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 / aspirin / motrin / tylenol / codeine / plavix / percocet / zofran / morphine / optiray 320 / visipaque / tramadol / ketorolac / metoclopramide attending: chief complaint: chest pain major surgical or invasive procedure: pericardiocentesis with placement of a pericardial drain history of present illness: 41 y/o woman w/type i diabetes, htn, hl, dchf, history of pe () s/p ivc filter and ivc filter clot who has been off coumadin since (patient says a doctor told her to but has not been to see her pcp) who presents with 3 days of increasing lower extremity edema and 3 days of sharp left-sided substernal chest pain that radiates to the back which is the same as her previous chest pain. patient also reports shortness of breath, mild cough, nausea and one episode of emesis. patient denies dizziness, confusion, slurred speech, vision change, headache, palpitations, radiation of the pain to her jaw or arm, of note she had an admission in for le edema (at this time patient had also stopped taking her coumadin) and was found to have a ivc filter clot, ir attempted thrombectomy but the patient developed respiratory distress thought to be due to anaphyaxis vs. pe despite being premedicated with steroids and benadryl and she was d/c'd on lovenox bridge to coumadin. during that admission she was evaluated by heme/onc and had a negative hypercoagulable work up. she has also had multiple previous admissions for similar chest pain, work ups unrevealing and the patient has left ama due to not receiving iv dilaudid. it is documented in omr that she has multiple hospital admissions in the hospitals but has dnkd multiple pcp in our system. in the ed, initial vitals were 98.4 110 175/72 22 96%on ra. on labs troponin 0.03, inr 1.2. ekg looks like left bundle, consistent with past. t max 100, got levaquin b/c ?consolidation on cxr. also could not get cta due to dye allergy and can't do a vq scan logistically. so she was started her on heparin gtt. guaiac positive brown stool. also got lasix 100mg po daily and 1mg dilaudid. current vs, hr 104, on 2l02 (for chest pain). on the floor the patient reports severe chest pain, unrelenting, and nausea. no reported improvement in the ed with pain meds, patient requests phenergan. past medical history: # dm type i - since age 12 # cad s/p nstemi - recent cath at w/ 50% lcx lesion, 40% rca lesion (though original reports not available) # migraines # htn # ? of tia # h/o pe in , at hospital - s/p ivc filter in but date unclear (? ). # onic chest pain: patient also had multiple admissions for chest pain at , and other hospitals with chest pain of undiagnosed etiology (not pe-related) # hyperlipidemia # erosive gastritis # gastroparesis # h/o dchf - ? flash pulm edema normal echo in # s/p ccy # s/p ovarian cyst removal in - c/b staph infection - was a 3 month hospitalization # anemia - s/p several transfusions, dates back to # rentinal hemmorahge w/ initation of laser treatment social history: she is married and lives with her husband . she is on disability due to her diabetes. she previously worked as a pharmacist. she denies any tobacco use or etoh use ever. she does not have any children but did have one spontaneous miscarriage at 2 months in . family history: father has a history of mi, is s/p 4v cabg, and has a pacer. her mother died at age 56 of cardiac arrest. she also had dm and was on dialysis. her mother's dialysis line was "blocked" and during the attempt to clear the blockage, she arrested and died. she has one sister who is in good health. a paternal uncle had a blood clot to his heart and died. she has one cousin who died of a stroke at age 47. she does not know any medical history about her grandparents on either side. physical exam: vitals: 99.8 181/91 101 20 96% on 2l gen: obese female in no acute distress, anxious appearing but not using accessory muscles. heent: perrl, sclera anicteric, mmm cv: s1+, s2+, rrr, 2/6 systolic blowing murmur at lsb resp: right sided mild crackles at the base, mild end expiratory wheeze. left ctab abd: soft, nt/nd +bs, obese ext: warm, 2+ edema to knees bilaterally. neuro: awake, conversive, appropriate. gait deferred due to pain. pertinent results: 08:15pm blood wbc-5.6 rbc-3.51* hgb-9.4* hct-29.2* mcv-83 mch-26.8* mchc-32.3 rdw-15.5 plt ct-473* 08:15pm blood pt-13.6* ptt-20.3* inr(pt)-1.2* 08:15pm blood glucose-240* urean-33* creat-1.6* na-139 k-4.2 cl-107 hco3-22 angap-14 10:30am blood alt-11 ast-12 ck(cpk)-323* alkphos-79 totbili-0.2 08:15pm blood ck-mb-3 probnp-1391* 08:15pm blood ctropnt-0.03* 10:30am blood ck-mb-2 ctropnt-0.04* 12:36am blood ck-mb-3 ctropnt-0.02* 04:52am blood ck-mb-3 ctropnt-0.03* 07:55pm blood albumin-3.3* mg-1.5* reports: le u/s bl : impression: no evidence of dvt in the bilateral lower extremities within limits of exam. cxr : 1. patchy opacity at the lung bases may represent atelectasis or infection. 2. stable cardiomegaly without overt pulmonary edema. echo : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is a moderate sized pericardial effusion. the effusion appears circumferential. there are no echocardiographic signs of tamponade. no right atrial collapse is seen. impression: moderate circumferential pericardial effusion without evidence of tamponade. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. probable dysfunction. mild mitral regurgitation. compared with the prior study (images reviewed) of , the size of the pericardial effusion has increased. mri chest/abdomen : limited examination as the patient was not able to hold her breath. 1. no central pulmonary emboli, however, segmental pe cannot be excluded. 2. moderate-to-large bilateral pleural effusions with atelectasis in the lower lobes. moderate-to-large pericardial effusion. 3. no evidence of an aortic dissection. 4. susceptibility artifact is seen from the ivc filter. no thrombus seen in the visualized ivc below and above the filter. a wet read was placed in the ccc at the time of the mri examination on . cxr pa/la : impression: moderate cardiac enlargement, most likely representing pericardial effusion, mild-to-moderate bilateral pleural effusions regressing. no new infiltrates. echo : there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. the tricuspid valve leaflets are mildly thickened. there is a small to moderate sized pericardial effusion. there is right ventricular collapse, consistent with impaired fillling/tamponade physiology. compared with the prior study (images reviewed) of , right ventricular collapse is now present. brief hospital course: 41 y/o woman with h/o cad (s/p nstemi in ), type i diabetes, htn, hl, dchf, history of pe () s/p ivc filter and ivc filter clot who has been off coumadin since (patient says a doctor told her to but has not been to see her pcp) who presents with 3 days of increasing lower extremity edema and 3 days of sharp left-sided substernal chest pain that radiates to the back which is the same as her previous chest pain. . # chest pain: patient has had several hospitalizations for similar chest pain, twice revealing pulmonary embolism. acs ruled out by neg ekg, enzymes, and poor story for angina. pt was also found to be in severe acute dchf with frank anasarca. mri of chest/abdomen was negative for dissection and pe, however poor image quality and heparin was continued. initial echo showed mild to moderate pericardial effusion, which, on repeat echo, was worsening, associated with wider pulsus paradoxus (see below). please see below, ultimately it was felt that her chest pain was a result of recurrent pericarditis. she was treated with colchicine and po hydromorphone with good response. . # pericarditis and pericardial effusion: patient was found to have pulsus paradoxus and tamponade physiology on echo. she underwent pericardiocentesis on . post-pericardiocentesis, the patient was transferred to ccu for close monitoring. she intermittently continued to experience left sided, pleuritic chest pain, requiring opioids for adequate relief. repeat bedside ttes daily x 2 days following pericardiocentesis revealed only trivial pericardial effusion. pericardial drain was pulled on . given patient's multiple allergies, including to nsaids, patient was put on colchicine for pericarditis. on transfer back to the floor on , patient's chest pain was better controlled. workup for etiology of pericardial effusion included negative rf and . dsdna is pending. furthermore, patient had no viral prodrome prior to admission. on the patient had normal vital signs and negative pulsus. . # anemia: likely secondary to anemia of inflammation. spep, elevated erythropoetin, elevated haptoglobin. given patient is guaiac positive, concern for gi bleed if hct dropping rapidly, however pt is having her period, and hcts have been stable. patient did not require any transfusion during this admission. . # chronic kidney disease: likely htn and dm induced. baseline between 1.2 and 2.0. she had acute kidney injury with cr to 2.3 in the setting of diuresis and tamponade likely causing prerenal kidney injury. diuretics were held then gently restarted on a lower dose (40 mg daily from 80 mg ) at discharge. . # dm: pt with elevated bs on admission, no gap. home regimen of 50units of glargine and iss were continued. . # htn: patient's home regimen was continued with reasonable control of blood pressure. # hyperlipidemia: simvastatin was switched to pravastatin after colchicine was started to redue the risk of rhabdomyolysis. . # psych: citalopram and clonazepam were continued per outpatient regimen. the patient received a diabetic/heart healthy/low salt diet. she received sc heparin for dvt prophylaxis. she was full code. to be followed outpatient 1) inr - patient restarted on coumadin on 2) bmp - patient restarted on lasix, had arf 3) acute renal failure - patient had arf in the setting of tamponade, evaluate for resolution 4) pericarditis/tamponade - patient had rheumatologic labs drawn in idiopathic tamponade workup (dsdna and anca), pending at medications on admission: 1. citalopram 20 mg tablet sig: three (3) tablet po daily (daily). 2. clonazepam 0.5 mg tablet sig: one (1) tablet po daily (daily). 3. furosemide 80 mg tablet sig: one (1) tablet po bid (2 times a day). 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 5. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 6. insulin glargine 100 unit/ml solution sig: fifty subcutaneous at bedtime. 7. insulin lispro 100 unit/ml solution sig: ten (10) subcutaneous three times a day: with and applied sliding scale. discharge medications: 1. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 2. clonazepam 0.5 mg tablet sig: one (1) tablet po daily (daily). 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 4. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 5. furosemide 40 mg tablet sig: one (1) tablet po once a day: start tomorrow on . disp:*30 tablet(s)* refills:*1* 6. insulin glargine 100 unit/ml solution sig: sixty (60) units subcutaneous at bedtime. 7. insulin lispro 100 unit/ml solution sig: as directed units subcutaneous qidachs: restart insulin sliding scale as previously instructed. 8. hydromorphone 2 mg tablet sig: 1-2 tablets po four times a day as needed for pain for 3 days. disp:*15 tablet(s)* refills:*0* 9. colchicine 0.6 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 10. pravastatin 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnosis: pericardial effusion, concern for constrictive pericarditis acute exacerbation of chronic congestive heart failure secondary diagnoses history of venous thromboembolic disease hypertension gastroparesis discharge condition: good, tolerating po, pain reduced ambulating independently mental status alert and oriented *3 discharge instructions: you were admitted to the hospital because you were having pain in your chest. we did tests that showed you seemed to have fluid overload so some fluid was removed. you also were found to have fluid around your heart that caused low blood pressures and problems with your heart's pumping. this fluid was drained and you improved. it is unclear what caused this fluid to accumulate. it will be important to follow up with your primary care doctor to finish the evaluation of this problem. your medications have been changed. your warfarin (coumadin) has been restarted to help prevent blood clots. your should continue to take this medication unless told to stop by your physician. been started on colchicine, a medication to help reduce the inflammation in the pericardium and help your pain. you have been given a small amount of hydromorphone (dilaudid) pills to help deal with your pain over the next couple days. your simvastatin (zocor) has been switched to pravastatin as this medication is safer to use with colchicine. otherwise your medications have not been changed. followup instructions: you should follow up in in the next week or two to see how you are doing and help set you up for further necessary follow-up. our clinic will call you next week to set up an appointment. you should also re-establish care with the to help follow your coumadin levels. it will be important for post discharge clinic to check your electrolytes and fluid balance in the context of the reduced dose of water pills. they can also monitor your pain, check to make sure your blood pressure is stable, and make sure you have follow up to monitor your coumadin levels. procedure: venous catheterization, not elsewhere classified pericardiocentesis pulmonary artery wedge monitoring diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified acute on chronic diastolic heart failure chronic kidney disease, unspecified old myocardial infarction long-term (current) use of anticoagulants constrictive pericarditis diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled gastroparesis chronic pulmonary embolism 

Answer: The patient is high likely exposed to