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: erythromycin base attending: chief complaint: weakness major surgical or invasive procedure: plasmapheresis cathether placement plasmapheresis history of present illness: 65 year old female with past medical history of abdominal aortic aneurysm status post endovascular repair, hypertension, cerebrovascular accident, atrial fibrillation, small cell lung cancer and myasthenia who presented to the er today with weakness and hypoxia. of note, she presented to her neurologist complaining of weakness on and he was concerned for steroid myopathy. he decreased her dose of prednisone to 40mg daily, started imuran and stopped cellcept. patient has felt weak for the past few weeks with generalized exhaustion without any known causative events. patient has fallen a few times this week with one fall sustaining head impact last night. no loss of consciousness. over the past couple of days, patient has also had some dysuria as well as vomiting without nausea, fever, or chills. . in the ed, initial vs were: t 98.2 p 92 bp 150/97 r 22 o2 sats of 88% on ra. cxr and ct head were negative for acute processes. patient was given ceftriaxone 1gram for a positive urinalysis and mestinon 60mg for her myasthenia. neurology was consulted and felt this was unlikely consistent a myasthenia crisis but recommended following nifs. patient was found to have elevated lactate at 4 and transferred to the icu for respiratory monitoring after gentle hydration. . on arrival to the icu, patient was denying chest pain, shortness of breath, abdominal pain, nausea, joint pain. she complains of generalized exhaustion. no sick contacts. . review of systems: (+) per hpi, reports good appetite with 20 pound weight gain, chronic cough occasionally productive of yellow sputum (-) denies fever, chills, night sweats. denies headache, sinus tenderness, rhinorrhea or congestion. denied shortness of breath. denied chest pain or tightness, palpitations. denied nausea, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. denied arthralgias or myalgias. past medical history: 1. myasthenia dx in : primary neurologist in , mild crisis in past marked by visual changes (diplopia) nd generalized weakness, treated with mestinon 60mg tid, prednisone and cellcept. at baseline, uses wheelchair for any extended travel and walks around the home with a walker, adls with support by her husband- primary caretaker 2. stroke, - residual weakness in blle 3. history of lung ca in , s/p chemoradiation, treated by dr. in , ? small cell lung cancer. 4. atrial fibrillation on dig/coumadin 5. hypertension 6. hypercholesterolemia 7. osa 8. gerd 9. chronic low back pain 10. spine surgery, 11. bilateral knee arthroscopy 12. degenerative arthritis 13. cholescystecomy social history: lives with husband. she is a former heavy smoker up to a pack and a half of cigarettes per day and stopped smoking in . denies alcohol or drug use. family history: denies any known neurological familial history. physical exam: on admission: vitals: t: 98.8 bp: 184/94 p: 81 r: 19 o2: 97% on 4l nc general: alert, oriented, no acute distress heent: sclera anicteric, mmm dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: irregularly irregular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, muscle strength in all extremities, sensation intact all four extremities, mild dysarthria and bilateral lid lag. pertinent results: on admission: wbc-13.9* rbc-4.37 hgb-14.3 hct-43.1# mcv-99* mch-32.8* mchc-33.2 rdw-15.5 plt ct-162 neuts-83.2* lymphs-10.1* monos-6.0 eos-0.3 baso-0.4 pt-23.3* ptt-21.0* inr(pt)-2.2* glucose-142* urean-27* creat-1.5* na-131* k-4.0 cl-84* hco3-34* angap-17 albumin-4.3 calcium-15.9* phos-5.8*# mg-1.7 uricacd-9.6* pth-16 freeca-1.65* calcium trends: () 15.9 -> () 13.5 -> 12.4 -> 11.8 -> () 9.9 -> 9.3 -> () 9.3 urine culture (final ): proteus mirabilis. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ proteus mirabilis | amikacin-------------- 4 s ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- 2 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s piperacillin---------- =>128 r piperacillin/tazo----- 16 s tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r ekg: atrial fibrillation. incomplete right bundle-branch block. extensive st-t wave changes may b e due to myocardial infarction. also, consider digitalis effect. cxr: no acute intrathoracic process. stable appearance of enlargement of the main pulmonary arteries compatible with pulmonary hypertension. ct head: 1. no evidence of acute intracranial abnormalities. 2. moderate chronic small vessel ischemic changes. abdominal films: 1. gastric distention. no evidence of small bowel dilatation or free air. 2. stool and air are seen throughout the colon. ct chest: 1. left upper lobe nodular density with adjacent bronchial dilatation is most likely infectious or inflammatory in etiology. 2. persistent right infrahilar nodular density with adjacent infrahilar lymphadenopathy for which fdg pet is recommended to exclude neoplasm. because pet may be false positive in the setting of infection, consider postponing the pet until after antibiotic treatment for the potentially infectious lesion in the left apex to avoid a false positive finding in this location. 3. new scleotic lesion of the t8. although compression fracture is most likely, pathological fracture can not be excluded. this may also be assessed at the time of pet. echo: dilated right ventricle with normal systolic function. mild symmetric left ventricular hypertrophy with preserved systolic function. moderate tricuspid regurgitation. moderate pulmonary hypertension with signs of rv volume overload. brief hospital course: weakness: likely due to myasthenia crisis or hypercalcemia. patient's home dose of pyridostigmine and prednisone 40mg were continued and azathioprine started. patient received five plasmapheresis sessions. at discharge, patient was saturating in the high 90s on room air and denied shortness of breath at rest. negative intrathoracic force ranged from 30-50 and vital capactities were between 0.8-1.3l. . hypercalcemia: calcium on admission was 15.9 but was down around 8 after receiving calcitonin and bisphophonate. parathyroid hormone, parathyroid related hormone, and vitamin d levels were normal. given history of small cell cancer, there is a concern for an osteolytic process secondary to metastasis. chest ct showed lesion in t8. would recommend pet imaging for further evaluation. . hypertension: patient's anti-hypertensive regimen was altered during admission. hydrochlorothiazide was discontinued due to hypercalcemia and hydralazine discontinued due to peripheral edema. patient was switched from 25mg metoprolol three times daily to atenolol 100mg daily and lisinopril 40mg po twice daily. . atrial fibrillation: coumadin was held during plasmapheresis. heparin drip was started. coumadin was restarted on after completion of plasmapharesis. inr at discharge was 1.1. digoxin was held because of ekg findings of digoxin toxicity on admission. rate control was achieved with beta blockers. . urinary tract infection: patient's urine culture was positive for proteus sensitive to ceftriaxone. patient completed a three day course of ceftriaxone. medications on admission: advair diskus 250 mcg-50 inh 1 puff ambien 5mg po qhs ascorbic acid 500mg po qday asa 81mg po qday atrovent bisacodyl 10mg po qday citalopram 20mg po qday colace 100mg po bid digoxin 250mcg po qday ferrous sulfate 325mg po qday folic acid 1mg po qday hydralazine 25mg po q6 hours hctz 50mg hydrocodone-apap 5-500mg po qday hyoscyamine sulfate 0.375mg po qday ibuprofen 400mg po q4 prn isopto tears 0.5% 1 drops ou lisinopril 40 mg mestinon 60mg po tid metoprolol tartrate 12.5mg mvi omega 3 1g tid omeprazole 20mg po qday oyster shell calcium 1g tid prednisone 40 mg qday (just changed from 60mg qd) provigil 200mg po qday senna 8.6mg po qhs vitamin d 800 units qday warfarin 3mg po qday discharge disposition: extended care facility: hospital discharge diagnosis: primary diagnosis: myasthenia flare, hypercalcemia secondary diagnosis: hypertension, atrial fibrillation, small cell lung cancer, discharge condition: stable discharge instructions: you presented with generalized weakness. you were admitted to the icu due to concern about your respiratory status. you did not require intubation in the icu. work up showed that your weakness was likely due to your diagnosis of myasthenia or high calcium level. you were started on azathioprine and your home dose of pyridistigmine was increased. you also received five sessions of plasmapheresis. you also received bisphophonate and calcitonin to reduce your calcium level. during plasmapheresis, coumadin was held and heparin drip started. the heparin drip was discontinued and coumadin restarted after completion of plamapharesis. . please seek medical care immediately if you experience worsening weakness, difficulty breathing, changes in mental status, fevers, chills or any other concerning symptoms. followup instructions: please follow up with dr. (endocrinologist) in clinic on at 1pm. his clinic is on the of the building. . please follow up with dr. (neurologist) on at 4pm. his clinic is on the of the building. . please give warfarin 7.5 mg on , then 5mg po daily for two days and then 3mg po daily. please monitor inr with goal of . . please check calcium, magnesium, albumin and phosphate level on and fax results to dr. at . . please follow up on anti-hypertensive regimen which was altered during admission. procedure: venous catheterization, not elsewhere classified therapeutic plasmapheresis diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) pure hypercholesterolemia urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation personal history of malignant neoplasm of bronchus and lung other chronic pulmonary heart diseases alkalosis other late effects of cerebrovascular disease long-term (current) use of anticoagulants dehydration secondary malignant neoplasm of bone and bone marrow proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site chronic diastolic heart failure other disorders of muscle, ligament, and fascia benign essential hypertension myasthenia gravis with (acute) exacerbation 

Answer: The patient is high likely exposed to