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: bactrim attending: chief complaint: shortness of breath major surgical or invasive procedure: thoracentesis history of present illness: reason for micu admission: hypoxia respiratory distress . primary care physician: , . . cc: cough, shortness of breath . hpi: 83yo female russian with history of cll presenting with respiratory distress. . per patient she reports 6 days of productive cough and progressive dyspnea. she reports associated fevers up to 100.2 and sore throat. two days prior to admission prescribed bactrim by her son who is a physician. worsened and she presented to her pcp . there vital signs notable for o2 sat 89% ra, improved to 92% on 2l nc. cxr with right increased effusion and possible left sided infiltrate. she was referred to ed for further eval. . in the ed, initial vs: 99.3 81 118/46 20 96% nrb. labs notable for wbc of 33.2, 61% lymphocytes; k: 5.2, creatinine 2.7, lactate 1.3. blood cultures obtained. cxr performed which demonstrated interval increase in moderate - large right pleural effusion as well as opacity lateral to left hilum. patient received po tylenol 650mg x1, iv ceftriaxone and levofloxacin. the patient was attempted to be weaned to nc, but desated to 90%. she was placed back on a nrb and transferred to for further evaluation and management. . in the the patient states that her breathing has improved. . ros: +: as per hpi -: denies any chills, weight change, nausea, vomiting, abdominal pain, diarrhea, constipation, melena, hematochezia, chest pain, orthopnea, pnd, lower extremity edema, urinary frequency, urgency, dysuria, lightheadedness, gait unsteadiness, focal weakness, vision changes, headache, rash or skin changes. past medical history: past medical history: # oncologic history chronic lymphocytic leukemia - diagnosed in : rai stage 0 in - s/p 5 cycles of fludarabine ending in . - recurrent anemia and advancing peripheral blood lymphocytosis and lymphadenopathy, prompted 4 additional 3-day cycles of fludarabine from to . # pmh 1. macular degeneration; legally blind. 2. chronic renal failure: baseline creatinine 1.5 3. hypothyroidism secondary to hemithyroidectomy on 4. diabetes: last hga1c: 7.0 5. hypertension. 6. in , she was admitted to hospital with respiratory infection due to h1n1 influenza a. she received 6 days of tamiflu and levaquin with improvement in symptoms. myelosuppression during her viral illness improved. . surgical history: hysterectomy at age 43. appendectomy. right thyroidectomy social history: lives with her husband. two children. retired teacher. originally from tob: none etoh: none family history: father - h/o esophageal cancer mother - h/o skin cancer sister - h/o breast cancer physical exam: on admission: gen: well-appearing, well-nourished, no acute distress heent: eomi, perrl, sclera anicteric, no epistaxis or rhinorrhea, mmm, op clear neck: no jvd, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline cor: rrr, ii/ vi sem, no m/g/r, normal s1 s2, radial pulses +2 pulm: diminished bs at the right base, otherwise no w/r/r abd: soft, nt, nd, +bs, no hsm, no masses ext: no c/c/e, no palpable cords neuro: alert, oriented to person, place, and time. cn ii ?????? xii grossly intact. moves all 4 extremities. strength 5/5 in upper and lower extremities. patellar dtr +1. plantar reflex downgoing. no gait disturbance. no cerebellar dysfunction. skin: no jaundice, cyanosis, or gross dermatitis. no ecchymo pertinent results: 05:30pm wbc-33.2* rbc-4.31 hgb-12.5 hct-36.5 mcv-85 mch-29.1 mchc-34.3 rdw-15.9* 05:30pm plt smr-normal plt count-164 05:30pm neuts-34* bands-0 lymphs-61* monos-5 eos-0 basos-0 atyps-0 metas-0 myelos-0 05:30pm hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 05:30pm glucose-134* urea n-48* creat-2.7*# sodium-136 potassium-5.2* chloride-102 total co2-20* anion gap-19 10:28pm pt-13.6* ptt-28.0 inr(pt)-1.2* 05:30pm ck(cpk)-89 05:30pm ctropnt-<0.01 05:35pm lactate-1.3 10:28pm pt-13.6* ptt-28.0 inr(pt)-1.2* 05:30pm ck-mb-4 probnp-1345* 11:09pm urine hours-random urea n-390 creat-52 sodium-37 potassium-30 chloride-16 11:09pm urine osmolal-270 11:09pm urine color-yellow appear-clear sp -1.008 11:09pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 11:09pm urine rbc-<1 wbc-1 bacteria-none yeast-none epi-<1 11:09pm urine mucous-rare 11:09pm urine eos-negative . igg iga igm 05:57 963 52* 66 . micro: legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. 2:33 pm pleural fluid gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (preliminary): no growth. anaerobic culture (final ): no growth. urine culture (final ): <10,000 organisms/ml pleural pathology: pending ct chest: findings: bulky lymphadenopathy is present in the imaged portion of the lower neck, superior mediastinum, throughout the intrathoracic mediastinum, bilateral hila, and to a lesser extent within the axillary regions. large right pleural effusion is dependent in location and measures simple fluid density. a small amount of loculated fluid is also present within the major fissure and in the anterolateral portion of the right lower chest. extensive consolidation is present within the right lower and right middle lobes. peribronchiolar abnormalities are present in both upper lobes with a combination of ground glass and consolidation accompanied by bronchial wall thickening and small peribronchial nodules. a dominant peribronchial nodule in the left upper lobe measures 2.2 cm and is surrounded by a halo of ground-glass opacity (26, series 3a). this corresponds to a rapidly growing focal opacity on serial chest x-rays between and . additional peribronchiolar abnormalities are present to a lesser extent within the left lower lobe. exam was not tailored to evaluate the subdiaphragmatic region, but note is made of retroperitoneal or intra-abdominal lymphadenopathy as well as incompletely imaged splenomegaly. lucent spine lesions within the lower thoracic spine (image 53, series 3a and image 48, series 3a) are probably hemangiomas. degenerative changes are also noted at multiple levels throughout the spine. impression: 1. multifocal lung abnormalities most suggestive of a widespread infectious process. nodular opacity with ground-glass halo in left upper lobe is nonspecific, but this appearance may be associated with angioinvasive aspergillus infection in the setting of neutropenic fever. 2. large simple right pleural effusion. 3. extensive lymphadenopathy, likely related to the provided history of cll. splenomegaly is also in keeping with this diagnosis. 4. two lucent thoracic vertebral body lesions in the lower thoracic spine which probably reflect hemangiomas. . tte the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 0-10mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal left ventricular cavity size and wall thickness with preserved global and regional biventricular systolic function. no clinically significant valvular regurgitation. borderline pulmonary artery systolic hypertension. an area of echodensity measuring 7.4 cm x 4.9 cm (clip ) is seen that appears to be contained within a small right pleural effusion. clinical correlation and consideration of a chest ct for further characterization suggested. . leni: findings: color and -scale son was performed on the bilateral lower extremities. the bilateral common femoral, superficial femoral and popliteal veins are normal in compressibility, augmentation, and doppler waveforms. the calf veins are patent and compressible. there is no deep vein thrombosis in either lower extremity. . brief hospital course: this is a 83 year-old female with a history of cll who presents with respiratory distress. . # respiratory distress. etiology likely secondary to worsening effusion as well as new infiltrates concerning for multifocal pneumonia. patient with known malignancy and therefore at risk for hypercoagulable state. score appears to be low -1 (+1 for malignancy, -2 for other cause of dyspnea). lenis negative. biomarkers flat. tte with normal systolic and diastolic function. patient underwent uncomplicated thoracentitis on , 500cc was removed. fluid largely transudative. gram stain with no growth. cytology pending. cxr with lul infiltrate. urine legionella negative. blood cx: ngtd. ct scan consistent with multifocal pneumonia; though question of fungal per radiology, clinical suspicion higher for pneumococcal pathogen. patient continued on ceftriaxone and levofloxacin with plan for 8-10day course. patient's respiratory status improved on these antibiotics and o2 was weaned as tolerated. at time of transfer to floor on , oxygen saturation was >94% on 3l nc. narrowed to levofloxacin alone prior to discharge . pending cytology needs follow up. also recommend ct chest after treatment completed. . # . patient with history of chronic renal insufficiency with baseline creatinine 1.5. creatinine on admission 2.7. etiology pre-renal, ain in setting of recent bactrim usage. ua and urine culture without sign of infection. urine eosinophils negative. fena: 1.3. creatinine slowly improved with ivf and was 2.3. at time of transfer to the medical floor. trending daily. it was lowered to 1.7 prior to discharge. . # cll. patient diagnosed in . patient last treated with fludarabine in . labs notable for elevated wbc >20 since 4/. patient without anemia or thrombocytopenia. igg levels checked. igg level wnl. dr followed patient closely. no plan for ivig infusion. . # diabetes. last hga1c: 9.0. patient states she does not take any meds for diabetes and her daughter said she eats whatever she wants. monitoring qid fs, iss. . # hypothyroid. continued synthroid . # fen: ivf, replete prn, diabetic/cardiac diet . # access: piv . # ppx: subq heparin, home ppi . medications on admission: see admission note discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po q12h (every 12 hours). 2. tramadol 50 mg tablet sig: one (1) tablet po daily (daily). 3. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 4. lipase-protease-amylase 12,000-38,000 -60,000 unit capsule, delayed release(e.c.) sig: one (1) cap po bid (2 times a day). 5. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*0* 6. levofloxacin 750 mg tablet sig: one (1) tablet po q48h (every 48 hours) for 2 doses. disp:*2 tablet(s)* refills:*0* 7. home oxygen 2 liters continuous pulse dose for portability. dx: pleural effusion 8. metformin 500 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. discharge disposition: home with service facility: family & services discharge diagnosis: community acquired pneumonia with parapneumonic effusion chronic kidney disease stage iii cll hypothyroidism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted for treatment for severe pneumonia as well as fluid in the lung. the fluid in the lung was sampled. you were started on antibiotics with improvement in your symptoms. please continue your antibiotics to complete the full course. please take all other medications as prescribed. you need to see you pcp in close follow up. lung fluid cytology is pending at discharge and will need to be followed up. also, we recommend a follow up ct scan of the chest once your symptoms resolve. start: levofloxacin 750mg every 48 hours albuterol inhaler as needed followup instructions: please follow up with dr. as soon as possible department: center when: wednesday at 8:20 am with: , m.d. building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: tuesday at 1:30 pm with: , rn building: campus: east best parking: garage department: medical specialties when: thursday at 9:30 am with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: thoracentesis diagnoses: pneumonia, organism unspecified acute kidney failure with lesion of tubular necrosis diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypopotassemia chronic kidney disease, stage iii (moderate) macular degeneration (senile), unspecified personal history of antineoplastic chemotherapy leukocytosis, unspecified legal blindness, as defined in u.s.a. chronic lymphoid leukemia, without mention of having achieved remission acquired absence of both cervix and uterus sulfonamides causing adverse effects in therapeutic use hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified postsurgical hypothyroidism other specified forms of effusion, except tuberculous 

Answer: The patient is high likely exposed to