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: sob major surgical or invasive procedure: cardiac catheterization history of present illness: 82 yo m w/ h/o imi, dm, htn, hypercholesterolemia, chf with ef of 30%, and copd who was recently admitted to for sob and was treated for copd flare with steroids. after d/c pt experienced sob, pnd, orthopnea for 2 nights and daughter called ems on for sob, but on their arrival pt was improved sitting in chair sat'ing 95% on ra and was not treated. the next day (doa) pt was again feeling sob with pnd, orthopnea, and abd pain and was brought to . pt has h/o recent h.pylori infxn and was c/o black stools. hct was 39.2 and occult blood negative. he was given 2l ns for ? gib in the ed and developed worsening sob and cardiac enzymes revealed ck 111, mb 9 trop 0.12. ekg showed st elevations in v2-v3. pt received lopressor, nitro, amio (for ? runs of nsvt per ed nursing note), heparin gtt, and integrillin. he was taken to the cath lab where coronaries showed no acute disease. it showed mild lad, lcx, 60% lmca, and to of rca with collaterals supplying territory. ra 13, rv 67/17, pa 44/24, pcwp 18, co 2.97, ci 1.6. pt became agitated and had decreased ms so was electively intubated. iabp was inserted and sbp dropped to the 40's. iabp was d/c'd and the sbp rose to the 70's. dopamine and levophed were started and sbp increased to the 110's. echo showed some ai, severity unclear. family ros was positive for fevers, chills, cough productive of brown sputum. past medical history: 1. diabetes mellitus. 2. hypertension. 3. coronary artery disease with remote imi. 4. copd. 5. hypothyroidism. 6. chf. 7. hypercholesterolemia. 8. mild organic brain syndrome/depression. social history: notable for occasional alcohol. a 100-pack-year history of tobacco, but quit. no iv drug abuse. lives with wife. family history: notable for a brother who died in his 50s from a mi, no diabetes, no pulmonary disease or cancer. physical exam: t: 96.7 hr: 65 bp: 94/47 rr: 18 ac rate of 12, breathing at 14, tv 600 fio2 1.00, peep 5. gen: intubated, sedated. heent: perrla. mm moist with tube in place. neck: supple, no lymphadenopathy. no carotid bruits. cv: rrr, no m/r/g. heart sounds distant. r groin with venous sheath - coagulated blood surrounding gauze. no bruit. lungs: (ant ausc) cta bilaterally. no wheezes or crackles abd: s/nd. +bs. no hsm. ext: +clubbing b ue. 3+ pitting edema to just above ankles. pulses 1+ bilaterally dp's. pt not palpable or dopplerable b le. neuro: intubated, sedated. not following commands. eyes squint when flashlight shined above eyes. pertinent results: cxr (): the heart is top-normal in size. mediastinal contours are unchanged. there is perihilar haziness bilaterally and slight prominence of the upper zone pulmonary vasculature, consistent with mild congestive heart failure. the left costophrenic angle is excluded from the radiographs on all three views. allowing for this, there are probable bilateral pleural effusions, right greater than left. the surrounding osseous structures appear osteopenic. flattening of the hemidiaphragms and coarsened interstitial markings bilaterally, consistent with emphysematous change. coronary cath (): 1. selective coronary angiography of this right dominant system revealed multi vessel coronary disease. the lmca had a distal 60% lesion. the lad had serial 50% stenosis in the proximal and mid vessel. the rca was totally occluded proximally, but filled via left to right collaterals. 2. resting hemodynamics revealed an elevated mean pcpw of 28mmhg. cardiac index was low at 1.6 l/m/m2. central aortic pressure was elevated at 164/81. 3. left ventriculography was not performed. 4. due to respiratory distress the patient was intubated during the procedure. 5. due to decompensated chf, an intra-aortic baloon pump was inserted. shortly following insertion and intubation, the patient became hypotensive with systolic blood pressures in the 80s. the iabp was stopped and the pressure improved to 90s to 100s. this raised concern for ai so an echocardiogram was performed which revealed markedly depressed ejection fraction of ~20%. ai was noted on color doppler and seemed to increase when the baloon pump was turned on. for this reason, the baloon pump was removed. the patient was sent to the ccu intubated, on dopamine and levophed for hemodynamic support. on leaving the catheterization lab, the patient's cardiac index had increased to 2.4 l/min/m2 and his sbp was in the 110s. his pcpw had decreased to 20mmhg. final diagnosis: 1. two vessel coronary artery disease. 2. severe systolic ventricular dysfunction. echocardiogram () the left ventricular cavity is dilated. there is severe global left ventricular hypokinesis (ejection fraction 20 percent). right ventricular chamber size is normal. right ventricular systolic function appears depressed. the aortic valve leaflets (3) are mildly thickened but not stenotic. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. right groin ultrasound (): normal flow is seen in the right common femoral artery and vein. there is a small tract extending from the right common femoral artery all the way to the skin likely representing the former catheter tract. this tract is small and measures approximately 5 mm immediately under the skin. color flow is seen within the tract, and some arterial flow on doppler signal is also identified within it. impression: persistent flow in the former catheter tract over a length of 2.9 cm (5 mm in largest diameter). this would be amenable to ultrasound guided embolization if clinically warranted. art dup ext r le;f/u () duplex evaluation was performed of the right lower extremity arterial and venous system with concentration on the inguinal region. the appearance and wave forms of the femoral artery and vein are normal. there is no evidence of pseudoaneurysm or av fistula. impression: no evidence of right inguinal pseudoaneurysm or av fistula brief hospital course: 82 yo m with cad, chf ef 30%, recent copd exacerbation, diarrhea, f/c, h. pylori infxn who p/w sob, cath without evidence of acute disease who developed subsequent hypotension, leukocytosis, and coffee-ground emesis. 1. cv: a. cad: no evidence of acute lesions on cath (just chronic). asa was continued. bp meds were held initially while pt was intubated on pressors, but then after extubation acei and diltiazem were restarted and titrated up to achieve good bp control. b. pump: ef 30% shown on echo x one week ago at osh. repeat echo showed severe left lv hypokinesis with ef of 20%. 1+ mr, 1+ar. pt was weaned off of pressors and then diuresed with iv lasix. his cr bumped slightly to 2.2, but then started trending down. the pt had good uop and a successful diuresis. spironolactone was also started. c. rhythm: pt had many runs of nsvt, the longest of which were 22 beats in duration. ep was consulted but pt stated he would not want any interventions, incluing a ep study or icd or biv pacer. d. hypotension: when the pt left the cath lab he was very hypotension, and the etiology seemed to be most likely adrenal insufficiency. random cortisol level was very low. pt had been on prednisone x 12 days from his previous hospitalization. he was given dexamethasone 4mg iv q8 for 24 hours, then this was tapered down to prednisone 20 mg po qd. the pt will remain on this for copd until it is tapered by pcp as after lungs have improved. e. r groin psuedoaneurysm: after the pt's catheterization the pt was found to have a small r groin pseudoaneurysm by u/s. a pressure dressing was placed and a repeat u/s showed that the pseudoaneurysm had resolved and no injection was needed. the pt still had a good deal of ecchmosis but no bruits. this will be monitored at rehab. 2. pulmonary: pt was initially intubated due to respiratory distress. pressors were weaned and he was extubated without difficulty. however, he still had wheezes and crackles. chf, pna, and copd all contributing to lung problems. was diuresed as above. pna - treating per id below. copd - continue nebs standing and inhalers. continue prednisone 20 mg po qd until pt is clinically improved - pt will follow up with dr. for taper after copd is clinically more improved. 3. renal: pt had arf on cri at thought to be diuresis too quickly. cr did bump slightly to 2.2 here after diuresis but on d/c was trending down. pt should have labs checked with pcp to ensure full resolution 4. id: when pt initially presented his wbc count was concerning. pt had been receiving steroids, but there was still concern for pna vs. c.diff given h/o cough and diarrhea. sputum and stool samples came back negative, but cxr indicated a probable pna and pt was covered empirically with levo and flagyl x 10 days to cover for possible aspiration as well as typical pneumonia. he remained afebrile and wbc count trended down. 5. gi: in the ed the pt had presented with coffee grounds emesis x 1, but cleared with 300 cc lavage. pt had no more episodes of emesis after this and hct remained stable, although stools were heme-occult positive. pt has been h.pylori positive and will require egd/colonoscopy as outpt before beginning triple therapy for h.pylori 6. gu: no issues. 7. heme: hct remained stable. plts fell slightly but then after heparin sc was stopped it remained stable. dr. will check a cbc to ensure plt counts remain stable. 8. endo: pt had bg's in the 300's throughout his hospitalization, which was likely due to steroid use, and sliding scale insulin was increased to accomodate this. pt will continue insulin sliding scale along with his prior dose of glyburide while at rehab and then once prednisone is tapered dr. may determine if pt needs to be on insulin injections long term. 9. dnr/dni: during this hospitalization pt stated that he would like to be dnr/dni due to his age and multiple medical problems. medications on admission: atorvastatin 20 mg q.h.s., aspirin 325 mg p.o. q.d. glyburide 10 mg b.i.d. levothyroxine 75 mcg p.o. q.d. zoloft 50 mg p.o. q.d. trandolapril 2 mg p.o. b.i.d. prednisone 20 taper qd hctz 25 qd glucophage 500 qd protonix 40 qd advair 1 combivent cardia 180 qd. discharge medications: 1. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 2. fluticasone propionate 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 3. salmeterol xinafoate 50 mcg/dose disk with device sig: one (1) disk with device inhalation q12h (every 12 hours). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 6. zolpidem tartrate 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 7. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 4 days. 8. olanzapine 2.5 mg tablet sig: two (2) tablet po qd (once a day) as needed for prn agitation. 9. aspirin 325 mg tablet sig: one (1) tablet po qd (once a day). 10. atorvastatin calcium 20 mg tablet sig: one (1) tablet po qd (once a day). 11. levofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 4 days. 12. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 13. prednisone 20 mg tablet sig: one (1) tablet po qd (once a day). 14. levothyroxine sodium 75 mcg tablet sig: one (1) tablet po qd (once a day). 15. spironolactone 25 mg tablet sig: 0.5 tablet po qd (once a day). 16. lisinopril 5 mg tablet sig: three (3) tablet po qd (once a day). 17. diltiazem hcl 240 mg capsule, sustained release sig: one (1) capsule, sustained release po qd (once a day). 18. furosemide 20 mg tablet sig: one (1) tablet po qd (once a day). 19. glyburide 5 mg tablet sig: two (2) tablet po bid (2 times a day). 20. insulin lispro (human) 100 unit/ml solution sig: one (1) injection subcutaneous asdir (as directed). scale as below: humalog ********************breakfast lunch dinner bedtime 61-150 mg/dl 0 units 0 units 0 units 0 units 151-200 mg/dl 6 units 6 units 6 units 3 units 201-250 mg/dl 8 units 8 units 8 units 5 units 251-300 mg/dl 10 units 10 units 10 units 7 units 301-350 mg/dl 12 units 12 units 12 units 9 units 351-400 mg/dl 14 units 14 units 14 units 11 units discharge disposition: extended care facility: hospital - discharge diagnosis: chf, copd, pneumonia discharge condition: stable. discharge instructions: please make changes to medications (look at list carefully). follow up with dr. as indicated below. if shortness of breath increases significantly, call dr. right away. watch daily weights - if increases by more than 3 lbs call dr. and increase lasix dose. followup instructions: please follow up with dr. in 1 week. call to schedule an appointment. ask him to assess your lungs and to taper prednisone if copd exacerbation is improved. also, diabetes management needs to be addressed, especially while you are on steroids. upon leaving the rehabilitation facility, it will need to be determined if you need insulin injections at home. please discuss this with dr. . also, have platelet count checked. please arrange to have an egd/colonoscopy due to recent gi bleed and h.pylori infection. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours injection or infusion of platelet inhibitor left heart cardiac catheterization coronary arteriography using a single catheter insertion of endotracheal tube implant of pulsation balloon angiocardiography of right heart structures diagnoses: intermediate coronary syndrome congestive heart failure, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus peripheral vascular complications, not elsewhere classified cardiogenic shock other emphysema acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to