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: codeine attending: chief complaint: s/p vf arrest major surgical or invasive procedure: s/p cardiac cath with bms to lad; s/p iabp and swan ganz catheter placement and removal s/p cardiac cath with bms to left circ history of present illness: mr. is an 88 year-old male with a history of cad s/p pci to lcx , chf, moderate to severe aortic stenosis who was transferred from for catheterization with nstemi. according to records the patient presented from home complaining of "not feeling well" since last night. he had +cough productive of white sputum. he denied chest pain, abdominal pain and fever. he later complained of shortness of breath he was initially treated with iv diuresis and biomarkers were cycled. labs were significant for bnp 600, troponin 0.08>1.43>1.65>0.38, ck 225>195, ckmb 12.7>8.9. he also had a positive stress test. of note, he also had 7 beat run of vt at osh and atenolol was increased. . today during catheterization patient was noted to have tight 95-99% stenotic lesion just after the lcx stent. the pressure wire was placed in the lad and became totally occluded. patient had chest discomfort with st depressions on ecg and decrease in bp. at that time the patient became hypotensive and bradycardic. he received 2mg atropine and subsequently developed vf. cpr was initiated. he received multiple shocks (), amiodarone 300mg x 1 followed by 150mg x 1, epinephrine 2mg and lidocaine 100mg x1. he was also started on an amiodarone gtt at 2mg/min decreased to 1mg/min and a lidocaine gtt at 2mg/min. he was also intubated for airway protection. an iabp was inserted. the lad was reopened successfully and stented with a bare metal stent. an echocardiogram was also done in the cath lab which showed normal lv, ? small segment of anterior hypokinesis. a swan showed pcwp of 35 after the case (initially was 15). . on transfer to the ccu, the patient is intubated. he is off of the lidocaine gtt, continues on amiodarone at 1mg/min and is on dopamine 10mcg/min to maintain his maps. an intra-aortic balloon pump is in place in the right groin. . of note, at the patient was seen by gu for gross hematuria. this was felt attributable to traumatic catheter insertion. they recommended sending urine cytology and outpatient cystoscopy to rule out mass or obstruction. review of systems the patient denies any claudication-type symptoms, melena, rectal bleeding, or transient neurologic deficits. no change in weight or bowel habit. no cough, fever, night sweats, arthralgias, myalgias, headache or rash. all other review of systems negative. . past medical history: cad s/p des to om1 congestive heart failure, diastolic renal insufficiency hyperlipidemia iddm, type 2 s/p l carotid endarterectomy s/p turp aortic stenosis peripheral neuropathy hypertension gout . cardiac risk factors: dyslipidemia, hypertension, diabetes . cardiac history: cabg: no history of cabg . percutaneous coronary intervention in anatomy as follows: - 2 vessel cad, lmca with mild disease, lad with proximal 40% stenosis, lcx with 50% ostial stenosis and om1 was diffusely diseased with a focal stenosis of 80%. rca was totally occluded proximally. elevated right and left sided filling pressures with rvedp 21, lvedp 22 and pcwp 25. successful stenting of om1 with des. social history: mr. is widowed and has three children. he was born in went to college. was in the air force and in wwii. he worked for the government including , cpa and is now retired. he enjoys golf, charitable work, human services and photography. social history is significant for the absence of current tobacco use. pt quit smoking in . there is no history of alcohol abuse - he drinks 1 glass of wine daily. family history: father - ht dz mother - ht dz siblings - two one with ht dz physical exam: vs t 96.8, bp 158/44, hr 58-81, rr 11-22, o2sat 100% on ac 40% fio2 600x22 peep 5 gen: wdwn elderly male in nad. intubated, sedated heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: s/p l cea scar cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. mid to late peaking systolic murmur. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. clear anteriorly. no crackles, wheezes or rhonchi. abd: soft, nd. + bowel sounds. ext: 1+ edema bilaterally. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp dopp+ pt dopp+ left: carotid 2+ femoral 2+ popliteal 2+ dp dopp+ pt dopp+ pertinent results: admission labs 03:45pm blood wbc-17.4* rbc-3.86* hgb-11.8* hct-33.5* mcv-87 mch-30.6# mchc-35.2* rdw-15.0 plt ct-286 03:45pm blood pt-22.4* ptt-62.8* inr(pt)-2.1* 12:30pm blood glucose-371* urean-25* creat-1.4* na-139 k-3.0* cl-101 hco3-23 angap-18 12:30pm blood alt-148* ast-136* alkphos-70 amylase-75 totbili-0.4 03:45pm blood ck-mb-18* mb indx-5.5 ctropnt-0.46* 12:10pm blood glucose-287* lactate-8.2* na-137 k-4.1 cl-101 12:24pm blood lactate-7.5* na-131* k-2.9* cl-93* 04:02pm blood lactate-2.0 06:01pm blood lactate-1.6 06:10am blood caltibc-242* ferritn-211 trf-186* 12:30pm blood vitb12-763 03:45pm blood ck-mb-18* mb indx-5.5 ctropnt-0.46* 11:48pm blood ck-mb-82* mb indx-15.0* ctropnt-2.23* 05:47am blood ck-mb-75* mb indx-4.5 ctropnt-3.68* 04:00am blood ck-mb-30* mb indx-3.0 ctropnt-3.46* 08:33pm blood ck-mb-35* mb indx-4.1 ctropnt-3.39* 03:18am blood ck-mb-13* mb indx-3.3 ctropnt-3.94* 04:13am blood ck-mb-7 ctropnt-4.75* 04:48am blood glucose-173* urean-60* creat-3.0* na-140 k-3.8 cl-105 hco3-24 angap-15 06:10am blood glucose-202* urean-52* creat-2.2* na-136 k-4.2 cl-100 hco3-21* angap-19 06:10am blood pt-16.0* ptt-57.9* inr(pt)-1.4* 06:10am blood wbc-12.5* rbc-2.97* hgb-9.6* hct-26.5* mcv-89 mch-32.4* mchc-36.2* rdw-15.0 plt ct-244 discharge labs 139 102 57 93 agap=17 3.9 24 2.3 estgfr: 27/33 (click for details) ca: 8.6 mg: 2.4 p: 3.7 alt: 35 ap: 97 tbili: 0.8 alb: 3.4 ast: 32 ldh: 465 dbili: tprot: mcv 90 wbc16.7 hgb8.7 plt286 hct 24.9 3/3echo:suboptimal image quality. overall left ventricular systolic function is mildly depressed (lvef= 50 %) with probable mild anterior wall hypokinesis. the right ventricular cavity is mildly dilated with borderline normal free wall function. the aortic valve leaflets are mildly thickened. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , left ventricular systolic function is slightly less vigorous. the right ventricular function is borderline hypokinetic. the other findings are similar. cath comments: 1. coronary angiography in this right dominant system revealed three vessel coronary artery disease. the lmca had no angiographically apparent disease. the lad had a 50-70% lesion at d1; d1 was a moderately small vessel with diffuse disease. the lcx had 30% ostial and proximal lesions. the stent in the om was widely patent with 80% stenosis distal to the stent. the rca was known to be occluded and filled via lad collaterals. 2. resting hemodynamics revealed elevated left and right filling pressures with lvedp of 26 mmhg, mean pcw of 15 mmhg, and rvedp of 22 mmhg. there was moderate systolic pulmonary hypertension with pasp of 40 mmhg. there was normal systemic arterial central pressure of 138/55 mmhg. the cardiac index was preserved at 2.54 l/min/m2. 3. there was mild-moderate aortic stenosis with peak to peak gradient of 22 mmhg and an aortic valve area of 1.2 cm2. 4. successful ptca and stenting of the mid lad stenosis with a 2.5x18mm minivision stent. final angiogram revealed patent stent, no angiographically apparent dissection and timi iii flow (see ptca comments). 5. successful insertion of iabp through the right femoral arterial sheath. final diagnosis: 1. three vessel coronary artery disease. 2. normal ventricular function. 3. successful ptca and stenting of the lad. 4. successful placement of iabp. cath: comments: 1- selective angiography of this co-dominant system showed hree vessel disease. the lmca was calcified with a 30% distal lesion and nmild pressure dampening when deeply engaged. the lad had a proximal 40% at s1 followed by patent fresh stent. the jailed and previously lost calcified diagonal now had timi flow with an origin 80% stenosis. the mid-distal lad had mild diffuse disease and gave rise to septal collaterals to the rca. the lcx was heavily calcified with 40% ostial and 40% proximal (slightly hazy) followed by aneurysmal segment. the major om2 had 30% proximal before the prior cypher stent, followed by patent stent and distal 85% beyond the cypher spanning a small lower pole and leading to a bifurcation with a long tortuous lower pole and a long upper pole with an 80% stenosis. the av groove lcx was moderately and diffusely diseased just after the om2 with a larger caliber very distal av groove lcx, also giving collaterals to the distal rca. the high om1 was a small vessel with moderate proximal disease. the rca was known to be occluded and was not engaged. 2- limited resting hemodynamic assessmet revealed normal systemic arterial blood pressure (115/60 mmhg). 3- successful stenting of the a 2.5x13 mm cypher des in the om2 overlapping with and distal to the previously placed cypher stent. final angiography showed appropriate tapering of the prior and new stent without dissection or distal emboli. 4- paradoxical reaction to midazolam with marked agitation upon administration two (0.25 mg iv) . final diagnosis: 1. three vessel coronary artery disease. 2. successful placement of a cypher stent in the large om2 distal to and overlapping with the prior cypher stent. 3. asa and plavix (dual therapy) for a minimum of one year followed by uninterrupted asa for life. 4. three reanl adjusted of cefazolin for skin flora. 5. avoid benzodiazipines in future procedures as it was associated paradoxical agitation. cxr (): new small left effusion. retrocardiac opacity. subtle right basilar opacity. the findings may represent pneumonia or aspiration. noevidence of pulmonary edema. micro urine culture (final ): enterococcus sp.. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ <=2 s nitrofurantoin-------- <=16 s tetracycline---------- =>16 r vancomycin------------ <=1 s brief hospital course: patient is an 88 year old male with history of cad s/p stent to lcx (06), moderate to severe as and diastolic dysfunction who was transferred from for cath. catheterization was complicated by acute lad occlusion during attempt to pass pressure wire and resultant vf arrest. spontaneous circulation returned after multiple shocks, epinephrine, lidocaine and amiodarone. . #. cad: known history of cad s/p stent to lcx. cath on admission notable for stenosis distal to lcx stent. during evaluation of anatomy patient developed to of lad which is known to supply collaterals to occluded rca as well. this resulted in vf arrest requiring multiple shocks, amiodarone, lidocaine. a bms was able to be placed to the lad with resultant good flow. arrest is due to ischemia as clearly evidenced on catheterization to of lad. had stemi with peak cks 1674 and mbi 15. he was initially on iabp with heparin for full anticoagulation with pump and dopamine as needed to maintain map>55. he was intubated while balloon pump in. he also had a swan to monitor pa pressures. initially continued amiodarone gtt but discontinued due to bradycardia and obvious now reversed source of totally occluded lad. icu and hospital course complicated by delirium. patient had 1:1 sitter and sedation with fentanyl and haldol. once stabilized, he was taken back to cath lab and had placed in om2. he was continued on asa(lifelong), plavix for at least one year, and high dose statin. transitioned back onto oral metoprolol. . # s/p intubation: pt intubated in setting of vf arrest for airway protection with no acute hypoxic or hypercarbic event. confirmed tube placement with cxr. placed aline to follow abgs. extubated successfully on after weaned off ballon pump on . . #. pump: diastolic heart failure, aortic stenosis. echo was performed. initially with pcwp of 15, however after arrest pcwp elevated to 35. followed volume status with swan at first. swan d/ced and patient was relatively euvolemic. restarted beta blocker and ace inhibitor. . #. rhythm: currently in sinus rhythm s/p vf arrest. monitored on tele with no further events. . # renal insufficiency: creatinine 1.6 post arrest. trended up to 3.0. likely poor forward floow in setting of stemi. received precath hydration. trended down to 2.2 upon discharge. . # hypertension:once stabilized in icu, resumed home antihypertensive regimen including metoprolol and acei. . # uti: pt had leuocytosis so u/a and urine cx sent since he had foley in place and did not have any other signs or symptoms of infection. urine cx positive for >100k enterococcus sensitive to ampicillin and vanco. he will complete 7 day course of antibiotics for complicated uti. . # aspiration pna: had some sob and desat to 88%. cxr obtained and showed possible aspiration pna. he was started on a 10 day course of levofloxacin and metronidazole and his sats improved to 90s prior to discharge. . #delirium: developed in icu including anxiety/delirium after 2nd cath. improved with haldol and zyprexa. . # hyperlipidemia: continued statin. cholest 125 triglyc 90 hdl 40 chol/hd 3.1 ldlcalc 67. . #. diabetes mellitus: continued insulin as per home regimen. hgb a1c 7.4 . #. fen: cardiac diet #. code: full medications on admission: asa 325mg daily lipitor 80mg daily imdur 30mg daily pantoprazole 40mg daily atenolol 25 daily multivitamin daily spironolactone 25mg qod plavix 75mg daily januvia 100mg daily insulin 70/30 12u subq lasix 20mg dialy discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): take every day for one year, do not miss . 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. nitroglycerin 0.3 mg tablet, sublingual sig: tablet, sublinguals sublingual asdir (as directed). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 6. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 7. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 8. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 9. quetiapine 25 mg tablet sig: one (1) tablet po hs (at bedtime). 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) vial inhalation q6h (every 6 hours) as needed. 11. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 9 days: last dose 3/21. 12. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 9 days: last dose 3/21. 13. amoxicillin 250 mg capsule sig: two (2) capsule po q12h (every 12 hours) for 5 days. 14. insulin nph & regular human 100 unit/ml (70-30) cartridge sig: sixteen (16) units subcutaneous twice a day. 15. insulin regular human 300 unit/3 ml insulin pen sig: per sliding scale units subcutaneous four times a day. discharge disposition: extended care facility: - discharge diagnosis: coronary artery disease cardiogenic shock requiring intraaortic balloon pump acute on chronic diastolic congestive heart failure acute renal failure hypertension diabetes discharge condition: stable. discharge instructions: you had a heart attack and was trasferred from for a catheterization. during the catheterization, you had a dangerous rhythm that required multiple medicines and defibrillation to control. you had a bare metal stent to your left coronary artery. you will need to take plavix every day for at least one year and possibly longer. do not stop taking plavix unless dr. tells you to. you were put on a breathing machine and transferred to the ccu. your blood pressure and breathing improved and we were able to do another catheterization on where a drug eluting stent was placed in another artery. you became very confused after getting some medicine in the catheterization lab. this is slowly improving. . weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1500cc followup instructions: cardiology: provider: phone:( date/time: thursday at 2:45pm. , . . primary care: please make an appt to see your dr. after you get home from rehab. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters coronary arteriography using two catheters angiocardiography of left heart structures injection or infusion of platelet inhibitor left heart cardiac catheterization insertion of endotracheal tube arterial catheterization implant of pulsation balloon pulmonary artery wedge monitoring cardiopulmonary resuscitation, not otherwise specified insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel procedure on single vessel diagnoses: subendocardial infarction, initial episode of care anemia, unspecified coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified gout, unspecified acute on chronic diastolic heart failure aortic valve disorders paroxysmal ventricular tachycardia other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus cardiac arrest cardiogenic shock ventricular fibrillation streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] unspecified hereditary and idiopathic peripheral neuropathy chronic total occlusion of coronary artery 

Answer: The patient is high likely exposed to