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: sulfa (sulfonamide antibiotics) attending: chief complaint: septic/cardiogenic shock major surgical or invasive procedure: endotracheal intubation history of present illness: 67 yo f with h/o chf and amyloidosis receiving chemotherapy at presents with altered mental status and increasing lbp x 5 days with some new bowel/bladder incontinence and le weakness. . mrs. started her first cycle of velcade / decadron chemotherapy regimen 1 month ago and last dose was 10 days ago. over the last 5 days she experienced worsening back pain and lower extremity weakness. she has become confused with an altered mental status according to her husband and developed new bowel and bladder incontinence 1 day prior to presentation. . the patient presented to in a hypotensive state with ards/pul edema on cxr. initially, pneumonia vs chf was considered. the pt was given lasix, ivf, ceftazidime and levaquin. because of patients acute change in mental status, the pt was given a full dose asa and sent for head ct which was negative. a u/a positive for blood. the pt was deemed to have ble weakness and after decadron 10mg iv she was transferred to for possible cauda equina vs. sepsis. the patient was incontinent of stool en route. . in the ed, initial vs were: 99 76 85/41 18 100% on nrb. initially the patient was confused but a&ox3 and complained only of fatigue and aching in low back. neuro exam revealed weak-normal rectal tone and le weakness, but normal reflexes and sensation. cxr in ed was consistent with chf. bnp was (previously in ). ekg v-paced but does not st criteria for stemi. troponin was 0.15 here (trop at higher, but they may be using a different assay). because of concern for a possible epidural abscess, the pt was sent for ct of full (c, t and l) spine that showed no obvious fluid collections. the patient cannot be sent for mri because she has a pacemaker. she started on vancomycin and received a 500cc ns bolus, had a right ij line place and was started on levophed. sbp rose to 110s with an spo2 98% on 4l nc with rr 20. she was transferred to for hemodynamic instability and concern for sepsis vs. cardiogenic shock. on transfer, her vitals were 95.3f 61 102/59 19 95% on 5l o2 by nc. . on the floor, pt is alert, but disoriented on 0.06mcg/kg/min levophed with a warming blanket for hypothermia. past medical history: 1) primary amyloidosis diagnosed in . renal biopsy showed a lambda light chain deposition and she had light chains in her urine. at that time, she has had marked lower extremity edema and recurrent infections. she ultimately had her stem cells mobilized with cytoxan and underwent autologous stem cell transplant with melphalan as her conditioning regimen. transplant was complicated by gi bleed and icu admission; however, she was ultimately discharged and has been doing quite well since transplant. 2) pacemaker for symptomatic sinus block early 3) chf 4) htn 5) high cholesterol 6) left wrist fracture 7) history of premature ventricular complexes 8) history of duodenal ulcer 9) multiple bilateral breast cysts: biopsies negative for cancer. 10) tendon repair right leg in 's social history: she has been married for 47 years. she has three children and five grandchildren who live locally. - tobacco: one to two cigarettes a day. family history: unable to obtain secondary to confusion physical exam: general: appears ill, aware she is at , but disoriented to time. heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp 3cm above sternal angle, no lad lungs: + upper airway transmitted sounds on expiration, a few wheezes, inspiratory crackles. cv: regular rate and rhythm, faint s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley draining clear fluid. ext: warm, well perfused, 2+ pulses, 1+ pedal edema bilat up to knees. neuro: perla, good strength of facial muscles, normal tongue movements, palate rises. strength 5/5 in ankles and elbows for extension and flexion. strength 3/5 for hip flexion bilat. dtr patellar 3+ right, 1+ left. achilles 1+ bilat. biceps 3+ bilat. -ve babinski bilat. good sensation and equal bilat in feet. skin: brownish discoloration above ankles bilaterally, macular non blanching rash with confluent areas over inguinal/pubic area. pertinent results: 12:00am type-mix po2-32* pco2-40 ph-7.36 total co2-24 base xs--3 12:00am lactate-1.5 12:00am o2 sat-53 12:00am freeca-1.07* 11:18pm glucose-119* urea n-71* creat-1.7* sodium-136 potassium-4.8 chloride-102 total co2-23 anion gap-16 11:18pm alt(sgpt)-366* ast(sgot)-482* ck(cpk)-540* alk phos-105 tot bili-0.8 11:18pm ck-mb-8 ctropnt-0.14* 11:18pm calcium-8.0* phosphate-6.6* magnesium-2.2 11:18pm tsh-2.5 11:18pm wbc-7.3 rbc-4.14* hgb-13.4 hct-40.2 mcv-97 mch-32.2* mchc-33.2 rdw-16.1* 11:18pm plt count-60* 11:18pm pt-13.9* ptt-37.2* inr(pt)-1.2* 09:25pm urine color-yellow appear-clear sp -1.011 09:25pm urine blood-lg nitrite-neg protein-75 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 09:25pm urine rbc-* wbc-0-2 bacteria-rare yeast-none epi-0-2 05:05pm comments-green top 05:05pm lactate-1.4 05:00pm glucose-88 urea n-66* creat-1.7* sodium-131* potassium-5.2* chloride-101 total co2-19* anion gap-16 05:00pm estgfr-using this 05:00pm ctropnt-0.15* probnp-* 05:00pm calcium-8.1* phosphate-5.4*# magnesium-2.1 05:00pm wbc-5.8 rbc-4.01* hgb-12.8 hct-38.1 mcv-95 mch-31.9 mchc-33.6 rdw-16.8* 05:00pm neuts-95* bands-3 lymphs-0 monos-0 eos-0 basos-0 atyps-0 metas-2* myelos-0 nuc rbcs-5* 05:00pm hypochrom-normal anisocyt-1+ poikilocy-occasional macrocyt-1+ microcyt-normal polychrom-normal ovalocyt-occasional 05:00pm plt smr-very low plt count-55*# labs prior to expiration: 06:36am blood wbc-18.9* rbc-2.89* hgb-9.3* hct-27.3* mcv-95 mch-32.3* mchc-34.1 rdw-17.0* plt ct-44* 06:36am blood neuts-93.9* bands-0 lymphs-4.3* monos-1.5* eos-0 baso-0.3 06:36am blood pt-21.6* ptt-40.6* inr(pt)-2.0* 06:36am blood glucose-112* urean-114* creat-4.3* na-131* k-5.1 cl-102 hco3-16* angap-18 06:36am blood alt-89* ast-127* ld(ldh)-1585* alkphos-113* totbili-0.9 06:36am blood calcium-6.8* phos-6.2* mg-2.0 02:25pm blood freeca-1.01* 02:45pm blood o2 sat-67 02:25pm blood lactate-1.0 imaging: ct spine : no evidence of fracture or fluid collection of the cervical spine. echo : impression: amyloid heart ct head : no acute process bal cytology : negative for malignant cells. macrophages, some hemosiderin-laden, lymphocytes and neutrophils ct head : impressions: newly apparent loss of -white matter differentiation along the posterior right mca vascular distribution raises concern for interval infarction, not previously seen on . no acute intracranial hemorrhage or shift of normally midline structures. mri recommended for more sensitive evaluation of infarction if patient's cardiac pacemaker is mri-compatible. ct chest : impression: extensive bilateral dependent consolidations, accompanying pleural effusions and ground-glass-like opacities in the left dependent lung regions. the findings suggest a combination of pulmonary edema and infection. extensive lymph node calcifications, splenic calcifications and hepatic calcifications. several nonspecific mainly subpleural pulmonary nodular lesions. the monitoring and support devices in correct position. the study and the report were reviewed by the staff radiologist. renal us : impression: 1. diffuse increased echogenicity of the renal cortices, compatible with chronic medical renal disease. 2. abnormal doppler evaluation of the kidneys bilaterally, with elevated ris and decreased diastolic flow. 3. echogenic foci with posterior shadowing seen in the right kidney at the corticomedullary junction. while the appearance suggests nephrocalcinosis, the unilaterality is atypical, and these may rather represent non-obstructing stones. however, of note, on prior ct of the lumbar spine dated , scattered dense foci were seen as well on the left, not seen by ultrasound. 4. simple right renal cysts. micro: -blood cultures negative -blood fungal cx negative -hsv culture negative -urine cx's negative -stool cx's negative bal : gram stain (final ): no polymorphonuclear leukocytes seen. 1+ (<1 per 1000x field): budding yeast. respiratory culture (final ): commensal respiratory flora absent. yeast. 10,000-100,000 organisms/ml.. of two colonial morphologies. potassium hydroxide preparation (final ): this is a low yield procedure based on our in-house studies. if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). test requested by dr. # . budding yeast with pseudohyphae. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (final ): yeast. of two colonial morphologies bal : gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): no growth, <1000 cfu/ml. legionella culture (final ): no legionella isolated. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (final ): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): no mycobacteria isolated. viral culture: r/o cytomegalovirus (preliminary): no virus isolated so far. viral culture: r/o herpes simplex virus (final ): no herpes simplex (hsv) virus isolated. varicella-zoster culture (preliminary): no virus isolated so far. -cryptococcal antigen: neg -groin swab vzv positive brief hospital course: 67 yo f h/o amyloidosis, including cardiac involvement s/p pacemaker with mixed septic and cardiogenic shock and respiratory failure to pneumonia of unclear etiology. pt eventually expired multiorgan failure in setting of septic/cardiogenic shock. issues throughout icu stay included: *shock. likely secondary to a septic process combined with an exacerbation of chronic hf. treated w/ dopamine, levophed and fluids. id favored vzv pneumonia as the most likely source and also considered pcp likely possibly / a bacterial superinfection. *respiratory failure. likely secondary to a pneumonia of unknown etiology, perhaps a vzv pneumonia. developed large area of consolidation in rll>lll visible on ct and rll bleeding observed on bal. . *renal failure: atn shock and worsening renal function from day to day with urine output declining to 10-15cc/hr. renal u/s showed evidence of chronic amyloid kidney and doppler showed decreased diastolic flow. . *possible stroke on ct head in the right posterior mca territory. . *decreased perfusion to feet secondary to cardiogenic failure and the requirement for levophed to maintain her blood pressure. this was treated by warming her feet and prefering dopamine over levophed as a pressor to reduce vasoconstriction and increase cardiac output. . *tachycardia. underlying atrial tachycardia likely with a sensed v paced pacermaker settings. intermittent tachy into the 110s. possibly exacerbated by her dopamine requirement. tachycardia tolerated for hr < 130 as long as bp not affected in order to maintain foot perfusion. . *thrombocytopenia. likely sepsis. hit assay negative. dic work up negative. transfused plts to maintain platlet count > 50. . *transaminitis. likely shock liver. trended down during admission. . *vzv rash over left anterior thigh. treated with acyclovir and improved. . *leg weakness and fecal incontinence. patient seen by ortho spine and neurology and both services agreed that there were no focal signs of cauda equine. the patient endorsed a mechanical fall a week prior to admission as source of leg pain and weakness. hip films negative for fracture. . *at a family meeting, the patient's multiple organ failure and poor prognosis was discussed with her husband and three children. they agreed that the patient would not want her life to be prolonged without a significant hope of a return to her previous quality of life. the patient was made dnr/dni and no escalation of care and then made cmo when her family was ready. she expired at 13:10 on . medications on admission: amiodarone - (prescribed by other provider) - 200 mg tablet - 2 tablet(s) by mouth once a day for 7 days then 1 tablet daily atorvastatin - (prescribed by other provider) - 20 mg tablet - 2 tablet(s) by mouth once a day citalopram - (prescribed by other provider) - 10 mg tablet - 1 (one) tablet(s) by mouth once a day dexamethasone - 4 mg tablet - 10 tablet(s) by mouth once per day for 4 days or as directed furosemide - (prescribed by other provider) - 40 mg tablet - 1 (one) tablet(s) by mouth twice a day potassium chloride - (prescribed by other provider) - 20 meq tab sust.rel. particle/crystal - 2 tab(s) by mouth once a day ranitidine hcl - (prescribed by other provider) - 150 mg tablet - 1 tablet(s) by mouth twice a day discharge medications: pt expired discharge disposition: expired discharge diagnosis: septic and cardiogenic shock secondary to pneumonia. discharge condition: expired discharge instructions: expired followup instructions: expired procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: thrombocytopenia, unspecified nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified septicemia hyposmolality and/or hyponatremia severe sepsis peripheral stem cells replaced by transplant acute respiratory failure cardiogenic shock septic shock cardiac pacemaker in situ acute on chronic combined systolic and diastolic heart failure varicella (hemorrhagic) pneumonitis other amyloidosis nutritional and metabolic cardiomyopathy 

Answer: The patient is high likely exposed to