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: gluten attending: chief complaint: pericardial tamponade major surgical or invasive procedure: pericardiocentesis history of present illness: events / history of presenting illness: 75 year old male with a history of iddm, htn and ckd with recent admission for lle cellulitis treated with augmentin (he has 4 days left on this course) who was seen in clinic for malaise and admitted based on his laboratory results (na of 129, anemia with hct of 29.4 and acute renal failure with cr of 3.2 from baseline of 2.0). . in the ed, vitals were: t:97.8, hr:102, bp:129/109, rr:20, o2sat:95% on ra. he was found to have a uti and was given unasyn. he was given 2l normal saline for his sodium of 126 and admitted to night float. . the patient reports he was in his usual state of health which includes walking daily until friday when he awoke from his nap and experienced shaking chills and whole chest, back and shoulder pain "in the muscles". he states that this improved after he was wrapped in several blankets. then saturday at 2 am, he awoke to check his blood glucose and noted whole chest, arm and back pain. he was unable to clarify this pain further other than to say it was unbearable. he states it was worse with movement, lying flat, and deep inspiration. he took tylenol and it resolved. he reports generalized fatigue, and decreased appetite. he developed nausea on monday prior to admission, and the day before admission felt unwell and saw his pcp. clinic he was felt to have a viral syndrome and was sent home with precautions. he recalled and admitted for lab abnormalities as above. . on morning assessment the patient was found to be in atrial fibrillation with rapid ventricular rate up to 150, hypotensive down to systolic 70s, temp 99.9, and respiratory distress 93% on 4lnc. the patient also endorsed pleuritic chest pain, similar to the pain he had no the saturday prior to admission. due to his clinical deterioration, the patient was transferred to the micu for further care. while in the micu the patient had a tte that showed a large pericardial effusion with evidence of tamponade (lvef 55%). he was taken for an urgent pericardiocentesis. he continued on a course of antibiotics for a uti. . in the cardiac cath lab he had 600 cc of clear pericardial fluid drained. on arrival to the ccu his chest pain was resolving and his breathing was improved. . ros: the patient denies any dyspnea, fevers, diarrhea, constipation ( bm ), vomiting, dysuria. he does report decreased amount of urine recently. he also endorses fatigue, malaise, poor appetite. no increased leg swelling, at baseline his left leg is swollen since a prior broken leg. he endorses dyspnea on exertion and exertional angina with walking up stairs quickly or walking carrying heavy bundles. the shortness of breath has been most notable over the past 3 days. past medical history: past medical history: iddm * 45 years hypercholesterolemia hypertension ckd, from acute phosphate nephropathy, baseline (2-2.4) anemia, attributed to ckd, on procrit, baseline hct 33-36 coronary artery disease s/p mi in ; negative ett- echo for ischemia in celiac sprue bph, bx negative, psa 4.5, 3.6, 4.5 thyroid nodule . cardiac risk factors: +diabetes, +dyslipidemia, +hypertension . cardiac history: none . percutaneous coronary intervention: with ptca of the mid rca and om2 . pacemaker/icd placed: none social history: born in , moved to us in . lives with his wife. former organic chemistry professor. he has never smoked. he does not consume alcohol on a regular basis (1 drink every 2-3 months). family history: none physical exam: vs: 98.5 128 95/66 29 91%10l pa 47/24 gen: wdwn elderly russian male in nad, resp or otherwise. oriented x3. mood, affect appropriate. pleasant. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp elevated cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no s4, no s3. chest: pericardial drain in place. no chest wall deformities, scoliosis or kyphosis. resp were unlabored. crackles at lateral bases abd: obese, soft, ntnd, no hsm or tenderness. no abdominal bruits. ext: no c/c/e. no femoral bruits. arterial and venous access in right groin. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp neuro: alert and oriented x3 moving all 4 extremities symmetrically pertinent results: 09:45pm wbc-8.8 rbc-3.15* hgb-9.9* hct-30.0* mcv-95 mch-31.5 mchc-33.1 rdw-13.4 09:45pm glucose-307* urea n-54* creat-3.9* sodium-126* potassium-4.8 chloride-90* total co2-22 anion gap-19 05:27am calcium-8.7 phosphate-3.8 magnesium-2.2 09:45pm pt-13.3 ptt-24.8 inr(pt)-1.1 09:45pm ck(cpk)-28* 09:45pm ck-mb-3 ctropnt-<0.01 08:44am blood ck(cpk)-21* 08:44am blood ck-mb-notdone ctropnt-<0.01 03:45pm pericardial fluid tot prot-5.0 glucose-349 ld(ldh)-369 amylase-25 albumin-2.9 03:45pm pericardial fluid wbc-2335* rbc-* polys-61* lymphs-14* monos-7* eos-2* mesotheli-6* macrophag-6* other-4* 3:45 pm fluid,other pericardial fluid. gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (preliminary): fungal culture (preliminary): no fungus isolated. pericardial fluid cytology: negative for malignant cells. 05:40am blood tsh-2.4 05:40am blood t4-8.3 free t4-1.7 04:37am blood -positive titer-1:80 04:37am blood rheufac-23* l leni : no evidence of left lower extremity dvt. l tib/fib xr: no radiographic evidence of osteomyelitis. cxr : dense left basilar opacity, with at least some component of pleural fluid, possibly also representing some pneumonic consolidation or atelectasis. ekg : atrial fibrillation with rapid ventricular response. low voltage in limb leads. non-specific inferolateral st-t wave changes. compared to the previous tracing of the rhythm is now atrial fibrillation. limb lead voltage is lower. clinical correlation is suggested. the precordial lead voltage is also lower. urine culture : no growth. brief hospital course: 75 yo m w/ iddm, ckd, htn, presented with malaise, respiratory failure and renal failure, found to have pericardial effusion, s/p pericardiocentesis, developed afib with rvr, pleural effusion. . # pericardial effusion: tte showed a large pericardial effusion with evidence of tamponade. he was taken to the cardiac cath lab for an urgent pericardiocentesis. approximately 600 cc of clear pericardial fluid was drained, resulting in improvement in his symptoms. the tap was traumatic, but the pericardial fluid was clear and non-bloody per report. cytology revealed no malignant cells. echo following pericardiocentesis showed decreased pericardial effusion and no signs of tamponade. the patient was monitored clinically and with repeat echocardiograms which demonstrated further decreases in the size of the pericardial effusion. the effusion was likely of viral etiology given his history of recent prodromal symptoms. less likely etiologies include malignancy (dysplastic nevi noted - r/o melanoma; has not been seen by a dermatologist in >10 years), vs. thyroid (tfts normal) vs. autoimmune (rf and neg) vs. dresslers (ce negative on admission with no known recent cardiac events) vs. uremic (cr bump likely not significant enough per renal). pt has scheduled outpatient follow up with cardiologist as well as dermatology. . # pleural effusion/respiratory failure/diastolic chf: on initial presentation, he was noted to be in respiratory distress and had a significant oxygen requirement. significant bilateral pleural effusions were noted on cxr and the patient was clinically noted to have bilateral crackles and le edema. he was diuresed, responding well to lasix 20 mg iv and then 40 mg po. his oxygen requirement gradually decreased. a pleural tap was considered but as pt subsequently with improvement on clinical exam and cxr, diuresis continued with continued improvement. on the final day of admission it was noted that the pt's oxygen sats were stable, but after diuresis the prior day the patient was mildly hypovolemic, with bp dropping to 80's systolic on standing. this was thought to be in part due to restarting his flomax the night before and also in part due to vigorous diuresis. the patient was not discharged on a standing dose of lasix, and instead was instructed to follow up with outpatient doctor in a week to determine whether standing lasix would be necessary. on discharge, patient with no home oxygen requirement; satting in high 90s at rest, desats to low 90s on ambulation. . # atrial fibrillation pt developed paroxysmal atrial fibrillation which converted to sinus rhythm either spontaneously or after administration of metoprolol 5-10 mg iv. however, as patient continued to have frequent episodes of a fib, amiodarone initiated. he was started on amiodarone on , with plans to give 400mg for 7 days, then 400mg qd for 7 days, and then 200mg qd. baseline tfts and lfts wnl. pt will need to have pfts checked as an outpatient. as he has a chads score of 4, patient was started on anticoagulation with coumadin with a goal inr of 1.8-2.5 as patient with recent pericardial tap and on amiodarone. clinic notified of goal inr. . # r tibial dvt: lenis showed thrombus in r tibial vein. lower leg dvt is not likely to result in significant thromboembolism, and given his acute on chronic renal failure, he probably would not tolerate a pe ct well, so no workup for possible pe was pursued. however, pt adequately treated as already on systemic anticoagulation for afib and asa for cad. . # acute on chronic renal failure: fena 0.1%, suggestive of prerenal etiology. likely poor forward flow in setting of volume overload/pericardial tamponade. urine output and cr improved with diuresis. . # cellulitis: keflex initially started for cellulitic area on left leg. however, this was discontinued as outside records showed that pt had already completed a 14 day course of augmentin. i&d was not indicated by physical exam. . # cad no evidence of acute ischemic event on ekg or cardiac enzymes (negative over 12 hours). patient continued on asa, statin, beta blocker. . # uti: pt originally admitted with a question of possible uti and treated with cipro, but as ucx was negative, this was discontinued. . # anemia: hct was stable. anemia is attributed to renal failure. fe stores appear replete. pt continued on procrit. . # dm - type i per records pt was treated with glargine and lispro sliding scale. due to high blood sugars, his glargine dosage was increased. pt should discuss with pcp whether clinic could help him improve his glycemic control. medications on admission: aspirin 325 mg daily isosorbide dinitrate 20 mg po tid (pt reports as 40mg am, and 20mg pm) metoprolol 12.5 mg po bid simvastatin 40 mg daily fluticasone nasal spray fluticasone-salmeterol 250/50 inh albuterol glargine 6 u subq daily lispro sliding scale montelukast 10 mg daily calcitriol 0.25 mg po daily sevelamer 400 mg po tid -- patient has not been taking this tamsulosin 0.4 mg daily mvi polysaccharide iron complex 150 mg capsule loratadine 10 mg daily augmentin 500/125 discharge medications: 1. epoetin alfa 10,000 unit/ml solution sig: one (1) injection every 2 weeks. 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal (2 times a day). 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) vial inhalation q6h (every 6 hours) as needed. 7. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 8. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 9. sevelamer hcl 400 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 10. multivitamin tablet sig: one (1) tablet po daily (daily). 11. polysaccharide iron complex 150 mg capsule sig: one (1) capsule po bid (2 times a day). 12. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day) for 2 days: last dose on . disp:*10 tablet(s)* refills:*0* 13. metoprolol succinate 50 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po daily (daily). disp:*45 tablet sustained release 24 hr(s)* refills:*0* 14. amiodarone 200 mg tablet sig: one (1) tablet po twice a day for 7 days: start on and continue for 7 days. . disp:*14 tablet(s)* refills:*0* 15. amiodarone 200 mg tablet sig: one (1) tablet po once a day: start on . disp:*30 tablet(s)* refills:*2* 16. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 17. loratadine 10 mg tablet sig: one (1) tablet po once a day. 18. lispro insulin please continue home sliding scale. 19. lantus 100 unit/ml cartridge sig: twelve (12) units subcutaneous once a day. 20. warfarin 3 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: family & services discharge diagnosis: primary: pericardial effusion acute on chronic diastolic dysfunction acute on chronic renal failure paroxysmal atrial fibrillation . secondary: anemia of chronic disease diabetes type i on insulin hypercholesterolemia hypertension coronary artery disease s/p mi in celiac sprue bph thyroid nodule discharge condition: stable discharge instructions: you had fluid around your heart called a pericardial effusion that was tapped and has not reaccumulated. you have fluid near the base of your lungs called pleural effusions. you were started on a diuretic which improved the effusions, it also helped to decrease the fluid in the rest of your body. you have atrial fibrillation, a new irregular heart beat, and you were started on amiodarone to control the rhythm and coumadin to prevent blood clots. the dose of amiodarone for the first 2 days that you are at home is 400mg twice daily, the dose of amiodarone after that will be 200mg twice daily for 1 week, the dose of amiodarone after that will be 200mg once daily continuously. you were noted to have a blood clot in your left calf and the coumadin should help to dissolve this. you were noted to have many moles on your skin and should follow up with dermatology. . you were started on the following new medications: - amiodarone - coumadin (dose adjusted by coumadin clinic) - lovenox (take until coumadin level therapeutic) the following medications were changed: - metoprolol 12.5 daily twice daily -> toprol xl 75 mg daily - glargine increased to 12 u daily the following medications were discontinued: - isosorbide dinitrate - augmentin please take all medications as prescribed. . please check your blood sugars before meals. . weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet so that you don't retain fluid. please use your teds stockings every day and keep your legs elevated when you are sitting down. . if you experience chest pain, worsening shortness of breath, weakness on one side of your body, difficulty speaking or swallowing, fever/chills, please call 911 or go to the er. followup instructions: you have the following appointments: primary care: provider: , : date/time: 8:10 provider: , m.d. date/time: 10:30 provider: , m.d. date/time: 2:10 please speak with your pcp about whether you may benefit from an appointment at the clinic () for better control of your blood sugars. . cardiology: provider: , m.d. phone: office will call you at home with appt. please follow up lasix dose which was used inpatient for diuresis. provider: , m.d. phone: date/time: 9:20 . clinic at : . they will call you to arrange follow-up of your coumadin levels. . dermatology: provider: . phone: ( date/time: at 1:45pm. procedure: coronary arteriography using a single catheter pericardiocentesis right heart cardiac catheterization diagnoses: hyperpotassemia anemia in chronic kidney disease pure hypercholesterolemia congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure chronic kidney disease, unspecified acute respiratory failure cellulitis and abscess of leg, except foot cardiogenic shock long-term (current) use of insulin celiac disease diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled acute venous embolism and thrombosis of deep vessels of distal lower extremity acute idiopathic pericarditis cardiac tamponade 

Answer: The patient is high likely exposed to