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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath major surgical or invasive procedure: intubation x2 picc line placement history of present illness: 67y/o m with a pmh of dm type 2, mechanical (), ascending aorta repair with graft (),cad, s/p cabg,hx of vf arrest s/p aicd , recurrent high grade cons and vre bsi s/p removal of leads who presented to with shortness of breath. he was discharged from team on , and presents again complaining of shortness of breath. . his last admission was primarily for pseudomonas urosepsis, which was complicated by acute pulmonary edema in the setting of systolic heart failure s/p intubation x3. exacerbations are thought to be secondary to hypertension and not acute ischemia. overall he was diuresed >12kg during that admission, and discharged to on . . on , he presented from to complaining of suddent onset dyspnea when he woke up this morning. on arrival to osh ed, abg 7.36/47/68. he was placed on cpap en route, and received 80mg iv lasix, with 100cc urine output. . he was started on dopamine at osh ed at 10/hour, and transitioned to levophed at osh icu. levophed was 5mcg/min, and patient had systolic bps in 90s. he got 500mg gentamicin x1. he was transitioned to 50% venti mask, and transferred to at patient's request. . currently, patient continues to feel short of breath. he denies any chest pain, palpitations, fevers, or chills. he denies any dysuria or urinary frequency. last bm yesterday. no diarrhea. . on review of systems, s/he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. s/he denies recent fevers, chills or rigors. s/he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, palpitations, syncope or presyncope. past medical history: cad s/p cabgx3 - h/o vf arrest s/p icd placement; required explantation for mrsa pocket infection with reimplantation , s/p lead removal - mechanical , . , - ascending aorta repair c graft - chf (ef 20% per tte ) - high grade cons bacteremia in c/b high grade cons, vre bactermia while on vancomycin , s/p 4 weeks daptomycin and explantation of icd leads - pseudomonas uti s/p cefepime x 14 days, now pseudomonas uti s/p meropenem x 14 days - r lateral foot ulcer s/p debridement s/p zosyn x 14 days - dm2 c/b neuropathy - hep c (dx , 2.38 million iu/ml. seen by hepatology, note emphasizes deferring ifn/ribavirin tx for now given infections, etc.) - htn - hlp - pvd s/p l bka - hypothyroidism - h/o opiate dependence, ?benzo dependence - acute on chronic sdh, - h/o r scapula fx - h/o mrsa elbow bursitis, - h/o closed bimalleolar fx s/p repair, removal of hardware social history: lives in , though has been in rehab for much of the past few months. former cab driver. social history is significant for the current tobacco use of 40 pack years. there is no history of alcohol abuse or recreational drug use. lives with common-law wife of 35 years who is a home health aid. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: t=97.7 bp=115/57 on 0.03 of levophed hr= 86 rr=20 o2 sat= 100% on 12l ventimask general: wdwn m clearly short of breath. oriented x3. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple. jvp difficult to assess body habitus, however appears to be just under the mandible. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no murmurs. no s3 or s4. lungs: labored breathing. diffuse bilateral rales bilaterally. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: warm well perfused. 1+ le edema bilaterally. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: 2:43p . ua: leuk lg bld lg nitr neg prot 100 glu neg ket neg rbc >1000 wbc >1000 bact many yeast none epi 0 . 05:35a 135 98 28 agap=11 ------------ 110 3.8 30 1.1 ca: 8.5 mg: 2.3 p: 3.3 . 7.8 5.2 ------ 213 24.9 . pt: 20.8 ptt: 85.1 inr: 1.9 osh ekg : nsr @ 61bpm. lbbb. no st segment changes. cxr on admission findings: as compared to the previous radiograph, the signs evocative of pulmonary edema have slightly decreased. however, today's image shows a typical presentation of mild-to-moderate persisting pulmonary edema with cardiomegaly, increased vascular markings, increased reticulations and a borderline width of the right mediastinum. minimal blunting of the left costophrenic sinus but cannot exclude the presence of a small pleural effusion. no focal parenchymal opacities have newly occurred. unchanged alignment of sternal wires after sternotomy. status post valvular replacement. the picc line projects with its tip over the superior svc. brief hospital course: 67y/o m with a pmh of dm type 2, mechanical (), ascending aorta repair with graft (),cad, s/p cabg, hx of vf arrest s/p aicd , recurrent high grade cons and vre bsi who presents with acute onset shortness of breath and hypotension, found to be in acute exacerbation of chronic systolic and diastolic chf with flash pulmonary edema x2 requiring ventilation. . # chf exacerbation with episodes of flash pulmonary edema: patient presented with fluid overload, exacerbation of well known systolic and diastolic chf (ef 20%). med nonadherence unlikely as pt presented from rehab facility. patient was diuresed aggressively with lasix gtt, and was initially on nitrates for vasodilation. however, when pt's sbp>100, he had flash pulmonary edema and needed intubation two times during this admission. captopril was initiated (in place of his lisinopril, which was initially held for low bp) with the goal of aggressive afterload reduction, and pt was maintained at sbp<100. patient was also initiated on torsemide and diuril prn (received 1 dose so far) after lasix drip was d/c'ed to keep him negative 0.5-1l/day to prevent volume overload and flash pulmonary edema. <<*****he should continue to be diuresed to his dry weight on torsemide and diuril prn.*****>> patient's flash pulmonary edema is also suspected to be related to vagal episodes with straining for bowel movements, and he is on an aggressive bowel regimen, which should only be decreased if the patient develops diarrhea. <<*****please maintain aggressive bowel regimen.*****>> <<*****please do not hold anti-hypertensive regimen (captopril, metoprolol) for sbp <80. patient has flash pulmonary edema with sbp >100.*****>> . # hypotension: bp 80s/50s at osh, on levophed initially, then weaned off. initially believed to be acute pulmonary edema and poor forward flow vs. sepsis (as pt had recent urosepsis and recently completed a 14 day course of meropenem for pseudomonas uti). ucx grew klebsiella, bcx were negative, patient was treated with meropenem. patient appears to live with sbp in 80's - 90's. in fact, pt had flash pulmonary edema when sbp>100, and patient's goal sbp was <100 while in-house. see above for course of medication changes with pt's low bps. . # cad s/p recent cardiac cath: patient has known cad s/p cabg. recent cath showed 2vd, patent lima to lad, and diastolic dysfunction. no interventions were performed at that time. pulmonary edema not believed to be acs, as negative cath 4 days prior to admission, without acute ekg changes, and essentially negative ces. pt was continued on home aspirin, statin. bb and lisinopril was initially held in the setting of hypotension initially, then re-started on metoprolol as sbp stable in 80's-90's. lisinopril was changed to captopril for afterload reduction, being discharged on 27.5mg tid. . # s/p mechanical : pt was discharged on heparin gtt just prior to re-admission, inr initially sub-therapeutic on coumadin (and heparin gtt). inr became supra-therapeutic and coumadin was held, then re-started and half dose with goal inr 2.5 - 3.5. heparin bridge continued until inr in therapeutic range prior to discharge. . # r leg ulcer - s/p surgical debridement by vsurg . wound vac placed . wound vac removed and leg was wrapped, vascular was re-consulted prior to discharge and stated pt can bear weight on the r leg. . # dm2 - on ssi with home glargine 120 u qhs. . # ?vision changes: ophtho was consulted for c/o ?decreased vision; pt has cataracts os>od, no gross abnormalities, will need to keep his f/u with ophtho at . . # hep c - per hepatology, deferred tx in-house, may need outpt reassessment in the future. . # h/o vf - pt does not have working pacer/icd at this time persistent bacteremia that led to lead removal earlier this year. no indication for pacer/icd placement in-house, may need to be re-assessed for one in the future. . # h/o hypothyroidism - pt not on thyroid replacement as outpatient. last tsh wnl. . . *** please do not hold anti-hypertensive regimen for sbp <80. patient has flash pulmonary edema with sbp >100. . *** please maintain aggressive bowel regimen. . *** please continue diuresing -1l/day. attempting to diurese to dry weight. medications on admission: amiodarone 200 mg po daily atorvastatin 40 mg po daily furosemide 80 mg po bid gabapentin 600 mg po tid insulin glargine 120 units qhs humalog ssi levetiracetam 500 mg po qhs lisinopril 2.5 mg po daily metoprolol tartrate 12.5mg po daily nitroglycerin 0.4 mg sl prn cp oxycodone-acetaminophen -1 tab po q4-6h prn pain potassium chloride 40 meq po daily ranitidine 150 mg po bid warfarin 4-6 mg po qhs maalox qid prn indigestion aspirin 81 mg po daily bisacodyl, senna ativan 0.5-1mg po q6h prn anxiety ferrous sulfate 325mg po daily heparin gtt (for inr<2.5) torsemide 20mg po bid at 8am and 2pm discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po bid (2 times a day): hold for diarrhea. 4. amitriptyline 10 mg tablet sig: one (1) tablet po hs (at bedtime). 5. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 8. captopril 25 mg tablet sig: two (2) tablet po tid (3 times a day): hold for sbp< 85. 9. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. outpatient lab work please check inr daily with chem-7, cbc every other day 12. heparin (porcine) in d5w 25,000 unit/250 ml parenteral solution sig: per weight based protocol units intravenous continuous: d/c after inr >2.5 for 48 hours. 13. lorazepam 0.5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for anxiety: please offer every 4 hours and give if pt seems anxious. 14. levetiracetam 500 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 15. gabapentin 400 mg capsule sig: one (1) capsule po q8h (every 8 hours). 16. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: titrate per the instructions. 17. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 18. acetaminophen 500 mg tablet sig: two (2) tablet po every eight (8) hours as needed for pain. 19. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po bid (2 times a day) as needed for constipation. 20. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours) as needed for wheezing. 21. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 22. meropenem 500 mg recon soln sig: one (1) bag intravenous every six (6) hours: last dose. 23. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 24. torsemide 20 mg tablet sig: two (2) tablet po bid (2 times a day). 25. metolazone 5 mg tablet sig: one (1) tablet po bid (2 times a day): please decrease this medicine first if pt appears dry. 26. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 27. potassium chloride 20 meq packet sig: one (1) po once a day: please check potassium every 3 days with an electrolyte/chemistry panel, and hold for k >4.0. 28. insulin glargine 100 unit/ml solution sig: forty (40) units subcutaneous at bedtime. 29. insulin lispro 100 unit/ml solution sig: per sliding scale units subcutaneous four times a day. discharge disposition: extended care facility: & rehab center - discharge diagnosis: acute on chronic systolic congestive heart failure ef 20% coronary artery disease klebsiella urinary tract infection chronic le wound constipation s/p with valve acute on chronic anemia hepatitis c vf s/p icd placement and removal infection discharge condition: stable temp max: 98 temp current: 97.5 hr:65-69 rr: 20 bp: 83-99/40-50's. o2 sat: 100% ra 24 hour i= 1485 o= 4000cc 8 hour i= 519 o= 1050 weight: 109.7 (113.4) discharge instructions: you had episodes of sudden congestive heart failure that caused you to be intubated twice. we have adjusted your medicines to help prevent this from happening again. weigh yourself every morning, call provider if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. adhere to 2 gm sodium diet fluid restriction: 1500cc medication changes: 1. captopril was increased to 50 mg tid 2. torsemide was increased to 40mg 3. gabapentin was decreased to 400 mg q 8h 4. meropenem was added to treat klebsiella uti 5. your bowel regimen was increased to prevent constipation followup instructions: cardiology: provider: , md phone: date/time: 3:00 primary care: provider: , : date/time: 11:20 provider: , md phone: date/time: 1:10 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified insertion of endotracheal tube insertion of endotracheal tube diagnoses: anemia of other chronic disease abnormal coagulation profile coronary atherosclerosis of native coronary artery tobacco use disorder urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site unspecified acquired hypothyroidism unspecified viral hepatitis c without hepatic coma aortocoronary bypass status diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled constipation, unspecified other and unspecified hyperlipidemia heart valve replaced by other means acute respiratory failure long-term (current) use of insulin automatic implantable cardiac defibrillator in situ personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits anticoagulants causing adverse effects in therapeutic use atherosclerosis of native arteries of the extremities, unspecified precipitous drop in hematocrit below knee amputation status other specified hypotension ulcer of heel and midfoot unspecified cataract acute on chronic combined systolic and diastolic heart failure opioid type dependence, in remission personal history of traumatic fracture 

Answer: The patient is high likely exposed to