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: weight gain major surgical or invasive procedure: placement of tunneled dialysis line placement of temporary dialysis line cvvh history of present illness: mr. is an 80 year old gentleman with cll, ckd, apical hypertrophic cardiomyopathy, afib on coumadin, recent ppm placement one month ago, presenting with dyspnea, edema, and mild weight gain. he is followed by vna at home, and was noted by wife to have decreasing urinary output, generalized edema, and dyspnea with minimal exertion. weight slightly up from 157.5 at last clinic visit with dr. one week ago, now up to 158.5 lbs, though his wife notes that his baseline weight is actually 145 lbs. patient notes that he has been feeling increasingly short of breath over the last week with minimal exertion. he feels bloated with swelling of his face, abdomen, back, scrotum. on review of systems, he does admit to some lightheadedness. he notes that he feels he has something in the back of his throat but cannot cough it up. otherwise denies any chest pain, orthopnea, cough, hemoptysis, constipation, diarrhea, black stools or red stools. he denies recent fevers, chills or rigors. he does have frequent urination, unchanged from prior. he also notes dry mouth, which he "always" has. does also complain of right shoulder pain, particularly with movement. past medical history: cardiac risk factors: (-)diabetes, (-)dyslipidemia, (+)hypertension . cardiac history: cabg: none percutaneous coronary intervention: none . pacemaker/icd, in for av block and syncope - dual chamber in vvir mode. . other past history: - chronic atrial fibrillation - type apical hypertrophic cardiomyopathy - tricuspid valve prolapse with severe regurgitation and rv volume overload - hypertension - cll - diagnosed , ct c/a/p () was negative for enlarging lymphadenopathy. skin bx reviewed by pathologist confims cll and negative for 11;14 translocation. - bph s/p turp - shoulder surgery repair ligament - bilateral total hip replacements social history: married. lives with his wife. nonsmoker. retired salesman and lives in . patient notes that he used to be a gymnast and has been physically fit most of his life. family history: mother had stroke, father had heart disease physical exam: admission exam: vs - 109/71 73 24 99%ra gen: wdwn elderly male in nad, though heavy breathing, lying supine, speaks words at a time prior to taking breath. mood, affect appropriate. heent: edematous face. sclera anicteric. eomi. conjunctiva pink, oropharynx clear, mildly dry mucus membranes. cv: irregular rhythm, distant heart sounds. lungs: resp somewhat labored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: + distended and firm but not tympanic. normoactive bowel sounds. no hsm or tenderness. ext: bilateral weeping arm edema. right shoulder pain with abduction or any movement; pain goes away when patient lifts arm above 45 degrees. no ankle edema, but significant pitting sacral edema, back edema, scrotal edema. 1+ dp pulses. skin: stasis dermatitis changes on lower extremities, left lateral leg stitch in place from previous hospitalization. good sensation in feet. pertinent results: admission labs: 12:50pm blood wbc-9.4 rbc-3.03* hgb-8.7* hct-28.3* mcv-93 mch-28.7 mchc-30.7* rdw-17.9* plt ct-229 12:50pm blood pt-17.2* inr(pt)-1.5* 12:50pm blood glucose-111* urean-85* creat-2.6* na-131* k-4.0 cl-94* hco3-20* angap-21* 12:50pm blood calcium-8.8 phos-5.9* mg-2.6 chest (pa & lat) study date of 6:25 pm impression: pa and lateral chest compared to through : since minimal increase in severe chronic cardiomegaly and pulmonary vascular congestion could be due to different phases of cardiac and respiratory cycles, while small bilateral pleural effusions have decreased, and there is no pulmonary edema. transvenous right atrial and right ventricular pacer leads are unchanged in their respective positions. dup extext bil (map/dvt) study date of 2:49 pm findings: duplex evaluation was performed of bilateral lower extremity veins. visualization of the tibial veins was difficult due to leg swelling. there is normal compression, augmentation and phasicity of the common femoral, thigh femoral, and popliteal veins bilaterally. there is no deep venous reflux bilaterally. there is reflux in the right greater saphenous vein below the knee. there is no reflux in the left greater saphenous vein. there is no reflux. the lesser saphenous veins bilaterally. tibial veins were visualized and noted to be patent by color flow evaluation. cannot rule out nonocclusive thrombus. incidental note is made of a right groin node measuring 2.4 cm. impression: no evidence of proximal deep vein thrombosis in bilateral lower extremities. cannot rule out nonocclusive tibial vein thrombosis. there is reflux only on the right greater saphenous below the knee. carotid ultrasound on -scale and color doppler son was performed of the right and left eca, ica, cca, and vertebral arteries. grayscale imaging demonstrates mild plaque within the right and left icas. no left carotid artery dissection is seen. antegrade flow is seen within the vertebral arteries. the following velocity measurements were obtained: right: proximal ica 88/16 cm/sec, mid ica 82/26 cm/sec, distal ica 52/18 cm/sec, cca 104/22 cm/sec, eca cm/sec, vertebral artery 50 cm/sec. the right ica/cca ratio is 0.84. left: proximal ica 91/17 cm/sec, mid ica 67/23 cm/sec, distal ica 81/15 cm/sec, cca 106/20 cm/sec, eca 121 cm/sec, vertebral artery 43 cm/sec. left ica/cca ratio 0.85. impression: findings are consistent with less than 40% stenosis bilaterally. renal ultrasound on clinical indication: elevated creatinine. this study was done portably at the bedside demonstrating the right kidney to measure 10.4 cm in length and the left kidney 10.1 cm. these measurements are unchanged from a prior scan of . neither kidney shows evidence of hydronephrosis, stone disease or concerning masses. there is a small subcentimeter lower pole cyst in the right kidney and a 1.2 x 1.5 cm parapelvic cyst in the left kidney with a single thin septation. these are also unchanged in size. the bladder is not well evaluated due to limited amount of urine within, but there is evidence of ascites in the pelvis and right flank. conclusion: normal-sized kidneys without evidence of obstruction and without significant change since . there is new ascites however. echocardiogram on the left and right atria are markedly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is diastolic septal flattening c/w right ventricular volume overload. apical hypertrophy is not appreciated, but there is an apically displaced papillary muscle and the apex is now well delineated. the right ventricular cavity is markedly dilated with normal free wall contractility. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the tricuspid valve leaflets fail to fully coapt. severe tricuspid regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is a very small pericardial effusion, primarily around the apical portion of the right atrium. compared with the prior study (images reviewed) of , the severity of tricuspid regurgitation is somewhat incresaed. the other findings are similar. brief hospital course: mr. is an 80 year old gentleman with hypertrophic cardiomyopathy, atrial fibrillation on coumadin, recent ppm placement, now presenting with edema, weight gain, and shortness of breath consistent with chf exacerbation. #. acute on chronic diastolic congestive heart failure - patient has hypertrophic (apical predominent) cardiomyopathy with small lv cavity, diastolic lv failure, causing pulmonary hypertension; also with long standing severe tr and right sided overload and underfilling of left ventricle. having presented to clinic with volume overload the week prior to admission, patient's torsemide was increased to 40mg daily, and his spironolactone was discontinued. he noted a one pound increase in weight since the week prior to admission, though nearly 14 lbs above his baseline. he presented with significant fluid overload and pitting edema in sacrum, back, dependent areas, and decreased breath sounds in lung bases. cxr from last week clinic visit showed small pulmonary effusions. patient was started on furosemide drip on admission at 20mg/hr with metolazone 2.5mg to which he diuresed well. he was placed on 1l fluid restriction per day. furosemide drip was gradually increased to 40mg/hr with metolazone 5mg with improvement in lower extremity and scrotal edema, though patient persisted with thigh and sacral edema. because progress was limited with furosemide drip, patient was transferred to ccu to for ultrafiltration through temporary hd ij line. patient had successful cvvh and was near euvolemic upon discharge back to the floor where torsemide and metolazone was tried for diuresis. . patient subsequently spiked a fever to 102 (see below) and was transferred back to the ccu. . after transfer back to ccu, the pt was again diuresed, however in the setting of poor forward flow, the pt's kidney function began to deteriorate (see below). as the kidneys began to stop responding to iv diuretics, renal was consulted again and the decision was made to put the patient back on cvvh. . unfortunately, the patient was unable to sustain blood pressures high enough for cvvh, and so was maintained on a levophed drip much of the time to assist with cvvh. the patient's bps often would fall to the 70s systolic, and the pt's mental status began to wane during this time. throughout the last two weeks, the pt remained volume overloaded. a thorough workup of potential causes of hypotension was undertaken, but no obvious reversible cause could be determined. the pt's course continued to deteriorate over another 2 weeks on cvvh and levophed, and the pt was made cmo and taken off cvvh on . . #. acute on chronic renal failure - patient with acutely elevated creatinine to 2.6 on presentation from ~1.9-2.1 the week prior, likely in setting of poor forward flow. he presented with a mild gap acidosis, likely in the setting of new renal failure. during diuresis, creatinine improved to 2.2, then peaked at 2.8 despite still being very fluid overloaded, likely still due to poor forward flow. creatinine improved to around 1.5 with cvvh. patient's creatine bumped on to the 3s. he was given 4l ivfs, without any improvement in cr. urine sediment was notable for granular/hyaline casts and renal us w/o evidence of obstruction. subsequent arf likely secondary to hypotensive episodes and atn secondary to sepsis (see below). patient's urine output was reduced, and as above, cvvh was started after consulting with renal. the pt eventually became anuric. . #. sepsis: patient spiked a fever to 102; blood cultures demonstrated mssa. patient was hypotensive and tachycardic, requiring levophed pressor support. patient was resucitated with ivfs and treated with nafcicillin. pressors were weaned off . the patient was maintained on nafcillin as per id recommendations throughout his stay. . #. hyponatremia - hypervolemic hyponatremia fluctuated in the setting of diuresis with a nadir of 125. when possible, the patient was fluid restricted in the setting of hyponatremia. . #. atrial fibrillation - patient was in atrial fibrillation on presentation and was intermittently paced throughout hospitalization. he had been subtherapeutic on warfarin because his warfarin dosing had been reduced previously. the primary team attempted to restart the patient's warfarin, however in the setting of uremia and anticoagulation, the pt began to bleed from puncture sites and instrumentation sites after a tunneled line was placed. for that reason, the coumadin was d/c'ed and was not restarted for the remainder of his hospitalization. . #. leukocytosis - the pt developed a leukocytosis of uncertain etiology. the patient remained afebrile for his last two weeks, and a systematic approach was taken to identify the source, however this was unsuccessful. . #. right shoulder pain patient has chronic shoulder pain; he had shoulder surgery about three years ago, notes that pain persists constantly. his symptoms were controlled with tylenol and oxycodone. #. anemia - hematocrit remained stable. anemia likely secondary to cll. in the setting of bleed after procedure, and in the setting of longstanding anemia, the patient was transfused with prbcs to maintain a hct of ~29%. #. bph, s/p turp - patient has frequency of urination for at least a couple of years. was started on tamsulosin the week prior to admission at cardiology clinic appointment but did not notice subjective improvement, likely in setting of acute renal failure and decreased urine output overall. tamsulosin was discontinued per outpatient cardiologist. # left leg varicosity patient had left leg varicosity with uncontrollable bleeding during last hospitalization with stitch placed in his wound by vascular surgery with successful hemostasis. patient was scheduled for a followup appointment with dr. which was missed because of this hospitalization. vascular surgery removed stitch on admission. venous duplex ultrasound was done to look for reflux, showing no evidence of proximal dvt in lower extremities, though nonocclusive tibial vein thrombosis could not be ruled out. reflux was seen only in the right greater saphenous vein below the knee. . of note, on the venous duplex ultrasound, there was an incidental finding of one enlarged groin lymph node. the patient does have a history of cll. . #. gout - allopurinol was held on admission in setting of acute renal failure. medications on admission: warfarin 1 mg p.o. daily torsemide 40 mg p.o. daily (dose had just been increased week prior to admission) metoprolol succinate 25 mg p.o. daily allopurinol 100 mg p.o. daily. tamsulosin 0.4 mg daily (stopped last week, per dr. : spironolactone 12.5 mg p.o. daily) discharge disposition: expired discharge diagnosis: deceased discharge condition: deceased discharge instructions: n/a followup instructions: n/a md, procedure: other endoscopy of small intestine diagnostic ultrasound of heart hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis diagnoses: other primary cardiomyopathies acidosis hyperpotassemia acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified acute posthemorrhagic anemia hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases methicillin susceptible staphylococcus aureus septicemia sepsis chronic kidney disease, unspecified hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) urinary frequency disorders of phosphorus metabolism long-term (current) use of anticoagulants cardiac pacemaker in situ other ascites infection and inflammatory reaction due to other vascular device, implant, and graft kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure encounter for palliative care diseases of tricuspid valve delirium due to conditions classified elsewhere other specified hypotension leukocytosis, unspecified chronic lymphoid leukemia, without mention of having achieved remission oliguria and anuria pain in joint, shoulder region anemia in neoplastic disease edema of male genital organs asymptomatic varicose veins atrioventricular block, unspecified 

Answer: The patient is high likely exposed to