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: patient recorded as having no known allergies to drugs attending: chief complaint: cardiac arrest major surgical or invasive procedure: cardioversion intubation history of present illness: the patient is a 76 year old male with a history of cad s/p cabg, htn, af, syncope s/p ppm who presents following out-of-hospital cardiac arrest. the patient has been noted to be slightly dysnpic over the last two days. he has not experienceid any chest pain, palpitations, light-headnedness, or any other symtpoms. on the day of presenation, the patient went out to do errands. he had spoken to his wife pulling into a wall-mart parking lot, and did not make any notable complaints. he was found down in the parking lot unresponsive. the event was unwitnessed. security was called, who placed an aed on the patient, and fired twice for a shockable rhythm. ems was activated. from being found down to confirmation of a purfusing rhythm, the estimated time down is roughly ten minutes. he was intubated in the field and transfered to . . while there, the patient was noted to be hemodynapically stable. a ct scan of the head and neck were performed, and reportadly normal. the patients wife says that at the patient was squeezing hands on command and was intially grabing at lines with purposeful movement of all for extremities. he was emergently transfered to for futher evaluation and care. . in the ed, the patient's hr was 72, bp 137/74, satting 100% on the ventillator. he was give iv versed for sedation. he was noted to have brb in the anal vault. the patient was transfered to the ccu for further care. . on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, or presyncope past medical history: 1. cardiac risk factors:: dyslipidemia, hypertension 2. cardiac history: -cabg: in by dr. coronary interventions: -pacing/icd: ppm placed in following syncopal event 3. other past medical history: . atrial fibrillation social history: married, former physical exam: vs: t=96 bp= 123/71 hr= 60 rr= 16 o2 sat= 100% ac tv 600/5/40% general: elderly male, intubated, sedated, unresponsive. in c-colllar. heent: ncat. perrl (3mm to 2mm), in c-collar. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. scar on left leg and arm. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ . neuro: absenct corneal reflex, down going babinski, no clonus, opens eyes to name calling pertinent results: labs on admission: . 09:00pm blood wbc-17.6* rbc-3.38* hgb-12.4* hct-34.7* mcv-103* mch-36.8* mchc-35.7* rdw-16.3* plt ct-152 01:54am blood wbc-13.4* rbc-3.44* hgb-12.2* hct-34.5* mcv-100* mch-35.4* mchc-35.3* rdw-16.9* plt ct-148* 09:00pm blood neuts-83.5* lymphs-12.1* monos-3.5 eos-0.3 baso-0.5 . 09:00pm blood pt-28.2* ptt-33.0 inr(pt)-2.8* . 09:00pm blood glucose-161* urean-28* creat-1.3* na-139 k-4.7 cl-105 hco3-20* angap-19 01:54am blood glucose-187* urean-28* creat-1.1 na-135 k-5.2* cl-105 hco3-19* angap-16 . 09:00pm blood alt-20 ast-27 ck(cpk)-83 alkphos-60 totbili-0.8 . 01:54am blood ck(cpk)-124 11:38am blood ck(cpk)-269* 09:00pm blood ck-mb-notdone ctropnt-0.27* 01:54am blood ck-mb-11* mb indx-8.9* ctropnt-0.34* 11:38am blood ck-mb-14* mb indx-5.2 ctropnt-0.17* . 09:00pm blood calcium-9.1 phos-3.0 mg-2.3 01:54am blood triglyc-113 hdl-30 chol/hd-3.4 ldlcalc-49 . 09:16pm blood type- temp-37.3 ph-7.26* 11:11pm blood type-art rates-/16 tidal v-600 peep-5 fio2-100 po2-408* pco2-34* ph-7.39 caltco2-21 base xs--3 aado2-278 req o2-53 -assist/con intubat-intubated 09:16pm blood glucose-152* lactate-4.2* na-141 k-4.8 cl-102 calhco3-21 . urine studies: . 09:00pm urine color-yellow appear-clear sp -1.017 09:00pm urine blood-lg nitrite-neg protein-tr glucose-neg ketone-15 bilirub-neg urobiln-neg ph-5.0 leuks-neg 09:00pm urine rbc-* wbc-0-2 bacteri-mod yeast-none epi-0-2 09:00pm urine castgr-0-2 casthy-* . studies/imaging: . cxr - findings: single ap chest radiograph without comparison shows et tube terminating 3.6 cm above the carina. the lungs are clear. the heart is moderately enlarged. the patient is status post median sternotomy and cabg. there is no pleural effusion or pneumothorax. ng-tube is in satisfactory position with tip in the stomach. leads of a right-sided pacemaker terminate in the right atrium and ventricle. surgical staple overlies the left upper abdomen. impression: moderate cardiomegaly without evidence of pneumonia or overt chf. . cta - impression: 1. no pulmonary embolism or thoracic aortic dissection. 2. small-to-moderate bibasilar consolidation with aspiration favored over pneumonia. 3. small amount of secretions surrounding the proximally visualized endotracheal tube. 4. dilated ascending thoracic aorta . echo : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. there is severe regional left ventricular systolic dysfunction with inferior, inferolateral and basal inferoseptal akinesis (likely rca territory). there is moerate to severe hypokinesis of the remaining segments (lvef = 15-20%). the right ventricular cavity is mildly dilated with borderline normal free wall function. the aortic root is moderately dilated at the sinus level. the ascending aorta is moderately dilated. the descending thoracic aorta is mildly dilated. there are three moderately thickened aortic leaflets, with poor excursion. two-dimensional imaging suggests significant aortic stenosis, but its severity cannot be reliably quantified given low lv stroke volume. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: severe regional and global left ventricular systolic dysfunction, suggestive of a global process (toxic, metabolic, etc.) on a background of prior inferior myocardial infarction. mild right ventricular systolic dysfunction. significant aortic stenosis. moderate tricuspid regurgitation. mild pulmonary hypertension. dilated thoracic aorta. . echo : . the left atrium is dilated. there is an inferobasal left ventricular aneurysm. there is severe regional left ventricular systolic dysfunction with akinesis of the inferior, inferolateral segments. the other segments are moderately hypokinetic. there is no left ventricular outflow obstruction at rest or with valsalva. the right ventricular cavity is mildly dilated with borderline normal free wall function. the aortic root is moderately dilated at the sinus level. the ascending aorta is moderately dilated. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are moderately thickened. significant aortic stenosis is present (not quantified as lv systolic function is significantly impaired). the mitral valve leaflets are mildly thickened. mild mitral regurgitation is seen. moderate tricuspid regurgitation is seen. the tricuspid regurgitation jet is eccentric and may be underestimated. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the inferior and inferolateral akinesis persists. the other segments have slightly better function. the other findings - aortic stenosis, mild mitral and at least moderate tricuspid regurgitation - are similar. brief hospital course: 76 y/o male w/ a hx of cad s/p cabg, syncope s/p ppm, af who presented with cardiac arrest, intubated and transferred to for further care. . # sepsis. sources included vap and line related infection. on , pt was found to be febrile with sbps below 90mmhg, and rr 20-30s. bcx from r femoral line placed on (no neck access due to neck collar) grew pseudomonas a. he remained hypotensive and required pressor support with dopamine and levophed. patient also had also developed bilateral opacities on cxr, thick and bloody secretions. his sputum and grew mssa and enterobactericae. ua and ucx were negative, there was no diarrhea. r femoral line was removed on . he was started on zosyn and vancomycin on and pt intially defervesced on this regimen, however next day became febrile again. tobramycin was added for initially unknown gnr coverage in sputum. once cx from sputum and perphery were finalized, abx regimen was changed to nafcicillin iv and ciprofloxacin for a total treatment length of 14 days. his dopamine was weaned on , while levophed was weaned on . pt. was successfully extubated on . he remained afebrile until discharge. since patient developed worsening renal failure on , which was felt to be consistent w/ ain, his nafcillin was changed to cefazolin iv. he has completed that course. he is still due to complete the 14 day course of cipro, and is currently on day 10 of 14. . # respiratory failure. pt. was intubated on transfer. most likely felt to be possible volume overload and vap (see above). he was initially afebrile and euvolemi on exam, but required volume resuscitation due to hypotension developed on hd#2. initial cxrs did not show vascular congestion or consolidation, however pt became febrile on and was found to have b/l lower lobe opacities. he was started on treatment for vap. abgs were consistent w/ mixed respiratory alkalosis and metabolic alkalosis, likely sepsis and possible cns injury. pao2/fio2 min was 214. by ph and co2 normlaized, cns status improved significantly and patient was successfully extubated. pt. continued to have mild wheezing on exam, treated w/ albuterol nebs prn. he has since been oxygenating well on room air, and has not required additional nebulizer treatments. . # coronaries: patient with history of cad, s/p cabg. no ischemic changes on ekg, although limited to interpret with v pacing. cks peaked at 269, mb at 15 w/ index 8.9 and normalized by hd#1. it was felt that ck elevations were due to fall and possible vf that lead to cardiac arrest. this event was not believed to be ischemic in nature. patient was continued on asa, beta-blocker and ace were held due to septic shock. ldl was 49 and hba1c was 6.2. patient was continued on simvastatin. low dose metoprolol was restarted on once bp tolerated. lisinopril was held due to worsening rf, but has since been restarted. . # pump. patient w/ known history of chf, systolic likely cad. last ef of 30-35% on echo as outpatient in . patient was noted to have ef of 15-20%, severe regional and global left ventricular systolic dysfunction on a background of prior inferior myocardial infarction (akinesis). mild right ventricular systolic dysfunction was also noted. pt had significant as, moderate tr and mild pah. as patient was volume resuscitated for septick shock, he became volume overloaded evident w/ peripheral edema and vascular congestion on cxr. as sepsis was controlled and patient was extubated, he was started on low dose lasix with moderate effect. on patient was started on spironolactone 25mg qd which was subsequently d/ced due to worsening renal failure. a repeat echo on showed mild improvement in ef 20-25%, new l inferobasal aneurysm, and inferior and infrelolateral akinesis persisting w/ prior findings. given akinesis of inferior wall and atrial fibrillation, patient was started on heparin gtt and transitioned to coumadin. patient will require follow up echo and cardiology appt in one month to assess for icd placment. he will have his repeat tte in weeks, and see dr. in clinic for evaluation of possible crt/d. . # rhythm: hx of chronic afib. ppm interrogations showed episodes of vt, followed vf prior to cardiac arrest. patient received 2 shocks from aed. throughout hospitalization patient was in atrial fibrillation w/ v-pacing 40 - 60% of the time. he was restarted on coumadin as well as started on amiodarone 400mg for cardioversion on to augment co w/ atrial kick. cardioversion with biphasic 200j and 300j was attempted with patient remaining in atrial fibrillation. the patient is being continued at amioderone 400mg daily, and will have a second attempt at cardioversion in weeks. he will also see dr. in clinic in weeks for icd placement versus crt/d. . # cardiac arrest. based on records, it appears he was in vf for up to 6 minutes and it is unclear how long patient remained w/o rhythm. during this time, he received two dccv but it is not entirely clear if he was receiving chest compressions as well. he was intubated in the field. pt was unresponsive on admission. no initial neurological exam off sedation was performed at osh. in pt had "absent corneal reflexes but opened eyes to name." ct head at osh was wnl. patient underwent 24 hours of cooling to 34c per artic sun cooling protocol. repeat at did not show ich or infarction. exam at 72h off sedation showed eyes opening to command, intact corneal and pupillary reflexes, spontaneous extermities movements and flexor withdrawal to pain, all consistent w/ ~ 50% meaningful neurological recovery. neurology team was consulted and followed patient throughout the stay. on patient was following simple commands, responding to yes/no questions with improving strength in all extremities. he was extubated on . his neurological status improved, orientation (a&ox3). patient with generalized weakness, but no focal deficit. given previous cardiac arrest and ef ~ 20-25% patient is to undergo a 1mo follow up echo with further evaluation for icd placement with dr. . . # htn. patient was hypotensive in shock during early stages of hospitalization. once shock resolved, patient was restarted on low dose bbk, ace, and spironolactone. . # bg management. pt initially w/ fs consistently > 200. no known history of diabetes, w/ hba1c of 6.2. he was maintained on tf while intubated. his bg was consistently elevated and he was on lantus and iss. his lantus had to be uptitrated to 18units daily. this regimen will be continued while in rehab, but should be switched to metformin in coordination with his pcp, . . # anemia. normocytic, hypoproliferative. hct on admission of 35, dropping to 22. hct on discharge was 25. this was felt to be due to combination of acd and dilutional effects from fluid administaration (at hct nadir, pt was 7.8l positive). fe studies were consistent w/ acd. haptoglobin was nl, as were tsh, b12 and folate. the patient was started on iron, folate, and pyridoxime supplementation. . # renal failure. baseline unknown. cr. on admission was 1.3 and fluctuated between 1.4 and 0.8 during cooling and sepsis. on cr increased to 1.6 with diuresis and aldactone and rose to maximum of 2.1. this was felt to be most likely pre-renal etiology and ain given feurea of 37% and wbc cast/eosinophilia on ua. patient's nafcillin was switched to cefazolin on . at time of discharge, cr was improved to 1.5. medications on admission: warfarin 2mg daily lisinorpil 20mg daily zocor 10mg daily hctz 25mg daily fishoil 1000mg tid discharge medications: 1. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 3. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 4. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. pyridoxine 50 mg tablet sig: one (1) tablet po daily (daily). 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 9. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm. 10. ciprofloxacin 250 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 4 days. 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily). 13. insulin glargine 100 unit/ml solution sig: eighteen (18) subcutaneous at bedtime. 14. insulin lispro 100 unit/ml solution sig: sliding scale subcutaneous qachs: see attached sliding scale. discharge disposition: extended care facility: - discharge diagnosis: primary: cardiac arrest, sepsis, pneumonia, acute renal failure secondary: coronary artery disease, heart failure, hypertension, hyperlipidemia, chronic atrial fibrillation discharge condition: hemodynamically stable, afebrile. discharge instructions: you were admitted to with cardiac arrest. to help treat this event, you required intubation and a cooling procedure to maintain your brain function. your course was complicated by sepsis (severe infection in your blood and other orgains). you required treatment with multiple intravenous antibiotics and medications to maintain your blood pressure. with these treatments your condition improved significantly. you were extubated and your mental functioning improved significantly. your course was also complicated by worsening heart failurek, kidney failure and atrial fibrillation (irregular heart rate in your atrium). you underwent a cardioversion procedure for atrial fibrillation which was unsuccessful. your heart failure and your kidney failure are much improved at time of discharge. you will need to complete a 14 day course of ciprofloxacin to treat your blood infection. you are being discharged to rehab. we will plan a second attempt at cardioversion in weeks, and you will see dr. in clinic for evaluation of an icd in weeks. your medication regimen was also changed significantly from the medications you were taking at home. please review the list provided below and take the medications as prescribed. it was felt that your cardiac arrest was likely due to a dangerous arrhythmia, vetricular fibrillation (irregular heart beat of your ventricle). for this reason, you will require a close follow up with your cardiologist and an additional evaluation for a defibrillator, once your heart failure is stable. should you experience worsening shortness of breath, chest pain, sweats, palpitations, cough, fevers, chills, nausea, or any other symptom concerning to you, please call the rehabilitation facility doctor or go to the nearest emergency room. please follow up with your appointments as listed below. followup instructions: please follow up with your pcp, and neurologist. you have a follow up with dr. on at 1:20pm in the building of the of on the . you will be contact to set up a second attempt at cardioversion and follow up echocardiogram planned for weeks. if you do not hear in week, please call and ask for jassen . you had requested a referral for a cardiologist. you could see , , phone: ( ext.3822 we would recommend follow up in the next 4 weeks. you should also follow up with your pcp, . , in weeks. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances atrial cardioversion transfusion of other serum artificial pacemaker rate check diagnoses: anemia, unspecified pneumonia due to other gram-negative bacteria acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified toxic encephalopathy unspecified essential hypertension hyposmolality and/or hyponatremia severe sepsis atrial fibrillation aortocoronary bypass status hypopotassemia paroxysmal ventricular tachycardia other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia acute respiratory failure anoxic brain damage septic shock methicillin susceptible pneumonia due to staphylococcus aureus pressure ulcer, lower back ventricular fibrillation cardiac pacemaker in situ surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation other and unspecified infection due to central venous catheter ventilator associated pneumonia other abnormal glucose mixed acid-base balance disorder pressure ulcer, stage ii acute on chronic combined systolic and diastolic heart failure septicemia due to pseudomonas aneurysm of heart (wall) 

Answer: The patient is high likely exposed to