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: history of present illness: the patient is a 61 year old female with a history of asthma and abdominal mesothelioma that was diagnosed three months prior to admission. she is now status post resection and debulking of tumor with local recurrence. she has been treated with doxil. patient's most recent dose of doxil was seven days prior to admission. since last dose patient notes increased lower extremity swelling bilaterally and three days of progressive fatigue as well as decreased appetite and poor p.o. intake. she was seen in clinic at cancer institute on , the day of admission, where she was found to be anemic and was transfused two units of packed red blood cells. patient initially felt fine after transfusion, but 15 to 30 minutes later when she was on her way home, she became acutely short of breath and collapsed in the parking lot, complained of associated chest tightness and was brought to by ambulance. in the e.d. patient had a room air oxygen saturation of 87% which improved to 96% on 6 liters face mask. e.d. staff was concerned about transfusion related lung injury and anaphylaxis, thus she was initially treated with benadryl, solu-medrol and epinephrine. also given patient's history of asthma, e.d. staff elected to treat with albuterol and atrovent nebs. patient had limited improvement in symptoms with the above treatment. chest x-ray was notable for a large left pleural effusion, moderate right pleural effusion, patchy opacity in the right upper lobe with questionable evidence of pulmonary edema. given lack of improvement in symptoms, e.d. staff obtained a pe protocol chest ct which revealed a small pe in one of the left upper lobe segmental branches of the pulmonary artery as well as a svc clot. patient had a head ct that was unremarkable. thus she was started on heparin. patient was eventually given 40 of iv lasix times one with 1200 cc of urine output to that and much improved symptoms. of note, in the e.d. patient's ecg was notable for poor r wave progression, lvh by voltage criteria and elevations in v2 and v3. the first set of cks that was sent from the emergency department showed ck of 105, mb fraction 7, troponin 0.3. on review of systems patient denied fever, chills, cough. she had no history of doe, pnd or orthopnea. she had no previous history of chest pain or chest tightness. patient did complain of odynophagia and a feeling of food and medications lodging in her throat over the past few weeks. past medical history: remarkable for mesothelioma as above. patient is followed by dr. at cancer institute as well as by the onc fellow, noopur raje. patient has a history of asthma with no history of intubation. history of hypertension. allergies: penicillin and sulfa. medications on admission: ms contin 15 mg p.o. b.i.d., msir 7.5 mg p.o. q. three to four hours p.r.n. pain, calan sr 240 mg p.o. q.day, hydrochlorothiazide 25 mg p.o. q.day, singulair 10 mg p.o. q.day, prilosec 20 mg p.o. q.day, senna two tabs p.o. b.i.d., colace 100 mg p.o. b.i.d., klonopin 0.5 mg p.o. q.h.s. p.r.n., celexa 40 mg p.o. q.day, ritalin 2.5 mg p.o. b.i.d., reglan 10 mg q.i.d. a.c. h.s. with food. physical examination: on admission patient's temperature was 98.7, pulse 128, blood pressure 167/66. patient was breathing 25 times a minute, sating 98% on 6 liters face mask. generally she was very uncomfortable, using accessory muscles, however, alert and oriented times three. heent: patient's pupils were equal, round and reactive to light. extraocular movements were intact. she had dry mucous membranes. no notable oropharyngeal lesions. neck was supple. jugular venous pressure was appreciated at 7 cm. chest: patient had decreased breath sounds on the left to half of her lung field, decreased breath sounds on the right at base, scattered expiratory wheezing. she was dull to percussion on the left to half of her lung field. cardiovascular exam was notable for tachycardia, normal s1, s2, no murmurs. abdomen was distended and firm with mild diffuse tenderness, no rebound, no guarding. bowel sounds were present, but quiet. extremities: patient had 2+ pitting edema bilaterally in her lower extremities. neurologic exam was limited due to patient's respiratory distress, but grossly intact. laboratory data: on admission white count was 15.1 with differential notable for 65 neutrophils, no bands, 25 lymphocytes, hematocrit 32.6, platelets 957,000. sodium was 139, k 3.9, chloride 95, bicarb 28, bun 27, creatinine 0.7, glucose 127. she had an abg done which was on 6 liters face mask which was notable for ph of 7.39, pco2 46, po2 121. ecg as noted above was sinus at 120 with normal qrs axis and normal p axis. she had normal pr intervals, normal qt intervals and qrs duration of 100 msec. she had elevations in v2 and v3 and poor r wave progression in the lateral leads. chest x-ray was described in the hpi as was the cta. hospital course: the patient is a 61 year old female with a history of abdominal mesothelioma presenting with acute shortness of breath after receiving two units of packed red blood cells in clinic. patient was found to be hypoxic in the setting of newly diagnosed pe, large pleural effusion and ecg with st changes that were concerning for ischemia. 1. pulmonary. patient's initial presenting complaint was shortness of breath. she was, indeed, acutely dyspneic and required large volumes of oxygen to maintain saturation above 90% on admission. patient's shortness of breath was likely multifactorial due to pulmonary embolus, large pleural effusion and pulmonary edema which was most likely due to diastolic dysfunction in the setting of acute mi. patient responded well to diuresis. after she was stable from a cardiovascular standpoint, she underwent therapeutic thoracentesis of the right sided effusion. patient had an ultrasound guided tap which revealed an exudative effusion with 825 white blood cells, 49,000 red blood cells. differential on the white blood cells was notable for no polys, 71 lymphocytes, 11 monos, 7 mesothelial cells that were still being reviewed by pathology at the time of discharge. gram stain and culture of her pleural fluid were negative. given the appearance of atypical mesothelial cells in the patient's pleural fluid analysis, it is concerning that this may be extension of her malignancy into the peritoneal cavity. patient continued to improve after thoracentesis with continued diuresis. at the time of schedule she was sating 95% or higher on 4 liters nasal cannula. chest x-ray on the day of discharge was notable for some reaccumulation of the right sided fluid. would suggest following this over time as patient may need to undergo further drainage of this fluid for symptomatic relief and possible pleurodesis in the future. 2. cardiovascular. coronary artery disease. patient was anticoagulated on heparin at the time of admission. she did, indeed, rule in for mi. although her cks remained flat, her troponin reached a high of 18 before trending downward. her ekg showed anteroseptal changes which evolved from st elevation to t wave inversion in leads v2 and v3. patient was started on aspirin which she remains on at the time of discharge. patient was not started on a iib/iiia inhibitor due to concern of continued bleeding from her tumor into the peritoneum. no interventional cardiac measures were undertaken given patient's likely poor prognosis from her tumor. pump. patient initially showed signs of acute chf in the setting of acute mi. patient was hypertensive and tachycardiac on admission. patient was started on a nitro drip for pain and blood pressure control as well as being started on an esmolol drip to better rate control. on the esmolol drip patient had several episodes of bradycardia that were symptomatic into the 30s. bradycardia was most likely secondary to too much nodal blocking as patient was later started on amiodarone for an episode of nonsustained v-tach. once esmolol was discontinued, patient had no further episodes of bradycardia. patient was aggressively diuresed with good results and improvement in symptomatology. echocardiogram post infarct was notable for an ejection fraction of 40% as well as anteroseptal and anterior free wall hypokinesis. patient was eventually weaned off the nitro drip and started on isordil, captopril and lopressor to control her blood pressure. rhythm. patient had one episode of peri-mi nonsustained v-tach lasting 25 seconds which resolved with a precordial thump. patient was not hemodynamically unstable during this time, however, she was subjectively very short of breath. patient was seen by cardiology and started on amiodarone for nonsustained v-tach. patient was appropriately loaded with amiodarone and then transitioned to p.o. amiodarone. as noted above, patient had several episodes of bradycardia that were symptomatic while she was on both esmolol drip and amiodarone. these appeared to be due to increased nodal blocking and patient had no further episodes once the esmolol drip was discontinued. pulmonary embolism. unclear whether this was acute or a long standing embolism that was noted on admission ct. however, given the patient's svc clot, she was started on lovenox 80 mg p.o. b.i.d. lenis were performed which showed no evidence of lower extremity dvt. 3. gastrointestinal. odynophagia. on admission patient had complained of extreme pain with swallowing as well as the feeling of things lodging in her throat. she initially had trouble swallowing p.o. things while in-house. given her pressing pulmonary and cardiac issues, she was not evaluated by gi. however, she may benefit from a barium swallow or endoscopic evaluation in the future. at discharge she was taking p.o. with some resolution of symptoms. 4. oncology. we were in touch with patient's primary oncologist throughout the course of her stay. given that she had a dose of doxil seven days prior to admission, we watched her white count carefully. on the day of discharge her white count was 8. patient was not neutropenic at any point during her stay. patient is likely being transferred to today to pursue further treatment options for her primary mesothelioma. 5. heme. patient had a history of iron deficiency anemia which, according to her oncology team, is thought to be due to bleeding into the peritoneal tumor. patient required two units of packed red blood cells during the course of her admission. on the day of discharge hematocrit was 28.2. patient was also noted to have platelets that were as high as 1,000,000. per her primary oncologist this is not a problem. does have a history of reactive thrombocytosis due to her iron deficiency anemia. 6. glucose control. patient had elevated sugars during the course of her admission and it is not clear why she had elevated sugars. this is likely due to the stress dose solu-medrol she received in the e.d. she was maintained on sliding scale insulin while in-house. it is likely that this could be discontinued. 7. hypernatremia. patient became hypernatremic during the course of her stay with sodium as high as 150. patient was given free water and her sodium had corrected to 144 on the day of discharge. since patient was taking p.o., we decided to let her continue to replete her own free water rather than giving her more intravenous d5. 8. code status. patient's wishes were discussed with her and her family. she strongly wishes to remain full code at this time. daily discussions with her onc team and with patient about prognosis have not succeeded in changing patient's mind regarding her wishes for continued aggressive care at this point. the patient was discharged to cancer institute for further care and for possible new chemotherapeutic agents on . discharge diagnoses: 1. acute mi. 2. coronary artery disease. 3. hypertension. 4. asthma. 5. pulmonary embolus. 6. abdominal mesothelioma. discharge medications: 1. captopril 75 mg p.o. t.i.d. 2. metoprolol 25 mg p.o. t.i.d. 3. lovenox 80 mg p.o. subcu q.12 hours. 4. amiodarone 400 mg p.o. t.i.d. 5. ms contin 15 mg p.o. b.i.d. 6. msir 7.5 mg p.o. q.four to six hours p.r.n. 7. protonix 40 mg p.o. q.24 hours. 8. hydrochlorothiazide 25 mg p.o. q.day. 9. aspirin 325 mg p.o. q.day. 10. montelukast sodium 10 mg p.o. q.day. 11. albuterol nebs q.three to four hours p.r.n. 12. regular insulin sliding scale. 13. senna one tab p.o. b.i.d. 14. colace liquid 100 mg p.o. b.i.d. 15. isosorbide dinitrate 10 mg p.o. t.i.d. 16. maalox p.r.n. 17. reglan 10 mg p.o. with meals. 18. klonopin 0.5 mg p.o. q.h.s. 19. celexa 40 mg p.o. q.h.s. 20. oxygen nasal cannula. , m.d. dictated by: medquist36 procedure: thoracentesis diagnoses: unspecified pleural effusion iron deficiency anemia secondary to blood loss (chronic) acute myocardial infarction of other anterior wall, initial episode of care paroxysmal ventricular tachycardia hyperosmolality and/or hypernatremia diastolic heart failure, unspecified other pulmonary embolism and infarction other venous embolism and thrombosis of inferior vena cava malignant neoplasm of peritoneum, unspecified 

Answer: The patient is high likely exposed to