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: 61 year-old female diagnosed with primary amyloidosis in , recently harvested after cytoxan chemotherapy, being admitted for melphalan therapy followed by auto-bmt as a palliative measure. major surgical or invasive procedure: triple lumen catheter placement () esophagogastroduodenoscopy ( and ) right femoral line cordis placement () endotracheal intubation ( to ) history of present illness: ms. is a 61 year-old woman diagnosed with primary amyloidosis in . at that time, she presented with progressive lower extremity edema. work-up revealed significant proteinuria. a renal biopsy was then performed and showed lambda light chain deposits. she was also found to have lambda light chain in her urine. a diagnosis of primary amyloidosis was subsequently made. she was recently harvested after cytoxan therapy and is now being admitted for melphalan chemotherapy followed by autologous stem cell transplant. her screening evaluation revealed normal pulmonary function and no significant cardiac dysfunction. except for the proteinuria, her renal function is normal. other than her leg edema, ms. complains of increasing weakness and fatigue. she denies sob, cough, headache, syncope, chest pain or palpitation, abdominal pain or dysuria. she also denies any recent febrile illness. past medical history: 1) primary amyloidosis diagnosed in following clinical proteinuria. renal biopsy demonstrated a predominance of lambda light chains. bone marrow biopsy in showed low level (5-10% of the cellularity) monoclonal lambda plasmacytosis. 2) multiple bilateral breast cysts: biopsies negative for cancer. 3) history of premature ventricular complexes 4) history of duodenal ulcer 5) surgery to right leg ligamentin 's social history: she currently lives with her husband and has three children. her younger son had disease approximately 3-4 years ago. she has a 20 pack-year smoking history and reports occasional alcohol consumption, no drugs. family history: significant for disease in her son. she ahd a brother with renal cell carcinoma. her mother is alive at the age of 93. her father died at the age of 84 of "old age". physical exam: general: pleasant woman in nad. vital signs: temp 97, hr 104, bp 110/64, rr 20, oxygen saturation 96% on ra heent: perrl, eomi. no sinus tenderness. clear oropharynx. neck: no jvd. no carotid bruit. resp: clear to auscultation bilaterally cvs: normal s1, s2. no murmur/rub or gallop. left subclavian triple lumen in place. gi: normal bs. soft and non-tender. no hepatosplenomegaly. ext: 3+ pitting edema to thighs. no clubbing, no cyanosis. neuro: aao x3. cn ii-xii intact. strenght thoughout. pertinent results: pertinent laboratory results on admission include wbc-12.5* (neuts-82.6* lymphs-11.5* monos-4.0 eos-0.7 basos-1.2), hgb-12.0, hct-34.5*, plt 588*. chemistry reveals glucose-153*, urea n-21*, creat-0.6, sodium-141, potassium-3.8, chloride-106, hco3-25, calcium-8.5, phosphate-3.8, magnesium-1.6, uric acid-9.5*, albumin-2.8*. liver enzymes show alt-16, ast-18, alp-115 with normal bilirubin profile. ldh 276. imaging: cxr (): normal skeletal survey (): normal echo (): lvh with low normal lvef (50-55%), 1+ mr. brief hospital course: her hospital course will be reviewed by problems: 1) primary amyloidosis: ms was treated with 2 days of high dose melphalan, followed by one rest day. stem cells were reinfused on . her anc reached a nadir on , then was above 500 on . she was given neupogen from until . she tolerated the chemo well. 2) cns: on (day +1), the patient developed a transient right visual field defect which resolved spontaneously after one hour with no recurrence. neurology was consulted. mri head on revealed a hyperintense region in the left temporal lobe consistent with acute infarction. work-up for an embolic focus was initiated and was negative. ekg revealed nsr. echo (tte) showed no evidence of a thrombus, moderate symmetric lvh and lvef low-normal 50-55%. tee was not performed given low anc and low platelets. carotid doppler () showed no stenosing lesion. she was also placed on telemetry for evaluation of arrhythmia (see cvs). decision was taken not to administer asa given thrombocytopenia post reinfusion. heparin was also not indicated in her case, given negative embolic work-up and high risk of heparinization. she was iv hydrated to maintain her bp at a higher level, and continued on lipitor. her cva was subsequently felt to be possibly related to hypercoagulability secondary to her nephrotic syndrome. during her hospital stay, ms was also found to have a fluctuating mental status, mostly at night, starting around day +18. infectious and metabolic work-ups were negative, including tsh, b12, and rpr. psychiatry was consulted, with an impression of delirium. all bdz, anticholinergics and cognitive depressant medications were held. patient's mental status subsequently improved. she will follow-up with psychiatry as an out-patient to evaluate for underlying depression in setting of her medical condition. 3) gi: on day 6 post bmt, patient developped some hematuria, followed by a small volume of hematemesis. this was followed by massive hematochezia and hematemesis ~450cc total. platelets were 37. with each episode, she became more fatigued and hypotensive, with sbp decreasing to 70's (baseline 100's) and decreased mentation. agressive ivf and blood product support were initiated. she was transferred to the for hemodynamic instability. gi was consulted emergently. the patient was electively intubated for endoscopy. egd revealed a smooth, non-bleeding, 12 cm mass in the mid-body of the greater curvature, but no evidence of active bleeding. she was started on protonix iv. she overall received 2l ns, 1l lr, 4u prbc's, 2u ffp, 6hr pressor support with levophed over initial stabilization. hct initially dropped from 25-->16, then increased to 29 after 4u prbc's. a repeat ct head showed no bleed. she returned to the floor on . on , a repeat egd was performed to assess prognostication prior to anticoagulation for a subclavian catheter-related thrombosis. it revealed grade 2 esophagitis in the lower third of the esophagus and a segment suspicious for barrett's esophagus. more importantly, it showed a 10 cm x 1,5 cm cratered ulcer in the stomach body. given high-risk of rebleeding, decision was taken not to anticoagulate. the line was pulled out with no complications. high dose protonix was started along with carafate. her hematocrit remained stable while on the floor. she was last transfused on . helicobacter pylori serology negative. she will follow-up with gi as an out-patient and will need a repeat egd. 4) respiratory: after extubation, ms. required supplemental oxygen up to 4l via np to maintain her oxygen saturation above 92 %. she was gradually weaned off oxygen on the floor and supplemental oxygen was discontinued on . at discharge, her oxygen saturation is 92-94 % on room air. serial cxrs revealed fairly stable bilateral pleural effusions and vascular congestion consistent with pulmonary edema. no evidence of pneumonia or pulmonary infiltrate. 5) cvs: as mentionned, patient was placed on telemetry following cva/tia. she had a few asymptomatic episodes of nsvt, up to 12 beats, without hemodynamic instability. her primary cardiologist was contact (dr. ) and an ep consult was obtained. as per ep, she was started on metoprolol 12.5 mg po bid. we were unable to increase the dose to a target of 25 mg po bid given patient's borderline low bp (sbp in 90s-100s). a repeat cardiac echo on showed mild , mild symmetric lvh with low normal lvef (55%) and a small pericardial effusion was seen. ekgs revealed sinus tachycardia, probable prior anterior and inferior mi and non-specific lateral st-t changes were noted. of note, her qtc is slightly prolonged and should be followed. she will follow-up with her primary cardiologist at d/c. 6) gu: patient's volume status remained a major issue during her hospital stay. she has anasarca secondary to her primary condition, proteinuria and hypoalbuminemia. she was gently diuresed with lasix with good results. her creatinine remained normal throughout. her electrolytes were repleted as needed. a 24-hour urine collection revealed a total protein of 232 mg/dl, ucreat of 25. her albumin remains low at 2.3 at discharge. she will be discharged on lasix 20 mg po bid and should have biweekly chem 10 with electrolyte repletion as necessary. she experienced multiple episodes of incontinence while on the floor, both of urine and feces, felt secondary to reduced mobility and access. she reports a history consistent with stress incontinence prior to her admission. on the floor, a foley was inserted for a short period of time. u/a and urine cultures were negative. she also complained of bladder spasms, controlled with ditropan. no further incontinence at d/c. off ditropan. nutrition: she was started on tpn upon return from the status post massive ugi bleed. diet was advanced slowly and tpn was d/c'd on . 7) id: patient had some diarrhea while in hospital. flagyl was started on and d/c'd on given c.diff negative on 3 occasions. her diarrhea was felt to be most likely secondary to erythromycin, started post ugi bleed to increase gi motiliy. she also had a low-grade temperature starting on (100.1). she was continued on her prophylactic levoquin (started on day -2). vancomycin was added. levo switched to cefepime. all antibiotics were d/c'd on given no longer neutropenic and negative work-up. 8) skin: while in hospital, ms. had a severe candidal rash involving her groins, genitalia and buttocks. fluconazole and miconazole powder were prescribed. the rash improved on the above regimen and with a foley catheter which kept the area dry (patient incontinent at times). she also has 2 groin lesions from previous femoral sticks/cordis in the icu. plastic surgery was consulted, who felt that the lesions were superficial and required no antibiotics. wound care with wet-to-dry dressings were recommended. she was followed by ot and pt in hospital and will benefit from continued services at d?c. she will be discharged to a skilled nursing facility. condition stable at discharge. medications on admission: asa 81 mg po once daily ranitidine 150 mg po once daily lipitor 20 mg po once daily toprol 20 mg po once daily discharge medications: 1. lipitor 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 2. carafate 1 g tablet sig: one (1) tablet po every six (6) hours: please take on an empty stomach. disp:*120 tablet(s)* refills:*0* 3. metoprolol tartrate 25 mg tablet sig: half tablet po twice a day: take 12.5 mg po twice daily. disp:*30 tablet(s)* refills:*2* 4. acyclovir 400 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 5. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 6. lasix 20 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* discharge disposition: extended care facility: life care facilities discharge diagnosis: 1) primary amyloidosis 2) gastric ulcer discharge condition: patient discharged to skilled nursing facility in stable condition. discharge instructions: please call your primary oncologist or return to the clinic if you develop fever or chills, or if you experience worsening shortness of breath or increased leg swelling. please follow-up with dr , dr , dr (gastroenterology) and psychiatry as indicated below. followup instructions: 1) please follow-up with dr in the next 3 weeks. please call his office at to schedule an appointment in early . 2) please follow-up with gastroenterology for your stomach ulcer. your appointment is scheduled for at 0900 with dr as indicated below: provider: , md where: medical specialties phone: date/time: 9:00 3) please call your cardiologist dr. and schedule an appointment to see him in the next 1 month. 4) you may call the psychiatry clinic to schedule an appointment at . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine other endoscopy of small intestine insertion of endotracheal tube arterial catheterization transfusion of packed cells injection or infusion of cancer chemotherapeutic substance autologous bone marrow transplant without purging diagnoses: iron deficiency anemia secondary to blood loss (chronic) cardiac complications, not elsewhere classified paroxysmal ventricular tachycardia other complications due to other vascular device, implant, and graft chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction cerebral artery occlusion, unspecified with cerebral infarction 

Answer: The patient is high likely exposed to