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 83-year-old african american male with a history of heart association class iv- heart failure secondary to ischemic cardiomyopathy with an ejection fraction of 20%, coronary artery disease status post coronary artery bypass graft times three in with re-do in . atrial fibrillation, chronic renal insufficiency with a baseline creatinine of 2.2, status post aicd with biventricular pacer placed who presented with hyperthermia and a temperature of 107 degrees. the patient was recently discharged from the service on , the day before admission, after a three week hospital stay for acute congestive heart failure exacerbation complicated by difficulty diuresing and low urine output. the patient was found in his home, unresponsive, on the floor by a caregiver who noted the apartment to be very warm. the same caregiver had been in the apartment the night before and noted that the heat was on and could not be turned off. the ambient temperature the day the patient was found was greater than 90 degrees. ems was called, they found the patient to have a temperature of 107 degrees, heart rate of 100 and regular. blood pressure 180/palp. respiratory rate 36 and an oxygen saturation of 100. the patient was intubated and brought to the emergency department. in the emergency department the patient's temperature was 105. the patient was given ice packs to the groin and axilla and a cooling blanket as well as three liters of normal saline with a resulting temperature of 102 and a heart rate of 87 and a blood pressure of 118/59. the patient was noted to have some convulsive and twitching movements in his facial muscles that were not rhythmic and in his extremities and was therefore given 4 mg of versed intravenous and 4 mg ativan intravenous with no improvement. two grams of ceftriaxone intravenous and 1 gram of vancomycin were also given. in the micu the patient's temperature improved to 99 degrees. his blood pressure and heart rate remained stable. the patient was placed on assist control ventilation with a volume of 500 and rate of 10. pressor support of 5 with peep of 5 and an fio2 of .4. his subsequent gas was 7.46, 44 and 119. at this time the neurological exam revealed the patient to be unresponsive, not following commands, not withdrawing from pain but with spontaneous movements. sluggish pupillary response and intact ventilatory drives were seen. past medical history: 1. coronary artery disease. status post coronary artery bypass graft in with a re-do coronary artery bypass graft in . a persantine mibi on was noted to have moderate reversible defects in the inferior base, global hypokinesis and an ejection fraction of 21% with uninterpretable electrocardiogram changes secondary to a paced rhythm. this is a stable study compared with his study performed on . 2. ischemic cardiomyopathy. class iv- congestive heart failure. most recent transthoracic echocardiogram in showed an ejection fraction of 35% 3. chronic renal insufficiency with a baseline creatinine of around 2. 4. hyperlipidemia. 5. hypertension. 6. monoclonal gammopathy of undetermined significance. 7. prostate cancer, status post prostatectomy. 8. tophaceous gout. 9. cervical spondylosis. 10. status post appendectomy. 11. history of atrial fibrillation, status post implantable cardioverter, defibrillator with biventricular pacemaker in . 12. history of gave syndrome. 13. status post knee surgery and spinal cyst removal. medications on admission: 1. allopurinol 100 mg p.o. q day. 2. imdur 60 mg p.o. q day. 3. norvasc 10 mg p.o. q. day. 4. multivitamin one p.o q day. 5. protonix 40 mg p.o. q day. 6. buspar 10 mg p.o. twice a day. 7. timoptic eyedrops three times a day. 8. colace 100 mg p.o. twice a day. 9. iron 325 mg p.o. twice a day. 10. hydralazine 50 mg p.o. three times a day. 11. potassium chloride 20 meq p.o. q day. 12. lipitor 10 mg p.o. q day. 13. metazabine 50 mg p.o. q h.s. 14. digoxin .125 mg p.o. q o.d. 15. epogen 4000 units intramuscular every wednesday. 16. 1 tablet p.o. q day. 17. metolazone 5 mg p.o. twice a day. 18. bumex 4 mg p.o. twice a day. 19. dulcolax 10 mg p.o. q day. 20. carvedilol 3.125 mg p.o. twice a day. allergies: morphine. social history: the patient lives at home with visiting nurse and occasional home health aide. he denies any history of current alcohol use. he has one daughter who lives in and another child who died many years ago. tobacco history revealed the patient states that he quit smoking approximately 40 years ago. he had a significant history prior to that. family history: noncontributory. physical examination:: vital signs revealed a temperature of 102, blood pressure 118/59, heart rate 87, respiratory rate 20 and oxygen saturation of 100% and an fio2 of 0.4. in general the patient was unresponsive. he did not open his eyes or move limbs to command. he was a chronicly ill appearing very thin male. on head, eyes, ears, nose and throat he had bilateral cataracts, left greater than right with no pupillary response on the left and a sluggish pupillary response to light on the right. there were bloody secretions in the oropharynx and a very poor dentition. mucous membranes were dry. there was significant suborbital edema bilaterally. neck: supple with full range of motion and no elevation of the jugular venous pulsation. chest: lungs that were clear to auscultation anteriorly and bilaterally. cardiovascular exam was without tachycardia with a regular rhythm, no murmurs, rubs or gallops. no third or fourth heart sounds were heard. the abdomen was soft, nontender, nondistended with normal bowel sounds. extremities: 1+ bilateral lower extremity pitting edema in the feet and ankles. neurological exam revealed an unresponsive patient. the patient did not respond to voice or commands. he was moving limbs spontaneously and initiating ventilation. no withdrawal to painful stimuli. pertinent laboratory: on admission revealed a white blood count of 6.8, hemoglobin 16.0, hematocrit 31.1, platelets 164. prothrombin time of 13.5, inr 1.2, sodium was 144, potassium 5.1, chloride 0.101, bicarbonate 25, bun 111, creatinine 4. glucose 123. creatinine kinase was 340. troponin 6.4, calcium 9.6, magnesium 2.3, phosphorus 2.5, alt 29, ast 43, ape 3, lipase 57, amylase 193, albumin 3.8, lactate 3.7. chest x-ray showed an enlarged heart, no pleural effusions, patchy opacities bilaterally with less basilar atelectasis. head ct revealed no acute intracranial pathology. electrocardiogram revealed ventricular paced rhythm at 83 beats per minute, no acute t-waves or st segment changes. impression: 83-year-old male with class iv congestive heart failure, ischemic cardiomyopathy with ef of 20%, coronary artery disease, status post coronary artery bypass graft, status post aicd with biventricular pacer admitted with severe hyperthermia. micu course by systems: 1. hyperthermia. the patient's hyperthermia was thought to be due to heat stroke from the increased temperature in his apartment and his limited ability to regular his temperature secondary to his decreased cardiac output and chronic diuretic use. workup for septic or toxic etiologies was negative. the patient has no history of taking neuroleptic medications. the patient's temperature had returned to the normal range by the time he arrived in the micu. his temperature remained stable throughout his stay. 2. neurologic: the patient began to wake up on and by he was fully responsive, awake and alert and asking to go home. he was occasionally oriented times three and occasionally confused but seems to have returned to his normal mental status. a ct of his head showed no acute bleed or stroke. initially the patient was given loading doses of dilantin in order to treat his seizure like activity in the emergency department. he was continued on dilantin at prophylactic doses and in the micu. an eeg done showed diffuse swelling and no seizure activity. there was no further seizure like activity noted on exam and due to the lack of seizure activity and the likelihood that the seizure were due to his hypothermia the dilantin was discontinued on . 3. infectious disease. it was felt that the patient's fever was due to heat stroke as there were no signs of infection or sepsis and and developed during his stay. lumbar puncture revealed 2 white blood cells and 3 red blood cells. blood, urine and sputum cultures remained negative. therefore, the ceftriaxone and vancomycin were discontinued on . the patient was continued on levofloxacin and metronidazole for possible aspiration pneumonia. these were discontinued on prior to transfer to the floor. 4. renal. the patient had acute on chronic renal failure with a creatinine of 4.0 up from his baseline of 2.2. the acute renal failure was most likely due to a combination of factors including rhabdomyolysis with myoglobin induced tubular damage (ck 1671), hypotension with pre-renal failure and atn. in addition the patient was anuric in the emergency department and for the next 24 hours in the micu. he was given d5 with 3 amps of hco3 to alkalinize his urine. a subsequent electrolyte panel and arterial blood gases showed metabolic alkalosis so his fluids were changed to normal saline. these were run at 175 cc's per hour to maintain good renal perfusion and gfr. on day two the patient was still aneuric and a renal consult was called. they recommended continuing his outpatient diuretics so that the patient was started on lasix intravenous 80 mg twice a day and zaroxolyn 5 mg twice a day. the patient was 9 liters positive and still aneuric. renal ultrasound was done and showed no foley in the bladder. foley was flushed with no return and then repositioned with the return of one liter of bloody urine. the patient was thought to have had the foley placed in the prostate. after voiding the patient began to decrease his respiratory rate and increase his tidal volume. the patient voided a total of 1,515 cc's. the following day the patient's exam was consistent with congestive heart failure so he was given lasix 160 intravenous with no urine output. foley was again flushed with no return. urology was called to replace the foley and the patient voided 600 cc's bloody urine and then continued to void 100 cc's per hour. on day three the patient was noted to have a free water deficit of 2.5 liters. renal recommended keeping the patient .5 to 1 liter positive overall and not replacing free water. 5. heme. the patient's hematocrit on admission was 27. considering his history of coronary artery disease he was transfused one unit packed red blood cells to maintain a hematocrit greater then 30. on day four of admission the patient was noted to have an inr of 1.3 and a ptt of 42.8 with platelets of 97 so he was given one dose of vitamin k and a dic panel and lfts were sent. 6. cardiac. the patient ruled in for myocardial infarction with troponin of 27, ck of 1881. he was started on metoprolol 12.5 mg twice a day. because of bloody og suction, aspirin and heparin were held. ep was consulted and they interrogated his pacer and found it to be operating properly with no events prior to admission. a lead electrocardiogram showed paced rhythm and could not be evaluated with st changes. the patient was 9 liters positive on with crackles on lung exam therefore, he was given 160 mg intravenous lasix in addition to his usual home doses of diuretic. in addition the patient was having more trouble oxygenating which was thought to be the result of his congestive heart failure and he was mildly hypertensive with a blood pressure of 160/80. therefore, he was given 10 mg intravenous of hydralazine to help decrease afterload. it was later noted that the increased blood pressure and decreased oxygen sat was likely secondary to pain from urinary retention. 7. pulmonary. the patient was intubated for airway protection by ems. he was over breathing the vent, oxygenating and ventilating well with minimal secretions. rsbi on was 70 to 100 and he did well with a supraventricular tachycardia over three hours. he was therefore, extubated on with no complications. that afternoon he began to have oxygen saturation of 80% and was given lasix and hydralazine and he improved. on discharge to floor the patient required 4 liters nasal cannula to maintain oxygen saturation greater than 94% 8. gastrointestinal. some bloody suction from the og tube. aspirin was held. by discharge suction was minimal. 9. speech pathology was consulted to evaluate for aspiration precautions. 10. prophylaxis. ppi and heparin subcutaneously were given. 11. communication with his daughter who planned on flying from on saturday night for a family meeting on sunday. 12. full code. though mr. states repeatedly that he did not want to be intubated and does not want cpr his daughters think he is not competent to make those decisions and wants him to be full code until the family meeting. 13. disposition: the patient was transferred to the medical floor on . mr. was discharged to the floor on the same medications that he was on as in the micu. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung arterial catheterization arthrocentesis application of splint diagnoses: acute kidney failure with lesion of tubular necrosis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hemorrhage complicating a procedure acute respiratory failure acute myocardial infarction of unspecified site, initial episode of care mixed acid-base balance disorder other complications due to genitourinary device, implant, and graft heat stroke and sunstroke 

Answer: The patient is high likely exposed to