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: codeine / dilaudid / ciprofloxacin attending: chief complaint: abdominal pain major surgical or invasive procedure: pericardiocentesis and drain history of present illness: pt is 43 yo m with pmhx sig. esrd s/p failed transplant and subsequent nephrectomy in who p/w abdominal pain. he was recently hospitalized from for worsening dyspnea and abdominal pain. he was admitted to the micu for urgent hd as he missed his previous hd session. he also developed chest pain attributed to new onset systolic chf (?sirs related to graft rejection and recent nephrectomy, ischemia, or high output failure form av fistula) and pericarditis uremia. the abdominal pain was felt to be localized over the nephrectomy site, and serial exams did not show a surgical abdomen. he was noted to have new isolated elevated ast; an abdominal us did not show gallbladder pathology. it did show 4.7 x 2.2 x 2.9 cm thick-walled fluid collection in rlq, decreased in size from . pt was treated with acetaminophen and low dose iv morphine. his course with comblicated by gram-positive bacteremia, likely from hd line. he was treated with vancomycin for 2 week course. . he returns today with worsening abdominal pain, now for past 3 weeks, and poor appetite. . in the ed, initial vital signs were: . he had an abdominal ct scan that showed no infectious processes. the ct scan did show new ascites and pericardial effusion, which was not seen on cardiac mri on . cardiology performed a bedside echo that showed large effusion but no cardiac tamponade physiology. his p stable. pulsus is 6. the plan is to have cardiology take him to the cath lab tomorrow. renal has been notified of his arrival and will likely need to dialysis him post-cath. of note, his ct scan was complicated by infiltration of his iv. about 70 cc of contrast was run into his arm. per protocol, plastic surgery was consulted to eval for compartment syndrome. plastics felt exam was benign and recommended warm compresses. . on review of systems, s/he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. s/he denies recent fevers, chills or rigors. s/he 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, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope past medical history: * esrd secondary to fsgs s/p cadaveric transplant in , failed in now s/p nephrectomy of transplanted kidney in * hepatitis c virus * congenital single kidney * hypertension * depression * status post mva in with a right facial fracture and orbital zygomatic fracture * rem behavior disorder social history: lives with his wife, 2 step-sons, and 2 grandchildren. no pets. no current alcohol, tobacoo, or drug use. previously worked as a janitor. family history: reports brother had end-stage renal disease. physical exam: vs: t 97.9, bp 164/106, p 87, rr 16, 100% on nrb gen: alert, oriented, appropriately responsive heent: perrl bilaterally, eomi, sclerae anicteric, mmm, op clear, neck supple with prominent external jugular veins chest: left tunnelled ij hd catheter in place, site nontender pulm: crackles up 1/2 posterior lung fields with dullness to percussion at bases, decreased breath sounds at bases, no wheezing or rhonchi cv: rrr, 3/6 systolic murmur at lusb abd: normoactive bowel sounds, nontender without guarding or rebound throughout, incision at nephrectomy site well-healed with one area of point tenderness overlying apparent retained suture, no erythema or oozing from site ext: right av fistula with clean incision skin: no rash neuro: alert, oriented, cn ii-xii intact, moving all extremities without difficulty, sensation intact to light touch in all four extremities, toes downgoing bilaterally pertinent results: 03:00pm blood wbc-6.6# rbc-3.31* hgb-9.0* hct-27.8* mcv-84 mch-27.1 mchc-32.3 rdw-18.8* plt ct-499*# 06:50am blood wbc-6.0 rbc-3.37* hgb-9.1* hct-28.5* mcv-85 mch-26.9* mchc-31.7 rdw-17.9* plt ct-367 03:00pm blood neuts-68.4 lymphs-19.8 monos-9.1 eos-1.7 baso-1.0 02:24am blood neuts-76.0* lymphs-15.6* monos-6.4 eos-1.5 baso-0.5 05:25pm blood pt-17.3* inr(pt)-1.6* 03:40pm blood glucose-124* urean-59* creat-11.0*# na-138 k-5.6* cl-96 hco3-28 angap-20 06:50am blood glucose-86 urean-21* creat-6.2* na-137 k-4.9 cl-100 hco3-27 angap-15 06:05am blood alt-118* ast-67* alkphos-76 totbili-0.4 06:40am blood alt-68* ast-31 alkphos-77 06:31pm blood ck-mb-notdone ctropnt-0.10* 01:45am blood ck-mb-notdone ctropnt-0.09* 06:50am blood calcium-9.3 phos-3.1 mg-2.1 02:53am blood caltibc-189* ferritn-305 trf-145* 02:24am blood tsh-1.6 02:24am blood t4-8.2 ========================================= ekg prolonged q-t interval. low voltage in the standard leads. left ventricular hypertrophy. non-specific st-t wave changes in leads i, avl and v2-v6. compared to the previous tracing of no significant change. the non-specific t wave changes are similar. the qtc interval is somewhat shorter. ========================================= ct chest/abdomen/pelvis 1. no retroperitoneal bleed. 2. interval decrease in size of the pericardial effusion, now small. 3. interval increase in bilateral pleural effusions, moderate on the right and small on the left, with associated atectasis at the lung bases. ========================================== study flow study demonstrates no fibrin sheath or significant thrombus of existing left-sided tunneled hemodialysis catheter. ========================================== pa lateral small bilateral pleural effusions have decreased, moderate enlargement of the cardiac silhouette due to cardiomegaly and/or pericardial effusion is diminished, interstitial edema is cleared and bibasilar opacification has improved. overall findings are consistent with resolved pulmonary edema. cystic structure at the right lung apex now contains fluid, probably edema fluid in a bulla, not concerning for infection. dual-channel supraclavicular left-sided central venous catheter projects over the upper right atrium. no complications. =========================================== tte : the left atrium is moderately dilated. the right atrium is markedly dilated. the right atrial pressure is indeterminate. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. regional left ventricular wall motion is normal. the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size is mildly increased with normal free wall motion. there is abnormal diastolic septal motion/position consistent with right ventricular volume overload. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a small circumferential pericardial effusion. there are no echocardiographic signs of tamponade. ============================================= cath : 1. limited resting hemodynamics revealed elevation and near-equalization of diastolic filling pressures with a mean ra of 25mmhg, padp of 28mmhg, and mean pcwp 30mmhg. the pericardial pressure was also measured at 25mmhg. the initial cardiac index was 2.9l/min/m2. 2. after removal of 1200cc of pericardial fluid, the mean ra fell to 8mmhg, the pericardial pressure normalized at 0 to -3mmhg, and the cardiac index increased to 4.2l/min/m2. final diagnosis: 1. successful drainage of 1200cc of pericardial fluid with resolution of tamponade physiology. 2. a drainage catheter was successfully placed into the pericardial space over a wire and sutured in place to the skin. brief hospital course: 43 yo m with pmhx sig. esrd s/p failed transplant and subsequent nephrectomy in who p/w abdominal pain, found to have pericardial effusion without tamponade physiology. pericardiocentesis performed and 1200cc fluid removed; drain placed and later removed. hospital course complicated by thrombus on tip of tunnel cath seen during echo, but subsequently not present on dedicated catheter study. hospital course also c/b episode of hemoptysis in setting of heparin drip (ptt>150) for suspected thrombus. . # hemoptysis: this has occured to pt during previous hospitalization. isolated incident. no findings on ct of the chest. pulmonary was consulted and felt that suspicion for tuberculosis was very low. etiology most likely related to to supratherapeutic ptt>150 from heparin drip. pt was sceduled with outpt follow-up in the pulmonary clinic. . # pericardial effusion: ddx includes uremia vs malignant effusion vs idiopatic. patient's cultures and acid fast/tuberculosis negative. no evidence of malignancy on ct chest/abdomen/pelvis. cytology of pericardial fluid negative for malignant cells. repeat echo x2 showing minimal effusion, much decreased s/p drainage. pericardial drain removed without complications. pt has appt for f/u echo as outpt, and has f/u scheduled with cardiology. . # hd catheter thrombus: noted on echo . subsequent dedicated catheter flow study did not detect thrombus. in the interim, pt was anticoagulated, but no indication to anticoagulate at the time of discharge. . # rhythm - patient had several short runs of nsvt on which were attributed to electrolyte changes post-dialysis. this again occured on post-dialysis. dialysis bath was altered to include more k and nsvt did not recur. . # hct drop (28-->20): ct of abdomen showed no evidence of bleed. guiaic negative. iv iron therapy to be started at dialysis. source of hct drop not found. hemolysis labs negative. pt received total of 3 units of blood and hct responded appropriately. hct was 28.5 at time of discharge. . # ascites/ hepatitis: lfts with mild elevation. this transaminitis may be fleeting and secondary to recent pericardial effusion presentation vs. worsening hep c. given increased inr and low albumin, may represent worsening cirrhosis--pt will f/u in hepatology clinic where he is followed for his hep c. . # esrd s/p failed transplant and subsequent nephrectomy in : - hd: pt will resume usual tues/thurs/sat routine - renal team following the maturation of the pt's fistula with plan to remove the tunneled cath when ready; during this hospitalization fistula was accessed, but reanl team would prefer to use fistula several more times before being comfortable with remoal of line. . # htn: continue lisinopril and carvedilol (previously on metoprolol). medications on admission: atorvastatin 10 mg po daily citalopram 20 mg po daily clonazepam 1 mg po qhs as needed for insomnia. imipramine hcl 25 mg po hs lisinopril 40 mg po daily metoprolol tartrate 25 mg 1.5 tablets po bid nephrocaps pantoprazole 40 mg po q24h oxycodone 5 mg po q6h (every 6 hours) as needed for pain. sevelamer hcl 800 mg (3) tablet po tid w/meals calcium carbonate 1000 mg po tid w/meals ferrous sulfate 325 mg po daily nitroglycerin 0.3 mg sublingual prn ibuprofen 400 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. vancomycin hd protocol discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) capsule po once a day. 3. vicodin 5-500 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain: do not drive while taking this medicine. 4. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 5. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual every 5 minutes for three doses as needed for chest pain. 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. sevelamer hcl 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). 8. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po tid (3 times a day). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. nut.tx.impaired renal fxn,soy liquid sig: one (1) can po three times a day. 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 12. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed. 13. heparin (porcine) 5,000 unit/ml solution sig: 4000- units injection prn (as needed) as needed for line flush: dwell in line, use as needed for dialysis. 14. carvedilol 25 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: pericardial effusion bacteremia non sustained ventricular tachycardia chronic diastolic congestive heart failure end stage renal disease hypertension iron deficiency anemia/anemia of chronic disease transaminitis discharge condition: medically stable for d/c hct: 27.3 creat: 7.2 discharge instructions: you had pericardial effusion and a temporary tube was placed to drain the fluid. you will need to get an echocardiogram in 2 weeks to see if the fluid has returned. . you also had fluid collections in your abdomen and lungs. we gave you extra dialysis treatments to remove this fluid. . you developed a severe anemia that required blood and iron transfusions. it is likely that frequent blood draws contributed to this. . you also had some irregular heart beats that are probably bacause of electrolyte shifts after dialysis. we have given you extra phosphate and potassium to treat this. . new medicines: 1. carvedilol: this replaces your metoprolol 2. you will get iron trasfusions with your hemodialysis please stop taking the following medicines: 1. clonazepam 2. citolopram 3. imipramine followup instructions: psychiatry: provider: , m.d. phone: date/time:please call to reschedule missed appointment gastroenterology: provider: , md phone: date/time: at 10:00 am. hematology/oncology: provider: . phone: date/time: 10:45 nephrology: provider: , md . primary care: , md phone: date/time: cardiology: , md phone: date/time: at 4pm. . echocardiogram: at 11 am. sc clinical ctr, . pulmonology: provider: . & dr. phone: date/time: 2:30 . nephrology transplant: ,, md (transplant)date/time: 02:20p , . md, procedure: hemodialysis pericardiocentesis right heart cardiac catheterization diagnoses: end stage renal disease anemia, unspecified congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma paroxysmal ventricular tachycardia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease unspecified disease of pericardium bacteremia iron deficiency anemia, unspecified other ascites chronic diastolic heart failure 

Answer: The patient is high likely exposed to