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: increasing dyspnea; transfer from for evaluation of large pericardial effusion major surgical or invasive procedure: pericardiocentesis with drain placement history of present illness: mr. is a 51 male with h/o mvp/mr s/p pacemaker placement who presents 2.5 weeks after a mechanical mvr with increasing sob and cough. he was doing well postoperatively until earlier in the week, when he developed a superficial wound infection around his sternotomy incision, and he was started on keflex. during the workup of the infection, his pcp got cxr, blood cultures, inr (>4) and noted that his cardiac silhouette appeared enlarged on the cxr. he requested that he have this followed up at nishoba with an echocardiogram. he was found to have a moderate sized pericardial effusion, with signs of tamponade. he was transferred to ccu for further evaluation and possible pericardiocentesis. . he has recently been feeling well, with his major complaint being a weak voice and feeling sob when talking. he has reports feeling intermittently diaphoretic. he has not had any chest pain. he has been doing home pt since his surgery, and per report has been progressing well - walking for 10 minutes several times per day. he denies orthopnea, pnd, claudication. he denies sick contacts. . ros: he denies fever, chills, night seats, sore throat, rhinorrhea, headache. he has had a cough productive of clear sputum, that is exacerbated when he talks. he denies abdominal discomfort, nausea, vomiting, diarrhea, constipation, dysuria, frequency, hematuria, hematochezia, melena. . ed course: he was taken directly to the cath lab, where he was found to have presereved (lvef 55%), well seated mechanical mitral valave without regurgitant flow, and a large, circumferential pericardial effusion (4cm). the effusion is echo dense, consistent with blood, inflammation or other cellular elements. there is right ventricular diastolic collapse, consistent with impaired fillling/tamponade physiology. he was taken directly to the cath lab for pericardiocentesis and drain. past medical history: mvp/mr s/p #33 mechanical/asd closure sinus s/p pm vea (pvcs, bigeminy) broken collar bone as teenager social history: was working as a correction officer. he is single and lives with his mother. has never smoked or used alcohol family history: maternal gm with colon ca. no cad / sudden death physical exam: vs- 115/60 (pulsus paradoxus 15-20) 75 94% 2l gen- anxious appearing male, lying at 30 degrees hob elevation in nad heent- mmm, anicteric, eomi, op clear, no sinus tenderness neck- supple, no lad, jvp cv- rrr, mechanical s2, no murmur or rub. chest- cta bilaterally abd- soft, nt, nd, pos bs, no hsm ext- no c/c/e; 2+dp pulses; 2+ femoral pulses without bruit neuro- aao x 3, maew, cn grossly intact skin- healing sternotomy scar, with mild erythema and no purulent drainage or fluctuance pertinent results: echo : . conclusions: limited views making the study suboptimal. 1. overall left ventricular systolic function is normal (lvef>55%). 2.the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. 3. a bileaflet mitral valve prosthesis is present.the mitral valve is well seated. no significant gradient obtained across mitral valve. no mitral regurgitation is seen. 4.there is a large pericardial effusion. the effusion appears circumferential. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. there is right ventricular diastolic collapse, consistent with impaired fillling/tamponade physiology. . card cath comments: 1. the patient received 2 units of ffp prior to the procedure. 2. upond the third needle pass, successful entry into the pericardial space was achieved and verified by fluouroscopy. 3. the initialy mean peridcardial pressure was 17mmhg and decreased to 0mmhg after removal of 1000cc of grossly blood fluid. 4. post procedure echo demonstrated a mild to moderate effusion that remained in the posterior area. 5. pericardial drain was sutured in place. . echo . conclusions: left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). right ventricular systolic function is borderline normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. a mechanical mitral valve prosthesis is present. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. no right ventricular diastolic collapse is seen. compared with the prior study (images reviewed) of , the pericardial effusion has signficantly decreased in size. there is no longer evidence of tamponade. brief hospital course: impression/plan: 51 male with h/o mvp and mr now 2.5 weeks s/p mechanical mvr who presents with a large pericardial effusion with an echo and exam consistent with tamponade. . pericardial effusion: initially patient received ffp to reverse anticoagulation, no vitamin k was given. a drain of effusion provided 1 liter of bloody fluid, hct 24, consistent with a hemorrhagic effusion. a pericardial drain was placed. his coumadin was discontiued and heparin started 12 hrs after subtherapeutic inr to allow coagulation. heparin drip was restarted, minimal drain output was noted, and repeat echocardiogram showed a stable small effusion. coumadin was subsequently restarted at 2mg daily for the first 2 days, his inr remained low, and coumadin was increased to 4mg on . his inr trended up very slowly on this dose, which was the same dose that had led to a supertherapeutic inr. his other medications including the keflex and amiodarone were continued at the same dose as outpatient. . mvr: valve appears to be functioning well on echo. coumadin restarted as above, goal inr 2.5-3.5, needs careful monitoring given recent complication and especially while patient is on amiodarone and on antibiotics. patient was continued on amiodarone for prevention of atrial fibrillation in the setting of recent surgery. . anemia: stable hct since his discharge 2.5 weeks ago. hct remained stable during admission, retic index was 3.6. no evidence of bleeding or effusion reaccumulation noted. . htn: continued outpatient regimen of metoprolol 12.5 mg . code: full medications on admission: asa 81 mg percocet prn keflex 500 qid (day ) ferrous sulfate 325mg ascorbic acid 500mg metoprolol 12.5mg kcl 20meq qd (completed two weeks) furosemide 40 mg qd (completed two weeks) amiodarone 200mg warfarin 3mg qhs (changed from 4mg qhs by pcp ) discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day). 2. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 5. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 6. outpatient lab work inr checked on . please send results to dr. , r. office phone number # . warfarin 4 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* 8. zolpidem 5 mg tablet sig: one (1) tablet po at bedtime. 9. cephalexin 500 mg tablet sig: one (1) tablet po every six (6) hours for 2 days. discharge disposition: home discharge diagnosis: pericardial effusion with tamponade s/p mechanical mitral valve replacement discharge condition: good, ambulating, afebrile, tolerating po diet, oxygenating well on room air. discharge instructions: if you experience any chest pain, difficulty breathing, excess coughing, passing out, high fever, please seek immediate medical attention. you should have a repeat cardiac echo in about one week to re-evaluate for evidence of increasing effusion. you should see your pcp next week, and should have your inr blood test checked on monday, and have the results faxed to dr. . you should also have a follow up appointment with dr. next week as scheduled below. followup instructions: dr. on at 1:45pm call your pcp to schedule follow-up appointment please call to schedule a cardiac echo for follow up of your effusion next week, preferably prior to your appointment with dr. . procedure: pericardiocentesis transfusion of other serum diagnoses: abnormal coagulation profile anemia, unspecified other postoperative infection unspecified essential hypertension cardiac complications, not elsewhere classified heart valve replaced by other means cardiac pacemaker in situ anticoagulants causing adverse effects in therapeutic use hemopericardium aftercare following surgery of the circulatory system, nec 

Answer: The patient is high likely exposed to