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: horse/equine product derivatives / calcium channel blocking agents-benzothiazepines / metoprolol attending: chief complaint: altered mental status major surgical or invasive procedure: attempted lp history of present illness: 83 m w/ pmh of esrd on hd, afib s/p avn ablation and dual-chamber pm, systolic chf (ef 25%, 2+as, 3+mr) transferred from nursing home, w/ ms change. his son who accompanies him says that he has noticed an increase in his rr over the past few days and a decrease in his energy level. when he went to visit him this morning, he was very sleepy and not coherent which is a change so they called the ambulance. bp and o2 sats there noted to be low. he did not eat breakfast this morning which is very unusual for him. . in the emergency department, initial vitals: 19:00 u 97.1 74 98/63 22. 97% on 5l nc. arrived hypotensive in 70s, ms a+ox3 here (but per son, not at baseline), bp unresponsive to 2l ns so left femoral central line placed under u/s guidance (as inr 13) and levo started. moving arms but legs weaker. 2 u ffp, 10 vit k iv. cxr w/ increased chf. head ct neg. could not pass foley x 2, now w/ small amt of blood. given vanco 1g iv, levo 750 mg iv, flagyl 500 mg iv. cool hands/feet, dopplerable pt but not dp, vasc called and will see on the floor. guaiac + brown stool. . on arrival to the icu, his son states he is more alert now but not back to baseline. . review of systems: pt. states he feels short of breath but cannot clarify further. past medical history: on 2-3l o2 at nh for unclear reason - pvd (followed by ) w/ chronic lue and bilateral le ischemis - chronic renal failure on hd x 4 years (thought to be due to obstructive uropathy, kidney stones, bph) - systolic heart failure w/ ef 25% on echo - moderate aortic valve stenosis (area 1.0-1.2cm2). moderate (2+) aortic regurgitation is seen. moderate to severe (3+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. () - hx atrial fibrillation and paroxysmal atrial tachycardia - s/p av nodal ablation and implantation of a dual chamber pacemaker - baseline av conduction delay - hypertension - coronary artery disease with old posterior mi on ekg and pmibi in with ef44%, global hypokinesis, no reversible defects. - hx left 4-9th rib fx, left hemothorax - r kidney stone s/p lithotripsy (, complicated by esbl klebsiella uti) - s/p stroke (cerebellar), found on mri, sxs of gait instability - hx gait d/o, hand paresthesias, polyneuropathy, c3/c4 spinal cord compression cerival spondylosis, l median nerve injury - anemia - benign prostatic hypertrophy - headaches - hx of positive ppd, never treated - hx squamous cell and basal cell ca - hsv keratouveitis - ventral hernia - s/p open cholecystectomy - s/p small bowel resection (80-90%) for mesenteric ischemia - s/p umbilical hernia repair - s/p cystocele repair - s/p laminectomy - c/b osteomyelitis - s/p turp social history: patient has been at a nh and has not gotten home since hospitalization in . his wife lives in . he is a retired psychiatrist. social history is significant for the remote tobacco use, 3ppd x 40 years, quit 20 years ago. he drinks alcohol occasionally, denies illicit drug use. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: vital signs: t 95.9 bp 96/61 hr... rr... o2 general: awake but confused, nad. answers do not make sense. heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. dry mm. op w/ poor dentition. neck supple. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or but very distant heart sounds. lungs: occasional crackles anteriorly and posteriorly w/ poor inspiratory effort. abdomen: nabs. soft, midline scar. no hsm extremities: anasarca, palp radial pulses, dopperable pt/dp bilaterally. l hand w/ purple fingertips on fingers 2, 3 and 4. skin: xerosis. neuro: alert but not oriented. speaking nonsensical sentences. able to show 2 fingers on the r but not l. able to wiggle toes. could not follow other commands. pertinent results: 07:20pm blood wbc-8.6 rbc-4.09*# hgb-14.5# hct-48.4# mcv-118*# mch-35.6* mchc-30.1* rdw-21.7* plt ct-200 03:15am blood wbc-14.9* rbc-3.37* hgb-12.0* hct-38.1* mcv-113* mch-35.6* mchc-31.4 rdw-21.3* plt ct-172 07:20pm blood neuts-91* bands-1 lymphs-4* monos-3 eos-0 baso-0 atyps-1* metas-0 myelos-0 nrbc-2* 07:20pm blood pt-99.7* ptt-60.9* inr(pt)-13.2* 03:04am blood pt-21.9* ptt-43.0* inr(pt)-2.1* 09:55am blood pt-17.8* ptt-39.7* inr(pt)-1.6* 03:15am blood pt-17.0* ptt-38.0* inr(pt)-1.5* 07:20pm blood glucose-98 urean-45* creat-4.3* na-137 k-4.6 cl-92* hco3-26 angap-24* 03:15am blood glucose-76 urean-54* creat-4.5* na-138 k-4.7 cl-94* hco3-18* angap-31* 07:20pm blood alt-13 ast-18 ck(cpk)-31* alkphos-128* totbili-0.3 07:20pm blood ctropnt-0.41* 03:04am blood ck-mb-notdone ctropnt-0.34* 07:20pm blood albumin-4.1 calcium-8.3* phos-6.9* mg-1.5* 03:15am blood calcium-7.8* phos-5.5* mg-1.9 03:15am blood vanco-9.2* 10:30pm blood type- po2-70* pco2-79* ph-7.13* caltco2-28 base xs--4 12:54am blood type-central ve po2-42* pco2-79* ph-7.17* caltco2-30 base xs--1 07:18am blood type- po2-32* pco2-56* ph-7.28* caltco2-27 base xs--2 intubat-not intuba 03:09am blood lactate-2.6* 07:18am blood lactate-1.2 03:09am blood o2 sat-56 . cxr findings: comparison is made to . right pacemaker and two intracardiac leads remain in place. since prior exam, left ij hemodialysis catheter has been placed, with tip low in position, possibly within the ivc. stens are noted in the left subclavian and brachiocephalic vein. cardiomegaly again noted with central congestion, bilateral pleural effusions. lung bases are suboptimally assessed given low lung volumes though compared with prior, effusion and chf is increased. impression: 1. dialysis catheter tip low, likely in ivc. 2. chf, worse. . ct head non-contrast head ct: no edema, masses, mass effect, hemorrhage or infarction is detected. the ventricles and sulci are slightly prominent consistent with involutional changes. periventricular white matter hypodensities are compatible with small vessel ischemic changes. mild mucosal thickening of the right ethmoid sinus is unchanged. the remainder of the visualized part of the paranasal sinuses and mastoid air cells is clear. calcification of cavernous carotid arteries is noted bilaterally. there has been interval placement of a hearing aid device on the left side. incidental note is made of posterior non- fusion of c1. impression: no acute intracranial pathology. . cxr impression: ap chest compared to : moderate right and small left pleural effusions have increased, mild-to-moderate pulmonary edema stable or worsened. moderate cardiomegaly longstanding. left basal atelectasis severe and unchanged. no pneumothorax. dual-channel left central venous line ends in the right atrium, transvenous right atrioventricular pacer leads in standard placements. brief hospital course: assessment and plan: 83 m w/ pmh of esrd on hd, afib s/p avn ablation and dual-chamber pm, systolic chf (ef 25%, 2+as, 3+mr) transferred from nursing home, w/ ms change and hypotension. etiology of hypotension and hypercarbia were never clarified during his hospital course. the hypotension was concerning for sepsis given l-shift, indwelling hd line and h/o line infection (stenotrophomonas (xanthomonas) maltophilia} w/ prior hd line. also has a pacemaker. could not get a urine specimen. cxr w/ loss of diaphragm on r but w/o obvious infiltrate. could also be from cardiogenic shock given baseline depressed ef. given his presentation w/ altered mental status, he was covered with vanc, ceftriaxone, ampicillin and acyclovir for possible meningitis. an lp was attempted but not successful given prior lumbar laminectomy surgery and an ir-guided lp was planned. he was initially on ne for blood pressure support but this was weaned off the day after admission. the following morning, when the resident went in to round on mr. , she noted that he was apneic and without a pulse. a code was called and he was given epi/atropine, insulin, dextrose, bicarb for pea. he was intubated by anesthesia. his wife was called and she asked that agressive recussitation be stopped (it had not been successful to that point) and he expired. . hospital course also complicated by the following problems: . #. acute respiratory acidosis: unclear precipitant. ddx from percocets vs infection vs hypophosphatemia vs respiratory muscle fatigue. he tolerated bipap the night of admssion with a small decrease in co2. his mental status improved slightly over the next day. . #. altered mental status: ddx from hypercarbia vs from percocets vs from infection. ct head w/o acute process. could possibly be from meningitis but no nucal rigidity or headache. - treatment w/ bipap and antibiotics for meningitis as above . #. hypoxia: cxr seems consistent w/ pulmonary edema. likely from worsening valvular disease. could also be an infiltrate that is hidden by edema. apparently has been on l nc at rehab w/ unclear diagnosis but getting spiriva and albuterol. no formal dx of copd. - albuterol and atrovent nebs . #. esrd on hd: dialysis mwf at dialysis. - renal followed him and was planning for dialysis the day he expired . #. systolic heart failure: unclear if ischemic in etiology or from valvular disease (mod as, severe mr). - appeared total body volume overloaded despite hypotension. . #. afib: inr supratherapeutic at 13.2 on admission but quickly resolved s/p 2 u ffp and 10 mg vit k iv x 1 in the ed. no obvious signs of bleeding. hct w/ hemoconcentration given baseline of 32. s/p avn ablation and dual-chamber pacemaker. - held coumadin - trended coags . #. pvd: known lue and bilateral le pvd followed by dr. . - per , nothing to do for now . #. macrocytic anemia: current hct likely hemoconcentration. no signs of bleeding. b12/folate wnl in . . emergency contact: (, , wife medications on admission: (per med sheets) coumadin 3 mg daily dialysis at dialysis mwf acetaminophen asa 325 mg daily calcium acetate 667 mg 2 tabs tid dextroamphetamine 2.5 mg daily docusate folate 1 mg daily lotemax 0.5% eye drops mucinex 600 mg mucomyst nebs nephrocaps pantoprazole 40 mg daily sensipar 30 mg spiriva daily tobramycin 0.3% eye drops valtrex 500 mg daily lactulose lorazepam 0.5 mg percocet 5/325 dexadrine 5 mg daily albuterol vit b12 1000 mg daily nepro 235 daily albumin w/ dialysis darbapoetin w/ dialysis discharge medications: n/a discharge disposition: expired discharge diagnosis: hypercarbic respiratory failure discharge condition: expired discharge instructions: n/a followup instructions: n/a procedure: venous catheterization, not elsewhere classified insertion of endotracheal tube diagnoses: acidosis end stage renal disease renal dialysis status anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified septicemia severe sepsis atrial fibrillation peripheral vascular disease, unspecified personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified forms of chronic ischemic heart disease acute respiratory failure personal history of other malignant neoplasm of skin septic shock other acquired absence of organ chronic systolic heart failure mitral valve insufficiency and aortic valve stenosis cardiac pacemaker in situ personal history of methicillin resistant staphylococcus aureus 

Answer: The patient is high likely exposed to