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: sulfanilamide / lisinopril / penicillins attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: ms. is an 82 y/o lady with a history of severe aortic stenosis ( 0.7, transvalvular peak gradient 77mmhg, mean 54mmhg on echo from ), ulcerative colitis, breast cancer in , presented to ed on with worsening dyspnea, sob, dry cough, chills, and a fast heart rate. over the past 2 weeks she has been having worsening sob and orthopnea. she denies chest pain, syncope, or edema. no sick contacts or recent hospital admissions. . she was diagnosed with moderate as in , she saw her cardiologist in for occasional shortness of breath with exertion (ie climbing an incline with groceries). repeat echo showed severe as (valve area 0.7) and mild ar. she had follow up appt with cardiologist recently where findings from echo were reviewed. at that appt, she was noted to have frequent pacs and there was concern that this may be precurser for a fib. he recommended cardiac surgery evaluation. . in the ed, initial vitals were t 101.4, hr 58, 117/54, rr 20, 97%2l labs and imaging significant for: wbc 13.4, hct 34, plt 580, lactate 1.0. she received levofloxacin 750mg and tylenol 1000mg. cxr significant for lul and rll pneumonia and hyperexpanded lungs consistent with underlying emphysema. vitals on transfer to unit were temp 36.9 p 134, bp 125/78, rr 29 92% on 3 l . review of systems on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, hemoptysis, black stools or red stools. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, syncope or presyncope. past medical history: 1. cardiac risk factors: -diabetes, +dyslipidemia, +hypertension 2. cardiac history: aortic stenosis, 0.7, transvalvular peak gradient 77mmhg, mean 54mmhg on echo from mild ar 3. other past medical history: ckd stage 3 (cr 1.1-1.4) breast ca, in remission osteoporosis ulcerative colitis social history: retired, independent in adls, lives with son and daughter in law in 2 story house -tobacco history: former smoker 80 pack years quit 20 years ago -etoh: 4 oz /week -illicit drugs: denies family history: mother cad, c, pvd. father died at 69 of cause. brother with congenital heart disease. physical exam: on admission: vs: temp 36.9 p 134, bp 125/78, rr 29 92% on 3 l general: wdwn in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 10 cm. cardiac:irregular rhythm, normal s1, soft s2. late iii/vi systolic murmur at rusb radiating to back and carotids. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. occasional pursed lip breathing. decreased b/s in rll, rare expiratory wheeze. no crackles. abdomen: soft, ntnd. no hsm or tenderness. no abdominial bruits. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ on discharge: 98.2 90/35mmhg p70 rr18 95%ra ga: a&ox3, pleasant heent: mmm, eomi, perrl cv: irregular rhythm, 3/6 systolic murmur at rusb, no rubs or gallops pulm: trace bibasilar crackles, no wheezes or rhonchi abd: soft, ntnd, no hsm ext: no peripheral edema, full pulses throughout skin: warm, dry pertinent results: 01:30pm plt count-580* 01:30pm neuts-91.4* lymphs-4.8* monos-3.3 eos-0.2 basos-0.3 01:30pm wbc-13.5* rbc-3.66* hgb-11.3* hct-34.1* mcv-93 mch-30.8 mchc-33.1 rdw-13.1 01:30pm tsh-2.9 01:30pm estgfr-using this 01:30pm glucose-180* urea n-25* creat-1.2* sodium-134 potassium-5.0 chloride-98 total co2-25 anion gap-16 02:10pm lactate-1.0 02:10pm type- comments-green top 02:20pm urine hyaline-1* 02:20pm urine rbc-1 wbc-15* bacteria-few yeast-none epi-2 trans epi-1 02:20pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 02:20pm urine color-yellow appear-clear sp -1.010 02:20pm urine uhold-hold 02:20pm urine hours-random 02:51pm pt-11.4 ptt-25.8 inr(pt)-1.1 06:12pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 06:12pm urine color-straw appear-clear sp -1.003 10:10pm ptt-105.7* . ekg: afib with rvr hr 150 . 2d-echocardiogram (): conclusions 1. frequent atrial premature beats. 2. there is mild concentric left ventricular hypertrophy. 3. tissue and transmitral doppler demonstrate pseudonormal filling (moderate grade ii diastolic dysfunction). 4. the left atrial volume is moderately increased. 5. there is severe aortic stenosis present, with a calculated valve area of 0.7cm2. 6. compared with the findings of the prior report of , the measured gradients are a little higher, resuling in a slightly lower calculated aortic valve area. . echo : the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal/small. overall left ventricular systolic function is normal (lvef 60%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is critical aortic valve stenosis (valve area 0.5 cm2) (may represent an entity known as "low flow/low gradient aortic stenosis with preserved ejection fraction"). mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the supporting structures of the tricuspid valve are thickened/fibrotic. there is moderate pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is no pericardial effusion. discharge: 08:50am blood wbc-6.5 hct-30.6* 08:50am blood glucose-147* urean-28* creat-1.5* na-134 k-4.7 cl-99 hco3-25 angap-15 brief hospital course: 82f history of critical aortic stenosis ( 0.7, transvalvular peak gradient 77mmhg, mean 54mmhg on echo from ), ibd, breast cancer in remission, presenting with sob, found to have new atrial fibrillation with rvr, hypotension, and pneumonia. . # pneumonia: shortness of breath with decreased o2 sat at 88%, fever (tmax of 101.4) and chest x-ray consistent with lul pna. initially thought to be community-acquired pna. however, patient continued to be hypoxic after treatment with levofloxacin. therefore, pulmonology was consulted, and they recommended broadening with vancomycin and cefepime, which were eventually stopped. on , she completed an 8-day course of levofloxacin for cap. sputum and blood cultures did not grow any organisms. . # new afib with rvr: etiology was thought to be pneumonia or valvular (aortic) disease. given hypotension, diltiazem and metoprolol were not in itially considered, and she was started on amiodarone with an understanding of the thromboemoblic risk of chemical cardioversion. metoprolol was started on when bp would tolerate. her chads2 score was 3, and she was started on heparin drip. in preparation for discharge, pt started on lovenox, renally dosed. on discharge, rhythm still in atrial fibrillation, hemodynamically stable. pt discharged with amiodarone, lovenox 40mg sc daily and stopped aspirin in preparation for cardiac surgery in near future. . # aortic stenosis: critical with valve area of 0.7 cm^2, she has had gradual onset dypsnea per her outpatient cardiology notes, which is likely associated with her valvular disease. initially denied angina and syncope/presyncope, but had an episode of syncope during the hospitalization on ; at that time, further questioning revealed that patient may have had episodes of syncope/presyncope at home. case was discussed with cardiac surgery who recommended optimization of pneumonia and atrial fibrillation treatment prior to surgery. in preparation for surgery, she underwent catheterization on , which showed minimal coronary artery disease. aortic valve replacement surgery scheduling will be discussed at appt with dr. . # c.diff colitis: the patient developed diarrhea. stool studies were sent which showed c. diff positive. the patient was started on flagyl 500mg q8h on for 2 week course. at time of discharge, diarrhea improved. # hyperlipidemia: simvastatin was continued. . # blood pressure: patient has a history of hypertension, but was hypotensive when she presented, likely due to the atrial fibrillation with rvr. home losartan was held throughout hospital course as pressures were 90s to low 100s. pt discharged with metoprolol and instructed to no longer take home losartan. . transitional issues: -pt is to followup with c- on with dr is to followup with pcp dr on . -pt is to have c.diff stool pcr/toxin rechecked 2 weeks after finishing 2 wk course of flagyl -spiculated rul nodule: seen on chest ct. should be followed up with repeat ct. # code: full code confirmed # emergency contact: daughter medications on admission: preadmission medications listed are correct and complete. information was obtained from patientatriuswebomr. 1. losartan potassium 50 mg po daily 2. simvastatin 10 mg po hs 3. mesalamine 800 mg po tid 4. multivitamins 1 tab po daily 5. aspirin 81 mg po daily 6. vitamin b complex 1 cap po daily discharge medications: 1. mesalamine 800 mg po tid 2. multivitamins 1 tab po daily 3. simvastatin 10 mg po hs 4. vitamin b complex 1 cap po daily 5. enoxaparin sodium 40 mg sc daily rx *enoxaparin 40 mg/0.4 ml one syringe daily disp #*10 syringe refills:*2 6. metoprolol succinate xl 50 mg po daily rx *metoprolol succinate 50 mg one tablet(s) by mouth daily disp #*30 tablet refills:*0 7. metronidazole (flagyl) 500 mg po q8h rx *metronidazole 500 mg one tablet(s) by mouth three times a day disp #*36 tablet refills:*0 8. amiodarone 200 mg po daily rx *amiodarone 200 mg one tablet(s) by mouth daily disp #*30 tablet refills:*0 discharge disposition: home with service facility: vna discharge diagnosis: severe aortic stenosis c difficile colitis hypertension atrial fibrillation acute on chronic kidney injury delerium community axquired pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , it was a pleasure taking care of you at . you had a pneumonia and was treated with antibiotics. during this time, your aortic stenosis was causing you to retain fluid and you needed diuretics to remove the extra fluid. you will need surgery to fix the aortic stenosis. we found that the diarrhea was from an infection called c difficile and you are on a 14 day course of antibiotics to treat this. dr. wants to know that this infection is cured before he performs surgery so dr. will arrange for another test of your stool to be sent after the antibiotics are finished. your heart developed an irregular rhythm called atrial fibrillation. this rhythm puts you at increased risk of a stroke so you are on lovenox, a blood thinner, to prevent blood clots. you will need to have your daughter give you the injection of lovenox every day while you are at home. you will need to save a stool sample after the flagyl is finished to see if the c. difficile infection is gone. dr. will help you with this. you should also stop your aspirin in preparation for your aortic valve replacement in the near future. followup instructions: department: cardiac surgery when: wednesday at 2:30pm with: , md building: lm campus: west best parking: garage . name: , md when: monday st at 12:10 location: address: , , phone: md procedure: coronary arteriography using two catheters left heart cardiac catheterization diagnoses: pneumonia, organism unspecified anemia, unspecified acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure aortic valve disorders personal history of malignant neoplasm of breast personal history of tobacco use chronic kidney disease, stage iii (moderate) acute respiratory failure osteoporosis, unspecified intestinal infection due to clostridium difficile other emphysema examination of participant in clinical trial personal history of other diseases of digestive system 

Answer: The patient is high likely exposed to