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 / simvastatin attending: chief complaint: major surgical or invasive procedure: pericardial window history of present illness: 52 year old male with hypertension, hyperlipidemia and with a recent diagnosis of pericarditis () who presented with daily fevers, myalgias, shortness of breath/dyspnea on exertion. history dates to before which he was feeling entirely well. that evening he notes acute onset of mild chest pain which he attributed to "regular chest pain" meaning something of gi etiology. he went to sleep and felt well the next morning (). the pain returned that night, and worsened throughout the night to the point that it was "excruciating chest pressure" prompting presentation to ed, where he was admitted. the diagnosis of pericarditis was made based on ekg, and echo showed small-moderate pericardial effusion. cta of the chest had not demonstrated pe. he was discharged with nsaids and asked to followup as an outpatient. between and he developed fevers at night that made it difficult for him to sleep. the pain was controlled with nsaids and it was the that prompted his presentation. he measured it to 100.7 at most but felt subjectively very warm. when he had the fevers the chest pain seemed to get worse and he would also develop shoulder ache. . on readmission, he was found to have an 8 point hct drop from discharge to admit . initial echo demonstrated moderate effusion with loculation and he was scheduled for a pericardiocentesis on . overnight his clinical status worsened with increasing chest pain, shortness of breath and increased pulsus from 3 to 10 mm hg. repeat echo demonstrated "significant, accentuated respiratory variation in mitral/tricuspid valve inflows, consistent with impaired ventricular filling and elevated intrapericardial pressures and suggestive of early tamponade." he underwent pericardiocentesis of 650 cc of fluid and pericardial window on . drain was pulled . . he continues to have daily fevers occurring between 3pm and 10pm. tmax was 101.3. he is on vancomycin, levofloxacin and flagyl and all cultures to date have been negative. id is following the patient, and rheum was consulted today. he reports improved exercise tolerance with walking, but continues to have pleuritic chest pain. no other localizing signs/symptoms for infection. he is transferred back to the medicine service for further evaluation of his ongoing fevers. . ros: denies rash, denies abdominal pain, had mild visual changes today (rainbow color in right visual field - patient relates this to blood sugar elevated to 140), no change in hearing. no joint pains other than mentioned above. difficulty sleeping (because of fevers). subjective weakness past medical history: hypertension hyperlipidemia previous tia pericarditis osa (does not use his cpap) social history: no tobacco, etoh, drugs. works in construction. born and raised in ; came to us 20 years ago; no travel outside of area for last year. married; lives with wife and two children (age 25, 18). no sick contacts. pets; no animal contacts. family history: family history of htn. no history of cancer, rheumatic diseases. physical exam: general: sitting in bed, cooperative, able to communicate well. vitals: tm 100.0 tc 97.8 bp 116/64 hr 71 rr 20 98%ra repeat pulses: +2 skin: no rashes, no lesions heent: anicteric, eomi, perrl, mmm chest: decreased breath sounds at bases, otherwise clear heart: rrr, 2/6 sem back: no cva tenderness, no spinal tenderness abdomen: +bs, soft, tender to palpation in mid-epigastric region, no rebound/guarding ext: no clubbing/cyanosis/edema. good pulses. neuro: a+ox3 pertinent results: 07:50pm blood wbc-8.7 rbc-3.11* hgb-9.4* hct-26.7* mcv-86 mch-30.1 mchc-35.0 rdw-13.0 plt ct-345# 08:10pm blood wbc-11.2* rbc-3.53* hgb-10.5* hct-30.7* mcv-87 mch-29.7 mchc-34.2 rdw-13.6 plt ct-427 06:50am blood wbc-6.4 rbc-3.84* hgb-11.2* hct-33.5* mcv-87 mch-29.2 mchc-33.5 rdw-14.0 plt ct-458* 07:50pm blood neuts-69.5 lymphs-18.5 monos-8.1 eos-3.2 baso-0.6 02:29am blood neuts-84.1* bands-0 lymphs-9.3* monos-6.2 eos-0.4 baso-0.1 05:40am blood neuts-60.9 lymphs-27.6 monos-5.7 eos-5.5* baso-0.2 07:50pm blood pt-13.4* ptt-25.6 inr(pt)-1.2* 08:10pm blood pt-16.9* ptt-28.7 inr(pt)-1.6* 07:00am blood pt-15.0* ptt-27.0 inr(pt)-1.3* 07:50pm blood glucose-123* urean-20 creat-1.2 na-138 k-3.8 cl-104 hco3-23 angap-15 07:00am blood glucose-99 urean-19 creat-1.1 na-141 k-4.8 cl-106 hco3-29 angap-11 06:50am blood glucose-107* urean-17 creat-1.0 na-140 k-4.8 cl-106 hco3-27 angap-12 06:10am blood alt-176* ast-56* ck(cpk)-63 alkphos-200* amylase-42 totbili-0.5 07:00am blood alt-97* ast-72* alkphos-138* totbili-0.3 05:40am blood alt-90* ast-49* ld(ldh)-246 alkphos-135* totbili-0.3 06:50am blood alt-57* ast-21 alkphos-123* totbili-0.2 06:10am blood lipase-32 06:10am blood calcium-8.1* phos-3.4 mg-2.7* iron-22* 06:10am blood caltibc-194* hapto-330* ferritn-1026* trf-149* 02:33pm blood %hba1c-6.0* 01:20pm blood hbsag-negative hbsab-negative hbcab-positive hav ab-positive 07:15am blood igm hbc-negative 01:58pm blood anca-negative b 05:10am blood rheufac-7 01:20pm blood -positive titer-1:80 02:29am blood igg-1211 igm-50 01:20pm blood hcv ab-negative 05:32pm blood type-art po2-72* pco2-37 ph-7.52* caltco2-31* base xs-6 intubat-not intuba vent-spontaneou 12:58am blood type-art po2-118* pco2-38 ph-7.45 caltco2-27 base xs-3 05:57am blood type-art po2-78* pco2-31* ph-7.48* caltco2-24 base xs-0 ace level: 4 cocksackie b1-6 antibodies: <1:8 mycoplasma igg: neg igm: 14 anti-sm antibodies: <0.2 (negative) anti-rnp anti-ro anti la: pending . pa and lateral chest radiographs: there is no evidence of pneumonia. in the interval there has been development of small bilateral pleural effusions with a mild amount of fluid noted within the left major fissure. adjacent probable compression atelectasis is present within the lower lobes bilaterally. globular cardiomegaly is unchanged. there is no evidence of pulmonary edema, pneumothorax and hilar contours are within normal limits. impression: 1. interval development of small bilateral pleural effusions with mild adjacent compression atelectasis. no evidence of pneumonia. 2. unchanged globular cardiac silhouette likely representing combination of pericardial effusion and cardiomegaly. . liver ultrasound: the liver parenchyma is normal without evidence of mass lesions. the portal vein is patent with hepatopetal flow. the gallbladder is not distended. there is no evidence of stones, pericholecystic fluid or gallbladder wall edema to suggest acute cholecystitis. the common bile duct measures approximately 4.5 mm. there is no evidence of intra- or extrahepatic biliary dilatation. a small right pleural effusion is noted. there is perihepatic and perisplenic fluid collections that are better evaluated on ct abdomen and pelvis done the same day. impression: 1. no evidence of acute cholecystitis. 2. perihepatic and perisplenic fluid collections as well as a small right pleural effusion are noted and are better evaluated on ct abdomen and pelvis performed the same day. . findings: there has been marked enlargement of the known pericardial effusion, now measuring at least 2.5 cm in circumference along the left lateral wall. there are small pleural effusions, left greater than right with associated atelectasis. no focal consolidative airspace disease or nodule. the liver is slightly enlarged with a tiny amount of perihepatic ascites. gallbladder is decompressed. spleen, pancreas and adrenal glands are unremarkable. the kidneys excrete contrast symmetrically without hydronephrosis. pelvis: bowel loops are unremarkable, and contrast has passed to the colon. no dilated bowel loops. no free air or free fluid. small retroperitoneal lymph nodes, not meeting ct criteria for pathologic enlargement. vascular structures are intact. review of bone windows demonstrates no suspicious lytic or blastic lesions. impression: 1. marked enlargement of known pericardial effusion, now quite large (2.5 cm in diameter). echocardiography advised to assess for potential tamponade. 2. no evidence for retroperitoneal hematoma or other source of recent drop in hematocrit. this was discussed with dr. at the time of initial interpretation. . echo (): conclusions the left atrium is normal in size. the estimated right atrial pressure is 5-10 mmhg. 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 aortic valve leaflets appear structurally normal with good leaflet excursion. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is a moderate sized pericardial effusion measuring 2cm inferolateral and lateral to the left ventricle and anterior to the right atrium with <1cm anterior to the right ventricle and around the apex. the effusion appears circumferential but sttranding is visualized c/w organization/loculation. no right atrial or right ventricular diastolic collapse is seen but there is accentuation of respirtatory variation in the transtricuspid e wave velocity. compared with the prior study (images reviewed) of , the effusion is much larger and mild increase in pericardial pressure is suggested. clinically correlation and serial evaluation is suggested . cxr () two views. comparison with . there is continued evidence of small bilateral pleural effusions. there is increased density in the retrocardiac area consistent with atelectasis and/or consolidation. the cardiac silhouette is enlarged, as before. mediastinal structures are otherwise unremarkable. the bony thorax is grossly intact. impression: bilateral pleural effusions and atelectasis or consolidation at the left base. cardiomegaly. no significant interval change . pericardial fluid: negative for malignant cells pericardial tissue: diagnosis: pericardium, excision: organizing fibrinous pericarditis. addendum: gram and gms stains performed on blocks a and b are negative for bacterial and fungal organisms, respectively. . echo (pre-drainage) the left atrium is normal in size. the estimated right atrial pressure is 16-20 mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) right ventricular chamber size and free wall motion are normal. there is abnormal septal motion/position. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a large pericardial effusion. the effusion appears loculated. stranding is visualized within the pericardial space c/w organization. no right atrial or right ventricular diastolic collapse is seen. there is significant, accentuated respiratory variation in mitral/tricuspid valve inflows, consistent with impaired ventricular filling and elevated intrapericardial pressures. compared with the prior study (images reviewed) of , the pericardial effusion is slightly larger. this echo is suggestive of early tamponade. . echo (post-drainage) no spontaneous echo contrast is seen in the body of the left atrium. no spontaneous echo contrast is seen in the body of the right atrium. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. there is mild to moderate global left ventricular hypokinesis (lvef = 40-45 %). the right ventricular cavity is mildly dilated. there is moderate global right ventricular free wall hypokinesis. there is abnormal septal motion/position. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is a large pericardial effusion. the effusion appears loculated. stranding is visualized within the pericardial space c/w organization. the pericardium appears thickened. there are no echocardiographic signs of tamponade. after drainage, there is only small remnants of the pericardial effusion - a small pocket located inferolaterally and another next to the right atrium. the left pleural effusion has also been drained. the left ventricular systolic function actually seems somewhat improved after drainage. the right ventricle is still moderately globally depressed. . chest ct ct of the chest without iv contrast: the central airways are patent to the subsegmental levels, bilaterally. linear opacities in the left lung consistent with subsegmental atelectasis. there is no pleural effusion. the patient is status post pericardial window. a small amount of left chest wall subcutaneous emphysema and a tiny loculated air pocket presumabily in the subpleural space. unchanged small pericardial effusion. there is no evidence of consolidation. no evidence of mediastinal or hilar lymphadenopathy. numerous axillary lymph nodes are noted, not pathologically enlarged by ct criteria. this study is not designed for subdiaphragmatic evaluation, however, the imaged portions of the upper abdomen are unremarkable. no bone findings suspicious for malignancy. impression: 1. status post pericardial window with post-surgical changes as described above. small pericardial effusion. 2. atelectatic changes in the left lung without evidence of consolidation. . rle u/s: findings: grayscale, color, and doppler ultrasound images demonstrate a tortuous venous structure without flow in the right lateral calf consistent with a thrombosed varix. impression: superficial thrombosed varix brief hospital course: mr. was admitted under medical team d/t with unclear etiology but thought possibly related to recent pericarditis. cardiology was consented and pt underwent echocardiogram on . echo revealed pericardial effusion thought to be larger than prior echo with mild increase in pericardial pressure. also underwent liver/gb us d/t epigastric pain and elevated lfts which showed no cholecystitis. plus underwent an abd/pelvic ct for the epigastric pain and low hct upon admission which showed marked enlargement of known pericardial effusion, but no evidence for retroperitoneal hematoma or other source of recent drop in hematocrit. patient was medically managed over next couple of days and planned for pericardiocentesis. cardiac surgery was consulted on for possible pericardial window. underwent repeat echo on which revealed the pericardial effusion was slightly larger and suggestive of early tamponade. id was consulted and later on this day he was brought to the operating room where he underwent a pericardial window. following surgery he was transferred to the cvicu in stable condition. shortly after surgery he was weaned from sedation, awoke neurologically intact and extubated. on post-op day one he was transferred to the sdu for further care. chest tube was removed on post-op day two. . # : etiology unclear, initially suspecting infectious etiologies, and then had gram positive rods growing in anaerobic pericardial fluid culture which speciated as p. acnes. unclear if this is contaminant or real infection as per id, pathologist reports no neutrophilic infiltrate in tissues. fungal stains negative. he received broad spectrum antibiotic coverage while here with vancomycin/levofloxacin/metronidazole, which was then narrowed to 14d course of vancomycin, but overall p. acnes felt to be more likely a contaminant. as infectious etiologies of began to be ruled out, fevers were controlled with tylenol pre-treatment each evening. had chest ct to evaluate possible retrocardiac opacity as source of fevers, only atelectasis noted. infectious disease service followed patient throughout hospitalization. concerning infectious etiologies were ruled out and it was felt that patient could go home with close followup. rheumatology also involved in patient's care and felt that he had few other symptoms to suggest systemic rheumatologic disease. they considered a diagnosis of adult still's disease but left this as a diagnosis of exclusion once id workup completed and recommended bone marrow biopsy and lymph node biopsy to search for other causes. also suggested other causes of periodic fevers such as familial mediterrean , tnf receptor related periodic syndrome but thought it would be difficult to make this diagnosis on the basis of only 2 weeks of fevers. he will see rheumatology in followup. . # pericardial effusion: received pericardial window as above. loculated fluid suggested chronic infection. although patient began to be relatively hypotensive in the days prior to discharge, he was not tachycardic and did not have an increased pulsus paradoxus so reaccumulation of fluid and tamponade were not thought to be at play. given loculated effusion, this was a concern. hctz was stopped and he was discharged with followup of blood pressure and consideration of further elimination of lisinopril. (given recent weight loss it was felt that his antihypertensive requirements may have been reduced). #r leg mass patient noted to have a 1cm superficial nodular mass on right calf which was nontender and mobile. ultrasound showed it to be a thrombosed superficial varix. no further evaluation was pursued. . #.abnormal lfts low-grade elevation on admission of uncertain etiology, but most likely a manifestation of systemic ilness such as a viral syndrome. they were trending down throughout hospital course. they were not high enough to suggest acute hepatitis, hepatitis serologies show hcv negative, hav ab positive (likely old), and hbv surface ag and ab negative but core igg positive suggesting either window period or old infection with decline in surface ab titers. core igm negative suggesting this was more likely old hbv infection with declining surface antibody titers . #anemia hct initially low on admission, received 1uprbcs during this admission. thought had been bleed into pericardium versus gi bleed given nsaid use. stools were guiac negative x2 (at least). now has stabilized, pericardium would seem to be most likely site of bleeding. ferritin high, iron low - may also have element of acd, which would be in keeping with ongoing inflammatory state. hct was stable ~31-33 for several days prior to discharge. . # hyperlipidemia: continued pravastatin medications on admission: ibuprofen 800 mg tid aspirin 325 mg qday lisinopril/hctz 10/12.5 atenolol 25mg daily clonapin 0.5mg prn pravastatin 20mg daily mvi discharge medications: 1. pravastatin 10 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*1* 2. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*1* 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*1* 5. hydromorphone 2 mg tablet sig: one (1) tablet po at bedtime as needed for incisional pain for 4 weeks. disp:*15 tablet(s)* refills:*0* 6. outpatient lab work vancomycin trough level on , please send results to dr. at 7. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) gram intravenous q12h (every 12 hours) for 6 days. disp:*12 gram* refills:*0* 8. heparin lock flush (porcine) 100 unit/ml syringe sig: two (2) ml intravenous daily (daily) as needed for 6 days: flush 10 ml ns followed by 2ml of 100units/ml heparin (200 units heparin). disp:*1200 units* refills:*0* 9. clonazepam 0.5 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed for sleep. 10. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation: stool softener for constipation while taking narcotic pain medications. disp:*60 capsule(s)* refills:*0* discharge disposition: home with service facility: iv infusions discharge diagnosis: pericardial effusion s/p pericardial window pmh: h/o pericarditis , hypertension, hyperlipidemia, h/o tia, sleep apnea discharge condition: good discharge instructions: you were admitted with an inflammation around the heart which led to fluid build up. it is still unclear if this is due to an infection or an inflammatory disease. we believe that the reason for this fluid build up will become clear over time but that you do not have to sit in the hospital as you have continued to be stable and have only low-grade fevers which are controlled with tylenol. you should continue with one of the antibiotics, vancomycin, for 6 more days and we have arranged for an intravenous antibiotic company to administer this to you. we have scheduled a number of followup appointments for you (see below) for your incision: call your doctor , redness or drainage from incision. no driving while taking narcotic pain medicine. you can shower, no baths until incision is closed. no lotions, creams or ointments on incision. medication changes: vancomycin iv as above stopped atenolol, stopped hydrochlorothiazide. continued lisinopril at 10mg (you were previously on a combination pill of hydrochlorothiazide and lisinopril). you should have your blood pressure checked on thursday at dr. office, if it is low, she should call dr. to consider reducing your lisinopril dose. please return to the emergency room if you experience a racing heart rate, difficulty breathing, worsening chest pain, lightheadedness or fevers that are not controlled by tylenol. followup instructions: please have your blood pressure checked with a nurse phone: date/time: 11:00 please call the cardiac surgery office at ( to schedule followup with dr. of cardiac surgery in approximately 4 weeks. please followup with dr. of cardiology on at 9am in the building on the on the . ( friday at 10:00am - infectious disease clinic (located in basement of ) ( clinic followup - , 10am. call (. dr. procedure: diagnostic ultrasound of heart pericardiocentesis pericardiotomy diagnoses: anemia of other chronic disease obstructive sleep apnea (adult)(pediatric) unspecified pleural effusion unspecified essential hypertension pulmonary collapse other and unspecified hyperlipidemia acute pericarditis, unspecified varicose veins of lower extremities with other complications 

Answer: The patient is high likely exposed to