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: history of present illness: this is an 88-year-old caucasian female patient of dr. with a history of rheumatic heart disease status post avr in , who presented to the ed after an episode of diaphoresis and feeling faint. the patient also had associated nausea and left arm pain. the patient denies any chest pain, shortness of breath, fevers, chills, night sweats, nausea, vomiting, abdominal pain, diarrhea, bright red blood per rectum, melena, loss of consciousness, lightheadedness, dysuria, and frequency. patient has had vertigo for many years and takes meclizine for diagnosis of labyrinthitis. she has occasional headaches over her left eyebrow, and more of a sharp pain minimally relieved with tylenol, last 2-3 minutes. past medical history: 1. rheumatic heart disease with an echocardiogram in which showed an ef of over 55%, mild left ventricular hypertrophy, avr with mildly thickened leaflets and transaortic gradient, mild mr, pr, ascending aorta 4.2. 2. status post mi with a negative stress test in . 3. gerd. 4. vertigo/labyrinthitis. 5. fibroid uterus. 6. scoliosis. 7. hyperlipidemia. 8. atrial fibrillation. 9. anemia. 10. osteoporosis. 11. avr in . medications: 1. ecotrin q.o.d. 2. atorvastatin 10 mg q.d. 3. diovan 160 mg q.d. 4. ditropan xl 5 q.d. 5. meclizine 25 q.h.s. 6. tums 500 q.i.d. 7. iron sulfate 325 q.d. 8. tylenol 325 as needed. allergies: codeine. social history: the patient lives alone in a apartment. she denies alcohol, tobacco, or drug use. physical examination: vitals: 97.1, 126/26, 75, 23, and 99% on room air. general: elderly female in no acute distress, alert and oriented times three. heent: pupils are equal, round, and reactive to light. extraocular movements are intact. oropharynx is clear. moist mucous membranes. neck: supple, full range of motion, and no evidence of carotid bruits, lymphadenopathy, or jugular venous distention. lungs: bibasilar rales, but otherwise clear to auscultation. cardiovascular: regular, rate, and rhythm, normal s1, s2. there is a holosystolic murmur at the left lower sternal border and a diastolic murmur over her right upper sternal border. no gallops or rubs. abdomen: normoactive bowel sounds, soft, nontender, nondistended. extremities: no evidence of clubbing, cyanosis, or edema. neurologic: alert and oriented times three. cranial nerves ii through xii intact. motor strength is diffusely. sensation is intact to light touch and proprioception. laboratories: white blood cells 5.9, hematocrit 33.3, platelets 156. pt 12.8, ptt 25.6, inr 1.1. sodium 138, potassium 3.7, chloride 104, co2 25, bun 25, creatinine 1.0, glucose 124. ck 83, troponin less than 0.01. chest x-ray: pleural effusions bilaterally. no evidence of consolidation or signs of failure. cta: no evidence of aortic dissection, ascending aorta dilated to 4.3 cm tapers to normal on the descending section, no evidence of pulmonary emboli, no pericardial effusion, there is a small right pleural effusion, no pneumothorax. there is a mild intrahepatic ductal dilation and simple kidney cysts. ekg: normal systolic rhythm with a rate of 70 beats per minute. there are q waves in v1 to v2 and t-wave inversions in i and avl. there are no st changes. hospital course: 1. chf: patient was admitted with bibasilar rales on lung examination with a loud diastolic murmur. she was initially evaluated in the emergency department with a cta for a question of pulmonary embolus. the patient did not tolerate the dye load and had a creatinine that bumped to 2.2 and was acutely short of breath requiring a face mask. given her loud murmur; an echocardiogram was performed on , which showed new deterioration of his lv systolic function with focal hypokinesis of the basal inferior lateral wall. overall lv ejection fraction was over 55%. she had a mildly dilated ascending aorta with prosthetic aortic valve leaflets thickened, but not stenotic. there is a noted focal fluttering echo density on the left ventricular side of the leaflet consistent with valve tissue or vegetation. the patient was given gentle hydration on her first hospital day for her intolerance of the contrast during her cta. she was noted to have an increasing short of breath, and was requiring high amounts of oxygen. she was placed on lasix and nesiritide drip. the ccu was contact for transfer. on transfer to the micu, the patient was maintained on the nesiritide and lasix with a urine output that gradually increased. the etiology of her chf was thought to be secondary to worsened aortic regurgitation with a possibly small contribution from her non-st-elevation myocardial infarction, which eventually ruled in for. the patient was briefly maintained on the nitroglycerin drip for mean arterial pressures over 80% while in the ccu. during her brief stay in the ccu, the patient was eventually switched over to lasix iv and chlorothiazide iv and had a good urine output. her sats were noted to be stable in the 90s on liters of oxygen by nasal cannula, and the patient was transferred back to the floor on . patient diuresed 2-3 liters on her first several days back on the floor and was eventually switched over to p.o. diuretic regimen with lasix 20 q.a.m. and hydrochlorothiazide 25 q.d. the patient's urine output decreased slightly over the next several days, but she remains stable with good oxygen saturations and improving lung examination with a decreased jugular venous distention. 2. mi: the patient was admitted for a rule out mi and eventually ruled in with a peak ck of 339 and troponin of 0.91. the patient was maintained on aspirin and a beta blocker throughout her hospitalization. a cardiac catheterization was postponed given the patient's development of acute renal failure and chf. it was decided toward the end of her hospitalization, to delay cardiac catheterization until the patient is out of the hospital. she remained stable throughout her hospitalization without nausea, which was considered to be her anginal equivalent. 3. atrial fibrillation: the patient was in normal sinus rhythm until when she went into a brief episode of atrial fibrillation. the covering team started the patient on low dosed digoxin. the patient was maintained on digoxin and on beta blocker throughout the rest of her hospitalization, and self converted the following day into normal sinus rhythm and was noted to be in a normal rhythm throughout the remainder of hospitalization. 4. renal: on admission to the hospital, the patient received a cta for evaluation for pulmonary embolus. after receiving a small amount of contrast, the patient became acutely hypoxic and required a face mask, and it was noted that her creatinine jumped to 2.2 from her initial creatinine of 1.0. patient was given iv fluids, and was noted to go into heart failure. patient's renal function slowly resolved throughout the rest of her hospitalization, and her creatinine drifted down to 1.7. the patient was maintained on diuretics throughout her hospitalization, and was eventually switched over to p.o. the etiology of her acute renal failure was thought likely secondary to contrast-induced atn versus congestive heart failure causing transient hypotension and decreased perfusion of her kidneys. 5. id: the patient was noted to have citrobacter in her urine on hospital day #4. she was placed on renally dosed levofloxacin and should receive a total of seven doses of levofloxacin. her blood cultures were negative throughout her hospitalization, and the patient remained afebrile. 6. heme: the patient had decreasing hematocrits throughout her hospitalization. she was initially placed on heparin and integrilin after she ruled in for a mi, but given hematuria and melanic stools, the heparin and integrilin were d/c'd. the patient received 2 units of packed red blood cells on transfer to the ccu for a hematocrit of 27.4. throughout the rest of her hospitalization, the patient was noted to have no further blood loss, and her hematocrit was stable around 33. condition on discharge: good. discharge diagnoses: 1. non-st-elevation myocardial infarction. 2. congestive heart failure with aortic valve insufficiency. 3. acute renal failure. 4. rheumatic heart disease status post atrioventricular replacement. discharge medications: 1. atorvastatin 10 mg p.o. q.d. 2. meclizine 25 mg p.o. q.h.s. 3. ferrous sulfate 325 mg p.o. q.d. 4. ranitidine 75 mg p.o. q.d. 5. colace 100 mg p.o. b.i.d. 6. senna two tablets p.o. b.i.d. 7. bisacodyl 10 mg p.o. q.d. prn. 8. simethicone 40-80 mg p.o. q.i.d. prn. 9. calcium carbonate 1 gram p.o. t.i.d. with meals. 10. nitroglycerin 0.3 mg sublingual prn. 11. aspirin 325 mg p.o. q.d. 12. metoprolol 12.5 mg p.o. b.i.d. 13. digoxin 125 mcg p.o. q.d. 14. furosemide 20 mg p.o. q.a.m. 15. miconazole powder t.i.d. 16. hydrochlorothiazide 25 mg p.o. q.d. 17. levofloxacin 250 mg p.o. q.48h. x7 doses. followup: patient is encouraged to followup with her primary care doctor and cardiologist, dr. . dr. would like the patient to call to schedule an appointment. she has an appointment with him on at 11 a.m. she also has an appointment with dr. on at 10:30 a.m. discharge instructions: the patient will be discharged to facility, where she will hopefully have daily physical therapy to increase her activity level. she should be fluid restricted to 1500 cc and be maintained on a low cholesterol, low saturated fat, salt-free diet. , m.d. dictated by: medquist36 procedure: injection or infusion of platelet inhibitor arteriography of other intrathoracic vessels injection or infusion of nesiritide computerized axial tomography of thorax diagnoses: subendocardial infarction, initial episode of care acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified atrial fibrillation rheumatic heart failure (congestive) heart valve replaced by transplant other drugs and medicinal substances causing adverse effects in therapeutic use rheumatic aortic insufficiency 

Answer: The patient is high likely exposed to