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: augmentin / sulfa (sulfonamide antibiotics) / flagyl / penicillins / ultram / percocet attending: chief complaint: dyspnea with minimal exertion. fatigue. major surgical or invasive procedure: redo-sternotomy, mitral valve replacement ( tissue) , tricuspid valve repair (#28 ring) history of present illness: 61 year old female with history of rheumatic heart disease who underwent a mitral valve repair in by dr. . more recently she has noted worsening heart failure symptoms which include dyspnea with minimal exertion. she has been followed for what is believed to be significant mitral stenosis, secondary pulmonary hypertension and right ventricular dysfunction with interventricular dependence in the setting of severe tricuspid regurgitation related to the mitral stenosis. as her symptoms have worsened, a repeat echo was obtained which showed trivial mitral stensosis with severe 4+ tricuspid regurgitation. given the severity of her disease and the progression of her symptoms despite an escalating medical therapy, she has been referred for surgical evaluation. past medical history: 1. rheumatic valve disease, status post mitral valve repair for severe mr, with residual mild mitral stenosis. 2. secondary pulmonary hypertension and severe tricuspid regurgitation due to mitral stenosis. 3. hypertension. 4. obstructive sleep apnea. 5. depression. 6. cutaneous lupus. 7. diverticulosis gastritis. 8. gout. 9. chronic low back pain. 10. osteoarthritis, left hip with arthroplasty, bilateral hip replacements, bilateral rotator cuff disease. 11. left knee bursitis and cellulitis. 12. pancreatitis 13. lupus 14. h/o labial herpes/pid 15. headaches 16. chronic lower back pain past surgical history: 1. - mitral valve repair (26 mm annuloplasty ring). 2. - diagnostic laparoscopy with the method. 3. - laparotomy with lysis of adhesions and total abdominal hysterectomy. 4. - exploratory laparotomy, extensive dissection of multiple abdominal and pelvic adhesions, bilateral salpingo-oophorectomy and appendectomy. 5. - cystometrogram, uroflow, voiding cystourethrogram. 6. - left total hip arthroplasty 7. - laparoscopic cholecystectomy. 8. - arthroscopy, right knee. subtotal medial meniscectomy. chondroplasty of medial femoral condyle. lysis of medial plica. 9. - 1. right great toe akin osteotomy. 2. second proximal interphalangeal joint arthroplasty. 10. - arthroscopy left knee, subtotal medial and lateral meniscectomies. 11. - primary right total hip arthroplasty social history: race: african american last dental exam: 3 yrs ago lives with: grand-daughter contact: phone # occupation: - cigarettes: smoked no yes last cigarette _____ hx: other tobacco use: denies etoh: < 1 drink/week drinks/week >8 drinks/week illicit drug use: denies family history: mother with mi at age 52. father died of a stroke. physical exam: pulse: 55 resp: 18 o2 sat: 100% b/p right: 104/68 left: 131/107 height: 69" weight: 230 general: well-developed female in no acute distress skin: dry intact bug bites right foot and upper right back heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur grade abdomen: soft non-distended non-tender bowel sounds + obese extremities: warm , well-perfused edema/varicosities: none neuro: grossly intact pulses: femoral right: 2+ left: 2+ dp right: 2+ left: 2+ pt : 2+ left: 2+ radial right: 2+ left: 2+ carotid bruit right: - left: - pertinent results: echo : pre bypass the left atrium is dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. the right atrium is dilated. no atrial septal defect is seen by 2d or color doppler. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is dilated with borderline normal free wall function. there is abnormal diastolic septal motion/position consistent with right ventricular volume overload. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve is s/p repair. the annular ring is well seated. the gradient across the mitral valve is increased (mean = 9 mmhg). there is severe valvular mitral stenosis (area <1.0cm2) using the pisa method. physiologic mitral regurgitation is seen (within normal limits). severe tricuspid regurgitation is seen. systolic reversal of blood flow in the inferior vena cava is seen. there is a trivial/physiologic pericardial effusion. dr. was notified in person of the results in the operating room at the time of the study. post bypass the patient was initially av paced but then transitioned to sinus rhythm. she was receiving epinephrine, norepinephrine, and milrinone by infusion. there is some septal dyssynchrony but overall left ventricular systolic function is normal. the right ventricular free wall appears dyskinetic. in total, right ventricular systolic function is severely depressed. there is a bioprosthesis located in the mitral position. it appears well seated and the leaflets appear to have normal mobility. there is trace valvular mitral regurgitation. the maximum gradient through the valve was 16 mmhg with a mean of 4 mmhg at a cardiac output of around 4 liters/minute. the tricuspid valve is s/p placement of a valvuloplasty ring. it appears well seated. there is at least mild tricuspid regurgitation seen, though it may be as much as mild to moderate. the thoracic aorta is intact after decannulation. no other significant changes from the pre-bypass study. 09:35am blood wbc-8.2 rbc-3.03* hgb-9.4* hct-28.4* mcv-94 mch-30.8 mchc-33.0 rdw-16.5* plt ct-78*# 01:51am blood wbc-7.6 rbc-2.88* hgb-9.3* hct-26.4* mcv-92 mch-32.5* mchc-35.3* rdw-16.5* plt ct-48* 01:36pm blood wbc-9.8 rbc-2.71* hgb-8.3* hct-25.0* mcv-92 mch-30.7 mchc-33.3 rdw-16.5* plt ct-51* 04:06am blood wbc-9.0 rbc-2.93* hgb-9.0* hct-26.7* mcv-91 mch-30.8 mchc-33.8 rdw-16.4* plt ct-65* 09:35am blood glucose-145* urean-20 creat-1.2* na-139 k-4.4 cl-105 hco3-27 angap-11 09:20pm blood na-136 k-4.1 cl-102 01:51am blood glucose-95 urean-19 creat-1.3* na-139 k-4.2 cl-103 hco3-28 angap-12 04:06am blood glucose-99 urean-18 creat-1.2* na-139 k-4.0 cl-107 hco3-26 angap-10 brief hospital course: mrs. was a same day admit and on was brought directly to the operating room where she underwent a redo-sternotomy, mitral valve replacement and tricuspid valve repair. please see operative note for surgical details. following surgery she was transferred to the cvicu for invasive monitoring in stable condition. she was received from the or on epinephrine/levophed/milrinone. she was weaned off epineprhine and levophed by pod#1. she was kept on milrinone until pod#2 and this subsequently weaned with good cardiac index/svo2. she was started on a lasix drip on pod#1 for a negative fluid balance and extubated without incidence after diuresing. she was transitioned from a lasix drip to tid lasix on pod3 and beta blockers were started at a low dose and titrated up as bp tolerated. chest tubes were removed without incidence and she was transferred to f6. pacing wires were left in with thrombocytopenia and platelets slowly recovered with hit coming back negative. pacing wires were removed pod#5 per cardiac surgery protocol. she continued to progress well and worked with physical therapy for strength and endurance. by pod #6 she was tolerating a full oral diet, her incisions were healing well with a scant amount of serosanguinous drainge noted from distal aspect of sternal incision. incision was painted with cloraprep and covered with a dsd. she was evaluated by physical therapy and able to ambulate with assistance. on pod#6 she was claered for discharge to rehab in stable condition. she will return for a wound check and to have the staples in her right groin removed- instructions and appointmenst have been advised. medications on admission: acetaminophen-codeine - 300 mg-30 mg tablet - one tablet(s) by mouth every six hours prn pain allopurinol - 300 mg tablet - 1 tablet(s) by mouth daily clindamycin hcl - 300 mg capsule - 2 capsule(s) by mouth 30-60 minutes before dental procedure clobetasol - 0.05 % solution - apply to scalp qhs as needed for scaling max of 2 weeks per month colchicine - 0.6 mg tablet - 1 tablet(s) by mouth daily as needed for as needed for gout attack dicyclomine - 10 mg capsule - 1 capsule(s) by mouth twice a day ketoconazole - 2 % shampoo - wash scalp 2-3 times per week lisinopril - 30 mg tablet - one tablet(s) by mouth daily metoprolol succinate - 100 mg tablet extended release 24 hr - 1 tablet(s) by mouth once a day omeprazole - (prescribed by other provider) - 40 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth twice a day torsemide - 20 mg tablet - 2 tablet(s) by mouth once a day triamcinolone acetonide - 0.1 % cream - apply to affected area for max of 2 weeks warm mist humidification unit - for dry mucous membranes/nose bleeds. medications - otc artificial tear (hypromellose) - (prescribed by other provider) - dosage uncertain aspirin - (prescribed by other provider) - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day cholecalciferol (vitamin d3) - 1,000 unit capsule - 1 capsule(s) by mouth qday discharge medications: 1. allopurinol 300 mg po daily 2. aspirin ec 81 mg po daily 3. bisacodyl 10 mg pr daily:prn constipation 4. docusate sodium 100 mg po bid 5. metoprolol tartrate 25 mg po bid hold for hr < 55 or sbp < 90 and call medical provider*please check w/house officer prior to 1st dose 6. milk of magnesia 30 ml po hs:prn constipation 7. omeprazole 40 mg po daily 8. acetaminophen w/codeine tab po q4h:prn pain rx *acetaminophen-codeine 300 mg-15 mg tablet(s) by mouth every four (4) hours disp #*65 tablet refills:*0 9. furosemide 40 mg po bid to help your body get rid of excess fluid gained during surgery . potassium chloride 20 meq po q12h hold for k+ > 4.5 discharge disposition: extended care facility: - discharge diagnosis: mitral stenosis and tricuspid regurgitation s/p mitral valve replacement and tricuspid valve repair past medical history: 1. rheumatic valve disease, status post mitral valve repair for severe mr, with residual mild mitral stenosis. 2. secondary pulmonary hypertension and severe tricuspid regurgitation due to mitral stenosis. 3. hypertension. 4. obstructive sleep apnea. 5. depression. 6. cutaneous lupus. 7. diverticulosis gastritis. 8. gout. 9. chronic low back pain. 10. osteoarthritis, left hip with arthroplasty, bilateral hip replacements, bilateral rotator cuff disease. 11. left knee bursitis and cellulitis. 12. pancreatitis 13. lupus 14. h/o labial herpes/pid 15. headaches 16. chronic lower back pain past surgical history: 1. - mitral valve repair (26 mm annuloplasty ring). 2. - diagnostic laparoscopy with the method. 3. - laparotomy with lysis of adhesions and total abdominal hysterectomy. 4. - exploratory laparotomy, extensive dissection of multiple abdominal and pelvic adhesions, bilateral salpingo-oophorectomy and appendectomy. 5. - cystometrogram, uroflow, voiding cystourethrogram. 6. - left total hip arthroplasty 7. - laparoscopic cholecystectomy. 8. - arthroscopy, right knee. subtotal medial meniscectomy. chondroplasty of medial femoral condyle. lysis of medial plica. 9. - 1. right great toe akin osteotomy. 2. second proximal interphalangeal joint arthroplasty. 10. - arthroscopy left knee, subtotal medial and lateral meniscectomies. 11. - primary right total hip arthroplasty discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with tyleonol #3 incisions: sternal - healing well, no erythema scant serosang drainage from distal - painted w/ chloraprep and covered w/ dsd- no tape groin: staples in right groin leg: trace edema 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***pad w/ gauze as needed **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments wound check at 10:45 am in medical office building, ***staples in right groin**** surgeon: dr. on at 1:45 pm in medical office building, cardiologist: dr. on at 11:40 am please call to schedule appointments with your primary care dr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** procedure: extracorporeal circulation auxiliary to open heart surgery annuloplasty open and other replacement of mitral valve with tissue graft diagnoses: systemic lupus erythematosus thrombocytopenia, unspecified obstructive sleep apnea (adult)(pediatric) anemia, unspecified esophageal reflux unspecified essential hypertension chronic airway obstruction, not elsewhere classified gout, unspecified other chronic pulmonary heart diseases depressive disorder, not elsewhere classified rheumatic heart failure (congestive) lumbago diseases of tricuspid valve diverticulosis of colon (without mention of hemorrhage) hip joint replacement acquired absence of both cervix and uterus personal history of tuberculosis mitral stenosis with insufficiency 

Answer: The patient is high likely exposed to