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: morphine attending: chief complaint: sob major surgical or invasive procedure: none history of present illness: mr. is a 57 y/o m with h/o gi bleed, htn, cad, chf (ef 20%), pafib, dm2, cri, hcv, and polysubstance abuse who p/w 4 days sob and cp. states that he has had progressive dyspnea over the 4 days pta, limiting him to a few steps at a time. also more leg edema and orthopnea. reports medical compliance, but questionable dietary compliance; girlfriend buys food with lots of salt. denies f/c, n/v; had cough productive of clear sputum. also had cp, substernal, "like someone walking on it," without radiation. notes last cocaine use several days before admission, last etoh was 1 day pta. in the ed, ecg was not ischemic and cxr demonstrated signs of volume overload. his vs were t98 105 206/91 36 84%ra-->100%nrb. guaiac +. abg 7.27/51/174. he refused intubation and was placed on bipap. he received asa, lasix 40mg iv, nitro gtt, dilaudid 1mg, ativan 1mg, benadryl, 10u regular insulin. . in the micu, he required bipap initially but was weaned to 2l nc and eventually to ra. echo showed no change from prior. on steroids and azithromycin for history of copd. he was diuresed with 80 iv lasix, putting out 5 liters net in 3 days and 1.6 liters on the day of transfer. he also had altered mental status with a normal head ct, but he was found to have a r occipital mass/hematoma on ct, stable since ; the patient refused us of this lesion. he was transfused 1 unit prbcs when hct dropped, then refused further blood draws. he was also placed on ciwa scale for etoh withdrawal. . ros negative for fever, chills, palpitations, n/v/d, dysuria, other sx of concern to him. + for cp, sob, cough. past medical history: past medical history: polysubstance abuse - crack cocaine, etoh, tobacco. hypertension type ii diabetes mellitus dyslipidemia cad s/p mi, mibi in showed inf/lat reversible defect chf ef 20-30% severe global hk. atrial fibrillation cri anemia h/o gi bleed- duodenal avm's, angioectasia in the proximal jejunum, angioectasia in the stomach body, s/p thermal therapy, sigmoid diverticuli hepatitis c chronic pancreatitis affective disorder s/p multiple psychiatric hospitalizations due to si depression gerd gout s/p arthroscopy with medial meniscectomy inflatable penile prosthesis social history: usually lives in apt with his girlfriend. used to be an electrician for , but has been on disability. tob: 45 pack-yr etoh: history of abuse with hospitalizations for delirium and detoxification. last drink one day p.t.a. illicits: 15 yr h/o crack cocaine use, last used two days ago. family history: his father with alcoholism, an uncle who committed suicide by hanging, and a cousin with cell anemia physical exam: vitals: 98.1 bp148-170/71-83 hr109-119 rr20s o2 96%ra gen: well-appearing man in nad, walking around room. heent: nc/at. mmm no erythema/exudate. poor dentition. jvp elevated to 2 cms below jaw while sitting at 90 degrees. neck supple w/o lad. pulm: clear to auscultation bilaterally. cv: tachycardic with regular rhythm, with no murmurs, rubs, or gallops. abd: soft, non-tender and non-distended. bowel sounds are normoactive. ext: 3+ pitting peripheral edema to knees bilaterally; 2+ dorsalis pedis pulses; no clubbing or cyanosis. neuro: aaox3. cnii-xii grossly intact. pertinent results: . labs: chem 7: 137 106 36 184 4.5 21 3.4 ca: 9.0 mg: 1.9 p: 4.0 hct 24.3 bnp: . cxr: cardiomegaly, engorgement of pulm vasculature, pulm edema . tte : the left atrium is mildly dilated. the inferior vena cava is dilated (>2.5cm). the left ventricular cavity is mildly dilated. overall left ventricular systolic function is mildly depressed. tissue velocity imaging e/e' is elevated (>15) suggesting increased left ventricular filling pressure (pcwp>18mmhg). resting regional wall motion abnormalities include with inferior/inferolateral hypokinesis. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study of , left ventricular function now appears improved. of note, patient in sinus rhythm for the current study (in aflutter with rapid ventricular response in prior study). . mibi 1. interval development of moderate reversible inferiolateral perfusion defect. 2. left ventricular enlargement, again slightly worse with stress than rest. 3. global hypokinesis with ejection fraction of 25%, decreased compared to the prior study, when it was 32%. . egd normal mucosa in the esophagus few nonbleeding avms in the duodenal bulb erosions in the duodenal bulb . colonoscopy angioectasia in the proximal jejunum (thermal therapy) angioectasia in the stomach body (thermal therapy) otherwise normal small bowel enteroscopy to mid jejunum . head us: the region of interest could not be adequately evaluated with ultrasound due to the presence of thick overlying hair in the region. this area could be better evaluated with a mri examination. . head ct: 1. no evidence of acute intracranial hemorrhage or mass effect. 2. hyperdense mass again demonstrated in the right occipital soft tissues, also seen on the study of . while this appearance is consistent with a hematoma, it would seem most unlikely that a hematoma is still present over the long interval between scans, without expected evolution to lower density material or regression. correlate for history of recent trauma, and also correlate with direct physical examination. if desired, further evaluation with son or mr study could be considered to exclude other pathology. brief hospital course: a/p: this is a 57 y/o m w/ h/o chf (ef 20-30%), cad, h/o gastric avm with frequent gi bleeds who presented with sob, likely due to chf. . #) chf exacerbation. refused intubation in ed. initially received bipap in the micu with stable abg's which was changed to nc. he tolerated nc overnight with good o2 sats. was on nitro gtt to afterload reduce and bring down bp that was then titrated off. he was given lasix 80 mg iv for net neg 1l q day. with improvement in respiratory status he was transferred to floor. he was continued on iv lasix. his sob improved and his lung exam was clear, although he continued to have significant le edema. he was weaned off oxygen without difficulty. his lasix was changed to po when he had a bump in cr that suggested patient had been adequately diuresed. the patient was non-compliant with fluid resriction and diet restriction and was frequently seen getting food and water from the kitchen. bb was initially held due to remote cocaine use and repeated gi bleeds with low hct, however, pt. developed a-fib with rvr and was started on lopressor for rate control. given patient's h/o cocaine use and non-compliance he was switched back to diltiazem for rate control in preparation for d/c. started dilt 90mg qid acei was held given arf. his lasix was held prior to discharge given bump in cr. this should be titrated for sob and not le edema. . #) afib: patient has history of atrial fibrillation in the past with cardioversion. during the hospitalization he converted from nsr to a fib with rvr. initially given bb for rate control without significant effect and then switched to diltiazem with hr in 80s-90s. pcp does not feel pt. is candidate for coumadin and patient refused to be on anticoagulation. ep was consulted for possible cardioversion but they felt he was not a candidate for cardioversion given refusal to take coumadin after procedure. . #) leukocytosis. afebrile, no localizing signs of infection. likely due to steroids. wbc trended down as steroids were tapered. . #) dm2. patient had very difficult to control blood sugars. likely secondary to dietary non-compliance and steroids. nph was increased to 30u qpm and 20u qam. this resulted in some low fs in the morning so he was decreased to 26u and 16u. he often required coverage with sliding scale and his ss had to be increased. . #) anemia/gi bleed. chronic, known avms. serial hct were monitored. there was no evidence of current bleed but hct trended down to low 20s and the patient received a transfusion for this. he had an appropriate bump in cr but then proceeded to trend down once again., on the day of discharge he was recommened to have a blood transfusion. the patient refused and stated that he wanted to go home and be with his family. the risks of this decision were explained clearly to him and he wished to sign out ama. dr. , the patient's pcp was aware and made an appointment to see him in 2 days for labwork. while in the hospital he was continued on iron and folate as well as ppi . . #) copd. given the patient's significant smoking history it was felt that he may have had an element of copd exacerbation contributing to his dyspnea. he was given a 5-day course of azithomycin and placed on a short prednisone taper. he was also given nebs prn. . #) substance abuse. patient was placed in ciwa scale and showed no evidence of withdrawal so this was discontinued. he was continued on folate/thiamine. he was seen by addiction nurse and initially refused any formal treatment. he is considering treatment at house. . #) occipital soft tissue lesion on ct. seen on previous head ct from 1 year ago--? hematoma. attempted us but patient became agitated at us. - will try to repeat u/s in future as patient more cooperative . #) cri: cr was at baseline ~3.5-3.9, however it started to trend upwards after aggressive diuresis to a peak of 5.1. likely in setting of over-diuresis. his lasix was discontinued. urine lytes showed feurea of 26% c/w pre-renal etiology. has occurred on previous hospitalizations in setting of diuresis and responded to gentle diuresis. received 1l ivf with no improvement in renal function. ? component of atn in setting of over-diuresis. hesitant to give more fluids given tenuous fluid status. given that the patient has progressive kidney dysfunction, dr. talked at length with him about the possibility of progressing to esrd at which point he would need diaylsis. renal was asked to come by and see him, however, he signed out ama prior to them seeing him. he has an appointment with dr. at in two weeks. . #) pancreatic neck lesion: further workup required as an outpatient . #) fen: placed on fluid restriction, low na diet. followed lytes while diuresing. . #) ppx: ppi , sq heparin, access: piv . #) code: full . #) dispo: patient left ama . medications on admission: medication at home: 1. aspirin 325 mg po daily 2. ferrous sulfate 325 po daily 3. atorvastatin 20 mg po daily 5. thiamine hcl 100 mg po daily 6. folic acid 1 mg po daily 7. calcitriol 0.25 mcg po daily 8. calcium acetate 667 mg po tid 9. carvedilol 6.25 mg po bid 10. pantoprazole 40 mg po q12h 11. citalopram 40 mg po once a day. 12. lasix 80 mg po once a day. 13. insulin nph 20u qam and 10u qpm. 14. riss . meds on transfer: aspirin 325 mg po daily atorvastatin 20 mg po daily hydralazine 10 mg iv q6h azithromycin 250 mg po q24h prednisone 60 mg po daily taper hydromorphone (dilaudid) 1 mg sc q2h:prn haloperidol 2.5 mg po bid:prn agitation insulin sc (per insulin flowsheet) diphenhydramine hcl 25 mg po q6h:prn itching pantoprazole 40 mg iv q12h ferrous sulfate 325 mg po daily folic acid 1 mg iv daily thiamine hcl 100 mg iv daily docusate sodium 100 mg po bid senna 1 tab po bid:prn bisacodyl 10 mg po daily:prn constipation sarna lotion 1 appl tp qid:prn itching discharge medications: 1. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po once a day. 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). :*60 tablet, delayed release (e.c.)(s)* refills:*2* 6. insulin nph human recomb 100 unit/ml suspension sig: twenty six (26) units subcutaneous every morning. 7. insulin nph human recomb 100 unit/ml suspension sig: sixteen (16) units subcutaneous every night. 8. one touch ultrasoft lancets misc sig: one (1) lancet miscellaneous twice a day. :*1 box* refills:*2* 9. one touch ultra test strip sig: one (1) strip miscellaneous twice a day. :*100 strips* refills:*2* 10. dilt-cd 300 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po once a day. :*30 capsule, sust. release 24hr(s)* refills:*2* 11. hydralazine 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). :*120 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: congestive heart failure atrial fibrillation anemia cocaine abuse alcohol abuse acute renal failure cad htn depression pancreatic neck lesion discharge condition: pt. left ama discharge instructions: patient left ama. he was told that he should stay due to multiple medical issues and he wanted to go home against medical advice. . weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1500ml daily . you were admitted to the hospital for a chf exacerbation. you were also found to be anemic (low blood counts) and have worsening kidney function. because of you anemia we recommended that you receive a blood transfusion, but you refused and stated that you wanted to leave the hospital. you stated that you understood the risks of this (bleeding, organ damage, death) and asked to follow up with your pcp . in two days for bloodwork. . please refrain for drinking alcohol and using cocaine as these drugs are very toxic and causing damage to your body. followup instructions: you have an appointment with dr on at 12:10pm. you must go to this appointment to have your blood work checked as you may need a blood transfusion. you will have your kidney function checked at this time as well. phone:. . you have an appointment to see a nephrologist dr. , at on at 3:30pm. please keep this appointment as your kidney function has been worsening and you will need follow up for this. md procedure: non-invasive mechanical ventilation transfusion of packed cells diagnoses: tobacco use disorder congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified iron deficiency anemia secondary to blood loss (chronic) unspecified viral hepatitis c without hepatic coma atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation cocaine abuse, unspecified chronic kidney disease, unspecified personal history of noncompliance with medical treatment, presenting hazards to health angiodysplasia of intestine with hemorrhage other and unspecified alcohol dependence, unspecified unspecified disease of pancreas nonspecific (abnormal) findings on radiological and other examination of skull and head 

Answer: The patient is high likely exposed to