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: mevacor attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: patient is a 68 year old russian speaking male with hodgkins lymphoma (in remission, last chemo end of ) cad/chf, and atrial fibrillation admitted with dyspnea on exertion and lower extremity edema. since the end of , patient has had an increasing amount of lower extremity edema, dyspnea on exertion. he used to be able to walk 10 blocks and now is able to walk block without shortness of breath. per patient's wife, he had an abdominal ultrasound which showed ascites and a tte in doctor's office which showed an ejection fraction of ~15%. patient increased his lasix po, but refused to take aldactone. in the ed, patient was given lasix 40 mg po and aspirin 325 mg with some relief. he had a cough with white sputum and remained afebrile. he was admitted to the medicine service for further evaluation and treatment. past medical history: chf- ef 10-15%, due to multiple infarcts cad- acute myocardial infarction with ptca of proximal lad hodgkins lymphoma (nodular type)- in remission. last chemo (mopp) was in atrial fibrillation- patient was on coumadin prior to admission social history: does not smoke, quit about 10 years ago. drinks alcohol occasionally. lives with his wife; daughter is also very involved in his care. retired lab manager. family history: noncontributory physical exam: on admission, his physical exam was as follows: t: 97.1; bp: 107/44; p:80; rr:20; o2 95% on room air general: no acute distress, alert and oriented x 3, slow but appropriate speech heent: oropharynx dry, without exudate. pupils equal, round, and reactive. cv: jvp ~10 cm. irregularly irregular, i/vi systolic murmur respiratory: diffuse bibasilar crackles abdomen: obese, nontender, nondistended, normal bowel sounds extremities: + pitting edema bilaterally to the upper thighs skin: erythema of the lower extremities bilaterally pertinent results: initial labs: 02:10pm blood ctropnt-0.06* 02:10pm blood digoxin-1.8 02:10pm blood tsh-5.2* 02:10pm blood albumin-4.2 02:10pm blood alt-16 ast-22 ld(ldh)-308* ck(cpk)-93 alkphos-253* totbili-1.3 02:10pm blood glucose-101 urean-37* creat-1.4* na-140 k-4.8 cl-104 hco3-24 angap-17 02:10pm blood plt ct-219 07:46pm blood pt-20.4* ptt-36.7* inr(pt)-2.8 02:10pm blood hypochr-3+ anisocy-1+ poiklo-1+ macrocy-2+ microcy-normal polychr-1+ ovalocy-occasional schisto-occasional tear dr1+ 02:10pm blood neuts-70 bands-0 lymphs-14* monos-16* eos-0 baso-0 atyps-0 metas-0 myelos-0 02:10pm blood wbc-8.9 rbc-4.80 hgb-14.0 hct-46.5 mcv-97 mch-29.2 mchc-30.2* rdw-17.9* plt ct-219 recent: 03:03am blood wbc-7.7 rbc-3.69* hgb-10.6* hct-34.8* mcv-94 mch-28.8 mchc-30.5* rdw-21.4* plt ct-188 04:14am blood neuts-74.6* lymphs-17.4* monos-6.3 eos-1.0 baso-0.7 10:25am blood pt-14.3* ptt-49.3* inr(pt)-1.3 03:03am blood glucose-109* urean-28* creat-1.5* na-144 k-3.2* cl-103 hco3-31* angap-13 03:03am blood calcium-8.6 phos-3.5 mg-2.2 09:20am blood alt-117* ast-36 alkphos-136* totbili-3.6* 05:00am blood ck-mb-notdone ctropnt-0.11* 03:03am blood vitb12-1097* folate->20 10:25am blood ammonia-42 02:10pm blood tsh-5.2* 07:57am blood t3-71* brief hospital course: 1) cardiovascular - the patient was initially treated on for decompensated chf with iv lasix, aldactone, and ace inhibitor. he was resistant to this regimen, and natrecor was added on . he continued to be difficult to diurese due to hypotension. on he became febrile and hypotensive (bp 70-80s), and ciprofloxacin was added for a uti. on he continued to be hypotensive and was transferred to the ccu for tailored diuresis. in the ccu he was diuresed and received milrinone, with successful diuresis and improvement in his respiratory status. he was transfered from the ccu on , but later that day became febrile and hypotensive and was sent to the micu for presumed sepsis. he was treated and returned to the floor on . since that time he has continued to diurese slowly with lasix iv, with slow improvement in his chf on exam and cxr. he has remained stable, with sbp 90-115 and o2 sats 95-98% on 2l. on discharge he is felt to be slightly volume overloaded, but requires very gentle diuresis to avoid hemodynamic decompensation and intravascular volume depletion. pt. converted from captopril 6.25 tid to lisinopril 2.5 qhs (has been unable to tolerate higher doses secondary to hypotension) and lasix 40 mg po qd. followup with dr. arranged. rhythm - the patient was been in afib throughout his course. he has been rate controlled in the 70-80s. his digoxin has been held due to nsvt (see below). he has been anticoagulated on a heparin drip, but has begun to bridge to coumadin 5 mg po qd starting on . he has also had numerous episodes of nsvt, including one 25 beat run; he remains on toprol 50 qd both for rate control and ectopy suppression. he was seen by the electrophysiology service, who recommend vt ablation, followed by placement of a biventricular pacer, at some point in the near future after his acute issues have resolved (especially his current infections). pt. will follow up with electrophysiology. ischemia - the patient has long-standing chest pain that has been unchanged during his course. multiple ekgs have shown no changes concerning for acute ischemia. troponins were briefly elevated to 0.14 immediately after his micu course, but this was felt to be due to severe chf and his concurrent renal insufficiency at that time. 2) respiratory - his saturations have remained stable during his stay. they continue to be low (90%) on room air but improve to high 90s with 2l by nc. on he developed fever, hypotension, and respiratory distress (rr 40), and on transfer to the micu was felt to have a pneumonia on cxr (presumed due to aspiration). this has been treated with zosyn iv (14 day course). on he again developed confusion and respiratory distress with no new infiltrate on cxr, and vancomycin iv was added for a 7 day course. a rij catheter was removed. he has since had no respiratory distress, and his lung exam and o2 sats have improved to the high 90s on 2l. he remains at 100% on 4 l. 3) heme - in the ccu, the patients platelets fell to 53k. this was initially presumed due to hit and the pt was switched to argatroban. hit antibodies were subsequently negative x2, his platelets have recovered to >150, and he resumed a heparin drip for anticoagulation for afib when he returned to the floor after the micu on . his platelets have been stable since. on his transfer to the micu, he had inr>30 and ptt>150, in the context of elevated ast/alt/bilirubin; this was felt to be due to shock liver caused by sepsis. since his return to the floor, his inr has slowly fallen to 1.3, and his ptt has returned to therapeutic levels on a heparin drip. coumadin was started on for afib. the hematology service consulted on and followed the patient throughout his stay. 4) id - on transfer to the ccu on the patient was febrile to 104, and was treated for a uti with ciprofloxacin. he was transferred to floor on , but again became febrile to 102.4; he was transferred to the micu for sepsis and treated with zosyn iv for presumed aspiration pneumonia. he was also found to have bilateral mastoiditis (r>l) by head ct, and was started on tobramycin drops (14 day course) to the right ear. on he again developed confusion and respiratory distress with no new infiltrate on cxr, and vancomycin iv was added for a 7 day course. all blood cultures have been negative during his stay, except one bottle growing coag-negative staph (felt to be a contaminant). pt's right ij line placed on , a possible source (although culture negative) was removed. urine culture is negative as of . c. diff assay was negative on . since he has been afebrile, with stable bp. on the day of discharge he is on day 11 of 14 of zosyn, day 5 of 7 of vanco, and day 11 of 14 of tobramycin drops. 5) renal - his cr has been generally stable throughout his course, with a brief elevation to 2.0 during his micu stay, felt to be due to intravascular volume depletion in the setting of sepsis. he has since maintained a cr in the 1.1 to 1.5 range, which is approximately at his baseline. lasix has been titrated to pt's creatinine level. 6) mental status - he has been quite confused during his course, although per report his baseline at home is to be quite functional. he has consistently been agitated and required zydis as well as 1:1 sitters for the majority of his floor stay, although he has become calmer and more oriented in the last several days. his confusion is likely due to a combination of medications, infection, prolonged hospital stay, language barrier. he had a head ct during a period of acute confusion that showed no acute changes, mass effect, or bleed. ammonia, b12, and folate levels were normal at discharge. it was not felt that he required further neurologic workup at this time and will hopefully improve with resolution of his chf and infections. we believe the current ms changes are secondary to a delirium, and have stopped the zyprexa, as it may have exacerbated his condition. 7.)fen - pt. evaluated by speech and swallow, was felt not to be an aspirator, but recommendation was to continue soft solids, no straws, and re-eval when mental status improved. 8.)access - l picc placed 9.)prophylaxis - protonix, heparin 10.)code - full medications on admission: digoxin 250 mcg qd elalapril 5 mg qd lasix 180 mg qd leukoran prednisone 20 mg qd coumadin ? dose ntg prn kcl 20 meq qd procarbazine wellchol colace allopurinol discharge disposition: extended care facility: - discharge diagnosis: congestive heart failure, complicated by respiratory failure pneumonia, complicated by sepsis atrial fibrillation coronary artery disease hodgkin's disease, in remission bilateral mastoiditis discharge condition: fair discharge instructions: take all medications as directed. please notify your doctor if you have chest pain, shortness of breath, lightheadedness, palpitations or fevers. please check ptt q 6h until heparin dose is completely stable with goal 60-80. please check inr on , goal 2.0-3.0. readjust coumadin dose accordingly. please check potassium level on . followup instructions: make an appointment to follow up with your pcp (dr. . please make an appointment with dr. for wks from now. call for an appointment. provider: , md where: cardiac services phone: date/time: 10:00 provider: , md where: hematology/oncology phone: date/time: 9:30 provider: , multi-specialty multi-specialty thoracic unit-cc9 where: clinical ctr. - 9th fl. multi date/time: 9:30 md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube pulmonary artery wedge monitoring injection or infusion of nesiritide diagnoses: other primary cardiomyopathies thrombocytopenia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified unspecified septicemia paroxysmal ventricular tachycardia acute respiratory failure pneumonitis due to inhalation of food or vomitus hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites 

Answer: The patient is high likely exposed to