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: no known allergies / adverse drug reactions attending: chief complaint: dyspnea major surgical or invasive procedure: pericardiocentesis history of present illness: 72 yo m with htn, hld, and dmii presenting with worsening exertional dyspnea and chest pain for the past three days. he and his family report that he had been in his usual state of health, but began to notice that he would have to rest after walking up stairs and later after walking on flat ground. he denies symptoms at rest, no orthopnea, no pnd, no change in chronic le edema, no increased salt intake, but does report a chronic noctural nonproductive cough. he denies sharp chest pains and his symptoms were not positional. . wednesday evening, he reported having such difficulty breathing walking to his car that he could barely walk more than a few steps, prompting a family friend to drive him to the emergency room. he denies recent viral illness, but does report having multiple "colds" this year. no fevers or chills, occasional "sweats" that he attributes to his blood sugar being low, but no over night sweats. he has lost 10 lbs in the last 2 months, but has intentionally been trying to eat less. . he is originally from somolia and to in . he later moved to in . he is not currently working, but previously worked as a tractor operator. he denies known tuberculosis exposure and is unsure of his ppd status (of note, according to our medical records, it appears he may have had a positive in the past). no history of chest trauma or intrathoracic surgeries. . in the ed, his initial vitals were 98.3, 75, 150/70, 17, 100% 2-4l nc. a ekg revealed nsr at 80 bpm with evidence of electrical alternans. his labs were significant for a k of 8.4, a hct of 26.8, a bicarb 16, and cr of 2.4. pt underwent a bedside echo which revealed a large pericardial effusion with evidence of tamponade physiology. he was given 40 mg of lasix iv and remained hemodynamically stable. he was then taken to the cath lab for pericardiocentesis and then transferred to the ccu for further management. upon arrival to the floor, the patient reported feeling much better. his breathing as significantly improved, although he reports having some pain at the incision site that is worse with sitting forward. he is not having other chest pain, no numbness or tingling or palpitations. . review of systems on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. all of the other review of systems were negative. past medical history: 1. cardiac risk factors: (+)diabetes, (+)dyslipidemia, (+)hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: none -pacing/icd: none 3. other past medical history: -htn -dmii, on insulin -hld -?positive ppd social history: he is originally from somolia and fled to in . he later moved to in . he is not currently working, but previously worked as a tractor operator. stopped smoking cigarettes approximately 11 years prior, no etoh or recreational drugs. family history: dmii, remainder unknown. physical exam: admission- vs: t 98.7 bp 175/59 hr 82 rr 22 o2 sat 95% on 4l nc general: well appearing man in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: , pt is lying flat. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. possible faint rub. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, scattered bibasilar crackles, no wheezes or rhonchi. abdomen: firm, ntnd. no hsm or tenderness. nabs. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 1+ pt 1+ left: dp 1+ pt 1+ discharge- vs- 97.3, 159/68 (sbp 144-183), 89 (64-89), 24, 100% on 2l i/o ; wt 90.6 general: well appearing man in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. neck: , pt is lying flat. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab. no wheezes, rales, or rhonchi. abdomen: firm, ntnd. no hsm or tenderness. nabs. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 1+ pt 1+ left: dp 1+ pt 1+ pertinent results: admission- 09:20pm blood wbc-10.1 rbc-2.80* hgb-8.0* hct-26.8* mcv-96 mch-28.5 mchc-29.7* rdw-16.0* plt ct-464*# 09:20pm blood neuts-74.0* lymphs-14.5* monos-7.3 eos-3.7 baso-0.5 09:20pm blood pt-11.9 ptt-30.5 inr(pt)-1.1 09:20pm blood glucose-213* urean-48* creat-2.4* na-134 k-8.4* cl-108 hco3-16* angap-18 09:20pm blood calcium-7.7* phos-5.9* mg-3.1* 12:45am blood type-art o2 flow-3 po2-74* pco2-38 ph-7.36 caltco2-22 base xs--3 intubat-not intuba 03:12am blood crp-117.8* 03:12am blood esr-114* 03:12am blood hapto-350* 08:01am blood -pnd 09:33pm blood lactate-1.5 09:20pm blood probnp-458* 09:20pm blood ctropnt-<0.01 03:12am blood alt-102* ast-58* ld(ldh)-267* alkphos-184* totbili-0.2 01:21am urine hours-random urean-133 creat-15 na-90 k-17 cl-93 totprot-49 prot/cr-3.3* 10:30pm urine hours-random discharge- 06:18am blood wbc-9.9 rbc-2.96* hgb-8.2* hct-26.3* mcv-89 mch-27.5 mchc-31.0 rdw-15.2 plt ct-549* 03:12am blood neuts-71.2* lymphs-17.2* monos-7.2 eos-4.0 baso-0.6 06:18am blood pt-12.1 ptt-29.1 inr(pt)-1.1 06:18am blood glucose-65* urean-42* creat-1.8* na-138 k-4.5 cl-106 hco3-25 angap-12 06:18am blood calcium-7.2* phos-4.7* mg-2.5 pericardial fluid- 12:15am other body fluid wbc-* hct,fl-15.0* polys-27* lymphs-45* monos-19* eos-5* macro-4* 12:15am other body fluid totprot-4.4 glucose-156 ld(ldh)- amylase-36 albumin-2.3 microbiology- 12:15 am fluid,other; pericardial fluid. gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (preliminary): no growth. anaerobic culture (preliminary): no growth. fungal culture (preliminary): acid fast culture (pending): acid fast smear (final ): no acid fast bacilli seen on direct smear. 12:15 am fluid received in blood culture bottles. pericardial fluid. fluid culture in bottles (preliminary): no growth. cytology pericardial fluid , transthoracic echos tte ( at 11:11:46 pm) overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is a moderate to large sized 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: moderate to large pericardial effusion with evidence of early tamponade physiology. tte ( at 1:09:06 am) there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the findings of the prior study (images reviewed) of , the pericardial effusion has been successully drained. tte ( at 3:40:36 pm) there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. the echo findings are suggestive of constrictive physiology. impression: no significant residual pericardial fluid seen. there is now evidence of constrictive physiology with echocardiographic equivalent of kussmaul's sign. pcxr () findings: single ap upright portable view of the chest was obtained. since the prior study, there has been significant interval enlargement of now globular cardiac silhouette, raising concern for underlying pericardial effusion. there may be mild pulmonary vascular congestion without overt pulmonary edema. no definite focal consolidation is seen. the left costophrenic angle is not well seen, which may be due to overlying soft tissue, although a small pleural effusion is not excluded. no neumothorax. impression: significant interval increase in size of cardiac silhouette which is globular in configuration, concerning for underlying pericardial effusion. possible minimal-to-mild pulmonary vascular congestion without overt pulmonary edema. slight blunting of the left costophrenic angle is most likely due to overlying soft tissue, although a trace pleural effusion is not excluded. ct chest, abd & pelvis w/o contrast () - prelim prelim impression: 1. moderate pericardial effusion. 2. small left loculated pleural effusion. 3. no abdominal or pelvic adenopathy or other evidence of occult malignancy. 4. severe multilevel thoracolumbar degenerative disease. brief hospital course: 72 yo m with h/o htn, hld and dmii presenting with shortness of breath and chest pressure x3 days. noted to have pericardial effusion with concern for tamponade physiology. s/p pericardiocentesis and drain placement on . . # pericardial effusion s/p pericardiocentesis (~720 cc) and tube placement upon admission. it was felt that this represented a subacute fluid accumulation given hemodynamic stability and symptomatology course. the etiology of his effusion remains unclear. although concerning for malignancy (lymphoma/breast/lung/melanoma), the prelim cytology and ct torso did not reveal overt evidence of a malignant process. cultures remain negative to date, and his afb smear was negative. was also pending upon discharge. subsequent tte revealed resolution of the effusion. he is to follow up with cardiology in weeks. . # hypertension: the patient has a history of hypertension on an outpatient regimen consisting of hctz, amlodipine, toprol, lisinopril, and clonidine. his acute hypertension was felt to likely be secondary to not taking his home medications and rebound hypertension from unopposed alpha agonism given stopping clonidine. he was started on carvedilol in place of metoprolol and restarted his clonidine patch (with po clonidine doses to bridge). he was the restarted on amlodipine. both lisinopril and hctz were held and not restarted upon discharge given . . # acute systolic heart failure the patient presented with evidence of clinical volume overload. felt to be secondary to the effusion and early tamponade physiology seen on admission echo. the patient was diuresed with lasix boluses and appeared euvolemic upon discharge. repeat tte revealed a preserved lvef of 55%. . # acute on chronic kidney injury, as per report from his pcp, patient's baseline cr was 2.0. upon admission, his cr had increased to 2.4. felt to be secondary at least in part to poor forward flow. the etiology of his chronic kidney disease is unknown, but felt to be secondary to hypertension vs. diabetic nephropathy. his cr improved throughout his admission and was 1.8 at discharge. . # hyperkalemia the patient's admission k was noted to be 8.9 in the ed. his pcp's office reported a baseline of 6.0. the acute increase was felt to be secondary to aockd. the patient did not have electrocardiographic evidence of hyperkalemia. he had no evidence of increased potassium intake or intracellular shift. his potassium level trended down during his hospital stay but should continue to be monitored. . # arrythmia noted to have pauses (longest 2.9 seconds) on telemetry, asymptomatic and sleeping. the patient should consider a referral to sleep medicine for concern for possible osa. . # normocytic anemia baseline unknown, pericardial fluid was hemorrhagic, but unlikely to lead to his extent of anemia. he did not have evidence of hemolysis, dic, or other bleeding. this should continue to be monitored as an outpatient. . # diabetes pt reports being on insulin at home and was maintained on his home nph regimen with a humalog sliding scale. . ========================================= transitions of care ========================================= 1. pericardial effusion: etiology unclear studies pending upon discharge - final read of ct torso, final fluid culture date, final fluid anaerobic culture, final fluid acid fast culture, final fluid cytology report. 2. history of positive ppd: pt should have a quantiferon gold study sent as an outpatient. 3. changes to antihypertensive regimen: started carvedilol, continued amlodipine, continued clonidine patch, stopped lisinopril, stopped hydrochlorothiazide 4. normocytic anemia: baseline and etiology unclear, no evidence of hemolysis or dic. pt would likely benefit from outpatient work up. 5. arrythmia: pt noted to have symptomatic pauses on telemetry, would likely benefit from outpatient sleep medicine referral. medications on admission: nph 40u qam, 35 qpm norvasc 10mg daily toprol xl 100mg daily lisinopril 40mg daily clonidine patch 0.1mg qweek hctz 25mg daily simvastatin 20mg daily asa 81mg daily ultram 50mg tid tylenol 500mg qid:prn doxepin 25mg qhs calcium, vit d 500/200 daily naprosyn 50mg :prn discharge medications: 1. insulin nph & regular human 100 unit/ml (70-30) suspension sig: as directed units subcutaneous twice a day: please take 40 units in the morning and 35 units in the evening. 2. amlodipine 10 mg tablet sig: one (1) tablet po once a day. 3. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch transdermal qsat. 4. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 5. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 6. ultram 50 mg tablet sig: one (1) tablet po three times a day as needed for pain. 7. doxepin 25 mg capsule sig: one (1) capsule po at bedtime. 8. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 10. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 11. acetaminophen 500 mg tablet sig: one (1) tablet po four times a day as needed for pain. discharge disposition: home discharge diagnosis: primary -pericardial effusion secondary: -acute on chronic kidney insufficiency -hyperkalemia -hypertension -acute systolic heart failure -insulin dependant diabetes mellitus, type 2 discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking part in your care during this hospitalization. you were admitted because fluid had collected around your heart and you were having difficulty breathing. the fluid was drained and we gave you medication to help reduce fluid that had built up in your lungs. we are not exactly sure what caused this fluid to build up. it is very important that you continue to follow up with your new cardiologist. you also were found to have some kidney injury. we think that this is a long problem that had been made worse by the fluid around your heart. this has begun to improve. we hope you continue to feel well. please make the following changes to your medications: -start: carvedilol 12.5 mg twice daily (this is for your blood pressure) -stop: metoprolol (toprol) -stop: lisinopril -stop: hydrochlorothiazide -stop: naprosyn (naproxen) as this medication can be bad for your kidneys your cardiologist and pcp may restart some of these medications in the future if you continue to improve. you had a number of studies and labs that were not back at the time of discharge. be sure to ask about these when you see your pcp and cardiologist. followup instructions: please call ( on monday to schedule an appointment with your new cardiologist, dr. in weeks. it is very important you make and keep this appointment. please also call your primary care doctor, dr. , () to schedule an appointment this coming week. be sure to tell him you were recently hospitalized for fluid around your heart. procedure: pericardiocentesis diagnoses: acidosis hyperpotassemia obstructive sleep apnea (adult)(pediatric) anemia, unspecified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified other and unspecified hyperlipidemia unspecified disease of pericardium other specified cardiac dysrhythmias acute systolic heart failure other specified disorders resulting from impaired renal function cardiac tamponade 

Answer: The patient is high likely exposed to