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: nausea major surgical or invasive procedure: intubation central line placement echocardiography history of present illness: 58 year old with pmh of ischemic cm (ef 20%), cad, severe 3vd (not a cabg candidate), type 1 dm presents with nausea and hypotension. recently seen in advanced heart failure clinic on , bp noted to be over 200, and his hyral was increased from 25 qid to 50 tid. lasix increased from 60 qam to 60 am/40 qpm. also got mri of his kidneys which showed severe renal artery narrowing. pt reports that since the next day after the mri, he has increasing nasuea; no f / c / n s / c p/sob/pnd/orthopnea/vomiting/diarrhea/hematochezia/melena/recent nsaid use/decreased uop. in ed, initial vs sbp in 60s, af, pulse in 60s. given insulin/d50, kayexalate, ca for k of 6.1. blood and urine sent. started on dopa, central line placed. given vanc/levo/flagyl/hydrocort, 1 am nabicarb. past medical history: 1. ischemic cm with ef 20% 2. cad with severe 3vd, not cabg candidate 3. pvd s/p b aka 4. type 1 dm 5. blindness 6. complete occlusion of r ica 7. cri s/p renal xplant ; b/l cr 1.2-1.4 social history: lives alone, no smoking or alcohol use family history: non-contributory physical exam: pe 97.8 90 94/47 20 91%2l cvp 5 pertinents mmm supple, jvp 8 cm rales way up rrr, grade ii/vi sem, ?diastolic murmur no tenderness around iliac fossa pertinent results: data ct 1. no evidence of intraabdominal abscess. 2. patchy consolidation at the right lung base. could represent pneumonia or atelectasis. clinical correlation is recommended. bilateral pleural effusions, right greater than left. 3. distended stomach likely representing gastroparesis. 4. extensive vascular calcification. 5. transplant kidney is seen in the right lower quadrant brief hospital course: this is a 56 year old gentleman with dm type i and a history of 3 vessel coronary disease (seen in cath.), ischemic cardiomyopathy (ef of 25 % on echo this admission), aortic stenosis ( 0.9 cm), pvd s/p b/l aka, s/p renal transplant (baseline cr 1.2 to 1.4) who was admitted for hypotension and nausea. pta he had been in heart failure clinic on where sbp noted to be in 200's; his hydralazine dose was doubled and his lasix dose increased. on presentation to ed sbp noted to be 60's pulse in 60s. also given insulin/d50, kayexalate, ca for k of 6.1. started on dopa, central line placed. given vanc/levo/flagyl/hydrocort, 1 am nabicarb. pt admitted to micu, intubated. started on 2 pressors for blood pressure support with gentle ivf. per cardiology service recommendations, a swan-ganz catheter was placed to help determine etiology of hypotension. initial swan numbers revealed elevated pcwp of 23, pap of 63/23, cvp 9, and svr of 1300 consistent with cardiogenic shock and l ventricular overload. echo peformed on revealed no significant changes from prior with ef of 25%, degree of av stenosis was essentially unchanged. pt weaned off pressors and began lasix diuretic therapy for chf exacerbation. his estimated pcwp has trended down since then with creatinine today 1.8 down from 2.2. serial chest x-rays revealed resolving pulmonary edema. pt also being followed by renal service for elevated creatinine and for his status post renal transplant in . the patients creatinine was elevated on admission but slowly trended back to normal range by discharge. he was maintained on his immunosuppressive therapy of azathioprine, prednisone, and cyclosporine. per his nephrologist dr. , his cyclosporine levels were adequate. there was some concern for rejection on a renal ultrasound but the patient's creatinine had returned to his baseline pt was extubated . pt is now off pressors with stable blood pressure, breathing normally on room air. swan ganz catheter d/c'd . last readings were pap of 54/21 cvp of 7. he was transferred to the floor. his stay was relatively uneventful. his blood pressure was generally stable (sbps in 100-110 range). his blood sugars were noted to trend downward and was found to be 31 in morning of . this resolved with amp of d50 (to 131); his insulin sliding scale was converted from regular to humalog; his nph dosing was adjusted to 10 units in the morning and 5 units at bedtime. pt was also noted to have a hematocrit that had trended down from 28 to 25 over the prior week. per renal service, this was felt to be secondary to his renal disease and his epogen was therefore doubled in dosing; in addition, the patient received one unit of blood before his discharge; blood was given with lasix. in summary, this is a 56 year-old type i diabetic male with 3 vessel cad, ischemic cardiomyopathy with ef 25%, aortic stenosis, s/p b/l aka, admitted for hypotension after increases in blood pressure medication and admitted to micu for hypotension, intubated for respiratory distress. found to be in cardiogenic shock necessitating pressor support and in chf. now off pressors, blood pressure w.n.l. breathing on room air with no sign of volume overload on physical exam. infectious workup has been unrevealing. . issues and pal 1) cardiovascular . perfusion: three vessel disease not amenable to pci, not candidate for cabg -continue aspirin and plavix -continue lipitor (40) -started smaller dose of beta blocker (metoprolol 12.5) . pump: ef 25%, aortic stenosis ( 0.9), chf seems to be class ii. status post cardiogenic shock--now resolved, appears secondary to increase in his blood pressure medications. -continue lasix at 40 mg po bid -continue digoxin at 0.0625 mg every other day, check digoxin levels regularly -avoid lisinopril given renal disease -continue hydralazine at 25 mg po tid -please restart isordil and uptitrate as his pressure tolerates. -will follow up with of outpatient heart failure service. rhythm: nsr occasional pvcs -low ef, pt may benefit from icd placement; per attending dr. , patient has declined this option understanding that he remains at increased risk of scd. . pvd: s/p b/l amputations -continue aspirin and plavix -will need physical therapy from extended hospital stay . 2) renal disease, s/p transplant, creatinine now at baseline -continue azathioprine, cyclosporine, please have nephrologist follow this patient. dr. is his primary nephrologist. -csa levels to be checked regularly -if creatinine levels rise, please check renal ultrasound -renally dose all medications . 3) anemia. status post 1 prbc transfusion prior to discharge -have increased epogen from 4000 to 8000 qmwf -monitor hct -if pt needs further transfusion, please give lasix (40 mg iv) before and after transfusion to prevent volume overload. . 4) diabetes, (type i) -in setting of renal insufficiency and renal transplant will need to be on humalog sliding scale. also should continue nph 10 units qam, 5 units qpm. . 5) fen: diabetic/cardiac healthy; please continue sodium and fluid restriction. . 6)prophylaxis should include hep sc, ppi . 7) code: full . 8) disposition: was seen by physical therapy who recommended rehabilitation. patient is being discharged to hospital. medications on admission: prednisone 10 qod lipitor 40 hydral 50 tid plavix asa enalapril 10 lasix 60/40 toprol xl 50 imuran 50 qd isordil 20 tid cyclosporin 100/50 ativan insulin discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. azathioprine 50 mg tablet sig: one (1) tablet po daily (daily). 4. cyclosporine modified 100 mg/ml solution sig: 0.25 ml po q pm (). 5. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 6. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 7. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 8. prednisone 10 mg tablet sig: one (1) tablet po qod (). 9. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed. 10. cyclosporine modified 25 mg capsule sig: one (1) capsule po q am (). 11. epoetin alfa 4,000 unit/ml solution sig: one (1) injection injection qmowefr (monday -wednesday-friday). 12. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed) as needed for rash. 13. lorazepam 1 mg tablet sig: four (4) tablet po hs (at bedtime) as needed for insomnia. 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 15. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 16. insulin nph human recomb subcutaneous 17. insulin for insulin, please give 10 units in the morning and 5 units at bedtime. please use humalog sliding scale per attached flow sheet. 18. digoxin 50 mcg capsule sig: 1.5 capsules po every other day (every other day). 19. metoclopramide 5 mg/ml solution sig: one (1) ml injection q6h (every 6 hours). 20. dolasetron 12.5 mg/0.625 ml solution sig: one (1) injection intravenous q8h (every 8 hours) as needed for nausea. 21. hydralazine 25 mg tablet sig: one (1) tablet po tid (3 times a day). discharge disposition: extended care facility: & rehab center - discharge diagnosis: cardiogenic shock. congestive heart failure exacerbation/ischemic cardiomyopathy. aortic stenosis. coronary artery disease (three vessel disease) diabetes type i. peripheral status post kidney transplant. discharge condition: good. now breathing normally on room air. blood pressure stable. no symptoms of dizziness or nausea. no chest pain. able to work with physical therapy for rehabilitation exercises. discharge instructions: please return to hospital if you experience chest pain, shortness of breath or palpitations. please return to hospital if you start becoming light-headed, dizzy, and/or you feel like passing out. please return to hospital if pt becomes hypotensive. followup instructions: patient is going to rehabilitation facility. please follow up with the nephrology service. please coordinate care with his pcp and nephrologist dr. . pt also to be followed up by of outpatient heart failure service. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization pulmonary artery wedge monitoring monitoring of cardiac output by other technique transfusion of packed cells infusion of vasopressor agent diagnoses: hyperpotassemia anemia in chronic kidney disease coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension aortic valve disorders other specified forms of chronic ischemic heart disease acute respiratory failure atherosclerosis of renal artery cardiogenic shock unspecified disorder of kidney and ureter complications of transplanted kidney diabetes with peripheral circulatory disorders, type i [juvenile type], not stated as uncontrolled above knee amputation status unqualified visual loss, both eyes gastroparesis 

Answer: The patient is high likely exposed to