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: ace inhibitors attending: chief complaint: back pain major surgical or invasive procedure: egd blood transfusion history of present illness: 72 year-old portuguese-speaking female with history of chronic thoracic aneurysm s/p stent graft for type b dissection with penetrating ulcer, hypertension who presented to with back pain similar to initial presentation with taa. sbp at osh in 200s and cta showed small dissection, resulting in transfer to . here, cta showed: no new abnormalities, focal dissection 2 cm from the superior portion of the thoracic stent unchanged from . . the patient was initially admitted to ct surgery but once the graft was acknowledged to be stable she was transferred to the micu for blood pressure management. bp controlled with labetalol and nipride gtt. ngt was placed for nausea/vomiting soon after admission showing dark maroon drainage. 2u transfused around midnight the night of admission following difficult t&c. gi consulted for gib and performed egd which showed gastritis. patient was placed on ppi and serial hematocrits were monitored; hematocrit stable at 28 prior to transfer. the patient's blood pressure regimen was transitioned to oral regimen of hydralazine, isosorbide, and nifedipine. . on review of systems, the patient complains of recent chills. she denies any chest pain, back pain, shortness of breath, fevers, weight loss, fatigue, headaches, dizziness, blurred vision, nausea, vomiting, abdominal pain, dysuria, hematuria, increased urgency, diarrhea, hematochezia, melena. all other systems reviewed in detail and negative except for what has been mentioned above. past medical history: 1. chronic thoracic aneurysm s/p stent graft for type b dissection with penetrating ulcer 2. hypertension 3. aortic abdominal aneursym 4.2 x 3.9 cm on cta 4. left iliac aneursym 1.8 cm in diameter on cta 5. diastolic chf (ef 55% by tte in ) 6. hypercholesterolemia 7. rheumatoid arthritis 8. osteoporosis 9. anemia of chronic inflammation 10. right lower lobe nodules, cta showed unchanged from previous social history: patient is originally from . lived previously in and approx 30yr ago. retired; used to work in factories. no hx of blood transfusions. 3 children from 3 men, now currently married. denies etoh, ciggs, iv drug use. family history: dm cva history of aneurysms in sister and physical exam: on arrival to the micu: tm/c 99 71 147/75 (120/147/58/75) 17 100ra nad mmm, ngt in place, no lad ctab nl s1/s2; hsm @ lusb and apex, i/vi diastolic murmur @ lusb soft, nt, nd, +bs wwp x 4 w/o c/c/e . on arrival to the floor: vs: t: 96.3 hr: 66 bp: 133/72 rr: 22 sat: 99% on ra gen: elderly woman breathing comfortably, in no acute distress heent: ncat, perrl, sclera anicteric, no ulcers, oropharynx otherwise clear, throat with no erythema or exudates, no thrush, no cervical lymphadenopathy, no jvd cv: normal s1/s2, rrr, +s4, no tenderness to palpation of precordium, lungs: crackles at bases, r>l abdomen: soft, nontender, nondistended, normoactive bowel sounds, no hepatosplenomegaly, no ascites ext: 1+ peripheral edema bilaterally, no clubbing, cyanosis, no calf pain, dp pulses are palpable bilaterally neuro: a + o x 3, moving all extremities well skin: pink, warm, no rashes pertinent results: labwork on admission: 01:28pm wbc-3.7* rbc-2.48* hgb-8.6* hct-25.5* mcv-103*# mch-34.9* mchc-34.0 rdw-16.7* 01:28pm plt count-145* 01:28pm neuts-82.4* lymphs-11.9* monos-3.3 eos-2.1 basos-0.3 01:28pm pt-11.8 ptt-28.0 inr(pt)-1.0 01:28pm glucose-168* urea n-23* creat-1.2* sodium-133 potassium-3.6 chloride-100 total co2-21* anion gap-16 01:28pm alt(sgpt)-8 ast(sgot)-22 ld(ldh)-306* ck(cpk)-31 alk phos-68 amylase-98 tot bili-0.5 01:28pm lipase-20 01:28pm ck-mb-notdone ctropnt-<0.01 . cta thorax w&w/o c & recons there is an endovascular stent graft within the descending thoracic aorta. there is no endoleak identified. superior to the aortic stent graft, at the level of the carina (series 3, image 17), there is a small plaque ulceration unchanged from the prior study of . it measures approximately 4 x 11 mm. this finding is confirmed on the sagittal images as well. the small previously seen superior type 1 endoleak is stable compared to . as mentioned on the prior report, this could represent a focal dissection or ulceration at the superior end of the stent. however this is unchanged from . impression: 1. no new abnormalities. focal dissection 2cm from the superior portion of the thoracic stent is unchanged from . . ecg study date of 1:49:26 pm sinus rhythm. first degree a-v block. left ventricular hypertrophy with secondary st-t wave changes. anterolateral st-t wave abnormalities most likely related to left ventricular hypertrophy, but cannot rule out myocardial ischemia. compared to the previous tracing of anterolateral st-t wave abnormalities and voltage criteria for left ventricular hypertrophy are new. clinical correlation is suggested. . labwork on discharge: 07:03am blood wbc-2.2* rbc-3.33* hgb-10.9* hct-31.6* mcv-95 mch-32.7* mchc-34.4 rdw-19.1* plt ct-158 07:03am blood glucose-82 urean-18 creat-1.5* na-135 k-4.2 cl-103 hco3-20* angap-16 brief hospital course: 73 year-old with chronic thoracic aortic aneurysm status post stent transferred from osh with back pain, resolved soon after admission, but ongoing hypertension, upper gi bleed secondary to gastritis s/p two units prbc, and acute renal failure likely contrast-induced. cta showed stable graft. . 1. thoracic aorta aneurysm: here, her cta showed stable appearance of her stent graft. ct surgery initially managed the patient; however, once her graft was assessed to be stable, she was transferred to the micu for blood pressure control. the patient's blood pressure was initially controlled with labetalol and nipride gtt in micu with goal sbp 120-140. the patient was then transitioned to oral medications for blood pressure control. the patient's aneurysm is believed secondary to atherosclerotic disease; extensive rheumatologic and infectious work-up on previous admission was negative. the patient's blood pressure was controlled with isosorbile, nifedipine, and metoprolol prior to discharge. the patient was scheduled for repeat cta torso scheduled in with cardiac surgery follow-up . 2. acute renal failure: baseline creatinine 0.7. the patient's creatinine peaked at 1.6 and trended down to 1.5 prior to discharge. the acute renal failure was likely secondary to contrast administration. fena 0.20 consistent with pre-renal etiology, although the patient was not oliguric. the patient did not respond to fluid challenge and was 6 liters positive for length of stay. urine eosinophils negative. kidneys appeared normal on ct abdomen. the patient's medications were renally dosed. the patient will follow-up with her primary care doctor for resolution. . 3. nausea/vomiting/gastritis: ngt on admission following episodes of nausea/vomiting revealed dark maroon drainage. etiology of nausea unclear but resolved soon after. the patient has history of gastritis likely secondary to rheumatoid arthritis. the patient denies any prior brbpr, melena or prior hematemesis/coffee ground emesis. she received 2 units prbc on admission for drop in hematocrit. gi consulted; egd revealed gastritis in body and fundus of the stomach. this duplicates egd from from which also showed gastritis. the patient should schedule a follow-up endoscopy in one month. the patient was given ppi for one month until follow-up. . 4. anemia: she received 2 units prbc on admission for drop in hematocrit secondary to gastritis as above. hematocrit subsequently remained stable at 28. the patient has anemia of chronic disease per iron studies . the patient has a history of rheumatoid arthritis diagnosed last admission. the patient's folate and b12 were within normal limits. the patient should schedule a follow-up endoscopy in one month and continue ppi until that time. the patient should follow-up with her primary care doctor as necessary. . 5. leukopenia, thrombocytopenia: the patient has long-standing leukopenia; she was seen by hematology and this is believed secondary to rheumatoid arthritis. the patient had new mild thrombocytopenia during admission, as well likely secondary to her underlying inflammatory arthritis. the patient's platelets were at nadir 130s and platelets improved to 150 prior to discharge. the patient did not receive heparin on this admission. the patient does not have splenomegaly clinically or on imaging studies. the patient's leukopenia and thrombocytopenia remained stable during admission. the patient should follow-up with her primary care doctor as necessary. . 6. hypertension: previously on regimen of metoprolol 25 mg at home. in setting of aneurysm, sbp goal 120-140. she was initially managed with labetalol and nipride drips, but was later titrated off and started on a regimen of metoprolol, isosorbide, and nifedipine. of note, the patient is allergic to ace-inhibitors. the patient will follow-up with her primary care doctor. . 7. urinary tract infection: urinalysis positive for infection. patient with chills but otherwise asymptomatic. the patient remained afebrile without leukocytosis. the patient completed a three-day course of ciprofloxacin. urine culture was contaminated with genital flora. . 8. cardiac: age-indeterminate septal mi per osh echocardiogram. the patient had no complaints during admission. a. ischemia: extensive coronary artery calcifications. cardiac enzymes negative on admission. the patient's aspirin was initially held in the setting of gastrointestinal bleeding but restarted prior to discharge. the patient was restarted on metoprolol. the patient's ldl < 100 off statin. b. pump: diastolic chf with ef 55%. euvolemic. crackles likely secondary to ra lung disease. the patient was started on isosorbide and nifedipine for afterload reduction. c. rhythm: no active issues. the patient was continued on metoprolol. . 9. aortic abdominal aneurysm: 4.2 x 3.9 cm on cta . the patient should schedule follow-up with vascular surgery. . 10. rheumatoid arthritis: no active issues. the patient likely has rheumatoid lung disease. . code: full medications on admission: asa 81 mg qd lopressor 25 mg discharge medications: 1. aspirin ec 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 3. isosorbide dinitrate 20 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 6. nifedipine 90 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). disp:*30 tablet sustained release(s)* refills:*2* discharge disposition: home with service facility: vna of southeastern mass. discharge diagnosis: primary: 1. back pain 2. stable chronic thoracic aortic aneursym 3. hypertensive emergency 4. gastritis, likely secondary to rheumatoid 5. pancytopenia, likely secondary to rheumatoid 6. urinary tract infection . secondary: 1. chronic thoracic aneurysm s/p stent graft for type b dissection with penetrating ulcer 2. hypertension 3. aortic abdominal aneursym 4.2 x 3.9 cm on cta 4. left iliac aneursym 1.8 cm in diameter on cta 5. diastolic chf (ef 55% by tte in ) 6. hypercholesterolemia 7. rheumatoid arthritis 8. osteoporosis 9. anemia of chronic inflammation 10. right lower lobe nodules, cta showed unchanged from previous discharge condition: afebrile, vital signs stable. discharge instructions: you were hospitalized with back pain. this was likely secondary to uncontrolled blood pressure and your chronic thoracic aortic aneursym. there was no change to the aneursym. you need to take your blood pressure medications as prescribed to prevent future episodes. . you were diagnosed with irritation of your stomach. you should take protonix twice daily for treatment to reduce stomach acid. . you were diagnosed with a urinary tract infection. you finished a course of ciprofloxacin, an antibiotic, for treatment. . please contact a physician if you experience fevers, chills, chest pain, shortness of breath, back pain, pain with urinating or having to go more often, or any other concerning symptoms. . please take your medications as prescribed. - you should take coated aspirin to protect your stomach. - you should continue metoprolol 25 mg twice daily for blood pressure. - you were started on isosorbide dintrate 20 mg three times daily for blood pressure. - you were started on nifedipine 90 mg daily for blood pressure. - you were started on protonix twice daily to reduce stomach acid and prevent bleeding. . please keep your follow-up appointments as below. followup instructions: follow-up with your primary care doctor, dr. , on at 10:00 am. please call if you have any questions or concerns. talk with her about checking your electrolytes. . you should call to make an appointment with dr. of vascular surgery for followup of your aneurysm. this appointment should be in about 3 months. please call to make an appointment. . you will also need a followup endoscopy to evaluate your stomach irritation. this should be in about 1 month. you can call to make an appointment with dr. for this procedure. . previously scheduled appointments: provider: scan phone: date/time: 10:45 provider: , cardiac surgery lmob 2a date/time: 2:15 procedure: other endoscopy of small intestine transfusion of packed cells diagnoses: pure hypercholesterolemia urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified thoracic aneurysm without mention of rupture osteoporosis, unspecified unspecified gastritis and gastroduodenitis, with hemorrhage iron deficiency anemia, unspecified rheumatoid arthritis abdominal aneurysm without mention of rupture backache, unspecified diastolic heart failure, unspecified aneurysm of iliac artery 

Answer: The patient is high likely exposed to