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: weakness major surgical or invasive procedure: picc line placement history of present illness: this is a 78 year-old male with a history of afib, pes while on coumadin, pulmonary hypertension and hypothyroidism who is admitted with shock on pressors. ems was initially called as the patient was experiencing extreme fatigue over the last 2 days which had become progressively worse. ems reports that the patient was aaox2, eyes open, no complaints other than weakness. he denied n/v/d, headache, chest pain, fever, chills, abdominal pain. he was able to follow commands. initial ecg showed 2nd degree av block per report. fluid boluses were given without improvement, so atropine 0.5 mg iv x1 was given which improved his heart rate. as his bp began to fall, dopamine was infused peripherally at 10 mcg/min with improvement in bp on arrival to the ed at . . in the ed at , the patient was continued on dopamine and was given ctx 1 gm iv, levaquin 750 mg iv, and vancomycin 1 gm iv. he additionally rec'd 1 unit of prbcs and dexamethazone 10 mg iv for possible adrenal insufficiency. he was also given an additional 3l ns with minimal increase in bp. a trial of levophed at 10 mcg/min resulted in decreased bps to the 60s, so the patient was placed back on dopamine with bps in the 110s. . as the patient refused an ij for access, a femoral line was placed to continue pressor support. he was transferred on 10 mcg/kg. . of note, the patient had a recent admission in of this year to for hypotension. he was admitted to the icu. he had a tte at that time showing ef of 65% and rv dysfunction, not significantly changed from prior. a chest ct showed inflammatory/infectious etiology and sputum cultures grew serratia marcescens and citrobactor amalonaticus. repeat imaging and bronchoscopy yielded evidence of likely cop. he was started on prednisone for concerns of cop/boop and amiodarone was discontinued due to concerns of pulmonary toxicity. he was also fluid overloaded during the admission given his hypotension and icu stay and was diuresed prior to discharge. ros: the patient denies any fevers, chills, weight change, nausea, vomiting, abdominal pain, diarrhea, constipation, melena, hematochezia, chest pain, shortness of breath, orthopnea, pnd, lower extremity oedema, cough, urinary frequency, urgency, dysuria, lightheadedness, gait unsteadiness, focal weakness, vision changes, headache, rash or skin changes. past medical history: pulmonary hypertension followed by dr. at , on viagra hypothyroidism gout cad - denies history of mi hypercholesterolemia staph bacteremia afib/flutter formerly on amiodarone, now on coumadin/digoxin (amio was stopped during admission, but patient believes he is still taking it) r tka complicated by protracted icu stays, on chronic suppressive antibiotics (augmentin/bactrim) multiple pes (2 diagnosed 5 years ago while on coumadin) social history: lives with his wife. uses a wheelchair primarily to mobilize. denies alcohol, tobacco, drugs. family history: nc physical exam: on presentation: gen: nad, ill appearing vss heent: dry mm, cobblestone appearance of lower oral mucosa with poor dentition but not clear evidence of abscess or infection at rl mandible cv: regaulr rate pulm: rales/rhonchi at bilateral bases abd: soft, ntnd ext: knee with open wound/crusted serous material surroundign wound, no pus apparent, l knee with well-healed wound, stage 2 decub over coccyx pertinent results: echocardiogram: the left atrium is dilated. the right atrium is markedly dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the right ventricular cavity is markedly dilated with severe global free wall hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: markedly dilated and hypokinetic right ventricle. the distal apex has relatively normal function. there is moderate to severe tricuspid regurgitation, likely secondary to ventricular dilatation. at least moderate pulmonary hypertension (likely underestimated - given severity of tricuspid regurgitation, the right atrial pressure is likely substantially greater than 10mm hg.). there is evidence of pressure and volume overload of the right ventricle with a small, normally functioning left ventricle. ct head: 1. unchanged rounded 9 mm right frontal extra-axial hyperdensity, more likely representing a small meningioma than a subdural hematoma. further evaluation by head mri with and without contrast is suggested. 2. resolution of previously noted gas in the masticator spaces, infratemporal fossae and temporomandibular joints. brief hospital course: 78 year-old male with a history of pes, pulmonary hypertension, cop, chronic knee infection, afib/flutter and hypothyroidism who is transferred from with shock and acute renal failure. shock was thought to be his end stage pulmonary hypertension and right ventricular failure which significantly improved by increasing his dose of sildenafil to 100mg tid. family meeting held to address goals of care given the end stage nature of his disease in spite of his improvement on increased dose of sildenafil. the decision was made to transition him to home hospice. he was discharged home in stable condition with home hospice. # goals of care: family meeting held to discuss goals of care and prognosis. outcome of discussion was to attempt to wean patient off of pressors in and transition him to home hospice. discussed medication regimen at length with team and the following decisions were made: 1. continue sildenafil at 100mg tid to treat his rv failure, keep him off pressors and allow him to go home with hospice 2. intravenous antibiotics were discontinued as has been no clear infection. oral bactrim for prophylaxis continued. 3. weaned off stress dose steroids and will continue oral prednisone for cop. 4. coumadin discontinued given patient was guaiac (+) as osh given risk of bleed. patient does have hisotry of pe while on anti-coagulation. # shock nos: thought to be secondary to rv failure (chronic) and sub-optimally treated pulmonary hypertension as patient has not desired full treatment in the past. patient with leukocytosis which is likely to stress dose steroids as not clinically systemically infected. initially on pressors which have been able to be weaned off with increased dose of sildenafil at 100mg tid. p patient with extremely poor forward flow and has little ability to maintain blood pressures with changes in posture. physical therapy saw him and patient was able to ambulate safely. # hyperkalemia: potassium elevated at 6.8 on admission. resolved with kayexalate and lactulose. # acute renal failure: secondary to decreased perfusion in setting of shock. improving. renally dosed meds. avoid nephrotoxins. has low ca, did not work up given goals of care. # cryptogenic organizing pneumonia: steroid dependent since , has been unable to wean below 10 mg daily. was treated with stress dose steroid initially which are currently being weans down with transition to oral prednisone prior to discharge. continued bactrim for prophylaxis. # leukocytosis: stable, likely steroids. # right total knee replacement: has known chronic infection. plain film showing free air within the joint space. was treated with iv antibiotics on admission given concern for sepsis as cause of shock. these were discontinued given negative cultures and transition to home hospice. he was however continued on oral suppressive therapy with augmentin and bactrim. # diastolie chf: echo showed marked rv dysfunction with rv bowing into lv as above. prior echo in showed ef 65% with some old rv dysfunction, likely from prior pes. also with end stage pulmonary hypertension. fluids managed cautiously as in very delicate balance. # multiple pes: had history of developing new pes while on anticoagulation. also has pulmonary hypertension pes on sildenafil. d/c'ed coumadin as below. patient will follow up with pulmonary in 2 weeks and will have inr check and revisit coumadin. # anemia: thought to be anemia of chronic disease. had no signs of bleeding though has guaiac pos stool in ed. baseline hct around 32 per report. got 1 unit prbc at osh, none here. # afib/flutter: coumadin was initially continued and then held for supratherapeutic inr. decision was made to d/c coumadin given goals of care and transition to home hospice. digoxin was continued as keeping patient rate controlled important for maintenance of bp and quality of life. # ecg changes: he does have s1q3t3, though not significantly changed from prior, patient has old rbbb. troponin mildly elevated, and some st depression in lateral precordial leads. no cp. not acitvely treated. medications on admission: apothecary in - will need to confirm meds and doses in am lasix 40 mg daily viagra 25 mg tid allopurinol 100 mg daily bactrim ds mwf digoxin 0.125 mg qod colchicine 0.6 mg prn folate 1 mg daily prednisone 10 mg daily synthroid 50 mcg daily augmentin once daily prilosec 20 mg daily mvi coumadin discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*6* 2. sildenafil 50 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*6* 3. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po mwf (monday-wednesday-friday). disp:*30 tablet(s)* refills:*3* 4. amoxicillin-pot clavulanate 500-125 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*60 tablet(s)* refills:*6* 5. digoxin 125 mcg tablet sig: one (1) tablet po every other day (every other day). disp:*30 tablet(s)* refills:*3* 6. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*6* 7. allopurinol 300 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*6* 8. colchicine 0.6 mg tablet sig: one (1) tablet po once a day as needed for pain: use for gout pain. disp:*30 tablet(s)* refills:*2* 9. synthroid 50 mcg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*6* discharge disposition: home with service facility: season's hospice discharge diagnosis: primary: pulmonary hypertension secondary: hypothyroidism gout cad hypercholesterolemia afib/flutter right total knee replacement complicated by protracted icu stays, on chronic suppressive antibiotics (augmentin/bactrim) history of pulmonary embolism while on coumadin discharge condition: vitals stable with stable blood pressures in 80-90's at rest. on oxygen. discharge instructions: you were transferred to this hospital after your blood pressure was low and your oxygen requirement increased. it was eventually determined that your symptoms were due to right-sided heart failure from you long standing pulmonary hypertension. your sildenafil was increased to 100mg three times a day and this has helped control your symptoms. you are being discharged on the following medications, all other medications should be stopped: ***prednisone 10 mg once a day ***digoxin 0.125 mg every other day ***amoxicillin-clavulanic acid (augmentin) one tablet twice a day ***sulfameth/trimethoprim ds (bactrim) one tab mon, wed, fri ***sildenafil (viagra)100 mg three times a day ***omeprazole (prilosec) 20 mg once a day ***levothyroxine (synthroid) 50mcg once a day ***allopurinol 300mg once a day ***colchicine 0.6mg once a day as needed for gout pain you have an appointment with dr. who took care of you in the icu on at 3pm. he will determine then whether or not to restart your coumadin and may adjust other medications. be sure to eat a high protein diet (chicken, beef, pork, beans) and drink at least 2 cans of ensure (or another protein shake) a day. it was a pleasure meeting you and participating in your care. followup instructions: pumonology: , m.d. phone: date/time: 3:00 procedure: venous catheterization, not elsewhere classified diagnoses: acidosis hyperpotassemia anemia in chronic kidney disease coronary atherosclerosis of native coronary artery pure hypercholesterolemia other postoperative infection congestive heart failure, unspecified adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified unspecified acquired hypothyroidism gout, unspecified atrial fibrillation other chronic pulmonary heart diseases atrial flutter chronic kidney disease, unspecified right bundle branch block long-term (current) use of anticoagulants personal history of venous thrombosis and embolism surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation knee joint replacement leukocytosis, unspecified chronic diastolic heart failure nonspecific abnormal electrocardiogram [ecg] [ekg] other specified alveolar and parietoalveolar pneumonopathies shock, unspecified 

Answer: The patient is high likely exposed to