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: no known allergies / adverse drug reactions attending: chief complaint: altered mental status major surgical or invasive procedure: arterial catheter history of present illness: 85 yof with hx of afib with new diagnosis of nephrotic syndrome p/w ams. . patient recently admitted and discharged 5 days ago. . the pt went to on . while there she noted increasing chest heaviness and doe, decreased appetite, decreased energy. she felt increasing swelling of her extremities, and weight gain. due to her husband's concern the pt returned to . she then went into her pcp for evaluation and was sent to the ed for concern re: new hypervolemia. . her admission from , by problem: # found to have nephrotic syndrome likely secondary to focal segmental glomerulosclerosis (anasarca, pr:cr ratio 15.3, albumin of 1.9, ldl 225, + oval fat body casts, and cr of 5.0 up from her prior normal baseline of 0.9). full evaluation below. she was started on 60mg of prednisone (day 1 = ) which she tolerated well with only mild improvement in her renal function over the first 2 week period (5.0 -> 4.2). she was also started on vit d and calcium supplements and continued on her ppi for steroid prophylaxis. repeat prot/cr ratio was down to 12. # positive quantiferon gold: she was tested with quantiferon gold prior to initiation of steroids and had a positive result which likely represents past exposure to tuberculosis. she was without symptoms and had a negative cxr. id was consulted and she was started on inh 300mg daily with pyridoxine 50mg po daily x 9 months # rue chronic arterial thrombus s/p thrombectomy: patient triggered twice for hypotension and found to have asymmetrical blood pressures in in her arms and partiallly occlusive thrombus in her right axillary/brachial artery and underwent arterial thrombectomy which was complicated by right arm hematoma. per the surgical report and speaking with the surgeons, the thrombus was quite large and felt to be chronic and atherosclerotic in nature. discharged on coumadin with a goal inr of . . for the last two days at they were unable to draw labs. this am, the pt was very sleepy. at 11 am on , she was 129/91, 98, 20, 99%, 98.7 temp. patient's family reports that her mental status change in the last couple of days. she really doesn't have any specific complaints. . in the ed: - triage: 98.7 98 129/91 16 99% ra - bedside echo: pericardial effusion -became hypotensive to 60 systolic - given 2l ns - came up to high 80's - cvl - left ij - levophed - k 5.9 - insulin and glucose - cardiology - tte - effusion but no tamponade - given vanc and cefepime - sores in perineum - ekg - no peaked t's - cxr - vascular congestion. - 100 mg hydrocort - bp 102/70, 102, 18, 100% ra . in the micu - bipap - attempted a-line - cvvh initiated - flagyl initiated for presumptive c-diff past medical history: nephrotic syndrome with a poag (primary open-angle glaucoma) severe stage glaucoma weight loss anorexia gait disorder obesity unspec colonic adenoma helicobacter pylori infection common biliary duct stricture leukopenia atrial fibrillation hypercholesterolemia osteoarthritis cataract anticoagulant long-term use poag (primary open-angle glaucoma) severe stage glaucoma weight loss anorexia gait disorder obesity unspec colonic adenoma helicobacter pylori infection common biliary duct stricture leukopenia atrial fibrillation hypercholesterolemia osteoarthritis cataract social history: pt lives in but spends winter in . says when she was in was in the plateau central, drank water that was purchased or boiled, but did eat fresh fruits and vegetables. did not swim, used overhead shower from the tap. no antimalarials. family history: non-contributory physical exam: admission exam: discharge vs: 97.5, tm 99.3, bp 133/84 (118-150/60-100), hr 71 (68-93), rr 18, spo2 100ra admit - bp 102/70, 102, 18, 100% ra general - eyes closed, laboured breathing, nonpurposeful response to verbal stimulation heent - cataracts bilaterally, mmm lungs - air movement to bases, decreased bs, rhochi and loud stridorous sounds heart - 2/6 systolic murmur, irregularly irregular rhythm abdomen - obese, tender to deep palpation globally, nd, nabs, no organomegaly. anasarca extremities - anasarca pulses: 1+ on my exam at b/l radials, non-palpable pulses in pt's and dp's bilaterally (dopplerable per vascular surgery)\ . discharge exam: expired pertinent results: admission labs 12:55pm blood wbc-38.7*# rbc-3.23* hgb-9.5* hct-28.2* mcv-87 mch-29.5 mchc-33.9 rdw-14.9 plt ct-158 12:55pm blood neuts-96.1* lymphs-2.4* monos-1.0* eos-0.2 baso-0.2 12:55pm blood pt-36.7* ptt-38.4* inr(pt)-3.6* 09:39pm blood fibrino-492* 12:55pm blood glucose-136* urean-174* creat-4.2* na-145 k-5.9* cl-118* hco3-16* angap-17 12:55pm blood alt-18 ast-29 alkphos-68 totbili-0.5 07:37am blood ld(ldh)-534* amylase-521* 07:37am blood lipase-49 12:55pm blood albumin-1.9* calcium-8.3* phos-6.3* mg-3.6* 02:49pm blood type-mix po2-36* pco2-29* ph-7.37 caltco2-17* base xs--6 02:49pm blood o2 sat-60 07:33pm blood freeca-1.20 pertinent labs 01:02pm blood lactate-3.4* 02:49pm blood lactate-2.8* 06:23pm blood lactate-3.2* k-5.3* 07:33pm blood lactate-2.8* 06:56pm blood lactate-1.8 02:49pm blood o2 sat-60 blood culture x2 pending echo overall left ventricular systolic function is normal (lvef>60%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is a moderate to large sized circumferential pericardial effusion, measuring 1.0 cm overlying the right ventricle, 0.7 cm overlying the right ventricular apex, 1.5 cm adjacent to the left ventricular apex, and 2.4 cm adjacent to the basal left ventricle. adjacent to the right ventricle, the effusion is echo dense, consistent with blood, inflammation or other cellular elements. adjacent to the left ventricle, the effusion is echolucent, with occasional stranding is visualized within the pericardial space c/w organization. though there is significant, accentuated respiratory variation in mitral/tricuspid valve inflows, there is no sustained right atrial or right ventricular diastolic collapse. there is minimal invagination of the right ventricle during diastole. echocardiographic signs of tamponade may be absent in the presence of elevated right sided pressures. impression: moderate to large circumferential pericardial effusion (largely adjacent to left >> right ventricle) without frank echocardiographic signs of tamponade. echodense effusion adjacent to right ventricle suggests cellular organization. normal biventricular systolic function. mild mitral regurgitation. . cxr new left ij line with tip in the proximal svc. no visualized pneumothorax. potential progression of the left greater than right opacities suggestive of effusions with underlying airspace disease not excluded. . ct head without contrast no acute intracranial process. . 01:15pm urine blood-mod nitrite-neg protein-300 glucose-70 ketone-neg bilirub-neg urobiln-neg ph-7.5 leuks-neg 01:15pm urine rbc-7* wbc-2 bacteri-none yeast-none epi-0 . cxr (): there has been mild interval increase in size in moderate left pleural effusion. the cardiomediastinum is shifted towards the left side consistent with left lower lobe collapse and new left upper lobe collapse. right lower lobe atelectases are stable. there is a small right pleural effusion. left ij catheter tip is in the mid-to-lower svc. there is no evident pneumothorax. brief hospital course: primary reason for admission: 85f with hx of afib with new diagnosis of nephrotic syndrome p/w ams. . active problems: . # goals of care: on admission, the pt was dnr/dni. on a lengthy family meeting was held and the patient status was changed to focus on comfort as the priority (cmo), consistent with the patient's previously expressed wishes. she expired within minutes of discontinuation of pressors with family at the bedside. . # altered mental status - multifactorial. 1) infection - pneumonia, concern for c.diff given very elevated leukocytosis but no stool makes this less likely; at admission was empirically started on flagyl. c.diff assay was never completed absence of bm and flagyl was stopped empirically. for pneumonia, the patient was empirically treated for hcap with vanc and zosyn. this was discontinued when the pt was made cmo on . 2) uremia, started on cvvh. 3) poor substrate given prior strokes. the pt never regained her baseline mental status and expired within hours of being made cmo after a lengthy family meeting. . # hypotension: likely related to decreased intravascular volume in the setting of nephrotic syndrome and distributive physiology in the setting of pneumonia. the pt became markedly hypotensive early in her course in the setting of attempted volume removal with cvvh. she was started on norepinephrine, which was discontinued when she was made cmo. . # anasarca/nephrotic syndrome: she was started on cvvh at time of admission. renal consult was obtained and cvvh was continued until the pt was made cmo. her hydrocortisone was also continued, though her renal function never recovered. . # afib, arterial thromboses: partial reversal with ffp for cvvh catheter. she was started on a heparin gtt thereafter, which was stopped when she was made cmo. . # bullae: pt was noted to have tense bullae of the bles. dermatology c/s was obtained and the bullae were felt to be severe edema in the setting of nephrotic syndrome. derm recommended volume removal per renal. . transitional issues: pt expired with family at the bedside. medications on admission: warfarin 3 mg latanoprost qhs dorzolamid/timolol metop succ 25 qd isoniazid 300 b6 50 pre 60 simva 20 calcium acetate 667, 3 caps tid omeprazole 20 q discharge medications: none discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: venous catheterization, not elsewhere classified hemodialysis venous catheterization for renal dialysis diagnoses: pneumonia, organism unspecified hyperpotassemia acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation other and unspecified hyperlipidemia septic shock osteoarthrosis, unspecified whether generalized or localized, site unspecified acute pericarditis, unspecified cardiac tamponade severe stage glaucoma primary open angle glaucoma nephrotic syndrome with lesion of proliferative glomerulonephritis 

Answer: The patient is high likely exposed to