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: penicillins / tetracyclines / plaquenil / chloroquine / sulfonamides / floxin / heparin agents attending: chief complaint: hypotension major surgical or invasive procedure: transesophageal picc line placement history of present illness: the pt is a 51-year-old woman with sle and severe pah diagnosed in with excellent response to flolan, recently admitted and discharged on day pta for right heart cardiac cath performed for progressive hypoxemia with increased need for supplemental oxygen despite an improved and six-minute walk test distanceand renal biopsy for proteinuria, transferred from hospital with hypotension sbps 60s-70s. patient discharged from , awoke this am around noon with confusion, lethargy, dizziness with standing. on arrival to ed bp 73/48,hr 103, rr18 95% 4l, t98.2. prior to transfer bp 85/53, 100% ra. only osh lab data wbc 4.2 hct 30, plt 133. cxr low lung volumes with no acute process. piv x 2 placed, received 4l ns and linezolid x 1 and transferred to micu. upon arrival pt's vitals 100.7 hr 106 bp 95/57 rr19 74-99% o2 sats. she reports she has had dizziness, low bps and overall malaise x 2-3 days. also reports subjective fevers, no chills, and tenderness at line site x 1 week but no purulent drainage or erythema. she has had line x 1 year and reports prior h/o similar presentations with line sepsis. has minimal pain at left flank site of biopsy, no pain in right groin where had cath. only other complaint is chronic headache and recurrence of chronic bilateral shoulder pain x 2 days. recent medictaion changes include addition of lisinopril 1 week prior and holding of coumadin for procedure (renal biopsy) planned to be restarted . denies change in chronic dyspnea or le edema, denies cough, chest pain, le pain, dysuria, hematuria, melena, hematochezia, numbness/weakness. past medical history: -systemic lupus erythematosus with history of pleuritis, glomerulonephritis () -diabetes mellitus type 2 -pulmonary arterial hypertension on flolan -atrial septal defect of the secundum type (versus a stretched pfo) -obstructive sleep apnea on home oxygen -anticardiolipin antibody (although disputed in recent heme-onc notes, recent tests negative) -type 1 heparin induced thrombocytopenia (although questionable per heme/onc) -obesity -restrictive pulmonary disease -migraines -history of sinusitis -fibromyalgia. -history of a miscarriage psh s/p cholecystectomy, s/p hysterectomy social history: she has not ever worked outside the home. she lives in . she has no tobacco or alcohol use. she has four children. family history: her father died of colon cancer at age 73. her mother is healthy as are her brother and sisters. physical exam: vitals - t 100.7 hr 106 bp 95/57 rr 19 o2sat 74-99% general: patient sitting back in bed with nasal cannula oxygen, nad, speaking in full sentences. cushingoid appearance heent: dry mm. ncat. sclera anicteric. eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: thick. unable to appreciate jvd. cv: tachy. prominent split s2. no thrills, lifts. no s3 or s4. chest: crackles in bases l>r. no wheezes or rhonchi. right chest tunneled hickmans with mild tenderness just superior to line. no purulence or drainage. minimal erythema. abd: obese. hypoactive bs. somewhat distended, soft, nt. no hsm or tenderness. no cva tnederness. no palpable hematoma over left ext: trace edema. no clubbing or cyanosis. r groin dsg c/d/i. no femoral bruits or thrills. skin: thinning, ecchymoses rle, ue bl, erythema over anterior chest and back neuro: cn 2-12 intact. aao x 3 pertinent results: imaging: cxr: azygos distention reflects increased intravascular fluid volume. pulmonary circulation is borderline engorged but there is no edema. mild cardiomegaly stable. no pleural effusion or pneumothorax. right subclavian line tip projects over the mid svc. no pneumothorax chest ct: impressions: 1. main pulmonary artery enlargement is little changed compared to , and is consistent with the history of pulmonary hypertension. cardiac enlargement, with prominence of the right ventricle, is unchanged. 2. no evidence of interstitial lung disease or other new intrathoracic process is seen to account for increasing oxygen requirement. 3. small pericardial effusion may be related to the patient's underlying lupus. 4. mild small airway obstruction. 5. allowing for differences in technique, sub-4 mm right lower lobe nodule is not changed from . without strong risk factor for intrathoracic malignancy, no further followup is recommended guidelines. tte: the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the aortic arch is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the estimated pulmonary artery systolic pressure is slightly higher. tee: the left atrium is mildly dilated. the right atrium is moderately dilated. there is a small secundum atrial septal defect with mild bidirectional shunting across the interatrial septum at rest. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to 45 cm from the incisors. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. the pulmonic valve leaflets are thickened. no masses or vegetations are seen on the aortic, mitral, triucuspid and pulmonary valves the tricuspid valve leaflets are mildly thickened. the main pulmonary artery is dilated. there is no pericardial effusion. impression: no valvular vegetations seen. small secondum asd with bidirectional shunt (small). dilated main pulmonary artery. mild-to-moderate tricuspid regurgitation. globally hypokinetic rv. renal u/s: no evidence of hematoma or abscess s/p biopsy head ct: impression: no evidence of acute intracranial hemorrhage or mass effect. lucent area seen within the right frontal bone, most likely a venous ; however, please correlate clinically with history of prior surgery or history of underlying malignancy. mri may be obtained for the latter. studies cardiac catheterization final diagnosis: 1. severe pulmonary arterial hypertension despite supplemental oxygen and flolan infusion. 2. mild right ventricular diastolic dysfunction. 3. normal left-sided filling pressures as reflected in the pcw. ct chest 1. main pulmonary artery enlargement is little changed compared to , and is consistent with the history of pulmonary hypertension. cardiac enlargement, with prominence of the right ventricle, is unchanged. 2. no evidence of interstitial lung disease or other new intrathoracic process is seen to account for increasing oxygen requirement. 3. small pericardial effusion may be related to the patient's underlying lupus. 4. mild small airway obstruction. 5. allowing for differences in technique, sub-4 mm right lower lobe nodule is not changed from . without strong risk factor for intrathoracic malignancy, no further followup is recommended guidelines. echo the left atrium is normal in size. the right atrial pressure is indeterminate. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no ventricular septal defect. the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. there is no aortic valve stenosis. the mitral valve appears structurally normal with trivial mitral regurgitation. the tricuspid valve leaflets are mildly thickened. there is mild to moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the rv has decreased in size (less dilated) and the estimated pa systolic pressure has decreased. abg: 7.35/42/87 crp: 26.7 esr: > 100 cre: 0.9 on admission, 0.8 on discharge hct stable in high 20s to low 30s cks flat, trop 0.02 on admission. brief hospital course: # sepsis: likely in setting hickman line infection, which patient has had in the past (). patient was initially septic on admission, meeting sirs criteria for fever, tachycardia, elevated wbc, and positive blood cultures. no evidence of endocarditis on tte or tee. no evidence of pna or uti. no evidence of septic hematoma from recent procedures (renal biopsy or right heart cath). she was initially treated with fluid boluses, daptomycin and levofloxacin, and became hemodynamically stable without requiring pressors. vancomycin sensitive strep viridans and cns were subsequently noted to be growing on osh cultures. id was consulted for antibiotics management and recommended a rule out for endocarditis and removal of the hickman catheter for culture and removal of infection nidus. however, per dr. and dr. , the decision was made that the hickman line was to be kept in place for her continuous flolan, due to the difficulty and the danger to her general health of discontinuing the infusion. she will receive 4 weeks of vancomycin as an outpatient through the picc line taht was placed. surveillence cultures were noted to have microccoccus spp, subsequent cultures neg. she will need repeat blood cultures if febrile as outpatient. she will have blood cultures, cbc, lfts, bun and cre, and vancomycin trough checked weekly as an outpatient while on vancomycin. #pulmonary hypertension: recent cardiac cath demonstrated severe pulm htn despite flolan. flolan was continued. lasix was held low bps and can be reinitiated as an outpatient. supplemental oxygen was continued to maintain o2 sats >93%. she was restarted on her coumadin prior to discharge for prevention of chronic pulmonary emboli that may have contributed to her pulm htn. # lupus nephritis: patient has lupus nephritis with recent worsening of proteinuria, most recently protein/creatinine ratio 8, improved from 15-16 . her renal biopsy showed an igg immune deposition, diabetic nephropathy, and lupus nephritis. no treatment regimen was recommended at this time per nephrology consult given her other medical issues. lisinopril was inititally administered, but she was unable to tolerate it and had issues with hypotension and ams (see below.) she will follow up with them as an outpatient and has been scheduled into dr. clinic. #ams: likely initiated by hypotension. patient trigged for hypotension 10-12 hours after being administered lisinopril with sbps into the 70s. she was noted to be somnolent. no hypoglycemia was noted. pt did not take more than her usual vicodin and tylenol #3, but out of concern for narcotics overdose, narcan was administered. akathisia-like movements were then noted after narcan administration, which were relieved with benadryl and benztropine. pt reports similar event one week ago at home in setting of low blood pressure with ams and loss of memory of events. her lisinopril and lasix were subsequently held and her sbps were maintained > 100. her mental status was at baseline on discharge. patient should have another head ct in months. # dm: oral hypoglycemics were held and she was controlled on iss while hospitalized # depression/anxiety: pt on multiple meds at home. originally there was some concern for serotonin syndrome given multiple medications and received linezolid at osh however her hypotension resolved after the linezolid was discontinued and the other antiobiotics were started. continued cymbalta, amitriptyline, holding wellbutrin #migraines: continued amitrityline medications on admission: medications: tylenol with codeine allopurinol 100 mg once a day amitriptyline 200 mg q.h.s. wellbutrin 150 mg twice a day premarin 0.625 mg once a day cymbalta 60 mg once a day flolan 15 ng/kg/minute continuous iv vitamin d fexofenadine furosemide 40 mg twice daily gabapentin 1600 mg twice a day vicodin prn lisinopril metformin nystatin prednisone 10 mg once a day. 4 mg of warfarin (held x 1 week) ambien fluconazole 150 mg qmwf lorazepam 0.5 mg q four hours prn anxiety. supplemental oxygen, 4l x approx. 14 hours per day discharge medications: 1. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). 2. lorazepam 0.5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. 3. bupropion 75 mg tablet sig: two (2) tablet po bid (2 times a day). 4. amitriptyline 50 mg tablet sig: four (4) tablet po hs (at bedtime). 5. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 6. gabapentin 400 mg capsule sig: four (4) capsule po qhs (once a day (at bedtime)) as needed. 7. acetaminophen-codeine 300-30 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed. 8. hydrocodone-acetaminophen 5-500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 9. duloxetine 30 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 10. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime). 11. epoprostenol 0.5 mg recon soln sig: one (1) recon soln intravenous infusion (continuous infusion). 12. fluconazole 150 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). 13. insulin lispro 100 unit/ml solution sig: variable units subcutaneous asdir (as directed): per sliding scale. 14. vancomycin 1,000 mg recon soln sig: 1250 (1250) mg intravenous twice a day for 4 weeks: start date end date . disp:*48 doses* refills:*0* 15. warfarin 2 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 16. outpatient lab work please check weekly cbc with differential, chem 7, and liver function tests. results should be faxed to . 17. normal saline flushes sig: 5-10 cc asdir for 30 days: please use pre and post dose. no heparin given allergy to heparin agents. . disp:*150 flushes* refills:*0* discharge disposition: home with service facility: accredo iv home infusion discharge diagnosis: sepsis likely from hickman catheter infection discharge condition: the patient was afebrile and hemodynamically stable prior to discharge. discharge instructions: 1) you were admitted to the hospital with low blood pressure. this was from an infection of the catheter in your chest. you were given antibiotics for this infection. you should continue these antibiotics for the full course described below. you will need to take your antibiotics (vancomycin) for four weeks, starting from until . you had a semipermanent line called a picc line placed for this reason. 2) the following changes were made to your medications: your lasix was stopped due to low blood pressure. your lisinopril was stopped due to low blood pressure. 3) please keep all of your followup appointments 4) please call your doctor or come back to the hospital if you experience light-headedness, dizziness, chest pain, shortness of breath, rash, itchiness, fevers, abdominal pain, nausea, vomiting, pain with urination, diarrhea, leg swelling, or any other concerning symptoms. . 5) you should have a repeat head ct in months for further evaluation of findings noted on your imaging studies from this hospitalization. followup instructions: please call for a follow up appointment with your pcp , . at in 2 weeks. please follow up with your pulmonologist dr. within 1-2 weeks after discharge. please discuss restarting your lisinopril and lasix with her at this time. please follow up with renal as an outpatient for treatment of your nephritis. you are scheduled to see dr. on at 3:00 pm. the phone number for the renal clinic is 61- in case you need to schedule. you will be contact by the renal clinic if an earlier availability opens up, per dr. . other appointments: provider: , md phone: date/time: 1:00 provider: function lab phone: date/time: 2:30 provider: ,interpret w/lab no check-in intepretation billing date/time: 2:30 procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart diagnoses: systemic lupus erythematosus other iatrogenic hypotension nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere obstructive sleep apnea (adult)(pediatric) other chronic pulmonary heart diseases sepsis dysthymic disorder other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure ostium secundum type atrial septal defect other diseases of lung, not elsewhere classified primary hypercoagulable state obesity, unspecified encephalopathy, unspecified other and unspecified infection due to central venous catheter streptococcal septicemia myalgia and myositis, unspecified migraine, unspecified, without mention of intractable migraine without mention of status migrainosus pain in joint, shoulder region unspecified sinusitis (chronic) pleurisy without mention of effusion or current tuberculosis lung involvement in other diseases classified elsewhere heparin-induced thrombocytopenia (hit) 

Answer: The patient is high likely exposed to