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: sulfonamides / tetanus antitoxin attending: chief complaint: nausea major surgical or invasive procedure: cardiac catheterization thoracentesis esophagogastroduodenoscopy history of present illness: 84f with history of coronary artery disease, status post ptca of lcx () who presented to ed this morning with nausea and lethargy. pt was recently seen in clinic with fevers and increased cough and cxr showed right middle and lower lobe infiltrate and small surrounding effusion consistent with pneumonia. ekg in ed notable for 2 mm ste in iii and f. mb index 17 and troponin i 0.73. pt started on heparin gtt and integrillin gtt, given asa 325 mg po and metoprolol 5 mg iv and transferred to cath lab. . in cath lab, found to have elevated filling pressures: ra 17, rv 42/2, pa 39/17, w 17. pt has 3vd with lmca 30%, lad 70% prox, 70% dist, lcx 70% om1, rca 70% dist with cut off at rpl after spontaneous reperfusion at dist rca stenosis. 40% after stenosis patent. distal rca stented with vision stent, unable to deliver des. . post cath, pt denies any chest pain, sob, orthopnea, pnd or leg swelling. she does report moderate rright groin discomfort and back pain related to her spinal stenosis and laying flat on the stretcher. pt usually sleeps in a recliner secondary to back pain from spinal stenosis. social history: patient lives at house. she denies smoking, alcohol, or illicit drug use. children live in the area. retired fashion consultant/dressmaker. currently enjoys painting watercolors and acrylics. family history: mother and sister with type 2 dm. mother died of mi. father died of "heart trouble" physical exam: pe: vs 97.2 bp 100/61 hr 65 r 15 100% ra gen: nad, laying flat on stretcher, pale appearing heent: eomi, perrl, o/o clear neck: unable to assess neck veins laying flat, no lad chest: clear anteriorly cv: rrr nl s1 s2 no mrg appreciated abd: soft, nt, nd + bs ext: pt has clamp on r groin so pulses not palp on r side, but full on l at dp and pt. r groin without hematoma or bruit. pertinent results: 07:10am blood wbc-15.7* rbc-2.87* hgb-8.6* hct-26.3* mcv-92 mch-30.1 mchc-32.8 rdw-16.3* plt ct-224 07:20am blood wbc-16.7* rbc-3.06* hgb-9.3* hct-27.6* mcv-90 mch-30.3 mchc-33.6 rdw-16.3* plt ct-291 12:50pm blood wbc-20.5* rbc-3.32* hgb-10.0* hct-29.8* mcv-90 mch-30.0 mchc-33.4 rdw-16.2* plt ct-348 03:57am blood wbc-22.8* rbc-3.60* hgb-10.6* hct-32.1* mcv-89 mch-29.5 mchc-33.1 rdw-15.6* plt ct-380 08:00am blood wbc-17.1* rbc-3.31* hgb-9.9* hct-29.7* mcv-90 mch-29.9 mchc-33.3 rdw-16.2* plt ct-328 02:22pm blood wbc-18.5* rbc-3.11* hgb-9.1* hct-27.8* mcv-90 mch-29.2 mchc-32.7 rdw-15.9* plt ct-282 12:50pm blood neuts-91.7* bands-0 lymphs-4.2* monos-3.8 eos-0.1 baso-0.2 12:50pm blood hypochr-normal anisocy-1+ poiklo-1+ macrocy-normal microcy-normal polychr-1+ ovalocy-1+ 07:20am blood pt-14.1* ptt-27.7 inr(pt)-1.3 07:20am blood plt ct-291 07:10am blood plt ct-224 07:10am blood glucose-129* urean-125* creat-3.8* na-132* k-4.5 cl-101 hco3-18* angap-18 03:57am blood ld(ldh)-638* 07:10am blood ck(cpk)-331* 09:21pm blood ck(cpk)-434* 12:05pm blood ck(cpk)-298* 07:10am blood ck-mb-45* mb indx-13.6* ctropnt-2.66* 09:21pm blood ck-mb-61* mb indx-14.1* ctropnt-2.54* 12:05pm blood ck-mb-52* mb indx-17.4* ctropnt-0.73* 07:10am blood calcium-8.6 phos-4.7* mg-2.2 07:20am blood hapto-281* 07:00am blood caltibc-143* ferritn-379* trf-110* 04:58pm blood freeca-1.12 cxr: reduction in the size of the right pleural effusion since the prior film of the same date. no pneumothorax. there is persistent small right pleural effusion and atelectases are present at both lung bases. . egd:: -small hiatal hernia -grade ii esophagitis in the middle third of the esophagus and lower third of the esophagus -erythema and congestion and mild atrophy in the stomach body and antrum compatible with gastropathy -otherwise normal egd to fourth part of the duodenum ** recommendations: followup biopsies continue current medications additional notes: the esophagitis is a possible source of gi bleeding, although there is no blood or stigmata of bleeding at present. the etiology is likely reflux, but biopsies were done to rule out or other infectious causes * cxr : -interval increase in opacity overlying the r lung c/w effusion layering posteriorly. likely element of volume loss and infiltrate in the right lower lung as well. there is an increased left effusion with retrocardiac opacity consistent with volume loss/infiltrate/ effusion. impression:worsening pulmonary edema. underlying infectious etiology cannot be totally excluded. . cxr : impression: new right effusion and associated air space consolidation affecting right middle and lower lobes. findings consistent with pneumonia in the appropriate clinical setting. . echo: ef > 55%, 1+ ar . ekg (pre cath): nsr at 70 bpm with 2 mm ste in iii and f. qtc 440. . ekg (post cath): 65 bpm, l axis, bad baseline, qtc 458, 0.5 mm ste in iii and f. lvh by avl criteria. . studies: echo the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). wma cannot be fully excluded. rv chamber size and free wall motion are normal. the av leaflets are mildly thickened. mild (1+) ar. mv leaflets are mildly thickened. (+) mr. there is mild pa systolic htn. . cardiac cath : l main coronary art: 30% stenosis lad 70% prox stenosis; 70% stenosis of diag branch om1 w/ 70% lesion 40% prox rca lesion 70% distal rca lesion w/ cut-off in distal rca branch distal rca w/ minivision stent rvedp: 16mmhg, pcwp: 15mmhg brief hospital course: 84 female with recent pneumonia who presented with malaise and nausea and was found to have an inferior stemi. pt underwent a cardiac catheterization, found to have thrombosed rca with distal embolization which was stented with a vision stent. after the catheterization the hospital course has been complicated by pleural effusions, gastrointestinal bleeding and acute renal failure. ms. at 1300 on . . cardiac: ischemia ms. has a history of coronary artery disease and is status post myocardial infarction (ck peak: 434, trop-t peak: 2.66). she presented with ekg changes suggestive of a right ventricular coronary artery disease. she likely had a right ventricular infarction. the pt underwent a cardiac catheterization showed three vessel coronary artery disease, the left main coronary artery had a 30% stenosis, the left anterior descending artery had a 70% proximal stenosis. there was no angiographic evidence of obstructive coronary artery disease in the mid and distal lad. there was a 70% stenosis of the a diagonal branch. the left circumflex artery had no angiographic evidence of obstructive coronary artery disease. the om1 had a 70% lesion. there was angiographic evidence of a 40% proximal rca lesion and a 70% distal rca lesion and there was a cut off in the pl branch, likely after spontaneous reperfusion at the distal rca stenosis. the pt underwent successful stenting of the distal rca with a 2.5 mm minivision stent. the pt was recommended medical therapy as initial treatment, she was determine to not be a surgical candidate. after cardiac catheterization, the pt was noted to have a dropping hematocrit for which she was transfused 1 unit of prbc. during the transfusion, the patient became acutely short of breath and was noted to have flash pulmonary edema. she was transferred to the cardiac care unit (ccu) where she responded to aggressive lasix diuresis. she was transferred back to the the following day. she was continued on aspirin, plavix, statins and beta-blockers (which were titrated down in the setting of low blood pressure). . cardiac: pump the patient was noted tohave a left ventricular ejection fraction of >50% on echo. she was continued on an ace inhibitor for remodeling benefit. the patient's hemodynamics during the cathterization were notable for elevated right sided pressures. the patient was managed with diuresis. . cardiac: rhythm the patient has a pacemaker and has been a sensed v paced. she was noted to have no significant events on telemetry. . renal failure: acute on chronic ms. has a history of chronic renal failure with a baseline creatinine of 1.4. during her hospital stay ms. creatinine was monitored daily. in the post-catheterization setting her creatinine was noted to rise as high as 3.9 with a corresponding rise in phosphate to a maximum of 6.0. ms. was also noted to have aninitial pre-renal failure and had poor presponse to iv fluids in teh setting of decreased po intake. she was seen by the nephrology team and was offered dialysis, which she refused. a renal ultrasound to assess her kidneys showed atrophic changes but not evidence of hydronephrosis. during the hospital stay, ms. was also noted to have a yeast urinary tract infection which was treated with fluconazole. . anemia: ms. has a history of normocytic anemia )with a negative bone marrow biopsy in the past) for whihc she was treated with procrit in the past. she underwent several transfusions for gastrointestinal bleeding (in the setting of guaiac stools). ms. an egd on . esophageal biopsies taken during the egd showed fragments of granulation tissue and exudate with acute and chronic inflammation consistent with ulceration. the pt was offered a colonoscopy but declined to undergo the procedure after weighing the risks and benefits. she was medically managed with a dose of pantoprazole. . diabetes mellitus: ms. was on nph (qam) and regular insulin sliding scale at home. she was maintained on teh sliding scale with qid fingersticks. . polymyalgia rheumatica: ms. has a history of discoid lupus and polymyalgia rheumatica for which she was on 7.5 mg po prednisone daily. given the risk of wall rupture, ms. was not given a stress dose of steroids. she was maintained on her home dose of prednisone. . pneumonia: ms. presented to the hospital with a recent diagosis of pneumonia. she was treated with a 5 day course of azithromycin and iv ceftriaxone (for total 14 day course). she remained afebrile during the hospital stay. she was noted to have progressive bilateral (right more than left) pleural effusions. she underwent two thoracocentesis (with removal of 1 liter each time). the effusions were noted to be inflammatory in nature (no empyema). a post-procedure chest x-ray did not show any evidence of pneumothorax. . hypertension: ms. was continued on lopressor and lisinopril. her hctz was held while in hospital because she was not hypertensive. . spinal stenosis: ms. was maintained on tylenol, oxycodone and morphine (once she was cmo status) for pain control. . macular degeneration: ms. was continued on her vitamins. . fluids/electrolytes/nutrition: ms. was maintained on a diabetic, heart healthy diet. her electrolytes were monitored and relpeted as needed. . access: peripheral iv . code status: dnr/dni with comfort measures only. during a family meeting with the pt and her daughters on the goals of continued care were discussed. the patient and her family were reluctant to pursue further medical intervention and they decided (with the patient in agreement) that she would be comfort measures only. it was decided that the patient would be offered medications (aspirin, plavix) that would prevent instent thrombosis/stenosis. she will be maintained on medications that would make her comfortable. . prophylaxis: subcutaneous heparin pantoprazole for gi protection medications on admission: metoprolol tartrate 50 mg po bid hydrochlorothiazide 25 mg po daily acetaminophen 325 mg po q 4-6 h prn folic acid 1 mg tablet sig: one (1) tablet po daily (daily). ferrous gluconate 300 mg po daily aspirin 325 mg po daily prednisone 7.5 mg po daily b-complex with vitamin c tablet po qd calcium carbonate 500 mg po daily cholecalciferol (vitamin d3) 200 unit tablet po daily clopidogrel 75 mg po daily lisinopril 20 mg po daily insulin nph (18) units subcutaneous qam. procrit injection borrage oil sig: 1000 (1000) mg once a day. pantoprazole 40 mg po once a day. azithromycin 500 mg po qd (d3) discharge disposition: extended care discharge diagnosis: non st elevation myocardial infarction community acquired pneumonia congestive heart failure acute renal failure blood loss anemia polymyalgia rheumatica restless legs transudative pleural effusions gi bleed grade ii esophagitis yeast urinary tract infection discharge condition: fair - comfort management only discharge instructions: comfort management only- patient at 1300 on symptom management and support. followup instructions: none procedure: insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters thoracentesis thoracentesis esophagogastroduodenoscopy [egd] with closed biopsy cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery polymyalgia rheumatica urinary tract infection, site not specified acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified rheumatic heart failure (congestive) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease personal history of other diseases of circulatory system acute myocardial infarction of other inferior wall, initial episode of care old myocardial infarction macular degeneration (senile), unspecified cardiac pacemaker in situ encounter for palliative care hemorrhage of gastrointestinal tract, unspecified esophagitis, unspecified other extrapyramidal diseases and abnormal movement disorders rheumatic heart disease, unspecified other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria spinal stenosis, lumbar region, without neurogenic claudication lupus erythematosus candidiasis of unspecified site 

Answer: The patient is high likely exposed to