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 / compazine attending: chief complaint: chest pain major surgical or invasive procedure: picc placement history of present illness: 67f with h/o of cva (l hemiparesis), nidm, cri, htn, hld, cad s/p cabg with lima-lad, svg-om1, svg-om2 with dr. on and was discharged to rehab on . she was improving at rehab but developed left substernal chest pain around 9 pm last night of sudden onset and was sent to ed. . last night at 9pm, the patient was watching tv when she noticed sudden onset of left shoulder pain that eventually radiated to her sternum and became substernal chest pain. the pain was at first stabbing in sensation but later became a dull pressure that reminded her of her previous mi. her pain worsened with a cough as well as inspiration. it did not seem to worsen with exertion, although she is primarily bedbound since the surgery. she also reports the pain worsens with lying flat and improves while leaning forward. she denies any associated sob, diaphoresis, nausea, vomitting, dizziness, numbness/tingling of her extremities. she reports 6-pillow orthopnea and feels uncomfortable while lying flat currently. she denies recent pnd, palpitations, lightheadedness, edema. . in the ed, initial vs were: t 98.5 p 58 bp 115/68 r20 o2 sat100% on 2l. patient was found to have an elevated wbc to 13.8, with increased b/l pleural effusions and a possible new infiltrate on cxr. her troponin is 0.5 x2 and she has slight t wave inversions in v3-v6 which are new from previous ekg. bnp was noted to be . cr. is stable at 2.1. she was given vanco/levoflox for treatment of presumed hap. chest pain responded to nitro gtt, given plavix as patient is allergic to aspirin. currently, chest pain free. on review of her micro, noted to have had recent pan-sensitive pseudomonas uti. consulted cards and ct surgery. . on the floor, she was found to be in chest pain and when she takes a deep breath. she was on a nitro gtt. she was actively orthopneic. . review of systems: (+) per hpi (-) denies fever, chills, night sweats. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. past medical history: past medical history: coronary artery disease s/p cerebrovascular accident with l hemiparesis noninsulin dependent diabetes mellitus chronic renal insufficiency with microalbuminuria hyperlipidemia hypertension asthma morbid obesity past surgical history: s/p bilateral carpal tunnel release s/p cabg : lima-lad, svg-om1, svg-om2 social history: lives alone, currently at rehab s/p cabg on occupation: nurse no history of smoking, no etoh, no ilicit drug use, including no cocaine. family history: mother had dm. no known cad. no history of early mi or blood clot. physical exam: vitals: 97.7 59 141/55 16 100%2lnc general: alert, oriented, obese, looks uncomfortable but in no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated but difficult to discern given habitus, no lad lungs: reduced breath sounds at the right lower and mid fields, positive egophony on the right, no wheezes, rhales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: obese, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley catheter in place ext: 1+ edema l>r however recent svg harvest was on the left. +lle calf tenderness but no pain. warm, well perfused, 2+ pulses, no clubbing, cyanosis. pertinent results: labs on admission: 12:08am blood wbc-13.8* rbc-2.97* hgb-9.2* hct-27.0* mcv-91 mch-31.1 mchc-34.2 rdw-15.2 plt ct-265 12:08am blood neuts-80.4* lymphs-12.8* monos-2.3 eos-4.3* baso-0.2 12:08am blood glucose-245* urean-54* creat-2.3* na-137 k-4.5 cl-102 hco3-27 angap-13 12:08am blood ck(cpk)-87 12:08am blood ck-mb-2 probnp-* 12:08am blood ctropnt-0.05* 12:08am blood calcium-9.1 phos-2.4*# mg-2.1 other labs: 04:30pm blood pt-13.1 ptt-34.4 inr(pt)-1.1 04:30pm blood alt-43* ast-52* alkphos-120* totbili-0.5 04:30pm blood albumin-3.5 calcium-9.2 phos-3.9 mg-2.0 cardiac enzymes: 12:08am blood ck-mb-2 probnp-* 12:08am blood ctropnt-0.05* 07:50am blood ctropnt-0.05* 03:42pm blood ck-mb-2 ctropnt-0.05* 04:30pm blood ctropnt-0.05* discharge labs: 11:00am blood wbc-5.9 rbc-5.09# hgb-15.7# hct-46.5# mcv-91 mch-30.8 mchc-33.8 rdw-15.3 plt ct-106*# 11:00am blood glucose-284* urean-66* creat-2.7* na-137 k-5.0 cl-99 hco3-30 angap-13 11:00am blood mg-1.9 ecg : sinus bradycardia. consider inferior myocardial infarction of indeterminate age. rsr' pattern in lead v1 with early r wave progression. other st-t wave abnormalities. since the previous tracing of the axis is less right inferior. the qrs complex is narrower. t wave abnormalities are probably more prominent. clinical correlation is suggested. cxr : pa and lateral views of the chest: lung volumes are low. there are bilateral small pleural effusions which are slightly increased in size since the previous study. there is bibasilar atelectasis which as slightly improved at the left base since the prior study. mild cardiomegaly is unchanged. mild central pulmonary vascular prominence is again seen, unchanged. there is no pneumothorax. midline sternotomy wires remain intact. impression: bilateral pleural effusions have slightly increased in size since the previous study. tte : the left atrium is dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef 75%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the findings are similar. bilateral lower ext veins us : no evidence of dvt in the lower extremities. unilateral upper ext veins us (left): no evidence of dvt of the left upper extremity. brief hospital course: the patient is a 67yo female with h/o of cva (l hemiparesis), dm, cri, htn, hld, cad s/p cabg , admitted from rehab after the acute onset of sharp, substernal chest pain on the night of . #) chest pain: patient c/o sharp substernal chest pain, non-radiating, and worse with inspiration. ecg revealed diffuse t wave inversions, which were concerning for possible cardiac ischemia. however, pain seemed more consistent with pleuritic chest pain than with angina, and patient ruled out for an mi after cardiac enzymes were negative x3. other differential diagnoses for chest pain included pe, pericarditis, pneumonia, and infection of her sternotomy incision. she had bilateral lower extremity venous ultrasounds, which did not reveal any evidence of dvt, as well as a left upper extremity venous ultrasound, which also did not reveal any dvt. the patient was started on vancomycin and cefepime for possible hap, as she had an elevated wbc on admission and possible focal consolidation on cxr. an sternotomy incision infection seemed unlikely, as her incision was without any erythema, pus, or fluctuance. ct surgery was following, and felt her pain may be incisional but did not feel the incision site was infected. pericarditis remained on the differential, given the timing of her recent cabg and diffuse, non-specific ecg changes. an echo on did not reveal any evidence of pericardial effusion. the patient's pain had generally resolved within the first day of her admission, after being placed on a nitro gtt and receiving morphine. given her renal disease, she was not started on ibuprofen or colchicine for presumed pericarditis, but rather will be discharged on tylenol and oxycodone as needed for her chest pain. her tramadol was stopped. . #)pna: the patient was started on vancomycin and cefepime for possible hap, as she had an elevated wbc on admission and possible focal consolidation on cxr. she remained afebrile throughout her hospital course. a picc line was placed on , and she will continue on an 8-day course of antibiotics for presumed hap. will be the last day of her antibiotic therapy. a vanc trough on was 22.5, and the patient's vanc dose was decreased to 500mg daily. she should have a repeat vanc trough on prior to her dose of vancomycin. #) diastolic heart failure: patient felt to be in mild acute on chronic congestive heart failure, possibly secondary to hap, as well as her lasix being held. she was gently diuresed with lasix, with cautious monitoring of her electrolytes, fluid balance, and renal fucntion. she was continued on ramipril, but her dose was decreased in setting of her rising cr. dose will be further decreased to 5mg po daily on discharge. she was ordered for metoprolol 12.5mg po bid, but this was held for most of her admission as her hr was in the 40s-50s. she was continued on a low sodium diet. the patient was not felt to be significantly volume overloaded, and aggressive diuresis was not pursued given her elevated cr. her oxygen sats remained 100% on 2l nasal cannula, and remained in the 90s off oxygen. . #) coronary artery disease: the patient's chest pain was not thought to be secondary to acs after her cardiac enzymes remained negative, and her ecg did not significantly change over the course of her admission. she was continued on plavix, and not given asa given her h/o asa hypersensitivity. she was weaned off the nitro drip within the first 24 hours of admission, and remained generally chest pain free. she was continued on a statin and metoprolol, but metoprolol was frequently held in setting of bradycardia. . #) rising cr - the patient's cr was 2.3 on admission, down from 2.9 on (the day of discharge following her cabg). her cr rose to 2.8 on , in the setting of diuresis for mild pulmonary edema. additional lasix was then held, with cr trending back down to 2.6-2.7. it is unclear what the patient's baseline cr will be, as she had an episode of atn secondary to hypotension during her recent hospitalization, and as she also has underlying chronic renal insufficiency secondary to diabetic nephropathy. her bun/cr and renal function should be closely monitored. . #) hypertension - her bps were stable, and generally normotensive during her hospital course. her hydralazine was stopped, and she was continued on ramipril, metoprolol, amlodipine, clonidine, and several doses of lasix. as above, her metoprolol was held secondary to bradycardia. . #) asthma - the patient had several brief episodes of sob, which she felt may be secondary to her asthma. she was ordered for ipratropium and albuterol nebs as needed for dyspnea. . #) sleep apnea - the patient reported having a previous diagnosis of osa, for which she has been on bipap in the past. a respiratory consult was ordered, and the patient may benefit from a sleep study and cpap in the outpatient setting. . #) h/o cva: she was continued on crestor, plavix. . #) dm type 2: she was on lantus 16 units qhs, as well as an insulin s/s. she will not be discharged on pioglitazone, and her regular insulin will be changed to aspart. . #) prophylaxis: she was on sc heparin for dvt prophylaxis. she was on colace, senna, miralax prn constipation, and lactulose prn constipation. medications on admission: ranitidine hcl 150 mg po daily docusate sodium 100 mg po bid clopidogrel 75 mg po daily amlodipine 10 mg po daily lidocaine 5 %(700 mg/patch) adhesive patch one daily (daily) as needed for back pain. tramadol 50 mg q 4 hours prn pain heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) u sc injection tid (3 times a day). metoprolol tartrate 12.5 mg po bid polyethylene glycol 3350 17 gram/dose powder sig: seventeen (17) gram/dose powder po daily (daily). clonidine 0.2 mg po tid rosuvastatin 40 mg po daily ciprofloxacin 500 mg po daily (last dose ) acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever or pain. bisacodyl 5 mg tablet sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. saline nasal spray lactulose 30cc po q 12 hours prn constipation trazadone 25 mg po qhs insulin regular sliding scale qid glargine 16 units qhs zolpidem 5 mg po qhs lorazepam 1mg po q 4 hours prn anxiety hydralazine 25 mg po q6 hours nitroglycerin 0.4 mg sl q 5 minutes x3 for chest pain discharge medications: 1. amlodipine 10 mg tablet sig: one (1) tablet po once a day: hold sbp < 10. 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day): hold for diarrrhea. 4. cefepime 1 gram recon soln sig: one (1) recon soln injection q24h (every 24 hours) for 5 days. 5. vancomycin 500 mg recon soln sig: one (1) recon soln intravenous q 24h (every 24 hours) for 5 days. 6. lantus 100 unit/ml solution sig: sixteen (16) units subcutaneous at bedtime. 7. insulin aspart 100 unit/ml solution sig: as per sliding scale units subcutaneous four times a day. 8. ramipril 5 mg capsule sig: one (1) capsule po qam (once a day (in the morning)): hold sbp < 100. capsule(s) 9. rosuvastatin 40 mg tablet sig: one (1) tablet po once a day. 10. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 11. clonidine 0.2 mg tablet sig: one (1) tablet po tid (3 times a day). 12. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day): hold hr < 55. sbp < 100. 13. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 14. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 15. heparin (porcine) 5,000 unit/ml solution sig: one (1) syringe injection tid (3 times a day). 16. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 17. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 18. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) patch topical once a day: on for 12 hours during the day. 19. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily) as needed for constipation. 20. acetaminophen 325 mg tablet sig: two (2) tablet po tid (3 times a day): please give atc for chest pain. 21. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for chest pain: please give for breakthrough pain. 22. trazodone 50 mg tablet sig: 0.5 tablet po at bedtime as needed for insomnia. 23. lactulose 10 gram/15 ml solution sig: thirty (30) cc po twice a day as needed for constipation. 24. lorazepam 1 mg tablet sig: one (1) tablet po every four (4) hours as needed for anxiety. 25. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tab sublingual every 5 minutes x 3 doses as needed for chest pain. 26. saline nasal 0.65 % aerosol, spray sig: one (1) spray nasal every 6-8 hours as needed for dry nose. discharge disposition: extended care facility: - discharge diagnosis: chest pain coronary artery disease s/p cornary artery bypass grafting diabetes mellitus type 2 hypertension hyperlipidemia history of cerebrovascular accident asthma obstructive sleep apnea discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you had chest pain and was admitted for evaluation. we did not find any evidence for a heart attack. we think that the chest pain could be due to pericardial irritation from the surgery or possibly from a pneumonia. you were started on iv antibiotics and a picc line was placed for the antibiotics and to draw blood. you will have a total of 8 days of the antibiotics. you heart rate has been low and we have been holding your metoprolol. you had an exacerbation of your congestive heart failure and some lasix was given. your kidney function worsened and is now improving. weigh yourself every morning, md if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. . medication changes: 1. stop taking hydralazine, tramadol, zolpidem, pioglitizone and gabapentin 2. start taking ramapril 5 mg in the am 3. start vancomycin and cefepime to treat a pneumonia. you will have an eight day course. 4. start oxycodone and tylenol to treat the chest pain 5. start senna to treat constipation . weigh yourself every day and call dr. if your weight increases more than 3 poounds in 1 day or 6 pounds in 3 days. followup instructions: department: cardiac services when: monday at 2:40 pm with: , md building: campus: east best parking: garage department: when: wednesday at 2:10 pm with: , md building: sc clinical ctr campus: east best parking: garage department: cardiac surgery when: monday at 2:15 pm with: , md building: lm campus: west best parking: . garage procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified acute on chronic diastolic heart failure aortocoronary bypass status asthma, unspecified type, unspecified chronic kidney disease, unspecified other and unspecified hyperlipidemia long-term (current) use of insulin morbid obesity late effects of cerebrovascular disease, hemiplegia affecting unspecified side other chest pain diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to