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 attending: chief complaint: scheduled pericardiocentesis major surgical or invasive procedure: pericardiocentesis history of present illness: 64 yr old woman has a history of copd, hypertension, hyperlipidemia, pvd s/p left iliac stenting, and carotid artery disease s/p bilateral carotid endarterectomies. she notes that in she developed a chest cold with productive cough of yellow sputum which has continued since without resolution of symptoms. furthermore, in , she underwent a preop screening for ent surgery for vocal cord lesions and was noted on ekg to have atrial fibrillation. she was subsequently started on coumadin and metoprolol. she was referred for a nuclear stress test on given her worsening pulmonary symptoms which was reportedly normal, and she subsequently had an echocardiogram on which revealed ef >55%, moderately dilated left atrium, lipomatous change to intra atrial septum, normal valves, mild pulmonary hypertension and a large pericardial effusion with no evidence of tamponade. given her significant smoking history and recent cough, chest ct was also done to assess for malignancy in the setting of the effusion which confirmed the large pericardial effusion but no evidence of pulmonary mass. fatty infiltration of the myocardium was also noted, and she subsequently underwent cardiac mri to assess for arrhythmogenic right ventricular dysplasia which again confirmed large effusion but no arvd. she has since been referred to for a scheuduled pericardiocentesis for her pericardal effusion which she underwent today with removal of 600 ml of turbid looking fluid. fluid significant for 283 wbcs and 9750 rbcs with cultures pending and a drain was placed. there were no complications from the procedure and she has been transferred to the ccu for post-pericardiocentesis monitoring. on the floor, initial vitals were t=97.5 bp= 124/73 hr=95 rr=17 o2 sat= 95% ra with significant wheezine noted on exam. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. . cardiac review of systems is notable for absence of chest pain. she has baseline dyspnea on exertion with 2 pillow orthopnea which has remained stable for months. she notes occasional ankle edema in the summer and is on lasix daily, but no current edema. she has noted increased bruising in the setting of her starting coumadin past medical history: 1. cardiac risk factors: hypertension, hyperlipidemia 2. cardiac history: - cabg: none - percutaneous coronary interventions: none 3. other past medical history: pericardial effusion copd vocal chord abnormality carotid artery disease s/p bilateral carotid endarterectomies-left , right peripheral arterial disease esophageal reflux gastric ulcer related to nsaids hypothyroidism atrial fibrillation current smoking-> pack per day right acl repair cholecystectomy bladder suspension x 3 right rotator cuff repair shingles depression pvd: successful stenting of left common iliac stenosis followed by covered stenting for dissection and possible extravasation .occluded superficial femoral artery with reconstitution of heavily diseased above-knee popliteal artery. social history: - tobacco history: she has smoked 1-1.5 ppd for seveal decades - etoh: former etoh abuse but not currently - illicit drugs: denies family history: both parents with cad, her mother had mi at unknown age. brother had mi at age 51. she also cad in multiple other family members physical exam: general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. cardiac: drainage catheter is cdi, draining serosanguinous fluid. irregularly irregular rate. pmi located in 5th intercostal space, midclavicular line. normal s1, s2. systolic murmur at left sternal border no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. bilateral diffuse wheezes, no crackles abdomen: obese, soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 1+ pt 1+ left: carotid 2+ dp 1+ pt 1+ pertinent results: 04:00pm other body fluid wbc-283* rbc-9750* polys-13* lymphs-18* monos-2* mesothe-16* macro-51* 04:00pm other body fluid totprot-5.5 glucose-118 ld(ldh)-119 amylase-15 albumin-3.5 07:35am blood wbc-15.4* rbc-4.95 hgb-14.1 hct-41.5 mcv-84 mch-28.5 mchc-33.9 rdw-15.3 plt ct-348 07:35am blood plt ct-348 07:35am blood pt-13.5* inr(pt)-1.2* 07:35am blood glucose-105* urean-24* creat-0.7 na-141 k-3.9 cl-101 hco3-29 angap-15 07:35am blood mg-1.9 07:20am blood %hba1c-6.5* eag-140* 05:00am blood probnp-2438* 04:24am blood tsh-6.1* 04:24am blood free t4-1.3 04:24am blood -negative - tte: the left atrium is markedly dilated. the right atrium is moderately dilated. left ventricular wall thicknesses and cavity size are normal. overall left ventricular systolic function is low normal (lvef 50-55%). the right ventricular cavity is mildly dilated with normal free wall contractility. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. there are no echocardiographic signs of tamponade. impression: no significant residual pericardial effusion. compared with the prior study (images reviewed) of , findings are similar. - cxr: reason for examination: followup of the patient with pericardial effusion after pericardiocentesis. pa and lateral upright chest radiograph was compared to , . the current cardiac silhouette appears to be unchanged, not even slightly increased since the prior study, which potentially may be due to appearance of pe, which may be due to upright position of the patient and relatively low lung volumes but definitely no decrease in the cardiac silhouette has been demonstrated. there is also presence of increased interstitial markers that are worrisome for at least mild interstitial pulmonary edema. upper lungs are essentially clear except for those mild interstitial markers. there is no pneumothorax. there is small amount of bilateral pleural effusion. note is made that the overall cardiac silhouette appears to be unchanged since the prior study. brief hospital course: 64 yo female with pmh significant for copd, hypertension, hyperlipidemia, pvd, carotid artery disease, with new diagnosis of a. fib and pericardial effusion, now s/p pericardiocentesis. . # pericardial effusion: s/p uncomplicted pericardiocentesis with 600cc of fluid removed. fluid notable for elevated wbcs and rbcs, with cultures pending. etiology unclear at this point. osh chest ct which ruled out lung malignancy, but another occult malignancy could still be a possibility. negative breast and skin exam. viral process could also explain the effusion, especially with her recent history of persistent uri symptoms over the past several months. repeat echo the morning after drain placement showed minimal pericardial effusion and the drain was pulled without complication. echo one day later showed no recurrent effusion. she will need an echo as an outpatient in 3 weeks. . # a fib: rate controlled with metoprolol and anticoagulated with coumadin. on the floor, she is in rate controlled a. fib. coumadin was held pre-procedure, and restarted prior to discharge at 6 mg daily for two days, with instructions to have inr checked on monday . she was continued on home metoprolol 100 mg daily. . # copd: patient has extensive smoking history, stating she started when she was 8 years old. on presentation, she was noted to be hypoxic to high 80s on 4l, with diffuse wheezing. she was treated for a copd exacerbation with 5 days of prednisone and 7 days of azythromycin, along with nebulizer treatments. on discharge, she was sating 96% on room air, 93% with ambulation on room air. she was discharged with advair and nebulizers as needed. she will need outpatient pulmonary evaluations with pfts. . # htn: continued on home regimen of metoprolol, amlodipine, and lasix. . # hld: continued on home simvastatin 20mg daily, ezetimibe 10mg daily. . # hypothyroidsim: tsh 6.1 on admission. dose of levothyroxine increased to 100 mcg ped day on discharge. . # depression/bipolar: continued on home abilify and seroquel (25mg po tid, 200mg qhs prn for sleep) . # gerd: continued on home omeprazole. medications on admission: amlodipine 10 mg daily aripiprazole 20 mg daily ezetimibe-simvastatin 10 mg-20 mg qam fluticasone-salmeterol 250 mcg-50 mcg 1 puff inhaled twice a day furosemide 40 mg qam levothyroxine 75 mcg qam metoprolol tartrate 100 mg qhs omeprazole 40 mg qam quetiapine 25 mg tid quetiapine 200 mg qhd prn ranitidine 300 mg qpm warfarin 4 mg daily vitamin d 1,000 units daily lorazepam 2 mg qhs discharge medications: 1. amlodipine 10 mg tablet sig: one (1) tablet po once a day. 2. aripiprazole 20 mg tablet sig: one (1) tablet po once a day. 3. ezetimibe-simvastatin 10-20 mg tablet sig: one (1) tablet po once a day. 4. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. furosemide 40 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 6. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. metoprolol succinate 100 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* 8. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 9. quetiapine 25 mg tablet sig: one (1) tablet po tid (3 times a day). 10. quetiapine 200 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for sleep. 11. ranitidine hcl 150 mg tablet sig: two (2) tablet po qpm (once a day (in the evening)). 12. warfarin 2 mg tablet sig: three (3) tablet po once daily at 4 pm: please take 6mg daily for saturday and sunday evenings. then continue regular dosing as prescribed by dr. . tablet(s) 13. cholecalciferol (vitamin d3) 1,000 unit capsule sig: one (1) capsule po once a day. 14. lorazepam 1 mg tablet sig: two (2) tablet po hs (at bedtime). 15. prednisone 20 mg tablet sig: two (2) tablet po once a day for 2 days. disp:*4 tablet(s)* refills:*0* 16. azithromycin 250 mg tablet sig: one (1) tablet po daily (daily) for 2 days. disp:*2 tablet(s)* refills:*0* 17. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily) as needed for withdrawl for 6 weeks. disp:*42 patch 24 hr(s)* refills:*0* 18. nicotine 7 mg/24 hr patch 24 hr sig: one (1) patch transdermal once a day for 2 weeks: to start after 14 mg patch is finished. disp:*14 patch* refills:*0* 19. nebulizer home nebulizer machine for severe emphysema 20. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day). 21. combivent 18-103 mcg/actuation aerosol sig: one (1) vial inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*1 box* refills:*2* discharge disposition: home discharge diagnosis: pericardial effusion acute diastolic dysfunction chronic obstructive pulmonary disease exacerbation hypothyroidism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you had a planned pericardiocentesis where fluid was removed from the area surrounding your heart. you do not have any evidence of reaccumulation of the fluid before you were discharged. we tested the fluid and did not find any evidence of cancer or infection. we do not know at this time why the fluid accumulated. you also had some fluid that accumulated in your lungs and abdominal area. we gave you intravenous furosemide (lasix) to get rid of the extra fluid. you will need to continue to take your furosemide at home in pill form and watch for any return of the breathing problems that you had before you were admitted. please weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. your weight at discharge is 91.8 kg or 202 lbs. we have also arranged for you to see a pulmonologist here at to help you manage your emphysema. you need to quit smoking to prevent your lung function from worsening and becoming dependent on oxygen. . we made the following changes to your medicines: 1. increase your warfarin to 6mg daily for the next 2 days. after this, please return to your regularly scheduled dose as directed by dr. . please get your inr checked this monday, with results to dr. . 2. increase your levothyroxine to 100 mcg daily 3. change the metoprolol to a long acting version called metoprolol succinate. 4. start prednisone at 40 mg for 2 days to treat your emphysema. 5. start a nicotine patch and do not start smoking again at home. this is extremely important to prevent your lung function from worsening. 6. start azithromycin, an antibiotic, to treat your emphysema exacerbation which we be continued for 2 more days. 7. use an albuterol/ipratroprium nebulizer as needed at home for wheezing or shortness of breath. do not use more often that every 6 hours. 8. please increase your furosemide, also known as lasix, to 40mg twice daily followup instructions: name: , r. location: address: , ste 2f, , phone: *please call the number above to schedule an appointment with dr. . you should see the doctor within 1 week. name: , location: bldg, address: , , phone: when: , :00 department: pulmonary function lab when: thursday at 1:10 pm with: pulmonary function lab building: campus: east best parking: garage department: medical specialties- pulmonology when: thursday at 1:30 pm with: dr. / dr. building: sc clinical ctr campus: east best parking: garage procedure: pericardiocentesis diagnoses: tobacco use disorder unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation other and unspecified hyperlipidemia unspecified disease of pericardium long-term (current) use of anticoagulants hypoxemia atherosclerosis of native arteries of the extremities, unspecified other bipolar disorders heart disease, unspecified other diseases of vocal cords chronic gastric ulcer without mention of hemorrhage or perforation, without mention of obstruction 

Answer: The patient is high likely exposed to