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: anuria major surgical or invasive procedure: emergent replacement of ascending aorta and hemiarch (22 mm gelweave)/resuspension of aortic valve. history of present illness: 63 yo m with no significant pmhx who presents from as a transfer. patient was found to have new onset renal failure, with creatinine 5.8. patient initially presented to osh ed after developing acute onset sharp chest and back pain while sitting in a chair while on the computer. he noted that with this onset of acute pain, he also developed anuria and diffuse weakness and myalgias. he states that the pain persisted for several hours, and he was concerned that he had an mi, and presented to an osh, where he was diagnosed with pneumonia and stomach "gas bubble" and treated with ciprofloxacin and metaclopromide. his symptoms failed to improve, and he then presented to his urologist, who transferred him to the ed to be seen. in the ed, patient was noted to have acute renal failure and markedly elevated lfts. he denies fever, chills, weight loss, headache, vision changes, sob, abdominal pain, flank tenderness, dysuria, hematuria, urinary frequency. he has not traveled recently, and denies any recent sexual exposures, blood transfusions, ivdu, or new medications other than above. pt admitted to micu, a subsequent ct scan showed aortic dissection and the patient underwent an emergent repair past medical history: borderline htn social history: + alcohol use. denies illicit drug use or tobacco. lives at home alone. unemployed but has worked in past as a taxi driver. family history: nc family history of dvt's and pe's physical exam: admission vs: 99.1 hr 94 bp 127/55 rr 12 o2sat 95% ra gen: well appearing in nad. heent: sclera anicteric. mmm. no oral ulcers or lesions. neck supple. hrt: rrr. no mrg lungs: ctab no rrw abd: soft. obese. no organomegaly. normoactive bowel sounds. back: no cvat. foley draining clear yellow urine. no penile lesions. ext: wwp. no cce. skin: no jaundice. discharge vs t 98.2 bp 135/50 hr78 sr rr 20 o2sat 93% ra gen nad neuro a&ox3, nonfocal exam pulm cta bilat cv rrr sternum stable, incision w/steri strips cdi abdm soft, nt/nd/+bs ext warm, 1+ pedal edema bilat pertinent results: 07:18pm hgb-10.4* calchct-31 02:05pm lactate-2.4* 01:00pm glucose-143* urea n-66* creat-5.6* sodium-133 potassium-4.1 chloride-97 total co2-18* anion gap-22* 01:00pm ck-mb-8 ctropnt-0.58* 01:00pm plt count-110* 01:00pm pt-15.4* ptt-25.9 inr(pt)-1.4* 07:47am glucose-117* urea n-64* creat-5.8* sodium-135 potassium-4.0 chloride-100 total co2-19* anion gap-20 07:47am alt(sgpt)-1863* ast(sgot)-882* ld(ldh)-881* alk phos-82 tot bili-0.7 06:15am blood wbc-8.4 rbc-3.35* hgb-9.5* hct-28.3* mcv-84 mch-28.2 mchc-33.5 rdw-14.3 plt ct-266 06:15am blood plt ct-266 02:50am blood pt-14.9* ptt-23.8 inr(pt)-1.3* 06:15am blood glucose-98 urean-33* creat-1.3* na-140 k-4.5 cl-105 hco3-27 angap-13 06:20am blood alt-177* ast-39 ld(ldh)-306* alkphos-100 amylase-134* totbili-0.5 06:33pm blood hbsag-negative hbsab-negative hbcab-negative hav ab-negative radiology final report chest (pa & lat) 8:49 am chest (pa & lat) reason: evaluate pleural effusions medical condition: 63 year old man s/p asc aorta and hemiarch replacement reason for this examination: evaluate pleural effusions indication: evaluate pleural effusions. pa and lateral chest: comparison to two days prior reveals increase in size of left-sided pleural effusion, which is moderate. right-sided pleural effusion is small and likely decreased. retrocardiac density persists, which likely represents atelectasis and effusion; however, focal consolidation cannot be excluded. today's exam reveals multiple predominantly upper lung field nodular densities measuring up to approximately 4 mm in size, which likely were present on and may represent multiple granulomas. the patient is status post sternotomy, and mediastinal and hilar contours are unchanged. impression: 1. increase in size of moderate left-sided pleural effusion with decrease in size of small right-sided pleural effusion. 2. retrocardiac density, which likely represents a combination of atelectasis and effusion; however, focal consolidation cannot be excluded. 3. multiple predominantly upper lung field small nodular lesions, which likely represent small granulomas. the study and the report were reviewed by the staff radiologist. dr. dr. cardiology report echo study date of patient/test information: indication: abnormal ecg. aortic dissection. aortic valve disease. chest pain. hypertension. pericardial effusion. tamponade. status: inpatient date/time: at 19:59 test: tee (complete) doppler: full doppler and color doppler contrast: none tape number: 2007aw2-: test location: anesthesia west or cardiac technical quality: adequate referring doctor: dr. measurements: left ventricle - ejection fraction: 40% to 45% (nl >=55%) aorta - valve level: 3.4 cm (nl <= 3.6 cm) aorta - ascending: *6.4 cm (nl <= 3.4 cm) pericardium - effusion size: 1.0 cm interpretation: findings: left atrium: normal la size. no spontaneous echo contrast in the body of the laa. no la mass/thrombus (best excluded by tee). right atrium/interatrial septum: normal ra size. no spontaneous echo contrast in the body of the ra. a catheter or pacing wire is seen in the ra and extending into the rv. no asd by 2d or color doppler. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. normal lv wall thickness. normal lv cavity size. normal regional lv systolic function. mild-moderate regional lv systolic dysfunction. lv wall motion: regional lv wall motion abnormalities include: basal anterior- hypo; mid anterior - hypo; basal anteroseptal - hypo; mid anteroseptal -hypo; basal inferoseptal - hypo; mid inferoseptal - hypo; basal inferior - hypo; mid inferior - hypo; basal inferolateral - hypo; mid inferolateral - hypo; basal anterolateral - hypo; mid anterolateral - hypo; anterior apex - hypo; septal apex - hypo; inferior apex - hypo; lateral apex - hypo; apex - hypo; right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. markedly dilated ascending aorta. focal calcifications in ascending aorta. markedly dilated aortic arch. moderately dilated descending aorta focal calcifications in descending aorta. aortic valve: three aortic valve leaflets. no as. moderate to severe (3+) ar. mitral valve: mildly thickened mitral valve leaflets. no ms. mild (1+) mr. tricuspid valve: mild tr. pericardium: moderate pericardial effusion. no pericardial thickening. brief ra diastolic collapse. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. no tee related complications. the patient received antibiotic prophylaxis. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. the patient was under general anesthesia throughout the procedure. conclusions: pre-cpb:1. the left atrium is normal in size. no spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). 2. no spontaneous echo contrast is seen in the body of the right atrium. no atrial septal defect is seen by 2d or color doppler. 3. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. there is mild to moderate regional left ventricular systolic dysfunction with mild global lv systolic dysfunction. 4. right ventricular chamber size and free wall motion are normal. 5. the ascending aorta is markedly dilated the aortic arch is markedly dilated. the descending thoracic aorta is moderately dilated. there are three aortic valve leaflets. there is no aortic valve stenosis. moderate to severe (3+) aortic regurgitation is seen. there is a dissection flap visible at the level of the rca, although flow is demonstrated in both the rca and the lmca. the dissection flap extends into the arch and to the descending aorta at the level above the lsca origin. 6. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. 7. there is a moderate sized pericardial effusion. there is no pericardial thickening. there is brief right atrial diastolic collapse. post-cpb and circ arrest: on infusions of epinephrine and phenylephrine. improved aortic regurgitation, now 1+. flow seen in both rca and lmca. well-seated aortic tube graft in the ascending aorta. there is still evidence for a small dissection flap in the descending aorta at the level of the subclavian artery but there is no lumenal compromise seen. there is preserved biventricular systolic function on inotropic support with a lvef = 45%. electronically signed by , md on 01:36. radiology final report mra chest w&w/o contrast 3:26 pm mra chest w&w/o contrast reason: eval for aortic dissection contrast: magnevist medical condition: 63 year old man with recent sudden onset chest pain radiating to back now with atn and likely ischemic liver, please eval for aortic dissection reason for this examination: eval for aortic dissection mra chest. clinical history: 63-year-old man with recent sudden onset chest pain radiating to back. now with atn and likely ischemic liver. please evaluate for aortic dissection. no prior studies available for comparison. technique: multiplanar t1- and the t2-weighted images were acquired on a 1.5 t magnet, including dynamic 3d imaging, obtained prior to, during, and after the intravenous administration of gadolinium-dtpa. multiplanar 2d and 3d reformations and subtraction images were generated on an independent workstation. findings: there is aortic dissection, extending from the aortic root through the proximal portion of the descending thoracic aorta, distal to the great vessels. this finding is compatible with type a/debakey type i aortic dissection. the aortic root is dilated, measuring 6.2 x 6.0 cm (sequence 7, image #90). there is a fenestration between the true and false lumens in the proximal ascending aorta, best demonstrated on cine series (sequence 7, image #88). aortic regurgitation is also appreciated on cine sequences (sequence 7, image #29). the dissection extends into the right brachiocephalic artery, with associated focal occlusion of the brachiocephalic artery, however, the right carotid artery is patent and not involved by the dissection. note is made of a bovine arch, a normal variant. the dissection extends into the left subclavian artery as well. the dissection does not appear to involve the major coronary artery branches. there is a moderate pericardial effusion consistent with hemopericardium. no specific mr signs of tamponade are appreciated; notably the svc and ivc are of normal caliber and cine sequences demonstrate grossly normal ventricular wall motion. this would be better assessed on echocardiography, if clinically warranted. there are bilateral pleural effusions, moderate on the right and small on the left. there is mild adjacent atelectasis. multiplanar reformatted images were essential in the delineation of the above findings. findings were discussed with the surgical team at the time the study was being performed. the findings were subsequently discussed with cardiothoracic surgeon, dr. , prior to surgical intervention. impression: 1. ascendnig aortic dissection originating at the dilated (6 cm) aortic root, extending to proximal portion of the descending thoracic aorta, consistent with type a aortic dissection. involvement of all great vessels, as described above. the origin of the right coronary artery is uncertain, the left originates from the true lumen; both are patent. 2. moderate hemopericardium without specific mr signs of cardiac tamponade. aortic regurgitation. 3. bilateral pleural effusions, right greater than left. 4. patent sma, celiac, and duplicated bilateral renal arteries. the study and the report were reviewed by the staff radiologist. dr. dr. approved: mon 11:00 am brief hospital course: patient was transfer from so hospital with new onset acute renal failure. pt states this illness began with acute onset sharp chest and back pain that persisted for several hours, myalgia and anuria were associated symptoms. the patient was treated for "pneumonia and gas bubble". symptoms did not improve and his urologist referred him back to er where he was noted to have renal failure and elevate lft's. pt was ythen transferred to for further care. he was admitted to micu, a subsequent ct scan showed aortic dissection and he was brought emergently for replacement of ascending aorta and resuspension of aortic valve on . he tolerated the operation well and was transferred to the cardiac surgery icu, see or report for details. patient did well in the immediate postop period, he remained hemodynamically stable, was weaned from the ventilator and extubatedon pod1. on pod2 he was weaned from all vasoactive iv medications and on pod3 was transferred to the floor for continued care. he continued to do well, his activity level was increased. his renal and hepatic function continued to improve and on pod6 it was decided he was stable and ready to discharge to rehabilitation medications on admission: none discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 3. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 4. tramadol 50 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 5. testosterone 1 % (25 mg) gel in packet sig: 2.5 mg transdermal once a day. 6. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). discharge disposition: extended care discharge diagnosis: type a aortic dissection htn discharge condition: good. discharge instructions: call with fever, redness or drainage from incision or weight gain more than 2 pounds in one day or five in one week. shower, no baths, no lotions, creams or powders to incisions. no lifting more than 10 pounds or driving until follow up with surgeon. followup instructions: dr. 2-3 weeks provider: , call to schedule appointment md procedure: extracorporeal circulation auxiliary to open heart surgery resection of vessel with replacement, thoracic vessels diagnoses: acidosis acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified unspecified essential hypertension acute and subacute necrosis of liver iron deficiency anemia, unspecified dissection of aorta, thoracic hemopericardium 

Answer: The patient is high likely exposed to