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: dyspnea major surgical or invasive procedure: ivc filter placement history of present illness: 83f with history of epilepsy, peripheral edema, osteoporosis and recent admission for atrial fibrillation referred to ed from rehab for complaint of intermittant dyspnea, nausea x 7 days and worsening fatigue. additionally, she was ntoed to have new hypoxia of 92-93% on room air. she was sent from rehab to rule-out pe. patient has some dementia at baseline, unable to describe any further symptoms. in the ed, initial vitals were 98 64 121/76 20 99% 2l nc. ekg with no st or t-wave changes. initial labs bnp of 9605, wbc of 13.6, ck 13, troponin 0.03, creatinine 103 (baseline 1.0), na 123, potassium 5.5. chest x-ray showed widened mediatstinum and volume overload. cta chest showed large filling defects in right and left pulmonary arteries to subsegmental branches, evidence of right heart strain. no pericardial effusion. guaiac negative, gave asa 325 mg, ns 500 cc bolus, started on heparin gtt. of note, patient had gi bleed during recent admission. egd showed ulcerative esophagitis, and reflux of gastric secrtions (biopsy), large hiatal hernia with stomach body above diaphragm, suggestive of type iii hiatal hernia. past medical history: - epilepsy (on dilantin for many years, recently switched to keppra) - osteoporosis - peripheral edema social history: the patient holds a high school education. she was a live-in nanny/housekeeper for the family in for greater than 40 years. she retired four years ago. she transitioned into facility approximately four years ago. she dresses herself and cooks her own breakfast. she eats lunch and dinner in the dining . the patient mainly gets around by walking. she does not smoke or drink alcohol. no illicit drugs. family history: no family history of seizures. mother deceased at age 57, potentially due to colitis. father deceased at age 68. brother deceased at age 65 with prostate cancer. physical exam: on admission: . vs: temp: 98.1 bp: 126/66 hr: 82 rr: 18 o2sat 96%2l gen: pleasant, comfortable, nad, pale. oriented x 2 (did not know what month it was) heent: surgical right pupil, eomi, anicteric, pale conjunctivae, mmm, op without lesions, jvp elevated 5-7cm, no thyromegaly or thyroid nodules resp: cta b/l with good air movement throughout cv: regular rate and rhythm, s1 and s2 wnl, 2/6 systolic murmur llsb abd: non-tender, non-distended, +b/s, soft, no masses or hepatosplenomegaly ext: 1+ pitting edema in left le, trace in right le - no palpable cord. some dorsal toe skin discoloration consistent with chronic venous changes.tp and dp pulses b/l 1+ skin: no rashes/no jaundice/no splinters neuro: alert, oriented x 2. cn ii-xii grossly intact. spontaneously moving all 4 extremities. . on discharge: . vs: 95.3/99 bp: 137/77 (100s-140s/60s-80s) 79 (60s-80s) rr:20 o2:95% ra gen: pleasant, comfortable, nad, pale. heent: surgical right pupil, eomi, anicteric, pale conjunctivae, mmm resp: cta b/l with good air movement throughout cv: rrr, s1,s2, 2/6 systolic murmur llsb abd: non-tender, non-distended, +b/s, soft, ext: 1+ edema b/l. tp and dp pulses skin: no rashes/no jaundice/no splinters neuro: alert, oriented x 2. cn ii-xii grossly intact. strength throughout, and sensation intact pertinent results: admission labs: . 04:00pm blood wbc-13.6*# rbc-3.95* hgb-12.3 hct-36.0 mcv-91 mch-31.2 mchc-34.3 rdw-14.0 plt ct-222 04:00pm blood neuts-75* bands-2 lymphs-6* monos-4 eos-2 baso-0 atyps-0 metas-9* myelos-2* 06:59pm blood pt-13.4 ptt-24.5 inr(pt)-1.1 04:00pm blood glucose-106* urean-22* creat-1.3* na-123* k-5.5* cl-91* hco3-24 angap-14 04:00pm blood ck-mb-2 probnp-9605* 01:52am blood calcium-8.5 phos-3.1 mg-2.0 04:00pm blood osmolal-262* 01:52am blood cortsol-23.5* . cardiac enzymes: 04:00pm blood ctropnt-0.03* 01:52am blood ck-mb-2 ctropnt-0.02* 07:59pm blood ck-mb-1 ctropnt-<0.01 . phenytoin levels: 07:40am blood phenyto-8.3* 07:30am blood phenyto-8.1* 07:20am blood phenyto-10.0 07:05am blood phenyto-9.8* . discharge labs: 07:05am blood wbc-10.8 rbc-3.84* hgb-12.2 hct-34.8* mcv-91 mch-31.7 mchc-35.0 rdw-14.0 plt ct-348 07:05am blood glucose-83 urean-10 creat-0.8 na-135 k-4.5 cl-98 hco3-27 angap-15 07:05am blood calcium-8.6 phos-3.1 mg-1.9 . ct chest - 1. massive pe with ct signs of right heart strain. 2. scattered bilateral opacities are consistent with multifocal pneumonia. 3. no aortic dissection. 4. large hiatal hernia. . echo the left atrium is dilated. the right atrium is moderately dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal left ventricular systolic function. dilated, hypokinetic right ventricle with pressure-volume overload, moderate to severe tricuspid regurgitation and severe pulmonary artery hypertension. . ultrasound doppler left lower extremity : there is echogenic thrombus identified within the left distal superficial femoral and left popliteal veins consistent with an above-knee dvt. no flow or compression or augmentation demonstrated within these vessels. the proximal superficial femoral and common femoral vein on the left side are patent. ultrasound doppler right lower extremity: normal flow, compression and augmentation demonstrated within the deep venous system of the above-knee deep veins of the right lower extremity. impression: above-knee dvt of the left lower extremity. . ivc placement : 1. ivc gram demonstrating a single patent ivc. 2. final scout image demonstrating good position with ivc filter inferior to the renal veins. impression: uncomplicated placement of the eclipse ivc filter below the level of the renal veins. no immediate complications noted. brief hospital course: 83 female with past history of epilepsy, osteoporosis and recent afib with rvr and esophagitis presented with dyspnea found to have bilateral pe's. . # submassive pulmonary embolism/dvt - initially with bilateral pe's, hemodynamically stable, on 2l oxygen by nasal canula. due to high clot burden and recent gi bleed, mrs. was admitted to the micu for close monitoring while initiating systemic anticoagulation with heparin. she was bolused with heparin then placed on weight based scale. ptts were therapeutic. she was found to have left distal superficial femoral and left popliteal veins consistent with an above-knee dvt. she underwent ivc filter placement by ir. echo showed dilated, hypokinetic right ventricle with pressure-volume overload, moderate to severe tricuspid regurgitation and severe pulmonary artery hypertension. she was guiac negative. she was transfered to the floor and systemic anticoagulation was initiated with lovenox. her inciting event is unclear, but has been more immobile of late since last admission. no known malignancy. her breathing remained stable and saturated well on room air on discharge. however she did have an oxygen requirement with ambulation, so will be set up with oxygen at rehab. she is being discharged on lovenox, but may consider changing lovenox to coumadin after she completes her amiodarone load and is on a stable dose of 200mg daily with an inr goal of . recommend 2 readings between prior to discontinuing lovenox. in terms of her ivc filter, ir did not recommend routine follow up, unless the decision is made to remove it in the future. . # hyponatremia - was 123 on admission with unclear etiology. initially thought to be hypovolemia and improved with fluids to 128. she was also hyperkalemic which was suspicious for adrenal insufficiency, but she was noted to have a random cortisol of 23 ruling this out. sodium subsequently dropped again to 126 and we thought that there may be a component of siadh in the setting of her pe vs. pain. she was fluid restricted to 2l/day, and sodium improved to 135 at discharge. would periodically follow sodium as an outpatient to ensure stabilization. . # acute renal failure - pre-renal in nature, responded to 500 cc ns iv. monitored with daily labs and was 0.9 on discharge. a foley catheter was placed in the micu and removed the day prior to discharge. she was noted to have some decreased urine output after removal of the foley, but this improved with a po fluid challenge. . # afib with rvr - normal sinus rhythm during admission, continued amiodarone load with plan to decrease dose from 400mg daily to 200mg daily on . metoprolol succinate was held on admission but was restarted at home dose of 100mg po daily on day of discharge once it became clear that there was no signs of gi bleed while on anticoagulation. . # gerd/nausea - pt described having some nasuea and gerd like symptoms after eating. we continued her ppi, and added sucralfate, gi cocktail of maalox/diphenhydramine/lidocaine, zofran, and h2 blocker. in the differential is peptic/duodenal ulcer but there was no tenderness on physical and her hct was stable. her pain at times is relieved with food. could also be consistent with gastritis. her symptoms improved on discharge. she discharged on ranitidine 150mg qam (decreased from in-house to decrease cognitive side effects), omeprazole, zofran, and maalox. carafate was discontinued in an effort to reduce polypharmacy. . # elevated bnp - up to 9605 on admission. likely in setting of heart strain with bilateral pe's. she did have some le edema which she said was her baseline. she was not short of breath, so we did not diurese. she did have an o2 requirement with ambulation and will be discharged to rehab on o2 as above. . # history of gi bleed - hematocrit was 36 on admission. subsequently dropped to 31.9 but remained stable throughout admission and was 34.8 on discharge. we continued po ppi for gi prophylaxis while systematically anticoagulating. no signs of gi bleed in-house. . # depression - continued home citalopram 20mg daily. this was a new medication for her on her last admission and should be followed to ensure toleration. . # epilepsy- had no seizure acitivity during this admission. phenytoin was continued at her home dose of 300mg daily during admission, and trough levels ranged from during admission. despite borderline low levels she corrected to an appropriate range when albumin levels were factored in. . # code: pt is confirmed full code . # follow up/transitional: -lovenox 70mg sc bid should be continued with consideration of changing to coumadin once on stable dose of amiodarone. recommend 2 inr readings between prior to discontinuing lovenox. -sodium should be periodically monitored to ensure stable resolution -consider gentle diuresis given elevated bnp if pt's o2 requirement increases or develops sob. -phenytoin levels should continue to be monitored -pt with outpt gi follow up -routine follow up not needed for ivc filter per discussions with ir, unless decision is made in the future to remove it. -pt should be followed for her celexa given that this is a new medication from prior admission. medications on admission: - amiodarone 400mg x 2 days, 400 mg daily , 200 mg daily onward - augmentin 1 tab (started ) - calcium carbonate 650 mg - vitamin d 1000 unit qday - citalopram 20 mg daily - metoprolol succinate 100 mg daily - multivitamin 1 tab daily - omeprazole 40 mg - phenytoin 300 mg po daily - tylenol 650 mg po q4h prn fever/pain - magnesium hydroxide 30 ml daily - senna 2 tabs daily discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily): take 400mg daily from then reduce to 200 mg daily as per prior regimen. 3. vitamin d 1,000 unit capsule sig: one (1) capsule po once a day. 4. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 5. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 6. phenytoin sodium extended 100 mg capsule sig: three (3) capsule po daily (daily). 7. calcium carbonate 650 mg (1,625 mg) tablet sig: one (1) tablet po twice a day. 8. enoxaparin 80 mg/0.8 ml syringe sig: seventy (70) mg subcutaneous q12h (every 12 hours). mg 9. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 10. maalox advanced 200-200-20 mg/5 ml suspension sig: five (5) ml po tid (3 times a day) as needed for nausea/gerd . 11. ranitidine hcl 150 mg tablet sig: one (1) tablet po qam. 12. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 13. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. discharge disposition: extended care facility: armenian nursing & rehabilitation center - discharge diagnosis: primary: pulmonary embolism lower leg dvt secondary: epilepsy discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure to care for you. . you were brought to the hospital because of nausea and were found to have lung clots and a leg clot. you underwent a ivc filter for this and started on anticoagulation with lovenox. you had persistent nausea and it improved with anti nausea medications. you will also be discharged with supplemental oxygen as your oxygen levels were a bit low with walking. . we made the following changes to your home medication list: started: ranitidine 150mg by each morning started: maalox 5-10ml by mouth 3 times daily as needed for nausea/heartburn started: enoxaparin (lovenox) 70 mg subcutaneously every 12 hours started: zofran 4mg oral dissolving tabs every 8h as needed for nausea stopped: augmentin stopped: multivitamin ***your doctors at rehab consider changing lovenox to coumadin after you are on a stable dose of amiodarone. recommend 2 inr readings between prior to discontinuing lovenox. please follow up with the outpatient appointments below: followup instructions: you do not need routine follow-up for your ivc filter. the decision as to whether or not to remove this can be made between you and your outpatient physician. department: div. of gastroenterology when: tuesday at 2:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage procedure: interruption of the vena cava diagnoses: urinary tract infection, site not specified acute kidney failure, unspecified hyposmolality and/or hyponatremia atrial fibrillation depressive disorder, not elsewhere classified diaphragmatic hernia without mention of obstruction or gangrene osteoporosis, unspecified epilepsy, unspecified, without mention of intractable epilepsy acute venous embolism and thrombosis of deep vessels of proximal lower extremity other pulmonary embolism and infarction reflux esophagitis 

Answer: The patient is high likely exposed to