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 / ethyl alcohol / erythromycin base / latex gloves / bactrim / dilaudid attending: chief complaint: abdominal pain major surgical or invasive procedure: - repair of thoracoabdominal aortic aneurysm with a 28-mm vascutek (cosselli) graft with multiple side branches to the visceral vessels and partial right heart bypass. history of present illness: 40 year old female who has undergone repair of type a dissection that represented abdominal pain with plan for intervention on thoracic aneurysm dilitation. however during that admission in she had sternal wire removal and was discharged for readmission now for treatment and heparin bridge prior to surgery. she continues with abdominal pain times a week sharp lasting less than 30 minutes, continues on oxycodone. admiited now for surgical management of her thoracoabdominal aortic aneurysm. past medical history: htn marfan's syndrome - first evaluated at the on for evaluation of a type b aortic dissection - emergent repair of her type a dissection in with ascending aorta replacement and cabg x 1 asthma hashimoto's thyroiditis hyperprolactinemia arthritis loss of vision in the right eye borderline ovarian cancer s/p lso - recent pelvic ultrasound returned normal endometriosis - controlled with implanon depression . past surgical history: bentall procedure with cabg x 1 - total arch replacement grafts to the lcca and the innominate artery and coronary artery bypass grafting w/ reverse saphenous vein graft from the neo ascending aorta to the lad d&c with left salpingo-oophorectomy polypectomy - hsc polypectomy - hospital - abd mmy - - laparoscopic lysis of adhesions of adhesionoa and left salpingo oophorectomy for borderline ovarian tumor - aortic dissection repair social history: patient lives with husband in . she is not employed. she denies tobacco or etoh or illicits. family history: cousin with marfans, ao dissection, and mi. uncles with . no family hx of ovarian or breast cancer. physical exam: pulse: 72 resp: 18 o2 sat: 100% ra b/p right: 122/70 left: height: weight: 78.2 kgs general: skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur crisp valve sounds abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema varicosities: none neuro: grossly intact pulses: femoral right: 2+ left: 2+ dp right: 2+ left: 2+ pt : 2+ left: 2+ radial right: 2+ left: 2+ carotid bruit right: no left: no pertinent results: echo 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. overall left ventricular systolic function is normal (lvef 60%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the descending thoracic aorta is mildly dilated. a bileaflet aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. mild (1+) aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. abdominal ultrasound no evidence for biliary ductal dilation or hepatic arterial compromise. given the technically limited nature of this examination, there is high concern for compromised hepatic arterial flow, cross-sectional (cta) imaging is recommended. abdominal mra 1. status post thoracoabdominal aortic graft placement with grafting of the celiac artery, sma, and renal arteries. there is slight mural irregularity at the sites of the anastomoses, however, all of these vessels remain patent. 2. slight heterogeneous perfusion on the left lateral segment of the liver, of uncertain significance. 3. left-sided pleural effusion/seroma with associated atelectasis. 4. slightly decreased enhancement of the medial left kidney, which may be due to ischemia. 5. proteinaceous or hemorrhagic left renal cysts. gallbladder ultrasound: 1. limited study, without evidence for biliary ductal dilatation. 2. main hepatic artery and main portal vein appear grossly patent. slight blunting of the systolic peak and notching of the waveform at early diastole are of uncertain significance, and may relate to the altered anatomy from aortic aneurysm repair and graft placement. wbc-13.5* rbc-3.40* hgb-9.8* hct-29.5* rdw-15.0 plt ct-623* wbc-14.0* rbc-3.60* hgb-10.3* hct-31.5* rdw-15.3 plt ct-636* wbc-16.0* rbc-3.74* hgb-10.7* hct-32.3* rdw-15.2 plt ct-500* wbc-19.2* rbc-4.04* hgb-11.5* hct-35.1* rdw-15.3 plt ct-457* wbc-17.6* rbc-3.94* hgb-11.6* hct-34.6* rdw-15.5 plt ct-385 wbc-13.7* rbc-3.87* hgb-11.2* hct-33.4* rdw-15.6* plt ct-266 wbc-12.4* rbc-4.15* hgb-11.7* hct-36.2 rdw-15.5 plt ct-237 pt-33.0* ptt-49.3* inr(pt)-3.3* pt-39.9* ptt-50.0* inr(pt)-4.2* pt-35.4* ptt-48.6* inr(pt)-3.6* pt-51.8* ptt-51.3* inr(pt)-5.7* pt-49.2* inr(pt)-5.4* pt-27.9* inr(pt)-2.7* pt-22.3* inr(pt)-2.1* pt-27.7* ptt-44.2* inr(pt)-2.7* pt-42.3* ptt-51.2* inr(pt)-4.5* pt-45.1* inr(pt)-4.8* pt-43.8* ptt-43.9* inr(pt)-4.7* pt-38.2* ptt-39.3* inr(pt)-4.0* glucose-121* urean-8 creat-0.5 na-134 k-4.2 cl-100 hco3-25 glucose-99 urean-9 creat-0.6 na-136 k-4.0 cl-100 hco3-26 angap-14 glucose-91 urean-9 creat-0.6 na-136 k-3.8 cl-102 hco3-25 angap-13 glucose-89 urean-7 creat-0.6 na-134 k-4.0 cl-98 hco3-27 angap-13 glucose-87 urean-9 creat-0.6 na-135 k-4.2 cl-99 hco3-27 angap-13 glucose-105* urean-9 creat-0.7 na-134 k-3.9 cl-101 hco3-27 glucose-96 urean-10 creat-0.9 na-135 k-3.6 cl-99 hco3-28 angap-12 alt-91* ast-49* ld(ldh)-420* alkphos-152* amylase-143* totbili-2.6* alt-106* ast-50* ld(ldh)-473* alkphos-159* amylase-121* totbili-2.8* alt-174* ast-50* ld(ldh)-470* alkphos-186* amylase-109* totbili-3.9* alt-211* ast-58* ld(ldh)-467* alkphos-197* amylase-103* totbili-4.4* alt-260* ast-79* ld(ldh)-452* alkphos-199* amylase-105* totbili-5.9* alt-357* ast-98* ld(ldh)-492* alkphos-188* amylase-112* totbili-5.6* alt-481* ast-130* ld(ldh)-609* alkphos-138* amylase-143* totbili-7.1* dirbili-4.4* indbili-2.7 alt-932* ast-312* ld(ldh)-576* alkphos-127* amylase-158* totbili-5.7* dirbili-3.7* indbili-2.0 lipase-166* lipase-179* lipase-145* lipase-119* lipase-125* lipase-125* albumin-2.8* calcium-8.1* phos-3.3 mg-1.9 albumin-3.1* calcium-8.3* phos-3.4 mg-2.0 albumin-2.5* calcium-8.2* phos-3.1# mg-1.9 albumin-2.7* calcium-8.1* phos-5.0* mg-1.8 albumin-2.7* phos-2.5* mg-2.2 brief hospital course: mrs. was admitted to the on for surgical management of her thoracoabdominal aneurysm. heparin was started as she had been off coumadin for several days in preparation for surgery. on , mrs. was taken to the operating room where she underwent repair of a thoracoabdominal aneurysm. please see operative note for details. following surgery, she was taken to the intensive care unit for monitoring. on postoperative day one, mrs. awoke neurologically intact and was extubated. she had a transient period of delirium and hallucinatins which resolved over several days. thrombocytopenia was noted but there was no issues with active bleeding. a heparin induced assay (hit panel) was sent which was negative. by discharge, thrombocytopenia resolved. due to perisistent nausea and elevated liver enzymes, a right upper quadrant ultrasound was obtained which was unremarkable. an mra was also performed which showed no evidence of vascular compromise to her abdominal organs. her nausea gradually improved and her diet was advanced as tolerated. lft's gradually improved. warfarin was resumed for her mechanical aortic valve and titrated for a goal inr between 2.0 - 3.0. inr flucuated and she appeared to be very sensitive to warfarin. she required two units of fresh frozen plasma on for an inr of 5.4. prior to discharge, her inr improved and low dose warfarin was resumed. she experienced significant epistaxis for which ent was consulted. successful nasal packing was performed on and she will followup with ent on as an outpatient for a pack pull. clindamycin was started for nasal packing which should continue until pack removed. also started on ciprofloxacin for postoperative urinary tract infection(gram negative bacteria). she was discharged to home in stable condition on pod#15. she will follow up with ent on mon. to have her nasal packing removed and her coumadin will be followed by dr. at the health center. medications on admission: aspirin 81 mg daily - states not on but was discharged on levothyroxine 75 mcg daily oxycodone-acetaminophen 5-325 mg tablet prn 1-2 times a week atorvastatin 40 mg daily disp:*30 tablet(s)* refills:*0* fluoxetine 20 mg daily losartan 50 mg daily docusate sodium 100 twice a day prilosec 40 mg daily magnesium oxide 400 mg daily triamterene-hydrochlorothiazide 37.5-25 mg daily metoprolol tartrate 12.5 mg twice a day amlodipine 5 mg daily albuterol inhaler 2-4 puffs prn asthma attack ~ 1 month coumadin stopped - 7.5 mg daily discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*90 tablet, delayed release (e.c.)(s)* refills:*2* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. atorvastatin 40 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*90 tablet(s)* refills:*2* 5. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 7. fluoxetine 20 mg capsule sig: two (2) capsule po daily (daily). disp:*60 capsule(s)* refills:*2* 8. losartan 50 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 9. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po every 6-8 hours as needed for pain. disp:*30 tablet(s)* refills:*0* 10. warfarin 1 mg tablet sig: one (1) tablet po once a day: take as directed by dr. . daily dose may vary according to inr. goal inr between 2.0 - 3.0. disp:*60 tablet(s)* refills:*2* 11. sodium chloride 0.65 % aerosol, spray sig: three (3) spray nasal tid (3 times a day). disp:*1 month supply* refills:*0* 12. oxymetazoline 0.05 % aerosol, spray sig: two (2) spray nasal (2 times a day). disp:*1 month supply* refills:*0* 13. clindamycin hcl 150 mg capsule sig: two (2) capsule po q6h (every 6 hours) for 4 days: 5 day course will be completed on . disp:*32 capsule(s)* refills:*0* 14. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 doses: total of 6 doses -last dose on . disp:*2 tablet(s)* refills:*0* 15. outpatient lab work please check inr every mon, wed and friday for several weeks until inr stabilizes. dr. will monitor inr as outpatient and titrate frequency accordingly. goal inr between 2.0 - 3.0. dr. phone number is (. please call cardiac surgery office at with any questions or concerns. discharge disposition: home with service facility: homecare discharge diagnosis: repair of thoracoabdominal aortic aneurysm s/p bental (mechanical avr) total arch replacement, and cabg . s/p sternal wire removal hypertension postop epistaxis, s/p packing postop delirium postop nausua with elevated liver function tests - improved postop urinary tract infection discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesics incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. discharge instructions: 1) please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage 2) please no lotions, cream, powder, or ointments to incisions 3) each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart 4) no driving for approximately one month until follow up with surgeon 5) no lifting more than 10 pounds for 10 weeks 6) please call with any questions or concerns *females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments: surgeon: dr. tuesday 3:30pm ( ent: dr. on @ 1045 am. address is in . instructed to arrive at least 30 minutes prior to appt please call to schedule appointments with your: primary care dr. in weeks cardiologist dr. in weeks vascular dr. in 4 weeks. **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication mechanical avr goal inr: 2.0 - 3.0 first draw: results to: dr. , phone( procedure: extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart resection of vessel with replacement, thoracic vessels resection of vessel with replacement, aorta, abdominal other operations on vessels control of epistaxis by posterior (and anterior) packing diagnoses: thrombocytopenia, unspecified anemia, unspecified urinary tract infection, site not specified unspecified essential hypertension aortocoronary bypass status asthma, unspecified type, unspecified heart valve replaced by other means 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 long-term (current) use of anticoagulants nausea alone dissection of aorta, thoracoabdominal delirium due to conditions classified elsewhere epistaxis other and unspecified anterior pituitary hyperfunction marfan syndrome profound impairment, one eye, impairment level not further specified chronic lymphocytic thyroiditis 

Answer: The patient is high likely exposed to