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 / sonata attending: chief complaint: gib and respiratory distress major surgical or invasive procedure: none. history of present illness: 75 m with severe copd with multiple intubations in the past. also with a fib on coumadin, htn, 3+ mr/2+tr with dilated r ventricle. h/o of gib in but does not recall details. presented to ed with acute onset sob and wheezing am opf admission. denies cp. denies f/c/diaphoresis/n/v. in ed, given nebs and steroids with improvement in breathing but bp 72/30 and inc. with 2 : to 96/52. hct 27.9, guiac positive. ngl with blood tinged sputum. transfused 1 unit prbc, vit k 10 mg, and ffp. past medical history: copd as above htn afib ugib ' etoh abuse depression echo w/ ef>50% social history: lives @ home. consumes 1 pint etoh per day. last drink 2d prior to admission. family history: +htn. no cancer, dm or other ilness. physical exam: temp 100.8 bp 104/88 pulse 79 resp 22 o2 sat 98% gen - alert, some resp distress with 4 l o2,s peaks in partial sentences, using accessory muscles, not fatigued heent - perrl, extraocular motions intact, anicteric, mucous membranes moist neck - no jvd, no cervical lymphadenopathy chest - good air mvmt, no crackles, some wheezing cv - distant hs, normal s1/s2, rrr, no murmurs, rubs, or gallops abd - obese, soft, nontender, nondistended, with normoactive bowel sounds back - no costovertebral angle tendernes extr - no clubbing, cyanosis, 1 + edema. 2+ dp pulses bilaterally neuro - alert and oriented x 3, cranial nerves intact, upper and lower extremity strength 5/5 bilaterally, sensation grossly intact; dysarthric skin - no rash pertinent results: 07:12am po2-14* pco2-69* ph-7.22* total co2-30 base xs--3 07:45am plt count-317 07:45am hypochrom-3+ poikilocy-1+ macrocyt-1+ 07:45am neuts-73.4* lymphs-16.1* monos-9.5 eos-0.7 basos-0.4 07:45am wbc-11.1* rbc-2.89* hgb-8.5* hct-27.9* mcv-97 mch-29.4 mchc-30.4* rdw-15.6* 07:45am calcium-8.9 phosphate-6.3*# magnesium-2.1 07:45am ck-mb-notdone ctropnt-0.04* 07:45am lipase-26 07:45am alt(sgpt)-25 ast(sgot)-27 ck(cpk)-82 alk phos-61 amylase-29 tot bili-0.5 07:45am glucose-118* urea n-67* creat-3.0*# sodium-142 potassium-4.7 chloride-103 total co2-24 anion gap-20 07:55am lactate-2.8* 08:30am urine rbc-0 wbc-0-2 bacteria-mod yeast-none epi-0-2 08:30am urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 08:30am urine color-amber appear-clear sp -1.018 08:55am pt-28.4* ptt-38.1* inr(pt)-5.1 08:56am hgb-8.0* calchct-24 08:56am temp-38.2 po2-104 pco2-47* ph-7.26* total co2-22 base xs--5 intubated-not intuba 01:30pm hgb-9.4* hct-30.2* 01:42pm hgb-9.8* calchct-29 04:53pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 04:53pm hct-27.7* 04:53pm vit b12-475 folate-15.1 04:53pm ck-mb-notdone ctropnt-0.02* 04:53pm ck(cpk)-81 04:56pm hgb-9.6* calchct-29 04:56pm glucose-108* 05:59pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 05:59pm urine hours-random 08:48pm hct-19.7*# 10:15pm hct-27.8*# cxr: cardiomegaly unchanged, no chf possible rll infiltrate ecg: a fib, 85 bpm, nl qrs, nl axis, tw flattening i, avl, v6, st seg 0.5 mm elevated v3 brief hospital course: 1. upper gib bleed: pt admitted with 2 pivs, type and crossed, transfused a total of 1 unit of blood while in ed. ngt lavage cont. to be coffee grounds for a first part of stay and then cleared, when ngt was d/c'd. gi consult felt pt did not need emergent scope, likely medication related gastritis. hct remained stable for rest of hospital stay. however, given other medical problems, gi felt that he should be scoped as an outpt when other medical issues were stable. placed on protonix 40 mg , scheduled for outpt gi follow up for outp egd/colonoscopy. 2. hypotension: thought to be related to blood loss. improved with blood products within 24 hrs not requiring pressors. 3. acute renal failure: pt with renal insufficiency on arrival who had atn to hypotension. cr remained 2.7-3.0 during hopsital stay and did not improved with hydration. renal consult confirmed this with urine studies. given his chf, they felt it was reasonable to continue his lasix . his urine outpt remained extremely good while in house. f/u with dr in a few weeks. 4. copd exaccerbation: abg suggested resp acidosis liklely chronic. his 02 sat on arrival was 100% on 4 l. placed on prednisone 60 mg and tapered. will need to continue taper as outpt with baseline at 5 mg. cxr's revealed no infection. he was placed on azithromycine for antiinflamatory effects. his o2 requirement decreased and he is % on room air with mild destauration on ambulation. he was given neb txts as needed and then returned to scheduled inhalers. 5. tacycardia: pt in sinus tachycardia for first part of visit. increase bb and ccb to current dose with good effect. on telemetry no events except one 6 beat run of nsvt when he was asx. pts rate 70-90s on d/c on current regimen. 6. atrial fibrillation: pt on coumadin for many days. however, given delirium and risk of falling, it was decided by dr to stop this for now and readdress this as an outpt. 7. neuro: mri on admission showed evidence of old infarct. slurred speech was concerning to team so neuro consutl obtained showing toxic-metabolic delirium related to renal failure and alcohol use. over the next few days on the floor, pt would occassionally become agitated requiring zyprexa and ativan (out pt med). psych consult revealed that seroquel would be helpful in managing agitation. he will follow up with dr to determine further pscyh follow up . cont on ativan for aggitation. 8. petichial rash: stable rash on lower legs. unclear etiology. plts stable and dic panel checked and was negative. follow this as outpt. 9. diabetes: elevated bs while on stress dose steroids. no need for insulin now but would check bs and cover appropriately. needs to be readdressed once on 5 mg prednisone. 10. ankle pain: likely related to edema. xrays checked and offical read need to be f/u as outpt. pt was seen by pt/ot and rehab reccomended for deconditioning. wife supportive and involved in care. medications on admission: coumadin 5 mg lasix 20 mg qd albuterol 2 mg qid atrovent prednisone 5 mg qd ativan 1 mg verapamil 40 mg metorprol 50 mg flovent 2 puffs mirtazipine 7.5-15 qhs discharge medications: 1. lorazepam 1 mg tablet sig: one (1) tablet po bid (2 times a day). 2. multivitamin capsule sig: one (1) cap po qd (). 3. verapamil hcl 80 mg tablet sig: one (1) tablet po q8h (every 8 hours). disp:*30 tablet(s)* refills:*2* 4. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 5. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 6. fluticasone propionate 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*qs * refills:*2* 7. warfarin sodium 5 mg tablet sig: one (1) tablet po hs (at bedtime). 8. prednisone 10 mg tablet sig: one (1) tablet po qd () for 3 days: then decrease to 5 mg qd. disp:*20 tablet(s)* refills:*0* 9. calcium acetate 667 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 10. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 12. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4h (every 4 hours). 13. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 14. seroquel 25 mg tablet sig: 0.5 tablet po twice a day: hold in morning for sedation. disp:*30 tablet(s)* refills:*2* 15. seroquel 25 mg tablet sig: 0.5 tablet po q4:prn: for agitation. disp:*30 tablet(s)* refills:*2* discharge disposition: extended care facility: - discharge diagnosis: 1. copd exaccerbation 2. upper gi bleed 3. renal failure 4. atrial fibrillation 5. delirium discharge condition: stable. discharge instructions: if you have fever, shortness of breath, chest pain, confusion/agitation, please come to the ed or call your pcp. followup instructions: provider: , md where: phone: date/time: 2:00. please follow up on ankle xray done in house for ankle pain. provider: , m.d. where: cardiac services phone: date/time: 9:00 provider: breathing tests where: pulmonary function lab phone: date/time: 8:45 gi follow up: will need egd/colonoscopy as outpt. renal: dr , clinic on tues. at 4 pm. provider: , md where: medical specialties phone: date/time: 1:40 md, procedure: transfusion of packed cells transfusion of other serum diagnoses: pneumonia, organism unspecified acidosis mitral valve disorders acute kidney failure with lesion of tubular necrosis acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute and chronic respiratory failure long-term (current) use of anticoagulants unspecified gastritis and gastroduodenitis, with hemorrhage diseases of tricuspid valve other and unspecified alcohol dependence, continuous 

Answer: The patient is high likely exposed to