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: shortness of breath major surgical or invasive procedure: none this hospitalization history of present illness: this is a 19 year-old indian with no significant pmh but a recent diagnosis of idiopathic dilated cardiomyopathy (ef 15%, 2d-echo ), presenting with acute-onset of shortness of breath for 2-days. . of note, the patient was recently admitted to the -cardiology service on when he presented with palpitations, dyspnea, some uri symptoms, which was associated with substernal chest pain, found to have evidence of volume overload and peripheral edema consistent with decompensated dilated cardiomyopathy. a 2d-echo was performed and showed 3+ mitral regurgitation with an lvef of 15-20%. he was started on a nitro gtt and aggressively diuresed, requiring a lasix gtt with conversion to po torsemide prior to discharge. his weight on admission was 97 kg (dry weight estimated at 90 kg) and this improved to 89.8 kg at discharge. in terms of cardiomyopathy investigation - his hiv, lyme antibody, cmv, ebv, hepatitis serologies, tsh and virus testing were all negative. of note, the patient has a strong family history of dilated cardiomyopathy, with two uncles who expired in their 30s from heart failure. additions to his medication list at that time included an acei, beta-blocker and spironolactone. he was also loaded with digoxin and was uptitrated to 375 mcg po daily. he was discharged on . the patient's 2d-echo was repeated on showed similar findings after initiation medical therapies. . he now presented with shortness of breath while at his rehabilitation facility the day prior to admission, , which was occurring at rest and worst with exertion. this was associated with substernal chest pain that radiated to the right scalp, worse with deep inspiration and relieved by leaning forward. he has noted no unintentional weight gain, leg swelling. he also denied fevers or chills, nausea, palpitations and diaphoresis. he denies uri symptoms or productive cough or abdominal pain. . in the ed, initial vs 98.1 105 137/79 15 100%ra. his exam was notable for tachypnea, tachycardia, but no leg swelling or jvp elevation. his wbc was 21.1 (n 82.9%, l 10.3%), pro-bnp 2968, troponin < 0.01. in the ed, his tachypnea progressed and he required rsi (etomidate, succinylcholine) for airway protection and increased work of breathing. cardiology was consulted. cardiac u/s in the ed showed no evidence of pericardial effusion, poor squeeze and a dilated left ventricle. cta chest showed small, lll subsegmental pulmonary embolus with possible right lung base pna. prior to transfer, vs 97.7 100 99/72 22 100% intubated (500/22/5/1.0). . in the micu, patient was started on heparin gtt following bolus for small, lll subsegmental pulmonary embolus. they continued vancomycin, cefepime and levofloxacin for presumed healthcare-associated pneumonia given ct findings of right lung base consolidation. cardiology recommended discontinuing anti-hypertensives and continuing anticoagulation. he was extubated on and his heparin gtt was bridged to coumadin with some mild hemoptysis. he spiked a temperature to 101.5f, developed tachycardia to the 120s and had a repeat 2d-echo on showing right ventricular systolic function that was more severely impaired when compared to the study. he developed intermittent abdominal pain with hyperbilirubinemia and a moderate transaminitis concerning for cardiogenic hepatic congestion. a ruq ultrasound showed prominent hepatic veins, mild distention of the gallbladder with mild wall thickening and no gallstones. at this point, his outpatient cardiologist, dr. , recommended transfer to the ccu for iv lasix and milrinone therapy given his biventricular cardiac failure. . on arrival to ccu, has some nausea and on-going small volume hemoptysis but he is without lightheadedness or dizziness. he denies chest pain or trouble breathing. . on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative; see hpi for details. . cardiac review of systems is notable for absence of chest pain. it is notable for dyspnea on exertion, but no paroxysmal nocturnal dyspnea. he did notes some orthopnea, but was without ankle edema, palpitations, syncope or pre-syncope. past medical history: past medical history: * cardiac risk factors: no dyslipidemia, hypertension or diabetes * cardiac history: recently diagnosed with dilated cardiomyopathy with 2d-echo showing 3+ mitral regurgitation with an lvef of 15-20% * cabg: none * percutaneous coronary interventions: none * pacing/icd: none . past medical & surgical history: 1. dilated cardiomyopathy (3+ mitral regurgitation with an lvef of 15-20%) social history: patient is a never-smoker. he notes drinking alcoholic beverages weekly, ocassionally up to 7-beers in one sitting (4 drinks on the friday prior to presentation). notes ocassional marijuana use with no ivdu. he is student studying international relations and economics; he has a girlfriend, and he is sexually active with her monogamously. he denies history of sits (although never tested prior to presentation). has traveled to wooded areas within , but does not recall ticks or insect bites. prior travel to both cities and rural areas of , , ; was born in , , traveled to the uk, uae, and usa. has not traveled to latin or south america. family history: mother's brother developed cardiomyopathy s/p and is cardiac transplant. father's brother died of cardiomyopathy around age 30 years; both of these cases were caused by an infectious etiology. no other family history of heart disease, sudden cardiac death, or dysrrhythmias. physical exam: physical exam (on admission to ccu): vitals: 98.8 104 108/73 81 33 96%ra general: appears in no acute distress. alert and interactive. robust-appearing male. heent: normocephalic, atraumatic. eomi. perrl. nares clear. mucous membranes dry with dry-blood at mouth edges. no xanthalesma. neck: supple without lymphadenopathy. jvd 2-3 cm above the clavile at 30-degrees. cvs: pmi located in the 5th intercostal space, mid-clavicular line. sinus tachycardia with normal rhythm, with 2/6 holosystolic murmur, without rubs or gallops. s1 and s2 normal. no s3 or s4. resp: respirations unlabored, no accessory muscle use. decreased breath sounds bilaterally without adventitious sounds. no wheezing, rhonchi or crackles. stable inspiratory effort. abd: soft, mildly tender diffusely, non-distended, with normoactive bowel sounds. no palpable masses or peritoneal signs. abdominal aorta not enlarged to palpation, no bruit. no hepatomegaly noted. extr: no cyanosis, clubbing; + non-pitting edema, 2+ peripheral pulses derm: no stasis dermatitis, ulcers, scars. neuro: cn ii-xii intact throughout. alert and oriented x 3. strength 5/5 bilaterally, sensation grossly intact. gait deferred. pulse exam: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: 10:15pm blood wbc-21.1*# rbc-5.03 hgb-14.1 hct-42.3 mcv-84 mch-27.9 mchc-33.2 rdw-13.7 plt ct-245 . 06:45am blood wbc-9.2 rbc-4.25* hgb-11.7* hct-35.7* mcv-84 mch-27.4 mchc-32.7 rdw-13.4 plt ct-245 . 10:15pm blood neuts-82.9* lymphs-10.3* monos-5.7 eos-0.7 baso-0.4 . 06:45am blood pt-33.8* ptt-33.5 inr(pt)-3.3* . 03:22am blood pt-16.9* ptt-74.5* inr(pt)-1.5* . 10:15pm blood pt-16.1* ptt-26.9 inr(pt)-1.4* . 06:45am blood glucose-99 urean-15 creat-0.8 na-132* k-4.1 cl-93* hco3-32 angap-11 . 10:15pm blood glucose-142* urean-15 creat-0.9 na-134 k-4.6 cl-101 hco3-22 angap-16 . 06:45am blood alt-160* ast-59* alkphos-59 totbili-1.7* . 03:21pm blood alt-226* ast-244* alkphos-55 totbili-2.0* . 05:20am blood alt-24 ast-21 alkphos-50 totbili-1.7* . 10:32am blood lipase-62* . 05:20am blood ctropnt-<0.01 . 10:15pm blood ctropnt-<0.01 probnp-2968* . 06:45am blood calcium-8.3* phos-2.4* mg-2.2 . 04:55am blood albumin-2.9* calcium-8.1* phos-2.0* mg-1.7 iron-23* . 10:15pm blood calcium-9.3 phos-3.0 mg-2.1 . 04:55am blood caltibc-243* ferritn-573* trf-187* . 06:45am blood vanco-12.2 . 10:15pm blood digoxin-0.8* . cardiac cath: none . microbiology data: urine culture - negative blood culture (x 2) - pending mrsa screen - negative urine legionella antigen - negative sputum culture - contaminated specimen sputum culture - contaminated specimen urine culture - pending . 2d-echo () - the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is severely dilated. there is severe global left ventricular hypokinesis (lvef = 15 %). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular free wall thickness is normal. the right ventricular cavity is dilated with depressed free wall contractility. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. significant augmentation of contractile function of the left ventricle is seen during postextrasystolic beats. . 2d-echo () - the left atrium is dilated. the right atrium is markedly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is severely dilated. with severe global free wall hypokinesis. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. the main pulmonary artery is dilated. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , right ventricular systolic function is now more severely impaired. the left ventricle is now more dilated. mitral regurgitation is now slightly less prominent. . cardiac mr imaging - severely increased left ventricular cavity size with severe global dysfunction. the lvef was severely decreased at 12%. the effective forward lvef was severely decreased at 8%. no cmr evidence of prior myocardial scarring/infarction. these findings areconsistent with a nonischemic cardiomyopathy. mildly increased right ventricular cavity size and severe global dysfunction. the rvef was severely decreased at 15%. no thrombus seen in the left ventricular cavity. moderate-to-severe mitral regurgitation. mild pulmonic regurgitation. the indexed diameters of the ascending and descending thoracic aorta were normal. the main pulmonary artery diameter index was normal. mild biatrial enlargement. normal coronary artery origins with no evidence of anomalous coronary arteries, and normal signal characteristics of all visualized vessel segments. there is mild to moderate pulmonary edema. moderate bilateral simple pleural effusions (right greater than left) and bibasilar consolidations, likely representing atelectasis. . cta chest w&w/o c&recon - pulmonary emboli within subsegmental branches of the left and right lower lobe pulmonary arteries. small right pleural effusion, decreased from prior. non-enhancing consolidation in the right lung base which may reflect pneumonia or aspiration in the appropriate clinical circumstance. stable mediastinal and right hilar lymphadenopathy. stable moderate cardiomegaly. no pericardial effusion. standard position of lines and tubes. . liver or gallbladder us - right pleural effusion. prominent hepatic veins. mild distension of the gallbladder along with mild thickening of its wall, no stones identified. trace amount of pericholecystic fluid. brief hospital course: 19m with no significant pmh presents with likely famlial dilated cardiomyopathy with recent hospitalization for acute failure who responded to diuresis who now returns with shortness of breath found to have pneumonia and subsegmental pulmonary embolus with evidence of biventricular failure and volume overload. . # idiopathic dilated cardiomyopathy - the patient presented on in overt volume overload with evidence of congestive heart failure. he was noted to have decompensated dilated cardiomyopathy with a 2d-echo showing 3+ mitral regurgitation with an lvef of 15-20%. he responded to aggressive lasix gtt with conversion to po torsemide with improvement in symptoms at that time. etiologies for his cardiomyopathy included: ischemic (unlikely given age and no risk factors; no cardiac cath data) vs. infectious (hiv, lyme, viral, chagas - last admission his hiv, lyme antibody, cmv, ebv, hepatitis serologies, tsh and virus testing were all negative) vs. toxic (alcohol, cocaine, medications - unlikely given no prior medication; prior toxicology screens negative, although moderate alcohol intake was noted) vs. familial (most likely possibility given strong family history noted above; genetic vs. autoimmunity-related). he now returned with dyspnea on exertion and at while at rest without overt volume overload symptoms, but was found to have a subsegmental lll pulmonary embolus requiring heparinization. a repeat 2d-echo () showed right ventricular systolic dysfunction that was now more severely impaired. the left ventricle was also more dilated. overall it appeared to be consistent with right ventricular failure and right atrial dilatation occurring in the setting of subsegmental lll pulmonary embolus and infection (pneumonia) that had precipitated -ventricular failure (his admission pro-bnp was 2968). he also had significant abdominal pain and transaminitis which was attributed to cardiogenic-hepatic congestion or congestive hepatopathy. he was admitted to the ccu after transfer from the medical icu, and was initiated on a milrinone infusion of 0.25 mcg/kg/min following an initial loading dose of 50 mcg/kg over 15-minutes. this was titrated to 0.375 mcg/kg/min at one point, but he developed tachycardia, and this was decreased to the 0.25 mcg/kg/min dosing with good tolerance. simultaneously, he was started on a continuous iv lasix infusion at 5-7 mg/hr and together with the inotropic effect of milrinone, he diuresed roughly 6-8l of fluid to a weight of 90.2 kg (95 kg on admission; dry weight 89.8 kg). he will continue on milrinone therapy and will be transferred to center for cardiac transplant surgery evaluation. we trended his transaminitis and monitored his abdominal pain, which both steadily improved with diuresis. his acei (lisinopril) and spironolactone therapy were held in the setting of acute heart failure, but his metoprolol was titrated back at 12.5 mg by mouth twice daily; we also continued his digoxin therapy. we strictly monitored his in's and out's and optimized his electrolytes; he was monitored via telemetry. . # pulmonary embolus - the patient was found to have pulmonary embolism in a segmental branch of the left lower lobe of the pulmonary artery - initially presenting with worsening dyspnea. he received heparin gtt and he was bridged to coumadin. a 2d-echo showed right ventricular failure and right atrial dilatation with acute -ventricular failure; but it is unlikely that a distal, subsegmental pe induced right ventricular failure, but this should be considered. ekg was without evidence of poor r-wave progression; and he maintained his oxygen saturations. in light of his recent hospitalization, the risk of thromboembolic disease should be noted. he was started on coumadin 5 mg po daily and his dose was titrated to an inr of . . # healthcare-associated pneumonia - the patient presented with right sided chest pain with tachypnea. he was found to have right lower lobe consolidation on ct imaging. the patient was recently discharged from the hospital and was in a rehab facility. this was all associated with leukocytosis with a left shift. the patient was afebrile in the ed. nonetheless, he was given iv vancomycin, cefepime, and levofloxacin (started ) for healthcare associated pneumonia coverage. the patient was initially intubated in the ed for airway protection and increased work of breathing, but he was swiftly extubated without desturations. he did have some evidence of hemoptysis, likely from his infectious alveolar process and anticoagulation needs. this steadily improved and he remained hemodynamically stable without evidence of large volume bleeding. his u/a was reassuring and blood, urine cultures were negative. he remained afebrile and his leukocytosis improved. he will continue on healthcare associated pna coverage with vancomycin, cefepime, levofloxacin for a total of days. . # coronaries - he has no evidence of ischemic cardiomyopathy or coronary disease; no prior cardiac catheterizations; no htn, smoking history or strong atherosclerotic family history (only familial nicm history) - presented with some atypical chest pain symptoms - but now pain free - troponin < 0.01 x 2-sets with reassuring ekg showing only sinus tachycardia and no st-changes on admission. he has no indication for aspirin - risk score calculates to 10-year risk of 1% - given hdl 44, cholesterol 167, age < 20, male, no smoking history and no indication for statin at this time. he was monitored with serial ekgs. . # rhythm - no evidence of arrhythmia or history of dysrrhythmia. . transition of care issues: 1. the patient is being transferred to center for management of his acute biventricular heart failure and will be evaluated by the cardiac transplantation service. 2. continue lasix gtt at 5 mg/hr and titrate to adequate diuresis. 3. continue vancomycin, levaquin and cefepime for 10-14 days for coverage of healthcare-associated pneumonia; start date of . 4. morphine iv for pain control. 5. his acei and spironolactone were held while his acute biventricular failure was managed. medications on admission: home medications (confirmed with patient) 1. lisinopril 25 mg po daily 2. metoprolol succinate 25 mg xl po daily 3. spirinolactone 12.5 mg po daily 4. digoxin 325 mcg po daily discharge medications: 1. digoxin 125 mcg tablet sig: three (3) tablet po daily (daily). 2. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 3. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 4. milrinone 0.25 mcg/kg/min iv infusion maximum dose: 0.5 mcg/min 5. furosemide 10 mg/ml solution sig: five (5) mg/hour injection infusion (continuous infusion): titrate to uop 100cc/hour. 6. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 7. morphine 5 mg/ml solution sig: 2-4 mg injection q3h (every 3 hours) as needed for pain. 8. levofloxacin in d5w 750 mg/150 ml piggyback sig: seven y (750) mg intravenous q24h (every 24 hours): day 1=. 9. vancomycin 500 mg recon soln sig: 1250 (1250) mg intravenous q 8h (every 8 hours): day 1 . 10. cefepime 2 gram recon soln sig: two (2) g injection q8h (every 8 hours): day 1=. 11. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for fever or pain. discharge disposition: extended care facility: medical center discharge diagnosis: primary diagnoses: 1. acute biventricular heart failure 2. dilated cardiomyopathy 3. pulmonary embolism 4. healthcare-associated pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: patient discharge instructions: . you were admitted to the cardiac intensive care unit (ccu) at on cc7 regarding management of your severe heart failure and pulmonary embolism with pneumonia. you were treated with an iv inotropic (promotes heart contractility) with iv diuretics to promote better heart function with promotion of fluid removal. you tolerated this therapy in the icu well and diuresed to near-baseline weight. you were also anticoagulated for your pulmonary clot. you were treated with iv antibiotics for presumed healthcare associated pneumonia. your abdominal pain, volume status and shortness of breath improved prior to your transfer to center. the cardiac transplant team will continue your management and care. . please call your doctor or go to the emergency department if: * you experience new chest pain, pressure, squeezing or tightness. * you develop new or worsening cough, shortness of breath, or wheezing. * you are vomiting and cannot keep down fluids, or your medications. * if you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include: dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit, or have a bowel movement. * you experience burning when you urinate, have blood in your urine, or experience an unusual discharge. * your pain is not improving within 12 hours or is not under control within 24 hours. * your pain worsens or changes location. * you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. * you develop any other concerning symptoms. . changes in your medication reconciliation: . * upon admission, we added: you are being transferred on: milrinone 0.25 mcg/kg/min iv continuous infusion (maximum dosing 0.5 mcg/min); lasix drip titrated to urine output 100cc/hour; cefepime, vancomycin and levofloxacin. monitor your inr and restart warfarin when your inr is no longer supratherapeutic at 3.3 (ideal range is ). we changed: metoprolol succiante 25 mg xl daily to metoprolol tartrate 12.5 mg by mouth twice daily. . * the following medications were discontinued on admission and you should not resume: discontinue: spironolactone discontinue: lisinopril . * you should continue all of your other home medications as prescribed, unless otherwise directed above. followup instructions: department: cardiac services when: monday at 2:00 pm with: echocardiogram building: sc clinical ctr campus: east best parking: garage . department: cardiac services when: monday at 3:00 pm with: dr. building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube diagnoses: pneumonia, organism unspecified other primary cardiomyopathies hyperpotassemia mitral valve disorders congestive heart failure, unspecified nausea with vomiting acute respiratory failure acute on chronic systolic heart failure other pulmonary embolism and infarction jaundice, unspecified, not of newborn nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] 

Answer: The patient is high likely exposed to