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: percocet attending: chief complaint: chf exacerbation major surgical or invasive procedure: none history of present illness: mr. is a 76 year old gentleman with a history of 3 vessel cad s/p cabgx3 and multiple stents, chf, htn, hyperlipidemia, crf who presented to the with chest pain overnight and worsening sob. in general, mr. he was in his normal state of health two days prior to admission; the day prior to admission he felt fatigued, but didn't develop cp or sob until lying in bed the night prior to admission. at this time, he had difficulty lying flat. he describes the chest discomfort as pressure and a squeezing sensation in his neck; it was the same as cp that he has had in the past. he took 3 nitros without resolution of symptoms. this morning, he continued to have cp and started having n/v- according to his wife this is not characteristic for his usual cp. mr. wife explains that his functional capacity had been decreasing over the past year in the setting of multiple chf exacerbations. however, he had been doing well since he was last hospitalized in for gouty arthritis and aspiration pna. at baseline, he can walk around the house and down his driveway but not around the block. he can climb a flight of stairs slowly. he does not get chest pain or shortness of breath with either activity. he describes occasionally getting chest pain at home, the last time two months ago, that always resolves with sublingual nitro. he sleeps with 1-2 pillows and this has not increased lately. he weighs himself daily and is usually around 164-166 lbs; he has not noticed this increasing lately and weight on saturday was 167 lbs. he denies any recent swelling in his legs. he takes his bp daily; this morning it was 142/56; it usually runs in the 120s systolic. he did develop a dry cough this am, but did not have a cough prior. no fever, no recent illness. admission to in for fever and joint pain that was attributed to gouty arthritis. patient was diuresed during that admission and his creatinine bumped and so he was discharged on half home dose of lasix; in this was increased to 160 by dr. who thought he was fluid overloaded in clinic; lisinopril was decreased at this time to 20 mg po daily. in the ed, vitals were vs 99.0 84 120/57 36 96% bipap. ekg showed intraventricular conduction delay with st elevations but no intervention per cards fellow. he was given 325 aspirin, 3 nitro total, now on nitro gtt. received levaquin/flagyl for rll pna. on transfer to the ccu, patient was cp free on non-rebreather. past medical history: 1. cardiac risk factors: diabetes, dyslipidemia, hypertension 2. cardiac history: -cabg: : cabg with svg-om2cad : cabg with lima-lad and svg-?diagonal -percutaneous coronary interventions: ptca ptca of rca bms to svg-om2 3 des to svg-om2 : des to lmca and rca : repeat des to lmca into lcx : poba of lad and lcx : ptca of in-stent restenosis of his left main into the proximal circumflex stent. -pacing/icd: none 3. other past medical history: carotid stenosis 60-69% right ica stenosis, 70-79% left ica stenosis in dmii- last hga1c 7.7 gout pvd depression and anxiety social history: retired. machine operator in stethoscope factory. married with three children. stopped smoking 30 years ago. smoked 2-3 packs per day. no etoh. no drugs. he typically is able to walk short distances in his house. he just recently started going for daily walks. family history: b: died of mi at 42, b: had multiple mis; f, m: died. whole mothers side diabetes mellitus physical exam: admission exam: vital signs: t 97.3, hr 76, bp 129/61, rr 20, sat % 99 on ra . gen: well appearing, somewhat drowsy man in nad. . extrem: no erythema, warmth or prominent effusion in any joint. can not fully extend at elbows bilaterally; extend to approximately 170 degrees. prominent tophi on r elbow. full strength in extension but decreased strength in flexion at elbow bilaterally. some pain to manipulation of elbow joints, r>l. full rom of shoulders above head but can not reach arms to touch face anteriorly. weakness to pressure when holding arms at 90 degrees. thick fingers with multiple small nodules on l dips that appear to be tophi. weak grip and also unable to fully extend fingers. no other finger deformities. full rom in knees and ankles without pain upon manipulation. full strenth in lower extremities. no pain with pressure to muscles in calves, thighs or arms. . skin: no rashes. dark discoloration on anterior lower legs bilaterally consistent with venous changes. discharge exam: tmax: 98 t current: 98 hr: 59-84 rr: 18-20 bp: 102-116/45-60 o2 sat: 95% ra 24 hour: i=890 o=880 stool x2, dar, ob neg weight: 152 (152.8) . exam: alert heent - oropharyx clear. cv - s1, s2 with 2-3/6 systolic murmur at the lusb. lungs - clear to auscultation ab - soft, non-tender, bs + ext - no edema, feet warm, radial/pedal pulses 2+ pertinent results: echo: left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is moderate to severe global left ventricular hypokinesis (lvef = 25 %). no masses or thrombi are seen in the left ventricle. right ventricular cavity size is normal with borderline normal free wall motion. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: left ventricular cavity enlargement with marked global hypokinesis. mild-moderate mitral regurgitation. mild-moderate aortic regurgitation. compared with the prior study (images reviewed) of , the severity of aortic regurgitation is increased (may be related to much higher systemic blood pressure). the estimated pulmonary artery systolic pressure is now lower. bieventricular sizes and systolic function are similar. clinical implications: the left ventricular ejection fraction is <40%, a threshold for which the patient may benefit from a beta blocker and an ace inhibitor or . based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. cxr: impression: ap chest compared to 5:56 p.m.: right internal jugular line has been partially withdrawn and now ends at or just below the anticipated location of the superior cavoatrial junction. multifocal pneumonia and mild-to-moderate pulmonary edema are unchanged. moderate cardiomegaly, small bilateral pleural effusions are stable. et tube in standard placement and nasogastric tube passes below the diaphragm and out of view. no pneumothorax. cxr: findings: as compared to the previous radiograph, the right-sided central venous access line has been removed. the lung volumes continue to be low, with an unchanged aspect of the bilateral, predominantly basal parenchymal opacities, likely to reflect a combination of pneumonia and pulmonary edema. unchanged moderate cardiomegaly. status post bypass surgery. no evidence of pleural effusions. video swallow study: impression: aspiration with thin liquids and penetration with nectar consistency. brief hospital course: 76 year old gentleman with a history of 3 vessel cad s/p cabgx3 and multiple stents, chf, htn, hyperlipidemia, crf who presented to the with chest pain and worsening sob. respiratory failure thought to be secondary to septic shock from pna with additional element of chf; patient had recurrent fevers and he was intubated and swan was placed showing increased wedge and decreased svr, confirming septic shock as well as chf component. # pneumonia/septic shock: pt found to have multifocal pna on cxr and sepsis. initially intubated and swanned which showed cardiac pressures consistant with septic shock. pt was treated with a course of ceftriaxone, azithromycin and flagyl for pneumonia and transitioned to vanc/zosyn to end of course. he was sucessfully extubated and transitioned to the step down unit. cxr on showed no change in pneumonia but pt was weaned off o2 and has had no significant cough or sob. # acute on chronic diastolic chf: known diastolic and systolic chf with ef 35% on echo . lasix dose increased to . pt currently appeared euvolemic by day of discharge. given history of multiple chf exacerbations, spironolactone was started at low dose. continues on lisinopril and metoprolol xl at lower doses than on admission. at rehab, recc checking daily weights and keep on low na diet. on discharge his weight was 68.8 kg or 151 pounds # leukocytosis and fever: wbc peaked at 18 and decreased to 11.7 by discharge. leukocytosis was attributed to his pna and sepsis. despite improvement of the pneumonia, wbc continued to be elevated and pt had recurrent fevers. multiple cultures of urine and blood sent, all negative. c-diff, lengionella antigen also negative. recurrent low grade fevers were attributed to gout flair with elevated ua and arthralgias and warm joints. rheum saw pt and decision was made to give pt colchicine every other day as well as prednisone 10mg. pt has been afebrile for the 4 days prior to discharge. he will follow up with rheum outpatient. . # delerium: likely hospitalization, acute illness and disrupted sleep schedule. cleared somewhat before discharge although pt continues to have mild confusion. initially agitated at night after extubation, now restless at night only. clonazepam was not continued during hospital stay because of somnolance and confusion. citolapram was restarted. infectious w/u negative as above. pt's delerium improved during hospitalization although he continued to have episodes of sun-downing the days prior to dsicharge. . #hyperglycemia: humalog sliding scale. . # acute on chronic kidney disease: baseline cr 1.5-1.7, creatinine as high as 3.0, decreased to 1.8 by day of discharge. . # cad: extensive cad history. history of acute onset cp in the setting of pulmonary edema concerning for mi on admission. ruled out for mi. no cardiac cathatheterization done. continued on aspirin, clopidogrel, siimvastatin and metoprolol. . # gout: arthalgias and a few warm joints and low grade recurrent fevers. rheumatology consult felt pain and stiffness was was multifactorial including arthritis, torn rotator cuff and gout. inceased uric acid level was suggestive of gout. high sed rate (100s) thought infections and hospitalization. home dose of allopurinol was continued and colchiciine, prednisone and tylenol added to treat pain. pt will see his outpatient rheumatologist in f/u next week. he will continue his prednisone 10mg daily and colchicine for now. . # anxiety: citolapram restarted. held benzos for delerium/sedation. medications on admission: cardiac: furosemide 160 mg po daily lisinopril 20 mg daily toprol xl 100 mg nifedipine 90 mg daily isosorbide mononitrate 60 mg daily atorvastatin 40 mg daily plavix 75 mg daily asa 325 mg daily nitroglycerin 0.4 mg sc as needed . gout: allopurinol 100 mg daily . vacscular dementia: pentoxifylline 400 mg tid . depression: citalopram 10 mg daily clonazepam 0.5 mg . diabetes: nph insulin 40 u in am; 50 u pm regular 3 u am; 4 u pm . other: docusate 100 mg senna 8.6 mg ketoconazole 2% cream as needed fluocinonide 0.05% cream as needed discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 2. senna laxative 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. colchicine 0.6 mg tablet sig: one (1) tablet po every other day (every other day). 7. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 8. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day). 9. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 10. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 11. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet sublingual every 5 minutes for total of 3 doses as needed for chest pain. 12. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily): hold sbp < 100. 13. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). 14. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 15. pentoxifylline 400 mg tablet sustained release sig: one (1) tablet sustained release po twice a day. 16. heparin (porcine) 5,000 unit/ml solution sig: one (1) syringe injection tid (3 times a day). 17. furosemide 80 mg tablet sig: two (2) tablet po bid (2 times a day). 18. spironolactone 25 mg tablet sig: 0.5 tablet po daily (daily). 19. outpatient lab work please check chem-7 on sunday discharge disposition: extended care facility: discharge diagnosis: sepsis secondary to pneumonia chronic systolic congestive heart failure delerium hypernatremia discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the hospital for shortness of breath. we determined that you had a serious infection on top of congestive heart failure. because of these two complicated problems, you had to be intubated in the icu for treatment. you were treated with antibiotics and pills to remove the fluid from your lungs and body. . we made the following changes to your medications: 1. start colchicine every other day to treat your gout 2. start tylenol every 8 hours to treat your joint pain. 3. start prednisone for joint pain, you will taper this off slowly 4. decrease toprol to 25 mg daily 5. decrease lisinopril to 2.5 mg daily 6. stop taking imdur, clonazepam and nifedipine 7. start taking trazadone to help you sleep 8. decrease penoxifylline to twice daily because of your kidney function 9.start taking heparin injections to prevent blood clots. 10. increase furosemide to 160 mg twice daily 11. decrease insulin to 40 units at night weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 puonds in 3 days. followup instructions: department: rheumatology when: wednesday at 12:00 pm with: , md building: lm bldg () campus: west best parking: garage department: when: friday at 11:00 am with: , m.d. building: sc clinical ctr campus: east best parking: garage department: cardiac services when: at 1:40 pm with: , md building: campus: east best parking: garage procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization pulmonary artery wedge monitoring diagnoses: pneumonia, organism unspecified anemia in chronic kidney disease acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortocoronary bypass status peripheral vascular disease, unspecified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified other and unspecified hyperlipidemia acute respiratory failure pneumonitis due to inhalation of food or vomitus septic shock hyperosmolality and/or hypernatremia delirium due to conditions classified elsewhere acute pancreatitis acute gouty arthropathy acute on chronic combined systolic and diastolic heart failure chronic gouty arthropathy with tophus (tophi) 

Answer: The patient is high likely exposed to