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 / univasc / tetanus & diphtheria tox,adult / shellfish attending: chief complaint: shortness of breath major surgical or invasive procedure: cath history of present illness: 77 y/o f pmh significant cad s/p several stents, dm, hyperlipidemia, htn who presents with shortness of breath of 2 days duration. patient reports difficulty breathing at rest and with exertion. she denies any associated chest pain. she reports baseline ankle edema. she denies orthopenia and pnd. she denies any chest pain or sob since her cath in . she denies sick contacts, fevers, , increased sputum production, sore throat and muscle aches. she reports nausea and episode of soft stool yesterday. she denies bloody or black stool. . patient presented to ed - reported to be hypoxic with improvement on nc. initial vitals t 100.3, tm 100.8, p 107, rr 20, bp 137/62, o2sat 87% ra. concern for pna based on cxr and given ceftriaxone/azithromycin. per report no ekg changes and given 4 baby aspirin. troponin elevated 0.28 consequently transferred to for further management. on arrival to t 96.9, bp 124/63, hr 82, rr 18, 97% 4l. patient normotensive. o2 sat 97-98% 2-3l. nitro drip started. ordered for 1 prbc but not hung prior to transfer. guaiac negative. . patient had recent admission for nstemi s/p des to lm, lad and rca during the course of two catheterizations. metoprolol and norvasc increased, hydralazine started. patient transfused 2 units for angioseal bleed. ct scan ruled out rp bleed. acute on chronic renal failure - felt to be related to contrast load in cath and required ultrafiltration in ccu. past medical history: 1. cardiac risk factors: diabetes, hyperlipidemia, hypertension 2. cardiac history: -extensive cad s/p multiple stents -cabg: none -pacing/icd: none 3. other past medical history: # h/o cva # visceral stenosis (70% stenosis of the celiac, sma, and followed by ) # pvd # dm ii - not on insulin, most recent a1c 7.1 in # hypertension # migraine headaches # gastritis - no peptic ulcer disease history. # depression x30 years, initially reactive social history: widowed, daughter lives with her. previously independent. -tobacco history: denies -etoh: will have one drink when she goes out to dinner. family history: mother had cad and mi. father died at a young age of mi. physical exam: gen: pleasant, comfortable, nad heent: perrl, eomi, anicteric, mmm, jvd to clavicle resp: decreased breath sounds left base. mild wheezes throughout. no crackles. cv: rr, s1 and s2 wnl, 3/6 systolic ejection murmur radiates throughout. abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: aaox3. 5/5 strength throughout. rectal: guaiac negative. pertinent results: labs on admission: 12:55am blood wbc-9.9 rbc-2.64* hgb-7.9*# hct-23.0*# mcv-87 mch-29.9 mchc-34.3 rdw-14.2 plt ct-390 12:55am blood neuts-82.3* lymphs-13.2* monos-4.0 eos-0.2 baso-0.3 12:55am blood pt-14.0* ptt-31.3 inr(pt)-1.2* 12:55am blood glucose-201* urean-40* creat-1.4* na-142 k-4.2 cl-109* hco3-20* angap-17 06:29am blood calcium-8.5 phos-5.6*# mg-2.2 iron-15* . ce trend: 12:55am blood probnp-* 12:55am blood ctropnt-0.30* 06:29am blood ck-mb-4 ctropnt-0.33* 04:00pm blood ck-mb-5 ctropnt-0.46* 05:26am blood ck-mb-4 ctropnt-0.56* . labs on discharge from micu: 05:26am blood wbc-8.2 rbc-3.84*# hgb-11.5*# hct-32.9* mcv-86 mch-29.8 mchc-34.8 rdw-14.6 plt ct-408 05:26am blood glucose-133* urean-38* creat-1.4* na-141 k-4.4 cl-107 hco3-24 angap-14 05:26am blood calcium-9.0 phos-5.0* mg-2.1 06:29am blood calcium-8.5 phos-5.6*# mg-2.2 . discharge labs 09:05am blood wbc-8.1 rbc-3.82* hgb-11.3* hct-34.0* mcv-89 mch-29.7 mchc-33.3 rdw-14.1 plt ct-574* 09:05am blood glucose-178* urean-41* creat-2.3* na-141 k-4.2 cl-105 hco3-23 angap-17 09:05am blood calcium-9.0 phos-5.1* mg-2.4 . iron studies: iron-15* 06:29am blood caltibc-157* ferritn-654* trf-121* . cxr on admission: 1) persistent loculated left effusion with increasing fluid within the left pleural cavity and new partial left lower lobe atelectasis. 2) new mild pulmonary edema. 3) new small right pleural effusion. . echo : normal left ventricular cavity size and wall thickness with preserved global and regional biventricular systolic function. elevated left ventricular filling pressures. mild aortic stenosis with mild aortic regurgitation. mild to moderate mitral and tricuspid regurgitation. mild pulmonary artery systolic hypertension. very small to small anterior pericardial effusion. . cardiac cath (preliminary report): coronary angiography- right domimant lmca- stent widely patent. because of the proximal mild lucency, it was interrogated with pressure wire that showed ffr of 0.92 indicative of no significant disease. lad- patent mid lad stent with 30% isr, no other significant disease lcx- small vessel with no significant disease rca- all stents are widely patent. mild mid pda disease. final diagnosis: 1. widely patent stents in lmca, lad and rca 2. mildly elevated lvedp 3. minimal aortic valve gradient . ct chest without contrast : the trachea and central airways are patent to the subsegmental level. there is mild senile calcification of the tracheobronchial tree. the aorta and great vessels are normal in caliber and contour, though dense calcification of the aorta, as well as dense calcification of the right and left coronary arteries, is noted. the heart is normal in size. there is a small pericardial effusion. there is no mediastinal or hilar adenopathy identified. the esophagus appears normal. calcification of the aortic valve is also noted. there are small bilateral pleural effusions, though the effusion on the right has slightly increased compared to . this is simple fluid in attenuation. on the left, the amount of pleural fluid is likely unchanged, also simple fluid in attenuation. there is a focal higher-density region at the periphery of the lingula and left lower lobe, which might represent rounded atelectasis, which appears slightly larger than on the prior study. within the lungs, there is a small calcified granuloma seen at the left base (2:25). there are no additional pulmonary nodules or masses identified. apical pleural scarring is seen bilaterally. in the visualized upper abdomen, visualized liver, spleen, and adrenal glands are normal. hyperdense material in the upper pole of the left renal collecting system likely represents retained contrast from cardiac catheterization performed one day prior. bone windows: degenerative changes are noted in the thoracic spine. no suspicious lytic or sclerotic osseous lesions identified. impression: 1. bilateral small simple pleural effusions, likely unchanged on the left and slightly increased on the right. 2. probable subpleural rounded atelectasis/collapse in the lingula and left lower lobe, slightly worse in appearance since the most recent comparison of . the oval hyperdense mass previously seen in the pleural space anteriorly adjacent to the lingula on might also represent a focus of atelectasis/collapse. recommend followup imaging after resolution of pleural effusions to assess stability of findings. 3. dense aortic and coronary atherosclerotic calcification, with additional calcification of the aortic valve. 4. retained contrast within the renal collecting system secondary to recent cardiac catheterization. brief hospital course: 77 y/o f pmh significant cad s/p stents, dm, hyperlipidemia, htn who presented with shortness of breath of 2 days duration, found to have large pleural effusions and was diuresed. hospital course complicated by episode concerning for acs but taken to cardiac cath and stents found to be patent. on discharge breathing well, but continued to have drenching night sweats which will require very close outpatient follow-up. . # pleural effusions/acute diastolic heart failure: most likely secondary to chf and pleural effusion. patient reports recent increase in salt intake (chinese, pizza over the weekend). improved with diuresis on lasix drip (greater than 2 l) during stay. pleural effusion (chronic) most likely secondary to chf but other possibility is malignancy based on ct scan last admission with ? lung lesion. cxr demonstrates loculated left pleural effusion and left lower lobe collapse. transthoracic echocardiogra showed preserved ef, 1+ mr, and elevated left ventricular end-diatolic pressures. following diuresis, pt went to cath which found lvedp 12, demonstrating euvolemia consequently lasix drip stopped prior to transfer to cardiology. on cardiology service, patient was successfully weaned off oxygen and breathing comfortably. repeat imaging showed improvement in pleural effusions after diuresis and no thoracentesis was pursued. the possibility of malignant effusions cannot be ruled out. repeat ct of the chest reported that they hyperdense mass commented on ct from is most likely rounded atelectasis, and not a mass; however repeat imaging after resolution of pleural effusions is recommended. the patient has had thoracentesis on previous admissions sent for cytology and found to be negative for malignancy. she may benefit from repeat diagnostic thoracentesis in future if pleural effusions reaccumulate. she was discharged on po lasix 20 mg daily. . # type b symptoms: pt reports several months of night sweats and indeed had drenching night sweats while an inpatient. she also notes a pound weight loss over past 2-3 months. these symptoms are highly concerning for occult malignancy or chronic infection. there was a concerning area on chest ct from which seemd more likely to represent rounded atelectasis on repeat ct from this admission. follow-up imaging is recommended after resolution of pleural effusions. of note, thoracentesis from was consistent with transudative process and cytology was negative for malignancy. . # cad: ekg on admission t-wave flattening and inversions anterior leads. patient had episode of acute nausea/diaphoresis with ekg changes borderline st elevation v1/v2, depression v4-v6. patient with mild diaphoresis morning and continued to have st depressions v4-v6. troponins increased in setting of worsening renal function, but ck-mb remained flat. patient started on a heparin drip and underwent cath which demonstrated no in-stent thrombosis. heparin drip was stopped. asa and continued throughout stay. . # anemia: guaiac negative. likely secondary to chronic kidney disease with a question of contribution from other systemic source of inflammation (? occult malignancy). responded to 1 prbc. iron studies consistent with anemia of chronic inflammation. . # acute on chronic renal failure: improved from baseline. losartan was held as patient was at high risk of contrast nephropathy following cath, last cath on cvvh due to renal failure. given mucomyst and ivf following cath. pt did develop contrast induced nephropathy after cath with cr peaking at 3.3. renal consult was called. pt was monitored and cr improved prior to discharge (down to 2.3) with expected continued improvement. of note, losartan was held on discharge but should be restarted as an outpatient. . # diabetes: held metformin and placed on insulin sliding scale in house. discharged on home metformin. . # hyperlipidemia: continued lipitor. . # hypertension: continued hydralazine, norvasc, metoprolol . # depression/psych: continued trazadone, remeron, ritalin. . # hypothyroidism: continued home dose levothyroxine 100 mcg cap. . # transition of care: -pt requires close follow-up for highly concerning symptoms of persistent night sweats and weight loss. -pt needs follow-up chest imaging with resolution of pleural effusions. -pt should have creatinine checked in next 2-4 weeks to ensure return to previous renal function. -pt's losartan should be re-started as an outpatient. -pt needs further teaching regarding adherence to low salt diet. medications on admission: per needhem med rec - patient does not know - losartan 50 mgs qd - levothyroxine 100 mcg cap - hydralazine 50 mg tid - imdur 120 mg 24 hour daily - lipitor 80 mg tab - metformin er 500 mg qd - prilosec 20 mg - 75 mg qd - trazadone 75 mgs qhs - remeron 30 mg qhs - norvasc 10 mg qd - metoprolol tartate 150 mgs - asa 81 mg - ambien 5 mg - lasix 20 mg - ritalin 5 mg 1 qam and 1 qpm - nitro prn discharge medications: 1. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 2. hydralazine 50 mg tablet sig: one (1) tablet po three times a day. 3. imdur 120 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 4. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 5. metformin 500 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 6. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 7. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 8. trazodone 50 mg tablet sig: 1.5 tablets po at bedtime. 9. mirtazapine 30 mg tablet sig: one (1) tablet po hs (at bedtime). 10. norvasc 10 mg tablet sig: one (1) tablet po once a day. 11. metoprolol tartrate 50 mg tablet sig: three (3) tablet po bid (2 times a day). 12. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 13. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 14. lasix 20 mg tablet sig: one (1) tablet po once a day. 15. ritalin 5 mg tablet sig: one (1) tablet po twice a day. 16. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet sublingual three times a day as needed for chest pain: can take 1 tablet every 5 minutes for up to three tablets for chest pain. discharge disposition: home discharge diagnosis: primary diagnosis: bilateral pleural effusions, acute renal failure, contrast induced nephropathy . secondary diagnoses: coronary artery disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital for shortness of breath. you were found to have fluid around your lungs. you were given diuretics to help remove extra fluid from your lungs. you had an episode that was concerning for a cardiac event. you were taken to the cath lab where we found the blood vessels supplying your heart, including those with stents, to all be patent. you developed an injury to your kidneys from the contrast dye used during the catherization. your kidneys recovered on their own and you were discharged home. you have a follow-up with dr. (see below) during which you should be evaluated for your night sweats. . the following change was made to your medications: -- stop losartan. dr. should restart this medication after your kidneys have completely recovered. . weigh yourself every morning, md if weight goes up more than 3 lbs. please be sure to limit the amount of salt in your diet to less than 2 grams daily. . it was a pleasure taking care of you. followup instructions: department: when: tuesday at 12:45 pm with: , md building: (, ma) campus: off campus best parking: on street parking procedure: coronary arteriography using two catheters left heart cardiac catheterization monitoring of coronary blood flow diagnoses: anemia in chronic kidney disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified depressive disorder, not elsewhere classified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified pulmonary collapse other and unspecified hyperlipidemia loss of weight old myocardial infarction generalized hyperhidrosis personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits atherosclerosis of native arteries of the extremities, unspecified migraine, unspecified, without mention of intractable migraine without mention of status migrainosus unspecified gastritis and gastroduodenitis, without mention of hemorrhage chronic diastolic heart failure other drugs and medicinal substances causing adverse effects in therapeutic use acute kidney failure with other specified pathological lesion in kidney celiac artery compression syndrome neoplasm of unspecified nature of respiratory system other specified forms of effusion, except tuberculous 

Answer: The patient is high likely exposed to