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: sob, anemia to 22, weakness major surgical or invasive procedure: bronchoscopy x2 bone marrow biopsy mechanical ventilation history of present illness: 78 yo woman with mds, presenting to with sob, hypotension, anemia (hct = 22.1, hbg = 7.6), leukocytosis (wbc = 31.4 with 21 bands), thrombocytopenia (plt = 10). pt reports productive cough for 2 months of yellow phlegm. she describes rhinorrhea x 1 month associated with sneezing. over last 3 days, she reports decreased eating/drinking and feeling "funny". denies dysuria, fevers, hematuria, n/v/c/d/cp, hematuria, joint or bone pain, myalgias. c/o increasing back pain and bruising (abd bruising d/t injections). at , her u/a was positive for infection. given ceftaz, ivf's, and 1 unit of blood. pt was transferred to for transfusion and bone marrow biopsy to r/o progression to aml. last bone marrow biopsy in was negative for leukemia, just c/w mds. past medical history: 1. myelodysplasia - 2. anemia secondary to myelodysplasia 3. right breast cyst 4. hypertension - on 480mg verapamil qd. sbp usually in 170's. 5. s/p hysterectomy 6. s/p cholecystectomy 7. glaucoma 8. lentigo melanoma on right face - with wide excision. pathology reportedly at 9. pan - polyarteritis nodosa. biopsy of heel done at . social history: widowed, active with family, minimal alcohol, nonsmoker. family history: one son and brother has hemochromatosis, a sibling died of leukemia at age 30. physical exam: t: 99.4 p: 76 bp: 112/60 rr: 22 96% on 2l nc (90% on ra) gen: alert and oriented, pleasant woman sitting upright in bed, conversant, breathing comfortably heent: nc/at, pupils surgical, anicteric, mmm, op clear cv: rrr, no m/r/g lungs: no wheezing. inspiratory crackles at l base, unchanged from prior. o/w cta bilaterally. abd: resolving ecchymoses on abdomen ( injections). abd is soft, nt/nd. +bs. ext: no edema, brisk distal pulses. pertinent results: from : cr: 1.3 (baseline 0.6) with bun = 33. troponin: 0.3 wbc = 31.4 with 21 bands, hct = 22.1, hgb = 7.6, plt = 10. u/a: 50-100 wbc, many bacteria bcx x 4: 1 of 4 bottles grew coag neg staph resistant to erythromycin and pcn. ucx: 10-25k of each coag neg staph and diphtheroids admission labs at : 03:30pm gran ct-* 03:30pm wbc-19.9* rbc-2.57* hgb-7.8* hct-23.9* mcv-93 mch-30.4 mchc-32.7 rdw-18.6* 03:30pm haptoglob-332* 03:30pm albumin-3.7 calcium-8.3* phosphate-4.1 magnesium-2.2 uric acid-10.6* 03:30pm alt(sgpt)-24 ast(sgot)-25 ld(ldh)-416* ck(cpk)-43 alk phos-66 tot bili-0.8 dir bili-0.3 indir bil-0.5 03:30pm glucose-127* urea n-30* creat-1.2* sodium-140 potassium-3.7 chloride-105 total co2-20* anion gap-19 03:30pm fibrinoge-372 03:30pm ret aut-2.2 discharge and other relevent labs: 02:00am blood wbc-1.8* rbc-2.78* hgb-8.2* hct-24.2* mcv-87 mch-29.6 mchc-33.9 rdw-14.8 plt ct-39* 02:00am blood glucose-94 urean-15 creat-0.2* na-137 k-3.9 cl-104 hco3-24 angap-13 12:00am blood fibrino-204 01:50am blood fdp-0-10 01:20am blood ret aut-6.1* 12:53am blood glucose-86 urean-17 creat-0.2* na-138 k-3.7 cl-105 hco3-25 angap-12 01:20am blood vitb12-472 folate-10.4 hapto-100 12:00am blood caltibc-164 ferritn-> trf-126* 12:00am blood hapto-<20* 12:00am blood hapto-<20* 12:45am blood hapto-<20* 04:19am blood tsh-0.91 03:56am blood anca-negative b 03:56am blood -negative 04:20am blood lactate-3.3* 04:15am blood glucose-121* lactate-1.3 abd ct : 1. no evidence of intra or retroperitoneal hemorrhage. 2. splenomegaly as above with increased heterogeneity and possible focal splenic lesions. given the timing of the contrast , ultrasound is recommended for further evaluation. 3. small left pleural effusion and associated atelectatic changes. brief hospital course: 1. respiratory: ms. was initially admitted to the bmt unit but was transferred to the with progressive hypoxia on the floor on . her o2 sats dropped to 90% on a nrb. this was originally felt to be due to a combination of causes: 1) chf due to large amt of fluid received via blood products (had 2 units prbcs, 3 units platelets in prior 3 days), and 2)? aspiration during her bone marrow biopsy . she had not been responding to lasix on the floor. upon admission to the , she improved markedly on bipap. because she was increasingly uncomfortable with the bipap mask, she was changed back to a nrb for awhile, and was eventually placed on nasal cpap. overnight on , she began having increasing hemoptysis, first having blood-tinged sputum and then coughing up frank blood. she also developed worsening diffuse bilateral infiltrates on cxr. she was intubated on so that she could undergo bronchoscopy. while it was hoped that her intubation was only for the bronch, she instead required mechanical ventilatory support until . the bronch revealed increasingly bloody fluid with successive lavage, so it was felt she may have dah (vs a fungal or bacterial pna). she underwent a course of high-dose steroids (methylprednisolone 500 mg iv bid x 6 doses) for presumed dah. on , she developed a pneumothorax on the r side that was moderate sized (r ij tlc was placed on evening of with 2 subsequent cxrs not demonstrating a ptx, had bronch , then had ptx on cxr , so unclear etiology.) this was treated with 100% o2 and resolved on its own, not requiring chest tube placement. she had another episode of bleeding and underwent repeat bronchoscopy . this was also nondiagnostic. she was very difficult to wean from the ventilator, and eventually a family meeting was had with her primary oncologist, dr. . it was decided to extubate her and see how she did, and her family preferred not to have her reintubated if she didn't do well. however, she did very well. she was able to be transferred back up to the floor on , and was slowly weaned off her oxygen. by discharge, she was alternating between room air and 2 liters o2 per nasal cannula. she has persistent patchy alveolar and interstitial infiltrates on cxr, esp in her lll. the etiology of her respiratory failure was never fully confirmed. her bronch grew out a spore called sporobolomyces salmonicolor, which both the id fellow and the microbiology lab felt was a contaminant (as it didn't grow out until ). she may have had a pneumonia, as she improved on caspofungin, ceftazidime, and vancomycin. she also may have had dah. she definitely had at least a superimposed component of diastolic failure, and she was diuresed aggressively while on the floor, approximately 1-2 liters per day. she was originally on standing lasix, but by time of discharge she only received lasix (20 mg iv) after rbc transfusions. in terms of the etiology of her disease, there was also a question of vasculitis (as she has a hx of polyarteritis nodosum which was reportedly treated at .) however, her esr was 18, and house officers here obtained her records from which consisted only of one cbc and no notes of any sort. 2. cardiovascular: on admission, she had an echo that showed an ef >55%, with 1+ mr. on the evening of , mrs. went into a-fib with rvr, rates up to 170s and bp 70s/40s. she was given lopressor 5 mg iv x1, diltiazem 10 mg iv x1, and placed on a dilt gtt. she initially did not respond to any of these measures, and the dilt gtt was maxed out at 20 mg/hr. a few hours later, she spontaneously converted back to sinus rhythm with rates in the 80s, and the dilt gtt was discontinued. later on in the icu, she developed what was originally felt to be atrial flutter and was evaluated by cardiology. they felt she had a combination of atrial tachycardia and atrial fibrillation ,and recommended control with a dilt gtt as needed, and po verapamil. she eventually no longer required the dilt, and was maintained on verapamil with good results. she remained in nsr while on bmt as she was originally monitored on telemetry, which was eventually discontinued. ekgs were unremarkable other than a-fib. 3. id: given her fxnal neutropenia, she was begun on empiric antibiotics when she originally developed diffuse opacities on cxr. she was treated with ceftriaxone, vancomycin, bactrim, and clinda (initially). her vanc was discontinued 2 days later and she was begun on ambisome for empiric antifungal coverage. due to the lipid content in ambisome and its possible interaction with surfactant in the lung, she was changed to caspofungin. her induced sputum was immunofluroescent negative for pcp. rest of her bronch studies were negative for organisms other than the spore mentioned above. her antibiotics were all eventually stopped and she remained afebrile for a while. she also developed a sacral decubitus ulcer while in the icu, which was evaluated by the wound care nurses and dressed per their recommendations. twice in the week before discharge, she had low-grade temperatures but was asymptomatic. she had a negative urine culture and cxr showed a possible worsening of her lll infiltrate. the team recommended that she begin po levaquin, but she declined this. she expressly stated that she did not want to take any antibiotics, oral or intravenous. she understood the consequences and stated them clearly, but wished to not pursue the infectious workup any further. therefore she was not begun on any antibiotics. 4. hematology: her bone marrow biopsy on was negative for blasts, as was a repeat biopsy . while she was in the hospital, she required increasing frequency of transfusions. she received packed red blood cells and platelets every other day, to keep a hematocrit greater than 25 and platelets greater than 20k (given the fear that she had bled into her lungs, it was felt that a platelet transfusion threshold of 20k was more advantageous than 10k). it was felt that her low hematocrit was to her mds and was not the result of another process. she had a negative dat x 2. she did have evidence of hemolysis, with a low haptoglobin, elevated ldh, elevated indirect bilirubin, and a reticulocyte count of 6%. because of her large transfusion requirements and possible hemolysis, a super-coombs and an anti-platelet antibody test were sent, and were pending at time of discharge. it was also felt likely that these processes were all due to her myelodysplasia. on examination of her bone marrow biopsy, the attending heme pathologist felt that it was likely her cells were so dysplastic they did not survive long in the periphery. prior to d/c a conversation was had with the patient where it was discussed and agreed upon by everybody (including the attending hematologist) that there was no further treatment indicated for her mds, and she would continue with symptomatic transfusions. on d/c her wbc count was also low, with an anc of 1100. this is also felt to be mds. 5. liver: there was a question of whether the patient had hemochromatosis, whether iatrogenic or otherwise. (has son and brother with this disease.) the hemochromatosis genetic mutations were sent and were pending at time of discharge. her ferritin was greater than . it was decided not to chelate her at this time. medications on admission: danazol 100mg po bid procrit 20,000units sq qd neupogen verapamil sa 480mg qd zestril 5mg qd iron 325mg qd fosamax 10mg qmonday ca++ 600mg qd mvi qd potassium prn? 20mg po qd asa 81mg qd colace prn discharge medications: verapamil 120 mg po tid protonix 40 mg po daily ambien 5 mg po qhs:prn tylenol prn lasix 20 mg iv only post-rbc transfusions discharge disposition: extended care facility: - discharge diagnosis: myelodysplastic syndrome discharge condition: stable discharge instructions: please take your medications as prescribed. it is very important to continue taking your verapamil as it keeps your heart from beating too quickly, as it did when you were in the icu. you do not need to resume taking epogen, neupogen, or danazol. followup instructions: please f/u with your hematologist, dr. at , his discretion. he will receive a copy of your d/c summary. ***important: pt, family, and team all had discussion regarding her further care. she does not wish to have any antibiotics, and wishes only to have transfusions as needed. she is dnr/dni. she does not have a health care proxy form, but wishes to have her son as her health care proxy and will contact her lawyer regarding this. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube non-invasive mechanical ventilation biopsy of bone marrow closed [endoscopic] biopsy of bronchus transfusion of packed cells diagnoses: unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation unspecified glaucoma pulmonary collapse acute respiratory failure pneumonitis due to inhalation of food or vomitus iatrogenic pneumothorax pressure ulcer, lower back diastolic heart failure, unspecified personal history of malignant melanoma of skin unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pulmonary eosinophilia 

Answer: The patient is high likely exposed to