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: patient recorded as having no known allergies to drugs attending: chief complaint: respiratory distress major surgical or invasive procedure: intubation picc line placement history of present illness: the pt. is a 66y/o m with pmh of atrial fibrillation and l carotid stenting on coumadin admitted with sublingual bleed and respiratory distress. the pt returned from noting a few days of "throat discomfort", voice change and difficulty swallowing. per the patient's wife, the patient recently had increased bruising along his arms but deferred having his inr checked. while in , he complained of throat irritation and discomfort. on the day of admission, he flew to airport and had significant voice change prompting presentation to the ed. on arrival to the ed, the patient was minimally responsive with sats in the low 90's. anesthesia attempted oral intubation unsuccessfully due to severe trismus. an emergent fiberoptic intubation was performed at the bedside. inr from ed returned at 9.8. 2units ffp and 10mg vit k given. past medical history: chronic atrial fibrillation, on coumadin peripheral vascular disease, asymptomatic carotid artery disease status post stenting in hypertension. hyperlipidemia. history of gerd. hearing loss with bilateral hearing aids social history: significant for past history of tobacco, drinks alcohol occasionally family history: no history of early cad or stroke. mother with a stroke at 85 years. physical exam: admission exam: general: well appearing male laying in bed comfortably vitals: 138/48, 77, 97%ra, 20 heent: no tongue swelling, op clear, no blood in oropharynx, mmm cv: irregularly irregular, no mrg lungs: sparse crackles at the bases. no wheezes noted, no stridor abd: soft non tender, non distended. + bs extr: trace edema, 2+ pulses foley in place pertinent results: admission labs 08:10pm blood wbc-9.5# rbc-4.01* hgb-13.4* hct-36.6*# mcv-91 mch-33.4* mchc-36.6* rdw-14.2 plt ct-208 08:10pm blood neuts-71.7* lymphs-18.8 monos-6.8 eos-2.3 baso-0.3 08:10pm blood pt-77.9* ptt-59.3* inr(pt)-9.8* 08:10pm blood glucose-98 urean-19 creat-0.9 na-140 k-3.9 cl-108 hco3-22 angap-14 06:45am blood calcium-8.4 phos-3.4 mg-2.2 10:59pm blood type-art po2-69* pco2-46* ph-7.33* caltco2-25 base xs--1 . discharge labs: 05:37am blood wbc-9.5 rbc-3.00* hgb-9.9* hct-28.6* mcv-95 mch-33.0* mchc-34.6 rdw-14.4 plt ct-121* 05:37am blood pt-14.9* inr(pt)-1.3* 05:37am blood glucose-90 urean-17 creat-0.9 na-138 k-4.1 cl-107 hco3-23 angap-12 05:37am blood calcium-8.0* phos-2.5* mg-2.2 . cxr- as compared to prior radiograph, there is increased opacity of left base, probably atelectasis. there is mild fluid overload. the tip of endotracheal tube projects at 67 mm above the carina. minimal pleural effusion on the left. the cardiac size is unchanged. . ct neck - ltd study secondary to intubation. oropharyngeal secretions likely related to intubattion. no retropharnygeal abscess. prominent adenoid and tonsillar tissue. . cxr - endotracheal tube just below the superior aspect of the clavicles, terminating approximately 7.7 cm from the carina. the tube can be advanced for optimal positioning. . 12:45 pm urine source: cvs. **final report ** urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. pseudomonas aeruginosa. predominating organism. of two colonial morphologies. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- <=1 s ceftazidime----------- 2 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s . 4:45 pm blood culture **final report ** blood culture, routine (final ): pseudomonas aeruginosa. final sensitivities. sensitivities: mic expressed in mcg/ml ________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 2 s ceftazidime----------- 2 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s brief hospital course: micu course: in micu, placed on decadron, famotidine, benadryl given potential allergic reaction to lisinopril with angioedema. started on unasyn transitioned to augmentin for potential sinus infection per ent. on po atenolol and verapamil long acting. transitioned to iv metoprolol while here, then developed a fibb with rvr into 160's. patient was successfully extubated and transfered to the floor. . on the floor, the patient was frequently complaining of throat irritation and dryness. decadron was discontinued. he was also in afib with rvr which improved with changing to long acting verapamil, but which required increased dosing. he received a additional dose of verapaminl sr 120mg x 1 at 1pm. today, he received 750cc ns at 150cc/hr in the morning for concern for dehydration. in the afternoon, he began complaining of sob. he was found to be wheezy on exam. abg demonstrated po2 49. lasix 40mg iv and dexamethasone 10mg iv were given. ent was consulted given the concern for airway compromise. he was transfered to the icu. ent performed laryngoscopy which demonstrated subglottic swelling/hematoma but open airway. as there was no stridor, pt able to speak and swallow, it was decided not to intubate the patient. . patient was observed in the micu overnight and had an impressive diuresis of >4l to his initial lasix 40mg iv. he was also transitioned to a steroid taper of prednisone over a six day course. upon transfer, xopenex was discontinued for any bronchospastic component given his tendency to develop afib with rvr. rather, he was maintained on scheduled ipratroprium. coumadin continued to be held. . hospital course: 66y/o m with pmh of atrial fibrillation on coumadin admitted with sublingual bleed and respiratory distress concerning for lisinopril induced angioedema. ultimately inflammation in the op improved and pt was discharged at baseline. his hospitalization was complicated by uti which was treated. . # urinary tract infection: pt with rising wbc and low grade temp. ua positive for infection. pt also with malaise. note: pt was s/p foley catheter. initially started ciprofloxacin but remained febrile. switched to pip-tazo. ucx and bcx ultimately growing pseudomonas, sensitive to cipro so dicharged on cipro 500mg and dc on . . # orthostatic hypotension: unclear if due to low volume or too much verapemil. was on 360mg verapemil. decreased verapemil to 240mg and improved fluid status with boluses. . # respiratory distress - sublingual hematoma on exam in setting of inr of 9.8 also consider laryngeal edema vs infection. unclear etiology for respiratory distress with ddx of sub-lingual hematoma vs angioedema though **largely resolved with patient on ra w good sats. was treated with dexamethasone, benadyl, h2 blocker in icu. re-inflamed off dexamethasone, so discharged on prednisone taper. holding lisinopril as a possible cause. dry mm was a major issue, now resolved. . # inr - pt received vitamin k 10mg iv x1 and 2 u ffp in ed for inr 9.8. inr 1.5 on transfer to medicine. resuming coumadin with goal inr of 2.0 per ent and cards. unclear if pt was given warfarin pills at wrong dose as wife reports the most recent prescription looked different. we ask the pt to throw away all of his old pills and he was given prescriptions for all new ones. . # chronic atrial fibrillation - patient with episodes of afib with rvr in the setting of holding medications, but also on recent holter monitor. initially had better rate and pressure control on verapamil xl 360mg po daily compared to home dose of 240, but hypotensive. returned to home dose on . resuming coumadin with goal inr 2.0 medications on admission: atenolol 12.5 mg daily lipitor 80 mg daily lisinopril 5 mg daily verapamil 240 mg daily coumadin aspirin 81mg daily flonase advair discharge medications: 1. ipratropium bromide 17 mcg/actuation aerosol sig: one (1) puff inhalation three times a day. disp:*1 inahler* refills:*2* 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). disp:*1 nasal inhaler* refills:*2* 4. advair diskus 250-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day. disp:*1 inhaler* refills:*2* 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 7. verapamil 240 mg cap,24 hr sust release pellets sig: one (1) cap,24 hr sust release pellets po once a day. disp:*30 cap,24 hr sust release pellets(s)* refills:*2* 8. dextromethorphan-guaifenesin 28-600 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po twice a day for 30 days. disp:*60 tablet sustained release 12 hr(s)* refills:*0* 9. warfarin 4 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 10. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 12 days. disp:*24 tablet(s)* refills:*0* 11. atenolol 25 mg tablet sig: 0.5 tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnosis: sublingual hematoma, angioedema . secondary diagnosis: atrial fibrillation with rapid ventricular response, hypertension, hearing impairment discharge condition: good, stable vital signs discharge instructions: you were admitted with trouble breathing and with a very high inr (normal is , and yours was 9.8). because of your very high irn you may have bled in the soft tissues in your throat which obstructed your airway. you were intubated and given steroids. it is also possible that one of your medicines, lisinopril, may have contributed to the swelling in your throat. we have discontinued this medication. please do not take it again. please throw away your old coumadin pills since these may not be the right dose. finally, you developed a infection which we treated with antibiotics. you will need to keep taking the antibiotic after you leave the hospital. . please take your medications as prescribed. we have added the following medications: - ciprofloxacin (antibiotic) for you to take for the next 12 days - dextromethorphan-guaifenesin (cough suppressant) for you to take for the next month - pantoprazole (acid suppressant) for you to take for the next month - ipratropium bromide inhaler (asthma medication) for you to take for the time being . please make an appointment to see your pcp in week. please check in with your doctor's office about monitoring your inr. . please call your doctor or go to the nearest emergency room if you have trouble breathing, notice more bruising, unusual bleeding, chest pain, palpitation, weakness, trouble walking or speaking, uncontrolled vomiting or diarrhea, or other concerning symptoms. followup instructions: please make an appointment to see your pcp, , in a week. . provider: , dermatology gen- (nhb) date/time: 10:30 . provider: , m.d. phone: date/time: 2:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube transfusion of other serum diagnoses: urinary tract infection, site not specified unspecified essential hypertension atrial fibrillation peripheral vascular disease, unspecified paroxysmal ventricular tachycardia other and unspecified hyperlipidemia acute respiratory failure bacteremia long-term (current) use of anticoagulants angioneurotic edema, not elsewhere classified anticoagulants causing adverse effects in therapeutic use hypovolemia pseudomonas infection in conditions classified elsewhere and of unspecified site other disorders of muscle, ligament, and fascia other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to