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: penicillins / sulfa (sulfonamide antibiotics) / avocado attending: chief complaint: complex pulmonic effusion major surgical or invasive procedure: -intubation -chest tube placement history of present illness: 60 yo woman with dm, htn, hld who was transferred to ct surgery from osh due to loculated pleural effusion. she says that she had a few weeks of fatigue/malaise, and then hit her right ribcage on a towel rack, presenting with pleuritic chest wall pain to osh on - she had a normal cxr and was sent home with analgesia. on she re-presented to with severe dyspnea and again chest pain. per report, she decompensated over 24 hours and was intubated for respiratory distress. cxr showed a loculated effusion, ct showed no pe and a small pleural effusion. she was noted to be febrile and was started empirically on ceftriaxone/azithromycin. on she underwent brochoscopy and thoracentesis. bronch revealed extrinsic compression of the r bronchus intermedius without invasion of the bronchus or trachea. thoracentesis had a few pmns, no organisms and was negative for afb. at this point she was transferred to for possible vats given concern for empyema. imaging at revealed a loculated r sided pleural effusion, concerning for infection versus malignancy, a collapsed rml and rll. pt. underwent a bronchoscopy on , which revealed grossly purulent secretions in rll, no malignant appearing lesions. a chest tube was inserted with production of 300 cc straw colored fluid, no blood. past medical history: diabetes hypertension hyperlipidemia hypothyroidism bacterial mengingitis during childhood past surgical history: s/p bronchoscopy/thoracentesis as above s/p hip replacement social history: is a kindergarten teacher; there have been some sick contacts at work. lives with husband, there is marital strife, considering divorce. no recent travel or exposures as per hpi. tobacco: 25pk years, quit 20 yrs ago alcohol: occasional illicits: denied family history: non-contributory physical exam: vitals: t: 101.7f bp:129/51 p:71 r: o2: 94% on fio2 50% cmv-ac tv 400, rr 12, peep 12 general: ill appearing, intubated, ct in place. heent: sclera anicteric, mmm, et tube in place. neck: supple, jvp could not be appreciated as pt. in l lat. decub. position for chest tube clearance lungs: absent breath sounds 1/2 up r lung post, anteriorly and on left, there are significant rhonchi and inspiratory crackles throughot. cv: regular rate, normal s1 + s2, 2/6 systolic murmur at 2lics, radiating parasternally. abdomen: soft, non-tender, non-distended, bowel sounds present gu: foley ext: warm, well perfused, edematous ues and les, non-pitting edema. pertinent results: healthcare records: : pleural fluid: rare wbc, no orgs : bronch: fungal smear negative, no afb on smear : crp: 297; esr 143 bcx : ngtd x 48 hours cytology : hypocellular specimen with atypical epithelioid cells. . pleural fluid: 6k wbc; 17.5k rbc, 75 percent polys, 4 bands, 10 lymphs. protein 3.7, glucose 126, ldh 352, albumin 2.2 . ct chest :impression: 1. loculated right pleural effusion, with new anterior and worsening interfissural component, and adjacent atelectasis of the right lower lobe and right middle lobe. 2. extrinsic compression to the bronchus intermedius from loculated effusion. 3. new small left pleural effusion, with adjacent atelectasis at the left lung base; however cannot exclude superinfection/pneumonia. 4. 4-mm ground glass nodule in the right upper lobe, attention on next followup, likley infectious with interval decrease in size. 5. chest tube in place extending into the major component of the pleural effusion along the chest wall and the tip at the right lung apex; however, not draining the loculated effusion. . echo : impression: moderate symmetric left ventricular hypertrophy with hyperdynamic systolic function and moderate resting left ventricular outflow tract gradient. . cytology pleural fluid: negative for malignant cells. predominantly neutrophils and lymphocytes with few mesothelial cells and histiocytes. . ct chest : impression: 1. persisting but improved right loculated pleural effusion. 2. resolution of left pleural effusion and atelectasis. 3. trace pneumothorax to which attention in follow-up radiographs is suggested. cxr : impression: 1. persistent moderate right loculated pleural effusion, with mild interval decrease in size compared to prior. persistent atelectasis at the right lung base. 2. stable minimal right apical pneumothorax. 3. persistent focal opacity at the left mid lung. brief hospital course: ms. is a 60 year-old lady who presented to with loculated right-sided pleural effusion that was most likely secondary to infection. 1) infectious loculated effusion. the etiology of the patients loculated effusion was initially unclear - a diagnosis of infectious versus malignant effusion could not be made. the differential diagnosis initially also included rheumatologic causes, pancreatitis or pe. the patient was initiated on broad antibiotic therapy, vancomycin, metronidazol and levofloxacin. the patient received a bronchoscopy on , which revealed grossly purulent secretions in the right lower lobe and no malignant appearing lesions. a chest tube was inserted with production of 300 cc straw colored fluid and no blood. the effusion was exudative by ldh and albumin criteria. on tpa was administered to her chest tubes and she was diuresed with good urine output and chest tube drainage. by , her respiratory status had improved such that she was successfully extubated. cytology from her bronchoscopy at this time was negative for malignant cells. the cells were predominantly neutrophils and lymphocytes with few mesothelial cells and histiocytes. the etiology of her effusion was infectious, likely group b streptococcus, which often goes to the pleura, although all cultures were no growth throughout her micu stay. the patient remained on triple antibiotic therapy (day 4 of 14 at time of transfer) and vancomycin troughs were measured and dosing was adjusted as required. she was transferred to medicine on vanc/levo/flagyl - she was able to be weaned onto room air and was breathing comfortably. she was transitioned to po moxifloxacin (goal = total of 14 days of antibiotics). per ct surgery recs, her chest tube was d/c'd when it stopped draining; repeat cheat ct showed smaller but persisting loculated effusion which could be followed up on as an outpatient (may require pleur-x or pigtail catheter in the future). by the end of her stay, she was able to ambulate around the floor on room air without desatting; she was sent home with close pc follow-up and thoracic surgery clinic follow-up. . 2. hypoxic respiratory failure. the patient's respiratory failure was presumed hypoxic. the hypoxmemia was likely secondary to a combination of right middle and lower lobe collapse with a componenet of volume overload. as the patient was at high risk for cad and had a significant systolic ejection murmur on physical exam and echo was performed on to assess for heart failure. the echo showed mild diastolic failure with preservation of systolic function (ef> 75%). diuresis of the patient improved respiratory function such that she was successfully intubated on . diuresis continued post transfusion with a goal of net negative 1 liter per day as patient continued to be volume overloaded. . 3. diastolic heart failure: the patient was continued on her home medication, carvedilol. she received an echo on to assess possible heart failure as a contributor of the patient's respiratory failure in the setting of a significant risk factors systolic ejection murmur on physical exam. the echo showed mild diastolic failure with preservation of systolic function (ef> 75%). she was started on lisinopril 20 mg daily on for her evident diastolic dysfunction. she is being discharged on carvedilol and lisinopril. . 4. diabetes mellitus the patient was hyperglycemic to 200-300 when she arrived. whe was started on insulin gtt by the surgical team. on the patient was switched to 20 of lantus and iss as her blood sugars stabilized. her lantus was increased to 35 on as the patient began to eat. her metformin was held as an inpatient. she was discharged on her metformin and her home sliding scale of novolog. 5. hypothyroidism she was continued on her home synthroid as an inpatient. . # access: difficult access. had an ij placed , removed . medications on admission: oxycodone q 6 hrs prn naprosyn po valium prn metformin 1 gram po bid novolog sliding scale ibuprofen coreg 25mgpo synthroid 150mcg cymbalta 60mg po daily discharge medications: 1. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 2. duloxetine 30 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 3. levothyroxine 75 mcg tablet sig: two (2) tablet po daily (daily). 4. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 5. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for itching. disp:*1 container* refills:*0* 6. moxifloxacin 400 mg tablet sig: one (1) tablet po daily (): for 6 more days (total antibiotic course will have been 14 days). disp:*6 tablet(s)* refills:*0* 7. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 8. novolog sliding scale 9. ibuprofen 400 mg tablet sig: one (1) tablet po every hours as needed for pain. tablet(s) discharge disposition: home with service facility: vna assoc. of discharge diagnosis: community acquired pneumonia loculated effusion respiratory failure requiring intubation discharge condition: patient is being discharged to home, with visiting na of . she is able to ambulate independently and maintain adequate o2 sats. she is alert and oriented. discharge instructions: you came into the hospital in respiratory distress; you were found to have a right-sided pleural effusion. you were intubated and treated for pneumonia; a chest tube was placed to drain the fluid. now you are breathing fine on room air, and the chest tube is out. you still have some pockets of fluid in your lung and it is very important thaat you follow up with your primary care doctor as well as your cardiothoracic surgeon. we made the following changes to your medications: -decreased your dose of coreg -please stop using naprosyn and use ibuprofen instead -please stop using the valium for now, and follow up with your pcp lotion for itch -added a blood pressure pill, lisinopril followup instructions: primary care appointment: when: monday, :40pm name: dr. address: , , phone: thoracic clinic: at 10:30 116 md procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more injection or infusion of thrombolytic agent injection or infusion of thrombolytic agent thoracentesis arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute on chronic diastolic heart failure acute respiratory failure hypoxemia other specified acquired hypothyroidism chronic lymphocytic thyroiditis 

Answer: The patient is high likely exposed to