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: albumin products / lipitor / mevacor / ace inhibitors / amiodarone attending: chief complaint: shortness of breath with progression over the past 3 days major surgical or invasive procedure: hemodialysis history of present illness: 55m with chf who is admitted from dr. clinic for diuresis. mr. has h/o afib, cad s/p mi and cabg + mvr , re-do mvr and most recently in underwent tricuspid valvuloplasty + mvr + -atrial maze. subsequently had worsening fluid retention and admitted to cardiac for exacerbation of congestive heart failure. echo revealed normal working bioprosthetic mitral valve and no tr. was gently iv diuresed with lasix gtt and discharged home after 6 day hospital course. subsequently underwent successful cardioversion on for his af followed by a plasmapheresis for his high ldl . over the past week has noticed worsening leg edema, increased abdominal girth and decreased exertional tolerance - short of breath at twenty paces. he increased lasix from 40 to 60 on then 60 to 80mg 4 days ago without improvement. he is currently 217lb and says his dry weight is 205. this morning felt especially weak and malaised, had trouble sleeping at night. saw dr. in clinic who referred him to the ccu for further treatment. he denies any recent symptom of febrile/infectious illness. denies food indiscretion. he has been taking his medications w/o fail. he denies recent chest pain. he denies orthopnea, pnd. reports nocturia x1. on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, cough, hemoptysis, black stools or red stools. denies recent fevers, chills or rigors. denies exertional buttock or calf pain. all of the other review of systems were negative. cardiac review of systems is notable for absence syncope or presyncope. see hpi otherwise. past medical history: - mitral valve regurgitation s/p mitral valve replacement in , - tricuspid valve regurgitation s/p tricuspid annuloplasty in - chronic systolic congestive heart failure - coronary artery disease, s/p mi in , s/p s/p cabg (lima to lad, svg to om, svg to pda to plv) ,rca and lad pci's - paroxysmal/persistent atrial fibrillation s/p five prior cardioversions, ablation in and biatrial maze in - history of nsvt s/p aicd implant in , vt ablations - moderate pulmonary artery hypertension, aicd reimplant in - severe hyperlipidemia(intolerant of statins, undergoes plasmapheresis every two weeks at kidney center with av graft in the left arm - mild anemia - obstructive sleep apnea (cpap) - chronic renal insufficiency - carotid disease - chronic renal insufficiency social history: the patient is married and has two children 14 y/o girl, 17 y/o boy. he is a substitute teacher in a local elementary school and is currently not working. he was a salesman in the past. he quit tobacco over 20 years ago and had prior 20 pack year history, occasional beers but not for the past 2 months. . family history: father - healthy mother - atrial fibrillation + cad. 4 brothers, 1 sister healthy. physical exam: on admission: general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: jugular veins are prominent to earlobe, jh reflux positive. cardiac: rrr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: minimal -basilar crackles, no wheezes or rhonchi. abdomen: distended but soft, nt. there is flank dullness and shifting dulness. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominal bruits. extremities: no femoral bruits. edema + 4 to thighs, minimal pitting edema on sacrum. skin: stasis dermatitis on shins, no ulcers, av fistula on his left forearm pulses: right: carotid 2+ femoral 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ dp 1+ pt 1+ on discharge: dry weight 83kg, on room air, jvd to ~4cm above sternal notch lungs clear bilaterally ext with 1+ pitting edema pertinent results: admission labs: 03:27pm glucose-118* urea n-35* creat-1.7* sodium-130* potassium-9.8* chloride-95* total co2-30 anion gap-15 03:27pm ck(cpk)-178 03:27pm ck-mb-2 ctropnt-0.03* probnp-* 03:27pm calcium-9.4 phosphate-4.1 magnesium-2.2 03:27pm wbc-4.3 rbc-2.84* hgb-9.0* hct-27.3* mcv-96 mch-31.6 mchc-32.9 rdw-16.4* 03:27pm plt count-181 03:27pm pt-20.8* ptt-28.8 inr(pt)-1.9* micro: 9:31 pm urine source: cvs. **final report ** urine culture (final ): enterobacter cloacae. >100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- 64 i tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s studies: ekg: marked baseline artifact. normal sinus rhythm alternating with an atrial paced, ventricular sensed and atrial paced, ventricular paced rhythm alternating with one hundred percent ventricular paced rhythm. frequent ventricular premature beats and one ventricular couplet is noted. in the leads which are comparable to tracing performed on there is no diagnostic interval change. several leads cannot be compared because all the beats are paced. cxr: current study demonstrates interval progression of interstitial pulmonary edema currently moderate in severity associated with small bilateral pleural effusions. pacemaker defibrillator leads are unchanged. replaced valve, most likely mitral appears to be in unchanged position. no pneumothorax is seen. tte: the left atrium is moderately dilated. the left ventricular cavity is moderately dilated. lv systolic function appears moderately-toseverely depressed (on milrinone), left ventricular ejection fraction = 30%. however, the stroke volume and cardiac index are preserved (due to the fact that the left ventricle is dilated). the right ventricular free wall thickness is normal. right ventricular chamber size is normal. with borderline normal free wall function. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. the gradients are higher than expected for this type of prosthesis. the tricuspid valve leaflets are mildly thickened. a tricuspid valve annuloplasty ring is present. there is mild tricuspid stenosis due to the annuloplasty ring. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. during transient total occlusion of the patient's arteriovenous fistula there was no change in left ventricular stroke volume. impression: dilated left ventricle; reduced left ventricular ejection fraction with preserved cardiac index; no change in stroke volume during temporary occlusion of arteriovenous fistula ekg: artifact is present. probable atrial pacing with native ventricular conduction. ventricular ectopy. there is a non-specific intraventricular conduction delay. non-specific st-t wave changes. compared to the previous tracing of ventricular pacing is no longer present. tte: the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is severely depressed (lvef= 15-20%). there is a mild resting left ventricular outflow tract obstruction. the right ventricular cavity is dilated with depressed free wall contractility. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. the gradients are higher than expected for this type of prosthesis. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. a tricuspid valve annuloplasty ring is present. there is no pericardial effusion. compared with the prior study (images reviewed) of , left ventricular systolic function appears similar to slightly more vigorous. qrs appears slightly narrower and wall motion appears slightly more synchronous. brief hospital course: 55m with chronic systolic chf ef 20%, h/o afib, cad s/p mi and cabg + mvr , re-do mvr ; tricuspid valvuloplasty + mvr + -atrial maze , s/p successful cardioversion 8 days prior to admission for af who is admitted with worsening heart failure evidenced by significant fluid retention. diuresed 20l with iv medication and discharged home in stable condition. # acute on chronic systolic heart failure: patient was s/p recent surgery with mitral + tricuspid annuloplasty with post surgical course notable for worsening fluid retention. on admission weight was up approximately 20l of fluid. echo was unchanged from prior. he was aggressively diuresed with iv lasix, dopamine and milrinone which initially he did not respond to. renal was consulted for uf and he underwent one treatment through is av fistula with marked improvement in his reponse to the iv medications. he was negative 19l for his length of stay. he was transition to oral diuresis of metolazone and torsemide and stopped his lasix as it had been ineffective as an out-patient. additionally, his heart rate was not well controlled on his home cardevilol and heart rate control was felt to be important to maintain adequate cardiac filling time. his carvedilol was stopped and metoprolol succinate 200mg once a day was started. # acute on chronic kidney injury: felt to be pre-renal in setting of poor forward flow from acute chf. initally required uf once with renal and then responded well to iv diuresis. creatinin returned to baseline. # hypokalemia: required twice daily repletion in setting of aggressive diuresis and discharged home on home oral potassium # coronary artery diease: asymptomatic throughout hospital stay. continued on home medications except cardvedilol change to metoprolol succinate as above. he receives -monthly plasmapheresis for ldl as he has experienced significant side effects from statin therapy. # atrial fibrillation: long history of af s/p pvi and most recently cardioversion prior to admission. rate control was not adequate on carvedilol and changed to metoprolol as above. patient was continued on digoxin and warfarin. # urinary tract infection: postive ua and culture grew out enterobacter. he was treated initially with ceftriaxone and changed to po bactrim and completed a 7 day course on . # chronic back pain: treated with standing tylenol. no focal deficits on neuro exam and was consistent with musculoskeletal strain. # osa: patient was offered cpap at home settings, initially continued but then refused. # chronic normocytic anemia: multifactorial in setting of ckd and acute and chronic illness. remained at baseline. # code: full (discussed with patient) medications on admission: carvedilol 25 mg digoxin 125 mcg daily furosemide 80 mg tablet potassium chloride 10 meq tablet daily spironolactone 25 mg daily warfarin 3 mg tablet daily zolpidem 5-7.5mg daily aspirin 81 mg tablet daily discharge medications: 1. torsemide 20 mg tablet sig: three (3) tablet po once a day. disp:*90 tablet(s)* refills:*2* 2. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 5. warfarin 1 mg tablet sig: three (3) tablet po once a day. 6. metolazone 2.5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. metoprolol succinate 200 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. disp:*30 tablet extended release 24 hr(s)* refills:*2* discharge disposition: home discharge diagnosis: 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: you were admitted to the hospital for congestive heart failure. 20 l of water were removed with a lasix infusion. the following medication changes were made: ***stopped: lasix, please stop taking this medication. ***stopped: carvedilol, you should stop taking this medication. ***started: torsemide 60mg once a day (a total of three 20mg tablets). this is a medication that will help your body get rid of the extra fluid in your body and it replaces the lasix. ***started: metolazone 2.5mg once a day. this medication will also help your body get rid of fluid. ***started: metoprolol succinate 200mg once a day, this replaces the carvediolol. no other medication changes were made, you should continue all your other home medications as previously directed. please be sure to weigh yourself every morning, md if your weight goes up more than 3 lbs. it was a pleasure meeting you and participating in your care. followup instructions: department: cardiac services when: monday at 3:30 pm with: dr. building: sc clinical ctr campus: east best parking: garage department: cardiac services when: wednesday at 4:00 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: hemodialysis central venous catheter placement with guidance diagnoses: anemia in chronic kidney disease obstructive sleep apnea (adult)(pediatric) other chronic pain urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status hypopotassemia chronic kidney disease, unspecified pure hyperglyceridemia other and unspecified hyperlipidemia old myocardial infarction heart valve replaced by transplant acute on chronic systolic heart failure backache, unspecified 

Answer: The patient is high likely exposed to