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: shortness of breath, increasing oxygen requirement major surgical or invasive procedure: none history of present illness: 67 y/o female with metastatic breast ca (mets to liver, lung, and possibly cavernus sinus) on ongoing weekly paclitaxel, presented with persistent fevers. on patient began her cycle 2 day 1 of paclitaxel. on that day she was found to have a fever of 100.9. her only symptom was generalized achiness. at that time cxr was negative, as were blood cultures. her urinalysis showed 6 wbcs and few bacteria. she was treated empirically with ciprofloxacin for a possible uti x 1 week. . fevers continued with development of uri symptoms, myalgias, non-productive cough. she was admitted to on . cxr on showed no acute cardiopulmonary process. cxr on showed mild asymmetry in the upper zones with some suggested increased opacification on the right. . of note, her wbc has trended down to 1.6 in setting of recent chemotherapy and reaching nadir. vancomycin, cefepime, and azithromycin were started on . . on the floor, patient triggered twice for increased respiratory rate into the high 20s and low 30s. her oxygen requirement has risen from 98% on 2l nc to 88-90% on l nc overnight. her abg was 7.43/40/62 on 5l nc. cta is read as atypical infiltrate versus diffuse lymphangitic carcinomatosis resulting in congestion of the lung parenchyma. oseltamivir 75 mg po/ng was added on , id was consulted, and icu admission was requested for increasing oxygen requirement and request for bronchoscopy with biopsy - question is whether this pulmonary process is indeed lymphomatous spread or simply atypical infection. . of note, patient has been on intermittent decadron doses since cyperknife treatment (last dose 5 days ago). . prior to transfer, patient was hemodynamically stable. o2 reported as 80% on 4l nc and 90% on 6l nc. . on arrival to the icu the patient reported that she was working somewhat more than usual to breath. she denied pain anywhere or any other complaints. past medical history: # metastatic breast cancer: - : a mass was found in her left breast on mammogram - : lumpectomy. pathology showed invasive ductal carcinoma, er positive but her2 negative. - : received chest irradiation followed by adjuvant endocrine therapy on protocol ma27 with exemestine. she continued on exemestine until when a chest x-ray showed a 4 mm mass in her left lung and biopsy by dr. showed metastatic breast carcinoma. - : received capecitabine - : chemotherapy was switched to liposomal doxorubicin because of progressive lung metastases. she continued on liposomal doxorubicin until she again had progressive disease and was started on paclitaxel. - : pet showed fdg-avid disease in her lungs and possbily the liver. - early : she experienced increased, but mild, headache frequency. she experienced blurry vision in os that lasted for seconds upon awakening in a.m. mri showed meckel's cave enhancing mass. this was felt to be possible brain met vs. unresectable meningioma. she was treated with cyberknife which she completed on . she was on dexamethasone during her cyberknife treatments. . other medical history: hypertension hypercholesterolemia tah-bso for fibroids. social history: retired. smoked less than 1 pack of cigarettes per day for 10 years before quitting in . zero to 3 alcoholic drinks per week. no illicit drugs family history: her mother has hypertension and hypercholesterolemia. her father died at age 81 from pancreatic cancer. brothers have hypertension and hypercholesterolemia. daughter had allograft after resection of a right radius giant cell tumor. physical exam: gen: alert in nad heent: eomi, perrl, neck supple, mmm, no thrush/exudate lung: fine right sided crackles, no wheezes or rhonchi cv: rrr, s1+s2, no m/r/g abd: +bs, nt/nd ext: no edema, no rash, 2+ pedal pulses neuro: cn ii-xii without focal deficit pertinent results: hematology 06:20am blood wbc-5.7 rbc-2.70* hgb-9.1* hct-26.6* mcv-98 mch-33.7* mchc-34.3 rdw-17.2* plt ct-179 06:00am blood wbc-5.0 rbc-2.16* hgb-7.5* hct-22.3* mcv-103* mch-34.4* mchc-33.4 rdw-16.0* plt ct-172 05:55am blood wbc-3.4*# rbc-2.17* hgb-7.4* hct-22.0* mcv-101* mch-34.1* mchc-33.7 rdw-15.2 plt ct-147* 03:24am blood wbc-1.7* rbc-2.30* hgb-8.2* hct-23.1* mcv-101* mch-35.7* mchc-35.5* rdw-15.9* plt ct-141* 06:40am blood wbc-1.6* rbc-2.38* hgb-8.3* hct-24.0* mcv-101* mch-34.9* mchc-34.6 rdw-14.9 plt ct-132* 09:00pm blood wbc-1.8* rbc-2.54* hgb-8.8* hct-25.4* mcv-100* mch-34.5* mchc-34.4 rdw-15.2 plt ct-161# 06:05am blood wbc-1.4* rbc-2.31* hgb-8.1* hct-23.1* mcv-100* mch-34.9* mchc-34.9 rdw-15.1 plt ct-106* 06:00pm blood wbc-1.6* rbc-2.49* hgb-9.1* hct-25.1* mcv-101* mch-36.4* mchc-36.1* rdw-16.6* plt ct-146* 12:15pm blood wbc-2.3* rbc-2.78* hgb-9.7* hct-27.2* mcv-98 mch-35.0* mchc-35.8* rdw-14.8 plt ct-169 06:00am blood neuts-79.7* lymphs-13.1* monos-6.8 eos-0 baso-0.3 06:40am blood neuts-60 bands-6* lymphs-26 monos-6 eos-0 baso-0 atyps-0 metas-2* myelos-0 nrbc-2* 06:00am blood pt-13.7* ptt-27.8 inr(pt)-1.2* 05:55am blood pt-13.6* ptt-23.7 inr(pt)-1.2* 05:55am blood gran ct-2830 03:24am blood gran ct-1450* 06:05am blood gran ct-1000* 12:15pm blood gran ct-1730* chemistries: 06:20am blood glucose-112* urean-21* creat-0.9 na-136 k-5.2* cl-103 hco3-25 angap-13 10:55am blood na-135 k-4.8 cl-101 06:00am blood glucose-124* urean-18 creat-0.8 na-138 k-4.6 cl-106 hco3-22 angap-15 05:55am blood glucose-184* urean-15 creat-0.6 na-137 k-4.0 cl-105 hco3-22 angap-14 03:24am blood glucose-193* urean-13 creat-0.6 na-137 k-3.8 cl-105 hco3-24 angap-12 06:40am blood glucose-113* urean-10 creat-0.6 na-136 k-3.4 cl-102 hco3-27 angap-10 06:05am blood glucose-114* urean-10 creat-0.6 na-137 k-4.0 cl-103 hco3-26 angap-12 06:00am blood alt-82* ast-44* ld(ldh)-571* alkphos-55 totbili-0.4 05:55am blood alt-85* ast-61* ld(ldh)-602* alkphos-54 totbili-0.4 03:24am blood alt-84* ast-77* ld(ldh)-625* alkphos-59 totbili-0.4 06:40am blood alt-61* ast-59* ld(ldh)-521* alkphos-53 totbili-0.6 09:00pm blood alt-67* ast-69* ld(ldh)-570* alkphos-62 totbili-0.6 06:20am blood calcium-8.5 phos-4.3 mg-2.4 06:00am blood albumin-3.0* calcium-8.3* phos-3.5 mg-2.4 05:55am blood albumin-3.0* calcium-8.0* phos-2.9 mg-2.2 03:24am blood calcium-7.4* phos-2.9 mg-2.1 06:40am blood albumin-2.9* calcium-7.9* phos-2.6* mg-2.0 09:00pm blood albumin-3.2* calcium-8.1* phos-2.0* mg-2.0 06:05am blood calcium-7.9* phos-2.5* mg-2.0 09:41am blood vitb12-greater th folate-15.2 01:40pm blood cea-7.9* 05:42pm blood vanco-18.3 07:54am blood vanco-8.0* 09:08am blood type-art tidal v-5 fio2-100 po2-62* pco2-40 ph-7.43 caltco2-27 base xs-1 aado2-628 req o2-100 micro: bcx , , , : neg ucx , : coag+ staph (mrsa) ucx : neg legionella ag: neg crypto ag: neg vaginal swab: neg for yeast cmv viral load: neg induced sputum : 1+ organisms c/w op flora, res cx: pnd, pcp: anc: 2830 galactomanin/beta glucan: neg imaging: echo the left atrium is dilated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). doppler parameters are indeterminate for left ventricular diastolic function. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. no masses or vegetations are seen on the aortic valve. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. no mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: normal global and regional biventricular systolic function. indeterminate diastolic indices. no endocarditis, abscess or significant valvular regurgitation seen cta : 1. no pulmonary embolus or acute aortic abnormality. 2. diffuse lymphangitic carcinomatosis, with resulting widespread ground-glass opacities indicating parenchymal congestion (reflecting non-cardiogenic edema). 3. grossly unchanged innumerable pulmonary nodules compatible with metastases. cxr : impression: no evidence of pulmonary abnormalities to suggest the cause of the patient's ongoing fever. no acute cardiopulmonary process. cxr : findings: in comparison with the study of , there is little overall change. there is, however, mild asymmetry in the upper zones with some suggested increased opacification on the right. this could conceivably be a developing area of consolidation. mild indistinctness of pulmonary vessels raises the possibility of mild elevation in pulmonary venous pressure. brief hospital course: # hypoxia ?????? on admission, patient had oxygen saturations in mid-90s on 6l nc. ct showed diffuse lymphangitic carcinomatosis resulting in congestion of the lung parenchyma which was thought to the be the cause of her hypoxia. infectious etiology was considered and she was treated with bactrim 2ds q8h for empiric pcp treatment, azithromycin 5 days and prednisone. she was also intitially treated with cefepime for broad coverage, which was stopped once she improved clinically. by discharge, she no longer required with oxygen supplementation. # uti: have been the source of her fevers. two urine cultures grew staph aureus. she was treated with iv vancomycin, which will be continued as outpatient via picc line. echo was done and was negative for cardiac vegetation. # metastatic breast cancer: most recent paclitaxel dose was on . cea elevated at 7.9 up from 4.9 last month. further treatment per outpatient oncology. # elevated lfts - elevated on admission. were normal 1 month prior when last checked. have been secondary to liver metastases vs. infectious process vs secondary to steroids. cmv was negative. # hypertension: stable. continued on atenolol 50 mg daily and lisinopril 5 mg daily. # gerd: continued on ppi. # hypothyroidism: continued on levothyroxine 75 mcg daily. # hyperlipidemia: continued on simvastatin 20 mg daily. medications on admission: atenolol 50 mg daily chlorhexidine mouthwash ciprofloxacin 500 mg esomeprazole 40 mg ibandronate 150 mg monthly levothyroxine 75 mcg daily lisinopril 5 mg daily lorazepam 0.5-1 mg q6h prn nausea, insomnia simvastatin 20 mg daily aspirin 81 mg daily calcium-vitamin d3 630 mg-400 units daily cholecalciferol 1000 units daily mvi omega-3 fatty acids discharge medications: 1. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 2. vancomycin 500 mg recon soln sig: 1250 (1250) mg intravenous q 12h (every 12 hours) for 10 days: stop . disp:*20 recon soln(s)* refills:*0* 3. esomeprazole magnesium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 4. ibandronate oral 5. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 6. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 7. lorazepam 0.5 mg tablet sig: 1-2 tablets po every six (6) hours as needed for nausea, anxiety. 8. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. multivitamin oral 11. omega-3 fatty acids oral 12. chlorhexidine gluconate 0.12 % mouthwash mucous membrane 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*30 tablet(s)* refills:*0* 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 15. prednisone 20 mg tablet sig: see below tablet po see below for 17 days: take 2 tabs twice a day until for 1.5 days. starting take 2 tabs once a day for 5 days. then starting take 1 tab once a day for 11 days (stop ). disp:*27 tablet(s)* refills:*0* 16. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: two (2) tablet po q 8h (every 8 hours) for 18 days: until . disp:*108 tablet(s)* refills:*0* 17. miconazole nitrate 2 % cream sig: one (1) appl vaginal hs (at bedtime) for 7 days: (stop ). 18. calcium 600 + d(3) oral 19. cholecalciferol (vitamin d3) oral discharge disposition: home with service facility: home solutions discharge diagnosis: primary: lymphangetic carinomatosis, urinary tract infection secondary: metastatic breast cancer discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure taking part in your care. you were admitted to the hospital with persistent fevers. you were found to have a urinary tract infection. you were treated with intravenous antibiotics. you will continue to take antibiotics after discharge. the instructions are: -vancomycin 1250 mg iv infusion twice a day until you also had difficulty breathing. this was thought to be caused by an infection. you improved with steroids and antibiotics. we got a repeat ct scan which showed that you had spread of your cancer in your lungs. this may have contributed to your shortness of breath. the following changes were made to your medications: -started vancomycin 1250 mg intravenous twice a day until -started bactrim ds 2 tabs every 8 hours until . after you finish this prescroption you will need to be on bactrim for prophylaxis for pcp. prednisone taper- until -started miconazole vaginal cream- until -started senna 1 tab twice a day as needed for constipation -started colace twice a day to prevent constipation followup instructions: you may need to follow-up with the infectious disease clinic. the number to call is: (. please keep the following appointments: department: radiology when: monday at 9:55 am with: radiology mri building: campus: east best parking: garage department: neurology when: monday at 11:30 am with: , md building: campus: east best parking: garage department: hematology/oncology when: tuesday at 10:30 am with: , np building: campus: east best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: esophageal reflux malignant neoplasm of liver, secondary urinary tract infection, site not specified unspecified essential hypertension unspecified acquired hypothyroidism personal history of malignant neoplasm of breast other and unspecified hyperlipidemia acute respiratory failure secondary malignant neoplasm of brain and spinal cord pneumocystosis methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site secondary malignant neoplasm of lung pulmonary congestion and hypostasis secondary and unspecified malignant neoplasm of intrathoracic lymph nodes 

Answer: The patient is high likely exposed to