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: penicillins attending: chief complaint: dyspnea on exertion, r shoulder pain major surgical or invasive procedure: none history of present illness: 66-year-old woman with history of dm2, htn, hl p/w dyspnea on exertion for the past few weeks. she also reports right shoulder pain that occurs at times on exertion and at times at rest. she had one episode of nausea and nonbloody vomiting this morning, . she denies any diaphoresis, substernal chest pain. she saw her pcp for the r shoulder pain, was thought to have msk pain and prescribed ibuprofen. earlier today, with persistent r shoulder pain and dyspnea on exertion, she represented to her pcp's office, was seen by a different doctor, and was advised to come to the ed. . she reports intermittent constipation. denies any melena, brbpr, hematemesis, hemoptysis. her most recent colonoscopy was in , revealing grade 1 internal hemorrhoids but no other pathology. . in the ed, t 98.2, p 98, bp 131/94, rr 17, o2 sat 100%ra. on exam she was pale, with negative guaiac. patient was found to have hct of 14.4 with mcv 53. ce neg x 1; ecg showed lateral st depressions that were unchanged from prior. cxr was unremarkable. she was started on her first unit of prbcs and admitted to micu for further management. . on arrival, patient was awake, alert, with stable vitals. past medical history: dm2 htn hl social history: no smoking, drinking, or drug use. retired. family history: daughter and sister have "anemia" but only during pregnancies. no other family history. physical exam: vitals: t: bp: p: r: 18 o2: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not well visualized due to body habitus lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly msk: shoulders with from, motor strength, no tenderness ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs on admission and discharge: 04:25pm blood wbc-16.1* rbc-2.70*# hgb-3.8*# hct-14.4*# mcv-53*# mch-14.3*# mchc-26.7*# rdw-20.1* plt ct-404# 04:35am blood wbc-16.2* rbc-3.71*# hgb-8.2*# hct-24.7*# mcv-67*# mch-22.1*# mchc-33.1# rdw-27.3* plt ct-331 06:45am blood wbc-14.3* rbc-3.95* hgb-9.3* hct-28.2* mcv-71* mch-23.4* mchc-32.9 rdw-29.2* plt ct-301 04:25pm blood neuts-86* bands-0 lymphs-12* monos-2 eos-0 baso-0 atyps-0 metas-0 myelos-0 . 04:25pm blood pt-15.0* inr(pt)-1.3* 06:45am blood pt-15.2* ptt-36.6* inr(pt)-1.3* . 04:25pm blood glucose-198* urean-22* creat-1.0 na-127* k-3.9 cl-91* hco3-22 angap-18 06:45am blood glucose-113* urean-8 creat-0.8 na-138 k-4.2 cl-104 hco3-27 angap-11 . 04:25pm blood alt-37 ast-36 ld(ldh)-196 ck(cpk)-99 alkphos-65 totbili-0.5 . 04:35am blood ck(cpk)-104 05:25pm blood ck(cpk)-84 02:29am blood ck(cpk)-71 08:31am blood ck(cpk)-90 04:25pm blood ctropnt-<0.01 04:35am blood ck-mb-3 ctropnt-<0.01 05:25pm blood ck-mb-notdone ctropnt-<0.01 02:29am blood ck-mb-notdone ctropnt-<0.01 08:31am blood ctropnt-<0.01 . 05:35am blood probnp-980* . 04:25pm blood iron-9* 04:25pm blood caltibc-527* hapto-109 ferritn-4.9* trf-405* 05:25pm blood tsh-3.0 05:25pm blood free t4-1.3 07:45am blood ttg-iga-3 . 03:52am urine rbc-0-2 wbc-* bacteri-few yeast-none epi-0-2 03:52am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-1 ph-6.5 leuks-mod 03:52am urine color-yellow appear-clear sp -1.021 . 08:37am urine rbc->50 wbc- bacteri-few yeast-mod epi-<1 08:37am urine blood-lg nitrite-pos protein->300 glucose-neg ketone-15 bilirub-lg urobiln-4* ph-7.0 leuks-lg 08:37am urine color-red appear-cloudy sp -1.015 . microbiology: bcx - negative ucx - mixed flora stool cx - negative for o&p. . cxr on admission: .impression: low lung volumes. mild cardiomegaly. no acute cardiopulmonary abnormality. . cxr : impression: 1. unchanged right pleural effusion. 2. mild volume overload. . echo : . the left atrium is dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. there is an anterior space which most likely represents a fat pad. . impression: mild symmetric lvh. normal global and regional biventricular systolic function. moderate mitral and tricuspid regurgitation. moderate pulmonary artery systolic hypertension . lenis: . bilateral lower extremity ultrasound: echogenic focus in the periphery of the right common femoral vein spanning 1.7 cm demonstrating normal surrounding flow represents nonocclusive dvt. the right and left common femoral, superficial femoral, and popliteal veins demonstrate normal compressibility, waveforms, augmentation, and flow. the calf veins are unremarkable bilaterally. . impression: nonocclusive residual thrombus in the right common femoral vein . cta chest : . impression: 1. no evidence of pe. 2. 4 mm right pulmonary nodule should be followed in one year to document stability if there are risk factors such as smoking or primary malignancy, otherwise no followup is necessary. . ct abdomen/pelvis: . impression: 1. small amount if fluid in the pelvis aadjacent ot he bladder. there is a small locule of gas in the nondependent portion of the bladder and would recommend correlation with prior instrumentation. 2. multiple non-pathologically enlarged lymph nodes seen in the periaortic, pericaval and periportal regions. two calcified nodes seen in the mesentery which may be related to prior granulomatous disease or treated lymphoma if clinical history is supportive. 3. small bilateral pleural effusions with bibasilar dependent atlectatic changes. 4. cholelithiasis without cholecystitis. 5. calcified degenerated fibroid in the uterus. 6. bilateral pars defects at l4. . egd : . minimal erythema in the antrum compatible with mild gastritis, otherwise normal egd to third part of the duodenum . colonoscopy : . diverticulosis of the rectum, otherwise normal colonoscopy to cecum brief hospital course: 60-year-old woman with dm2, htn, hl p/w dyspnea on exertion, right shoulder pain, and hct 13, now know to be due to severe fe defficiency anemia, etiology under investigation, whose course was c/b pea arrest of unclear etiology, and patient found to have a dvt, with cta negative for pe. patient had undergone ct of abdomen/pelvis in search of a possible malignancy leading to the anemia, which was negative for gross abnormality to account for the anemia. finally patient had undergone an egd and colonoscopy (see below for results). . # anemia: admission hct 13 and mcv 53, fe/tf were very low, with high tibc and impaired retic count, all consistent with fe deficiency aneamia. hct ipmroved s/p 5u prbcs, hct ranged 26 - 29. this anemia was felt to be chronic in nature. there was no evidence of hemolysis. ddx included gib and/or thalassemia. her doe improved with transfusion (see complications below). peripheral smear with reactive pmns and multiple morphologies or rbcs (see pertinent results). patient was treated empirically with iv ppi until gib couldbe ruled out. given anemia and dvt (see below), she underwent a ct abdomen/pelvis in search of cancer source. this did not reveal an obvious malignant source (see pertinent results). ct chest showed one 4mm nodule in the rml. this should be followed with a serial ct. patient finally underwent an egd which showed minimal erythema in the antrum compatible with mild gastritis, otherwise normal egd to third part of the duodenum. colonoscopy showed diverticulosis of the rectum, otherwise normal colonoscopy to cecum. . she was started on oral fe, 325mg with a bowel regimen which she tolearted well. her hb electrophoresis was pending at time of discharge. she was arranged follow up with hematology as outpatient for further management and investigation. . # doe/chf/pulmonary hypertension: was felt to be from severe anemia, in combination of pulmonary hypertension. doe improved significantly with transfusions. she had a stable o2 sat and on echo was noted to have ef 65%, lvh, and 2+mr and 2+tr as well as pulmonary hypertension (50-60mmhg). there was some evidence of vascular congestion and mild pulmonary edema on cxr. (? outpatient osa w/up). has dm, htn, hl, no hx of mi, but has sx of hf even prior to this presentation, romi completed. has small pleural effusions, which were felt to be contributing to doe. on hd#3, patient was found to be dyspneic, with increased wob, oxygen requirement. following this, patient developed pea arrest (see below). she was transferred back to micu, where she was treated for flash pulmonary edema intubated x 12hrs. trali was considered, however the event occured over 16 hours after completion of last transfusion, thus making trali very unlikely. she was subsequently extubated and transferrred back to the medical floor on hd#4. she was found to be in mild chf and diuresed with a total of 80mg iv lasix. with this treatment, her doe improved significantly, rr decreased from 30s on admission to 18 and she remained free of oxygen requirement after transfer from the micu. she was restarted on bb, and ace-i. she will require outpatient evaluation for pulmonary hypertension (osa evaluation and possibly a r heart catheterization based on initial studies). . # dvt. lle dvt. her only identifiable risk factor is hospitalization with decreased mobility. there was no pe on the cta. she was started on heparin gtt and transitioned to lovenox. her cancer work up was performed as noted above. her prior colonoscopy in was negative. she had a negative mammogram in , no paps in system. see above for egd and colonoscopy results. she will require transition on lovenox to coumadin with eventual treatment of 6 months and outpatient hypercoagulable w/up if dvt recurs. she will require updated mammogram and pap smear. . # pea arrest. etiology unclear. was in junctional rhythm and bradycardic, w/o a palpable pulse at time of assessment with heart rate in 40s. there were no metabolic derangements. no pe. the most plausible theory was that patient may have developed flash pulmonary edema in setting of 5 u prbcs, with subsequent hypoxemia leading to above cardiac findings. she completed romi (3 sets of enzymes) x2 over course of hospital stay. . # leukocytosis, pmn predominant, reactive on smear. the only infectious source was a positive ua w/ sx of uti, thus patient was treated with ciprofloxacin for 3 days. it is also possible that leucocytosis was a reactive process due to severe anemia. no overt evidence of other infection was noted. her blood cultures were negative at time of discharge. . # hematuria. improved with irrigation to pink urine. likely due to anticoagulation and traumatic foley as patients ua was negative for rbcs on admission. given hx of anemia, plus the appearance of her bladder on ct scan, she will require outpatient evaluation with cystoscopy. . # dm2: patient had fasting hypoglycemia in am, thus her lantus was decreased to 50u qhs. her metoformin was held while inpatient and she was restarted on home regimen prior to discharge. medications on admission: fluticasone - 50 mcg spray, suspension - 2 spray nasally daily hydrochlorothiazide - 25 mg tablet - 1 tablet(s) by mouth daily ibuprofen - 600 mg tablet - 1 tablet(s) by mouth every 6 hours take the medication with food. insulin glargine - 100 unit/ml solution - 70 units sc (pt increased) in am (cared for at clinic) metformin - 850 mg tablet - 1 tablet(s) by mouth twice a day with meals metoprolol tartrate - 25 mg tablet - 1 tablet(s) by mouth twice a day moexipril - 15 mg tablet - 1 tablet(s) by mouth twice a day - no substitution pravastatin - 40 mg tablet - 1 tablet(s) by mouth daily aspirin - 325 mg tablet - 1 tablet(s) by mouth daily calcium citrate-vitamin d3 - 315 mg-200 unit tablet - 2 (two) tablet(s) by mouth twice a day dextromethorphan-guaifenesin - 600 mg-30 mg tablet sustained release 12 hr - 1 tablet(s) by mouth twice a day ketotifen fumarate - 0.025 % drops - one drop topical ou loratadine - 10 mg tablet - 1 (one) tablet(s) by mouth once a day multivitamin - tablet - 1 (one) tablet(s) by mouth once a day omeprazole magnesium - 20 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth twice a day discharge medications: 1. insulin glargine 100 unit/ml solution sig: fifty (50) units subcutaneous at bedtime. 2. insulin lispro 100 unit/ml solution sig: as per sliding scale subcutaneous three times a day. 3. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 4. calcium citrate + d 315-200 mg-unit tablet sig: two (2) tablet po twice a day. 5. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). 6. metformin 850 mg tablet sig: one (1) tablet po twice a day: with meals. 7. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day. disp:*90 tablet(s)* refills:*2* 8. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*0* 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 10. zaditor 0.025 % drops sig: one (1) ophthalmic (2 times a day). disp:*1 bottle* refills:*2* 11. moexipril 15 mg tablet sig: one (1) tablet po twice a day. 12. enoxaparin 100 mg/ml syringe sig: one hundred (100) mg subcutaneous q12h (every 12 hours). disp:*6000 mg* refills:*2* 13. metoprolol succinate 50 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po once a day. disp:*90 tablet sustained release 24 hr(s)* refills:*2* 14. prevacid 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 15. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. 16. coumadin 2 mg tablet sig: 2.5 tablets po once a day. disp:*75 tablet(s)* refills:*2* 17. acetaminophen 500 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 18. outpatient lab work cbc, ptt/pt/inr, please obtain and forward results to: name: , location: address: , , phone: fax: discharge disposition: home with service facility: uphams corner home care discharge diagnosis: primary: iron deficiency anemia, source unclear; s/p pea arrest secondary: htn, hl, dm discharge condition: stable discharge instructions: you were admitted to with anemia, shortness of breath and fatigue. this was found to be an iron defficiency anemia. for this you received blood transfusions. with this treatment your symptoms improved significantly. however, your course was complicated by pulseless electrical activity arrest (requireing chest compressions). this was of unclear source. you were treated for this in the intensive care unit and recovered well. in addition, you were found to have a vein clot (dvt, deep venous thrombosis), but no lung clots. for this you were treated with blood thinners. you also underwent a cat scan of your abdomen/pelvis to look for the source of the clot, this showed no evidence of overt cancer, however did show some stranding around your bladder. because of this and blood in your urine, you will require outpatient evaluation with cystoscopy. it is unclear what is causing your anemia at this time. preliminary tests have been negative. you also underwent a colonoscopy and upper endoscopy which were both negative. you will also need a follow up of anemia with a gastroenterologist and a hematology specialist as outpatient. these appointments have been arranged for you. you have also been arranged for a capsule endoscopy (a study of your intestine), this has been arranged for you (see below). in addition, you had undergone an echocardiogram of your heart to evalute shortness of breath. this found that your heart had a normal pumping function, but you also had pulmonary hypertension. you will require follow up iwth your primary care doctor for this. you were discharged home in stable condition. the following changes were made to your medications: - aspirin was discontinued - dextromethorphan was discontinued - ibuprofen was discontinued - metoprolol was increased - iron tablets started two times daily - senna and colace started for constipation - lovenox injections for your blood clot. - coumadin for you blood clots. should you develop worsening shortness of breath, chest pain, fatigue, fevers, chills or any other symptom concerning to you, please call your primary care doctor or go to the nearest emergency room. followup instructions: md: dr. specialty: internal medicine date and time: tuesday at 8:30 am location: , ma phone number: ( appointment #2 md: dr. specialty: hematology date and time: friday at 11:00 am location: building phone number: ( please follow up with dr. , at 2.30pm, please call to confirm your appointment. please to , . provider: mammogram phone: date/time: 1:15 please attend at capsule endoscopy study at , please arrive by 7.45am, please 4 in . this must be authorized by your pcp and your insurance company. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other endoscopy of small intestine insertion of endotracheal tube colonoscopy cardiopulmonary resuscitation, not otherwise specified diagnoses: mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia acute on chronic diastolic heart failure other chronic pulmonary heart diseases other and unspecified hyperlipidemia cardiac arrest iron deficiency anemia, unspecified obesity, unspecified gross hematuria pulmonary congestion and hypostasis leukocytosis, unspecified pain in joint, shoulder region other respiratory abnormalities acute venous embolism and thrombosis of deep vessels of distal lower extremity 

Answer: The patient is high likely exposed to