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: compazine / reglan / opioids-morphine & related attending: chief complaint: shortness of breath major surgical or invasive procedure: intubation thoracentesis (multiple) chest tube history of present illness: 52 year old female with a history of lone atrial fibrillation and lyme meningitis presenting with progressive shortness of breath over past 2 weeks. on , patient awoke with 10/10 pleuritic pain radiating down to left shoulder to left arm associated with sob and diaphoresis. she went to pcp who ordered cta which was negative for pe and diagnosed her with pleurisy. she was prescribed motrin 800mg tid. . her pain was mildy improved with the motrin but she developed doe which progressed to dyspnea at rest over the past 2 weeks. also endorsing chest heaviness, pleuritis left sided/luq pain, orthopnea and pnd. her pain would be releived sitting forward. denies le edema. 1 week ago she experienced 1 day of vomiting x5 episodes nbnb. in the past few days had fevers/chills and abd distention associated with constipation and low grade headache. tmax of 101.3. also had dry cough. saw pcp who took cxr which showed pna with b/l pleural effusions. . in the ed, initial vitals were t 101 hr 120 bp 120/77 rr 18 pox 89% ra. resp distress. cxr l>r effusion and pericardial effusion. triggered in the ed for hypoxia to 89% ra, placed on o2 by n/c + abx(ctx and lev), 2l bolus, followed by 150/hr. cards c/s: resolving pericardial effusion, decided not to tap. labs notable for alt: 146 ap: 483 tbili: 2.4 alb: 3.3 wbc to 17 (no bands). believe that pleural effusion may be bigger issue. had thoracentesis in ed 1200cc straw colored fluid. prior to transfer, 99.4, 110, 122/85, 20, 100% by n/c 5l. . upon arriving to the icu, patient was in left sided pleuritic chest pain. she felt sob slightly improved. pain worse and different after thoracentesis. also endorsed "contact" dermatitis with couple blisters on lower extremities worse 2 weeks ago thought to be a nickel allergy. she has been drinking pos well recently but appetite poor. endorsed 1 year of nightsweats which she believes are postmenopausal. of note, she missed her mammogram. . ros: review of systems: (+) per hpi (-) review of systems: gen: no recent weight loss or gain. heent: no sinus tenderness, rhinorrhea or congestion. cv: no palpitations. pulm: no wheezing. gi: no nausea, diarrhea, or abdominal pain. no recent change in bowel habits, no hematochezia or melena. gui: no dysuria or change in bladder habits. msk: no arthritis, arthralgias, or myalgias. neuro: no numbness/tingling in extremities. psych: no feelings of depression or anxiety. all other review of systems negative. past medical history: shoulder pain, left-s/p labral tear repair and ac repair fracture, finger osteopenia menopausal state lyme disease meningitis s/p 3 years of abx(seasonal plaquinel plus doxycycline alternating with clarithromycin, finished in atrial fibrillation-paroxsymal since age 24 migraine herpes simplex costochondritis social history: she has one dtr age 8. she is a landscape designer who runs her own business. she does not smoke. denies recent travel. does live in and has hiked recently but no noted ticks. denies ever having ppd placed etoh: martinis a week. tobacco: none illicits: none family history: mother-mi but survived 4 younger siblings healthy father died of at 54, grandfather died of lung ca in 50s, a smoker, paternal aunt had cancer died in 50s physical exam: vs: 97.3 113 122/76 93%3l, pulsus 12mmhg gen: pleasant, visibly in discomfort from l sided chest pain heent: perrl, eomi, anicteric, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy, jvp to jaw, no carotid bruits, no thyromegaly or thyroid nodules resp: decreased bs at b/l bases with poor airmovement effort and pain cv: rr, s1 and s2 wnl, no m/r/g abd: mild distension, +b/s, soft, ttp in b/l upper quadrants, no masses or hepatosplenomegaly, no rebound or guarding ext: no c/c/e skin: no jaundice/no splinters, left skin with 1inch diameter round erythematous plaque, ? en, right posterior le with small 1 cm erythmatous bliser neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. no pass-pointing on finger to nose. 2+dtr's-patellar and biceps rectal:deffered pertinent results: ekg: sinus tachycardia at a rate of 117, normal axis, non-specific st,t changes, diffusly low voltage, rbbb pattern. right bundeloid. st, t changes are new since . . 2d-echocardiogram: () the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is a moderate sized pericardial effusion (1.3 cm anteriorly and 1.8 cm around the right atrium). the effusion is echo dense, consistent with blood, inflammation or other cellular elements. stranding is visualized within the pericardial space c/w organization. no right ventricular diastolic collapse is seen. there is brief right atrial diastolic invagination. there is significant, accentuated respiratory variation in mitral/tricuspid valve inflows, consistent with impaired ventricular filling. . compared with the prior study (images reviewed) of , the pericardial effusion is new. no overt tamponade is seen however elevated intrapericardial pressure is suggested. . echo: overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the small pericardial effusion is echo dense, consistent with blood, inflammation or other cellular elements and appears largely organized with minimal free fluid. the pericardium may be thickened. . compared with the prior study (images reviewed) of /201, the pericardial effusion now appears slightly smaller . laboratory data: 140 104 14 ---|----|---|------< 17.4 >------< 424 3.9 26 0.8 33 troponin < 0.01 alt: 146 ap: 483 tbili: 2.4 alb: 3.3 ast: 33 ldh: dbili: tprot: : lip: 17 pt: 15.9 ptt: 30.5 inr: 1.4 . micro: pleural, blood, urine cultures, urine legionella negative. rubeola antibody igg positive. . cxr : extensive left pleural effusion, that occupies approximately one-half of the left hemithorax. a small right basal pleural effusion. additional mild fluid markings of the fissures and slight distention of the vasculature suggests mild pulmonary edema. subsequent areas of bilateral atelectasis. the contour of the cardiac silhouette cannot be reliably determined. . cxr post : infiltrate worse on right, improved on left, no ptx . cta grossly normal study, specifically no evidence of pulmonary embolism. . cxr: indication: bilateral pleural effusions, status post right thoracocentesis. . comparison: at 01:33 p.m. (approximately three hours earlier). . chest radiograph, portable view: interval removal of left pigtail catheter. when compared to the most recent study, there has been decrease in bilateral pleural effusion, now small. . no pneumothorax is noted. bibasilar atelectasis is again noted, left more than right. . the cardiomediastinal and hilar silhouettes appear unchanged. . pleural fluid: atypical. rare atypical epithelioid cell in a background of reactive mesothelial cells, histiocytes, and lymphocytes; see note. note: one hematology slide labeled 1556e- was reviewed and demonstrates mesothelial cells; no atypical cells seen. . brief hospital course: 52 year old female with a history of lone atrial fibrillation and lyme meningitis presenting with progressive shortness of breath and doe over past 2 weeks admitted to the micu with pleural effusions and a pericardial effusion in the setting of presumed viral pleurisy and pericarditis that developed into an effusion after chronic nsaid use possible aspiration/cap pna who developed afib with rvr secondary to pain and pericardial effusion, transaminitis with cholestasis and acute renal failure in the setting of anemia and nsaid use who has a persistent o2 requirement with pleuritic pain and resolving pericardial effusion. she improved clinically prior to discharge after ct placement for her l effusion and a thoracentesis to remove her r sided pleural effusion. . # sob/cp/hypoxia: likely multifactorial with most obvious etiologies being pleural, pericardial effusions, and . pe was less likely given cta negative. due to her effusions, it was thought she may have an underlying pna and she was started on levaquin for cap. she was given a prolonged course due to concern that she may have had infection in her pericardial fluid. the day after admission () she was intubated for hemodynamic control(afib rvr 150s), pain control, and for potential procedure for a possible pericardial window. from a respiratory prospective she was comfortable prior to intubation which was done under rapid sequence given signs of early tamponade. she was extubated without event when it was determined that cardiology did not think her pericardal effusion needed to be drained. instead, cardiology recommended serial echo's to follow the effusions size. an echo on showed that the effusion was reduced in size compared to prior imaging. . #afib with rvr: the patient has a history of lone atrial fibrillation. on day of admission patient went to afib to 200s briefly sustaining in the 160s. this was thought to pain and infection vs tamponade physiology. she received metroprolol iv and dilt drip. when patient was intubated, she converted back to sinus rhythm and maintained in sinus rhythm. after extubation and while on the floor the patient did not have any palpitations or further episodes of afib wtih rvr. - she will need to discuss with her outpatient physician with aspirin when her pericardial effusion resolves. . # pleural effusions: she presented with pleuritic chest pain which was initially attributed to her pleural effusions. initially, the ddx was broad including infectious(lyme/parvo negative, pending), malignant(cytology ultimately negative), and rheumatologic( negative and c3/c4 normal). chf and cirrhosis unlikely based on h+p. lipase normal makes pancreatits unlikely. thoracentesis reveals exudate, likely parapneumonic given fevers, and a viral pleuritis was also considered. id was consulted who recommended empiric coverage for cap with a prolonged course of levofloxacin (14 days - finish on ) due to a concern that the pericardial fluid could infection. cytology negative, cultures negative. morphine and fentanyl pleuritic cp. the most likely diagnosis was a viral infection with a superimposed bacterial process possibly in the setting of aspiration 1 week prior. of note her effusions persisted despite antibiotic therapy and nsaid therapy. she was given diuretics with lasix which did not reduced the size of her effusion. therefore, a l sided chest tube placement by ip in addition to a right sided thoracentesis. after subsequent removal of her bilateral pleural effusions, her symptoms of sob and o2 requirement resolved. . # pericardial effusion: initially echo concerning for early but not overt tamponade physiology and exam was concerning. patient was given ivf to maintain preload. serologies were sent as above. her pulsus was monitored closely and was never above 12mmhg. cardiology consult followed closely and serial echos showed improvement in effusions. the decision was made not to drain effusions for diagnostic purposes given the risks involved. she was restarted on nsaid therapy for viral pericarditis. of note, her effusion improved by echo prior to discharge. . # cap: given her exudative effusion and viral pleuritis there was concern for cap and possible aspiration. she was given a two week course of levofloxacin to finish on the date listed above. . # diarrhea: she had transient episode of diarrhea while on antibiotics, and her diarrhea resolved. . # /low uo: dark urine and poor output early in icu course. thought potentially from nsaids. renal spun urine and it was not active. she had low uop, which improved with ivf. . cholestasis and hepatitis: she was noted to have to have abnormal lft's with cholestatsis in addition to pleuritic r sided abdominal pain. there was concern that she could have either a viral induced hepatitis with cholestasis versus a congestive hepatopathy in the setting of mild volume overload. cholecystitis was less likely given the absence of a white count. her lft's trended down independent of diuresis thereby suggesting/confirming a possible viral etiology for her hepatitis and cholestasis. of note her hepatitis serologies were negative. . # anemia: baseline hct 40s most recently in . no signs or symptoms of bleeding. likely from systemic process going on. normal colonoscopy in . of note, she is currently menopausal, and has iron studies that suggest she has anemia of chronic disease, or at least anemia with acute inflammation. - she will need a cbc as an outpatient. medications on admission: -aspirin tab 81mg ec (aspirin) 1 qd discharge medications: 1. polyethylene glycol 3350 17 gram/dose powder sig: one (1) pack po daily (daily) as needed for constipation. disp:*30 packets* refills:*0* 2. levofloxacin 750 mg tablet sig: one (1) tablet po daily (daily) for 4 days. disp:*4 tablet(s)* refills:*0* 3. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). disp:*5 adhesive patch, medicated(s)* refills:*0* 4. ibuprofen 600 mg tablet sig: one (1) tablet po q8h (every 8 hours). 5. colace 100 mg capsule sig: one (1) capsule po twice a day. 6. benadryl 25 mg capsule sig: one (1) capsule po every six (6) hours as needed for prior to morphine: please take before morphine as needed for itching. please do not drive after taking this medication. disp:*20 capsule(s)* refills:*0* 7. morphine 10 mg capsule, ext release pellets sig: one (1) capsule, ext release pellets po every six (6) hours as needed for pain: please do not drive after taking this medication. disp:*20 capsule, ext release pellets(s)* refills:*0* discharge disposition: home discharge diagnosis: pleuritis with bilateral pleural effusion and pericardial effusion discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance discharge instructions: dear mrs. , you were admitted for worsening shortness of breath due to fluid in your lungs and around your heart. the exact cause of this is unknown. your breathing has markedly improved and you are presently able to breathe without use of supplemental oxygen. you will need to be followed by your primary care physician. were started on an antibiotics and ibuprofen. the following medicaiton changes were made: added: levaquin, ibuprofen, miralax, morphine, lidocaine patch, benadryl, morphine, colace stopped: aspirin followup instructions: please visit your primary care physician for bloodwork and to determine whether you will need to take more lasix (the 'water-pill' that you during your stay in the hopsital). name: , l. location: personal health care, p.c. address: , , , phone: appt: at 4pm procedure: insertion of intercostal catheter for drainage insertion of endotracheal tube thoracentesis thoracentesis diagnostic ultrasound of other sites of thorax diagnostic ultrasound of other sites of thorax diagnoses: pneumonia, organism unspecified anemia, unspecified coronary atherosclerosis of native coronary artery acute kidney failure, unspecified atrial fibrillation constipation, unspecified diarrhea hepatitis, unspecified unspecified analgesic and antipyretic causing adverse effects in therapeutic use acute idiopathic pericarditis proteinuria other specified forms of effusion, except tuberculous 

Answer: The patient is high likely exposed to