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: doxycycline / tetracycline / augmentin attending: chief complaint: shortness of breath, chest pain major surgical or invasive procedure: right heart catheterization history of present illness: ms. is a 44 year-old chinese ( dialect, related to cantonese, history) speaking female who presents for acute onset of shortness of breath and palpitations. she has a complicated pmh: is s/p l pneumonectomy for tuberculosis in that was c/b post-pericardiotomy syndrome; has newly diagnosed pulmonary hypertension, with chronic hypoxia on home 3l o2 and cpap; and a history of breast cancer s/p r mastectomy and chemo in -. she says that she woke up this morning at 0500-0600 and felt a sharp pain over her heart, shortness of breath, sweatiness, ha and blurry vision. she took hot milk and water, and then felt worse, with a heart rate of 180. she says that she felt like she was in "shock". the pain radiated down her arm and into her shoulder and "liver region". not associated with taking deep breaths. she was taken to the ed and arrived around 0745. she says this was similar to her symptoms last week when admitted to , but the intensity of this episode was far greater, especially with regard to her heart rate and sob. she denies cough, fevers, but + chills. she denies any recent sick contacts. night sweats but + diaphoresis. has had 3-4 days of nausea and diarrhea, with 3-4 bowel movements/day (essentially since discharge). she does not feeling generally short of breath for a few months, with decreased appetite over the last 1 month and a 2-lb weight loss. she felt well yesterday. notably, she did present to the ed on with again similar complaints which resolved after oxygen and observation. she did not keep her cardiology appointment on . upon presentation to the ed, her vs were hr 124, and she was 77% on 4l nc. she was put on a nrb and her o2sat improved to 100%. vs prior to transfer were 98.1, hr 103, bp 107/69, rr 28, o2sat 99% on 4l nc. a cxr was done and showed minimal change from . ekg with sinus tachycardia, no significant changes. labs without elevation in wbc, normal lactate, cardiac enzymes normal in ed x 1. . currently she reports feeling at her baseline with no sob or chest discomfort. still feels her heart rate is fast. past medical history: - tuberculosis s/p extrapleural left pneumectomy with mediastinal repositioning and serrated mediastinal flap c/b myopericarditis treated with ibuprofen, c/b pericardial effusion and tamponade - pulmonary hypertension - osa/nocturnal hypoventilation - right-sided stage i breast cancer er/pr neg, her-2/neu negative, diagnosed in --- s/p lumpectomy and sentinel node biopsy in and s/p 4 cycles adriamycin and cytoxan on --- s/p completion mastectomy was done on as radiation would have compromised pulmonary function further ---s/p weeks of taxol c/b neuropathy social history: the patient lives at home with her husband and son. she does not work. she immigrated from in . she denies any tobacco, alcohol, or illicit drug use. family history: her mother's sister was diagnosed with breast cancer at the age of mid-40s. her grandfather had diabetes. no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory physical exam: vs: t 98.6, bp 95/66, hr 102, rr 24, o2sat 98%4l general: thin appearing female in nad. heent: perrl, eomi. conjunctiva pink, no pallor or cyanosis of the oral mucosa. neck: supple, no jvd chest: no chest wall tenderness. s/p r mastectomy with well-healed incision. cardiac: tachycardic, normal s1, split s2 with loud p2. lusb ii/vi systolic murmur, llsb i/vi systolic murmur. no thrills, lifts. no s3 or s4. lungs: transmitted bs in left lung but right lung clear with no crackles, wheezes or rhonchi. abdomen: soft, mild ttp in epigastric area, otherwise nontender, non-distended, no rebound or guarding. +bs. extremities: no le edema. pulses equal, + in both les pertinent results: cbc/diff: 08:25am blood wbc-4.4 rbc-4.06* hgb-10.3* hct-34.9* mcv-86 mch-25.4* mchc-29.6* rdw-14.0 plt ct-222# 07:07am blood wbc-3.5* rbc-4.12* hgb-10.4* hct-35.9* mcv-87 mch-25.2* mchc-28.8* rdw-13.7 plt ct-246 08:25am blood neuts-80.8* lymphs-11.1* monos-7.3 eos-0.5 baso-0.2 . coags: 08:25am blood pt-11.4 ptt-25.3 inr(pt)-0.9 07:07am blood pt-11.1 ptt-27.7 inr(pt)-0.9 . lytes 08:25am blood glucose-125* urean-10 creat-1.0 na-137 k-4.3 cl-95* hco3-36* angap-10 07:07am blood glucose-93 urean-8 creat-0.6 na-139 k-4.7 cl-92* hco3-42* angap-10 07:07am blood calcium-8.9 phos-4.1 mg-1.9 . cardiac enzymes: 08:25am blood ck(cpk)-36 03:20pm blood ck(cpk)-38 08:25am blood ck-mb-notdone ctropnt-<0.01 03:20pm blood ck-mb-notdone ctropnt-<0.01 . abg : 02:43pm blood type-art o2 flow-4 po2-116* pco2-106* ph-7.25* caltco2-49* base xs-14 . echo : the left atrium and right atrium are normal in cavity size. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. the right atrial pressure is indeterminate. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the right ventricular cavity is moderately dilated there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the image quality on the current study is suboptimal. trace aortic regurgitation is now seen. biventricular cavity size and systolic function are similar. the estimated pa systolic pressure is now lower, but may be related to technical quality rather than a true change. intravenous saline contrast injection does not suggest right-to-left shunt. . c. cath : comments: 1. resting hemodynamics revealed moderate pulmonary hypertension, with pa systolic pressure of 70mmhg on room air, with normal to mildly elevated mean pcwp of 13 mmhg. 2. with 100% inhaled oxygen, the pa systolic pressure decreased to 62mmhg from 70mmhg, and mean pa pressure decreased from 45mmhg to 38mmhg, with a decrease in pvr from 730 dynes-s/cm5 to 645 dynes-s/cm5. 3. inhaled nitric oxide caused no significant change in pulmonary pressures or pvr above 100% oxygen. final diagnosis: 1. moderate pulmonary hypertension, responsive to 100% oxygen. .. cxr : as compared to the previous radiograph, there is no relevant change. left post-pneumonectomy chest with typical changes. on the right, massive apical post-infectious, potentially post-tuberculous changes are seen with a retraction of the hilar and apical lung parenchymal structures.in the remaining lung, extensive fibrotic scars are seen. these, however, have not increased in extent as compared to the previous examination. no newly appeared focal parenchymal opacities in the right lung. the pre-existing minimal pleural effusion has completely resolved. brief hospital course: this is a 43 yo f with a history of tuberculosis s/p l pneumonectomy c/b post-pericardiotomy syndrome, pulmonary hypertension, osa, and r stage i breast cancer s/p r mastectomy in presenting with acute onset of shortness of breath, chest pain, tachycardia, and hypoxia. her events during this hospitalization are summarized as below: . # sob/chest pain: patient with long history of hypoxemia and is on home o2 and cpap, although her compliance with the cpap is questionable. her initial o2 sats improved drastically in the ed on the non-rebreather, and she remained stable on 4l by nc on the floor. it was felt that most likely she had some event at home (o2 not on) that led to her presentation. cardiac events were felt unlikely given normal enzymes, unchanged ekg, symptom resolution. she has a history of pulmonary htn, with echo during last admission demonstrating significantly worsening pressures and rv dilation. she had a cxr in the ed without pna although with pleural effusion that has been relatively stable; however she had no cough or clear fevers at home so this was not thought to be a contributing factor. pe was felt to be less likely given a negative cta during the last admission. on the floor, she was continued on o2 by nc. she had no desaturation events overnight. on hd#2, an abg was drawn. this demonstrated severe hypercapnea with a pco2 of 106. patient was asymptomatic. because bipap could not be done on the floor, the patient was then transferred to the micu. . patient was placed on bipap in the icu and pco2 levels only mildly improved. patient was counseled extensively regarding the importance of compliance with bipap. her anxiety was a major obstacle in wearing the bipap mask. patient's ability to tolerate bipap improved with the introduction of ativan 0.25 mg qhs. she was encouraged to wear her supplemental oxygen at all times and to use bipap whenever sleeping or feeling tired. the etiology of patient's significant hypercarbia and hypoxia was unclear. has presumed phtn in the setting of left pneumonectomy. her recent ct chest also showed some evidence of pulmonary edema/effusions. patient reports her symptoms are largely unchanged over the last few months, however, she is requiring frequent hospital admissions. an echo was performed that showed no evidence of shunt. ultimately the decision was made to undergo right heart catheterization to evaluate pulmonary pressures. the catheterization showed decreased pressures with increased oxygen delivery. as a result of the right heart catheterization she was started on sildenafil 20 mg po tid. patient had an episode of increased somnolence and hypercarbia (pco2 132) after starting the sildenafil. it was unclear whether the increased oxygenation decreased respiratory drive or whether use of ativan contributed to this presentation. he ativan dose was decreased, she was placed on bipap and her pco2 returned to her baseline of 115 and her symptoms resolved. after discussion with ms. , her pulmonologist dr. , and her family the decision was made to transfer her to a pulmonary rehabilitation center that could work with her increase her bipap tolerance and increase her mobilty. patient was counseled extensively regarding the importance of compliance with bipap. her anxiety was a major obstacle in wearing the bipap mask. patient's ability to tolerate bipap improved with the introduction of ativan 0.25 mg qhs. she was encouraged to wear her supplemental oxygen at all times and to use bipap whenever sleeping or feeling tired. . # sinus tachycardia/palpitations: this was felt to be most likely from hypoxia. initially dehydration from recent diarrhea was also considered. she was given a 500 cc ns bolus on hd#1. her hr continued to be elevated. her tsh was normal. per medical records the patient's tachycardia is chronic and asymptomatic. heart rate ranged from 90-110 during majority of hospitalization. # avnrt: patient had a brief episode of avnrt in the evening following right heart catheterization. she was symptomatic with lightheadedness, hypotension (sbp 80s), and neck palpitations. the arrhythmia resolved abruptly with vagal maneuver. patient's outpatient cardiologist dr. was notified. the decision was made not to start a low dose beta blocker as patient has problems in the past with orthostasis and this may exacerbate those symptoms. she was monitored on telemetry for the duration of the hospitalization without further episodes. . # discharge: pulmonary rehab # code: full medications on admission: - levothyroxine 25 mcg po daily - ranitidine hcl 150 mg po bid - alendronate 70 mg po once a week: every saturday. - loratadine 10 mg tablet po once a day prn allergy symptoms. - calcium 500 + d 500 mg(1,250mg) -400 unit tablet po twice a day. - albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs qid prn shortness of breath or wheezing. - multivitamin po once a day. - zolpidem 5 mg tablet po at bedtime for 5 days. discharge medications: 1. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 2. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 3. lorazepam 0.5 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for anxiety. 4. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for sob/wheezing. 8. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for wheezing. neb 9. acetaminophen 500 mg tablet sig: one (1) tablet po every hours as needed for fever or pain. discharge disposition: extended care facility: - discharge diagnosis: pulmonary hypertension pulmonary edema sinus tachycardia discharge condition: patient has persistent sinus tachycardia (her baseline) and stable blood pressures. she requires 4l supplemental oxygen via nasal cannula and bipap during sleep. discharge instructions: you were admitted to the hospital after presenting to the emergency department for shortness of breath and chest pain. when you arrived in the emergency room, your blood oxygen level was low. this returned to a better level once we gave placed you on bipap. because of your high oxygen requirements and your need for bipap you were transferred to the icu where you were closely monitored. you underwent several studies to evaluate your heart and lung function. . the following changes were made to your home medications: 1) start sildenafil 20 mg by mouth three times a day to help your oxygen levels 2) start lorazepam 0.25 mg by mouth at night to help with anxiety while on bipap machine it is very important the you use your supplemental oxygen at all times and that you use your bipap every night. followup instructions: please follow up with dr. within two weeks of discharge. procedure: non-invasive mechanical ventilation right heart cardiac catheterization diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux unspecified essential hypertension other chronic pulmonary heart diseases personal history of malignant neoplasm of breast acute and chronic respiratory failure other specified cardiac dysrhythmias hypoxemia acute edema of lung, unspecified 

Answer: The patient is high likely exposed to