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: febrile neutropenia major surgical or invasive procedure: picc placement bone marrow biopsy history of present illness: 60yo woman with mantle cell lymphoma s/p rice (day 1 ) who presented to the ed with approximately 24h of nausea,vomiting, fever to 102 and loose stools. she also had fatigue and poor po intake. no cough or sob. she denied any photophobia, neck pain or visual changes. in ed her temp 102. hr 130, sbp 130s -> 85 after 2l but then increased to 90s. patient received total of 3 l of ivf and electrolyte repletion for magnesium and potassium. at time of admission to she felt very tired. she denied sob, cp, photophob, abd pain, or new skin rashes. past medical history: oncologic hx: - dx mantle cell lymphoma in - completed four cycles of r-chop followed by zevalin by - progressed by -> began velcade/rituxan ** had l cervical ln - again progressed by 5th cycle velcade/rituxan/dex in l cervical ln - admitted for on , and r- on - pet showed good response initially - planned for autosct on but ct on admit showed progressive dz - received eshap w/ plans for autosct if dz stable post eshap - pet on reported progression of her disease - bmb on showed a mildly hypocellular marrow with trilineage hematopoiesis, no evidence of mantle cell, nl cytogenetics - admitted for 2nd cycle of eshap - given rituxan on and 3rd cycle eshap - c1d1 rituxan/bendamustine on - ct showed disease progression . other pmhx: - lyme - herpes zoster social history: patient lives with her husband. she is a computer teacher in an elementary school, but took a leave of absence recently. she has two sons, both married. she lives in . she does not drink alcohol, smoke tobacco, or use illicit drugs. family history: mother had cancer. uncle with stomach cancer. physical exam: temp: 102.2 106 96/60 22 100% ra gen: dry, pale, nad neuro: aao x3. able to follow commands. good alertness. toes down bilat. hand strength symmetric. eomi perrla. no nuchal rig or photophob heent: jvp flat. mm very dry cards: rrr, early systolic murmur resp: clear bilat abd: bs+ nt nd soft, no masses, no rebound or guarding ext: no edema or rashes pertinent results: ekg: sinus tachy, na ni, no acute st t changes cxr: nad (my read) ua neg . 127 90 9 -----------------< 142 3.2 24 0.9 ca: 9.1 mg: 1.2 p: 2.5 alt: 12 ast: 19 lip: 17 ap: 55 tbili: 0.5 alb: . wbc: 0.1 hct: 27 (baseline low 30s) plt: 23 (down from baseline) n:13 band:13 l:38 m:25 e:0 bas:13 . pt: 12.9 ptt: 29.1 inr: 1.1 echo: the left atrium is elongated. left ventricular wall thicknesses and cavity size are normal. there is mild to moderate regional left ventricular systolic dysfunction with hypokinesis of the septum and anterior wall. 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 leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a small pericardial effusion. the effusion appears circumferential. there are no echocardiographic signs of tamponade. impression: regional lv systolic dysfunction. mild mitral regurgitation. small pericardial effusion without echo evidence of tamponade. pelvic ultrasound: no evidence of a fluid collection. moderate amount of subcutaneous edema in the left labial region. cxr: as compared to the previous radiograph, the pre-existing pulmonary edema has almost completely cleared. on today's examination, small bilateral pleural effusions are seen. also clear is the preexisting partial retrocardiac atelectasis. the overall size of the heart is unchanged. the right-sided central venous access line is in standard position. ct abd/pelvis: 1. no acute intra-abdominal process identified. 2. non-specific stranding within the anterior subcutaneous tissues of the lower abdomen, compatible with given history of cellulitis. no abscess identified. 3. small bilateral pleural effusions, new from . 4. resolution of pericardial effusion. echo: the left atrium and right atrium are normal in cavity size. there is mild to moderate regional left ventricular systolic dysfunction with hypokinesis of the septum and anterior wall. right ventricular chamber size and free wall motion are normal. the right ventricular free wall is hypertrophied. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a small to moderate sized pericardial effusion. the effusion appears circumferential. there are no echocardiographic signs of tamponade. impression: moderate regional lv systolic dysfunction. small to moderate circumferential pericardial effusion without evidence of tamponade. mild mitral regurgitation. compared with the prior study (images reviewed) of , the pericardial effusion is slightly larger. there is still no clear-cut echo evidence of tamponade. the wall motion abnormalities and ejection fraction are similar. ct chest : 1. interval progression of the large mediastinal mass has considerably increased in size since the previous examination of . 2. newly occurred pericardial effusion. 3. newly occurred pleural effusions. 4. mild increase in size of pre-existing paraaortic lymph nodes. ct neck : larynx appears obliterated on the axial scan due to adduction of left vocal cord. mediastinal mass continues to enlarge. bone marrow biopsy : final results pending brief hospital course: 1)febrile neutropenia: pt admitted to the icu for febrile neutropenia. blood cultures from admission were positive for 4/4 bottles pansensitive pseudomonas, with most likely source being gut translocation versus labial eschar/cellulitis. she was treated with a 14 day course of meropenem. patient remained afebrile from to time of discharge and has remained hemodynamically stable. at time of discharge she is no longer neutropenic, afebrile and feeling well. patient was continued on her outpatient regimen of prophylactic acyclovir. she was started on atovaquone 1500mg po daily for pcp prophylaxis and discharged on both of these medications. 2)mantle cell lymphoma: s/p rice (day 1 ). patient initially pancytopenic but counts nearly have recovered. platelets have remained low. a chest ct scan on did not show a significant change compared to her chest ct on indicating that her lymphoma was resistant to the rice she received. patient was given a dose of rituxan on when it was thought that she would undergo another cycle of chemotherapy. however, on she had an acute episode of stridor/dysphagia that resolved after steroids and benadryl. a neck ct on showed approx 90% compression of her esophagus by her mediastinal mass. ent saw patient and noted right vocal cord paralysis, which has been known. radiation oncology was consulted and the new plan was for xrt rather than proceeding with more chemo. given patient's respiratory status was stable and she could swallow soft solids and thin liquids, as per speech and swallow, emergent xrt was not done. at time of discharge patient was able to eat soft solids and thin liquids without no issues. her respiratory status was stable and she felt generally well. the plan is for patient to return to outpatient 7 clinic on monday, to discuss xrt with radiation oncology team and decide on when this therapy will begin. she was discharged with a two day course of prednisone 40 mg po daily and received one dose prior to discharge. dr. and rad onc can decided whether further steroid therapy is necessary. 3)nstemi - on she had 19 beat run of vt with associated dyspnea, also with bump in cardiac enzymes. her troponin peaked at 0.23, and her ck and ckmb remained normal. she had and echocardiogram which showed moderate hypokinesis of the anterior and septal walls that was new compared with prior from . she was evaluated by cardiology who did not feel that diagnostic cath was indicated in the setting of her recent chemo. they advised medical management with atorvastatin, beta-blockade as tolerated by her blood pressure. in addition they recommend stress testing once she is medically stable. patient was discharged with atorvastatin and metoprolol. these medications should continue to be managed as an outpatient and pt should follow up with her primary care physician regarding stress test. 4) l labial cellulitis: she had a cellulitis extending from her lower abdomen to her left labia and peri-rectal area. initially patient had moderate pain to palpation of area. a translabial u/s on showed no evidence of abscess or fluid collection. abd/pelvic ct on also did not show an evidence of abscess or fluid collection. pt followed by id during hospital course. cellulitis made significant improvement as patients white cell count improved. patient received a 16 day course of vancomycin. at time of discharge cellulitis appeared was completely resolved. 5) l labial and l peri-rectal ulcer: ulcers noted upon admission at which time they were covered by black eschars. they are painless punched out ulcers down to the dermis. seem to be c/w ecthyma gangrenosum. ulcers were followed by id, ob-gyn and derm. ulcers continue to improve with daily baths and bacitracin/gauze dressings. according to derm, these ulcers could take weeks to fully heal. at time of discharge ulcers looked clean and seemed to be forming increased granulation tissue. patient was instructed how to care for ulcers and actively cared for them herself as an inpatient. ulcers should continue to be monitored for continued resolution. 6) electrolyte repletion: patient was continued on potassium and magnesium replacement which were determined based on her needs as an inpatient. she is scheduled to have her labs drawn on at 7 clinic and her dosages of these electrolytes should be adjusted accordingly. medications on admission: allopurinol 300 daily ativan 0.5 q6h prn compazine 10 q8h prn potassium 20 daily mag oxide 800 albuterol prn benzonatate 100 tid acyclovir 400 tid discharge medications: 1. acyclovir 200 mg capsule sig: two (2) capsule po tid (3 times a day). 2. allopurinol 300 mg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*0* 5. atovaquone 750 mg/5 ml suspension sig: 10 ml po daily (daily). disp:*300 ml* refills:*0* 6. prednisone 20 mg tablet sig: two (2) tablet po daily (daily) for 2 days. disp:*4 tablet(s)* refills:*0* 7. magnesium oxide 400 mg tablet sig: two (2) tablet po once a day. disp:*60 tablet(s)* refills:*0* 8. potassium chloride 20 meq packet sig: 20 meq po twice a day. disp:*60 * refills:*0* 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: pseudomonas bacteremia secondary: cellulitis, mantle cell lymphoma discharge condition: good discharge instructions: you were admitted with nausea/vomitting and fever and found to have an infection in your blood. we gave you antibiotics and the infection resolved. during your admission we determined that you had injury to your heart. the cardiologists who saw you felt that medical management of this problem would be appropriate at the present time. we started you on two new medications for you heart. it is recommended that you have a cardiac stress test as an outpatient. we also found that you had a skin infection on your lower abdomen and genital area. we treated you with antibiotics and this infection improved, as well. you still have ulcers in your genital and rectal area which you should continue treating with daily baths and application of bacitracin covered by gauze. we monitored your blood cell counts closely during you hospital stay since you were neutropenic upon admission. your blood counts have risen and you are no longer neutropenic. in regards to your mantle cell lymphoma, we rescanned chest and scanned your neck and found the the mass in your neck has enlarged. this is likely contributing to your difficulty swallowing. you were seen by the radiation oncologists who along with your primary oncologist feel that radiation would be an appropriate treatment. you were seen by speech and swallow who recommended that you eat soft solids and thin liquids, take sips after each bite, and tuck your chin when swallowing. you were started on the following new medications; 1) metoprolol: this medication helps to control heart rate and will help protect your heart muscle. 2) atorvastatin: this medication reduces cholesterol and also helps to protect your heart function. 3) atovaquone: this is prophylaxis against pneumonia. 4) prednisone: you should take this for the next two days. dr. will decide whether you need to continue taking this 5) omeprazole: this is to help with reflux you should follow up on monday at the 7 outpatient clinic. during this visit we will have you meet with the radiation oncology team and decide on plans for radiation therapy. if you should have fevers, chills, night sweats, significant nausea or vomitting, chest pain, shortness of breath or dizziness please go to your local emergency room. followup instructions: 7 heme/ clinic: monday, at 12:30 pm procedure: venous catheterization, not elsewhere classified biopsy of bone marrow laryngoscopy and other tracheoscopy injection or infusion of cancer chemotherapeutic substance diagnostic ultrasound of peripheral vascular system diagnoses: thrombocytopenia, unspecified subendocardial infarction, initial episode of care severe sepsis hypopotassemia paroxysmal ventricular tachycardia nausea with vomiting disorders of phosphorus metabolism septic shock diarrhea dehydration pulmonary congestion and hypostasis unilateral paralysis of vocal cords or larynx, partial family history of malignant neoplasm of gastrointestinal tract septicemia due to pseudomonas laryngeal spasm ulcer of anus and rectum vaginitis and vulvovaginitis, unspecified ulceration of vulva, unspecified mantle cell lymphoma, intrathoracic lymph nodes 

Answer: The patient is high likely exposed to