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: hydrochlorothiazide / levaquin attending: chief complaint: shortness of breath major surgical or invasive procedure: right heart catheterization history of present illness: mr is a 52 year old man with pulmonary hypertension detected approximately six months ago by echo, afib, pad, copd (2l of home o2), chronic edema and anasarca and dm2 who presented to after a fall. he reports that he had difficulty getting up after his fall. during his admission at his weight was found to be over 400 pounds. he was found to be volume overloaded and they began diuresis. he was noted to be dropping his o2 sats to the mid 70??????s with exertion on oxygen. he is usually on 3l home oxygen. on review of systems, he denies history deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, palpitations, syncope or presyncope. past medical history: pulmonary hypertension copd atrial fibrillation peripheral artery disease type 2 diabetes a1c: 5.3 chronic leg edema and anasarca social history: history of smoking but no current tobacco use, alcohol or ivdu family history: there is no family history of premature coronary artery disease or sudden death. physical exam: vs: t: 98 hr: 76 (76-84) bp: 114/79 (91-114/52-79) rr: 20 o2: 94% on ra ins: 1241/1700 = net neg 450ml wgt: 116.5 from 117.6 kg yest gen: nad, soft spoken, sitting in chair cardiac: no jvd, irir, mid systolic murmur lungs: ctab, decreased airmovement diffusely abd: grossly distended and anasarcic, bs normoactive, nt, ue: radial 2+, picc line in l arm no erythema or induration le: brawny lower extermities with bluish discoroloration, only trace edmea to mid-shins now, dp 2+ pertinent results: admission labs (): #)cbc: wbc-5.6 rbc-3.33* hgb-10.3* hct-32.0* mcv-96 mch-31.1 mchc-32.3 rdw-14.8 plt ct-177 #)coags: pt-24.3* ptt-39.6* inr(pt)-2.3* fibrino-312 #)chem: glucose-94 urean-15 creat-0.9 na-140 k-3.8 cl-90* hco3-47* angap-7* alt-7 ast-17 alkphos-94 totbili-1.2 calcium-8.9 phos-3.3 mg-2.2 #)abg: type-art po2-66* pco2-74* ph-7.41 caltco2-49* base xs-17 . other labs: #) ua (): color-ltamb appear-hazy sp -1.012 blood-lg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-8* ph-6.5 leuks-lg rbc-276* wbc-68* bacteri-few yeast-none epi-0 #) urine cx (): staph aureus coag +. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _______________________________________________________ staph aureus coag + | gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s nitrofurantoin-------- <=16 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s . other studies: #) cxr (): impression: ap chest reviewed in the absence of prior chest radiographs: lower aspect of the chest is excluded from the examination. cardiac enlargement is severe and pulmonary vasculature both peripherally and in the hila is engorged. opacification blanketing the right lower chest is probably effusion. borderline pulmonary edema is present. consolidation particularly in the lower chest and right apex medially is suspected. . #) cxr (): impression: left-sided picc line terminating in similar position as before. marked regression of pulmonary vascular distention related to successful dehydration. no new infiltrates or pneumothorax. . #) abd u/s (): limited ultrasound of the abdomen demonstrates a moderate amount of ascites, predominantly within the lower quadrants. a right pleural effusion is seen. . #) ct neck/lungs with and without contrast () findings: there is a tunneled left-sided central venous line with the tip terminating at the proximal svc. the arch vessel origin is normal. there are no abnormally enlarged superior mediastinal nodes. a tiny wall calcification is in the aortic arch and both cervical carotid bifurcations and cavernous carotid segments. head: there is no significant cervical or intracranial stenosis, aneurysm, or occlusion. neck: there is no significant cervical or intracranial stenosis, aneurysm, or occlusion. note is made of a left maxillary sinus mucous retention cyst. there are no abnormally enlarged cervical nodes. the left aryepiglottic fold is mildly thickened compared to the right and the left piriform fossa is partially effaced. there is enlargement of the left laryngeal ventricle, and mild thickening of the left aryepiglotic fold, consistent with left vocal cord paralysis. impression: partially effaced left piriform sinus and mild asymmetric thickening of left aryepiglottic fold. no compressive lesion of the recurrent laryngeal nerve is demonstrated on the current study. . #) mri brain (): impression: normal intracranial appearances. . #) echo (): echocardiographic measurements results measurements normal range left atrium - long axis dimension: *6.7 cm <= 4.0 cm left atrium - four chamber length: *8.3 cm <= 5.2 cm right atrium - four chamber length: *6.9 cm <= 5.0 cm left ventricle - septal wall thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 5.3 cm <= 5.6 cm left ventricle - systolic dimension: 3.6 cm left ventricle - fractional shortening: 0.32 >= 0.29 left ventricle - ejection fraction: >= 60% >= 55% right ventricle - diastolic diameter: *3.7 cm <= 2.1 cm aorta - sinus level: 3.6 cm <= 3.6 cm aorta - ascending: 3.1 cm <= 3.4 cm aorta - arch: 2.6 cm <= 3.0 cm aorta - descending thoracic: 2.2 cm <= 2.5 cm aortic valve - lvot diam: 2.2 cm mitral valve - e wave: 1.2 m/sec mitral valve - e wave deceleration time: 175 ms 140-250 ms tr gradient (+ ra = pasp): *45 mm hg <= 25 mm hg pericardium - effusion size: 1.0 cm conclusions the left atrium is markedly dilated. a color doppler jet of left-to-right shunt across the interatrial septum is seen at rest c/w a small secundum atrial septal defect. premature appearance of echo contrast is seen in the left atrium post-cough and valsalva release. the estimated right atrial pressure is 0-5 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. an eccentric, inferolaterally directed jet of mild to moderate (+) mitral regurgitation is seen. the tricuspid regurgitation jet is eccentric and may be underestimated. there is moderate pulmonary artery systolic hypertension. there is a atrivial/physiologic pericardial effusion. impression: pulmonary artery systolic hypertension. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. small secundum atrial septal defect. mild-moderate mitral regurgitation. . #) cardiac cath () - preliminary report: comments: 1. resting hemodynamics revealed elevated right and left heart filling pressures with rvedp 15 mmhg and pcwp 19 mmhg. there was moderate pulmonary arterial hypertension with pasp 55 mmhg. the cardiac index was preserved at 3.1 l/min/m2. the pulmonary vascular resistance was elevated at 200 dyn-sec/cm5. final diagnosis: 1. mildly elevated biventricular filling pressures. 2. moderate pulmonary arterial hypertension. 3. mildly elevated pulmonary vascular resistance. . discharge labs (): chest : left pic line can be traced as far as the left brachiocephalic vein, but the tip is indistinct. there are severe cardiomegaly and moderate right pleural effusions are unchanged. pulmonary edema is mild if any. consolidation in the lower lungs is difficult to exclude because of relative and there may be a region of consolidation or other poorly defined lesion in the right suprahilar lung medially. conventional radiographs are essential for better characterization. brief hospital course: id: mr. is a 51 year old man with pulmonary hypertension detected approximately six months ago by echo, afib, pad, copd (2l of home o2), chronic edema and anasarca and dm2 who presented to s/p fall and found to be in congestive heart failure with subsequent transfer to . . #. right sided heart failure: on admit, pt volume overloaded with generalized edema and anasarca. thought due to right heart failure to obstructive sleep apnea/copd. outside echo showed ef 55-60% with increased right-sided pressures. exertional desaturation, lung crackles, and boarderline pulmonary edema on presentation argued for some degree of left heart involvement. diuresis was started with a lasix drip and continued for 4 weeks until . good response with daily goal 2-3l neg. creatinine never rose. eventually transitioned iv pushes before home dose of po lasix started on . final net fluid output for hospitalization was roughly 85l negative with patient's weight falling from 410lbs pre admission to 255lbs at time of discharge. echo and right heart cath on are mentioned in results. pt was changed back to his home regimen of lasix 80mg po bid with the new addition of spironolactone two days before discharge. he was achieving a net negative output for two days on this regimen before discharge. . #. hemoptysis: pt had intermittent cough which started to be productive of small amounts of blood. pt was on either warfarin or heparin gtt while experiencing this trace hemoptysis. pulmonary saw pt in consult and lung imaging was obtained which did not show evidence of pulmonary process. all anticoagulation was stopped for the period of 1 week and hemoptysis resolved, but reocurred within 24hrs of reinitiation of heparin gtt. when ent saw pt regarding vocal cord paralysis they described traumatic changes to both nares likely caused by prolonged use of a nasal cannula. because of this and the patient's report that he often felt bloody tasting drainage at the back of his , he small amount of hemoptysis was believed due to dry upper airway mucosa, worsened when pt was on anticoagulation. pt was restarted on warfarin 2 days before discharge had not experienced any degree of hemoptysis for 48 hours prior to his discharge although his inr was not yet therapeutic. . #. persistent atrial fibrillation: pt in persistent atrial fibrillation during his admission. after admission his coumadin was held in anticipation of a proceedure and pt was started on a heparin drip for anticoagulation. heparin was also stopped for 1 week later in proceedure and pt was put on full strength asa in attempt to decrease hemoptysis, which was successful. home warfarin dose restarted before discharge in light of atrial fib. . # pulmonary hypertension: elevated pulmonary pressures thought to osa and copd. pulmonary was consulted which recommeneded aggressive diuresis. sleep medicine who thought that he needed bipap and he was was sent to the ccu on for bipap trial which he did not tolerate. sleep recommended outpt sleep study once closer to dry weight. . #. copd: pft's from outside hospital revealed severe obstructive disease. initial abg showed hypercarbia (pco2 of 73) with a bicarb of 48 suggestive of a chronic process. pt was placed on tiotropium and fluticasone/salmeterol inhalers with prn short-acting coverage while inpt. initially required supplementary o2 both at rest and with exertion, but after large volume diuresis was satting between 90-96% on ra at rest and rarely used o2 throughout day. the day before discharge patient was able to tolerate 5 minutes of ambulation which brought his heart rate up to 130s without dropping his room air sat below 94%. as a result it appears unlikely that pt needs daytime supplementary oxygen s/p the large volume diuresis from this hospitalization. . # lower extremity edema/wounds: most likely to heart failure. dermotology thought that his findings are consistent with stasis dermatitis. they recommended current leg elevation, compression by ace bandages, aggressive diuresis, clobetosol propionate 0.05% cream for stasis dermatitis followed by wrapping with kerlix then ace bandaging, and cleansing with mild cleanser, moisture barrier ointment. he was noted to have tinea pedisand started on ketaconazole 2% topical ointment for four weeks. wound care service also saw patient in hospital and skin changes and chronic wounds improved with their management and above treatment. . #. uti: he was found to have a urine culture pos. for coag + staph - mssa. he was started on dicoxacillin 12.5mg on and completed a 7 day course. . #. acid reflux: he had been complaing of indigestion consistent with acid reflux. he was started on pantoprazole 40 mg po q24h and aluminum-magnesium hydrox.-simethicone 15-30 ml po/ng qid while in hospital. because pt did not have symptoms the last 10 days in the hospital his acid reflux medications were stopped before discharge. . medications on admission: atenolol 100mg lasix 80mg warfarin 5mg daily finasteride 5mg daily lasix 80mg combivent 2 puffs qid ventolin 2 puffs q2hrs aspirin 81mg daily k-dur 20mg flomax 0.4mg daily oxycodone 15mg q12 prn sertraline 100mg daily lorazepam 0.5mg daily discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. furosemide 80 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*3* 3. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 4. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 5. spironolactone 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 6. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po twice a day. disp:*60 tab sust.rel. particle/crystal(s)* refills:*0* 7. combivent 18-103 mcg/actuation aerosol sig: one (1) inhalation twice a day. 8. ventolin hfa 90 mcg/actuation hfa aerosol inhaler sig: one (1) inhalation prn as needed for shortness of breath or wheezing. 9. advair diskus 250-50 mcg/dose disk with device sig: one (1) inhalation twice a day. disp:*60 1* refills:*0* 10. oxycodone 15 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po bid: prn as needed for pain. 11. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed) as needed for rash: apply to rash under stomach folds as needed . disp:*1 bottle* refills:*0* 12. clobetasol 0.05 % cream sig: one (1) appl topical (2 times a day) for 7 days. disp:*1 tube* refills:*0* 13. ketoconazole 2 % cream sig: one (1) appl topical (2 times a day) for 7 days. disp:*1 tube* refills:*0* 14. outpatient lab work inr, potassium, bun, creatinine to be check by vna on , . . results should be communicated to dr. with internal medicine: phone 15. sertraline 100 mg tablet sig: one (1) tablet po once a day. 16. toprol xl 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. discharge disposition: home with service facility: homehealth vna discharge diagnosis: primary diagnosis: right sided heart failure left vocal cord paralysis urinary tract infection secondary diagnosis: atrial fibrillation obstructive sleep apnea discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , you were admitted because of heart failure. you were having difficulty breathing because you had fluid in your lungs and had fluid backed up into your stomach and lower extremities. you were put on a lasix drip for diuresis and urinated over 80 liters of fluid over the course of 4 weeks. . you were coughing up small amounts of blood during your hospital stay. we believe this was coming from dry upper airway mucosa in your nose. . you came to the hospital with a horse voice. the ear,nose and doctors examined your and observed that your left vocal cord was paralyzed. a cat scan of your neck and lungs and an mri of your head showed no masses that would explain your hoarseness. you will need to follow up with an ears, nose and doctor when you leave the hospital. . you also developed a urinary tract infection while in the hospital which was treated successfully with antibiotics. . medications changed during your admission: stop: atenolol stop: lorazepam new med: start metoprolol succinate 100mg daily new med: spironolactone 25mg by mouth twice each day new med: advair diskus inhaler, 1 puff in morning and 1 puff in evening new med: potassium chloride 20meq tabs, 2 tabs by mouth twice a day new med: clobetasol cream for both lower legs to be applied twice each day for 1 week new med: ketoconazole cream to be applied to feet tonails twice each day for 1 week new med: miconazole powder to be applied beneath stomach skin fold daily for 1 week . scheduled follow-up: primary care doctor: dr. . see below pulmonologist: dr. . see below cardiologist: dr. , at 2pm. see below. . home with services: vna for lab draws and skin care. . weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: pcp . . pulmonologist dr. . cardiologist: dr. , at 2pm clipper cardiovascular associates . , phone: fax: before the visit you will need to fax/bring your medical records to the office 24hrs before your appointment. you will need to bring a copy of your medication list to the appointment and you will need to bring your insurance card. . ent to be referred by dr. if persisting hoarseness could consider outpt voice therapy referral -ask dr. . procedure: laryngoscopy and other tracheoscopy right heart cardiac catheterization diagnoses: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases paroxysmal ventricular tachycardia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site anticoagulants causing adverse effects in therapeutic use acute diastolic heart failure pressure ulcer, heel epistaxis chronic respiratory failure venous (peripheral) insufficiency, unspecified unilateral paralysis of vocal cords or larynx, partial candidiasis of skin and nails history of fall pressure ulcer, unstageable 

Answer: The patient is high likely exposed to