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: this 85-year-old male with a history of coronary artery disease, in the coronary care unit status post myocardial infarction, congestive heart failure, aortic valve endocarditis, gi bleed, diabetes mellitus, chronic obstructive pulmonary disease, paroxysmal atrial fibrillation, and thalassemia, who was transferred from community hospital to the coronary care unit for continued management of hypotension presumed secondary to heart failure. he was admitted to the outside hospital initially with fever and found to have a pneumonia for which he was treated with fluoroquinolone antibiotics. he was found to have a pleural effusion as well as a pericardial effusion that was identified by transesophageal echocardiogram without evidence of tamponade. he underwent both thoracentesis and pericardiocentesis with a laboratory analysis of both consistent with transudative fluid. he was also dc cardioverted to normal sinus rhythm at the outside hospital. he was felt to have developed pulmonary edema secondary to congestive heart failure and for this reason he was started on dobutamine. on he was transferred to the at the request of the family with chronic atrial fibrillation. on transfer his medications included dobutamine, digoxin, enalapril lasix and aldactone. past medical history: 1. gi bleed in the setting of anticoagulation. 2. staphylococcus aortic valve endocarditis in . 3. coronary artery disease status post inferior myocardial infarction. 4. congestive heart failure with ejection fraction of 40%. 5. type 2 diabetes mellitus. 6. chronic obstructive pulmonary disease. 7. paroxysmal atrial fibrillation. 8. thalassemia. 9. anemia with a negative gi work-up. 10. osteoarthritis. 11. hypertension. 12. gout. 13. peripheral neuropathy. 14. abdominal aortic aneurysm status post surgical repair. 15. steroid-induced osteoporosis. medications on transfer: 1. dobutamine. 2. allopurinol 100 mg p.o. q.d. 3. digoxin 0.125 mg p.o. q.d. 4. colace 100 mg p.o. b.i.d. 5. enalapril 20 mg p.o. b.i.d. 6. famotidine 20 mg p.o. b.i.d. 7. flovent 2 puffs inhaled b.i.d. 8. lasix 40 mg b.i.d. 9. neurontin 100 mg p.o. t.i.d. 10. regular insulin sliding scale. 11. iron sulfate. 12. levothyroxine. 13. aldactone 25 mg p.o. q.d. 14. theophylline 300 mg p.o. b.i.d. 15. tylenol. 16. ativan. 17. meperidine. 18. promethazine. allergies: the patient has no known drug allergies. social history: he is a former smoker. his family is supportive. he lives in the area and spends in . physical examination: temperature 97.6, heart rate 82 in sinus, blood pressure 109/40, respiratory rate 16, oxygen saturation 95% on four liters nasal cannula. general: no apparent distress. heent: pupils were equal, round, and reactive to light. heart: regular rate and rhythm with a positive s3 and a 2/6 systolic ejection murmur audible at the left sternal border. jugular venous pressure was 8 cm. chest: audible crackles at the bases bilaterally. abdomen: nontender, nondistended, soft with normal active bowel sounds. extremities: no edema. laboratory data: sodium 137, potassium 3.6, chloride 96, bicarbonate 32, bun 27, creatinine 1.3, glucose 197, inr 1.3, patient 4.0, ptt 26.9, alt 11, ast 10, alkaline phosphatase 62, total bilirubin 0.6. chest x-ray on admission showed a small bilateral pleural effusion and vascular markings consistent with mild congestive heart failure. hospital course: the initial impression on admission was that mr. was transferred for continued management of congestive heart failure and volume overload in the setting of a reported history of ischemic cardiomyopathy and depressed ejection fraction of 40%. he was initially continued on dobutamine and attempts were initially made at aggressive diuresis to which he responded suboptimally. his hemodynamic and volume status was not entirely clear and for this reason he underwent placement of a swan-ganz pulmonary artery catheter which revealed cardiac filling pressures and physiology consistent with sepsis. for this reason he had volume replacement with both blood and intravenous fluids. he was started on broad-spectrum antibiotics and his pressor support was changed from dobutamine to dopamine. over the course of the next several days he demonstrated decreased requirement of dopamine and eventually was able to wean off of dopamine. his blood pressures stabilized and he was able to be started on an ace inhibitor. on a cat scan of the chest was performed to rule out an abscess or other etiology that would lead to persistent pneumonia or predispose to sepsis after having received an adequate course of antibiotics at the outside hospital. this study demonstrated persistent bilateral pleural effusions on the right greater than the left and patchy bibasilar consolidations consistent with aspiration or pneumonia. there was mild pulmonary edema noted as well as cardiomegaly and a small to moderate sized pericardial effusion suggestive of either chronic pericarditis or complex pericardial fluid collection. the etiology of the persistent pleural effusions was felt secondary to decompensated congestive heart failure, yet the etiology remained not entirely clear, and for this reason the pulmonary service was consulted. the patient underwent two thoracenteses. the first revealed again transudative fluid. the second thoracentesis performed removed about a liter of fluid and resulted in symptomatic improvement in his shortness of breath. on a transthoracic echocardiogram was performed that revealed mild left ventricular hypertrophy and moderate lv dilation with moderately depressed lv systolic function, severe inferior and posterior hypokinesis, ejection fraction 30-40%, 2+ mitral regurgitation and a small pericardial effusion without evidence of tamponade. this study was not felt to be significantly changed since that of . the patient's pneumonia appeared to stabilize on a regimen of levaquin and flagyl. his pulmonary status improved with thoracentesis, treatment of the pneumonia, and nebulizer treatments. the patient was back in atrial fibrillation shortly after his transfer from while in the setting of ongoing infection and use of dobutamine and dopamine. he was noted to be in atrial fibrillation with a slow ventricular rate off medications but without pauses. the electrophysiology service was consulted for the question of indications for repeat elective cardioversion versus permanent pacemaker placement to allow the use of beta blockers in the setting of congestive heart failure and coronary artery disease. he was started on amiodarone to facilitate sinus rhythm restoration although he did not convert on his own. for this reason, he was dc cardioverted to sinus rhythm on and continued on amiodarone. he was not felt to have an indication for pacemaker implantation unless he were to develop significant and symptomatic sinus bradycardia while on amiodarone. given his history of recurrent atrial fibrillation it was recommended that he be anticoagulated despite his history of significant gi bleed. this matter was discussed at length with the patient and his family. despite the associated risks of deferring anticoagulation in the setting of his history of paroxysmal atrial fibrillation and low ejection fraction, the family and patient have deferred anticoagulation. condition on discharge: stable. discharge status: mr. will be transferred to rehabilitation where he will need continued monitoring of his fluid status and physical therapy for his deconditioned state. he will require follow-up appointments with dr. on . he has an appointment with dr. scheduled for this date at 1:15 pm. dr. office number is . he will also need a follow-up appointment scheduled with his primary care doctor, dr. . discharge medications: 1. amiodarone 200 mg p.o. b.i.d. x 30 days, then switch to 200 mg p.o. q.d. 2. lisinopril 5 mg p.o. q.d. 3. levaquin 250 mg p.o. q.d. x 14 days then discontinue. 4. flagyl 500 mg p.o. t.i.d. x 14 days then discontinue. 5. lipitor 10 mg p.o. q.h.s. 6. enteric-coated aspirin 325 mg p.o. q.d. 7. levothyroxine 0.125 mg p.o. q.d. 8. gabapentin 100 mg p.o. t.i.d. 9. fluticasone inhaler 110 mcg 2 puffs inhaled b.i.d. 10. miconazole powder applied to affected area b.i.d. p.r.n. 11. nateglinide 120 mg p.o. t.i.d., give 10-20 minutes before meals. 12. lasix 20 mg p.o. q.d. 13. albuterol nebulizer q. 4 hours p.r.n. 14. atrovent metered dose inhaler four puffs inhaled b.i.d. 15. albuterol inhaler 2 puffs inhaled q. 4 hours p.r.n. 16. colace 100 mg p.o. b.i.d. 17. senna 2 tablets p.o. q.h.s. p.r.n. constipation. other comments: 1. use metered dose inhalers with spacers. 2. provide and instruct in use of an incentive spirometer. 3. fingerstick blood sugar q.i.d. with use of a regular insulin sliding scale as needed. discharge diagnoses: 1. pneumonia. 2. right and left pleural effusion status post thoracentesis. 3. paroxysmal atrial fibrillation status post dc cardioversion. 4. dilated cardiomyopathy, ejection fraction 30-40%. 5. anemia/thalassemia with baseline hematocrit 27. 6. chronic obstructive pulmonary disease. , m.d. dictated by: medquist36 procedure: other electric countershock of heart thoracentesis pulmonary artery wedge monitoring diagnoses: other primary cardiomyopathies mitral valve disorders unspecified pleural effusion congestive heart failure, unspecified unspecified septicemia chronic airway obstruction, not elsewhere classified atrial fibrillation pneumonitis due to inhalation of food or vomitus 

Answer: The patient is high likely exposed to