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: history of present illness: the patient is an 84-year-old female with a past medical history significant for parkinson disease with associated body dementia and a long history of tobacco abuse who was noted with fevers. the patient was in her usual state of health until two weeks prior to admission when she developed rhinorrhea. the patient and her daughter deny any other symptoms at that time. however, on the evening of the patient reports that she developed pain in the right side of her neck. the following day, she had a temperature to 101 with continued intermittent right-sided neck pain. she was again febrile on the morning of admission and called her primary care physician for his advise. he suggested that she report to the emergency department for further evaluation. in the emergency department, the patient's vital signs revealed a temperature of 100 degrees fahrenheit, her heart rate was 75, her blood pressure was 93/46, her respiratory rate was 18, and her oxygen saturation was 96% on room air. a chest x-ray in the emergency department showed consistent cardiomegaly. an opacity in the right lower lobe with probable right pleural effusion was identified. there was no pneumothorax. the patient was started on levofloxacin for a presumed community-acquired pneumonia. blood cultures were obtained. review of systems: on review of systems, the patient reports that she has "usual" cough productive of scant white sputum. she has had no recent dental work. the patient denies ear pain, tooth pain, sores in her mouth, a sore throat, shortness of breath, chest pain, and diarrhea. the patient does report overall weakness for the last one and a half prior to admission. the patient denies sick contacts. past medical history: 1. parkinson disease with associated body dementia. the patient is currently not taking any medications because of "bad reactions" in the past. 2. hypertension. 3. deep venous thrombosis in . 4. depression. 5. a benign breast nodule by mammography in . 6. osteoporosis. allergies: 1. penicillin (which causes a rash). 2. sinemet (which causes dizziness). medications on admission: 1. zestril 5 mg by mouth once per day. 2. zoloft 25 mg by mouth once per day. 3. multivitamin one tablet by mouth once per day. social history: the patient lives alone in her own home. her daughter checks in with her frequently. she no longer drives but can accomplish her own activities of daily living. she has an extremely supportive family. she has a 65-pack-year smoking history. the patient denies drugs. family history: the patient's mother died from a cerebrovascular accident. the patient's father died of heart disease. physical examination on presentation: examination on admission revealed the patient's temperature was 98.8 degrees fahrenheit, her blood pressure was 128/70, her heart rate was 74, her respiratory rate was 20, and her oxygen saturation was 95% on room air. in general, alert and oriented. she was in no acute distress. she was able to talk in complete sentences comfortably without shortness of breath. there was an occasional cough. head, eyes, ears, nose, and throat examination revealed normocephalic and atraumatic. the pupils were equal, round, and reactive to light. the patient was edentulous. the mucous membranes were very dry. no lesion in the oropharynx. the neck was supple. there was no tenderness to palpation. there was no lymphadenopathy. cardiovascular examination revealed a regular rate and rhythm. first heart sounds and second heart sounds. pulmonary examination revealed decreased breath sounds approximately halfway up the right lung. rare left lower lobe crackles. the abdomen was soft, nontender, and nondistended. there were positive bowel sounds. there was no hepatosplenomegaly. extremity examination revealed venous stasis skin changes. there was no clubbing, cyanosis, or edema. the dorsalis pedis pulses were 1+ bilaterally. neurologic examination revealed cranial nerves ii through xii were intact. strength was in the upper and lower extremities bilaterally. pertinent laboratory values on presentation: laboratories on admission revealed her white blood cell count was 26.2, her hematocrit was 39.8, and her platelets were 264. differential revealed 87 neutrophils, 5 bands, 0 lymphocytes, 7 monocytes, 0 eosinophils, 0 basophils, and 0 atypical cells. chemistry-7 revealed her sodium was 142, potassium was 3.5, chloride was 101, bicarbonate was 27, blood urea nitrogen was 17, creatinine was 0.9, and her blood glucose was 125. her calcium was 10.4, her phosphorous was 2.4, and her magnesium was 1.8. her lactate was 2. her albumin was 3.9. urinalysis revealed 1.019 specific gravity, moderate blood, ph was 6.5, 0 to 2 red blood cells, and a few bacteria. urine culture was pending. blood culture was pending. concise summary of hospital course by issue/system: 1. pulmonary issues: within the first few days of her admission, the patient was treated with levofloxacin for a presumed community-acquired pneumonia. however, despite antibiotic treatment, the patient's white blood cell count remained elevated in the low 20s. it did trend down slightly during this time period. throughout the first few days of her admission, the patient denied any shortness of breath and had an oxygen saturation in the mid 90s on room air. on , a posterior/anterior and lateral chest x-ray was obtained to re-evaluate the patient's presumed pneumonia. in comparison to the admission film, the right lower lobe opacity had increased in size and intensity. there was a probable right pleural effusion. there was also slightly more prominent pulmonary vessels on the right which were considered to be positional. the left lung was relatively clear at that time with minor atelectasis at the base. the following day (on ), a chest computed tomography was obtained to better visualize the patient's lungs. this showed a right loculated pleural effusion with parietal pleural enhancement and several small gas reflections. in addition, there was right lower lobe atelectasis and consolidation and left upper lobe ground-glass opacities consistent with a second infectious process. at this time, a pulmonary service consultation was obtained. antibiotics were changed to vancomycin and ceftazidime. the patient was taken to interventional pulmonary for placement of a chest tube on the right to drain the loculated effusion. following placement of the chest tube, the patient had a small amount of hemoptysis in interventional pulmonology. in addition, her oxygen saturation dropped to 88% on 3 liters via nasal cannula. the patient was placed on 100% nonrebreather with an increase in oxygen saturations to 96%. at that time, the patient was transferred to the medical intensive care unit for further care. in the intensive care unit, the patient's oxygen requirement rapidly decreased. however, the chest tube did not drain the pleural fluid as expected. it was found to not be in a sufficient pocket of pleural fluid. cardiothoracic surgery was consulted, but the patient and her family wished to avoid surgery at that time. therefore, on , the patient was called out to the floor for further treatment with antibiotics. her chest tube was removed. the patient was treated broadly with ceftazidime, vancomycin, and metronidazole. a long discussion was held with the patient and her family regarding the slim possibility of cure of her loculated infection with antibiotics alone. however, they continued to desire to avoid invasive procedures. they were willing for a pigtail catheter to be placed in interventional radiology to see if it could drain some of her pleural effusion, and this was done on . fluid continued to drain from the pigtail catheter over the next several days. during this time, the patient's white blood cell count remained elevated but she was afebrile and had good oxygen saturations on room air. however, despite broad-spectrum antibiotics and drainage from the pigtail catheter, the patient's white blood cell count was still significantly elevated on at 22,000. at that time, the family spoke to the cardiac surgery and decided to proceed with a video-assisted thoracic surgery. the patient underwent the video-assisted thoracic surgery procedure on . following the procedure, she was initially extubated. however, in the recovery unit, the patient developed hypotension to a systolic blood pressure in the 70s requiring treatment with neo-synephrine, acute respiratory distress with desaturations to the low 90s on face mask, and was eventually reintubated and transferred to the medical intensive care unit for further management. the patient was successfully extubated in the medical intensive care unit the next day (on ). the patient was returned to the general medical floor later that day and has done well since that time. at the time of this dictation, the patient was saturating in the mid to high 90s on room air. in addition, her white blood cell count continued to decrease following the video-assisted thoracic surgery procedure. on her white blood cell count was 11.5. her chest tube was removed on without difficulty. an infectious and cytologic workup had been pursued on the fluid drained through the chest tube and pigtail catheter. in addition, specimens were sent during the video-assisted thoracic surgery procedure. at the time of this dictation, the fluid obtained on grew scant gram-positive rods. all other cultures have been negative to date. cytology specimens were negative for malignant cells. final report of pleural tissue pathology was still pending. 2. neck pain issues: a wide differential was considered on admission for the patient's right-sided neck pain. the patient had the neck pain only she was spiking fevers. it was not reproducible on examination. two days into the hospital course, her neck pain resolved spontaneously and has not returned. 3. hypertension issues: on admission, the patient was continued on her home dose of lisinopril with good blood pressure control. following the video-assisted thoracic surgery procedure, the patient became hypotensive in the recovery unit and required pressors. however, her blood pressure quickly returned to a normal range. she was re-initiated on lisinopril 5 mg by mouth once per day on . 4. depression issues: the patient was continued on sertraline throughout her hospital course. 5. parkinson disease with body dementia issues: this was stable throughout the hospital course. the patient does not take any medications for this condition. 6. rehabilitation issues: physical therapy worked with the patient as tolerated during her admission. 7. fluids/electrolytes/nutrition issues: the patient was maintained on a low-sodium diet. her potassium and magnesium were repleted as needed. 8. prophylaxis issues: the patient was maintained on subcutaneous heparin for deep venous thrombosis prophylaxis. pantoprazole for gastrointestinal prophylaxis. senna and colace for a bowel regimen. the patient was placed on a nicotine patch during her admission to avoid withdrawal given her long smoking history. 9. code status issues: at this time, the patient is do not resuscitate/do not intubate. her family is very involved in the medical decision making. condition at discharge: condition on discharge was stable. discharge status: the patient was to be discharged to . she is currently saturating in the mid 90s on room air. she was afebrile, and her white blood cell count was trending down. the patient reported that she felt well. discharge diagnoses: 1. community-acquired pneumonia complicated by loculated effusion and probable empyema. 2. parkinson disease with associated body dementia. 3. hypertension. 4. depression. 6. tobacco abuse. 7. respiratory distress; resolved. medications on discharge: 1. lisinopril 5 mg by mouth once per day. 2. sertraline 25 mg by mouth once per day. 3. multivitamin one tablet by mouth once per day. 4. pantoprazole 40-mg tablets one tablet by mouth once per day. 5. nicotine patch 21-mg transdermally once per day. 6. subcutaneous heparin 5000 units one injection q.8h. 7. docusate 100-mg tablets one tablet by mouth twice per day. 8. senna one tablet by mouth twice per day as needed. 9. trazodone 12.5 mg by mouth as needed at hour of sleep. 10. albuterol meter-dosed inhaler q.6h. 11. ipratropium meter-dosed inhaler q.6h. 12. metronidazole 500 mg intravenously q.8h. (for 10 days). 13. vancomycin 1 gram intravenously q.12h. (for 10 days). 14. ceftazidime 1 gram intravenously q.8h. (for 10 days). 15. combivent 4 puffs inhaled q.6h. as needed. 16. tylenol 325-mg tablets one to two tablets by mouth q.4-6h. as needed (for pain). discharge instructions/followup: 1. the patient was to go to for intensive physical therapy and followup. 2. the patient was instructed to follow up with her primary care physician (dr. in one to two weeks. , m.d. dictated by: medquist36 procedure: insertion of intercostal catheter for drainage insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube fiber-optic bronchoscopy decortication of lung transfusion of packed cells diagnoses: pneumonia, organism unspecified tobacco use disorder chronic airway obstruction, not elsewhere classified paralysis agitans dementia in conditions classified elsewhere without behavioral disturbance empyema without mention of fistula dementia with lewy bodies 

Answer: The patient is high likely exposed to