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: bactrim ds / levaquin / sulfa (sulfonamide antibiotics) attending: chief complaint: shortness of breath major surgical or invasive procedure: intubation and mechanical ventilation with subsequent extubation bronchoscopy replacement of 14f nephrostomy cath via loop ileostomy history of present illness: mr. is a 79 year old man with esrd who has not been feeling well over the last couple of weeks. he had been prescribed azithromycin as an oupatient. reportedly, a recent dialysis session took off more fluid than normal. patient became pre-syncopal. he later went to the . a cxr showed bilateral infiltrates. he started taking ceftriaxone for presumed pneumonia. he did not significantly improved. yesterday he went into afib after hd. he remembers feeling weak, pale, and being short of breath. he received iv metoprolol and his rhythm converted to sinus. ekg showed st depression in lateral leads. he received a chest cta which showed prominent mucous plugging, complete blockage of r mainstem, collapse of rll. he was transferred to for further management. he arrived on a mediccal floor on a nrb. he was then sent to the ed. . in the ed he was tachypneic, working to breathe, and denied any chest pain. he was not short of breath and not moving any air on the right. trop was reportedly up to 1. he had a ph of 7.21 on vbg. he was placed on bipap prior to transfer to the floor. also of note he has elevations in v2 and v3. this was seen by cardiology and felt possibly related to demand and there would be no acute intervention. he was given vancomycin and cefepime. . on arrival to the micu, he was able to speak in full sentences and denied any pain. past medical history: *bladder cancer s/p neobladder *prior uti *rectal cancer s/p abdominal-pelvic resection c/b pelvic abscess formation *right hydronephrosis with stent placement from nephrostomy through kidney and into pt's ileal conduit *hypertension *gerd *anemia of chronic disease *ckd stage v, new baseline cr around 6.6 social history: pt is married and lives w/ wife. rare etoh; no tobacco or drugs. retired construction worker. family history: denies family hx of heart disease. mother died in 60s of breast cancer, father died in 80s, a brother died at 83 of colon cancer. physical exam: discharge physical exam: vitals: t 97.5 bp 134/61 (134-149/61-62) hr 88 rr 20 o2 sat 97% on 2l via nc weight 74.2kg general: patient sitting in bed during hd session with hob elevated in nad heent: eomi. mmm. neck: supple. no jvd. cv: regular rate and rhythm. 2/6 systolic murmur appreciated throught the precordium lungs: clear to auscultation bilaterally, anteriorly. no crackles or wheezes appreciated. nml work of breathing. abd: nabs+. soft. nt/nd. ileostomy with nephrostomy tube coming out with blood-tinged present in the bag. ext: no pitting edema bilaterally. 2+ dps. skin: across the back, erythema scattered across the back. pertinent results: admission labs: 08:30pm blood wbc-7.5 rbc-3.40* hgb-10.3* hct-33.1* mcv-98 mch-30.3 mchc-31.0 rdw-14.3 plt ct-215 08:30pm blood neuts-75.2* lymphs-14.7* monos-8.1 eos-1.5 baso-0.4 08:30pm blood pt-12.7* ptt-27.2 inr(pt)-1.2* 08:30pm blood glucose-88 urean-55* creat-6.4* na-133 k-5.0 cl-92* hco3-27 angap-19 08:30pm blood calcium-8.5 phos-7.0*# mg-1.9 microbiology: 8:30 pm blood culture blood culture, routine (pending) 8:45 pm blood culture 2 of 2. blood culture, routine (pending) 12:02 pm sputum source: expectorated. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): rare growth commensal respiratory flora. 4:52 pm bronchoalveolar lavage gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): no growth, <1000 cfu/ml. legionella culture (preliminary): no legionella isolated. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): 3:54 am blood culture source: line-cvl right hand. blood culture, routine (pending): cytology: bronchial lavage: negative for malignant cells. abundant neutrophils, scattered macrophages, and bronchial cells. imaging: head ct: findings: presence of previous intravenous contrast slightly limits the evaluation for small intracranial hemorrhage but there is no large acute hemorrhage, edema, mass effect, or territorial infarction. the sulci are mildly prominent, consistent with age-related atrophy. _the visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. no acute skeletal abnormalities. impression: no acute intracranial process. tte: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is moderately depressed (lvef= 35 %) secondary to inferior and posterior wall hypokinesis. the right ventricular free wall thickness is normal. the right ventricular cavity is dilated with depressed free wall contractility. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.4 cm2). the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , mild aortic stenosis, moderate left ventricular contractile dysfunction, moderate pulmonary hypertension, and significant right ventricular dilatation and hypokinesis are now present. discharge labs: 05:58am blood wbc-11.6* rbc-3.35* hgb-10.2* hct-33.2* mcv-99* mch-30.5 mchc-30.8* rdw-14.1 plt ct-220 05:58am blood glucose-94 urean-26* creat-5.0*# na-136 k-4.7 cl-97 hco3-34* angap-10 05:58am blood calcium-8.5 phos-3.6# mg-2.0 brief hospital course: mr. is a 79 year old man with esrd on hd tues/thurs/saturday, htn, bladder cancer s/p resection and neobladder c/b multiple utis, rectal cancer s/p c/b pelvic abscesses, right hydronephrosis s/p ureteral stent and nephrostomy tube placement who presented from osh with shortness of breath and transferred to the micu for further management, including intubation who is now extubated, found to have decreased ef with posterior-inferior hypokinesis concerning for missed cardiac event transferred to cardiology service for further management. = = = = = = = = = = = = = = ================================================================ micu course: respiratory failure: patient was empirically covered with vancomycin and zosyn. a bal was done and a large mucus plug was suctioned. his fever curve trended down. cxr was consistent with pulmonary edema rather than pneumonia, so he was run 3 l negative on dialysis with improvement in his vent settings. he was subequently successfully extubated. antibiotics were discontinued. systolic dysfunction: patient's troponins were elevated on admission with tte showing new inferoposterior hypokinesis, consistent with acute coronary syndrome at some point in the last several weeks. ef was 35%. he was on aspirin, atorvastatin 80, and metoprolol. ace-i was initially held given low blood pressures. atrial fibrillation: patient had very brief runs of atrial fibrillation during dialysis the morning after admission. end stage renal disease: on tuesday, thursday, and saturday schedule. patient was run in the unit negative 4 l with improvement in respiratory function. = = = = = = = = = = = = = = = = = = ================================================================ cardiology floor course: # acute on chronic systolic heart failure with evidence of focal hypokinesis: tte showing ef of 35% with evidence of inferior and posterior wall hypokinesis, which is concerning for a missed coronary event. given the patient's other co-morbidities, the decision was made to medically manage the patient's presumed cad. he was started on 81mg aspirin, atorvastatin 80mg daily, and metoprolol tartrate 25mg , then transitioned to metorpolol succinate 50mg daily. the patient's volume status was trended clinically, and renal followed the patient. he was euvolemic on day of discharge. the patient's weight on day of discharge 74.2kg. acei was deferred due to persistently low blood pressures # respiratory failure: extubated . thought to be likely secondary to pulmonary edema and inability to clear secretions with mucus plugging leading to lobar collapse. chest pt and acapella were done during the patient's floor stay for chronic bronchiectasis and should be continued on an outpatient basis. pending bal studies will need to be follow-up upon discharge. # hypertension: well-controlled, requiring no anyti-hypertensives as an inpatient. # leukocytosis: the patient was noted to have a white count on day of discharge of 11.7. patient was afebrile with no localizing symptoms concerning for infection. leukocytosis was attributed to stress reaction in the setting of recent procedure. outpatient issues: check cbc with next lab check at hemodialysis to ensure that white count has resolved. # paroxysmal atrial fibrillation: patient has been in sinus rhythm since icu admission. no prior history of atrial fibrillation. chads-2 score of 4, placing patient at elevated risk for stroke. he was monitored on telemetry and started on metoprolol succinate 50mg daily. coumadin was not started given his other co-morbidities; the decision to initiate coumadin can be readdressed as an outpatient with the patient's primary care physician. # nephrostomy through kidney via patient's ileal conduit: interventional radiology replaced replacement of 14-french nephrostomy cath via loop ileostomy. patient will have follow-up to be scheduled by interventional radiology. # end stage renal disease on hd: patient on tues/thurs/sat hd, which was continued through his cardiology floor course. renal consult service followed the patient through his hospitalization. nephrocaps were continued daily. calcium acetate was increased to 1000mg tid per renal recommendations in light of elevated phosphorous. outpatient issues: trend phosphorous with labs at hemodialysis and consider decreasing calcium acetate if phosphorous is lower. # gerd: resume omeprazole as an outpatient. = = = = = = = = ================================================================ transition of care: --check cbc with next lab check at hemodialysis to ensure that white count has resolved. --decision to initiate coumadin can be readdressed as an outpatient upon discharge from rehab. --trend phosphorous with labs at hemodialysis and consider decreasing calcium acetate if phosphorous is lower. --follow-up pending bal studies and blood cultures. --interventional radiology follow-up. full code medications on admission: --meprazole 20 mg capsule, delayed release(e.c.) one (1) capsule, delayed release(e.c.) po daily (daily). --b complex-vitamin c-folic acid 1 mg capsule one (1) cap po daily (daily). --calcium carbonate 200 mg calcium (500 mg) tablet, chewable one (1) tablet, chewable po tid w/meals (3 times a day with meals) discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: two (2) tablet, chewable po tid w/meals (3 times a day with meals). 5. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for itching. 6. toprol xl 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. discharge disposition: extended care facility: cape & islands discharge diagnosis: primary diagnosis: respiratory failure mucous plugging acute on chronic systolic heart failure secondary diagnosis: end-stage renal disease paroxysmal atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: it was a pleasure taking care of you during your hospitalization at . you were hospitalized for respiratory failure secondary to mucous plugs in your lungs and excess volume in your lungs. you were intubated during your hospitalization and subsequently exutabted. during your hosptialization, you were found to have depressed pumping function of your heart, called systolic heart failure, concerning for a missed heart attack. the decision was made to medically manage you in light of your other medical issues. you continued to have dialysis during this hospital admission. take all medications as instructed. note the following medication changes: --*added* aspirin 81mg daily --*added* atorvastatin 80mg daily --*added* metoprolol succinate 50mg once daily --*new* sarna lotion 1 application to the back three times daily ask your cardiologist whether you start coumadin as an outpatient for your intermittent heart arrhythmia. during this admission you also underwent nephrostomy tube replacement by interventional radiology. keep all hospital follow-up appointments. your hospital appointments are provided in a list for you. followup instructions: department: radiology care unit when: monday at 8:30 am building: de building ( complex) campus: west best parking: garage department: radiology when: monday at 10:00 am with: xsp west building: cc campus: west best parking: garage md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis closed [endoscopic] biopsy of bronchus ureteral catheterization diagnoses: acidosis anemia in chronic kidney disease end stage renal disease renal dialysis status esophageal reflux congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation aortic valve disorders pulmonary collapse hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure personal history of malignant neoplasm of bladder family history of ischemic heart disease acute on chronic systolic heart failure ileostomy status leukocytosis, unspecified stricture or kinking of ureter family history of malignant neoplasm of gastrointestinal tract other acute and subacute forms of ischemic heart disease, other family history of malignant neoplasm of breast inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation other artificial opening of urinary tract status personal history, urinary (tract) infection personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus foreign body in other specified parts bronchus and lung 

Answer: The patient is high likely exposed to