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: service: medicine history of present illness: the patient is an 84 year old woman with a history of rheumatic heart disease status post mechanical mitral valve replacement, critical aortic stenosis, atrial fibrillation, chronic obstructive pulmonary disease and a prior episode of epistaxis, who presented to on , with profuse epistaxis. this was treated with anterior/posterior balloon packing for five days. inr was 4.8 at the time of presentation. her course was complicated by pan- sinusitis for which cefpodoxime was initiated. during this admission, the patient required transfusion of four units of packed red blood cells for decreased hematocrit. during this hospitalization, coumadin was discontinued and heparin was initiated. the patient was discharged to rehabilitation on one day following discharge, the patient developed recurrent profuse epistaxis and was readmitted to . inr at presentation was 1.9 with ptt 39.2 and a hematocrit of 29.4 which decreased to 26.7. anterior and posterior balloon packing was reinserted with effective tamponade. the patient was transfused one unit of packed red blood cells. due to multiple co-morbidities, ent preferred a non-operative approach and the patient was transferred to for consideration of embolization. of note, the patient had experienced recurrent right sided headache at , prompting two head ct scans which both revealed no hemorrhage. pan-sinusitis was present. past medical history: 1. atrial fibrillation: on coumadin. 2. history of rheumatic heart disease status post mitral valve replacement (bjork/shiley valve) in . 3. critical aortic stenosis with a valve area of 0.5 cm2. 4. chronic obstructive pulmonary disease on home o2, two liters nasal cannula at night. 5. anemia. 6. gastroesophageal reflux disease. 7. osteoporosis. 8. status post c6, c7 compression fracture. 9. history of gastrointestinal bleed in , requiring transfusion of five units of packed red blood cells. no colonoscopy or endoscopy was performed at that time and patient was started on protonix 40 mg twice a day. 10. colonic polyps status post polypectomy in . 11. history of epistaxis in . 12. hypertension. medications at the time of transfer: 1. heparin intravenously. 2. coumadin 7.0 to 7.5 mg p.o. q. h.s. 3. combivent mdi two puffs q. six hours. 4. pulmicort two puffs twice a day. 5. lanoxin 0.125 mg p.o. q. day. 6. k-dur 40 meq p.o. twice a day. 7. multivitamin one tablet p.o. q. day. 8. diamox 250 mg p.o. q. day. 9. toprol xl 25 mg p.o. q. day. 10. aldactone 25 mg p.o. q. day. 11. iron 325 mg p.o. three times a day. 12. protonix 40 mg p.o. twice a day. 13. calcium 1000 mg p.o. q. day. 14. lasix 60 mg p.o. twice a day. 15. nitroglycerin patch 0.2 mg per hour. 16. rocephin one gram intravenously q. 24 hours. allergies: no known drug allergies. social history: the patient lives alone; has a supportive daughter involved in her care. quit tobacco approximately seven years ago. physical examination: on admission, temperature 99.1 f.; blood pressure 115/60; o2 saturation 97% on room air. in general, the patient was a thin, elderly woman, breathing comfortably. heent: extraocular muscles are intact. nasal packing in nares bilaterally. neck: carotid pulses parvus and tardus. chest: mild expiratory wheezes bilaterally. good air movement. cardiovascular: irregularly irregular; mechanical heart sounds; iii/vi systolic ejection murmur heard across the precordium radiating to carotids bilaterally. abdomen soft, nontender, nondistended, normal bowel sounds. extremities: dorsalis pedis pulses bilaterally. chronic venous stasis changes bilateral lower extremities. neurological: cranial nerves ii through xii intact. strength five out of five in the upper and lower extremities bilaterally. sensation intact to light touch. laboratory: on the day of admission, white blood cell count 12.7, hematocrit 31.5, ptt 38.9, inr 1.5. sodium 133, potassium 4.4, creatinine 0.7. hospital course: the patient is an year old woman with a history of rheumatic heart disease status post mechanical mitral valve replacement, aortic stenosis, atrial fibrillation, and epistaxis, on chronic systemic anti-coagulation, who presents for embolization procedure for recurrent massive epistaxis. 1. ent: the patient underwent cerebral angiography with embolization for recurrent epistaxis. post-procedure, the patient was monitored in the intensive care unit overnight for recurrent bleed. the patient had no recurrent episodes of epistaxis. the nasal packing was removed on without difficulty. there was no evidence of necrosis of integument. 2. cardiovascular: on admission, the patient's diuretics were held and intravenous fluids were initiated in the setting of recent acute bleed. post-embolization procedure, the patient became hypotensive with systolic blood pressure of 77 after receiving lopressor. the lopressor dose was subsequently decreased from 25 mg twice a day to 12.5 mg p.o., twice a day. on hospital day number three, the patient's diuretics were re- instituted. of note, the patient had a 15-beat run of non- sustained supraventricular tachycardia post procedure with no further events on telemetry during intensive care unit stay. on hospital day number four, the patient complained of shortness of breath associated with left sided chest tightness. o2 saturation was 96% on room air with pulse in the 70s. ekg was obtained which showed no ischemic changes and no changes from admission ekg. chest x-ray was obtained which showed mild congestive heart failure. the patient's diuretics had been re- instituted that morning. the patient was placed on humidified air with slight improvement in her symptoms. 3. pulmonary: the patient's oxygen saturation remained 96 to 100% on room air. the patient was continued on combivent and flovent for history of chronic obstructive pulmonary disease. 4. infectious disease: post-embolization, the patient spiked temperature to 102.2 f., in the setting of known pan-sinusitis. in addition, the patient's white blood cell count increased to 17.9. blood cultures were drawn which showed no growth to date. in addition, urine culture showed no growth. the patient was switched to augmentin 500 mg p.o. t.i.d. to complete a total of 14 days of antibiotics for pan-sinusitis. 5. hematology: the patient had no further episodes of epistaxis during this admission. in addition, the patient required no transfusions. post-procedure, heparin intravenously was restarted and the patient was started on coumadin 7.0 mg p.o. q. h.s. on . she will continue heparin until her coumadin is therapeutic, given prosthetic valve and atrial fibrillation. 6. code status: "do not resuscitate". condition on discharge: stable. discharge status: the patient will be discharged to a skilled nursing facility. discharge instructions: 1. the patient is to have follow-up appointment with dr. (ent) in three to six weeks. medications at the time of discharge: 1. heparin intravenously at 900 units per hour. 2. coumadin 7.0 mg p.o. q. h.s. 3. combivent mdi two puffs q. six hours. 4. pulmicort two puffs twice a day. 5. lanoxin 0.125 mg p.o. q. day. 6. k-dur 40 meq p.o. twice a day. 7. multivitamin one tablet p.o. q. day. 8. diamox 250 mg p.o. q. day. 9. toprol xl 25 mg p.o. q. day. 10. aldactone 25 mg p.o. q. day. 11. iron 325 mg p.o. q. day. 12. protonix 40 mg p.o. twice a day. 13. calcium 1000 mg p.o. q. day. 14. lasix 60 mg p.o. twice a day. 15. nitroglycerin patch 0.2 mg per hour q. 12 hours a day. 16. augmentin 500 mg p.o. three times a day times ten days. , m.d. dictated by: medquist36 procedure: arteriography of cerebral arteries injection or infusion of other therapeutic or prophylactic substance control of epistaxis by other means diagnoses: anemia, unspecified esophageal reflux congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation heart valve replaced by other means osteoporosis, unspecified epistaxis pathologic fracture of vertebrae 

Answer: The patient is high likely exposed to