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: erythromycin base attending: chief complaint: shortness of breath and chest pain. major surgical or invasive procedure: - cabgx1, avr (19mm st. supra porcine valve) history of present illness: the patient is a 78-year-old woman who presented with angina and congestive heart failure in the setting of atrial fibrillation. she converted to sinus rhythm. she was found on echo to have aortic stenosis, mitral regurgitation, but preserved left ventricular function. catheterization showed severe aortic stenosis, mild aortic mitral regurgitation and a 60% lesion of the proximal left anterior descending artery. it was decided to proceed with aortic valve replacement and coronary artery bypass grafting. past medical history: aortic stenosis atrial fibrillation rheumatic heart disease hypercholesterolemia hypothyroid osteoporosis vein stripping coronary artery disease appendectomy social history: lives alone in , ma. no smoking or drinking history. family history: noncontributory physical exam: 99.0 175/78 70 96% on 3l nc gen: a+ox3 head: ncat neak: without masses or bruits chest: mildly diminished breath sounds at bases. heart: nl s1-s2. iii/vi systolic murmur abd: soft, nt/nd/nabs ext: no clubbing, cyanosis or edema, + varicosities neuro: nonfocal pulses: 1+ dorsalis pedis bilaterally pertinent results: 08:44pm pt-14.0* ptt-33.9 inr(pt)-1.3 08:44pm plt count-302 08:44pm wbc-11.6* rbc-3.52* hgb-9.0* hct-26.6* mcv-76* mch-25.6* mchc-33.9 rdw-17.7* 08:44pm %hba1c-5.8 -done -done 08:44pm alt(sgpt)-30 ast(sgot)-26 ld(ldh)-184 alk phos-129* amylase-109* tot bili-0.6 08:44pm glucose-101 urea n-26* creat-1.2* sodium-135 potassium-4.3 chloride-97 total co2-27 anion gap-15 07:20am blood wbc-15.1* rbc-3.85* hgb-10.1* hct-30.8* mcv-80* mch-26.3* mchc-32.9 rdw-18.0* plt ct-263 07:40am blood pt-16.9* inr(pt)-2.0 07:40am blood urean-48* creat-1.9* k-4.2 - video swallow aspiration during and after swallowing of nectar thickened liquids. ineffective cough reflex. mild residue within the oral cavity and valleculae. in the ap view, movement of the right vocal cord was not demonstrated. - renal ultrasound 1. small right renal cyst. otherwise normal right kidney without evidence of hydronephrosis. 2. redemonstration of large heterogeneous left renal mass, likely representing a renal cell carcinoma. this large mass obscures evaluation of the remaining normal renal parenchyma. 3. moderate bilateral pleural effusions. - cxr mild congestive heart failure. bilateral pleural effusions, slightly improved. 06:10am blood wbc-13.0* rbc-3.64* hgb-9.6* hct-29.6* mcv-81* mch-26.3* mchc-32.3 rdw-17.9* plt ct-254 04:48am blood pt-19.5* inr(pt)-2.7 04:48am blood glucose-88 urean-48* creat-1.9* na-143 k-4.7 cl-102 hco3-30 angap-16 brief hospital course: ms. was admitted to the on for surgical management of her coronary artery and aortic valve disease. she was worked-up in the usual preoperative manner. on , ms. was taken to the operating room where she underwent coronary artery bypass grafting to one vessel and aortic valve replacement utilizing a 19mm st. supra porcine valve. postoperatively she was taken to the cardiac surgical intensive care unit for monitoring. on postoperative day one, ms. neurologically intact and was extubated. she developed atrial fibrillation which was treated with amiodarone. beta blockade and aspirin therapy were also started. she was transfused with packed red blood cells for postoperative anemia. as she continued to have paroxysmal atrial fibrillation on amiodarone, coumadin was started for anticoagulation. as ms. was noted to cough with feedings, the swallow service was consulted. a bedside exam was suggestive of aspiration with this liquids thus a pureed diet with nectar thick liquids was started. on postoperative day four, ms. was transferred to the cardiac surgical step down unit for further recovery. the physical therapy service was consulted to assist with ms. postoperative strength and mobility. heparin was started as abridge to coumadin as her inr was slow to climb. the swallow service returned to evaluate ms. for possible advancement of her diet however noted that she has developed a new globus sensation in her throat with all consistency foods. a video swallow was recommended as well as an ent consult. a video swallow was performed which showed aspiration during and after swallowing of nectar thickened liquids. ineffective cough reflex, mild residue within the oral cavity and valleculae. in the ap view, movement of the right vocal cord was not demonstrated. the ent service also evaluated her and noted a paresis of her right vocal chord. she was able to tolerate purees and honey thickened liquids without issue. as ms. continued to have paroxysmal atrial fibrillation, the electrophysiology service was consulted. thyroid studies were obtained which showed mild hypothyroidism and her beta blockade was advanced. the occupational therapy service was also consulted to assist with ms. recovery. ms. was noted to have an elevated creatinine and a renal consult was obtained. a renal ultrasound was performed which showed a small right renal cyst and redemonstration of large heterogeneous left renal mass, likely representing a renal cell carcinoma. moderate bilateral pleural effusions were also noted. her creatinine promptly improved. on , a left thoracentesis was performed for a left pleural effusion draining 600cc of serous fluid. her lasix was restarted on and on her creatinine was again noted to be elevated to 2.3. the lasix was again held until the creatinne had decreased to less than 1.9. she was also noted to be in a sinus bradycardia with rates in the 50s. the decision was made to discontinue her lopressor and continue with her amiodarone. on 1.7 she was cleared for discharge to rehab. medications on admission: synthroid .75 mcg daily cartia lipitor plavix lasix aspirin lopressor discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. warfarin 1 mg tablet sig: one (1) tablet po daily (daily): check inr qd and dose coumadin for goal inr 2.0-2.5. no coumadin 3. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 4. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po every 4-6 hours as needed for pain. 5. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 6. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. prevacid 30 mg susp,delayed release for recon sig: one (1) po once a day. 9. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily). 10. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day): hold until creat<1.9. discharge disposition: extended care facility: hospital of & islands - discharge diagnosis: aortic stenosis atrial fibrillation rheumatic heart disease hypercholesterolemia hypothyroid osteoporosis vein stripping pleural effusion right vocal chord paresis/aspiration discharge condition: good discharge instructions: 1) monitor wounds for signs of infection. these include redness, drainage or increased pain. 2) monitor vital signs. report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 3) no lifting more then 10 pounds for 10 weeks. 4) no driving for 1 month. 5) staples to be removed on postoperative day 14 followup instructions: follow-up with dr. in 4 weeks. follow-up , m.d. phone: date/time: 10:00am follow-up with dr. in 2 weeks. follow-up with dr. in weeks. follow up with dr. (ent)( upon d/c from rehab call all providers for appointments. procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery thoracentesis open and other replacement of aortic valve with tissue graft transfusion of packed cells diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified pleural effusion unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation malignant neoplasm of kidney, except pelvis rheumatic heart failure (congestive) other specified cardiac dysrhythmias osteoporosis, unspecified mitral valve insufficiency and aortic valve stenosis unilateral paralysis of vocal cords or larynx, complete 

Answer: The patient is high likely exposed to