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: no known allergies / adverse drug reactions attending: chief complaint: tachypnea, shortness of breath major surgical or invasive procedure: ir guided thoracentesis history of present illness: ms. is an 89 yo f with a history of atrial fibrillation, ckd, htn, hypothyroidism who presents from her nursing home with hypoxia and tachypnea. the patient mentions that she was in her usual state of health, when last night at her nursing home she was "unable to get comfortable". this morning she felt short of breath. denies any chest pain, but has had occasional palpitations. denies fevers, chills, cough, or sputum production. . her lasix 20mg daily was changed on to lasix 40mg po daily. she was also started on azithromycin 500mg on . on the morning of admission, she was found to have a weight of 144lbs (baseline 139lbs). this morning at rehab she was found to be 86% on ra, and was placed on a nrb. hr 123, t 96.3. ems was called. . notably, the patient was recently admitted from with dyspnea on exertion and acute renal failure. she was diuresed, and discharged on lasix 20mg po daily. she was not discharged on a beta blocker as she had hypotension and 2 episodes of vasovagal syncope during her admission. she was previously on atenolol, which may have accumulated during her episode of acute renal failure. her valsartan, atenolol, and hctz were all stopped on discharge. she was dnr/dni during that admission. . in the ed, initial vs were: t98.2 hr 122 bp 170/101 rr 20 75% on ra --> 96% on nrb. cxr was concerning for vascular congestion and bilateral pleural effusions. patient was given 20mg iv lasix x1, 10mg iv diltiazem. she was briefly started on a nitro gtt, but became hypotensive, so this was stopped. she was started on bipap 10/4 fio2 100% with improvement in tachypnea. the edstarted her on a diltiazem gtt for improved rate control, and to empirically start vancomycin 1g, ceftriaxone 1g, and azithromycin 500mg iv x1 for pneumonia. vitals prior to transfer were bp 120s/60s hr 100-110 rr 18. . on the floor, the patient is breathing comfortably on 80% high flow. she denies any chest pain, fevers, or cough. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes past medical history: atrial fibrillation hypothyroidism s/p thyroidectomy htn hl ckd stage 3 chronic venous stasis depression social history: lives alone in independent. says she can do all her adl alone. vna visits 2x/week. son, , lives in . she has 2 granddaugthers. lives in her entire life. never smoked. family history: daughter- breast ca, died in her 40s sister- breast ca mother-esophageal ca sister- lung ca, smoker brother- mi in 40s brother- as child, died of perf appendicitis physical exam: admission exam: vitals: t: 97.9 bp: 134/59 p: 94 r: 22 o2: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp to mandibular angle, no lad lungs: decreased breath sounds at bases with quiet crackles way up bilaterally cv: irregularly irregular. no murmurs. abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses. 2+ le edema discharge exam: vs: tmax 98.7 tc 98.6 bp 123/79 (100-153/49-89) hr 82 (68-88) rr 18 o2 sat 98%ra (high 90s on ra or 1l) i/o: over 24h weight 61.4kg --> 59.1kg general: nad. a&ox3. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple, no jvd. cardiac: irregular, normal s1/s2. no m/r/g. lungs: poor respiratory effort. respirations unlabored, no accessory muscle use. bibasilar crackles r >l, improved since yesterday abdomen: soft, nt/nd. nabs. no hsm or tenderness. extremities: wwp. 1+ edema bilaterally to shins. skin: +venous stasis dermatitis bilaterally. pulses: right: carotid 2+ femoral 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ dp 2+ pt 2+ pertinent results: admission labs: 11:50am blood wbc-9.5# rbc-4.07* hgb-11.6* hct-35.5* mcv-87 mch-28.4 mchc-32.6 rdw-15.2 plt ct-382 11:50am blood neuts-94.6* lymphs-3.3* monos-1.4* eos-0.2 baso-0.4 11:50am blood pt-12.9 ptt-24.4 inr(pt)-1.1 11:50am blood glucose-119* urean-46* creat-1.4* na-138 k-4.1 cl-93* hco3-30 angap-19 . discharge labs: 07:45am blood wbc-8.9 rbc-3.93* hgb-11.1* hct-34.6* mcv-88 mch-28.3 mchc-32.2 rdw-15.1 plt ct-353 07:45am blood pt-18.2* ptt-28.0 inr(pt)-1.6* 07:45am blood glucose-102* urean-30* creat-1.1 na-141 k-4.9 cl-101 hco3-34* angap-11 07:10am blood ld(ldh)-187 07:45am blood calcium-8.8 phos-3.1 mg-2.0 04:55pm blood caltibc-393 ferritn-55 trf-302 12:59am blood triglyc-108 hdl-74 chol/hd-2.5 ldlcalc-86 07:44am blood tsh-5.4* 03:42am blood free t4-1.6 07:44am blood t4-9.5 micro: urine culture (final ): no growth. blood culture, routine (final ): no growth. ecg : atrial fibrillation with rapid ventricular response and probable ventricular premature beat. low limb lead qrs voltage. delayed r wave progression. modest right precordial lead t wave changes are suggested but unstable baseline in those leads makes assessment difficult. findings are non-specific. since the previous tracing of ventricular rate is faster. portable cxr : findings: ap upright portable chest radiograph is obtained. layering bilateral pleural effusions are present with pulmonary vascular congestion and probable mild pulmonary edema. heart size is difficult to assess. atherosclerotic calcification along the aortic knob noted. bones appear grossly intact with degenerative changes in the upper lumbar spine and mild scoliosis. there are consolidations/atelectasis at both lung bases, likely atelectasis, though cannot exclude underlying pneumonia. impression: findings compatible with congestive heart failure with bilateral pleural effusions. portable cxr : findings: there is a moderate to large right pleural effusion. there is associated volume loss on the right. left small to moderate effusion and basal atelectasis is also seen. superimposed consolidation is not excluded. no pneumothorax is seen. comparison to prior exam somewhat limited by different projection with different dependent positioning of the bilateral effusions compared to prior exam. there is likely to be minimal change allowing for this. brief hospital course: 89 yo f with a history of atrial fibrillation, ckd, htn, hypothyroidism who presents from her nursing home with hypoxia and tachypnea. # chf exacerbation: she presented in acute hypoxic respiratory distress from her nursing home with both desaturations on room air and increased work of breathing. congestion and effusion seen on cxr suggested diastolic heart failure decompensation as a likely etiology. given her elevated filling pressures, she likely cannot tolerate increased heart rates, and her rvr likely precipitated the pulmonary congestion. her trops were mildly elevated with flat mb fractions, suggesting a rate-induced demand. she was diuresed aggressively with furosemide 20mg iv wityh good effect and transitioned to home dose of furosemide 20mg daily and hr control was accomplished initiatlly with diltiazem gtt before transitioning to metoprolol tartrate 25mg . upon transfer back to the floor , one additional dose of lasix was given but further diuresis was held as pt appeared clinically euvolemic. she remained net negative ~500cc daily despite additional diuresis. she was discharged to rehab on her home dose of lasix 40mg daily. # pleural effusion: pt had large bilateral pleural effusions on cxr r>l. she initially declined thoracentesis at icu. however, upon transfer to the floor, this was re-addressed and pt was willing to undergo thoracentesis. ir guided thoracentesis was performed and 1l of pleural fluid drained from right pleural space. she tolerated the procedure well. pt was satting in high 90s on room air by discharge. follow-up cxr following thoracentesis showed right lower lobe opacities likely representative of re-expansion pulmonary edema; pneumonia was also possible but clinically pt without fever, cough or leukocytosis to suggest infection. she was discharged to rehab on her home dose of lasix. # atrial fibrillation with rvr: she presented in rvr with rates in the 120s and was initially controlled with a diltiazem gtt before adding po metoprolol tartrate at 25mg . she had orthostatic syncope during her previous hospitalization in response to augmented atenolol availability in the setting of renal failure, so she had not been discharged on rate control agents. as her chf is likely rate related, nodal blockade will likely be necessary and she should be considered for dccv. she was started on metoprolol 25mg tid. she had no further episodes of afib with rvr while at the floor. she was seen by ep who also recommended anticoagulation. she was started on coumadin 2mg daily given her chads score 3 (chf, htn, age). risks and benefits of anticoagulation were discussed with family who agreed with initiation of coumadin. coumadin was briefly held for ir guided thoracentesis on and restarted upon discharge. inr was 1.6 at discharge. aspirin dose was reduced from 325mg to 81mg on discharge. she was discharged with follow-up with her cardiologist to discuss possible initiation of amiodarone as outpatient. # somnolence: when pt was first transferred back from the icu to the floor on , she became very somnolent and difficult to arouse. she was transferred back to the icu for hypercarbic respiratory failure. initial abg showed metabolic alkalosis with bicarb peaking in the 40s. it was felt that her primary hypopnic drive was her metabolic alkalosis but she then developed a respiratory acidosis perhaps from sedating effects of acetazolamide which was the only new medication. ventilation was also impaired by her pleural effusions. acetazolamide was discontinued, diuresis was held. she was given kcl to prevent hydrogen ion loss via kidneys. she did not tolerate bipap. her mental status and oxygen improved as her bicarb normalized. she had one episode of coughing with liquids. as mental status improved and with proper positioning she was able to swallow under observation. a speech and swallow consult was ordered and showed mild oral dysphagia, likely baseline function given her age. she was noted to have signs and symptoms of aspiration with consecutive straw sips of liquid only. she was continued on her diet of soft solids and thin liquids. # gerd: pt complained of gerd-like symptoms including bitter taste in her mouth and burping. she was started on pantoprazole. # hypothyroidism: tsh slightly elevated at 5.4, though levothyroxine dose was recently uptitrated and will need another few weeks prior to considering dose adjustment. # depression: pt had been on mirtazapine and venlafaxine at home. she had bouts of tearfulness while in the hospital. when she became somnolent and was re-transferred to the micu on , potentially sedating medications, including mirtazapine, were discontinued. geriatrics consult was obtained for patient's depression; recommended that the mirtazapine continue to be held while pt was in the hospital. however, suggested that effexor be uptitrated as needed as outpatient and that mirtazapine could be re-started as outpatient if patient stable. geriatrics consult also felt that pt would benefit from speech therapy. these recommendations were communicated to the patient's pcp. # chronic kidney disease: baseline cr ranged 1.5-1.7. cr during hospital admission ranged 1.1 to 1.6. cr was 1.1 on discharge. # hyperlipidemia: she was continued on her home dose of statin. ldl was 86. # iron deficiency: iron level was low at 23. she was started on ferrous sulfate supplementation. medications on admission: 1. aspirin 325mg po daily 2. simvastatin 20mg po qhs 3. docusate 100 mg po bid 4. senna 8.6 mg po bid prn constipation 5. acetaminophen 650 mg po q6h prn pain 6. levothyroxine 125 mcg po daily 7. multivitamin po daily 8. calcium carbonate 200 mg (500 mg) po daily 9. vitamin d 1,000 unit po daily 10. mirtazapine 15 mg po qhs 11. lasix 20 mg po daily 12. effexor 37.5mg po daily discharge medications: 1. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain, fever. 5. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 6. multivitamin tablet sig: one (1) tablet po daily (daily). 7. venlafaxine 37.5 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po daily (daily). 8. vitamin d 1,000 unit tablet sig: one (1) tablet po once a day. 9. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po once a day. 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). tablet, delayed release (e.c.)(s) 11. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 12. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 13. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 14. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm. 15. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: senior healthcare of discharge diagnosis: chf exacerbation atrial fibrillation pleural effusion discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ms. , you were admitted to with difficulty breathing from heart failure as well as a rapid heart rhythm called atrial fibrillation. your heart rate was better controlled with a medication called metoprolol. you were also started on a blood thinner called coumadin to prevent strokes. the blood thinner requires frequent monitoring of a blood test called the inr to make sure that levels are therapeutic. you will be going to a rehab facility where you will have close monitoring. you also had the fluid in your lungs drained to help your breathing. . we made the following changes to your medications: -start ferrous sulfate 325mg daily -start pantoprazole 40mg daily -start metoprolol 25mg three times a day -start coumadin 2mg daily -decrease aspirin from 325mg to 81mg daily -stop mirtazapine 15mg at night followup instructions: name: , location: healthcare - medical group address: ,8th fl, , phone: **please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge** . department: cardiac services when: wednesday at 12:00 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: thoracentesis diagnoses: unspecified pleural effusion congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure depressive disorder, not elsewhere classified other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) acute respiratory failure iron deficiency anemia, unspecified do not resuscitate status venous (peripheral) insufficiency, unspecified mixed acid-base balance disorder family history of malignant neoplasm of gastrointestinal tract postsurgical hypothyroidism family history of malignant neoplasm of trachea, bronchus, and lung family history of malignant neoplasm of breast dysphagia, oral phase 

Answer: The patient is high likely exposed to