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: penicillin v attending: chief complaint: lightheadedness major surgical or invasive procedure: placement of et tube placement of ng tube placement of central line history of present illness: 80 y/o f with h/o cad s/p mi with stents in , htn, hl and recent bout of pneumonia, transferred to from osh where she was found to have a leukocytosis of 137k with 88% lymphocytes. she had been in usoh after discharge on from recent admission for pneumonia at hospital, where she had been treated with antibiotics and steroids. for the past days, she has been experiencing dizziness, lightheadedness, nausea, cough, and diarrhea. she saw her pcp earlier today, who found her to have orthostatic hypotension, and checked labs revealing leukocytosis to 113k with 84% lymphocytes and many atypical lymphs. she was referred to hospital, where repeat labs showed wbc of 137k, with 88% lymphocytes and moderate smudge cells. labs at were also notable for bun/creat of 30/1.2. . of note, she was recently admitted to hospital from for pneumonia, and was discharged on antibiotics (completed course on ) and prednisone (last dose of 30 mg taken on ). . in the ed, initial vs were 97.3, 82, 128/66, 18, 98%ra. exam was notable for irregularly irregular heart rhythm. labs revealed leukocytosis of 96.3k with 88% lymphocytes and no bands. hct and plts were normal. ldh was 332, and uric acid 7.8. lactate was 2.4. troponin was negative. ecg showed atrial fibrillation at ~80 bpm, lad, twi in i, avl, v4-v6, and q waves in v1-v2. patient was given 1l ivf, in addition to another liter given at the osh. she was also given ceftriaxone and azithromycin for possible infiltrate (vs. resolving pna) on cxr. . while on the floor this morning, the team noted that she was hypotensive to 90s/60s and she was started on vancomycin and cefepime for coverage of possible hcap. heme/onc also saw the patient and reviewed her blood smear and saw that she had smudge cells consistent with cll but also some immature lymphocytes. this in conjunction with a rapid rise in her wbc count over the past year made cause for concern that she might have an immature clone, and her blood was sent for flow cytometry. . this evening, the patient subsequently developed an extremely rapid heart rate of 130s-140s while continuing to drop her pressures, which nadired at 78 systolic on the floor and spiked a temperature of 101.1. she also developed some respiratory distress and wheezing and was given a duoneb. the patient continued to mentate throughout, and complained of dizziness and lightheadedness whenever she moved. she reported some mild shortness of breath but no chest pain. she was bolused 1l on the floor without improvement of her blood pressures and was transferred to the icu for further management. past medical history: -cad s/p mi and stent placement x2 in (first stent , 2nd ) -htn -hl -atrial fibrillation (never on warfarin, past gi bleed) -hx of hemolytic anemia in (confirmed by pcp), rx'd rituximab (not confirmed by pcp patient does not remember) -iron deficiency anemia -s/p appendectomy -s/p hysterectomy -s/p l shoulder arthroscopy -s/p tonsillectomy social history: lives at home with children/grandchildren. works as customer service representative at book distributor. past smoker, quit ~10 years ago. denies current or past etoh or illicit drug use. performs all her own adls, and remains active with her employment. family history: sister has "heart disease." father also had heart disease, and mother had colitis/ileitis. her children are adopted. physical exam: on admission: vitals: t:97.5 bp:108/50 p:76 r:18 o2:95% ra general: pleasant well-appearing elderly female. alert, oriented, nad heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated. no cervical or supraclavicular lymphadenopathy. lungs: ctab, no wheezes, rales, ronchi cv: irregularly irregular. normal s1/s2. + holosystolic murmur most prominent at apex. no rubs. no s3/s4 abdomen: no splenomegaly or hepatomegaly. soft, nt/nd, bs present, no rebound tenderness or guarding ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. no axillary or inguinal lymphadenopathy neuro: 5/5 strength upper and lower extremities, proximally and distally. sensation to light touch grossly intact throughout. cn grossly intact . on discharge: pertinent results: admission labs: 11:45pm blood wbc-96.3* rbc-4.85 hgb-14.1 hct-41.1 mcv-85 mch-29.0 mchc-34.3 rdw-15.6* plt ct-261 11:45pm blood neuts-12* bands-0 lymphs-88* monos-0 eos-0 baso-0 atyps-0 metas-0 myelos-0 11:45pm blood pt-12.3 ptt-24.3 inr(pt)-1.0 11:45pm blood glucose-98 urean-28* creat-1.0 na-142 k-4.0 cl-104 hco3-25 angap-17 11:45pm blood alt-18 ast-27 ld(ldh)-332* alkphos-39 totbili-0.5 11:45pm blood albumin-4.0 calcium-8.4 phos-3.6 mg-2.4 uricacd-7.8* . discharge labs: ................................................................ microbiology: **all blood, urine, and sputum cultures negative** ................................................................ imaging: ................................................................ pathology: cxr: right middle lobe opacity may represent atelectasis or pneumonia. small right pleural effusion. . b/l le leni: no dvt of the bilateral lower extremity. . tte: the left atrium is dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). diastolic function could not be assessed. there is a moderate resting left ventricular outflow tract obstruction. there is no ventricular septal defect. right ventricular chamber size is normal. with normal free wall contractility. the number of aortic valve leaflets cannot be determined. the aortic valve is not well seen. significant aortic stenosis is present (not quantified). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is systolic anterior motion of the mitral valve leaflets. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. impression: moderate lvh, small, hyperdynamic left ventricle with consequent development of an lvot gradient as the mitral valve, chordae and papillary muscle contact the interventricular septum during systole. the severity of the obstruction cannot be determined but is probably moderate to severe. diastolic dysfunction probably present. the rv is not well seen but is probably normal in size and function. there is calcific aortic stenosis, again the severity cannot be determined on the basis of this echo. there is at least mild mitral regurgitation. . tte: moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. compared with the prior study of , left ventricular systolic function is less dynamic and a resting lvot gradient is no longer seen. the heart rate is much slower and the severity of mitral regurgitation has increased. pulmonary artery systolic hypertension is now identified. . tte: the aortic valve is thickened. severe aortic valve stenosis is suggested with a peak velocity of 4m/s (64 mmhg). . renal u/s: no hydronephrosis and no stones. brief hospital course: 80 y/o f with h/o cad s/p mi with stents in , htn, hl and recent bout of pneumonia, transferred to from osh where she was found to have a leukocytosis of 137k with 88% lymphocytes concerning for leukemia. she developed hypotension and respiratory distress in the setting of afib with rvr, and was tranferred to the icu for further management. the patients condition continued to deteriorate, her renal function consistent with atn. a tee demonstrated severe lvot obstruction. after a family discussion regarding goals of care the patient was made comfort measures only and extubated on the and passed the following night. . active issues: #. goals of care: after discussion with patient's family, decision was made to change patient's status to comfort measures only, as her family did not feel she would have wanted continued aggressive treatment without making improvement. the patient was extubated on the night of , and started on a morphine gtt titrated to comfort. all other medications were stopped. she was made comfortable with a morphine gtt, scopolamine patch, lorazepam and sublingual levsin. she expired the following evening with her daughter at bedside. . # respiratory distress/shock: initially felt to be secondary to sepsis considering the patient's recent treatment for pneumonia, small infiltrate on cxr, and sputum positive for gnrs. she was started on vanc/cefepime/cipro for possible hcap, and the vanc/cipro were later stopped. on she was febrile to 103 and antibiotics were broadened from cefepime to vanc/zosyn/cipro. she required pressor support. she was intubated on due to worsening respiratory distress. an echo revealed a hyperdynamic lv with consequent development of an lvot gradient at the mitral valve. repeat echo showed severe as, and much of her symptoms were felt to be due to this. dr. was asked to evaluate for possibility of percutaneous valvuloplasty. however, subsequent tee demonstrated that patient's cardiac dysfunction was secondary to significant lvot obstruction, and that her aortic valve was not significantly stenosed. she was given increased volume with hopes of increasing cardiac output, without significant improvement. . # atrial fibrillation: patient was initially anticoagulated with aspirin only, due to history of upper gib. the patient's home atenolol was switched to metoprolol which was uptitrated. she continued to have rvr and was started on an amiodarone gtt and heparin gtt. on she developed svt vs. vt (rate 200/minute), pulse present. shock delivered - returned to atrial fibrillation with slower rate (<100). the amiodarone was eventually switched to po and the heparin gtt was stopped due to coffee grounds from ng tube. . # : fena 0.2%. urine sediment showed 30-40 monomorphic rbcs per hpf, 3-5 wbcs, several granular casts, and a few muddy brown casts, consistent with atn. this was felt likely due to poor renal perfusion in the setting of hypotension. . # cll: peripheral smear showed smudge cells and immature lymphoctyes, concerning for acute transformation. she was started on allopurinoal and ivf due to elevated uric acid and risk of tumor lysis. flow cytometry later came back confirming cll. . # gi bleed: pt with h/o erosive gastritis seen on an egd in . she had intermittent coffee-ground material suctioned from her ng tube. protonix drip was started. she required intermittent rbc transfusions. . # cad, mi s/p stenting: . # hypertension: anti-hypertensives were initially held in the setting of sepsis. . # hyperlipidemia: continued simvastatin. . transitional issues the patient expired medications on admission: 1. amlodipine 5 mg daily 2. atenolol 50 mg daily 3. calcium 500 mg daily 4. furosemide 20 mg po 3x/week 5. iron ? dose 6. levothyroxine 50 mcg daily 7. lomotil 2.5mg prn 8. prilosec 20 mg prn daily 9. simvastatin 20 mg daily discharge medications: patient expired discharge disposition: expired discharge diagnosis: patient expired discharge condition: patient expired discharge instructions: patient expired followup instructions: patient expired procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances other electric countershock of heart diagnoses: coronary atherosclerosis of native coronary artery pneumonia due to other gram-negative bacteria acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation acute on chronic diastolic heart failure percutaneous transluminal coronary angioplasty status paroxysmal ventricular tachycardia other and unspecified hyperlipidemia acute respiratory failure cardiogenic shock old myocardial infarction unspecified gastritis and gastroduodenitis, with hemorrhage chronic lymphoid leukemia, without mention of having achieved remission 

Answer: The patient is high likely exposed to