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: prochlorperazine attending: chief complaint: cough, sob major surgical or invasive procedure: none history of present illness: 37 year old female with a history of all, s/p allo sct c/b neutropenic fever and skin gvhd, presents with one day of shortness of breath and cough. . patient has had a chronic cough for several months. she also had some mild ggo on prior cts, followed monthly, stable from through . this morning, she woke up feeling short of breath, with worsening cough productive of green sputum. she felt progressively fatigued throughout the day. she presented to oncology clinic where she was found to have a fever of 100.4. she initially had an oxygen saturation of 94 on ra in clinic. blood cultures were drawn, nasal swab sent for viral screen, and she was given cefepime iv 2g and admitted for fever. past medical history: - allogenic double cord blood sct on , course complicated by neutropenic fever and acute skin gvhd. - all - asthma - htn - cervical intraepithelial neoplasia - c-section in - cardiomyopathy due to early anthracycline-related cardiotoxicity 9/. past oncologic history: presented to ed with right chest and right upper extremity pain and paresthesias and visual blurriness. cbc demonstrated wbc 149,000. leukapheresis --> wbc 35,000. admitted to bmt. started hydrea. -aspirate smear: >90% cellularity, interstitial infiltrate of immature cells consistent with blasts in sheets occupying 95% of marrow cellularity. -special stains: mpo-negative, pas-positive with cytoplasmic granular pattern. -immunophenotyping (flow cytometry:) positive: cd34 (subset 32%,) hla-dr, tdt, 19 cd15 (subset 52%) negative: cd20, cd10 cd13, cd33, cd14, cd117, cd64, cd11c and cd56 -dx = precursor b-cell all -cytogenetics: --some aberrations (including trisomy 22) seen in single metaphase. --fish: ph-negative, abnormal pattern in 60/100 cells indicative of trisomy 22, abnormal mll rearrangement in 90/100 cells induction: phase i, weeks , day 1 = daunorubicin 60 mg/m2 iv day 1, 8, 15 and 22 vincristine 1.4 mg/m2 iv day 1, 8, 15 and 22 dexamethasone 10 mg iv tid day l-asparaginase 10,000 iu day 17-28 mtx 12.5 mg it day 8 (instead of day 15) -csf = rare atypical mononuclear cells, favor atypical lymphocytes. phase ii, weeks , day 1 = cyclophosphamide 650 mg/m2 = 1160 mg iv days 1, 15 and 29. cytarabine 75 mg/m2 = 130 mg iv days , , 15-18, 22-25 mercaptopurine 60 mg/m2 = 100 mg day mtx 12.5 mg it days 1, 8, 15, 22 response evaluation: bone marrow aspirate/biopsy on cr: -no morphologic evidence of residual leukemia -normal cytogenetics, negative fish for mll intensification therapy 3 cycles of hd-mtx 3 g/m2 days 1 (-given), 8, and 22 standard leucovorin rescue l-asparaginase 10,000 iu days 2 (-given,) 9, and 23 allogenic double cord blood sct conditioning was achieved with fludarabine, and ara-c and tbi. during the conditioning phase, nausea control was achieved with dexamethasone, lorazepam, zofran prn. ciprofloxacin, fluticasone and acyclovir were initiated for prophylaxis as per protocol. course complicated by neutropenic fever and acute skin gvhd. social history: smoke: never etoh: occassional in past, none currently drugs: never lives/works: single, has two children (ages 7 and 18). lives in , her aunt is living with her. was previously employed at , hasn't been working since being diagnosed with all in . family history: mother had gastric cancer physical exam: vs: t 101.0 bp 136/94 hr 109 rr 40 spo2 86/ra -> 94%/4l general: african american female in moderate distress, tachypneic cv: rrr, no m/r/g, jvp not elevated, 2+ pulses dp resp: diffuse rhonchi bilaterally, worse at right base abd: nt, nd, bs+ ext: no edema, warm well perfused neuro: aao x 3, speech fluent, no pronator drift pertinent results: admission labs: chemistries: urea n-9 creat-1.0 sodium-143 potassium-3.7 chloride-107 total co2-28 anion gap-12 alt(sgpt)-9 ast(sgot)-21 alk phos-84 tot bili-1.0 calcium-8.5 phosphate-3.3 magnesium-1.6 tacrofk-8.8 cbc: wbc-8.4 rbc-2.88* hgb-9.1* hct-28.5* mcv-99* mch-31.6 mchc-32.0 rdw-16.4* diff: neuts-64 bands-0 lymphs-26 monos-9 eos-1 basos-0 atyps-0 metas-0 myelos-0 hypochrom-2+ anisocyt-1+ poikilocy-1+ macrocyt-2+ microcyt-normal polychrom-normal ovalocyt-2+ plt smr-low plt count-104* 1:40 am bronchoalveolar lavage **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): 10,000-100,000 organisms/ml. commensal respiratory flora. pseudomonas aeruginosa. ~/ml. further workup on request only. isolates are considered potential pathogens in amounts >=10,000 cfu/ml. id and susceptibility requested by . sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- <=1 s ceftazidime----------- 2 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- 8 s tobramycin------------ <=1 s legionella culture (final ): no legionella isolated. potassium hydroxide preparation (final ): this is a low yield procedure based on our in-house studies. test requested by # . no fungal elements seen. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (final ): no fungus isolated. cytology from bal: negative for malignant cells. reactive bronchial cells, pulmonary macrophages, and squamous cells. note: no viral inclusions or fungal forms seen by routine stain. see also corresponding microbiology studies. ct chest with and without contrast : impression: 1. no evidence of pulmonary embolism. 2. extensive bilateral alveolar opacities, the pattern suggests generalized infection, pcp and bacteria should be included in the differential diagnosis. 3. small bilateral pleural effusions. 4. mild pericardial effusion. 5. two small splenules, borderline size of the left adrenal. the referring physician, . was contact by telephone at the time of dictation. cxr : 1. extensive bilateral alveolar opacities are concerning for generalized infectious process. pcp and bacterial pneumonia are included in the differential diagnosis. 2. bilateral small pleural effusions. 3. left picc tip projects over the mid/lower svc. the study and the report were reviewed by the staff radiologist. brief hospital course: #. pseudomonas pna - on admission, was believed to be a likely infectious process given fever, hypoxia and productive cough. given h/o chf, this could be contributing, but she has no clinical signs of hf. she has a h/o ggo opacities with multiple infections in the past. upon admission to the floor, she was transferred to the micu for ongoing respiratory distress and urgent bronchoscopy with extensive infiltrates seen on ct chest. she received vancomycin and cefepime prior to admission to the icu and also underwent a cta chest that was negative for pe. bronchoscopy was performed. she was continued on vancomycin and cefepime. in the micu, the patient was transiently on caspofungin, given that she had been on voriconazole for prophylaxis. she was started on bactrim iv as empiric pcp . considering she was on bactrim, her atovaquone was held. she improved overnight with decreased o2 requirement and, on the day following her transfer to the , she was transferred back to the floor. bal culture grew psudomonas aerginoasa sensitive to cefepime and ciprofloxacin. she was switched to a combination of cefepime and ciprofloxacin for double abx coverage for pseudomonas. the patient was also continued on po voriconazole in place of caspofungin. the patient was also switched back to atovaquone for pcp . the patient continued to show significant symptomatic improvement over the next several days, with no further fevers and no longer had an oxygen requirement. she was able to ambulate with good o2 sats. she is being discharged home to complete a 14 day total abx course of cefepime and ciprofloxacin. the patient was also administered ivig prior to discharge as her igg level was low. she will continue prednisone at 10mg daily upon discharge and will follow-up with her oncologist dr. . vision changes: description of blurry vision on admission, incideous in onset, was initially concerning for fungal or intracranial process while the patient was in micu. however, the symptoms resolved shortly thereafter. headache: the patient with a history of migraines. the headache on admission was consistent with migraine ha. no meningismus. not related to vision changes temporally. the symptoms resolved by hospital day 3 and the patient remained free of headaches. allo sct w/ skin gvhd: we continued cellcept, prednisone, and tacrolimus. we also continued folic acid. chronic systolic chf: no signs of acute exacerbation or change in baseline status. cont home bb, daily weights and heart healthy diet. asthma: cont advair, and nebs as above htn: hypertensive on admission, we continued carvedilol. gerd: reports occoasional symptoms for which she takes omeprazole daily, which was continued while in hospital medications on admission: acyclovir 400mg po tid atovaquone 1500mg po daily enzonatate 100mg po tid carvedilol 37.5 mg po bid advair 500/50 inh folic acid 1mg po daily cellcept 250mg po bid omeprazole 20mg po daily prednisone 10mg po daily tacrolimus 0.25mg po bid voriconazole 200mg po q 12 mag oxide 133mg po tid mvi 1 tab daily discharge medications: 1. cefepime 2 gram recon soln sig: one (1) recon soln injection q12h (every 12 hours) for 6 days: last day = in am. disp:*12 recon soln(s)* refills:*0* 2. prednisone 10 mg tablet sig: one (1) tablet po daily (daily): until directed otherwise by dr. . disp:*30 tablet(s)* refills:*2* 3. ciprofloxacin 750 mg tablet sig: one (1) tablet po every twelve (12) hours for 9 days: last day = . disp:*12 tablet(s)* refills:*0* 4. mycophenolate mofetil 250 mg capsule sig: one (1) capsule po bid (2 times a day). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. tacrolimus 0.5 mg capsule sig: 0.5 capsule po q12h (every 12 hours). 7. acyclovir 400 mg tablet sig: one (1) tablet po q8h (every 8 hours). 8. voriconazole 200 mg tablet sig: one (1) tablet po q12h (every 12 hours). 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 10. atovaquone 750 mg/5 ml suspension sig: one (1) po daily (daily). 11. valsartan 80 mg tablet sig: one (1) tablet po daily (daily). 12. carvedilol 12.5 mg tablet sig: three (3) tablet po bid (2 times a day). 13. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day). 14. magnesium oxide 84.5 mg (140 mg) capsule sig: one (1) capsule po three times a day. 15. advair diskus 250-50 mcg/dose disk with device sig: one (1) inhalation twice a day. disp:*1 disk* refills:*2* discharge disposition: home with service facility: critical care systems discharge diagnosis: primary: pneumonia secondary: all status post allogeneic stem cell trasnplant 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 because you developed shortness of breath, cough, fevers, and were found to have a pneumonia. we performed a procedure called bronchosopy to evaluate the cause of your pneumonia. we found that it was caused by a bacterium known as pseudomonas. we gave you appropriate antibiotics and your symptoms improved. at this time, you no longer require oxygen and are able to walk without getting short of breath. we also gave you ivig because your antibody levels were low. you will need to complete a course of antibiotics as follows: we started you on cefepime 2 grams iv every 12 hours. you will need to get infusions of this antibiotic until we started you on ciprofloxacin. please take 750mg every 12 hours until . we decreased your dose of advair to 250/50 to one inhalation twice a day. please continue to take all your other medications as prescribed. you will need to follow up with your oncologist dr. as shown below. please call bmt fellow on call or come back to the hospital right away if you develop fevers, worsening cough, shortness of breath, nasal congestion, or any other concerning symptoms. please weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: you have you an appointment this friday at 8:30 am in clinic with dr. . you will also have your labs drawn at that time. you also have the following appointments: provider: phone: date/time: 1:00 pm provider: . phone: date/time: 2:00 pm provider: , md phone: date/time: 3:30 pm md procedure: closed [endoscopic] biopsy of bronchus diagnoses: other primary cardiomyopathies congestive heart failure, unspecified unspecified essential hypertension asthma, unspecified type, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pneumonia due to pseudomonas chronic systolic heart failure complications of transplanted bone marrow hypoxemia migraine, unspecified, without mention of intractable migraine without mention of status migrainosus acute graft-versus-host disease dysplasia of cervix, unspecified acute lymphoid leukemia, in relapse 

Answer: The patient is high likely exposed to