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: patient recorded as having no known allergies to drugs attending: chief complaint: fatigue major surgical or invasive procedure: hemodialysis placement of temporary coronary sinus pacing wire placement of permanent pacemaker central venous intrajugular line femoral venous line for dialysis femoral venous sheath for pacing wire placement history of present illness: mrs. is an 84 year old female with history of cll, htn, lymphedema of le, atrial fibrillation, and hcv, who is sent in by her pcp for symptomatic bradycardia and creatinine elevation. the patient says that she first noted fatigue and weakness on , in addition to increase in her baseline shortness of breath. she denied chest pain. at that time she spoke with dr. , her pcp, scheduled her for an echocardiogram. she says that on the day prior to admission, while walking with a home physical therapist, she felt extremely weak and her pulse was found to be 40, with a bp of 85/40, per report from the patient. she came in for her scheduled echo on the day of admission and again felt lightheaded. her pulse was noted to be as low as the 30s at times, and she was sent to the ed. the patient denies recent medication changes, and says that her weight has been stable. additionally, the patient says that she has recently been treated for a uti with bactrim. she first noted difficulty urinating about 2 months prior to admission, at which time she had urgency, but decreased urine output. she was found to have a uti and treated with bacrim, however symptoms recurred recently and she was treated with a second course of abx which she just finished on the day prior to admission. she denies any increase in thirst, but she continues to have decreased urine output. denies fevers/chills, changes in urinary color, dysuria. in the ed her hr ranged in the 30s to 50s, with sbp 80-100. she was afebrile, with o2 sat 100% on ra. she recieved one dose of asa 325 mg, and a 500 cc bolus of ns, with 50 cc urine output. past medical history: 1) chronic lymphocytic leukemia 2) hypertension 3) paroxysmal atrial fibrillation, on amiodarone since . gets palpiations with atrial fibrillation though not consistently. had a holter in that did not demonstrate atrial fibrillation. 4) hepatitis c 5) irritable bowel syndrome 6) anxiety 7) status post cholecystectomy 8) status post hysterectomy social history: patient lives in senior apartment in with her husband. she denies any smoking history of alcohol use. family history: no family history of cad. physical exam: vs: 94.8, 89/27, 35, 14, 100% on ra gen: overweight russian speaking female, lying flat in bed, appearing comfortable and non-tachypneic. heent: moist mm. neck: jvp difficult to evaluate secondary to obesity. cor: rr, bradycardic, distant heart sounds. lungs: rales at bases b/l. abd: nabs, soft, nt/nd, non-palpable liver/spleen. extr: massive pitting edema b/l with hyperpigmentation, skin fissuring and thickening. pertinent results: wbc-9.9 hct-37.7 mcv-93 mch-29.8 mchc-32.2 rdw-15.6* plt ct-123* wbc-6.2 hct-30.2* mcv-95 mch-30.8 mchc-32.6 rdw-15.6* plt ct-96* wbc-13.0* hct-28.1* mcv-90 mch-29.7 mchc-32.9 rdw-15.6* plt ct-89* wbc-11.7* hct-31.3* mcv-90 mch-29.2 mchc-32.5 rdw-16.0* plt ct-89* wbc-10.1 hct-31.8* mcv-90 mch-29.4 mchc-32.8 rdw-15.3 plt ct-95* neuts-50 bands-3 lymphs-34 monos-9 eos-4 baso-0 atyps-0 metas-0 myelos-0 neuts-37.8* bands-0 lymphs-54.0* monos-4.4 eos-3.4 baso-0.4 atyps-0 metas-0 myelos-0 pt-12.4 ptt-29.9 inr(pt)-1.0 pt-12.3 ptt-32.8 inr(pt)-1.0 glucose-119* urean-69* creat-3.3*# na-140 k-5.5* cl-110* hco3-18* glucose-95 urean-29* creat-1.4* na-146* k-3.5 cl-105 hco3-35* urean-68* creat-3.8* k-5.5* alt-90* ast-67* ld(ldh)-265* ck(cpk)-31 alkphos-96 totbili-0.2 alt-80* ast-61* ld(ldh)-280* alkphos-68 totbili-0.6 probnp-3049* albumin-2.8* calcium-8.4 phos-2.9 mg-2.1 iron-31 caltibc-276 vitb12-639 folate-6.2 ferritn-251* trf-212 albumin-3.9 calcium-9.2 phos-4.5 mg-2.4 calcium-8.6 phos-3.0 mg-1.8 tsh-0.81 pth-58 06:35pm urine color-amber appear-clear sp -1.018 blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-mod urobiln-1 ph-5.0 leuks-neg rbc-205* wbc-6* bacteri-none yeast-none epi-<1 casthy-8* 11:15am urine color-dkamb appear-clear sp -1.010 blood-lge nitrite-pos protein-30 glucose-neg ketone-neg bilirub-sm urobiln-1 ph-5.0 leuks-neg rbc-66* wbc-0 bacteri-none yeast-none epi-<1 6:35 pm urine site: catheter **final report ** urine culture (final ): no growth. 8:56 am blood culture site: a line aerobic bottle (pending): anaerobic bottle (pending): 11:15 am urine site: catheter **final report ** urine culture (final ): no growth. echo : conclusions: 1. the left atrium is mildly dilated. the left atrium is elongated. the right atrium is moderately dilated. 2. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). 3. right ventricular chamber size is normal. right ventricular systolic function is normal. 4.the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. 5. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. 6. there is no pericardial effusion. cxr : impression: no acute cardiopulmonary process. a follow-up pa and lateral set of radiographs might be helpful if there is continuing clinical concern for pneumonia. ekg : sinus bradycardia with top normal p-r interval of 200 milliseconds. non-specific qrs interval widening. left axis deviation. possible left anterior fascicular block. anteroseptal myocardial infarction. compared to the previous tracing of cardiac rhythm is now sinus mechanism. multiple other abnormalities as previously noted persist without major change. renal us : renal ultrasound: the right kidney measures 9.7 cm. the left kidney measures 9.7 cm. there is no evidence of stones, masses, or hydronephrosis. there is a foley catheter within the urinary bladder. the ureters are not dilated. impression: normal renal ultrasound. ekg : sinus bradycardia. compared to the previous tracing no major change. cxr : temporary transvenous femoral pacemaker terminates in the region of the tricuspid valve. left basilar subsegmental atelectasis versus early infiltrate. chf. cxr : impression: satisfactorily placed cardiac pacemaker. r hip x-ray : impression: no evidence of right hip fracture. ekg : atrial paced rhythm. intraventricular conduction delay - probable atypical left bundle branch block. consider prior anteroseptal myocardial infarction. clinical correlation is suggested. since previous tracing of , atrial pacing seen. cxr : impression: small bilateral pleural effusions with associated compressive atelectasis. no chf or pneumonia. brief hospital course: 84 year old female with history of cll, htn, lymphedema of le, atrial fibrillation, and hcv, who was sent in by her pcp for symptomatic bradycardia and creatinine elevation. in brief, she had an av pacer placed in house, with normalization of her blood pressure and renal function subsequently. she was started on epogen for her anemia, attributed to her chronic renal insufficiency, however she may not need this in the future. 1) bradycardia: the patient had a history of paf, and presented with symptomatic bradycardia, taken together likely representing sick sinus syndrome. however, the patient was on amiodarone and a beta blocker, and given her renal failure on admission, she may have had impaired clearance of her bb, further contributing to her bradycardia. she was hypotensive to systolic of 80s on admission, however asymptomatic, and was therefore kept on the floors overnight with an attempt at bringing up her blood pressure with ivf, and awaiting clearance of the beta blocker. unfortunately the following morning she was becoming hypoxic from fluid overload, and her heart rate had not improved. the patient was therefore transferred to the ccu, where she was started on a dopamine drip with little resultant increase in blood pressure or heart rate. this refractoriness did not respond over several days, making beta blocker toxicity less likely as an etiology and indicating a likely underlying sinus node/conduction dysfunction. a temporary pacemaker was placed, followed by a permanent pacemaker (ddi at 75 bpm). post-procedure she had an episode of afib, which was also complicated by a pacemaker sensing error and wide complex tachycardia from pacing. given her paf, she was restarted on coumadin for anticoagulation, which she should continue for the time being. if she is found to be in sinus rhythm and stays that way for a prolonged period of time, her pcp and dr. can considering stopping the coumadin, as the patient is reluctant to be on it again. she was restarted on her amiodarone, as well as the atenolol, both at her outpatient doses. she remained atrial paced during the admission, however her pacer does not guarantee that she will not go into paroxysmal a-fib. 2) pump: her echo on admission showed normal ef, however it may actually be lower given her mr. she had massive le edema, with chronic changes, however this did improve significantly during the hospitalization, implying that she was volume overloaded on admission. the patient was hypotensive even on the dopamine (although this was likely inability to increase the heart rate), and was given large amounts of fluids to maintain her bp while in the ccu. post-ppm placement, she was felt to be fluid overloaded with sat's decreasing occasionally into the low 90s, and was given multiple doses of 40-80 mg iv lasix. shortly after pacer placement she began auto-diuresing (polyuric phase atn--see below) and became quite negative (4.6l urine output on ). however, on transfer to she remained fluid overloaded by exam and cxr and therefore received 1 more dose of iv lasix prior to being switched over to her usual daily dose of 40 mg po bid, which she will be discharged on. she had an oxygen saturation of 98% on ra on the day of discharge, and did not desaturate with ambulation. 3) ischemia: not an active issue during this hospitalization. she had no enzyme elevation, no chest pain, echo without evidence of ischemic changes. she was continued on asa 81 mg daily. 4) acute renal failure: her creatinine had increased from 1.8 in to 3.3 on admission, most likely in the setting of decreased renal perfusion from hypotensive bradycardia. on transfer to the ccu, she was in frank oliguric atn and over the next couple of days required hemodialysis once due to concerns of increasing acidosis and hypervolemia. upon pacemaker placement, her urine output improved and her creatinine decrease back to around her baseline of 1.6 - 1.8. she continued to have satisfactory urine output on the floors, with creatinine decreasing to 1.4 on the day of discharge. given that her kidney has just recovered, she was sent home on half of her usual dose of lisinopril (20 mg daily) - additionally, her blood pressure was well controlled on the lower dose. 5) thrombocytopenia: stably low platelets in the setting of cll. hit ab was sent, which was negative. 6) anemia: the patient was anemic throughout the hospitalization, with hct ranging around 30. this was felt secondary to her chronic renal insufficiency, and she was therefore started on epogen by the renal team. given that her renal function has improved markedly since her pacer placement, to 1.4 which is better than it has been in over a year, she may not continue to require epogen. she will have her hematocrit checked by dr. when he sees her in clinic, and monthly thereafter while she remains on the epogen. 7) r hip pain: the patient complained of r hip pain with weight bearing, however there was no tenderness on palpation of the region, and a hip x-ray was negative for fracture. it is unclear what is causing this hip pain, however she was able to ambulate with physical therapy. she is encouraged to take advil sparingly for this pain, as needed. medications on admission: acetaminophen 500mg--2 capsules four times a day as needed amiodarone hcl 200mg--3 tabs every day x 14 days then one tablet every day amlodipine besylate 10mg--one tablet every day aspirin 81mg--one tablet every day atenolol 25 mg--one tablet in morning, tablet in evening celebrex 200mg--one by mouth q day celexa 40mg--one tablet every morning clonazepam 2mg--one tablet at bedtime fluocinonide 0.05%--apply 1-2 times daily to legs furosemide 40mg--one tablet twice a day hyoscyamine sulfate 0.125mg--one tablet as needed isosorbide mononitrate 60 mg--1 tablet(s) by mouth every morning incontinence liner --use as directed for incontinence lisinopril 40 mg--one tablet every day prilosec 20 mg--one daily outside md protonix 40mg--one a day serax 10mg--one daily as needed for nerves spironolactone 25mg--one tablet every day discharge medications: 1. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 2. amiodarone hcl 200 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 4. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. hyoscyamine sulfate 0.125 mg tablet sig: one (1) tablet po qid (4 times a day) as needed for bladder spasm. 6. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. isosorbide mononitrate 60 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). 8. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 9. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 10. amlodipine besylate 10 mg tablet sig: one (1) tablet po once a day. 11. coumadin 2.5 mg tablet sig: two (2) tablet po once a day: the coumadin clinic will change your dose according to your blood tests. disp:*60 tablet(s)* refills:*2* 12. atenolol 25 mg tablet sig: one (1) tablet po see below: take one tablet in the morning, tablet in the evening. disp:*45 tablet(s)* refills:*2* 13. epogen 3,000 unit/ml solution sig: one (1) ml injection once a week. disp:*8 syringes filled* refills:*2* 14. oxazepam 10 mg capsule sig: one (1) capsule po hs (at bedtime) as needed. discharge disposition: home with service facility: , discharge diagnosis: sick sinus syndrome acute on chronic renal failure requiring dialysis hypotension secondary to bradycardia urinary tract infection anemia secondary to chronic renal failure discharge condition: good discharge instructions: you have the appointments below, with dr. (nephrology), dr. for your heart, and dr. . we have started two new medications. one is called coumadin, which you have been on in the past. you will need to follow up in coumadin clinic to have your blood drawn every few days in the beginning, and then less frequently once you are on a stable dose of coumadin. the other new medication is called epogen, which is a subcutaneous injection once a week. the home health aid will help you with this, and dr. , the kidney doctor, will check your blood when he sees you at the appointment listed below. this medication will help to keep your blood level up. we have also decreased your lisinopril dose to 20 mg daily (you were on 40). otherwise, resume all of your previous medications, including lasix 40 mg twice a day, and amiodarone 200 mg once a day. followup instructions: provider: clinic where: cardiac services phone: date/time: 3:00 provider: , md where: phone: date/time: 9:40 a.m. provider: , m.d. where: medical specialties phone: date/time: 3:30 provider: , m.d. where: cardiac services phone: date/time: 1:45 provider: , m.d. where: center phone: date/time: 2:00 procedure: venous catheterization, not elsewhere classified hemodialysis venous catheterization for renal dialysis initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle insertion of temporary transvenous pacemaker system infusion of vasopressor agent diagnoses: anemia in chronic kidney disease acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified unspecified viral hepatitis c without hepatic coma atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease pain in joint, pelvic region and thigh acute diastolic heart failure sinoatrial node dysfunction other specified hypotension chronic lymphoid leukemia, without mention of having achieved remission 

Answer: The patient is high likely exposed to