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: paba / silvadene / bacitracin attending: chief complaint: pericardial effusion major surgical or invasive procedure: pericardiocentesis () pericardial drain removal () pacemaker lead revision history of present illness: 76yom with h/o vascular dementia, pvd, ckd, aaa, h/o pe s/p ivc filter, afib s/p ppm on coumadin, copd, critical as ( < 0.8) who presented to after feeling unwell after dinner last night. pt is very poor historian due to baseline dementia. his wife reports that they ate dinner last night and after he felt "woozy" but was unable to more fully qualify it; he was pointing to his abdomen though. he went to bed at 9pm (early for him) and woke up this morning. he had difficulty putting his pants on, which is different for him, and complained of abdominal pain, possibly in the ruq, but the history is not very specific. they went to bidn where he had an ruq ultrasound which showed pericholecystic fluid that was concerning for gb carcinoma. he was sent to for further w/u. there, he received cipro/flagyl and 2l ns. lowest blood pressure there was 90. in the ed initial vitals: 98.2 88 113/78 12 100%. no abdominal pain here. ultrasound done at the bedside in ed was conerning for gb stone and sludge and incidentally noted a pericardial effusion with rv collapse. surgery and cards were both consulted. he was given a nicotine patch and 5mg zyprexa for agitation at , he was noted to have which was thought to be hypovolemic and creatinine improved with intravenous fluids. he was given vitamin k 5 mg po x for elevated inr and subsequently underwent pericardiocentesis. in the cath lab, he underwent pericardiocentesis with drainage of blood fluid and decrease of pressure from 18 mmhg to negative. tte pre-pericardiocentesis showed wire/catheter in anterior pericardial space but ekg showed few ventricular pacing capture beats. post-pericardiocentesis tte showed no residual pericardial effusion. past medical history: htn, increase chol, pvd, dm - diet controlled, filter, vena cava clipping, r fem - op , r illio profunda bp ', l fem bk with left arm vein (), vein patch angioplasty of l fem bk () social history: pos tobacco 1.5 ppd rare alchohol family history: father deceased at 54 - stroke physical exam: admission exam 97.6 144/53 paced 65 23 96% 2lnc elderly gentleman in no distress, family at bedside. keeps asking to go to bathroom despite being told repeatedly that he has a foley in place. eomi, no scleral icterus noted mouth and lips appear very dry but no clear lesions noted jvd not noted ctab with light dry sounding crackle at r base, o/w ctab s1/s2 very faint, almost inaudible, best heard at the apex abd soft, nontender in any quadrant, no hepatomegaly no ble edema but with prominent chronic venous stasis changes. extrems are warm and well perfused. dp's are not easily palpalbe cn 2-12 intact, spontaneously moving all 4 extremities, no gross focal neuro deficit pertinent results: 02:00pm blood wbc-12.5* rbc-4.47* hgb-12.8* hct-39.3* mcv-88 mch-28.7 mchc-32.6 rdw-16.4* plt ct-136* 03:45am blood wbc-10.3 rbc-3.76* hgb-11.1* hct-33.3* mcv-89 mch-29.6 mchc-33.4 rdw-16.5* plt ct-114* 03:56am blood wbc-13.5* rbc-4.16* hgb-12.3* hct-36.4* mcv-88 mch-29.5 mchc-33.7 rdw-16.7* plt ct-146* 05:27am blood wbc-12.8* rbc-3.93* hgb-11.6* hct-34.4* mcv-88 mch-29.5 mchc-33.7 rdw-16.7* plt ct-156 02:00pm blood pt-33.2* ptt-29.2 inr(pt)-3.3* 06:16am blood pt-30.8* ptt-30.4 inr(pt)-3.0* 03:45am blood pt-21.4* ptt-26.9 inr(pt)-2.0* 06:23am blood pt-16.3* ptt-23.6 inr(pt)-1.4* 03:56am blood pt-15.6* ptt-22.7 inr(pt)-1.4* 02:00pm blood glucose-201* urean-59* creat-2.1*# na-136 k-5.3* cl-107 hco3-16* angap-18 03:45am blood glucose-132* urean-34* creat-1.2 na-141 k-4.0 cl-111* hco3-19* angap-15 05:27am blood glucose-146* urean-22* creat-1.0 na-145 k-3.9 cl-110* hco3-24 angap-15 08:35pm blood alt-393* ast-330* ld(ldh)-491* ck(cpk)-166 alkphos-154* totbili-0.5 03:56am blood alt-340* ast-64* ld(ldh)-224 alkphos-126 totbili-0.7 02:00pm blood probnp-* 08:35pm blood ck-mb-3 ctropnt-0.01 02:00pm blood albumin-4.0 calcium-8.7 phos-3.8 mg-2.1 06:23am blood albumin-3.4* calcium-8.9 phos-1.9* mg-1.9 tte () the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 10-20mmhg. overall left ventricular systolic function is probably moderately depressed (lvef= 35-40 %). there is no ventricular septal defect. tissue synchronization imaging demonstrates significant left ventricular dyssynchrony with the lateral wall contracting significantly later than the septum. rv with normal free wall contractility. there is moderate aortic valve stenosis (valve area 1.0-1.2cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is a moderate sized pericardial effusion which is circumfirential and fairly clear. no right ventricular diastolic collapse is seen. there is brief right atrial diastolic collapse. compared with the prior study (images reviewed) of , the lvef has decreased and the pericardial effusion is new. the degree of as is probably similar. impression: moderate pericardial effusion. elevated intrapericardial pressure without overt tamponade. moderate as. depressed lvef with dysynchron (pacing induced). ruq us () markedly thickened gallbladder wall and thickened septum through the apparent center of the gallbladder with areas of internal vascularity, highly concerning for gallbladder malignancy. cholelithiasis and possible very trace to zero pericholecystic fluid. again, if there is concern for acute cholecystitis, a hida scan can be considered. pericardial fluid cytology () showed ... pericardiocentesis () 1. pericardial access was obtained via the sub-xiphoid approach. the pericardial fluid was sanguinous. injection of contrast into the pericardial space showed the effusion to be freely flowing and non-loculated. initial mean pressure of the pericardium upon entrance was 17 mmhg which went down to a mean of 2 mmhg after drainage of pericardial fluid. final diagnosis: 1. tamponade physiology which resolved with drainage of pericardial fluid. ct abdomen () 1. obstructing stone in the distal common bile duct at the level of the ampulla. no evidence for mass 2. cholelithiasis without evidence for cholecystitis. 3. fatty infiltration of the liver. 4. multiple hypodense lesions in both kidneys. a lesion in the left upper pole measures higher density and may represent a complex cyst. it is seen anteriorly and measures 2.7 cm in size. a second lesion on the left measuring 7.2 cm also demonstrates increased density (20 ). confirmation of the cystic nature of these lesions with ultrasound is recommended. 5. infrarenal aortic aneurysm measuring 3.7 cm. 6. small amount of ascites. 7. diverticulosis without evidence for diverticulitis. cta coronaries () evaluation of the pacemaker leads demonstrate that the right pacemaker lead is minimally perforating the right atrial anterior wall, 6a:102, with its most distal tip being within the pericardial space. no acute extravasation has been demonstrated. the origin of the coronary arteries is conventional. extensive coronary calcifications as well as aortic valve calcifications are present. there is minimal pericardial effusion noted. pericardial drain is following posterior inferior pericardial aspect terminating at the aortopulmonic window. extensive aortic calcifications are present. no evidence of arterial thrombosis is seen. bilateral pleural effusions are small to moderate associated with bibasilar consolidations that based on their size most likely represent atelectases and are unlikely to represent infectious process. airways are patent to the level of subsegmental bronchi bilaterally. in the upper lungs, there are several emphysematous bullae noted, 2:14. there is a focal opacity noted at the left apex, 2:9, which might represent infectious process that should be further followed to exclude the possibility of neoplasm. bulla also seen along the mediastinal pleura in the left upper lobe and along the mediastinum pleura in the superior aspect of right lower lobe, consistent with bullous paraseptal emphysema. atelectasis in the lingula is present. the imaged portion of the skeleton demonstrates no evidence of lytic or sclerotic lesions worrisome for infection or neoplasm. left ventricular lead appears unremarkable. tte () left ventricular wall thicknesses and cavity size are normal. the inferior wall is akinetic. significant aortic stenosis is present (not quantified). mild (1+) aortic regurgitation is seen. mild (1+) mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion, most apparent around the right atrium in the apical four-chamber view, with no evidence for hemodynamic compromise. compared with the prior study (images reviewed) of , the pericardial effusion is similar. cxr () permanent pacemaker is present with leads terminating in the right atrium and right ventricle. pericardial catheter remains in place. cardiac silhouette is enlarged but stable in size. improving pulmonary vascular congestion and resolving pulmonary edema. small pleural effusions. new mild-to-moderate gastric distension in the upper abdomen. impression: resolving pulmonary edema. small pleural effusions. . labs on discharge: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 09:10 13.2* 4.20* 11.6* 36.9* 88 27.6 31.4 16.5* 133* renal & glucose glucose urean creat na k cl hco3 angap 09:10 278*1 25* 1.2 144 3.7 105 29 14 chemistry calcium phos mg 09:10 9.2 3.0 1.8 basic coagulation pt ptt plt smr plt ct inr(pt) 09:10 133* 09:10 16.2* 22.7 1.4* brief hospital course: 76 year old male with history of vascular dementia, peripheral vascular disease, chronic kidney disease, aaa, history of pe s/p ivc filter, afib s/p ppm on coumadin, copd, critical as ( < 0.8) who presented to with vague abdominal pain and found to have transaminitis and ruq u/s concerning for gallbladder malignancy with incidental pericardial effusion concerning for tamponade and acute kidney injury. 1. pericardial effusion: tte in micu showed tamponade physiology with right ventricular diastolic collapse. he was taken to cath lab for pericardiocentesis which revealed pericardial pressure of 18 mm hg concerning for pericardial effusion due to pacemaker lead perforation. 150 cc of bloody drainage was removed which dropped the pericardial pressures from 18 mm hg to 0 mm hg. pericardial drain was left in placed and he was transferred to ccu. pericardial fluid stain and culture were negative. cytology was still pending at the time of discharge. he had 600 cc of pericardial drainage over next 24 hours. cta coronaries showed right atrial pacemaker lead perforation so he underwent right atrial lead revision on . he had only 50 cc of pericardial fluid drainage over next day with repeat tte showing no change in residual pericardial effusion without tamponade physiology. pericardial drain was removed. cxr showed appropriate location of right atrial and right ventricular pacemaker leads. he was given vancomcyin per ep for 4 days and discharged on oral clindamycin for 2 more days to complete seven days of antibiotics. he should have a repeat echocardiogram in weeks to confirm that effusion is not reaccumulating. 2. concern for gall bladder ca: ruq us very suggestive at two different hospital and radiologist. ct abdomen/pelvis showed 3 cm cbd stones. surgery evaluated the patient and thought that further outpatient evaluation was appropriate as the patient did not have an obstructive pattern in lft elevation. he will see his outpatient gastroenterologist in 2 days. . 3. transaminitis: unsure of the etiology. with negative alkaline phosphatase and bilirubin unlikely to be obstructive. simvastatin was held with concern for transaminitis. ruq and ct abdomen showed no liver patholgoy. they were trending down with alt of 132 and ast of 33 on discharge. his simvastatin was restarted. 4. atiral fibrillation s/p dual chamber ppm on coumadin: inr supratherapeutic on admission. was given 5mg vitamin k prior to pericardial drain placement. inr trended down to 1.4 on . coumadin was restarted at 5 mg po qdaily. with chads2 of 2 and right atrial lead perforation leading to pericardial effusion, he was not bridged with iv heparin. his inr was 1.4 on discharge. he was rate controlled with metoprolol 50 mg po bid. he will f/u with a new electrophysiologist here at in 1 month for further evaluation. 5. delirium with underlying advance dementia. no source of infection noted. attempt to orient frequently. foley was removed on (kept due to having pericardial drain in place and concern from nursing staff regarding pulling it out while wanting to go to the bathroom). he had episodes of sundowning daily which responded to im haldol 0.5 mg which was eventually changed to prn. he was discharged on olanzapine prn for agitation although it is noted by nursing that this has not been a very effective medicine. 6. acute on chronic systolic heart failure with ef of 35% (tte ) and severe aortic stenosis. he was noted to be tachypnic and hypoxic on with bibasilar crackles on exam. he was diuresed with iv lasix 10 mg x 2 with negative two liters of diuresis. he was started on lasix 20 mg per day on discharge. his moexipril and metoprolol were continued. weight on discharge is 81 kg. he has bibasilar crackles, 1+ peripheral edema but no o2 requirement on discharge. he should have a low na diet. 7. thrombocytopenia: stable from admission. 8. copd: continued on home tiotropium and advair. 9. peripheral vascular disease: discontinued home cilostazol since it could affect systolic heart function and likely has no benefit for the patient's peripheral vascular disease. 10. hypertension: home amlodipine and moxepril were held on admission with concern for pericardial effusion but restarted on . 11. type 2 diabetes. patient on metformin at home which was held on admission and restarted at discharge. . the patient remained full code during this admission. communication was with his wife. medications on admission: - amlodipine 10 mg daily - buproprion 150 mg er - cilostazol 100 mg - advair diskus 250 / 50 - metformin 500 mg er - metoprolol succinate 100 mg daily - moexepril 7.5 mg daily - simvastatin 40 mg daily - spiriva 18 mcg daily - warfarin 5 mg sunday and 7.5 mg mon-sat discharge medications: 1. amlodipine 10 mg tablet sig: one (1) tablet po once a day. 2. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po bid (2 times a day). 3. advair diskus 250-50 mcg/dose disk with device sig: one (1) inhalation twice a day. 4. metformin 500 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po twice a day. 5. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 6. moexipril 7.5 mg tablet sig: one (1) tablet po daily (daily). 7. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 8. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 9. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 10. lasix 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 11. clindamycin hcl 150 mg capsule sig: three (3) capsule po q6h (every 6 hours) for 2 days. 12. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po once a day as needed for agitation. discharge disposition: extended care facility: alzhemer center discharge diagnosis: primary diagnosis 1. pericardial effusion due to right atrial pacemaker lead perforation of right atrial wall 2. gallbladder wall thickening 3. 3 cm common bile duct stone discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you had some dizziness and abdominal pain and was admitted to and transferred to after an ultrasound showed some fluid around your gallbladder. an echocardiogram of your heart showed that there was some fluid there as well and a drain was placed to drain the fluid and keep it from reaccumulating. your pacemaker lead needed to be replaced as well. your kidneys worsened and now are improving. you also had a different heart rhythm called aflutter that needs to be evaluated by an electrophysiologist in a few weeks. you are on antibiotics because of the work done on your pacemaker. you will need to have an echocardiogram in weeks to check to see if the fluid around the heart has returned. . following medication changes were made to your medical regimen stop cilastazol with concern for its adverse effect on your heart start lasix 20 mg by mouth once a day start clindamycin pills to prevent an infection at the pacer site. start olazapine as needed for agitation followup instructions: name: ,md specialty: pcp/gastroenterology address: , , phone: when: thursday, at 3:45pm department: cardiac services when: friday at 12:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters pericardiocentesis revision of lead [electrode] diagnoses: acidosis thrombocytopenia, unspecified abnormal coagulation profile congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortic valve disorders peripheral vascular disease, unspecified chronic kidney disease, unspecified long-term (current) use of anticoagulants personal history of venous thrombosis and embolism anticoagulants causing adverse effects in therapeutic use sinoatrial node dysfunction acute on chronic systolic heart failure mechanical complication due to cardiac pacemaker (electrode) delirium due to conditions classified elsewhere cerebral atherosclerosis calculus of bile duct without mention of cholecystitis, without mention of obstruction cardiac tamponade vascular dementia, with delirium 

Answer: The patient is high likely exposed to