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: daypro / carafate / procardia / prilosec / diflunisal attending: chief complaint: initiation of chemotherapy. major surgical or invasive procedure: -picc line placement on the r -picc line placement on the l -r ij central line placement -chemotherapy on and . history of present illness: mrs. is a 76 y/o f with history of autoimmune hepatitis, diastolic chf, hypertension, t2dm, as well as abdominal b cell lymphoma, diagnosed after recent onset of abdominal pain. she initially presented to nebh ambulatory care for mild abdominal pain, where, abdominal exam reportedly was notable for a palpable mass. labs that day were notable for hematocrit 30.5 (baseline 37-39) calcium of 13.1 (albumin 3.5), creatinine 1.8 (baseline 1.2-1.5), and bnp 333. . she underwent abdominal/pelvis ct scan, which revealed a large soft tissue density surrounding the cecum and ascending colon with significant stranding, initially believed to be a phlegmon possibly appendicitis or appendiceal rupture. there was moderate concentric narrowing but no obstruction. ct also showed a smaller, similar phlegmon anterior to the transverse colon. ct chest was negative for malignancy. she was admitted for surgical evaluation and biopsy, and triaged to the icu for intensive fluid management in the setting of her severe diastolic chf. . she underwent abdominal open surgery on , with biopsy of her mass in multiple abdominal locations - diagnosis felt to be large b cell lymphoma. as above, ct chest was negative for malignant involvement. she did not undergo any other staging studies. patient was transferred for possible chemotherapy. per signout reported patient got prednisone 80 mg x 2 days , - but this is not listed in the discharge summary. . in regards to her hypercalcemia, she was treated with normal saline and furosemide, with normalization of her serum calcium levels. on day of transfer, her calcium was 9.8 with albumin of 2.2, suggesting mild hypercalcemia. she underwent tte on that was reportedly not consistent with dchf. . nebh d/c summary reports today's exam notable for no fevers, mild hypotension with systolic bps in the 90s, regular heart rhythm with rate in the 80s, and normal oxygen saturation. she was reported as having a distended, slightly tender abdomen. labs today were notable for stable cbc, inr 1.3, creatinine 1.5, and ldh 648. d/c summary also indicated that today's cxr was unchanged, showing poor inspiratory effort, prominent hila, basilar atelectasis bilaterally but no significant change from prior chest x-rays. discharge summary also reports a supraventricular tachycardia 5 days ago treated with po lopressor and diltiazem. . at time of admission patient's on compliant is dysuria and vaginal pain. otherwise denies shortness of breath, chest pain or abdoiminal pain. past medical history: past medical history: -autoimmune hepatitis confirmed by biopsy in which was treated with azathioprine and prednisone. recent hepatology note indicates desire to transition from prednisone to budesonide. primary hepatologist is dr. . -hypertension treated with metoprolol and lasix -osteoarthritis -sleep apnea -diabetes mellitus insulin-dependent, treated with novolin and regular insulin -copd -possible pulmonary hypertension (this was not borne out by a recent echocardiogram which although technically difficult, did not show evidence, doppler or otherwise of diastolic dysfunction) -hiatal hernia treated with nexium -multiple allergies with intermittent use of zyrtec -hyperuricemia treated with urolic -possible history of chf, which has been treated with lasix -headaches treated with fioricet. . past surgical history: -oophorectomy and appendectomy in -hysterectomy -cholecystectomy -bowel resection in as well social history: a 35-pack-year, quit in and no alcohol. she is married. family history: unable to obtain at time of admission. physical exam: upon admission: gen: nad, patient complains in pain heent: perrla, eomi, anicteric, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: aaox3. cn ii-xii grossly intact. moves all extremity. at discharge: vs: tmax 97.7 / bp 87-131/58-82 / hr 79-90 / rr 20-24 / sats 92-96% on 2l blood sugars: 165-218 gen: nad, more comfortable today skin: diffusely swollen, most on bilateral lower extremities and some on r hand, skin on stomach is friable around abdominal wound. abdominal wound has steri-strips over most of incision but one area at apex and one at base of incision are opened and packed with gauze. area around wound is not indurated and there is no significant surrounding erythema cardiac: rrr, s1, s2, no m/r/g, jvp not elevated pulm: ctab in anterior and lateral fields, fair air movement abdomen: soft, nt, distended to body habitus, positive bowel sounds extremities: 3+ pitting edema up to mid-thigh bilaterally with 2+ pulses at bp and radial arteries neuro: a&ox3, cn ii-xii intact, language normal pertinent results: upon admission: 03:25am blood wbc-6.8 rbc-3.17* hgb-10.4* hct-32.2* mcv-102*# mch-32.9* mchc-32.3 rdw-22.1* plt ct-271 03:25am blood pt-13.5* ptt-21.1* inr(pt)-1.2* 03:25am blood glucose-139* urean-45* creat-1.2* na-139 k-5.2* cl-98 hco3-30 angap-16 11:49am blood alt-72* ast-91* alkphos-65 totbili-0.7 03:25am blood ld(ldh)-720* 11:49am blood albumin-3.0* calcium-10.7* phos-5.2* uricacd-6.1* imaging/pathology: bone marrow immunotyping (): results: three color gating is performed (light scatter vs. cd45) to optimize lymphocyte yield. cd45 bright, low side scatter lymphoid events are less than 2% of total analyzed events. b cells comprise 5% of lymphoid-gated events, and do not express aberrant antigens. clonality is difficult to assess due to scant numbers, but appears polyclonal. t cells comprise 68% of lymphoid gated events, and express mature lineage antigens. interpretation non-specific t cell dominant profile; diagnostic immunophenotypic features of involvement by non-hodgkin lymphoma are not seen in specimen. correlation with clinical findings and morphology (see s10-) is recommended. flow cytometry immunophenotyping may not detect all lymphomas due to topography, sampling or artifacts of sample preparation. chromosome analysis bone marrow (): karyotype: 46,xx interpretation: no clonal cytogenetic aberrations were identified in metaphases analyzed from this unstimulated specimen. this normal result does not exclude a neoplastic proliferation. mosaicism and small chromosome anomalies may not be detectable using the standard methods employed. note: fish studies were not performed because assessment of the specimen by pathology showed no evidence of lymphoma. tissue bone marrow (): clinical: lymphoma, nhl. newly diagnosed dlbcl. pathology slides (): diagnosis: high-grade b-cell lymphoma, diffuse large b cell type, see note. echo (): conclusions the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef 70%). right ventricular chamber size and free wall motion are normal. there are focal calcifications in the aortic arch. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. rue u/s (): impression: occlusive thrombus within the subclavian and axillary veins adjacent to a picc. the cephalic, basilic, and paired brachial veins are patent. attempts to contact the medical team and nursing staff were unsuccessful and so these findings were reported into the radiology critical report dashboard. ct of abdomen/pelvis (): impression: 1. extensive wall thickening centered in the ileocecal region but also involving the ascending and proximal transverse colon. appearances may be due to lymphoma, typhilitis or colitis. comparison with any pre-treatment imaging would be extremely helpful. no fluid collections seen. 2. small bilateral pleural effusions. 3. moderate amount of ascites. 4. periportal edema noted. 5. multiple small low-attenuation lesions noted in both kidneys. 6. diffuse anasarca. 7. extensive calcification of the abdominal aorta. final addendum ct images from dated have now become available for comparison. a large soft tissue mass in the right lower quadrant involving the ascending colon and terminal ileum is significantly decreased in size. the mass previously measured 13.4 x 13.3 cm and currently measures 11.4 x 9.3 cm in a similar location. the previously noted eccentric wall thickening in the transverse colon has significantly improved. the wall measured previously 3.3 cm in largest thickness and currently measures 1.3 cm. cxr pa/lat (): impression: 1. mild residual pulmonary venous congestion, but improved perihilar infiltrates likely reflect improved pulmonary edema. 2. basal atelectasis with possible small area of superimposed consolidation at left base. 3. t9 compression as on prior ct exam. 4. small basal pleural effusions. 5. left picc passes cranially, presumably into the left internal jugular vein. the tip is excluded from the field of view. microbiology: urine cx (): **final report ** urine culture (final ): proteus mirabilis. >100,000 organisms/ml.. presumptive identification. enterococcus sp.. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ proteus mirabilis | enterococcus sp. | | ampicillin------------ =>32 r <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- <=4 s tetracycline---------- =>16 r tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r vancomycin------------ 1 s follow up bcx, ucx, and c diff toxins negative. urine chemistry: creat 99 / na less than 10 / k 35 / cl less than 10 / calcium 1.32 / hco3 less than 30 / osm 585 discharge labs (): wbc 15.9 / hgb 9.5 / hct 28.4 / plts 141 na 135 / k 4.5 / cl 106 / hco3 24 / bun 26 / cr 0.8 / plts 202 ca 7.7 / mg 1.8 / phos 2.9 / alt 19 / ast 31 / ldh 442 / alk phos 222 inr 1.4 hit ab: negative pending: factor v leiden blood cx ( and ) brief hospital course: 76 y/o female with diastolic chf, t2dm, autoimmune hepatitis, and newly diagnosed b cell lymphoma of the abdomen, transferred from nebh for initiation of chemotherapy. . #b cell lymphoma: diagnosed with pathology, cytology, and flow consistent with a b cell lymphoma. oncology preformed bone marrow today for - ipi stage 5. started with solmedrol 100 mg iv dose x 1. tumor lysis labs were followed q8hours without issue, and bicarb d5w 75 cc/hr was also given with allopurinol. echo revealed mild diastolic chf. she was transferred to the oncology floor on day 1 s/p solumedrol infusion without issue. she was started on chop therapy cycle one on . counts dropped as expected and recovered again by with the aid of neupogen injections. pt required intermittent blood transfusions, although no plts transfusions, while counts were low. pt tolerated the chemo fairly well although her hospital course was complicated by some of the below issues. pt was kept npo during the first 11 days of chemo over concerns that as her bowel mass shrunk she was at risk for perforation of the bowel. decision was made to give 2nd cycle of chop, plus rituxan, on morning of discharge (), because pt unable to receive rituxan at rehab center. pt discharged to in with plans for follow-up with dr. on at 2pm. . # atrial fibrillation: pt had reported episode of afib with rvr at nebh before transfer. on arrival in icu, pt was initially placed on diltiazem and had dose uptitrated to control rate. after transfer to floor still difficulty with rate control with rates in 110-130s. pt was switched to metoprolol and dose uptitrated to 100mg metoprolol tartrate to good effect. at times pt would get dehydrated and hr would bump up but these times usually responded to small fluid boluses (500-1000mls ns. . # delerium: pt had reported episode of delerium while at nebh but was not delerious at time of transfer to . no issues with initiation of chemotherapy but pt complained of intermittent back pain from old known compression fracture and was given one dose of iv dilaudid as at time had elevated lfts and questionable renal function. pt became very delerious from dilaudid. this cleared slowly over next three days, with the help of iv haldol. by time of discharge pt alert and oriented x 3 and with no signs of delerium. . # copd: pt with history of underlying lung disease of uncertain severity. initially pt was on 6l of nasal cannula in order to keep sats in low-mid 90s. unclear how much of this due to lung disease and how much to other issues. able to be titrated down to 4l nc but not low in first week. increased frequency of albuterol and ipratropium and changed both to standing doses and nebs and resulting improvement in sats so that pt only required 2l nc to keep sats in low to mid 90s. . # febrile neutropenia: during pts count nadir from above chop, pt developed fevers. due to concern for abdominal source, started initially on cefepime and metronidazole and then broadened to vancomycin when fevers persisted. fevers went away after 48hrs and all culture data was negative. abx were stopped after counts recovered so that pt no longer neutropenic. . # diabetes type ii: pt with history of dm ii and on insulin at home. with initiation of chemo and accompanying steroids, pt had blood sugars very difficult to control into 300s routinely with just iss coveage. once tpn started, insulin was placed in tpn but sugars still high so started on nph and uptitrated to 8u am / 8u pm with resulting sugars in mid 100s with 45 units regular insulin in tpn. . # abdominal wound: ex-lap as part of dx at nebh on . general surgery at saw pt 12 days later and removed staples. two seroma collections opened up and drained serious fluid. wounds were packed with gauze with plan to let heal from inside out although healing slow due to multiple medical issues. at time of d/c wound not infected but still opened and packed at both superior and inferior portion of wound. . # gerd: pt with no history of hiatal hernia and accompanying bad gerd which caused significant intermittent abdominal discomfort. pt was started on iv ppi to help with this. ppi worked to good effect and was titrated down to daily at time of d/c. . medications on admission: medications at home: per omr - patient unable to recall azathioprine - 100 mg tablet - 1 tablet(s) by mouth once a day budesonide - 3 mg capsule, sust. release 24 hr - one capsule(s) by mouth daily citalopram - (prescribed by other provider) - 10 mg tablet - 1 tablet(s) by mouth once daily take with one 20mg tablet for dose of 30 citalopram - (dose adjustment - no new rx) - 20 mg tablet - 1 tablet(s) by mouth once a day take with one 10mg tablet for total of 30mg esomeprazole magnesium - 40 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth twice a day furosemide - (prescribed by other provider) - 40 mg tablet - 4 tablet(s) by mouth q am and 2 q pm insulin lispro - (prescribed by other provider) - 100 unit/ml solution - 80 units q am and 18 units q pm metoprolol succinate - (prescribed by other provider; dose adjustment - no new rx) - 50 mg tablet sustained release 24 hr - 3 tablet(s) by mouth at bedtime total of 350 mg daily metoprolol tartrate - (dose adjustment - no new rx) - 100 mg tablet - 2 tablet(s) by mouth once daily total of 350 mg regular insulin sliding scale - (prescribed by other provider) - - as directed medications - otc aspirin - (prescribed by other provider) - 81 mg tablet - 1 tablet(s) by mouth once a day calcium carbonate-vitamin d3 - (prescribed by other provider) - 500 mg (1,250 mg)-400 unit tablet - 1 tablet(s) by mouth three times a day multivitamin - (prescribed by other provider) - tablet - 1 tablet(s) by mouth once a day potassium - (prescribed by other provider) - dosage uncertain . meds on transfer: -insulin detemir 20 units subq in a.m. - novolin insulin sliding scale -hydroxyzine pamoate 25 mg p.o. p.r.n. itching -albuterol ipratropium 1 vile duoneb q6h as needed for shortness of breath -metoprolol 100 mg po q 8 hours -citalopram 30 mg p.o. daily -senna docusate 8.6/50, senokot-s 2 tabs as needed at bedtime -econazole powder 2% b.i.d. topically to areas of rash -heparin 5000 units subq q8h -lorazepam 1 mg p.o. as needed daily -febuxostat 80 mg p.o. daily -zofran 4 mg p.o. can be used as needed q6h for nausea -continue diltiazem 60 mg t.i.d. p.o. -maalox 30 ml as needed q6h for nausea or indigestion -phosphate powder 1 package p.o. daily that is neutrophos. -re-started prednisone 5 mg a day - because on chronic dosing prior to admission discharge medications: 1. citalopram 20 mg tablet sig: 1.5 tablets po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for oral thrush. 4. metoprolol tartrate 100 mg tablet sig: one (1) tablet po twice a day: hold for sys bp < 90 and hr < 60. 5. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 6. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain or fever: max of 2g acetaminophen each day. 7. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for rash. 8. oxycodone 5 mg/5 ml solution sig: 2.5 mg po q8h (every 8 hours) as needed for severe pain: please try to limit narcotic use as patient is easily made delerious with narcotics. 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours). 10. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 11. prednisone 50 mg tablet sig: two (2) tablet po q24h (every 24 hours) for 4 doses: give on days 2, 3, 4, and 5. 12. enoxaparin 30 mg/0.3 ml syringe sig: one (1) subcutaneous q12h (every 12 hours). 13. sodium citrate 4% 3 ml dwell tid please place in rij ports in palce of heparin 14. aprepitant 125 mg capsule sig: one (1) capsule po q 24h (every 24 hours) for 3 days. 15. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 16. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous once a day. 17. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed for nausea. 18. haloperidol 1 mg tablet sig: one (1) tablet po at bedtime as needed for agitation. 19. tpn order volume(ml/d) 1800ml amino acid(g/d) 75g/d dextrose(g/d) 300g/d fat(g/d) 40g/d trace elements will be added daily standard adult multivitamins nacl 110 / naac 0 / napo4 40 / kcl 0 / kac 35 / kpo4 25 / mgs04 14 / cagluc 9 insulin(units) 45 total volume of solution per 24 hours. 20. insulin sliding scale fingerstick q6hinsulin sc fixed dose orders breakfast: nph 8 units / bedtime nph 8 units insulin sc sliding scale q6h humalog glucose insulin dose 0-70 mg/dl proceed with hypoglycemia protocol 71-150 mg/dl 0 units 151-200 mg/dl 2 units 201-250 mg/dl 4 units 251-300 mg/dl 6 units 301-350 mg/dl 8 units 351-400 mg/dl 10 units > 400 mg/dl notify m.d. 21. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 22. dextrose 50% in water (d50w) syringe sig: one (1) intravenous prn (as needed) as needed for hypoglycemia protocol. 23. neupogen 480 mcg/0.8 ml syringe sig: one (1) injection once a day: please start on sunday (). discharge disposition: extended care facility: center discharge diagnosis: primary diagnosis: - abdominal b-cell lymphoma secondary diagnosis: - autoimmune hepatitis - atrial fibrillation - type ii diabetes - urinary tract infection - copd - delerium discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: , it was a pleasure taking care of you during your stay. you were transfered to from for treatment of your abdominal lymphoma. you were started on a chemotherapy regimen known as chop and you were given the first round of this treatment on and the second round on . you tolerated your chemo well with few side effects and your blood counts had recovered by time of next treament on . during you hospitalization, our general surgeons removed your abdominal staples and opened to areas of your wound that contained fluid. we have been packing this with gauze and this should be continued at rehab. you also had both a uti and later a fever which were treated effectively with anti-biotics. you had an episode of delerium during your stay which was triggered by a narcotic medication. in the future you should try to limit your use of narcotics as your body seems very sensative to them and you may go into a delerium again. you should follow-up with dr. on as noted below. you should take the following medications: -citalopram 20 mg tablet sig: 1.5 tablets po daily (daily). -docusate sodium 100 mg capsule sig: one (1) capsule po bid -nystatin 100,000 unit/ml suspension five (5) ml po qid prn thursh -metoprolol tartrate 100 mg tablet sig: one (1) tablet po bid -polyethylene glycol 3350 17 gram/dose powder 1 po daily prn -acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain or fever: max of 2g acetaminophen/day -miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for rash. -oxycodone 5 mg/5 ml solution sig: 2.5 mg po q8h (every 8 hours) as needed for severe pain: please try to limit narcotic use as patient is easily made delerious with narcotics. -albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours). -ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). -prednisone 50 mg tablet sig: two (2) tablet po q24h (every 24 hours) for 4 doses: give on days 2, 3, 4, and 5. -enoxaparin 30 mg/0.3 ml syringe sig: one (1) subcutaneous q12h (every 12 hours) -neupogen 480 mcg/0.8 ml syringe sig: one (1) injection once a day: please start on sunday (). -tpn and insulin as directed. followup instructions: department: hematology/bmt when: thursday at 2:00 pm with: , np building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: thursday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: parenteral infusion of concentrated nutritional substances biopsy of bone marrow injection or infusion of cancer chemotherapeutic substance central venous catheter placement with guidance diagnoses: other iatrogenic hypotension obstructive sleep apnea (adult)(pediatric) esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other chronic pulmonary heart diseases personal history of tobacco use other opiates and related narcotics causing adverse effects in therapeutic use chronic kidney disease, unspecified pulmonary collapse other malignant lymphomas, unspecified site, extranodal and solid organ sites long-term (current) use of insulin antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use seroma complicating a procedure dehydration drug-induced delirium drug induced neutropenia other and unspecified coagulation defects proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site chronic diastolic heart failure hypercalcemia fever presenting with conditions classified elsewhere autoimmune hepatitis tumor lysis syndrome 

Answer: The patient is high likely exposed to