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: patient recorded as having no known allergies to drugs attending: chief complaint: fall major surgical or invasive procedure: intubation pericardial tap and drain placement history of present illness: 74 yo man with chf and ef of 20%, a fib on coumadin s/p recent avj ablation who was recently started on hd, presents s/p mechanical fall backwards on onto back of head down steps w/o loc. patient eventually transferred to the ccu for management of large pericardial effusion and evidence of early tamponade, seen on echo. . presented to osh a&o x 3, neurologically intact. ct demonstrated sah without mass effect & c6-7 widening. pt developed nausea and ams, was intubated for airway protection, was started on levophed for hypotension, given ffp and vitamin k, and then transferred to for further management. at the ed, ct torso demonstrated a moderate pericardial effusion and bilateral pleural effusions. he also had signs of active bleeding into his left thigh. . according to his wife and 4 daughters, at baseline mr. is able to mow the lawn & perform many adls/iadls without chest pain. he was very well until ~ 1 month ago when he developed "a cold," and was hospitalized with acute on chronic renal failure, course c/b afib with rvr, volume overload and hypotension. he had 2 prolonged hospitaliztions but according to his wife was home now and finally getting back to his baseline functional status. he has dyspnea on exertion which has been improving since starting hd, as has his le edema. no history of orthopnea, pnd, or syncope. he has had symptoms of orthostatic hypotension since starting hd which are worse on his dialysis days. his fall was witnessed and was clearly mechanical. echo on demonstrated a severely depressed lvef (20-25%), as well as a large pericardial effusion with evidence of early tamponade. as such, the patient was transferred to the ccu. patient underwent pericardiocentesis on , and 1350cc serosanguinous fluid drained (drain left in place). . past medical history: atrial fibrillation on coumadin, s/p ablation recently (unclear if afib vs avn ablation) chf with ef 10-15% s/p ppm/icd () esrd on hd(last hd = ) s/p liver transplant for cryptogenic cirrhosis, on chronic immunosuppression (, ) social history: non-smoker. no alcohol, drugs. lives with wife. 4 daughters. family history: non-contributory physical exam: vitals: t:98.4degrees farenheit, bp: 135/70 mmhg, hr 96 bpm, rr 20 bpm, o2: 96% gen: responsive, alert & oriented, asking where his wife is : no conjunctival pallor. no icterus. + ett neck: in c-collar, unable to assess jvp, carotids. cv: pmi laterally displaced, mid clavicular line. rrr. nl s1, s2. no murmurs, rubs, clicks, or . cardiac sounds distant. lungs: rhonchorous sounds transmitted from the upper airways. abd: nabs. soft, nt, nd. no hsm. abdominal aorta was not enlarged by palpation. no abdominal bruits. ext: wwp, trace edema in rle, 1+ pitting edema in lle. full distal pulses bilaterally. no femoral bruits. skin: no rashes/lesions, ecchymoses. neuro: cn ii-xii intact, maee psych: appropriate pertinent results: cardiac studies: echo : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is severe regional left ventricular systolic dysfunction with akinesis of the mid to distal inferior and inferolateral walls. overall left ventricular systolic function is severely depressed (lvef= 20-25 %). right ventricular chamber size and free wall motion are normal. there is abnormal diastolic septal motion/position consistent with right ventricular volume overload. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is a large pericardial effusion. the effusion appears circumferential. stranding is visualized within the pericardial space c/w organization. there is right ventricular diastolic collapse, consistent with impaired fillling/tamponade physiology. impression: severe left ventricular systolic dysfunction. large pericardial effusion with evidence of early tamponade. . cardiac cath : 1. opening pericardial pressure was 18 mm hg. this fell to 15 mm hg after removal of 100 cc of serosanguinous fluid from the pericardial space. after removal of 1350 cc of serosanguinous fluid, the pericardial pressure fell to -5 mm hg. final diagnosis: 1. pericardial tamponade. 2. successful removal of 1350 cc of serosanguinous pericardial effusion. . echo : impression: concentric left ventricular hypertrophy with global hypokinesis and more severe hypokinesis of the inferior wall. mild mitral regurgitation. mild pulmonary hypertension. trivial pericardial effusion which is slightly more prominent around the right atrium. compared with the prior study (images reviewed) of , the large pericardial effusion has mostly resolved. estimated pulmonary artery pressures are slightly higher. the left ventricular ejection fraction appears slightly more vigorous. . echo : lv systolic function appears depressed. rv with depressed free wall contractility. there is no aortic valve stenosis. there is a trivial/physiologic pericardial effusion. . other imaging studies: ct c-spine: 1. widening of the ventral intervertebral disc space at the c6-c7 level, suggestive of anterior longitudinal ligament rupture. no associated fracture is identified at this level. please note, patient has a cardiac pacer and cannot get mr. 2. multilevel degenerative change with a prominent posterior osteophyte noted at the c5 to c6 level. . ct head: 1. diffuse bilateral subarachnoid hemorrhage, right greater than left. 2. small amount of intraventricular hemorrhage in the left lateral and 4th ventricles. no associated hydrocephalus. 3. left parietal subgaleal hematoma. 4. fluid in the nasopharynx and bilateral ethmoid sinuses most likely attributed to intubation. . ct chest: the aorta opacifies normally without evidence of traumatic injury. the pulmonary arteries opacify normally without evidence of pulmonary embolism. the heart is mildly enlarged and there is a large simple pericardial effusion. no mediastinal or hilar lymphadenopathy is identified. there are moderate bilateral pleural effusions which are simple with adjacent atelectasis. no masses or nodules are identified. an aicd is in place. an endotracheal tube terminates above the carina. secretions are noted at the carina. an ng tube is noted within the esophagus terminating in the stomach. . ct abdomen: the liver, spleen, adrenal glands, and pancreas are normal in appearance. there two low-density lesions in the upper pole of the right kidney which most likely represents a renal cyst. the left kidney is somewhat small in appearance, but otherwise unremarkable. there is no mesenteric or retroperitoneal lymphadenopathy. there is no free fluid or free air within the abdomen. there is atherosclerotic disease of the descending aorta with no evidence of traumatic injury. specifically, there is atherosclerotic disease at the origin of the celiac trunk with narrowing and post stenotic dilitation. . ct pelvis: there are no pelvic masses. there is a small amount of simple free fluid in the pelvis. a foley is noted within the bladder. there is diverticulosis of the descending colon without evidence of diverticulitis. the small bowel is unremarkable in appearance. there is a hematoma noted adjacent and posterior to the left iliac bone which measures 2.8 x 8.3 cm. there is a focus of high-density material in the hematoma likely representing a small amount active extravasation. also noted is stranding in the subcutaneous tissues. . bone windows: there is loss of height involving the l1 and t12 vertebral bodies, of indeterminate chronicity. no discrete fractures are identified. there are no suspicious lytic or sclerotic lesions. . impression: 1. acute hematoma in the left lower back with evidence of active bleeding. 2. large simple-appearing pericardial effusion and moderate simple bilateral pleural effusions with adjacent atelectasis. 3. small amount of free fluid in the pelvis, likely related to patient's history of renal failure. . ct head : impression: 1. no significant change in diffuse subarachnoid hemorrhage. 2. intraventricular hemorrhage, which appears slightly more prominent compared to prior study, without evidence of new hydrocephalus . upper extremity us : impression: deep vein thrombosis in the left subclavian and axillary veins. . ct c-spine : no abnormal motion noted at the c6-c7 interspace on the currently acquired radiographs, although the extension view is suboptimal. given the findings displayed on the recent ct, it is still highly suspicious for an underlying injury to the anterior longitudinal ligament. . ct head : impression: 1. continuing evolution of multiple areas of subarachnoid hemorrhage within the bilateral frontal lobes, left parietal lobe, and suprasellar cistern. no evidence of new hemorrhage. 2. interval resolution of hemorrhage within the occipital horns of the lateral ventricles. . pathology: pericardial fluid: - negative for malignant cells. - see cytology c09- for correlation . lab values: on admission: wbc 17.3* hgb 8.4* hct 27.6* platelets 246 pt 25.1* ptt 39.9* inr 2.4* glucose 171* bun 29* crn 3.5* 139 4.3 101 28 14 brief hospital course: in summary, mr is 74 yo man with chf and non-ischemic cardiomyopathy (20%), a fib on coumadin s/p recent ablation, ckd on hd s/p fall c/b subarachnoid hemorrhage, who was found to have b/l pleural effusions and pericardial effusion. . # pericardial effusion/pericardial tamponade: believed to be chronic due to size; perhaps secondary to uremia (requiring dialysis), complication from ablation (bleed/trauma), or due to viral pericarditis (patient had uri recently) s/p pericardiocentesis. cytology negative for malignancy. no evidence of infection at this time. given high rbc ct in fluid, suspect that it may be slow bleed from prior trauma from pacemaker placement or from icd placement months ago. pericardial fluid culture neg, afp/anaerobic pending. - no antiplatelets, on heparin gtt for lue dvt (see below, neurosurgery aware, ptt goal 50-70). coumadin was restarted prior to discharge. - monitor on telemetry - tte yesterday showed no reaccumulation of fluid. - will need repeat echo in 4 weeks. . # pleural effusions: stable during admission and patient was without increasing oxygen requirements or respiratory distress, therefore pleural effusions were not drained. he should have a repeat cxr to assess if he becomes hypoxic again. . # s/p liver transplant: initially patient was unable to take po given aspiration risk and ng tube was unable to be placed, therefore sirolimus was not administed for one day. liver was consulted and recommended increase sirolimus dosing to 3 mg daily per hepatology recs. rapamune level on discharge is 6.7. - continue rapamune (sirolimus) 3mg po daily - check levels on monday, . please fax results to hepatologist dr. . - f/u with transplant at next week on tuesday. . # atrial fibrillation: rate controlled. anticoagulation was reversed on admission due to subarachnoid hemorrhage and held due to the high risk of bleeding. anticoagulation was restarted after patient was found to have lue dvt (see below). beta blocker continued while in the hospital. inr this am was 1.3. home dose of warfarin is 5 mg daily. please d/c heparin gtt 48 hours after inr > 2.0. . # hypertension: patient was started on carvedilol during admission instead of metoprolol tartrate and started on valsartan for afterload reduction in setting of low ef. # systolic heart failure: poor ef, currently stable. has biv icd. interrogated today and found to be working properly. -continue bblocker, -holding statin given liver enzyme elevation and transplant. . # ckd on hd: pt was continued on regular hemodialysis schedule while in the hospital. last dialysis was today. . # lue swelling: lue us noted to have dvt in the left subclavian and axillary veins, unclear if related to pacer placement 6 months ago. patient was started on low dose coumadin, inr 1.3. will need to bridge with heparin gtt given patient's renal dysfunction. - will need daily inrs and coumadin adjustment with goal inr . - please d/c heparin gtt 48 hours after inr > 2.0. . # subarachnoid hemorrhages: after fall, patient's head ct showed sah. neurosurgery was consulted. pt was treated with keppra for seizure prevention. the patient's sah was re-imaged shortly after starting anticoagulation and did not show interval worsening of the hemorrhages. . # c6-c7 widening; cervical spine instability: may require c-spine stabilization procedure which patient refused at this time. patient's admission ct c spine showed c6-7 widening, with 10mm step off. patient was maintained in a c-collar. flexion extension films were obtained and demonstrated 3mm stepoff concerning for anterior ligamentous injury. orthopedics evaluated the patient and recommended six more weeks of continuing c-collar and follow up with ortho in two weeks. - continue c.collar for at least 6 weeks - f/u with ortho on friday as scheduled. # aspiration: video swallow showed silent aspiration to all consistancies. he will need to remain npo. paitent had ir guided ng tube placed during admission. will need peg until c collar comes off and he gets another video swallow. he will also need ent consult to scope and check cords to see if he has bilat vocal cord movement. for now, will keep in ngt and give all nutrition and meds via this. # leukocytosis: unclear etiology, and no focal sxs, afebrile. pt was closely monitored given his immunosuppressed state and white count normalized without intervention. medications on admission: rapamycin 1mg daily 5mg daily asa 81mg daily niaspan 500mg daily omeprazole 20mg phoslo 2 tabs tid digoxin 0.125 qod metoprolol 100mg (family to clarify if succinate or tartrate) discharge medications: 1. guaifenesin 100 mg/5 ml syrup : 5-10 mls po q6h (every 6 hours) as needed for cough. 2. calcium acetate 667 mg capsule : two (2) capsule po tid w/meals (3 times a day with meals). 3. heparin (porcine) 5,000 unit/ml solution : 4,000-11,000 units injection prn (as needed) as needed for line flush. 4. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 5. carvedilol 12.5 mg tablet : two (2) tablet po bid (2 times a day). 6. warfarin 2 mg tablet : one (1) tablet po once daily at 4 pm: check inr daily, goal . 7. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 8. levetiracetam 100 mg/ml solution : five (5) cc po bid (2 times a day). 9. guaifenesin 100 mg/5 ml syrup : 5-10 mls po q4h (every 4 hours) as needed for cough. 10. valsartan 40 mg tablet : 0.5 tablet po daily (daily). 11. niacin 500 mg tablet : one (1) tablet po at bedtime. discharge disposition: extended care facility: medical center - discharge diagnosis: sub arachnoid hemmorhage pericardial effusion neck trauma s/p fall lue deep vein thrombosis acute on chronic systolic congestive heart failure liver transplant chronic kidney injury discharge condition: stable discharge instructions: you had a fall and sustained some bleeding in your head. you were seen by neurologists and the bleeding is stable. we have discontinued your warfarin for now and will keep you on heparin intravenously to manage the blood clot in your left arm. you also had a pericardial effusion that was drained. an echocardiogram was done on which showed no reaccumulation of fluid. you should have another echocardiogram checked in weeks. there was fluid in your lungs that has been resolving slowly. you now do not need oxygen. you were having trouble swallowing and needed a feeding tube. a video swallow study showed that you will need to continue to have a tube until at least the collar can be removed. you may need a tube through the stomach wall soon, this will be a lot more comfortable. . medication changes: 1. increase sirolimus to 3mg. 2. stop metoprolol 3. start carvedilol to slow your heart rate 4. start keppra to prevent seizures 5. stop omeprazole and start lansoprazole 6. stop digoxin 7. start diovan to help your heart work better 8. decrease your warfarin to 2 mg. followup instructions: spine surgery/orthopedics: dr. phone: date/time: friday at 9:00am. clinical center, . . . . cardiology: cardiology dr. phone: date/time: at 11:15. , . . hepatology: dr. phone: date/time: at 3:30pm. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours enteral infusion of concentrated nutritional substances hemodialysis pericardiocentesis diagnoses: other primary cardiomyopathies anemia in chronic kidney disease end stage renal disease unspecified pleural effusion congestive heart failure, unspecified atrial fibrillation accidental fall on or from other stairs or steps long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ hyperosmolality and/or hypernatremia liver replaced by transplant acute on chronic systolic heart failure sprain of neck other specified diseases of pericardium leukocytosis, unspecified cardiac tamponade subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness acute venous embolism and thrombosis of subclavian veins acute venous embolism and thrombosis of axillary veins 

Answer: The patient is high likely exposed to