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: penicillins attending: chief complaint: airway monitoring major surgical or invasive procedure: : right video-assisted thoraoscopy with decortication history of present illness: 61 year old female with pmhx of hth presented with severe sore throat for 2 days rapidly getting worse associated with difficulty swallowing liquids and neck pain. also found to have fever and tachycardia. unable to take meds, only took bp meds this am. voice is hoarse and descrbed as "hot potato" by pcp. as a flight attendant, travelled all over europe recently. sister with sore throat as well. in pcps office, unable to open her mouth, tender thick neck unable to evaluate pharynx. per report pts sore throat has progressed rapidly over past 2 days. unable to swallow her secretions, no tipoding or drooling present. . in the ed, 100.8 81 125/77 16 99%ra. she was given clindamycin, dexamethasone, morphine sulfate 4mg syringe, hydromorphone (dilaudid) 1mg/1ml syringe, gentamicin 80mg. labs unremarkable. ct neck showed retropharyngeal phlegmon. ent scoped her, has epiglottis and supraglottic swelling. symptoms improved. fever 102 in ed. prior to transfer 117/78 18 100% ra. . upon arrival to the floor, patient able to phonate but voice still hoarse. no stridor or tripoding noted. reports inability to get secretions up. . review of systems: (+) per hpi (-) denies night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: hypertension allergic rhinitis social history: lives with sister, smokes 1/2-1ppd for the past 40 years, drinks on occasion, denies drugs. she was flight attendent for us air. family history: sister with cancer and thyroid cancer in 50s physical exam: admission exam: vs: 98.7 82 136/65 13 98% on ra ga: aox3, hoarse voice heent: perrla. mmm. no lad. no jvd. neck tender to palpation anterior and posterioly, unable to visualize pharynx cards: pmi palpable at 5/6th ic space. no rvh. rrr s1/s2 heard. no murmurs/gallops/rubs. pulm: rhonchi heard and left base abd: soft, nt, +bs. no g/rt. neg hsm. neg sign. extremities: wwp, no edema. dps, pts 2+. skin: wnl neuro/psych: cns ii-xii intact. 5/5 strength in u/l extremities. dtrs 2+ bl (biceps, achilles, patellar). sensation intact to lt, pain, temperature, vibration, proprioception. cerebellar fxn intact (ftn, hts). gait wnl. . pertinent results: 05:02pm lactate-1.4 04:23pm glucose-116* urea n-9 creat-0.7 sodium-139 potassium-4.2 chloride-106 total co2-23 anion gap-14 04:23pm wbc-10.1# rbc-4.27 hgb-13.6 hct-37.9 mcv-89 mch-31.9 mchc-36.0* rdw-13.1 04:23pm neuts-92.8* lymphs-4.1* monos-2.8 eos-0 basos-0.2 04:23pm plt count-225 . scope ent (on admission): her glottic opening is about 4mm on scope exam without symptoms including stridor or retraction. . ct neck with contrast (): retropharyngeal fluid collection spanning from c2/3 to c5/6 with extensive surrounding edema and inflammation of the hypopharynx. the airway is narrowed to 4mm at the level of the hyoid. patent cervical vasculature. . cxr (): as compared to the previous radiograph, there is no relevant change. no pathologic mediastinal widening. borderline size of the cardiac silhouette. presence of minimal pleural effusions cannot be excluded. no focal parenchymal opacity suggesting pneumonia. no pulmonary edema. . ct neck and chest w/ contrast (): 1. interval slight decrease of the retropharyngeal fluid collection and improved airway patency. 2. no evidence of lemierre's disease or new abscess formation. 3. no evidence of extension of the fluid collection into the mediastinum. no evidence of mediastinitis. . chest ct (): impression: 1. rapidly enlarging multiloculated right pleural effusion. this could be due to empyema considering clinical suspicion for this entity, but definitive diagnosis would require correlation with thoracentesis results. 2. small dependent left pleural effusion has also increased in size since the prior study but does not have loculated components. 3. slight increase in size of pre- and sub-carinal lymph nodes as well as right hilar nodes. these are likely reactive. 4. ground-glass opacities in left upper lobe which are likely infectious or inflammatory in etiology. . tte (): the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). 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) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. . cxr reason for examination: evaluation of the patient with complicated pleural effusion. portable ap radiograph of the chest was reviewed in comparison to . there is interval increase in right pleural effusion, loculated, better appreciated on the prior radiograph but the change in size is significant. no pneumothorax is seen. left pleural effusion is unchanged. bibasal areas of atelectasis are noted. . 5/28cxr discharge labs . micro. blood culture, routine (preliminary): haemophilus influenzae, beta-lactamase negative. beta- lactamase negative: presumptively sensitive to ampicillin. . beta-lactamase confirmation requested by dr. . aerobic bottle gram stain (final ): reported to and read back by dr. on at 0720. gram negative rod(s). brief hospital course: 61 yo f with pmhx of htn presenting with sore throat, neck pain, and odynophagia found to have epiglottis and retrophargyneal phlegmon. . #epiglottis/retropharyngenal phlegmon: diagnosed on ct neck and by ent scope. symptoms consistent with this. the patient did improve clinically with steroids, ceftriaxone and clindamycin. the patient's airway was closely monitored in the icu and underwent repeat ent scoping on that showed ongoing arytenoid edema but completely patent airway. repeat ct neck and chest with contrast, in the setting of ongoing posterior neck pain and inspiration pain as well as worsening erythematous lesion (see below), did not show lemierre's or mediastinitis. there was minimal interval improvement in the phlegmon collection, however. blood cultures from admission were positive for gnrs, later grew out haemophilus influenzae. planned for 14 day course from day of first negative culture. the patient remained hemodynamically stable and re-evaluation by ent in the icu showed improved of supraglottic swelling so she was transfered to the floor. repeat cultures were negative ???? hiv was sent and was negative. patient continued to be symptom free on the floor and did not have any further airway complaints or problems. she was treated symptomatically with cepacol lozenges and was kept on a nicotine patch and received nebulizers prn. . #erythematous lesion: patient developed a 3x3 inch erythematous lesion on her anterior chest, 2 inches below cricoid and poorly demarcated. the patient endorsed feeling warm and mildly tender to palpation in this area with no pruritis. no plaques/papules/bullae. the lesion was very blanching. dermatology was consulted on given spread of this lesion to ~4x4 inches despite broadening to vancomycin. given the timing of her antibiotics, this lesion was not felt due to drug eruption, although a very early drug eruption can not be ruled out. the erythema was felt most consistent with a toxic exanthem, which is a vasodilation that occurs in patients with bactermia (more often staph, strep). supportive care was provided. derm followed patient while in house. by hospital day 4 the rash had significantly receeded. derm did not feel compelled to biopsy - they thought it was likely due to her infectious process but did not represent a cellulitis. her rash improved later in her hospital course. . #pneumonia and pleural effusion: she was noted to have intermittent hypoxemia and r sided pleuritic chest pain on . medicine was consulted on , and in setting of new moderate pleural effusions r>l on cxr, recommended chest ct, which showed rapidly expanding and loculated effusion on r. she was then transferred to medicine, and id was consulted. her antibiotics were changed to ceftriaxone. her pleural effusion was attempted to be drained by ir, but they only withdrew 30 cc of fluid, given loculation. thoracic surgery was then involved and carried out a vats procedure which was uncomplicated and the patient was transferred back to medicine. . #hypertension: blood pressures normal and intermittently high (sbps 150s) in-house. the patient's atenolol, lipitor were held in the setting of epiglottis/retropharyngeal phlegmon but restarted once she was able to tolerate pos. atenolol was initially started at half home dose 50mg, then back to her full dose.however due to asymp. bradycardia into the 40's atenolol was discontinued ad replaced with chlorthalidone on . . # intermittent bradycardia to 40s, asymptomatic: she was monitored on telemetry with occasional intermittent bradycardia to the 40s. her ekg was otherwise normal, without avb. tte was done which showed no hd significant pericardial effusion, abscess, or vegetations. her bradycardia may have been due to vagal tone in setting of pleural effusions and pleuritic pain. . # lower extremity edema: she noted increased edema during this admission. she had some baseline edema as a flight attendant but only while standing for long durations. she had no jvd or hjr, and tte was normal. . #ppx: heparin sq #full code, confirmed. medications on admission: -lipitor 20 mg tab 1 tablet(s) by mouth once a day -atenolol 100 mg tab 1 tablet(s) by mouth once a day -proair hfa 90 mcg/actuation aerosol inhaler two puffs(s) inhaled every 4-6 hours as needed for sob/wheezes -flovent hfa 110 mcg/actuation aerosol inhaler 2 puffs(s) twice a day -fluticasone 50 mcg/actuation nasal spray, susp 2 sprays each nostril daily discharge medications: 1. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). disp:*30 patch 24 hr(s)* refills:*2* 2. atorvastatin 20 mg tablet sig: one (1) tablet po hs (at bedtime). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 5. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: five (5) ml po q4h (every 4 hours) as needed for pain. disp:*250 ml(s)* refills:*0* 6. proair hfa 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. 7. flovent hfa 110 mcg/actuation aerosol sig: two (2) puffs puffs inhalation twice a day. 8. fluticasone 50 mcg/actuation spray, suspension sig: two (2) puffs nasal once a day: 2 sprays to nose daily. 9. outpatient lab work 1. cbc with differential 2. esr 3. crp please obtain this blood work on and fax results to infectious disease at ( 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 11. chlorthalidone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. levofloxacin 500 mg tablet sig: one (1) tablet po once a day for 14 days. disp:*14 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: bacterial supraglottitis bacteremia loculated pleural effusions pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: please call your doctor or nurse practitioner if you experience the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain is not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. . general discharge instructions: please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. you were admitted with a severe throat infection and bacteremia with h influenza. you also developed a rash on your chest thought to be due to this bacteria. your rash and throat improved, but you then developed shortness of breath due to increasing pleural effusions. you were thought to have pneumonia, and your pleural effusion was treated by thoracic surgery with vats procedure. your antibiotic course will be levofloxacin until told to stop by the infectious disease doctors. you will be seen by them as an outpatient. . medication changes: start levaquin (aka levofloxacin) for your infection stop atenolol (this was stopped because your heart rate was low) start chlorthalidone (for blood pressure control) . you should take all your other medication as prescribed by your doctors. . thoracic surgery call dr. office if you experience: -fevers > 101 or chills -increased shortness of breath, cough (it is normal to cough-up blood tinge sputum for a few days) or chest pain -incision develops drainage or increased redness -chest tube site remove dressing and cover site with a bandaid until healed -should site drain cover with a clean dressing and change as needed activity -shower daily. wash incision with mild soap and water, rinse, pat dry -no tub bathing, swimming or hot tubs until incision healed -no lifting greater than 10 pounds -no driving while taking narcotics followup instructions: ent (ears nose and throat): please follow up with dr. in 2 weeks. her office can be reached at to make a follow-up appointment. . infectious disease : you have an appointment on with dr. @ 2:50pm. please note that you also have a ct of your neck ordered for (you need to call to confirm the time/location of this exam). before your appointment with dr. , you will need to have your blood drawn and have the results faxed to (. thoracic surgery: follow-up with dr. date/time: 3:00 on the clinical center, chest x-ray radiology 30 minutes before your appointment please also follow up with your pcp. your appointment you should have your blood drawn with the following results sent to the infectious disease team (cbc with differential; esr;crp). the number to fax them to is (. note that you have the following appointment scheduled: department: - adult med when: monday at 10:15 am with: , md building: (, ma) campus: off campus best parking: free parking on site procedure: insertion of intercostal catheter for drainage thoracentesis laryngoscopy and other tracheoscopy thoracoscopic pleural biopsy thoracoscopic decortication of lung diagnoses: pneumonia, organism unspecified tobacco use disorder unspecified essential hypertension chronic airway obstruction, not elsewhere classified pulmonary collapse other and unspecified hyperlipidemia other specified cardiac dysrhythmias bacteremia hemophilus influenzae [h. influenzae] infection in conditions classified elsewhere and of unspecified site retropharyngeal abscess supraglottitis unspecified, without obstruction acute epiglottitis without mention of obstruction other specified forms of effusion, except tuberculous toxic erythema 

Answer: The patient is high likely exposed to