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: amiodarone / zocor attending: chief complaint: dyspnea major surgical or invasive procedure: thoracentesis. history of present illness: ms. is an 80 year-old woman with a history of copd, severe pulmonary artery hypertension, atrial fibrillation on coumadin and alzheimer's who initially presented on with dyspnea, initially admitted to the icu, then transitioned to the medical floor. based on review of her record, icu notes and discussion with admitting physicians, the day prior to admission, patient's family called her cardiologist to report worsening dypsnea while sleeping and after showering. lasix was increased without relief so she presented to an outside hospital. there she was found to have large pleural effusions. upon transfer to , initial thoracentesis was deferred given inr >2.0. she was noted to have a wbc of 14.7 and a positive ua, and she receieved levofloxacin and vancomycin empirically. after arrival to the floor, patient triggered for respiratory distress with a recorded respiratory rate of 34 and increased work of breathing; an abg showed 7.47/47/97. after little improvement with lasix and increasing o2 requirement, she was transferred to the icu. icu course: after receiving 5mg vitamin k and ffp, underwent thoracentesis with removal of 1800cc of serous fluid. bp initially dropped to 60/50 after , then improving to 80/50 within one minute. results were consistent with transudative effusion. dyspnea improved, as did initial chest film though repeat film showed reaccumulation of fluid. in addition, while in the micu, she was transiently hypotensive (as low as a recorded value of 59/43); as such, she received no doses of verapamil and just one dose of lasix. hr ranged from 70s up to low 100s. her breathing and bp stabilized, and she was transferred to the medical floor. on the medical floor. past medical history: 1. coronary artery disease - cath (): only mild plaqueing and no significant obstructive coronary disease in the lad, lcx or rca; mid rca stent patent - pci () des to prox and mid rca 2. mitral valve prolapse with severe mr 3. atrial fibrillation 4. hypercholesterolemia: -- tc 162, tg 142, hdl 56, ldl 78 5. copd 6. alzheimer's disease 7. history of sciatica in 8. macular degeneration 9. s/p appendectomy social history: remote 30 pack/year smoking history, rare etoh, denies drugs. patient lives with husband and daughter in home and is retired from office work. they typically go to in the winter though do not plan on doing so this year. family history: non-contributory; pt reports mother may have had anginal sxs physical exam: vitals: t: 98.9, bp: 120/78, hr: 110, rr: 26-30, o2: 96% 5l general: awake, alert, pursed-lip breathing, moderate respiratory distress, occasionally having to stop to breathe. heent: nc/at; perrla, eomi; op clear, nonerythematous neck: supple, no lad, no jvd cv: s1, s2 nl, irregular rhythm, no m/r/g appreciated lungs: decreased bs on r>l w/ bronchial bs at the right base, fine crackles scattered bilaterally, no wheezes, no egophany abd: soft, nt, nd, + bs ext: no c/c/e neuro: grossly intact; oriented x 3 pertinent results: 03:15pm blood wbc-14.7* rbc-4.57 hgb-13.9 hct-40.2 mcv-88 mch-30.4 mchc-34.5 rdw-14.7 plt ct-234 03:15pm blood neuts-89.2* lymphs-5.8* monos-4.7 eos-0.2 baso-0.1 04:38pm blood pt-25.7* ptt-28.5 inr(pt)-2.5* 03:15pm blood glucose-143* urean-16 creat-0.9 na-141 k-3.3 cl-94* hco3-33* angap-17 03:15pm blood ck(cpk)-63 03:15pm blood ck-mb-notdone ctropnt-<0.01 probnp-4825* 09:50pm blood calcium-9.0 phos-3.8 03:21pm blood lactate-4.3* 07:38pm blood lactate-3.6* ecg: atrial fibrillation with a rapid ventricular response. leftward axis. consider inferior myocardial infarction. right bundle-branch block. since the previous tracing of the rate has increased. cxr (): increased size of bilateral pleural effusions, right greater than left with bilateral lower lobe opacities, which may represent atelectasis, although an underlying pneumonia cannot be excluded. cxr (; post ): in comparison with study of , there has been a dramatic decrease in the right pleural effusion. no evidence of pneumothorax. cxr (): in comparison with the study of , there has been increased opacification in the right lower lung zone consistent with the re-accumulation of pleural fluid. there is a linear stripe running along the right lateral chest wall in the mid and low end lower lung zones. it is unclear whether this represents a pneumothorax, since it does not extend to the apex and there is the vague suggestion of lung markings lateral to it that suggests merely a skin fold. cxr (): increase in the amount of right pleural fluid compared to the prior study with stable right and left lower lobe opacities and mild pulmonary vascular congestion. cxr (): impression: little change echo (): - left atrium is elongated - mild symmetric lvh - lvef>55% - rv cavity mildly dilated with mild global free wall hypokinesis (there is abnormal septal motion/position consistent with right ventricular pressure/volume overload - partial mitral leaflet flail with moderate to severe (3+) mr - severe pulmonary artery systolic hypertension - trivial/physiologic pericardial effusion. brief hospital course: this is an 80 y.o. female, which severe (3+) mr, severe pulmonary hypertension (likely as a result), who presented with worsened dyspnea and pleural effusions. # dyspnea/pleural effusions: primary cause of dyspnea likely the large pulmonary effusions, which are most likely secondary to severe mitral reguritation and pulmonary htn. symptoms improved greatly after thoracentesis though this was transient as the fluid reaccumulated. repeat echo showed severe mr m htn, not significantly changed from prior echo. she was diuresed but this was difficult with blood pressure in the 90s-100s systolic. afterload has been attempted on an admission in , though lisinopril was stopped on a subsequent outpatient follow-up due to relateive hypotension. a conversation with her outpatient cardiologist revealed that she is a poor surgical candidate for mvr given her advanced dementia. a discussed about percutaneous mv repair followed; this procedure is not performed at and not by any experiened physician in . given the risk of such a procedure, unknown amount of benefit, and likely stress on the patient to travel to have such a procedure performed, her family and outpatient cardiologist opted not to pursue this. goals of care were addressed and her family (hcp is daughter ) decided that her comfort was the primary goal. she was set up for home hospice, and given morphine prn for shortness of breath. supplemental oxygen was continued and she will go home on it. she was made dnr/dni. # positive blood cultures: gpc in bottles, treated with vancomycin until speciated as multiple species of coag neg staph as well as strep. it was felt this was likely a contaminent, and vancomycine stopped after 3 days. she had no further fever or evidence of bacteremia. # urinary tract infection: urine culture grew ppansensitive e.coli treated with ciprofloxacin x 7 days. course completed . # atrial fibrillation: given relative hypotension, verapamil was held early in course with heart rates running in the high 90s / low 100s. coumadin was held peri- and restarted afterwards. as her bp improved, she was placed back on her home dose of verapamil. # cad: continued on pravastatin. not on aspirin per dr. (her cardiologist's) notes. # alzheimer's: the patient's home regimen of namenda and aricept were continued. # code: dnr/dni (confirmed with hcp, daughter ) medications on admission: amoxicillin 2 grams prn (prior to dental procedures) citalopram 20 mg po qd donepizil 10 mg po qd futicasone 220 mcg 2 puffs furosemide 40 mg po bid potassium chloride 20 meq po qd memantine 10 mg po bid pravastatin 40 mg po qd spiriva verapamil 120 mg po bid warfarin 3mg 3x/wk; 2mg 4x/wk mvi discharge medications: 1. pravastatin 40 mg tablet sig: one (1) tablet po once a day. 2. verapamil 120 mg tablet sig: one (1) tablet po bid (2 times a day). 3. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 4. potassium chloride 20 meq packet sig: one (1) po once a day. 5. warfarin 1 mg tablet sig: three (3) tablet po as directed (): mon/wed/sat. 6. warfarin 2 mg tablet sig: one (1) tablet po as directed (): sun/tue//fri. 7. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 8. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 9. fluticasone 220 mcg/actuation aerosol sig: two (2) inhalation twice a day. 10. donepezil 10 mg tablet sig: one (1) tablet po once a day. 11. memantine 10 mg tablet sig: one (1) tablet po twice a day. 12. multivitamin tablet sig: one (1) tablet po daily (daily). 13. oxygen by nasal cannula 2-4 liters continuous. pulse dose for portability 14. morphine 20 mg/5 ml solution sig: 2-5 mg po q1h as needed for shortness of breath or pain. disp:*qs ml* refills:*0* discharge disposition: home with service facility: discharge diagnosis: primary: 1. pleural effusions, secondary to mitral regurgitation 2. mitral regurgitation 3. urinary tract infection, completed 7 day course of ciprofloxacin on 4. bacteremia, gpc secondary: 1. coronary artery disease 2. atrial fibrillation 3. hypercholesterolemia 4. copd 5. alzheimer's disease discharge condition: hemodynamically stable. needs 2 liters nasal canula at all times discharge instructions: you were admitted with shortness of breath and found to have large pleural effusions (fluid around the lung space) which were likely a large contributor. the most likely cause of this is back flow of blood from your heart, caused by a leaky heart valve. after discussing the options, you and your family decided against a higher risk mitral valve repair, and instead opted for hospice care to maximize your comfort. - no changes were made to your medications, with the exception of a prescription of a comfort pack of medications to be explained by your hospice nurse. in addition you provided with a prescription for morphine to be used for shortness of breath. - you should use oxygen, by nasal progs, 2 liters at all times. if you feel short of breath, you may increase the dose up to 4 liters - you should be with your family member (husband, daughter, or other family/friend) at all times for your safety. - please call your hospice nurse as a first contact, if you have any symptoms. followup instructions: you should call your hospice nurse or primary care provider if you have any questions. your cardiologist, dr. , is also available to you. md procedure: thoracentesis diagnoses: coronary atherosclerosis of native coronary artery pure hypercholesterolemia mitral valve disorders unspecified pleural effusion urinary tract infection, site not specified congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases long-term (current) use of anticoagulants alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to