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: patient recorded as having no known allergies to drugs attending: chief complaint: severe tr here for valve repair/replacement major surgical or invasive procedure: cardiac cath tvr/ra reduction surgery via right thoracotomy ( 33 mm ce pericardial valve) picc line bronchoscopy history of present illness: ms. is a 66 yo f with h/o rheumatic mitral stenosis s/p mechanical mvr () on coumadin, right heart failure due to severe tr and celiac disease who presents for heparin and catheterization prior to tricuspid valve repair on . the patient presents with progressive tr and right heart failure refractory to diuresis efforts. on review of old medical records, tr was first mentioned in a report dated 07/. at that time it was noted that she had a large right atrium and significant tr, however she was asymptomatic and able to maintain euvolemia with po diuretics. however, she was recently admitted to an osh for diuresis due to increased peripheral edema. per the patients report, despite iv lasix, she was only able to diurese 1-2lbs. mr in , showed enlarged rv with severe tr and preserved lv function. over the past two months the patient reports increased weight gain and le edema. she has been taking lasix/metolazone daily without any improvement in symptoms. aside from the le edema and fatigue she denies any other symptoms. she does not have any chest pain, palpitations, lightheadedness, dizziness, syncope or presyncope. she does report sob with ambulation however feels that it is due to the exertion required to move her le around. this shortness of breath has been stable over the past month. per her report, her dry weight is 145lbs, recently up to 158lbs. . the patient's last dose of coumadin was and her inr today was down to 1.7 per outside records (was 3.9 on friday). . on review of symptoms, she reports occasional diarrhea and fecal urgency especially in the morning. this has been stable since she saw dr. in . she follows a strict diet for celiac sprue, however per dr. last note she may have a refractory sprue. biopsies on last colonoscopy were negative. she reports a normal appetite with weight gain as above. she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea (sleeps with 1 pillow baseline), palpitations, syncope or presyncope. past medical history: mitral valve replacement, on coumadin. treatment for rheumatic ms. h/o mv commissurotomy in . celiac sprue lactose intolerance elevated lfts h/o af prior to mechanical valve placement social history: social history is significant for the absence of current tobacco use. there is no history of alcohol abuse. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: vs: t97.9, bp110/66, hr87, rr20, o2 97% on ra 63" 72 kg gen: wdwn elderly female in nad, resp or otherwise. oriented x3. mood, affect appropriate. slightly anxious. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: jvp to angle of jaw. cv: +rv heave, loud s1 (mech mv), normal s2, holosystolic murmur, diastolic murmur. no rubs or gallops. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. no crackles, wheeze, rhonchi. abd: soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: 3+ edema bilaterally to upper thighs. no femoral bruits. skin: chronic venous stasis changes. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; 1+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 1+ dp . pertinent results: admission labs: 02:45pm blood wbc-5.0 rbc-3.53* hgb-12.0 hct-35.9* mcv-102* mch-34.0* mchc-33.3 rdw-14.6 plt ct-119* 02:45pm blood pt-19.8* ptt-150* inr(pt)-1.9* 02:45pm blood plt ct-119* 02:45pm blood glucose-119* urean-23* creat-0.6 na-137 k-3.7 cl-101 hco3-30 angap-10 02:45pm blood alt-36 ast-58* ld(ldh)-326* ck(cpk)-53 alkphos-75 totbili-1.1 10:25am blood lipase-34 04:00am blood lipase-15 02:45pm blood ck-mb-notdone ctropnt-<0.01 02:45pm blood albumin-2.6* calcium-8.2* phos-2.9 mg-1.9 02:45pm blood tsh-5.0* 06:34pm blood type-art po2-138* pco2-43 ph-7.47* caltco2-32* base xs-7 intubat-not intuba comment-nasal 08:43am blood glucose-93 na-137 k-3.3* 06:34pm blood hgb-12.3 calchct-37 o2 sat-97 08:43am blood freeca-1.05* studies: c. cath: 1. coronary arteries are normal. 2. severe tricuspid regurgitation with elevated right atrial pressure. 3. mild pulmonary hypertension. 4. no mitral stenosis. cardiology report echo study date of left ventricle - ejection fraction: >= 55% (nl >=55%) left atrium: marked la enlargement. right atrium/interatrial septum: dilated ivc (>2.5cm) with no change with respiration (estimated rap >20 mmhg). left ventricle: mild symmetric lvh with normal cavity size. suboptimal technical quality, a focal lv wall motion abnormality cannot be fully excluded. right ventricle: markedly dilated rv cavity. moderate global rv free wall hypokinesis. paradoxic septal motion consistent with prior cardiac surgery. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. aortic valve: mildly thickened aortic valve leaflets (3). no as. systolic doming of aortic valve leaflets. trace ar. mitral valve: bileaflet mitral valve prosthesis (mvr). mild (1+) mr. tricuspid valve: bioprosthetic tricuspid valve (tvr). increased tvr gradients. mild tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. 02:10am blood wbc-7.8 rbc-2.20* hgb-7.6* hct-23.5* mcv-107* mch-34.4* mchc-32.2 rdw-19.2* plt ct-174 05:25am blood wbc-8.4 rbc-2.25* hgb-7.7* hct-24.3* mcv-108* mch-34.2* mchc-31.6 rdw-19.0* plt ct-158 01:58am blood wbc-9.4 rbc-2.30* hgb-8.0* hct-24.2* mcv-106* mch-34.8* mchc-33.0 rdw-20.0* plt ct-142* 09:05am blood pt-15.9* ptt-44.8* inr(pt)-1.4* 02:10am blood pt-15.1* ptt-111.1* inr(pt)-1.4* 05:25am blood pt-12.6 ptt-33.6 inr(pt)-1.1 03:48pm blood pt-12.4 ptt-66.2* inr(pt)-1.1 09:05am blood k-4.6 02:10am blood glucose-103 urean-30* creat-0.4 na-141 k-3.8 cl-108 hco3-28 angap-9 05:25am blood urean-31* creat-0.5 cl-109* hco3-29 brief hospital course: ms. is a 66 yo f with history of rheumatic valve s/p mvr (87) on coumadin with severe tr and right heart failure here for cardiac cath and tr repair. admitted . cath done prior to surgery. underwent right thoracotomy/tvr with dr. on . transferred to the csru in stable condition on phenylephrine, propofol, vasopressin and epinephrine drips. extubated early the next morning.drips weaned over the next several days. nutrition consult done for history of celiac sprue. c. diff. culture sent for diarrhea, but this was negative. picc line placed for continued iv abx and coumadin and heparin restarted for prior mechanical mvr/afib. ct scan of chest showedright effusion and bronchoscopy done on for thick secretions. transferred to the floor on pod #12 to begin increasing her activity level and aggressive pulmonary toilet. tranferred back to the csru for hypercarbia and decreased responsiveness without respiratory distress on early am. bipap used intermittently. right thoracentesis on and heparin drip restarted for subtherapeutic inr. chest ct repeated on showed partial right lung collapse, and aggressive pulmonary toilet continued. she was seen by pulmonology for persistent hypoxia, aggresive diuresis and nebs continued. tube feedings and cpap continued. she was reintubated on . bronchoscopy on showed moderate to severe tracheomalacia. she was seen by surgery who performed a tracheostomy and peg on . she was evaluated for passy-muir valve, and is able to wear it for very short periods of time. she was too fatigued to attempt swallow evaluation. she was discharged to rehab on . she was transfused 2 units prbcs prior to discharge. medications on admission: diovan 160 mg daily lasix 40 mg a day metolazone 2.5 mg a day coumadin 4 mg a day alt with 2 mg a day kcl supplement mvi citracal immodium discharge medications: 1. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 2. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 4. ferrous gluconate 300 mg tablet sig: one (1) tablet po daily (daily). 5. hexavitamin tablet sig: one (1) cap po daily (daily). 6. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 7. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. white petrolatum-mineral oil cream sig: one (1) appl topical tid (3 times a day) as needed: lower extremity. 10. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 11. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 12. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed. 13. loperamide 2 mg capsule sig: one (1) capsule po tid (3 times a day) as needed. 14. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: six (6) puff inhalation q4h (every 4 hours). 15. beclomethasone dipropionate 80 mcg/actuation aerosol sig: one (1) inhalation (). 16. furosemide 20 mg iv bid 17. heparin (porcine) in d5w 100 unit/ml parenteral solution sig: eight hundred (800) units/hour intravenous asdir (as directed). 18. warfarin 5 mg tablet sig: one (1) tablet po once (once) for 1 doses. discharge disposition: extended care facility: - discharge diagnosis: tvr/ra reduction via right thoracotomy prior mvr rheumatic heart disease mitral stenosis s/p mitral commissurotomy celiac sprue lactose intolerance a fib discharge condition: stable stable discharge instructions: no lotions, creams, ointments or powders on any incision no driving until cleared by surgeon call for fever greater than 100.5, redness or drainage no lifting greater than 10 pounds for 6 weeks may shower over incisions and pat dry followup instructions: see dr. in weeks see dr. in 4 weeks dr. 2 weeks already scheduled appointments: provider: , .d. date/time: 2:15 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis other bronchoscopy non-invasive mechanical ventilation excision or destruction of other lesion or tissue of heart, open approach percutaneous [endoscopic] gastrostomy [peg] other intubation of respiratory tract temporary tracheostomy transfusion of packed cells transfusion of other serum open and other replacement of tricuspid valve with tissue graft injection or infusion of nesiritide continuous intra-arterial blood gas monitoring diagnoses: other iatrogenic hypotension atrial fibrillation pulmonary collapse rheumatic heart failure (congestive) heart valve replaced by other means acute respiratory failure celiac disease intestinal disaccharidase deficiencies and disaccharide malabsorption other diseases of trachea and bronchus bacterial pneumonia, unspecified acute rheumatic endocarditis 

Answer: The patient is high likely exposed to