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: no known allergies / adverse drug reactions attending: chief complaint: left knee pain major surgical or invasive procedure: revision of left knee replacement history of present illness: mr. is a 69-year-old gentleman with a past medical history significant for osa, htn, sinus bradycardia, chronic renal failure, bipolar disorder, bph who was admitted for a total left knee replacement, subsequently transferred to the micu for fever and hypotension, now transferred to the general medicine floor upon resolution of his symptoms. patient presented on for left tka, and did well post-op with mild hypotension on to systolic 80s. however, he spiked a fever to 101.2 on with no obvious source. he then triggered for delirium on and labs were notable for worsening renal function, cr 2.3 from 1.8, and wbc 13.2 from 9.7. med consult was called for fever workup and management of delirium. patient then spiked another fever to 102.3, and triggered again for hypotension with systolics in the 80s. a voiding trial was attempted on but patient could not urinate so a foley was replaced. he was written for 1l bolus and started on vanc/cipro to cover for possible knee infection, given recent operation, though no signs of infection of the left knee. prior to transfer to the micu, his vs were 102.3 90/48, 74, 98% on 2lnc. on arrival to the micu patient complained of pain in his right arm and wrist, which he attributed to overuse from writing multiple notes on facebook. patient was continued on vanc/cipro and given 2 more liters of ivf. his blood pressure stabilized and he was discharged back to the general medicine floor on . ortho will follow closely. on transfer from micu, vitals were: 98, 102/60, 76, 16, 96% on ra. ros: patient complains of being asked too many questions. he reports pain in his right shoulder and wrist. discomfort on his left thigh from traction device. no chest pain, shortness of breath, nausea, vomiting, diarrhea. denies chills or feeling feverish. has foley in place. has not moved his bowel since surgery. past medical history: - bipolar d/o - sinus bradycardia - 1st degree av block - htn - osa on cpap - obesity - h/o urinary retension - ckd (baseline cr 1.8) - bph social history: lives with wife (or ex-wife). denies any alcohol use. stopped smoking in . family history: father and mother died of cad and dm. two brothers with dm. physical exam: admission exam: physical exam vs: 98, 102/60, 76, 16, 96% on ra general: elderly appearing gentleman, obese, no acute distress heent: mucous membranes dry neck: no cervical, submandibular, or supraclavicular lad cardiac: rrr, no mrg abdomen: +bs, obese, soft, non-tender, non-distended extremities: left knee dressing clean, dry, and intact, left leg in traction device, pneumoboots in place, right wrist in soft cast (not removed at this time) skin: ruddy complexion, skin is moist neuro: alert and oriented, keeps complaining that people are asking him to name the days of the week and months backward, tangential, usually appropriate but very easily distracted, short attention span discharge exam: vs: t 99.1 also tm, bp 152/79, hr 76, r 20, svo2 95% ra. general: elderly appearing gentleman, obese, no acute distress heent: mmm neck: no lad cardiac: rr, nl rate, no mrg pulm: ctab, bibasilar crackles, no wheezes, comfortable breathing abdomen: +bs, obese, soft, non-tender, non-distended extremities: left knee dressing clean, dry, and intact, stables in place, right wrist slightly swollen, mildly warm, able to move with limited range of motion secondary to pain, right knee with small effusion, no warmth, able to move freely, pneumoboots in place. neuro: alert and oriented, keeps complaining that people are asking him to name the days of the week and months backward, tangential, usually appropriate but very easily distracted, attention stable. pertinent results: admission labs: 07:20am blood wbc-9.7 rbc-3.83* hgb-11.5* hct-34.0* mcv-89 mch-29.9 mchc-33.7 rdw-13.4 plt ct-147* 07:20am blood plt ct-147* 07:20am blood glucose-128* urean-28* creat-1.8* na-139 k-4.7 cl-106 hco3-27 angap-11 imaging: chest (portable ap) study date of : impression: new pleural effusions, left greater than right right wrist film : right wrist: extensive degenerative changes are present within the right wrist. it is maximal at the radial-carpal junction. there is, however, no evidence of a fracture present. impression: degenerative changes within the carpal bones. cxr: findings: single frontal image of the chest demonstrates new opacity at the left lateral lung base which could be consistent with fluid and/or atelectasis. it is difficult to assess this opacity fully given the patient's extremely rotated position. lungs are otherwise clear. there is no pneumothorax. cardiomediastinal silhouette is unchanged from prior imaging. impression: new left lateral lung base opacity consistent with pleural effusion and/or atelectasis. 07:50am blood wbc-20.0* rbc-3.32* hgb-9.9* hct-30.6* mcv-92 mch-29.7 mchc-32.2 rdw-13.6 plt ct-449* 07:30am blood neuts-84* bands-3 lymphs-5* monos-5 eos-0 baso-0 atyps-0 metas-2* myelos-1* 07:30am blood glucose-148* urean-42* creat-1.6* na-141 k-4.6 cl-104 hco3-30 angap-12 07:30am blood calcium-10.0 phos-2.7 mg-2.0 05:49am blood lactate-1.1 07:55am blood vanco-12.6 06:05am blood alt-39 ast-41* ld(ldh)-221 alkphos-101 totbili-0.6 05:45am blood wbc-16.6* rbc-3.17* hgb-9.4* hct-29.3* mcv-92 mch-29.6 mchc-32.1 rdw-13.7 plt ct-443* brief hospital course: 69m with hist of osa, htn, sinus bradycardia, ckd (baseline cr 1.8), bipolar disorder, bph with history of urinary retention who presents after revision of left knee replacement. the course was complicated by hypotension, fevers, urinary retention, gout and pneumonia. # pneumonia: the patient had fevers to 102, a rising leukocytosis, productive cough and delirium. he had an cxr which showed an opacity in the left base. it was not clearly infectious in etiology, however, given the clinical symptoms we treated him for health care associated pneumonia with vancomycin and cefepime for a 7 day course to be completed on . the fevers resolved, his delirium improved as did his cough. the patient and his family refused any further studies such at ct of the chest. given his clinical improvement we felt that he was safe to discharge with a course of antibiotics to be completed at rehab. after completion of his antibiotics, he should be monitored for temperature or othesigns of infection. # acute gout: the patient had significant right wrist swelling and pain worse with active or passive movement. given his fevers there was some concern for gout vs septic arthritis. he had a joint aspiration which was consistent with crystalopathy. given his kidney function he was treated with a prednisone taper with significant improvement in his wrist pain and mobility. he has a total of 4 more days of prednisone (as outlined in medication list). # left knee revision: per report of our orthodist service went well. no evidence of infection of left knee. the joint is warm but the incision is clear/dry/intact. the recommendations of orthopedists are listed below: - please keep your wounds clean. you may shower starting five (5) days after surgery, but no tub baths or swimming for at least four (4) weeks. no dressing is needed if wound continues to be non-draining. any stitches or staples that need to be removed will be taken out at first follow up appointment two weeks after your surgery. - please do not take any non-steroidal anti-inflammatory medications (nsaids such as celebrex, ibuprofen, advil, aleve, motrin, etc). this is important given your chronic kidney disease. - anticoagulation: please continue your lovenox for four (4) weeks to help prevent deep vein thrombosis (blood clots). if you were taking aspirin prior to your surgery, it is ok to continue at your previous dose while taking this medication. stockings x 6 weeks. - wound care: please keep your incision clean and dry. it is okay to shower five days after surgery but no tub baths, swimming, or submerging your incision until after your four (4) week checkup. please place a dry sterile dressing on the wound each day if there is drainage, otherwise leave it open to air. check wound regularly for signs of infection such as redness or thick yellow drainage. staples will be removed at first post op appointment in two (2) weeks. - vna (once at home): home pt/ot, dressing changes as instructed, wound checks. - activity: weight bearing as tolerated on the operative extremity. mobilize. rom 0-60 x 1 week (until ) then advance as tolerated. no strenuous exercise or heavy lifting until follow up appointment. # hypotension: he was given ivf and broad spectrum antibiotics. an infectious work up was negative and he initially became afebrile. his blood pressure responded to iv fluids. the antibiotics were discontinued (later restarted for suspected pneumonia -- see above). atenolol and losartan initially held. restarted once blood pressure improved. # hypertension: he did have some hypertension at the time of discharge. blood pressures ranged from sbp 110s to 150s. he was discharged on losartan and atenolol. hydrochlorothiazide was held. # acute on chronic renal failure: improved with ivf to his baseline chronic kidney disease (baseline around 1.8). he was resumed on his losartan. he was educated on avoiding nsaids (which he states that he understands but will refuse to comply with the recommendations as he has been "taking nsaids for 70 years and it hasn't hurt him yet" -- he acknowledges and can repeat our concerns but chooses to ignore the recommendations). # delirium: he had acute change in mental status that was waxing and in nature. he was evaluated by psychiatry who agreed with the diagnosis of acute delirium. the likely etiology was medication effect, hypotension and hospital setting. with usual delirium precuations he returned to his baseline mental status. he did require some haldol for agitation while he was delirius. # right knee pain: he states that a transporter dropped him. it is unclear as it is not documented and no nurses are aware of this happening. i cannot confirm or deny that he was dropped. his right knee improved at the time of discharge and he has his baseline range of motion. # bph/urinary retention: on tamsulosin and finasteride. failed voiding trial x2 and had a foley placed. he will follow up with dr. for outpatient management of his acute on chronic urinary retention. # osa: continue bipap at night. # anemia: he had stable anemia. after starting prednisone, his differential was atypical. this should be checked after resolution of prednisone and infectious symptoms to make sure no more atypical cells are present in his blood. # social issues: the patient was intermittently very upset with the care he received at the hospital. the son was definitely upset. after significant conversations with the patient and his family, the major complaints were: 1) he was held in the hospital against his wishes, 2) he was not medically cleared to go to rehab sooner, 3) we were not able to definitively say he had pneumonia (and refused to undergo ct chest which would have been helpful in the diagnosis), 4) he states we "drilled a hole into his hand" referring to the joint aspiration, he states this was against his wishes despite obtained consent, 5) he refuses to accept that he had fevers or an infection in the hospital (as does the son), 6) he states that we gave him gout, 7) his son was unhappy that he was cared for by a hospitalist, 8) the son accused the hospital of medicare fraud -- given that he didn't have fevers or infections or other issues other than his knee and gout, 9) the son states he will the hospital and the physician for multiple reasons including the above and a reported incident with the transporter. after long discussions the patient seems agreeable with the explanations of the issues involved in his case and the care that he received. the wife, , is also agreeable and thankful. the son, , is very angry and seemed only to get more angry with discussion of any of the above issues. he states that he is in "the medical field" however, seemed to have a limited vocabulary or knowledge of the situation regarding his father. attempting to explain the situation did not go well and ended in him stating "you better contact your lawyers". i offered the number for patient relations to the family (his son refused - please see note) and i contact our risk management office. # communication: patient, wife , son # code: full transitional issues: - rehab - ortho follow up - removal of staples, further assessment - urology follow up - consider voiding trial, blood in ua - remove picc after antibiotics - monitor for signs of infection - pcp follow up regarding gout issues, also, would check cbc with differential to evaluate atypical cells resolve with treated infection and off prednisone medications on admission: preadmission medications listed are correct and complete. information was obtained from webomr. 1. zolpidem tartrate 10 mg po hs:prn insomnia 2. atenolol 50 mg po daily hold for sbp < 110, hr < 60 3. baclofen 10 mg po bid 4. tamsulosin 0.8 mg po daily hold for sbp < 110, hr < 60 5. hydrochlorothiazide 25 mg po daily hold for sbp < 110, hr < 60 6. lorazepam 1 mg po hs:prn insomnia 7. losartan potassium 100 mg po daily hold for sbp < 110, hr < 60 8. mobic *nf* (meloxicam) 15 mg oral daily 9. multivitamins 1 tab po daily 10. gabapentin 400 mg po bid 11. vardenafil *nf* 20 mg oral prn 12. finasteride 5 mg po daily 13. vitamin d 400 unit po daily discharge disposition: extended care facility: life care center at discharge diagnosis: failed left uni-compartmental knee replacement discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). followup instructions: provider: , : date/time: 1:40 procedure: arthrocentesis revision of knee replacement, total (all components) central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) anemia, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) chronic kidney disease, stage iii (moderate) retention of urine, unspecified knee joint replacement delirium due to conditions classified elsewhere acute gouty arthropathy osteoarthrosis, localized, not specified whether primary or secondary, lower leg mechanical loosening of prosthetic joint 

Answer: The patient is high likely exposed to