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: azithromycin attending: chief complaint: pericardial effusion major surgical or invasive procedure: 1. pericardiocentesis 2. thoracentesis history of present illness: 67 yo female with history of left breast cancer and pericardial effusion in who presented to the ccu s/p pericardiocentesis for pericardial effusion with tamponade physiology. . approximately two weeks ago, she reports feeling sore ribs in her back and pain with deeping breathing. she went to see her pcp . who felt this was most likely a viral infection given normal cbc and cxr. he recommended one week of tylenol. she reports a large stressor after seeing her estranged sister at a family party on saturday. on monday, her fever persisted so levaquin was started with concern for cap. her fever continued and a cta was obtained on wednesday which revealed an effusion but no pe. she reported to the ed on thursday. upon arrival, bedside echo revealed a large pericardial effusion without tamponade. repeat tte this morning revealed a larger effusion and impaired ventricular filling with rv collapse. patient is asymptomatic. pulsus was 30 so she proceeded with pericardiocentesis this afternoon. vitals this morning are 105/73 105 92% on ra. sbp was 120 when doing pulsus. she received 1l of ivf at 200/hr prior to the procedure. . on review of systems, she notes fever, dry cough, and nausea but denies vomiting, abdominal pain, diarrhea, dysuria, urinary incontinence, sinus tenderness or rash. she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, hemoptysis, black stools or red stools. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, syncope or presyncope. she reports palpitations and a sore chest. . pericardiocentesis removed 520cc of bloody fluid. echo done after the procedure revealed a thick pericardium but no residual effusion. pericardial pressures were high initially at 15 but then resolved. right atrial pressures were also elevated and decreased but were still high at the end of the procedure. currently, the patient feels sore and fatigued. past medical history: 1. breast cancer dx in (8mm grade iii infiltrating ductal cancer, five positive lymph nodes, er negative, her-2/neu negative, negative lvi) s/p cytoxan, adriamycin followed by taxol and xrt 2. "labile htn" social history: pt lives in . not married. no children. one wine a night though not recently with chemo. no smoking. no drugs. pt hosts a talk show on public assess television about health care. former stock broker. family history: mother with breast cancer physical exam: admission exam general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 5 cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. drain site is c/d/i. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: +bs, soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: wwp, no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ neuro: cn 2-12 intact discharge exam: vs: 98.3, 98.7, 117/77 (104-132/72-83), 88 (85-140), 95ra i/o: 420/200 + bm x 1 general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 5 cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. drain site is c/d/i, still with tenderness to palpation around site, but no erythema lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi, decreased breath sounds at bases bilaterally. abdomen: +bs, soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: wwp, no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ neuro: cn 2-12 intact pertinent results: admission labs: 11:45am wbc-8.8 rbc-3.78* hgb-11.6* hct-35.2* mcv-93 mch-30.7 mchc-33.0 rdw-12.2 11:45am neuts-84.6* lymphs-9.9* monos-5.1 eos-0.2 basos-0.1 11:45am glucose-114* urea n-17 creat-0.9 sodium-141 potassium-3.9 chloride-101 total co2-27 anion gap-17 11:45am calcium-9.1 phosphate-3.2 magnesium-2.3 . pertinent labs: 11:45am blood probnp-590* 11:45am blood ctropnt-<0.01 11:45am blood d-dimer-3006* 03:09pm blood crp-144.2* 03:09pm blood esr-104* . discharge labs: 05:40am blood wbc-8.3 rbc-3.56* hgb-11.0* hct-33.2* mcv-94 mch-31.0 mchc-33.1 rdw-12.2 plt ct-518* 05:40am blood pt-12.5 inr(pt)-1.1 05:40am blood glucose-107* urean-14 creat-0.6 na-142 k-4.2 cl-106 hco3-27 angap-13 05:40am blood calcium-8.5 phos-3.3 mg-2.2 . chest ct 1. since and , a simple pericardial effusion has increased, now moderate to large in size. tamponade is not excluded on this study. 2. moderate-sized left pleural effusion, increased since , , but decreased since . small right effusion and atelectasis. 3. no findings suggestive of pneumonia. 4. radiation fibrotic changes in the left upper lobe. . cta impression: 1. no pulmonary embolism. 2. moderate-sized left pleural effusion, trace right pleural effusion, and large pericardial effusion are unchanged since the chest ct performed yesterday. . echo the estimated right atrial pressure is at least 15 mmhg. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef 60%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is a large pericardial effusion. the effusion appears circumferential. there are no echocardiographic signs of tamponade. no right atrial or right ventricular diastolic collapse is seen. . echo impression: large circumferential pericardial effusion with echocardiographic signs of impaired ventricular filling. compared with the prior study (images reviewed) of , there is evidence of impaired ventricular filling. . echo: overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , the findings are similar. . echo: the estimated right atrial pressure is 0-5 mmhg. overall left ventricular systolic function is normal (lvef>55%). the aortic valve leaflets appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. impression: versy small residual pericardial effusion without echocardiographic signs of tamponade. compared with the prior study (images reviewed) of the findings are similar pericardial and pleural fluid were negative for malignant cells brief hospital course: 67 yo female with history of breast cancer and prior pericardial effusion in who presents to with large pericardial effusion and tamponade after two weeks of fever and viral illness. . # large pericardial effusion with tamponade: the patient presented with a large pericardial effusion with evidence of rv diastolic collapse. she has a history of prior transient pericardial effusion, likely from a viral etiology. the patient ins now s/p pericardiocentesis, tapped ~500cc of bloody fluid, which was found to be exudative. when the patient's output from the drain slowed down, the drain was pulled. a repeat tte done after pulling the pericardial drain showed that there was no significant re-accumulation of pericardial effusion. unclear etiology of pericardial effusion, but differential includes viral pericarditis, idiopathic, radiation therapy-related, or malignancy induced. . upon discharge, the patient was also started on colchicine 0.6 mg and ibuprofen for anti inflammatory effects. she was instructed to take the colchicine for a total of three months, and the ibuprofen for a total of one month. she was also told to take omeprazole daily while on the ibuprofen. the patient was also instructed to get an echocardiogram of the heart two weeks after discharge. this was also communicated with her primary care doctor. pericardial and pleural fluid were negative for malignant cells . # atrial fibrillation: after the placement of the pericardial drain, the patient had a few isolated episodes of atrial fibrillation, that all self-resolved. one of these episodes was while having a bowel movement. it is likely that these episodes are secondary to pericardial irritation from the drain. the patient's home metoprolol was uptitrated to 100 mg daily and upon discharge her rates were well controlled and she was in normal sinus. the patient was also discharged on a baby asa daily. her chads score is 1 and the patient was not discharged on anticoagulation. however, this should be followed up as an outpatient. . # pleural effusion: the patient has evidence of pleural effusion on cxr and echo. she is s/p thoracentesis , taking off ~600cc of blood tinged, clear pleural fluid. fluid was sent for analysis, including cytology. . # fever: patient febrile to 101.7 after placement of pericardial drain. she never had a white count, and fevers have resolved, and she is currently afebrile. moreover, patient denied any infectious symptoms besides dry cough and because of this, no antibiotics were started; upon discharge, the all blood cultures were no growth to date and the patient remained afebrile. . # hypertension: the patient was prescribed metoprolol succ 12.5mg po bid per omr, and 25 mg per patient. the patient's pressures were well controlled while in the ccu, and her metoprolol was uptitrated because of her elevated heart rates. ... transitional: - please make sure that your pcp schedules an echo for you in two weeks. - please follow up paroxysmal atrial fibrillation as an outpatient with cardiologist; the patient was started on daily asa 81. - the patient still has cytology on pleural and pericardial fluid pending; will need to be followed up as an outpatient; if positive for malignacny, the patient will have to follow up with oncology. medications on admission: -metoprolol succinate 12.5mg -levofloxacin 500 mg tablet daily since monday -no vitamins or supplements. discharge medications: 1. ibuprofen 600 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 1 months. disp:*90 tablet(s)* refills:*0* 2. colchicine 0.6 mg tablet sig: one (1) tablet po bid (2 times a day) for 3 months. disp:*60 tablet(s)* refills:*0* 3. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. disp:*30 tablet extended release 24 hr(s)* refills:*0* 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day for 1 months: please stop this medication at the end of your course of ibuprofen. disp:*30 capsule, delayed release(e.c.)(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: pericardial effusion pleural effusion paroxsymal atrial fibrillation secondary diagnosis: breast cancer viral infection discharge condition: level of consciousness: alert and interactive. activity status: ambulatory - independent. mental status: clear and coherent. chest pain free. discharge instructions: dear ms. , it was a pleasure taking care of you while you were hospitalized at . you were admitted to the hospital because you were having some soreness with breathing, and echocardiogram of your heart showed that you had some fluid in the bag that is surrounding your heart. you underwent a procedure where a needle was inserted into this space and fluid was drained (pericardiocentesis). we left the drain in for a day, but once fluid stopped draining we pulled it. a repeat echocardiogram showed that the fluid did not reaccumulate. . you also had a lot of fluid in the space around your lungs on the left side. we did a similar procedure and inserted a needle into the area and drained about 600 cc of fluid from your lungs. we sent both the fluid from your lungs and heart to the laboratory for further analysis. .. after your procedure, you had some instances of elevated heart rates. we think that this happened because of some irritation that the fluid caused your heart. it has since stopped, but we think that there is a possibility that it will come and go. please follow this issue up with your outpatient cardiologist. we are sending you home on aspirin for this, but you can follow this up with your outpatient cardiologist and decide whether you want to continue this medication. .. it is very important that you see your primary care doctor, radiation oncologist, and cardiologist. you will need to get an echocardiogram of your heart in two weeks. please make sure that your primary care doctor orders this test for you. .. we made the following changes to your medications: -change metoprolol succinate to 100 mg daily -start colchicine 0.6mg by mouth twice daily for 3 months or as directed by your pcp (hold for diarrhea) -start ibuprofen 600mg by mouth three times daily for 1 month or as directed by your pcp (hold for upset stomach or gi bleeding) -start omeprazole 20 mg once a day while you are taking the ibuprofen -start aspirin 81 mg daily for atrial fibrillation . please follow-up with the appointments below. followup instructions: please attend the following appointments: department: when: friday at 1 pm with: , md building: (, ma) campus: off campus best parking: on street parking department: cardiac services when: friday at 1:20 pm with: , md building: campus: east best parking: garage department: dermatology and laser when: monday at 2:30 pm with: , md building: (, ma) campus: off campus best parking: free parking on site please schedule an appointment with dr. for within one month. procedure: coronary arteriography using a single catheter pericardiocentesis thoracentesis right heart cardiac catheterization diagnoses: unspecified pleural effusion unspecified essential hypertension atrial fibrillation personal history of malignant neoplasm of breast unspecified disease of pericardium other specified cardiac dysrhythmias cardiac tamponade 

Answer: The patient is high likely exposed to