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: penicillins attending: chief complaint: chest pain, atrial fibrillation, fever, mental status changes, hypotension, dyspnea major surgical or invasive procedure: none. history of present illness: 77 year old man with history of atrial fibrillation during a previous hospitalization which was converted to nsr and was followed up with a good performance on a stress test who presented to the ed with chest pain. he was in his usual state of health until two days prior to admission when he developed a "cold" consisting of a dry cough and fevers to 37.8 in addition to chest pain. he described the chest pain as a , dull and intermittent located in his mid-chest and radiating to his right shoulder. he also noted loss of appetite and diaphoresis. he reports that he gets this same combination of fever, chest pain, and diaphoresis every fall. no recent fatigue, no dysuria, no diarrhea. no recent travel, no leg swelling. no recent weight loss. in the ed he was noted to have a temperature of 101 and hypotension to 83/53 which improved with 2 l ivf. past medical history: -hypertension -hyperlipidemia -atypical chest pain (ett and stress test normal) -anxiety -s/p fall with multiple facial fractures () -s/p removal infected mandibular hardware () -remote h/o afib controlled with amiodarone; d/c by cards() -hemorrhoids -colonic polyps (colonoscopy ) -glaucoma social history: moved from about 14 years ago, traveled 3 years ago to but no other travel. h/o tobacco in , none recently. uses etoh socially on weekends ( drinks/week); denies ivdu. lives with his wife. family history: no cad. physical exam: vs: 97.3; bp: 146/82; p:97; rr: 22, labored; o2 sat: 100% on 2l gen: resting in bed watching tv, labored breathing using accessory muscles but nad, able to speak in full sentences, rr of 22, patient is very uncooperative and refuses to be interviewed heent: perl neck- supple, no cervical or supraclavicular lad. no bruits. no jvd. cv- irregular, tachycardic, no murmur appreciated. chest- expiratory wheezes noted bilaterally abd- taut, possibly distended, non-tender, no masses, no organomegaly ext: warm, well perfused, no edema neuro: limited exam, seems to have no focal findings pertinent results: 10:18pm ck-mb-3 ctropnt-<0.01 10:18pm ck(cpk)-194* 08:53pm lactate-2.8* 04:55pm urine color-yellow appear-clear sp -1.029 04:55pm urine blood-mod nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 04:55pm urine rbc-0-2 wbc-0-2 bacteria-few yeast-none epi-0-2 04:10pm glucose-151* urea n-19 creat-1.2 sodium-132* potassium-3.8 chloride-96 total co2-24 anion gap-16 04:10pm ctropnt-<0.01 04:10pm ck(cpk)-104 04:10pm ck-mb-2 probnp-1598* 04:10pm wbc-16.0*# rbc-4.85 hgb-13.4* hct-38.7* mcv-80* mch-27.7 mchc-34.8 rdw-14.3 04:10pm neuts-95.0* bands-0 lymphs-2.9* monos-1.9* eos-0 basos-0.1 04:10pm hypochrom-normal anisocyt-1+ poikilocy-occasional macrocyt-normal microcyt-3+ polychrom-normal ovalocyt-occasional 04:10pm plt smr-normal plt count-174 04:10pm pt-13.5* inr(pt)-1.2* brief hospital course: he was admitted to cc7. on the medicine floor, he was ruled out for myocardial infarction with serial enzymes. he was orthostatic and his hypotension initially improved with fluid rehydration. a fever work up including ua, cultures, cxr, and lp was started and has so far been inconclusive. serum tox screen negative. he had a head ct without any obvious intracranial bleed or mass; some maxiallary sinus mucosal thickening was noted. he was started on antibiotics the evening of , when he was spiking fevers with altered ms; he was started empirically on vanco/levo/flagyl. his wbc had trended down and his fevers were intermittent (tmx: 102). he developed atrial fibrillation with rvr on the floor; his rate was controlled with lopressor, at the expense of his bp. he also became more tachypnic, breathing 40/min while sleeping, with abg 7.41/29/91 on 3l nc. he was transferred to the micu. a work up for his change in mental status resulted in a repeat negative head ct, an abnormal eeg which showed changes consistent with metabolic abnormalities, infection, ischemia or anxiety, an unrevealing second lp, a negative rpr, b12 of 289 and tsh of 1.0. he was treated with zyprexa and ativan for agitation and placed on the ciwa protocol. his atrial fibrillation was treated with lopressor, amiodarone, and heparin and warfarin. an echocardiogram showed no vegetations. due to increased wheezing, he was started on albuterol nebs and inhaled fluticasone with an improvement in his tachypnea and wheezing. his wbc continued to trend downwards and his blood pressure stabilized. antibiotics were continued. on he was transferred to 7 for further management. 1. atrial fibrillation the patient's atrial fibrillation with rvr has remained stable with hr ranging from 90-125. he was started on amiodarone hcl 400 mg po starting , and his home dose of metoprolol was increased from 25 mg to 75 mg . heparin on and sliding scale and warfarin 2.5 mg po were begun with an increase in warfarin to 5 mg po daily on since the inr remained low at 1.3. lovenox 90 mg sc was begun at 6 pm and heparin discontinued in anticipation of discharge. inr upon discharge 1.3. home vna will help administer lovenox. 2. changes in mental status a work up for his change in mental status resulted in a negative head ct, an abnormal eeg which showed changes consistent with metabolic abnormalities, infection, ischemia or anxiety, two unrevealing lps, a negative rpr, b12 of 289 and tsh of 1.0. he was treated with zyprexa and ativan and placed on the ciwa protocol for concerns about possible alcohol withdrawal. the patient's mental status improved during his hospital stay with more difficulties at night. he was fully alert and oriented with a mini-mental status score of 27/30 with only some difficulty on fine points of orientation including the floor of the hospital he was on, the county we were in, and the date the day before discharge. 3. fever of unknown origin at discharge, the patient was afebrile with a wbc of 9.4, down from 16.0 upon admission. id believes he had a viral infection which has resolved. he was treated with levofloxacin for 6 days, and vancomycin and flagyll for 5 days during his hospitalization. 4. dyspnea the patient improved with a rr of 22, an oxygen saturation of 95% on room air, and lungs ctab upon discharge. the dyspena is believed to be due to copd although the patient only has a remote history of smoking. a chest/abdominal/pelvic ct concluded "1.prominent mediastinal fat likely corresponds to the widened appearance of the mediastinum on chest radiograph. on this study limited by patient motion artifact and suboptimal contrast bolus timing, there is no evidence of aortic dissection, aneurysm, or central pulmonary embolism. 2. posterior dependent atelectatic changes and minimal bilateral pleural, effusions. 3. right renal lesions incompletely characterized, but likely cysts. 4. prostatic enlargement. 3.8 cm cystic area of right prostate is of uncertain signficance and clinical correlation is suggested." during this hospitalization he was treated with albuterol 0.083% nebs every four hours, fluticasone propionate 110 mcg 4 puffs inhaled and albuterol 0.083% 1-2 nebs inhaled every hours prn. he will be discharged on spiriva, combivent and albuterol for presumed copd. 5. hypotension the patient's blood pressure has remained stable since his return to the medical floor. 6. hematuria the patient had one episode of blood tinged urine. a ua showed only large amount of blood and rbc >1000. his is and os have been excellent. 7. chest pain his chest pain resolved soon upon admission. ekgs do not show ischemic changes and his cardiac enzymes were negative x3. echocardiogram performed concluded: left ventricular systolic function is low normal, mild to moderate (+) mitral regurgitation, moderate tricuspid regurgitation is seen. there is borderline pulmonary artery systolic hypertension. 8. microcytic anemia the patient had a microcytic anemia with a hct in the low 30s and an mcv of 79 which was not fully worked up. he was placed on 1000 mcg of b12 due to a low normal b12 value, b12: 289. at the time of discharge, pt had no further chest pain and was rate-controlled. his systolic pressures were excellent and he was discharged with followup plans discussed with his primary care provider. medications on admission: fluoxetine 20mg daily ativan 0.25mg tid prn lipitor 10mg daily metoprolol 25mg discharge medications: 1. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 2. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 4. cyanocobalamin 500 mcg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. combivent 103-18 mcg/actuation aerosol sig: 1-2 puffs inhalation four times a day. disp:*qs inhaler * refills:*2* 6. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation once a day. disp:*qs inhaler+caps* refills:*2* 7. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4-6 hours prn as needed for shortness of breath or wheezing. disp:*qs 1 inhaler* refills:*0* 8. warfarin 5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 9. lovenox 80 mg/0.8 ml syringe sig: one (1) syringe subcutaneous twice a day for 7 days. disp:*14 syringes* refills:*0* 10. metoprolol tartrate 25 mg tablet sig: three (3) tablet po twice a day. disp:*180 tablet(s)* refills:*2* discharge disposition: home with service facility: family and children services discharge diagnosis: 1. atrial fibrillation with rapid ventricular response 2. atypical chest pain 3. hypertension 4. hypercholesterolemia 5. anxiety 6. changes in mental status 7. probable copd 8. probable alcohol withdrawal 9. acute on chronic renal insufficiency discharge condition: stable no further rapid ventricular response. discharge instructions: 1. please take your medications as prescribed. 2. please return to the hospital or call your pcp if you develop shortness of breath, chest pain, fevers or other worrisome symptoms. 3. you will need to continue taking enoxaparin (lovenox) for the next 5 days. also continue taking warfarin as directed by your doctor's office. you have also been started on a number of new medications for your breathing difficulty. followup instructions: please followup with your primary care doctor: , md phone: date/time: 11:30 recommend pulmonary function tests as outpatient as baseline for amiodarone therapy. procedure: spinal tap incision of lung diagnoses: mitral valve disorders unspecified essential hypertension hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified atrial fibrillation chronic kidney disease, unspecified other and unspecified hyperlipidemia unspecified viral infection iron deficiency anemia, unspecified diseases of tricuspid valve alcohol withdrawal 

Answer: The patient is high likely exposed to