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: no known allergies / adverse drug reactions attending: chief complaint: thoracoabdominal aortic anuerysm major surgical or invasive procedure: open thoracoabdominal aortic aneurysm repair left lower lobe wedge resection exploratory laparotomy, repair of small bowel enterotomy, and multiple serosal tears history of present illness: this is a 56yo man with a thoracoabdominal aortic aneurysm complicated by paraplegia. he had prior stenting of the aortoiliac segments given the extension particularly of the left common iliac. he is admitted now for surgical resection and replacement of the thoracic and abdominal aorta. past medical history: 1. chronic type b aortic dissection complicated by paraplegia. 2. hypertension. 3. chronic diastolic congestive heart failure. 4. atrial fibrillation. 5. history of sick sinus syndrome. 6. chronic renal insufficiency. 7. history of gallstone pancreatitis, status post ercp. 8. dyslipidemia. 9. lung nodule in the left lower lobe. 10. prior tia in . 11. history of gout. 12. history of gi bleed. 13. anemia. psh: - excision of right groin arteriovenous fistula. aortic dissection repair, aortic fenestration and stenting of the distal aorta as well as common iliac arteries, distal aortic and bilateral cia stenting., cholecystectomy in social history: at baseline lives at home with partner family history: unknown aortic aneurysm hx physical exam: gen: wdwn male in nad; paraplegic; alert and oriented x 3 card: irreg (afib) lungs: cta bilat abd: soft no m/t/o extremities: warm, well perfused, palpable femoral/dp/pt pulses bilat wound: thoracoabdominal incision c/d/i, staples in place pertinent results: renal u.s.; duplex dopp abd/pel clip # reason: renal doppler study medical condition: 56 year old man with acute renal failure s/p thoracoabd aortic aneurysm repair - reason for this examination: renal doppler study wet read: shsf mon 9:56 pm normal arterial wave form involving the main renal arteries bilaterally with slightly elevated resistive indices. wet read audit # 1 preliminary report !! wet read !! normal arterial wave form involving the main renal arteries bilaterally with slightly elevated resistive indices. 11:09 pm stool consistency: not applicable source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). chemistry urean creat 03:25am 52* 4.3*# 02:56am 95* 6.5* 04:00am 66* 5.6*# 05:36am 43* 4.1*# 05:58am 93* 5.5* 12:07am 90* 5.4* 03:26pm 81* 5.0* 03:14am 66* 4.6* 06:28am 71* 4.7* 01:38am 50* 4.0* 02:42am 48* 3.7* 03:11am 31* 2.8*# 02:55am 49* 3.9* 02:33am 54* 4.7* 04:30am 62* 5.5* 01:40pm 54* 5.2* 02:54am 41* 4.6* 02:55am 34* 3.7* 02:46am 29* 2.9* 08:46pm 27* 2.6* 08:17pm 22* 1.4* 8:17 pm mrsa screen source: nasal swab. **final report ** mrsa screen (final ): no mrsa isolated. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram negative rod(s). respiratory culture (final ): rare growth commensal respiratory flora. pseudomonas aeruginosa. sparse growth. of two colonial morphologies. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 4 s ceftazidime----------- 8 s ciprofloxacin---------<=0.25 s gentamicin------------ 2 s meropenem------------- 0.5 s piperacillin/tazo----- s tobramycin------------ <=1 s echocardiography report , tte (complete) done at 3:43:24 pm final referring physician information , c. , status: inpatient dob: age (years): 56 m hgt (in): 68 bp (mm hg): 140/90 wgt (lb): 172 hr (bpm): bsa (m2): 1.92 m2 indication: left ventricular function. s/p abd ao repair icd-9 codes: 424.0, 424.2 test information date/time: at 15:43 interpret md: , md test type: tte (complete) son: , rdcs doppler: full doppler and color doppler test location: west echo lab contrast: none tech quality: adequate tape #: 2011w000-0:0 machine: vivid q-2 echocardiographic measurements results measurements normal range left atrium - long axis dimension: *6.0 cm <= 4.0 cm left ventricle - septal wall thickness: *1.4 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.7 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.6 cm <= 5.6 cm left ventricle - ejection fraction: >= 75% >= 55% left ventricle - stroke volume: 68 ml/beat left ventricle - lateral peak e': 0.09 m/s > 0.08 m/s left ventricle - septal peak e': *0.04 m/s > 0.08 m/s left ventricle - ratio e/e': *15 < 15 aorta - sinus level: *4.5 cm <= 3.6 cm aorta - ascending: *3.9 cm <= 3.4 cm aortic valve - peak velocity: 1.6 m/sec <= 2.0 m/sec aortic valve - lvot vti: 15 aortic valve - lvot diam: 2.4 cm mitral valve - e wave: 1.0 m/sec mitral valve - e wave deceleration time: *63 ms 140-250 ms tr gradient (+ ra = pasp): *61 mm hg <= 25 mm hg findings this study was compared to the prior study of . left atrium: marked la enlargement. left ventricle: moderate symmetric lvh. normal lv cavity size. normal regional lv systolic function. hyperdynamic lvef >75%. tdi e/e' >15, suggesting pcwp>18mmhg. no resting lvot gradient. no vsd. right ventricle: normal rv systolic function. abnormal septal motion/position. aorta: moderately dilated aorta at sinus level. mildly dilated ascending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. trace ar. mitral valve: normal mitral valve leaflets with trivial mr. s. tricuspid valve: mildly thickened tricuspid valve leaflets. no ts. moderate tr. severe pa systolic hypertension. pulmonic valve/pulmonary artery: no ps. pericardium: very small pericardial effusion. no echocardiographic signs of tamponade. conclusions the left atrium is markedly dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. rv with normal free wall contractility. there is abnormal septal motion/position. the aortic root is moderately dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of /201, the degree of tr and pulmonary hypertension detected has increased brief hospital course: date of admission: date of discharge: the patient was admitted for planned operative management of known thoracoabdominal aneurysm with type b dissection. he was taken to the or with vascular and cardiac surgery. he underwent repair of the thoracoabdominal aortic aneurysm from distal descending thoracic aorta down to both common iliac arteries. in addition to an aorto-biiliac graft, a multi-branch graft was also placed with individual anastomoses to the celiac artery, superior mesenteric artery, and right and left renal arteries. the patient also had a preoperative ct scan demonstrating an area of nodularity in the left lower lobe. during the same anesthesis he underwent left lower lobe wedge resection of this abnormality. two chest tubes were left in place. the patient was brought to the icu postoperatively in stable condition, intubated. however, over the course of pod0, he began to develop a pressor requirement and had two guaiac positive bowel movements. additionally, ct abdomen demonstrated stranding within the mesentery and small bowel thickening suspicious for ischemia. west 1 surgery was consulted due to the suspicion of mesenteric ischemia and the patient underwent an exploratory laparotomy on that was negative for mesenteric ischemia or other pathology. he was again brought to the icu post-operatively and remained intubated on pressors. while in the icu he began to experience decreased urine output with increased serum creatinine. he was started on a lasix drip which was not able to produce sufficient diuresis. at this point nephrology was also following this patient. hemodialysis was initiated and the patient remained on hd for the duration of the hospital stay. on he successfully self-extubated, and remained stable with face mask oxygen initially. however he also at this time had a sputum culture positive for pseudomonas and although remained afebrile was treated for pneumonia. he was reintubated on and remained intubated overnight. he was succesfully extubated . he remained in the icu and recieved blood transfusions for a goal hematocrit of 30. on he was evaluated by speech and swallow, and after passing was advanced to a regular diet and tube feeds were discontinued. he continued to be treated with broad spectrum antibiotics for pneumonia, and require bipap for hypoxia. he continued to receive daily dialysis while in the icu to treat his fluid overload. on , patient was transfered from the icu to the step-down vicu. at this point he was tolerating regular diet, chest tubes had been removed, dobhoff was removed, extubated and on nasal cannula, and hemodynamically stable. he remained stable in the vicu. nutrition was following this patient and he tolerated a general diet with no issues. he continued to undergo every other day hemodialysis. he was kept on telemetry monitoring as he has a pacemaker and did have sporadic ekg changes, although cardiac workup was negative. cardiology was consulted and continued to follow. on he had a tunneled line placed for continued hemodialysis after discharge. at time of discharge, he continues to require ongoing hemodialysis for acute renal failure. his long-term renal function is unknown. he is requiring intermittent straight catheterization as he does make some urine. he has required this in the past, prior to this hospitalizatin. he is tolerating a general diet with nutritional supplements. he is working with physical therapy and will require further pt after discharge to regain his baseline functional status. he continues to require iv cipro/flagyl for graft protection, telemetry monitoring for cardiac status, and close follow-up with a nephrologist for monitoring of his acute renal failure. he is discharged to in for further management of these issues in a long-term care setting. medications on admission: medications - prescription clonidine - (prescribed by other provider) - 0.2 mg/24 hour patch weekly - once a week q monday furosemide - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth once a day lisinopril - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth twice a day metoprolol succinate - (prescribed by other provider) - 100 mg tablet extended release 24 hr - 1 tablet(s) by mouth twice a day nifedipine - (prescribed by other provider) - 90 mg tablet extended rel 24 hr - 1 tablet(s) by mouth once a day potassium chloride - (prescribed by other provider) - 20 meq tablet, er particles/crystals - 1 tab(s) by mouth twice daily simvastatin - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth once daily warfarin - (prescribed by other provider) - 5 mg tablet - 1 tablet(s) by mouth daily 7.5mg thurs/sunday; 5 mg daily x 5 days or as directed for inr goal discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for fever or pain. 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 3. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 4. nifedipine 10 mg capsule sig: one (1) capsule po q8h (every 8 hours) as needed for hypertension: prn syst bp >170. capsule(s) 5. metoprolol tartrate 100 mg tablet sig: one (1) tablet po three times a day: hold for hr<55, sbp<100. 6. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: 5-10 mls po q4h (every 4 hours) as needed for pain. 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for skin yeast. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. warfarin 1 mg tablet sig: three (3) tablet po once daily at 4 pm. 13. outpatient lab work pleaes check pt/inr starting ; check at least three times per week and as needed, may decrease frequency when off antibiotics 14. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 15. ciprofloxacin 400 mg/40 ml solution sig: four hundred (400) mg intravenous once a day for 1 weeks. 16. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: five hundred (500) mg intravenous every eight (8) hours for 1 weeks. 17. simvastatin 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: hospital - discharge diagnosis: thoracoabdominal aortic aneurysm acute renal failure type b aortic dissection s/p endovascular stent distal aorta s/p exploratory laparotomy s/p left lower lung resection discharge condition: alert and oriented x3 non-ambulatory at baseline discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: cardiac surgeon: , md phone: date/time: 1:30 cardiologist:dr. at 2:15pm thoracic surgeon: cat scan phone: date/time: 1:15 provider: , md phone: date/time: 3:00 vascular surgeon: please call to schedule appointments with: primary care: dr. () in weeks labs: pt/inr for coumadin ?????? indication :atrila fibrillation goal inr 2.0-2.5 first draw day after discharge ***** please arrange for coumadin /inr followup prior to discharge from rehab provider: , md phone: date/time: 2:15 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis exploratory laparotomy resection of vessel with replacement, thoracic vessels resection of vessel with replacement, aorta, abdominal other local excision or destruction of lesion or tissue of lung suture of laceration of small intestine, except duodenum diagnoses: pneumonia, organism unspecified acidosis other iatrogenic hypotension acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation accidental puncture or laceration during a procedure, not elsewhere classified other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) cardiac pacemaker in situ other diseases of lung, not elsewhere classified hemorrhage of gastrointestinal tract, unspecified paraplegia chronic diastolic heart failure volume depletion, unspecified thoracoabdominal aneurysm, ruptured other specified agents primarily affecting the gastro-intestinal system causing adverse effects in therapeutic use other secondary thrombocytopenia mitral valve stenosis and aortic valve insufficiency 

Answer: The patient is high likely exposed to