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: vicodin / penicillins attending: chief complaint: worsening fatigue and exertional major surgical or invasive procedure: redo mvr ( . mechanical) craniotomy history of present illness: 49yo female with congential heart disease(asd and mitral repair at age 9)who was admitted to good samaritain in with nstemi and elevated bnp. she underwent extensive cardiac evaluation which showed normal coronary arteries, moderate mitral stenosis with severe pulmonary hypertension. due to the above findings, she has been referred for redo operation. surgery however has been delayed to due gi and pulmonary workup. after extensive preoperative evaluation by gi and pulmonary, she has finally been cleared to proceed with redo operation. currently symptoms include worsening fatigue and exertional dyspnea. she also complains of intermittent chest pain, and occasional presyncope. she denies orthopnea and lower extremity edema. ** recently treated for urinary tract infection with improvement in symptoms ** past medical history: congenital heart disease nstemi in pulmonary hypertension hypertension dyslipidemia paroxysmal atrial fibrillation, s/p ablation history of seizures history of migraine ha morbid obesity hypothyroid depression/anxiety osteoarthritis chronic back pain diverticulosis sleep apnea - does not wear cpap history of recurrent uti - most recent in chronic anemia, unknown etiology past surgical history: - atrial septal defect closure and mitral valve cleft repair via sternotomy in - af ablation at in - left foot surgery x 3, most recent - left rotator cuff surgery - lap cholecystectomy - right knee surgery social history: lives: home with father occupation: on disability cigarettes: never etoh: denies illicit drug use: denies family history: father had cabg at age 64. paternal grandfather died of mi at age 61. physical exam: bp: 116/49 pulse: 59 resp: 18 o2 sat: 96% room air general: obese female in no acute distress skin: dry intact well healed sternotomy scar noted upper extremities(left more than right) with minor erythema - appears more allergic than infectious reaction heent: perrla eomi - teeth in poor repair neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur grade llsb abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema: none varicosities: none neuro: grossly intact, limited rom of left shoulder pulses: radial right: 1+ left: 1+ carotid bruit right: none left: none pertinent results: tee :conclusions prebypass no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. there is thinned out area at the septum primum consistent with previous pericardial septal patch. 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%). the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is moderate valvular mitral stenosis (area 1.0-1.5cm2). mild to moderate (+) mitral regurgitation is seen. postbypass biventricular systolic function is preserved. there is a well seated, well functioning, bileaflet mechanical prosthesis in the mitral position. valvular mr is present which is appropriate in quantity and location for this type of prosthesis. no flow across the previous asd repair is seen by color doppler. the study is otherwise unchanged from the prebypass period. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 12:58 mra head : findings: there is no significant interval change in the evolving extensive right mca territory infarction involving the basal ganglia as well as the overlying cortex. the amount of midline shift and subfalcine herniation remains stable. the patient is status post right-sided hemicraniectomy. the right-sided mca branches are not well visualized. a small extra-axial collection noted at the craniectomy site. the calcifications noted in the left frontal periventricular white matter are associated with mild amount of gliosis. there is no edema. no significant signal dropout is seen on the gradient echo images. impression: no significant interval change in extensive evolving right mca infarction. small amount of blood products are noted relating to recent surgery. left frontal periventricular calcifications do not demonstrate enhancement or mass effect. 01:42am blood wbc-9.7 rbc-3.04* hgb-9.0* hct-26.9* mcv-88 mch-29.7 mchc-33.6 rdw-16.5* plt ct-302 02:41am blood pt-18.7* ptt-30.1 inr(pt)-1.8* 09:20am blood ptt-86.2* 01:42am blood glucose-110* urean-28* creat-0.5 na-135 k-3.7 cl-92* hco3-35* angap-12 radiology report chest (portable ap) study date of 7:31 am , r. csurg csru 7:31 am chest (portable ap) clip # reason: eval for consolidation/effusion final report indication: 49-year-old female status post mitral valve replacement. comparison: multiple chest radiographs dating back to , , most recent . technique: portable upright ap chest radiograph. findings: there has been slight increase in lung aeration with corresponding decrease in bibasilar atelectasis. there is no pneumothorax or areas of focal consolidation concerning for infection. there is unchanged cardiomegaly and pulmonary edema. right-sided picc catheter is seen, unchanged in position in the upper right atrium. tracheostomy tube is seen unchanged in position. sternotomy wires remain unchanged in alignment and position with no obvious hardware failure. impression: 1) unchanged cardiomegaly and moderate-to-severe pulmonary edema. 2) slight increase in lung aeration with decrease in bibasilar atelectasis. no pneumothorax. brief hospital course: admitted and underwent redo sternotomy/mitral valve replacement with a . mechanical valve with dr.. transferred to the cvicu in stable condition on titrated insulin, propofol, and phenylephrine drips. she developed neurologic deficits with l side weakness and r eye deviation upon weaning of sedation. neurology was consulted and scanning revealed a right mca distibution cva. intracranial pressures necessitated craniotomy on with neurosurgery. she remained intubated and tube feeds were started. she required manitol and eventually became more alert. she had seizures immediately following her stroke and was treated with keppra and depakote. the seizures resolved and the depakote was discontinued and the keppra dose was decreased. the patient continued to improve and was weaned down in the ventilator. she underwent a tracheostomy and open g-j tube placement on and has continued to wean. currently she is on a trach collar during the day and cpap on the vent at night. she has tried the passe-muir valve once this week and will take on to rehab with her. neurologically she moves all extremities spontaneously with the exception of the lue, and intermittently follows commands. her staples from her craniotomy site and abdominal incision were discontinued on . she will return to see dr. of neurosurgery and have head ct prior to her appointment on . dr. will determine the timing of cranioplasty at that time. she needs to wear her helmet when she is out of bed. she has been anticoagulated with heparin and coumadin for her mechanical mitral valve and is currently on a heparin gtt at 1400 and will receive 3 mg of coumadin. her inr goal is 2.5-3. she had a small amount of bleeding around the trach site this week and was scoped twice. there were no findings from this. the bleeding has now resolved. she is being transferred to for further rehab. medications on admission: - baclofen - 10 mg tablet - 1 tablet as needed for prn - butalbital-aspirin-caffeine - 50 mg-325 mg-40 mg capsule - 1 capsule as needed for prn - carisoprodol - 250 mg tablet - 1 tablet once a day qpm - citalopram - 20 mg tablet - 1 tablet once a day - divalproex - 250 mg tablet extended release 24 hr - 1 tablet qam and 2 tablets qpm - furosemide - 40 mg tablet - 1 tablet once a day - levothyroxine - 50 mcg tablet - 1 tablet once a day - lorazepam - 2 mg tablet - 1 tablet as needed prn - metoprolol - 25 mg tablet - 1 tablet once a day - nabumetone - 750mg twice daily - nitrostat - 0.3 mg tablet, sublingual - 1 tablet prn - omeprazole - 20 mg capsule - 1 capsule(s) by mouth twice a day - potassium chloride - 20 meq tablet - 1 tablet(s) once a day - simvastatin - 40 mg tablet - 1 tablet(s) by mouth once a day - tramadol - 50mg twice daily medications - otc - aspirin - 325 mg tablet - 1 tablet(s) by mouth once a day - meclizine - (25 mg tablet, chewable - 1 tablet as needed discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. senna 8.6 mg tablet : 1-2 tablets po bid (2 times a day) as needed for constipation. 3. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 4. magnesium hydroxide 400 mg/5 ml suspension : thirty (30) ml po prn (as needed) as needed for constipation. 5. levothyroxine 50 mcg tablet : one (1) tablet po daily (daily). 6. metoprolol tartrate 25 mg tablet : one (1) tablet po tid (3 times a day). 7. miconazole nitrate 2 % powder : one (1) appl topical tid (3 times a day). 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 9. warfarin 1 mg tablet : three (3) tablet po once daily at 4 pm: titrate for an inr goal on 2.5 to 3. 10. acetaminophen 650 mg/20.3 ml solution : one (1) po q4h (every 4 hours) as needed for pain. 11. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : 2-4 puffs inhalation q4h (every 4 hours). 12. amiodarone 200 mg tablet : two (2) tablet po once a day for 7 days: then decrease dose to 200 mg po daily. 13. simvastatin 10 mg tablet : two (2) tablet po daily (daily). 14. levetiracetam 500 mg tablet : one (1) tablet po bid (2 times a day). 15. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 16. furosemide 10 mg/ml solution : two (2) injection twice a day. 17. heparin, porcine (pf) 10,000 unit/5 ml solution : one (1) 1400 intravenous drip. 18. ultram 50 mg tablet : one (1) tablet po every 4-6 hours. discharge disposition: extended care facility: discharge diagnosis: congenital heart disease s/p redo mvr postop r mca cva s/p craniotomy prior asd/mv repair nstemi in pulmonary hypertension hypertension dyslipidemia paroxysmal atrial fibrillation, s/p ablation history of seizures history of migraine ha morbid obesity hypothyroid depression/anxiety osteoarthritis chronic back pain diverticulosis sleep apnea - does not wear cpap history of recurrent uti - most recent in chronic anemia, unknown etiology respiratory failure-s/p tracheostomy g-j tube placement past surgical history: - atrial septal defect closure and mitral valve cleft repair via sternotomy in - af ablation at in - left foot surgery x 3, most recent - left rotator cuff surgery - lap cholecystectomy - right knee surgery discharge condition: trach and peg, on trach collar during the day, cpap on vent at night. alert, moves all extremities except left arm, intermittently follows commands. incisional pain managed with oral analgesics incisions: healing well, c/d/i sternal: healing well, no erythema or drainage edema: trace discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr. please call for an appointment when pt leaves cardiologist:dr. please call for an appointment when pt leaves neurosurgery: dr. @ 10:40 am. head ct prior to appointment at radiology . provider: scan phone: date/time: 10:00 provider: , md phone: date/time: 11:00 **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication mechanical mvr goal inr 2.5-3.5 first draw ***please arrange for coumadin follow-up prior to discharge from rehab procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances temporary tracheostomy open and other replacement of mitral valve percutaneous (endoscopic) jejunostomy [pej] other craniectomy insertion of catheter(s) into cranial cavity or tissue central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified obstructive sleep apnea (adult)(pediatric) anemia, unspecified mitral valve disorders urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site unspecified acquired hypothyroidism other chronic pulmonary heart diseases other convulsions personal history of other diseases of circulatory system cerebral edema old myocardial infarction morbid obesity long-term (current) use of anticoagulants surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation cerebral embolism with cerebral infarction diverticulosis of colon (without mention of hemorrhage) iatrogenic cerebrovascular infarction or hemorrhage personal history, urinary (tract) infection acute respiratory failure following trauma and surgery hemiplegia, unspecified, affecting dominant side personal history of (corrected) congenital malformations of heart and circulatory system 

Answer: The patient is high likely exposed to