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: no known allergies / adverse drug reactions attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: mr. is a 76 yo m with h/o cad s/p cabg, dm, htn, ckd (baseline cr ~3), chf with ef 45%, pvd with chronic right 3rd toe ulceration, s/p bioprosthetic aortic valve replacement, who is being transferred from osh for shortness of breath, found to have pneumonia and chf exacerbation. patient was recently discharged from to rehab (newbridge on the ) after admission for falls and uncontrolled diabetes. prior to that he had been living independently at home. during hospitalization at sturdy, his ace inhibitor and bumex were stopped due to worsening renal function. while in rehab, he subsequently developed respiratory distress and hypoxia to 82% on ra. he was admitted to , where he was found to have worsening respiratory failure possibly due to pneumonia or chf. cxr showed likely multifocal bl pneumonia, +/- pulmonary edema. echo showed lvef 40%, moderately depressed lv systolic function, hypokinesis/near-akinesis of at least basal and mid-anteroseptal segments, moderate mr. negative (cpk 100, mb 2.3, trop t 0.129 -> 0.138). ekg unremarkable. bnp . lasix gtt @ 5cc/hr was started with good diuresis (-1300cc on , -1500cc on ) but limited improvement in oxygenation. patient received dose of vanc/azithro/ceftriaxone in ed, then started on azithro and ceftriaxone as inpatient. on transfer to , he is on 100% nonrebreather satting in the 80s, antibiotics and lasix gtt. he is currently normotensive. . on arrival to the ccu, patient is hemodynamically stable, satting in low 90's on 100% nrb. he complains of "weakness" but denies dyspnea. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: -chf (ef 45%), requiring hosp 2 yrs ago -cad s/p cabg ~10 yrs ago -s/p bioprosthetic aortic valve replacement () -ckd (baseline cr 3) -pvd with chronic right 3rd toe ulceration -htn -hld -iddm -anemia requiring multiple blood transfusions, details unknown -frequent falls -hypothyroidism social history: prior to hospitalization and rehab, patient continued to work at the bay teaching appliance maintenance and refrigeration. he has not smoked for more than 50 years. he lives independently with his girlfriend. family history: noncontributory physical exam: admission physical exam: general: elderly m in nad, aaox2.5, slightly confused, poor historian, somewhat tachypneic when talking with examiner heent: perrl, sclera anicteric, mmm, oropharynx clear neck: jvd 6-7cm above clavicle, with positive hepatojugular reflux, carotid pulsations normal lungs: crackles 1/3 up bases without wheezes or rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: 1+ bilateral lower extremity edema warm, well perfused, 2+ pulses, no clubbing, cyanosis. +bruising in bue. neuro: cn??????s grossly intact. +ble flexor/extensor weakness. patient somewhat confused with word finding difficulties. . discharge physical exam: deceased. pertinent results: admission labs: wbc-12.8* rbc-2.49* hgb-7.7* hct-23.6* mcv-95 mch-31.1 mchc-32.8 rdw-16.0* plt ct-235 pt-14.5* ptt-29.7 inr(pt)-1.4* glucose-209* urean-81* creat-2.9* na-142 k-4.1 cl-105 hco3-18* angap-23* alt-65* ast-42* ck(cpk)-83 alkphos-182* totbili-0.4 ck-mb-5 ctropnt-0.13* calcium-8.4 phos-5.0* mg-2.5 vbg: po2-46* pco2-30* ph-7.40 caltco2-19* base xs--4 lactate-2.0 . labs on admission to (): na 132, k 4.9, cl 99, hco3 18, bun 79, cr 3.0, glucose 348, ca 8.1 wbc 12.3 (92% pmns), hct 21.6 (baseline ~25), mcv 97 inr 1.1 alt 92, ast 92, ap 254, tbili 0.77, albumin 2.6 lactate 2.1 bnp 38,000 cpk 100, mb 2.3, trop t 0.129 -> 0.138 (5:30am on ) ua: trace blood, protein 30, glucose 100, no wbcs a1c recently 9.0 abg (, 5:50 pm): 26/62/18.5 . cxr (, ): the patient is status-post cabg and median sternotomy wires are intact. there is diffuse air space opacity overlying the right hemithorax and portions of the left hemithorax with sparing of the left lung apex and upper lobe. the opacity obscures the cardiomediastinal silhouette. there is no pneumothorax or large pleural effusion. impression: bilateral air space opacities, worse on the right. in the proper clinical scenario, these are consistent with multifocal pneumonia. less likely, this would represent pulmonary edema. . cxr (): bilateral pulmonary edema and possible bilateral infiltrates, pleural effusion on left. . ekg (, ): nsr at a rate of 74 beats per minute, normal axis, qtc of 495, minimal st depression in v5 alone. . ekg (): st depressions v4-v6 . echo (, ): dilated. ra moderately dilated. normal lv wall thickness and cavity size. mild/moderate regional lv systolic dysfunction with hypokinesis of the basal and mid anteroseptal segments. due to suboptimal technical quality, additonal focal wall motion abnormalities cannot be fully excluded. overall lv systolic function is moderately depressed (lvef= 40 %). there is abnormal septal motion/position. a bioprosthetic aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. trace aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is severe mitral annular calcification. moderate (2+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: biatrial enlargement. normal left ventricular cavity size and wall thickness with moderately depressed left ventricular systolic function and hypokinesis/near-akinesis of at least the basal and mid anteroseptal segments. right ventricle not well-visualized. well-seated, normally functioning bioprosthetic aortic valve. at least moderate mitral regurgitation in the setting of severe mitral annular calcification. mild pulmonary artery systolic pressure. . eeg (): impression: this is an abnormal continuous icu video eeg because of frequent bursts of generalized periodic epileptiform discharges at 1-1.5 hz in the beginning of the recording which became prolonged induration by the afternoon. these do not have any clinical correlation. in between bursts of gpeds, the background remains slow and disorganized at a maximum of 5 hz posteriorly indicative of moderate diffuse encephalopathy. during the recording, frequent right arm and leg writhing movements that are sometimes generalized are seen, associated with grunting at times, and do not have any electrographic correlate or clear association with gpeds. no clear electrographic seizures are present in this recording. compared to the previous day, there is no significant change. brief hospital course: primary reason for hospitalization: 76 yo m with h/o cabg, dm, htn, ckd (baseline cr ~3), systolic chf with ef 40-45% who is being transferred from osh for shortness of breath, found to have pneumonia and chf exacerbation thought to be due to pneumonia and cessation of lasix. active diagnoses: # s/p pea arrest: cardiac arrest most likely occurred in the setting of hypoxia; he was pulseless for about 5 minutes. cooling protocol started overnight on , goal temperature reached at 23:30, rewarming started at 23:30 and complete on at 3pm - will be able to get a better idea of neurological prognosis now that pt is warmed and off all sedation. currently he opens eyes to voice, intermittently responds to commands, has brisk cough/gag reflexes. pressors have been weaned down and pt is now only on minimal dose of levophed (have been unable to entirely wean as maps drop to 50s when levophed is stopped). he was extubated 3 days s/p arrest. his neurologic status however continued to decline, with increased epileptiform activity and increased seizure activity, despite being on 2 antiepileptics. #.hypoxia/respiratory distress: ct chest on consistent with ddx of multifocal pna vs chf given pulmonary edema and effusions. on broad spectrum abx for hcap. echo c/w prior from report (ef 50-55%). had been on nrb, but after hypoxic pea arrest, was intubated. lasix gtt and torsemide were discontinued due to creatinine bump (now 4 up from baseline 3). also started on isordil for afterload reduction on . patient was ventilating and oxygenating well on on spontaneous breathing trial, so was then extubated. he was continued on iv vancomycin, levoquin and cefepime for possible multifocal pneumonia and finished an 8 day course, after which he was started on vanc/zosyn because he spiked a temperature to 102f despite abx. respiratory status continued to worsen after extubation with respiratory alkalosis. after family meeting, it was decided based on overall prognosis that it would be best to not intubate. he passed away the day after making him cmo. #.cad s/p cabg: troponin was mildly elevated on admission and stable, likely ckd and demand ischemia from underlying infection. rechecked on in setting of pea arrest, mildly elevated at 0.09. he was maintained on asa 325mg po daily, atorvastatin 40mg per outpatient cardiologist. his carvedilol was held in the setting of hypotension. #.metabolic derangements: pt had primary respiratory alkalosis with metabolic compensation after pea arrest; normalized once respiratory rate normalized. pt also hyperphosphatemic today . had ag, but could be from renal failure and uremia. #.ckd: creatinine 4s throughout (baseline 3.0). his acei was held. #.anemia: etiology unclear, thought initially to be transfusion dependent per report, but pt, his partner and son deny any transfusions for 2 years. baseline hct ~25. transfused 2 units prbc on for hgb 7, guaiac neg stools. #.iddm: blood sugars difficult to control, was on insulin gtt prior to code and now less likely to absorb sc insulin given cooling so insulin gtt restarted. his insulin drip was increased while he was getting d5w. #.hypertension: holding antihypertensives while on pressors. patient is on hydralazine, amlodipine, and accupril at home. #.hypothyroidism: continued home levoxyl. patient passed away at 8:33am , seen asystolic on telemetry. no heart sounds or breath sounds, pupils nonreactive. family notified, autopsy declinded, death certificate filled out. medications on admission: home meds: amiodarone 100 mg daily. amlodipine 5 mg daily. calcium 1300 mg daily. vitamin d3 1000 units daily. lantus 10 units at bedtime. humalog insulin sliding scale. levoxyl 75 mcg daily. tylenol 650 mg q.4 h. bisacodyl rectal suppository daily. senna 2 tablets daily. . meds on transfer: lasix gtt @ 5cc/hr azithromycin 250mg iv daily (start date ) ceftriaxone 1g iv q24 hrs (start date ) novolog senna 2 tabs po daily vitamin d 1000 u po daily calcium carbonate 500mg po daily amlodipine (norvasc) 5mg po daily asa 325mg po daily heparin 5000mg sc tid lantus novolog levothyroxine 75 mcg po daily amiodarone 200mg po daily discharge medications: n/a discharge disposition: expired discharge diagnosis: n/a discharge condition: n/a discharge instructions: n/a followup instructions: n/a md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: pneumonia, organism unspecified acidosis congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other convulsions chronic kidney disease, unspecified ulcer of other part of foot acute respiratory failure long-term (current) use of insulin heart valve replaced by transplant encephalopathy, unspecified hyperosmolality and/or hypernatremia acute on chronic systolic heart failure atherosclerosis of native arteries of the extremities with ulceration 

Answer: The patient is high likely exposed to