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: heparin agents attending: chief complaint: chest pain, sob, uncontrolled diabetes major surgical or invasive procedure: none history of present illness: 71 year old male with pmh of diabetes, cad, valve replacement, htn, presents to er via ems for evaluation of chest pain, sob, and elevated blood sugars. pt is a poor historian, but says that he has had increasing sob and doe over the last few weeks. denies pnd, but did note orthopnea. denies cough, sore throat, sputum production, fever, or chills. + weight loss, but can't tell over how long. states it was unintentional. also associated with sharp, l sided chest pain. chest pain has been going on "for years", no change in frequency recently, states it happens almost daily. relieved by 2 sl ntg. associated w/ diaphoresis and sob - "takes my breath away". cp seems nonpleuritic. + nausea, but no vomiting or hematemesis. + black stools "for months" - can't remember if he's on iron supplements. recently has had increased thirst, polyuria and dysuria. was told in past that he no longer has diabetes so hasn't checked a fs in months and hasn't taken any medications for his diabetes. per report in ed, was recently hospitalized for ? dka, with fs in the 500s. in ed, labs were drawn and were notable for multiple derangements, including an inr of 8.4, a cr of 2.2 and a serum glucose in the 700s. he was also noted to have low na, low cl and an anion gap in the 20s. he was started on an insulin gtt and given ivf (? 2l) with improvement in his fs. for his elevated inr, he received 2u ffp (repeat coags revealed an inr of 9.4). he was also given vitamin k 5mg po x1. he was monitored on telemetry. ekg revealed lvh with a strain pattern (st depressions in lateral leads v4-v6 as well as i, ii). q waves were also noted in iii and avf. all of these findings were new compared to his last ekg here in . his interim care has been at . troponins were negative x3. he remained hemodynamically stable in the ed and was transferred to the micu for further care. his icu course consisted of ivfs, insulin gtt, serial lytes and monitoring of his cardiac, coagulapathic and renal function. given ketones in the urine, this was presumed to be dka. his anion gap closed over the first 24 hours, his blood sugars improved (778, 716, 347, 171, 73) with an am sugar of 156 on the morning of transfer. he was started on glargine and a hiss. his ekg changes and chest pain were attributed, at least in part, to his recent use of cocaine. he also became thrombocytopenic (160s to 76); heparin was stopped and argatroban was started. an echo was performed and showed lvh with normal lv function and a normal avr. past medical history: 1. htn 2. hepatitis c 3. h/o substance abuse - heroin, cocaine use in past 4. cad - s/p cabg - mibi of 1/98: inferior wall defect seen, in the presence of soft tissue attenuation; hypokinetic apex; ef of 47% 5. h/o endocarditis - s/p valve replacement, but can't remember which - "all of them" - on anticoagulation w/ goal of 2.5 - 3.5 6. dm 7. h/o bph -> s/p total prostatectomy social history: tobacco: + in past, now only 1 cig "now and then" etoh: "occasional" but never heavy in past drugs: + cocaine use last week, + heroin in past (last use yrs ago) occupation: used to work as blacktop driver, now retired lives w/ "friend" - have a child together family history: (per omr) mother: + stroke and htn father: htn sister: htn brother: dm physical exam: vs - t 98.1, bp 151/101, hr 84, rr 7, sats 98% on ra gen: wdwn thin elderly male in nad. heent: sclera anicteric, mildly injected, perrl, eomi, op clear, no erythema, exudate on tongue. mm dry. cv: rr, ii/vi systolic murmur best heard at rusb, obscures s1; audible click for s2. no r/g. lungs: ctab, no crackles/wheezes/rhonchi. abd: soft, ntnd, mildly protuberant, two well healed scars in midline and rlq. + bs. no hsm. no fluid wave. + bs. ext: no edema. 2+ pt, radial pulses bilaterally. neuro: cn ii-xii grossly intact. aaox3. strength 5/5 in ue and le bilaterally, both distally and proximally. babinski equivocal bilaterally. skin: dry, flaky, no rashes. pertinent results: lab data: chemistries: 09:15pm glucose-778* urea n-33* creat-1.8* sodium-122* potassium-7.2* chloride-80* total co2-22 anion gap-27* cbc: 09:15pm wbc-12.1*# rbc-6.01# hgb-17.5# hct-49.9# mcv-83# mch-29.1 mchc-35.1* rdw-14.2 09:15pm neuts-87.3* lymphs-9.1* monos-2.8 eos-0.4 basos-0.4 09:15pm plt count-155# lplt-2+ lfts: 09:15pm alt(sgpt)-25 ast(sgot)-43* ck(cpk)-171 alk phos-94 amylase-58 tot bili-0.8 09:15pm lipase-45 09:15pm tot prot-8.8* albumin-4.7 globulin-4.1* ua: 09:15pm urine color-straw appear-clear sp -1.031 09:15pm urine blood-neg nitrite-neg protein-neg glucose-1000 ketone-50 bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 04:48am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 10:36am urine cocaine-pos cardiac enzymes: 09:15pm ck-mb-9 ctropnt-<0.01 11:45pm ck-mb-10 mb indx-8.3* ctropnt-<0.01 04:48am ck-mb-9 ctropnt-<0.01 coags: 11:45pm pt-66.2* ptt-90.7* inr(pt)-8.4* misc: 11:41am hiv ab-negative abg: 11:58pm type-art po2-134* pco2-36 ph-7.40 total co2-23 base xs--1 intubated-not intuba cxr (): 1) no acute cardiopulmonary process. 2) prominent right paratracheal stripe likely relates to normal vasculature, but a pa & lateral could be obtained to confirm. ekg: sinus rhythm. inferior myocardial infarction - probably old. left ventricular hypertrophy with secondary st-t wave changes. left atrial abnormality. compared to the previous tracing of q waves in leads iii and avf are new suggesting interim inferior wall myocardial infarction. left ventricular hypertrophy is new. clinical correlation is suggested. lower ext us (): no hematoma or pseudoaneurysm. echo (): the left atrium is normal in size. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. a bileaflet aortic valve prosthesis is present (appears well seated). the transaortic gradient is normal for this prosthesis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no pericardial effusion. brief hospital course: 1. hyperglycemia/dka/diabetes: the patient presented having been off diabetes medications - for an unclear period of time - and had symtoms of increased thirst, polyuria and dysuria. he had not checked a fs in months. at presentation, his blood sugars were in the 700s with an anion gap of 26 and positive ketones in his urine. this picture seemed to be a mixture of hyperosmolar syndrome and dka, with a picture more consistent with the latter. his icu course consisted of ivfs, insulin gtt, serial lytes and monitoring of his cardiac, coagulapathic and renal function. his anion gap closed over the first 24 hours, his blood sugars improved (778, 716, 347, 171, 73) with an am sugar of 156 on the morning of his transfer to the floor. he was started on glargine and a hiss. over the course of his time on the floor, his blood sugars remained elevated despite increasing doses of long-acting insulin (glargine). his discharge regimen consisted of: glargine, 50 units qhs metformin, 500mg pioglitazone, 30mg daily he was given a prescription for these medications, along with prescriptions for lancets, strips and a glucometer with instructions to check finger sticks at least twice daily. he recieved teaching on how to dose insulin and how to perform finger-sticks, along with diabetic nutrition counseling. 2. coagulopathy/avr: the patient presented with an inr of 8.4-->9.4. he was/is on coumadin for an avr; it was unclear what his dosing regimen consisted, although it appeard that he supposed to be taking 5mg every tu/th and 2.5 all other days. this was reported by strand pharmacy, , . initially, his coumadin was held and he was he received 2u ffp and was given vitamin k 5mg po x1. he was placed on a heparin gtt initially; when his platelets began to fall (155 on presentation --> 76) the heparing was stopped and he was placed on argatroban. a hit antibody was positive and a serotonin release antibody was pending on discharge. he was restarted on coumadin, 5mg daily on and discharged on this dose. the coumadin clinic was contact via email with plan for him to have long-term follow-up with them. in the short-term, he was given instruction to have an inr drawn 2-3 days after discharge with the results to be reviewed by his pcp. 3. acute renal failure: presented with scr of 2.2 which trended down after the administration of ivf (0.8 on discharge). the etiology was felt to be hypovolemia with prerenal azotemia. 4. cad/chest pain: presented with chest pains; given his history of recent cocaine use (with positive urine), this was felt to be related to vasospasm. an ekg revealed lvh with a strain pattern (st depressions in lateral leads v4-v6 as well as i, ii). q waves were also noted in iii and avf. all of these findings were new compared to his last ekg here in . his interim care had been at . troponins were checked and negative x3. his chest pain resolved; he complained of occasional left sided pains while on the floor which he said had been going on for "years". the patient presented on a beta-blocker. given his history of cocaine use, he was counseled at length regarding the concurrent use of this medication and cocaine. he was taken off the beta-blocker given worry of future cocaine; he was discharged on diltiazem, 120mg daily. he was continued on asa. 5. anemia: this was a normocytic anemia; his retic count was 0.7 with an index of 0.21% suggesting underproduction of red cells. an intial work-up showed a normal iron and ferritin with a low tibc. an outpatient work-up, including b12 and folate were suggested. 6. hypertension: presented having previously been on (according to pharmacy) hctz, lisinopril, clonidine, isosorbide mononitrate and metoprolol. this the sporatic nature of his medication use, the clonidine was not felt to be an ideal medication (given it's propensity for rebound hypertension). therefore, this was slowly stopped. as above, the metoprolol was stopped. the hope was to simplify his regimen. his discharge regimen included: lisinopril, 30mg daily diltiazem, 120mg daily hctz, 25mg daily isosorbide mononitrate, 20mg 7. hepatitis c: the patient presented with a history of hepatitis c infection. a viral load was checked and 45,100,000 iu/ml. an alt was checked and normal suggesting against ongoing inflammation. outpatient follow-up was recommended. as of 9/98 he was hbsab and hbsag negative; therefore, vaccination would be appropriate. hiv was checked and negative. 8. groin hematoma: the patient experienced pain at the site of repeated femoral sticks. an us showed no hematoma or pseudoaneurysm. 9. medications on discharge: on discharge, his medication regimen included: diabetes: insulin glargine 50 units sq qhs (prescription given) metformin 500mg (prescription given) pioglitazone 30mg tablet (prescription given) lancets (prescription given) syringe (prescription given) glucometer strips (prescription given) glucometer (prescription given) hypertension: lisinopril 30mg tablet (prescription given) isosorbide mononitrate 20mg (prescription given) diltiazem 120mg daily (prescription given) hydrochlorothiazide 25mg daily (prescription given) cad: simvastatin 20mg daily (prescription given) aspirin 325mg daily avr: warfarin 5.0mg daily (prescription given) outpatient lab work: ptt/pt/inr drawn in days misc: fluticasone 50 mcg (prescription given) docusate sodium 100mg prilosec otc 20mg daily ibuprofen 400mg 1-2 tablets po every 4-6 hours as needed for pain. plan was for follow-up with dr. in one week. medications on admission: strand pharmacy, , ) coumadin 5mg daily (changed to 5mg tu/th, 2.5 all other days on ) hctz 25mg daily lisinopril 40mg daily (has "stop" and tablet written on bottle) clonidine 0.3mg isosorbide mononitrate er 60mg daily (has "stop" written on bottle" metoprolol 100mg nitro sl simvastatin 20mg daily (has "stop" written on script bottle) protonix 40mg daily discharge medications: 1. simvastatin 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 2. glucometer elite classic kit sig: one (1) miscell. four times a day. disp:*1 1* refills:*0* 3. warfarin 2.5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 4. fluticasone 50 mcg/actuation aerosol, spray sig: one (1) spray nasal (2 times a day). disp:*1 inhaler* refills:*2* 5. lisinopril 30 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 6. isosorbide mononitrate 20 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 7. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 8. insulin glargine 100 unit/ml solution sig: one (1) 50 units subcutaneous at bedtime. disp:*qs box* refills:*2* 9. pioglitazone 30 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 10. diltiazem hcl 120 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). disp:*30 capsule, sustained release(s)* refills:*2* 11. lancets misc sig: one (1) miscell. three times a day. disp:*1 box* refills:*2* 12. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 13. prilosec otc 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 14. aspirin 325 mg tablet sig: one (1) tablet po once a day. 15. ibuprofen 400 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. 16. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 17. syringe misc sig: one (1) miscell. once a day: insulin syringes. disp:*1 box* refills:*2* 18. glucometer dex test sensors strip sig: one (1) miscell. twice a day. disp:*1 box* refills:*2* 19. outpatient lab work please have your ptt/pt/inr drawn in days. have the results sent to dr. at () discharge disposition: home with service facility: vna discharge diagnosis: diabetes - type ii htn hepatitis c cad avr bph discharge condition: good; improved discharge instructions: you were admitted with very elevated blood sugars. it will be very important that you continue to check your blood sugars (at least three times daily). if you experience any fevers, chills, weakness, numbness/tingling or have any other concers, be sure to call your pcp or go to the emergency room. please be sure to have your blood work drawn in days. a prescription has been attached. you may go to the clinic ( of building; ) to have the blood drawn. also, please check your finger sticks 3-4 times a day and keep a record of these values; bring this with you when you go to your follow-up appointment. followup instructions: you have a follow-up appointment scheduled with dr. () for next wedndesday () at 10:30am. the phone number is . procedure: venous catheterization, not elsewhere classified diagnoses: thrombocytopenia, unspecified anemia, unspecified pure hypercholesterolemia unspecified essential hypertension acute kidney failure, unspecified unspecified viral hepatitis c without hepatic coma coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) candidiasis of mouth cocaine abuse, unspecified heart valve replaced by transplant other and unspecified coagulation defects diabetes with ketoacidosis, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to