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: transfer from with hypotension and a fever to 103.8f. major surgical or invasive procedure: central line placement intubation history of present illness: mr. is a 78-year-old gentleman with htn, dm2, cad s/p mix2, 3 vessel cabg in (lima-lad, svg-d1, svg-om1, svg-pda), cath in with stent to lad, afib on coumadin, ischemic cardiomyopathy with ef 30%, nsvt with pacer/ transferred from osh with fevers, hypotension. the patient was discharged from on after ventricular ablation for vt. . his most recent icd firing was in which was felt to have been induced by exercising on a stationary bicycle. as a result, he underwent cardiac catheterization and received a stent to his lad. since his discharge in , he has had further chest discomfort and reevaluation of his coronary arteries via cardiac catheterization on which showed a patent lad stent and no change in his coronary anatomy. in , he was hospitalized in after he developed acute onset chest discomfort and was admitted to an emergency room with wide complex tachycardia at a rate of 130 beats per minute. his icd did not fire as it was programmed for faster rates. reportedly his arrhythmia self-terminated and the question of atrial fibrillation with aberrency versus vt. patient was apparently stable as the arrhythmia lasted for an hour and he never had syncope. . the patient was seen on at clinic where heart histograms suggested reasonable rate control of his atrial fibrillation with his average heart rate 70-80 beats per minute. additionally, there is no significant amount of ventricular high rates greater than 110 beats per minute which suggest that this arrhythmia which occurred in was likely to be ventricular tachycardia. he seems to tolerate the wct hemodynamicaly (no syncope), but has significant chest pain with it. the patient was seen here on for an ep study that resulted in 5 ablations of the 14 discovered foci. the remaining foci was resistant to sustained vtach by induction. the patient was discharged on . he complained of dysuria after discharge presumably from a traumatic foley tap in the ep lab. while on the ferry to he developed acute shortness of breath, chills, rigors and ams. he was immediately brought to the with a temperature of 103.7f sating 100% on 15l nrb with a rr in the 30s and bp of 107/60 with a hr of 77. his wbc was 3, bun was 38 and cr and 2.1. anesthesia attempted to intubate him, but failed. he was given 80mg iv lasix, 0.25mg iv digoxin and 100mg iv lidocaine for multiple pvcs. arrived and successfully intubated the patient for transport, but the patient became acutely hypotensive and was started on a dopamine and levophed drip and was 3l net positive. past medical history: htn dm 2- recently diagnosed, diet controlled cad s/ mix2 , 3 vessel cabg , and stenting , afib on coumadin, ischemic cardiomyopathy with ef 30%, nsvt with pacer/icd hypothyroidism obstructive sleep apnea (on bipap) left hemi diaphragm dysfunction s/p right inguinal hernia repair hard of hearing (bilateral aids) social history: former smoker quit 40 years ago, daily drinks alcohol, no drug use. family history: grandfather with mi at age 74, brother with strokes starting at age 60. physical exam: t:99.7 bp:106/66 hr:80 rr:13 o2sat:97% intubated wt 109 gen: intubated and sedated heent: no supraclavicular or cervical lymphadenopathy, no jvp elevation, no carotid bruits, no thyromegaly or thyroid nodules resp: intubated cv: rr, s1 and s2 wnl, no r/g 2/6 systolic murmur at apex. abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e. some evidence of early venous stasis. skin: no rashes/no jaundice neuro: sedated and intubated access: 3 peripheral 18 gauge iv pertinent results: 11:44pm blood wbc-15.0*# rbc-3.95* hgb-13.4* hct-39.8* mcv-102* mch-33.9* mchc-33.3 rdw-14.3 plt ct-113* 06:38pm blood wbc-28.6* rbc-3.73* hgb-13.1* hct-37.8* mcv-101* mch-35.2* mchc-34.8 rdw-14.7 plt ct-107* 05:21am blood wbc-21.9* rbc-3.37* hgb-11.8* hct-33.7* mcv-100* mch-35.0* mchc-35.0 rdw-14.9 plt ct-114* 06:31am blood wbc-15.2* rbc-3.33* hgb-11.6* hct-33.5* mcv-101* mch-34.9* mchc-34.6 rdw-14.8 plt ct-104* 12:49am blood wbc-7.5# rbc-3.23* hgb-11.3* hct-33.1* mcv-102* mch-35.1* mchc-34.3 rdw-14.6 plt ct-85* 05:53am blood wbc-6.9 rbc-3.29* hgb-11.5* hct-32.7* mcv-99* mch-34.9* mchc-35.1* rdw-15.3 plt ct-129* 05:53am blood pt-18.0* ptt-30.4 inr(pt)-1.7* 04:41am blood glucose-163* urean-60* creat-3.8* na-134 k-4.8 cl-103 hco3-15* angap-21* 06:31am blood glucose-146* urean-57* creat-3.0* na-139 k-4.0 cl-106 hco3-21* angap-16 05:53am blood glucose-116* urean-47* creat-2.1* na-140 k-4.3 cl-105 hco3-25 angap-14 12:49am blood alt-314* ast-100* ld(ldh)-190 alkphos-104 amylase-49 totbili-5.9* 05:55am blood alt-198* ast-49* alkphos-117 totbili-4.4* 07:15am blood alt-110* ast-36 alkphos-148* amylase-160* totbili-4.4* dirbili-3.0* indbili-1.4 06:45am blood alt-83* ast-36 ld(ldh)-169 alkphos-141* amylase-151* totbili-3.8* cxr: : blunted costophrenic angles not specifically suggesting effusion. poorly defined retrocardiac opacity probably representing atelectasis, cannot associate consolidation. no overt chf u/s: : findings: real-time ultrasound evaluation of the abdomen reveals the liver to be homogeneous in echotexture without evidence of focal lesion. the hepatic parenchymal echogenicity is normal. the gallbladder demonstrates multiple small hyperechogenic foci consistent with gallstones. there is no intrahepatic biliary ductal dilatation, and the common duct measures 5 mm. main portal vein is patent with antegrade flow. the pancreas is not well visualized due to gas. the spleen is normal in size and echogenicity. the right kidney measures 11.8 cm and demonstrates a simple cyst in the mid pole measuring 2.2 cm. the left kidney measures 11.7 cm and demonstrates a simple cyst in the mid pole measuring 1.9 cm. there is no evidence of renal calculi or hydronephrosis. the aorta demonstrates atherosclerotic changes. impression: 1. cholelithiasis without evidence of cholecystitis. 2. bilateral renal cysts. brief hospital course: 78 y/o male with htn, dm2, cad s/p mix2, 3 vessel cabg in , stenting of lad on , afib on coumadin, ischemic cardiomyopathy with ef 30%, nsvt with pacer/ transferred from osh intubated and on pressors with fevers and respiratory distress 1 day s/p vt ablation at . . sepsis: patient arrived to the osh after a traumatic foley insertion during an ep study on with chills, rigors and a fever to 103.7f. patient was started on vancomycin and zosyn for empiric coverage of suspected complicated polymicrobial uti. flavobacterium (resistance to tetracycline otherwise pan-sensitive) and presumed enterococcus sensitive to vancomycin and penicillin were cultured at the osh. all blood, urine and sputum cultures drawn here have been negative. patient's antibiotics were switched to pen g and levoquin to cover the enterococcus, flavobacterium and possible aspiration pneumonia. patient remained afebrile for 5 days prior to transfer and his leukocytosis (wbc=28.6) resolved. the patient will continue on pen g until to finish off a 14 day course of vancomycin transitioned to pen g. he also received a 7 day course of zosyn transitioned to levoquin for possible pna. . cardiac: the patient underwent vt ablation on resulting in 5 ablations of the 14 foci. the other 9 foci did not induce sustained vt. the patient complained of dysuria after discharge on and began having chills and rigors with a temp of 103.7f at an osh. he was transferred to the ccu intubated and on pressors for presumed septic shock. shortly after admission, the patient went into monomorphic vtach with at least two different morphologies. he failed icd cardioversion x 3, and he was finally paced terminated out of his vtach. his pacer was set at 80 bpm to maintain his blood pressure. he was started on vancomycin and zosyn, and given 3 pressors with +7l of fluid to maintain perfusion pressures for presumed septic shock. the patient was weened off pressors and extubated over the next three days without complications. his pacer was reset to 60 bpm and he remained in afib with a conduction in the 60-80's with occassional pacing on metoprolol 12.5mg po bid. when we attempted to raise his metoprolol to 25mg po bid, he became orthostatic with a rate of 60bpm and 100% paced. the patient was restarted on his coumadin for afib after we pulled the central line. his heparin was continued to bridge him to a therapeutic inr. his inr at transfer was 1.7. the patient was on amiodarone 200mg qd, asp 325mg qd, metoprolol 12.5mg , simvastatin 40mg qd, warfarin 4mg qhs and furosemide 80 qd at the time of transfer. his blood pressure have ran in the 100's/50's. his home medications of digoxin, spironolactone and cozaar were not restarted as his bp was too low. he will need them added back on as his blood pressure tolerates. . liver: patient's ast/alt were elevated and have trended down to normal during his hospital stay. this is likely due to shock liver that has resolved. his lipase, alk phos and tbili trended up during his hospital stay and was concerning for biliary obstruction vs pancreatitis vs pancreatic cancer. patient was jaundiced and denied any abdominal pain. ruq u/s revealed no dilation of his common bile duct with no focal lesions of the liver. his pancreas, however, could not be visualized during the study. the following day, his lipase, tbili and alk phos began to trend down and gi felt that the patient's enzyme bump was caused by biliary sludge in the setting of his septic shock and recommended a recheck lipase, alk phos and bili in a week. . arf: patient cr at discharge trended down to 2.0 down from 3.8 on arrival. his baseline cr is 1.6. his arf was likely due to atn caused by septic shock. . endocrine: patient's dm was treated with ssi and he was given his home dose of levothyroxine to treat his hypothyroidism. medications on admission: nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual q5min () as needed for chest pain. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). metoprolol succinate 50 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). furosemide 80 mg tablet sig: one (1) tablet po daily (daily). spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). losartan 25 mg tablet sig: three (3) tablet po daily (daily). warfarin 2 mg tablet sig: two (2) tablet po daily (daily). ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q4-6h (every 4 to 6 hours) as needed for fever. 2. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. insulin regular human 100 unit/ml solution sig: as dir as dir injection asdir (as directed). 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 6. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 7. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. warfarin 2 mg tablet sig: two (2) tablet po hs (at bedtime): goal inr . please check inr daily and adjust coumadin as needed. 10. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 11. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). 12. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for nasal dryness. 13. penicillin g pot in dextrose 2,000,000 unit/50 ml piggyback sig: two (2) million units intravenous q6h (every 6 hours) for 5 days: last day . million units 14. heparin (porcine) in d5w 100 unit/ml parenteral solution sig: as dir as dir intravenous asdir (as directed): titrate to ptt 60-80, may discontinue when inr > 2.0 for 3 days in a row. discharge disposition: extended care facility: discharge diagnosis: primary: septic shock from enterobacterium / flavobacterium ventricular tachycardia congestive heart failure secondary: diabetes mellitus chronic renal insufficiency hypothyroidism sleep apnea discharge condition: patient was feeling better, and stable for discharge to discharge instructions: please continue your medications. some of your doses may have been changed. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1200 cc daily. if you have shortness of breath, chest pain, dizziness, pass out, or have other concerns, please call your primary care physician or return to the ed. followup instructions: please follow up with your pcp pearl, the week after discahrge from rehab. you have an appointment with dr. on at 3:40pm. please call if you have any questions or need to reschedule. . you have an appointment with , np on at 1pm. please call if you have any questions or need to reschedule. . you also have an appointment set up for: provider: cc2 pulmonary lab-cc2 date/time: 11:00 provider: , intepretation billing date/time: 11:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified severe sepsis unspecified acquired hypothyroidism atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status chronic kidney disease, unspecified paroxysmal ventricular tachycardia septic shock automatic implantable cardiac defibrillator in situ other septicemia due to gram-negative organisms 

Answer: The patient is high likely exposed to