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: amoxicillin / bactrim / keflex attending: chief complaint: hypercarbic respiratory failure major surgical or invasive procedure: bronchoscopy (x3) / tracheostomy placement history of present illness: hpi: 68yom with cad s/p cabg, mvr, s/p ppm/icd, esophageal ca who presented to osh on with respiratory distress. he was noted to be more lethargic and dyspneic on admission to osh. it was felt that the pt was in chf. he was also noted to be bradycardic at the time of admission (hr 40) and concern for 2nd degree type i heart block per notes. his bp was 80/60 on admission. he was given low dose dopamine and diuretics for his chf and brady/relative hypotension. according to osh notes, the pt's ppm was checked and had back-up rate at 39 bpm and was functioning properly. tte at osh showed ef 50% with mild mr. was also noted to be somnolent with pco2s (79-91) in the prior 48hrs before tx. he was placed on bipap and did well with improvement in pco2 to 49. he was transitioned to nasal cannula and transferred to for futher care. at , the pt was found to be afebrile with stable vs but somnolent on appearance. abg was 7.25/90/111 on 3l nc. given the hypercarbic respiratory failure and somnolent appearance, the pt was transferred to the icu for further care. in the icu the pt was intubated for impending respiratory failure and hypersomnulance. at that time abg was 7.09/137/385. he was then noted to be bradycardic to the 40s and sbps dropped to the 60s. he was bolused 250 cc of ivf and started on dopamine and continuous ivfs. his sbps trended up to the 120s on dopamine. past medical history: 1. cad s/p cabg 3v in 11' ---lima --> lad, svg --> om, and svg --> rca ---ischemic cardiomyopathy (lvef = 40%), s/p icd placement in 2. s/p mitral valve replacement (carbomedics mechanical prosthesis) in 3. atrial fibrillation 4. hypertension 5. diabetes 6. idiopathic pulmonary fibriosis s/p pulmonary rehab at new rehab in ' ---severe restriction on his pulmonary function testing, which is markedly worse than his preoperative tlc of 75% predicted. some of this restriction may reflect worsened fibrotic lung disease or it may be due to some element of pleural thickening releated to his previous problems with pleural effusions as per his pulmonologist. 7. ?amiodarone pulmonary toxicity 8. stage ii esophageal cancer t3, n0, mo, status post xrt, chemotherapy and esophagectomy. ---s/p j-tube and port-a-cath placement on by . ---concurrent radiation therapy and chemotherapy on with infusional 5-fu and cisplatin, completed . ---s/p esophagectomy, by dr. . social history: social history: the patient is married and lives in , ma. he has three children and is a former engineer. he has never smoked and denies ever drinking alcohol. he does not use recreational drugs. family history: family history: denies any h/o cancer, cad. parents died when he was young, unsure of causes. physical exam: physical examination: vs: t 99.1 hr 71 bp 120/64 rr 19 o2 sat 100% ac 400 x 22 fi02 0.5 peep 5 abg 7.43/51/173 gen: intubated male in nad heent: anicteric sclera, intubated neck: supple cardio: rrr, nl s2, loud click heard during s1 pulm: cta b/l abd: soft, nt, nd + bs ext: 1+ pitting edema b/l, cool extremities, unable to palpate extremity pulses pertinent results: osh studies: most recent abg 7.30/78/120 ( at 1350) bicarb 34 bun 94 cr 1.7 (from notes) dig 1.0 () bnp 3700 () wbc 9.4 (from 13.6) hct 36 plt 155 2.0 . labs here: pls see below . ecg: anterolateral twi that were present in previous ekgs, bradycardia with rate of 40, appears to have high grade av block with a junctional rhythm . tte : la: elongated. lv: wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with severe hypo/akinesis of the distal third of the left ventricle. the remaining walls contract well. no masses or thrombi are seen in the left ventricle. rv: chamber size and free wall motion are normal. aortic valve: leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. mitral valve: a bileaflet mitral valve prosthesis is present. the mitral prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. no mitral regurgitation is seen. pulm artery pressure: the estimated pulmonary artery systolic pressure is top normal. pericardium: there is no pericardial effusion. . cardiac cath : 1. selective angiography of this right-dominant system revealed three-vessel and lmca disease. the lmca had a distal 40-50% distal stenosis. the lad had severe ostial and proximal diffuse diseased and was totally occluded after d1. the distal lad filled via left-to-left and right-to-left collaterals. the d1 branch had a 70% stenosis at its ostium. the lcx had a 40% stenosis at the origin of a large om1. the om1 branch had serial 70% lesions proximally and mid vessel with distal luminal irregularities. the rca had a mid-vessel tubular 60% stenosis and a 70% stenosis just before the rpda. there were luminal irregularities in the pda and rpl. 2. entry hemodynamics revealed a central aortic pressure of 140/81 mmhg. the lvedp was 16 mmhg. 3. left ventriculography revealed an ejection fraction of 29%. imaging was suboptimal due to ejection of the pigtail catheter back into the aorta. there was anterobasal hypokinesis, anterolateral akinesis, apical dyskinesis/akinesis, inferior and posterobasal hypokinesis. there was mild to moderate (+) mitral regurgitation. brief hospital course: a/p: 68 yo male with h/o cad s/p cabg, idiopathic pulmonary fibrosis, esophageal cancer, mvr and bradycardia s/p ppm/icd who presented with somnolence, hypercarbic respiratory failure, bradycardia, hypotension and likely urosepsis. pt ultimately developed worsening tracheal secretions, resulting in repeated bronchoscopy, then on developed severe tracheal obstruction, c/b bleeding, resulting in worsening hypoxemia and ultimately pea. acls x 30 min, without recovery. pt pronounced dead at ~10:45 am. * respiratory failure: patient was transferred from an osh for possible pacemaker replacement and had significant respiratory distress at presentation. he had been on bipap at the osh but had worsening hypercarbic respiratory failure upon arrival here. his gas of 7.09/137/385 led to him being intubated. the patient had a h/o of severe idiopathic pulmonary fibrosis, but it was unclear what the underlying insult was. initially cardiogenic vs. septic process was debated. he was covered broadly with vancomycin, levaquin and flagyl to cover for a pna. he was ruled out for mi with three sets of ces. echo was done to evaluate cardiac function and showed nl ef with ? rv strain. cta was then done and was negative for pe. pt was continued on ventilator but did not tolerate psv very well. he also had episodes of tachypnea and tachycardia but these improved with sedation. after d/w the pt and his family he had a trach placed on . he completed 8 days of levaquin to cover for a pna and had sputum cx that had rare growth of coag + staph, but this was thought to be colonization. . . pt continued to have difficulty with tracheal secretions, resulting in repeat bronchoscopy on , and again on . on the monring of pt was noted to have decreased tidal volumes and found to be in respiratory distress with o2 sats of 97% on 100% o2. manual bagging was commenced, an an emergent bronchoscopy was performed which revealed ball-valve clot/soft-tissue obstruction at distal trach with complete luminal occlusion during exhalation. attempts to clear clot with suction or forceps were unsucessful. a cook catheter was passed via trach distal to obstruction allowing ventilation with improvement in o2 sats from 70%->96%, but tidal volumes remained low. an urgent thoracic surgery consult was placed, and collective decision was made to intubate from above. pt subsequently developed progressive hypoxemia and bronch then revealed diffuse bleeding from above and below. pt progresively decompensated, resulting in pea resulting in acls x 30 minutes without recovery of signs of life. case was discussed with wife and decision was made to discontinue ongoing aggressive resuscitation and focus on comfort. acls stooped at ~10:30am,, pt decased ~10:45am. pt declined autopsy, medical examiner made aware. *hypotension/sepsis: pt was hypotensive at admission. he was known to have a uti at the osh, so it was thought that hypotension was potentially to urosepsis. his cxr also showed a consolidation. he was pan cultured at that time and started on vancomycin, flagyl and levaquin at that time. his osh records showed growth of enteroccocus in the urine, sensitive to vancomycin. his cultures here later showed growth of methicillan resitant coag negative staph in a bcx from and enterococcus in the urine on as well. initially it was unclear whether pt's hypotension was to sepsis or cardiac source. as mentioned above he had nl ef and no evidence of cardiac ischemia. svo2 was high , also suggesting sepsis and positive culture data was further c/w this. pt also had a cotrosyn stimulation test and the initial cortisol level was low, so he completed a dose of stress dose steroids for 7 days. he was weaned off pressors over several days. b/c he had bacteremia and sepsis in the setting of a mvr, there was concern for endocarditis. b/c of his h/o of esophagectomy he required egd to evaluate his esophagus and then esophageal dilatation prior to tee. several attempts were made at a tee, but were not successful until . tee was negative for endocarditis and all abx were stopped at that time. his ucx from showed continued growth of enterococcus so foley was changed on and ucx re-checked. *bradycardia: patient was initially admitted to cardiology for w/u of bradycardia and possible pacemaker replacement. ekgs demonstrated several different rhythms from nsr and atrial fibrillation to 2nd degree heart block. ekg here at one point showed bradycardia with high degree heart block and junctional escape rhythm. pacemaker settings were changed by ep on . his back-up rate was changed from 39 to 55. * hypernatremia: na was slightly elevated at around 146 at times. he had free water fluid boluses in his tfs to replace his free h20 defecit. *renal insufficiency: baseline cr in was 0.6-0.9. during his stay his uop dropped and cr slowly trended up. renal u/s was unchanged and urine lytes suggested pre-renal source. he did not respond to fluid boluses and cvps were high. he was then diuresed with good results and only slight elevation in cr. *anemia: hct had been slowly trending down over his admission. he received one unit prbcs on and remained hemodynamically stable after. he had guiac + stools in the setting of being on heparin but had been seen by gi and a decision was made that he did not need to be scoped at this time. he also had some bloody respiratory secretions which could also have contributed to slow loss. his secretions continued to increase, and on frank was found in the trachea at time of emergent bronchcopy described above. * abdominal distension: pt was noted to have abd distension during his stay. he had not had a bm in multiple days, so his bowel regimen was increased. pt had kub that was negative for obstruction and abd distension has decreased after having bms. he was being treated with lactulose, senna and colace. *cad: pt has h/o cad s/p cabg. he was continued on asa and started on a statin. bb was held in the setting of his intermittent episodes of hypotension. *mvr: pt has mvr in place and took coumadin at home. he was started on a heparin gtt at admission. * hematuria: suspect foley trauma in the setting of anticoagulation. appears to be lightening some. good uop so no worry about clot at this time *dm: sugars well controlled with ssi and qid fs. *code status: full code 9 *ppx: ppi, bowel regimen, heparin. . * access: - r subclavian placed - a-line placed . *contact: wife: pcp: medications on admission: medications on transfer: 1. levoflox 250 daily (d#4) 2. digoxin 0.0625 daily 3. diamox 250 daily 4. lopressor 25 tid 5. levoxyl 88mcg daily 6. protonix 40 daily 7. colace 100 . medications at home: 1. lopressor 50 mg once daily 2. digoxin 0.0625 mg daily 3. levothyroxine 88 mcg daily 4. lasix 40 mg b.i.d., 5. warfarin 6. zantac b.i.d. . allergies: amoxicillin / bactrim / keflex discharge disposition: expired discharge diagnosis: respiratory failure / pulseless electrical activity discharge condition: deceased. discharge instructions: none. followup instructions: none. md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine other endoscopy of small intestine diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization temporary tracheostomy bronchoscopy through artificial stoma dilation of esophagus dilation of esophagus diagnoses: urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia iron deficiency anemia secondary to blood loss (chronic) severe sepsis atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status acute respiratory failure septic shock heart valve replaced by transplant hyperosmolality and/or hypernatremia stricture and stenosis of esophagus 

Answer: The patient is high likely exposed to