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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath major surgical or invasive procedure: - pericardectomy - cardiac catheterization - pericardial window - cardiac catheterization history of present illness: the patient is a 70 year old woman with history of paf, hypertension who presents with shortness of breath. the patient has had some sob and cough since , when she was admitted to st e with chest pain (sharp, substernal, pleuritic, non-positional), shortness of breath and fatigue found to be in new afib and started on coumadin. at that time an ett was negative and she completed a r/o mi. she was hypoxic at that time requiring 4-6l of nasal cannula. on she had a cta chest that showed small bilateral pleural effusions and bilateral lower lobe atelectasis w/o evidence for pe. on she had a tte ef>70% and trivial pericardial effusion. she subsequently saw her cardiologist (at ) who stopped coumadin as has converted to sinus. she saw her pcp cough, sob, abd pain ct abd -> bilat effusions, small pericard effusion and started on levoflox. she represented to her pcp with worsening shortness of breath and fatigue and was referred to the ed. she is very mildly short of breath and her cough is dry. she only gets mild chest pain with coughing. . ed course: initial vital signs were 100.4 75 88/54 24 96%4l. she transiently dipped her blood pressure to 80s which responded slowly but well to 2l ivf. she also received 1 dose of empiric decadron for adrenal insufficiency. she had a cta that was negative for pe but showed pericardial and pleural effusions as well as mediastinal fat stranding. a formal tte was done as well which showed no tamponade physiology. ct surgery was consulted with regard to the fat stranding and recommended getting cultures of the effusions if possible. she received ceftriaxone and azithromycin. . ros: weight stable, prior abdominal bloating is gone. no rash. no joint pain, no muscle pain. her last colonoscopy was 1year ago and was normal. never been on steroids. no tanning of skin. chronically constipated but had black stools 3 days ago. had been drinking very little for the past week. past medical history: paroxysmal atrial fibrillation dementia hypertension osteopenia hypercholesterolemia social history: born in , worked as xray tech, married and lives with husband. one daughter lives out of state. no cig/drug/etoh. never worked on farm nor in factory. no pets. family history: mother died of heart disease physical exam: t: 98.3 bp: 118/70 p:74 rr: 24 o2 sats: 93%6l, 91% on ra pulsus gen: nad heent:ncat, perrla, eomi neck: no masses, supple. no bruits, jvp ~12-13 cm cv: distant heart sounds, rrr no mrg, nl s1, s2 resp: dullness at base bilaterally, decreased breath sounds bilaterally way up abd: nabs, soft, ntnd, no guarding/rigidity/rebound back: no cva tenderness rectal: no tenderness, no masses guaiac: negative brown stool ext: no cce, 2+/4 symmetric pedal pulses neuro: a,ox3 cn: ii-xii intact sensation: light touch intact to face/hands/feet strength: in upper and lower extr skin: no rashes joints: no knee, wrist or hand swelling or tenderness pertinent results: ekg: sinus @70. nl axis and intervals. no st-t changes. compared to cxr: 1. moderate bilateral pleural effusions, left greater than right. 2. mild enlarged cardiac silouhette, with a slight globular appearance. cta chest: 1. moderate sized pericardial effusion with stranding in the mediastinal and epicardial fat concerning for mediastinitis. given this finding, clinical correlation for infected pericarditis is recommended. given the early phase of imaging, enhancement of the pericardium will not be detectable on this study. 2. large bilateral pleural effusions, left greater than right, with associated compressive atelectasis. 3. no evidence of pulmonary embolism. 4. right thyroid nodules and calcifications. clinically correlate. tte: - normal left atrium size. no asd. right atrial pressure is 10-15mmhg. lv wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) rv chamber size and free wall motion are normal. there is abnormal septal motion/position. mildly dilated ascending aorta. mildly dilated aortic arch. the aortic valve leaflets (3) are mildly thickened but no aortic stenosis. no ar. the mitral valve leaflets are mildly thickened. no mvp. physiologic mr. moderate tr. the estimated pulmonary artery systolic pressure is normal. small pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. there are no echocardiographic signs of tamponade. pericardial constriction cannot be excluded. tte - overall lv systolic function is normal (lvef>55%). rv chamber size and free wall motion are normal. there is abnormal septal motion. small, echodense pericardial effusion. the pericardium appears thickened. the echo findings are suggestive but not diagnostic of effusive-constrictive process. there are no echocardiographic signs of tamponade. impression: small echodense pericardial effusion without echo signs of tamponade. probable effusive-constrictive physiology. if clinically indicated, a cardiac mr () or right heart catheterization is recommended to investigate for constrictive physiology. tte - pre-pericardial window: 1. no atrial septal defect is seen by 2d or color doppler. 2. overall left ventricular systolic function is normal (lvef>55%). 3. right ventricular chamber size and free wall motion are normal. 4. simple atheroma in the aortic arch and the descending thoracic aorta. 5. aortic valve leaflets are mildly thickened. no ar 6. the mitral valve leaflets are mildly thickened. no mr 7. the tricuspid valve leaflets are mildly thickened. 8. small pericardial effusion measuring 1-1.2cm located primarily along the inferior and inferior-lateral aspects of the heart. the pericardium appears thickened. no echocardiographic signs of tamponade. 9. there are bilateral pleural effusions, right greater than left. . tte post-pericardial window: 1. biventricular function is preserved. 2. the size of the pericardial effusion has decreased to 0.5 cm along the inferior-lateral position. 3. bilateral pleural effusions are no longer evident post-chest tube placement. wbc-19.8*# rbc-3.77* hgb-11.6* hct-33.2* mcv-88 mch-30.8 mchc-35.0 rdw-12.7 plt ct-401 neuts-84* bands-3 lymphs-4* monos-9 eos-0 baso-0 atyps-0 metas-0 myelos-0 wbc-12.5* rbc-3.98* hgb-12.0 hct-36.0 mcv-91 mch-30.3 mchc-33.4 rdw-12.4 plt ct-451* wbc-10.5 rbc-3.91* hgb-12.4 hct-35.3* mcv-91 mch-31.8 mchc-35.1* rdw-13.0 plt ct-419 wbc-10.3 rbc-3.69* hgb-10.9* hct-32.8* mcv-89 mch-29.6 mchc-33.3 rdw-12.8 plt ct-334 pt-16.5* ptt-28.8 inr(pt)-1.5* pt-15.3* ptt-44.9* inr(pt)-1.3* pt-14.1* ptt-25.7 inr(pt)-1.2* glucose-117* urean-33* creat-1.7* na-133 k-4.9 cl-96 hco3-22 calcium-8.6 phos-3.3 mg-2.2 glucose-95 urean-23* creat-1.1 na-142 k-4.3 cl-103 hco3-27 glucose-107* urean-16 creat-0.9 na-137 k-3.8 cl-102 hco3-23 glucose-97 urean-15 creat-0.9 na-139 k-3.7 cl-103 hco3-27 06:55am blood alt-25 ast-17 ld(ldh)-252* alkphos-145* totbili-0.2 10:05am blood ld(ldh)-229 04:45pm blood %hba1c-6.1* 08:10am blood tsh-2.4 06:55am blood rheufac-17* -negative 06:55am blood virus b antibodies-pnd 06:55am blood adenovirus antibody-pnd 07:40am blood mycoplasma pneumoniae antibody igm-pnd 03:00pm urine color-yellow appear-clear sp -1.010 03:00pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 06:12pm pleural totprot-3.4 glucose-114 ld(ldh)-1432 06:13pm pleural wbc-750* rbc-* polys-15* lymphs-65* monos-0 eos-1* meso-8* macro-11* 1:31 pm pleural fluid gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (preliminary): no growth. anaerobic culture (pending): acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (pending): fungal culture (pending): 2:30 pm tissue pericardium. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. tissue (final ): no growth. anaerobic culture (preliminary): no growth. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (pending): fungal culture (preliminary): no fungus isolated. legionella culture (preliminary): no legionella isolated. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirvovecii (carinii). cmv igg antibody (final ): positive for cmv igg antibody by eia. 51 au/ml. reference range: negative < 4 au/ml, positive >= 6 au/ml. cardiac catheterization 1. one vessel branch coronary artery disease with diffuse atherosclerosis. 2. mild left and moderate right ventricular diastolic heart failure. 3. mild pulmonary arterial hypertension. 4. hemodynamic findings consistent with pericardial constriction. brief hospital course: mrs. was admitted to the on for further management of her shortness of breath. an echocardiogram was suggestive of a small pericardial effusion and pericardial constriction could not be ruled out. a cta was performed which revealed a moderate sized pericardial effusion with stranding in the mediastinal and epicardial fat concerning for mediastinitis. given this finding, clinical correlation for infected pericarditis was recommended. the cardiology service was consulted who recommended a pericardial window. the cardiac surgery service was consulted and on mrs. was taken to the operating room where she underwent a pericardial window with dr. . please see separate dictated operative note for details. pathology revealed organizing fibrinous pericarditis with adjacent adipose tissue has a prominent perivascular lymphocytic inflammation that is focally transmural (lymphocytic vasculitis). the latter findings raise the possibility of the spectrum of collagen vascular diseases. viral and bacterial cultures were negative except for an indeterminate past cytomegalovirus. postoperatively she developed rapid atrial fibrillation for which digoxin and beta blocker were given. as she remained in rapid atrial fibrillation, amiodarone was started. mrs. continued to have symptoms of constrictive pathology and an echocardiogram was performed which confirmed continued constriction. she was taken back to the catheterization lab where she was found to have single branch vessel coronary artery disease and hemodynamics strongly suggestive of constrictive physiology. given these findings it was elected to return to the operating room. on , mrs. was taken to the operating room where she underwent a sternotomy with pericardiectomy. please see operative note for details. postoperatively she was taken to the intensive care unit for monitoring. she later awoke neurologically intact and was extubated. diuresis was initiated. on , mrs. was transferred to the cardiac surgical step down unit for monitoring. amiodarone was continued for atrial fibrillation. dr. followed mrs. and recommended of hearts monitor on discharge. physical therapy worked with her daily to increase her strength and mobility. subcutaneous heparin was started as she was not as ambulatory as expected. coumadin was started for atrial fibrillation. mrs. continued to make steady progress and was discharged to rehabilitation on . she will follow-up with dr. , dr. and her primary care physician as an outpatient. dr. will manage her coumadin dosing once she is discharged from rehabilitation for a goal inr of 2.0-2.5 for atrial fibrillation. medications on admission: levofloxacin started atenolol 50 mg daily aspirin 325 mg daily hydrochlorothiazide 25 mg daily simvastatin 20 mg daily actonel 35 mg weekly colace prilosec 20 mg daily celebrex 200 mg discharge medications: 1. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 2. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. 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:*0* 5. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily) for 1 weeks: then starting switch to 200mg daily until otherwise instructed. 6. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 7. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 8. coumadin 1 mg tablet sig: dose for goal inr of 2.0-2.5 for af tablets po once a day: goal inr is 2.0-2.5 for af. tablet(s) 9. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 10. lasix 40 mg tablet sig: one (1) tablet po once a day for 7 weeks. 11. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day for 7 days. 12. heparin (porcine) 5,000 unit/ml solution sig: one (1) 5000 units injection tid (3 times a day): continue until inr therapeutic. discharge disposition: extended care facility: of discharge diagnosis: primary: pericardial effusion s/p pericardial window and pericardiectomy secondary: pleural effusion atrial fibrillation hypertension hypoxia acute renal failure discharge condition: stable discharge instructions: 1) call with fever, redness or drainage from incision or weight gain more than 2 pounds in one day or 5 pounds in one week. please contact surgeon with any wound issues. ( 2) shower daily. no baths, lotions, creams or powders to incisions until they have fully healed. 3) no lifting more than 10 pounds for 10 weeks. 4) no driving for 1 month or until follow up with surgeon. 5) take amiodarone 400mg daily for 1 week and then () decrease to 200mg daily therafter. 6) of hearts monitor on discharge with daily transmissions to dr. office. 7) coumadin follow-up upon discharge from rehab as per preasdmission with dr. (. goal inr is 2.0 for af. 8) continue sub q heparin until inr therapeutic or patient is ambulating more. 9) call with any questions or concerns followup instructions: please schedule an appointment with your primary care doctor dr. at in the next 1 to 2 weeks. you should also schedule an appointment with cardiologist, dr. ( in the next 2 weeks. follow up with dr. ( in 4 weeks. md procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters pericardiectomy pericardiotomy diagnoses: pure hypercholesterolemia unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation atrial flutter hypoxemia glucocorticoid deficiency diastolic heart failure, unspecified constrictive pericarditis 

Answer: The patient is high likely exposed to