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: shortness of breath major surgical or invasive procedure: intubation colonoscopy egd history of present illness: this is a 84 y/o with h/o avr, chf, paf, h/o lgib, who complains of progressive sob x 1 mo. presently, she is sob even at rest. no cp, n/v associated with this sob. she has also been very fatigued for about one year. she endorses orthopnea, pnd and occ le edema. she has been having black stools recently and reports diarrhea after eating since her last intestinal operation (unclear date). she reports a 20 lb weight loss in the last five months. she has had decreased appetite over this time period. she has not been ambulating over the last few days fatigue but normaly walks independently and can climb stairs. . of note, one mo ago the pt was hospitalized at for virus and periph edema and then was sent to from there. . in the ed, noted to have: af, bp 122/59 hr 75 rr 16, sats 91-98 ra, 100 on 4 l nc. cxr consistent with effusion/collapse/consolidation wet read per radiology. hct 23, unknown baseline. ed called up to floor that pt. was guaiac negative, but it is not documented anywhere in ed paperwork. on arrival to the floor, found to be guaiac positive with brown stool. called , no baseline hct info. called pcp, /c md dr. , who called and reported back that her hct was 33.9. past medical history: --cad --chf --avr --paroxysmal a fib --hypothyroidism --hx. lgib --anemia --pvd social history: lives at . no tob, etoh, drugs. family history: nc physical exam: tm/c 97.9, bp 103/67 sbp 82-103, p 90 (90-100) r 23, sa02 100% ra gen - alert, spanish speaking, cachectic female, breathing with mod effort heent - perrl, extraocular motions intact, anicteric, mmm, pale conjunctiva neck - jvd to earlobes, no cervical lymphadenopathy cv - harsh, mechanical $/6 sem with click, pmi displaced laterally pulm- diminished bs rll with occ crackles, + exp wheeze in lll abd - soft, nontender, nondistended, with normoactive bowel sounds back - no costovertebral angle tendernes extr - no clubbing, cyanosis, 1+ edema. trace dp pulses bilaterally neuro - alert and oriented x 3, skin - no rash, chronic venous stasis changes in le. pertinent results: 05:50pm blood wbc-7.5 rbc-2.50* hgb-7.5* hct-23.3* mcv-93 mch-29.9 mchc-32.1 rdw-20.2* plt ct-240 08:25am blood wbc-7.9 rbc-3.08* hgb-9.5*# hct-27.6* mcv-90 mch-30.8 mchc-34.4 rdw-19.9* plt ct-177 10:05am blood hct-29.0* 06:00am blood wbc-10.2 rbc-3.15* hgb-9.6* hct-28.6* mcv-91 mch-30.6 mchc-33.7 rdw-19.7* plt ct-180 05:40am blood wbc-5.3 rbc-2.97* hgb-9.2* hct-26.8* mcv-90 mch-30.9 mchc-34.2 rdw-19.5* plt ct-150 01:24am blood wbc-10.2# rbc-3.29* hgb-10.1* hct-30.0* mcv-91 mch-30.8 mchc-33.8 rdw-18.9* plt ct-140* 05:30am blood wbc-4.3 rbc-3.08* hgb-9.3* hct-28.1* mcv-91 mch-30.0 mchc-32.9 rdw-18.4* plt ct-107* 05:20am blood wbc-4.5 rbc-2.99* hgb-8.8* hct-27.0* mcv-90 mch-29.4 mchc-32.5 rdw-18.0* plt ct-105* 05:50pm blood pt-31.6* ptt-37.7* inr(pt)-3.4* 06:30am blood pt-22.1* ptt-78.0* inr(pt)-2.2* 05:30am blood pt-16.9* ptt-62.8* inr(pt)-1.6* 05:50pm blood glucose-110* urean-18 creat-0.8 na-130* k-3.7 cl-97 hco3-29 angap-8 01:24am blood glucose-80 urean-24* creat-1.0 na-133 k-3.4 cl-100 hco3-21* angap-15 05:20am blood glucose-93 urean-9 creat-0.8 na-134 k-3.3 cl-101 hco3-27 angap-9 08:25am blood alt-18 ast-34 ck(cpk)-37 alkphos-70 totbili-2.5* cxr (): 1. cardiomegaly, with slight upper zone redistribution, but no overt chf. 2. prosthetic ball and cage type valve noted. 3. opacification at right base consistent with right lower lobe collapse and/or consolidation and effusion. echo (): the left atrium is elongated. the right atrium is markedly dilated. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast. the estimated right atrial pressure is 11-15mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. the right ventricular cavity is markedly dilated. there is mild global right ventricular free wall hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic root is mildly dilated at the sinus level. the ascending aorta is moderately dilated. a "ball-and-cage" type aortic valve prosthesis is present. the prosthetic aortic leaflets appear normal.the transaortic gradient is top normal for this prosthesis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. the mitral valve shows characteristic rheumatic deformity. there is no mitral valve prolapse. there is moderate thickening of the mitral valve chordae. there is moderate mitral stenosis (area 1.0-1.5cm2). moderate to severe (3+) mitral regurgitation is seen. the mitral regurgitation jet is eccentric. the tricuspid valve leaflets are moderately thickened. severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. the main pulmonary artery is dilated. there is no pericardial effusion. cxr (): there has been interval increase in moderate right pleural effusion with increase in right lower and right middle lobe atelectasis. left lower lobe retrocardiac opacity consistent with atelectasis is new. there is no overt chf. ett tip is 3.9 cm above the carina. unchanged calcified granuloma is in the left upper lobe. there is no pneumothorax. the patient is post median sternotomy and valve replacement. there is no overt chf. ct chest (): 1. right lower lobe atelectasis surrounded by moderate sized simple right pleural effusion. ground glass opacities within the lingula are likely related to pulmonary edema. 2. mild interstitial pulmonary edema, cardiomegaly with biatrial enlargement and rv failure, and 5cm ascending aorta dilatation. mild dilatation to main pulmonary artery suggestive of underlying pulmonary hypertension. 3. unchanged appearance to appropriately positioned endotracheal tube and malpositioned left-sided picc catheter with tip in unclear location and possibly extravascular. cxr (): bilateral pleural effusions, worse on the right than the left and unchanged. chf, unchanged. brief hospital course: 84 y/o with hx of avr, chf, paf, h/o lgib, who complains of progressive sob x 1 mo, found to have possible rll pna and gib with an inr of 3.4 on warfarin and a greater than 10 point hematocrit drop from baseline. # gib: on admission the patient was found to have a gib with guaiac + brown stool and a hct 23 from a baseline of about 30 per records. she received a total of three units prbc from with a hct stable between 27-29. she was started on protonix iv bid and her hct was checked q4 hrs. she continued to have melena with one episode of brbpr. gi was following the patient and recommended letting her inr drift down from 3.4 on admission. they advised a heparin bridge once her inr was <1.5. the plan was to scope her when her inr<1.5. she completed 4l golytely without worsening of her black tarry stool. she received 2u ffp on the morning of . after the first unit had infused, the patient became tachypneic and hypoxic with sa02 in the low 70s and had rigors and diffuse wheezes/crackles on lung exam. she was given iv methylprednisolone and diphenhydramine for presumed transfusion rxn, furosemide for volume overload and was intubated. she was then transferred to the micu. a transfusion reaction workup wa performed, and it was preliminarily c/w trali. in terms of her gi bleed, her hct remained stable, she was extubated and transferred back to the floor. after her inr drifted down on a heparin drip, a colonoscopy and egd were performed without any evidence of a source for her gib. heparin was continued, and she was discharged with a stable hct. # pna: on admission cxr, the pt was found to have a rll infiltrate/effusion/collapse per radiology read and she was treated with a 7-day course of vancomycin and levofloxacin without any change in her cxr. # hyponatremia: most likely etiology is secondary to heart failure. stable throughout admission. # chf: she was discharged on her home dose of furosemide 40 # hypothyroidism: continued synthroid 75 mcg. she should have her tsh ckecked again as an outpt as ppis can affect the absorption of levothyroxine. # cad: no sx. pt ruled out with two sets on admission. continued digoxin. her aspirin was held in light of her gib, and she was discharged only on warfarin and the heparin drip. her aspirin can be restarted as an outpatient when she is off the heparin drip. # avr: heparin bridging while inr subtherapeutic. medications on admission: coumadin iron 325 mg daily synthroid 150 mcg daily digoxin 0.25 mg daily alprazolam 0.25 mg qhs prn lasix 40 mg every other day triamt/hctz 37.5 mg/25mg eery other day mvi bowel meds discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q4-6h (every 4 to 6 hours) as needed. tablet(s) 2. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 3. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 4. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for sob, wheeze. 5. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 9. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 10. heparin (porcine) in d5w 100 unit/ml parenteral solution sig: one (1) intravenous asdir (as directed). discharge disposition: extended care facility: center discharge diagnosis: primary: gi bleed pneumonia transfusion reaction respiratory failure secondary: cad chf s/p avr paroxysmal a fib pvd hypothyroidism hx. lgib anemia gout/pseudogout h/o sbo s/p bowel resection discharge condition: stable discharge instructions: you were admitted with bleeding. no source was found. you should call your pcp or return to the hospital if you experience bleeding, chest pain, shortness of breath or have any other concerns. please take all of your medications as prescribed. please keep all of your follow-up appointments. followup instructions: please call your primary care doctor to make a follow-up appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other endoscopy of small intestine insertion of endotracheal tube closed [endoscopic] biopsy of bronchus colonoscopy transfusion of packed cells transfusion of other serum diagnoses: other primary cardiomyopathies thrombocytopenia, unspecified mitral valve disorders congestive heart failure, unspecified hyposmolality and/or hyponatremia unspecified acquired hypothyroidism gout, unspecified atrial fibrillation peripheral vascular disease, unspecified heart valve replaced by other means acute respiratory failure long-term (current) use of anticoagulants methicillin susceptible pneumonia due to staphylococcus aureus pressure ulcer, lower back hemorrhage of gastrointestinal tract, unspecified diseases of tricuspid valve 

Answer: The patient is high likely exposed to