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: no known allergies / adverse drug reactions attending: chief complaint: fever, chills, malaise major surgical or invasive procedure: ir guided drainage of right psoas fluid collection history of present illness: ms. is a 62f with pmhx of aggressive urothelial cancer s/p nephroureterectomy in who presented to on for several days of weakness, chills and reduced po intake and more acutely difficulty ambulating on morning of ed visit. she has a complicated history of urothelial carcinoma which after nephroureteral resection was shown to recur in liver and ?rectus sheath for which she received 5 cycles cisplatin/gemcitabine starting . of note she has had profound leukocytopenia and thrombocytopenia with chemotherapy. her last dose consisted of carboplatin/gemcitabine was completed . since last round she has become increasingly weak, confused, with worsening rlq pain and rle thigh pain, she also had some shaking of her ue bilaterally tuesday night into wednesday. she saw her heme/onc on wednesday who sent her to the ed because of increased confusion, shaking and difficulty ambulating. in ed she was found to be febrile, pancytopenic, profoundly thrombocytopenic with hypotension and tachycardia. she was admitted to micu for ams and possible cns infection. head ct scan completed which revealed no evidence of metastatic disease or bleed. ct abdomen showed ?fluid collections concerning for possible abscess. she was treated empirically with doripenem, acyclovir, doxycycline and vancomycin. she was transferred to for further work up/management and ?ir guided drainage of abdominal fluid collection. of note also, she has a tick bite on rle 4 weeks ago. . on the floor her vitals were: t: 100.0 hr:104 bp 105/48 (on levo) o2 100% on 3l nc. she was lethargic but arousable, she answered questions appropriately and was oriented x3. she knew the vice president of the usa and could spell world backwards but demonstrated poor concentration only getting in serial 7s. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - uroepithelial ca +peritoneal mets - rle dvt, on lovenox, - malignancy associated hypercalcemia - epilepsy (age 14), mal - skin graft s/p burn, right arm and hand - h/o lyme disease social history: married, lives with husband who is healthcare proxy and supportive. two daughters who live in eastern . was working until as medical receptionist, previously lab work in biochemistry. - tobacco: none - alcohol: rarely - illicits: none family history: - (mother, maternal grandfather). no history of genitourinary tract malignancies. physical exam: admission vitals: t:100.0 (po) bp: 105/48 p:98 r:20 o2:100% 3l nc general: lethargic but arousable, answers appropriately. seems to have some increased work of breathing but is in nad heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, s1 s2 clear and of good quality, no murmurs, rubs, gallops abdomen: distended with diffuse ecchymoses from sc anticoagulation. tense but nt, no rebound and no guarding. there is a superficial hard round mass over rlq which is not painful. she has active bs, tympanic to percussion gu: foley in place draining light urine ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. diffuse petechiae over le bilaterally r>l. rle has + edema up to mid tibia. neuro: lethargic but arousable, falls asleep occasionally during questioning. answers appropriately, oriented to person, place, time, knows president and vice president. correcetly spells world backwards, in serial 7s. follows commands well, moves all extremities purposefully, 5/5 strength ue and le bilaterally. cn 2-12 grossly intact, perrl, eomi. exam on discharge: ****** pertinent results: labs on admission: 12:09am blood wbc-2.1* rbc-3.07* hgb-9.7* hct-28.1* mcv-92 mch-31.7 mchc-34.6 rdw-25.0* plt ct-17* 12:09am blood neuts-62 bands-13* lymphs-18 monos-4 eos-2 baso-0 atyps-1* metas-0 myelos-0 12:09am blood pt-12.6 ptt-30.6 inr(pt)-1.1 12:09am blood glucose-129* urean-17 creat-1.0 na-134 k-4.1 cl-109* hco3-20* angap-9 12:09am blood albumin-2.3* calcium-7.3* phos-1.9* mg-2.0 12:29am blood lactate-1.2 11:03pm blood lactate-1.0 12:29am blood freeca-1.09* imaging cxr: there is a port-a-cath with distal lead tip in the distal svc. cardiac silhouette is within normal limits. there are bilateral pleural effusions and a left retrocardiac opacity. minimal prominence of the pulmonary vascular markings are present. there is no pneumothorax. bony structures are grossly intact. ct guided ie drainage: impression: technically successful ct-guided drainage of fluid collection in the right psoas. the contents appeared to represent primarily hemorrhagic products so the collection is likely to represent a subacute or chronic hematoma, although superinfection would be a consideration. fluid sent for gram stain and microbiology studies. 5:00 pm abscess gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. culture (final ): no growth. anaerobic culture (preliminary): no growth tte (trans-thoracic echocardiogram) done impression: normal global and regional biventricular systolic function. no pulmonary hypertension or clinically-significant valvular disease seen. chest (portable ap) study date of findings: in comparison with study of , the degree of pulmonary vascular congestion has substantially decreased. there also appears to be decreased pleural effusions with a thick band of atelectasis at the bases. no definite acute focal pneumonia, though an area of increased opacification at the right base, most likely reflecting atelectasis and crowding of vessels. lung (v/q) scan study date of low probability of pulmonary embolism. ventilation images demonstrate central clumping consistent with airways disease. there is also patchy aeration at the bases, likely reflecting atelectasis as seen on chest radiograph. perfusion images show subsegmental perfusion defects at the lung bases corresponding to areas of decreased ventilation. lung perfusion is otherwise normal with no unmatched perfusion defects identified. venous doppler/duplex ultrasound bilat lower ext veins study date of impression: no evidence of deep venous thrombosis in either right or left lower extremity. labs on discharge: 09:36am blood wbc-4.5 rbc-2.89* hgb-9.1* hct-27.5* mcv-95 mch-31.4 mchc-33.0 rdw-23.0* plt ct-15* 09:36am blood neuts-74.9* lymphs-17.8* monos-4.3 eos-2.8 baso-0.2 05:07am blood glucose-133* urean-21* creat-1.2* na-141 k-4.4 cl-105 hco3-29 angap-11 05:52am blood alt-7 ast-15 ld(ldh)-112 ck(cpk)-5* alkphos-88 totbili-0.4 05:59am blood calcium-9.8 phos-3.5 mg-1.6 05:52am blood d-dimer-1872* 05:52am blood hapto-58 10:15am blood vanco-18.0 brief hospital course: 62yo f pmhx aggressive urothelial ca s/p right nephroereterectomy +chemo p/w ams, fever, hypotension was initially admitted to micu for management of sepsis. . #sepsis: patient initially treated empirically with vancomycin and zosyn, initially briefly requiring levophed; likely source was thought to be abdominal abscess seen on ct abdomen however patient underwent ir guided drainage of the cyst and cultures were negative and the fluid collection was felt to not represent an abscess. id consulted and recommended continuing vanco/zosyn for a total of 14 days. #pancytopenia: she was leukopenic and thrombocytopenic, but her anc never dropped below 500. hematology/oncology was consulted regarding both care of her chronic malignancy as well as possible neupogen to improve her cell lines, they did not recommend neupogen. they felt the leukopenia and thrombocytopenia was secondary to chemotherapy (most recent dose of carboplatin/gemcitabine was , 3wks prior to admission) and sepsis - both causing supression of her bone marrow. both cell lines are recovering, with platelets lagging behind the wbc. heme-onc is aware of this and is not concerned. they feel she should receive a platelet transfusion is her platelets drop below 10,000 (should not happen since her plts are rising) or if she develops a significant bleed that cannot be cotrolled with conservative measures such as pressure. her platelet counts and wbc with differential should be checked at least once a week at the to ensure they are continuing to head in the right direction. . #urethelial carcinoma: pt w h/o aggressive malignancy s/p chemotherapy and right nephrouretectomy, with evidence of abdominal metastasis. the patient was seen here and requested an appointment with dr. , which was arranged for her. . #h/o dvt: she was initially continued on treatment doses of lovenox for treatment of prior dvt. she has been on this dose since . however, le dopplers were negative for dvt here and v/q scan was low probability, so since she had received 6 months of treatment for her first episode of dvt (arguably known source - ca), she was changed to prohylactic dose of lovenox. given her malignancy the risk-benefit of continuing prophylactic lovenox indefinetely probably favors continuing it. however, if her bleeding risk increases (i.e. if she becomes thrombocytopenic again), this may need to be reconsidered. . #pain: pt w abd chronic pain malignancy and resections, on chronic narcotics as an outpatient. pain was exacerbated by ir drainage (see above), and pain was refratory to 5mg oxycodone tabs, so pt was started on morphine sr to improve basal control. . inactive #seizure disorder: continued depakote, lacosamide, keppra. . after her icu stay and severe illness, she is very weak and deconditioned and will require rehabilitation before returning home. medications on admission: - depakote 250mg po tid - lacosamide (anti-epileptic) 100mg po bid - remeron 2.5mg po qhs - keppra (unknown dose) - ondansetron 8mg po q6hrs prn - lovenox - tylenol 1gm q67hrs prn - dulcolax supp - senna 1 tab po daily - oxycontin 30mg po qhs - oxycodone 5mg po q4hrs prn discharge medications: 1. valproic acid 250 mg capsule sig: one (1) capsule po tid (3 times a day). 2. lacosamide 50 mg tablet sig: two (2) tablet po bid (2 times a day). 3. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 4. ondansetron 4 mg tablet, rapid dissolve sig: two (2) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 5. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain or fever >100.4. 6. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). 7. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day) as needed for dry nose. 8. morphine 15 mg tablet extended release sig: one (1) tablet extended release po q12h (every 12 hours). 9. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): on in the morning and off in the evening. 10. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). 11. bisacodyl 10 mg suppository sig: one (1) suppository rectal (2 times a day) as needed for constipation. 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 13. enoxaparin 30 mg/0.3 ml syringe sig: one (1) subcutaneous q24h (every 24 hours). 14. oxycodone 5 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. 15. heparin flush (10 units/ml) 5 ml iv prn line flush indwelling port (e.g. portacath), heparin dependent: flush with 10 ml normal saline followed by heparin as above daily and prn per lumen. 16. heparin flush (100 units/ml) 5 ml iv prn de-accessing port indwelling port (e.g. portacath), heparin dependent: when de-accessing port, flush with 10 ml normal saline followed by heparin as above per lumen. 17. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) gram intravenous q 24h (every 24 hours) for 6 days. 18. piperacillin-tazobactam 4.5 gram recon soln sig: 4.5 grams intravenous every eight (8) hours for 6 days. discharge disposition: extended care facility: care & rehab discharge diagnosis: sepsis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were transferred from with sepsis (severe infection). the source of the infection was not identified, but you improved with antibiotics and, per our infectious disease service, need to finish two full weeks of iv antibiotics. you were also seen by our oncology service and they feel that your blood counts are rising as expected after chemotherapy and the infection, including the platelet count which is rising more slowly. you were found to not have any evidence of blood clots in your legs or your lungs so the dose of lovenox was decreased to 30 mg per day in order to prevent further blood clots from forming. it is a blood thinner, so it needs to be held or stopped if you develop any significant bleeding. followup instructions: department: hematology/oncology when: thursday at 1:30 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: percutaneous abdominal drainage diagnoses: malignant neoplasm of liver, secondary unspecified septicemia severe sepsis secondary malignant neoplasm of other specified sites malignant neoplasm of kidney, except pelvis septic shock antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use abdominal pain, other specified site headache secondary malignant neoplasm of skin personal history of antineoplastic chemotherapy neutropenia, unspecified secondary malignant neoplasm of other digestive organs and spleen neoplasm related pain (acute) (chronic) acute venous embolism and thrombosis of deep vessels of distal lower extremity unspecified diseases of blood and blood-forming organs psoas muscle abscess other secondary thrombocytopenia generalized nonconvulsive epilepsy, without mention of intractable epilepsy late effects of other and unspecified infectious and parasitic diseases antineoplastic chemotherapy induced anemia 

Answer: The patient is high likely exposed to