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: no known allergies / adverse drug reactions attending: chief complaint: fever, hypoxia major surgical or invasive procedure: central venous catheterization history of present illness: yo russian speaking male with schf (~ 36% on echo ), cad, critical as < 0.8 cm^2, copd on 2l nc (fev1 121% in ) presents from senior life with fever up to 103, tachycardia to 110s, and reported hypoxia down to 66% on ra. per report, patient was given tylenol 650 mg at 9pm and then brought in by ems for further evaluation. he was placed on nrb. upon arrival to the ed, vs 102.5 110 107/53 32 98% 10l nrb. apparently patient was oriented and denied any complaints, such as fever, chest pain, sob, any other pain. he was noted to be drowsy on exam. there was concern for pna although cxr was per report without obvious infiltrate. he was tried on non-invasives, but it did not improve his respiratory status, had poor seal, and in fact, patient constantly tried to take the mask off. he was given vancomycin and zosyn for presumed pneumonia. then, ua was found to be grossly positive. he was also noted to be hypotensive to sbp in the 70s. lij was placed and he received 1 l of ivf. upon transfer, vs 94 92/48 35 97% nrb on the floor, patient was awake. he denied any pain. he stated to the daughter over the phone that he was comfortable. review of systems: (+) per hpi (-) denies night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - critical as w/ valve area of < 0.8cm2 on echo ; followed by dr. - cad s/p mix2 in the distant past; last p-mibi in 04/. catheterization was deferred given chronic renal failure and potential risks. - schf, last ef 36% () - mild lvh - mild (1+) mitral regurgitation - mild (1+) aortic regurgitation - history of pe s/p hip surgery, with right atrial thrombus s/p right atrial thrombectomy in . he is also s/p ivc filter placement - hypertension - hyperlipidemia - peripheral vascular disease - type ii dm - osteoarthritis, s/p l hip arthroplasty in - chronic le edema - tremor - copd on home o2 - parkinsonism - h/o left proximal femoral periprosthetic intertrochanteric fracture social history: - patient was an aeronautical engineer in . - currently living at senior life. - tobacco use 100 pack years but quit several years ago - denies etoh, ivdu. family history: father with history of early sudden cardiac death. brother with stomach cancer. brother with disease. physical exam: admission exam vs 98.2, hr 84, bp 85/45, rr 22, o2sat 98% 50% standby general: comfortable, opens eyes to voice, no acute distress heent: sclera anicteric, mucous membrane moist, oropharynx clear neck: supple, jvd to the of the neck, no lad lung: + crackles up to of the lung on the left and slightly better on the right, no wheeze or rhonchi cv: rrr, + 4/6 sem, no rub or gallop abd: obese, soft, nt, nd, bs+ extremities: 2+ pitting edema up to the thighs, 2+ dp pulses r and 1+ dp on the l gu: + foley with sediments . discharge exam vs: 98.0, 69, 98/51, 26, 92% on 3l gen: nad heent: perrl, mmm, op clear neck: supple, jvp at mid neck heart: rrr, 4/6 sem with radiation to carotids lung: cta bl abd: soft, nt/nd, +bs ext: 1+ pitting edema to thigh, 1+ sacral edema pertinent results: admission labs cbc 10:35pm blood wbc-6.1 rbc-4.56* hgb-13.2* hct-39.4* mcv-86 mch-29.0 mchc-33.5 rdw-13.9 plt ct-158# 10:35pm blood neuts-92.3* lymphs-3.9* monos-1.3* eos-2.0 baso-0.4 10:35pm blood glucose-223* urean-33* creat-1.3* na-141 k-3.3 cl-105 hco3-24 angap-15 10:35pm blood pt-28.9* ptt-30.9 inr(pt)-2.8* . discharge labs 06:20am blood wbc-10.5 rbc-3.82* hgb-11.0* hct-32.9* mcv-86 mch-28.7 mchc-33.4 rdw-13.6 plt ct-333 06:20am blood pt-13.8* ptt-29.5 inr(pt)-1.3* 06:20am blood glucose-143* urean-24* creat-1.2 na-142 k-3.3 cl-99 hco3-36* angap-10 06:20am blood calcium-8.3* phos-3.8 mg-2.5 04:28pm blood glucose-118* urean-26* creat-1.2 na-136 k-3.9 cl-94* hco3-32 angap-14 . cardiac enzymes 10:35pm blood ck(cpk)-80 10:35pm blood ck-mb-5 ctropnt-0.12* probnp-2871* 05:20am blood ck-mb-13* mb indx-6.0 ctropnt-0.55* 02:51pm blood ck-mb-8 ctropnt-0.46* . lactate 10:43pm blood lactate-3.2* 05:41am blood lactate-2.6* . urine studies 11:25pm urine color-yellow appear-cloudy sp -1.012 11:25pm urine blood-lg nitrite-pos protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-lg 11:25pm urine rbc-155* wbc->182* bacteri-mod yeast-none epi-0 11:25pm urine wbc clm-many . microbiology legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. (reference range-negative). performed by immunochromogenic assay. a negative result does not rule out infection due to other l. pneumophila serogroups or other legionella species. furthermore, in infected patients the excretion of antigen in urine may vary. . urine - positive for pansensitive e.coli blood cx , x2, , all no growth mrsa screening pos sputum - commensal respiratory flora . cxr findings: single ap upright portable view of the chest was obtained. the patient is status post median sternotomy. there are low lung volumes. blunting of the right costophrenic angle may be due to a trace effusion. subtle bilateral patchy opacities may relate to infection versus mild volume overload. cardiac and mediastinal silhouettes are stable. no pneumothorax. . cxr in comparison with the study of , there is again enlargement of the cardiac silhouette with substantial pulmonary edema and bilateral pleural effusions with compressive atelectasis at the bases. . echo the left atrium is moderately dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is mild to moderate global left ventricular hypokinesis (lvef = 35-40%). right ventricular chamber size is normal with mild global free wall hypokinesis. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. . impression: dilated left ventricle with mild to moderate global systolic dysfunction. mild right ventricular systolic dysfunction. critical calcific aortic stenosis. mild aortic regurgitation. mild mitral regurgitation. brief hospital course: yo russian speaking male with critical aortic stenosis and systolic chf as well as copd on 2l o2 by nasal cannula at baseline presenting from senior life with rigors, fever to 103, tachycardia and hypoxia in the setting of uti. 1) acute on chronic systolic heart failure/chronic as: the patient has known critical as and is not an operative candidate due to age and recent comorbid conditions (percutaneous valve was considered at one time but likely not feasible at this time given multiple recent medical issues). on admission he was hypotensive, likely due to peripheral vasodilation in the context of sepsis and capillary leak. the patient was bolused and developed massive lower extremity edema and crackles over both lung fields with pulmonary edema seen on chest radiograph. he was diuresed successfully in the micu and later on the floor. he was initially treated with oral lasix and later with lasix gtt, which he tolerated well. however he remains fluid overloaded on exam with pitting edema up to his sacrum. he was already on 12mg of lasix and we added melolazone 2.5mg to his current regimen. he has responded well and has remained hemodynamically stable. his bp at baseline in the 90s-100s/50s which is thought to be due to his critical as. of note, the patient is not on beta blocker or acei due to low blood pressure. - cont on lasix drip at 12mg/hour (please titrate to uo >100cc/hour) as bp tolerates - monitor electrolytes and creatine while pt is on lasix drip (last checked this pm. he was given 20meq of kcl po). please keep k> 4 and mg >2 - i would switch back to oral lasix 40 mg (or higher depending on how pt responds) once sacral and thigh edema has improved - cont on metolazone 2.5mg as pt tolerates - he has appointment with cardiologist in early , but trying to schedule earlier appointment within 1-2 weeks 2) sepsis: on presentation patient noted to be hypotensive with sbp in the 70s and febrile in the ed with rigors and marked leukocytosis. pt had positive ua and urine culture positive for pansensitive e.coli. patient received vancomycin and piperacillin/tazobactam in the ed for presumed infection with pulmonary source (given marked hypoxia). on final read of initial chest radiograph and micu review pulmonary infection was felt less likely. he was then treated for an uti and antibiotic was switched to cipro which he had the last dose this evening. pt's bp improved to low 100s after three liters of iv fluid. septic physiology improved thereafter and patient remained afebrile and with falling wbc count. further minor hypotension (sbp's in 90's which is his baseline). he is currently hemodynamically stable. . 3) copd: the patient has a history of copd diagnosed in the . however, his pft in showed fev1/fvc at 121%. during much of his hospitalization, crackles and signs of volume overload predominated suggesting pulmonary edema, not copd exacerbation was the primary driver of his hypoxemia. he was treated with duoneb prn. . 4) arf: patient baseline creatinine is 0.9-1.0. this was elevated at 1.3 on admission but quickly improved and stabilized near 1.2. . 5) pneumonia: on presentation radiographs with no clear infiltrate and patient had no signs or symptoms of pneumonia so this was not thought a causative factor of his illness. pt had respiratory distress multiple times in the setting of volume overload. pneumonia was on the differential several times, and pt was empirically covered with levofloxacin and vanco/zosyn at times. however, his response to diuresis is consistent with pulmonary edema. pt remained afebrile and no leukocytosis and not on treatment for pneumonia at the time of discharge. . chronic issues # h/o cad/htn/hld: on admission patient had elevated trop ekg without significant changes felt to be reflective of demand ischemia. troponin was noted to trend downward. he was continued on his home paravastatin and aspirin. . # anticoagulation: patient was on warfarin at presentation. the indication was somewhat unclear. record, coumadin was started during his hip surgery in . he had remote history of dvt/pe in the setting of hip surgery. after patient left micu attending hospitalist discussed this with attending physician at life who was also unable to declare exact reason, simply reporting patient was on this medicine at transition to long term care. by records patient appears to have been started on recent period of anticoagulation in of this year for prophylaxis after he sustained a hip fracture. given patient remains largely immobile and has a history of venous thromboembolism with no history of bleeding complications it seems reasonable to continue anticoagulation for now with a low threshold to stop for problems. his current inr is 1.3 (he was supratherapeutic on sat and coumadin was held. he was also given one dose of vit k in the icu last week). continue to monitor inr and titrate as needed . # t2dm- he was continued on insulin sliding scale while admitted. . transitional issues # code status: dnr/dni (confirmed with daughter/hcp) # communication: patient, daughter home, cell # medication changes - start lasix gtt (see below for details) - start metalozone 2.5 mg - start aspirin 325 - start aggressive bowel regimen given critical aortic stenosis (colace 100 mg , senna qd prn, mom q6 prn, bisacodyl po/pr prn) # follow up plan - recommend lasix gtt as pt has sacral and le pitting edema, likely liter positive. will target liter negative as bp and renal function tolerates. will hold for sbp < 85 or dbp < 45 or evidence of poor perfusion (baseline bp 90s/50s) - please check lytes at least given aggressive diuresis - recommend insulin sliding scale - follow up appointment with dr. , md (phone: fax: ). currently scheduled on . will recommend arrange an earlier appointment. medications on admission: - warfarin 3 mg tues/thurs/sat - warfarin 2.5 mg sun/mon/wed/fri - warfarin 1 mg - pravastatin 10 mg - trazodone 100 mg qhs - aspirin 81 mg daily - cyanocobalamin 1000 mcg - kcl 20 meq - omeprazole 40 mg - miralax 17 g - furosemide 40 mg - furosemide 20 mg - ammonium lactate qhs discharge medications: 1. cyanocobalamin (vitamin b-12) 500 mcg tablet sig: two (2) tablet po daily (daily). 2. pravastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. warfarin 1 mg tablet sig: three (3) tablet po q16 on tue, thr, sat (). 4. warfarin 2.5 mg tablet sig: one (1) tablet po q16 on sun, mon, wed, fri (). 5. metolazone 2.5 mg tablet sig: one (1) tablet po bid (2 times a day). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. senna 8.6 mg tablet sig: one (1) tablet po daily (daily) as needed for constipation. 8. furosemide 10 mg/ml solution sig: titrate to neg liter fluid balance while pt still edematous as bp and kidney function tolerate injection infusion (continuous infusion): 5-15mg per hour- titrate to uo> 100cc/hour. hold or decrease rate for sbp<90 . 9. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation: please hold for diarrhea. 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily) as needed for constipation: please hold for loose bm/diarrhea. 11. insulin lispro 100 unit/ml solution sig: sliding scale subcutaneous asdir (as directed). 12. duoneb 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: one (1) neb treatment inhalation every hours as needed for shortness of breath or wheezing. 13. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 14. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 15. miralax 17 gram powder in packet sig: one (1) po once a day as needed for constipation: please hold for loose bm/diarrhea. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnoses: - uti with sepsis - critical as - acute on chronic chf secondary diagnoses: - parkinsonism - dm 2 - peripheral vascular disease 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: dear mr. , you were admitted at our hospital for urinary tract infection that caused low blood pressure in the context of your very tight valve in your heart. you were treated with antibiotics and fluid initially to support your blood pressure. this necessary treatment in the emergent setting on admission caused a lot of burden to your already weakened heart. you were then given iv medications to remove the fluid from your lungs. you improved significantly and are being discharged back to the facility where you lived previously. . please note that the following medication has changed: - please start to take aspirin 325 mg tablet by mouth daily - please start to take colace 100 mg tablet by mouth twice a day, please hold for loose stool - please start to take senna 8.6 mg tablet daily as needed for constipation - please start to take magnesium hydroxide suspension 30 cc every 6 hours as needed for constipation - please start to take bisacodyl 5 mg tablet, 2 tablets daily by mouth or through the rectum as needed for constipation - please start the furosemide iv drip titrate to daily fluid balance negative (currently at 12mg/hour) liter as your blood pressure tolerates until your sacral and thigh edema resolves. - start metolazone 2.5 mg po bid until this is further please hold for sbp < 85 - there are no further changes to your medication . you have an appointment with dr. on (see below for details), however we are trying to get you an appointment in the next 1-2 weeks. will help you take your medications and titrate these as needed. . it has been a great pleasure taking care of you here at . we wish you a speedy recovery. followup instructions: department: cardiac services when: monday at 11:20 am with: , md building: campus: east best parking: garage - we will try placing an appointment with dr. within the next 1-2 weeks. procedure: central venous catheter placement with guidance diagnoses: other primary cardiomyopathies anemia in chronic kidney disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortic valve disorders peripheral vascular disease, unspecified chronic kidney disease, unspecified other and unspecified hyperlipidemia paralysis agitans acute respiratory failure septic shock old myocardial infarction personal history of venous thrombosis and embolism do not resuscitate status acute on chronic systolic heart failure other and unspecified coagulation defects other dependence on machines, supplemental oxygen bacterial pneumonia, unspecified acute cystitis 

Answer: The patient is high likely exposed to