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: patient recorded as having no known allergies to drugs attending: chief complaint: scheduled cathetirization major surgical or invasive procedure: cardiac cathetirization history of present illness: 64 y old f hx af, severe pulmonary artery hypertension (4+ tr, gradient 94mm hg), 1+ mr, htn. she presents today for a scheduled admission for scheduled cardiac cathetirization tomorrow in order to further evaluate her pah. . ms has been followed by dr. in pulmonary clinic, seen by dr. during last hospitalization. as per dr. summary, she initially presented with sob, which worsened in . in she presented severely hypoxemic, with an elevated bnp and bilateral pleural effusions, an echocardiogram demonstrated severe ph (pulmonary hypertension) with a tr gradient of 58 mmhg as well as markedly dilated rv, severe rv hypokinesis, moderately dilated ra, and moderate symmetrical lvh with a normal ejection fraction. she was aggressively diuresed and underwent cardiac catheterization which demonstrated elevated right-sided filling pressures with a ra mean pressure of 13, rv diastolic pressure of 18. her pulmonary artery pressure (pap) was 82/27 with a mean of 46 and the mean wedge pressure was 12. the pvr was 777. with the addition of 100% fio2 and inhaled nitric oxide her pap did not significantly change, 78/27 with mean 43, but the wedge pressure rose to 16. the pvr dropped to 480 due to the rise in cardiac output from 3.5 to 4.5 (cardiac index from 1.9 to 2.5). she was started on sildenafil 50 mg three times daily. she initially improved, but then became progressively short of breath and more hypoxemic despite no change in her weight. repeat echo demonstrated worsened tr with gradient worsened to 94 mm hg. pt notes increase in 7 lbs in weight over last 2 weeks, some increased abdominal girth associated with it. she notes very mild increase in orthopnea, although still using only 1 pillow, no pnd. her functional status includes ambulation around her house to the batroom, she is able to climb 6 stairs at a time before having to stop. she lives by herself, performs adls. she also notes that ocassionaly her hr is in the 40s during which times she hold her digoxin. she took her coumadin 2.5mg this morning. past medical history: # atrial fibrillation - s/p several failed attempts at cardioversion - currently rate controlled and anticoagulated on coumadin # h/o etoh abuse # idiopathic pulmonary hypertension # raynaud's syndrome - (+) (1:1280), (+) anti-centromere antibodies. - (-) negative ssa, ssb, scl-70, sm, rnp antibodies # htn # s/p hysterectomy social history: retired nurse, catholic. former smoker, stopped 30 years ago, 30 pack year history of smoking. quit drinking , former heavy alcohol use with up to a of vodka a day or 1 bottle of wine. never had withdrawl or withdrawl seizures. lives at home alone, able to perform all adls on her own, recently more difficult with shortness of breath. family history: no hx of pulmonary hypertension or similar lung diseases. physical exam: temp 97.4, bp 130/60, hr 80, rr 12, o2 sat 95% on 4l gen: pleasant elderly female, speaks in full sentences heent: anicteric, op claer neck: supple, jvd to jaw at 90 degrees lungs: minimal crackles at bases abd: soft, + large umbilical hernia, + bs extr: tr edema, 1+ pulses b/l neuro: non-focal pertinent results: labs on admission: wbc-4.8 hct-31.4* mcv-90 plt ct-165 pt-23.4* ptt-35.9* inr(pt)-2.3* glucose-110* urean-24* creat-1.1 na-138 k-4.1 cl-100 hco3-27 angap-15 alt-9 ast-21 ld(ldh)-233 alkphos-46 totbili-0.8 probnp-* albumin-4.0 calcium-9.7 phos-3.6 mg-2.1 digoxin-1.3 . labs on discharge: wbc-4.3 hct-27.3* mcv-89 plt ct-233 pt-28.8* ptt-46.1* inr(pt)-3.0* glucose-88 urean-13 creat-0.8 na-140 k-3.8 cl-104 hco3-25 angap-15 calcium-9.5 phos-3.8 mg-2.0 probnp-6740* . labs during hospitalization: -positive titer-1:640 cntromr-positive c3-119 c4-19 hiv ab-negative dna autoantibodies, ssdna igg antibody <69 (negative) sm/rnp antibodies (without ) sm antibody negative sm/rnp antibody negative . micro: : urine cx enterococcus 10-100,000 org/ml, pansensitive : urine cx enterococcus 10-100,000 org/ml, pansensitive : blood cx x2 no growth : urine cx: enterococcus 10-100,000 org/ml, 2nd isolate <10,000 . imaging: ett: the patient exercised for 3 minutes on protocol and stopped due to progressive shortness of breath. this represents a poor functional capacity for age. the patient denied any arm, neck, back or chest discomfort throughout the study. there were no significant st segment changes noted over baseline abnormalities. the rhythm was atrial fibrillation with intermittent vpbs (which tended to decrease with exercise) and a rare vent couplet. the hr response to exercise was exaggerated and there was an abnormal blood pressure response to exercise. . echo: the left atrium is elongated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is markedly dilated. there is moderate global right ventricular free wall hypokinesis. there is abnormal diastolic septal motion/position consistent with right ventricular volume overload. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. echocardiographic signs of tamponade may be absent in the presence of elevated right sided pressures. . cath: pa sat 49% ao sat 99% ra 22/15/14, hr 51 rv , max dp/dt , hr 48 pcw 25/25/10, hr 59 pa 78/23/39, hr 53 . foot xr: 1. possible erosion medially at the left first tmt joint involving the distal aspect of the medial cuneiform. 2. soft tissue swelling at the level of the right ankle, particularly laterally. 3. no acute fracture or dislocation. . cxr: the right transjugular swan-ganz line loops in the right atrium and passes into the right ventricle where the course is obscured by cardiac motion, but i suspect it is still below the pulmonary outflow tract unchanged since 1:58 a.m. moderate cardiomegaly is stable. there is no pulmonary edema. small left pleural effusion is probably present. no pneumothorax. lungs are essentially clear. . cxr: tunneled catheter terminates in svc at level of carina. catheter has not been advanced into the pulmonary artery. . 6 min walk test: results pending at time of discharge brief hospital course: ms. is a 64yo f with a pmh of afib, severe pulmonary artery hypertension (4+ tr, gradient 94mm hg), 1+ mr, and htn. she presented on for scheduled r sided cardiac catheterization to further evaluate her pulmonary artery hypertension. on admission, patient had a supratherapeutic inr from her coumadin and was felt to be volume overloaded (~7lbs up from her dry weight. she was gently diuresed while her inr trended down. once her volume status was stable and her inr was normal, she underwent catheterization on which revealed severe pulmonary hypertension, but essentially unchanged from prior catheterization. she was kept on a heparin gtt (as anticoagulation for her afib) while a decision was made regarding next step in her evaluation for pulmonary artery hypertension. she was transferred to the ccu on for placement of a swan cathether and a trial of flolan. however, she developed a fever of 101.3 on the evening of . the team decided to hold off on central line placement given her fever, so she was transferred back to 6 for further fever workup. pulmonary continued to follow the patient. . of note, the patient developed bilateral foot pain on . she was noted to have low grade fevers the previous night, but had been receiving tylenol for her foot pain. she described the foot pain along the medial aspect of her left foot and up the achilles tendon on her left, as well as across the dorsal aspect of her right foot, along the anterior aspect of her ankle joint. the pain was so severe that it took her breathe away upon standing. at rest, it was more dull, but was worsenend simply by palpation. she was able to roll her ankles, but felt that her rom was limited by pain. she notes that the pain was reproduced upon dorsiflexion and plantarflexion of her feet. she noted that they both hurt equally and that she had never had pain like this before. she has had a previous episode of plantar fasciitis. she developed a fever on the night that she first noticed the pain, once the tylenol was stopped. in the ccu, after she spiked a temperature, she was restarted on tylenol and ibuprofen with improvement in her pain. her fevers then resolved, as did her pain. her urine cultures revealed 10-100,000 colonies of pan-sensitive enterococcus which was never treated given that her uas showed few bacteria and minimal if any wbcs. . she was also noted to be in acute renal failure on , with a creatinine of 1.8 (up from 1.2). it was felt that this was possibly due to over-diuresis. her diuretics were held and ibuprofen was discontinued, in case of interstitial nephritis. ua and urine lytes were checked and revealed a fena of 2.4% (una 55, uosm 204) and feurea of 24.8%, confirming a prerenal state. discontinuation of her medications and gentle fluid resuscitation resulted in improvement in her creatinine. at discharge, her creatinine had returned to 0.8. . ms. was transferred back to the ccu on . a central line was placed on and an attempt was made to float a swan ganz catheter, but the catheter was unable to be passed into the pa. she underwent pa catheter line placement under fluoroscopic guidance. flolan was initiated on and it was determined that she was a responder to pulmonary vasodilation as her pa pressure went from 83/26/48 -> 67/33/46 on 4 ng/kg/min. however, she developed an increased wedge pressure (10 -> 13), pressure on her chest, crackles on exam and dyspnea, raising concern for diastolic dysfunction. the dose of flolan was decreased to 2ng/kg/min with resolution of her symptoms. a second trial was attempted, but this time flolan was increased at a slower rate. on , ms. readings were suspicious for a misplaced pa line and cxr showed that the line was coiled in rv. the line was pulled back into the ra and was refloated. flolan continued to be uptitrated. ms. attempted a trial of ambulation (she was asymptomatic at rest with sats 88-100%) but dropped her o2 sats to the 70's with ambulation). flolan was increased to 7ng/kg/min on , up to 8ng/kg/min on , then up to 9ng/kg/min prior to transfer from the ccu. . trials of diuresis (lasix) and afterload reduction (captopril) were also simultaneously attempted. afterload reduction was eventually abandoned in favor of optimizing diuresis. she was continued on lasix with a goal of i/o even daily. her aldactone, however, was held. she began to develop a pancytopenia felt to be either a medication effect or part of a rheumatologic process. she also began to complain again of toe pain, as tylenol was being held, so tylenol was restarted rtc and she was also given oxycodone prn for pain. her renal function returned to baseline. a digoxin level was checked and was 1.4. lopressor was held due to bradycardia and she remained in afib with good rate control on digoxin alone. she continued on a heparin gtt until she had a tunnelled line placed on . she was then started on coumadin. she developed a pancytopenia that was felt to be either due to medication or perhaps her rheumatologic condition. her anemia workup revealed anemia of chronic disease. on discharge, her wbc and hct were both stable and her platelets remained normal. . rheumatology consulted on the patient and felt that she may have a crest type syndrome or mixed connective tissue disorder given her pulmonary hypertension, raynaud's syndrome, rheumatological telangectasias, + , and + anticentromere antibodies. the etiology to her foot pain was unclear, and given that it was completely resolved by the time rheumatology was able to evaluate her, they were unable to tell if it was related. repeat serologies were sent and showed: + with a 1:640 titer, centromere + c3 119, c4 19 ssdna igg ab <69 (negative) sm ab negative sm/rnp ab negative . ms. was transferred back to 6 on . at that time, she denied any fevers or chills, chest pain or pressure, sob at rest, cough, uri sx, nausea, vomiting, abdominal pain or diarrhea. she had been constipated but was taking colace and senna prn. she had no dysuria or frequency and no back pain. she had been up to a chair and ambulating w/ assistance. she has mild doe but notes she is most sob after having ambulated, when she is recovering from that activity. upon transfer to the floor, her flolan dose was 9ng/kg/min. she was slowly titrated up to 11ng/kg/min, but she then developed diarrhea so her dose was decreased to 10.5ng/kg/min which she appeared to tolerate well. she was ultimately discharged on this dose. a 6 minute walk test was performed on , but results were pending at time of discharge. she appeared euvolemic on discharge and was able to ambulate with only mild doe. she continued to be in atrial fibrillation, with hr in the 50s-60s. her toprol was held upon discharge because of bradycardia, but she was maintained on digoxin. her inr was 3.0 upon discharge. she remained afebrile when tylenol was changed from rtc to prn, so she was not discharged on any antibiotics. . of note, a ct scan performed earlier this year revealed enlarged paratracheal and mediastinal lymphadenopathy. no further workup of this lymphadenopathy was performed during this hospitalization and should be performed as an outpatient. . her code status was full throughout her hospitalization. she was discharged home with services with a plan to follow up with dr. in one week. medications on admission: lasix 80 mg daily aldactone 25 mg daily toprol xl 12.5 mg daily coumadin 2.5/5mg (wefri) qam digoxin 0.125 daily celexa 20 mg daily sildenafil 50 mg three times daily discharge medications: 1. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 2. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 4. epoprostenol 0.5 mg recon soln sig: 10.5 ng/kg/min intravenous infusion (continuous infusion). disp:*1 month supply* refills:*2* 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. 6. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. warfarin 2.5 mg tablet sig: one (1) tablet po at bedtime. discharge disposition: home with service facility: vna assoc. of discharge diagnosis: pulmonary hypertension atrial fibrillation discharge condition: good. bp 123/54, hr 60, rr 18, sats 98% on 4l. flolan at 10.5 units. discharge instructions: you were admitted to the hospital for a cardiac catheterization. you were diuresed and then had to start a heparin drip for the procedure, given that you are in atrial fibrillation. the procedure showed that you have severe pulmonary hypertension so you were brought to the ccu, had a central line and swan catheter placed, and were initiated on flolan. your hemodynamics improved while on flolan so a tunneled line was placed and your flolan dose was titrated up to the dose of 10.5 ng/kg/min upon discharge. . please follow all instructions as provided by the flolan company and nurses. . please resume your inr checks as you had been doing prior to your hospitalization. your coumadin dose has had to be adjusted prior to your discharge. your inr upon discharge is 3.0. . please continue to take all your medications as prescribed. you are no longer taking toprol or aldactone or sildenafil. you are instead taking flolan. you should continue to take lasix at 40mg daily and digoxin at 0.125mg daily. your coumadin dose will need to be monitored and titrated based on your inr. . please follow up with your pcp weeks. . you also need to follow-up with dr. within 1 week. please call dr. office on monday and speak to to set this appointment up, preferably on wednesday. her office number is . . 3 lbs. please adhere to a no-added salt diet. . please call your pcp or go to the nearest er if you develop any of the following symptoms: fever, chills, chest pain, sob, difficulty breathing, headaches, dizziness, worsening diarrhea, jaw pain or joint aches, leg swelling, or any other worrisome symptoms. followup instructions: please have your inr checked on monday, . . you also need to follow-up with dr. within 1 week. please call dr. office on monday and speak to to set this appointment up, preferably on wednesday. her office number is . . please call to make an appointment with a rheumatologist in your area. the rheumatology team here recommended dr. who is located in . his office number is (. you will likely need a referral from your pcp to make this appointment. . please call to make an appointment with dr. (cardiology) here at . you should see him in weeks. his office number is (. . please follow-up with your pcp in the next 1-2 months. procedure: venous catheterization, not elsewhere classified pulmonary artery wedge monitoring right heart cardiac catheterization diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation other chronic pulmonary heart diseases long-term (current) use of anticoagulants other diseases of lung, not elsewhere classified acute diastolic heart failure hypovolemia raynaud's syndrome effusion of joint, ankle and foot systemic sclerosis 

Answer: The patient is high likely exposed to