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: strawberry / watermelon / peel tincture,sweet / carrot attending: chief complaint: pre-syncope major surgical or invasive procedure: none history of present illness: this is a 55 yo woman with progressive metastatic rcc s/p il2, s/p cardiac arrest earlier this year, chf with ef 35-40%, who presents weakness and an episode of syncope earlier today. she describes that she felt tired yesterday and got up and attempted to go to work this morning. on the way to work she felt very tired and dizzy and then when she was in the elevator at work fell over. she denies any preceding palpitations or chest pain, and denies every feeling confused. no incontinence. she did hit her head but does not think that she lost consciousness. . she does state that in retrospect she had some urgency with urination over the last few days but no increased frequency or dysuria. no hematuria. otherwise, she has been in her normal state of health. no fevers or chills at home. has had a dry cough for the past few weeks, non-productive. . in ed she was mentating well throughout but with systolic bps in the 50s. she received 4l ns with transient rise in sbp to low 100s, then dropped again to 70s. cvl was placed and norepinephrine was started. labs were significant for wbc 16.9, lactate 3.2, ua moderate bacteria, 13 wbc, small leuk, negative nitrites. given concern for urosepsis; she was given levofloxacin 750mg x1 and bcx were drawn. she had a cta that was negative for pe. head ct was not done given no focal findings. of note, the patient's oncologist was notified in the ed. . ms. was recently admitted the the hospital at the beginning of for high dose il2 biotherapy. she developed hypotension and in the setting of high-dose il-2 biotherapy initiation. she was transferred to the micu after she devloped il-2 myocarditis and ventricular tachycardia that progressed to pulseless vt. she was resuscitation but her post arrest echo showed depressed global left ventricular systolic function. she was started on amiodarone prior to discharge. of note, she was also treated for a pansensitive klebsiella and e.coli uti during that admission with cetriaxone and then cefpodoxime. . since discharge, she has been following with dr. and ; she is not currently on chemo but has plans to start a clinical trial. she has also been following with and ; they discontinued her amiodarone because of transaminitis and she was started on toprol 3 days ago and her cardiolgists are considering icd. . on arrival to the icu, the patient was comfortable, without any pain or complaints. she was initially on oxygen but this was easily weaned off. past medical history: metastatic rcca -- revealed metastatic rcc clear cell origin -- ct showed b/l pulmonary nodules -- right nephrectomy -- right forearm mass resected on -- left clavicle soft tissue mass htn parathyroid adenoma hyperlipidemia anxiety internal hemorrhoids social history: married and lives with her husband in . she has 2 daughters, 16 and 19yo. no smoking, occasional etoh. no ivdu family history: non-contributory physical exam: admission exam: vitals: bp 101/42, 70, 16 98% 2l-> ra gen: well appearing, awake and alert, a+ox3 heent: small abrasion with scab over l forehead with 3 cmx3cm area of swelling. eomi, perrl, sclera anicteric, no epistaxis or rhinorrhea, dry mm. throat non-erythematous, no lesions or exudate neck: no jvd chest: left clavicle soft tissue mass 5cm, right ij cvl cor: rrr, no m/g/r, normal s1 s2 pulm: lungs ctab, no w/r/r abd: soft, nt, nd, +bs, no hsm, no masses; small well healed surgical scars ext: no le edema, palpable pedal pulses. neuro: awake, oriented to person, place, and time. cn ii ?????? xii intact on direct testing. moves all 4 extremities. strength 5/5 in upper and lower extremities. patellar dtr +1. plantar reflex downgoing. skin: no jaundice, no rashes, no open lesions. occasional scarred acne-like lesions across back. no ecchymoses. discharge exam: xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx pertinent results: admission labs: 09:25am pt-15.0* ptt-28.8 inr(pt)-1.3* 09:25am plt count-984* 09:25am neuts-75.0* lymphs-17.9* monos-3.7 eos-2.7 basos-0.7 09:25am wbc-16.2* rbc-3.76* hgb-8.7* hct-28.8* mcv-77* mch-23.1* mchc-30.1* rdw-16.7* 09:25am cortisol-44.5* 09:25am albumin-2.7* calcium-9.6 phosphate-3.6 magnesium-2.2 09:25am ctropnt-0.02* 09:25am alt(sgpt)-64* ast(sgot)-58* ld(ldh)-459* alk phos-299* tot bili-0.3 09:25am glucose-141* urea n-26* creat-1.1 sodium-134 potassium-5.9* chloride-98 total co2-22 anion gap-20 09:45am urine rbc-2 wbc-13* bacteria-mod yeast-none epi-1 trans epi-<1 09:45am urine blood-tr nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-sm 09:45am urine color-yellow appear-hazy sp -1.018 01:12pm glucose-142* lactate-0.9 k+-4.1 . discharge labs: 06:15am blood wbc-14.6* rbc-3.53* hgb-8.1* hct-26.6* mcv-76* mch-23.0* mchc-30.4* rdw-17.6* plt ct-879* 03:14am blood pt-14.4* ptt-32.2 inr(pt)-1.2* 06:15am blood glucose-118* urean-16 creat-0.9 na-138 k-4.7 cl-102 hco3-27 angap-14 06:15am blood alt-48* ast-35 alkphos-269* totbili-0.2 03:14am blood ck-mb-2 ctropnt-0.04* 06:15am blood albumin-2.6* calcium-9.5 phos-3.7 mg-2.4 . imaging: cxr: impression: allowing for differences in technique, mild interval increase in the known largest metastatic nodule in the right lung base. ct-a: impression: 1. no pulmonary embolism. 2. interval increase in the size and number of multiple metastases. echo: the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is moderate to severe global left ventricular hypokinesis (lvef = 30 %). the right ventricular free wall thickness is normal. right ventricular chamber size is normal. with borderline normal free wall function. 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. there is no mitral valve prolapse. an eccentric, posteriorly directed jet of moderate (2+) mitral regurgitation is seen. due to the eccentric nature of the regurgitant jet, its severity may be significantly underestimated (coanda effect). moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . cxr: impression: slight increase in size of small right-sided pleural effusion with new consolidation at the base of the right lower lobe which could represent pneumonia in the appropriate clinical setting. brief hospital course: 54 year-old female with a history of metastatic renal cell carcinoma who presented after a pre-syncopal event and hypotension in ed. : # hypotension: initially thought to be urosepsis and exacerbated by recent initiation of b-blocker. on initial presentation, she briefly required a pressor, but sbps resolved. admission lactate 3.2, which improved with ivf. of note, other possible explanations could be adrenal tumor invasion knowing metastatic rcc, but recent ct of ab/pelvis did not show any evidence of this and patient had a normal cortisol. the patient was initially on levophed but this was quickly weaned. she was given 4l ivf in the ed and then 500 cc ivf in the . her bb was held and she was treated with zosyn. her urine culture came back negative despite a positive u/a and treatment of her uti was discontinued. it is likely that her hypotension was in the setting of her initiation of metoprolol succinate 25mg po daily. ep saw her and recommended stopping the bb and not to restart amiodarone at this time. she was sent home on no medications for her underlying heart arrhythmias and will follow up in the outpatient setting for further management. . # chf w/ hx vt: patient developed o2 requirement in the in the context of fluid resuscitation. ekg unchanged with trop negative x 2. echo showed ef30% which was decreased from her last echo in . her cardiologists, dr. and dr. were contact. beta-blocker was held on discharge from icu. she was not restarted on any medications, nodal agents nor antiarrhythmics,and will follow up with her dr. in the outpatient setting. . # pre-syncope: likely due to hypotension given her history of pre-syncopal symptoms. could consider vt that was self-resolving but this seems unlikely from history. could also consider brain metastasis causing this but imaging was deferred during her icu stay. pe was ruled out on ct-a. . # hx head trauma during syncope: the patient had a non focal neurological exam on admission, with no headache. no imaging performed. # rcc: no treatment at moment, plan for clinical trial in the future. # anemia: hct dropped slightly after ivf administration but was stable. workup on last admission consistent with anemia of chronic disease. her anemia was not worked up further during this hospitalization. . # transaminitis: lfts elevated but trending down from prior. this was thought to be amiodarone, which was stopped one week prior to admission. her lft continued ot trend down and her lft were no longer trended. . # hypoalbuminemia: chronic, likely due to rcc. nutrition consult. . # depression: continued zoloft, hold ambien for now given stablization of pressures medications on admission: vit d 50,000u once weekly zoloft 100mg daily ambien 10 mg qhs toprol 25 mg qhs discharge medications: 1. sertraline 100 mg tablet sig: one (1) tablet po once a day. 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. azithromycin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 3 days. disp:*3 tablet(s)* refills:*0* 4. ambien 10 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 5. vitamin d 50,000 unit capsule sig: one (1) capsule po once a week. 6. cefpodoxime 200 mg tablet sig: one (1) tablet po every twelve (12) hours for 6 days. disp:*12 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: congestive heart failure hypotension secondary to beta blocker use . secondary diagnosis: metastatic renal cell cancer discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ms. , it was a pleasure taking care of you in the hospital. you were admitted after fainting and we found that you had very low blood pressure. we think this was due to your heart failure and the administration of your metoprolol. we gave you fluid to treat this and held your metoprolol. your blood pressures improved and you were sent to the regular floor. we also did an echo while you were here that showed that you continue to have heart failure. while on the floor you had a fever and were found to have pneumonia. we started you on antibiotics and you will complete a course of antibiotics at home. . we made the following changes to your medications. start cefpodoxime 200mg by mouth every 12 hours for 6 days start azithromycin 250mg x4 days . stop metoprolol 25mg po daily . please go to the followup appointments listed below. weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: department: cardiac services when: tuesday at 9:00 am with: , md building: campus: east best parking: garage department: bmt/oncology unit when: tuesday at 3:00 pm building: fd building (/ complex) campus: east best parking: main garage department: bmt/oncology unit when: tuesday at 3:00 pm building: fd building (/ complex) campus: east best parking: main garage procedure: venous catheterization, not elsewhere classified diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified unspecified septicemia severe sepsis septic shock chronic systolic heart failure secondary malignant neoplasm of lung hypovolemia personal history of malignant neoplasm of kidney 

Answer: The patient is high likely exposed to