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: the patient is a 59 year old woman with a five day history of inspiratory chest pressure, which increased over the last three days to shortness of breath at rest, orthopnea and paroxysmal nocturnal dyspnea. the patient went to see her primary care physician, discovered a new systolic murmur associated with a low grade fever. the patient was noted to have a white blood cell count of 14,000 and was admitted to . a transthoracic echocardiogram at that point showed severe mitral regurgitation which was previously unknown, inferior hypokinesis but no vegetations. blood cultures were drawn at that time and the patient was prophylactically begun on vancomycin, ciprofloxacin and gentamicin. cardiac enzymes were cycled and ck came back at 78 and troponin 0.231. the patient's shortness of breath worsened throughout her hospital course and a ct scan of the chest was performed to rule out dissection, which was negative. electrocardiogram showed st elevation in inferior leads and the patient was transferred to for a cardiac catheterization. upon admission to the catheterization laboratory, the patient was noted to be in severe respiratory distress. she was intubated and had transient hypotension requiring dopamine for blood pressure support. cardiac catheterization showed 40% eccentric left main stenosis, and 95% mid-right coronary artery, which was stented and had 0% residual. the patient was then transferred to the coronary care unit for hemodynamic monitor and stabilization while on an intra-aortic balloon pump. past medical history: 1. rheumatoid arthritis. 2. severe trigeminal neuralgia. 3. porphyria cutanea tarda. 4. raynaud's syndrome. 5. chronic pain syndrome. 6. depression. 7. migraines. past surgical history: left eye enucleation. family history: noncontributory. social history: the patient does not use alcohol but has a smoking history. allergies: sulfa, valium, erythromycin and barbiturates. medications on transfer: lovenox 40 mg s.c.b.i.d., fentanyl patch 100 mcg q.3 days, vitamin e, vitamin b12, lopressor 12.5 mg p.o.q.6h., protonix 40 mg p.o.b.i.d., ibuprofen 1,600 mg p.o.q.d. physical examination: on physical examination on admission to the coronary care unit, the patient had a temperature of 97, blood pressure 131/69, heart rate 119, respiratory rate 15; ventilator settings, tidal volume 600, respiratory rate 15, peep 5, fio2 100%. general: patient intubated and sedated but occasionally responsive to sternal rub. head, eyes, ears, nose and throat: non-elevated jugular venous pressure, right pupil reactive, left eye prosthesis, neck supple, no lymphadenopathy. cardiovascular: tachycardia, iii/vi early peaking systolic murmur, no rubs or gallops. chest: clear to auscultation bilaterally. abdomen: soft, nontender, nondistended, positive bowel sounds. extremities: 1+ dorsalis pedis and 2+ posterior tibialis pulses bilaterally, no lower extremity edema, no bruits appreciated over catheterization site. neurologic: patient moved all four extremities spontaneously. laboratory data: admission white blood cell count was 14.1, hemoglobin 9.7, hematocrit 28, platelet count 295,000, sodium 136, potassium 3.2, chloride 101, bicarbonate 20, bun 16, creatinine 0.7, glucose 213, calcium 7.3, phosphorous 4.7 and magnesium 1.7. electrocardiogram status post catheterization showed normalization of st changes in inferior leads, with mild diffuse st changes in the septal and lateral leads with a left atrial abnormality, patient was in sinus rhythm. coronary care unit course: 1. coronary artery disease: the patient was stabilized in the catheterization laboratory and sent up to the floor on an integrilin drip which was continued for 18 hours, aspirin and plavix for an inferior myocardial infarction. please see history of present illness section for the complete cardiac catheterization report. the intra-aortic balloon pump was pulled on hospital day number one with no complications. the patient was started on captopril which was titrated up to 50 mg three times a day and metoprolol which her blood pressure did not tolerated, so this was not continued. natrecor and intravenous nitroglycerin were used to maintain a systolic blood pressure around 110. nipride was transiently used for additional blood pressure control. 2. valvular dysfunction: the patient was admitted with new onset severe mitral regurgitation, which was noted at the outside hospital. it is assumed that the mitral regurgitation was due to an ischemic event. an echocardiogram performed at showed 3+ mitral regurgitation, no aortic insufficiency, inferior hypokinesis, akinesis and a left ventricular ejection fraction of 45%. the patient was aggressively diuresed with lasix as needed, with natrecor and intravenous nitroglycerin for preload control while in the coronary care unit. despite medical management, her mitral regurgitation persisted and there seemed to be no improvement with revascularization. therefore, the patient was taken to the operating room on for a mitral valve replacement and coronary artery bypass grafting. 3. infectious disease: the patient was admitted to the outside hospital with a low grade fever in the setting of a new onset systolic murmur. she was pancultured and started on empiric antibiotics. blood cultures were negative for any organisms. upon transfer to , the patient was febrile throughout her coronary care unit course, with temperature spikes to 102 to 103. the patient defervesced only briefly on hospital day number two. her white blood cell count was elevated for a majority of the time, with the high reaching 18,000. the patient was blood cultured times ten, with no growth on any sample. sputum culture on showed e. coli which was pansensitive. the patient was treated with aspiration pneumonia with a course of levaquin and ceftazidime for seven days. a transesophageal echocardiogram was performed to rule out the possibility of endocarditis as fevers remained elevated for the first two weeks of hospitalization, which showed no vegetations but was consistent with 3+ mitral regurgitation. upon discontinuation of ceftazidime and levaquin, the patient's fever defervesced, her white blood cell count fell and her differential count was noted to have 5% eosinophils. therefore, it was assumed that the patient elevated fever was related to a drug reaction to ceftazidime. of note, after discontinuation of the medications, a rash appeared on both the trunk and the arms. the rash was much improved on transfer. 4. hematology: the patient had a falling hematocrit status post her coronary artery bypass grafting. given her history of coronary disease, the patient was transfused on three occasions of two units, for a total of six units. she has stabilized at a hematocrit of 35. concerning her porphyria cutanea tarda, her primary hematologist, dr. , was contact and indicated no acute intervention for the disease at this point. he also stated that there was no contraindication for the cardiothoracic surgical procedure and there was no reason the patient could not be started on warfarin post procedure. 5. pulmonary: the patient was extubated on hospital day number two. she continued to have an oxygen requirement of five liters via nasal cannula throughout her coronary care unit course. this was thought to be secondary to pulmonary edema from pulmonary congestion from her mitral regurgitation as well as a left lower lobe aspiration pneumonia, which was treated. 6. disposition: the patient was transferred to the cardiothoracic surgery service on for mitral valve replacement with coronary artery bypass grafting. an additional discharge summary will be dictated upon discharge from the surgery service. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor insertion of endotracheal tube (aorto)coronary bypass of one coronary artery open and other replacement of mitral valve diagnoses: coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified pneumonitis due to inhalation of food or vomitus acute myocardial infarction of other inferior wall, initial episode of care rheumatoid arthritis raynaud's syndrome 

Answer: The patient is high likely exposed to