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: lovastatin attending: chief complaint: , afib with rvr major surgical or invasive procedure: none history of present illness: patient is an 80 yo cantonese man with pmhx significant for dmii, esrd on hd, htn, cad, paf with multiple recent hospitalizations for enterococcus urosepsis ()and of unknown source () who presents today with , chills, nausea, vomiting and diarrhea. patient was first hospitalized with enterococcus uti in early and was treated with 7 days of augmentin. he then returned a week later with and chills and had negative w/u including lp, head ct, abd/pelvic ct, mycotic culture, mycobacteria culture, urine culture, sputum culture, c.diff and blood cultures were all negative. thin/thick smear was negative for parasites. additionally, u/s negative for abscess/fluid collection at fistula site, cxr which showed a questionable right middle lobe pneumonia, however ct chest showed no evidence of pneumonia, and tte which showed no evidence of endocarditis. patient was given 4 days of antibiotics in total and then monitored. patient did not have thereafter and was discharged. patient was in his usual state of health until this am when he woke up with chills, weakness and some mild respiratory distress without cough. initial vs in the ed were t 100.4-->102.3 rectally, hr 122-150, bp 162/66, 93% ra. in the ed, he had episode of non-bloody emesis and brown guaic negative diarrhea. otherwise, patient denies dizziness, headache, neck stiffness, cough, sob, cp, abd pain, muscle/joint pain or diarrhea or vomiting at home. patient was also noted to have petechial on his right arm which was thought to be old per his nephrologist who knows the patient. prior to this knowledge there was concern that the could be sign of meningococcemia and he was given a dose of vancomycin and ceftriaxone. patient also had afib with rvr to 140s in the ed during the time when he was vomiting and nurses were trying to place iv access. he did not receive av nodal blocking agents but his hr came down to low 100s with ivf x 2.5 liters in total. patient also received 2 grams of magnesium. renal consulted in ed and plan to dialyze patient today. on presentation to icu, intial vs were: t 99.1, bp 106/49, hr 91, o2 sat 100% on 3 liters. patient reported feeling weak and tired but otherwise had no complaints. past medical history: 1. cad - reported as single vessel disease s/p catheterization in following ett-mibi demonstrating an inferolateral perfusion defect. mid lcx was stented with a drug eluting stent with successful rescue of the om1 with balloon angioplasty. 2. diabetes mellitus type ii - for more than 30 years. has nephropathy and proteinuria, as well as mild distal neuropathy. 3. atrial fibrillation - paroxysmal atrial fibrillation diagnosed in . on long-term anticoagulation. 4. hypertension 5. history of gi bleed - history of gastric ulcers. presumed lower gi bleed on . 6. chronic renal insufficiency - probable diabetic nephropathy. 7. sleep apnea 8. musculoskeletal problems: (a) bilateral severe carpel tunnel (b) polyneuropathy of hands (c) right flexor tendon nodules/ contracture (d) oa of dips, pips, and 1st cmc (e) gout - recent admission in for gout flair. (f) pseudogout. (g) osteopenia social history: mr. is cantonese speaking. he lives at home with his wife. has a remote 20-year history of tobacco smoking. he quit 20 years ago. no alcohol or illicit drug use family history: both parents deceased. father had diabetes. he has 2 children who are well and no siblings. . physical exam: vs: temp 99.1 : bp: 106/49 hr: 91 rr: 16 o2sat 100% on 3 liters nc gen: sleepy but easily arousable and appropriately answering questions, pleasant, comfortable, nad heent: ncat, perrl, eomi, anicteric, mmm, op without lesions neck: no supraclavicular or cervical lymphadenopathy, jvp 7-8 cm, no carotid bruits, no thyromegaly or thyroid nodules, neck supple w/ no pain on movement in all directions or cervical spine tenderness resp: bibasilar crackles, no wheezes or rhonchi cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e, warm, good pulses skin: right arm- non-blanching macular , red, non-tender neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. rectal: guaic negative in ed pertinent results: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 07:40am 10.3 3.75* 12.2* 37.5* 100* 32.6* 32.5 15.0 170 06:25am 11.2* 3.54* 11.5* 35.7* 101* 32.5* 32.2 14.2 155 11:21pm 11.8* 3.57* 11.4* 35.5* 99* 32.0 32.2 14.7 157 08:50am 14.5* 3.98* 12.7* 39.5* 99* 32.0 32.3 15.5 222 . renal & glucose glucose urean creat na k cl hco3 07:40am 140* 36* 2.9* 138 4.6 100 29 06:25am 136* 43* 3.3* 143 4.2 104 29 11:36am 234* 29* 2.7* 141 4.6 105 26 11:21pm 80 21* 2.3* 144 4.2 108 29 08:50am 144* 49* 4.0* 142 5.2*1 105 25 . 8:40 am influenza a/b by dfa source: nasopharyngeal aspirate. **final report **: negative for influenza a & b viral antigen . no growth on blood cultures x 2 no growth on urine culture . legionella urinary antigen (final ): negative for legionella serogroup 1 antigen brief hospital course: assessement/plan: pt is an 80 yo man with pmhx cad, esrd on hd, dm2, htn, paf admitted with fevers, developed vomiting in the ed, now with no further episodes of fevers. . # : pt with history of without known source despite extensive workup in , also in 2 other times during . admitted with a significant , however no further episodes during hospitalization. had a one day stay in the micu due to ?sepsis. pt did not develop any localizing signs without growth on blood or urine cultures, influenza & legionella antigens negative. ?drug with allopurinol, also no evidence of malignancy on imaging done. possibility that fevers may be related to dialysis as they started soon after initiation of hd, although no evidence of infection at av graft site. pt received an empiric course of antibiotics including vancomycin, flagyl & levaquin for a total of 3 days. pt did not have any further episodes of fevers during hospitalization. . # afib with rvr: episode of rvr on admission which resolved with single dose of metoprolol 5mg iv; also repeat episode in association with hypoglycemia and resolve with correction of metabolic derangement. uptitrated metoprolol dosing from 37.5mg to 50mg tid during hospitalizaton. pt also on coumadin, although inr slightly subtherapeutic at discharge. . # cad: no evidence of ischemia per ekg, pt without symptoms of chestpain or shortness of breath. continued aspirin, atorvastatin and increased metoprolol as above. held isosorbide mononitrate on admission but restarted prior to d/c. . # esrd: pt had 2 sessions of hemodialysis while on admission. usually with hd tues/thurs/sat. nephrology followed closely, continued pt on nephrocaps. . # h/o gout: significant gout, closely followed by rheumatology outpt. pt was continued on home regimen allopurinol and methylprednisolone. no acute issues while in house. . # dm: was labile initially during admission with an episode of hypoglycemia overnight on lantus 6u and sliding scale humalog. fsg ac & hs, diabetic diet. pt was changed to home regimen of levemir & novolog prior to discharge. . pt reached maximal hospital benefit and was discharged home to follow up with pcp. medications on admission: 1. isosorbide mononitrate 30 mg qd 2. allopurinol 200 mg tablet qd 3. metoprolol tartrate 37.5 mg tablet 4. methylprednisolone 8 mg qd 5. levothyroxine 75 mcg qd 6. folic acid 1 mg qd 7. atorvastatin 10 mg qd 8. aspirin 81 mg qd 9. protonix 40 mg qd 10. coumadin 2.5 mg tablet sig: one (1) tablet po 2days/week: take 2.5mg 2days per week. 11. coumadin 2.5 mg tablet sig: 0.5 tablet po once a day: please take 1.25mg 5 days per week. 12. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual up to 3 times as needed for chest pain: place under tongue for chest pain as needed. 13. levemir 100 unit/ml solution sig: sixteen (16) units subcutaneous at bedtime. 14. novolog 100 unit/ml solution sig: per sliding scale subcutaneous refer to sliding scale three days per day. 15. renal caps 1 mg capsule sig: one (1) capsule po once a day. discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 3. allopurinol 100 mg tablet sig: two (2) tablet po daily (daily). 4. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 5. methylprednisolone 8 mg tablet sig: one (1) tablet po daily (daily). 6. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 8. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 11. nitroglycerin 0.4 mg tablet, sublingual sig: tablet sublingual as directed as needed for chest pain. 12. levemir 100 unit/ml solution sig: sixteen (16) units subcutaneous at bedtime. 13. novolog 100 unit/ml solution sig: one (1) units subcutaneous before meals & at bedtime: per sliding scale. 14. warfarin 2.5 mg tablet sig: 0.5 tablet po 5x/week (mo,tu,we,fr,sa). 15. warfarin 2.5 mg tablet sig: one (1) tablet po 2x/week (,th). 16. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain, . 17. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 18. bacitracin 500 unit/g ointment sig: one (1) tube topical twice a day: apply thin layer of ointment over affected area. disp:*1 tube* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: of unknown origin atrial fibrillation diabetes ii hypertension gout discharge condition: stable, afebrile 96.8f discharge instructions: you were admitted with high fevers which resolved after admission. we did not find the source of your fevers. you received antibiotics for 3 days. you developed a very fast heart rate, we increased your metoprolol to control your hr. . we have made some changes to your medications. please increase your metoprolol to 50mg three times daily. you may continue to take your other medications as prescribed. . please call or come to the ed if you develop chestpains, shortness of breath, high fevers or any other worrisome concerns. followup instructions: provider: , m.d. date/time: 11:10 provider: , md phone: date/time: 8:30 provider: , dpm phone: date/time: 10:40 procedure: hemodialysis diagnoses: end stage renal disease coronary atherosclerosis of native coronary artery gout, unspecified atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of insulin long-term (current) use of anticoagulants osteoarthrosis, unspecified whether generalized or localized, site unspecified diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to