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: penicillins / percocet / heparin agents attending: chief complaint: sob major surgical or invasive procedure: thoracentesis history of present illness: ms. is an 86 year old female with diastolic chf, afib, cad, ms/mr, s/p bioprosthetic avr () and h/o cva who presents with shortness of breath on transfer from /osh. . patient was doing okay at home, 24hr home o2 3-4l, until this morning when her daughter thought she was more short of breath and tachypneic. per daughter, patient had a high "salty" diet on sunday, but otherwise denies medication changes, fevers, chills, nausea, vomiting, dysuria, cough, chest pain and palpitations at home. she has stable lower extremity edema, which does not seem to have worsened as well as orthopnea. she also has constipation alleviated with lactulose regularly 3-4times weekly. she endorses compliance with her medications, including lasix, metoprolol, diltiazam and aspirin. she has not had any recent changes in her medications. . she went to hospital and found to have bilateral rales with diminished breath sounds. an abg was 7.5/44/60/33 and she was desated to 70s% on ra. labs notable for hct of 30, wbc 11.6. a cxr showed pulmonary edema with large r sided pleural effusion. she got 80mg iv lasix, 120mg of dilt po and placed on bipap briefly and transferred her to . she was transferred on nrb. . at , her vs were t97.3 hr90 bp99/49 rr24 95% nrb. she was unable to be weaned off nrb, desating to 80s. she has put out ~600cc of urine. an ecg was notable for afib hr 98bpm, unchanged from baseline. . her vs on transfer are: bp 106/74, hr 94, rr 22, 97-98% nrb. full code for now. daughter is with her. . of note, patient was recently admitted in for chf exacerbation. she had a tte on that admission that showed ms/mr/tr, severe pulm artery systolic hypertension, ef 65%. she was found to have a pleural effusion that was tapped and showed transudative fluid, culture/cytology negative. she was diuresed with lasix and her symptoms improved. tia in 10/. no other cva or tia. . on review of systems, s/he denies any prior history of deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. s/he denies recent fevers, chills or rigors. s/he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: (+)dyslipidemia, (+)hypertension 2. cardiac history: cad -cabg: none. -percutaneous coronary interventions: -successful lad/d1 bifurcation ptca in -rotational atherectomy of the first diagonal branch -pacing/icd: none others: - af on coumadin -bovine aortic valve relacement in , complicated by brief episode of atrial fibrillation. has been on coumadin in the past but not currently. -right carotid endarterectomy in -peripheral vascular disease -fall with left hip fracture in . orif left intertrochanteric femur fracture -vertebral compression fracture, t8, -bilateral osteoarthritis of the knees -constipation -status post bilateral cataract extraction -diverticulosis social history: lives in with daughter , currently at rehab after hospitalization at . walks with a cane, good social support, non smoker, rare alcohol use. denies any other illicit drug use. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: 102/55 85 15 97% nrb, 6l general: petite elderly female in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp wnl. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: +scoliosis and kyphosis. resp were unlabored, no accessory muscle use. decreased breath sounds b/l, bibasilar rales extending up mid lung fields abdomen: soft, ntnd. no hsm or tenderness. extremities: 3+ pitting edema b/l extending to knees skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ left: carotid 2+ dp 2+ pertinent results: 11:44pm blood wbc-8.2 rbc-4.10* hgb-11.0* hct-33.7* mcv-82 mch-27.0 mchc-32.8 rdw-17.5* plt ct-307 06:05am blood wbc-6.4 rbc-3.88* hgb-10.2* hct-32.3* mcv-83 mch-26.2* mchc-31.5 rdw-17.3* plt ct-298 05:03am blood wbc-6.9 rbc-4.17* hgb-11.0* hct-34.6* mcv-83 mch-26.5* mchc-32.0 rdw-17.5* plt ct-297 11:44pm blood neuts-86.4* lymphs-8.8* monos-4.3 eos-0.3 baso-0.3 11:44pm blood pt-26.8* ptt-34.8 inr(pt)-2.6* 06:05am blood pt-28.5* inr(pt)-2.8* 09:41am blood pt-29.7* ptt-36.1* inr(pt)-2.9* 11:44pm blood glucose-130* urean-23* creat-0.7 na-132* k-4.0 cl-90* hco3-31 angap-15 02:59pm blood creat-0.7 na-138 k-3.1* cl-93* 12:49am blood na-138 k-3.7 cl-94* 06:05am blood glucose-112* urean-22* creat-0.8 na-139 k-3.2* cl-90* hco3-41* angap-11 06:32pm blood urean-30* creat-0.9 na-136 k-5.2* cl-90* hco3-36* angap-15 05:03am blood glucose-122* urean-32* creat-0.9 na-138 k-3.9 cl-89* hco3-40* angap-13 11:44pm blood probnp-5178* 11:44pm blood ctropnt-<0.01 06:05am blood calcium-9.1 phos-3.7 mg-2.2 05:03am blood calcium-9.7 phos-3.6 mg-2.1 . micro 12:21 am urine site: catheter **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ 8 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s . chest xray portable ap chest, ap semi-upright: there has been interval reaccumulation of a large right pleural effusion, with silhouetting of the right heart border and hemidiaphragm. a loculated effusion persists along the lateral left hemithorax. left lower lobe atelectasis is unchanged. cardiomegaly, vascular congestion, and pulmonary edema have slightly increased. cabg changes are present. there is continued tortuosity and calcification of the aorta. impression: 1. recurrent large right pleural effusion and loculated left effusion. 2. congestive heart failure. brief hospital course: 86yo elderly female w hx of cad, arv, mod-severe ms htn on echo managed on 24hr home o2 3-4 liters, chronic afib on coumadin, and vasculopathy transferred from osh for management acute sob x 2 days found to have edema and recurrent pleural effusion. . **pt made cmo for untreatable valve disease, afib, and pulmonary htn. her sob worsened gradually during her admission and she was made cmo by family on . palliative care was consulted. she was started on iv morphine drip titrated for comfort. she passed on afternoon with family at bedside and pastoral care. . . . # sob: chronic complaint, currently on home o2 since , acutely worsening in last 2 days. p/w rales and chest xray findings suggestive of edema and recurrent pleural effusion. diagnosis most likely heart failure valvulopathy with contribution from chronic afib. pt also with evidence of htn on recent tte and is on home o2. other less likely etiologies include mi, infection, pna but no chest pain, biomarkers negative, leukocytosis negative, afebrile. therapeutic approach was aggressive diuresis in setting of volume overload and dchf. thoracentesis was felt to be too invasive at this time given recurrence of symptoms. she was continued on o2 therapy and weaned from nrb to face shovel to **nc. home o2 3-4l via nc (ultimate goal). she was diuresed with iv lasix pushes and metolazone, and monitored for urine output. she was started on iv lasix drip on due to inadequate clinical improvement on iv pushes. she was continued on home meds metoprolol and diltiazem for rate control. her sob improved only minimally with diuresis and thoracentesis was attempted on to palliate her symptoms and improve her oxygenation status. we attempted to wean from shovel but patient continued to desat to low 80s with tachycardia to 130s w exertion, eating. . # afib: pt denies palpitations, although sob likely exacerbated by her chronic afib. maintained on coumadin anticoagulation therapy for arrhythmia which was continued as an inpatient. given her tia in , her chad2 score= 5, it is believed that pt is high risk for stroke. she was continued on metoprolol and diltiazem for rate control. per pcp, has been anticoagulated since and was not candidate for cardioversion given <4 wks therapeutic level on coumadin. . # cad: s/p atherectomy , single vessel disease w diffuse atherosclerosis. currently on statin, asa therapy. ekg at baseline. continued on statin, asa therapy as inpatient. cardiac biomarkers were negative on admission and there was no need to trend ce's given no ekg changes, and pt lack of chest pain. . # uti: pt found to have asymptomatic uti from ed culture - ecoli. started on ciprofloxacin po renally dosed x 14days. . # valve disease: h/o of avr and known ms/mr noted to be mod-severe on last tte 7/. valvulopathy likely contributing to her symptoms of sob and doe. there was no need to repeat echo given recent documentation. dr. reviewed her echo findings and confirmed her non-candidacy for valvuloplasty given mr , and per report not a surgical candidate for valve replacement as well. . #constipation: managed on lactulose at home 3-4x weekly. she was maintained on bowel regimen. medications on admission: acetaminophen 650 mg po/ng q6h:prn pain aspirin 81 mg po/ng daily morphine sulfate 1-2 mg iv q6h:prn sob bisacodyl 10 mg pr hs:prn constipation omeprazole 20 mg po daily calcium carbonate 500 mg po/ng tid ciprofloxacin hcl 500 mg po/ng q12h uti, tx 2wk course start senna 1 tab po/ng :prn constipation diltiazem extended-release 300 mg po daily simvastatin 20 mg po/ng daily docusate sodium 100 mg po bid simethicone 40-80 mg po/ng qid:prn bloat, abd pain furosemide 20 mg/hr iv drip infusion lactulose 30 ml po/ng q8h:prn constipation vitamin d 1000 unit po/ng daily metoprolol tartrate 12.5 mg po/ng tid discharge medications: none discharge disposition: expired discharge diagnosis: deceased discharge condition: deceased discharge instructions: deceased followup instructions: deceased procedure: thoracentesis diagnoses: abdominal pain, unspecified site coronary atherosclerosis of native coronary artery unspecified pleural effusion urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status constipation, unspecified other and unspecified hyperlipidemia acute respiratory failure long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits encounter for palliative care heart valve replaced by transplant other dependence on machines, supplemental oxygen mitral stenosis with insufficiency 

Answer: The patient is high likely exposed to