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: history of present illness: the patient is a 52-year-old female who has a history of metastatic breast cancer who was started on decadron on after starting stereotactic radiation therapy to the midbrain for a 7-mm metastasis as well as gemcitabine treatment. the patient had her last radiation treatment prior to admission. she reported to the hematology/ clinic on in order to receive her gemcitabine; however, she felt weak and had a fever at that time to 101.7. therefore, her chemotherapy was held. she was cultured and sent home. the patient continued to feel weak and had chills and shakes overnight, and therefore she called her oncologist who instructed her to report to the emergency department for a fever workup. the patient has had a recent sinus infection which was treated with augmentin; the course ended on . the patient denied any nausea, vomiting, urinary symptoms, diarrhea, cough, and shortness of breath. the patient did have fever, chills, and night sweats. she was lightheaded and weak. she also had a few episodes of epistaxis. she has had some nasal congestion which has been improving over the past two weeks after being stated on augmentin. the patient's port-a-cath in the left chest was without any erythema. there was no evidence of skin breakdown. the patient has noted increasing proximal muscle weakness over the past few weeks after being started on the decadron. in the emergency department the patient was pan-cultured and started on levaquin 500 mg p.o. past medical history: breast cancer diagnosed in . she was treated with mastectomy and radiation therapy as well as chemotherapy at the time of diagnosis. her cancer then recurred in , and she was treated with the stamp protocol bmt. in she was found to have a new left breast cancer (her original primary was in the right breast). she had eight positive lymph nodes that were estrogen-receptor positive. she was treated with herceptin and navelbine at that time. in she began to suffer from blurry vision. she had a head ct which showed multiple brain metastases. therefore, she was treated with wbxrt. she had a follow-up mri done on which showed residual brain metastases. she therefore was started on decadron and underwent stereotactic radiation therapy as previously described. medications on admission: 1. decadron 4 mg p.o. b.i.d. 2. fosamax 10 mg p.o. q.d. 3. senna p.r.n. 4. miacalcin 1 spray q.d. 5. tylenol p.r.n. 6. neurontin 300 mg p.o. q.h.s. p.r.n. allergies: the patient has an allergy to ciprofloxacin which causes a rash. she also has an allergy to tetanus horse serum which causes dystonia. it should be noted that the patient has tolerated her levaquin without any incidence of rash. family history: the patient's mother died of chronic obstructive pulmonary disease and alzheimer's disease. her father died of pancreatic cancer. she has four sisters who all had breast cancer. social history: the patient denies tobacco use. she drinks alcohol occasionally. she lives at home with her husband and her son. son is adopted, as the patient has infertility. physical examination on presentation: vital signs showed a temperature of 98.8 (down from 101 in the emergency department), pulse of 108, blood pressure of 90/54, respiratory rate of 20. in general, the patient was a thin woman with mild cushingoid features, somewhat restless. head, ears, nose, eyes and throat showed pupils were equal, round, and reactive to light. extraocular movements were intact. the mucous membranes were moist and pink. the neck had no lymphadenopathy. there was no jugular venous distention. the carotids were 2+ bilaterally. the heart had a 2/6 systolic ejection murmur heard best at the left upper sternal border. heart had a regular rate and rhythm. the lungs were clear to auscultation bilaterally. the chest had a hickman on the left. the site was clean, dry, and intact. it was nontender. the abdomen was soft, nontender, and nondistended. there was mild diffuse discomfort with pressure. the extremities were without clubbing, cyanosis or edema. the neurologic examination showed the patient to be alert and oriented times three. cranial nerves ii through xii were intact. motor examination was notable for some weakness in the triceps and hamstrings at a level of . her reflexes were 2+ and symmetric throughout. coordination was intact. the patient complained of mild double vision which was unchanged from her previous status. laboratory data on presentation: laboratories on admission showed a white blood cell count of 5.4, with a differential of 69% neutrophils, 20% bands, 6% lymphocytes, hematocrit of 26.2, platelets of 42. sodium of 135, potassium of 3.6, chloride of 98, bicarbonate of 27, blood urea nitrogen 26, creatinine 1.1, glucose 95. pt 12.2, inr 1, ptt 26.3. urinalysis was positive only for minimal protein. on microscopic examination there were no red blood cells, there were 0 to 2 white blood cells, occasional bacteria with 3 to 5 epithelial cells. blood cultures and urine cultures were obtained at the time of admission. the blood cultures from the day prior to admission showed no growth to date. a urine culture from the day prior to admission was negative. radiology/imaging: chest x-ray on admission showed the left subclavian central line to be in good position. there were no consolidations or pneumothorax. there was resolution of bilateral pleural effusions compared with previous examination. there was diffuse osteopenia. hospital course: the patient was admitted to the o-med service for further evaluation and treatment of her fever. at the time of admission the patient was felt most likely to have a possible sinus or abdominal source of infection. her line looked good. therefore, she was continued on levaquin empirically, and her cultures were followed. she had no real localizing symptoms of infection on admission. on the day following admission, the patient was noted to have bronchial irritability with persistent coughing with deep inspirations. she also then stated she had a dry cough at home for a couple of days prior to admission. at that point, a room air saturation was obtained and was found to be in the low 80s. it increased to 93 with deep inspiration. on ambulation the patient was found to again desaturate into the low 80s. a chest ct was obtained to look for possible infiltrates which could not be appreciated on chest x-ray, being most concerned with possible pneumocystis carinii pneumonia given the patient's previous steroid treatment and recent tapering of her steroids. the chest ct showed diffuse ground-glass opacities which were consistent with possible opportunistic infection. her ldh was measured which also was elevated in the 700s. therefore, based on the clinical findings the patient was felt to likely have pneumocystis carinii pneumonia. an induced sputum was attempted but was unable to be obtained. the patient was started on intravenous bactrim on the second hospital day, and she was continued on levaquin for empiric coverage of other community-acquired infections. on the third hospital day the patient was feeling well in the morning but was progressively requiring more oxygen throughout the day. on the fourth hospital day the patient desaturated into the 80s. she was requiring oxygen by face mask at that point. she was becoming more tachypneic and appearing much more uncomfortable. a repeat chest x-ray at that time showed bilateral alveolar infiltrates which were new compared with the three days prior. an arterial blood gas done on 35% face mask showed a ph of 7.47, pco2 of 29, and po2 of 50. the patient was transferred to the unit at that time as it was felt that she had rapidly progressive pneumocystis carinii pneumonia and was at risk for possible intubation. she remained in the unit for two days and received cpap while there. she was transferred back out to the floor on 70% face mask satting in the 90% range. she was looking more comfortable at that time. she also had been started on prednisone for her pneumocystis carinii pneumonia the day she had been transferred to the intensive care unit at a dose of 40 mg p.o. b.i.d. to be given for five days. after coming back to the floor the patient continued to require 70% oxygen by face mask, and she did not improve as quickly as would be expected. a repeat chest x-ray was obtained three days after being transferred out to the floor, and she was found to have a 30% pneumothorax in the left lung likely secondary to underlying pneumocystis carinii pneumonia as well as positive pressure ventilation in the unit. she had a chest tube placed on . she continued with the chest tube which resolved the pneumothorax nicely. the chest tube continued to have an intermittent air leak, however. by the patient was satting in the middle 90s on 2 liters to 3 liters nasal cannula. therefore, her bactrim was switched from intravenous to p.o. by the chest tube was without air leak. therefore, the pulmonary team pleurodeses the left lung. at the time of this dictation, on , the patient was still with a small apical residual pneumothorax on the left. she again had an air leak in her chest tube. she was satting at 90% on room air and 93% to 95% on 2 liters. she was breathing much more comfortably and had begun working with physical therapy. she has finished her levaquin course of 14 days today (on ). she is on day 13 of 21 of bactrim. her prednisone has been tapered to 20 mg p.o. q.d. today. the patient will continue with her chest tube to suction until it is again without an air leak, at which time she may possibly have the chest tube pulled. the patient's only other active medical problem while she has been an inpatient has included a low sodium level. it had first been noticed when she was in the intensive care unit. it was felt to be most likely secondary to syndrome of inappropriate secretion of antidiuretic hormone, although adrenal insufficiency secondary to long-term glucocorticoid use was also a possibility. urine electrolytes were pending. medications on discharge: (will be dictated in a future addendum when the patient is discharged) discharge followup: (will be dictated in a future addendum when the patient is discharged). discharge status: she will most likely will require a rehabilitation as she has become deconditioned during her hospitalization. , m.d. dictated by: medquist36 d: 17:46 t: 18:11 job#: procedure: other incision of pleura injection into thoracic cavity intermittent positive pressure breathing [ippb] diagnoses: personal history of malignant neoplasm of breast bone marrow replaced by transplant secondary malignant neoplasm of brain and spinal cord pneumocystosis other disorders of neurohypophysis disorder of bone and cartilage, unspecified cushing's syndrome 

Answer: The patient is high likely exposed to