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 attending: chief complaint: abdominal pain major surgical or invasive procedure: intubation paracentesis exploratory laparotomy, supracervical hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy, pelvic mass resection for large mass from r ovary. history of present illness: this is a 65 y/o woman with no known past medical history (she has not had medical care in about 20 years), who presented to the ed at an osh complaining of abdominal pain. she says she was getting out of the shower when she all of a sudden developed a pressure like abdominal pain. she denies any nausea, vomiting associated with the pain, was not eating at the time. the pain was so severe she became diaphoretic. she has never had this abdominal pain before. she denies any chest pain, shortness of breath, lower extremity edema, fevers. she states that she feels that her abdomen has been growing slowly over the last 6 months, and had attributed it to weight gain, although she had only gained three pounds over this period of time. she denies any family history of breast or ovarian cancer. . the only other time she had been in the hospital was when she gave birth. of note, she was recently treated at a walk in clinic for a uti with nitrofurantoin. because she still wasnt feeling well after the course of nitrofurantoin, she returned to clinic where they gave her two days of ciprofloxacin. . in the ed at the osh, she had an abdominal ultrasound which showed a ascites. this prompted a ct scan which was notable for a complex cystic low abdominal and pelvic mass, measuring 16 x 16.5 x 11.5 cm, positioned superior to the uterus. . she was admitted to the osh, and overnight, she developed a leukocytosis to 23,600, up from 11,000 on admission with a bandemia of 25%. she was started on levo/vanco/flagyl. her creatinine was noted to increase from baseline of 0.8 on admission to 2.8 ( at 6:45). bicarbonate decreased from 24 --> 16. her blood pressures transiently decreased to sbp of the 70s, and she was started on a dopamine gtt (1 mcg/min). she received one dose of mucomyst at 1700. was started on ns with 2 amps of bicarb at 250cc/hr for 800cc. . on arrival, the patient denied shortness of breath. she denied nausea, vomiting, abdominal pain. she denied fevers, chills, sweats. she denied diarrhea, constipation, brbpr, melena. her last episode of hematuria was ~1-2 weeks ago. . ros: she denies lightheadedness, palpitations. she denies chest pain. she denies weakness, blurry vision. past medical history: none - except for recent presumed uti (although pt has not seen a physician 20 years) social history: smoked 1 pack per day for 50 years, she quit smoking 15 years ago. she drinks socially and has never had a problem with alcohol abuse. she lives with her husband at home. has one child who is alive and well. she used to work as a telephone operator. . family history: she has a father who died of lung disease at 59 and a mother who died of " problem" at 70s. she has no fh of breast or ovarian cancer. . physical exam: temp 100.3 bp 110/70 pulse 120 resp 22 o2 sat 87% fm uo 0 cc. pulsus 5 gen - sleepy, arousable, accessory muscle use heent - perrl, extraocular motions intact, sclera anicteric, mucous membranes moist, no op lesions neck - no jvd, no thyromegaly nodes - no cervical, supraclavicular, axillary lymphadenopathy chest - distant breath sounds throughout, no w/c/r. cv - normal s1/s2, tachy, regular, no murmurs, rubs, or gallops abd - distended, (+) fluid wave, no hsm, normoactive bowel sounds back - no spinal, costovertebral angle tenderness extr - no clubbing, cyanosis, or edema. 2+ dp pulses bilaterally. no calf pain, erythema or cords palpable. neuro - alert and oriented x 3, cranial nerves intact, upper and lower extremity strength 5/5 bilaterally, sensation grossly intact. skin - no rashes pertinent results: . osh: 2/22 7am 9am 1815 cr 0.9 2.8 3.2 3.8 bun 8 22 8 32 . : cxr: lll atelectasis . : abd us: multiple shadowing gallstones. gb wall not thickened. ih ducts not dilated. common hepatic duct 4mm. ascites . : 1301: ct abd/pelvis with contrast - complex cystic and solid irregular mass - midline low abdomen and pelvis - 16x16.5x11.5cm. irregularly enhancing mural components and several low attenuation areas within the complex fluid commponents. extensive ascites. midline uterus. mild small bowel dilatation. kidneys normal without hydro/masses . ecg: hr 101, sinus tachycardia, normal intervals, no st depressions, normal axis, no q waves. no ecg available for comparison. ecg: here - sinus tach 111, nl axis, interval, sl peaked t waves in v2, otherwise no acute st t wave changes . cxr: left sided pleural effusion. mild vascular congestion . ct head 1.9 x 1.7 cm hyperdense, likely extra-axial lesion seen to the right of the cerebellum, most likely representing meningioma. comparison with prior studies if available would be helpful. if none are available, mri would be recommended for further evaluation. mri would also be more sensitive in the evaluation for potential metastases. * ekg sinus rhythm poor r wave progression - possible old anteroseptal myocardial infarction low qrs voltage in limb leads nonspecific t wave changes since previous tracing of , sinus tachycardia absent, and further t waves changes seen * leni no evidence of right or left lower extremity deep vein thrombosis. * cxr large right pleural effusion has increased slightly since with worsening of right basilar atelectasis. smaller left pleural effusion is unchanged. upper lungs show vascular redistribution but no indication of pneumonia. heart size is slightly larger today, but difficult to assess and the presence of adjacent pleural effusion. there is no mediastinal vascular engorgement to suggest elevated central venous pressure. no pneumothorax. * 08:43pm blood wbc-25.3* rbc-4.94 hgb-14.6 hct-45.7 mcv-93 mch-29.5 mchc-31.9 rdw-13.8 plt ct-487* 02:25am blood wbc-17.0* rbc-2.45* hgb-7.1* hct-21.8* mcv-89 mch-29.1 mchc-32.6 rdw-14.3 plt ct-219 05:31am blood wbc-23.9* rbc-3.90* hgb-11.7* hct-33.2* mcv-85 mch-29.9 mchc-35.1* rdw-15.1 plt ct-295 07:05am blood wbc-11.4* rbc-3.31* hgb-9.8* hct-28.7* mcv-87 mch-29.7 mchc-34.2 rdw-15.3 plt ct-572* 08:43pm blood pt-14.0* ptt-36.7* inr(pt)-1.2* 08:43pm blood fibrino-916* d-dimer-8124* 07:20am blood d-dimer-3722* 03:30am blood ret aut-1.4 08:43pm blood glucose-140* urean-35* creat-3.4* na-138 k-5.5* cl-108 hco3-15* angap-21* 05:06am blood glucose-134* urean-42* creat-0.9 na-146* k-4.2 cl-112* hco3-24 angap-14 11:35am blood glucose-95 urean-18 creat-0.5 na-139 k-3.3 cl-106 hco3-26 angap-10 08:43pm blood alt-20 ast-51* ld(ldh)-487* ck(cpk)-1081* alkphos-53 amylase-78 totbili-0.3 04:01am blood alt-17 ast-35 ld(ldh)-329* alkphos-41 amylase-86 totbili-0.3 03:30pm blood lipase-12 08:43pm blood ck-mb-22* mb indx-2.0 08:43pm blood ctropnt-<0.01 05:54am blood ck-mb-22* mb indx-1.8 ctropnt-0.01 08:26am blood hapto-212* 02:25am blood hapto-247* 04:53pm blood tsh-13* 04:53pm blood t4-5.3 t3-87 08:43pm blood cortsol-107.4* 05:54am blood cortsol-136.8* 08:43pm blood cea-10* ca125-96* 06:15pm blood afp-8.4 04:53pm blood anti-tg-less than thyrogl-22 09:04pm blood ca -9 -test 02:00am blood acth - frozen-test brief hospital course: this patient is a 65yo g3p2 with no known pmh presenting to osh with several weeks of abdominal bloating and a 16x16 pelvic mass and ascites, transferred with hypoxia and arf following ct with contrast. the patient was transferred to the micu. in the micu, her main issues were as follows: * 1. respiratory failure in the micu, she underwent evaluation to r/o pulmonary embolus given her rapid decompensation. she was started on empiric therapy with heparin. given the likelihood of acute renal failure from ct contrast, she could not be evaluated with cta. as a result, she had lenis that were neg and an echo that showed good ejection fraction with no rv strain. in consultation with pulmonary medicine, the decision was made not to treat her for pulmonary embolus. her respiratory failure was thought to be secondonary to mod/large bilat effusions seen on chest ct and large ascites, as well as volume overload from acute renal failure. she was intubated and remained on ventilatory support for 8 days. a left subclavian line was placed for hemodynamic monitoring. her first attempt at extubation was not successful due to pt drowsiness. a ct of the head was performed to r/o neurological injury. no hemorrhage was seen. she was eventually extubated the following day without complications. * 2. acute renal failure: on presentation to the micu, the patient was anuric and her creatinine was significantly higher than at the osh. this rapid rise was thought to be secondary to contrast induced nephropathy. a ct of the abdomen on showed no evidence of obstruction. the renal service was consulted and they recommended cvvhd dialysis which she underwent over the following 7 days with improvement in her urine output and creatinine measurement. * 3. fevers - on arrival, the patient was noted to have a fever with leukocytosis. blood, urine, sputum cultures were obtained that did not reveal any signs of infection. the cxr had no evidence of infiltrates. the abdominal ultrasound showed some cholelithiasis but no evidence of cholecystitis. she was treated empirically with vancomycin, ciprofloxacin and flagyl. her fevers improved after her second day in the micu, and her antibiotics were discontinued after surgery. * 4. altered mental status: on presentation, the patient had altered mental status that was thought to be secondary to taking dilaudid and benzodiazepine at osh. her neuro exam was non-focal. once stable from her respiratory status, she underwent ct head that revealed a small hyperdense mass in right cerebellum c/w meningioma. she was recommended for further imaging with mri. * 5. elevated cortisol: on arrival, the patient was found to have elevated cortisol levels. this was thought to be due to acute stress reaction and leukomoid reaction. as rare forms of ovarian cancer can also cause ectopic acth production, acth was also measured and found to be mildly elevated at 52. no further work-up was done. * 6. hypothyroidism: the patient was found to have an elevated tsh of 13 during her icu stay. this likely represents a stress response. she should have this retested 4-6 weeks after discharge to determine whether she has hypothyroidism. * 7. pelvic mass: ct of the abdomen from osh suggested a large pelvic mass. this was associated with ascites. on her second day, she underwent paracentesis under ultrasound guidance to improve her respiratory status and to r/o bacterial peritonitis. four liters were drained. although the fluid seemed suggestive of peritonitis, this was not associated with bacteria on gram stain. no malignant cells were seen. a second paracentesis was performed under ulstrasound guidance with 1l fuild drained. an attempt to further chracterise this mass, the patient underwent testing for a number of tumour markers. her ca-125 was mildly elevated at 96, cea as measured at 10, a 19-9 was significantly elevated at > and her hcg was negative. given the elevation in ca -9, she was seen by the surgical oncology who did not feel that this was consistent with pancreatic cancer despite such an abnormally elevated ca -9. dr from gynecology-oncology recommended exploratory laparotomy for likely ovarian cancer once stabilised. she was taken to the or on , eight days following her initial presentation. * the patient was taken to the operating room where she underwent exploratory laparotomy, supracervical hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy, pelvic mass resection for large mass from r ovary. please see operative note for full details. * her post-op course was complicated by: 1. wound infection 2. tachypnea likely secondary to atelectasis and pneumonia and presumed pulmonary embolus * 1. wound: on post-op day #2, the patient was found to have a wound infection for which she completed a 5 day course with vancomycin with complete resolution. * 2. tachypnea: on post-op day #4, the patient was found to be tachypneic with considerable shortness of breath at rest. this was a change from her baseline. a chest x-ray revealed worsening collapse of her rll and her rml. an infiltrate could not be ruled out. an abg was performed that did not show evidence of hypoxemia. there was concern for pulmonary embolus given that the patient had initially developed respiratory failure and had not been treated for embolus. pulmonary medicine was consulted and they felt strongly that this was likely secondary to atelectasis and mucus plugings but could not rule out pneumonia or pulmonary embolus. given her renal failure from ct contrast, she was not recommended for cta. moreover, given her ventilatory defects, a vq scan was not recommended either. us of the le was performed that did not show evidence of dvt. d-dimer was measured and was elevated. as pulmonary embolus could not be definitively ruled out, they recommended empiric therapy with lovenox. she was started on lovenox and will continue this for 6 months. she also received chest pt, nebuliser and advair and improved significantly. she was weaned off of oxygen on post-op day #7. she has a follow-up with pulmonary medicine after discharge. * otherwise, the patient's post-op course was uneventful. at the time of discharge, she was evaluated by pt who recommended some pt services at home. otherwise, her pain was well controlled, she was tolerating a regular diet and urinating without difficulty. * medications on admission: meds outpatient: nitrofurantoin cipro x 2 days . meds on transfer: levo vanco flagyl colace mom maalox tylenol reglan prn protonix xanax 0.25 prn dilaudid prn mucomyst discharge medications: 1. enoxaparin 80 mg/0.8 ml syringe sig: 70mg subcutaneous (2 times a day) for 6 months: this dose may need to be readjusted in case your weight changes over the next 6 months. disp:*qs * refills:*0* 2. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 8 days. disp:*8 tablet(s)* refills:*0* 3. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). disp:*60 disk with device(s)* refills:*2* 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*60 tablet(s)* refills:*2* 5. hydromorphone 2 mg tablet sig: 0.5-1 tablet po every hours as needed for pain. disp:*40 tablet(s)* refills:*0* 6. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. disp:*60 capsule(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: likely ovarian cancer post-op wound infection pneumonia presumed pulmonary embolus discharge condition: good discharge instructions: vomiting, worsening abdominal pain, difficulty with urinating, vaginal bleeding, worsening shortness of breath or any other worrisome symtom. * no driving while taking narcotics. * nothing in your vagina for 4 weeks (this includes intercourse) * no heavy lifting for 4 weeks. followup instructions: provider: , date/time: , 11:45, . * the following appts are on 7 (medical specialties) provider: breathing tests phone: date/time: 1:10 provider: , intepretation billing date/time: 1:30 provider: . /dr. phone: date/time: 1:30 md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube hemodialysis percutaneous abdominal drainage arterial catheterization other removal of both ovaries and tubes at same operative episode excision or destruction of peritoneal tissue other and unspecified subtotal abdominal hysterectomy diagnoses: pneumonia, organism unspecified other postoperative infection cellulitis and abscess of trunk acute kidney failure, unspecified acute respiratory failure other pulmonary embolism and infarction malignant neoplasm of ovary 

Answer: The patient is high likely exposed to