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: darvon attending: chief complaint: shortness of breath major surgical or invasive procedure: : tunnelled cath placement sc cabg x 3 (lima to lad, lesser saph vg to om, lesser saph vg to rca) history of present illness: 49 y/o female with very complex past medical histroy, c/o shortness of breath, with known cad with previous pci to lad. she initially presented to osh with chf and nstemi. then transferred to for further care. past medical history: type i dm w/ neuropathy, nephropathy (failing transplant), bilateral retinopathy s/p retinal detachment. failing kidney transplant - most recent creatinine of 5.3 - pt was scheduled for repeat transplant on but was cancelled because of her pvd history htn significant pvd history with multiple prior le bypass surgeries prior gi bleeding on asa and plavix cad s/p mi, s/p lad stents meningitis chronic anemia - likely multifactorial due to renal failure, hx of antral erosions and mild esophagitis on egd cva x 2 hyperlipidemia social history: two children in their 20s. she lives with her boyfriend. she formerly worked at the post-office. she has a 30-pack-year history of smoking and quit in . she does not drink alcohol. family history: her mother is alive at age 77 without significant medical problems. father died at age 76 of sepsis. he also had type 2 diabetes and prostate cancer. she has a sister age 51 and another sister age 41 who has type 1 diabetes. there is no family history of blood disorders or colon cancer. physical exam: vs: t 96.0, bp 154/65, p98, rr 20, sao2 93%2l pt reported weight and height: 152 lbs; 5'5'' gen: wdwn middle aged woman in nad. oriented x3. mood slightly depressed, affect appropriate. heent: sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple without jvd cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. iii/vi systolic ejection murmur hear best at lusb, no r/g. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. decreased breath sounds at the bases bilaterally 1/4th of the way up, with associated dullness to percussion. no wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. ext: 1+ edema bilaterally half to half way pt from snkle to knee. no cyanosis. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: cardiac cath: 1. coronary angiography in this right dominant system revealed three vessel coronary artery disease. the lmca was noted to be a short almost cloacl vessel and was heavily calcified. the lad had diffuse disease proximally and a 70& proximal stent edge restenosis in the mid lad. septal collateral were noted to the distal rca. the lcx had a near ostial heavily calcified 90% lesion with proximal 40% stenosis before om!. diffuse palquing was noted in om2 and a 50% stenosis was noted near the takeoff of av groove cx from om2. om collaterals to distal rca were noted as well. the rca was small and occluded proximally. 2. resting hemodynamics revealed mildly elevated left sided filling pressures with an lvepd of 16 mmhg. there was moderate systolic arterial hypertension with an spb of 176 mmhg. the cardiac index was preserved at 3.94 l/min/m2.o evidence of aortic stenosis as there was no pressure gradient on pullback from lv to aorta. there was no evidence of mitral stenosis upon analysis of pcwp and lvedp. cnis: there is less than 40% stenosis within bilateral internal carotid arteries. vein mapping: lesser saphenous veins patent bilaterally with diameters described as above and no visualization of the greater saphenous veins bilaterally. echo: pre bypass: the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. there is mild regional left ventricular systolic dysfunction with mild inferior hypokinesis. the remaining left ventricular segments contract normally. right ventricular chamber size and free wall motion are normal. there are multiple severe complex (>4mm) atheroma in the aortic arch and descending thoracic aorta. epiaortic scans of the intended sites of proximal anastamosis, cannulation, and cross clamp are clear. a long axis epiaortic pull through from valve up confirms substatial plaque in the arch, but not at the above mentioned sites..the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. trace eccentric aortic regurgitation is seen. the annular portion of the posterior leaflet of the mitral valve is partialy calcified but the tip and central portion move and coapt well.. with provacative manuvers and sbp 150's, mild to moderate (+) mitral regurgitation is seen. vena contracta meansures 4 mm at worst. there is a small pericardial effusion. there are pericardial calcifications. post bypass: patient is a paced, on epinephreine, phenylepherine infusions. lvef remains 50% with mild inferior hypokinesis. note is made of moderate anteroseptal hypokinesis which improves with nitroglycerin. mr is now mild. aortic contours are intact. remaining exam is unchanged. all findings discussed with surgeons at the time of the exam. chest ct: 1. new tiny left anterior pneumothorax. 2. small bilateral pleural effusions with associated compressive atelectasis. 3. sub 5 mm pulmonary nodules. in the absence of known malignancy or smoking, no further followup is necessary. 4. no retroperitoneal hematoma. 5. prominent ovaries. questionable soft tissue nodule in the left ovary. further evaluation with pelvic ultrasound is recommended. 05:50am blood wbc-9.7 rbc-3.36* hgb-8.8* hct-26.9* mcv-80*# mch-26.1* mchc-32.5 rdw-16.6* plt ct-373 06:00am blood wbc-12.7* rbc-3.76* hgb-10.4* hct-31.5* mcv-84 mch-27.7 mchc-32.9 rdw-16.9* plt ct-337 05:06am blood wbc-10.0 rbc-3.31*# hgb-9.9*# hct-28.3* mcv-85 mch-29.9 mchc-35.0 rdw-15.9* plt ct-268 05:50am blood pt-12.4 ptt-26.4 inr(pt)-1.1 05:15am blood pt-13.6* ptt-32.4 inr(pt)-1.2* 05:50am blood glucose-91 urean-105* creat-6.3* na-143 k-3.3 cl-102 hco3-22 angap-22* 05:00am blood glucose-260* urean-36* creat-3.4* na-138 k-4.0 cl-100 hco3-28 angap-14 01:43pm blood glucose-258* urean-27* creat-3.7*# na-136 k-4.5 cl-107 hco3-19* angap-15 01:43pm blood calcium-8.4 phos-3.2# mg-2.1 brief hospital course: pt was admitted to the service on )cardiology floor) at for work-up and treatment of chf exacerbation, nstemi, and her failing renal transplant. . pt was found to be volume overloaded with bilateral pleural effusions and peripheral edema. the decision was made to not continue levofloxacin since it appeared very unlikely to be infection (afebrile, no cough). chf was treated with agressive diuresis with furosemide 120 mg iv bid as well as metolazone 2.5 mg po bid with the goal of diuresis of at least 1l/day which she exceeded by about 1l on the first 2 days with decreases in her weight by about 2kg per day as well (for 2 days). clinically, pt improved also coming off oxygen at then end of hod#2. . pt was admitted with what was thought consistent with nsemi in the setting of previously known cad s/p mi, s/p lad stents and acute on chronic renal failure with failing renal transplant. pt was monitored on telemetry and cardiac enzymes were followed. the enzymes consistently trended downward indicating that pt had an nsemi prior to presentation to the osh. the initial approach was medical management as there was an obvious concern over the patients renal function. a renal transplant consult was placed; their recommendation was to initiate hd, as there was no reason to delay (now that transplant was not going to happen) and had a fragile volume window. pt had tunnelled cath placed on , with hd initiated that same day. the following day pt had coronary catheterization showing three vessel coronary artery disease, including a near ostial lcx lesion not favorable for pci, as one would have to stent back into the lmca jailing the lad, and "lmca" supplies the entire lv. hd was planned post-coronary cath but as pt appeared depressed about the news that she would have to have a cabg and tired from a long day. hd was performed early the following morning and was from thereon continued qd for 2 days before transitioning to qod hd. after initiation of hd pt was taken off standing diuretics and given one-time doses as needed for diuresis. . the night of the coronary cath pt had an episode of nausea and vomiting associated with some diaphoresis. ekg with ?st elevations in v2, v3. heparin was started and pt had not further episodes. cardiac enzymes were still downtrending and so it likley was not an acs. heparin was stopped after 48 hrs since there was no active concern over acs and pt had developed a small r groin hematoma, and a mild nosebleed with 6pt hct drop after coronary cath. 2 units of blood was given with good effect prior to stopping heparin treatment. hct remined stable at around 30 from this pt on until surgery. . regarding her failing kidney transplant, pt was continued on cellcept 1000mg po bid, and rapamune 4 mg po qam despite initiating hd in the case there was any chance that her kidneys were going to recover. . pt was also hypertensive throughout much of the hospital stay despite clonidine patch, 100mg po bid of metoprolol, and 60 mg po bid of nifedipine. her metoprolol was increased to 125 mg po bid on hod#6. on this dose her supine bp was 140s/50-60s and standing bp 110s/50s. bp meds were titrated to this standing bp given her hx of autonomic neuropathy and orhtostatic hypotension. . regarding her chronic anemia, the etiology was thought to likely be due to renal failure. aside from the transient hct drop as mentioned above after the cath, her hct remained at about her baseline of 30. on hod#5, epogen 6000 units given at the time of hd was initiated. referred to dr. for cabg and vein mapping showed the presence of bilat. lesser saph, veins.underwent cabg on . transferred to the cvicu in stable condition on nitroglycerin, propofol and epinephrine drips. extubated early the next morning. renal sevice continued to follow pt.for her dialysis management. transferred to the floor on pod #1 to begin increasing her activity level. beta blockade titrated and chest tubes and pacing wires removed without incident.tranfused 2 u prbcs for anemia, but cta negative for retroperitoneal bleed.a 5 mm pulm. nodule was noted. mutliple agents titrated for bp management. cleared for discharge to home with services on pod #6. pt. to make all followup appts. as per discharge instructions as well as maintaining her outpt. hemodialysis schedule. medications on admission: lasix 120mg iv every 12 hours, zaroxylin 2.5mg, asa 81, catapress patch once a week, lantus 6 units q am, humalog sliding scale, levaquin (for possible pneumonia), metoprolol 100mg po bid, cellcept 1000mg po bid, nifedipine 60 mg po bid, zocor 80mg po bid, rapamune 4 mg po qam discharge medications: 1. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 2. sirolimus 1 mg tablet sig: four (4) tablet po daily (daily). disp:*120 tablet(s)* refills:*0* 3. sevelamer 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). disp:*90 tablet(s)* refills:*0* 4. mycophenolate mofetil 500 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*0* 5. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 7. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 * refills:*0* 9. clonidine 0.2 mg tablet sig: one (1) tablet po tid (3 times a day) for 1 days. disp:*10 tablet(s)* refills:*0* 10. clonidine 0.3 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qtues (every tuesday). disp:*qs 1 month* refills:*0* 11. insulin glargine 100 unit/ml solution sig: eight (8) units subcutaneous at bedtime. disp:*qs 1 month* refills:*0* 12. humalog 100 unit/ml solution sig: as directed subcutaneous four times a day: per sliding scale. disp:*qs 1 month* refills:*0* 13. hydromorphone 2 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. disp:*50 tablet(s)* refills:*0* discharge disposition: home with service facility: vna of greater discharge diagnosis: coronary artery disease s/p coronary artery bypass graft x 3 pulmonary nodule pmh: iddm, esrd, chf, ^chol., pvd, s/p cva x2 , anemia, s/p gi bleed, nstemi , des->lad, retinopathy, neuropathy, meningitis, s/p ileo bifem, s/p r profunda-> , s/p l fem-, s/p renal transplant-failing, s/p cataract surgery, s/p tah 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 weeks dr. in 4 weeks dr. 2 weeks hemodialysis monday, wednesday friday@11am. already scheduled appointments: provider: , .d. phone: date/time: 11:20 provider: lab phone: date/time: 9:00 provider: , md phone: date/time: 10:00 procedure: venous catheterization, not elsewhere classified single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters (aorto)coronary bypass of two coronary arteries hemodialysis transfusion of packed cells diagnoses: anemia in chronic kidney disease end stage renal disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified polyneuropathy in diabetes cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other complications due to other cardiac device, implant, and graft accidents occurring in other specified places surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation accidents occurring in residential institution atherosclerosis of native arteries of the extremities, unspecified combined systolic and diastolic heart failure, unspecified complications of transplanted kidney background diabetic retinopathy diabetes with neurological manifestations, type ii or unspecified type, uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to