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: nsaids / bactrim ds attending: chief complaint: fevers, chills major surgical or invasive procedure: none history of present illness: 56 yo f with bronchiectasis, chronic sinusitis, asthma, acquired immunodeficiency, presents with fevers, chills, cough and new rll pneumonia. the patient was on cipro for chronic sinusitis for 3 months with improvement in her symptoms until when she developed recurrence of right sinus symptoms. her sinus cultures grew mrsa, but was not started on abx because it was thought to be colonization and not an acute infection. she was seen by ent, dr. , yesterday and found to have sinusitis with cultures taken. she was given a ex for gentamicin rinses, but had not started the treatment. overnight the patient developed fevers, chills, and worsening productive cough. she presented to her pcp, . , today and found to have a temperature of 102.2, hr: 125 130/75 and 98% on room air. her peak flow was 350 (baseline >400). a cxr was performed that showed a rll pneumonia. a sputum cx was taken as well as legionella. she was sent to the ed for further treatment. . in the ed, initial vs were: t101.5 p110 bp109/65 r16 o2 sat 97%ra. patient was given vanco/ctx on direction from outpatient team. cxr read as rll pneumonia. patient planned for admission to floor but became hypotensive in the ed with sbp in the 80's. patient was given 2l ns, and was redirected to the icu for further care. prior to transfer she dropped bp's to 70's, and had r-ij placed. received 4 additional liters of fluid with sbp remaining low. started on leveophed for bp support. abx broadened with levofloxacin. . last vs were sbp 91/56, hr 90's, o2 97% 2lnc. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: -chronic bronchiectasis -asthma -immunodeficiency (igg) -osteopenia -depression -gerd and nsaid induced gastritis -nephrolithiasis -etoh abuse in past - now abstains completely -s/p tah/bso for endometriosis social history: - tobacco: h/o tobacco use - alcohol: abstains, h/o etoh abuse - illicits: denies family history: niddm, and cad physical exam: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs on admission: 08:10pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-15 bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 08:10pm urine color-yellow appear-clear sp -1.015 08:10pm plt count-255 08:10pm neuts-88.0* lymphs-7.7* monos-3.5 eos-0.2 basos-0.7 08:10pm wbc-6.7 rbc-4.17* hgb-12.4 hct-35.5* mcv-85 mch-29.7 mchc-34.9 rdw-13.1 08:10pm urine gr hold-hold 08:10pm urine ucg-negative 08:10pm urine hours-random 08:10pm urine hours-random 08:10pm cortisol-50.3* 08:10pm calcium-9.1 phosphate-2.3* magnesium-1.6 08:10pm estgfr-using this 08:10pm glucose-127* urea n-16 creat-0.9 sodium-138 potassium-3.3 chloride-102 total co2-23 anion gap-16 08:20pm lactate-1.8 10:53pm lactate-1.1 images/studies: ecg : sinus rhythm. low qrs voltage. diffuse low amplitude t wave changes with prolonged qtc interval. findings are non-specific but clinical correlation is suggested for possible drug/electrolyte/metabolic effect. compared to the previous tracing of sinus bradycardia is absent and findings as outlined are now seen. cxr : chest, pa and lateral: new airspace opacities are seen in the posterior basal segment of the right lower lobe, silhouetting the right hemidiaphragm. a small parapneumonic effusion is likely present. the left lung is clear. the cardiomediastinal and hilar contours are normal. impression: new right lower lobe pneumonia. ecg : sinus rhythm. low qrs voltage. diffuse low t wave amplitude with prolonged qtc interval. findings are non-specific but clinical correlation is suggested for drug/electrolyte/metabolic effect. since the previous tracing of there is probably no significant change. cxr : findings: as compared to the previous radiograph, the right internal jugular vein access line has been placed. the tip of the line projects over the mid svc. the course of the line is unremarkable. there is no evidence of complications, notably no evidence of pneumothorax. the pre-existing right basal pneumonia is slightly more extensive than on the previous image. newly appeared are subtle, but similar changes at the left lung base. close radiographic monitoring is required. chest ct with contrast : findings: multifocal consolidation is worst in the lower lobes bilaterally and is also in the right upper lobe to a lesser extent and is in areas affected by moderate bronchiectasis, best seen on the previous study. small bilateral pleural effusions with atelectasis in the lower lobes are also present. the central, mediastinal, and hilar lymph nodes are pathologically enlarged up to 14 mm in the right hilum and 11 mm in the subcarinal region, most likely reactive. central airways are widely patent. the aorta, pulmonary artery, and heart size are normal with no pericardial effusion. this examination was not designed for subdiaphragmatic evaluation except to note a moderately distended gallbladder which does not appear thickened, although there is mild surrounding pericholecystic fluid. impression: multifocal pneumonia. small bilateral pleural effusions with adjacent atelectasis. multiple enlarged central, hilar, and mediastinal lymph nodes are most likely reactive, but follow-up ct imaging could be considered in 3 to 6 months to document resolution if warranted clinically. ct sinuses : findings: the patient is status post bilateral total ethmoidectomies and bilateral middle meatal antrostomies. there is mild mucosal thickening within the bilateral maxillary sinuses which is significantly improved compared to the prior study. small bilateral air-fluid levels are also identified. there is partial opacification within the residual bilateral ethmoid air cells and within the frontal ethmoid recess. the frontal and sphenoid sinuses are clear. the bilateral mastoid air cells and middle ear cavities are normal in appearance. the nasal septum is intact with a tiny left-sided nasal spur. the anterior skull base and lamina papyracea are intact. the visualized brain parenchyma is unremarkable in appearance. impression: status post bilateral total ethmoidectomies and middle meatal antrostomies with mild mucosal thickening and small air-fluid levels noted in the bilateral maxillary sinuses. echocardiogram : the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the estimated cardiac index is high (>4.0l/min/m2). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is high normal. there is a trivial/physiologic pericardial effusion. impression: no valvular pathology or pathologic flow identified. normal biventricular cavity sizes with preserved global and regional biventricular systolic function. cxr : brief hospital course: assessment and plan: 56 y/o f w/ chronic bronchiectasis, asthma, chronic sinusitis p/w pneumonia and sepsis. #. hypotension: this was presumed secondary to septic shock from bilateral pneumonia seen on imaging (as above). treatment was therefore chiefly aimed at addressing the underlying infection (see below). she was initially bolused with several liters of fluid, but pressures remained low. a cortisol level was checked and returned at ~50. she was therefore started on norepinephrine with good response and uop > 100 cc/hr. after 1 day, an attempt was made to wean the patient from pressors, but pressures and uop dipped so she was restarted on norepinephrine. she was successfully weaned on hospital day #2 with sbps in the 100s. cvps were stable in the 8-11 range while on norepinephrine. per patient (a nurse and excellent historian), her usual pressures run sbps in the 120s. she was never markedly tachycardic. once pressures stabilized, she was called out of the micu to the wards. on the floor she had no further issues with hypotension. # respiratory status/pneumonia: the patient was found to have a bilateral pna with effusions on chest imaging. she reported pleuritic chest pain with coughing/breathing. sputum cultures grew moraxella and blood cultures were negative. she was evaluated by the id consult service and treated empirically with zosyn/vanco/cipro. while in the icu, peak flow was measured at 300 (compared with 350 in clinic 1 week prior). she was continued on albuterol, fluticasone and advair for underlying respiratory disease. whilst on the floor pt was transitioned per id recommendations to vancomycin 1gm and ceftriaxone 2grams once a day. whilst on the antibiotics she was told to have her blood checked for lfts every week. # lymphadenopathy: enlarged lymph nodes noted on chest ct. most likely, these are reactive in the setting of infection, but radiology recs suggest consideration of follow up imaging. the patient and her pulmonologist dr. were alerted to this finding. she was recommended to have a cat scan of your chest in months time to check that they have returned back to normal. # immunodeficiency: id consult was called to discuss utility of ivig in this case. they recommended holding off on ivig but did recommend checking a complete immunoglobulin panel with igg subclasses (??? results ???). # sinusitis: treated with iv antibiotics (no topical rinses). she received fluticasone nasal spray. ct of the sinuses showed maxillary involvement as above but # depression: continued home medications. # rt sided pain: pt was noted to have some pain over the right lower lateral chest wall/ruq abdomen. given her elevated alk phos and ?ruq pain she underwent a ruq u/s which showed no biliary disease. pain is likely from her effusion. she was discharged on vicodin for pain control. # gerd: continued on home ppi. medications on admission: recent antibiotics: avelox augmentin bactrim doxycycline avelox avelox cipro ) discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) unit inhalation q6h (every 6 hours) as needed for wheezing/dyspnea. 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation four times a day. 3. citalopram 20 mg tablet sig: 1.5 tablets po daily (daily). 4. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal daily (daily). 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 7. trazodone 50 mg tablet sig: 0.5-1 tablet po hs (at bedtime) as needed for insomnia. 8. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever. 9. guaifenesin 600 mg tablet sustained release sig: two (2) tablet sustained release po bid (2 times a day). 10. multivitamin tablet sig: one (1) tablet po daily (daily). 11. calcium citrate-vitamin d3 315-250 mg-unit tablet sig: two (2) tablet po once a day: with food. 12. sodium chloride 0.65 % aerosol, spray sig: sprays nasal (2 times a day). 13. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: two (2) grams intravenous q24h (every 24 hours) for 13 days: last dose of this antibiotic will be . disp:*26 grams* refills:*0* 14. vancomycin 1,000 mg recon soln sig: one (1) gram intravenous twice a day for 10 days: your last dose of this antibiotic will be . disp:*20 units* refills:*0* 15. sodium chloride 0.9 % 0.9 % solution sig: ml injection every eight (8) hours as needed for line flush. disp:*30 units* refills:*1* 16. heparin flush 10 unit/ml kit sig: ml intravenous once a day as needed for line flush: daily and prn for line flush. disp:*30 kits* refills:*0* 17. hydrocodone-acetaminophen 5-500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 18. outpatient lab work please have your blood checked to monitor your liver function, specifically ast, alt, alk phos on .please have the results faxed attn: dr. , fax number discharge disposition: home with service facility: life care discharge diagnosis: right lower lobe, upper lobe pneumonia bronchiectasis immunodeficiency sinusitis lymphadenopathy depression discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital after experiencing fevers and chills which were found to be due to a pneumonia. you were also noted to have some fluid around your lungs from the infection (pleural effusion). we checked an x-ray which showed this fluid should resolve by itself in several weeks. you were started on 2 intravenous antibiotics for your pneumonia which you will need to continue as an outpatient. whilst on these medications you will need to get your liver function checked, please have your blood drawn to check you ast, alt and alk phos on , these will be followed up by your doctor. your initial chest cat scan showed some large lymph nodes in your chest, as we discussed this is likely due to the pneumonia. however we recommend you undergo a repeat cat scan of your chest in months time to check that they have returned back to normal. as you had some abdominal pain you also received an abdominal ultrasound which showed no evidence of gallbladder stones. you were started on the following new medications: 1. please start vancomycin 1,000mg twice a day intravenously. your last dose of this antibiotic will be 2. please start ceftriaxone 2grams once a day intravenously. your last dose of this antibiotic will be . 3. please take 1-2 tablets of hydrocodone-acetaminophen 5-500mg every 6 hours as needed for pain. this medication will cause drowsiness, please do not take more than 4 grams of acetaminophen over a 24 hour period. we made no other changes to your medications. followup instructions: ** chest ct showed enlarged lymph nodes in your chest. these lymph nodes are most likely enlarged because you have an infection in your lungs, but could also be a sign of other lung disease. dr. and dr. have been made aware of this finding. you should discuss with them at follow up whether you will require repeat chest imaging to evaluate these lymph nodes in the future. department: - adult med when: thursday at 2:00 pm with: , md building: (, ma) campus: off campus best parking: free parking on site department: adult medicine when: wednesday at 1 pm with: , md building: (, ma) campus: off campus best parking: free parking on site department: pulmonary function lab when: wednesday at 3:10 pm with: pulmonary function lab building: campus: east best parking: garage procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnoses: esophageal reflux unspecified pleural effusion severe sepsis other and unspecified alcohol dependence, in remission asthma, unspecified type, unspecified depressive disorder, not elsewhere classified septic shock methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site enlargement of lymph nodes bronchiectasis without acute exacerbation pneumonia due to hemophilus influenzae [h. influenzae] disorder of bone and cartilage, unspecified unspecified sinusitis (chronic) other selective immunoglobulin deficiencies septicemia due to hemophilus influenzae [h. influenzae] 

Answer: The patient is high likely exposed to