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: sulfa (sulfonamide antibiotics) / erythromycin base / neosporin scar solution / ampicillin / tobrex attending: chief complaint: dyspnea major surgical or invasive procedure: placement of a r ij dialysis catheter cvvh history of present illness: ms. is an 86yof with history of severe aortic stenosis, cad s/p cabg in and rca stents x3 in recently hospitalized here from for acute pulmonary edema who now is tf from osh for management of recurrent pulmonary edema. for details of her initial presentation see dr. admission note from . briefly, she presented to osh with 10/10 chest pain not relieved by nitro x4 and sob that developed at rest. she was transferred to and had an echo which showed severe aortic stenosis ( <0.8cm2) with preserved systolic function, ar (1+), mr (2+), tr (2+) and severe pah. unclear whether she was evaluated as inpatient by ct surgery but was to follow up with dr. and dr. as outpatient re need for open avr vs tavi. . on the evening she was discharged to her alf, she again developed acute chest pain and sob. she described the pain as and radiating to her l arm, and associated with diaphoresis. she notes that the chest pain was the same as the chest pain that she initially presented with, but the sob was more severe. she did not use ng as advised by the medical team on discharge. she called ems and she was transported back to osh. when she arrived she was noted to be in severe respiratory distress and was started on bipap. she received iv lasix 20mg x1. labs were notable for creat 3.35 (up from 2.31 on ), bnp 702, ck 153, trop 0.64. ekg showed sinus tach. she was admitted to the icu. after further diuresis her o2sats improved to 94% on 3l. cards was c/s and felt that cp was likely related to aortic stenosis and not acs. she was transferred to for further treatment and surgical evaluation. . on transfer, she feels well w/o complaints. she states that her chest pain has resolved and her breathing is comfortable on the bipap. she notes orthopnea c/w her baseline (requires 2 pillows), denies worsening peripheral edema. she believes she is 3lbs over her dry weight. past medical history: 1. cardiac risk factors: + diabetes (insulin-dependent for 27 years), + dyslipidemia, + hypertension 2. cardiac history: -cabg: off-pump cabg x 2: saphenous vein grafted to lad and saphenous vein graft to pda -percutaneous coronary interventions: pci and stentx3 (?bms) to rca () ptca to lad () aortic stenosis carotid stenosis status post right carotid endarterectomy chronic kidney disease (unknown baseline creat) left subclavian steal syndrome glaucoma sleep apnea (no longer uses cpap) past surgical history: tonsillectomy, left ankle repair, right carpal tunnel release, total abdominal hysterectomy, laser eye surgery, cabg as above social history: non-smoker, rare brandy, no drugs. lives in in . three sons, local. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. mother and father died from cancer. brother passed away from gi bleed and pud and another with liver cirrhosis. one sister passed away from cancer, another sister passed as a child. physical exam: admission physical exam: vs on transfer: t= 96.1 bp= 152/61 hr=88 rr=19 o2 sat= 95% on cpap (50% fio2) general: pleasant, comfortable-appearing, in no acute distress. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with 10cm jvp . surgical scar s/p right endartrectomy cardiac: s/p cabg, rrr, 4/6 systolic crescendo murmur loudest at lusb radiating to carotids, no r/g. lungs: bibasilar crackles to mid lung, faint expiratory wheezes. resp were unlabored, no accessory muscle use. abdomen: hysterectomy scar, abd is soft, non-tender, non-distended. extremities: wwp, no clubbing/cyanosis, trace pedal edema. skin: no stasis dermatitis, ulcers, scars, or xanthomas. right: carotid 2+ femoral 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ dp 1+ pt 1+ discharge physical exam: patient delirious, not oriented. on high flow face mask with good oxygen saturations cardiac exam unchanged. lungs continue to be wheezy on exam with elevated jvp pertinent results: admission labs: wbc 5.6 hgb 9.6 hct 27.5 plts 211 pt 11.4 ptt 25.7 inr 0.9 na 140 k 4.7 cl 99 co2 23 bun 70 cr 4.2 gluc 209 ca 8.4 mag 2.2 phos 5.2 ck 164 ckmb 12 trop-t 0.53 alt 17 ast 32 alk phos 133 t bili 0.4 admission studies: cxr: moderate pulmonary edema, worsened in comparison to prior study from . otherwise, no significant change. ekg: sinus rhythm, lvh, 1-2mm st depressions in i, ii tte : the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild focal lv systolic dysfunction with antero-lateral hypokinesis. the remaining segmetns are hyperdynamic and thus overall left ventricular ejection fraction is preserved (lvef>55%). there is no ventricular septal defect. the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (valve area 0.8-1.0cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is severe mitral annular calcification. there is mild functional mitral stenosis (mean gradient 8 mmhg) due to mitral annular calcification. at least moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , no change (the was slightly underestimated and regional antero-lateral hypokinesis was present but not commented on for the prior study). cxr : diffuse hazy opacification with cardiomegaly are consistent with pulmonary edema, unchanged in appearance from the prior examination. a small left pleural effusion is not significantly changed. no pneumothorax is seen. a previously seen right central venous line has been removed with no resulting hematoma or mediastinal widening. median sternotomy wires are unchanged. pertinent labs: renal function pre-cvvhd: 07:08pm blood urean-98* creat-6.4* renal function post-cvvhd: 09:59am blood urean-23* creat-2.0* 05:15am blood urean-33* creat-3.0* 03:57am blood urean-55* creat-3.7* 05:16am blood urean-65* creat-4.0* 05:45am blood urean-78* creat-4.6* 04:59am blood urean-86* creat-5.0* brief hospital course: primary reason for hospitalization: 83yof with h/o severe aortic stenosis and transfered from osh for sob flash edema from as. # acute on chronic diastolic heart failure - due to both severe aortic stenosis and mitral regurgitation. she was initially requiring bipap to maintain o2sats >90%, but this improved and by discharge she was maintaining o2 sats >90% on nc at 15l/min, with occasional episodes of sob requiring face mask. she was continued on her home bp meds to reduce afterload, with her metoprolol tartrate increased to 100mg . her imdur was initially increased to 90mg daily but then decreased to her home dose of 60mg daily. she was diuresed with iv lasix and metolazone. she was also treated with iv morphine to increase pulmonary venodilation and improve her sensation of dyspnea. this was later changed to iv dilaudid due to concern for poor clearance in setting of renal failure. she was evaluated by ct surgery, who felt that she was not an appropriate candidate for open avr given her comorbidities. she was then considered for tavi, but there was concern that she may not be a candidate for the procedure given her known atherosclerosis of femoral vessels and h/o difficult access for cardiac cath. patient opted to start cvvh to optimize her renal function, in order to pursue balloon valvuloplasty. review of her echo demonstrated that her mr was more significant than as and she would likely get little benefit from intervention on her aortic valve. patient clearly expressed her wishes to not pursue further invasive treatments and to focus on her comfort at a hospice facility. a family meeting was held with the patient's sons, palliative care, social work, and the primary team, and it was agreed that the patient's expressed wishes could best be served in a hospice house. the following day, however, she appeared to be very uncomfortable and it was thought that interventions at hospice may not be enough to keep her breathing more comfortably. she died at 11:40 pm on , family was contact and autopsy was offered and declined. . # cad - on admission pt c/o chest pain, thought most likely demand ischemia, low suspicion for acs given history and absence of ischemic changes on ekg. she was initially continued on aspirin 325mg, metoprolol, atorvastatin and clopidrogel. acei was held in the setting of renal failure. her isosorbide mononitrate cr was initally increased to 90mg daily, then reduced to 60mg daily as above. chest pain did not recur. # acute on chronic rf: creat increased from 2.2 on previous admission to 4.2, and continued to increase to 6.4. patient was started on cvvh on hd3 and tolerated this well. on hd5 cvvh was held when her dialysis line malfunctioned and renal function did not improve. creatinine continued to trend upwards and patient continued to have poor urine output. she did respond to bolus doses of 200 mg iv lasix and metolazone with some improvement in respiratory status. the renal service discussed the possibility of resuming dialysis with the patient, but she elected not to continue as she did not want to be on dialysis long-term. # hypertension: bp stable on home amlodipine, and metoprolol. imdur dose modified as described above. these meds were continued after goals of care transitioned to cmo in hopes of improving patient's respiratory status. # hypercholesterolemia: atorvastatin was initially continued throughout hospitalization but discontinued on changing goals of care to cmo. # diabetes mellitus: patient's blood sugar was well controlled throughout admission on home lantus and insulin sliding scale. she was contined on iss in hopes that glucose control would improve her mental status and quality of life. patient passed at 11:40pm on . family was notified. medications on admission: 1. lantus 100 unit/ml solution sig: as directed units subcutaneous at bedtime: please take 14 - 16 units at bedtime. . 2. humalog 100 unit/ml solution sig: as directed units subcutaneous before meals: as directed by your primary care doctor: 4-6 units prior to meals. 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day. 5. furosemide 40 mg tablet sig: one (1) tablet po as directed: take 40 mg daily on sunday, tuesday, thursday, and saturday. take 40 mg twice a day on monday, wednesday, and friday. 6. amlodipine 10 mg tablet sig: one (1) tablet po once a day. 7. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 8. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 9. isosorbide mononitrate 60 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 10. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 11. clopidogrel 75 mg tablet sig: one (1) tablet po once a day. discharge medications: n/a discharge disposition: expired facility: hospice of the discharge diagnosis: critical aortic stenosis coronary artery disease s/p cabg anemia moderate mitral reguritation acute on chronic renal failure hypertension discharge condition: expired discharge instructions: n/a followup instructions: n/a procedure: venous catheterization, not elsewhere classified hemodialysis arterial catheterization diagnoses: anemia, unspecified pure hypercholesterolemia congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled 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 coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified acute respiratory failure bacteremia mitral valve insufficiency and aortic valve stenosis encounter for palliative care do not resuscitate status other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria acute edema of lung, unspecified other drugs and medicinal substances causing adverse effects in therapeutic use nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney 

Answer: The patient is high likely exposed to