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: past medical history: 1. coronary artery disease. the patient is status post ptca and cardiac catheterization in , which showed two-vessel disease. the most recent admission resulted in p-mibi stress test, which revealed multiple reversible inferior-wall defect consistent with the stress mibi in . 2. congestive heart failure. ejection fraction by persantine mibi is about 50%. however, there are notes regarding previous echocardiograms in , which showed only 20% to 30%. therefore, it is unclear as to the actual ef. 3. paroxysmal atrial fibrillation. the patient is on coumadin. 4. history of renal cell carcinoma status post right nephrectomy in . this was followed by chemotherapy. 5. benign prostatic hypertrophy. 6. history of transient ischemic attacks. 7. history of retinal hemorrhages, status post laser treatment. 8. status post ddd pacer for atrioventricular block. 9. hypothyroidism. 10. hypertension. 11. colon cancer status post partial colectomy. 12. increased cholesterol. 13. depression. 14. bladder cancer, status post bcg treatment of the bladder. 15. history of tuberculosis status post inh times 12 months in . 16. dementia of unclear etiology. medications: 1. bumex 1 mg po q.d. 2. aldactone 12.5 mg po q.d. 3. aricept 10 mg po q.d. 4. concerta 80 mg po q.a.m. 5. provigil 200 mg q.a.m. 6. proscar 5 mg q.d. 7. synthroid 75 mcg q.d. 8. wellbutrin 150 mg b.i.d. 9. flomax 4 mg q.d. 10. celexa 40 mg q.d. 11. prilosec 20 mg q.d. 12. potassium chloride 20 mg q.d. 13. quinine 260 mg q.d. 14. lipitor 20 mg q.d. 15. atrovent 4 puffs t.i.d. 16. albuterol 2 puffs p.r.n. 17. coumadin 10 mg q.d. except on thursdays and sundays, when he takes 50 mg q.d. allergies: the patient is allergic to sulfa, penicillin, and lasix. social history: the patient was originally born in . he survived six years in the concentration camp, where he lost all his family members. immigrated to the united states soon following that. he is a dentist with degrees from several institutions. he has more than 100 pack per year history of smoking, but he is not currently smoking cigarettes. there is no history of alcohol abuse. family history: noncontributory. physical examination: examination revealed the following: general: the patient is uncomfortable, breathing labored. vital signs: temperature 99.7, heart rate 88, blood pressure 100/54, respiratory rate 24, oxygen saturation 98% on two liters. heent: perrla, extraocular muscles are intact. oropharynx clear with mucous membranes being dry. neck: there was no lymphadenopathy, no jvd. pulmonary: the patient has decreased bilateral breath sounds, left worse than right. there are occasional crackles. cardiovascular: irregularly irregular with no murmurs, rubs, or gallops. abdomen: soft, nontender, nondistended with a large ventral hernia. extremities: no evidence of edema, 1+ pulses bilaterally. neurological: the patient is somnolent, but arousable. cranial nerves intact. motor strength and sensory: intact. laboratory data: laboratory data revealed the following: white count 18.8, hematocrit 38.2, platelet count 393,000. sodium 141, potassium 4.4, chloride 105, bicarbonate 28, bun 26, creatinine 1.4, tsh 1.0, initial ck 30, troponin less than 0.3. ekg: revealed paced rhythm, unchanged from baseline. chest x-ray showed worsening of the bibasilar consolidations, continuing bilateral pleural effusions, and maybe mild chf. hospital course: #1. cardiovascular: the patient was originally admitted with rule out myocardial infarction. this was reasonable given his consistent chest pain and shortness of breath especially given the findings of a reversible inferior defect on the stress mibi one month prior to admission. the patient ruled out by enzymes. however, he continued to remain shortness of breath and had episodic chest pain. a repeat chest x-ray showed increase in the cardiac, as well as worsening chf. therefore, the patient was treated more aggressively for chf with iv diuretics. he had a good response with relatively good urine output initially. however, he continued to feel very short of breath and experienced chest pain. ct was obtained at that point to evaluate the pleural effusions and possible pneumonia, but there is an incidental finding of large pericardial effusion noted. this was followed by echocardiogram, which confirmed the findings of a large pericardial effusion, but no evidence of tamponade. the patient, at this point, was transferred to the service. given the first day on the service, the patient was extremely uncomfortable and as the day progressed the patient became acutely shortness of breath. the patient was now developing signs of constrictive physiology. notably, he had increase in the jvd, as well as pulsus paradoxus of over 20 mmhg. he appeared extremely uncomfortable and he was scheduled for drainage of the pericardial effusion. the patient pericardial effusion was drained in the cardiac laboratory and fluid was sent for cytology, as well as microbiology. the differential diagnosis of this pericardial effusion included tuberculosis given his history of previous tuberculosis, as well as spending six years in a concentration camp, malignant process, particularly in the context of three prior primary foci, or autoimmune process. of course, the pericardial effusion could also be related to the congestive heart failure. at this point, all the studies from the pericardial fluid have been completely negative including cytology and microbiology. the patient tolerated the procedure relatively well. the patient was transferred back to the floor. initially, he experienced significant improvement and the shortness of breath symptomatically improved. however, repeat chest x-ray the day following pericardial effusion drainage, revealed worsening of the chf with severe pulmonary congestion. he was, therefore, started on aggressive iv diuresis with initially very good response. however, on day #2, following the effusion, the diuresis tapered off and the urine output decreased. a fena at that point was less than 0.1% revealing intramuscular depletion in the larger picture of total volume-body overload. therefore, diuresis was discontinued and the patient was allowed to equilibrate. at this point, it appeared that this is a more of straightforward chf picture. the patient was started on the beta blocker carvedilol ....................and maximized on his ace inhibitor titrated up to captopril 50 mg t.i.d. this was switched to lisinopril 20 mg q.d. on the day of day to the floor. despite these interventions, he continued to remain shortness of breath and he felt very uncomfortable. repeat echocardiogram was obtained and this now showed multiple blood and fibrin clots in the pericardial space leading to decreased left ventricular filling, therefore, surgery was consulted and decision was made to take the patient to the operating room for pericardial window. this was done on . however, during the procedure, no pericardial effusion, fibrin or clots were identified in the pericardium. a piece of tissue was obtained from the pericardium for diagnosis and sent to pathology. the patient tolerated the procedure well with no complications. note: the diuresis was temporarily on hold during the acute decompensation in the context of enlarging pericardial effusion. however, given the evidence now, that there is no remaining pericardial fluid in the pericardial sac, a decision was made to restart the diuresis. he is now started on bumex 2 mg po and spironolactone 25 mg po q.d. #2. pulmonary: the patient has remained relatively short of breath throughout the hospital stay. this has been largely attributed to the chf. other causes would include pericardial constriction secondary to the effusion, as well as smoldering pneumonia. the pulmonary service was consulted and given the fact that the effusions were believed to be due to chf, no tapping of the effusions was advised at that point. differential diagnosis would include chf, pneumonia, or an inflammatory process. it is highly unlikely that the pneumonia alone would explain the effusions, as the patient has already received a two-week course of levofloxacin po and a ten-day course of iv ceftriaxone. the patient experienced occasional symptomatic relief with nebulizers, although he never had any frank wheezing. #3. infectious disease: on initial presentation, there was significant concern about continuing pneumonia. the patient was started on ceftriaxone iv and flagyl. however, with the developed of the pericardial effusion it became much more likely that the shortness of breath is due to constrictive physiology. the flagyl was, therefore, stopped, but the ceftriaxone was continued per infectious disease recommendations. note: the patient initially presented with a white count of 18 and the white count subsequently decreased with ceftriaxone treatment. all microbiological studies, including sputum, blood cultures, pericardial fluid cultures had been completely negative. it is very interesting that the patient has a history of treated of tuberculosis with a 12-month course of isoniazid. we were not able to obtain the exact records as to the circumstances around that treatment. however, given the high-risk factors for tuberculosis, afb sputum cultures were sent. the acid-fast stains were negative and the cultures were still pending. given the additional presence of pyuria, urine was sent for afb culture. it is also quite likely that the bladder washing with bcg during the treatment of the bladder cancer could have lead to dissemination of m bovine infection. therefore, cultures for m bovine were sent. #4. hematology: the patient was originally anticoagulated with coumadin for paroxysmal atrial fibrillation. this was held in the context of his repeated procedures and he required several units of fsp to reverse his coumadin. now that no more procedures are anticipated, he is being restarted on his 10 mg q.h.s. dosing. he never had any signs of active bleeding. #5. renal: baseline creatinine was about 1.1. the patient became slightly prerenal in the context of aggressive diuresis with the creatinine around 1.4. this was anticipated as optimal diuresis should lead to slight increase in creatinine. note: the patient was briefly started on indomethacin for symptomatic relief of his possible pericarditis. however, given that this coincided with his decrease in creatinine, the indomethacin was stopped and believed to contribute to his worsening renal function. he is currently receiving bumex 2 mg po q.d. and aldactone 20 mg po q.d. for diuresis. #6. psychiatry: the psychiatric service was consulted. apparently, the patient had trouble falling asleep at night and then dozing off during the day. ritalin was discontinued and he was started on risperidone 0.5 mg q.d. ekg was performed and showed no qt prolongation following the initiation of risperidone therapy, risperidone 0.5 mg as well as wellbutrin and celexa for depression, aricept for dementia and provigil. #7. gastrointestinal: in general, the patient's po intake has been relatively poor. however, gi symptoms have remained completely stable with no specific complaints. he is receiving protonix 40 mg q.d. given the poor po intake. #8. endocrine: the patient's has history of hypothyroidism. tsh was checked on two occasions during the admission and normal both times. he was continued on his regular dose of synthroid. #9. genitourinary: the patient has history of benign prostatic hypertrophy. he had a foley for most of his hospital stay. on a couple of occasions, this resulted to mild occlusion requiring flushing, which eventually lead to resume of urine flow. in general, the patient has a lot of hesitancy while voiding on his own, but he has not had any frank retention while in the hospital. #10. rheumatology: the patient denies any specific joint or muscle complaints. however, given these persistent pleural effusions as well as pericardial effusion, it is reasonable to send . please see addendum to this discharge summary for further hospital course and discharge medications. , m.d. dictated by: medquist36 procedure: pericardiotomy biopsy of pericardium diagnoses: congestive heart failure, unspecified unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation percutaneous transluminal coronary angioplasty status other persistent mental disorders due to conditions classified elsewhere cardiac pacemaker in situ constrictive pericarditis 

Answer: The patient is high likely exposed to