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: erythromycin base attending: chief complaint: mitral regurgitation major surgical or invasive procedure: mitral valve replacement (25mm st. mechanical) via right thoracotomy closed right thoracostomy history of present illness: this is a 76 year old female with history of rheumatic heart disease. she is s/p aortic valve replacement in . recent echocardiogram revealed moderate to severe mitral regurgitation. recent cardiac catheterization showed normal coronaries. she presented for redo-operation with mitral valve replacement on she was brought to the operating room. after intubation, she had an og tube placed which suctioned out approximately 30cc of coffee-ground fluid. there was concern for gi bleed and since surgery was elective, it was cancelled. gi was immediately consulted for an upper endoscopy. the patient was transferred to the cvicu, remained intubated and underwent an esophagogastroendoscopy by the gi service shortly thereafter. this showed gastritis with barrett's esophagus. this was treated with proton pump inhibitors and she was discharged.she now presents as a same day admit for surgery. past medical history: rheumatic valvular disease barrett's esophagus hypertension hyperlipidemia chronic atrial fibrillation neuropathy of lower extremities hemorrhoids arthritis s/p aortic valve replacement(bioprosthetic) by dr. at hysterectomy bilateral cataracts social history: last dental exam: several weeks ago, cleaning performed lives with: husband : tobacco: denies etoh: rare family history: father died of heart failure at age 61 physical exam: admission: pulse: 79 resp: 16 o2 sat: b/p right: 168/87 left: 127/85 general: elderly female in no acute distress skin: dry intact - well healed sternotomy and abd incision heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur - mixed systolic and diastolic murmurs, soft abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema trace bilaterally varicosities: none neuro: grossly intact pulses: femoral right: 2 left: 2 dp right: 1 left: 1 pt : 1 left: 1 radial right: 1 left: 1 carotid bruit right: none left: none pertinent results: 07:30am hgb-11.8* hct-34.1* 12:50pm glucose-102 lactate-1.2 na+-141 k+-3.6 cl--103 06:41pm fibrinoge-235 06:41pm pt-15.9* ptt-29.8 inr(pt)-1.4* 06:41pm plt count-164 06:44pm glucose-187* lactate-3.1* na+-139 k+-3.1* cl--105 08:13pm estgfr-using this 08:13pm urea n-14 creat-0.5 chloride-114* total co2-21* 06:05am blood wbc-13.7* rbc-3.01* hgb-8.9* hct-27.8* mcv-92 mch-29.6 mchc-32.0 rdw-17.5* plt ct-372 06:01am blood wbc-19.1* rbc-2.84* hgb-8.5* hct-26.1* mcv-92 mch-30.0 mchc-32.7 rdw-18.0* plt ct-383 06:05am blood plt ct-372 06:05am blood pt-31.5* inr(pt)-3.2* 06:01am blood pt-28.7* inr(pt)-2.8* 06:01am blood urean-20 creat-0.7 k-3.9 04:19am blood glucose-118* urean-21* creat-0.6 na-139 k-3.6 cl-100 hco3-31 angap-12 radiology report chest (pa & lat) study date of 10:14 am final report reason for examination: followup of the patient after mitral valve replacement with elevated white blood cells. pa and lateral upright chest radiographs were compared to . the right picc line tip is at the level of mid svc. the replaced aortic and mitral valves are in unchanged position. the right pleural effusion which is partially loculated with adjacent area of atelectasis did not change in the interim. there are no areas of consolidation worrisome for newly developed infectious process. no pneumothorax is demonstrated. dr. echocardiography report tee (complete) echocardiographic measurements results measurements normal range left ventricle - inferolateral thickness: *1.4 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 5.3 cm <= 5.6 cm left ventricle - ejection fraction: 55% to 60% >= 55% left ventricle - stroke volume: 62 ml/beat left ventricle - cardiac output: 3.80 l/min left ventricle - cardiac index: *1.98 >= 2.0 l/min/m2 left ventricle - peak resting lvot gradient: 3 mm hg <= 10 mm hg aorta - sinus level: 3.6 cm <= 3.6 cm aorta - ascending: *3.9 cm <= 3.4 cm aorta - arch: 3.0 cm <= 3.0 cm aortic valve - peak velocity: *2.4 m/sec <= 2.0 m/sec aortic valve - peak gradient: *23 mm hg < 20 mm hg aortic valve - mean gradient: 11 mm hg aortic valve - lvot vti: 18 aortic valve - lvot diam: 2.1 cm aortic valve - valve area: *1.3 cm2 >= 3.0 cm2 mitral valve - mva (p t): 2.0 cm2 tr gradient (+ ra = pasp): *46 to 50 mm hg <= 25 mm hg findings left ventricle: mild symmetric lvh. normal lv cavity size. overall normal lvef (>55%). aortic valve: avr leaflets move normally. thickened avr leaflets. cannot exclude as. no ar. mitral valve: moderately thickened mitral valve leaflets. partial mitral leaflet flail. mild valvular ms (mva 1.5-2.0cm2). moderate to severe (3+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. severely thickened/deformed tricuspid valve leaflets. no ts. moderate to severe tr. severe pa systolic hypertension. pulmonic valve/pulmonary artery: pulmonic valve not well seen. no pr. pericardium: no pericardial effusion. conclusions pre bypass: there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). the aortic valve prosthesis leaflets appear to move normally. the prosthetic aortic valve leaflets are thickened. the study is inadequate to exclude significant aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is partial mitral leaflet flail. there is mild valvular mitral stenosis (area 1.5-2.0cm2). moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the tricuspid valve leaflets are severely thickened/deformed. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. rv function mildly depressed at baseline, improved on milrinone infusion. post bypass: patient is in atrial fibrillation (baseline rhythm) on milrinone and phenylepherine infusions. preseved biventricular function. lvef >55%. a mechanical mitral valve prosthesis is in situ with peak gradient 8, mean 4 mm hg normal washing jets and a small, stable, perivalvular leak. aortic prosthesis is unchanged from baseline. aortic contours intact. remaining exam is unchanged. all findings discussed with surgeons at the time of the exam. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, brief hospital course: was a same day admit and underwent a mitral valve replacement via right thoracotomy on . please see operative note for surgical details. following surgery she was transferred to the cvicu for invasive monitoring on milrinone, epinephrine and neosynephrine she was tacchycardic to the 140s with good cardiac function. despite weaning off the epinephrine and small doses of beta blockers, her heart rate remained rapid and her bp was lower with the fast rate. the milrinone was then weaned and stopped with the heart rate falling into the 110-120 range. amiodarone and beta blockers did not slow her ventricular response adequtely and eventually digoxin was given with a drop in the rate to below 100. she remained stable. she was extubated during this time without incident. she became hypertensive postoperatively and required a nitroglycerin drip. she had pauses after digoxin loading and a heart rate in the 50's. digoxin was stopped, ep was consulted and lopressor was held until her heart rate improved. lopressor was added back and eventually converted to atenolol with reasonable heart rate control in the 80-90s. chest tubes were removed per cardiac surgery protocol. ms. was started on anticoagulation for chronic atrial fibrillation and the mechanical mitral valve. she was started on coumadin and then a heparin drip on postoperative day 3 at midnight. she was therapeutic on heparin and coumadin. on postoperative day 6 she developed guaiac positive stools. a chest xay was done which showed a right hemothorax. a chest tube was placed which drained 1.9 l dark red fluid. she was hemodynamically stable throughout this. she was transfused with 2 units of packed red blood cells and serial hematocrits were done. hematocrit remained stable at 26. cxr showed improvement of the effusion with a moderate lateral residual component on . coumadin was restarted with inr 2.2. she was transferred to the floor in stable condition. once on the floor her activity level was advanced. a picc line was placed on and the triple lumen catheter was removed from the jugular vein. a cxr demonstarted some improvement in the aeration of the right lung but a persisitent loculated effusion. the ct was removed per dr. . she continued to make slow improvement while awaiting her inr to become therapeudic. during this period she was noted to have an elevated white blood cell count, she was pan cultured and all cultures returned negative. her right groin cannulation site had slight erythema and she was begun on keflex with a resultant downward trend of her white cell count. on pod 15 she was discharged home with visiting nurses. inr levels and coumadin dose adjustments to be followed by dr medications on admission: atorvastatin 10 mg daily furosemide 80 mg daily gabapentin 300 mg am,600mg 1600,600my 2200 isosorbide dinitrate 30 mg daily colchicine 0.6 mg daily losartan 25 mg daily pantoprazole 40 mg metoprolol tartrate 50 mg ciprofloxacin 500 mg discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 3. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 5. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. losartan 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*90 capsule(s)* refills:*2* 9. furosemide 80 mg tablet sig: one (1) tablet po twice a day: take 80mg x10 days then 80mg qd. disp:*60 tablet(s)* refills:*1* 10. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po daily (daily). disp:*30 tab sust.rel. particle/crystal(s)* refills:*2* 11. keflex 500 mg capsule sig: one (1) capsule po twice a day for 2 weeks. disp:*28 capsule(s)* refills:*0* 12. atenolol 25 mg tablet sig: three (3) tablet po bid (2 times a day). disp:*180 tablet(s)* refills:*2* 13. warfarin 2 mg tablet sig: as directed tablet po once a day: take 6mg on and then as directed by dr . disp:*100 tablet(s)* refills:*0* discharge disposition: home with service facility: area vna discharge diagnosis: mitral regurgitation s/p mitral valve replacement rheumatic valvular disease hypertension hyperlipidemia chronic atrial fibrillation neuropathy of lower extremities hemorrhoids arthritis s/p 21mm avr (bioprosthetic) by dr. at s/p hysterectomy bilateral cataracts discharge condition: good discharge instructions: monitor wounds for signs of infection. these include redness, drainage or increased pain. report any fever of greater then 100.5 report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. shower daily. wash wound with soap and water. no lotions, creams or pwoders to incision until it has healed. no lifting greater then 10 pounds for 10 weeks from date of surgery. no driving for 1 month from date of surgery and taking narcotics. please call with any questions or concerns. take all medications as directed followup instructions: 6 wound clinic in 2 weeks-nurses to schedule prior to discharge dr. in 4 weeks () dr. in weeks () dr. in weeks please call providers for all appointments procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery open and other replacement of mitral valve removal of thoracotomy tube or pleural cavity drain diagnoses: acidosis other iatrogenic hypotension thrombocytopenia, unspecified unspecified essential hypertension atrial fibrillation mononeuritis of lower limb, unspecified rheumatic heart failure (congestive) other and unspecified hyperlipidemia other specified cardiac dysrhythmias other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of anticoagulants nonspecific abnormal findings in stool contents heart valve replaced by transplant aphasia barrett's esophagus hemopericardium oliguria and anuria rheumatic mitral insufficiency arthropathy, unspecified, site unspecified adhesive pericarditis other specified forms of effusion, except tuberculous 

Answer: The patient is high likely exposed to