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: benzodiazepines attending: chief complaint: found unresponsive major surgical or invasive procedure: right internal jugular vein central venous catheter placement - intubated prior to admission history of present illness: the patient is a 60yo m with history of chf, copd, dm who was brought to an outside hospital after bieng found down and was transferred here for management of shock and respiratory failure. . he was found unresponsive at home by his wife. she reported that he had increasing lethargy over the several weeks prior and seemed normal his morning but wa unresponsive around 3pm. at that time blood glucose was 41. he was given 1 amp d50 by ems. after an additional amp of d50 and blood glucose 195, his mental status was still poor. he was also hypothermic with temperative 93 and he was taken to . his initial vitals there were t 92.2 bp 105/60, hr 56, rr 12, o2 90. a head ct was negative. a cxr there was concernign for fluid overload. an echo showed ef 10-15%. he was intubated for concern for mental status. the initial impression was that he was in cardiogenic shock and he was started on a heparin gtt and given pr asa before transfer here. . on arrival here, his cxr was felt to be consistent with pneumonia and heparin was stopped and he was given cefepime and levofloxacin. glucose was still low at 56 and he was given 1amp d50. he arrived with peripheral dopamine. this was weaned off initially but blood pressure trended down and a r ij was placed and levophed started. on transfer, vs were 97/59, 57, 15, 99% vent fio2 100%, peep 5, tv 528 past medical history: chf depression copd gerd hyperlipidemia dm s/p r bka social history: - tobacco: 1ppd - alcohol: denies - illicits: denies family history: non-contributory physical exam: admission physical exam: general appearance: overweight / obese head, ears, nose, throat: normocephalic, endotracheal tube, og tube cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: not assessed), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: crackles : ) abdominal: soft, distended extremities: right lower extremity edema: 2+, left lower extremity edema: 2+, right bka skin: warm neurologic: responds to: not assessed, movement: not assessed, sedated, tone: not assessed exam: unchanged except for as below: weight at (after duiresis): 121kg lungs: mild crackles at the lung bases bilaterally, improved extremities: left bka, 1+ edema on right le heent: et and og tubes removed pertinent results: 06:45pm blood wbc-5.2 rbc-3.26* hgb-9.4* hct-30.4* mcv-93 mch-28.8 mchc-30.9* rdw-19.8* plt ct-355 06:45pm blood pt-20.6* ptt-150* inr(pt)-1.9* 06:45pm blood glucose-58* urean-42* creat-1.8* na-141 k-3.3 cl-110* hco3-19* angap-15 06:45pm blood alt-29 ast-28 alkphos-106 totbili-1.5 imaging: -cxr () - low-lying et tube. retraction by at least 1.5 cm is advised. advancement of ng tube result in more optimal positioning. scattered bilateral pulmonary opacities are concerning for multifocal pneumonia, less likely pulmonary edema. findings d/w dr. . -tte () - the left atrium is moderately dilated. late saline contrast is seen in left heart suggesting intrapulmonary shunting. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is severely depressed (lvef= 25 %) secondary to akinesis of the posterior and lateral walls and of the apex, and hypokinesis of the inferior free wall. the right ventricular free wall thickness is normal. the right ventricular cavity is dilated with depressed free wall contractility. 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. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. at least moderate tricuspid regurgitation is seen by color flow doppler. however, the inferior vena cava spectral doppler signal suggests that the tricuspid regurgitation could actually be 3+ or 4+. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. -renal us () - 1. markedly limited examination secondary to poor acoustic windows. no gross evidence of hydronephrosis. 2. doppler examination was unable to be performed. -ct head () - 1. no acute intracranial process. 2. apparent lucency through the right frontal bone, upon correlation with coronal and sagittal reconstructions, is felt to likely represent a suture, less likely nondisplaced fracture. clinical correlation may be helpful. -cxr () - in comparison with study of , the patient has taken a slightly better inspiration and the monitoring and support devices have been removed except for the left subclavian catheter. there is continued enlargement of the cardiac silhouette with mild elevation of pulmonary venous pressure, though this is substantially decreased from the previous study. -video swallow () - aspiration with thin liquids. for complete report, please see speech and swallow note in omr. labs: 07:20am blood wbc-5.6 rbc-3.03* hgb-8.7* hct-27.8* mcv-92 mch-28.8 mchc-31.4 rdw-17.3* plt ct-425 07:20am blood glucose-44* urean-62* creat-3.2* na-146* k-3.5 cl-100 hco3-34* angap-16 07:20am blood calcium-9.2 phos-5.3* mg-2.1 brief hospital course: 60m with chronic systolic chf (ef=25%), t2dm who p/w ams, bilateral opacities on cxr. # metabolic encephalopathy - most likely result of hypoglycemia and subsequent pneumonia. unlikely from stroke given normal head ct and lack of focal deficits. he was weaned off midazolam, but remained significantly altered. he has had prolonged delirium with benzos in the past. he was started on seroquel 50mg tid with little improvement. his sedation was switched to precedex with relatively little change. extubation was attempted but the patient was very altered and agitated, eventually requiring re-intubation. with time his mental status improved, and after extubation his mental status had cleared. seroquel was stopped. we held additional sedating medications and ms improved. he was noted to have periods where he was sleepy while on the floor, this usually occurred after he didn't wear cpap overnight and improved when he was compliant with this therapy. # septic shock - most likely pneumonia, ? community acquired vs. aspiration. he was started on broad spectrum antibiotics, levofloxacin/cefepime/vancomycin. his medication was dosed renally and for cvvh. he underwent bronchoscopy on which showed thick purulent sputum. urine legionella was negative. bal grew only yeast, which was not treated as the patient is immunocompetent. patient was treated for 8 days and abx were stopped. he subsequently had a fever but was hemodynamically stable. cultures were negative. his r ij was replaced by a picc line. the patient was afebrile x72hrs prior to leaving the icu. on the floor, he remained afebrile and hemodynamically stable. # multifocal pneumonia - differential includes community acquired vs. aspiration. he was covered broadly with cefepime, vancomycin and levofloxacin. treated for total of 8 days given the severity of his pneumonia, as above. speech and swallow after extubation found that he could eat normal solids and nectar pre-thickened fluids. re-evalution with a video swallow showed silent aspiration of thin liquids. at , he has only been cleared for nectar thick liquids and will need further assessment by speech and swallow at rehab. # hypoxic respiratory failure - most likely pneumonia. intubated while in the icu, successfully weaned and satting well on ra at . # acute on chronic systolic hf - ef was noted to be 25-30% over the last few years per outside record. repeat echocardiogram confirmed systolic heart failure. cardiac enzymes were mildly elevated but also in the setting of arf. trial of dobutamine was used during his initial micu stay, but was not found to be helpful. diuresis was held given septic shock. he was subsequently duiresed upon arrival to the floor. weight was 121kg. he will be discharged on lasix 80mg po bid. he is still thought to be total-body fluid overloaded and should continue to diurese net negative. unfortunately, he does not know his dry weight. he should have daily fluid inputs and outputs measured, as well as daily weights. he should also have outpatient discussion about aicd. # acute on chronic renal failure - most likely atn based on urine lytes and sediments and poor forward flow given schf and septic shock. nephrology evaluated patient as he became anuric. received cvvh via a left ij dialysis catheter for 3 days, finishing the evening . afterwards he received one session of intermittent dialysis before his urine output improved and he was able to be diuresed with doses of 80mg iv lasix. it remains unclear what his new baseline creatinine will be. at , cr has mildly improved to 3.5. his weight is 121kg. he will follow-up with nephrology after and did not require further hemodialysis on the floor. he was also started on acetazolimide for persistent metabolic alkalosis with an elevated bicarbonate level. # transaminitis. thought to be secondary to congestive hepatopathy. resolved at . # type 2 diabetes on insulin - found to be hypoglycemic at presentation, requiring d10. improved with tube feeds, and transitioned to regular sc insulin. at , he will be continued on lantus and sliding scale insulin. his po intake had been very variable and we significantly decreased his lantus this admission. he will likely need this titrated as his po intake improved over time. # depression - he was continued on zoloft. cymbalta was held given arf. # copd - not on oxygen prior to admission, at he is breathing comfortably on room air and maintaining sats. he did not have significant wheezing during this admission. he was continued on his home advair and spiriva. # gerd - continued on home ppi. # hyperlipidemia. simvastatin was initially held. as transaminitis improved, simvastatin and ezetimibe were restarted #code status during this admission - full code #transitional issues - -will need weekly chem-10 to measure electrolytes given poor renal function, particulary phosphate. -a urinalysis and urine culture was sent prior to , this will need to be followed-up as an outpatient. -lisinopril and spironolactone were held during this admission given his acute on chronic renal failure, these medications should be re-considered at his follow-up nephrology appointment as they are important for systolic chf. -will need ongoing evaluation by speech and swallow for aspiration with thin liquids -should continue to wear cpap at night for osa, will need a machine at home after from rehab -will follow-up with nephrology regarding his acute on chronic kidney disease -will need his insulin titrated after , po intake has been variable and he is on significantly less lantus than at admission -monitor for serotonin syndrome given cymbalta/zoloft combination -continued diuresis with measurement of i/os and daily weights. -discussion about aicd. -ot follow up to improve functioning of his hands. medications on admission: zoloft 100 mg tab oral 1.5 tablet(s) once daily, at bedtime lantus 70 units solution(s) twice daily (every 12 hrs) nizoral 2 % shampoo topical 1application shampoo(s) twice weekly lisinopril 5 mg tab oral 1 tablet(s) once daily cymbalta 60 mg cap oral 1 capsule, (e.c.)(s) once daily, at bedtime coreg 6.25 mg tab oral 1 tablet(s) once daily simvastatin 20 mg tab oral 1 tablet(s) once daily, at bedtime lasix 40 mg tab oral 1 tablet(s) once daily novolin r 2-10 units solution(s) sliding scale coverage spiriva once daily advair diskus 250 mcg-50 mcg/dose twice daily zetia 10 mg tab oral 1 tablet(s) once daily aldactone 25 mg tab oral 1 tablet(s) once daily plavix 75 mg tab oral 1 tablet(s) once daily neurontin 800 mg tab oral 1 tablet(s) three times daily aspirin 81 mg tab oral 1 tablet(s) once daily vitamin d -- unknown strength 1 tab capsule(s) once daily one daily multivitamin tab oral 1 tablet(s) once daily omeprazole 20 mg tab twice daily folic acid 1 mg tab oral 1 tablet(s) once daily unisom 25 mg tab oral 1 tablet(s) once daily, at bedtime medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever or pain: not to exceed 4000mg per day. 3. albuterol sulfate 1.25 mg/3 ml solution for nebulization sig: one (1) nebulizer inhalation every 4-6 hours as needed for shortness of breath or wheezing. 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. carvedilol 3.125 mg tablet sig: two (2) tablet po bid (2 times a day). 6. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). 7. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 8. duloxetine 30 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 9. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 11. gabapentin 300 mg capsule sig: one (1) capsule po q12h (every 12 hours). 12. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection three times a day: need for ongoing dvt prophylaxis to be re-assessed by rehab physicians. 13. lantus 100 unit/ml solution sig: twenty five (25) units subcutaneous twice a day. 14. insulin lispro 100 unit/ml solution sig: sliding scale units subcutaneous three times a day: 151-200 = 2 units 201-250 = 4 units 251-300 = 6 units 301-350 = 8 units 351-400 = 10 units >400 = md. 15. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 16. sertraline 50 mg tablet sig: three (3) tablet po daily (daily). 17. simvastatin 10 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 18. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 19. multivitamin tablet sig: one (1) tablet po once a day. 20. folic acid 1 mg tablet sig: one (1) tablet po once a day. 21. vitamin d-3 400 unit capsule sig: two (2) capsule po once a day. 22. lasix 80 mg tablet sig: one (1) tablet po twice a day. 23. acetazolamide 250 mg tablet sig: one (1) tablet po twice a day. 24. outpatient lab work weekly chem-10 at rehab disposition: extended care facility: - diagnosis: primary diagnoses: multifocal pneumonia respiratory failure acute on chronic systolic heart failure acute kidney injury secondary diagnoses: type 2 diabetes hyperlipidemia copd depression condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. instructions: dear mr. , it was a pleasure taking care of you during your admission to for pneumonia, chf and kidney failure. you initially presented after being found unresponsive. your blood sugar was low and you were given sugar. it was also found that you had a severe pneumonia and you were treated with antibiotics. you were also on a ventilator. because of the infection and sepsis, your blood pressure was low and you required pressors to maintain your blood pressure. during this time when your blood pressure was low, your kidneys were injured and you temprarily required dialysis. your kidney function has not returned to and you will see a kidney doctor . you will be discharged to a rehab facility to get your strength back. you will follow-up with the kidney doctors as as your pcp. the following changes were made to your medications: start acetazolomide 250mg by mouth twice daily start calcium acetate 1334mg by mouth three times daily with meals start albuterol 1 nebulizer inhaled every 4-6 hours as needed for wheezing or shortness of breath change insulin glargine 25 units subcutaneous twice daily change gabapentin 300mg by mouth twice daily change lasix 80mg by mouth twice daily followup instructions: department: west clinic when: tuesday at 2:30 pm with: , md building: de building ( complex) campus: west best parking: garage procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis closed [endoscopic] biopsy of bronchus diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux tobacco use disorder acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified depressive disorder, not elsewhere classified other and unspecified hyperlipidemia acute respiratory failure pneumonitis due to inhalation of food or vomitus anoxic brain damage alkalosis long-term (current) use of insulin septic shock obesity, unspecified metabolic encephalopathy acute on chronic systolic heart failure other and unspecified coagulation defects diabetes with other specified manifestations, type ii or unspecified type, uncontrolled below knee amputation status ulcer of ankle malnutrition of moderate degree physical restraints status 

Answer: The patient is high likely exposed to