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: celebrex / glucotrol xl attending: chief complaint: tachycardia major surgical or invasive procedure: tkr history of present illness: the patient is a 78 y.o. male with dm, htn, dyslipidemia, djd, atrial fibrillation who was admitted for total knee replacement surgery which he underwent on . his post op course was c/b hypotension for which he was placed on neosynepherine gtt. he was weaned off with fluid boluses and was transfused 1 u prbcs. he then developed atrial fibrillation with rvr with rates =150. he was asymptomatic. he was given 150 mg iv amiodarone along with 100 mg po amidarone- his home dose. his atrial fibrillation remained poorly controlled and thus he was transferred to medicine for further management. past medical history: 1. atrial fibrillation 2. diabetes type 2 3. coronary artery disease 4. htn 5. dyslipidemia 6. degenerative joint disease 7. chronic renal insufficiency social history: positive tobacco history, no significant alcohol use. us veteran family history: noncontributory physical exam: vs tm=100.9, tc = 99.7, bp = 100-120s/40s, p 69-140s rr 18 o2sat 93% on 3l i/o = 3660/1402 and 5425/1465 thus approx 5l positive general: elderly male laying in bed. nad he has a productive cough heent: nc/at, perrl, eomi without nystagmus, no scleral icterus noted, mmm, no lesions noted in op neck: supple, no jvd or carotid bruits appreciated pulmonary: bibasiar crackles with soft wheezes diffusely cardiac: tachy irreg, irreg, nl. s1s2, abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no c/c/e bilaterally, 2+ radial, dp and pt pulses b/l. neurologic: -mental status: alert, oriented x 1. , nixon president. obeys commands pertinent results: studies/imaging: ecg: afib at 140 . cxr: small left pleural effusion and adjacent atelectasis developed yesterday, are stable. upper lungs are clear. mild cardiomegaly is unchanged. pleural thickening extending from the right costal pleural surface into the minor fissure has been present without change since , of no active clinical significance. tip of the right central venous line projects over the svc. no pneumothorax, mediastinal widening or right pleural effusion. . stress: 6 mins on modified - test stopped due to fatigue. no anginal sx lvef = 59% and no ischemia identified. . echo: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 60%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but not stenotic. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is no pericardial effusion. . pfts : mild restrictive defect . brief hospital course: 78 y.o. m with dm, htn, atrial fibrillation/atrial flutter s/p l tkr whose post op course was complicated by hypotension requring neo, low grade fevers, cough and atrial fibrillation with rapid response. . 1. cv: a. rhythm: the pt has known atrial fibrillation and developed rapid ventricular response post op. the etiology of the rapid ventricular response was initinally unclear, however the ddx included chf, copd flare, pna, pe, or stress secondary to post op. lenis were negative for dvt, and the cxr was more consistent with pulm edema rather than pna. he was therefore treated symptomatically for his atrial fibrillation and was also diursed aggressively with lasix to remove the source of stimulation. he was loaded on amiodarone iv but also required additional nodal agents including beta blockers and a diltiazem drip for adequate control of his rate. he was subsequently weaned off diltiazem and the amiodarone was decreased to a maintenance dose and he converted to nsr. in addition, he was also started on coumadin anticoagulation as well for dual benefit of atrial fibrillation and tkr ppx. at time of discharge, his medication regimen for atrial fibrillation consisted of amiodarone 200mg once daily as well as metoprolol 25mg and coumadin 3mg qhs. the pt should follow up with his private cardiologist dr. in re: to his atrial fibrillation. of note, he was admitted on plendil, hctz, bb, acei and amiodraone however the plendil, bb and hctz was discontinued in favor of other antihypertensives with nodal action as above. acei was continued but at a reduced dose for additional cad benefit. . b. ischemia: although unlikely, ischemia could not be ruled out as a cause of rapid ventricular response. he was therefore ruled out with enzymes x3. in addition, ecgs were without acute st or t wave changes. he was continued on asa, the lisinopril dose was decreased as above (from 40 to 2.5mg) to allow for more room for rate control. please try to wean down the nitro paste to off and continue to titrate up the acei dose as tolerated as an outpt once his amiodarone dose is stabilized. the statin dose was increased based on lipid panel obtained during the admission. the pt was discharged on simvastatin 40mg qhs. . c. pump: the pt was clinically in overt chf with pulm edema visible on cxr as well as physical exam and le edema with elevated jvp. the pt was rate controlled as above and also was started on afterload reduction with acei and he was diuresed with lasix iv. he was given 40mg iv lasix with good response. as an outpt, he should be continued on 80mg po lasix (the po equivalent to iv lasix) with close monitoring of his kidney function. he should have daily weight and strict ins and outs measured to verify appropriate diuresis (with goal of neg 500cc/day) without compromise of kidney function as verified by routine labs (chem7) drawn atleast twice a week. . 2. tkr: the pt underwent a tkr by dr. on . he should be on weightbearing as tolerated on the left leg. continue to use the cpm (continuous passive motion) machine to improve the range of your knee - 0 to 90 degrees. he should continue the keflex for two weeks post discharge, this should subsequently be followed up by dr. as an outpt after the appointment. in re: to wound care, please keep incision clean and dry. apply a dry sterile dressing to the wound each day while it is draining. once draning has stopped, you can leave the wound open to the air. you may begin showering with a waterproof dressing over the wound after being discharged from the hospital. you can shower normally (no bandage) starting one week after surgery (as long as there is no drainage from the wound. if the wound is draining, wait 24 hours after it has stopped before showering) - pat the incision dry with a towel, do not rub the incision. do not take a bath, swim or otherwise submerge your incision in water. monitor the wound daily for signs of infection including redness around the incision that is warm to the touch, pus-like drainage from the wounds, fever/chills, temp>101.5, or any other symptoms that concern you. notify dr. if you have any concern for possible infection. . 3. id: the pt also complained of a productive cough, with low grade temps and wheezing which was concerning for pna/bronchitis vs. copd exacerbation (given known h/o tobacco use). another consideration was also chf from massive fluid resuscitation during ticu stay post op. the pt was monitored closely for other signs of infection (chills, rigors, wbc count, bacteremia). blood cultures were ngtd, sputum cultures were ngtd and ua was also unrevealed. he was therefore treated empirically for copd exacerbation and chf. the chf was treated as above, while his copd was managed with the addition of flovent and standing nebulizer treatments of atrovent and albuterol. the pt continued to have some wheezing throughout the remainder of the hospital course but his respiratory status remained stable and he was without any evidence of infection. he was only maintained on post op cephlexin as per orthopaedic service. . 4. dm: the pt was admitted on oral hypoglycemics, however given the multitude of complications, the pt was taken off his oral hypoglycemics and started on lantus 10units qhs. pioglitazone was added back to his regimen later for additional cad ppx. however given the decompensated chf, the pt was not started back on sulfonylureas for risk of hypoglycemia. the pt may be able to be started back on glyburide 1.25mg daily once his chf is compensated as an outpt. . 5. mental status: the pt was delerious post op. this was thought to be due to narcotics and post op pain. infection was ruled out as above. this has resolved by the time of transfer to medicine. . 6. pain: the pt was continued on oxycodone and acetominophen rtc as per ortho for pain. . 7. prophylaxis: the pt was initially given iv heparin but was transitioned to coumadin as above, ppi was contineud for gi ppx and he was continued on a bowel regimen. . 8. fen: diabetic p.o. diet as tolerated . 9. code: full. . the discharge summary was completed by dr. on the day of discharge. medications on admission: admission medications: actos 45 mg daily amiodarone 100 mg aspirin 81 mg daily plendil 10 mg daily glyburide1.25 mg daily hydrochlorothiazide 12.5 mg qd, lisinopril 40 mg qd metoprolol 50 mg , zocor 40 mg daily sulfasalazine 500 mg . . medications on transfer: 1. 1000 ml ns bolus 1000 ml 2. heparin 5000 unit sc tid order date: @ 1403 3. hydrochlorothiazide 25 mg po daily 4. insulin sc (per insulin flowsheet) 5. ipratropium bromide neb 1 neb ih q6h:prn 6. acetaminophen 1000 mg po tid 7. lisinopril 40 mg po daily 8. albuterol 0.083% neb soln 1 neb ih q6h:prn 9. amiodarone hcl 200 mg po daily 10. metoprolol 50 mg po bid 11. amiodarone hcl 150 mg iv once 12. milk of magnesia 30 ml po q6h:prn constipation 13. aspirin 81 mg po daily start: 14. oxycodone 5 mg po q4-6h:prn 15. calcium carbonate 500 mg po daily 16. pantoprazole 40 mg po q24h 17. calcium gluconate 2 gm / 100 ml d5w iv prn ca<115 18. docusate sodium 100 mg po tid 19. felodipine 10 mg po pm 20. simvastatin 40 mg po daily order date: @ 1139 21. flunisolide inhaler *nf* 250 mcg/actuation inhalation qd 1 spray each nostril qd * patient taking own meds * 22. sulfasalazine 500 mg po daily order date: @ 0555 23. furosemide 40 mg iv once duration: 1 doses 24. zolpidem tartrate 5 mg po hs:prn order date: @ 2137 25. glyburide 2.5 mg po daily order date: @ 1314 discharge medications: 1. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). 2. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day). 3. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 4. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed. 5. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day). 6. dolasetron 12.5 mg/0.625 ml solution sig: 12.5 mg intravenous q8h (every 8 hours) as needed. 7. acetaminophen 500 mg tablet sig: two (2) tablet po qid (4 times a day). 8. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. ipratropium bromide 0.02 % solution sig: two (2) inhalation q6h (every 6 hours). 12. albuterol sulfate 0.083 % solution sig: two (2) inhalation q4h (every 4 hours) as needed. 13. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 14. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 15. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 16. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 17. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 18. warfarin 1 mg tablet sig: three (3) tablet po hs (at bedtime). 19. lasix 80 mg tablet sig: one (1) tablet po once a day. 20. pioglitazone 45 mg tablet sig: one (1) tablet po daily (daily). 21. insulin glargine 100 unit/ml solution sig: ten (10) units subcutaneous at bedtime. disp:*20 ml* refills:*2* 22. sulfasalazine 500 mg tablet sig: one (1) tablet po daily (daily). 23. cephalexin 250 mg capsule sig: one (1) capsule po q12h (every 12 hours) for 14 days. 24. nitroglycerin 2 % ointment sig: 0.5 transdermal q6h (every 6 hours): please titrate down as tolerated. discharge disposition: extended care facility: - discharge diagnosis: 1. tkr 2. atrial fibrillation with rapid ventricular response 3. pulmonary edema 4. diabetes discharge condition: good discharge instructions: please follow up with your doctors. please take all of your medications as instructed. several changes in your medications have been made after discussion with your other doctors. please weigh yourself daily. if you notice an increase in body weight of more than 3lbs, please call your pcp as this may indicate a need to change your lasix (furosemide) dosage. please have the rehab facility check routine labs (chem7) to evaluate your kidney function. please also have the rehab facility check your inr to adjust your coumadin dose as necessary. activity: weightbearing as tolerated on the left leg. continue to use the cpm (continuous passive motion) machine to improve the range of your knee - 0 to 90 degrees. wound care: please keep incision clean and dry. apply a dry sterile dressing to the wound each day while it is draining. once draning has stopped, you can leave the wound open to the air. you may begin showering with a waterproof dressing over the wound after being discharged from the hospital. you can shower normally (no bandage) starting one week after surgery (as long as there is no drainage from the wound. if the wound is draining, wait 24 hours after it has stopped before showering) - pat the incision dry with a towel, do not rub the incision. do not take a bath, swim or otherwise submerge your incision in water. monitor the wound daily for signs of infection including redness around the incision that is warm to the touch, pus-like drainage from the wounds, fever/chills, temp>101.5, or any other symptoms that concern you. notify dr. if you have any concern for possible infection. followup instructions: please follow up with your pcp within two weeks of discharge. although you already have an appointment with dr. in the end of , please schedule an earlier appointment to verify satisfactory progress as well. you can reach her office at . provider: , phone: date/time: 9:30 provider: , medicine (private) date/time: 9:00 provider: , md phone: date/time: 10:00 md procedure: transfusion of packed cells total knee replacement diagnoses: other iatrogenic hypotension anemia, unspecified pure hypercholesterolemia unspecified pleural effusion congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation pulmonary collapse hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease accidents occurring in other specified places surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation osteoarthrosis, localized, not specified whether primary or secondary, lower leg 

Answer: The patient is high likely exposed to