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: codeine attending: chief complaint: cough major surgical or invasive procedure: vats history of present illness: the patient is an 80 year old female with cerebral palsy, htn, hypothyroid, paf, osteoporosis here s/p mech fall on r side 3 weeks ago (no head or neck trauma) who presents with 3 days of nonproductive cough, low grade fever, leukocytosis and a cxr that shows new r pleural effusion concerning for hemothorax versus paraneumonic effusion. the patient states she slipped on water 3 weeks ago, landing on ankle. had significant swelling in right le and yesterday had a film that showed no fracture. however, had also developed right sided flank/rib pain approximately 3 days ago. patient believes this may have been related to twisting while getting out of bed and currently is only present on movement. a rib film to evaluate this demonstrated a right sided pleural effusion with question of loculation. patient came to the ed to be further evaluated. . presented to the ed today and was found on repeat cxr to have continued loculated pleural effusion. ct without contrast was done to see if able to delineate between paraneumonic vs. hemothorax, but still unclear. denies any sob, doe, chest pain, lightheadedness, dizziness. states cough present for one week, nonproductive. no fevers, chills, night sweats, but +fatigue. labs demonstrated elevated wbc. was given ceftriaxone and azithromycin in ed and blood cultures sent. currently she states that she feels better than when she first presented to the ed. . ros significant for constipation, last bm on monday, as well as mild nausea, no vomiting. o/w negative for ha, uri sxs, chest pain, orthopnea, pnd, palpatations, melena, hematochezia, dysuria, hesitancy. past medical history: cerebral palsy bilateral leg weakness occular muscle weakness htn afib social history: retired, lives alone, supportive family, no etoh, no tob, no ivdu . family history: noncontributory physical exam: vitals: afebrile, hr 93, bp 160/70 (118-160/63-70), rr 17-20, 90% on ra (now on nc) gen: well groomed female with mildly increased work of breathing, pleasant, in nad heent: perrl, mmm, mucous in mouth, op clear neck: no lad, no jvp cardiac: rrr, nl s1 and s2, holosystolic murmur at llsb lungs: decreased bs on right with mild crackles, exp wheeze, upper airway sounds throughout abd: soft, protruding abdominal hernias, retractable, ntnd ext: mild le edema on right, none on left, 2+ dp pulses bilaterally neuro: a&o x 3, cn iii-xii grossly intact, mae pertinent results: right ankle films : history: right ankle pain. four radiographs of the right ankle demonstrate normal mineralization. no fracture. the mortise is congruent. talar dome maintains a normal contour. phleboliths are noted within the regional soft tissues. the subtalar joint is normal. impression: unremarkable radiographs of the right ankle. . cxr : impression: 1. no evidence of rib fracture or pneumothorax. 2. new moderate-sized right-sided pleural effusion with evidence of loculation. right basilar airspace opacities likely representing atelectasis . cxr : there is a persistent moderate-to-large multiloculated right pleural effusion, without change since the recent radiograph of , but new compared to radiograph. parenchymal opacities in the right middle and lower lobes adjacent to the effusion may relate to areas of atelectasis or contusion. there is no left pleural effusion. the heart is upper limits of normal in size. the aorta is tortuous, and the pulmonary vascularity is normal. upon comparison to the radiograph, apparent elevation of the right hemidiaphragm is thought to be due to a subpulmonic component of the pleural effusion. impression: no short interval change in moderate-to-large loculated right pleural effusion. considering history of recent trauma, this raises a concern for hemothorax. adjacent parenchymal opacities in the right middle lobe may relate to atelectasis or contusion. . ct chest w/o contrast: moderate to large left effusion with loculation. measures low attenuation fluid density. consolidation with air bronchograms in right lung also, likely pneumonia versus contusion. . abd kub : impression: no evidence of intestinal obstruction. no hernia is identified on this single ap projection. a lateral radiograph would be useful to assess for presence of abdominal wall hernia. . ekg: nsr, rad, ivcd, no st changes, intervals normal (of note, on prior ekg there was lad present) . pleural fluid analysis: wbc: 1060* rbc: 340* polys: 49* lymph: 24* monos: 21* macros: 6* protein 4.6 ldh: 666 chol: 76 . pleural fluid negative for malignant cells mixed inflammatory cells and proteinaceous debris . r pleural debris focally organizing fibrin with extensive acute inflammation. special stain for fungi and pneumocystis is negative with appropriate positive control. . pleural fluid: pleural fluid: negative for malignant cells. rare mesothelial cells, neutrophils, lymphocytes, histiocytes and blood. . pleural fluid culture: 1+ polymorphonuclear leukocytes. 4+ gram positive cocci. in pairs and clusters and in short chains. tissue (final ): no growth. anaerobic culture (final ): no growth. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. acid fast culture (pending): fungal culture (preliminary): no fungus isolated. potassium hydroxide preparation (final ): no fungal elements seen. legionella culture (final ): no legionella isolated. . cxr indication: 80-year-old woman status post vats, decortication for loculated pleural effusion, chest tubes removed. assess effusion, loculation. chest, two views: comparison is made to a prior study of . the heart size is in the upper limits of normal. the mediastinal and hilar contours are unremarkable. the pulmonary vasculature is normal. there is some scarring in the left lower lobe and a loculated right pleural effusion is again noted. this is unchanged in comparison to the prior study. impression: no change in the loculated right pleural effusion. . video oropharyngeal swallow findings: fluoroscopic guidance was provided to the speech and swallowing pathologist. barium of various consistencies was administered. premature spillover was identified. there was moderate-to-severe residue, in the valleculae more than the piriform sinuses. the right side was more severely affected than the left. penetration was identified both with nectar-thickened as well as with thin liquids. when the patient swallowed thin liquids, followed by pudding, there was a moderate amount of aspiration identified due to residue in the piriform sinus. this was subsequently followed by an ineffective cued cough. impression: 1. moderate aspiration after the swallowing of thin liquids, followed by pudding. 2. penetration with both thin and nectar-thickened liquids. 3. moderate-to-severe residue in the valleculae and piriform sinuses as well as premature spillover . echo: conclusions: 1. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. 2. the aortic valve leaflets (3) are mildly thickened. trace aortic regurgitation is seen. 3. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. 4. there is mild pulmonary artery systolic hypertension. . emg impression: essentially normal study. the electrophysiologic findings do not support a pre- or postsynaptic disorder of neuromuscular transmission. the findings do not support a generalized myopathy or generalized disorder of motor neurons. . mri brain findings: there is mild prominence of the ventricles and sulci consistent with age-related involutional change. no abnormalities are identified on diffusion-weighted images to indicate acute brain ischemia. there is no mass effect, shift of normally midline structures or hydrocephalus. susceptibility artifacts are present indicating prior hemorrhage. a small old infarct within the left cerebellar hemisphere is unchanged from prior study. the expected flow voids of the basal cisterns appear unremarkable. impression: stable mild brain atrophy. no evidence of cortical infarct, mass effect or hydrocephalus. . labs: 03:40pm wbc-21.9*# rbc-3.58* hgb-11.8* hct-34.7* mcv-97 mch-32.9* mchc-33.9 rdw-12.9 03:40pm neuts-89.3* lymphs-4.9* monos-4.9 eos-0.7 basos-0.1 03:40pm plt count-399# 09:00pm urine color-yellow appear-clear sp -1.010 09:00pm urine blood-neg nitrite-neg protein-30 glucose-100 ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-mod 11:32pm lactate-0.8 . wbc 16.8* rbc 3.23* hg 10.4* hct 31.8* mcv 99* plt 492* . mycoplasma ab negative . : glucose 54* urea 9 cr 0.5 na 140 kcl 4.5 cl 101 hco3 32 gap 12 brief hospital course: a/p: 83 year old female s/p fall 3 weeks pta who presented with cough, right sided pain and cxr demonstrating pna with large effusion. . # pna/effusion - the patient is an 80 year old female with cerebral palsy, htn, hypothyroid, paf, osteoporosis here s/p mech fall on r side 3 weeks ago (no head or neck trauma) who presented with 3 days of nonproductive cough, low grade fever, leukocytosis and a cxr that shows new r pleural effusion concerning for hemothorax versus paraneumonic effusion. ct scan showed large loculated effusion on the right. thoracentesis performed and was exudative, thought to be parapneumonic effusion. patient went to vats on for decortication and drainage, and recieved 2 chest tubes. . post op course complicated by hypercarbia and acidosis, and patient required bipap and neosynephrine for a short period of time. urine culture grew out vanc sensitive enterococcus, and vancyomycin was started. the patient's sob improved and the chest tubes were present for approx 3 days and removed without any complications. cxr showed improved effusion, but not completely resolved. she was treated with levofloxacin and flagyl for cap and aspiration pna, as well as vancomycin for enterococcus sensitive uti. culture data showed gpc in prs and clusters but did not grow anything (see results section). urinary legionella was negative. the patient did well and had no further respiratory compromise. thoracic surgery did not recommend repeating the ct while inpatient, and they would follow up with her as an outpatient. will plan to treat with four weeks of antibiotics, with d1 . wbc decreased from 22 on admission to 16 on discharge. the day prior to d/c wbc was 14.8, so this should be repeated at rehabilitation facility to make sure it does not continue to rise. . # oral and pharyngeal dysphagia - patient has had progressive dysphagia since 2 days pta. dysphagia started 9 years ago after intubation for blood loss s/t gyn surgery, but it worsening priot to admission and while in-house. speech and swallow evaluated the patient with barium study and videooropharyngeal swallow and found significant aspiration as well as oral and pharygeal dysfuction in a pattern suggestive of neurologic process. neurology was consulted and did not feel that the dysfunction was d/t cerebral palsy and was not d/t another primary neurologic disorder. however, this was further worked up with an emg which was negative (see results section) and mri brain which showed no acute or old infarcts to correlate with dysphagia. patient and family are very concerned about underlying cause, but currently there is not clear understanding. speech and swallow worked with patient extensively to teach techniques to reduce aspiration. patient and family were hesitant to peg, but calorie counts were performed x 3 days which demonstrated that patient only had 50% of calories and 40% of protein required to sustain current weight. peg was placed by gi and tubefeedings were initiated. patient currently at goal with only complication minor intermittent pain with movement. patient may take small amounts of pureed nectar and ground foods for pleasure. plan for repeat video swallow prior to d/c from rehab. . # uti - found to have vancomycin sensitive enterococcus and treated with 7 days of vancomycin. . # htn - initially hypertensive on admission, hypotensive s/p vats, transient asymptomatic episodes of hyposention (sbp 80's), currently normotensive. maintained only on low dose beta blocker for episodes of svt. . # paf - patient is rhythm controlled with amiodarone, not anticoagulated. remained in nsr throughout hospitalization with intermittent episodes of asymptomatic avrt. cariology consulted and recommeneded continuing amiodarone and considering ep consult if episodes prolonged or if patient became symptomatic (not done). low dose bb was added, uptitrated but caused 2 sec pause and episode of a.m. bradycardia, so now on 12.5 mg po in a.m. only, and tolerating well. should have cariology f/u to determine if bb needed. . # cerebral palsy - present since birth and followed by neurology. stable while in-house. continued on valium for muscle spasms. . # osteoporosis - continued on calcium and vit d. stopped fosamax as needs to be taken whole and patient at aspiration risk. . # pain - no pain until peg placed. controlled effectively with mso4 and tylenol. . # anxiety - started on low dose buspar with improvement in anxiety. . # hypothyroidism - continued synthroid at home dose. . # ppx - sq hep, ppi, aggressive bowel regimen . # code - full . medications on admission: amiodarone 100 mg qd synthroid 37.5 mcg qd fosamax 70 mg qweek norvasc 5 mg qd valium 2mg qd for muscle spasm and anxiety hctz 12.5 mg qmwf asa 81 mg qd calcium/vit d aciphex 20 mg qd mobic 15 mg qd for pain discharge medications: 1. amiodarone 200 mg tablet sig: 0.5 tablet po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 5. levothyroxine 75 mcg tablet sig: 0.5 tablet po daily (daily). 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 7. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed. 8. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 9. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 10. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 11. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 12. diazepam 2 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 13. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid w/ meals (). 14. buspirone 10 mg tablet sig: one (1) tablet po qd (). 15. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours): please give for 4 weeks, with d1 on . 16. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day): please give for 4 weeks, with d1 . 17. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 18. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 19. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po qam (once a day (in the morning)). 20. oxycodone 5 mg/5 ml solution sig: 5-10 mg po q4-6h (every 4 to 6 hours) as needed. 21. prochlorperazine 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 22. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 23. outpatient lab work please check cbc on to follow wbc. discharge disposition: extended care facility: for the aged - acute rehab discharge diagnosis: pneumonia with complicated parapneumonic effusion oral and pharyngeal dysphagia choreo-athetoid cerebral palsy occular muslce weakness hypertension atrial fibrillation, episodes of avrt osteoporosis abdominal hernia discharge condition: good. patient oxygenating well (92-92% ra), not short of breath, tolerating tube feeds discharge instructions: 1) please take all of your medications as prescribed. 2) please call your pcp or return to the ed if you haveing worsening shortness of breath, chest pain, fevers, chills, nausea, vomiting, or any other symptom that is of concern to you. followup instructions: # please follow up with dr. , at on at 10:30. you should have a chest x-ray performed prior to this appointment, and the order for this is in the computer. # please follow up with dr. at on at 2:10 p.m. # provider: md phone: date/time: 1:30 # provider: , m.d. phone: date/time: 10:00 procedure: enteral infusion of concentrated nutritional substances thoracentesis non-invasive mechanical ventilation percutaneous [endoscopic] gastrostomy [peg] decortication of lung other incision of pleura diagnoses: pneumonia, organism unspecified acidosis urinary tract infection, site not specified unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation pneumonitis due to inhalation of food or vomitus osteoporosis, unspecified streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] empyema without mention of fistula pain in joint, ankle and foot 

Answer: The patient is high likely exposed to