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: lasix / bumex attending: chief complaint: shortness of breath, fatigue major surgical or invasive procedure: thoracentesis on with 1l of serosanguinous fluid removed. history of present illness: 82 year old oxygen dependent (2l) male with diastolic chf, cad s/p 5v cabg in , a. fib presents with chief complaint of worsened sob, le edema over past 3 days. he notes that he is normally able to ambulate throughout his one level apartment with mild sob, but noted sob with shorter distances and even while at rest. he uses 2l o2 at baseline at home which he bumped up to 3l on his own over the last week, but sob progressive so presented. he has chronic le edema for which he wears teds and notes that over the past 3 days, swelling in his legs has also worsened. he denies leg pain, redness, warmth. he denies dietary indiscretions, no cp/palpitations. he has been urinating without difficulty. he sleeps with 2 pillows and hob at an angle at baseline and reports this has not changed--however, he has been waking up at night short of breath and moves to a recliner in which he is somewhat more comfortable. no fevers/chills. reports infrequent cough which was productive of small amount of clear sputum last night with blood specks throughout; this am clear sputum only, no blood. . of note, he was admitted in with chief complaint of hemoptysis. imaging suggested pulmonary hemorrhage. he underwent bronchoscopy at that time without hd compromise, requiring 2u prbc transfusions throughout his stay. he underwent bronchoscopy which did not demonstrate any active bleeding or endobronchial lesions. washings were sent for cytology and were negative for malignant cells. given negative w/u otherwise, his hemoptysis was thought to be in the setting of decompensated chf and pulmonary htn. in the setting of a.fib and elevated chads2 score, he was continued on his coumadin upon discharge. he was discharged home on 80mg po torsemide, which has been increased by his cardiologist to 200mg qam, and 100mg qpm since d/c. . in the ed, intial vitals were t: 97.5 bp: 140/44 hr: 60 rr: 16 o2sat: 95% 3l nc. cxr was performed which showed new left pleural effusion and interstitial edema. he received ethacrynic acid 50 mg iv x1 (pharmacy did not have torsemide). hct was 23 on presentation, down from 28.5 on (last in our system). records from from his indicate a hematocrit of 20.4 and cr of 3.9, and hct of 23. physical exam revealed guaiac positive brown stool. repeat hct in ed was 21.6. he reports dark colored stool in the setting of taking iron which is unchanged and reports rare bright red blood on tp only when constipated; none recently. he was transfused 1 u prbc in the ed, and received a second dose of 50 gm iv ethacrynic acid. total recorded uop in ed was 2 liters. . ros: as above. additionally, no lh/dizziness. +50lb weight loss since cabg in 7/. poor appetite over the past week. no ha/changes in vision. no numbness/tingling/weakness. no n/v/abdominal pain. no dysuria/hematuria. no joint pain. no rashes. in general, his most bothersome complaint is fatigue. past medical history: -cad s/p coronary artery bypass graft x 5 (left internal mammary artery > left anterior descending, saphenous vein graft > diagonal, saphenous vein graft > obtuse marginal 1, saphenous vein graft > obtuse marginal 2, saphenous vein graft > posterior descending artery) -diastolic chf -htn -mitral regurg (1+), aortic regurg (1+), tricuspid regurg (2+) -dyslipidemia -hypothyroidism -gout -bladder ca (12 years ago) -pericarditis (remote) -stage iv ckd; largely secondary to microvascular disease of the kidney, but possibly with a component of atheroembolic disease in light of persistently elevated eosinophil count and mildly low complement levels. -atrial fibrillation -hemoptysis () -s/p right knee replacement social history: pt. is a retired cpa, he recently moved into an facility. he is able to maintain adls, cares for himself. pt. smoked but quit 45 years ago; does not drink alcohol currently and used rarely before his cabg, and has never used recreational drugs. he is a veteran of wwii. family history: n/c physical exam: vitals: 100.0/100.0, 140/50, 56, 18, 96%2l weight: 94.1kg general appearance: resting in bed, comfotable, pleasant. speaking in full sentences cardiac: rrr. iii/vi systolic murmur heard loudest at left sternal border. jvp not elevated, ~8cm. pulm: diminshed breast sounds at left base, otherwise clear to auscultation. abd: soft, + bs, nt, nd. ext: warm and well perfused. edema not significantly changed. skin: no jaundice nor rashes appreciated pertinent results: cxr (): 1. new moderate-to-large left pleural effusion with left basilar opacity concerning for possible underlying infection. parapneumonic effusion cannot be excluded. 2. vascular congestion with evidence of interstitial edema. . cxr (): slightly improved interstitial pulmonary edema and left pleural effusion, but residual right lower lobe airspace opacity. followup radiographs after appropriate diuresis recommended to exclude underlying consolitdation. . renal ultrasound (): no evidence of hydronephrosis. . tee (): the left atrium is moderately dilated. the right atrium is moderately dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 60-70%) there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. the tricuspid regurgitation jet is eccentric and may be underestimated. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. compared with the findings of the prior study (images reviewed) of , the findings are similar. . cxr (): 1. worsening left more than right pleural effusion. 2. stable cardiomegaly and pulmonary edema. . cxr (): 1. worsening left more than right pleural effusion. 2. stable cardiomegaly and pulmonary edema. . chest ct (): 1. new multifocal ground-glass opacities, affecting the right lung to a much greater degree than the left. these findings are concerning for an evolving infection in the appropriate clinical setting. an asymmetric distribution of pulmonary edema is less likely. other causes such as hemorrhage should also be considered in the appropriate clinical setting. 2. increasing moderate left pleural effusion. 3. new 7-mm right basilar lung nodule, most likely inflammatory or infectious considering rapid development in three months. followup ct in three months is recommended to document resolution and to exclude the less likely possibility of malignancy. 4. improved mediastinal lymphadenopathy. . cxr (): interval reduction in the large left pleural effusions with persistent small bilateral pleural effusions status post left thoracentesis without development of pneumothorax. brief hospital course: 1. sob/dchf: cxr with pulmonary edema and new left sided pleural effusion in conjunction with worsening le edema, most c/w chf exacerbation. denies cp and ekg without changes concerning for active ischemia (essentially unchanged from prior). on admission, his trop was mildly elevated to 0.13, but this is in the setting of ckd where bl trop runs 0.10-0.15, and trending down. patient ruled out for mi and was diuresed with iv ethacrynic acid and diurel. max 1.5 liter negative on 100 mg eth. acid and 500 mg diuril . attempted transition to po diuretics, but this yielded only a 400 cc negative fluid balance. patient is oxygen dependent because of chronic pulmonary edema. patient was transfered to the icu and cvvh ultrafiltration with dialysis and his weight dropped from 116kg to 91kg. he was transfered back to the floor and resumed his oral diuertic regimen. he continued to gain weight and experienced electrolyte abnormailities including hyperkalemia and hyperphosphatemia so the decision was made to initiate dialysis on . . 2. renal failure: likely pre-renal azotemia exacerbated by chf, as described above. received dialysis during ultrafiltration, on , and on ; dispo to macu with mwf dosing schdule. . 3. anemia: chronic renal insufficiency with epo resistance due to iron deficiency. received four units prbc on this hospitalization and 4 infusions of iv iron with stabilization of blood counts at 28. has guaiac positive stool and known history of hemorrhoids--outpatient follow up, do not think this is playing a major role in his anemia currently. returned to po iron, then epo + iron during hemodialysis. . 4. hemoptysis: blood tinged sputum, small volume, 1-2 times per day. resolved by transfer back from micu. had bronchoscopy and ct at last hospitalization without clear endobronchial lesion per notes. pulm consulted on this hospitalization as well, and think this is pulm hypertension with pulmonary edema. holding coumadin for anticoagulation for now, see below. . 5. paroxysmal atrial fibrillation: given 12.5 mg metoprolol which is leading to a hr near 60 on telemetry. higher doses led to bradycardia in 40s-50s, which possibly contributed to his presentation (per his home meds, was on 75 mg toprol xl ). in normal sinus rhythm on discharge with some pvcs and missed beats. given the ongoing hemoptysis, plan is to continue aspirin 325 mg daily for now. once fluid status more stable, can re-challenge with coumadin. would prefer coumadin for ac given high chads2 score. if transitioned back to coumadin, needs aspirin dose lowered to 81 mg daily. please follow-up as outpatient. . 7. hypertension: began norvasc, metoprolol, hydralazine and isordil per outpatient regimen. after ultrafiltration volume loss resulted in hypotension, currently on asa and metoprolol, holding hydralazine, amlodipine, and isordil. no ace/ given acute on chronic renal insufficiency, per renal recommendations. recommed discussion on follow-up. . 8. leukopenia/thrombocytopenia: mild and not neutropenic. ? degree of mds or marrow suppression. no need for platelets at this time. . 9. dyslipidemia: continued statin and niacin. . 10. hypothyroidism: continued outpatient dose of levoxyl. of note, tsh was elevated on multiple last admissions. ft4 was normal at that time, however. dose of levothyroxine was increased during last admission, however tfts have not been repeated within our system since then. be contributing to volume status if is under repleted. continued levothyroxine at current dose. . 11. gout: continued allopurinol renally dosed. medications on admission: isordil 20 mg po bid calcitriol 0.25 mg po daily lipitor 20 mg daily toprol xl 75 mg po bid allopurinol 100 mg eod norvasc 10 mg daily hydralazine 50 mg tid torsemide 200 mg/100 mg synthroid 88 mcg daily kcl 40 meq daily trazodone 200 mg qhs albuterol inh qid lexapro 20 mg daily coumadin 2 mg procrit u/ml qthursday feso4 325 mg daily oscal 500 mg po bid slo niacin 500 mg dialy lysine 500 mg daily mag oxide 400 mg daily centrum silver vitamin c aspirin 81 mg daily citrucel senna po bid prn tylenol 650 mg 2 tablets daily discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: chf exacerbation iron deficiency anemia acute renal failure on chronic renal insufficiency secondary: coronary artery disease discharge condition: stable, on 2 l o2. discharge instructions: the patient was admitted for chf exacerbation, anemia and acute on chronic renal failure. he was diuresed and transfused 4 units of rbc. the patient failed transition to an oral diuretic regimen and was admitted to the icu for cvvh/ultrafiltration. over 20l of fluid was removed, and the patient was transfered back to the medical floor. he again failed oral diuresis and was initiated on hemodialysis. the patient carries a diagnosis of heart failure with an ejection fraction of 60-70% on the most recent echocardiogram. please weigh him before dialysis. please maintain a low sodium (<2g), cardiac/heart healthy diet. a fluid restriction is not necessary at this time. the patient is not currently taking an ace-inhibitor, at nephrology follow-up please discuss the addition of an ace-inhibitor now that the patient is on hemodialysis. the patient carries a diagnosis of paryoxsmal atrial fibrilation. when admitted he was taking both aspirin and warfarin for prophylaxis, but the warfarin was held in the setting of hemoptysis. at follow-up, please discuss the risks vs benefits of adding warfarin back to the patient's medication regimen. please call a physician or have the patient return to the hospital if he develops a fever > 102f, develops increasing shortness or breath, chest pain, or any other concerning symptoms. followup instructions: you will be followed by the doctors rehab after discharge. you have an appointment for follow-up with dr. , from nephrology in the center on thursday, at 3:30pm. you have an appointment for follow-up with dr. from pulmonology at the center on at 1:30pm. please arrive at 12:30pm for a chest xray. md, procedure: hemodialysis hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis thoracentesis transfusion of packed cells transfusion of other serum diagnoses: pneumonia, organism unspecified hyperpotassemia anemia in chronic kidney disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified unspecified acquired hypothyroidism chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation acute on chronic diastolic heart failure aortocoronary bypass status personal history of tobacco use other and unspecified hyperlipidemia disorders of phosphorus metabolism long-term (current) use of anticoagulants personal history of malignant neoplasm of bladder pressure ulcer, buttock knee joint replacement mechanical complication of other vascular device, implant, and graft tricuspid valve disorders, specified as nonrheumatic unspecified hemorrhoids without mention of complication 

Answer: The patient is high likely exposed to