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: labetalol / duloxetine / morphine / sulfa (sulfonamide antibiotics) / dilaudid attending: chief complaint: chest pain major surgical or invasive procedure: pericardial effusion tap history of present illness: 54 y.o woman with history of htn, hyperlipidemia transferred here from after presenting there with chest pain and shorness of breath and was found to have a pericardial effusion. last saturday, the patient began to have chest pain and presented to , where she was ruled out for an mi with cardiac enzymes x2. she was given toradol at that time with good effect for her chest pain. . she represented to her pcp . on tuesday when she started feeling generally unwell with increasing shortness of breath, weakness, chills and subjective feelings of cold. she was sent to where a ct scan demonstrated bilateral pulmonary infiltrates and a pericardial effusion. she got echoes on and , which demonstrated worsening pericardial effusion and early signs of tamponade with ra diastolic collapse. she was then transferred to for further care. . on review of systems - no nausea, vomiting or diarrhea. no sick contacts. positive for non productive cough. she does also report having night sweats frequently over the last several years, worsening over the last 2 weeks. denies recent weight loss. past medical history: 1. cardiac risk factors: dyslipidemia, hypertension 2. cardiac history: none 3. other past medical history: spinal spondylosis chronic pain syndrome fibromyalgia depression ptsd gerd actinic keratosis social history: -tobacco history: 12 cigarettes a day since age 15 -etoh: none -illicit drugs: none born and raised in , no history of living in developing countries. no recent travel, does not live or has not recently gone hiking near wooded areas. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission physical exam: vitals: t97.0 bp145/96 p108 rr25 sao2:96% 3l nc pulsus paradoxus: 20mmhg general: woman in mild distress, appearing uncomfortable heent: jvp 10cm, pink slcera, mucous membs moist cardiac: s1/s2. 2/6 systolic murmur, no muffled heart sounds. lungs: l>r wheezes and rales, no ronchi abdomen: soft, ntnd. liver border smooth and nontender. extremities: warm, no edema, dp/pt pulses 2+bl skin: no stasis dermatitis, no rash. on discharge: same as above except pulsus <10, comfortable pertinent results: labs/studies ekg: nsr at 89, electrical alternans, diffuse t wave flattening, biphasic p wave in v1, nonspecific deflection in the s wave of v1. 02:30am pt-12.9 ptt-32.4 inr(pt)-1.1 02:30am plt count-313 02:30am wbc-9.8 rbc-3.13* hgb-10.4* hct-29.7* mcv-95 mch-33.3* mchc-35.1* rdw-13.1 02:30am tot prot-6.1* albumin-3.3* globulin-2.8 calcium-8.6 phosphate-3.5 magnesium-2.2 02:30am alt(sgpt)-14 ast(sgot)-23 ld(ldh)-296* alk phos-102 tot bili-0.2 02:30am estgfr-using this 02:30am glucose-89 urea n-6 creat-0.5 sodium-135 potassium-4.4 chloride-101 total co2-25 anion gap-13 06:00am other body fluid wbc-* hct-9.5* polys-91* lymphs-9* monos-0 06:00am other body fluid tot prot-3.7 glucose-70 ld(ldh)-717 amylase-12 albumin-2.1 on discharge: 11:20am blood wbc-7.9 rbc-2.70* hgb-8.9* hct-26.1* mcv-97 mch-32.9* mchc-34.1 rdw-13.7 plt ct-445* 11:20am blood glucose-90 urean-8 creat-0.6 na-132* k-4.3 cl-95* hco3-27 angap-14 pericardial fluid: negative for malignant cells. echo : overall left ventricular systolic function is normal (lvef>55%). with normal free wall contractility. there is a moderate sized pericardial effusion. there is sustained right atrial collapse, consistent with low filling pressures or early tamponade. impression: moderate circumferential pericardial effusion with evidence of impaired ventricular filling/early tamponade. findings were discussed with the ordering team by the cardiology fellow at the time of the study. echo repeat : overall left ventricular systolic function is normal (lvef>55%). there is normal right ventricular free wall contractility. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: no clinically-significant pericardial effusion.compared with the prior study (images reviewed) of , there is less pericardial fluid now. cath lab report : 1. successful pericardiocentesis via subxiphoid approach with removal of approximately 220cc of bloody fluid. final diagnosis: 1. pericardial effusion with early tamponade. 2. successful pericardiocentesis with removal of approx. 220 cc of bloody fluid. cxr :there are extensive parenchymal consolidations bilaterally in the perihilar and lower lobe distributions that potentially might represent pulmonary edema. on the other hand multifocal pneumonia is a consideration. there is left retrocardiac consolidation that might represent combination of atelectasis with the parenchymal widespread process. ards would be another possibility to consider. the left and right pleural effusion are present, left slightly greater than right. there is no pneumothorax. the contours of the cardiac silhouette on the left are obscured by the consolidation, thus the change in cardiac size after pericardiocentesis cannot be estimated. echo :there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (lvef= 50-55 %). right ventricular chamber size is normal. with borderline normal free wall function. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the ascending aorta is mildly dilated. 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 mildly thickened. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is probably moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , left ventricular systolic function is slightly less vigorous and heart rate is lower. there is no significant change in pericardial effusion. cxr : impression: improvement of changes most likely related to chf component. some basal infiltrates and pleural effusions remaining. further followup is recommended. brief hospital course: 54 y.o woman with pericardial effusion s/p pericardiocentesis and multifocal pneumonia, pleural effusions of unknown etiology. . #pericardial effusion - on admission, patient noted to have pulsus paradoxus with chest pain and sob. she went for pericardiocentesis with drain placement. on arrival to the ccu, she had 270cc sanguinous exudate in the drain and accumulated an additional 30cc. the pericardial drain was placed to gravity and then pulled once output decreased substantially. repeat echo shows no effusion. chemistry on the fluid is consistent with exudate, cultures show no growth. etiology of effusion is unclear at this time and includes inflammatory, malignant and infectious. was normal/weakly positive at 1:40, anca negative, hiv and hepc ab negative, hbsag and hbsab were negative. tsh wnl. the cytology of 60ml of pericardial fluid was negative for malignancy. the culture showed: gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (preliminary): no growth. acid fast smear (final ):no acid fast bacilli seen on direct smear. acid fast culture (preliminary): no mycobacteria isolated. fungal culture (preliminary): no fungus isolated. pulsus noted immediately prior to repeat echo showing no fluid. her pulsus was measured twice a day, and was within normal limits at discharge. patient will have cardiology follow up appointment, as well as rheumatology follow up upon discharge. breast exam wnl. she should have colonoscopy and mammogram as part of malignancy workup. . # atrial fibrillation: patient noted to be in rvr at presentation. started on metoprolol and titrated up to 150mg xl daily. also started on proprafenone (may not need this long term). chads2 score 1 so no need for warfarin, started on aspirin 325. had further episodes of rvr during admission but none at discharge metoprolol dose. . # pulmonary infiltrates - patient with ct findings consistent with multifocal pneumonia and chf and had 3l o2 requirement. she was started on azithromycin at , added ceftriaxone and transitioned to levofloxacin for total 5 day course. legionella antigen in urine was negative. mycoplasma igg positive, igm negative, indicating immunity and no active infection. chlamydia serology pending. blood cultures negative. no o2 requirement at time of discharge. should have repeat cxr in 6 weeks. . # hypertension: bp hard to control on home regimen. initially held antihypertensives in the setting of pericardial effusion. added back felodipine and diovan post drainage. lisinopril not restarted given . potassium stopped. diovan increased to 120mg . metoprolol added for afib. bp better controlled in the . #chronic pain syndrome: continued home meds, except lowering tizanidine to 2mg tid in setting of proprafenone interaction. used lorazepam prns throughout. . #hyponatremia: na 132 at discharge, osm 257, lowest 126. na to be checked by vna. medications on admission: elodipine 5mg dialy prilosec 20mg 60-120mg po daily diovan 160mg daily flonase k-chlor 20meq ativan 1mg qid prn simvastatin 40mg daily tizanidine 4mg tid trazodone 200mg qhs lisinopril 20mg daily hctz 12.5mg daily gabapentin 800mg tid oxycodone 20mg qid prn pain . medications on transfer from : celcoxib 200mg daily - discontinued guifenesin 5ml q6h trazodone 200mg qhs simvastatin 40mg qhs flunislide 1 puff ibuprofen 400mg q8h prn valsartan 160 daily omeprazole 20mg lorazepam 1mg qid lisinopril 20mg daily gabapentin 800mg tid felodipine 5mg daily azithromycin 500mg q23h oxycodone acetaminophen 650mg q4h prn pain fexofenadine 60mg prn discharge medications: 1. felodipine 5 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 2. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 3. -d 12 hour 60-120 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po once a day. 4. valsartan 160 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. flonase 50 mcg/actuation spray, suspension sig: one (1) spray nasal twice a day. 6. lorazepam 1 mg tablet sig: one (1) tablet po qid (4 times a day). 7. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 8. tizanidine 4 mg capsule sig: 0.5 capsule po three times a day. 9. trazodone 100 mg tablet sig: two (2) tablet po at bedtime. 10. hydrochlorothiazide 12.5 mg tablet sig: one (1) tablet po once a day. 11. gabapentin 800 mg tablet sig: one (1) tablet po three times a day. 12. oxycodone 20 mg tablet sig: one (1) tablet po four times a day as needed for pain. 13. metoprolol succinate 100 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po once a day. disp:*45 tablet sustained release 24 hr(s)* refills:*2* 14. propafenone 150 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 15. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 16. outpatient lab work please check chem-7 on friday with results to dr. at discharge disposition: home with service facility: discharge diagnosis: atrial fibrillation with rapid ventrixular response pericardial and pleural effusions hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you had chest pain and some trouble breathing and was admitted to . a pericardial and pleural effusions were found and you needed to have a tap or the pericardial effusion done here at . this was done on and the effusion has not returned. it is unclear why you had these effusions. you had no evidence of cancer or infection that would cause effusions. you will need to have a mammogram and colonoscopy arranged by dr. as an outpatient. you also had atrial fibrillation, an irregular and fast heart rate that was controlled with two new medicines, metoprolol and propafenone. you are now back in a regular rhythm. if you have palpitations or trouble breathing, please call dr. . your sodium is a little low. please have the vna draw some blood on friday . . medication changes: 1. increase diovan to 120 mg twice daily 2. stop taking potassium and lisinopril 3. start metoprolol succinate to lower your heart rate and blood pressure and keep you in a normal rhythm 4. start propafenone to keep you in a normal rhythm. 5. start a full dose (325mg) aspirin daily to prevent a stroke. 6. decrease the tizanidine to 2mg three times a day. this is because the propafenoone increases the effect of tizanindine and may make you dizzy. followup instructions: name: ,md specialty: primary care location: internists associated address: , , phone: when: at 1:00pm department: cardiac services with: dr. : will call you at home with an appt. health care 15 brothers , phone: ( dr. 15 brothers , phone: ( please call him if you have palpitations or increasing shortness of breath and you cannot contact dr. . procedure: pericardiocentesis diagnoses: pneumonia, organism unspecified anemia, unspecified esophageal reflux unspecified pleural effusion unspecified essential hypertension hyposmolality and/or hyponatremia atrial fibrillation other and unspecified hyperlipidemia other and unspecified special symptoms or syndromes, not elsewhere classified myalgia and myositis, unspecified acute pericarditis, unspecified spondylosis of unspecified site, without mention of myelopathy posttraumatic stress disorder 

Answer: The patient is high likely exposed to