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: demerol attending: chief complaint: transfer from after respiratory failure and stemi major surgical or invasive procedure: cardiac catheterization placement of an intra-aortic balloon pump history of present illness: mr. is a 68 yo male with h/o cad s/p cabg in with lima to lad, svg to om, svg to rca and subsequent catheterization x2 in revealing both svg grafts down and receieved stents to lcx, cabg c/b opsteomyelitis with open wound, om3, om4 and rca, ischemic cardiomyopathy with ef of 35%, iddm, copd and transferred from after respiratory failure and stemi. he was originally admitted to in the end of for a lle cellulitis which was treated with linezolid because of concern of rash with oxacillin. he was discharged on , but was readmitted on after being seen in his pcp's office with severe lle pain as he was discharged without narcotics given his history of narcotic abuse. the wound appeared unchanged and was only tender in the immediate area of the wound. a pain consult was obtained given his history of respiratory arrest after receving morphine the past and he was started on 25 mcg fentanyl patch and dilaudid 2 mg po q 4-6h prn pain. he was admitted to the medical floor for pain control. over the course of the past 2 days he was noted to be somnolent and confused, and his dilaudid was discontinued. he was found to have urinary retention and a foley was placed. he became increasingly delerious as he had in the past on narcotics. he was found unresponsive in his room at 11pm with "white froth in his mouth." he was intubated and sent to the icu with hypercarbic and hypoxic respiratory failure. cxr, per report, revealed cardiomegaly and likely aspiration pneumonitis. he was started on zosyn and vancomycin. ekg revealed st elevations in the inferior leads. ce's were obtained and trop 0.28->3.32->3.32->5.45. cardiology was consulted and patient was started on dopamine gtt, heparin gtt, asa and prn atropine. dopamine was attempted to be weaned off but he became hypotensive and with sbp in 60s and hrs in 30s with high degree av block and was restarted on the dopamine drip. he was transferred to for further management. . of note, he recently had a pharmacologic stress test on at hospital which revealed reported inferior reversible ischemia evidence of ischemia (final report not available in records), but after discussion with the patient and his wife, it was decided that he would not undergo cardiac catheterization given the risk of renal failure, and per the discharge summary he had also had a long discussion with his cardiologist who also thought medical management was the best option and his lopressor was titrated up to a total of 200 mg daily, zocor was increased to 80 mg and ace-i was added to his regimen. . could not obtain ros given patient intubated and sedated. past medical history: 1. left circumflex stent in 3/. 2. catheterization in with three vessel disease. 3. status post coronary artery bypass graft x 3 as above. 4. s/p catheterization x2 - with stent to native right coronary artery with an occluded saphenous vein grafts and subsequent catheterization with stents to lcx, om3 and om4 . 5. insulin dependent diabetes mellitus. 6. cri with a baseline creatinine of 1.8. 7. hypothyroidism 8. copd 9. ? pe in per d/c summary in 10. history of etoh. 11. pancreatitis. 12. s/p cabg complicated by osteomyelitis of the sternum. the patient had a left hemisternectomy in due to infection. sternal debridement rectus flap and bilateral pectoralis flaps. still has open wound since surgery. 13. history of lens transplant in right eye secondary to cataract. 14. left hand hematoma 15. right bka c/b sepsis in 16. bilateral carotid stenosis 17. positive stress test in , but no cath because of fear of worsening renal failure 18. lymphoma s/p radiation 19. left le cellulitis 20. history of stroke with left hand weakness 21. ? mrsa infection versus colonization social history: he lives with his wife. they have 4 children and 18 grandchildren. ex-smoker, quit 6 months ago. has 150 pack-year smoking history. prior etoh use. history of addiction to narcotics. family history: f: died at 63 of mi physical exam: admission physical examination: vs: t 99.4, bp 105/61 , hr 104, o2 97 % on ac tv 600/18/5/0.4 breathing at a rate of 22 gen: middle aged male intubated and sedated. heent: sclera anicteric. right pupil slightly reactive but surgical, left reactive to light. conjunctiva were pink, et tube in place neck: large neck, could not appreciate jvd. cv: visible beating of heart under pectoral flap, sternum absent, tachycardic, rr, normal s1, s2. no murmurs appreciated. chest: sternum absent. few scattered rhonchi bilaterally. abd: obese, soft, mildly distended, no hsm or tenderness. no abdominal bruits. open 5 cm x 2 cm wound c/d/i with dressing, no drainage ext: right bka, warm, diffuse, patchy erythematous rash on rle. right groin line in place. healing eschar on lateral aspect of lle 4cmx2cm with slight surrounding erythema skin: dry, flaking erythematous rash on scrotum. pulses: right: carotid 2+ without bruit left: carotid 2+ without bruit; 1+ dp, 2+pt pertinent results: admission labs: 08:04pm blood wbc-25.6*# rbc-3.34* hgb-10.2* hct-31.7* mcv-95 mch-30.6 mchc-32.3 rdw-15.2 plt ct-400 08:04pm blood neuts-88.5* bands-0 lymphs-5.5* monos-4.8 eos-0.1 baso-0.2 08:04pm blood pt-19.0* ptt-150* inr(pt)-1.8* 08:04pm blood glucose-252* urean-40* creat-3.1*# na-137 k-4.8 cl-106 hco3-20* angap-16 08:04pm blood alt-137* ast-323* ld(ldh)-601* ck(cpk)-1591* alkphos-186* totbili-0.6 08:04pm blood albumin-3.1* calcium-8.3* phos-3.8 mg-2.2 04:57pm blood freeca-1.06* cardiac enzymes: 08:04pm blood ck-mb-213* mb indx-13.4* ctropnt-3.18* 05:14am blood ck-mb-238* mb indx-14.4* ctropnt-4.38* 12:29pm blood ck-mb-191* mb indx-16.2* ctropnt-3.75* 04:46am blood ck-mb-94* mb indx-12.2* ctropnt-3.97* 04:37pm blood ck-mb-65* mb indx-10.6* 04:57am blood wbc-21.8*# rbc-3.39* hgb-10.2* hct-32.4* mcv-96 mch-30.0 mchc-31.4 rdw-15.8* plt ct-533* 06:40am blood neuts-68.1 lymphs-19.9 monos-7.1 eos-4.5* baso-0.4 04:57am blood plt ct-533* 04:57am blood glucose-150* urean-34* creat-1.4* na-148* k-4.6 cl-111* hco3-25 angap-17 05:33am blood alt-55* ast-87* ld(ldh)-256* alkphos-143* totbili-0.6 04:57am blood calcium-10.5* phos-3.7 mg-1.9 06:45am blood caltibc-280 ferritn-206 trf-215 04:48am blood vitb12-1204* folate-16.8 01:56pm blood ammonia-13 06:02am blood tsh-2.1 06:02am blood free t4-1.6 02:38pm blood pth-126* 06:38pm blood cortsol-16.4 06:08pm blood anca-negative b 06:08pm blood -negative 06:08pm blood rheufac-39* 05:20pm blood crp-9.1* 1:00 pm csf;spinal fluid tube 3. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. fungal culture (preliminary): no fungus isolated. viral culture (preliminary): no virus isolated so far. 3:30 pm influenza a/b by dfa source: nasopharyngeal aspirate. **final report ** direct influenza a antigen test (final ): negative for influenza a viral antigen. direct influenza b antigen test (final ): negative for influenza b viral antigen. 3:22 pm stool consistency: formed source: stool. **final report ** clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. (reference range-negative). 6:49 pm blood culture **final report ** blood culture, routine (final ): no growth. 3:35 pm catheter tip-iv source: right ij. **final report ** wound culture (final ): no significant growth. 11:28 pm urine source: catheter. **final report ** urine culture (final ): no growth. radiology final report in-111 white blood cell study in-111 white blood cell study reason: cad s/p cabg stemi mental status change ? occult infection radiopharmeceutical data: 480.0 uci in-111 wbcs (); history: patient with coronary artery disease post stemi with mental status change. assess for occult infection. interpretation: following the injection of autologous white blood cells labeledwith in-111, images of the whole body were obtained at 24 hours. these images show physiologic distribution of labelled white cells in the liver,spleen, and bone marrow. there are no abnormal foci of tracer to suggest occult infection. note is made of a right below the knee amputation. impression: no evidence of occult infection. normal wbc study. cxr:findings: as compared to the previous examination, the nasogastric tube has been removed. there is unchanged evidence of mild pulmonary edema. no evidence of focal parenchymal opacity suggestive of pneumonia, no pleural effusions. the size and the shape of the cardiac silhouette is unchanged. impression: status post removal of the nasogastric tube, unchanged. mild cardiomegaly with mild signs of pulmonary edema, no pleural effusions, no parenchymal opacities ct chest/abd/pelvis:1. compared to the prior exam from , the lungs show progressive emphysema. note is made of several small pulmonary nodules/nodular opacity within the left lower lobe, which is not clearly present on prior exam from and given emphysema, 12 month follow up is recommended. small bilateral pleural effusions and adjacent dependent atelectasis is identified. a small amount of debris seen dependently in central airways. 2. parenchymal calcifications within the pancreas consistent with chronic pancreatitis. 3. stable cortical scarring and atrophy involving the upper pole of the left kidney, unchanged. 4. mild bladder wall thickening, which may be secondary to underdistension, however, cystitis cannot be excluded and therefore recommend correlation with ua. 5. balloon of foley catheter is inflated within the prosthetic urethra and tip appears to project within the vas deferens. this was discussed with clinical team at time of interpretation. mri and mra brain and neck: there is no signal abnormality on diffusion series to suggest acute ischemia. there is evidence of chronic infarction in the subcortical right frontal, right temporal, and right occipital regions. there is possible chronic infarct in the left occipital lobe. only one anterior cerebral artery is visualized. there is mild irregular flow signal in the right carotid artery with no evidence of high-grade stenosis. there is no evidence of hemorrhage, edema, or mass effect. impression: 1. no evidence of acute ischemia. 2. chronic infarcs in frontal, temporal, and occipital lobes card cath: 1. selective coronary angiography of this right-dominant system demonstrated severe three native vessel disease. the rca and lad were occluded proximally. the lcx had 70% proximal stenosis, the om1 had 90% origin stenosis, and the om2 was occluded with stent thrombosis and likely isr. 2. artefrial conduit angiography revealed patent lima-lad. the svg-om and svg-rca were known occluded and were not assessed. 3. limited resting hemodynamic assessment of this intubated patient initially revealed normal systemic arterial pressure (113/70 mmhg) and moderately elevated pulmonary arterial pressure (52/31 mmhg). the filling pressures were elevated with a mean pcwp of 28 mmhg. the cardiac output and index were preserved at 4.71 l/min and 2.3 l/min. 4. successful ptca of the om1 ostium with a 2.0 and the a 3.0 balloon. final angiography revealed a 30% residual stenosis at the ostium, no dissection and timi iii flow. 5. successful stenting of the proximal lcx with a 3.5 x 12 mm vision bms. after stent deployment the patient became hypotensive requiring iabp placement and pressors. final angiography revealed no residual stenosis, no dissection and timi iii flow. (see ptca comments) final diagnosis: 1. three vessel coronary artery disease with patent lima-lad. 2. successful ptca of the om1. 3. successful stenting of the proximal lcx. 4. hypotensive episode requiring iabp and pressors. brief hospital course: # respiratory failure: initially the patient suffered a respiratory arrest at an osh, likely due to narcotics. the patient was intubated during this time. he also suffered an inferior st elevation mi complicating his course (see below for more details). his icu course was further complicated by an aspiration pneumonia, treated with a full course of vancomycin, cefepime and flagyll with improvement. his respiratory status continued to improve and he was extubated successfully after approximately 2 weeks of intubation. he has been stable mostly on room air (with intermittent o2 reuirement during sleep) since extubation with no further signs of respiratory distress. . # stemi: the patient was diagnosed with an inferior stemi requiring ptca of om1 ostium and bare metal stent to proximal left circumflex artery, complicated initially by profound hypotension, bradycardia, and hypoxia during the catheterization requiring intra-aortic ballon pump placement. his hypotension and bradycardia spontaneously resolved and did not recur. he was begun on maximum medical management of his coronary artery disease, including maximum dose lisinopril, metoprolol, aspirin, plavix, and lipitor. he will follow up with his outpatient cardiologist for further management. . # leukocytosis: after treatment of his initial aspiration pneumonia and resolution of the associated leukocytosis, the patient again developed a leukocytosis of unknown origin. the patient remained afebrile but was having diarrhea after broad spectrum antibiotics. however c.difficile was negative x3. nonetheless, he was treated with a 14 day course of flagyll for presumptive c.difficile infection. however, this did not resolve his leukocytosis. a c.difficile cytotoxin b is still pending at the time of this writing. multiple sets of blood cultures off antibiotics were negative as well as urine and sputum cultures. a lumbar puncture was performed which revealed no signs of infection and grew nothing on culture. a contrast ct scan of the chest, abdomen, and pelvis revealed no signs of occult infection including abscesses or colitis. he did have yeast colonization of his urine but fungal blood cultures were negative. however, he was then treated for oral thrush with a 7 day course of fluconazole with improvement in the thrush but no improvement in his leukocytosis. hematology/oncology was consulted and felt that this leukocytosis, and its associated thrombocytosis, was reactive. in discussion with his pcp, lymphoma history was clarified and appeared to be in remission after radiation in and confirmed by yearly ct scans. thus, it was felt to not be contributing to his current leukocytosis. a tagged white blood cell scan showed no localizing source of infection. . #thrush: finished fluconazole for 7 day course, ending . # ms changes: after extubation the patient had persistent mental status changes. intitially he was unresponsive but very agitated with associated hypertension and tachycardia. this was initially thought to be consistent with a withdrawal state and treated with valium. this resolved his agitation but his unresponsiveness remained. he received no more sedating medications for 10 days. he was well outside the window for further withdrawal states. slowly he slightly improved, becoming more awake and localizing to voice. however, he still did not respond to commands or exhibit purposeful movement. neurology was consulted. an mri showed only signs of older strokes and an eeg showed only diffuse slowing, consistent with an encephalopathy. he had a normal urinanalysis and culture, normal lfts with a normal ammonia level. neurology felt his condition was likely a toxic metabolic encephalopathy, related to the same process causing his leukocytosis. however, they could not rule out some level of anoxic brain injury, likely suffered during his initial arrest and subsequent hypotension, not seen on mri. they could not prognisticate on his chance of recovery although he was showing signs of recovery before discharge with some return of coherent speech and response to commands. . # sinus tachycardia: the patient remained persistently in sinus tachycardia, with rates of 90-110s. this was from an unclear cause. tsh and free t4 were normal, he was afebrile, not anemic and not hypovolemic. it was suspected that his tachycardia may be from pain that he cannot tell us about. thus he was begun on standing tylenol, a low dose fentanyl patch, and lyrica for pain control. . # hypernatremia: the patient initially exhibited some hypernatremia, as high as 150 which was resolved by increasing free water boluses in his tube feeds. na on d/c was 145. pls continue free water boluses and monitor na. # pump: a post procedure echo showed ef 40% with inferior/lateral akinesis. however, the patient remained euvolemic with no signs of volume overload without the need for standing lasix. he was continued on an increased dose of lisinopril and metoprolol. . # hypertension: continued on increased doses of metoprolol and lisinopril . # acute on ckd: last creatinine per records was 1.8. patient was briefly elevated post cath but returned to below baseline creatinine at 1.4 before discharge. . # abdominal wound: secondary to rectus muscle flap to cover sternal removal wound. healing by secondary intention. not draining, and does not appear infected. wound care consulted and appropriate care taken. . # r bka erythema: appeared to be due to fungal infection. treated with topical antifungal for 14 day course. . # dm: monitor fingersticks, currently well controlled on 50 units of lantus and humalog iss . # copd: albuterol and atrovent inhalers prn . # hypothyroidism: continued levothyroxine with good results . # fen: peg in place, tolerating tube feeds at goal . # prophylaxis: heparin sc tid, ppi, mouth care . # access/lines: l arm picc, single lumen . # code: full, confirmed with wife and hcp . # communication: wife, home , cell medications on admission: medications on transfer: aspirin 81 mg po qday hydrocortisone 1% cream miconazole powder riss nystatin cream heparin gtt propofol drip dopamine drip 5 mcg per kg levohyroxine 150 mcg po qday omeprazole 20 mg po qday combivent inhaler zosyn 2.25 g q6h (? if dose given) atropine prn home medications (per dischareg summary): lisinopril 10 mg po qday lopressor 50 mg po tid remeron 30 mg po qhs prilosec 20 mh po qday lyrica 50 mg po tid zocor 80 mg po qday asa 325 mg po qday lantus 50 units qhs, iss doxazosin 2 mg po qday levothyroxine 150 mcg qday citalopram 40 mg po qday imdur 60 mg po qday lasix 40 mg po qday discharge medications: 1. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 2. aspirin 325 mg tablet : one (1) tablet po daily (daily). 3. levothyroxine 50 mcg tablet : three (3) tablet po daily (daily). 4. miconazole nitrate 2 % powder : one (1) appl topical tid (3 times a day) as needed. 5. miconazole nitrate 2 % cream : one (1) appl topical (2 times a day). 6. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 7. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day) as needed. 8. metoprolol tartrate 50 mg tablet : two (2) tablet po tid (3 times a day). 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 10. folic acid 1 mg tablet : one (1) tablet po daily (daily). 11. lisinopril 40 mg tablet : one (1) tablet po once a day. 12. acetaminophen 160 mg/5 ml solution : 1000 (1000) mg po q 8h (every 8 hours). 13. albuterol sulfate 2.5 mg/3 ml solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed. 14. atorvastatin 80 mg tablet : one (1) tablet po hs (at bedtime). 15. insulin glargine 100 unit/ml solution : fifty (50) units subcutaneous at bedtime. 16. fentanyl 12 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 17. pregabalin 75 mg capsule : one (1) capsule po bid (2 times a day). 18. mirtazapine 30 mg tablet : one (1) tablet po hs (at bedtime). 19. clopidogrel 75 mg tablet : one (1) tablet po daily (daily). 20. heparin lock flush (porcine) 100 unit/ml syringe : two (2) ml intravenous daily (daily) as needed. discharge disposition: extended care facility: & rehab center - discharge diagnosis: inferior st elevation myocardial infarction s/p bare metal stent to left circumflex and om1 hypertension diabetes type 2 chronic kidney disease encephalopathy of unclear origin persistent leukocytosis discharge condition: all vital signs stable, afebrile, mental status improving. discharge instructions: you were admitted after a cardiac arrest and heart attack. this was alleviated by stents to two of your arteries. you also have persistently decreased mental status, likely from your cardiac arrest. this may slowly improve over time. you were unable to pass a swallowing test safely so a tube was placed into your stomach to provide nutrition and medications. this will need to retested at a later date. please take all your medications as prescribed and attend all follow up appointments. please return to the emergency room if you experience chest pain, shortness of breath, fevers, chills, nausea, vomitting or any other symptom that concerns you. followup instructions: please call dr. office at to schedule a follow up appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] implant of pulsation balloon cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: other iatrogenic hypotension toxic encephalopathy diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified protein-calorie malnutrition hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified candidiasis of mouth chronic kidney disease, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus acute myocardial infarction of other inferior wall, initial episode of care retention of urine, unspecified hyperosmolality and/or hypernatremia other diseases of trachea and bronchus non-healing surgical wound 

Answer: The patient is high likely exposed to