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: history of present illness: the patient is a -year-old female, with a past medical history of hypertension, chronic atrial fibrillation, chronic stable angina, who presents to the emergency department with shortness of breath. of note, the patient was recently hospitalized at in late- with chest pain that radiated to the neck, was ruled out for mi, and was found to have a normal p-mibi with an estimated ejection fraction of 63 percent, and no wall motion abnormalities. the patient did well at the rehab nursing home following discharge, until approximately the morning of admission when she began to experience worsening shortness of breath. in the ed, her heart rate was noted to be in an afib rhythm at a rate of up to 160, and the patient's physical exam, as well as chest film were thought to be consistent with chf. the patient was given lasix, as well as iv diltiazem 20 mg in the ed, though subsequently became hypotensive and briefly required a dopamine drip for blood pressure stabilization. in addition, cpap was administered for worsening hypoxia in the ed. past medical history: hypertension. atrial fibrillation, chronic. the patient is anticoagulated on coumadin. congestive heart failure. dvt, status post ivc filter placement. hypothyroidism. anemia. history of breast cancer, status post mastectomy. allergies: the patient has no known drug allergies. medications on admission: 1. zocor 20 mg qd. 2. sorbitol solution 30 mg hs. 3. enteric-coated baby aspirin 81 mg qd. 4. digoxin 0.0625 qd. 5. colace. 6. lasix 40 mg qd. 7. prevacid 30 mg qd. 8. synthroid 88 mcg qd. 9. zestril 20 mg qd. 10.citrucel. 11.metoprolol 25 mg . 12.nitro-derm patch 0.6 mg. 13.senna. 15.aldactone 25 mg qd. 16.coumadin 4 mg q hs. 17.milk of magnesia. social history: the patient is a resident of the facility. she has several children who are involved with her care. she denies any alcohol intake, does not smoke cigarettes, and has no history of ivda. physical examination on admission: temperature 101 (rectal), pulse 143 and irregular, blood pressure 113/69, respiratory rate 26, o2 sat 100 percent on cpap. the patient was tachypneic with moderate accessory muscle use and noted to be in moderate distress. pupils were equally round and reactive to light. extraocular muscles were intact. there was no jvd in upright position. she had an irregularly irregular heart rhythm which was tachycardic, and there was a ii/vi holosystolic murmur present at the apex. there were bibasilar crackles present on exam. abdomen soft, mildly distended, tender in the left lower quadrant though. there was no rebound and no guarding. there were no masses. she had no peripheral edema. no calf tenderness. laboratories on admission: sodium 139, potassium 3.7, chloride 96, bicarb 23, bun 29, creatinine 1.1, glucose 202, anion gap 20, white count 4.6, with 80 neutrophils and 8 bands, 37 hematocrit, platelets 74, digoxin level 0.5, tsh 7.1. a ua demonstrates a nitrite negative, leukocyte esterase negative, with a sediment of 0-2 red cells and white cells, though many bacteria were present on sediment. echocardiogram: revealed an ef of 20 percent with akinesis of the apical half of the left ventricle. there was also 1 plus ar, 2 plus mr, and 3 plus tr. ekg: demonstrated atrial fibrillation at a rate of 160 with borderline left axis, q waves present in v1, v2 (old), with relation to v2. chest film: demonstrated cardiomegaly, as well as bilateral pulmonary edema, and small bilateral effusions. kub: demonstrated slightly dilated small bowel loops in the lower abdomen with a relative paucity of gas in the colon consistent with prior partial small bowel obstruction. hospital course: 1. urosepsis: the patient was febrile on admission, had a significant bandemia, and was noted to have many bacteria in her urine sediment. urine culture revealed pansensitive citrobacter freundii greater than 100,000 organisms. the patient was begun on intravenous ceftriaxone empirically 1 mg iv qd. prior to receiving the result of this culture, the patient was also begun on empiric vancomycin and received 1 dose of 1 gm. however, once the urine culture results were apparent, the vancomycin was not continued. the patient was initially hypotensive and required significant intravenous saline boluses to maintain adequate blood pressure. likewise, the patient initially required phenylephrine to maintain adequate blood pressure. the patient improved significantly with antibiotic and intravenous saline, and it was possible to wean off the neo-synephrine on the 13 of . the patient remained afebrile for 72 hours prior to discharge. the patient maintained adequate blood pressure's off neo-synephrine for the 48 hours prior to discharge, and it was possible to reinitiate her chf regimen, including beta blocker and ace inhibiting medications. the patient will be switched to oral antibiotics on the day of discharge, and will complete a 10-day course of antibiotics for her urosepsis. 1. acute renal failure: the patient was noted to be significantly dehydrated on admission presumably secondary to her sepsis, and creatinine subsequently rose from her baseline of 0.8 to maximum of 1.4 on the . however, with ongoing intravenous saline boluses and increasing po intake, the patient's creatinine decreased to 0.8 on the . 1. atrial fibrillation: the patient, as mentioned in hpi, was noted to be in atrial fibrillation with rapid response on admission. she was initially loaded with iv amiodarone in the emergency department. however, the patient did not tolerate the iv amiodarone well and became hypotensive subsequently, and briefly required dopamine to maintain adequate pressures. the amiodarone was discontinued on admission to the ccu, and it was possible to wean off the dopamine shortly thereafter. nonetheless, the patient's heart rate remained in the 100-130 range. the patient was initially started on po amiodarone 400 mg . however, when it became possible to restart her metoprolol for rate control, she maintained adequate rate control with heart rates in the 90-120 range, and the amiodarone was discontinued on the . the patient was maintained in a therapeutic inr range. however, as the amiodarone, as well as her antibiotic interacted with her coumadin, her inr was noted to be supertherapeutic, reaching a maximum level of 5.9 on the . at that point, the patient was given 5 mg of oral vitamin k, with subsequent decrease in her inr to 3.8. her warfarin was continued to be held until the , when it may be started the evening of the 15 at her usual dose. 1. ischemia, rule out mi: the patient was noticed to have a significantly decreased ejection fraction with new wall motion abnormalities on the admission echocardiogram which was in striking contrast to the p-mibi of just 1 month prior. the patient ruled out for mi by serial negative cardiac enzymes. her ck ranged from 80-94. though her troponin-t was initially 0.48 and reached a maximum of 0.73, it was felt that this was more likely related to congestive heart failure and demand ischemia in the setting of rapid ventricular rate. the patient was maintained on aspirin, statin, and was given prn morphine over the first 2 days of admission for chest pain. the patient was restarted on low dose beta blocker prior to discharge. as mentioned above, the patient's significantly different cardiac function demonstrated on the echocardiogram, which included an ef of less than 20 percent, with akinesis of the apical half of the ventricle, as well as 1 plus ar, 2 plus mr and 3 plus tr was felt to be new since her previous admission of . it was felt that most likely she underwent a myocardial infarction in between the 2 admissions. alternatively, it is possible that the patient developed a rate-related myopathy, given the rapid ventricular response that she was evidenced to have on admission with rates up to 160. 1. hypothyroid: the patient was maintained on her outpatient dose of synthroid. 1. anemia: the patient's hematocrit remained stable over the course of this admission. her hematocrit ranged from 37 on admission to 34 the day prior to discharge. 1. thrombocytopenia: the patient was noted to have a platelet count of 74 on admission. however, dic labs were negative, and her subsequent platelet counts were in the 132-146 range which is close to her baseline. it was felt that the initial platelet was most likely erroneous. the patient was discharged in stable condition. discharge diagnoses: chronic atrial fibrillation. urosepsis. cardiomyopathy. hypothyroid. dehydration. anemia. mitral regurgitation. tricuspid regurgitation. aortic insufficiency. congestive heart failure. follow up: the patient will follow-up with her primary care physician. discharge medications: 1. levothyroxine 88 mcg qd. 2. colace. 3. senna. 4. pantoprazole er 40 mg qd. 5. simvastatin 20 mg qd. 6. lactulose prn. 7. trazodone 12.5 hs prn. 8. digoxin 0.0625. 9. warfarin 4 mg hs for a target inr of .0. 10.enteric-coated aspirin 81 mg qd. 11.toprol xl 25 mg qd. 12.lisinopril 2.5 mg qd. , procedure: venous catheterization, not elsewhere classified diagnoses: other primary cardiomyopathies thrombocytopenia, unspecified intermediate coronary syndrome urinary tract infection, site not specified acute kidney failure, unspecified unspecified septicemia atrial fibrillation rheumatic heart failure (congestive) septic shock 

Answer: The patient is high likely exposed to