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 attending: chief complaint: shortness of breath major surgical or invasive procedure: cabg x 1, pericardial avr history of present illness: 75 f with pmh severe as, dvt, htn, hyperlipid, presented with sob to hospital on with chf decompensation. the patient has been hospitalized many times in the past several weeks. she was at for a cath in , in preparation for avr in . at cath, pt was found to have rca disease, moderate om, moderate lad disease. dr. sent pt for venous us of legs for vein mapping. pt was found to have a dvt and was started on coumadin. she has been on coumadin for 3 months now. followup venous us of legs at during this hospitalization showed no dvts. tte at showed ef 40%, with av area 0.7 cm2, consistent with severe as. . pt was admitted to on and discharged on , then readmitted on at 9 pm with hypoxic respiratory failure, brought in by ems. in the field, she was given lasix 80 iv x1 and morphine 12 mg x1, then lasix 80 iv x1 in ed. initial sbp was 140s, but decreased to 70s after intubation, and dopamine was started for presumptive cardiogenic shock. pt was found to have an nstemi with ck 108, mb 4.5, trop 2.9, cr 1.2. pt was placed on lovenox 80 mg x1 for dvt ppx. pt was transferred to for possible iabp for cardiogenic shock management and ct for planned avr. pt arrived intubated: ac 500/14/5/80%, and febrile to 103 rectal. past medical history: severe as hypothyroidism htn hyperlipidemia dvt gout hemorrhoids migraines osteo cholecystectomy and hernia repair social history: married and lives independently with husband and daughter. active in her own care. takes all her own medication, weighs and records her weight daily. is coming to the house now since d/c from hosp . does not drink alcohol, does not smoke cigarettes. family history: father died at age 45 of an mi. brother had a cva and an mi in his 60's and died at the age of 66. physical exam: 103 / 128/51 / 23 / 110 / 100% on 500/14+6/5/80%, pip 27 gen: can nod and answer appropriately heent: rej line, cannot assess jvd, no lad, op clear lungs: rales anteriorly bilaterally heart: 3/6 sem radiating up abdomen: soft, +bs, nd, nt neuro: motor skin: no rashes pertinent results: cath : 1. 2vd. 2. severe aortic stenosis. lmca - wnl rca - diffusely diseased, multiple 60-70% lesions lcx - co-dominant, large filling defect in the mid av groove at one point of bifurcation with the om1; om1 with ostial 50% lad - non-obstructive 40-50% mid vessel lv ventriculography was deferred given the known lesion on the av valve and critical aortic stenosis. limited resting hemodynamics demonstrated normal right (rvedp = 9 mm hg) and left (pcwp = 11 mm hg) filling pressures. the lvedp was not obtained due to known mobile mass on the aortic valve. tte: ef 40% 1. normal lv dimensions with mildly reduced lv systolic function. the inferior and posterior walls appear hypokinetic. 2. rv size and systolic function wnl 3. aortic valve is heavily calcified. peak velocity across av is 4.5 m/s. mean gradient is 49, calculated av area is 0.7 cm2 consistent with severe as. mild ar 4. mild annular calcification with mild mr. 5. other valves are normal with trace tr. 6. pasp 25-30 . 08:45am blood hct-33.6* 09:45am blood hct-29.8* 05:53am blood wbc-10.8 rbc-2.86* hgb-8.7* hct-25.1* mcv-88 mch-30.3 mchc-34.5 rdw-15.6* plt ct-125* 08:45am blood k-4.3 09:45am blood urean-20 creat-1.2* k-4.3 08:05am blood urean-23* creat-1.3* k-4.2 05:53am blood glucose-94 urean-26* creat-1.2* na-139 k-4.0 cl-103 hco3-27 angap-13 brief hospital course: 75 f with pmh severe as, dvt, htn, hyperlipid, presented with sob to hospital on with chf decompensation, admitted here with septic shock. she was treated in the cadiac care unit until she was optimized for her avr / cabg. . # septic shock: pt was hypotensive and febrile to 103 on admission. differential included av endocarditis, pneumonia, uti, line infection, hypothyroidism. cxr showed infiltrates which became more clear with diuresis. pt was covered with vanco and aztreonam for pcn allergy. levofloxacin was added on , since pt was still having low grade fevers after 3 days, for double coverage of gram negative organisms. sputum culture grew out gpc. tte and tee showed low likelihood of endocarditis, with severe as, no vegetation or mass seen on any valves. r femoral triple lumen cath and rej lines were changed to a rij swan. tsh was wnl. she finished a course for hap with vanco / levo / aztreonam, and remained afebrile in the five days prior to her surgery. . pt's beta blocker and were held for hypotension to sbp 75-85 on admission. pt was transferred on dopamine, and was changed to levophed after 1 day to maintain map>65. cortisol stimulation test was wnl. pt's fluid status was based in first few days on swan readings. she was successfully weaned off of all pressure support. . # hypoxic respiratory failure: pt was transferred from osh on ac vent, likely etiology due to chf exacerbation from pneumonia and severe as. pt was placed on vanc/aztreonam, and levofloxacin was added for double coverage of gram negative organisms. she was extubated one week after transfer, and required to go back on bipap three times after extuabtion; this was in the setting of increased hr / bp while anxious, with presumed acute pulmonary edema. she always responded well to gentle diuresis, and was tolerant of bipap as needed. she was weaned to room air prior to surgery. . # cardiac status: pump: tte showed ef 50%, e:a 1.25, critical as, possible 1 cm mass on aortic valve. tte and tee were performed, showing severe as and no vegetation or mass seen on any valve. it is likely that hypotension at osh may have been from low co from severe as and from medications given in the field, and that sepsis was an underlying cause. she was preparing for avr once her acute issues were resolved. she was taken to the or on where she underwent a cabg x 1 (svg->om) and avr (#23 pericardial). she was transferred to the csru in critical but stable condition. she was extubated on pod #1, and weaned from her drips and transferred to the floor by pod #2. she had a short bout of atrial fibrillation post operatively which resolved with amiodarone. she had no complications and was discharge to rehab on pod#7. ischemia: pt had a troponin leak at hospital with a trop 2.9. cath in shows 2vd; lmca - wnl; rca - diffusely diseased, multiple 60-70% lesions; lcx - co-dominant, large filling defect in the mid av groove at one point of bifurcation with the om1; om1 with ostial 50%; lad - non-obstructive 40-50% mid vessel. pt was placed on asa. pt was not on a statin as an outpatient, and was not placed on one inhouse. she evidently had a history of myalgias which were attributed to statins, so they were discontinued. . rhythm: pt remained in nsr during most of ccu admission. pt became sinus tachycardic on dopamine, and was changed to levophed as a pressor. she had an episode of atrial fibrillation, which was new for her. she was rate controlled with iv amiodarone, and converted to po amiodarone; she was continued on a beta blocker once off of pressors. she converted back to nsr, and remained in that rhythm up until the time of surgery. . # anemia: likely due to blood loss and anemia of chronic disease. pt's hct continued to drift down slowly during admission. pt's ngt was guaiac+, and stool was guaiac- on admission. hemolysis labs were negative. pt's hct was supported with transfusions, since hct drop was slow, and was monitored until respiratory status was stable. in preparation of surgery, she underwent an egd and a virtual colonoscopy to evaluate the anemia. the egd revealed mild gastritis without any active bleeding. the virtual colonoscopy (done due to her tenuous hemodynamic status at the time) revealed diverticulosis, no polyps, no active bleeding. the etiology of her anemia was still unclear, but stable. . # history of dvt: lenis were found to be negative at osh, and pt was given lovenox 60 x1 at osh. pt was maintained on heparin sc tid inhouse. . fen: pt was given tf through ogt medications on admission: admission medications: benicar 40mg daily. lasix 80 mg q am, 40 mg q pm. levothyroxine 50 mcg daily. toprol 25mg daily. norvasc 2.5 mg daily. calcitrol 0.25mcg daily. asa 81 mg daily. tums 1 tablet . allergies: pcn, no contrast or shellfish allergy discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 5. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 6. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day): 400 mg qd x 1 week, then 200 wd. tablet(s) 7. toprol xl 50 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. 8. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). tablet(s) 9. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 10. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po daily (daily). 11. calcitriol 0.25 mcg capsule sig: one (1) capsule po once a day. 12. tums 500 mg tablet, chewable sig: one (1) tablet, chewable po once a day. discharge disposition: extended care facility: life care center of discharge diagnosis: sepsis, pneumonia severe as, htn, hyperlipidemia, hypothyroidism, dvt discharge condition: good. discharge instructions: shower, no baths, no lotions, creams or powders to incisions. call with fever, redness or drainage from incisions or weight gain more than 2 poundsin one day or five in one week. no heavy lifting or driving. p instructions: 1. please follow up with your primary care physician, . , , within 1-2 weeks. dr. 4 weeks procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery other endoscopy of small intestine diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances (aorto)coronary bypass of one coronary artery open and other replacement of aortic valve with tissue graft transfusion of packed cells diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia iron deficiency anemia secondary to blood loss (chronic) severe sepsis unspecified acquired hypothyroidism atrial fibrillation aortic valve disorders acute respiratory failure septic shock dehydration 

Answer: The patient is high likely exposed to