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: cardiac tamponade major surgical or invasive procedure: pericardiocentesis history of present illness: ms. is an 83 yo female with iddm, htn, dyslipidemia and h/o lung cancer s/p xrt and rll resection who was taken to an osh by her family for increased sob and found to be hypotensive with a large pericardial effusion and rul opacity on ct. she was transferred to for further workup and management of the pericardial effusion. . per family, she has had progressive sob over the past month. at baseline, she is a "couch potato" and does not leave the house or exert herself much, but on the morning of admission stayed in bed due to fatigue and told her family that she wanted to be taken to the hospital. she has had a cough for several weeks, which has sounded wet but not been productive of sputum or blood. she has been clammy but the family denies f/c, n/v. she has had decreased appetite but no weight loss. . on further review of systems, the family denies any prior history of mi, syncope, stroke or tia. her husband does note black stools recently, but in the setting of iron pills. she is incontinent of urine at baseline. she is also occasionally lightheaded at home. . at the osh, she had negative lenis and no pe on cta. she was started on ceftriaxone and azithromycin for ? rul pna. . in our ed, initial vitals were t 97.3, hr 103, bp 111/67, pos 100%. she was given 1.5l fluid, ondansetron, albuterol and ipratroprium nebulizers. bedside u/s showed a large effusion with rv collapse and tamponade physiology. pulsus paradoxus was 30-40. she was taken to the cath lab for pericardiocentesis. . in the cath lab, she was initially hypotensive. an arterial groin line and venous groin line were place along with swan-ganz catheter. initial pcwp was 30mmhg. pericardicentesis showed initial pericardial pressure 30mmhg. 600cc of bloody fluid were drained and the pericardial pressure decreased to zero. pcwp post-procedure declined to 20mmhg. she was intubated due to increased agitation and progression of her acidosis which was thought to represent lactic acidosis. she received 2g zosyn in the cath lab. . on arrival to the unit, she was sedated and intubated, with stable blood pressures of sbp 130s. past medical history: cardiac risk factors: iddm, hypertension, dyslipidemia no past cardiac history other past medical history: -h/o lung cancer (patient declined treatment upon diagnosis) -depression (no current meds) -parkinson's disease with dementia -hypothyroidism -anxiety -s/p shoulder fracture -s/p arm fracture . social history: worked in a light bulb soldering and packaging factory for many years. -tobacco history: heavy smoker, quit . -etoh: family denies. family history: no family history of lung cancer physical exam: vs: t= 97.1 bp= 139/76 hr= 94 rr= o2 sat= 100% on 40% fio2 general: sedated, intubated. heent: ncat. sclera anicteric. perrl. conjunctiva were pink. neck: exam limited by large neck. jvd could not be appreciated. cardiac: exam limited by continuous rhonchi and soft heart sounds but rrr appreciated. no thrill was appreciated. lungs: resp appear unlabored on vent, no visible accessory muscle use. diffuse, loud rhonchi and wheezes throughout. no crackles appreciated on left lat decubitus exam. abdomen: soft, ntnd. no hsm or tenderness. no abd bruits. +bs. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ dp 1+ left: carotid 2+ femoral 2+ dp 1+ pertinent results: 06:05pm 8.4 10.8>----< 509 26.8 neuts-89.6* lymphs-6.1* monos-3.8 eos-0.4 basos-0.2 pt-16.8* ptt-28.8 inr(pt)-1.5* 141 / 108 / 66 -------------- 5.2 / 18 / 1.4 anion gap-20 calcium-9.6 magnesium-2.9* lactate-2.0 urine rbc-0-2 wbc-21-50* bacteria-mod yeast-none epi-0 blood-sm nitrite-neg protein-tr glucose-neg ketone-15 bilirubin-sm urobilngn-neg ph-6.5 leuk-mod abg: po2-247* pco2-38 ph-7.34* total co2-21 base xs--4 tsh-1.5 %hba1c-7.7* brief hospital course: 1. cardiac tamponade- on arrival, the patient was noted to have a large pericardial effusion on bedside echo. she underwent pericardiocentesis in the cath lab, with 600 cc bloody fluid drained, resulting in normalization of systemic and pulmonary wedge pressures. fluid was sent for chemical and cytological analysis, and showed no malignant cells. however, etiology of pericardial effusion is most likely malignant, as patient has lung cancer diagnosed over 1 year ago for which she preferred no treatment. she remained hemodynamically stable throughout course. home bp meds (ace) were held for borderline blood pressures. a repeat echo on showed no evidence of pericardial fluid reaccumulation, with normal rv chamber size and wall motion. lvef was >75%. 2. rul pna- cxr at admission showed right upper lobe pneumonia, likely post-obstructive due to right upper lobe mass, and small right pleural effusion. wbc was 12.5 at admission. the patient was started on levo/flagyl for a 10 day course which will be completed on . blood cultures were pending, sputum cultures showed rare yeast and urine legionella antigen was negative. patient remained afebrile throughout course and wbc trended down to normal range. she was initially intubated post-pericardiocentesis for agitation and increasing anion gap metabolic acidosis, thought to be lactic acidosis. she was successfully extubated, but continued to require high flow oxygen and nebs prn. family and patient were consulted regarding possible pulmonary intervention (bronchoscopy +/- stenting) but they declined in favor of non-invasive care moving towards palliative care. 3. r pleural effusion- etiology may be malignant or infectious. unlikely to be cardiac etiology since echo showed normal ef and effusion was right-sided only. therefore, diuretics would likely not be helpful, and were held in light of tenuous blood pressure. 4. uti- urinalysis on admission showed 21-50 wbcs and moderate bacteria. patient was already on levofloxacin for , no additional antibiotics were started. urine culture was negative. 5. respiratory distress- patient was extubated successfully but required high fi02 face mask and nebs prn. likely due to underlying copd and lung pathology, as well as post-obstructive pna. will continue to oxygenate as needed and complete course of levo/flagyl as above. 6. acid/base disturbance- abg post cath showed ph 7.26, down from 7.34 in ed with a lactate of 1.3 and normal pco2. given hypotension in the setting of cardiac tamponade, this likely reflected lactic acidosis along with respiratory alkalosis in the setting of respiratory distress. acid-base status improved as vent settings were adjusted accordingly. her most recent abg was from - ph 7.34 co2 41 o2 87. 7. cad/hl- no prior history of cad and no cp during this episode. cardiac enzymes negative for acs. off simvastatin given comfort focus of care. 8. presumed arf- baseline cre unknown but was 1.4 at admission. a component of prerenal arf was likely given hypotension in setting of tamponade. creatinine trended down to 0.8 by discharge. 9.dm-2: home basal lantus dose was continued with ssi coverage. 10. speech/swallow- patient is approved for thin liquids and crushed or whole medications as tolerated. medications on admission: lisinopril 20 mg po daily carbidopa/levodopa 25/100 mg po qid vitamin b12 sr 1,000 mcg po daily hydroxyzine 25 mg/ml im syringe qhs lantus 45u sc daily at supper regular insulin 20u sc daily at noon simvastatin 40mg daily synthroid 88mcg daily qam ferrous sulfate po daily discharge medications: 1. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for wheeze, cough, sob. 5. ipratropium bromide 0.02 % solution sig: one (1) inhalation q4h (every 4 hours) as needed for wheezing. 6. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 6 days. 7. levofloxacin 250 mg tablet sig: three (3) tablet po q48h (every 48 hours) for 6 days. 8. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 9. cyanocobalamin 500 mcg tablet sig: two (2) tablet po daily (daily). 10. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po qid (4 times a day). 11. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily). 12. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 14. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 15. insulin glargine 100 unit/ml solution sig: forty (40) units subcutaneous at bedtime. 16. insulin lispro 100 unit/ml solution sig: sliding scale subcutaneous qachs: see attached sliding scale. 17. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. tablet, rapid dissolve(s) 18. promethazine 12.5 mg tablet sig: 1-2 tablets po every six (6) hours as needed for nausea. 19. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. tablet(s) discharge disposition: extended care facility: rehab & nursing center discharge diagnosis: primary diagnosis: pericardial tamponade . secondary diagnoses: - primary lung cancer - pneumonia - pleural effusion - anemia discharge condition: stable discharge instructions: you were admitted to the hospital because you were having difficulty breathing. you were found to have a build-up of fluid around your heart, so this fluid was drained. you also had pneumonia which was treated with antibiotics, and fluid in your lungs. all of these problems were most likely caused by the cancer in your lungs. . you were started on two antibiotics, levofloxacin and flagyl. you should keep taking these antibiotics for 6 more days. you were also started on some medications to make you more comfortable, including percocet for pain, zofran and phenergan to help with nausea, trazodone to help you sleep and ipratropium and albuterol to help with your breathing. you can keep taking these medications as needed to make you more comfortable. we stopped your lisinopril because your blood pressure has been low, and stopped your simvastatin because it is no longer necessary. we lowered your dose of lantus insulin to 40 units because you are not eating as much. you should keep taking carbidopa/levodopa, synthroid, iron and vitamin b12 because they will help you feel better. . you are being discharged to a nursing facility. followup instructions: please follow-up your primary care physician in about two weeks. you can contact his office dr. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube pericardiocentesis arterial catheterization pulmonary artery wedge monitoring right heart cardiac catheterization diagnoses: pneumonia, organism unspecified other iatrogenic hypotension anemia of other chronic disease unspecified pleural effusion urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified personal history of tobacco use dysthymic disorder other and unspecified hyperlipidemia long-term (current) use of insulin surgical or other procedure not carried out because of patient's decision encounter for palliative care dementia in conditions classified elsewhere without behavioral disturbance malignant neoplasm of lower lobe, bronchus or lung dementia with lewy bodies mixed acid-base balance disorder acute pericarditis, unspecified cardiac tamponade 

Answer: The patient is high likely exposed to