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: morphine attending: chief complaint: abdominal pain major surgical or invasive procedure: ng tube placement history of present illness: 59yo m w cad s/p mi, dm, afib, ? hep c, chf with ef 30-35%, esrd on dialysis (tue//sat), polysubstance abuse, presents with fever, altered mental status and abdominal pain. he reports abdominal pain starting sunday (1 day pta), associated with fever, throat pain, nausea and vomiting. he reports using cocaine on saturday. he reports a bloody bowel movement on sunday and is still passing gas. he had a tooth removed on wednesday and has been on abx for that, but denies significant tooth pain. he also reports pain in his right shoulder that was similar to previous anginal pain. . in the ed, initial vs were: 104 124 162/90 34 85. his bp was stable, but he was febrile and tachypnic satting 85/ra, and put up to 100% on a nrb. history was difficult to obtain given waxing/ mental status. he had abdominal distension and pain. rectal exam with guaiac positive pink mucous. a kub showed gaseous distention without frank dilation of small bowel loops, air/stool seen throughout the colon. head ct unremarkable. ct scan with iv/po contrast showed small bowel distention with no clear transition point and fecalization of ti, thought to be ileus versus partial sbo. he was seen by surgery who recommended ng tube placement. ng tube produced a small amount of bilious contents. a right ej placed. he had a r 18g piv, then lost, replaced with a right piv in hand. he recieved 2.5 l ivf, vanc x 1 gm, ceftriaxone x2 gm, tylenol, zofran, 1 mg dilaudid. prior to transfer, vs: 103 113 30 18 121/74 100/nrb. . on the floor, he was feeling more awake. he continued to complain of throat, arm, and belly pain. he was thristy. . review of systems: (+) fever, chills, headache, cough productive of clear sputum, dyspnea, shoulder pain, nausea, vomiting, abdominal pain. (-) denies chest pain or tightness, palpitations. denied dysuria. denied arthralgias or myalgias. . after abdominal pain, fever, and repiratory distress was resolved in the icu, the patient was transfered to cc7. on the floor, the patient complained of intermittent 5/10 chest pain. he said that it was left-sided and worse after eating. he reported it to be the same pain he gets with heartburn. an ekg and troponins were ordered to rule out an mi, and they were both unremarkable and consistent with his baseline. on the floor, he had no abdominal pain, was having regular bms, and was satting 95% on ra. past medical history: # esrd on hemodialysis (tues/thurs/sat, dialysis, , ) # type 2 diabetes mellitus - peripheral neuropathy # cad s/p mi (patient cannot recall though cath unremarkable) - cardiac catheterization in without flow limiting stenoses - mibi in showed reversible defects inferior/lateral # chf with ef 30-35% ( tee) # atrial fibrillation/atrial flutter s/p aflutter ablation - not on anticoagulation # h/o atrial tachycardia s/p eps and ablation x 2 for l sided, triggered (not reentrant) atachs # hypertension # dyslipidemia: tc 101, ldl 54, hdl 29, tg 112 # history of gastrointestinal bleed: - duodenal, jejunal, and gastric avms s/p thermal therapy - diverticulosis throughout colon # chronic pancreatitis # ? hepatitis c, positive hcv ab in , subsequently negative x 2 , # gerd # gout s/p arthroscopy with medial meniscectomy # depression s/p multiple hospitalizations due to si # polysubstance abuse: crack cocaine, etoh, tobacco - frequent bouts of chest pain following crack/cocaine use # erectile dysfunction s/p inflatable penile prosthesis social history: he lives with a female partner named in , ma. 42 pack-year smoking history, recently up to 6 cigarettes per day. he has a history of alcohol abuse, with dts and detoxification, with last drink on . pt has used crack cocaine for years, approx. 2-3x/wk. last use several days before admission. family history: father with alcoholism. mother with type 2 diabetes, renal failure, died at age 58. son with diabetes. cousin with cell disease. physical exam: physical exam on admission: vitals: t: 100.1 bp:95/56 p:98 o2: 98/5l general: intermittantly somnilent, but able to relay history heent: sclera anicteric, dry mucous membranes, ng tube with bilious contents neck: supple lungs: good air movement bilaterally, patchy bibasilar rhonchi worse on right. cv: regular rhythm with mild tachycardia, hyperdynamic s1 + s2, no murmurs, rubs, gallops abdomen: distended, mild diffuse tenderness. absent bowel sounds. no rebound tenderness or guarding. ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis or edema physical exam on d/c from micu vitals: hr: 94 bp:129/80 rr: 16 sp02: 92% 2 lnc general: nad, comfortable heent: sclera anicteric, dry mucous membranes, perrla neck: supple, no jvd lungs: good air movement, cta bilaterally. cv: regular rate and rhythm, s1 + s2 clear, no murmurs, rubs, gallops abdomen: +bs, soft, nt, nd. no rebound tenderness or guarding. ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis or edema physical exam on discharge: vitals: t: 98.4/98.4 hr 93-97 bp 136-154/70-82 rr 16 sats 94-96% on ra gen: nad, comfortable cv: rrr s mrg. no jvd. resp: ctab abd: s, nt/nd, +bs ext: wwp, 2+ pulses pertinent results: 10:39pm type- po2-110* pco2-42 ph-7.49* total co2-33* base 10:39pm lactate-2.0 10:24pm ck(cpk)-230* 10:24pm ck-mb-5 ctropnt-0.46* 05:37pm ck(cpk)-246* 05:37pm ck-mb-5 ctropnt-0.49* 09:00am pt-15.3* ptt-33.7 inr(pt)-1.3* 12:00am ck(cpk)-183* 12:00am ck-mb-4 ctropnt-0.38* 11:59pm po2-145* pco2-40 ph-7.48* total co2-31* base xs-6 11:59pm lactate-1.5 07:15pm urine bnzodzpn-neg barbitrt-neg opiates-pos cocaine-pos amphetmn-neg mthdone-neg 07:15pm urine color-yellow appear-hazy sp -1.020 07:15pm urine blood-lg nitrite-neg protein-500 glucose-250 ketone-neg bilirubin-sm urobilngn-neg ph-6.5 leuk-tr 07:15pm urine rbc->50 wbc-* bacteria-few yeast-none epi-0-2 trans epi-0-2 07:15pm urine amorph-few 07:05pm glucose-214* urea n-51* creat-7.6*# sodium-130* potassium-5.9* chloride-88* total co2-26 anion gap-22* 07:05pm alt(sgpt)-17 ast(sgot)-19 alk phos-181* tot bili-1.2 07:05pm lipase-17 07:05pm calcium-11.0* phosphate-4.2 magnesium-2.2 07:05pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt neg tricyclic-neg 07:05pm wbc-5.3 rbc-4.43* hgb-11.7* hct-37.5* mcv-85 mch-26.4* mchc-31.1 rdw-15.9* 07:05pm pt-14.9* ptt-30.2 inr(pt)-1.3* imaging: ct abd/pel (): 1. dilated small bowel measuring up to 3.3 cm noted to level of ti with fecalization of ti. findings consistent with ileus vs partial sbo. no transition point identified. 2. lll airspace opacity may represent aspiration. infection cannot be excluded. 3. small rt pleural effusion. . cxr (): 1. small right pleural effusion and mild fluid overload. 2. possible retrocardiac opacity. dedicated pa/lateral recommended. . cxr (): interval improvement in the multifocal consolidation with stable right pleural effusion and new ng tube in satisfactory position. mild pulmonary venous congestion. . kub (): no ileus seen. . ekg: sinus tachycardia @ 125. left-axis. inferior q-waves, crochet in v1. compared to prior the axid is more leftward and p-wave morphology changed. no significant ischemic changes. brief hospital course: #1 ileus: ct revealed ileus vs. partial sbo, but passing gas & stool. unclear etiology, but initially thought to be in setting of cocaine/opiate use vs adominal infection. no infection revealed over micu course. vanc/zosyn given initially to cover ? abd infection, dc'd when no infection evolved. surgery consulted, ngt placed, pt monitored with serial abd exams,kubs,kept npo. as signs of distension on kub resolved, and ngt output decreased, patient ngt was clamped and pulled, and he was started on a diet of clears. pt able to tolerate clear fluids without n/v, and abd pain resolved. pt advanced to full diet without difficulty. . #2 dyspnea: patient presented febrile, tachypnic with significant o2 requirement and lung base infiltrates. initially thought to be pna, but due to rapid improvement, eventually thought to be a chemical pneumonitis. the patient was followed with daily cxr, started on vanc/zosyn initially to cover pna, given oxygen as needed, and started on albuterol prn sob. he was also placed on aspiration precautions. . #3 presented with altered mental status: likely substance use. pt had a negative head ct, and his mental status returned to baseline. . #4 chest pain: likely gerd. pt describes the pain as intermittent pain in the left upper chest that does not radiate and is worse after eating. the patient experiences the pain often. pt had a negative ekg and troponins. pain resolved with tylenol and ppi. . #5 coronary artery disease: right arm pain on presentation thought to be possible anginal equivalent. recent clean cath. cardiac enzymes were trended and he ruled out for mi. he was given a statin and diltiazem, and his aspirin was held in the setting of ?gib and low likelihood of mi. pt had history of rvr in absence of dilt, noted to have atrial tachycardia on admission with borderline bps. dilt given for rate control. currently in sinus, on dilt, ace, asa, statin. . #6 bloody stool: history of avm and bleeding with anticoagulation. no frank blood on exam. no blood in ng tube, no bleeding this admission, however aspirin was held, type and screen and 3u prbcs, and ppi started. . #7 esrd on tu/th/sa hd: on admission had missed last hd session and was s/p contrast in ed. pt had hd on , 1l removed, electrolytes, bps wnl after hd. pt had hd on as well. . #8 diabetes: hiss in micu, gfc were controlled. . #9 s/p tooth extraction: currently stable. on doa had one day remaining in antibiotics, but was covered by abx regimen. . #10 received social work consult given substance abuse. . was full code during admission. communication was with patient and hcp medications on admission: per pt medication bag: diltizam 240 mg po daily lipitor 20 po daily lisionopril 20 mg po daily vicoden 5/500 q 3-4 hrs amox 500 mg po tid (3 doses remaining) amiodiorone 200 mg po daily hydroxizine 25 mg po bid sl ntg prn discharge medications: 1. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 3. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 4. gabapentin 100 mg capsule sig: capsules po at bedtime. 5. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po twice a day as needed for itching. 6. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) sublingual prn as needed for chest pain. 7. vicodin 5-500 mg tablet sig: one (1) tablet po every four (4) hours as needed for pain. 8. selenium sulfide 2.5 % suspension sig: apply to skin topical 10 minutes before shower. 9. mupirocin 2 % ointment sig: apply to affected skin topical two to three times daily. 10. diltiazem hcl 240 mg capsule, sustained release sig: one (1) capsule, sustained release po once a day. 11. cinacalcet 60 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 12. renagel 800 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnoses: ileus, gerd, chemical pneumonitis secondary diagnoses: dm2, cad, atrial fibrillation, chronic systolic chf, htn, esrd on hemodialysis, polysubstance abuse discharge condition: the patient is being discharged in stable condition, with no abdominal pain, with regular bowel movements, with no fever, and with intermittent mild chest pain, most likely from gerd. discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet you were seen at the on because you had abdominal pain, a fever, and altered mental status. when you came to the emergency department, you had a fever and were very short of breath. we gave you oxygen to help you breath and we put an intravenous line into your arm so that we could give you fluids and medicines. we perfomed some imaging studies to look at what was going on inside your belly. it looked like things were not moving through your bowels, and that this was the cause of your belly pain. we placed a tube down your nose and into your stomach to help decompress the bowels and this gave you some relief. initially, you went to the icu because of your difficulty breathing and fever. the doctors thought might have an infection in your lungs and started you on antibiotics. you improved very quickly, and no longer required supplemental oxygen to breathe well. you also started having bowel movements and this helped your belly pain to go away. on you were transferred out of the icu to a different hospital floor. you had some chest pain that you felt was the same pain you get after eating from heartburn. we gave you protonix and some tylenol and the pain went away. we did several studies including an ekg and a lab test to look at your troponin levels that made us feel comfortable that this was not a problem with your heart. you received hemodialysis as an inpatient during your hospitalization. please follow up with your np, , on , at 10:30 am. office phone no.: if you experience the following symptoms: shortness of breath, chest pain, blood in your stool, fevers, confusion, or any other worrisome symptoms, please contact your pcp or go to the emergency department. followup instructions: provider: , phone: date/time: 10:30 md procedure: insertion of other (naso-)gastric tube diagnoses: end stage renal disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified other, mixed, or unspecified drug abuse, unspecified atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes atrial flutter old myocardial infarction chronic systolic heart failure paralytic ileus bronchitis and pneumonitis due to fumes and vapors 

Answer: The patient is high likely exposed to