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: penicillins attending: chief complaint: aortic aneurysm major surgical or invasive procedure: replacement of ascending aorta and non-coronary cusps, resuspension of aortic valve and coronary artery bypass grafting x1 (vein graft to right coronary aretry) picc line placement picc line replacement of present illness: mr. is a 55 year old gentleman with a family history which is signifiacnt for his mother and brother dying from aortic root aneurysms. he subsequently went to see his primary care physician for screening which revealed an enlarged ascending aorta. he was subsequently referred to dr. for surgical management. a cardiac catheterization was performed in preparation for surgery which revealed right coronary artery disease. past medical history: hypertension hypercholesterolemia gastroesophageal reflux disease past tracheostomy past hernia repair social history: lives with fiance in , ma. drinks 3 drinks weekely. quit smoking 5 years ago. he is a salesman. family history: mother died at 69 of aortic dissection brother died at age 57 of aortic dissection father with cabg in his 60's physical exam: 72 sinus bp: (r) 152/90 (l) 161/86 weight 220 gen: well appearing male in nad skin: normal without lesions heent: perrl, eomi, anicteric sclera, op benign neck: supple, no jvd, old tracheostomy scar lungs: clear heart: rrr, i/vi systolic murmur abd: benign extremities: warm, dry, no edema. no varicosities. 2+ pulses throughout neuro: cranial nerves grossly intact. no focal deficts pertinent results: 05:40am blood wbc-12.5* rbc-4.26* hgb-12.4* hct-38.3* mcv-90 mch-29.0 mchc-32.2 rdw-15.8* plt ct-781* 04:02am blood pt-19.8* ptt-36.5* inr(pt)-2.5 05:40am blood glucose-113* urean-27* creat-1.5* na-134 k-4.8 cl-102 hco3-20* angap-17 03:04pm blood alt-38 ast-46* alkphos-130* amylase-32 totbili-1.6* 08:00am blood cortsol-21.2* 08:00am blood tsh-1.5 bedside swallowing the pt's oropharyngeal swallowing function is within normal limits. a diet of thin liquids and ground solids is recommended. ground solids recommended for now d/t pt easily fatigued and periodically confused. he may not be able to take in enough at meals to maintain nutritional/caloric needs and may consider supplements between meals such as boost shake and/or boost pudding. upgrade to regular solid diet consistency when pt is more awake, less fatigued. ct scan 1) left psoas hematoma. 2) abnormal soft tissue surrounding the sternotomy site and in the retrosternal region. infection is not excluded, 3) status post ascending aortic repair. cxr 1) persistent left pleural effusion, with bilateral lower lobe atelectasis. 2) appearance of sternotomy wires suggesting sternal dehiscence. abdominal ultrasound 1. echogenic liver consistent with fatty infiltration. other forms of liver disease, including more significant hepatic fibrosis or cirrhosis, cannot be excluded on the basis of the present examination. 2. sludge within the gallbladder, without evidence of cholecystitis or biliary dilatation. neurophysiology abnormal portable eeg due to the slow and disorganized background and bursts of generalized slowing. these findings indicate a widespread encephalopathic condition affecting both cortical and subcortical structures. medications, metabolic disturbances, and infection are among the most common causes. no epileptiform features were evident. head ct no evidence of hemorrhage or infarction ospital course: mr. was admitted to on for surgical management of his aortic aneurysm. he was taken to the operating room where he replacement of his ascending aorta and non-coronary cusp with a 26 mm gel weave graft, resuspension of the aortic valve and coronary artery bypass grafting to one vessel (right coronary artery). postoperatively he was taken to the cardiac surgical intensive care unit for monitoring. on postoperative day one, mr. was extubated however required reintubation for hypotension. he developed bilateral upward eye deviation and twitching over the right arm. the stroke service was consulted who recommended starting dilantin and obtained an electroencephalogram eeg). the results of the eeg were negative for seizure activity. a head ct scan was obtained which was negative for an acute bleed or infarction. further metabolic studies were negative. his dilantin was subsequently discontinued and ativan was used for agitation. as mr. had a history of heavy alcohol use, it was assumed that he may be suffering from symptoms of withdrawal. ativan and haldol were thus used to keep mr. e. the pulmonary service was consulted for hypoxemia. adjustments were made to his ventilator with improvement. on postoperative day three, mr. developed junctional tachycardia versus atrial fibrillation. atrial pacing was started over his native rate and catecholamine infusions were avoided. beta blockade was also started. as he was still intubated, tube feeds were started for nutritional support. mr. developed a fever on postoperative day five for which he was pancultured and intravenous vancomycin was started prophylactically. as his sputum grew gram negative and positive rods as well as gram positive cocci, levofloxacin and flagyl were added. the infectious disease service was consulted for assistance with his care. as mr. continued to have fever , abdominal ultrasound was performed to rule out another source. this revealed hyperinflation of the liver, gallbladder sludge and no evidence of cholecystitis. a chest ct scan was performed which did not show any evidence of pneumonia or pulmonary embolism however a thrombus was noted in his left subclavian vein. heparin and coumadin were thus started for anticoagulation. he continued to have periodic agitation related to his alcohol withdrawal. as mr. to normal sinus rhythm, and his pacing wires were removed. he ventilator continued to be very slowly weaned given his postoperative respiratory failure. his vancomycin and levofloxacin were discontinued after 14 days. flagyl was continued to complete fourteen days given his diarrhea however c. difficile cultures were negative. mr. had a slight elevation in his creatinine and natrecor was started. the physical and occupational therapy services were consulted and continued to follow him throughout his postoperative course. on , mr. was extubated successfully. a picc line was placed as he had difficult venous access. a bedside swallow evaluation was performed given his extended intubation which showed him to be swallowing within normal limits. he continued to have periods of agitation for which clonopin was added to his medications. the psychiatry service was consulted who recommended to add seroquel at bedtime and haldol as needed. mr. developed a sternal click on postoperative day 16 and strict sternal precautions were instituted. a repeat ct scan showed interval separation of the sternal bone with associated high-attenuation fluid most likely hematoma, superimposed infection cannot be ruled out although no significant associated stranding or air and an incompletely evaluated rounded density in the left paraspinal region inferior to the crus of the diaphragm. it did not appear to be arising from the neural foramen and further evaluation with contrast ct or mr was recommended. an abdominal ct scan showed a psoas hematoma but otherwise no abnormalities. mr. redeveloped atrial fibrillation for which his beta blockade was increased and amiodarone was started. the wound care service was consulted for evaluation and management of a left and right gluteal pressure ulcer. duoderm and padding were applied with good effect. mr. status slowly improved and his clonopin was tapered off. on postoperative day 21, he was transferred to the cardiac surgical step down unit for further recovery. he continued to be gently diuresed towards his preoperative weight. his creatinine peaked at 1.8 and stabilized between 1.3-1.6. the electrophysiology service was consulted given his atrial fibrillation / atrial flutter and cardioversion was recommended. on , mr. successful cardioversion. coumadin was continued with a goal inr of 2.0-3.0. amiodarone was recommended to be continued at 400 mg three times daily for five days and then 400 mg daily for six weeks. liver enzymes should be followed while on coumadin and amiodarone. mr. sternum remained unstable however his wound remained intact and it was therefore decided to leave it alone. he continued to make steady progress and was discharged to his home on postoperative day twenty four. he will follow-up with dr. , his cardiologist, his primary care physician and the social worker as an outpatient. of hearts monitor, with strips to be sent to dr. . medications on admission: aspirin 325 mg daily prilosec 20 mg daily toprol 25 mg daily viagra prn discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*90 tablet, delayed release (e.c.)(s)* refills:*4* 2. warfarin sodium 1 mg tablet sig: two and a half tablet po as directed by physician: on discharge is 2.5mg daily. please take as instructed by dr. . adjust for goal inr 2.0-3.0. please separate several tablets into halves for patient. disp:*60 tablet(s)* refills:*2* 3. fluticasone propionate 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*1 months supply* refills:*2* 4. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 5. amiodarone hcl 200 mg tablet sig: two (2) tablet po three times a day: take 400mg three times a day until , then take 400mg once daily thereafter for a total of 6 weeks. disp:*108 tablet(s)* refills:*0* 6. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 7. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. disp:*1 mdi* refills:*0* 8. seroquel 25 mg tablet sig: 1-2 tablets po at bedtime as needed for anxiety/sleep. disp:*20 tablet(s)* refills:*0* discharge disposition: home with service facility: community vna discharge diagnosis: ascending aortic aneurysm with coronary artery disease. alcohol withdrawal respiratory failure postoperatively sternal dehissence atrial flutter gluteal ulcer discharge condition: good discharge instructions: please monitor vital signs. report any tachy/bradycadia, fever greater then 100.5 or hyper/hypotension. please report any weight gain greater then 2 pounds in 24 hours. monitor wounds for signs of infection. these include redness, drainage or increased pain. no driving a car for 4 weeks from surgery date. strict sternal precautions for 8 weeks. no lifting any weight greater then 10 pounds. no bathing or swimming for 2 weeks from discharge. you may shower. duo derm to gluteal ulcer with foam padding until healed. it is strongly recommended that you do not consume any alcoholic beverages. drinking alcohol with coumadin can be lifethreatening. p instructions: dr. in 4 weeks. dr. in 2 weeks dr. in 2 weeks. you will need a repeat ct scan with contrast or an mri for further evaluation of an incompletely evaluated rounded density in the left paraspinal region inferior to the crus of the diaphragm. , licensed social worker as needed. her card has been provided. please call for appointments and keep your appointments. follow-up is crucial to your recovery. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery enteral infusion of concentrated nutritional substances other electric countershock of heart (aorto)coronary bypass of one coronary artery resection of vessel with replacement, thoracic vessels suture of vein transfusion of packed cells operations on other structures adjacent to valves of heart diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery thoracic aneurysm without mention of rupture atrial fibrillation disruption of internal operation (surgical) wound aortic valve disorders accidental puncture or laceration during a procedure, not elsewhere classified pressure ulcer, buttock diarrhea other and unspecified alcohol dependence, unspecified systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction alcohol withdrawal 

Answer: The patient is high likely exposed to