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: nausea, dry heaving, rectal bleeding major surgical or invasive procedure: cardiac catheterization history of present illness: pt is a 41 yo f w/ pmhx of seizure d/o, chronic back pain, partial gastrectomy, for obesity, who presented with vague hx of intermittent nausea and dry heaving for 3-4 months, not associated w/ abdominal pain, but associated with anorexia and recently, over the past week with occasional fevers (to 102), chills, weakness, fatigue. she admits to poor po intake over recent weeks, as well as occasional dizzyness when standing up and a syncopal episode. . (hx below from prior admission notes and verified during pt interview): . she has had a 25-30 pound wt loss over the past 2 months, as well as leg and arm swelling. there was no recent travel, unusual foods, sick contacts, or new pets. she also notes constipation x3 mos leading to painful straining and bloody stools, which was evaluated by flex sig at osh showing hemorrhoids. she was started on docusate and notes loose stools lately associated with taking more laxatives. . since admission, ct was done and showed pancolitis. gi was consulted and did upper endoscopy which was normal. colonoscopy was aborted for poor prep. two days ago, the patient developed sharp chest pain radiating to her shoulders, no exertional component, no change with inspiration or cough. she has had dyspnea and chest pressure for the past week that has been constant. cardiac markers showed trop peak at 0.41 with ck/ckmb normal and no ekg changes. cards was consulted and felt this was not an mi, maybe myocarditis, and requested tte. this was done today showing systolic and diastolic dysfunction (lvef 20-30%) with a small effusion and possible early tamponade. . during this admission, pt has been persistently tachycardic (100s to 120s) and this evening pt was noted to have a hr 130s-140s. . on review of systems, s/he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. 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, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: - epilepsy - cholelithiasis - degenerative disc disease - partial gastrectomy for obesity - lysis of adhesion 3 weeks after gastrectomy social history: single, works at as administrator. recent breakup from boyfriend. lives alone. brother is a support -tobacco history:none -etoh: social -illicit drugs: none family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: t= 97.4 bp= 104/75 hr= 104 rr= 18 o2 sat= 99% general: nad, alert and oriented x3. flat affect. heent: ncat. sclera anicteric. pupils somewhat dilated but equally round and reactive to light and accomodation, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with non elevated jvp. 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: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: 2+ lower extremity and upper extremity edema. no clubbing or cyanosis skin: traumatic erythematous patch on r lower extremity pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: on admission: 01:04pm wbc-18.5*# rbc-4.59 hgb-13.1 hct-44.4# mcv-97# mch-28.5 mchc-29.5*# rdw-14.0 01:04pm neuts-84.0* lymphs-11.0* monos-4.6 eos-0.1 basos-0.3 01:04pm plt count-577*# 01:04pm albumin-2.6* 01:04pm lipase-7 01:04pm alt(sgpt)-45* ast(sgot)-68* alk phos-159* tot bili-2.3* 01:04pm glucose-114* urea n-12 creat-0.9 sodium-139 potassium-4.3 chloride-107 total co2-22 anion gap-14 03:11pm pt-17.5* ptt-37.5* inr(pt)-1.6* 12:00am plt count-353 12:00am wbc-7.9# rbc-3.10*# hgb-9.1*# hct-30.0*# mcv-97 mch-29.2 mchc-30.2* rdw-13.9 12:00am calcium-7.3* phosphate-2.6* magnesium-2.0 12:00am lipase-7 12:00am alt(sgpt)-27 ast(sgot)-24 alk phos-98 amylase-15 tot bili-0.7 12:00am glucose-110* urea n-12 creat-0.6 sodium-144 potassium-4.0 chloride-115* total co2-22 anion gap-11 tsh : 3.6 pth : 66 b12 : 1835 hcg : negative hiv neg hcv neg trig 185 vitamin b1 370 (normal) prealbumin 7 cpk isoenzymes ck-mb ctropnt probnp 03:09am notdone1 0.07*2 3928* protein electrophoresis normal upep : 27 (normal) . ruq ultrasound: 1. cholelithiasis without secondary signs to suggest cholecystitis. 2. echogenic liver most compatible with fatty infiltration. please note that other forms of hepatic disease such as cirrhosis/fibrosis are not excluded. . ct abd/pelvis: 1. pancolitis as decribed above. 2. cystic lesion in tail of pancreas, not fully evaluated on this examination. would recommend mri in 6 months for further characterization. 3. focal narrowing in sigmoid colon may represent focal collapsed bowel, however, bowel wall lesion cannot be excluded. would recommend imaging correlation such as colonoscopy or barium study as available. . mrcp: 1. severe hepatic steatosis. 2. biliary tree shows no abnormalities. 3. colonic wall thickening and mucosal enhancement, related to colitis as seen on recent ct scan. 4. cystic, non-enhancing lesion in the tail of the pancreas, that is most likely in keeping with a pseudocyst, however, a side branch ipmn cannot be excluded, although less likely. a followup mri is suggested in six months for further evaluation. 5. jejunal biopsy negative. . ct abd/pelvis: 1. no evidence of esophageal perforation. 2. resolution of colonic wall thickening demonstrated on prior ct. 3. hepatic steatosis. 4. low-attenuation lesion at the tail of the pancreas is compatible with a cyst versus dilated side branch. it is unchanged from prior recent mrcp and ct. as described on prior mrcp report, followup of this with mrcp in six months is recommended to assess for expected stability. . echo: the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is severely depressed (lvef= 20-30 %). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. right ventricular chamber size is normal. with focal hypokinesis of the apical free wall. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is a small to moderate sized pericardial effusion. no right atrial or right ventricular diastolic collapse is seen. however, the right ventricle appears underfilled. impression: severe anterior and apical hypokinesis/akinesis; small, primari8ly anterior pericardial effusion possibly with early tamponade. . cardiac catheterization: 1. selective coronary angiography in left dominant system demonstrated no flow limiting lesions. the lmca had minimal plaquing in the mid portion of the vessel. the lad had minimal luminal irregulairites with 15% stenosis at the origin of the vessel. the distal lad wraps around the apex with diffuse plaquing in the distal lad. the cx had minimal luminal irregularities and gave off a small caliber om1, an atrial branch a modest om2, a large lpl and a moderate lpda. the rca was a small nondominant vessel that initially had catheter induced vasospasm that improved after intracatheter nitroglycerine. 2. limited resting hemodynamics revealed elevated right and left filling pressures with an rvedp of 17 mmhg and an lvedp of 28 mmhg. there was mild pulmonary artery hypertension with a pasp of 38 mmhg. the cardiac index was preserved at 3.3 l/min/m2. the svr was slightly low at 754 dynes-sec/cm5 and the pvr was preserved at 69 dynes-sec/cm5. the central aortic pressure was 103/68 mmhg. there was no transaortic valve gradient on pullback from the lv to the aorta. final diagnosis: 1. coronary arteries have no flow limiting lesions. 2. mild pulmonary arterial hypertension. 3. severe left ventricular diastolic dysfunction. . on discharge: negative lyme, mrsa swab, hiv, hcv and urine cx ebv, vitamin d and cmv are still pnd complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:13am 7.5 3.03* 9.1* 29.4* 97 29.9 30.8* 15.0 431 renal & glucose glucose urean creat na k cl hco3 angap 05:13am 91 12 0.7 139 3.7 107 27 9 cosyntropin stimulation test : cortisol prior: 6.31 cortisol 30 min after cosyntropin: 23.9 cortisol 60 min after cosyntropin: 28.5 . brief hospital course: the patient is a 41 year old female with seizure disorder, gastrectomy, degenerative disc disease who presented with vague gi complaints, weight loss, and admitted to ccu after an episode of chest pain and she was found to have severe systolic/dystolic function as well as tachycardia. on , the patient was discharged in good condition, with stable vital signs, with appropriate outpatient follow-up arranged. ms. hospital course was notable for: . # hypotension: has been intermittantly hypotensive this admission but asymptomatic, likely low ef. hct is low and drfting down. random cortisol low normal and cortisone stimulation test was normally responsive. pt is not orthostatic or dizzy, is able to ambulate easily and denies any symptoms. her lisinopril and metoprolol was started at a very low dose. . # upper back pain: pt has a history of lower back scoliosis, myofascial pain syndrome and facet arthropathy that affects her lower back. her upper back pain is new. pt feels that her pain may be bedrest, and is relieved by morphine. no radicular symptoms. on muscle relaxer at home and chronic narcotics (roxicet) which pt states is ineffective. pt reports that clonazepam did not help as an additional muscle relaxer. she was given a limited morphine po prescription and instructed to contact the pain clinic at which she had used in . according to the patient, they recommended surgery which she has been reluctant to do. . # acute systolic dysfunction: cath showed no cad. noted increased filling pressures and furosemide and lasix po started. no o2 requirement or sob at present despite fluid overload. unclear etiology but fatigue in last few months may be related. tsh neg. multiple viral tests performed, all negative except for ebv and cmr which are pending. pt was discharged on lisinopril 2.5 mg and long acting metoprolol with furosemide twice daily. instructed to weigh herself daily and follow a low sodium diet. pt will follow-up with dr. for in . . # nausea, weight loss: pt had recent ct scan which showed pancolitis, and f/u ct scan which showed interval resolution. also w/ cholelithiasis and steatotic hepatitis. pt w/ fairly substantial gi surgical hx. gi and surgery following with plan for outpt ct colonoscopy for further evaluation. gi also recommends outpatient mri enterography for further evaluation. symptoms may represent malabsorption syndrome, such as celiac sprue, or possibly related to surgical gastric resection. albumin 2.0, thought to be contributing to her peripheral edema. egd done, bx showed inflmmation only. weight loss is at least in part r/t very decreased and erratic intake. pt describes very poor protein and calorie intake last 2 months. spoke with pt's mother who states that pt has not worked in 2 months, is considering disability, has been increasingly isolated in her apt with limited contact with friends. dr. , pts outpatient psychiatrist was informed of this information. worsening depression is suspected. she is tolerating po's at discharge. she has had extensive nutritional counseling after her gastric bypass but would consider outpatient referral again. . # anemia: normochromic, normocytic. on fe supplementation as fe studies suggest fe deficiency. no signs of acute bleed. had some rectal bleeding with stools recently, hemmorhoids. needs repeat outpt colonoscopy. on fe, b12 q week, folic acid supplements. . # epilepsy: no sz activity noted. continued home meds of levetiracetam, venlafexime, topiramate . # depression: see note above about poor po intake. increasing isolation, ahedonia and decreased intake all point to worsening depression. psych team saw pt in house but had no recommendations as they did not have accurate information from the patient. outpt psychiatrist was contact about symptoms and will f/u with pt. note that pt is very reluctant to discuss some information with her caregivers. medications on admission: b12 injection 1,000mcg monthly iron 65mg daily zolpidem 10mg hs prn folic acid 1mg daily venlafaxine 300mg daily amitriptyline 25mg hs (has not taken recently) clonazepam 1mg daily prn anxiety topiramate 100mg hs tizanidine 8mg hs roxicet 5/325 q6h prn levetiracetam 500mg omeprazole 20mg daily (no longer taking) discharge medications: 1. topiramate 100 mg tablet sig: one (1) tablet po daily (daily). 2. levetiracetam 250 mg tablet sig: two (2) tablet po bid (2 times a day). 3. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. clonazepam 1 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed for anxiety. 6. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily): take with iron. 7. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 8. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 9. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 10. cyanocobalamin 1,000 mcg/ml solution sig: one (1) injection injection once a week. 11. levetiracetam 500 mg tablet sig: one (1) tablet po twice a day. 12. tizanidine 4 mg capsule sig: two (2) capsule po at bedtime. 13. venlafaxine 150 mg capsule, sust. release 24 hr sig: two (2) capsule, sust. release 24 hr po once a day. 14. morphine 15 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. disp:*45 tablet(s)* refills:*0* 15. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* discharge disposition: home discharge diagnosis: heart failure: systolic dysfunction (ef 20-30%) and diastolic dysfunction colitis discharge condition: stable discharge instructions: you had nausea and vomiting and were admitted to the gastroenterology service. multiple tests were performed, you were found to have colitis, an irritation of the lining of your gastrointestinal tract. this is now resolving without treatment. your heart rate became high and you were evaluated by the cardiology team. your heart function is about 50% weaker than it should be. we have done many tests to find the cause of this weakness but have not identified a cause as yet. you did not have a heart attack. you need to eat a balanced diet with adequate protein and calories every day. because your heart is weak, you may retain fluid in your legs, lungs or hands. not eating enough protein makes your swelling worse. weigh yourself every morning, call dr. " if weight > 3 lbs in 1 day or 6 pounds in 3 days. adhere to 2 gm sodium diet fluid restriction: 1.5 liters per day or about 8 cups . in addition, you had a cortisol stimulation test to evaluate your low blood pressure. please review the results of this test with your primary care provider at your next visit. . . medication changes: 1. start furosemide (lasix) to decrease the amount of fluid in your body 2. lisinopril: to help your heart pump better, this will lower your blood pressure slightly 3. metoprolol: to slow you heart rate and help your heart work better 4. thiamine and vitamin c: to correct nutritional deficencies and help your anemia . please call dr. if you notice any trouble breathing, increased swelling or cough. followup instructions: cardiology: provider: phone: date/time: 2:20 . primary care: provider: , md , md phone: date/time: at 3:25pm. please call insurance and change pcp. . gastroenterology: cystic lesion in tail of pancreas, not fully evaluated on this examination. would recommend mri in 6 months for further characterization. pt needs to have a mr enterography and colonoscopy as an outpt. procedure: venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization coronary arteriography using two catheters parenteral infusion of concentrated nutritional substances colonoscopy esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: other iatrogenic hypotension congestive heart failure, unspecified unspecified essential hypertension other chronic pulmonary heart diseases depressive disorder, not elsewhere classified unspecified disease of pericardium other specified cardiac dysrhythmias loss of weight iron deficiency anemia, unspecified calculus of gallbladder without mention of cholecystitis, without mention of obstruction epilepsy, unspecified, without mention of intractable epilepsy other antihypertensive agents causing adverse effects in therapeutic use acute combined systolic and diastolic heart failure other disorders of plasma protein metabolism dehydration scoliosis [and kyphoscoliosis], idiopathic internal hemorrhoids with other complication other and unspecified postsurgical nonabsorption myalgia and myositis, unspecified hepatitis, unspecified cyst and pseudocyst of pancreas bariatric surgery status anorexia spondylosis of unspecified site, without mention of myelopathy other protein-calorie malnutrition universal ulcerative (chronic) colitis precordial pain 

Answer: The patient is high likely exposed to