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: patient recorded as having no known allergies to drugs attending: chief complaint: lower extremity pain and weakness major surgical or invasive procedure: lumbar puncture history of present illness: 50 f with history of polysubstance abuse, pulmonary hypertension on home o2, recent fevers and ?granulomatous disease with mediastinal adenopathy; admitted to neurology yesterday with back pain and bilateral foot numbness. started treatment for ?epidural abscess with plans for mri today. patient triggered overnight for tachypnea and o2 sats in 80s on ra. abg 7.46/27/66. placed on o2 with symptomatic improvement. this am patient again triggered for bp 89/52. this was following getting 2 mg iv ativan prior to mri. patient also with multiple lab abnormalities including elevated coags, leukocytosis with left shift, arf, elevated ldh. in ed, patient 95% on 2l (on 2 l at home "when i need it"; discharged last admit with sats low 90s on ra with desats to mid 80s with exertion). says she has been relatively short of breath since prior to last admission (no recent change). back pain better after received toradol early am, denies currently. feels bothered by parasthesias of hands and feet. past medical history: 1. asthma -does not use inhalers 2. htn -off meds for several years 3. rheumatoid arthritis -seronegative 4. chronic severe back pain 5. 4 c-sections. 6. history of secondary syphilis, treated. 7. polysubstance abuse, notably cocaine 8. depression 9. pulmonary hypertension tr gradient 61 10. restrictive lung disease 11. seizures in childhood social history: lives with boyfriend. 4 children. smokes cigarettes per day. drinks 3 drinks most nights, last 2 days ago. admits to cocaine (smoked) last on thursday. denies ivdu. denies other drugs. denies tuberculosis contacts/risks. family history: noncontributory, no history of stroke. physical exam: vitals: t 99.8, hr 99, 119/56, r24, 95% on 4l general: slightly tachypneic but speaking in full sentances, nad heent: perrl (3->2.5), sclera anicteric, mmm neck: + multiple small cervical and supraclav palpable nodes chest: cta bilat, few basilar crackles heart: rrr, slightly tachy, loud s2 abdomen: soft, nd, describes diffuse mild ttp "where i had heparin shots" extrem: warm, no edema back: no current ttp. neuro: a/o x 3, describes paresthesias of bilat le at feet and dorsal/palmar hands. strength grossly preserved. skin: no rashes/lesions. pertinent results: blood wbc-9.0 rbc-3.64* hgb-10.6* hct-32.7* plt ct-248 chemistry glucose-83 urean-11 creat-0.9 na-129* k-5.4* cl-98 hco3-29 8/3wbc rbc hgb hct mcv mch mchc rdw plt ct 21.3* 3.74* 11.1* 33.1* 89 29.7 33.5 16.2* 197 neuts bands lymphs monos eos baso atyps metas myelos 8/367 11* 14* 1* 6* 0 1* 0 0 fibrinogen 167 8/3glucose urean creat na k cl hco3 73 23* 2.3* 132* 3.9 106 16* 8/3alt ast ld(ldh) alkphos 15 22 506* 121* pos pco2 ph caltco2 66* 27* 7.46* 20* blood cultures x2, lyme serology pending last creatinine - 0.9 . micro from last admit: hiv neg, cmv neg, monospot pos ln on with ?exophiala jeanselmei on fungal cx (afb neg to date) . studies: . ecg: . pathology - lymph node excisional biopsy : reactive lymphoid tissue with necrotizing granulomas, see note. tissue sections show fragments of a lymph node and soft tissues with necrotizing granulomas (two), which contain neutrophils and eosinophils. special stains for fungal, bacterial, and mycobacteria organisms (gms, pas, , afb) are negative with adequate controls. there is no morphologic or immunophenotypic evidence of lymphoma. necrotizing granulomas containing neutrophils are suggestive of an infectious process and are most typical of bartonella (cat scratch disease), tularemia, yersinia, and lymphogranuloma venereum. fungal and mycobacterial infections remain formal possibilities and are far more common that the ones above. . cxr : there is no focal consolidation or superimposed edema. again noted is marked bilateral hilar and aorticopulmonary window lymphadenopathy. this is stable across multiple studies and has been diagnosed by biopsy. the mediastinum is otherwise stable. no effusion or pneumothorax is noted. the osseous structures again demonstrate markedly atrophic bilateral first ribs. impression: stable mediastinal lymphadenopathy. no acute pulmonary process. . ct head : no hemorrhage. brief hospital course: 50 year-olf female with history of cocaine abuse, pulmonary hypertension, mediastinal adenopathy, recent extensive admit to medicine for the above issues, initially admitted with lower extremity pain and eventual progressive weakness. her hospital course will be briefly reviewed by problems. 1) . progressive neurologic symptoms (worsening weakness in particular) led to lp on . this revealed wbcs and very high protein at 177. nifs and vital capacities were monitored and noted to be initially -20 and <1 liter respectively. she was again transferred to the micu on . nifs and vcs were closely monitored and improved slightly during her course. despite continued poor values, clinical respiratory status remained stable and she never required intubation. she received ivig x 5 daily doses. strength improved slightly. a slow and protracted recovery is expected. 2) hypotension: she had transient hypotension while on the floor, which resolved with iv bolus prior to going to micu. occured in setting of getting iv ativan earlier in the morning and few days of poor po intake. encouraged po intake. for her infection/sepsis workup, mri spine without evidence of epidural abscess. positive for c.diff; flagyl started. id consulted regarding exophilia fungus in past lymph node biopsy (from fna bronch); though to be a contaminant. 3) hyponatremia: sodium nadir 121. renal was consulted, and the possibility of pseudohyponatremia ivig versus siadh was raised. urine lytes suggestive of siadh, and fluid restriction 1000 ml instituted, liberal salt intake. on discharge, sodium was 129. 4) coagulopathy: she developed a mild coagulopathy with elevated inr, mild thrombocytopenia to 122k. hematology was consulted, picture overall most consistent with low-grade dic, possibly in the setting of c. diff. improved with antimicrobial therapy, vitamin k. 5) mediastinal adenopathy: mediastinoscopy during last admit. during this hospital stay, she continued to have palpable supraclav and cervical adenopathy (though seems improved per previous notes). necrotizing granulomas identified on prior biopsy. etiology remains elusive, to follow-up with pulmonary as an out-patient with f/u ct scan chest. 6) acute renal failure: peak creatinine 2.4, improved with hydration, nephrotoxic agents held. 7) chronic back pain: mri spine negative for abscess (though limited study). pain control achieved with oxycontin and oxycodone. medications on admission: 1. tizanidine 2mg tid 2. supplemental oxygen 3. ipratropium-albuterol q6h prn 4. motrin 800 mg tid discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 2. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 3. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for wheeze or shortness of breath. 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for shortness of breath or wheeze. 5. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 5 days: ten day course will be completed on . 6. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 7. gabapentin 400 mg capsule sig: one (1) capsule po tid (3 times a day). 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 10. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). 11. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. discharge disposition: extended care facility: - discharge diagnosis: primary: syndrome c. difficile colitis mild asymptomatic hyponatremia resolved coagulopathy secondary to low grade dic resolved acute renal failure secondary diagnoses: pulmonary hypertension chronic back pain polysubstance abuse granulomatous disease with bulky mediastinal and hilar lymphadenopathy discharge condition: stable for acute rehab. discharge instructions: it was a pleasure taking care of you while you were in the hospital. you were admitted to the hospital because of -?????? syndrome for which you were treated with ivig. you continued to improve, but still had residual weakness in your upper and lower extermeities. your respiratory status also improved and you remained on 2l of oxygen. you are being discharged to for rehab. because you sodium levels were low you will need to continue on a water restriction to one liter per day. we also encourage you to take in salty foods. please follow the medications prescribed below please follow up with the appointments below. followup instructions: pulmonary function lab phone: date/time: 1:10 pft,interpret w/lab no check-in pft intepretation billing date/time: 1:30 dr. & dr. phone: date/time: 1:30 dr. . please call for appt at md procedure: venous catheterization, not elsewhere classified spinal tap incision of lung injection or infusion of immunoglobulin diagnoses: thrombocytopenia, unspecified anemia, unspecified unspecified essential hypertension acute kidney failure, unspecified hyposmolality and/or hyponatremia other, mixed, or unspecified drug abuse, unspecified other chronic pulmonary heart diseases acute respiratory failure intestinal infection due to clostridium difficile rheumatoid arthritis other diseases of lung, not elsewhere classified hypoxemia enlargement of lymph nodes other disorders of neurohypophysis backache, unspecified other and unspecified coagulation defects other specified hypotension leukocytosis, unspecified acute infective polyneuritis other dependence on machines, supplemental oxygen other specified idiopathic peripheral neuropathy tachypnea dermatophytosis of other specified sites pyogenic granuloma of skin and subcutaneous tissue 

Answer: The patient is high likely exposed to