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: all allergies / adverse drug reactions previously recorded have been deleted attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization coronary artery bypass graft x2 (left internal mammary artery > left anterior descending, saphenous vein graft > obtuse marginal) history of present illness: 64 year old female with prior history of hypertension and chronic tobacco abuse who had an isolated episode of midsternal chest pain () while setting up a golf tournament this morning resolving with rest over 3 minutes. she reports a similar episode 1 week previously. no radiation of pain, shortness of breath, diaphoresis. she was referred for a cardiac catheterization which revealed 3 vessel coronary disease and was then referred to cardiac surgery for revascularization. past medical history: hypertension tobacco abuse (1ppd) s/p c-section x3 s/p tonsillectomy s/p bilateral knee replacments social history: she lives with her husband and is retired she is a current smoker of one pack per day for thirty-five years she drinks two alcoholic beverages daily family history: brother who had a coronary artery bypass grafting another brother who underwent percutaneous coronary intervention physical exam: pulse:96 resp:17 o2 sat:100/ra b/p right:132/75 left:135/88 height:5'3" weight:175 lbs general: awake alert oriented skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur: very soft systolic ejection murmur w/o radiation; abdomen: soft non-distended non-tender + bowel sounds extremities: warm , well-perfused ; some clubbing no edema no varicosities; bilateral healed incisions on the anterior surface of the knees neuro: grossly intact pulses: femoral right: 2+ left: 2+ dp right: 2+ left: 2+ pt : 2+ left: 2+ radial right: 2+ left: 2+ carotid bruit right: no left: no pertinent results: echocardiographic measurements results measurements normal range left ventricle - ejection fraction: 75% >= 55% findings left ventricle: mild symmetric lvh. small lv cavity. hyperdynamic lvef >75%. right ventricle: normal rv chamber size and free wall motion. pericardium: small pericardial effusion. effusion echo dense, c/w blood, inflammation or other cellular elements. conclusions there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. left ventricular systolic function is hyperdynamic (ef 75%). right ventricular chamber size and free wall motion are normal. there is a small pericardial effusion/collection subtending primarily the right ventricular free wall but possibly extensing to the inferior and posterior walls of the left ventricle. part of the clear space may be epicardial fat. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. no evidence of cardiac tamponade. chest ct after median sternotomy due to cabg. there is good apposition of the sternal changes, but there is an offset with the right hemisternum being approximately 3 mm anterior to the left hemithorax. the sternal wires are unremarkable. there is moderate, at least, amount of pericardial effusion. there is potential loculation of pericardial effusion and some questionable irregularity of pericardium that might represent infectious/inflammatory process. there is questionable compression of the right ventricle and correlation with echocardiography is required to exclude the possibility of tamponade physiology. native coronary arteries are extensively calcified. the aorta is normal in diameter. pulmonary arteries are not dilated. bilateral pleural effusion is noted, small to moderate, layering. in the anterior mediastinum, there is extensive stranding as well as several areas of collection continuing towards the upper abdomen, 2:45, with adjacent lymph nodes. the imaged portion of the upper abdomen reveals no abnormality within the limitations of the study technique except for extensive coronary calcifications. several mediastinal lymph nodes are borderline and might be reactive to the pulmonary process. airways are patent to the level of subsegmental bronchi bilaterally. evaluation of the pulmonary parenchyma demonstrate extensive ground-glass opacities and septal wall thickening which is diffuse, moderate-to-severe with no sparing of the lung parenchyma. there are areas of lucency in the right lower lobe and minimal similar areas in the left mid lung. though the areas might represent uninvolved parenchyma or on the opposite beginning of cystic formation. there are no bone lesions worrisome for infection or neoplasm. degenerative changes are noted in the thoracic spine. impression: 1. evidence of recent cabg. despite recent surgery, the presence of at least moderate pericardial effusion with questionable compression of the right ventricle and presence of anterior mediastinal collection at least 6.5 cm in length is consistent with ongoing inflammation/infection. correlation with echocardiography is required. 2. no definitive evidence of pulmonary fibrosis on both chest radiographs and chest ct. 3. extensive septal thickening and ground-glass opacities, findings consistent with pulmonary edema at the first place. the other option might a drug reaction for example to know administration of iv amiodorone. less likely a diffuse infectious process may be considered, for example pneumocystic pneumonia, especially if the patient is immunocompromised. ct of thorax: recent sternotomy noted in keeping with recent cabg. native coronary arteries are again noted to be extensively calcified. the previously noted pericardial effusion has decreased in size from 13 mm in anterior thickness to 10 mm (series 2, image 33). there has been a slight decrease in the amount of fluid tracking along the left oblique fissure. the right pleural effusion has resolved. the airways are patent to the level of the subsegmental bronchi bilaterally. there are bilateral extensive ground-glass opacities and septal thickening. changes are essentially unchanged from the prior study. subcentimeter prevascular and right paratracheal lymph nodes are unchanged. the imaged portion of the upper abdomen again reveals no significant abnormality. osseous structures: degenerative changes are noted involving the lower thoracic spine with bridging anterior osteophytes. no concerning lytic or sclerotic lesion identified. impression: 1. slight decrease in volume of the pericardial effusion and fluid within the left oblique fissure with resolution of the right pleural effusion. 2. minimal change in the ground-glass change and septal wall thickening on comparison with the prior study. the differential again includes pulmonary edema, drug reaction or less likely a diffuse infectious process. 3. satisfactory position of the recently placed right-sided picc line. , t f 64 radiology report chest (pa & lat) study date of 8:52 am , fa6a 8:52 am chest (pa & lat) clip # reason: eval opacities medical condition: 64 year old woman s/p cabg reason for this examination: eval opacities final report indication: patient status post cabg, please evaluate lung opacities. comparison: multiple imaging studies including preoperative pa and lateral radiograph on plus periodic follow up radiographs after surgery. ct chest without contrast on . findings: lung aeration and bilateral fine reticular diffuse radiopacities have improved considerably compared with . small pleural effusions if any and no pneumothorax. evaluation of cardiomediastinal and hilar contours is difficult due to obscuring of the silhouettes by lung opacities. sternotomy wires are intact and picc line remains in stable position. impression: interval improvement of diffuse radiopacities. as discussed in prior reports, fibrotic changes occurring in such a short period of time are concerning for drug reaction, less likely diffuse infectious process. complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:30 13.3* 3.49* 11.5* 33.7* 96 32.8* 34.0 16.4* 229 renal & glucose glucose urean creat na k cl hco3 angap 06:30 19 0.8 133 4.3 97 29 11 enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili indbili 05:39 75* 55* 420* 262* 43 1.2 brief hospital course: transferred from outside hospital for cardiac catheterization after presenting with chest pain. she was found to have coronary artery disease and cardiac surgery was consulted. post procedure she was admitted to cardiology and underwent preoperative workup. of note she had elevated hgba1c 7.4 and was consulted for new diabetes diagnosis. she was placed on insulin sliding scale for blood glucose management. on she was brought to the operating room for coronary artery bypass graft surgery. see operative report for further details in summary she had: coronary artery bypass graft x2 with a left internal mammary artery to the left anterior descending artery, and a reverse saphenous vein graft to the obtuse marginal artery. her bypass time was 62 minutes, with a crossclamp of 47 minutes. she received vancomycin and cefazolin for perioperative antibiotics, and ciprofloxacin for treatment of urinary tract infection. she tolerated the operation well andpost-operatively was transferred to the intensive care unit for post operative management. that evening she required neosynephrine for blood pressure management and was transfused with packed red blood cells for post operative bleeding. in the first twenty four hours she was weaned from sedation, awoke neurological intact, and extubated without complications. she continued on neosynephrine for blood pressure management and was started on lasix for diuresis. she was transitioned to insulin sliding scale with lantus from insulin drip for blood glucose management. on post operative day two she was found to have decreased saturations and chest xray that revealed pulmonary edema, she was switched to lasix drip for aggressive diuresis with good response. however she remained relatively hypoxic and that evening she required non invasive ventilation for hypoxia. over the next several days she continued with high oxygen requirement with non invasive ventilation, non breather mask, or high flow oxygen mask. she was weaned off neosynephrine on and started on beta blockers. early in the am she developed atrial fibrillation and was treated with amiodarone bolus and converted back to sinus tachycardia. she continued to have intermittent episodes of atrial fibrillation treated with betablockers and amiodarone over the next few days and then she remained in sinus rhythm. on she was noted to have elevated liver functions- an abdominal ultrasound was negative. her medications were adjusted as there was concern for drug related transaminase elevation, so metformin and amiodarone were stopped. her liver functions progressively improved. she again had occaisional bouts of atrial finrillation and diltiazem was added to the beta blockers with good effect. she developed acute kidney injury with baseline creatinine 0.4 peak 2.6 on . on lasix drip was stopped and diuresis held due to increased creatinine. on pulmonary was consulted due to ongoing hypoxia with high flow oxygen requirements. she was started steroids and had chest ct scan to further evaluate hypoxia. pulmonary continued to follow her and she was tapered from iv to oral steroids. with the addition of steroids she had worsening hyperglycemia and required insulin drip for managment. she slowly improved and was able to be weaned down to nasal cannula on . she continued to progressively improve and remained on nasal cannula, transitioned to sliding scale insulin with lantus and remained in sinus rhythm. on she was transferred from the icu to the floor for the remainder of her care. an initial attempt to taper steroids led to increased shortness of breath they were increased back to 60 mg daily. she was restarted on lasix for diuresis requiring intravenous lasix. she continues on telemetry for rhythm management. on her steroids were dropped to 50 mg daily to restart slow taper. on she had a guaiac positive melenotic stool. hematocrit was trending downward, requiring transfusion of 2 units of packed red cells. proton pump inhibitor was initiated along with a gastroenterology consult. for closer 24 hour observation, she was transferred back to cvicu for further gi workup. her pulmonary status remained tenuous but slowly improving. she was weaned to nasal cannula and she was on 3 liters at the time of discharge. dr. and gi discussed the risks and benefits of having a egd performed. initially she had been made npo and an egd scheduled but her hematocrit remained stable and it was felt that further workup could be done as an outpatient, so as to not set her back from a pulmonary standpoint, the egd was not performed during admission. she remains on medication for painful swallowing thought likely secondary to fungal esophagitis due to steroids, treated with nystatin swish and swallow and diflucan. she was ready for discharge to , on pod #37 with plan for follow up pfts and pulmonary appointment. additionally her steroids continue at 20 mg daily with taper plan to be determined at follow up with pulmonology. gastroenterology, as well as cardiology, and cardiac surgery follow up appointments advised. stop medications on admission: norvasc 5 mg daily asa 81 mg daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 4. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 5. vitamin a 10,000 unit capsule sig: two (2) capsule po bid (2 times a day): while on prednisone . 6. polyethylene glycol 3350 17 gram/dose powder sig: seventeen (17) gram po daily (daily). 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: three (3) ml inhalation q6h (every 6 hours). 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: three (3) ml inhalation q2h (every 2 hours) as needed for sob . 9. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 10. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 11. ipratropium bromide 0.02 % solution sig: three (3) ml inhalation q6h (every 6 hours). 12. senna 8.6 mg tablet sig: two (2) tablet po daily (daily). 13. white petrolatum-mineral oil cream sig: one (1) appl topical (2 times a day). 14. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily): to continue and will be reevaluated at outpatient pulmonary appointment . 15. potassium chloride 10 meq tablet extended release sig: four (4) tablet extended release po daily (daily). 16. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). tablet(s) 17. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. tablet(s) 18. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). 19. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) for 7 days. 20. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). 21. clonazepam 0.5 mg tablet sig: one (1) tablet po tid (3 times a day). 22. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 23. metformin 500 mg tablet sig: one (1) tablet po daily (daily). 24. sertraline 25 mg tablet sig: one (1) tablet po daily (daily). 25. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). 26. diltiazem hcl 180 mg capsule, extended release sig: one (1) capsule, extended release po daily (daily). 27. fluconazole 150 mg tablet sig: one (1) tablet po q24h (every 24 hours). discharge disposition: extended care facility: - discharge diagnosis: coronary artery disease s/p coronary artery bypass grafts post operative acute lung injury pulmonary edema post operative atrial fibrillation acute kidney injury diabetes mellitus (hgba1c 7.4%) hypertension discharge condition: alert and oriented x3, nonfocal ambulating with assistance and increased oxygen short distances incisional pain managed with ultram as needed incisions: sternal - healing well, no erythema or drainage leg left - healing well, no erythema or drainage. edema none discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr. on at 1:00 cardiologist: dr. on at 3:45pm pulmonary function test: date/time: 12:10 dr on at 12:30pm in medical specialties on 7 **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery left heart cardiac catheterization coronary arteriography using a single catheter (aorto)coronary bypass of one coronary artery central venous catheter placement with guidance diagnoses: other iatrogenic hypotension subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery tobacco use disorder urinary tract infection, site not specified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia cardiac complications, not elsewhere classified atrial fibrillation candidiasis of mouth other and unspecified hyperlipidemia ostium secundum type atrial septal defect blood in stool knee joint replacement other abnormal blood chemistry natural blood and blood products causing adverse effects in therapeutic use other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms candidal esophagitis 

Answer: The patient is high likely exposed to