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: past medical history: 1. coronary artery disease, status post inferior myocardial infarction complicated by left ventricular thrombus, status post left circumflex stent in . 2. congestive heart failure. 3. status post mitral valve and tricuspid valve prosthetic replacement . 4. aicd in . 5. history of cerebrovascular accident with residual left finger numbness. 6. history of hodgkin lymphoma at the age of 27, status post radiation and splenectomy. 7. hypercholesterolemia. 8. history of cervical diskectomy. 9. tracheostomy in . 10. gastrostomy tube placed in . 11. mrsa diagnosed in , , with witnessed aspiration with p.o. medications and liquids. 12. constrictive pericarditis. 13. iron-deficiency anemia. medications on admission: 1. ceftazidime started . 2. epogen. 3. amiodarone 400 p.o.q.d. 4. aspirin 325 p.o.q.d. 5. iron. 6. lasix 20 mg p.o.q.d., 20 mg iv. 7. spironolactone. 8. levothyroxine 200 p.o.q.d. 9. enoxaparin 40 subcutaneously b.i.d. 10. kayexalate. 11. ativan. 12. morphine p.r.n. allergies: no known drug allergies. family history: the patient's father died from colon cancer. no history of coronary artery disease. the patient is married. he used to self employed. he does not smoke or drink alcohol. he currently lives at rehabilitation center. physical examination: the patient is resting comfortably in bed in no acute distress. vital signs: blood pressure 76/43 left arm; 97/44 right arm. pulse 80. saturation 94% on 100 fio2. heent: pupils equal, round, and reactive to light and accommodation. extraocular muscles are intact; anicteric sclerae. hearing aids are in place. moist mucous membranes. neck was supple without lymphadenopathy. lungs: coarse sounds throughout; no wheezes or rhonchi. cardiovascular: no jugular venous distention. carotids normal with brisk upstrokes, regular rate and rhythm. mechanical s1 and normal s2; no rub or gallop. abdomen: abdomen was soft, nondistended, nontender, normoactive bowel sounds. extremities: positive pitting of the lower extremities of thigh, pitting edema in the arm, markedly improved from previous hospitalization. there was a well healed scar of the left arm, pic in the right arm. dressings to both heels decubitus ulcers. chest: well healed scar, muscular chest-wall defect dressed. decubitus on sacrum mildly erythematous without obvious drainage. laboratory data: laboratory revealed the hematocrit of 23.4; platelets 453,000, white blood cell count of 9.8 with no bands; sodium 134; potassium 5.2; chloride 99; bicarbonate 26; bun 123; creatinine 1.5; glucose 116; calcium 7.5; magnesium 3.4; phosphorus 5.6; albumin 2.5; inr 1.3; ptt 32; arterial blood gas on 90% with fio2 with 5-cm of peep revealed the po2 of 7.36, pco2 of 49, po2 of 56. chest x-ray showed diffuse alveolar filling with patchy interstitial markings. the last echocardiogram revealed an ef of 25 to 35% with normal valve function; severe global left ventricular hypokinesis; mild right ventricular dilation. hospital course: mr. was treated simultaneously for infectious pneumonic process, as well as congestive heart failure. for pneumonia he had initially received vancomycin, and the zosyn. he was extensively evaluated by the heart failure team, dr. for management of his chf and possible candidacy for heart transplant. he was initially tried on milrinone, but failed secondary to hypertension. dopamine was tried with limited success in conjunction with aggressive bolus lasix regimen. dopamine was discontinued and we started using a combination of afterload reduction and inotropic support. the patient did not successfully diurese to this regimen. sputum eventually showed polys with no organisms, but grew out a fairly resistant serratia and klebsiella and was started on imipenem. however, he developed a rash from the imipenem and he was started on bactrim. the bactrim was ultimately discontinued. he remained on the dopamine until . he had been intermittently tried on dopamine, dobutamine, and lasix drip with again limited success in terms of diuresis. multiple blood transfusions were given to support hematocrit greater than 30. his renal function intermittently improved and worsened based on the degree of diuresis. there was an episode of acute renal failure during the week of , probably secondary to hypotension after failed attempt to wean dopamine in conjunction with oncotic support in the form of packed red blood cells and lasix. renal function returned closer to baseline of 2. multiple trials of trach-mask were attempted, however, the patient did not have the cardiac function to support spontaneous ventilation and eventually tired. he has been intermittently using between 10 to 20-cm of pressure support in conjunction with 5-cm to 10-cm of peep and an fio2 ranging between .4 and 1. the dopamine was eventually weaned to off on and 21st with just dobutamine and lasix. the patient diuresed fairly successfully 3-4 liters over a day period. access had been a difficult issue secondary to extensive bleeding in the femoral region in the past. a right subclavian was attempted, but failed. right internal jugular complicated by arterial puncture and a picc line had been placed in the right arm, which is functioning at this point. over the week of to , the patient was tried on trach-mask trials. however, this in conjunction with changes in the ativan dosing produced hallucinations and delirium. the patient was placed back on pressor support ventilation and improved significantly in terms of his mental status. issue #1. cardiovascular: the patient is status post multiple inotropic trials to improve cardiac function and diurese both left and right side fluid overload. he has been intermittently tried on milrinone, dopamine, and dobutamine. the most successful of these regimens has been a combination of dobutamine and lasix. the patient did not tolerate milrinone secondary to hypotension. on dopamine, he would intermittently diurese, but not progressively. maintaining the patient 200 cc to 300 cc negative a day is a reasonable goal on a moderate dose of dobutamine at 6 mcg per k per minute using a lasix drip at 5 to 20 mg an hour. in terms of his tricuspid and mitral valve replacement, the patient was initially on coumadin, which had been stopped, however, his inr continued to take a long to drip down secondary to poor nutrition. he had an inr of 4.2. there was moderate bleeding from the trach-site. the patient was reversed with ffp. the inr was brought down to 1.9, at which time heparin was started. as the patient improved, he started on coumadin with a target inr of . the patient continues to be v-paced at 80. issue #2. pulmonary: the patient has a history of pneumonia, which in the past grew mrsa. during this admission grew klebsiella and serratia sensitive to imipenem and bactrim. the patient developed a rash to imipenem and was started on bactrim. the patient developed a rash to imipenem. the patient was started on bactrim. however, this was stopped in the setting of acute renal failure for the worry of possible interstitial nephritis. however, the patient did not seem, from the respiratory standpoint, to acquire antibiotics. antibiotics were stopped on the 10th and 12th of . chest ct was performed on the to help characterize the degree and extent of pulmonary disease. the ct was notable for consolidation and interstitial disease, which was central sparing the periphery consistent the primary pulmonary process. no significant chf was seen in the periphery. it is possible that the amount of radiation received 20 years ago may have resulted in a primary interstitial process to whatever cardiogenic process is occurring. with aggressive diuresis in on dobutamine and lasix the oxygen requirements decreased to fio2 of .41. ensuring a steady diuresis of 200-300 cc a day should prevent further oxygen requirements. however, it is unlikely secondary to the patient's poor cardiac function and extent of interstitial disease that he will become vent independent in the near future. issue #3: renal. the patient had sensitive renal function. creatinine ranged from 1 to 3. he is clearly sensitive to renal perfusion and systolic blood pressure and keeping the hematocrit above 30 to maintain good oncotic pressure for renal perfusion is necessary for good renal function. his renal function was very sensitive to blood pressures below 70 to 80, causing acute renal failure with an atn type picture. however, with improved and aggressive diuresis off the dopamine, his renal function has improved to a baseline of 1.1. a limit to his diuresis may be reached in terms of the bun, which has risen to the high 90s. issue #4: endocrinological: from an endocrinological standpoint he has a history of hypothyroidism; tsh has been relatively high and consistent with hypothyroidism in the setting of systemic illness. his levothyroxine doses have been progressively increased. he is now at 200 mcg a day and will need a tsh checked in the near future., issue #5: gastrointestinal. the patient was received tube feeds through his peg, however, due to increased agitation and abdominal distention in the absence of clear obstruction or perforation, his tube feeds were stopped in favor or tpn. as his fluid balance continues to improve, he should be able to start enteral feeding. issue #6: psychiatric. the patient was controlled primarily with remeron and ativan for sleep at night. when the ativan was discontinued in conjunction with trach-mask trials, his mental status acutely decompensated in the form of hallucination and delirium. the mechanical ventilation was restarted with progressive clearing of his mental status. there was no evidence of co2 narcosis. however, hypoxia is a significant possibility for cause of mental status changes during independent ventilation. the remeron was discontinued. the patient responds well to haldol, as needed. issue #7. electrolytes were followed closely. potassium was repleted as needed, as well as magnesium. nutrition was as above. the patient has a right peripherally inserted central catheter, which is functioning. the patient has been placed on a proton pump inhibitor and had an elevated inr for much of his hospitalization, but recently this has been reversed as described, and the patient has been heparinized. this discharge summary will continued in a dc addendum. the patient is currently a full code. numerous family discussions with his wife and himself were held. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances diagnoses: pneumonia due to other gram-negative bacteria congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia acute respiratory failure hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites drug-induced delirium pneumonia due to klebsiella pneumoniae 

Answer: The patient is high likely exposed to