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: percocet attending: chief complaint: fever, hypotension major surgical or invasive procedure: none history of present illness: ms. is a 50 year-old woman with a history of non-small cell lung cancer with recent meningitic spread, s/p recent xrt, with lower extremity weakness, who presents with a sacral ulcer and abdominal pain. she was recently admitted to when she presented with increasing lower extremity weakness. mri was suggestive of leptomeningeal spread, and lp was confirmatory. she received high-dose steroids and a total of 10 radiation treatments. she was discharged to . there she has been mostly bed-bound but being moved back and forth to wheelchair most days. she was aware that she had a sacral ulcer and believes that bandages were being changed regularly. she has mild pain at that site that has not changed recently. for the past two weeks she has also had constant abdominal pain that she calls her "gas pain". it is located in the periumbilical region and is described as sharp in nature. she has had some associated nausea without vomitting. she has been constipated and receiving multiple laxatives with no bm for the past two days. no blood in bowel movements. she did not have fevers or chills until the day prior to admission when she noted chills. no fever was recorded. of note she has an indwelling foley catheter bp at was found to be 70/palpable, hr 120s, o2 sat 88% on ra. she was transferred to for further management. in the ed, vs initially t 97.3, bp 99/71, hr 138, rr 20, o2 sat 100% on 6l. she had a ct of her torso that demonstrated air adjacent to a sacral decubitus ulcer. she was given 3 l ns, vancomycin 1 g iv, zosyn 4.5 mg iv, morphine 4 mg iv, dilaudid 1 mg iv, and asa 325 mg po x 1. she was admitted to the icu for further managment. . review of systems was positive as per hpi. review was negative for chest pain or palpiations. negative for shortness of breath, cough. no pain around her indwelling catheter. positive for ongoing lower extremity weakness that has been slowly worsening since her discharge. positive also for diplopia with rightward gaze. no numbness or tingling. . past medical history: past medical history: -anxiety/panic attacks -lung cancer as below (per recent note of dr. : . mrs. was found to have three pulmonary nodules on ct scan on . on , right upper lobectomy revealed stage i, 1.1 cm poorly differentiated large cell carcinoma with negative bronchial and vascular margins, no pleural or vascular involvement, and no involved lymph nodes. . ms. did well until when she developed worsening dyspnea. ct demonstrated increase in size of left lingular nodule. pet scan was negative, but she underwent a left vats/wedge resection which demonstrated a 0.6 cm poorly differentiated large cell carcinoma. it was felt that this was another primary stage i tumor. . in , she developed left-sided chest wall discomfort and swelling at the site of her previous wedge resection. ct in was unremarkable. u/s of the swelling showed a heterogeneous soft tissue mass. biopsy of this lesion on revealed metastatic poorly differentiated nsclc. pet scan was notable for an fdg avid left chest wall mass, suv 16.4, consistent with recurrent disease. there was also a single left 8mm axillary node with an suv of 2.7. she underwent resection of the mass on . the mass was a 4 x 4 cm poorly differentiated adenocarcinoma, histologically similar to her previous tumor, and involving the chest wall. three ribs needed to be resected to get a good margin around the tumor. there were multiple nodules seen and the superior nodule was noted to be metastatic moderately differentiated adenocarcinoma on pathology. all margins were negative, but there was concern for lymphangitic spread. she was started on cisplatin/docetaxel on and began xrt to the left chest wall in 2/. she did not complete chemotherapy due to side effects, but did complete xrt. in , she developed pain in the left axilla and left chest wall. ct chest on showed an enlarged left axillary lymph node and increase in the soft tissue component of the left chest wall lesion in the area of her prior surgery. biopsy of the lymph node was consistent with nsclc. pet on showed interval development of an fdg avid, enlarged soft tissue mass in the left axilla, abutting the chest wall, with adjacent fdg avid adenopathy. there was also increased avidity in the region of the left lateral sixth rib at the site of the prior resection, concerning for recurrent disease. she started carbotaxol, and avastin on . she completed 3 cycles of treatment but it was held on due to grade side effects of fatigue, leg cramps, neuropathy, pain and weight loss. her pet scan on showed disease progression. she was started on alimta . ct showed increase in her left axillary lymph node. avastin was added on . she completed 3 cycles of alimta + avastin. . in , she presented with lower extremity weakness and diplopia with rightward vision. mri was suggestive of leptomeningeal spread of her lung cancer, confirmed by lp. she started dexamethasone with a taper completed on and xrt to the brain and spine, completed on . social history: the patient lived in with her husband until her recent admission for weakness since when she has been residing at . prior to that she had recently completed training to become a counselor. she previously smoked a half pack per day but none for the past month. she has no children of her own, but four stepchildren who visit often. family history: no family history of lung cancer or other malignancy. physical exam: vitals: t 94.6, bp 118/64, rr 18, hr 123, o2 sat 100% on 4l nc gen: frail appearing middle aged woman huddled under bear-hugger, shivering heent: dry mucous membranes, oropharynx clear cardiovascular: regular rate and rhythm, tachycardic, no murmurs lungs: clear bilaterally back: 2 cm x 2 cm open ulcer just superior to the coccyx, packed with gauze, moderate amount of white discharge, tender to palpation, no surrounding erythema or crepitus abdomen: nondistended. tender to palpation diffusely in the periumbilical and epigastric region. no rebound or guarding. extremities: 1+ pitting edema up to the ankles, distal pulses present, r posterior thigh with mirapex bandage in place neuro: 2/5 strength of lower extremities in proximal and distal muscle groups bilaterally, sensation to light touch intact. strength of the upper extremities bilaterally. cranial nerves intact with the exception of r lateral gaze palsy. pertinent results: admission labs: 10:35am wbc-4.1 rbc-3.21* hgb-10.8* hct-32.2* mcv-101* mch-33.7* mchc-33.6 rdw-14.4 10:35am neuts-87* bands-3 lymphs-9* monos-1* eos-0 basos-0 atyps-0 metas-0 myelos-0 10:35am glucose-78 urea n-18 creat-0.8 sodium-130* potassium-7.0* chloride-88* total co2-29 anion gap-20 10:35am alt(sgpt)-32 ast(sgot)-48* ck(cpk)-91 alk phos-159* tot bili-0.4 07:50am blood wbc-5.9 rbc-2.92* hgb-9.1* hct-28.2* mcv-96 mch-31.2 mchc-32.3 rdw-16.1* plt ct-104* 06:15am blood wbc-8.8 rbc-2.73* hgb-9.1* hct-27.1* mcv-99* mch-33.3* mchc-33.5 rdw-16.1* plt ct-189 08:00am blood pt-13.0 ptt-30.5 inr(pt)-1.1 06:50am blood glucose-91 urean-8 creat-0.7 na-137 k-4.0 cl-98 hco3-30 angap-13 10:20pm blood alt-18 ast-17 ld(ldh)-149 ck(cpk)-34 alkphos-116 totbili-0.2 07:10am blood ck-mb-6 ctropnt-0.08* 04:05pm blood ck-mb-6 ctropnt-0.07* 06:50am blood calcium-8.8 phos-3.9 mg-1.8 04:40am blood hapto-410* 11:35am urine rbc-* wbc-21-50* bacteri-mod yeast-none epi-0 transe- 11:35am urine blood-mod nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-8.0 leuks-mod 11:35am urine color-yellow appear-hazy sp -1.014 09:13am urine rbc-<1 wbc-10* bacteri-few yeast-none epi-0 09:13am urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-tr micro blood cx and urine cx all ngtd imaging lue us impression: no evidence for dvt. cxr findings: in comparison with the study of , there is little change in the appearance of the heart and lungs. post-surgical changes at the lung base and apparent fibrotic streak in the left mid zone are both less prominent. old healed rib fracture on the right is again seen. cxr : findings: in comparison with the study of , there is little change and no evidence of acute focal pneumonia. post-surgical changes are again seen at the left base and there is evidence of old healed rib fractures on the right. ct torso :impression: 1. new large right sacral subcutaneous gas tracking anteriorly along the puborectalis muscle, this finding needs to be clinically correlated. air tracks to the coccyx. 2. no evidence of pulmonary embolism. 3. left axillary nodule, left paratracheal nodule, and left paraspinal lesion are all similar in size. multiple pulmonary nodules are redemonstrated, though some appear new. 4. striated left renal nephrogram, which may indicate pyelonephritis in the appropriate clinical context, recommend comparison with urinalysis. 5. very large amount of stool throughout the rectum and colon. 6. persistent left adnexal hyperdensity, recommend comparison with pelvic ultrasound if clinically indicated. brief hospital course: a 50-year-old woman with metastatic lung cancer and lower extremity weakness secondary to leptomeningeal spread presents with hypotension, hypothermia. . # hypotension and hypothermia: most likely secondary to sepsis. source suspected as below. she was responsive to fluid boluses, with map >65 and did not require cvp monitoring or pressors. she had one episode of hypotension with mild lightheadedness on the floor with sbp 80s which repsonded to 1l fluid bolus. she was normotensive with baseline sbp 90s prior to discharge. we continued to hold her lisinopril given persistent low bps # urinary tract infection: most likely source of septic picture. ua with moderate bacteria, 21-50 wbc. clinical signs of pyelonephritis. she has a chronic indwelling foley that likely contributed. regarding the likely microbiology, she recently had a pan-sensitive e coli during her previous admission that was treated with 3 days of bactrim. however, given recent hospitalization and long-term care facility wtih indwelling catheter, she is also at risk for resistant micro-organisms. she was initially covered with zosyn. foley catheter was changed (reportedly had not been done at in 5 weeks). cultures showed mixed bacterial flora. antibiotics were changed to levofloxacin and she remianed afebrile and hemodynamically stable on levofloxacin alone. she has to complete 4 days of 14 day course. . # sacral decubitus ulcer: contributing factors including prolonged immobilization with lower extremity paresis, recent xrt, and recent steroid use. there was initially concern for necrotizing fasciitis given air tracking along puborectalis on ct abdomen. surgery recommended that urgent surgical debridement was not indicated. wound does appear to have an infectious component, and would be concern for resistant bacteria given recent hospitalization and ltc facility but cx were all no growth so vanco was discontinued. dressings were changed as per surgery with duoderm to sacral wound eschar, wet-dry packing within wound itself. plastics was considering a skin flap, but after discussion decided against it. wound care recs included in dc planning as recommended. . # abdominal pain: chronicity was difficult to tease out, but most likely cause is pyelonephritis. possible contribution from constipation. ct abdomen did not show any acute intra-abdominal process. she was given a bowel regimen and pain was managed aggressively once blood pressure recovered. . # anemia: discharge hematocrit was 41 one month ago, fell to 32 on admission and as low as 21 later that evening. likely contribution from bone marrow suppression secondary to recent xrt and widespread cancer. concern for bleeding, although no evidence of such on ct torso. hemolysis unlikely given normal tbili and elevated hapto. she received 1 unit prbc with a more than adequate bump in her hct, raising the possibility that the hct 21 was not real. hct subsequently fell again. she received another unit of prbc. repeat hemolysis labs showed no evidence of hemolysis. hct subsequently remained stable around 26-28. . # hypoxia: unclear etiology. resolved over the first 12 hours of admission. . # lue swelling: pt noted to have mild lue edema on exam. lue us negative for dvt. . # chest tightness: pt c/o chest wall tightness intermittently which was constant and worse with movement. she has focal chest wall tenderness left chest wall/rib cage where lidocaine patch is and where she has ahd pain in the past. ecg unchanged from prior with q waves ii, ii, avf. felt unlikely to be cardiac since reproducible on exam and ecg without acute changes. continued lidoderm patch and she had no further complaints. biomarkers showed stable troponin and normal ck and mb. . # metastatic nsclc c/b near paralysis and multifocal pain: patient currently with good pain control now back on home regimen and with ms contin increased to tid dosing. continued po dilaudid for breakthrough pain. she was seen by palliative care here and discussions were started about hospice care. she should continue to be seen by hopice for discussions of palliative care at nursing facility. for malnutrition, she was continued on dronabinol and ensure supplements. medications on admission: folic acid 1 mg daily ms contin 60 mg hydromorphone 4-8 mg q4h prn mylanta 30 cc q4h prn nicotine patch 14 mg daily vitamin b12 1000 mcg daily marinol 2.5 mg heparin sc 5000 units sc daily nefazodone 200 mg daily fleet enema prn bisacodyl prn lorazepam 1 mg daily prn mom prn ibuprofen prn senna prn ondansetron prn dexamethasone taper completed peg prn prilosec 20 mg daily mvi vit d3 400 iu acetaminophen prn proair hfa 2 puffs q6h prn promethazine 25 mg prn . discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. morphine 30 mg tablet sustained release sig: two (2) tablet sustained release po q8h (every 8 hours). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 6. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po bid (2 times a day). 7. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours) as needed for sob or wheeze. 8. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 9. multivitamin tablet sig: one (1) tablet po once a day. 10. b-12 dots 500 mcg tablet sig: two (2) tablet po once a day. 11. dronabinol 2.5 mg capsule sig: one (1) capsule po bid (2 times a day). 12. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 13. nefazodone 150 mg tablet sig: one (1) tablet po hs (at bedtime). 14. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 15. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 16. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical q 24 hours (). 17. promethazine 25 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. 18. ativan 1 mg tablet sig: one (1) tablet po once a day as needed for anxiety. 19. hydromorphone 4 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 20. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 4 days. tablet(s) 21. gabapentin 100 mg capsule sig: one (1) capsule po q8h (every 8 hours). 22. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for heartburn, gas pain. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis sepsis secondary to uti vs pyeloneprhitis sacral pressure ulcer secondary diagnosis metastatic non small cell lung cancer chronic pain depression discharge condition: hemodynamically stable, sbp 90s-100s, o2 sats 90s room air, hr 90s discharge instructions: you were admitted to the hospital with low blood pressure, likely from a urinary tract infection. we treated you with an antibiotic called levofloxacin and stopped your lisinopril and your blood pressure improved. we made the following changes to your medications: 1. we increased your ms contin to three times daily 2. we added levofloxacin for 14 days (4 more days) 3. your lisinopril was stopped secondary to low blood pressure please return to the er or call your primary oncologist if you develop lighthededness, dizziness, chest pain, shortness of breath, or any other concerning symptoms. followup instructions: you have the following appointmetns scheduled. provider: , md phone: date/time: 10:30 provider: , md phone: date/time: 10:30 provider: mri phone: date/time: 8:35 procedure: transfusion of packed cells diagnoses: thrombocytopenia, unspecified anemia, unspecified tobacco use disorder unspecified septicemia unspecified protein-calorie malnutrition personal history of malignant neoplasm of bronchus and lung secondary malignant neoplasm of other specified sites depressive disorder, not elsewhere classified sixth or abducens nerve palsy constipation, unspecified displacement of cervical intervertebral disc without myelopathy pressure ulcer, lower back paraplegia secondary malignant neoplasm of other parts of nervous system pressure ulcer, stage iv neoplasm related pain (acute) (chronic) ulcer of thigh cauda equina syndrome with neurogenic bladder pyelonephritis, unspecified panic disorder without agoraphobia secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb 

Answer: The patient is high likely exposed to