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: history of present illness: mr. is an 85 year old man with a past medical history significant for hypertension, dyslipidemia, paroxysmal atrial fibrillation for the preceding one year, with a left ventricular ejection fraction of 40% to 45% in , who presented to on with a complaint of one month of progressive dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea plus a one day history of substernal/epigastric chest pressure. in the emergency room, the patient was found to be in atrial flutter with a ventricular rhythm in the 150s, blood pressure 128/94, respiratory rate 34 to 40 and an oxygen saturation of 95%, with an examination consistent with congestive heart failure. there was no improvement in his hemodynamic status, and evidence of worsening congestive heart failure despite initial treatment with intravenous diltiazem 70 mg, intravenous lopressor 40 mg and intravenous lasix 40 mg. dc cardioversion was attempted twice, with reversion to a nodal rhythm with a heart rate in the 40s and a blood pressure of 80 to 120/palpable. at that point, there was worsening hypoxia and cyanosis, and the patient was intubated. the intubation was traumatic and required multiple attempts before successful endotracheal placement was achieved. there was approximately a five minute period in which he was esophageally intubated with an sao2 dropping to the 60s. he remained hypotensive and bradycardiac and received atropine once before being started on a dopamine drip. the patient was initially admitted to the coronary care unit team for management of his congestive heart failure. he was then transferred one day later to the medical intensive care unit service with rising creatinine, rising liver function tests and concern for aspiration pneumonia. given his aspiration, bilateral infiltrates on a chest x-ray, hypoxia and poor pulmonary capillary wedge pressure, there was an initial concern that he was entering acute respiratory distress syndrome. however, he did not have difficulty with ventilation or oxygenation and was quickly weaned down on his fio2, eventually being weaned from the ventilator by . the patient had elevated troponin levels post cardioversion, with slightly elevated ck and a peak ck/mb of 10. it was unclear whether he had actually suffered a myocardial infarction in the setting of his presentation. a transthoracic echocardiogram at this point showed depressed left ventricular systolic function and his major cardiac issues in this admission to the medical intensive care unit were rate control and rhythm. shortly after his admission to the medical intensive care unit, the patient reverted to rapid atrial fibrillation and was controlled with nodal ablations. he required frequent intravenous lopressor boluses to control his heart rate and was started on a diltiazem drip. his blood pressure was controlled with a neo-synephrine drip for approximately three days following admission to the medical intensive care unit. the patient's creatinine peaked at 2.7 and began to trend down to baseline within the next five days and he had good urine output. he was started on levofloxacin and flagyl for concern for aspiration pneumonia. his transaminases peaked in the 5,000 to 7,000 range following his episode of hypotension and then continued to decline. this was presumed to be secondary to the effects of a shocked liver. the patient's neurological status was depressed during his medical intensive care unit stay, presumed to be secondary to an undetermined period of hypoxia during his initial presentation as well as large doses of ativan and fentanyl for sedation while he was intubated. his mental status was improving throughout his medical intensive care unit stay. on , the patient was transferred to the floor, where he stayed briefly, however, he had persistent agitation, requiring a one-to-one sitter and a significant amount of haldol. he failed a swallowing evaluation and, over the course of the day, was noted to be more lethargic with more labored breathing over the course of the day. his examination was notable for the development of decreased breath sounds and crackles at the left base. he was also found to have a rising temperature to 100.9 and laboratory data remarkable for a rising white blood cell count. arterial blood gases were remarkable for a rising co2. the patient was treated with intravenous lasix and placed on a nasal cannula. anesthesia was called to intubate the patient secondary to pending respiratory failure, and the patient was transferred to the medical intensive care unit, where he was placed on bipap. he did well in the unit and self extubated two days later. on a percutaneous endoscopic gastrostomy feeding tube was placed due to the patient's inability to swallow without aspiration. he was restarted on a diltiazem drip for heart rate control. he was weaned off all pressors and sedatives, extubated, and sent to the floor once again. medications: on arrival to the floor, the patient was taking protonix 40 mg per g-tube daily, saline nasal spray, promod fiber tube feeds, intravenous flagyl 500 mg every eight hours, diltiazem drip, prednisolone eye drops 1% one drop both eyes at bedtime, digoxin 0.25 mg per g-tube, intravenous ceftriaxone 1 gram every 24 hours, and heparin drip. allergies: the patient has no known drug allergies. physical examination: on physical examination, the patient had a temperature of 98.8, heart rate 93 to 102, blood pressure 104 to 133/43 to 77, respiratory rate 11 to 27 and oxygen saturation 99% on three liters nasal cannula. head, eyes, ears, nose and throat: anicteric sclerae, pupils equal, round, and reactive to light, extraocular movements intact, moist mucous membranes, no oral lesions. neck: supple, no lymphadenopathy, jugular venous distention more or less 8 cm. lungs: thin bibasilar crackles. cardiovascular: irregularly irregular rhythm, s1 and s2 normal, ii/vi systolic ejection murmur at apex. abdomen: soft, nontender, mildly distended, positive bowel sounds in all four quadrants, no rebound or guarding, percutaneous endoscopic gastrostomy tube in place. extremities: poor distal pulses, no cyanosis, clubbing or edema. laboratory data: white blood cell count 7.2, hematocrit 32.3, platelet count 238,000, prothrombin time 13.3, inr 1.2, partial thromboplastin time 60.8, sodium 144, potassium 3.5, chloride 108, bicarbonate 31, bun 16, creatinine 0.6, glucose 106, calcium 7.7, magnesium 2.1 and phosphorous 2.8. radiologic data: chest x-ray showed no cardiomegaly, pulmonary vasculature normal, persistent opacification of the retrocardiac space which was stable in appearance but most likely represented atelectasis versus pneumonia. echocardiogram from showed mildly dilated left atrium, mild symmetric left ventricular hypertrophy with overall severe depression of left ventricular systolic function and severe global left ventricular hypokinesis, mild aortic insufficiency, mild mitral regurgitation, no significant change from prior study of . hospital course: after transfer to the floor for the second time, mr. did extremely well. 1. cardiovascular: initially, the patient's atrial fibrillation with a rapid rate was difficult to control. his diltiazem was increased to 90 mg three times a day, with control of his heart rate into the 100s and blood pressure ranging around 150/70. cardiology was consulted regarding rate control and they felt he would benefit from an atrial ablation with pacemaker placement. this procedure was performed on without complications. a dual chamber pacemaker was placed. after ablation, the patient's rate was well controlled in the low 80s. he was continued on diltiazem and amiodarone. his beta blocker was restarted, which he tolerated well. in general, his cardiac status was stable and he required no further additional rate control agents. 2. pulmonary: the patient was continued on levofloxacin and flagyl for presumed aspiration pneumonia. his oxygen saturation remained good, in the 98% range initially on two to three liters of oxygen, which he was weaned off of throughout the course of his stay. it was felt that congestive heart failure continued to contribute somewhat to his pulmonary picture and he was restarted on a small dose of lasix, with good effect. 3. neurology: the patient's neurological status slowly resolved over the course of his stay, with increasing alertness, interaction and orientation. his speech remained somewhat dysarthric and he failed a subsequent swallowing study. at the time of dictation, he is still steadily improving from day to day and it is hoped that he will eventually make significant recovery. however, he will require rehabilitation for his neurological issues. 4. gastrointestinal: the patient remained on tube feeds via his gastrostomy tube, which he tolerated well at 100 cc/hour, with occasional boluses of free water. he will require follow-up from speech and swallow in the future to re-evaluate and see if he can begin to take oral supplements and food. 5. rehabilitation: the patient will require a rehabilitation stay. he was seen by both physical therapy and occupational therapy, who felt that he would benefit significantly from rehabilitation therapy from both aspects, given his current inability to care for himself as well as his severely deconditioned status from a one month hospital stay. as of the date of dictation, the current plan is for the patient to be discharged shortly to a rehabilitation hospital to receive the above mentioned care. he is stable from a medical standpoint and doing well, and his neurological issues are continuing to resolve. this dictation will be followed by an addendum detailing his further course as well as his discharge destination status and medications. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances excision or destruction of other lesion or tissue of heart, endovascular approach initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle percutaneous [endoscopic] gastrostomy [peg] insertion of temporary transvenous pacemaker system pulmonary artery wedge monitoring diagnoses: subendocardial infarction, initial episode of care acute and subacute necrosis of liver acute kidney failure, unspecified atrial fibrillation rheumatic heart failure (congestive) acute respiratory failure pneumonitis due to inhalation of food or vomitus anoxic brain damage other and unspecified coagulation defects 

Answer: The patient is high likely exposed to