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: compazine / benadryl decongestant attending: chief complaint: chest and abdominal pain major surgical or invasive procedure: pericardiocentesis with drain placement pericardial drain removal hemodialysis attempted thrombectomy of hd graft in left arm by interventional radiology placement of tunneled hd line through left ij by interventional radiology history of present illness: 62 year old male with a pmh of esrd s/p failed graft on hd, hep c genotype 1, dmii, htn, hld who presents from an osh with pericarditis complicated by pericardial effusion. . his osh course is as follows: he had an admission prior to this with pleuritic cp and rub, diagnosed with pericarditis. also, new lbbb and tropi of 0.125. echo showed small effusion and normal wall motion, mild as, mild mr, unchanged from baseline. he was treated with nsaids. due to lbbb, prolonged pr and underlying dchf (between dialysis sessions) his dilt was stopped and coreg (3.125) was added. he was discharged on 50mg tid of indocin. . several days after discharge he developed general weakness, vague diffuse low abd pain, and fatigue. dialysis was complicated by hypotension (new) and required fluid. admitted to osh with hypotension of 75/50 and above symptoms. he was fluid resuscitated, fluid responsive. ct a/p showed diverticulosis (no inflammation) and a mod pericardial effusion (incidental). ruq u/s with gb wall thickening, otherwise unremarkable. . he was admitted to the icu, bps maintained 100s-140s and hrs 50s-70s. treated presumptively for adrenal insufficiency with hydrocortisone. echo showed circuferential pericardial effusion (2.1-2.2 cm) reportedly without evidence of tamponade. his vitals remained stable and his labs were unremarkable (stable anemia hct ~30) and wbc elevation of 19 after steroids. creatinine 8.9, sodium 131. he was transferred from osh () to for further management. . at , he was admitted to inpatient medicine. he is comfortable without any acute complaints. he does still have mild chest discomfort that has persisted throughout his admission at the osh. he also has vague lower abdominal pain, but is otherwise without any acute complaints. no sob, no orthopnea, no pnd. past medical history: 1. cardiac risk factors: + diabetes, + dyslipidemia, +hypertension 2. other past medical history: - esrd secondary to fsgn, s/p failed graft placement and now temporarily off of the list (due to current illness) on hemodialysis from fsgs; av graft is thrombosed (he is dialyzed now through temp groin line) - hepatitis c genotype 1, biopsy showed fibrosis grade i - gout - s/p partial parathyroidectomy (adenoma) - neuropathy social history: lives in with his wife and daughter. is a former smoker that quit many years ago. no alcohol or drugs. he is a cab driver. family history: no renal disease in family, father with cad age 50s. no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission exam: vitals: t:98.1 bp:120/72 p:64 r:18 18 o2: 99% - pulsus 18 (doppler) general: alert, oriented, no acute distress, mildly fatigued heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp ~8, no lad lungs: clear to auscultation bilaterally, basilar crackles no wheezes, rales, ronchi cv: normal rate, regular rhythm, distant heart sounds abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, no clubbing, cyanosis, trace edema neuro: oriented. no gross deficits. . discharge exam: vs: tm 98.1 bp 122/57 p 81-86, r18, 100%ra pulsus: 8 gen: well-appearing male in nad heent: ncat mmm eomi anicteric neck: supple without lad, jvd not discernable pulm: cta b/l without wheeze or rhonchi cor: rrr (+)s1/s2 without m/g, former drain site c/d/i abd: soft, non-distended, non-tender to palpation, nabs extrem: 1+ le edema b/l, good distal pulses, warm and well perfused lue fistula with palpable cords. rle with increased edema, pain with passive movement. neuro: cnii-xii grossly intact, moving all extremities, mentating well lines/drains: rue picc, tunneled hd catheter pertinent results: #admission labs: 02:15am blood wbc-12.1*# rbc-2.82* hgb-8.7*# hct-27.6*# mcv-98 mch-30.9 mchc-31.5 rdw-16.3* plt ct-302 02:15am blood pt-16.5* ptt-67.6* inr(pt)-1.6* 02:15am blood 02:15am blood glucose-202* urean-51* creat-6.4*# na-132* k-4.6 cl-97 hco3-22 angap-18 02:15am blood alt-51* ast-49* ck(cpk)-46* 02:15am blood albumin-2.8* calcium-7.7* phos-5.5* mg-2.0 . #discharge/pertinent labs: 03:24pm blood hct-28.2* 04:00am blood wbc-7.6 rbc-2.45* hgb-7.8* hct-24.4* mcv-100* mch-31.6 mchc-31.7 rdw-15.5 plt ct-294 03:50am blood wbc-7.6 rbc-2.64* hgb-8.2* hct-26.0* mcv-98 mch-30.9 mchc-31.4 rdw-15.6* plt ct-272 02:50am blood wbc-7.1 rbc-2.68* hgb-8.4* hct-26.4* mcv-98 mch-31.4 mchc-32.0 rdw-15.6* plt ct-253 04:07am blood wbc-8.4 rbc-2.81* hgb-8.5* hct-28.1* mcv-100* mch-30.3 mchc-30.3* rdw-15.8* plt ct-292 05:47am blood wbc-7.0 rbc-2.70* hgb-8.4* hct-27.1* mcv-100* mch-31.1 mchc-31.0 rdw-16.2* plt ct-285 04:40am blood wbc-9.7 rbc-2.90* hgb-9.0* hct-28.3* mcv-98 mch-31.0 mchc-31.7 rdw-16.5* plt ct-309 04:23am blood wbc-9.7 rbc-2.97* hgb-9.3* hct-29.2* mcv-98 mch-31.1 mchc-31.6 rdw-16.9* plt ct-327 05:12am blood wbc-11.8* rbc-2.94* hgb-9.2* hct-28.8* mcv-98 mch-31.3 mchc-32.0 rdw-17.2* plt ct-332 06:30am blood wbc-12.2* rbc-3.07* hgb-9.6* hct-30.3* mcv-99* mch-31.3 mchc-31.6 rdw-17.6* plt ct-372 04:00am blood pt-25.1* ptt-55.0* inr(pt)-2.4* 10:06am blood pt-24.9* ptt-138* inr(pt)-2.4* 10:06am blood pt-24.9* ptt-138* inr(pt)-2.4* 05:41pm blood ptt-73.7* 07:36am blood ptt-87.1* 04:07am blood pt-17.7* ptt-64.0* inr(pt)-1.7* 05:47am blood pt-14.9* ptt-98.4* inr(pt)-1.4* 04:40am blood pt-15.0* ptt-40.6* inr(pt)-1.4* 04:23am blood pt-15.8* ptt-106.6* inr(pt)-1.5* 05:12am blood pt-13.8* ptt-30.6 inr(pt)-1.3* 06:30am blood pt-14.7* ptt-29.9 inr(pt)-1.4* 04:23am blood esr-70* 04:00am blood glucose-147* urean-53* creat-8.9*# na-130* k-4.4 cl-91* hco3-30 angap-13 02:50am blood glucose-83 urean-25* creat-5.7*# na-130* k-4.0 cl-90* hco3-31 angap-13 05:47am blood glucose-94 urean-35* creat-6.2*# na-132* k-3.9 cl-93* hco3-33* angap-10 04:23am blood glucose-126* urean-45* creat-6.6*# na-135 k-4.4 cl-97 hco3-29 angap-13 05:12am blood glucose-159* urean-105* creat-10.6*# na-133 k-5.2* cl-95* hco3-21* angap-22* 04:23am blood alt-36 ast-35 alkphos-36* totbili-0.5 05:12am blood alt-45* ast-37 ld(ldh)-176 alkphos-40 totbili-0.3 04:00am blood albumin-2.3* calcium-6.8* phos-2.7 mg-1.8 02:50am blood calcium-6.8* phos-2.6*# mg-1.7 04:07am blood totprot-5.4* calcium-7.6* phos-5.0* mg-1.8 04:40am blood calcium-7.5* phos-6.3* mg-1.9 05:12am blood albumin-2.8* calcium-7.2* phos-6.1* mg-2.1 06:30am blood calcium-7.6* phos-6.0* mg-2.1 05:12am blood %hba1c-5.2 eag-103 09:21am blood cryoglb-negative 05:12am blood tsh-2.0 12:55pm blood dsdna-negative 06:30am blood -positive * titer-1:160 04:07am blood pep-no specifi 05:47am blood c4-32 05:12am blood c3-73* 04:23am blood hiv ab-negative 12:55pm blood c2-test 09:30am other body fluid wbc-2675* hct,fl-10.5* polys-67* lymphs-23* monos-5* eos-2* atyps-1* nrbc-1* macro-2* 09:30am other body fluid totprot-4.9 glucose-129 ld(ldh)-1113 amylase-32 albumin-2.2 . #studies: 2d-echocardiogram: : the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a large pericardial effusion. there is sustained right atrial collapse, consistent with low filling pressures or early tamponade. there is significant, accentuated respiratory variation in mitral/tricuspid valve inflows, consistent with impaired ventricular filling. impression: large circumferential effusion with echocardiographic evidence of early tamponade physiology. . 2d-echocardiogram (post-pericardiocentesis): left ventricular wall thicknesses and cavity size are normal. there is an anterior space which most likely represents a prominent fat pad. no residual pericardial effusion identified. compared with the prior study (images reviewed) of , the pericardial effusion has resolved and tamponade physiology is no longer suggested. . ekg : sinus rhythm with first degree atrio-ventricular conduction delay. borderline left axis deviation. diffuse non-diagnostic repolarization abnormalities. qrs voltage in the precordial leads. compared to the previous tracing of there is no diagnostic change. rate pr qrs qt/qtc p qrs t 72 /455 0 -25 129 brief hospital course: brief clinical course: 62m w/ hx esrd s/p failed graft on hd, hep c genotype 1, dmii, htn, hld who presents from an osh with pericarditis complicated by pericardial effusion. the patient was intially admitted to a general medicine service. on , he developed atrial fibrillation and was found to have significant tamponade physiology, so was transferred to the cardiology service. a pericardiocentesis was performed on , and he was transferred to the ccu following the procedure. he was transferred back to the inpatient cardiology team on , and he was discharged on . . active issues: # pericardial effusion: on the floor, the patient was found to have a pulsus paradoxus of 15mmhg. an echo demonstrated a large effusion with significant tamponade physiology. he developed atrial fibrillation at this time (see below) with rates in the 90s-100s, but beta blockers were not used given the patient's hypotension, which was thoguht to be secondary to the tamponade physiology. on , the patient underwent pericardiocentesis with drain placement. approximately 720cc of bloody fluid was removed initially. an additional ~500cc of bloody fluid was collected from the drain in the following two days. in the ccu, the patient was nto hypotensive and did not demonstrate tamponade physiology. hi pulsus was measured to be 6-12mmhg in the days following drainage. echo following the pericardiocentesis demonstrated resolution of the effusion. the drain was removed on , and repeat echo demonstrated some fluid surrounding the heart, which was thought to be post-procedural inflammation as opposed to reaccumulation of an effusion. back on the cardiology floor, the patient had stable pulsus checks daily and a repeat echo prior to discharge demonstrated stable pericardial effusion. in terms of the etiology of the pericarditis and pericardial effusion, uremia was thought to be unlikely by the nephrology consult service, given that the patient is regularly dialyzed. a viral etiology was thought to be most likely and we continued the patient on twice weekly colchicine dosing, though no specific pathogen was identified. malignancy was considered, but the pericardial fluid showed no malignant cells on cytology. tuberculosis was considered, but ppd was negative. cryoglobulinemia was considered given the patient's hepatitis c, and testing revealed negative cryoglobulins. autoimmune etiology was considered, and testing revealed + but negative dsdna. the patient will follow up with his outpatient cardiologist, his pcp, surgery, and will return on for a f/u echo to monitor. . # atrial fibrillation: on the medicine floor early in the patient's hospitalization, the patient developed atrial fibrillation. he converted to normal sinus rhythm, and remained in sinus rhythm during his ccu stay. due to the risk of paroxysmal afib, he was started on heparin drip. this was continued during his ccu stay. his chads2 score was . the cardiology floor team considered whether or not to anticoagulate the patient with warfarin, and they decided to continue bridge the patient to coumadin with a heparin drip; the patient was therapuetic at discharge. the patient was continued on carvedilol. he came into the hospital on diltiazem, but this was held in favor of the carvedilol. the patient also reportedly had lbbb on ekg at osh. here he had anterior fascicular block, which was consistent with prior ekgs. . # mild diastolic heart failure: as per osh report, the patient has mild diastolic heart failure. diastolic heart failure is not clearly mentioned in records or echos and may need to be reassessed after complete resolution of the current pericardial disease. . # esrd on hd with thrombosed graft: on admission to ccu, bun>100 and cr>10 with associated anemia thought to be secondary to the renal disease. the patient also has a graft in the left upper extremity which has clotted multiple times. it was stented in the past, but has re-thrombosed. a temporary hd line was placed at the osh, and he did not miss dialysis. the temporary line was pulled after the patient was admitted to the ccu, and he was sent to ir for an attempted thrombectomy. ir removed a thormbus, but the graft reclotted within 10 minutes. therefore, a tunnel line was placed in the lij into the brachiocephalic. however, there was stenosis at the confluence of the left innominate/svc junction, and the tunnelled line obstructed the flow that had been previously able to get through this stenosed vessel. this resulted in edema of the patient's left arm. on , the patient returned to ir for balloon expansion of the brachiocephalic through the tunneled line. after the procedure, the edema subsided substantially within 24 hours. the patient was continued on his home nephrocaps and phoslo. he received epo with dialysis. he was follwed by nephrology and received 3x weekly dialysis while here. . # htn: patient had relatively low pressures prior to admission to the ccu compared to baseline, likely secondary to atrial fibrillation and early tamponade. he was not at all hypotensive after the pericardiocentesis procedure. his hypertension was treated with lisinopril and carvedilol. his home diltiazem was discontinued. . # dm: patient treated with insulin sliding scale. . # hld: simvastatin was continued. . # hep c: the patient's lfts were not elevated boyond his baseline. . # gout: inactive. . transitional issues: -patient will start back on his old hd regimen of tu, th, sat. patient discharged on a monday after received hd, will f/u on tuesday for hd session. -patient will have his inr monitored by dr. . -the patient will return on for f/u tte to monitor for an evolving effusion. medications on admission: preadmission medications listed are correct and complete information was obtained from patient 1. indomethacin 50 mg po tid (recently added for pericarditis) 2. carvedilol 3.125 mg po bid (this was started recently when dilt was being held, then it was held when dilt was restarted) 3. omeprazole 20 mg po daily 4. diltiazem 60 mg po qam 5. diltiazem 120 mg po qpm 6. calcium acetate 667 mg po tid w/meals 7. fenofibrate *nf* 160 mg oral daily 8. simvastatin 20 mg po hs 9. nephrocaps 1 cap po daily 10. docusate sodium 100 mg po bid 11. lisinopril 10 mg po daily - also took lactulose 15cc prn constipation until recently - was also on hydrocortisone recently at osh for pericarditis discharge medications: 1. outpatient lab work please check inr, cbc, on and fax results to , at 2. carvedilol 3.125 mg po bid 3. calcium acetate 1334 mg po tid w/meals rx *calcium acetate 667 mg 2 tablet(s) by mouth three times a day with meals disp #*120 tablet refills:*0 4. docusate sodium 100 mg po bid 5. nephrocaps 1 cap po daily 6. simvastatin 20 mg po hs 7. colchicine 0.3 mg po tuesday and friday rx *colchicine 0.6 mg 0.5 (one half) tablet(s) by mouth tuesday and friday disp #*5 tablet refills:*0 8. warfarin 2 mg po daily16 rx *warfarin 2 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 9. omeprazole 20 mg po daily 10. lisinopril 10 mg po daily discharge disposition: home discharge diagnosis: primary diagnosis pericardial effusion dvt secondary diagnosis end stage renal disease hepatitis c hypertension diabetes hypertension hyperlipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , it was a pleasure taking care of you. you were admitted to for having fluid around your heart that caused an irregular heart rhythm. you had the fluid removed and were monitored with multiple ultrasounds of your heart that showed no further fluid accumulation. you will follow up with your outpatient primary care physician, cardiologists and you will get a routine echocardiogram. please contact your primary care physician if you experience increased swelling or pain in your legs. we wish you and your family the best. followup instructions: name: dr. specialty: primary care when: monday at 9:40am address: , unit , , phone: *this is a follow up appointment for your hospitalization. you will be reconnected with your primary care provider, . , after this visit. you should also call your docotor's office tomorrow to discuss monitoring of your blood tests while you are on the blood thinner medication (coumadin) name: , md specialty: cardiology when: wednesday at 1:45pm location: cardiovascular specialists address: 90 ter heun dr, ste#300, , phone: department: cardiac services when: wednesday at 1 pm with: , md building: sc clinical ctr campus: east best parking: garage department: center when: friday at 10:30 am with: , md building: lm campus: west best parking: garage department: echo lab when: wednesday at 1 pm with: echocardiogram building: gz building (felbeerg/ complex) campus: east best parking: main garage procedure: hemodialysis angioplasty of other non-coronary vessel(s) angioplasty of other non-coronary vessel(s) angioplasty of other non-coronary vessel(s) venous catheterization for renal dialysis venous catheterization for renal dialysis pericardiocentesis procedure on single vessel procedure on single vessel diagnoses: anemia in chronic kidney disease end stage renal disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified viral hepatitis c without hepatic coma atrial fibrillation personal history of tobacco use paroxysmal ventricular tachycardia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia hypotension, unspecified surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation compression of vein other left bundle branch block awaiting organ transplant status glucocorticoid deficiency surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other complications due to renal dialysis device, implant, and graft chronic diastolic heart failure home accidents chronic glomerulonephritis with lesion of membranous glomerulonephritis acute idiopathic pericarditis cardiac tamponade acute venous embolism and thrombosis of upper extremity, unspecified 

Answer: The patient is high likely exposed to