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: history of present illness: this is a 78 year old white male with a past medical history of multiple medical problems including coronary artery disease, atrial fibrillation, congestive heart failure with ejection fraction of about 20%, multiple cancers, pericardial effusion, now status post cardiothoracic surgery for pericardial window and drainage. the patient had been feeling weak for several months and was admitted to a hospital in with negative workup. the beginning of he had complaint of shoulder pain, vague chest pain and shortness of breath. the patient was ruled out for myocardial infarction and had p-mibi which was unchanged from prior study of which showed a reversible inferior wall defect. the patient was treated for pneumonia at this time with a two week course of levaquin which was discontinued on . the patient continued to the hospital on , with continued weakness, chest pain for about one hour and shortness of breath. chest x-ray at the time showed larger bilateral effusions from the prior study and a computerized axial tomography scan of the chest showed a large pericardial effusion, small pleural effusion, nonspecific mediastinal lymphadenopathy and no evidence of pneumonia. the patient was increased for increased shortness of breath and increased effusion, despite recent antibiotic treatment. laboratory studies on admission , showed white count of 18.8, hematocrit 30.2, sodium 141, potassium 4.5, chloride 105, bicarbonate 28, bun 26, creatinine 1.4, negative cardiac enzymes. in the hospital the patient continued to have shortness of breath despite aggressive diuresis. chest x-ray of showed increased cardiac silhouette consistent with cardiac tamponade. pericardial effusion was drained. about 550 cc of straw colored fluid were removed, no organisms, acid fast bacillus negative. 1358 white blood cells, 8,025 red blood cells, 46% polys, 33% lymphocytes, all cultures negative. the patient continued to have congestive heart failure-like picture despite aggressive diuresis and developed decreased urine output with a fractional sodium excretion of less than 1%. another echocardiogram was performed which showed an ejection fraction of 25 to 30% on , moderate effusion and no tamponade. the patient went to cardiothoracic surgery for pericardial window and pericardial biopsy on the day of transfer and in surgery minimal effusion was drained, although most recent the day before surgery , shows reaccummulation of pericardial fluid consistent with blood. past medical history: 1. transitional renal cell carcinoma status post right nephrectomy, status post chemotherapy; 2. benign prostatic hypertrophy with urinary outflow obstruction; 3. transient ischemic attack; 4. retinal hemorrhage; 5. coronary artery disease, status post percutaneous transluminal coronary angioplasty in with two vessel disease and stents placed; 6. atrial fibrillation, on chronic anticoagulation; 7. ventricular pacer secondary to a-v blocks; 8. hypothyroidism; 9. hypertension; 10. congestive heart failure; 11. colon cancer, status post colectomy; 12. mild dementia; 13. hypercholesterolemia; 14. depression/sleep disturbances/post traumatic stress disorder; 15. bladder cancer treated with intravesicular bcg; 16. history of tuberculosis exposure status post inh times 12 months. allergies: sulfa, bactrim, penicillin, ampicillin, lasix, cardizem. medications on discharge: lisinopril 40 mg p.o. q.d.; carvedilol 25 mg b.i.d.; bumetanide 2 mg p.o. q.d.; spironolactone 12.5 mg p.o. q.d.; senna 1 tablet p.o. b.i.d.; bisacodyl 10 mg p.o. p.r. q.h.s.; risperidone 0.5 mg p.o. q.h.s.; enteric coated aspirin 325 mg p.o. q.d.; milk of magnesia 30 cc p.o. q. 6 prn; tylenol 650 mg p.o. q. 4-6 hours prn; nitroglycerin sublingual tablet 0.5 mg sublingual prn; hydrocortisone 1% p.r. prn; bupropion sr 150 mg p.o. b.i.d.; nf 200 mg p.o. q. am, docusate 100 mg p.o. b.i.d., 10 mg p.o. q.h.s.; finasteride 5 mg p.o. q.d.; levothyroxine 75 mcg p.o. q.d.; tamsulosin 0.5 mg p.o. q.h.s.; pantoprazole 40 mg p.o. q. 24 hours; citalopram 40 mg p.o. q.d.; quinine 260 mg p.o. q.h.s.; atorvastatin 20 mg p.o. q.h.s.; ipatropion 4 puffs inhaled t.i.d.; warfarin 10 mg p.o. h.s. family history: unknown. social history: world war ii concentration camp survivor times six years from , retired industry professor, tobacco use 50 to 100 pack years. physical examination: the patient complaining of mild epigastric tenderness at surgical site, no complaints of chest pain or shortness of breath. the patient feels sleepy. vital signs revealed temperature 97.9, blood pressure 130/70, pulse 82, respirations 20, 94% on 1.5 liters per nasal cannula. general, large male, sleepy but arousable in no distress. neurological, alert and oriented times three. answers questions appropriately but slowly. pulmonary, loud breathsounds, fine crackles at the left base. coronary, heartsounds distant, normal s1 and s2, no murmurs, rubs or gallops are heard. abdomen, tender to mild palpation in the epigastrium, large ventral hernia, large midline surgical scar, positive bowel sounds, no rebound and no guarding. extremities, trace edema over ankles, +, dorsalis pedis pulse bilaterally, feet warm. head, eyes, ears, nose and throat, oral mucosa moist, no injections seen, extraocular motions intact. hospital course: 1. cardiovascular - the patient had beta blocker and ace inhibitor slowly titrated over the hospital course from 6.5 mg b.i.d. of carvedilol to a final dose of 25 mg b.i.d. for carvedilol. the patient was initially switched to zestril 20 mg q.d. and titrated up to zestril 40 mg q.d. the patient tolerated titration well. heartrate and blood pressure were stable at all times. the patient at all times was chestpain free. the patient was not noted to have any changes in electrocardiogram. the patient was noted to have paced rhythm. the patient had pericardial biopsy at time of pericardial window placement. pericardial fluid cytology revealed no malignant cells, numerous neutrophils and lymphocytes, acid fast bacillus staining of pericardium was negative. pericardial biopsy revealed resolving fibrinous pericarditis with underlying chronic inflammation, possible etiologies offered are: 1. fungal/viral/bacterial infection, not tuberculosis; 2. trauma; 3. uremia although does not usually present with chronic inflammation; 4. post myocardial infarction changes; 5. connective tissue disorder, rheumatologic; 6. drug reaction, again not usually seen with chronic inflammation. the patient is known to have atrial fibrillation on chronic anticoagulation. warfarin was stopped for cardiothoracic surgery, however, it was restarted at 10 mg q.h.s. inr was slowly rising during the hospital course to 1.7 on . the patient was initially short of breath but this slowly resolved with continued diuresis, ace inhibitor and beta blocker. the patient had good urine output throughout the hospital course and tolerated diuresis well. pulmonary - the patient had repeat chest x-ray on with lateral decubitus films which showed bilateral pleural effusion, persistent pericardial effusion with findings consistent with tamponade and systemic venous congestion, no evidence of pulmonary venous congestion. the patient continued to be short of breath throughout hospital course, however, resolved somewhat later on in the stay, eventually not requiring oxygen per nasal cannula to be comfortable with eventual pulse oximetry of 100% on room air. rheumatologic - the patient was found to be negative. endocrine - the patient was known to be hypothyroid. levothyroxine 75 mcg q.d. was continued throughout hospital course. tsh was checked once and was found to be 1.3, within normal limits. tsh should be followed up in three months. infectious disease - the patient was followed closely by the infectious disease team throughout the hospital course which offered various etiologies for the recurrent pericardial effusions, including viral, fungal and tubercular. tubercular effusion was ruled out by acid fast bacillus staining, bacterial effusion ruled out by cytology and culture of pericardial fluid. mycoplasma igg, igm titers pending for patient. pericardial effusions may still be of viral etiology. psychiatry - the patient was followed by a psychiatry team in the hospital which recommended continuing him on his current medications of citalopram, bupropion sr and risperidone. the patient's mood elevated throughout the hospital course as he was feeling physically better. neurology - the patient has a history of mild dementia and was continued on aricept 10 mg p.o. q.h.s. genitourinary - later on in the hospital course the patient complained of foley irrigation and leaking. the foley catheter was discontinued and voiding trial for six hours was done. the patient voided 250 cc within the six hours and subsequently continued to void well. the patient is taking flomax at his regular dose. urinalysis and urine cultures were done prior to foley being discontinued which revealed specific gravity of 1.012, red blood cells , blood large, 3 white blood cells, 30 protein and ph of 5.0. urine culture done at the time was negative. renal - the patient's chem-7 was checked daily. bun and creatinine were stable throughout the hospital course, ranging bun between 21 to 35 and creatinine between 1 and 1.3. gastrointestinal - the patient complained of diarrhea once during the hospital course and had a large loose bowel movement. clostridium difficile study was sent and came back negative. the patient's bowel medications were held. the patient was restarted on docusate and senna. the patient was previously on lactulose and that was further held. recommend to hold lactulose until further constipation developed. fluids, electrolytes and nutrition - the patient tolerated full p.o. diet at all times. prophylaxis - the patient is currently on warfarin 10 mg p.o. q.h.s., has subtherapeutic inr but it is rising daily, inr should be checked within the next 48 hours. the patient is taking enteric coated aspirin daily, the patient is taking proton pump inhibitor. condition on discharge: good. discharge status: to hospital with medications as listed above. discharge diagnosis: 1. pericardial effusion of unknown etiology, status post pericardial window. 2. benign prostatic hypertrophy 3. coronary artery disease 4. congestive heart failure 5. atrial fibrillation 6. hypothyroidism 7. hypertension 8. colon cancer, status post colectomy 9. dementia 10. depression 11. bladder cancer 12. renal cancer, status post nephrectomy 13. urinary outflow obstruction , m.d. dictated by: medquist36 d: 18:54 t: 19:23 job#: procedure: pericardiotomy biopsy of pericardium diagnoses: congestive heart failure, unspecified unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation percutaneous transluminal coronary angioplasty status other persistent mental disorders due to conditions classified elsewhere cardiac pacemaker in situ constrictive pericarditis 

Answer: The patient is high likely exposed to