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: bactrim attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: right and left heart catheterization icu care with arterial cannulation, central venous cannulation mechanical ventilation history of present illness: 46f s/p autologous bmt for nhl in with course complicated by radiation-induced pulmonary fibrosis and chemo-induced cardiomyopathy now on transtracheal o2 who presents with increasing dyspnea on exertion, tachycardia, and cough. although omr notes reveal prior complaints of doe, patient reports worsening over the past 2-3 weeks. denies pleuritic chest pain but does report some back pain with coughing. no exertional chest pain (but she feels unable to exert herself enough to know - no history of exertional cp). she was previously on 2l tto at rest and increased to 4l with activity. she has now increased to 3l at rest with >4l with activity (she reports she turns it up as high as she can and is still unable to exercise - she even gets short of breath brushing her teeth). she has previously had volume overload but not in a long while and denies pedal edema or orthopnea. she had pneumonia in which presented with neck stiffness and wheezing - she denies these symptoms at present. reports seasonal allergies without asthma. she has a dog at home and has lived in the same place with that dog for years. previously worked as a field officer for nstar where she may have been exposed to hazardous fumes, but since she has been on disability. denies fevers. she reports tachycardia seems to have started with this worsening dyspnea as well. saw pulmonologist in beginning of who felt she was doing well. seen by pt in early as well - report states that she gets out of breath with exertion on treadmill but at that point she did not feel this was worse than previous and o2 sat actually was better than previously. of note patient is on hormone replacement therapy (premarin/provers) since it was decided that she should not have children post-chemo. she does not smoke. she has not had personal or family history of blood clots. past medical history: 1. non-hodgkin's lymphocytic lymphoma: diagnosed in , treated with radiation and adriamycin, autologous bone marrow transplantation in , one episode of congesive heart failure in the first one to two months after her transplantation, good recovery after that and cancer free since then. 2. ipf: developed sob 2 years ago, likely related to full body irradiation, found to have bilateral pulmonary fibrosis and apical blebs. has been treated with prednisone and supplemental oxygen. pfts from demonstrated no change in restrictive pattern since . 3. systolic heart failure: diagnosed in at same time of ipf, likely due to adriamycin treatment for nhl. echo from demonstrated mild to moderate global left ventricular hypokinesis (ejection fraction 40 percent) and moderate pulmonary artery systolic hypertension without r-ventricular abnormalities. this was no change from a echo. 4. pulm htn: echo from demonstrated moderate pulmonary artery systolic hypertension without r-ventricular abnormalities in size, structure, and contractile function. 5. chronic anemia: thought to be related to her bmt in . labs in omr since demonstrate hct ranging from 28.7 to 34.3. . psh: -none but currently being evaluated for lung vs heart/lung transplant at social history: general: is single, lives with family. no children. works as field rep for nstar. tobacco: quit smoking approximately four to five years ago. smoked 10 cigs per day for 15 years, quit after hospitalization in . etoh: denies use recreational drugs: denies use family history: -hypertension on her mother's side -maternal grandmother: heart disease as well as diabetes physical exam: t 97.0 bp 145/124(?) hr 104 rr 18 sat 98% on 2 l/min tto weight: 63 kg general: well-appearing heent: no scleral icterus; (+) transtracheal catheter neck: jvp 7 cm, supple chest: scatterred rales throughout left lung field; left-sided breath sounds also diminished; right lung field clear to auscultation cv: mildly tachycardic, regular; nl s1s2, no m/r/g abdomen: soft, ntnd, no hsm extremities: warm, no edema, 2+ pt pulses skin: no rashes/jaundice neuro: alert, appropriate, cn 2-12 intact pertinent results: 01:30am blood wbc-9.2 rbc-3.57* hgb-10.5* hct-31.4* mcv-88 mch-29.4 mchc-33.4 rdw-13.5 plt ct-274 10:45am blood wbc-7.5 rbc-3.38* hgb-9.6* hct-29.0* mcv-86 mch-28.3 mchc-33.0 rdw-13.3 plt ct-233 02:13am blood wbc-33.1*# rbc-3.45* hgb-10.4* hct-31.0* mcv-90 mch-30.0 mchc-33.4 rdw-16.6* plt ct-70* 02:21am blood wbc-20.9* rbc-3.34* hgb-10.2* hct-30.0* mcv-90 mch-30.5 mchc-34.0 rdw-16.5* plt ct-77* 03:47am blood wbc-25.9* rbc-3.22* hgb-9.8* hct-29.8* mcv-93 mch-30.5 mchc-32.8 rdw-17.7* plt ct-83* 03:34am blood wbc-34.8* rbc-3.47* hgb-10.5* hct-32.8* mcv-95 mch-30.4 mchc-32.1 rdw-18.0* plt ct-88* 03:00am blood neuts-71* bands-10* lymphs-12* monos-4 eos-0 baso-0 atyps-2* metas-1* myelos-0 nrbc-17* 02:21am blood neuts-79* bands-1 lymphs-7* monos-7 eos-0 baso-0 atyps-0 metas-5* myelos-1* nrbc-63* 01:30am blood plt ct-274 02:30am blood pt-12.6 ptt-26.6 inr(pt)-1.1 03:34am blood pt-19.8* ptt-31.7 inr(pt)-1.8* 02:51pm blood fibrino-357 04:50pm blood fdp-80-160* 06:06am blood fdp-40-80 01:30am blood glucose-115* urean-23* creat-1.1 na-141 k-4.2 cl-99 hco3-34* angap-12 10:45am blood glucose-146* urean-20 creat-0.9 na-139 k-3.8 cl-102 hco3-29 angap-12 07:40am blood glucose-110* urean-15 creat-0.9 na-139 k-4.4 cl-100 hco3-26 angap-17 03:47am blood glucose-144* urean-88* creat-3.2* na-140 k-4.4 cl-113* hco3-20* angap-11 03:34am blood glucose-99 urean-99* creat-4.4*# na-135 k-6.7* cl-106 hco3-16* angap-20 03:00am blood alt-1855* ast-828* ld(ldh)-925* alkphos-74 totbili-1.4 02:21am blood alt-891* ast-243* ld(ldh)-1099* alkphos-182* totbili-1.3 03:34am blood alt-613* ast-533* ld(ldh)-2235* alkphos-243* totbili-4.2* 01:30am blood ck-mb-notdone ctropnt-0.02* 10:45am blood ck-mb-notdone ctropnt-<0.01 05:38pm blood ck-mb-notdone ctropnt-<0.01 07:20am blood probnp-5249* 02:51pm blood ck-mb-notdone ctropnt-0.03* 02:51pm blood hapto-161 09:06am blood hapto-161 07:10am blood tsh-1.1 05:10am blood cortsol-24.2* 05:22am blood cortsol-30.1* 10:51am blood glucose-126* lactate-1.6 02:59pm blood lactate-6.5* 06:42pm blood glucose-235* lactate-6.3* 01:45am blood lactate-4.0* 12:30pm blood lactate-1.7 01:26pm blood lactate-2.5* 06:11pm blood lactate-2.4* 04:50pm blood aspergillus galactomannan antigen- test 08:47pm urine rbc->1000 wbc- bacteri-few yeast-none epi-0 10:58pm urine rbc->1000* wbc-59* bacteri-none yeast-none epi-0 08:49am urine rbc-* wbc-0-2 bacteri-few yeast-none epi-0-2 08:47pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-tr 10:58pm urine blood-lg nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-tr microbiology 10:19 am sputum source: expectorated. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): gram positive cocci. in pairs and chains. respiratory culture (final ): rare growth oropharyngeal flora. aspergillus species. rare growth. not flavus or . 1:10 pm sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (preliminary): oropharyngeal flora absent. yeast. sparse growth. mold. rare growth. sent to mycology. reports and studies 1. no pulmonary embolism or aortic dissection. the coronary arteries arise from the normal expected anatomical location. 2. chronic pulmonary fibrosis as described above in predominately subpleural location, unchanged. echo the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with mild hypokinesis of the anteroseptum and inferior walls. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular cavity is moderately dilated with mild hypokinesis of the free wall. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. the pulmonic valve is abnormal. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , subtle left ventricular regional wall hypokinesis was present, however, the right ventricle has increased in size with signs of pressure volume overload. severe estimated pulmonary systolic hypertension is now present. echo the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses is normal with wmall cavity size. there is mild regional left ventricular systolic dysfunction with hypokinesis of the distal anterior wall and apex. the remaining segments contract normally (lvef = 45%). the right ventricular cavity is markedly dilated with severe global free wall hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the right ventricle is larger with more prominent free wall hypokinesis. an apical left ventricular wall motion abnormality is now present. the severity of tricuspid regurgitation is similar. c cath 1. coronary arteries are normal. 2. hypovolemia. 3. no significant change in cardiac output with volume challenge. 3. significant increase in cardiac output with little change in pulmonary artery pressures during 100% o2 (therefore, pvr decreased). 4. compared to baseline, significant increase in cardiac output and decrease in pulmonary artery pressures with nitric oxide therapy. 5. given low cardiac index would use caution if considering calcium channel blocker therapy. brief hospital course: pulmonary hypertension / bacterial pneumonia the patient was admitted with dyspnea on exertion. she underwent cardiac catheterization which revealed elevated pulmonary vascular resistance that did not significantly improve after vasodilator trial. she was trialed on sildenifil without benefit, and this was discontinued. after catheterization, she developed sepsis, meeting sirs criteria with positive sputum gram stain with gram positive cocci. that culture ultimately grew aspergillus, discussed below. she developed respiratory distress with while septic, and was electively intubated without immediate complication. her pulmonary disease was quite severe, and she was difficult to ventilate, requiring high pressures in a pressure control ventilation mode. cardiac arrest / cardiogenic shock unfortunately 3-4 hours after intubation, the patient became bradycardic and became pulseless in pea arrest, and a code was called. she was given cpr and epinephrine x3 and atropine. a femoral code line was placed. she was briefly in what appeared to be vt and was shocked x1, and regained spontaneous circulation. she was initially hypertensive in the next few minutes but then became quite hypotensive, requiring vasopressor support, ultimately being maxed on 3 pressors. over the next 72 hours, pressors were slowly weaned, with the exception of severe hypotensive episode at 72h likely from hypoxia cuff leak, from which she recoved. echocardiogram showed severe pulmonary hypertension and right heart failure. respiratory failure the patient remained intubated, and was on pressure control ventillation, with a pip set initially at 45. this was attempted to be decreased, ended at pip of 41, but still with elevated peeps. sepsis the presumption at time of first meeting sirs criteria was that she had pneunomia. she was treated broadly with vancomycin and zosyn, and caspofungin added later for aspergillus. one week after her arrest, she again became hypotensive and febrile, with presumption of infection. sources included vap, line infection, urine, or progression of aspergillus. she remained on her broad spectrum antibiotics, and her femoral line was promptly discontinued, but the patient rapidly before she became febrile, hypotensive requiring multiple vasopressor support, high fio2, sedation and paralysis again. with her underlying severe pulmonary disease and recurrent severe septic episode, a family meeting was held, and the family via hcp decided to make the patient . aspergillus infection the patient grew aspergillus from expectorated sputum prior to intubation, and was started on caspofungin. acute renal failure the patient went into renal failure after her cardiac arrest, likely atn. she still maintained some concentrating capacity. expiration within hours of the decision, the patient died peacefully and quietly in the presence of her friends and family. medications on admission: toprol 50 mg daily mucinex 1200 mg aspirin 325 mg daily premarin 0.625 mg daily provera 2.5 mg daily calcarb with d 600/200 mg 2 tabs daily mvi discharge medications: none discharge disposition: expired discharge diagnosis: primary pulmonary hypertension pulmonary fibrosis cardiogenic shock acute systolic congestive heart failure septic shock severe sepsis aspergillus pulmonary infection cardiac arrest secondary history of: non-hodgkin's lymphoma anemia discharge condition: expired md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more combined right and left heart cardiac catheterization coronary arteriography using two catheters parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances cardiopulmonary resuscitation, not otherwise specified diagnoses: thrombocytopenia, unspecified other postoperative infection congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis bone marrow replaced by transplant acute respiratory failure cardiac arrest cardiogenic shock septic shock antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use acute systolic heart failure dehydration chronic and other pulmonary manifestations due to radiation aspergillosis pneumonia in aspergillosis radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure secondary cardiomyopathy, unspecified 

Answer: The patient is high likely exposed to