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: nausea/vomiting major surgical or invasive procedure: none history of present illness: mr. is a 47-year-old man with type 1 diabetes, hyperlipidemia, esrd on hd ( dm), p/w 3 days of n/v/d, but denied melena, brbpr, or hematemesis. did have pink tinge to emesis 1 day prior to admission. he also c/o fever x 2 days, dry cough x 1 week. no sick contacts. a left av fisula and a left hd tunnelled catheter. admits to poor po intake, malaise, but denies cp, sob, palpitations. mild abd pain. . in the ed, initial vs: t 101, 112, 182/92, 24, 96%ra. blood and urine sent for culture, and pt given tylenol. he had mild abd tenderness, so ct abd performed which was negative for acute process. ecg was unchanged from prior. was mildly tachypneic which resolved after ivfs (appears to have received 1l). he had a negative u/a and b/l pleural effusions on cxr, ? b/l infiltrate vs atelectasis. given vanco/zosyn to cover broadly and for pulm source. while in ed, he had 300cc of coffee ground emesis, which cleared with ng lavage. gi was called and recommended iv protonix which was given. he had serial hct which dropped from 31-->26. two pivs established. admitted to micu for concern for sepsis and ugib. vs prior to transfer: hr 90s, 180/87, 21, 99% ra. . in the micu, hct dropped from 30 to 26 in the setting of ivf. received vanc/zosyn to cover broadly for fever of unknown source. no further bleeding. he was called out to floor, and egd was complicated by vagal episode (bradycardia and hypotension) and procedure was discontinued. he then had a second presyncopal episode with elevated troponin with twi noted on ekg and was sent back to the icu. tte showed newly dpressed ef 30% with no focal wall motion abnormality. cards consulted and recommended work-up for cardiomyopathy. last hd yesterday in the setting of hyperkalemia (k 6). abx discontinued with no further fevers. viral screen pending. past medical history: # insulin-dependent diabetes for 20 years: hga1c 9.4% on # hypertension # hyperlipidemia with markedly elevated tgs # ckd (mid 2s to most recently) # pancreatitis; pancreas divisum # obesity # hyperuricemia # gerd social history: patient is married with five children. patient with disability due to poor vision from diabetic retinopathy. wife works at . denies tobacco. rare etoh. family history: mother and father with diabetes, no coronary disease, no colon cancer, no prostate cancer. physical exam: vs: t 97, bp 149/74, hr 92, rr 30, 90%ra gen: appears ill but not toxic heent: moist mucous membranes, perrl lungs: bibasilar crackles, expiratory wheezes heart: rrr, nl s1s2, no m/r/g abd: +bs, soft, nd/nt ext: trace edema, 2+ dp pulses neuro: aao, no focal defecit pertinent results: 12:40am wbc-6.0 rbc-3.40* hgb-10.6* hct-31.8* mcv-93 mch-31.3 mchc-33.5 rdw-14.5 12:40am plt count-234 12:26am lactate-2.2* 12:40am glucose-238* urea n-52* creat-8.7*# sodium-139 potassium-5.4* chloride-101 total co2-24 anion gap-19 12:40am alt(sgpt)-39 ast(sgot)-64* ck(cpk)-285* alk phos-63 tot bili-0.4 12:40am lipase-20 12:40am ctropnt-0.13* 07:45pm hct-30.4* . - tte: conclusions the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is mild global left ventricular hypokinesis (lvef = 40 %). the right ventricular cavity is mildly dilated with moderate global free wall hypokinesis. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . - cxr - findings: left subclavian double lumen central venous dialysis catheter with tip overlying the proximal right atrium. moderate bilateral effusions noted. increased interstitial markings in the lower lungs bilaterally consistent with mild interstitial edema. heart is at the upper limits of normal in size. no focal consolidation or pneumothorax within the visualized portion of the lungs. . - ct abdomen/pelvis - impression: 1. moderate-to-large bilateral pleural effusions, right greater than left. 2. no other ct findings to explain patient's abdominal pain. . test result reference range/units hereditary hemochromatosis, pcr, dna mutation negative interpretation: dna testing indicates that this individual is negative for the c282y and h63d mutations in the hfe gene. this negative result significantly reduces the likelihood of hereditary hemochromatosis (hh) in this individual. however, it does not rule out the presence of other mutations within the hfe gene or a diagnosis of hh. the risk of this individual carrying a hfe mutation other than those tested in this assay depends greatly on family and clinical history as well as ethnicity. this assay does not test for other primary or secondary iron overload disorders. . chagas'disease panel test result reference range/units trypanosoma cruzi igg >=1:256 (h) <1:16 trypanosoma cruzi igm <1:20 <1:20 interpretation past infection the serodiagnosis of chagas' disease or american trypanosomiasis by ifa is highly sensitive and specific, although cross-reactions occur with leishmaniasis. an anti-t. cruzi igm (> or = 1:20) response is observed in acute disease prior to an igg seroconversion. in chronic chagas' disease igg levels are usually detected at levels greater than or equal to 1:64. brief hospital course: 47 y.o. man with dm2, esrd on hd, dchf, presents with n/v/d, fever, and coffe ground emesis, new cardiomyopathy. . cardiomyopathy: patient with progressive dyspnea over the past year and interval decline in ef. he had a history of exposure to a chagas endemic country and was found to be chagas igg positive, igm negative, concerning for chagas cardiomyopathy. however, the pattern of heart disease was somewhat inconsistant, and he may have other causes for cardiomyopathy. of note, his ferritin was > and his fe/tibc ratio was 65%, suggestive of hemachromatosis. however, genotyping showed him to be negative for the common mutations in this disorder. further differential includes ischemic, ideopathic, infectious, or esrd-associated. no family history or history of toxin exposure. esr 46, 1:40, tsh 3, hiv negative. patient was continued on maximum dose and his beta blocker was uptitrated slightly. torsemide was restarted. - would recommend initiation of antitrypanosomal treatment. these results came back after discharge and were communicated to patient's primary care physician. outpatient cardiology follow up scheduled - continue carful volume control at hd - would consider cardiac mri and stress mibi to differentiate etiologies of cardiomyopathy. . upper gi bleed: coffee ground emesis most likely from upper gi source. most likely tear vs. pud. egd was deferred in the setting of hypotension. patient refused transfusion in icu, and hct improved without intervention. hematemesis resolved. - continue on ppi for one month. . fevers, nausea, vomiting, diarrhea: patient presented with somewhat atypical flu symptoms of unclear duration. he was found to be influenza positive. he was initially treated with antibiotics (vanc/levo), but these were stopped. he was discharged on droplet precautions to end 8 days after symptom onset. . wheezing: be cardiac asthma vs. undiagnosed mild intermittant asthma. he was started on albuterol. - reccomend outpatient pfts . end-stage renal disease: pt receives hd on mwf, and was contunued on a regular schedule. . anemia : b/l hct in low to mid 30s. serial hct stabilized. patient refused blood transfusion . diabetes: insulin dependent. bg > 300 upon admission. per omr takes 45 units of 70/30 in am and 40 in pm, but per patient he only takes 15-20 units. he was started on 20 units nph with plan to give 1/2 dose while npo. he was discharged on 20 units of 70/30 twice daily. - continue to monitor and titrate blood sugars prn . hypertension: on bb, . . hyperlipidemia: pravastatin/tricor. medications on admission: acetaminophen 325-650 mg po q6h:prn avapro *nf* 300 mg oral qd calcium acetate 667 mg po tid w/meals docusate sodium 100 mg po bid:prn doxazosin 4 mg po bid insulin 70/30: 20 units qam, 20 units qpm metoprolol succinate xl 100 mg po daily nephrocaps 1 cap po daily pravastatin 40 mg po daily senna 1 tab po bid:prn torsemide 20 mg po daily tricor *nf* 145 mg oral daily fluoxetine 10mg po daily sensipar 30mg po daily omeprazole 20mg po daily fluticasone nasal spray, 1 spray in nostrils daily discharge medications: 1. proventil hfa 90 mcg/actuation hfa aerosol inhaler sig: inhalation every four (4) hours as needed for shortness of breath or wheezing. disp:*2 inhaler* refills:*0* 2. insulin nph & regular human 100 unit/ml (70-30) cartridge sig: twenty (20) subcutaneous twice a day. 3. toprol xl 100 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po once a day. disp:*45 tablet sustained release 24 hr(s)* refills:*2* 4. irbesartan 300 mg tablet sig: one (1) tablet po daily (). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 7. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain, fever. 8. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 9. doxazosin 4 mg tablet sig: one (1) tablet po twice a day. 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day) for 30 days: take this medication twice daily for 30 days, then resume taking once daily. disp:*60 capsule, delayed release(e.c.)(s)* refills:*0* 11. torsemide 20 mg tablet sig: one (1) tablet po daily (daily). 12. fenofibrate micronized 145 mg tablet sig: one (1) tablet po daily (daily). 13. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 14. nephrocaps 1 mg capsule sig: one (1) cap po daily (daily). 15. fluoxetine 10 mg capsule sig: one (1) capsule po once a day. 16. fluticasone 50 mcg/actuation spray, suspension sig: one (1) nasal once a day. discharge disposition: home with service facility: vna discharge diagnosis: primary: influenza cardiomyopathy new diagnosis of systolic congestive heart failure upper gi bleed end-stage renal disease secondary: anemia diabetes hypertension hyperlipidemia gerd discharge condition: stable, ambulating, hct stable discharge instructions: you were admitted for fevers, muscle aches, and chills after hemodialysis. these symptoms were caused by the influenza virus. it will take seven days for this virus to run its course. in the meantime, you should take tylenol as needed for aches and pains. you should wear a mask for seven days from symptom onset to prevent transmission to others. we also did studies that showed your heart to be functioning poorly. this condition is called cardiomyopathy or heart failure. given this condition, you should be careful to avoid excess salt in your diet and continue to weigh yourself daily. you should continue your avapro and metoprolol to treat this condition. we initiated some tests to look for treatable causes of your cardiomyopathy. you should follow up with your pcp for further testing for this. please resume your regular dialysis tomorrow. followup instructions: please follow up with your pcp. have an appointment scheduled with , md, phone: date/time: 12:00. you should also follow up with cadidiology. you have an appointment scheduled with , md phone: date/time: 1:00 procedure: hemodialysis diagnoses: other primary cardiomyopathies hyperpotassemia end stage renal disease esophageal reflux congestive heart failure, unspecified acute posthemorrhagic anemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute systolic heart failure hemorrhage of gastrointestinal tract, unspecified surgical or other procedure not carried out because of contraindication diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled influenza with other respiratory manifestations 

Answer: The patient is high likely exposed to