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: patient recorded as having no known allergies to drugs attending: chief complaint: chest pain major surgical or invasive procedure: pericardial drain placement and removal history of present illness: this is a 52 y/o woman with h/o hiv (last cd 4 801, vl 84,700 on ) who p/w chief complaint of chest pain. patient states that beginning last friday she began to feel short of breath. first noted the sensation with exertion when she was nearly unable to climb the three flights of stairs to her residence. thereafter she noted that she felt short of breath with speaking, and began to have chest pain. she says the pain was sharp, located in the center of her chest but at times radiated to the back, and shoulder. this pain was constant, but worse with exertion and ? worse with breathing. patient endured pain over the weekend, but on sunday am was brought to er by ems after counselor in her shelter insisted. . in ed, t98.2, hr 120's, bp 123/83, rr 20, 96-100% on non-rebreather. patient was uncomfortable appearing and c/o pleuritic chest pain. pulsus 7mmhg. ekg demonstrated diffuse pr depressions and 1mmhg st elevations. ct chest demonstrated large pericardial effusion and possible rv diastolic collapse. cards consult found pulsus to be 11mmhg. patient was given asa 325, morphine 2mg x3, zofran, levofloxacin 500mg po and taken to cath lab for treatment/evaluation of tamponade. . in cath lab, ra pressure was mean 22mmhg (pre-drain), rv 37/19 mean 17, wedge 18mmhg, pa sat 39%, pa pressure 46/25 mean 33, pericardial opening pressure of 20mmhg. after 685cc sanguinous fluid was removed ra pressure was 4, pericardial pressure was 4. patient complained of left shoulder pain following drain, better with movement, given 75ucg of fentanyl with some relief. patient then admitted to ccu for management. . cardiac review of systems is notable for absence of paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: - hiv: last cd4 801, vl 84,700. not on haart. denies h/o opportunistic infections. - depression - lung cancer - diagnosed on recent admission -> found to have post-obstructive pneumonia, bronchoscopy demonstrated non-small cell lung cancer in washings although endobronchial lesion reportedly negative for malignancy. recent mri brain negative for metastatic disease to brain, pet scan + for mets to left lung, hilar lymphadenopathy, possibly r-ischium and spleen. splenic lesions possibly c/w lymphoma or inflammatory response to tumor. . cardiac risk factors: no known history of diabetes, dyslipidemia, hypertension social history: patient has a history of tobacco use, recently quit and is on the nicotine patch 7mg/day, denies illicit drug use but has history of cocaine use, lives at a shelter for women with hiv x 8 months. applying for mass health for housing assistance. has two children. history of domestic abuse from ex-husband (?). family history: family history non-contributory. physical exam: vs: t 99.3, bp 127/82, hr 114 sinus , rr 28, o2 100 % on 4l nc, pulsus 7mmhg gen: middle-aged woman, uncomfortable appearing, diaphoretic heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple. cv: pericardial drain in place, +pericardial friction rub, normal s1, s2, no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were labored. no wheezing, rales, ronchi. abd: overweight, soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: no c/c/e. no femoral bruits. r-femoral groin line in place. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; 2+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp pertinent results: cta chest : 1. massively increased pericardial effusion which is now large and measures slightly dense, worrisome for complex effusion including malignant or hemorrhagic etiologies. there appears to be compression on the right ventricle and right atrium and echocardiogram is recommended to assess for tamponade. no evidence of pulmonary embolism or aortic dissection. 2. no significant interval change to known non-small cell lung carcinoma involving the right suprahilar region causing obstruction of the posterior upper lobe bronchus. new peripheral opacity within the upper lobe likely represents a post-obstructive pneumonitis/pneumonia. 3. slight enlargement of bilateral metastatic lesions since chest ct . new small bilateral pleural effusions (right greater than left). 4. increased interstitial septal thickening, best appreciated within the left upper lobe, is likely related to mild amount of interstitial pulmonary edema. lymphangitic carcinomatosis cannot be excluded. 5. persistent but unchanged axillary, mediastinal, and hilar lymphadenopathy. . chest pa/lat: 1. short interval development of marked cardiac enlargement, without overt pulmonary edema, concerning for pericardial effusion. 2. right upper lobe opacity, consistent with known mass/consolidation. numerous pulmonary nodules consistent with metastatic disease. . echo : overall normal left ventricular cavity size and systolic function (lvef>50%). regional function could not be assess. the right ventricular cavity is mildly dilated with hypokinesis of the mid-free wall. the aortic valve is grossly normal. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is a trivial pericardial effusion. a catheter is seen in the pericardial space.there are no echocardiographic signs of tamponade. compared to the prior study of earlier in the day (images reviewed; ), the pericardial effusion has nearly resolved and tamponade physiology is no longer observed. right ventricular cavity enlargement with free wall hypokinesis is now identified. . echo : overall left ventricular cavity size and systolic function are normal (lvef>55%). the right ventricular cavity is somewhat small. there is a large circumferential pericardial effusion with right ventricular and right atrial diastolic collapse as well as accentuated respiratory variation in mitral/tricuspid valve inflows all consistent with impaired fillling/tamponade physiology. . pericardial fluid: pericardial fluid: positive for malignant cells consistent with non-small cell carcinoma. markedly atypical cells present. . cxr : 1. interval decrease in overall cardiac size as well as pulmonary vascular congestion. pericardiocentesis catheter noted. 2. right upper lobe volume loss and right suprahilar mass as well as multiple pulmonary nodules again noted. 3. persistent left basilar atelectasis. . echo: left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) right ventricular chamber size and free wall motion are normal. the mitral valve leaflets are mildly thickened. there is no pericardial effusion. compared with the prior study (images reviewed) of , the findings are similar. there is no accumulation of pericardial fluid. . echo: regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size is normal. right ventricular systolic function is normal. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , the findings are similar. the previously seen focal hypokinesis of the right ventricular free wall (mentioned on report of ) is not seen on the current study. the right ventricular free wall may be slightly thickened. . echo . this study was compared to the prior study of . left ventricle: overall normal lvef (>55%). pericardium: small pericardial effusion. no echocardiographic signs of tamponade. conclusions overall left ventricular systolic function is normal (lvef>55%). there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , no change. 09:40pm type- 09:40pm lactate-1.0 09:30pm glucose-111* urea n-11 creat-0.7 sodium-133 potassium-3.9 chloride-102 total co2-26 anion gap-9 09:30pm ld(ldh)-249 ck(cpk)-46 amylase-118* 09:30pm ck-mb-notdone ctropnt-<0.01 09:30pm tot prot-6.5 albumin-3.2* globulin-3.3 calcium-8.5 phosphate-2.5* magnesium-2.1 iron-20* 09:30pm caltibc-241* ferritin-181* trf-185* 09:30pm urine hours-random 09:30pm urine bnzodzpn-pos barbitrt-neg cocaine-neg amphetmn-neg mthdone-neg 09:30pm wbc-7.6 rbc-3.20* hgb-9.4* hct-28.6* mcv-89 mch-29.3 mchc-32.8 rdw-13.5 09:30pm plt count-298 09:30pm pt-13.9* ptt-25.1 inr(pt)-1.2* 05:30pm other body fluid wbc-8950* hct-24.5* polys-36* lymphs-8* monos-0 eos-1* mesotheli-17* macrophag-22* other-16* 09:36am lactate-2.9* 09:30am glucose-131* urea n-12 creat-0.8 sodium-132* potassium-4.2 chloride-98 total co2-23 anion gap-15 09:30am estgfr-using this 09:30am ck(cpk)-46 09:30am ck-mb-notdone ctropnt-<0.01 09:30am wbc-8.5 rbc-3.58* hgb-10.6* hct-31.2* mcv-87 mch-29.5 mchc-33.9 rdw-13.7 09:30am neuts-62.0 lymphs-32.8 monos-4.1 eos-0.9 basos-0.2 09:30am plt count-297 09:30am pt-13.2 ptt-24.8 inr(pt)-1.1 . at discharge . complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:40am 4.6 3.23* 9.4* 28.4* 88 29.0 33.0 14.6 249 differential neuts bands lymphs monos eos baso atyps metas myelos 08:05am 19* 0 76* 2 0 2 1* 0 0 brief hospital course: assessment/plan: 52 y/o f with h/o hiv (last cd4 801, vl on ), not on haart, p/w chest pain and sob found to be in pericardial tamponade and admitted to the ccu s/p pericardiocentesis and drain placement, transferred to omed for chemotherapy. . # pericardial effusion: with clinical and echocardiographic signs of cardiac tamponade on presentation. the patient was sent emergently to the cath lab where tamponade physiology was confirmed with a r heart cath and a pericardiocentesis was performed with aspiration of 685 ccs of sanguinous fluid. after pericardiocentesis, the ra pressure and pericardial pressures were 4. she was then transferred to the ccu where a repeat tte was significant for an absence of remaining pericardial fluid. pericardial fluid studies were significant for malignant cells consistent with non-small cell lung carcinoma. all other studies, including a gram stain, bacterial culture, fungal culture, and afb stain were negative. a ppd was negative. the pt was given toradol, percocet, and iv morphine prn for pain. serial ekgs, pulsus pardoxus, and ttes were all negative for a rapidly reaccumulating pericardial effusion. the pericardial drain was pulled on . subsequently, she was assessed clinically daily and visited often by dr (cardiologist), with no recurring signs of jugular distention or tamponade. oncology was reconsulted who recommended palliative chemotheraphy. cardiac and thoracic surgery teams were also called for possible placement of a pericardial window prior to initiation of chemotherapy and the patient was determined to not be a good surgical candidate. in omed, the patient received chemotherapy (carboplatin/gemcitabine regimen) but a second dose was not feasible due to neutropenia. neutropenia subsequently corrected. the functional status of the patient was good throughout her stay in omed and toward the end of her stay her main issue keeping her in the hospital was her unwillingness to be placed at the various institutions recommended by the team, social work, and case management. this was resolved satisfactorily in the end. it was felt that she would be a good candidate for further outpatient chemo. she did receive chemo again prior to discharge. . # id/hiv: the patient had never previously been on haart and cd4 count 801 in ; haart therapy initiated due to need for palliative chemotherapy. she was started on efavirenz and emtricitabine-tenofovir. ppd was negative for w/u of her hemorrhagic pericardial fluid. haart had to be stopped due to renal failure, tghen restarted at discharge. she was also arranged for follow up with infectious disease. . # anemia: c/w anemia of chronic disease. hct decrease from 37 to 31 over 1 week, likely hemorrhagic pericardial effusion. stools were guaiac negative. iron studies c/w acd. . # asthma: continued albuterol and ipratropium prn. . # tobacco/substance abuse: +utox for cocaine in , utox on admission negative. recently quit smoking, provided nicotine patch. . #depression: continued quetiapine 200mg qhs, 100mg . . follow up was arranged with all of the different specialists and the patient was not sob and had no pain at discharge. medications on admission: quetiapine 200mg qhs, 100mg albuterol inh q6h ipratropium inh q6h discharge medications: 1. quetiapine 100 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 2. quetiapine 100 mg tablet sig: one (1) tablet po bid (2 times a day). 3. ipratropium bromide 17 mcg/actuation aerosol sig: one (1) puff inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*1 bottle* refills:*1* discharge disposition: home with service facility: homecare discharge diagnosis: primary: non-small cell lung cancer hiv secondary: depression discharge condition: the patient was discharged hemodynamically stable, afebrile with appropriate follow up. discharge instructions: you were admitted to the hospital with chest pain and trouble breathing and you were found to have fluid around your heart. the fluid was drained and your symptoms of chest pain and shortness of breath improved. the cause for the fluid around your heart is related to your cancer. you were found to have non-small cell lung cancer and you were treated with two cycles of chemotherapy with gemcitabine and carboplatin. please keep all follow up appointments. they are listed below. you will need to follow up with your new oncologist dr. and your new cardiologist dr. . please call your pcp . or seek medical attention in the emergency room if you experience any chest pain, shortness of breath, nausea, vomiting, abdominal pain, or any other concerning symptom. followup instructions: provider: , md phone: date/time: 9:30 provider: , md phone: date/time: 9:30 provider: , rn phone: date/time: 10:30 call dr (cardiology) to make an appointment at as unable to make an appointment. md procedure: diagnostic ultrasound of heart diagnostic ultrasound of heart diagnostic ultrasound of heart diagnostic ultrasound of heart diagnostic ultrasound of heart diagnostic ultrasound of heart pericardiocentesis right heart cardiac catheterization injection or infusion of cancer chemotherapeutic substance diagnoses: human immunodeficiency virus [hiv] disease malignant neoplasm of upper lobe, bronchus or lung enlargement of lymph nodes tachycardia, unspecified other specified diseases of pericardium cardiac tamponade 

Answer: The patient is high likely exposed to