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: cephalexin / nsaids / phenergan / codeine attending: chief complaint: transferred from osh for stemi major surgical or invasive procedure: cardiac catheterization tee cardioversion pacemaker/defibrillator placement history of present illness: ms. is a 83 year old woman with a history of cad s/p cath with stent lcx and rca, esrd on hd for the past 5 weeks, hep b cirrhosis and copd who is transferred from and rehab center with stemi. . she was recently hospitalized at from to with left lower lobe pneumonia and esrd and started on hd. she was discharged to for treatment of her pneumonia. over the past week, she was noted to have increasing cough with white sputum production, bronchospasm, shortness of breath and orthopnea. she was treated with iv solumedrol and biaxin which was changed to prednisone 60 mg on . she was continued on levaquin and vancomycin and nebulizers. she was seen by pulmonary and they felt her wheeze and sob were due to chf rather than copd exacerbation. on they were unable to complete dialysis due to clotted access catheter. on she was started on 100 mg iv lasix and zaroxyln with good response. ecg done elevation in the inferior leads which were new compared to ecg from . ecg was repeated on and showed similar st elevation that was slightly decreased. ck was 115, ck-mb was 41 and tni was 14.88. she was transfered to the ed for further evaluation. of note her aspirin was discontinued one week prior to admission due to platelet count of . . in the ed the patient reported that she has been having chest pressure for several days. the pressure is worse with inspiration and expiration and worse with cough. she has had cough and shortness of breath for one month. she reported chest pain, radiating to her right shoulder. in the ed she received aspirin 325 mg, heparin 5000 bolus and 300 mg plavix. she was brought to the cath lab. . cath: findings notable for mod lmca calcification, lad mod calc with diffuse disease, lcx with non dom vessel, rca occ mid segment with l --> r collaterals, rca lesion dilated and then taxus stent x 5. . admitted to . . ros: reports 5/10 chest pain that is slightly better than prior to cath. worse with inspiration and expiration. she feels short of breath and feels like she has sputum that she cannot get up. she denies abdominal pain, diaphoresis, nausea, vomiting. feels her legs are restless. past medical history: 1. copd 2. hepatitis b cirrhosis 3. low back pain s/p laminectomy 4. chronic renal insufficency - baseline cr 2.9-3.3-> being followed by renal (dr. who feels this may be either hypertensive vascular disease or membranous glomerulonephritis secondary to hepatitis 5. rheumatoid arthritis 6. chronic renal insufficiency 7. recurrent urinary tract infections 8. right total knee replacement 9. anemia of chronic disease 10. coronary artery disease 11. hypothyroid 12. right orif of hip 13. depression 14. gout social history: lives with daughter family history: non contributory physical exam: pe: vs: t 96.8 hr 74 bp 123/55 rr 22 o2 sat 92-97% 2l gen: elderly woman, lying in bed flat, with some tachypnea and complaining of chest pain. heent: perrl, eomi, sclera anicteric, mmm. neck: jvp at 10 cm. no lymphadenopathy. lungs: crackles at left base with wheezes throughout. cv: regular, no murmurs, rubs or gallops appreciated. abd: soft, obese, non tender and non distended, active bowel sounds. ext: no edema, no rash. vascular: 2+ dp pulses. groin: no hematoma, no bruit, good pulse. neuro: alert and oriented. pertinent results: ecg: : sinus at 72 bpm, normal intervals. normal axis. 1mm ste in ii, iii, avf, (iii>ii) twi and st depressions i, avl, new since . . prior to cath: 1mm ste in ii, iii, avf, slightly improved. twi i, avl, st depressions i avl. . post cath: sinus 68 bpm. normal intervals and axis. ste ii, iii, avf, with twi and st depressions i and avl. . labs: see below, notable for elevated bun/cr, low plts, elevated mb/trop 01:40pm pt-11.6 ptt-32.8 inr(pt)-1.0 01:40pm plt smr-low plt count-93* 01:40pm hypochrom-normal anisocyt-2+ poikilocy-normal macrocyt-normal microcyt-normal polychrom-1+ schistocy-1+ 01:40pm neuts-93.3* bands-0 lymphs-3.1* monos-3.1 eos-0.2 basos-0.3 01:40pm wbc-6.8 rbc-4.54# hgb-14.7# hct-43.4# mcv-96 mch-32.4* mchc-33.9 rdw-15.9* 01:40pm calcium-8.9 phosphate-3.5 magnesium-2.1 01:40pm ck-mb-35* mb indx-31.0* ctropnt-5.12* 01:40pm ck(cpk)-113 01:40pm glucose-189* urea n-36* creat-4.1* sodium-138 potassium-4.6 chloride-97 total co2-26 anion gap-20 08:55pm pt-11.7 ptt-25.5 inr(pt)-1.0 08:55pm plt count-91* 08:55pm wbc-5.7 rbc-4.57 hgb-14.5 hct-43.0 mcv-94 mch-31.8 mchc-33.7 rdw-15.5 08:55pm albumin-3.9 08:55pm ck-mb-25* mb indx-24.0* ctropnt-5.25* 08:55pm alt(sgpt)-59* ast(sgot)-54* ld(ldh)-407* ck(cpk)-104 alk phos-117 tot bili-0.3 08:55pm glucose-154* urea n-44* creat-4.3* sodium-136 potassium-4.5 chloride-96 total co2-22 anion gap-23* 10:30pm plt count-81* 10:30pm ck-mb-notdone 10:30pm ck(cpk)-88 10:30pm potassium-4.3 11:01pm urine blood-mod nitrite-neg protein-500 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-sm 11:01pm urine color-yellow appear-cloudy sp -1.034 c.cath: comments: 1. selective coronary angiography showed a right dominant system with calcified lmca but no critical stenosis. lad had some moderate diffuse disease. lcx was a non-dominant vessel without critical lesions. rca was totally occluded through its mid-vessel course with some distal flow to the pda territory via l->r collaterals. 2. left ventriculography was deferred given cri. 3. hemodynamic assessment showed mildly elevated right-sided filling pressures consistent with volume overload. there was mild to moderate pulmonary hypertension. 4. the acute total occlusion of the mid rca was predilated with 1.5 x 6mm sprinter and 2.5 x 30mm maverick balloons, stented with 2.5 x 20mm, 3.0 x 20mm, 3.0 x 15mm and 3.5 x 32mm taxus stents and post dilated with 3.0 x 15mm nc ranger balloon with lesion reduction from 100% to 0%. the final angiomgram showed timi flow with no dissection and no embolisation. (see ptca comments) 5. r femoral arteriotomy site was closed with a 6fr angioseal. final diagnosis: 1. one vessel coronary artery disease. 2. normal ventricular function. 3 successful stenting of the mid rca lesion in the setting of an acute inferior stemi cxr: history: shortness of breath and cough. recent mi. please evaluate for chf versus pneumonia. ap upright and left lateral views of the chest show interval clearing of pleural effusion seen on the patient's prior portable study from . no focal consolidation is seen to suggest pneumonia and the pulmonary vasculature is not congested. moderate cardiomegaly appears stable and soft tissue mass at the right upper mediastinum has been shown to be vascular on previous cross sectional imaging studies. tunneled dialysis tubing is seen with distal tip at the level of the right atrium and the proximal tip at the level of the svc/right atrial junction. calcified atherosclerotic plaque is seen in the arch of the aorta. conclusion: no chf or pneumonia. echo: conclusions: the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50%) secondary to hypokinesis of the basal inferior wall. an apical intracavitary gradient is identified. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size is normal. right ventricular systolic function appears depressed. 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. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , inferobasal hypokinesis is now present. brief hospital course: 83 year old woman with history of cad, hep b cirrhosis, esrd on hd, recent pneumonia, s/p stmei with stent who developed post mi af. s?p dccv with brief stay in the ccu for observation. bradycardia concerning for sick sinus syndrome. . . 1. s/p stemi: patient experienced an st elevation mi. the patient tolerated catheterization well, and was pain free afterwards. she is s/p rca stents with continued ste on ecg, which gradually resolved, evolving into q waves. patient was started on usual post-mi care with asa, bb, statin, plavix, and aceis. patient does have diastolic , 50%. since diuresis would have been ineffective (patient has esrd), hd was used to take off fluid . c. rhythm: patient was in nsr post mi. on , she spontaneously converted to afib with rvr. she required iv diltiazem and iv lopressor to control her rate. she was also started on anti-coagulation with heparin and coumadin. the decision was made to cardiover the patient. s/p dccv, in sinus, cont to hold bb to observe rate for 24 hrs. patient then became bradycardic to 40s, and was transferred to ccu with a temp pacing wire. tee showed: no evidence for intracardiac ( and in particular left atrial )thrombus. severely hypokinetic right ventricle. hr stable in the ccu, but did have one episode of atrial tachycardia, ?wandering pacemaker, followed by a pause, junctional escape rhythm and return of sinus rythym. tolerated full course of hd prior to transfer. transferred back to for monitoring and placement. pt felt ok. has some difficulty breathing, + cough but unable to get much up. she developed a small left forarm bleed from an iv. then, the decision was made in consult with ep to place a ddd pacemaker. pt was given 2 doses of vancomycin pre and post-procedure. the procedure was w/o complications. post-pacemaker, the patient's hr alternated between 60s (paced) and 100s (afib). bb blocker was adusted to control hr. the patient has an appointment to follow up in device clinic. . 2. esrd on hd: renal consult was called, hd was initiated. initially had some difficulty due to hypotension associated with atrial fibrillation. post dccv+pacemaker placement, the patient tolerated hd ok. the patient is to have hemodialysis while at rehab on a schedule of hd mwf. all meds were renally dosed, and the patient was continued on sevelamer, and nephrocaps. patient needs her eletctrolytes to be checked 3 times a week with dialysis. electrolytes should be adjusted and sevelamer dosing (phosphate binder) should be adjusted according to phosphate levels. . 4. pneumonia: s/p levofloxacin for 14 days. the patient initially had some cough, but clear cxr, afebrile. expectorants were given, the patient continued to remain afebrile, and symptoms improved. . 5. copd: s/p steroid taper. the patient's lungs were without wheezes. we continued inhalers, nebs prn. . 6. uti: patient was discovered to have vre on cx. of note, the patient was started on vancomycin for "urinary infection" while at rehab, though there was no clear documentations regarding what was cultured from that urine. the patient was started on linezolid for 14 days, started on . . 7. thrombocytopenia: chronic and likely related to cirrhosis. albumin only slightly decreased and inr normal. will monitor while on heparin, platelets did not drop greater than 50%, stayed stable. . 8. anti-coagulation. patient has atrial fibrillation and was started on anticoagulation with heparin and coumadin. heparin was d/c'd and patient was therapeutic on her inr throughout her hospital stay. during the last day, the patient was supratherapeutic on her inr, but here was no evidence of bleeding, mental status changes or agitation. po vitamin k was given. at rehab, coumadin needs to be held for and . pt/inr needs to be re-checked on . if inr > 7, 5mg of po vitamin k should be given, and pcp needs to be notified for further guidance (and coumadin dosing needs to be held). medications on admission: calcitonin 3.7 ml nasal daily calcium/vitamin d 500 mg docusate 100 mg epoetin 8000 u mwf esomeprazole 40 mg daily fluticasone/salmeterol 250/50 folic acid 1 mg daily lasix 100 mg iv bid hydralazine 50 mg q 8 hours iron sucrose 100 mg iv mwf isosorbide mononitrate sr 120 mg daily lactulose 10 ml tid levalbuterol inhaled qid levofloxacin 250 mg po every other day, next due , last dose levothyroxine 25 mcg daily lorazepam 0.5 mg mwf 1/2 hour prior to dialysis zaroxyln 10 mg po bid lopressor 50 mg po bid miconazole powder nephrocaps 1 daily prednisone 60 mg daily requip 1 mg qhs for rls senna 1 sevelamer 1200 mg with meals tid spiriva one daily vancomycin 1 gm iv mwf with dialysis (level 9.7 on ) ambien 5 mg qhs prn: tylenol 650 mg po q4 hours prn bisacodyl 10 mg daily prn sarna qid prn levalbuterol (xopenex) q 6 hrs prn ativan 0.5 mg tid prn fioricet qid prn simethicone 80 mg qid prn discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. calcitonin (salmon) 200 unit/actuation aerosol, spray sig: one (1) nasal daily (daily). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) puff inhalation (2 times a day). 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 8. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 9. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 10. lorazepam 0.5 mg tablet sig: 1-2 tablets po qmowefr (monday -wednesday-friday): give prior to dialysis. 11. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 12. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 13. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day). 14. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 15. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 16. lorazepam 0.5 mg tablet sig: 1-2 tablets po tid (3 times a day) as needed for anxiety. 17. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed. 18. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 19. oxycodone 5 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 20. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 21. sevelamer 800 mg tablet sig: two (2) tablet po tid (3 times a day): take with meals. adjust according to chem 7 results. 22. pramipexole 0.125 mg tablet sig: one (1) tablet po qhs (). 23. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. 24. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 12 days. 25. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. 26. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 27. warfarin 2 mg tablet sig: two (2) tablet po hs (at bedtime): please dose according to inr. inr should be . call pcp for further guidance on warfarin dosing. 28. lisinopril 5 mg tablet sig: one (1) tablet po once a day: please hold if sbp < 90. 29. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day): please hold for hr < 50, sbp < 90. discharge disposition: extended care facility: - discharge diagnosis: st segment elevation myocardial infarction new onset atrial fibrillation, on anti-coagulation s/p tee cardioversion s/p pacemaker/icd placement end stage renal disease rheumatoid arthritis anemia thrombocytopenia discharge condition: stable, afebrile, ambulatory, chest pain free discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1500ccs/day -please follow up with all outpatient appointments -please take all your medications as directed -please attend dialysis as scheduled--monday, wednesday, friday -if you should feel more chest pain, palpitations, lightheadedness, dizziness, please let your doctor know immediately. -please re-check inr on saturday, . please watch for mental status changes, acute overt bleeding. continue to hold coumadin on and . if inr > 7 on saturday , give 5mg of vitamin k po, recheck inr on sunday. please call pcp to adjust warfarin dosing based on inr and further guidance. inr should be followup instructions: provider: clinic phone: date/time: 10:30 -please call your pcp , . at to arrange a follow/up appointment as soon as possible -patient needs hemodialysis mwf for removal of fluid as well clinic -pcp for adjustment of anti-coagulation provider: , . appointment should be in days procedure: coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization diagnostic ultrasound of heart hemodialysis initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle insertion of temporary transvenous pacemaker system atrial cardioversion insertion of drug-eluting coronary artery stent(s) artificial pacemaker rate check excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel insertion of four or more vascular stents diagnoses: pneumonia, organism unspecified other iatrogenic hypotension anemia in chronic kidney disease end stage renal disease abnormal coagulation profile coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified cirrhosis of liver without mention of alcohol cardiac complications, not elsewhere classified atherosclerosis of aorta atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation atrioventricular block, complete cardiac arrest infection with microorganisms without mention of resistance to multiple drugs acute myocardial infarction of other inferior wall, initial episode of care other chest pain streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] sinoatrial node dysfunction diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to