclude pneumonia. urinalysis negative. urine cultures and blood culture pending. recommend follow up speech and swallow assessment. medications on admission: home medications: *** humalog 4 units q am, 6 units q pm humalin n 26 units q am lopressor 100 mg norvasc 5 mg lasix 40 mg qam, 20 mg qpm allopurinol 100 mg colchicine 0.6 mg q day aspirin 81 mg q day colace 100 mg q day catapress 11 patch q week primrose oil 1000 mg 1 preservision discharge medications: 1. docusate sodium 100 mg capsule : one (1) capsule po daily (daily). 2. allopurinol 100 mg tablet : one (1) tablet po every other day (every other day). 3. atorvastatin 40 mg tablet : one (1) tablet po daily (daily). 4. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 5. artificial saliva 0.15-0.15 % solution : 1-2 mls mucous membrane q4-6h (every 4 to 6 hours) as needed. disp:*50 ml(s)* refills:*0* 6. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup : five (5) ml po q6h (every 6 hours) as needed for cough. disp:*30 ml(s)* refills:*0* 7. magnesium hydroxide 400 mg/5 ml suspension : thirty (30) ml po q6h (every 6 hours) as needed. disp:*120 ml(s)* refills:*0* 8. senna 8.6 mg tablet : two (2) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*0* 9. albuterol sulfate 0.083 % (0.83 mg/ml) solution : one (1) inhalation q4h (every 4 hours) as needed. disp:*1 * refills:*0* 10. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). disp:*60 tablet,rapid dissolve, dr(s)* refills:*2* 11. insulin glargine subcutaneous 12. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). 13. aspirin 325 mg tablet : one (1) tablet po daily (daily). 14. epoetin alfa 4,000 unit/ml solution : one (1) injection mwf (monday-wednesday-friday). 15. verapamil 120 mg tablet sustained release : one (1) tablet sustained release po q24h (every 24 hours). 16. metoprolol succinate 100 mg tablet sustained release 24 hr : two (2) tablet sustained release 24 hr po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: primary: atrial fibrillation hypertension diabetes mellitus type i upper gastrointestinal bleed acute renal failure - initiation of hemodialysis. secondary: chronic renal insufficiency history of methicillin resistant staph aureus pneumonia history of transitional cell carcinoma status post nephrectomy peripheral arterial disease of rt leg, b carotids hypercholesterolemia status post cholecystecomy status post achilles tendon rupture paget's disease of the bone s/p rt hip surgery discharge condition: stable discharge instructions: you were admitted to the hospital with difficulty breathing. you have had an extended hospital stay with multiple problems including a high heart rate, an upper gastrointestinal bleed, pneumonia, and high blood sugars. . we have made many changes to your medications, so it is important that you dispose the old medications and continue current meds as prescribe done on discharge. . if you have shortness of breath, chest pain, fevers, nausea, vomiting, fluctuations in your blood sugars please contact your pcp or return to the emergency room. followup instructions: you should also have a follow-up appointment with your pcp weeks after discharge. please call dr. at . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other endoscopy of small intestine other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis diagnoses: subendocardial infarction, initial episode of care pure hypercholesterolemia congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation infection with microorganisms resistant to penicillins chronic kidney disease, unspecified acute respiratory failure methicillin susceptible pneumonia due to staphylococcus aureus hemorrhage of gastrointestinal tract, unspecified diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled personal history of malignant neoplasm of kidney 

Answer: The patient is high likely exposed to