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: shortness of breath, cough major surgical or invasive procedure: transesophageal echo history of present illness: 73 yo f with h/o poorly-controlled htn, esrd, and dm p/w sob x1 day, started 1 day after regular hd session. sob associated with cough, white sputum for about a week. pt attributes this to a cold, although denies rhinorrhea, nasal congestion, sore throat. + sick contacts at dialysis center. notes increased abdominal girth for several days. loose bm 3 days ago, passing flatus. + subjective fever, low grade temp to 100.0 this morning. slight bleeding from fistula. . ed course: cxr with pulmonary edema, ? pneumonia - given ctx, azithro. recieved hd in preparation for cta which was negative for pe, + for pulmonary edema. . ros: + low grade fever, no n/v/abd pain, + loose stools several days ago, make urine, no dysuria or urinary frequency. +20 pound weight loss over last 6 months past medical history: ) type 2 diabetes mellitus: started insulin in . 2) hypertension: poorly controlled with many admissions to micu/ccu for hypertensive urgency. 3) renal artery stenosis: last mra revealed 3 left renal arteries, superior with question of stenosis and middle with stenosis. 4) hypercholesterolemia 5) esrd on hd m/w/f. followed by dr. 6) diastolic chf 7) osteoarthritis 8) depression 9) anxiety 10) sickle cell trait 11) hiatal hernia 12) gastroesophageal reflux disease 13) chronic constipation 14) history of mechanical falls. 15) chronic anemia: presumed secondary to renal failure. 16) status post hysterectomy in . social history: lives at home with her husband. moved to the us in . originally from barbados, but lived in for 20 years as well. she used to work as a medic in the pacu at , then later as a recreational assistant at another facility. denies any alcohol use, no history of smoking, no ivdu. has mother who is sick in a hospital in barbados. family history: mother alive at 89, with dm2, htn. father died of alzheimer's disease. brother with hypertension. physical exam: vitals: t 98.8, bp 163/76, hr 110-120, rr 16, o2 sat 98% on ra gen: a&o x 3, pleasant, thin f sitting up in bed in nad. no accessory muscle use, talking in full sentences. heent: eomi, op clear with mmm. neck: jvd to jaw cv: irregular, tachycardic, nl s1/s2, ii/vi sem at lusb lungs: crackles at bases bilaterally, good air entry abd: soft, moderately distended, palpable hepatomegaly, 10cm below costal margin, nt, +bs ext: tr pitting edema b/l, warm. l avf with palpable thrill. pertinent results: 06:15pm hct-28.8* 01:30pm ascites tot prot-4.5 glucose-211 creat-4.2 ld(ldh)-119 amylase-41 albumin-2.7 01:30pm ascites wbc-261* rbc-* polys-1* lymphs-32* monos-54* mesotheli-3* macrophag-10* 06:35am glucose-154* urea n-33* creat-4.2* sodium-135 potassium-3.6 chloride-90* total co2-33* anion gap-16 06:35am alt(sgpt)-22 ast(sgot)-30 ld(ldh)-215 ck(cpk)-55 alk phos-123* amylase-112* tot bili-0.5 06:35am lipase-141* 06:35am ck-mb-notdone ctropnt-0.15* 06:35am tot prot-7.9 albumin-4.3 globulin-3.6 calcium-9.7 phosphate-3.5 magnesium-2.1 iron-67 06:35am caltibc-231* ferritin-greater th trf-178* 06:35am wbc-10.3 rbc-4.41 hgb-10.4* hct-33.0* mcv-75* mch-23.6* mchc-31.5 rdw-21.8* 06:35am plt count-201 06:35am pt-17.1* ptt-30.4 inr(pt)-1.6* 02:20am ck(cpk)-57 02:20am ck-mb-notdone ctropnt-0.14* 04:15pm lactate-1.9 04:00pm glucose-282* urea n-29* creat-3.8* sodium-139 potassium-3.7 chloride-93* total co2-33* anion gap-17 04:00pm estgfr-using this 04:00pm ck(cpk)-56 04:00pm ctropnt-0.13* 04:00pm ck-mb-notdone probnp-* 04:00pm calcium-10.0 phosphate-3.6 magnesium-1.9 04:00pm wbc-9.0 rbc-4.32 hgb-10.5* hct-32.5* mcv-75* mch-24.2* mchc-32.2 rdw-21.8* 04:00pm neuts-76.4* lymphs-14.2* monos-7.9 eos-0.9 basos-0.6 04:00pm hypochrom-1+ anisocyt-2+ microcyt-3+ 04:00pm plt count-219 lplt-1+ 04:00pm d-dimer-1224* . imaging: . cxr: chf, no pna . abd xr: mpression: dilated loops of small bowel with multiple "step-ladder" fluid levels, and paucity of large bowel gas, highly concerning for small bowel obstruction; adynamic ileus is less likely. . ct chest, abd, pelvis: impression: 1) no pulmonary embolism or evidence of bowel obstruction. 2) moderate amount of ascites. 3) cardiomegaly with evidence of mild congestive heart failure and passive hepatic congestion. small right pleural effusion. 4) coronary artery calcification. 5) mild enlargement of the pulmonary arteries, suggestive of pulmonary arterial hypertension. 6) at least one small cystic lesion in the head of the pancreas, which appears likely to connect to the main pancreatic duct but is not well evaluated on ct; this could be followed up in 6 months. 7) adrenal lesions not well characterized on this study appear consistent with adenomas on prior studies. . ruq u/s: 1. liver doppler findings consistent with right heart failure/triscuspid regurgitation. patent hepatic vasculature. 2. hepatomegaly. no evidence of splenomegaly. 3. limited evaluation of the gallbladder which may contain stones. . echo: conclusions: moderate to severe spontaneous echo contrast is seen in the body of the left atrium. no mass/thrombus is seen in the left atrium or left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). no atrial septal defect is seen by 2d or color doppler. overall left ventricular ejection fraction appears somewhat reduced. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets are mildly thickened. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. impression: no left atrial or left atrial appendage clot, but severe left atrial appendage spontaneous echo contrast . cxr impression: improvement in the congestive heart failure seen on the prior examination. . other data: . hbcab negative () hcv ab negative () hepatitis be antibody non-reactive () . ascitic fluid cultures pending wbc rbc polys lymphs monos mesothe macroph 261* * 1* 32* 54* 3* 10* totpro glucose creat ld(ldh) amylase albumin 4.5 211 4.2 119 41 2.7 . saag greater than 1.1 ascitic fluid total protein is 4.5 (greater than 2.5) indicating a cardiac etiology for the ascites. brief hospital course: this is a 73 yo f with dm ii, htn, esrd on hd, who presented with shortness of breath, found to have new onset atrial fibrillation, cardiac ascites, course complicated by persistent bleeding in the setting of attempted in preparation for cardioversion, requiring transfer to the micu. . on the floor patient underwent an abdominal ct scan which showed moderate ascites as well as hepatomegaly. she also underwent abdominal ultrasound as well as paracentesis with 800cc of fluid removed, and ultimately it was thought that her ascites was c/w cardiac ascites. hepatology was consulted and agreed. hepatitis serologies have been negative. . she also had new onset atrial fibrillation, and patient was started on a heparin gtt with the plan for tee and subsequent cardioversion. however, after tee was performed, she had not yet been dialyzed and it was thought that cardioversion would not be successful in the setting of volume overload. cardioversion was postponed, and course was then complicated by continuous oozing and bleeding, both from her nares as well as paracentesis site. topical thrombin was applied to paracentesis site which eventually stabilized bleeding. the patient also had a significant amount of epistaxis, which was eventually tamponaded by ent with packing and afrin. paracentesis site again started to ooze, and it was difficult to control bleeding on the floor. her hematocrit trended downwards over this course from 28 --> 23. she had been scheduled to receive blood transfusion with dialysis, but hd would not accept her because she was bleeding. because nursing was not comfortable administering ddavp on the floor, the patient was transferred to the micu. she received 1 unit of prbcs prior to transfer to the unit. . trauma surgery was consulted for persistent bleed, and it was determined that she should no longer continue on a heparin gtt. heparin had not been supratherapeutic during this time, however, she had been bleeding almost persistently despite this. she was transfused one more unit of prbcs with an appropriate stabilization of her hematocrit. . # bleeding: initially patient was started on a heparin gtt and coumadin, was on asa 325mg. in addition, she is a dialysis patient and has platelet dysfunction at baseline. heparin gtt has been discontinued as well as coumadin, and asa was reduced to 81mg given bleeding. paracentesis site bleeding was initially tamponaded and controlled with topical thrombin, but in the setting of being on heparin gtt, bleeding has persisted, requiring compression for >30minutes and ddavp to control bleeding. epistaxis required ent consult with nasal packing to control. the patient received 2 u of prbc with an appropriate increase in her hct and vital signs stable. . # atrial fibrillation: no prior hx of afib, prior ekg interpreted as ? wandering atrial pacemaker. pt is at risk for developing af in setting of stretched r atrium and ecg is consistent with that. unable to perform cardioversion as unable to anticoagulate. moderate to severe contrast echo seen in atrium, representing likely very poor flow state, high risk for thrombus formation. there are also complex (>4mm) atheroma in the descending thoracic aorta. however, unable to anticoagulate given high risk of bleeding. the patient will be treated with aspirin 325mg po daily now that hct is stable. for rate control she is on metoprolol xl and verapamil sr. she had an episode of tachycardia to the 140s during dialysis, likely due to the fact that she was due for rate controlling medications. she has outpatient follow up appointment with cardiology. . # ascites: patient is s/p paracentesis, ascitic fluid consistent with portal hypertension from cardiac etiology. abdominal ultrasound also c/w liver enlargement from rhf, normal flow on dopplers. fluid cytology negative for malignancy. appreciate hepatology recommendations who also agree that ascites is most likely from cardiac etiology. . # diabetes mellitus, type 2, well controlled: glyburide discontinued on admission, given renal failure. likely should not be continued as an outpatient. on admission was on lantus 45u qam and 15 units of lantus qhs. she had multiple episodes of hypoglycemia during her admission and required a d10 gtt. likely hepatic impairment of gluconeogenesis as well as impaired renal clearance are likely playing a role. involved. lantus now decreased, made daily instead of dosing. the patient was informed of insulin regimen changes for outpatient and to continue to monitor blood glucose with fingersticks, primary physician's direction. . # esrd on hd: renal failure likely secondary to dm and htn. she received hemodialysis while inpatient and also nephrocaps, sevelamer, fluid restriction. dr. is outpatient nephrologist. . # hypertension: previously on regimen of labetalol, lisinopril, nifedipine, hydralazine, clonidine, and isosorbide. we have discontinued hydralazine, changed nifedipine to verapamil, and decreased metoprolol, titrated down clonidine. . # dyspnea: likely a combination of fluid overload, atrial fibrillation, mechanical stress of ascites. cta negative on admission for pe. no evidence of pneumonia on cxr. no evidence of new coronary event, troponin at baseline. dfa for influenza was negative. continue dialysis for volume overload. . # pancreatic lesion: ?cyst, consider mri eval as outpatient. medications on admission: labetalol 300 mg po tid lisinopril 40 mg po qd nifedipine 180 mg qd hydralazine 50 mg po bid clonidine 0.3 mg po bid isosorbide mononitrate 90 mg sustained release po daily atorvastatin 10 mg po daily pantoprazole 40 mg po once a day. ferrous sulfate 325 po daily clonazepam 1 mg po bid folic acid 1 mg daily insulin lantus 45 units qam, 15 units qpm glyburide 2 mg mvi 1 tablet daily b12 50 mcg po daily tylenol prn arthritis sevelemer 400 mg tid asa 325 mg daily rhinocort acqua discharge medications: 1. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 2. clonidine 0.1 mg tablet sig: two (2) tablet po bid (2 times a day). 3. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: four (4) tablet sustained release 24 hr po daily (daily). 4. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 7. clonazepam 1 mg tablet sig: one (1) tablet po q12h (every 12 hours) as needed for anxiety. 8. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 9. insulin glargine 100 unit/ml solution sig: twenty (20) units subcutaneous qam: take as directed by your doctor. . 10. hexavitamin tablet sig: one (1) cap po daily (daily). 11. cyanocobalamin 100 mcg tablet sig: 0.5 tablet po daily (daily). 12. sevelamer 400 mg tablet sig: one (1) tablet po tid (3 times a day). 13. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 14. metoprolol succinate 50 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po daily (daily). disp:*150 tablet sustained release 24 hr(s)* refills:*2* 15. verapamil 240 mg tablet sustained release sig: one (1) tablet sustained release po q24h (every 24 hours). disp:*30 tablet sustained release(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnosis: - atrial fibrillation - diastolic congestive heart failure . secondary diagnosis: - diabetes mellitus type 2 - hypertension - hypercholesterolemia - end stage renal disease on hemodialysis - osteoarthritis - gastroesophageal reflux disease - chronic anemia discharge condition: atrial fibrillation on aspirin, respiratory status stable discharge instructions: you presented to the hospital with shortness of breath and were found to have atrial fibrillation. you were originally treated with (blood thinner) but due to increased bleeding, the was held. you will need to go to a follow up appointment with your cardiologist to reassess . please take all medications as directed. some of your medications have been changed: a. stop taking labetalol, nifedipine, hydralazine, glyburide. b. new medications include metoprolol xl 150mg by mouth once daily, verapamil sr 240mg by mouth once daily. c. the doses have been changed on some of your medications. - decrease clonidine to 0.2mg by mouth twice daily - increase isosorbide mononitrate to 120mg by mouth once daily - insulin glargine has been decreased to 20 units once each morning. do not take any insulin glargine (lantus) in the evening. continue to check your blood sugar regularly and call your doctor if your blood sugar is less than 60 or greater than 400. please attend all follow up appointments. continue to go to your regularly scheudle dialysis appointments. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1500ml per day. if you develop fever, chills, shortness of breath, chest pain or any other symptom that concerns you, call your primary doctor, or if unavailable go to the emergency room. followup instructions: provider: . , md phone: date/time: 12:30 provider: , dpm phone: date/time: 9:50 pcp: , . date/time: 2:15pm follow up with your primary doctor (you will have already seen your cardiologist prior to this appointment), your blood sugar, and discuss a pancreatic cyst seen on imaging and mri may be indicated for further evaluation. procedure: diagnostic ultrasound of heart hemodialysis other electric countershock of heart percutaneous abdominal drainage transfusion of packed cells diagnoses: anemia in chronic kidney disease esophageal reflux pure hypercholesterolemia congestive heart failure, unspecified atrial fibrillation diaphragmatic hernia without mention of obstruction or gangrene hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease constipation, unspecified dysthymic disorder hemorrhage complicating a procedure long-term (current) use of insulin osteoarthrosis, unspecified whether generalized or localized, site unspecified diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled epistaxis chronic diastolic heart failure 

Answer: The patient is high likely exposed to