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: the patient is an 83-year-old man with a history of coronary artery disease and congestive heart failure, who was transferred from an outside hospital with complaints of shortness of breath and congestive heart failure after ruling in for a non-q wave myocardial infarction. he also had a history of restrictive lung disease, status post coronary artery bypass grafting, multiple admissions for congestive heart failure with the last being on and , chronic renal insufficiency and renal cell carcinoma status post right nephrectomy and prostate carcinoma. he was transferred at this time from hospital for continued management of shortness of breath, congestive heart failure and a non-q wave myocardial infarction. the patient was admitted to hospital from rehabilitation on with shortness of breath and desaturations to the 70s. he was treated for congestive heart failure with diuresis, with minimal improvement over several days. he ruled in for a non-q wave myocardial infarction on in the setting of continued likely demand ischemia from hypoxia. the patient underwent a pulmonary workup including a ventilation perfusion scan, which was read as low probability for pulmonary embolus, and a ct scan of the chest, which was consistent with diffuse interstitial lung disease. the patient was covered with an unknown antibiotic over an unclear duration for assumed underlying pneumonia. despite this treatment and continued supplemental oxygen, the patient continued to have low oxygen saturation, prompting intubation on . he eventually extubated on , but had since remained tenuous, requiring bipap and 100% nonrebreather. on , a pulmonary artery catheter was placed to investigate pulmonary versus cardiac etiology of his hypoxia. by report, the initial numbers were consistent with a cardiac output of 5.1, a cardiac index of 2.5 and a pulmonary artery diastolic pressure of 25. in the two to three days preceding transfer, he had a worsening oxygen requirement, requiring continuous bipap. on , the patient complained of chest pain and an electrocardiogram by report showed ischemic changes. he was started on intravenous nitroglycerin and received lopressor and lasix. his cardiac enzymes were elevated with a positive troponin and ck mb. he was transferred to the cardiac care unit for continued management. upon arrival, the chest x-ray was consistent with congestive heart failure, rales were audible on examination and he was requiring bipap to maintain his oxygen saturation. past medical history: 1. coronary artery disease, status post coronary artery bypass grafting in with a left internal mammary artery graft to the first diagonal artery, a saphenous vein graft to the distal left anterior descending artery and a saphenous vein graft to the first obtuse marginal artery, performed at . 2. congestive heart failure with hospitalizations in and and an ejection fraction of 20-30%. 3. paroxysmal atrial fibrillation. 4. renal cell carcinoma, status post right nephrectomy. 5. prostate cancer. 6. chronic renal insufficiency. 7. chronic obstructive pulmonary disease secondary to smoking with an fvc of 1.79 and an fev1 of 1.43. 8. coronary artery bypass grafting in complicated by prolonged intubation and tracheostomy. 9. gastroesophageal reflux disease. 10. psoriatic arthritis, previously treated with methotrexate. 11. gastrointestinal bleed secondary to diverticulitis. 12. degenerative joint disease of cervical spine. 13. restrictive lung disease, consistent with pleural fibrosis with bronchiectasis from severe postoperative pneumonia or interstitial lung disease secondary to methotrexate and/or deconditioning secondary to obesity. 14. calcified right fibrothorax. 15. history of cerebrovascular accident. medications on transfer: 1. amiodarone 200 mg q.d. 2. lipitor 20 mg q.d. 3. lovenox 90 mg q.d. 4. proscar 5 mg q.d. 5. folate one tablet q.d. 6. lasix 60 mg intravenous b.i.d. 7. reglan 10 mg intravenous q.i.d. 8. lopressor. 9. inderal. 10. zoloft. 11. ativan. 12. nitroglycerin drip. 13. proventil. allergies: the patient an allergy to morphine. social history: prior to his hospitalization, the patient was residing at rehabilitation. he had been previously living with his daughter. was a former pharmacist. he was a former cigar smoker, but had smoked no cigarettes. physical examination: the patient had a blood pressure of 113/58, a heart rate of 81 in atrial fibrillation, a respiratory rate of 32, a temperature of 98.1??????f and an oxygen saturation of 95% on 65% oxygen by bipap. in general, the patient was an agitated, tachypneic male with bipap mask on. on head, eyes, ears, nose and throat examination, we were unable to assess jugular venous distention. the lungs had rales halfway up bilaterally with dry crackles audible halfway up. the patient had discreet decreased breath sounds in the right upper lobe. the heart was irregular with an s1 and s2 and no rubs, murmurs or gallops. the abdomen was soft, nontender and nondistended with good bowel sounds. the extremities had trace lower extremity edema. on neurological examination, the patient was moving all extremities had answered questions with nodes. laboratory data: the patient had a white blood cell count of 14,200, hematocrit of 26.9, platelet count of 150,000 and mcv of 91. prothrombin time was 12.7, partial thromboplastin time was 36.9 and inr was 1.1. there was a sodium of 145, potassium of 3.6, chloride of 100, bicarbonate of 30, bun of 81, creatinine of 2.2 and glucose of 93. alt was 29, ast was 73, alkaline phosphatase was 110 and total bilirubin was 0.3. troponin was greater than 50 and ck was 89. albumin was 3.0, calcium was 8.7, phosphorus was 4.8 and magnesium was 1.8. arterial blood gases were 7.35/69/169. radiology data: a portable chest x-ray revealed bilateral vascular congestion and cephalization with congestive heart failure. electrocardiogram: an electrocardiogram was normal sinus rhythm at 73 beats per minute, borderline left axis and left ventricular hypertrophy by voltage criteria, primary atrioventricular block with a p-r of 210, isolated elevations in avf also seen previously, q waves in leads iii and avf and st depressions in v4 to v6. transesophageal echocardiogram: a transesophageal echocardiogram from showed depressed left ventricular and right ventricular function, 1 to 2+ mitral regurgitation and no clot. hospital course: briefly, the patient is an 83-year-old gentleman with a complex past medical history, who presented with hypoxic respiratory failure in the setting of a recent non-q wave myocardial infarction as well as underlying interstitial lung disease and chronic obstructive pulmonary disease. his hospital course is summarized by systems as follows: 1. pulmonary: the patient was intubated for hypoxic respiratory failure on . he was diuresed for suspected congestive heart failure with a lasix drip. on , a sputum sample revealed methicillin sensitive staphylococcus aureus which was treated with a 14 day course of oxacillin. on , a gallium scan was performed due to a question of amiodarone toxicity versus methotrexate toxicity. no evidence of an acute pulmonary process was seen on the scan. on , a sputum culture revealed infection with pseudomonas and treatment was begun with levofloxacin and ceftazidime. the ceftazidime was later discontinued, as the organism was found to be pansensitive. a repeat sputum culture from again grew out pseudomonas and sensitivities for this were missing or pending. on , a ct scan of the chest revealed bilateral lower lobe pneumonia, small pleural effusions and persistent volume loss on the right; it also revealed unchanged right fibrothorax. throughout his intensive care unit course, the patient continued to produce thick secretions which required frequent suctioning. on , a tracheostomy was performed. the patient had been switched to pressor support of 15 with 7.5 of peep and an fio2 of 50% prior to the tracheostomy. following this procedure, the patient required a switch back to assist controlled ventilation. besides having his pneumonia treated, the patient received lasix and occasional diuril at increasing doses to treat his underlying congestive heart failure. he also was started on albuterol and atrovent metered dose inhalers every four hours as well as flovent four puffs inhaled b.i.d. 2. cardiovascular: as far as his pump function was concerned, the patient was initially treated with intravenous nitroglycerin and lasix drips. he was subsequently weaned off the lasix drip and the nitroglycerin was discontinued. he continued to receive lasix and diuril intermittently. late in his course, as his renal function improved, the patient was started on captopril for afterload reduction. the patient required pressors intermittently during his hospital course, once in the setting of a tachycardia with a questionable left bundle branch block and hypotension. he also required pressors following a hypotensive episode during his tracheostomy on . as for his heart rhythm, he continued in atrial fibrillation and flutter, which was rate controlled without medication. his lopressor was discontinued in the setting of his hypotension. his anticoagulation was discontinued in the setting of an episode of hemoptysis and a hematocrit drop with occult blood positive stool. as far as his coronary artery disease was concerned, following his initial ischemic insult this remained stable with negative cks after the hypotensive episode. the patient was continued on aspirin and lipitor. 3. renal: the patient was status post nephrectomy. his baseline creatinine was 2.2. at its height, the patient's creatinine was 2.4 and then gradually improved over the hospital course to a level of 1.5. the patient had a slight rise in his creatinine after he was started on captopril, but this remained stable. 4. infectious disease: the patient grew methicillin sensitive staphylococcus aureus in his sputum on and was treated with oxacillin for 14 days. he grew pansensitive pseudomonas from his sputum on and was treated with levofloxacin and ceftazidime. the ceftazidime was discontinued. a 21 day course of levofloxacin will be completed on . at the time of discharge, a sputum sample from had grown pseudomonas, for which sensitivities were pending, as well as new gram-negative rod, the identification of which was also pending. in addition, the patient had several episodes of diarrhea and clostridium difficile assays were negative. he had numerous blood cultures, which were negative for growth to date. finally, on , the patient had a slight elevation in his white blood cell count to 11,400. his right internal jugular central venous line was changed over a wire and the tip was sent for culture. this culture was pending at discharge. 5. hematology: the patient was placed on epogen for anemia of chronic disease as well as for anemia of chronic renal insufficiency. he received a total of four units of packed red blood cells for a gastrointestinal bleed. he had no frank blood; however, he had guaiac positive stools. 6. fluid, electrolytes and nutrition: the patient was currently on total parenteral nutrition. he had been receiving criticare tube feeds at a goal of 60 cc/hour, which were held prior to placement of a peg-j tube (gastrojejunal tube) and prior to his tracheostomy. the tube feeds are to be restarted on . the total parenteral nutrition should be discontinued when tube feeds are at 50% of goal. 7. prophylaxis: the patient is receiving 6000 units of heparin and 150 mg of ranitidine in his total parenteral nutrition. subcutaneous heparin and a proton pump inhibitor per the gastrostomy tube should be restarted when the patient's total parenteral nutrition is discontinued. 8. access: the patient has a right internal jugular central venous line, which was placed on . he also has a left radial artery line, which was placed on . his tracheostomy was performed on . his peg-j tube was placed on . he also has a foley catheter and a rectal tube. 9. code status: after a lengthy discussion with the patient's daughter and son, the patient's code status was determined as no cardiopulmonary resuscitation and no defibrillation or cardioversion. they do feel that pressors and tracheostomy are appropriate. 10. communication: the patient's daughter, , and son, , are actively involved in the patient's care. the daughter, , can be reached by cell phone (), at work () or at home (). , the son, can be reached by cell phone (), by pager (), at home () or at work (). condition on discharge: fair. discharge diagnoses: 1. respiratory failure. 2. interstitial lung disease. 3. pneumonia. 4. chronic obstructive pulmonary disease. 5. coronary artery disease. 6. atrial fibrillation. discharge medications: 1. levofloxacin 250 mg intravenous p.o. q.d. (to be discontinued on ). 2. albuterol and atrovent metered dose inhalers every four hours. 3. nystatin swish and swallow 4 to 6 ml p.o. q.i.d. 4. nystatin cream 1% topically b.i.d. 5. flovent four puffs inhaled b.i.d. 6. ativan drip 1 to 10 mg intravenous, titrate to sedation. 7. lipitor 10 mg p.o./p.g. h.s. 8. criticare tube feeds with goal of 60 cc/hour. 9. epogen 3000 units subcutaneous on monday, wednesday and friday. 10. aspirin 325 mg p.o./p.r. q.d. 11. captopril 25 mg p.o./p.g. t.i.d. 12. neo-synephrine gtt, titrate to mean arterial pressure of greater than 65. 13. lactulose p.r.n. 14. dilaudid 1 to 2 mg intravenous p.r.n. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified unspecified septicemia atrial fibrillation acute respiratory failure pneumonia due to pseudomonas unspecified disorder of kidney and ureter postinflammatory pulmonary fibrosis nonspecific abnormal findings in stool contents 

Answer: The patient is high likely exposed to