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: penicillins attending: chief complaint: headache and viral exanthem major surgical or invasive procedure: central line insertion history of present illness: 49-year-old female with a history of tbi with splenectomy and sternotomy post chest stabbing presents with a day history of fever, headache, cough and general malaise. patient noted that she has felt unwell past 3-4 days. on went to a party of her aide's infant and noted that one of the parents had a cough ++ and after coming back was initially well then started coughing - non-productive by teh evening and put it down to her recent sick contact. by she woke up and felt awful, had the same dry cough and described general malaise with a sore throat. by the evening of she had fever and chills but no rigors, nausea with retching but no vomiting in addition to generalised body aches. still unwell and had worsening symptoms with persistent non-productive cough and by that evening had a gradually worsening whole head throbbing/pounding headache which reached a peak at 10/10 intensity and persistent subjective fevers. headache was without visual changes or neck stiffness or photophobia. she also noted some dehydration secondary to poor oral fluid intake despite a normal food intake - notes poor oral fluid intake is chronic for her as she does not want to have to trouble her husband to get her up to pass urine. she felt her left leg was stuffer than usual on . she felt light-headed since but did not feel faint and did not lose consciousness. she called her pcp and presented to the ed on . in the ed, vs: t: 101 hr: 132 bp: 103/56 18 saturating 93%. lp performed. csf with 0 rbc 1wbc (54% lymphocytes), protein 31, glucose: not measured. ua without sign of infection. influenza a/b antigen negative. blood cultures pending. cxr: unremarkable. in the ed patient received tylenol 1gm, ceftriaxone 2mg iv. dexamethasone sod phosphate 10mg/ml x1. baclofen 10mg po x1, morphine 4mg iv x1, toradol 30mg iv x1. found to be hypotensive and febrile in the ed 101 with tmax 103.2. due to previous splenectomy, they gave her presumptive treatment for possible meningitis with 2g iv ceftriazone, vancomycin, and dexamethasone prior to lp. lp was unremarkable. she became more hypotensive dropping her sbp to 70-80s despite 6l ivf and a cvc was inserted and started on norepinephrine infusion and was transferred to the icu. last vs in ed: hr 92, 95% ra, rr 16, bp 96/65 (0.12 levophed), cvp 11. she thinks her last flu shot was in and on questioning regarding vaccines denies pneumoococcal vaccination. in the icu, admission vitals were t 98.9 hr 94 bp 117/79 on 0.12 ne rr 18 so2 93% ra and 98% on 2l o2. currently feels well save persistent non-productive cough. denies pain or nausea, vomiting or diarrhoea (last bm yesterday). headache stopped 30 mins ago. no visual changes no neck stiffness no confusion. . ros: the patient denies any weight change, vomiting, abdominal pain, diarrhea, constipation, melena, hematochezia, chest pain, shortness of breath, orthopnea, pnd, lower extremity edema, urinary frequency, urgency, dysuria, new weakness, vision changes, rash or skin changes. past medical history: - anxiety - depression - hyperlipidemia - mva c/b closed head injury and left hemiplegia () and spasticity for which she receives botox injections - wheelchair bound -multiple stab wounds to the chest and ?lobectomy; sternotomy; in - s/p splenectomy . past surgical hx: as sequelae of mva: splenectomy liver lacs which were repaired fractured left femur and right foot social history: lives in , ma with husband. has severe depression- concern about husband's deteriorating health. requires regular pca care due to disability.no children. born and raised in ct,moved to ,her and her husband were evicted(states one of her pca's ran off with her and her husband's money), moved to occupation: disability prev clerical in auto-supply company tobacco: quit 18 yrs ago. (20 pack year smoking history) etoh: quit in ivdu: denies but frequent cannabis use last of which was ago many financial problems at home. family history: father: deceased 82 yrs stroke mother: deceased 62 yrs unknown cancer 6 brother(s) , 1 sister; 3 brothers deceased-one of cad ? illicit drug use, others from alcohol abuse. physical exam: admission exam: gen: well-appearing, well-nourished, no acute distress heent: eomi, perrl 3+/3+, sclera anicteric, no epistaxis or rhinorrhea, mmm, op clear neck: no jvd, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline cor: rrr, no m/g/r, normal s1 s2, radial pulses +2 pulm: lungs ctab. midline sternotomy scar abd: soft, nt, nd, +bs, no hsm, no masses. laparotomy scar. ext: no c/c/e, no palpable cords. marked ll spasticity. neuro: gcs 15/15 alert, oriented to person, place, and time. cn ii ?????? xii normal. considerable spasticity in left side ue and le with less spasticity in r le and ? slight increase tone in r ue. reflexes pathologically brisk in lower limbs esp on l and relatively preserved in rul and difficult to ellicity in lul due to tone. good power rul and +/5 in elbow flexion and extension in lul and minimal movement lul. 3-4/5 power in rll proximally with little distal power due to contractions. plantars flexor bilaterally. sensation seems intact to light touch. skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses. pertinent results: admission labs: 09:10am blood wbc-9.0 rbc-4.06* hgb-12.6 hct-37.1 mcv-91 mch-31.1 mchc-34.0 rdw-13.1 plt ct-356 09:10am blood neuts-82.7* lymphs-10.3* monos-5.5 eos-0.4 baso-1.1 09:10am blood glucose-107* urean-17 creat-0.7 na-142 k-3.8 cl-103 hco3-28 angap-15 09:10am blood calcium-9.5 phos-4.3# mg-2.0 09:13am blood lactate-0.6 . other labs: 09:10am blood ck(cpk)-67 09:10am blood ck-mb-2 ctropnt-<0.01 02:57am blood albumin-3.4* calcium-7.1* phos-2.5*# mg-1.7 09:10am blood crp-27.0* 02:59am blood crp-62.2* 09:13am blood lactate-0.6 08:15am blood lactate-0.9 . . urine: 12:00pm urine color-straw appear-clear sp -1.014 12:00pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-15 bilirub-neg urobiln-neg ph-5.0 leuks-neg 12:00pm urine rbc-0-2 wbc-0-2 bacteri-rare yeast-none epi-0-2 12:00pm urine ucg-negative . . csf: 11:58am cerebrospinal fluid (csf) wbc-1 rbc-0 polys-2 lymphs-54 monos-44 11:57am cerebrospinal fluid (csf) totprot-31 glucose-71 . . microbiology: time taken not noted log-in date/time: 11:59 am csf;spinal fluid #3. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. . 9:40 am influenza a/b by dfa source: nasopharyngeal swab. **final report ** direct influenza a antigen test (final ): negative for influenza a. direct influenza b antigen test (final ): negative for influenza b. . bc x2 pending ucx -ve . 10:18 am sputum source: expectorated. **final report ** gram stain (final ): pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. . bc x2 pending ucx -ve bc pending . 10:39 am rapid respiratory viral screen & culture source: nasopharyngeal aspirate. **final report ** respiratory viral culture (final ): test cancelled, patient credited. refer to respiratory viral antigen screen and respiratory virus identification test results for further information. respiratory viral antigen screen (final ): positive for respiratory viral antigens. specimen screened for: adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. refer to respiratory virus identification for further information. respiratory virus identification (final ): positive for influenza a viral antigen. . 1:30 pm throat culture viral culture (pending): . 4:06 am sputum source: expectorated. **final report ** gram stain (final ): <10 pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. . . radiology: xr chest (pa & lat) study date of 9:51 am findings: lateral view is slightly limited by patient's arm and positioning. there is no focal consolidation, pneumothorax, or pleural effusion. the cardiomediastinal silhouette is unremarkable. note is made of sternal wires and anterior mediastinal surgical clips, which are similar appearing compared to prior. left first and second anterior rib fusion is again noted. impression: no evidence for acute cardiopulmonary process. . xr chest (portable ap) study date of 2:44 pm findings: the left base is obscured by the patient's left upper extremity. within these limitations, the lungs are clear. there are no pleural effusions or pneumothorax. the patient is status post right internal jugular central venous catheter placement with tip terminating within the cavoatrial junction. there is no evidence of pneumothorax. there are no pleural effusions. the cardiomediastinal and hilar contours are normal. the patient is status post median sternotomy. impression: right internal jugular approach central venous catheter in standard position with no evidence of pneumothorax. . chest (portable ap) study date of 6:22 am portable ap chest radiograph was compared to prior study . large consolidation in the left lower lobe is noted as well as bilateral perihilar interstitial opacities and left mid upper lobe consolidation. these findings are consistent with aspiration and newly developed interstitial edema. . xr chest (portable ap) study date of 5:23 am impression: ap chest compared to through 20: previous mild pulmonary edema, in the right lung, has improved. extensive consolidation in the left lung has also decreased, consistent with stabilizing pneumonia. previous small pleural effusions have decreased or resolved. heart size is normal. the leftward shift of the mediastinum suggests a component of atelectasis in the left lung perhaps due to retention of aspirated material. no pneumothorax. right jugular line ends in the low svc. . . cardiology: ecg study date of 4:05:06 pm artifact is present. sinus rhythm with sinus arrhythmia. non-specific st-t wave changes. compared to the previous tracing of st-t wave changes are more prominent. read by: , h. intervals axes rate pr qrs qt/qtc p qrs t 70 156 76 428/445 73 82 32 brief hospital course: 49-year-old female with a history of tbi with splenectomy and sternotomy post chest stabbing presents with a day history of fever, headache, cough and general malaise consistent with viral exanthem. she appeared well other than bp which dropped to 70s-80s in ed and required inotropic support with noradrenaline. she had very high fevers compatible with a viral infection and although initial swab was negative, she was confirmed influenza by np swab. she had pulmonary edema and possible aspiration on cxr and antibiotics were stopped and she improved. she was weaned off pressors and was transferred from the icu on with improved cxr appearances and stable vitals. . . plan: # influenza a with possible aspiration event vs influenza pneumonia: she presented with symptoms suggestive of viral exanthema in addition to normal wbcs mild crp elevation and high fevers >104 which would not be compatible with a bacterial infection and during these she was not overly unwell. she initially required pressor support in the ed and was hypotensive requiring norepinephrine and iv fluids receiving 6l in the ed. given her headache she was worked up for possible meningitis with a negative csf with no growth on culture. her headache resolved. cultures showed no growth to date. she continued to have high fevers and although initial influenza swab was negative, repeat on was positive. she was initialy treated with iov ceftrioaxone to cover possible pneumococcal infection given asplenia. she was initially treated with respiratory precautions and following confirmation of influenza a these were re-instated. she had an episode of vomiting on without clear evidence of aspiration (her swallow has always been fine) and by had a high fever 104.5 and she desaturated to 90% on 3l o2. she received 2l iv fluid and had developed interval chest signs on the left base with reciprocal changes on her chest xr suggestive of aspiration and pulmonary edema. she was allowed to auto-diurese and antibiotics were briefly continued and these were stopped on . her crp was initially 27 and ahad risen to 66 on likely secondary to her possible aspiration vs development of influenza pneumonia. she remained well and her fevers lessened in severity. her blood pressure remained stable off pressors and her saturations improved with evidence of improvement in pulmonary edema and consolidation on repeat cxr on and she was stable to tranfer to the floor on . the patient was transferred to the floor and monitored for 36 hours. she remained afebrile on no antibiotics and her respiratory and bp status was also stable. she was discharged on with intruction to follow up with her pcp 1 week of being discharged. . # volume status. exam had elevated jvp and evidence of pulmonary edema on cxr on which was likely secondary to her 8l of total fluid resuscitation. she had a tte on which was unremarkable and was allowed to auto-diurese. at the time of discharge she was euvolemic. . # deranged lfts: ? cause. lfts were already uptrending in the community and were stable in-house. in the community there was thought to be due to her baclofen and the dose of this had been reduced. these were trended after her baclofen was reduced to 10mg po bid. her lfts trended down after this reduction and she was discharged on baclofen 10mg po bid. . # elevated ptt: it was unclear regarding her ptt which rose during her hspital stay while being normal on admission rose to 78 and latterly to 150 and fell to 56. due to concerns that her s/c heparin may be causing this, her heparin was stopped. we checked check antiphopholipid ab: lupus anticoagulant and anticardiolipin ab and they are all negative. it is recommended to get a mixing study in the outpatient setting. . # headache: headache was viral in origin secondary to influenza a as above and resolved withketorolac and required no further analgesia. her headache resolved as the course of her hospital stay progressed. at the time of discharge, she did not have any headache. . # s/p mva c/b closed head injury and left hemiplegia: no current change to residual neurologocal deficit. we continued baclofen at decreased dose. this was not an active issue duringher hospitalization. . # s/p splenectomy: at risk for infection with encapsulated organisms. she was initially treated with iv ceftriaxone and this was stopped when cultures came back negative after 48 hours. she should have pneumococcal and meningococcal vaccines in teh community. . # anxiety: we continued home lorazepam. this was not an active issue. . # depression: we continued home trazodone and citalopram. this was not an active issue . # hyperlipidemia: we continued home simvastatin. this was not an active issue. medications on admission: medications - prescription baclofen - (prescribed by other provider) - 10 mg tablet - 1 tablet(s) by mouth in am, 1 at noon and 2 at bedtime citalopram - (prescribed by other provider) - 40 mg tablet - 1 tablet(s) by mouth daily lorazepam - 0.5 mg tablet - tablet(s) by mouth every twelve (12) hours as needed for as needed for anxiety simvastatin - 40 mg tablet - 1 tablet by mouth once a day at bedtime trazodone - (prescribed by other provider) - 100 mg tablet - 1 tablet(s) by mouth at bedtime medications - otc bisacodyl - (prescribed by other provider) - 10 mg suppository - 1 suppository(s) rectally once a day calcium carbonate-vitamin d3 - (prescribed by other provider) - 600 mg-400 unit tablet - 1 tablet(s) by mouth twice a day docusate sodium - (prescribed by other provider) - 100 mg capsule - 1 capsule(s) by mouth twice a day senna - (prescribed by other provider) - 8.6 mg tablet - 1 tablet(s) by mouth twice a day sennosides - (prescribed by other provider) - 8.6 mg tablet - 1 tablet(s) by mouth in am 1 at noon discharge medications: 1. baclofen 10 mg tablet sig: one (1) tablet po bid (2 times a day). 2. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 3. lorazepam 0.5 mg tablet sig: 1-2 tablets po q12h (every 12 hours) as needed for anxiety. disp:*12 tablet(s)* refills:*0* 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. trazodone 50 mg tablet sig: two (2) tablet po hs (at bedtime). 6. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily). 7. calcium 500 + d (d3) 500-125 mg-unit tablet sig: one (1) tablet po once a day. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 10. sennosides 8.6 mg tablet sig: one (1) tablet po once a day: at noon. discharge disposition: home discharge diagnosis: primary diagnosis: influenza . secondary diagnosis: - anxiety - depression - hyperlipidemia - mva c/b closed head injury and left hemiplegia () and spasticity for which she receives botox injections - wheelchair bound -multiple stab wounds to the chest and ?lobectomy; sternotomy; in - s/p splenectomy 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 are being discharged from . it was a pleasure taking care of you. you were admitted to the hospital and it was found that you had very low blood pressure and you were admitted to the intensive care unit for blood pressure support and work up for an infection. we ultimately found that you had the flu. there was some concern that you had a pneumonia, but after following you for some time, we do not believe that you had a pneumonia and the antibiotics were discontinued. you will go home on your home medications and it is encouraged that you follow up with your primary care physician 1 week. it is important to make sure that you get your pneumococcal and meningococcal vaccines as an outpatient. there was some concern that your baclofen was causing your liver labs to rise a little and so your baclofen dose was decreased. please continue the dose as now prescribed. . the following medication was changed: baclofen --> 10mg by mouth twice a day. . please continue to take your other medications as prescribed. followup instructions: please call your pcp, . , on monday and make an appt to see him within 1 week. . please have your doctor check your lfts to make sure they are still going down. procedure: spinal tap incision of lung diagnoses: abnormal coagulation profile dysthymic disorder hypotension, unspecified pneumonitis due to inhalation of food or vomitus other acquired absence of organ headache hypovolemia influenza with other respiratory manifestations nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] late effects of motor vehicle accident other fluid overload late effect of intracranial injury without mention of skull fracture spastic hemiplegia and hemiparesis affecting unspecified side wheelchair dependence 

Answer: The patient is high likely exposed to