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: cefepime attending: chief complaint: fever major surgical or invasive procedure: mechanical intubation and ventilation history of present illness: the patient is a 29 y/o female w/ pmhx aml diagnosed in s/p 7+3 followed by 5+2 induction, now day 18 of 4th cycle of hidac consolidation who presents with febrile neutropenia. today, pt went for routine countcheck/eval, day 18 following 4th cycle of hidac. noted nasal congestion and drainage with sore throat. tmax at home this am 100.1. endorses fatigue, dry cough. normal po intake. denies denies any nausea, vomiting, diarrhea or constipation. denies any abdominal pain or cramping. denies any shortness of breath, chest pain, chills or night sweats, lightheadedness, or rashes. vital signs in the office today were: bp: 101/66. hr: 109. w: 98. bmi: 18.5. t: 100.5, 100.1. rr: 18 o2sat 100% past medical history: past oncologic history: ms. is a 29-year-old female with history of aml. she was in her usual state of health until about a month prior to initial presentation, which was in when she started to note some increased bruising. she then had developed some daily fevers and felt more fatigued and then ultimately had a syncopal episode. she went to hospital and then ultimately was transferred to and upon review of her peripheral smear was found to have blasts. she had a bone marrow biopsy on , which reveals aml-m2 with approximately 23% blasts. her blast expressed hla-dr, cd33, cd117, cd11c subset m. in terms of her presenting cytogenetics, she did not have any abnormal cytogenetics and she was with flt3 and npm negative. when she presented, she had a white count of 3.4, hemoglobin of 7.1, hematocrit of 18.9 and a platelet count of 23,000 with approximately 60% circulating blasts. she proceeded with 7 and 3 (cytarabine and daunorubicin). on her day 14 marrow, which was done on unfortunately, it revealed a hypocellular marrow with increased blasts, some left-shifted myelopoiesis. as a result of her persistent disease, she proceeded with 5 and 2 regimen with daunorubicin and cytarabine. her treatment course was complicated by fever and no clear source was identified. there was question as to whether it was related to her chemotherapy. she ultimately was discharged from the hospital on . had a bone marrow bx and aspirate on which did not reveal any morphologic or cytogenetic evidence of disease. . : cycle #1 high-dose ara-c, complicated by fever, most likely due to ara-c as had similar symptoms during induction. to : hospitalized for neutropenic fever and typhlitis. to : cycle #2 hidac. to : cycle #3 hidac. to : cycle #4 hidac. . other past medical history: reveals an admission to around which by her report was for 2 days for low blood counts, admission to hospital for gastroenteritis. social history: originally from , she has been in the us for 16 years. not currently working, but was previously a housekeeper. she is single, has an 8yo son, and they live with her twin sister ). parents remain in . no tobacco, alcohol or drugs. family history: mother--possible transfusion-dependent mds. father--healthy. no other major medical problems. physical exam: on admission: vitals - t: 100.1 bp 96/54 hr 85 rr 16 99% on ra general: nad skin: warm and well perfused, no excoriations or lesions, no rashes heent: at/nc, eomi, perrla, anicteric sclera, pink conjunctiva, patent nares, mmm, good dentition, nontender supple neck, no lad, no jvd cardiac: rrr, s1/s2, no mrg lung: ctab abdomen: nondistended, +bs, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly m/s: moving all extremities well, no cyanosis, clubbing or edema, no obvious deformities pulses: 2+ dp pulses bilaterally neuro: cn ii-xii intact . at discharge: pertinent results: admission labs: 09:55am blood wbc-0.5* rbc-2.93* hgb-9.5* hct-24.8* mcv-85 mch-32.5* mchc-38.3* rdw-15.4 plt ct-17*# 09:55am blood neuts-8 bands-0 lymphs-72 monos-17 eos-0 baso-0 atyps-3 metas-0 myelos-0 09:55am blood gran ct-8* 09:55am blood urean-9 creat-0.7 na-134 k-4.2 cl-97 hco3-26 angap-15 09:55am blood alt-51* ast-30 alkphos-132* totbili-1.1 cxr impression: pa and lateral chest compared to through : normal heart, lungs, hila, mediastinum and pleural surfaces. . cxr findings: as compared to the previous radiograph, there is no relevant change. normal appearance of the lung parenchyma, no pleural effusions. normal size and shape of the mediastinal structures and the cardiac silhouette. no pneumonia. . cxr overall, the cardiac and mediastinal contours are stable. the interstitium appears slightly prominent throughout both lungs but when compared to multiple previous studies given differences in technique, this is not likely significantly changed. no focal airspace consolidation is seen to suggest pneumonia. no pleural effusions or pneumothorax. if the patient's symptoms persist, followup imaging should be considered. no acute bony abnormality. . cxr findings: as compared to the previous radiograph, the inspiratory volume has decreased. in addition, there is a relatively ill-defined bilateral pattern of parenchymal opacities with air bronchograms and minimal bronchial cuffing. given the patient's clinical presentation, this change would be consistent with pneumonia. otherwise, there is no relevant change. borderline size of the cardiac silhouette. no evidence of pleural effusions. normal appearance of the hilar and mediastinal contours. chest ct : impression: 1. multifocal lung consolidations and small nodular opacities rapidly appearing over few days and given the clinical history is concerning for lung infection, likely bacterial. fungal infection though less likely, cannot be ruled out. alternatively, recent leukocytosis in immune challenged patient as reflected from online medical records, may cause similar appearance. 2. mild pulmonary artery hypertension. echo : the left atrium and right atrium are normal in cavity size. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thicknesses and cavity size are normal. there is mild to moderate global left ventricular hypokinesis (lvef = 35-40%). systolic function of apical segments is relatively preserved. right ventricular chamber size is normal with mild global free wall hypokinesis. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. impression: normal biventricular cavity sizes with mild-moderate global left ventricular hypokinesis and mild right ventricular free wall hypokinesis c/w diffuse process (toxin, metabolic, etc. - less suggestive of multivessel cad, but cannot fully exclude). compared with the prior study (images reviewed) of , global biventricular systolic function is now depressed. admission labs: microbiology: blood cultures 12/1- negative blood cultures - negative throat culture - gram stain- r/o thrush (final ): negative for yeast. no organisms seen. r/o beta strep group a (final ): no beta streptococcus group a found. rapid respiratory viral culture - negative blood cultures 12/3- negative urine culture - negative urine culture - negative expectorated sputum - gram stain >25 pmns and >10 epithelials/100x field, no acid fast bacilli on smear, culture pending blood culture for mycolytics- ngtd, pending urine culture - negative for urinary legionella antigen fungal culture pending bronchoalveolar lavage - rml- gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram positive cocci in pairs. culture- no legionella, no acid fast bacilli on smear, no pcp, >6000 commensal respiratory flora, no fungus lingula- gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram positive cocci in pairs. culture- no legionella, no acid fast bacilli on smear, culture showing >5000 commensal respiratory flora, no fungus rapid respiratory viral screen & culture- negative for hsv, cmv, vzv stool- c.diff negative cmv viral load ?????? no cmv dna detected aspergillus antigen- 0.1 beta-glucan- <31 histoplasma antigen - urine - negative .......................... mycoplasma pneumonia pcr- pending aspergillus antigen from bal- pending virus b antibodies - pending pertinent labs throughout hospital course cbc: 03:20pm blood wbc-10.4# rbc-2.94* hgb-9.4* hct-25.2* mcv-86 mch-31.9 mchc-37.2* rdw-14.9 plt ct-55* 06:28am blood wbc-3.3* rbc-3.23* hgb-10.3* hct-29.0* mcv-90 mch-31.8 mchc-35.3* rdw-17.7* plt ct-104* diff: 06:05am blood neuts-67 bands-1 lymphs-13* monos-18* eos-0 baso-0 atyps-1* metas-0 myelos-0 03:24am blood neuts-90.4* lymphs-5.0* monos-4.3 eos-0.2 baso-0.1 12:00am blood neuts-79.4* lymphs-10.2* monos-10.0 eos-0.1 baso-0.3 anc: 05:55am blood gran ct-144* 06:00am blood gran ct-710* 07:25am blood gran ct-1748* 06:05am blood gran ct-2584 12:00am blood gran ct-3260 lfts: 06:30am blood alt-30 ast-30 ld(ldh)-299* alkphos-97 totbili-0.8 07:14am blood alt-101* ast-110* alkphos-107* totbili-0.4 06:28am blood alt-48* ast-45* alkphos-105 totbili-0.5 other: 06:30am blood probnp-* 08:21am blood ck-mb-1 ctropnt-<0.01 12:00am blood ctropnt-<0.01 08:08am blood hapto-310* 06:28am blood tsh-2.8 06:28am blood cortsol-26.6* 08:08am blood fibrino-688*# brief hospital course: the patient is a 29 y/o female w/ pmhx aml diagnosed in s/p 7+3 followed by 5+2 induction, s/p 4th cycle of hidac consolidation who presents with febrile neutropenia, fevers to 104, and bilateral pulmonary infiltrates. # febrile neutropenia- pt s/p 4 cycles hidac consolidation, presented at 18 days from last cycle. p/w cough, rhinorrhea, nasal congestion, fatigue, and fever of 100.5 suggestive of viral infection. cxr, ua, cultures, viral swabs were all negative. on presentation her anc was 8. aztreonam and vancomycin were started. pt had been taking home cipro and acyclovir prophylactically. cipro was discontinued. pt continued to spike with fevers of 102-104. additionally, she developed a new o2 requirement. ambisome was added. ct chest showed bilateral extensive opacities, concerning for multifocal bacterial pneumonia, less likely fungal infection. other etiologies considered include dah, trali vs taco (1 prbcs had been administered on her 3rd day of hospitalization), drug pneumonitis given recent high dose ara-c. in the setting of potential pulmonary infection, levaquin was started, aztreonam switched to meropenem to cover for esbl, bactrim and prednisone started for pcp. transferred to the icu, electively intubated for bronchoscopy, which showed 1+ gpc and 1+ gnr, and negative pcp, which point bactrim and prednisone were discontinued. b-glucan and galactomannan were negative, urine legionella and histo ab negative. negative mycoplasma pcr and coccidiomycosis. virus antibodies still pending at time of discharge. ambisome was discontinued after patient clinically improved and fungal markers negative. bal cultures did not grow any organisms. pt defervesced and was extubated and transferred to the floor. pt remained afebrile with non-neutropenic counts throughout the rest of the hospital stay. # hypoxic respiratory failure- patient developed respiratory distress in the setting of fevers. ct chest showed extensive bilateral opacities concerning for multifocal bacterial pneumonia, viral infection vs fluid overload with multiple transfusions. patient electively intubated for bronchoscopy, initially difficult to extubate tachypnea and high fio2/pao2 ratio. antibiotics treatment per above. cxr began to clear after diuresis with lasix and auto-diuresis, and patient was extubated without complications. testing for fungal wall elements, histo, legionella, cmv, crypto, coccidio, and mycoplasma negative. unclear etiology of infection. virus antibodies pending. pt also with elevated bnp, c/f heart failure. tte showed newly decreased ef of 35-40% (see cardiomyopathy, below). # cardiomyopathy- in the setting of respiratory failure responsive to diuresis, a repeat echo was obtained with showed biventricular and global hypokinesis (new compared to ) and ef 35-40%. this is likely recent chemotherapy as pt received daunorubicin, exacerbated in the setting of sepsis and increased demands on the heart. pt started on carvedilol 3.125mg , to have follow up with cardiology in 2 weeks at which time most likely repeat of tte. on the floor, pt's blood pressure ran in the high 70s and 80s systolic. her first day out on the floor her sbps were in the high 70s and pt required two 250cc boluses to maintain sbp in the 80s, likely combination of dehydration (decreased po intake) in setting of decreased myocardial function. pt was started on low dose carvedilol, however she remained slighly hypotensive so this was switched to metoprolol. #hypotension - on admission, pt had sbp from high 80s to 120s. in the past it appears her sbps have run in the 90s. after pt was called out to the floor she had sbp in the high 70s. she reported some diarrhea, having just started her period, and decreased po intake in this setting, all likely compounding the effects of underlying cardiomyopathy with decreased ef and contributing to hypotension. pt was also started on carvedilol in the setting of chf. pt was monitored on telemetry without arrhythmia or other events, hr initially fluctuated between 60 and low 100s and then stabilized to remain in roughly the 80s range. carvedilol was switched to metoprolol for its decreased alpha blocking effects. pt went home on metoprolol xl 50mg daily. # aml/pancytopenia - s/p 4 cycles of consolidation. continue therapy per primary oncologist. patient counts recovering. supportive transfusion with threshold hct<21, and plt<10. patient required a total of 2 units prbc during this hospitalization. # transaminitis: mild, likely due to chemo. transaminase levels peaked towards the end of and trendeding back to baseline. during her stay in the icu, transaminitis recurred and was thought to be direct toxicity from one of the broad spectrum drugs she was receiving, likely ambisome. acyclovir was held in this setting. lfts trended down as antibiotic and fungal coverage narrowed. transitional issues: pt had tsh and am cortisol sent for evaluation of hypotension. these results were not back at the time of discharge. since then they have come back showing tsh of 2.8 and cortisol of 26.6, slightly elevated. also, virus antibodies pending at time of discharge. medications on admission: acyclovir 400mg tid ciprofloxacin 500mg discharge medications: 1. acyclovir 400 mg tablet sig: one (1) tablet po q8h (every 8 hours). disp:*90 tablet(s)* refills:*0* 2. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. disp:*30 tablet extended release 24 hr(s)* refills:*0* 3. fluconazole 100 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days. disp:*7 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: febrile neutropenia multifocal pneumonia acute systolic heart failure secondary: hypotension acute myeloid leukemia 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 during your recent hospitalization. you were admitted with a fever in the setting of very low white blood cell counts because of your recent chemotherapy. these are the cells needed to fight infection, so we started you on some very strong antibiotics. even so, you continued to have fevers and then developed low oxygen levels. a ct scan of your chest showed a pneumonia located in multiple different areas, and because of that it became more and more difficult for you to breathe. accordingly you were sent to the icu and placed on a breathing machine (intubated) while the infection cleared up. after several days you improved and you were able to come off the ventilator. during your stay in the icu your white blood cell counts recovered and were back to normal. you came back to the floor and continued to recover, however your blood pressure was low. an echocardiogram of your heart showed that your heart was not functioning as well as it had been the last time we looked at this in . we started a medication called metoprolol which has been shown to be very helpful in situations of decreased heart function. we think the problem is possibly related to one of the chemotherapy drugs, in addition to the serious infection. we think your low blood pressures were due to a combination of the heart function and being dehydrated. your blood pressure remained stable although on the low side, and you were able to walk around and drink enough fluids on your own to keep it in the normal range. we sent you home with an appointment to follow up with cardiology for the heart issue. you will also follow up in the bone . the following changes were made to your medications: start metoprolol succinate 50mg daily stop ciprofloxacin start fluconazole (for mouth infection) take for 7 more days continue your acyclovir as you had been taking it before you were admitted to the hospital (400mg tablet three times a day) followup instructions: please follow up with the appointments below. department: hematology/oncology when: tuesday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/bmt when: tuesday at 9:00 am with: , np building: sc clinical ctr department: cardiac services when: wednesday at 10:20 am with: , m.d. building: sc clinical ctr campus: east best parking: garage department: when: friday at 2:15 pm with: , md building: sc clinical ctr campus: east best parking: garage dr is your new physician at . she works closely with dr , both will be involved in your care. please call your insurance and name dr. as your pcp. must be done before your appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified other primary cardiomyopathies acidosis congestive heart failure, unspecified hypopotassemia acute respiratory failure hypotension, unspecified antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use hypoxemia acute on chronic systolic heart failure drug induced neutropenia nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] acute myeloid leukemia, without mention of having achieved remission fever presenting with conditions classified elsewhere other pancytopenia 

Answer: The patient is high likely exposed to