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: aspirin / penicillins / biaxin / azithromycin / heparin agents attending: chief complaint: increased abdominal girth major surgical or invasive procedure: placement of tunnelled dialysis cathether history of present illness: this is a 61 y/o woman with pmh notable for wpw s/p triple valve replacement (mv, av, tv) on chronic coumadin, cirrhosis heart failure, and chronic renal insufficiency (renal cr ~ 3) who presents with increased abdominal girth and dyspnea. patient has been at home for several weeks following a stay at . she states that there she had c diff colitis but is no longer on antibiotics. . in the ed, initial vs were: p 65 bp 137/66 r 16 o2 sat 98%. patient was given no medications in the ed. her bp did transiently decrease to 88/48 but came back up to 101/53 without intervention. temperature was noted to be 94.7. . call in note states patient has had inr 7 for past few days so coumadin has been held. . on the floor, the patient states that she has no dyspnea when not walking. she any chest pain. she endorses increased abdominal girth but abd pain or fevers. she notes recently decreased urine output but no dysuria. recent changes in her meds or antibiotic use. no nausea or vomiting; normal po intake for her. she reports she took 2.5 mg coumadin yesterday after taking 5 mg x 1 week with resultant inr 7.3. . ros: as above. no headaches, slurred speech, confusion. no sore throat, congestion, difficulty swallowing. no cough or sputum production. no hematemesis or blood in stool. chronically has diarrhea ("ibs" per her report). has chronic edema from knees to midchest. no joint pains, rash, or myalgias. past medical history: notes for dates: - a - last updated by , on @ 1328 patient location: fa10-1001-01 intern accept note . pcp: , md hepatologist: dr. . intern accept note: . cc: increased abdominal pain . please see admission h&p for full details of history. hpi: ms. is a 61 yo woman with a hx of cri and wpw s/p valve replacement on coumadin who presents with anasarca and acute on chronic renal failure. she has noted increasing girth for 3 weeks. for the past week she also noticed decreased urine output. . of note, coumadin had been held for 2 days for increased inr to 7. . in the ed, initial vs were: t 94.7 p 65 bp 137/66 r 16 o2 sat 98%. patient was given no medications in the ed. her bp did transiently decrease to 88/48 but came back up to 101/53 without intervention. us notable for large ascites, labs notable for creatinine 5.9 and lfts wnl. . on acceptance to the medicine service, ms. dyspnea at rest but does have it with exertion. further chest pain, abdomonial pain, fevers or chills. no dysuria, no nausea or vomitting. no blood in stools . . pmhx: * h/o hit * chronic renal insufficiency (baseline cr ~ 3) * h/o diastolic congestive heart failure * cirrhosis (thought heart failure) * s/p mvr, avr, tvr (on chronic coumadin), last valve replacement in * h/o wpw syndrome status post multiple surgeries with resultant valve replacements as above, s/p aicd placement * h/o parathyroid tumor s/p resection * h/o c diff colitis (several weeks ago at ) * h/o gout * h/o pvd with chronic leg ulcers * h/o pud with gi bleeding * chronic anemia * h/o subdural hematoma () in setting of supratherapeutic inr social history: divorced. son died 4 years ago from cardiomyopathy. has one daughter. previously lived alone and was independent in adls; recently in rehab but back at home. previously smoked, one alcoholic drink per week and illicit drug use. previously worked as an aide in nursing homes and hospitals. family history: n/c physical exam: vs: t 97.8 hr 62 bp 104/69 rr 22 sat 100% on ra gen: nad heent: mucous membranes moist neck: supple, no lad cv: rrr, loud s1, s2, 2/6 systolic murmur resp: l>r crackles in the bases abd: distended, nontender, bowel sounds present. extrem: 2+ pitting edema, thighs>calves/feet. b/l venous stasis changes on anterior shins breasts: asymmetrical, with l breast edema skin: no rash neuro: a&o x3, coherent pertinent results: us impression: large amount of ascites, largest pocket in the left lower and mid quadrants of the abdomen. 07:40pm glucose-105 urea n-100* creat-6.2* sodium-141 potassium-4.5 chloride-116* total co2-10* anion gap-20 07:40pm wbc-5.4 rbc-3.55* hgb-10.7* hct-34.2* mcv-96 mch-30.0 mchc-31.2 rdw-19.1* 07:40pm neuts-77.1* bands-0 lymphs-12.8* monos-7.1 eos-2.7 basos-0.3 07:40pm plt count-82* 07:40pm pt-48.3* ptt-47.2* inr(pt)-5.5* 05:50am glucose-79 urea n-98* creat-5.8* sodium-143 potassium-4.2 chloride-116* total co2-12* anion gap-19 05:50am alt(sgpt)-4 ast(sgot)-13 ld(ldh)-295* alk phos-140* tot bili-0.7 05:50am calcium-7.8* phosphate-5.5* magnesium-2.5 05:50am wbc-4.7 rbc-3.46* hgb-10.6* hct-33.7* mcv-97 mch-30.7 mchc-31.6 rdw-19.4* 05:50am neuts-75.7* lymphs-13.6* monos-6.8 eos-3.6 basos-0.3 05:50am plt count-87* 05:50am pt-47.2* ptt-50.2* inr(pt)-5.3* 05:34am urine hours-random urea n-563 creat-114 sodium-15 tot prot-38 prot/crea-0.3* 05:34am urine osmolal-341 02:45am urine blood-tr nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 02:45am urine rbc-0-2 wbc-0-2 bacteria-none yeast-none epi-0-2 02:45am urine amorph-mod 02:45am urine eos-negative 12:40am glucose-112* urea n-100* creat-5.9* sodium-142 potassium-4.0 chloride-115* total co2-14* anion gap-17 12:40am alt(sgpt)-5 ast(sgot)-13 alk phos-162* tot bili-0.7 12:40am lipase-74* 12:40am calcium-8.1* 12:40am ammonia-43 12:40am wbc-5.9 rbc-3.93* hgb-11.9* hct-37.5 mcv-96 mch-30.2 mchc-31.7 rdw-19.6* 12:40am neuts-76.4* lymphs-13.1* monos-5.9 eos-4.1* basos-0.5 12:40am ammonia-43 12:40am wbc-5.9 rbc-3.93* hgb-11.9* hct-37.5 mcv-96 mch-30.2 mchc-31.7 rdw-19.6* 12:40am neuts-76.4* lymphs-13.1* monos-5.9 eos-4.1* basos-0.5 12:40am plt smr-low plt count-86* 12:40am pt-52.6* ptt-46.8* inr(pt)-6.1* 10:40pm glucose-113* urea n-97* creat-5.9*# sodium-142 potassium-4.3 chloride-116* total co2-11* anion gap-19 10:40pm estgfr-using this 10:40pm alt(sgpt)-8 ast(sgot)-15 alk phos-151* tot bili-0.7 10:40pm lipase-66* 10:40pm albumin-3.8 brief hospital course: a 61 yo woman with cri, wpw s/p 3 mechanical valves, cirrhosis thought to be cardiac in etiology, presents with acute on chronic renal failure and ascites. . # renal failure: creatinine rose from 2.8 to 5.9 in the month prior to admission. exam was consistent with anasarca and volume overload of 20-30 liters. the likely contributing factors were felt to be poor forward flow (from cardiac failure and from overdiuresis) with possibly a lesser component of hepatorenal syndrome. urinalysis and smear for eosinophils was negative, the sediment was bland, and there was trivial protein in the urine. albumin was given initially, but renal failure persisted and continued to worsen. diuretics were held. plans were made for dialysis. given that she was so volume overloaded and had systolic bp 90-100, cvvh was the preferred initial dialysis route. after placement of a r tunneled hd catheter, she was transferred to the icu for cvvh on . . on presenation to the icu pt was severely fluid overloaded, with an estimated 30kg weight gain. she was diuresed agressively at a rate of 300-500ml/hr net, with a total diuresis of approximately 16l. pt tolerated the fluid removal very well and remained hemodynamically stable throughout, with sbps >80s. she was transferred back to the hepato-renal service. . the patient was mildly hypotensive after starting dialysis, and midodrine treatment was initiated, which improved sbp to 100-110 consistently and helped with orthostatic symptoms. this medication was continued on discharge. . planning for outpatient dialysis was undertaken, including a negative ppd and hepatitis panel. the physical therapy team saw the patient, and her functional status improved considerably. # cirrhosis/ascites: on admission, the patient appeared to have worsening diuretic-resistent ascites. sbp was unlikely given absence of fever or tenderness. diagnostic paracentesis was not done secondary to elevated inr and whole-body anasarca. nadolol was held given her borderline blood pressures. . # mechanical mv/tv/av: inr was supratherapeutic on admission. given her very high risk for thromboembolism and the absence of evidence of bleeding, her inr was allowed to drift down slowly. when the need for a tunneled hd line became apparent, argatroban was begun so that warfarin effects could be reversed with vitamin k. the argatroban was stopped briefly prior to the procedure and restarted soon after. warfarin was subsequently restarted and uptitrated with an ongoing argatroban bridge until inr was therapeutic at 4-5 (as argatroban falsely elevates inr by 2.) at that point argatroban was stopped, and the inr drifted down into the therapeutic range. she was discharged on 5 mg daily with plans to continue checking her inr at home and have dose adjustments over the phone as she had been doing prior to admission. . # atrial fibrillation: during this admission, the patient developed new atrial fibrillation. she was already undergoing therapeutic anticoagulation (as above). . # history of hit: all heparin products were avoided, and argatroban bridge was used instead as above. a non-heparin dependent tunneled line was placed, and sodium citrate flushes were used. # thrombocytopenia: platelets were near recent baseline and likely related to liver dysfunction. . # h/o gi bleeding: ppi was continued . # gout: in the ccu, pt developed gout of her right fifth digit. she was initially treated with colchicine without response, and later started on a short course of steroids with rapid improvement. medications on admission: coumadin 5 mg daily (x 1 week --> inr to 7), took 2.5 on epogen 40,000 u weekly lasix 120 mg daily nadolol 20 mg potassium 20 meq daily protonix 40 mg renagel 1600 mg tid discharge disposition: home with service facility: hospice and vna discharge diagnosis: primary: end-stage renal disease, atrial fibrillation, gout secondary: cirrhosis, -parkinson-white syndrome discharge condition: stable, dialysis-dependent discharge instructions: you were admitted to the hospital because you had increased fluid on your body. this was because your kidneys were not functioning well. in the hospital, a catheter was placed and dialysis was started to remove the fluid. you were also found to have an irregular heart rhythm called atrial fibrillation. the following medications were changed: lasix was stopped nadolol was stopped potassium was stopped renagel (sevelamer) was stopped nephrocaps (b-vitamin-b12-folate) were started midodrine was started. please call your physician or return to the ed if you have worsening swelling, shortness of breath, chest pain, or other symptoms that are concerning to you. please adhere to a low sodium (<2 gm/day) diet. followup instructions: for your coumadin, please take 5 mg today () and test your inr on thursday, . call the coumadin clinic as usual. they will change your dosing as needed. . please follow up for dialysis on as you discussed with the renal team. . please follow up with dr. on thursday, , at 2:15. if you need to reschedule call . . we also scheduled an appointment with dr. : , md phone: date/time: 4:40 procedure: hemodialysis venous catheterization for renal dialysis diagnoses: acidosis hyperpotassemia thrombocytopenia, unspecified anemia in chronic kidney disease end stage renal disease congestive heart failure, unspecified cirrhosis of liver without mention of alcohol acute kidney failure, unspecified gout, unspecified atrial fibrillation acute on chronic diastolic heart failure heart valve replaced by other means long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ other ascites kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypotension of hemodialysis venous (peripheral) insufficiency, unspecified anomalous atrioventricular excitation 

Answer: The patient is high likely exposed to