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: history of present illness: the patient is a -year-old male with a history of coronary artery disease, congestive heart failure, with an ejection fraction of 20%, hypertension, atrial fibrillation, depression, and anxiety. it should be noted that for atrial fibrillation, the patient has not been on coumadin, and there is a question of whether this is chronic versus paroxysmal. the patient's ejection fraction is 20% by echocardiogram done at last month. the patient was admitted initially to the micu with respiratory distress and acute renal failure. the patient was unable to answer questions, so all history was obtained by the patient's primary care physician, . . the patient lives is an assisted-living facility. he had mildly elevated creatinine to 2.5 one week prior to admission. this was felt to be secondary to lasix for congestive heart failure. there is little history for past week, but the patient saw his primary care physician on the day of admission, and was tachypneic and sent to the emergency room for evaluation. oxygen saturation could not be obtained, but abg revealed a pao2 of 112 on 100% nonrebreather. the patient was also hypotensive with an sbp in the 80s on presentation, but blood pressure increased to 120 on 1 l normal saline bolus. labs obtained that day found the patient to be hyperkalemic at 6.3. creatinine was 5.4. electrocardiogram revealed new st depressions and t-wave inversions in v1-v3. the patient was given kayexalate and admitted to the micu for further care. past medical history: 1. coronary artery disease. details are unknown. 2. congestive heart failure with an ejection fraction of 20% by echocardiogram done at last month. 3. hypertension. 4. atrial fibrillation, not known whether chronic or paroxysmal. the patient was not on coumadin. 5. the patient has a history of anxiety and depression. medications on admission: lisinopril 10 mg p.o. q.d., lasix 40 mg p.o. b.i.d., zyprexa 2.5 p.o. q.d., depakote dose unknown, dexacen 1 mg p.o. b.i.d., colace 100 mg p.o. b.i.d. allergies: no known drug allergies. social history: he lives in an assisted-living facility. per her primary care physician, is severely deconditioned and debilitated but refuses other living arrangements. daughter is active in his care. physical examination: vital signs: on admission pulse was 112, blood pressure 106/70 after fluid, oxygen saturation 100% on nonrebreather, respirations 28, temperature 97.8??????. general: the patient was alert and in no acute distress. heent: within normal limits. normocephalic, atraumatic. dry mucous membranes. oropharynx clear. neck: supple. no lymphadenopathy. thyroid normal. no jugular venous distention. heart: irregularly irregular. no murmurs, clicks, or gallops. lungs: clear to auscultation bilaterally. abdomen: soft, nontender, nondistended. no hepatosplenomegaly palpated. extremities: lower extremities with no clubbing, cyanosis, or edema. skin: without rashes. neurological: grossly normal. laboratory data: white count 14.1, hematocrit 40.1, platelet count 200; inr 1.2; sodium 149, potassium 5.9, chloride 110, bicarb 22, bun 130, creatinine 5.4, glucose 104; depakote level 36; abg 7.38 ph; ck 581, mb 30, troponin 0.88. hospital course: in the unit the patient was treated with vigorous intravenous fluids with improvement in renal failure and blood pressure. his course was complicated by anemia which was felt to be secondary to dilutional .................. acidosis which was .................. and felt to be secondary to dilutional acidosis. the patient had atrial fibrillation in the unit, as well as persistent fever. chest x-ray revealed pneumonia felt to be secondary to aspiration pneumonia. the patient was started on flagyl and levofloxacin. the patient was then transferred to the floor. 1. pneumonia: again this was felt to be secondary to aspiration pneumonia. the patient's antibiotics were changed from levofloxacin and flagyl to levofloxacin and clindamycin to provide better coverage for gram-positive aerobes. on the floor, the patient was initially stable on 2 l oxygen. he had vigorous chest physical therapy that was delivered to loosen up secretions, and he became stable on room air, with oxygen saturations 95-96% on room air. the patient's sputum culture was consistent with mixed oropharyngeal flora, and no organism was isolated. the patient was continued on clindamycin and levofloxacin and was discharged with these medications. in regards to his hospitalization on the floor, the patient remained stable in room air. 2. cardiovascular: pump: the patient was initially off afterload reducing agents such as ace inhibitor; however, lisinopril was added at 2.5 mg p.o. q.d. once his creatinine stabilized to his baseline of around 1.0-1.2. the patient tolerated this quite well. rate control: the patient was considered for beta-blocker; however, he was very sensitive to low-dose beta-blockers with decrease in blood pressure, and hence these were discontinued. the patient throughout his hospitalization remained in atrial fibrillation which was mostly very well rate controlled in the 70-80s. beta-blockers and other nodal agents were not continued given that the patient is very sensitive and would have low blood pressures. he otherwise maintained good blood pressure without problem. ischemia: there was no evidence of active ischemia. the patient did have elevated ck, ckmb, and troponins; however, these were felt to be secondary to demand ischemia in the setting of renal insufficiency. the patient did not actively complain of chest pain or have any other symptoms that would indicate active ischemia. further management was deferred. atrial fibrillation: the patient has a history of atrial fibrillation. this is unclear of whether this is chronic versus paroxysmal. the patient was not on coumadin on admission, and coumadin was not continued in-house. the patient was mostly very well rate controlled with rate in the 70s to 80s and had no evidence of acute embolic events throughout his hospitalization. hypotension: again this improved throughout his hospitalization. the patient had no symptomatic hypotensive episodes. his blood pressures were very well controlled on ace inhibitor at low dose. 3. acute renal failure: by the time the patient was on the floor, his renal failure had returned to baseline at approximately 1.0-1.2 for his creatinine. 4. congestive heart failure: the patient has a history of congestive heart failure. his diuretics were stopped entirely throughout his hospitalization. in fact, the patient was aggressively fluid resuscitated on admission to the micu. the patient was not maintained on diuretics at all, and his only medications included lisinopril 2.5 mg 1 p.o. q.d. for afterload reduction. the patient will not be discharged with a diuretic given that he is currently stable on room air and is not in decompensated heart failure, has no evidence of lower extremity edema. his lasix may need to be readded to his regimen as an outpatient once he is discharged from the hospital, as his volume status changes. his volume status should be followed quite aggressively, and he should be maintained on a low-sodium, puree, and thick liquid diet. additionally, his intake of fluids should not exceed 1500 cc per day. the patient's urine output should also be followed. 5. fen: again acidosis was non-gap and felt to be secondary to expansion. this resolved throughout his hospitalization. the patient's hypernatremia again was felt secondary to fluid resuscitation and free-water deficit. he was repleted with d5 normal with resolution of his hypernatremia at discharge. the patient's sodium of discharge was 143. additionally, hyperkalemia resolved with fluid resuscitation. the patient had no electrocardiogram changes consistent with hyperkalemia. the patient while in-house had a video, as well as bedside swallow study to evaluate his swallowing mechanism, given that it was felt that his pneumonia was an aspiration event. the patient passed his bedside swallow study; however, he also had a video-swallow which he did not pass. the overall recommendations from speech and swallow were that the patient should be maintained npo with consideration of peg tube for further tube feeding nutrition; however, the patient and his daughter refused tube feed as an option and did not want peg tube or ng tube placed. it was explained to them that the patient could have further aspiration events if he continued on a p.o. diet; however, the daughter understood this as did the patient. they were also explained that even with a peg tube, aspiration events cannot prevented given that the patient can aspirate one's own secretions. hence, the daughter and patient both decided that the patient would continue on a puree and thick liquid diet and that all eating events would be monitored by staff. the patient will be maintained on aspiration precautions and that the head of his bed should be elevated. both daughter and the patient wanted to defer ng tube or peg tube at this time. they wanted to continue the patient on p.o. diet as long as the patient could tolerate. 6. heme: the patient throughout his hospitalization received 1 u packed red blood cells. again his drop in hematocrit was felt to be secondary to dilution. after transfusion of his 1 u packed red blood cells, hematocrit remained stable between 30-31.9 at discharge. 7. psychiatric: the patient was continued on ................... and valproic acid throughout his hospitalization with no acute events. 8. prophylaxis: the patient was maintained on subcue heparin and h2 blocker. disposition: he will be discharged to a rehabilitation/nursing home facility. condition on discharge: fair to stable. he is stable on room air. he is maintained on antibiotics. he has been afebrile for greater than three days. he has had no witnessed aspiration events. mental status is at baseline. discharge medications: aspirin 325 mg p.o. q.d., bacitracin zinc ointment to be applied q.i.d. to the urethral meatus, albuterol nebs 1 q.6 hours as needed, ipratropium nebs 1 q.6 hours as needed, olanzapine 5 mg 0.5 mg 1 p.o. q.d., lisinopril 5 mg 0.5 mg tab 1 p.o. q.d., clindamycin 600 mg p.o. q.8 hours for 7 days, levofloxacin 500 mg 1 p.o. q.d. for 7 days, valproic acid 250 mg/5 ml to be taken 5 ml p.o. at bed time, .................. 40 mg/5 ml suspension to be taken at 2.5 ml 1 p.o. q.d. follow-up: the patient is to set up follow-up with his primary care physician . approximately one week after he is discharged from his extended rehabilitation facility. discharge labs: white count 8.6, hematocrit 31.9, platelet count 283; sodium 143, potassium 4.8, chloride 114, bicarb 21, bun 21, creatinine 1.2, glucose 90, calcium 9.6, magnesium 2.4, phos 2.7. , m.d. dictated by: medquist36 d: 09:12 t: 09:19 job#: procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified atrial fibrillation pneumonitis due to inhalation of food or vomitus 

Answer: The patient is high likely exposed to