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: erythromycin base / haloperidol / percocet attending: chief complaint: hematuria . major surgical or invasive procedure: cystoscopy, transurethral resection and fulguration of bladder tumor. . continuous bladder irrigation. . history of present illness: mr. is a year old male with pmh significant for dm, bph s/p turp, and remote low grade tcc s/p resection, who presents with a chief complaint of gross hematuria. he had previously been in his usoh until he began to have blood in his urine last night. he denies dysuria, changes in frequency of urination, difficulty voiding, pain with voiding, or abdominal pain. he had a urinary tract infection several months ago which presented with hematuria. he denies any fevers, chills, abdominal pain. . in the ed, the patient had a urinalysis, which showed trace leukocytes, large blood, and few bacteria. he was also found to have a white count of 13.4. he received 1 gram ceftriaxone iv. urology was consulted. . hospital course: patient was seen and examined by the medicine team. at approximately 1:00 am, the team was called to the room for a "code blue." the patient had been sitting on the side of the bed to have a bowel movement and apparently collapsed in the son's arms. the code team arrived, and found the patient awake. vital signs were immediately taken, pacer pads were placed on the patient's chest, and a nasal cannula was placed on the patient's nose. a bp was not able to be obtained initially, but he had 2+ bilateral pedal pulses. the patient was oriented to self, and responding appropriately. fingerstick glucose was measured to be 117. repeat hct had just returned at 35, which was a 3 point hct drop from the er. a fluid bolus of 500 cc ns was given. the decision was made with the micu team to get an ekg, which did not show new st changes compared with an old ekg. the attending was called, and the decision was made to keep the patient on the floor on telemetry. . past medical history: 1. cad - s/p mi in tx with lytic therapy and rescue angioplasty 2. chf - ef 20-25% 3. dm2 4. history of paf 5. s/p ppm 6. hypertension 7. hypercholesterolemia 8. l hip replacement c/b femur fx with "slipped prosthetic" 9. past utis, most recently with proteus mirabalis (ctx sensitive, fluoroquinolone resistant) 10. s/p turp 11. dementia - baseline aao x 1 . social history: lives with son. baseline and oriented x 1. wife passed away 4yrs ago. retired plumber who worked here at . . family history: non-contributory . physical exam: vitals: 98.2 f 55 148/70 16 95% ra general: elderly, well-appearing male in nad, appears stated age lungs: clear anteriorally at bases cardiovascular: normal rate, regular rhythm abdomen: soft, non-tender, non-distended gu: white patches on scrotum, foley in place, draining reddish urine extremity: no edema . pertinent results: admission labs: glucose-216* urea n-37* creat-1.5* sodium-136 potassium-4.6 chloride-96 total co2-29 wbc-13.4 hgb-12.8* hct-38.6* plt count-283 n-67.1 l-23.8 m-5.7 e-2.9 b-0.6 . urinalysis: color-red appear-cloudy sp -1.009 blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-tr rbc->50 wbc-21-50* bacteria-few yeast-none epi-0-2 . micro: urine culture: no growth blood culture: no growth 12/2 blood culture: no growth . studies: . cxr (ap): no evidence of acute cardiopulmonary process. . cxr (ap): no appreciable change. mild blunting of bilateral costophrenic angles. . ct abdomen/pelvis: 1. filling defect within the bladder may represent clot or recurrence of transitional cell carcinoma. direct visualization is recommended. 2. mild aspiration pneumonia. 3. extensive sigmoid diverticulosis without evidence of diverticulitis. 4. cholelithiasis without evidence of cholecystitis. 5. extensive degenerative changes of the thoracolumbar spine. . video oropharyngeal swallow: fluoroscopic assistance was provided for the speech and swallowing division. there is poor epiglottic deflection and no laryngeal elevation. penetration was seen both before and during administration of nectar thick liquids. there was premature spillover during the oral phase due to loss of bolus control and swallowing delay. microaspiration was seen with all consistencies. impression: multiple episodes of penetration with several episodes of microaspiration with all consistencies of barium. . bladder biopsy pathology: 1. low grade papillary urothelial carcinoma, no lamina propria invasion seen. 2. muscularis propria present. . brief hospital course: brief hospital course by problem: . ## hemorrhagic cystitis: the patient was admitted with hematuria and continued to have significant hematuria during most of the admission. he was evaluated by urology and maintained on continuous bladder irrigation. she was manually bladder irrigated by urology and approximately 2 units of clot were removed. he required a total of 6 units rbc transfusion. in the past, he has had admissions for uti, usually presenting with hematuria. given this history, he was treated with a 7 day course of ceftriaxone for empiric uti coverage, though his urine culture was negative. ct urogram was concerning for possible recurrence of tcc (showed filling defect in the bladder). he underwent cystoscopy on , which revealed recurrent tcc. the tumor was resected and fulgurated under spinal block anesthesia. after the procedure, his urine cleared. cbi and his foley were discontinued. he received a 3 day course of ciprofloxacin, per usual post-cystoscopy regimen. on discharge, his urine was clear and without clots. he will follow-up with dr. urology as an outpatient. . # troponinemia/cad: he had a troponin leak in the icu with peak of 0.21. troponin increased again on the floor with peak of 0.61. this likely represented demand ischemia in the setting of vasovagal syncope (during bm), uti, and anemia secondary to acute blood loss from hematuria. he had no new ekg changes. he did have one episode of chest pain prior to the initial troponin leak, however this was felt unlikely to be acs given transient nature and no ekg changes. he was evaluated by the cardiology service who recomended optimal medical management as he was not a candidate for intervention. he was treated with aspirin, statin, beta blocker, , and intermittent lasix. his outpatient cardiologist, dr. was made aware of these events. . ## hypotension: he had several episodes of transient hypotension during this admission. the first resulted in a code blue (as above) when he became hypotensive to the 60s and unresponsive while on the commode; likely a vasovagal episode. his sbp came back up to normal range without intervention. later, he again became hypotensive to the 60s 1-2 hours after manual bladder irrigation. given the hypotension and his leukocytosis there was concern for developing urosepsis and he was transferred to the micu. he was given ivf and his bp came back to the normal range. he was transferred back to the medical floor the next day. he had one further episode of hypotension, again with sbp transiently to the 60s 2 hours after manual bladder irrigation. he was given a 250cc bolus of ns and his bp responded appropriately. these episodes were most likely related to blood loss from his bladder vs vasovagal response to the fluid shifts with bladder irrigation. on discharge he was hemodynamically stable. urine and blood cultures were all negative making urosepsis less likely. . ## cough/wheeze/hypoxia: the patient became wheezy at times with productive cough and intermittent transient hypoxia. this was most likely related to mucous plugging vs mild chf. he would occasionally desaturate intermittently to low 90s but improve with suctioning of mucous plug. there was also concern for a possible aspiration event. he did have a leukocytosis with wbc up to 15-16, however he remained afebrile. he was treated with ceftriaxone for empiric uti coverage (as above) and this was felt sufficient to cover for possible aspiration pneumonia. he was also treated with nebulizers, chest physiotherapy, and lasix as needed. on discharge, he was restarted on his home lasix dose. . ## altered mental status: per his sons, the patient has a history of delirium and agitation when hospitalized. he did have several episodes of delirium and agitation, requiring restraints at time. he also responded to zyprexa. his sons are very involved in his care and were at the bedside as much as possible, helping to control his agitation. . ## acute renal failure: on admission, his creatinine was elevated to 1.5. this was likely pre-renal renal failure. his creatinine improved to baseline after ivf repletion. . ## acute on chronic systolic chf (ef 20-25%). he was intermittently diuresed with lasix for volume overload. he was continued on aspirin, statin, beta blocker, and . beta blocker and were held while in the micu and re-started on the floor when his blood pressure was stable. . ## dm2: he was covered with glargine and an insulin sliding scale. his oral hypoglycemics were held during his hospital stay and re-started on discharge. . the patient was full code for this admission, confirmed with his sons. medications on admission: asa 81 mg qday glipizide 15 mg insulin sliding scale losartan 25 mg sotalol 80 mg po bid lorazepam 1 mg for insomnia carbamazipine 200 qday nexium 40 qday mvi kcl . discharge medications: 1. sotalol 80 mg tablet sig: one (1) tablet po bid (2 times a day). 2. carbamazepine 200 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po daily (daily). 3. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 4. hexavitamin tablet sig: one (1) cap po daily (daily). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*1 inhaler* refills:*2* 7. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. losartan 25 mg tablet sig: one (1) tablet po daily (daily). 9. glipizide 5 mg tablet sig: three (3) tablet po twice a day. 10. insulin sliding scale please continue insulin sliding scale as previously prescribed 11. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po qhs (once a day (at bedtime)). disp:*30 tablet, rapid dissolve(s)* refills:*2* 12. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 13. insulin glargine 100 unit/ml cartridge sig: twenty four (24) units subcutaneous at bedtime. 14. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day. . discharge disposition: home discharge diagnosis: primary: recurrent bladder transitional cell carcinoma secondary: 1) chf 2) cad 3) acute renal failure 4) diabetes mellitus, type 2 . discharge condition: vital signs stable, urine clear. . discharge instructions: you were admitted to the hospital with blood in your urine and low blood pressure. while in the hospital you had a mild "silent" heart attack, which was felt to be due to strain on your heart from the significant amount of blood loss in your urine. you had a cystoscopy that revealed extensive bladder cancer as the cause for your hematuria. this was resected and cauterized in the or. you were also treated with antibiotics for possible urinary tract infection. please note that you have been started on a few new medications. these include atorvastatin for your heart, fluticasone for wheezing, and olanzapine to help with delirium at night. . if you develop significant blood in your urine, fever > 101, chest pain, sob, please return to the nearest er. please take all medications as prescribed. . followup instructions: please call dr. office to arrange follow-up within the next 2 weeks. please also follow-up with dr. (cardiology) in the next 2 weeks. . please call dr. (urology) to arrange follow-up in the next 2-4 weeks. the phone number is (. . md, procedure: transfusion of packed cells other transurethral excision or destruction of lesion or tissue of bladder artificial pacemaker rate check diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified atrial fibrillation personal history of tobacco use other persistent mental disorders due to conditions classified elsewhere hypotension, unspecified pneumonitis due to inhalation of food or vomitus chronic systolic heart failure cardiac pacemaker in situ hypoxemia diverticulosis of colon (without mention of hemorrhage) malignant neoplasm of other specified sites of bladder cystitis, unspecified 

Answer: The patient is high likely exposed to