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: sulfa (sulfonamide antibiotics) / aspirin / augmentin / azithromycin / fentanyl / paroxetine / precedex attending: chief complaint: dyspnea major surgical or invasive procedure: mechanical ventilation endotracheal intubation arterial line placement central venous line placement attempted left lung decortication placement of chest tube on the left history of present illness: is a 70 f w/ dm, htn, br ca in , thyroid ca in who was d/c'd yest for cap on levofloxacin. today, the pt presented to the ed with l sided cp. in the ed, vs 97.4 103 157/69 24 96 ra. the patient was given zofran 2mg x1 and morphine total 12mg iv and dailaudid 1mg iv. she never spiked a temp in the ed. her cxr looked worse so she was given vanc/zosyn. she became tachypneic to mid 30s. on arrival to the floor, reported being in pain which was most significantly located over left lateral ribs. she states "i can't breathe." she received 0.25 iv dilaudid x 2 doses with improvement of her pain to . sl ntg x1 did not relieve her pain. given crackles on exam, patient received lasix 20mg iv x 2. a cta chest was ordered which showed preliminarily lll collapse but no pe. her antibiotics were changed to vanco/cefepime/azithro per id. she was intolerant of nc so she was placed on 4l by facemask with o2 sats 95-97%. she remained tachypneic to the 30s, tachycardic to the 110s with sbps 160-170s and was using accessory muscles to breath so an icu consult was called. on icu eval, she seemed to be tiring from her high rr. pt c/o left sided "rib" pain which is not ttp. she also states she is sob. otherwise, she denies any other pain. review of systems: (+) per hpi (-) denies nausea, vomiting, abdominal pain, headache, lightheadedness. denies rashes or skin changes. past medical history: - breast ca - diagnosed s/p left mastectomy - thyroid ca - diagnosed s/p thyroidectomy and i-125. - dm 2 - hypothyroid - migraines - hyperlipidemia - htn - chronic pain - 60%-69% stenosis of the internal carotid social history: pt lives in independently with daughter nearby. tob (quit 40yrs ago). no etoh . no drugs family history: non-contributory physical exam: vitals: 97 72 132/66 22 96%ra general appearance: aox3, pleasant, appropriate, nad. eyes / conjunctiva: perrl, anicteric head, ears, nose, throat: normocephalic, op clear cardiovascular: rrr. no mrg respiratory / chest: rhonchorous bs throughout, diminished at r base. abdominal: soft, non-tender, bowel sounds present, not distended extremities: right lower extremity edema: none, left lower extremity edema: none, no cyanosis pertinent results: admission laboratories: 06:10am wbc-6.1 rbc-3.55* hgb-7.9* hct-26.9* mcv-76* plt ct-200 06:10am neuts-80.6* lymphs-12.4* monos-5.2 eos-1.5 baso-0.3 04:04am pt-12.1 ptt-22.9 inr(pt)-1.0 04:04am glucose-193 urean-10 cr-0.6 na-137 k-3.2 cl-101 hco3-23 08:22pm alt-12 ast-16 ld-261* ck(cpk)-111 alkphos-94 totbili-0.4 08:12pm calcium-7.6* phos-3.2 mg-1.7 ----------- micro: bcx ?????? negative ucx ?????? negative sputumcx ?????? rare yeast bcx ?????? negative ucx ?????? negative pleural fluid cx ?????? negative bal ?????? negative pleural fluid ?????? prelim negative ucx ?????? negative bcx ?????? negative bcx ?????? negative bal ?????? negative ucx ?????? negative bcx ?????? ngtd cdiff ?????? negative ---------- imaging: ct chest: 1)no pulmonary embolism to segmental level. 2) near complete left lower lobe collapse and consolidation, also involving the lingula, moderately large left pleural effusion and left upper lobe consolidation is consistent with pneumonia and has progressed since . the slightly expansile appearance of the consolidations is associated with pyogenic pneumonia with the differential including gram negative organisms such as klebsiella. ct head: no acute intracranial process. ct cspine: no fractures noted. unchanged mild degenerative changes of the cervical spine with mild canal stenosis. mra neck: 1. normal time-of-flight mra with no evidence for carotid dissection or hemodynamically significant stenosis within the limitations of the examination. 2. bilateral pleural effusions, left greater than right with left-sided chest tube. echo: left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with akinesis of the mid to distal septum and severe hypokinesis of the mid to distal inferior wall. overall left ventricular systolic function is mildly depressed (lvef= 45-50%). the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. the mitral valve leaflets are structurally normal. compared with the findings of the prior report (images unavailable for review) of , there is new regional lv dysfunction. ct head: no hemorrhage, edema, or evidence of acute process. cxr: no pneumothorax. residual left lower lobe infection and/or atelectasis and small volume of loculated (non-dependent) pleural fluid. 1. right pic catheter terminates at or below the level of the cavoatrial junction. 2. interval improvement in the left lower lobe opacity, likely residual infection or atelectasis. unchanged mild asymmetric left pulmonary edema and small left pleural effusion. discharge labs : wbc 13 hct 33.2 plt 425 na 143 k 3.8 cl 107 hco3 26 bun 16 cr 0.5 glc 195 ca 8.7 phos 4.4 mg 2.1 brief hospital course: 70 f w/ dm, htn, br ca in , thyroid ca in who was d/c'd the day prior to admission for cap on levofloxacin who presented again with cp and sob, found to have parapneumonic effusion, s/p chest tube. # respiratory failure with left sided pleural effusion/empyema: the patient presented to the icu with increased work of breathing and chest pain. she was found to have a left sided pleural effusion and lll collapse. she was recently hospitalized and discharged for community acquired pneumonia. the patient was initally started on vanco/zosyn which was expanded to vanco/cefepime/azithromycin. the patient was transferred to the icu for increased work of breathing and a pigtail catheter was placed by ir. pleural fluid was sent to pathology and for cultures. the ph of the fluid was 6.8, so it was presumably an empyema, though the cultures were negative. cytology was also negative for malignant cells. the patient was electively intubated for procedures. the patient underwent an attempted decortication of her left lung (since the pigtail did not fully drain her pleural effusion), though there were problems in the procedure because anesthesia was having difficulty ventilating just her right lung. she was intubated and extubated multiple times while in the operating room. due to her ventilation problems, the decortication procedure was not done and a chest tube was placed for drainage. the chest tube drained serosangious fluid. initially, it was to suction and then to waterseal. it was pulled prior to discharge. her pleural effusion improved. after the operating room, the patient continued to be ventilated. multiple attempts were taken to wean the patient off of the ventilator, though she became agitated with tachycardia and hypertension. the patient's medications were switched from fentanyl and versad to propofol, prn ativan, and prn morphine with limited success. precedex was tried, but the patient had bradycardia during the infusion, so she was therefore continued on the above regiment of propofol and prn ativan/morphine. the patient was further diuresed with a lasix drip and was successfully extubated after aggressive diuresis. she is now satting 96-100% on ra. # muscle rigidity: the patient was noted to have muscle rigidity and left sided ankle clonus after presenting from the operating room. in the operating room, the patient received isoflurance and sevoflurane as well as fentanyl. on return from the operating room, the patient was noted to have tachycardia to 130s and bps to ~200/110. physical exam showed left sided ankle clonus and muscle rigidity. neurology was consulted who felt that the patient's symptoms could be due to serotonin syndrome (on paxil and fentanyl). a ct of the head ruled out ich. a ct and mri of the spine ruled out any fracture or compression on the spinal cord. a mra of the neck ruled out carotid dissection. both fentanyl and paxil were immediately discontinued. anesthesiology was contact to ask about the possibility of malignant hyperthermia. the patient received inhaled anesthetics in the or, though her ck was normal. about 11 hours post-op, the patient spiked a fever to 101-102, so she was empirically given one dose of dantrolene for the possibility of malignant hyperthermia. the next documented examine after the dose of dantrolene (5-6 hours after administration) showed a resolution in her rigidity and clonus. # cardiac ischemia: the patient was noted to have persistent st depressions in her telemetry. cardiology was consulted who performed a stat echo showing mid-distal akinesis of the septum. her cardiac enzymes were trended and she did not have any biomarker evidence of an acute thrombotic event. the patient was re-started on her plavix and a beta blocker. cardiology recommended a catheterization when she is medically stable. # hypertension/tachycardia: the patient had multiple hypertensive and tachycardic episodes while intubated. these episodes took place during times of agitation and also during perceived resting states. since her blood pressures were so labile, she was started on an esmolol drip. post-extubation, she required esmolol and a nitro gtt to control her blood pressures. an ng tube was placed and she was given po medications and the drips were subsequently weaned. the patient is discharged on metoprolol and captopril with better bp control, sbp 120-150s. # altered mental status: post-extubation, the patient had altered mental status, thought likely due to her prolonged intubation and medications. her mental status slowly cleared. she was restarted on valium qhs prn. ms currently is at baseline - aox3, pleasant, interactive. u/a was positive on , urine culture from is pending and should be followed up by rehab md. # contact: the pcp was notified via email of the patient's admission. the icu team also communicated with her daughter and son. # speech/swallow: the patient was noted to choke/cough while drinking thin liquids on . the patient underwent swallow evaluation on - she is able to tolerate a regular diet and thin liquids. pills to be taken whole with thin liquids. oral care three times a day. # urinary frequency and some mid urinary retension while at the hospital. ua with moderate bacteria in setting of one epithelial cell. urine was nitrite and leukocyte negative. urine with 3-5 wbcs. cx was done and was pending at the time of discharge. medications on admission: plavix 75 mg daily valium 5 mg daily diltiazem xt 240 mg daily gabapentin 300 mg po bid glipizide er 2.5mg daily hydrocodone-homatropine 5mg-1.5mg/5ml syrup - 1 tsp q4h ibandronate 150 mg qmonthly levothyroxine 112 mcg daily metformin 500 mg qam and 1500mg qpm paroxetine 30mg daily maxalt 10 mg prn simvastatin 40 mg qhs vitamin d om3fa omeprazole 40 mg daily discharge medications: 1. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 2. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 11 doses: total 14 day course day 9 = day 14 = . 3. diazepam 5 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed for anxiety. 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain, fever. 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. levothyroxine 112 mcg tablet sig: one (1) tablet po daily (daily). 7. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 8. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 9. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day). 10. captopril 25 mg tablet sig: two (2) tablet po tid (3 times a day). 11. metoprolol tartrate 50 mg tablet sig: 1.5 tablets po tid (3 times a day). 12. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 13. cefepime 2 gram recon soln sig: two (2) recon soln injection q12h (every 12 hours) for 11 doses: total 14 day course day 9 = day 14 = . . 14. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 15. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation . 16. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation . 17. colace 100 mg capsule sig: one (1) capsule po twice a day. 18. gabapentin 300 mg capsule sig: one (1) capsule po twice a day. 19. glipizide 2.5 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 20. ibandronate 150 mg tablet sig: one (1) tablet po once a month. 21. metformin 500 mg tablet sig: one (1) tablet po qam. 22. metformin 500 mg tablet sig: three (3) tablet po at bedtime. 23. omega-3 fatty acids 1,000 mg capsule sig: one (1) capsule po once a day. 24. tessalon 200 mg capsule sig: one (1) capsule po four times a day as needed for cough. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: hypoxic respiratory distress lung empyema possible seratonin syndrome benzodiazepine withdrawal secondary diagnosis: hypertension diabetes mellitus hyperthyroidism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the icu with an infection of the lung known as an abscess or 'empyema'. you were treated with a breathing tube, and by having a catheter placed in your lung which drained the infection. you were treated with antibiotics as well. your hospital course was also complicated by a possible damage to your heart -- you were seen by cardiology, and you have been started on medications to protect your heart. there was also concern for a diagnosis known as 'seratonin' syndrome, for which your paroxetine was stopped. the breathing tube was removed, and you were no longer requiring oxygen on discharge. you are still weak and needed rehabilitation on discharge. please take your medications as directed. the following changes were made to your medications. stop diltiazem, paroxetine, hydrocodone-homatropine syrup. start metoprolol, captopril start tessalon for cough start colace, senna, bisacodyl as needed for stool softeners start trazodone as needed for sleep start miconazole powder start iv vancomycin and cefepime for a total 14 day course (last day = ) increase simvastatin from 40 mg to 80 mg by mouth daily. followup instructions: please follow up with your primary care physician weeks of discharge from rehab. , m. . please call cardiology for an appointment for follow-up after discharge from rehab. phone # other appointments: provider: , md phone: date/time: 10:00 procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization other intubation of respiratory tract closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus diagnostic ultrasound of other sites of thorax thoracoscopic drainage of pleural cavity diagnoses: acidosis other chronic pain anemia, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism personal history of malignant neoplasm of breast other opiates and related narcotics causing adverse effects in therapeutic use occlusion and stenosis of carotid artery without mention of cerebral infarction anxiety state, unspecified acute respiratory failure other specified cardiac dysrhythmias urinary frequency retention of urine, unspecified other and unspecified special symptoms or syndromes, not elsewhere classified altered mental status other extrapyramidal diseases and abnormal movement disorders antidepressants causing adverse effects in therapeutic use surgical or other procedure not carried out because of contraindication drug withdrawal migraine, unspecified, without mention of intractable migraine without mention of status migrainosus empyema without mention of fistula other nonspecific abnormal serum enzyme levels nonspecific abnormal electrocardiogram [ecg] [ekg] other sedatives and hypnotics causing adverse effects in therapeutic use personal history of malignant neoplasm of thyroid other diuretics causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to