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: lasix / diuril attending: chief complaint: epistaxis major surgical or invasive procedure: nasal packing history of present illness: 69yo with hx of mvr (mechanical), anemia of chronic disease (transfusion-dependent), copd/emphysema and ipf with trans trach on home o2 presented 5 days ago with epistaxis that had been intermitent over last 3 weeks prior to admission which has been chronic issue while on coumadin with negative work up. in ed was packed by ent with bilateral packings which required continuous o2 monitoring and stay in the micu, she was monitored and ir guided emolization was considered, but pt declined the required general anesthesia for an elective procedure with risk of stroke as well from emolization. now bleeding has slowed down with minimal packing and she feels better, but still with right sided facial pain/pressure from the packing and possible nerve injury. also stay complicated by conjunctivitios stable on e-mycin eye drops. no other shortness of breath or pain or other symptoms except constipation with pain meds. she is anxious to be about transfer to floor and increased ambulation so she can go home. past medical history: 1. chronic obstructive pulmonary disease. the patient uses 4 liters of oxygen at home. pulmonary function tests on showing fev1 of 1.39l (80%), fev1/fvc 75%, dlco of 17.34 (25% decrease since ) 2.idiopathic pulmonary fibrosis. 3. frequent nose bleeds--no etiology other than coumadin despite extensive work ups 4. placement of transtracheal oxygen cath due to o2 contrib. to epistaxis. has needed recanulation x1 5. anemia due to mvr, cri-- baseline 30 6. mvr (metal) replaced in due to acute mr 7. hypertension. 9. hypercholesterolemia. 9. hypothyroidism. 10. mrsa/vre colonization (negative swabs for both in ) 11. sinus node dysfunction s/p ddd in 12. congestive heart failure with echocardiogram with an ef of 40%, mild global hypokinesis, mitral valve regurgitation with trivial mitral regurgitation, 3+ tricuspid regurgitation, mild pulmonary artery systolic hypertension. 13. meniere's disease, tinnitus, diminished hearing bilaterally. 14. breast cancer treated with radical mastectomy of right breast. no chemotherapy. no radiation therapy. 15. spinal arthritis. 16. myopia, corrected with glasses. 17. cataracts. social history: the patient lives in with her husband. the patient works in human resources for the state of promoting diversity. the patient has a 36 pack year history of smoking, having smoked 1 ppd from the ages of 14 to 50. quit with the help of acupuncture. the patient uses alcohol occasionally. no ivdu. family history: there is no known history of bleeding or clotting disorders. there is a family history of muscle cramps. her father had polymyositis and her mother had cancer. physical exam: vs: hr 53 bp 131/52 sat 100% on 4l transtracheal o2 gen aao, nad heent perrl, mmm, ecchymosis right peri-nasal area, bilateral packing in place without blood, transtracheal cath in place for o2 chest ctab with occasional bibasilar crackles r>l, and occasional end exp wheezes bilaterally, +right sided scar cv rrr, mechanical s1, nl s2 abd soft nt, slightly distended, +bs ext no edema, 2+dp pulses bilaterally neuro cn ii-xii intact sensation, but with mildly decreased right motor muscle strength pertinent results: 04:15pm glucose-108* urea n-26* creat-1.4* sodium-149* potassium-4.3 chloride-112* total co2-33* anion gap-8 04:15pm iron-55 04:15pm caltibc-312 vit b12-1587* folate-greater th ferritin-633* trf-240 04:15pm wbc-4.2 rbc-2.89* hgb-9.1* hct-28.3* mcv-98 mch-31.6 mchc-32.3 rdw-15.1 04:15pm neuts-74.8* lymphs-15.2* monos-4.9 eos-4.9* basos-0.1 04:15pm plt count-114* 04:15pm pt-20.2* ptt-50.0* inr(pt)-2.6 11:45pm hct-27.1* 11:45pm pt-18.4* inr(pt)-2.1 brief hospital course: 69f with copd, ipf, htn, on coumadin for mvr here with epistaxis s/p packing and control of bleeding. 1)epistaxis: initially required nasal packing by ent which required continuous o2 monitoring, but remained stable and although embolization was considered, it was not done because patient did not want elective intubation which would have been required for the procedre and with the risk of stroke with embolization this procedure was deferred. the packing was eventually removed and an absorbable intranasal packing was placed and nares kept moist with ocean spray and vaseline. she did have occasional episodes of minimal epistaxis which was managed with courses of afrin and supportive measures and her hematocrit remained stable after 3 total units of blood transfusions. she was continued on ancef while packing remained in place. she did have some pressure headaches from the packing which was stable on percocet and dilaudid as needed. 2)s/p mvr: for severe mitral regurgitation 6 yrs ago-- stable for now-- initially coumadin held and reversed with vitamin k and 2units of ffp and eventually she was restarted on coumadin with goal inr around 2.5-3.0 as her risk of bleeding is significant. during her stay she was bridged with heparin until inr was therapeutic. 3)anemia: acute on chronic with blood loss anemia on top of anemia of chronic disease with baseline hematocrit around 30. she was transfused total of 3units of prbc and her hematcrit remained stable above 30 during the rest of her stay, she was also restarted on her home epogen regemin. 4)copd/ipf: stable at baseline home o2 via trans-tracheal catheter. drainage from trans-tracheal catheter was managed by interventional pulmonary team with periodic strippings and bronchoscopies as above. otherwise she was continued on her home doses of albuterol, combivent and inhaled steroids. 5)chf: 40% ef, but stable and euvolemic-- continued on home bumex and 6)hypothyroid: stable on home thyroid meds medications on admission: coumadin 7 x6 days and 12mg x1 day bumex 1mg qd levoxyl 112mcg qd lipitor 20mg qd cozaar 50mg qd quinine 260bid tums flovent combivent mucinex dm 600bid discharge medications: 1. bumetanide 1 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine sodium 112 mcg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin calcium 20 mg tablet sig: one (1) tablet po daily (daily). 4. losartan potassium 50 mg tablet sig: one (1) tablet po daily (daily). 5. quinine sulfate 325 mg capsule sig: one (1) capsule po hs (at bedtime). 6. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bidwm (2 times a day (with meals)). 7. fluticasone propionate 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 8. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 11. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. guaifenesin 100 mg/5 ml syrup sig: ten (10) ml po q4h (every 4 hours). 13. sodium chloride 0.65 % aerosol, spray sig: two (2) spray nasal qid (4 times a day). disp:*1 bottle* refills:*2* 14. warfarin sodium 1 mg tablet sig: seven (7) tablet po at bedtime. 15. epoetin alfa 4,000 unit/ml solution sig: one (1) injection injection qmowefr (monday -wednesday-friday). 16. outpatient physical therapy please continue to follow up with your pulmonary and respiratory therapists for care of your trans-tracheal catheter and stripping as you need to for diagnosis of copd and interstitial lung disease 17. erythromycin 5 mg/g ointment sig: 0.5 inch ophthalmic four times a day for 4 days. disp:*qs tube* refills:*0* 18. oxymetazoline hcl 0.05 % aerosol, spray sig: one (1) spray nasal (2 times a day) for 3 days. disp:*1 bottle* refills:*2* discharge disposition: home discharge diagnosis: epistaxis blood loss anemia anemia of chronic disease chronic anticoagulation for mitral mechanical valve chornic pulmonary obstructive disease interstitial pulmonary fibrosis discharge condition: good, ambulating without difficulty and breathing comfortably on 2l of oxygen via tran-tracheal catheter discharge instructions: please call your pcp or return if you have any increase in bleeding from your nose, shortness of breath or pain. please continue all your medications as prescribed. followup instructions: please see your pcp days. please have your inr checked in the next 2 days and get your trans-tracheal catheter followed by ip as you have been prior to admission. please follow up with your ent dr within the next month. provider: call where: none cardiac services phone: date/time: 9:00 provider: , pt, ccs where: rehab services (dyspnea) phone: date/time: 10:15 provider: call where: none cardiac services phone: date/time: 9:00 procedure: control of epistaxis by anterior nasal packing diagnoses: mitral valve disorders congestive heart failure, unspecified acute posthemorrhagic anemia unspecified acquired hypothyroidism personal history of malignant neoplasm of breast acute respiratory failure postinflammatory pulmonary fibrosis other emphysema long-term (current) use of anticoagulants epistaxis tracheostomy status 

Answer: The patient is high likely exposed to