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: codeine / meperidine / ace inhibitors / hydrocodone / sulfa (sulfonamides) / penicillins attending: chief complaint: epistaxis major surgical or invasive procedure: placement of epistat picc line placement and removal history of present illness: 78 f with esrd, cad, h/o cva, copd admitted from nh to with epistaxis in the setting of asa, plavix, coumadin. she was admitted on friday with inr 3.2 has required 3 units prbc and 4 units ffp. was seen by ent and epistat packing with resolution of bleeding until this am when she rebled during hd. ent replaced the epistat packing with control of the bleeding and labs from this morning hct 30, plt 221, inr 1.2 and she did not receive any further blood products. patient was transferred to for ent and possible embolization by neuro-interventional radiology. upon arrival to the icu ent arrived and confirmed no active bleeding. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, 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: esrd- patient on tts schedule cad- stents last in candidemia- on 4 wks cva copd dm heart failure- unknown ef (diastolic per report) depression h/o epistaxis htn aortic valve mass seen on tte pvd patent foramen ovale dementia glaucoma atrial fibrillation childhood seizures s/p hysterectomy s/p cholecystectomy s/p appendectomy s/p exploratory laparotomy -age 18 social history: lives in nursing home. - tobacco: none currently prior 45 pack year - alcohol: none - illicits: none family history: cad, dm, unknown cancer physical exam: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops 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, no clubbing, cyanosis or edema pertinent results: admission labs: 08:42pm blood wbc-13.6*# rbc-3.74* hgb-11.2* hct-34.5* mcv-92 mch-30.0 mchc-32.5 rdw-17.9* plt ct-251 08:42pm blood neuts-88.9* lymphs-6.9* monos-3.5 eos-0.4 baso-0.3 08:42pm blood pt-13.7* ptt-23.9 inr(pt)-1.2* 08:42pm blood glucose-126* urean-21* creat-4.1*# na-144 k-4.0 cl-103 hco3-27 angap-18 08:42pm blood calcium-9.6 phos-3.1 mg-1.8 . discharge labs: 05:19am blood triglyc-98 06:29am blood wbc-9.7 rbc-3.14* hgb-9.3* hct-28.9* mcv-92 mch-29.6 mchc-32.0 rdw-20.7* plt ct-226 05:47am blood pt-12.1 inr(pt)-1.0 06:29am blood glucose-120* urean-34* creat-5.1*# na-128* k-4.0 cl-88* hco3-25 angap-19 06:41am blood calcium-8.6 phos-3.5 mg-1.9 . micro: blood cx : no growth to date (not finalized) . imaging/studies: cxr : mild cardiomegaly may be smaller. no pulmonary edema, pulmonary vascular engorgement. a flame-shaped opacity projecting over the right first rib anteriorly is probably calcification, better appreciated on the radiograph. lungs are otherwise clear. there is no pleural effusion. mediastinal and hilar silhouettes are unremarkable. vascular stent and clips project over the left axilla. . tte : the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: no aortic valve mass seen. if indicated, a tee would be better to assess aortic valve structure. brief hospital course: 78 yo f with paf on coumadin, dementia, esrd on hd, cad who presents with posterior nasal bleed. pt was initially admitted to osh last friday for epistaxis in the setting of elevated inr 3.2 and taking asa, plavix and coumadin. she received 3 units prbc and 4 units ffp. she was stable until rebleeding on at dialysis and transferred to . . # epistaxis: patient was transferred to for epistaxis requiring multiple transfusions. she was initially admitted to the micu, where ent placed balloon in left nostril for posterior bleed. her hematocrit remained stable while in micu and she did not require further transfusion. she remained hemodynamically stable and the nasal balloon was removed from her left nostril on without complication. per ent, if the patient has any additional epistaxis, use afrin in each nostril, lean head forward, pinch nostrils closed for 20 minutes. patient should return to the hospital for any bleeding that does not resolve with these measures. coumadin should continue to be held for two weeks, and restarted thereafter. asa should be held for an additionally week, and restarted at 81 mg daily thereafter. plavix should be discontinued permanently. . # esrd: pt on tts schedule, last hd . next dialysis planned for tuesday, . she should continue nephrocaps and sevelamer. she will also continue to receive epogen with dialysis. additionally, patient should continue to receive fluconazole with dialysis for a total four week course. . # htn: antihypertensive medications were additionally, held and gradually restarted for goal systolic bp of 110. she should continue home anti-hypertensive regimen with amlodipine, metoprolol, hydralazine and imdur at discharge. . # dementia/ hx of embolic cva: coumadin and antiplatelet agents were held during this admission, given significant nasal bleed. the patient should resume anticoagulation with coumadin 2 weeks after discharge, and should restart asa 81 mg 1 week after discharge. . # cad: s/p pci with stent placement . all antiplatelet agents were held on this admission. she was continued on statin and antihypertensive regimen. given that last pci was greater than one year ago, the patient may discontinue plavix completely at discharge. she should restart asa 81 mg one week after discharge for coronary artery protection. . # hx copd: continued on inhalers prn. . # hx childhood seizures: the patient was continued on home dose keppra for seizure prophylaxis. . # comm: and daughter , md and son are hcp. daughter's phone numbers: # code: dnr/dni during this admission (but per hcp would consent for elective intubation for procedure or airway protection) medications on admission: coumadin 2mg daily norvasc 10mg daily aspirin 81mg daily keppra 500mg daily paxil 40mg daily plavix 75mg daily miralax daily hydralazine 25mg three times daily lopressor 25mg three times daily lipitor 80mg at bedtime senokot at bedtime travatan eye drops both eyes at bedtime trazodone 75mg at bedtime dalyvite vitamin daily imdur 60mg daily renvela 80mg three times daily with meals nitroglycerin 1/150 for chest discomfort ativan as needed lactulose as needed fluconazole 200mg after dialysis for 4 weeks. once positive blood cultures are negative, can be stopped after 4 weeks discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 3. paroxetine hcl 20 mg tablet sig: two (2) tablet po daily (daily). 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 5. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 6. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 7. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 8. renvela 0.8 gram powder in packet sig: one (1) po three times a day: with meals. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 11. multivitamin capsule sig: one (1) capsule po once a day. 12. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 13. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily). 14. travatan 0.004 % drops sig: one (1) drop ophthalmic at bedtime: both eyes. 15. fluconazole 100 mg tablet sig: two (2) tablet po qhd (each hemodialysis) for 4 weeks: 4 weeks once blood cultures negative. 16. levetiracetam 500 mg tablet sig: one (1) tablet po once a day. 17. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 18. hydralazine 25 mg tablet sig: one (1) tablet po three times a day. discharge disposition: extended care facility: rehabilitation & nursing center - discharge diagnosis: primary diagnosis posterior nasal epistaxis discharge condition: alert and oriented ambulating on discharge discharge instructions: you were admitted with a posterior nasal bleed. you were seen by our ent doctors who stopped the bleeding with a balloon tamponade packing. that packing has since been removed. the following changes were made to your medications. 1. stop plavix 2. hold aspirin and coumadin. it is fine to restart your aspirin one week after discharge and your coumadin two weeks after discharge. followup instructions: follow-up with your primary care physician 1-2 weeks of discharge. procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances hemodialysis control of epistaxis by posterior (and anterior) packing diagnoses: end stage renal disease renal dialysis status coronary atherosclerosis of native coronary artery congestive heart failure, unspecified iron deficiency anemia secondary to blood loss (chronic) hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified atrial fibrillation other persistent mental disorders due to conditions classified elsewhere hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of anticoagulants epilepsy, unspecified, without mention of intractable epilepsy personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits diastolic heart failure, unspecified epistaxis candidiasis of unspecified site 

Answer: The patient is high likely exposed to