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: penicillins / aspirin / sulfa (sulfonamides) / ivp dye, iodine containing attending: chief complaint: tamponade major surgical or invasive procedure: pericardiocentesis history of present illness: 79 yo w w/ hx gerd, mgus, ?mm on epo, tah/bso and parox aflutter, presented 2 weeks ago to osh w/ epigastric pain ? w/u given h2 blocker, d/c home. developed productive cough and got z pack. d ago while eating developed abd pain, rad to back, to osh. /lip wnl, ? elevated wbc, lft's nl. ct to evalute pain, notable for groin mass ? malignancy, fluid in abdomen, pericardial effusion, moderate. tte followed showing preserved ef and mod pericardial effusion w/ possible ra collapse and transferred here. . bp initially 100's, w/ abd pain, s/p morphine and sbp 80's, sinus tachy to 126, no ekg changes. ivf and no card enzymes checked, transferred, no pulsus paradoxus documented. . ros 15 lb wt loss/last year, poor po intake. . once here, bedside tte c/w moderate - large effusion, w/ fibrin deposition; pulsus paradoxus 15 on admission. past medical history: c/scope w/ tortuous colon incomplete mgus atrial flutter: on dig and bb gout gerd social history: married, no tobacco, rare etoh family history: nc physical exam: admission: pe: 98.9 96 140/60 19 93%ra gen: nad, a&o x 3 heent: eomi, perrl, mm dry, no thrush neck: flat veins. no lad heart: tachy. regular. no mrg. lungs: diffuse rhonchi, wheezes abd: soft, non-tender. nabs. ext: no c/c/e . discharge: 98.3 152/72 (131-152/58-72) 80 (80-92) 20 95ra 630/415 pulsus 8 gen: nad, a&o x 3 heent: eomi, perrl, mmm. neck: jvd flat. heart: regular. ii/vi murmur @ apex. pulsus 8. lungs: ctab abd: soft, non-tender. nabs. ext: no c/c/e pertinent results: 07:05am blood wbc-7.0 rbc-3.81* hgb-10.8* hct-32.6* mcv-86 mch-28.4 mchc-33.1 rdw-14.8 plt ct-475* 03:00am blood wbc-9.1 rbc-3.81* hgb-10.8* hct-32.8* mcv-86 mch-28.2 mchc-32.8 rdw-14.8 plt ct-439 03:46pm blood hct-30.7* 08:22am blood wbc-8.8 rbc-3.32* hgb-9.6* hct-29.1* mcv-88 mch-28.9 mchc-33.0 rdw-14.9 plt ct-273 03:46am blood wbc-9.5 rbc-3.31* hgb-9.3* hct-29.1* mcv-88 mch-28.2 mchc-32.1 rdw-15.0 plt ct-273 05:40pm blood wbc-15.2* rbc-3.88* hgb-11.1* hct-34.0* mcv-88 mch-28.5 mchc-32.5 rdw-14.9 plt ct-424 07:05am blood plt ct-475* 03:00am blood plt ct-439 03:00am blood pt-13.6* ptt-26.4 inr(pt)-1.2 04:19am blood plt ct-313 08:22am blood plt ct-273 03:46am blood plt ct-273 05:40pm blood plt ct-424 05:40pm blood pt-14.9* ptt-23.6 inr(pt)-1.5 05:40pm blood esr-55* 07:05am blood glucose-107* urean-19 creat-0.6 na-141 k-3.7 cl-102 hco3-28 angap-15 09:40pm blood glucose-109* urean-19 creat-0.7 na-141 k-3.8 cl-103 hco3-25 angap-17 03:00am blood glucose-97 urean-18 creat-0.7 na-141 k-4.1 cl-103 hco3-22 angap-20 03:46pm blood glucose-97 urean-18 creat-0.7 na-140 k-4.1 cl-105 hco3-23 angap-16 04:19am blood glucose-89 urean-23* creat-0.7 na-139 k-4.1 cl-107 hco3-23 angap-13 03:46am blood glucose-102 urean-35* creat-0.9 na-135 k-4.3 cl-105 hco3-20* angap-14 05:40pm blood glucose-121* urean-42* creat-1.2* na-135 k-5.5* cl-102 hco3-21* angap-18 04:19am blood ld(ldh)-114 05:40pm blood alt-16 ast-19 ld(ldh)-223 ck(cpk)-53 alkphos-43 totbili-0.5 05:40pm blood ck-mb-notdone ctropnt-<0.01 07:05am blood mg-1.7 03:00am blood calcium-9.6 phos-3.5 mg-1.6 03:46pm blood calcium-8.9 phos-3.3 mg-1.8 04:19am blood calcium-8.5 phos-2.9 mg-2.1 uricacd-6.8* 03:46am blood totprot-4.9* calcium-8.1* phos-3.7 mg-1.7 cholest-79 05:40pm blood albumin-3.3* calcium-8.9 phos-4.3 mg-1.9 05:40pm blood %hba1c-5.3 -done -done 03:46am blood triglyc-116 hdl-18 chol/hd-4.4 ldlcalc-38 ldlmeas-<50 05:48pm blood -negative 05:40pm blood rheufac-14 03:46am blood pep-no specifi 06:56pm blood type-art po2-104 pco2-35 ph-7.37 calhco3-21 base xs--3 intubat-not intuba 06:56pm blood k-4.9 06:56pm blood hgb-11.1* calchct-33 o2 sat-97 . abd us: indication: ? splenic granulomas and right inguinal cystic structure per outside hospital ct scan. no studies available for comparison. transabdominal ultrasound examination was performed. there are bilateral pleural effusions. the liver demonstrates no focal or textural abnormality. the gallbladder contains sludge. there is no evidence of acute cholecystitis. there is no intra or extrahepatic biliary ductal dilatation. the right kidney measures 10.6 cm. there is a 2.5 x 2.2 x 2.1 cm cyst at the lower pole of the right kidney. there is no hydronephrosis or stones. the left kidney measures 11.1 cm. there is a 2.4 x 2.5 cm cyst in the interpolar region of the left kidney. note is made of multiple scattered punctate hyperechoic foci, some of which demonstrate posterior acoustic shadowing in the spleen consistent with areas of calcification. the pancreas is poorly visualized in this study. evaluation of the right groin region demonstrates no abnormal cystic structure. impression: 1. splenic scattered calcifications. 2. bilateral renal cyst. 3. sludge in the gallbladder. the study and the report were reviewed by the staff radiologist. dr. dr. approved: mon 11:03 pm procedure date: . . torso ct: indication: 79-year-old female with tamponade, 6 months weight loss, and pelvic mass on outside hospital ct. evaluate. comparison: none. technique: mdct images of the chest, abdomen, and pelvis were obtained without intravenous contrast. ct chest without intravenous contrast: multiple enlarged axillary lymph nodes are seen bilaterally, which do not ct criteria for pathologic enlargement. within the mediastinum, there are multiple enlarged lymph nodes. a single right pretracheal lymph node measures 9 mm in short axis diameter. additional pre and paratracheal nodes measure 5-7 mm. there are mild coronary and aortic vessel calcifications. there is a moderately large pericardial effusion. moderate pleural effusions are seen bilaterally, with compressive atelectasis. additionally, there is diffuse edema within the surrounding soft tissues. on lung windows, there is a 4 mm nodule within the right lower lobe, a 3 mm nodule at the right lung base, and a 4 mm nodule within the left upper lobe. ct of the abdomen with oral, without intravenous contrast: imaging of the abdomen is limited by the lack of intravenous contrast. allowing for this, there is a small amount of intraabdominal ascites. the liver is normal in attenuation, without nodules or masses. the gallbladder and pancreas are within normal limits. multiple calcified foci are seen throughout the spleen, consistent with prior granulomatous infection. both adrenal glands are normal in appearance. the left kidney is normal in position, with multiple hypodense foci, most likely representing simple cysts, but inadequately characterized. the right kidney is inferiorly and anteriorly rotated. a large hypodense lesion within the interpolar right kidney, most likely represents a simple cyst, but is also inadequately characterize. the intra-abdominal loops of large and small bowel are normal in caliber and contour. there is no mesenteric lymphadenopathy. multiple shotty periaortic lymph nodes are identified. ct of the pelvis with oral, without intravenous contrast: there is sigmoid diverticulosis without evidence of acute diverticulitis. a foley catheter is seen within a collapsed bladder. the previously identified 2.1 x 3.6 cm low attenuation (fluid density) lesion within the right groin is most consistent with a fluid distended ilio- psoas bursa. again noted is diffuse subcutaneous edema. multiple prominent inguinal lymph nodes are seen, which do not meet ct criteria for pathologic enlargement. there is no significant pelvic lymphadenopathy. diffuse vascular calcifications are identified throughout the abdomen and groin. bone windows: there are no suspicious lytic or sclerotic osseous abnormalities. diffuse degenerative changes are seen along the thoracic and lumbar spine. impression: 1) moderate-sized bilateral pleural effusions. two nonspecific noncalcified 4 mm nodules within the right lung base and a 4 mm nodule within the left lung base. 2) mild intraabdominal ascites. 3) splenic calcifications consistent with the history of prior granulomatous infection. 4) multiple low-density lesions throughout bilateral kidneys, most likely representing cysts, but inadequately characterized on this noncontrast study. 5) 3.6 x 2.1 cm fluid-containing right ilio- psoas bursa. 6) diffuse, nonspecific lymph node prominence, without frank lymphadenopathy. 7) diffuse subcutaneous edema. 8) diffuse vascular calcifications. the study and the report were reviewed by the staff radiologist. dr. . dr. approved: wed 7:44 am procedure date: . . pa/lat cxr: indication: status post pericardial effusion and drainage. evaluate for edema or infiltrate. comparison: . findings: again seen are bilateral pleural effusions. the pulmonary vasculature is within normal limits. the mediastinal contours are stable in appearance. the cardiac contours are stable. there is a focal lucency within the right lower lobe, which may represent a confluence of overlying structures with associated aerated lung in that area; however, followup radiographs are recommended to document resolution of this. soft tissue and osseous structures are unchanged. impression: 1) again seen are bilateral pleural effusions; the pulmonary vasculature is within normal limits. there is no chf. 2) there is a focal lucency adjacent to the right cardiac heart border, the right lower lung zone, which likely represents a confluence of overlying shadows with associated underlying aerated lung tissue. however, followup radiographs are recommended to evaluate further. . indications for catheterization: pericardial tamponade final diagnosis: 1. pericardial tamponade. comments: 1. resting hemodynamics showed elevated right and left sided pressures (mean 19 mm hg) with equalization of pressures. the pericardial pressure was equal to the right atrial pressure. there was a pulsus paradoxus of 20 mm hg in the femoral arterial pressure tracing (sbp 144-164 mm hg). these hemodynamics are consistent with pericardial tamponade. the cardiac index was low normal, 2.12, at baseline. 2. pericardiocentesis was performed, during which time 320 cc of serosanguinous fluid was drained from the pericardium. 3. post-pericardiocentesis, the pericardial pressure decreased to less than 0, his ra pressure decreased to 12, and his pulsus paradoxus resolved. the post-procedure ci increased to 2.76. post-procedure echo showed only minimal pericardial effusion. technical factors: total time (lidocaine to test complete) = 30 minutes. arterial time = 27 minutes. fluoro time = 4 minutes. contrast: anesthesia: 1% lidocaine subq. anticoagulation: other medication: versed 0.5 mg iv fentanyl 25 mcg iv cardiac cath supplies used: - , pericardiosentisis set . admission echo: overall left ventricular systolic function is mildly depressed. the right ventricular cavity is dilated. right ventricular systolic function appears depressed. the aortic valve leaflets are moderately thickened. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is a large pericardial effusion with fibrin stranding.. the effusion appears circumferential. there is sustained right atrial collapse, consistent with low filling pressures or early tamponade. there is significant, accentuated respiratory variation in mitral/tricuspid valve inflows, consistent with impaired ventricular filling. impression: large circumfirential pericardial effusion. early cardiac tamponade. . dc echo: left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). the aortic valve leaflets are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a small circumferential, somewhat echodense pericardial effusion without evidence of hemodynamic compromise. compared with the prior study (tape reviewed) of , the findings are similar. . report approved date: specimen date: specimen received: pericardial fluid diagnosis: negative for malignant cells. numerous neutrophils and scant mesothelial cells. specimen description: received 200ml bloody fluid. prepared 1 thinprep slide. clinical data: none provided. immunohistochemistry test(s), if applicable, were developed and their performance characteristics were determined by the department of pathology at , , ma. they have not been cleared or approved by the u.s. food and drug administration. the fda has determined that such clearance or approval is not necessary. these tests are used for clinical purposes. they should not be regarded as investigational or for research. this laboratory is certified under the clinical laboratory improvement amendments of (clia - 88) as qualified to perform high complexity clinical laboratory testing. brief hospital course: this 79 y/o female with parox aflutter, and mgus was admitted to the ccu with cardiac tamponade. . pericardial efussion: a pericardial drain was placed and 320cc of serosanguinous fluid was removed. on this fluid, amylase was 29, ldh 626, wbc w/83%p, 7%l and 5% unidentified cells. was negative. rf was 14. esr 55. tp 4.9. spep was negative. upep is pending at time of discharge. cytology was negative. pulsus was 8 on the day of discharge. echocardiography showed resolution. drain was removed 2 days prior to dc. . mgus: spep was negative. upep pending at time of discharge. pt referred for fu w/primary oncologist, dr. . . a-flutter/fib: --pt in and out of fib; now in sr --rate well controlled on toprol 150; digoxin was dced --anticoagulation deferred several days to outpatient followup. the patient's risk of bleeding from site of pericardial drain was felt to be higher than risk of stroke at time of dc. . chf: the patient was diuresed as an inpatient for clinical chf which was compensated by time of discharge. there were small bilateral efussions which are attributed to tamponade physiology; these should be followed up on in several weeks time with cxr; primary care followup is arranged. . bronchitis: no wheezing, ronchi, sob by time of discharge --7d course of levofloxacin started inpatient to be completed as outpatient . pulm nodules: these were visualized on torso ct obtained for worry of malignancy in context of old groin mass and pericardial efussion. pt is up to date on nl cancer screening. pt is nonsmoker. we have arranged followup with patient's primary oncologist and recommend fu ct scan in 3 months. ct report is copied into this summary. to obtain scans, radiology can be reached at (. . anemia: uncertain etiology. uncertain baseline, takes epogen as op for epo-deficient anemia related to renal insuff, outpt hgb . --follow hct --epo 40,000 monthly (last dose ) . for prophylaxis, ppi, sqh and pneumoboots were used. . the patient was full code throughout her stay. medications on admission: epogen lipitor 10 dig 0.25 qd prilosec toprol xl 75 lotrel 2 tabs qd paxil allopurinol calcium, vit d fes04 ocuvite discharge medications: 1. pprilosec sig: one (1) once a day: please continue prilosec at prior dose. 2. paroxetine hcl 20 mg tablet sig: one (1) tablet po daily (daily). 3. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 4. calcium carbonate 1,250 mg tablet sig: two (2) tablet po bid (2 times a day). 5. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 6. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 2 days. disp:*3 tablet(s)* refills:*0* 7. ipratropium bromide 0.02 % solution sig: one (1) inhalation four times a day for 7 days. disp:*1 puffer* refills:*0* 8. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 9. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 10. cepacol 2 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed). disp:*60 lozenge(s)* refills:*2* 11. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 12. metoprolol succinate 100 mg tablet sustained release 24hr sig: 1.5 tablet sustained release 24hrs po daily (daily). disp:*45 tablet sustained release 24hr(s)* refills:*2* discharge disposition: extended care facility: rehabilitation and nursing center discharge diagnosis: idiopathic pericardial efussion with tamponade discharge condition: good discharge instructions: please take all medications as directed. please attend all followup appointments. if you experience chest pain, palpitations, shortness of breath, or any other symptoms of concern to you, please call your pcp: , j. or return to the ed immediately. followup instructions: pcp: , j. on mon, . please call oncology: dr. for a followup appointment to evaluate your lung lesions and followup on mgus. dr. should be aware that a ct scan of the chest was peformed here that should be followed up on in three months. md procedure: coronary arteriography using a single catheter pericardiocentesis right heart cardiac catheterization diagnoses: anemia, unspecified esophageal reflux mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation atrial flutter bronchitis, not specified as acute or chronic acute idiopathic pericarditis 

Answer: The patient is high likely exposed to