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: isosorbide attending: chief complaint: ?chest pain, shortness of breath. major surgical or invasive procedure: arterial line placement cardiac catheterization tracheal intubation and mechanical ventilation history of present illness: the patient is an 89-year-old man with history of hypertension, aortic stenosis, ckd stage 2-3, and chronic obstructive asthma who presented to the ed via ems from (a halfway house) with shortness of breath and hypoxemic respiratory failure. the history was obtained from ed reports and caregivers at his halfway house, since patient was intubated, sedated, and unable to provide history. . per report, patient was in his usual state of health until 3:20am on the morning of admission, when he developed acute onset chest pain and said that he "could not breath." ems was called at this time. in the ambulance en route to the hospital, patient became acutely dyspneic, with respiratory rate in the 40s and satting low 80s on non-rebreather. . he arrived to the emergency where initial vitals showed t 98.6, hr 96, bp 115/86, rr 40, satting 95% on 15l. per report, patient was talking and moving all extremities; however, he was extremely dyspneic with respiratory rate in the 30s to 40s, fighting to breath, and satting in the low 80s on the non-rebreather. patient reportedly said that he wanted "everything done" and he was therefore intubated in the emergency room for hypoxemic respiratory failure and started on fentanyl and versed (proprofol was started initially but his blood pressures dropped). prior to intubation, he had been given bronchodilator nebs with minimal improvement in symptoms. labs showed a white count of 19.9 with 78% polys and 1% bands. hematocrit was 36.6. chemistry showed bicarb of 20, with anion gap of 16. creatinine was 2.5 (baseline is unknown). an abg showed 7.44/23/89 with lactate 5.2 (down to 2.2 one hour later). cxr showed bilateral pleural effusions, and a bnp was drawn that came back at (unfortunately there are no priors for comparison). ekg revealed st-depressions in the lateral leads. an initial troponin was 0.18. bedside echocardiogram showed no pericardial effusion, per report. . for presumptive cap, patient was given levofloxacin 750 mg iv x1 and ceftriaxone 1 gm iv x1; he was fluid resuscitated with 2l normal saline. his vitals at the time of admission were afebrile, hr 79, bp 124/77, and sat 96% on assist control ventilation, fio2 100% with peep 12, vt 500, and rr 16. access includes 2x 20g peripheral ivs. . review of systems: unable to obtain as patient was intubated and sedated. past medical history: --aortic stenosis --essential hypertension --unspecified monoarthritis --benign prostatic hyperplasia --chronic obstructive asthma --chronic renal insufficiency, stage 2-3 --hyperlipidemia **negative ppd in ** social history: lives at , a halfway house . per the staff there, he has been living at since . this is a re-entry center that helps transition residents from prison back to the community. patient has a long history of incarceration, including gun possession at age 70. he has two daughters who live in . family history: unknown. physical exam: vs: 97.9 152/78 (146-160/70-90) 76 18 97% ra uop: 400cc since mn, 700cc over last 24h ga: aox3, confused, nad heent: perrla. dry mm. no lad. no jvd. neck supple. cards: rrr s1/s2 heard. systolic murmur appreciated pulm: ctab no crackles or wheezes abd: soft, nt, +bs. no g/rt. neg hsm. neg sign. extremities: wwp, no edema. dps, pts 2+. skin: neuro/psych: cns ii-xii intact. 5/5 strength in u/l extremities. dtrs 2+ bl pertinent results: admission labs () pt-14.1* ptt-47.4* inr(pt)-1.2* ck(cpk)-259 ck-mb-29* mb indx-11.2* ctropnt-1.19* glucose-114* urea n-49* creat-2.0* sodium-136 potassium-4.9 chloride-109* total co2-19* anion gap-13 ck(cpk)-252 ck-mb-25* mb indx-9.9* ctropnt-0.96* ck-mb-4 probnp-* wbc-19.9* rbc-4.26* hgb-12.7* hct-36.6* mcv-86 plt count-267 pt-13.1 ptt-23.0 inr(pt)-1.1 . discharge labs: wbc-9.3 rbc-4.02* hgb-11.9* hct-35.7* mcv-89 plt ct-271 glucose-167* urean-38* creat-1.6* na-137 k-4.5 cl-104 hco3-20* calcium-8.9 phos-3.0 mg-2.1 . micro data- urine legionella antigen- negative blood cultures from -pending urine culture - no growth sputum culture- rare growth commensal respiratory flora. . reports echocardiogram the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild to moderate regional left ventricular systolic dysfunction with severe ypokinesis of the inferior and inferolateral walls. there is mild hypokinesis of the remaining segments (lvef = 35 %). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild to moderate (+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: suboptimal image quality. minimal aortic valve stenosis. mild-moderate mitral regurgitation. pulmonary artery systolic hypertension. regional left ventricular systolic dysfunction suggestive of cad. . cardiac catherization final diagnosis: 1. three vessel coronary artery disease. 2. mild aortic stenosis. 3. severe diastolic dysfunction with markedly elevated left sided filling pressures with secondary pulmonary hypertension. 4. nstemi 5. successful pci to proximal lad with des 6. successful angioseal closure device. . cxr impression: 1. copd and suspected pulmonary hypertension. 2. mild cardiomegaly. 3. dense left lower lobe collapse and/or consolidation. the differential includes a pneumonic infiltrate. 4. chf with mild interstitial edema. 5. probable small bilateral effusions. chest (pa & lat) study date of 10:10 am 1. bilateral moderate effusions and associated atelectasis 2. possible right lung lower lobe pneumonia. brief hospital course: in summary this is an 89-year-old man with history of hypertension, hyperlipidemia, and aortic stenosis who presented with acute onset chest pain and shortness of breath, intubated in the emergency for hypoxemic respiratory failure. found to have nstemi and now s/p cardiac cath showing 3 vessel cad. . # hypoxemic respiratory failure: pt intubated in ed. etiology was either cap v. acs. pt found to have acs with chf on cardiac cath. 3 vessel cad, s/p bms to proximal lad. wedge pressure of 25-30, suggesting pulmonary congestion which is consistent with elevated bnp and cxr showing pulmonary edema. pt extubated on . patient was also treated for cap with ceftriaxone and levofloxacin given elevated wbc to 20 with 1% bands on admission. however with improving leukocytosis and no clinical evidence of pneumonia, antibiotics were discontinued. patient improved over remaining length of stay and was discharged without o2 requirement. . #nstemi: tte showing ef 35%. troponins peaked at 1.19; pt taken to cardiac cath s/p bms to prox lad. started aspirin, plavix, beta blocker, and high dose statin. given patient's unclear renal function, he should be evaluated as an outpatient and started on ace inhibitor if cr stable. . # hypertension: sbp to 160s-170's at times, however usually between 120-140??????s with uptitration of metorprolol. pt discharged on metroprolol 50 mg po tid. further titration should occur as an outpatient . #ams: patient delirious post extubation. placed on zyprexa while delirium resolved. on discharge patient aaox3 and did not have require any anti-psychotics. . # acute renal failure: unclear baseline function. at discharge, cr 1.7. represent chronic failure. ace inhibitor not started as inpatient. should be re-evaluated as outpatient and started on ace if cr stable. ______________________________________ medications on admission: doxazosin simvastatin atenolol aspirin discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*30 tablet(s)* refills:*2* 3. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily) for 1 months. disp:*30 tablet(s)* refills:*0* 5. doxazosin 1 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: non st elevation myocardial infarction pneumonia congestive heart failure - systolic dysfunction hypertension discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , you were admitted because you were having difficulty breathing. because of this you required a tube to help you breath for several days. we discovered that you had a heart attack which contributed to your difficulty breathing. the cardiologists placed a small stent in one of the arteries in your heart to keep the artery open. . you are being discharged to a rehabilitation center for strength training. . please see the following list for changes in your medications followup instructions: please make an appointment with a primary care physician in your area for follow up of your chronic problems. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of endotracheal tube arterial catheterization cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortic valve disorders hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other and unspecified hyperlipidemia acute respiratory failure chronic obstructive asthma, unspecified hyperosmolality and/or hypernatremia acute on chronic systolic heart failure delirium due to conditions classified elsewhere leukocytosis, unspecified 

Answer: The patient is high likely exposed to