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: patient recorded as having no known allergies to drugs attending: chief complaint: newly diagnosied pericardial effusion major surgical or invasive procedure: pericardialcentesis with drain placement and subsequent removal history of present illness: the patient is an 82 y/o russian spekaing female w/ hx of breast ca and prancreatic ca who is directly admitted for evaluation of newly diagnosied pericardial effusion w/ tamponade physiology. the patinet was diagnosed with pancreatic ca in after presentive w/ jaundice. over the last month the patient has noted new onselt leg edema, which as progressively worsened with each day. the leg swelling does not limit the adls in this self-described active women. additionally, over this time period, the normally hypertensive patient has been normo to hypotensive, and her bp medication was discontinued. the patient was recently at nyp hoslpital in ny 2d prior to presentation as part of a preoperative evaltion for a whipple. an echocardiogram obtained on showed a moderate to large pericardial effusion causing both right atrial and right ventricular diastolic collapse. she was recommended to have a cardiology consultation but surprisingly, she was not offered an admission to the hospital. the patient returned to , and was seen by dr. in clinic on the day of admission. the patinet returned home after her clinic visit, and was called at home this evening and told to come to the hospital. in discussion with the patient, she had any episodes of chest pain, shortness of breath, palpitations, presyncope or syncope. her breathing has been comfortable without any pnd or orthopnea. she has no prior cardiac history. she densies any recent illnesses, fever, or chills. she has no hx of renal dysfunction, ctd, or tuberculosis exposure. she is currently comfortable. past medical history: -hepatitis b 20 years ago, -status post total abdominal hysterectomy for uterine prolapse 20 years ago in and then re-do in , - status post parathyroidectomy for parathyroid adenoma nine years ago in , -status post basal cell resection at -status post left breast lumpectomy for breast cancer in in , me but not followed by xrt or chemotherapy social history: patient is a survivor of the holocaust, originally from . worked as an economist. no hx of tobacco or alcohol. has 2 children. family history: unknown as holocaust survior. physical exam: vs: t 95.9 bp 134/74 p 76 rr 100 % ra pulsus: 6 gen: elderly russian female, sitting in bed, alert and comfortable heent: ncat, oropharynx clear and without erythema or exudate, poor dentition. neck: supple, no lad, no appreciable jvd cv: rrr, normal s1s2, no murmurs, rubs or gallops. heart sounds not muffled. pulsus of 6. pulm: scoliosis. ctab, no w/r/r, good air movement bilaterally abd: soft, ntnd, normoactive bowel sounds, no organomegaly, no abdominal bruit appreciated ext: warm and well perfused, full and symmetric distal pulses, has 3+ pitting edema to knees. neuro: aaox3, responds appropriately to questions, cn 2-12 grossly intact pertinent results: 05:57am blood wbc-5.4 rbc-3.71* hgb-10.4* hct-33.2* mcv-90 mch-28.0 mchc-31.3 rdw-19.2* plt ct-360 09:10am blood neuts-49.1* lymphs-43.8* monos-5.9 eos-1.1 baso-0.1 09:10am blood pt-14.3* ptt-29.0 inr(pt)-1.2* 05:57am blood plt ct-360 05:57am blood glucose-97 urean-7 creat-0.7 na-142 k-3.1* cl-107 hco3-26 angap-12 09:10am blood alt-76* ast-104* ld(ldh)-224 alkphos-694* totbili-1.6* 09:10am blood albumin-2.1* calcium-8.0* phos-3.2 mg-1.7 09:10am blood tsh-4.5* 09:10am blood t3-62* free t4-0.83* echo pre pericardiocentesis: the left atrium is moderately dilated. the left atrium is elongated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a moderate sized pericardial effusion. the effusion appears circumferential. no right atrial or right ventricular diastolic collapse is seen. impression: moderate-sized pericardial effusion without echocardiographic signs of tamponade. preserved global biventricular systolic function. mild aortic regurgitation. pericadiocentesis: 1- diagnostic pericardiocentesis with limited removal of 7 cc of markedly viscous fluid. 2- the patient developed a brief vagal episode with heart rate down from 90 bpm to 55-65 bpm and sbp down to 60-70 mmhg (down from 140-160 mmhg). administration of atropine (0.5 mg iv) and intravenous fluids lead to rapid restoration of baseline vital signs. final diagnosis: 1. limited removal of 7 cc of markedly viscous pericardial fluid. specimen was sent for laboratory analysis. echo post pericardiocentesis: overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is a small pericardial effusion. the effusion may be loculated. there are no echocardiographic signs of tamponade. impression: small pericardial effusion. no tamponade. compared with the prior study (images reviewed) of , the effusion appears slightly smaller. pericardial fluid cell count rbc 650 wbc 91 polys 1 band 6:10 pm fluid,other site: pericardium culture. gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram positive cocci . in pairs and chains. 2+ (1-5 per 1000x field): gram negative rod(s). reported by phone to k. comen on @ 10:35 pm. fluid culture (final ): due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. viridans streptococci. heavy growth of two colonial morphologies. gram negative rod(s). moderate growth of two colonial morphologies. viridans streptococci. moderate growth strain 3. neisseria species. moderate growth. non-pathogenic. anaerobic culture (final ): no anaerobes isolated. acid fast culture (preliminary): acid fast smear (final ): no acid fast bacilli seen on concentrated smear. fungal culture (preliminary): no fungus isolated. blood cultures pending. brief hospital course: a+p: 82 y/o with h/o breast ca, pancreatic ca, presents with pericardial effusion originally worrisome for tamponade based on osh echo. pt only complains of le edema, repeat echo without signs of tamponade. . # pericardial effusion: evidence of tamponade physiology on nyp echo. no evidence of hemodynamic instability, with adequate bp and no symptomatic effects. low voltage on ekg c/w effusion. pulsus of 15 in clinic prior to admission, 6 on admission. given the size of the effusion w/ absence of a greater deal of hemodynamic compromise, likely more of a chronic, slow growing effusion. large differential, but given pancreatic ca and hx of breat ca, malignant pericardial effusion most likely. effusion to thyroid dysfunction in this patient w/ hx of hypothyroidism also a possibility. no viral illness to suggest post viral etiology, nor mi, uremia, tuberculosis, or ckd. a repeat echo on was without evidence of tamponade. consulted thoracic surgery for eval of pericardial window given likely malignant source of effusion which will likely reaccumulate. they defered on a window until definite diagnosis of effusion. suggested pericardialcentesis with drain which was performed. 7cc of viscous pericardial effusion was removed. however drain did not function well since effusion apears to be loculated and the drain was later pulled. cell count and culture results of pericardial effusion as detailed in results section. the effusion is felt to most likely be malignancy altough cytology is pendin,. the mixed flora in the fluid culture is concerning and blood cultures were obtained to r/o systemic infection. the pt was without fever or white count to suggest infection but is considered at risk her fairly recent pallative procedure for pancreatic ca which may have been a nitus for bacterial seeding. the pt refused to stay in house for further monitoring and agreed to close f/u in case the blood cultures were to positive. the results will need to be f/u by the pcp. understands that a postitive culture would need to be treated with iv antibiotics. blood cultures from remain pending as of . pt has a f/u echo scheduled as below. pt will also f/u with ct , dr as detailed below for further discussion of a pericardial window pending the final cytology results. . # lower extremity swelling: to diastolic heart failure in the setting of tamponade vs. low oncotic pressure in the setting of hypoalbunemia. no role for diuresis w/ potential tamponade. lenis ruled out dvt. should monitor to see if resolves with resolution of the pericardial effusion. . # hypothyroidism: tsh 4.5, free t4 0.83 in house. need continued alteration to home synthroid dose as outpt. etiology of pericaridial effusion less likely 2.2 thyroid given viscous loculated nature of fluid. . # hx of breast ca: had lumpectomy w/o xrt - cont home aromatase inhibitor . # code: full confirmed with pt and family. . #comm: care proxy and power of attorney: daughter . pcp: in / medications on admission: levothyroxine 0.05-mg/day, femara 2.5-mg/day since the breast cancer operation, and omeprazole 20-mg/day discharge medications: 1. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 2. letrozole 2.5 mg tablet sig: one (1) tablet po daily (). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. discharge disposition: home with service facility: abp discharge diagnosis: pericardial effusion pancreatic cancer discharge condition: good discharge instructions: you were admitted to the hospital because you have a pericardial effusion (fluid around the heart). this is very worrisome because it can impair heart function. you had an attempt to drain the fluid around the heart however it was not able to be drained. it is likely that the fluid is there because of the cancer but we have studies of the fluid that are not yet resulted which will give us more definate information. you had ultrasound of your legs which did not show any blood clots. you were followed by the cardio-thoracic surgery team who will see you in clinic and decide if a surgery is indicated to remove the fluid around the heart. the culture of the fluid around your heart had bacteria in it which is concerning that you could have an infection, although you do not have any symptoms compatible with this. we checked blood cultures to be sure that you don't have a blood stream infection but you did not want to wait for those cultures to be resulted. it is very important that you are able to be reached by phone in case these cultures come back positive. in that case you will need immediate intravenous antibiotics. please follow up as below. please call your doctor or return to the hospital if you have any concerning symptoms including chest pain, difficulty breathing, fever, light headedness or fainting or any other worrisome symptoms. followup instructions: 1) you have an appointment for an echocardiogram on friday at 2:00. please go to the of the building. please call if you need to reschedule. (please try to keep this appointment as we would like you to have this echocardiogram before your appointment with the surgeon) 2) please follow up with dr. , md phone: date/time: 10:30. 3) you have an appointment scheduled to follow up with your primary care doctor, dr. . 4) please call and schedule an appointment to follow up with dr. . procedure: pericardiocentesis diagnoses: congestive heart failure, unspecified unspecified acquired hypothyroidism personal history of malignant neoplasm of breast unspecified disease of pericardium streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus diastolic heart failure, unspecified other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms malignant neoplasm of other specified sites of pancreas 

Answer: The patient is high likely exposed to