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: no known allergies / adverse drug reactions attending: chief complaint: dyspnea major surgical or invasive procedure: none history of present illness: 82 year-old russian speaking f w/ hx of pe in , off coumadin now x6 months, iddm, htn, dyslipidemia, parkinson's, dementia, gerd, and hx gi bleed, p/w with one day history of dyspnea, although per her daughters sx may have persisted for several days but pt only mentioned them to family yesterday. apparently yesterday she developed sob which was worse with exertion, and episodes of left-sided cp that would last for approx 10 minutes. cp resolved on its own, and was not associated with any diaphoresis, palpitations, nausea or vomiting. patient also reported llq abdominal pain, . last bm yesterday, no diarrhea, and patient has not had any recent change in appetite. no fevers, chills, productive cough or dysuria. no recent surgeries; however daughters report pt has prolonged periods of immobility as she generally sits at home in a chair for long periods of time and does not get up much. she needs help with all of her adls including cooking, cleaning and bathing/dressing herself. her daughters also report her memory is not what it used to be and that she generally knows her name but has difficulty with dates. presented to ed for further evaluation. . in the ed, initial vs were: 97 76 107/63 18 98%. exam unremarkable. stool guiac negative. labs notable for cxr showed no acute process; ekg showed nsr=77, nonspecific lateral tw flattening, unchanged compared w/ priors. cta chest showed bilateral pes, and patient was started on heparin gtt. in the , pt was initially uncomfortable, moaning, c/o rectal pain and pulling off 100% nrb. while attempting to place , rn heard pts family screaming that pt was unresponsive w/ red face adn eyes rolled back into her head. heparin gtt was shut off and pt woke up and began responding to family w/n 5 min without intervention. while awaiting ambulance transport, pt was noted to have decreased sbp to 70s and was given 1l ns, with improvement in bp from 74/52 to 105/56. initially, thrombolysis was considered given pts hypotension; however, hemodynamics stabilized. . while in ed she had two episodes of probable syncope vs. seizure associated with bradycardia and desaturations, responsive to o2. ct head negative for acute intracranial process, though showed 8mm right frontal extra-axial lesion, likely a meningioma, and stable since . temp after head ct decreased to 95.2, warm blankets applied. also received 1l ns, 20 units humalog total for fsbs >400. she was admitted to the micu for further evaluation and management. she was also given 1g ctx x1 for uti in ed. . on the floor, pts bps are in the 110s and she appears comfortable. her daughters state her sx probably went on for a week but she only began to complain yesterday. she has memory deficits at baseline, does not perform adls, and is largely immobile. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, wheezing. denies chest pressure, palpitations. denies nausea, vomiting, diarrhea, constipation, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: diabetes mellitus, type i hypertension dyslipidemia parkinson's, c/b urinary incontinence senile dementia gerd hypothyroidism osteoarthritis (knees) hiatal hernia h/o ugib/lgib (internal hemorhoids , egd=polyps ) chronic low back pain secondary to spinal stenosis depression ?h/o neurogenic bladder ?h/o thyrotoxicosis h/o pe, diagnosed on v/q scan on , treated with coumadin (duration unclear) chronic onychodystrophy social history: lives at home with daughter, who helps with adls, walks with walker. immigrated from , divorced. denies tobbacco, denies alcohol, ivdu. family history: + premature cad. physical exam: admission exam: vs: afebrile, hr 73 bp 102/54 sao2 96% ra gen: elderly russian f lying in bed in nad heent: perrla, eomi, sclerae anicteric neck: supple, could not assess jvp lungs: ctab/l, good inspiratory effort cv: nl s1, s2 rrr no m/r/c/g abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge: vs: 97.0 143/73(sbp143-175) 92(70-92) 20 99%ra gen: comfortable, nad heent: mmm, op clear, sclerae anicteric neck: supple, no lad lungs: cta b/l cv: rrr no m/r/g abd: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding ext: wwp, 2+ dp/pt/radial pulses, no c/c/e pertinent results: blood counts 08:55am blood wbc-7.8 rbc-3.78* hgb-11.7* hct-35.9* mcv-95 mch-30.9 mchc-32.5 rdw-14.1 plt ct-297 07:20am blood wbc-9.5 rbc-3.42* hgb-10.8* hct-31.8* mcv-93 mch-31.5 mchc-34.0 rdw-14.3 plt ct-262 coags 08:55am blood pt-12.9 ptt-24.7 inr(pt)-1.1 07:20am blood pt-13.1 ptt-25.7 inr(pt)-1.1 chemistry 08:55am blood glucose-366* urean-34* creat-1.2* na-138 k-5.3* cl-102 hco3-25 angap-16 07:20am blood glucose-162* urean-15 creat-0.9 na-143 k-4.1 cl-107 hco3-25 angap-15 liver 08:55am blood alt-16 ast-30 alkphos-118* totbili-0.3 04:37am blood alt-22 ast-22 ld(ldh)-238 ck(cpk)-82 alkphos-108* totbili-0.4 cta chest/abd 1. bilateral pulmonary emboli. 2. there is mild wall thickening of the gastric antrum and pylorus, which may represent gastritis and appears slightly improved from prior exam. 3. stable appearance of hepatic hypodensities, likely cysts. 4. calcified uterine fibroid. tte the left atrium is dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: small, hypertrophied left ventricle with near-hyperdynamic systolic function. moderately dilated right ventricle with moderate hypokinesis. the rv apex has preserved function ( sign). mild pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , the rv appears more dilated and hypokinetic than on prior. on the prior echo, the rv was mildly dilated/hypokinetic and sign was probably present at that point also. brief hospital course: hospital course this is an 82 y/o russian speaking f with a history of prior pe status-post 6 months of coumadin, who presented with several days of dyspnea found to have massive b/l pes, hemodynamically stable, started on lovenox bridge to coumadin and discharged home with services. . active # pulmonary embolus: patient was a/w dyspnea, found to have multisegmental pes, without right heart strain on tte, placed on enoxaparin bridge to coumadin. discharge inr was 1.1, so patient was continued on enoxaparin bridge with close follow-up with pcp and . . # uti: admission urine culture grew out pansensitive ecoli. patient was without signs of systemic infection, received 2d ceftriaxone, and was discharged on po cipro with plan for 7 days of therapy. . inactive # dementia: continued seroquel, halcion, nemenda and rivastigmine . # dmii: standing lantus/nph and humalog sliding scale were continued. . # htn: continued on home lasix, metoprolol, lisinopril. . # hyperlipidemia: continued atorvastatin . # gerd: continue home ranitidine. . # hypothyroidism: continued home levothyroxine. . # depression: continued cymbalta. . transitional 1. code status: patient remained full code for the duration of this admission 2. pending labs: no labs pending at discharge 3. transition of care: details of this admission were discussed with pcp office; discharge summary faxed. patient was scheduled for pcp and pcp's anticoagulation nurses were alerted. vna instructed to check inr on monday and fax to pcp. medications on admission: atorvastatin 40 mg daily duloxetine 60 mg daily hydrochlorothiazide 25 mg daily insulin glargine - dosage uncertain levothyroxine 75 mcg tablet daily lidoderm - 5%(700mg) adhesive patch, medicated - apply to painful area for 12hrs per day, then remove for 12 hours per day memantine - 5 mg tablet nitroglycerin - dosage uncertain quetiapine - 100 mg tablet po qhs ranitidine hcl - 150 mg tablet rivastigmine - 9.5 mg/24 hour patch 24 hr - apply one to skin once a day triazolam - 0.125 mg table qhs polyethylene glycol 3350 - dosage uncertain discharge medications: 1. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. duloxetine 60 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 3. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 4. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 5. namenda 5 mg tablet sig: one (1) tablet po twice a day. 6. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 8. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 9. coumadin 1 mg tablet sig: four (4) tablet po once a day: as directed by your primary care doctor . disp:*120 tablet(s)* refills:*0* 10. quetiapine 100 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 11. ranitidine hcl 150 mg tablet sig: one (1) tablet po twice a day. 12. rivastigmine 9.5 mg/24 hour patch 24 hr sig: one (1) transdermal once a day. 13. triazolam 0.25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 14. ciprofloxacin 500 mg tablet sig: one (1) tablet po every twelve (12) hours for 3 days. disp:*6 tablet(s)* refills:*0* 15. humalog standing humalog and sliding scale as instructed by clinic 16. equipment walker with adjustable-height 17. lantus standing lantus at bedtime as instructed by clinic 18. nph insulin standing nph insulin every morning as directed by clinic 19. enoxaparin 150 mg/ml syringe sig: one y five (135) mg subcutaneous daily (daily) for 6 days. disp:*7 units* refills:*0* discharge disposition: home with service facility: , discharge diagnosis: primary pulmonary embolism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ms. , . it was a pleasure taking care of you at . you were admitted for cough and found to have blood clots in your lungs. to treat these clots, you were started on a blood thinner (coumadin). until your coumadin reaches high enough levels, you will need to receive injections of another kind of blood thinner called lovenox (enoxaparin). you will need to follow-up with your primary care doctor g of your coumadin level (inr). we have discussed your hospital stay with dr. and he requests that you call his office on monday morning. during this hospitalization the following changes were made to your medications: -started coumadin -started lovenox (to be continued until instructed by your primary care doctor) -started cipro (for treatment of uti, to be continued for 3 days) followup instructions: name: , np location: general medical group address: , , phone: appointment: tuesday at 9am procedure: central venous catheter placement with guidance diagnoses: esophageal reflux urinary tract infection, site not specified unspecified essential hypertension unspecified acquired hypothyroidism depressive disorder, not elsewhere classified other and unspecified hyperlipidemia paralysis agitans other encephalopathy diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled other pulmonary embolism and infarction senile dementia, uncomplicated 

Answer: The patient is high likely exposed to