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: aspirin / gantrisin / sulfa (sulfonamide antibiotics) attending: chief complaint: dyspnea major surgical or invasive procedure: elective intubation pericardiocentesis with placement of drain cardiac arrest, intubated, central line placement, bronchoscopy transesophageal echocardiogram history of present illness: 86m s/p avr, cabg with dr. . post-op course was relatively uncomplicated. he did revert to afib and coumadin was resumed. he was started on kefzol for a small amount of sternal drainage, which resolved. beta blockade was held due to 2nd degree av block. he was discharged to rehab on pod 5. he left on iv diuresis via his picc. he developed a pneumonia last week and has been treated with antibioitcs and a steroid taper. additionally, he has received multiple blood transfusions for anemia. reportedly, diuresis was discontinued at rehab on . the patient was seen at this cardiologist office today and was noted to be significantly sob and appeared fluid overloaded. he was sent directly to the er for evaluation and admission. he remained hemydynamically stable. stat bedside echo showed moderate effusion. creat elevated at 1.5. cxr clear. he was admitted to the cvicu for monitoring. stat tte was obatined which showed large pericardial effusion with rv collapse, no pulses paradoxes. interventional cardiology was consulted and the decesion was to hold off on doing percutaneous drainge of effusion until am. inr 2.0 coumadin held and ffp and vitamin k. past medical history: aortic stenosis s/p avr coronary artery disease s/p cabg chronic obstructive pulmonary disease peripheral vascular disease. status post abdominal aortic aneurysm repair (endovascular repair in at ). hypertension. dyslipidemia paroxysmal atrial fibrillation probable ischemic cardiomyopathy with chronic systolic heart failure with left ventricular ejection fraction of 30%. gout. mild obesity. first and second degree wenckebach. nephrolithiasis. vitiligo tuberculosis (45 years ago treated with inh). status post ventral hernia repair. status post right inguinal hernia repair x2. status post left wrist ganglion removal. left antecubital nerve repair, right heel spur. social history: non-smoker, 2-3oz wine per day, married, 3 daughters family history: father mi age 52, brother mi age 58 physical exam: on admission: pulse:70 resp: 36 o2 sat: 100 on 3l b/p right:130/60 general: skin: dry intact heent: perrla eomi neck: limitied rom chest: lungs clear bilaterally diminished in the bases heart: rrr abdomen: soft non-distended non-tender bowel sounds extremities: cool mottled varicosities: none neuro: grossly intact weak with upper ext tremors pulses: femoral right: +1 left:+1 dp right: dopp left:dopp pt : dopp left:dopp radial right: +1 left:trace carotid bruit right: none left:none pertinent results: 01:05am blood wbc-8.0 rbc-2.69* hgb-8.1* hct-25.3* mcv-94 mch-30.1 mchc-32.0 rdw-18.1* plt ct-163 11:05am blood wbc-12.0*# rbc-3.17* hgb-9.3* hct-29.6* mcv-94 mch-29.4 mchc-31.4 rdw-17.2* plt ct-199# 01:05am blood pt-18.0* ptt-34.6 inr(pt)-1.7* 11:05am blood pt-21.2* ptt-31.1 inr(pt)-2.0* 01:05am blood glucose-106* urean-119* creat-1.8* na-147* k-5.3* cl-115* hco3-23 angap-14 11:05am blood glucose-129* urean-69* creat-1.5* na-126* k-4.2 cl-86* hco3-28 angap-16 03:34am blood alt-25 ast-53* ld(ldh)-270* alkphos-96 amylase-56 totbili-0.4 08:00pm blood alt-26 ast-34 ld(ldh)-410* alkphos-94 totbili-0.6 echocardiography report , i tte (complete) done at 2:55:49 pm final referring physician information , - department of cardiac s , 2a , status: inpatient dob: age (years): 86 m hgt (in): 70 bp (mm hg): 121/59 wgt (lb): 180 hr (bpm): 83 bsa (m2): 2.00 m2 indication: evaluate ejection fraction and pericardial effusion. icd-9 codes: 785.0, 423.9, 424.1, 424.0, 424.2 test information date/time: at 14:55 interpret md: , md test type: tte (complete) son: doppler: limited doppler and color doppler test location: west echo lab contrast: none tech quality: suboptimal tape #: 2012w000-0:00 machine: e9-1 echocardiographic measurements results measurements normal range left atrium - four chamber length: *6.7 cm <= 5.2 cm right atrium - four chamber length: *6.4 cm <= 5.0 cm left ventricle - septal wall thickness: 0.9 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 1.1 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.1 cm <= 5.6 cm left ventricle - ejection fraction: 50% to 60% >= 55% left ventricle - stroke volume: 69 ml/beat left ventricle - cardiac output: 5.74 l/min left ventricle - cardiac index: 2.87 >= 2.0 l/min/m2 aortic valve - peak velocity: *2.8 m/sec <= 2.0 m/sec aortic valve - peak gradient: *31 mm hg < 20 mm hg aortic valve - mean gradient: 10 mm hg aortic valve - lvot pk vel: 1.70 m/sec aortic valve - lvot vti: 22 aortic valve - lvot diam: 2.0 cm aortic valve - pressure half time: 411 ms mitral valve - e wave: 0.8 m/sec tr gradient (+ ra = pasp): *30 to 36 mm hg <= 25 mm hg findings this study was compared to the prior study of . left atrium: elongated la. right atrium/interatrial septum: moderately dilated ra. normal interatrial septum. no asd by 2d or color doppler. left ventricle: normal lv wall thickness. normal lv cavity size. suboptimal technical quality, a focal lv wall motion abnormality cannot be fully excluded. overall normal lvef (>55%). trabeculated lv apex. no resting lvot gradient. no vsd. right ventricle: dilated rv cavity. rv function depressed. abnormal septal motion/position. aortic valve: mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. mild mitral annular calcification. no ms. mild (1+) mr. pericardium: very small pericardial effusion. effusion echo dense, c/w blood, inflammation or other cellular elements. no echocardiographic signs of tamponade. general comments: suboptimal image quality - poor echo windows. conclusions the left atrium is elongated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded (basal to mid infero-lateral hypokinesis is suggested on some images.). overall left ventricular systolic function is preserved (lvef>50%). there is no ventricular septal defect. the right ventricular cavity is dilated with depressed free wall contractility. there is abnormal septal motion/position. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is a very small pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , the pericardial effusion appears smaller. rv systolic function cannot be compared due to poor rv visualization on prior. lvef is probably similar. electronically signed by , md, interpreting physician 15:39 ?????? caregroup is. all rights reserved. , m 86 neurophysiology report eeg study date of object: no improvement in mental status post-cardiac arrest. assess for epileptic activity. referring doctor: dr. findings: abnormality #1: frequent generalized bifrontally dominant broad-based sharp discharges. abnormality #2: the background was diffusely slow and discontinuous with admixed theta and delta activity reaching maximal for 5-5.5 hz with no anterior-posterior gradient. background: the same as abnormalities #2 and #1. hyperventilation: is not performed as the patient is intubated. intermittent photic stimulation: is not performed due to portable equipment. sleep: no normal sleep morphologies are present. cardiac monitor: a single ekg channel shows a generally regular rhythm with an average rate of 78 bpm. impression: this is an abnormal awake and sleep eeg because of frequent generalized bifrontally dominant epileptic discharges indicative of areas of cortical irritability with potential epileptogenicity. in addition, background activity is diffusely slow and discontinuous suggestive of severe diffuse cerebral dysfunction in this case most likely related to hypoxic brain injury. other potential causes include medication effect or toxic or metabolic disturbances. no electrographic seizures are present. interpreted by: , h. () , m 86 radiology report mr head w/o contrast study date of 10:16 pm , csru 10:16 pm mr head w/o contrast clip # reason: eval for embolic event/ ischemic regions medical condition: 86 year old man unresponsive after code x 72 hours reason for this examination: eval for embolic event/ ischemic regions contraindications for iv contrast: none. final addendum degenerative changes are noted at c4/5 level. dr. peri approved: mon 12:05 pm , csru 10:16 pm mr head w/o contrast clip # reason: eval for embolic event/ ischemic regions medical condition: 86 year old man unresponsive after code x 72 hours reason for this examination: eval for embolic event/ ischemic regions contraindications for iv contrast: none. final report indication: unresponsive, aftercode x 72 hours; to evaluate for embolic event/ischemic regions, 72 hours. comparison: none. technique: mr of the head without contrast. findings: there is no obvious focus of slow diffusion to suggest an acute infarct. evaluation for subacute infarcts can be limited on the dwi sequence given the long interval. there are extensive periventricular and subcortical flair hyperintense foci, some of which are discrete and others are confluent in the frontal and the parietal lobes on both sides. there is moderate dilation of the lateral and the third ventricles including the temporal horns on both sides. the bifrontal diameter of the lateral ventricles at the level of foramen of measures 39.4 mm. the right temporal is larger than the left. a few small scattered foci of negative susceptibility in the brain parenchyma scattered in the cerebral hemispheres and a few faint foci in the right cerebellar hemisphere. the major intracranial arterial flow voids are noted. the right vertebral artery is dominant. the left vertebral artery is markedly diminutive in size. there is increased signal intensity in the mastoid air cells on both sides from fluid and mucosal thickening. slightly increased signal intensity in the right transverse sinus, may relate to slow flow. there is diffuse increased signal intensity in the paranasal sinuses and the ethmoid and the maxillary sinuses, right more than left and the sphenoid sinus along with fluid in the nasal cavity and nasopharynx related to intubation. impression: 1. no large area of obvious acute infarct. evaluation for subacute infarcts can be limited on the present study. 2. flair hyperintense areas in the cerebral white matter, non-specific in appearnace and a few scattered t2 susceptibility foci related to microhemorrhages as described above. 3. diffuse paranasal sinus disease with fluid in the nasopharynx; fluid and mucosal thickening diffusely in the mastoid air cells. 4. moderate dilation of the lateral and the third ventricles as described above-? related to parenchymal volume loss with or without a component of communicating hydrocephalus such as nph. correlate clinically. dr. peri approved: mon 12:03 pm imaging lab there is no report history available for viewing. , m 86 radiology report ct chest w/o contrast study date of 8:40 am , csru 8:40 am ct chest w/o contrast clip # reason: assess for dehisence of sternum medical condition: 86 year old man s/p avr cabg - now w/unstable sternum reason for this examination: assess for dehisence of sternum contraindications for iv contrast: none. wet read: sjbj tue 11:27 am there is dehisence of the superior and inferior ends of the sternum. a 3.8 x 3.5cm dense collection at the sterno manubrial junction has characteristics of hematoma. the superior manubrial fragments are seperated by 7mm. the upper most 2 sternal wires do not encircle the right sternal fragment. there is 14mm of dehiscence of the inferior left sternum lateral to the sternotomy with a non-hemorrhagic collection between the seperated fragments. moderate pericardial effusion with layering density suggestive of hematoma. moderate right and small left pleural effusions. mild pulmonary edema. wet read audit # 1 final report indication: 86-year-old man with post avr and cabg on with unstable sternum. comparison: chest radiographs and . technique: mdct data were acquired through the chest without intravenous contrast. data were reconstructed using soft tissue and lung kernels. images were displayed in multiple planes. findings: the initial ct tomogram confirms abnormal alignment of median sternotomy wires as identified on prior radiographs. there is a 3.5 x 3.9 cm dense fluid collection at the sternoclavicular articulation (2.9, 400b:36). two surgical clips are seen adjacent to this area (2.7). the two halves of the manubrium are seperated by 7mm. the most superior two sternal wires wind around only the left sternal half (2:14). the third and fourth sternal wires surround both fragments of the sternum, which are in appropriate relationship. although the fifth sternal wire appears to deviate towards the left, this wire appears to properly fixate both halves of the sternum. the most inferior three sternal wires are shifted to the right. there is approximately 2.7 cm of separation between the sternum and the left inferior costal cartiladge (2:38). fluid with simple attenuation fills this space. the thyroid has normal attenuation. no mediastinal, hilar or axillary adenopathy is present. there is a moderate pericardial effusion. dense material layers in the pericardial effusion likely representing blood products (2:46). severe three-vessel coronary artery atherosclerosis is identified. the aorta and aortic valve prosthesis is in expected position. a left pleural effusion is moderate and right pleural effusion is small. basilar dependent atelectasis is present. lung volumes are low and severe respiratory motion hampers their assessment. pulmonary edema is mild. no focal consolidation is identified. this exam is not tailored to evaluate subdiaphragmatic structures. no right adrenal nodule is identified. bone windows: compression deformities of t7 and t11 are noted. there is no lytic or sclerotic lesion concerning for malignancy. a left-sided svc line terminates in the upper svc. an enteric catheter extends into the stomach. impression: 1. manubrial and inferior left sternal dehisence 2. 3.8 x 3.5cm sterno manubrial hematoma. 3. 2.7cm left lateral inferior sternal non-hemorrhagic fluid collection 4. moderate pericardial effusion with layering density suggestive of hematoma. 5. moderate right and small left pleural effusions. 6. mild pulmonary edema. discussed with via phone at . the study and the report were reviewed by the staff radiologist. dr. dr. approved: tue 7:36 pm imaging lab there is no report history available for viewing. brief hospital course: mr was transferred from cardiologist office to emergency room for evaluation of dyspnea that was progressively worsening at rehab that was thought to be related to pneumonia and copd exacerbation at rehab. he had echocardiogram that revealed large pericardial effusion and right ventricular compression. his creatinine was elevated due to cardiac compromise with acute kidney injury and elevated troponin due to demand ischemia from cardiac strain. he was on coumadin and received fresh frozen plasma and vitamin k for reversal. he was treated with iv fluids and levophed for hemodynamic management. he was taken to the cardiac cath lab and underwent pericardiocentesis with placement of drain. of note prior to procedure he was electively intubated for the procedure in the intensive care unit. he tolerated the procedure, he was started on diuretics for diuresis as he was significantly volume overloaded. on he was extubated without any complications and was continued to be diuresed and creatinine continued to improve. on he was note for diarrhea and stool was positive for clostridium dificile, flagyl was started. he underwent echocardiogram as the drain had less than 50 ml, and based on echo finding the drain was removed, the remaining effusion was thought to be loculated. he was evaluated by speech and started a modified diet however his oral intake was not sufficient and dobhoff was placed for additional nutrition on . he continued to be diuresed but there was noted to be paradoxical breathing at times that was thought to be related to his sternum. he continued to be monitored. on ep was consulted due to arrythmia with concern for av nodal block but was diagnosed with atypical atrial flutter. on he underwent a ct scan due to ongoing paradoxical breathing, plastic surgery was consulted in regards to potential sternal plating or flap coverage due to dehiscence of the sternum. additionally due to worsening rashes on skin dermatology was consulted, the left lower extremity was felt to be hyperkeratosis and facial rash was vitiligo but felt to be chronic. he continued with diuresis, pulmonary exercises and non invasive ventilation at night. on the night of he had difficulty breathing while completing respiratory treatment and then became bradycardic with pea arrest. acls protocol was initiated see code sheet. he received chest compressions, defibrillation, medications, and intubation. after he was resuscitated he underwent bronchoscopy, echocardiogram, and central line placement. he was noted for significant secretions, was started on empiric antibiotics and bal revealed pseudomonas. he required vasopressors and inotropic support. infectious disease was consulted due to resistant pseudomonas and antibiotics were adjusted per their recommendation. he continued treatment for pneumonia, clostridium dificile, and urinary tract infection. he hemodynamically improved post cardiopulmonary arrest however was not waking up. neurology was consulted he underwent mri that did not reveal any acute findings and eeg that showed significant slowing which neurology felt he was unlikely to have a meaningful recovery. there was a family meeting on and the family wanted to continue treatment with plan for repeat eeg in 1 week. mr. remained unresponsive and without improvement. the eeg was repeated and showed slowing, likely from anoxic brain injury. the family discussed with dr. and the cardiac surgery team making mr. care measures only. on under the critical care guidelines, measures were instituted. reporting protocol was followed. medical examiner denied case and the family denied autopsy. please refer to death report for further information. ......stop medications on admission: medications at rehab aspirin 81 mg daily tamsulosin 0.4 mg at bedtime finasteride 5 mg daily probenecid 500 mg daily atorvastatin 80 mg daily allopurinol 300 mg daily prednisone 5 mg qam prednisone 2.5 mg qpm ranitidine hcl 150 mg albuterol sulfate 2.5 mg /3 ml neb q6h as needed for dyspnea. ipratropium bromide 0.02 % inhalation q6h as needed for dyspnea. warfarin 1 mg daily vancomycin cefapime discharge disposition: expired discharge diagnosis: respiratory arrest leading to cardiac arrest acute on chronic systolic heart failure healthcare acquired pneumonia clostridium dificile anemia pericardial effusion with tamponade cardiogenic shock due to tamponade demand ischemia due to tamponade acute kidney injury atypical atrial flutter retention hyperkeratosis sternal dehiscence urinary tract infection secondary: aortic stenosis s/p avr coronary artery disease s/p cabg chronic obstructive pulmonary disease peripheral vascular disease. status post abdominal aortic aneurysm repair (endovascular repair in at ). hypertension. dyslipidemia paroxysmal atrial fibrillation probable ischemic cardiomyopathy with chronic systolic heart failure with left ventricular ejection fraction of 30%. gout. mild obesity. first and second degree wenckebach. nephrolithiasis. vitiligo tuberculosis (45 years ago treated with inh). status post ventral hernia repair. status post right inguinal hernia repair x2. status post left wrist ganglion removal. left antecubital nerve repair, right heel spur. discharge condition: expired procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances pericardiocentesis arterial catheterization closed [endoscopic] biopsy of bronchus cardiopulmonary resuscitation, not otherwise specified right heart cardiac catheterization diagnoses: abnormal coagulation profile anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified long-term (current) use of steroids cardiac complications, not elsewhere classified atrial fibrillation disruption of internal operation (surgical) wound coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status asthma, unspecified type, unspecified atrial flutter paroxysmal ventricular tachycardia other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia other specified cardiac dysrhythmias cardiac arrest anoxic brain damage 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 cardiogenic shock intestinal infection due to clostridium difficile pressure ulcer, lower back do not resuscitate status anticoagulants causing adverse effects in therapeutic use heart valve replaced by transplant ventilator associated pneumonia acute on chronic systolic heart failure atherosclerosis of native arteries of the extremities, unspecified pseudomonas infection in conditions classified elsewhere and of unspecified site other and unspecified mycoses other respiratory abnormalities coma other second degree atrioventricular block pressure ulcer, stage ii acute pericarditis, unspecified personal history of tuberculosis cardiac tamponade acute kidney failure with other specified pathological lesion in kidney keratoderma, acquired 

Answer: The patient is high likely exposed to