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: benzocaine attending: chief complaint: right pleural effusion major surgical or invasive procedure: picc line placement pleurocentesis aborted bronchoscopy history of present illness: mrs. is a 40 year old previously healthy woman with a history of depression and anxiety presenting with right pleural effusion after laproscopic cholecystectomy performed at an outside hospital. 16 days prior to admission to the medicine team patient was admitted to with ruq abdominal pain. she was given the diagnosis of cholescystitis and had laproscopic cholesectomy. post-op it was noted that she had developed a "low output bile leak picked up by jp tube". 12 days prior to admission, she then had ercp with sphincterotomy. it was then reported that the jp output decreased and was then removed. 11 days prior to presentation mrs. still complained of ruq, had a fever of 103.2 and became hypoxic a chest ct was preformed that showed bilateral pleural effusions and bilateral pna with no intra-abdominal abnormalities. vq scan for plumary embolis was negative. 10 days prior to admission patient was started on zosyn for pna. 6 days prior she had a repeat chest ct that showed larger right pleural effusion with partial collapse of rll and smaller left pleural effusion. pt reports that she was disatisified with the level of care and service that she was recieving from , so 4 days prior to medicine admission, she was transfered to surgery team where her temperature ranged from 97.8-102.8 and her right pleural effusion became worse. at the time of interview patient complained of constant, diffuse abdominal pain, , that radiated to her lower back. she also stated that she had sob with exerction accompanied with sharp pain in her sternum and right upper portion of her chest. when questioned she denied having the pain when she inhaled. patient was at times an unreliable source due to her tendancy to perseverate on old injuries, bizarre affect and she was intermittently uncooperative with interviers (see mse). past medical history: -accident involving escalator requiring 5 orthopedic surgeries that left her disabled only able to get around with a walker/cruches/wheelchair; otherwise previously healthy denies htn, dm and cancers. social history: lives by herself in , ma in a "handicap" apartment; went to where she recieved her bachelors, worked as a financial consultant and teacher before accident; widowed x 8 years was married for 3 years with no children. etoh-occasional tobacco-denies past or present use sexual history-denies history of stds, denies sexual activity, can't remember last pap smear, lnmp family history: parents died 20 years ago in accident, patient became tearful and did not want to discuss their health or that of any other family members. physical exam: vs: t 98.6 (98-98.6) bp 142/90 (140-142/70-90) p 82 (82-104) rr 22 (22-26) o2sat 97% on non-rebreather (95-97% on nrb) general: obsese, disheveled woman lying in bed, in mild respiratory distress skin: bluish- macules on abdomen, otherwise unremarkable heent: normal cephalic, atraumatic neck: not assesed cv: regular rhythm, nl s1 and s2 with no extra heart sounds or murmurs, dorsalis pedial pulses palpated bilaterally resp: no breath sounds heard throughout right lung field, mild wheezing heard over left lung field, no crackles appreciated abd: obese, scars from laproscopic cholesectomy healed well; hypoactive bowel sounds, no masses felt, non-tender on palpation, non-distened ext: no muscle atrophy, swelling, patient walks with cane. strength and reflexes not assesed neuro: cn ii-xii grossly intact mse: patient was disheveled in apperance and seemed agitated she would frequently comb and pull at her hair. her behavior was inconsistent towards interviewers at some points she be cooperative and at other times she would become hostile. patient's speech was sometimes labored and slurred, but not pressured. her stated mood was not assesed, her affect was bizarre and labile, she would start crying when talking about her parents or her current medical condition and then the next minute start laughing at a joke she made. she preseverates on her accident that occured in and was tangential, it was sometimes impossible to get her to directly answer a question. patient denies active si/hi, however she frequently states that she wishes that she could go home lie down and die, but states that she does not want to try to kill herself because of her catholic faith. memory and concentration was not assesed. patient's insight is poor she believes that her accident in is somehow the cause for her current medical condition. pertinent results: admission labs: wbc-15.2*# rbc-3.88* hgb-9.9* hct-31.3* mcv-81* mch-25.6* mchc-31.8 rdw-14.7 plt ct-369# glucose-117* urean-9 creat-0.8 na-142 k-2.8* cl-99 hco3-35* angap-11 alt-27 ast-33 alkphos-224* amylase-24 totbili-0.3 lipase-34 calcium-9.0 phos-3.5 mg-2.2 totprot-7.4 albumin-3.8 globuln-3.6 calcium-8.8 phos-3.7 mg-2.2 . cardiac enzymes: 09:11pm blood ck-mb-notdone ctropnt-<0.01 12:33am blood ck-mb-notdone ctropnt-<0.01 10:48am blood ck-mb-notdone ctropnt-<0.01 09:11pm blood ck(cpk)-42 12:33am blood alt-26 ast-30 ck(cpk)-33 alkphos-193* amylase-28 totbili-0.4 10:48am blood ck(cpk)-45 . other: ggt-181* vitb12-433 folate-10.0 caltibc-205* ferritn-655* trf-158* tsh-3.2 free t4-1.1 . discharge labs: wbc-9.1 rbc-3.54* hgb-8.8* hct-27.3* mcv-77* mch-24.8* mchc-32.3 rdw-15.4 plt ct-305 glucose-107* urean-8 creat-1.3* na-142 k-3.8 cl-108 hco3-24 angap-14 alt-19 ast-22 alkphos-119* totbili-0.2 calcium-8.9 phos-2.1* mg-1.8 . micro: no growth of pathogens noted in blood, urine, sputum, and pleural fluid cultures. stool was negative for c. difficile toxin. pleural fluid negative for malignant cells. . ct chest w/o contrast moderate loculated right-sided effusion again noted with interval decrease in component tracking along the major fissure.there are multiple linear and patchy areas of atelectasis as described above. a superimposed infectious process cannot be entirely excluded. . ct chest w/o contrast 1) decrease of previously identified right-sided effusion with continued markedly loculated moderate-sized right-sided effusion. there has been reexpansion of the right lower lobe with continued multifocal areas of atelectasis. while the etiology of this loculated effusion is presumably due to pneumonia, the radiologic differential diagnosis also includes sequela of collagen vascular disease, malignancy, or tuberculosis if an infectious etiology is not clearly established. 2) left thyroid nodule as discussed previously. . chest (pa & lat) 1. continued right intrafissural loculated pleural effusion, smaller, with right middle and lower lobe atelectasis. 2. left lower lobe atelectasis and probable small loculated pleural effusion. 3. continued small right lateral apical loculated pleural effusion. . ct abdomen w/contrast 1) no ascites or intra-abdominal fluid collection. 2) interval marked decrease in right pleural effusion. residual bibasilar atelectasis. brief hospital course: 40 year old woman status post laparascopic cholecystectomy at osh complicated by bile leakage into peritoneum, status post ercp with sphincterotomy also at osh, course complicated by right lower lobe pneumonia and right pleural effusion. . rll pneumonia/pleural effusion: patient was transferred from the surgical service to the medical service on with rll pneumonia, r pleural effusion x 5d, and fever spiking through zosyn. she was seen by intervental pulmonology on day of transfer and they drained over 1400cc of bloody sterile exudative pleural fluid. cxr post thoracentesis showed persistent lower lung zone consolidation, decreased appearance of right pleural effusion and persistent lll atelectasis. she was kept on zosyn for a total of 18d including osh, started on vanc by the medicine team and kept on that for 5d total. she stopped having fevers and antibiotics were then held as the effusion was sterile and it was thought that her pneumonia was likely fully treated. she remained afebrile x 5d, then started spiking again. since her r effusion was still present, she went for a repeat ct scan that revealed, "decrease of previously identified right-sided effusion with continued markedly loculated moderate-sized right-sided effusion." thoracic surgery felt that her effusion could be followed on an outpatient basis and that her primary problem was her pneumonia, which was still quite impressive. she went for repeat tap by ip, but they could not see an area to tap on ultrasound, and decided to bronch her instead with bal. upon receiving hurricane spray, the patient developed methemoglobinemia and required transfer to the micu. she received 200 mg of methylene blue with resulting improvement in o2 sat and was able to be stably transferred back to the general medicine service. patient had no obvious source of infection and did not have further fever during the hospital course. microbiology studies of sputum, blood, urine, pleural fluid, and stool were unremarkable. while pneumonia was suspected, it was also possible symptoms were related to marked atelectasis for which the patient refused to use the incentive spirometer and was mostly sedentary lying in bed. at time of discharge, the patient's breathing had been stable on room air with good oxygen saturation for several days. per the thoracic surgery service review, it was decided that outpatient follow up was appropriate and the patient was discharged to home in her usual state of health. she had been tolerating an oral diet and mobile via wheelchair. followup with thoracic surgery, gastroenterology, and a pcp was recommended. . abdominal pain: initially, the pain was felt to be secondary to bile leak and post-op inflammation, though the patient also has an element of chronic abdominal pain that we do not know the reason for. the epigastric pain was controlled with ms d down to 15mg with breakthrough po morphine that was successfully tapered, and was thought to be close to baseline prior to discharge. she was started on reglan for chronic mild nausea and did not have laboratory evidence of an active hepatobiliary process. . acute renal failure: from her baseline cr 0.8 on , creatinine increased to 1.4 less than a week later in setting of antibiotic therapy and dehydration; considered most likely prerenal with fena < 0.1%, na<10. creatinine returned to baseline after rehydration with ivf. . hypokalemia: patient presented with low potassioum likely from diarrhea and lasix used post-op. potassium was repleted per iv. . anemia, microcytic: likely anemia of chronic disease; fe 19, tibc 205, ferritin 655; and there was no folate or b12 deficiency. oral iron supplementation was held. hct fluctuated daily and improved spontaneously; there were no signs of active bleeding; and stools were guaiac negative. patient refused blood products for symptomatic relief. . depression/anxiety: patient was continued on seroquel, klonopin (cut dose in half), and zoloft; sw as actively involved. at one point during this admit, patient fired her entire medical team and had to be switched to a new service. frequently, patient was difficult with the housestaff and refused multiple attempts for visits by the psychiatry consultation service. patient was generally noncompliant at times with medical care and was noted to have concerning behaviors such as defecating/urinating in her room/shower. patient's outpatient psychiatrist, dr. , was contact for patient's outpatient medical regimen and patient will follow up with him. . thyroid nodule, left: outpatient workup was recommended with appointment for the thyroid nodule clinic. . prophylactic measures included administration of a ppi, sc heparin, bowel regimen, and anti-fungal cream to peritoneum. . patient was full code. medications on admission: zoloft 200mg klonopin 2mg seroquel 25mg discharge medications: 1. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day). disp:*1 1* refills:*2* 2. nystatin 100,000 unit/g cream sig: one (1) appl topical (2 times a day). disp:*1 1* refills:*2* 3. sertraline hcl 100 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 4. albuterol 90 mcg/actuation aerosol sig: inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 2* refills:*0* 5. beclomethasone diprop monohyd 0.042 % aerosol, spray sig: two (2) spray nasal (2 times a day). disp:*1 1* refills:*2* 6. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). disp:*1 1* refills:*2* 7. quetiapine fumarate 25 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). disp:*60 tablet(s)* refills:*2* 8. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 9. clonazepam 1 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 10. morphine sulfate 15 mg tablet sig: one (1) tablet po every six (6) hours as needed for fever or pain for 7 days. disp:*30 tablet(s)* refills:*0* 11. metoclopramide hcl 10 mg tablet sig: one (1) tablet po qid (4 times a day) as needed for nausea: take as needed before meals. disp:*120 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: hypokalemia pneumonia, hospital acquired methemoglobinemia chronic anemia acute renal failure thyroid nodule dyspepsia other: s/p cholecystectomy and ercp, s/p mutiple orthopedic surgeries now on disability (ambulate with walker), morbid obesity, depression discharge condition: good, in usual state of health, hemodynamically stable breathing comfortably on room air, tolerating an oral diet, ambulating with walker. home services have been refused by the patient. discharge instructions: please take your medications as prescribed. please call your doctor or go to the ed if you have worsening abdominal pain, nausea, vomiting, shortness of breath, fevers, chills, or other concerning symptoms. followup instructions: -please follow up in the thoracic surgery clinic in weeks to evaluate your chronic lung fluid collection. call dr. office at ( to make an appointment. -please follow up in the gastroenterology clinic with dr. . call the clinic at ( within the next few weeks to make an appoinmtment at your convenience. -please follow up with your primary care physician affiliated with in weeks. call to make an appoinment. procedure: fiber-optic bronchoscopy thoracentesis diagnoses: pneumonia, organism unspecified abdominal pain, unspecified site anemia, unspecified unspecified pleural effusion acute kidney failure, unspecified depressive disorder, not elsewhere classified pulmonary collapse morbid obesity chronic ulcer of unspecified site 

Answer: The patient is high likely exposed to