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: penicillins / horse blood extract attending: chief complaint: dka major surgical or invasive procedure: central line history of present illness: mr. is a 79 y/o male with a history of dm1 on an insulin pump (last a1c 8.1), hypertension and glaucoma who presented with elevated blood sugars and altered mental status from nursing home (). patient also described abd pain as well. patient was found to be "glazed over" and blood sugar was found to be critically high. per nursing home, patient is very independent and takes care of many of his own adls, including taking his own medications. of note, patient had insulin pump malfunction on where he filled up reservoir w/ 100 units novolog and when restarting pump it accidentally discharged all 100 units insulin into the pt. patient was taken to ed and treated, bgs stabilized in 90's by evening over 2 hrs. not clear what happened w/ pump and pump may be malfunctioning, c/s, advised pt to contact pump company asap to get replacement. in the meantime, pt was to take 6 units lantus (given in ed eve of ) and cover meals as usual w/ novolog sq until he has a properly functioning pump. nursing home unaware of pump/lantus situation given that patient is so independent. . in the ed initial vitals were 96.1 101 138/121 25 100%ra. an hour later, patient became hypotensive to 95/46. patient's bs was 743 and started on insulin gtt, given kcl, normal saline (6l). patient's sbp remained in the 90s and a r ij was placed, patient started on levofed at 0.03 to maintain map >60. dka was thought to be perhaps due to infection and patient was pan cultured. vanc, levo, & flagyl were started, as patient has pcn allergy. cxr was obtained which showed bilat opacities c/w pna. an abd ct was performed as well as patient was complaining of abd pain, but was essentially negative, did show inguinal hernia. patient's cardiac enzymes were checked as well and were found to be elevated at 0.83. ekg revealed sinus tachy @100 with normal axis, normal intervals, new st depressions in lat leads. cardiology consulted, patient started on heparin gtt but thought due to demand. a bedside echo was performed, found to have good systolic function. patient was also given calcium gluconate, ativan & morphine x1, at some point as well. prior to transfer, vitals were 96.6 82 116/53 40 93%3l nc. . upon arrival to the icu, patient was arousable but somnolent. unclear if sedation due to medications given in ed or if this was how nursing home found patient. rpt ekg showed resolution of lateral st depression but new twi in v3 but rpt enzymes show trop elevation to 2.97 with mb 80s and mbi 6.6. cardiology was called, will come to eval patient & perform stat echo. patient satting at 90% on 2l but found to be mouth breather, placed on face mask fio2 40% --> sats 97%. he brought up frequent secretions and a sample was collected, appeared brown and bloody. review of systems as above, otherwise negative. . past medical history: 1. hypertension. 2. type i diabetes on an insulin pump 3. glaucoma. 4. history of a colon adenocarcinoma, resected. social history: patient lives in nursing home (), very independent. he quit tobacco 38 years ago. he is a retired computer scientist. family history: father had a question of coronary artery disease and had a pacemaker and died at the age of 81. his mother died of ca, unknown. physical exam: admission: vitals: t: 97.9 ??????f bp: 102/56 p:79 r:22 o2:97% on 2l nc and fm @40% general: somnelent, arousable, unable to really answer questions heent: sclera anicteric, dry mm neck: supple, no lad, jvd lungs: rhonchi/crackles diffusely cv: rrr, +s1, s2, no murmurs, rubs, gallops abdomen: soft, nt/nd, bs present, no r/r/g gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . pertinent results: 03:46am blood wbc-13.6* rbc-3.56* hgb-11.9* hct-33.6* mcv-95 mch-33.5* mchc-35.4* rdw-13.9 plt ct-168 11:55am blood wbc-16.7*# rbc-2.98*# hgb-10.1*# hct-32.0* mcv-107*# mch-33.9* mchc-31.6 rdw-14.5 plt ct-186 11:55am blood neuts-86.4* lymphs-9.5* monos-3.1 eos-0.7 baso-0.2 03:46am blood neuts-89.7* lymphs-7.2* monos-2.8 eos-0.3 baso-0 03:46am blood plt ct-168 11:55am blood pt-14.1* ptt-30.1 inr(pt)-1.2* 05:25pm blood na-140 k-3.4 cl-105 03:51pm blood glucose-276* urean-27* creat-1.2 na-136 k-6.5* cl-102 hco3-22 angap-19 03:46am blood glucose-72 urean-24* creat-1.1 na-140 k-2.9* cl-104 hco3-23 angap-16 11:55am blood glucose-743* urean-52* creat-2.1* na-136 k-5.3* cl-104 hco3-7* angap-30* 08:30pm blood ck(cpk)-1318* 03:46am blood ck(cpk)-950* 03:46am blood ck-mb-13* mb indx-1.4 ctropnt-1.82* 03:46am blood calcium-8.2* phos-2.0* mg-1.9 03:46am blood vitb12-1250* folate-5.8 03:49am blood %hba1c-7.7* eag-174* echo: : , s portable tte (focused views) done at 11:06:13 am final referring physician information , pulmonary, critical care & , e/ks-b23 , status: inpatient dob: age (years): 79 m hgt (in): bp (mm hg): 129/58 wgt (lb): hr (bpm): 90 bsa (m2): indication: assess lv function icd-9 codes: 410.91, 402.90, 424.1, 424.0, 424.2 test information date/time: at 11:06 interpret md: , md test type: portable tte (focused views) son: dreiding, rdcs doppler: limited doppler and color doppler test location: east micu contrast: none tech quality: adequate tape #: 2011e000-0:00 machine: vivid i-1 echocardiographic measurements results measurements normal range left ventricle - ejection fraction: 45% to 50% >= 55% aorta - ascending: *3.8 cm <= 3.4 cm tr gradient (+ ra = pasp): *26 mm hg <= 25 mm hg findings this study was compared to the prior study of . left atrium: dilated la. right atrium/interatrial septum: dilated ra. left ventricle: mild regional lv systolic dysfunction. no resting lvot gradient. right ventricle: moderately dilated rv cavity. mild global rv free wall hypokinesis. aorta: mildly dilated ascending aorta. aortic valve: normal aortic valve leaflets (3). no as. no ar. no ar. mitral valve: mildly thickened mitral valve leaflets. mild (1+) mr. tricuspid valve: mild pa systolic hypertension. pericardium: no pericardial effusion. general comments: suboptimal image quality - poor echo windows. suboptimal image quality - body habitus. conclusions the left atrium is dilated. the right atrium is dilated. there is mild regional left ventricular systolic dysfunction with mild septal hypokinesis. the remaining segments contract normally (lvef = 45-50%). the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild regional left ventricular systolic dysfunction, c/w cad. dilated right ventricle with mild systolic dysfunction. compared with the prior study (images reviewed) of , the findings are similar. . bilat lower ext veins study date of 10:49 am impression: no evidence of dvt in the bilateral lower extremities. the study and the report were reviewed by the staff radiologist. . head ct -impression: chronic microvascular ischemic disease. otherwise unremarkable. . :ct abd/pelvis impression: 1. no evidence for mesenteric ischemia. 2. bilateral lower lobe consolidations, left more than right, consistent with multifocal pneumonia. 3. small amount of ascites and gallbladder wall edema, consistent with third spacing, possibly related to vigorous fluid resuscitation. 4. multiple calcified granulomas in the liver and spleen. 5. left inguinal hernia containing ascites. 6. air overlying the left groin, likely related to attempted line placement. please correlate clinically. . cxr-indings: there is worsening right pulmonary edema. consolidations in thelower lobes bilaterally, left greater than right, and in the hila bilaterally,also left greater than right, have increased. pleural effusions are more conspicuous than before. the cardiac size is top normal. there are low lung volumes. right ij catheter tip is in the mid to lower svc. there is no evidence of pneumothorax. . 06:45am blood wbc-11.4* rbc-3.44* hgb-11.2* hct-33.9* mcv-99* mch-32.7* mchc-33.1 rdw-14.0 plt ct-555* 06:40am blood wbc-8.9 rbc-3.40* hgb-11.1* hct-33.6* mcv-99* mch-32.8* mchc-33.1 rdw-13.9 plt ct-620* 06:40am blood glucose-276* urean-21* creat-0.7 na-131* k-4.8 cl-100 hco3-24 angap-12 03:49am blood ck-mb-114* ctropnt-5.21* 10:18am blood ck-mb-112* ctropnt-3.97* 11:05pm blood ck-mb-55* mb indx-4.4 ctropnt-2.72* 03:46am blood ck-mb-43* ctropnt-2.47* 03:46am blood ck-mb-13* mb indx-1.4 ctropnt-1.82* 03:49am blood %hba1c-7.7* eag-174* 06:20pm urine color-yellow appear-hazy sp -1.022 06:20pm urine blood-tr nitrite-neg protein-100 glucose-70 ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-tr 06:20pm urine rbc-2 wbc-1 bacteri-few yeast-none epi-1 06:20pm urine casthy-5* c. diff (): negative blood culture x 2 sets (): no growth to date, final pending. brief hospital course: mr. is a 79 y/o male with a history of dm1 on an insulin pump last a1c 8.1, hypertension and glaucoma who presented with diabetic ketoacidosis, nstemi, and pneumonia. . . #diabetetic ketoacidosis: the potential causes include pneumonia, nstemi, or potentially malfunctioning insulin pump. he was continued on an insulin drip with d5 in normal or normal saline until the anion gap closed and he was tolerating a po diet. diabetes service provided recommendations. he was changed to lantus and sliding scale insulin initially. however, as the diabetes service felt that the patient would not be able to resume his insulin pump, and wanted to simplify his insulin regimen as much as possible, with the goal of having the patient being able to manage his own insulin regimen at home, he was then transitioned to a regimen with humalog 75/25 mix. his blood sugars have been stable on this current regimen, and he will follow-up with is outpatient endocrinologist after discharge. . nstemi: the patient was found to have new ekg changes with elevation in troponin, peaking at 5.21. tte showed mild regional left ventricular systolic dysfunction consistent with cad. he was evaluated by the cardiology service. the etiology of his mi was either secondary to hypoperfusion in setting of pneumonia/sepsis or he had a primary cardiac event. management options including cardiac catheterization were discussed with the patient and healthcare proxy. the decision was made to not pursue cardiac catheterization given high probability he would have multivessel disease and the patient was not interested in bypass surgery. he was put on a heparin drip for 48 hours, started on aspirin, plavix, atorvastatin and metoprolol. he has also received prn doses of lasix for volume overload, but appears to have been euvolemic for several days now off of lasix. can consider additional doses of prn lasix as needed. pt has responded well to low-dose iv lasix of 20mg. the patient wishes to follow-up with cardiology closer to home, and will ask his pcp for referral to a local cardiologist. he is also on his prior home dose of ace-inhibitor. his (losartan) has been discontinued to simplify his medical regimen, and his ace-i can still be uptitrated in follow-up as his blood pressure allows. . #pneumonia: he was found to have bilateral lower lobe consolidation concerning for pneumonia. urine legionella was negative. he was started on broad spectrum antibiotics for health care acquired pneumonia given that he is a nursing home resident. he received a course of vancomycin, aztreonam, and levofloxacin x8 days. his respiratory status has improved significantly, he has been afebrile, and his leukocytosis has resolved as well. . #altered mental status/encephalopathy- this was likely due to toxic-metabolic encephalopathy, which was likely multifactorial in the setting of infection, nstemi, dka. his mental status improved in the icu to where his son felt he was close to baseline. aaox3 on the medical floor. pt was treated for infection. . #acute kidney injury: his elevated creatinine on admission was thought to be due to pre-renal etiology, likely volume depletion in the setting of infection. he was volume resuscitated with normalization in the creatinine. . #thrombocytosis-likely reactive thrombocytosis due to recent infection and dka. patient should have repeat cbc checked in follow-up with his pcp. . # code: confirmed dnr/dni with hcp, : , or . medications on admission: lisinopril 10 mg tablet daily losartan 25 mg daily aspirin 325 mg daily furosemide - 20 mg daily insulin lispro - 100unit/ml solution - via pump brimonidine - gtt latanoprost eye gtt discharge medications: 1. brimonidine 0.15 % drops sig: one (1) drop ophthalmic daily (daily). 2. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for sob/wheezing. 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 8. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). 9. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 10. humalog mix 75-25 100 unit/ml (75-25) suspension sig: eighteen (18) units subcutaneous twice daily (with breakfast and dinner): if fs < 70, md. 11. sliding scale insulin regimen please check fingersticks qac and qhs. for breakfast and dinner fs 0-70, md fs 71 - 200, no units fs 201 - 250, humalog 3 units sq fs 251 - 300, humalog 5 units sq fs 301 - 350, humalog 7 units sq fs 350 - 400, humalog 9 units sq fs >400, md for lunch and bedtime fs 0 - 70, md fs 71 - 400, no units fs >400, md discharge disposition: extended care facility: livingcenter - discharge diagnosis: health care associated pneumonia diabetic ketoacidosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were sent from your assisted-living facility for elevated blood sugars. initially, you admitted to the icu and found to have diabetic ketoacidosis, pneumonia and a heart attack. for your diabetic ketoacidosis you were followed by the service, given insulin, and your symptoms improved. you will no longer use your insulin pump. for your pneumonia, you were started on and completed a course of antibiotics with improvement in your symptoms. for your heart attack, you were evaluated by the cardiology service and started on new medications. you and your family declined a cardiac catherization during this admission. . new medications: 1.plavix 2.metoprolol 3.atorvastatin 3. humalog 75/25 . please stop the folowing medications: 1. losartan please take all of your medications as prescribed and follow up with the appointments below. .please follow-up with your doctors as listed below. followup instructions: name: , location: diabetes center address: one place, , phone: when: , , 2pm . when you are ready to be discharged from rehab, please call your pcp's office, dr. at . you have asked to follow-up closer to home for cardiology, so please ask him for a cardiology referral. . procedure: arterial catheterization central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified acidosis subendocardial infarction, initial episode of care acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension unspecified septicemia severe sepsis unspecified glaucoma long-term (current) use of insulin septic shock personal history of malignant neoplasm of large intestine acute systolic heart failure metabolic encephalopathy diabetes with ketoacidosis, type i [juvenile type], uncontrolled volume depletion, unspecified essential thrombocythemia insulin pump status 

Answer: The patient is high likely exposed to