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: fever, hypoxia major surgical or invasive procedure: prbc transfusion history of present illness: the patient is a 74 year-old female with pmh significant for pnh c/b pancytopenia, who presented to clinic for routine c5 inhibitor treatment with eculizumab, and was found to have a fever to 102.4 and hypoxia to 82%ra. the patient reports a dry cough ongoing x 1 week without f/c or other symptoms. she notes "feeling warm" this am with sx of sob. she was able to perform her daily morning activities independently, but proceeded slowly sob. she also experienced sudden onset vomiting x 1 (mucous only) with no c/o nausea, abd pain, or diarrhea before or after this. she presentated to clinic for routine c5 administration, where she was noted to be febrile and hypoxic, as above. . of note, she reports + sick contacts at her nursing facility - "everyone has the flu". + flu vaccine earlier this season. she denies prior fevers, no chills/ rigors, abd pain, nausea, diarrhea, constipation, dysuria, myalgias, rhinorrhea. she currently feels "warm" but otherwise well without complaints. sob resolved with o2 by nasal cannula. past medical history: pnh- dx approx 25 yrs ago; treated with danazol, prednisone, ivig in the past; recently started on trial of cyclosporine type ii dm htn social history: soc hx: lives with daughter: nonsmoker, occasional etoh, no illicits family history: nc physical exam: vs: t 97.8 hr 65 rr 18 bp 138/53 o2sat 99%3l gen: wn, wd elderly female in nad heent: ncat, eomi, partially blind in l eye ?retinal hemorrhages - l pupil ~4mm. op clear, mmm, no e/o mucosal or gingival bleeding cv: rrr, i/vi sem > lsb, nml s1 and s2 chest: nml respiratory effort, + rales diffusely throughout abd: + bs, soft, nt, nd, no hsm ext: nml muscle bulk and tone, 2+ distal pulses, 3+ le edema to knees b/l neuro: cn iii-xii intact b/l (blind in l eye), spontaneously moving all four ext skin: diffuse ecchymoses on the arms, chest, and abdomen with petechiae present on the legs bilaterally and back. pertinent results: 10:30am blood wbc-1.5*# rbc-2.29* hgb-7.0* hct-19.9* mcv-87 mch-30.5 mchc-35.0 rdw-21.9* plt ct-11* 10:30am blood plt ct-11* 10:30am blood gran ct-990* 10:30am blood glucose-163* urean-33* creat-1.8* na-137 k-4.1 cl-102 hco3-26 angap-13 10:30am blood alt-75* ast-67* ld(ldh)-513* alkphos-114 totbili-2.4* dirbili-1.7* indbili-0.7 07:40am blood probnp-1531* 10:23am blood type-art temp-37 o2 flow-4 po2-78* pco2-34* ph-7.51* caltco2-28 base xs-3 intubat-not intuba comment-nc . studies: cxr: impression: right perihilar increased interstitial markings consistent with interstitial pneumonia given the clinical history. . cxr (ap port): findings: in comparison with study of , there is persistent enlargement of the cardiac silhouette with further increase in the interstitial pulmonary markings. more coalescent areas are seen in the upper lung zones, raising the possibility of focal areas of pneumonia. . micro: bcx: gpc in pairs and chains ucx: gnr > 100k, presumptive e. coli sputum: influenza neg. bcx: ngtd bcx: ngtd ucx: legionella urinary ag neg, cx p bcx: ngtd ucx: p brief hospital course: mrs. is a 74 yo w with pnh complicated by persistent pancytopenia who initially presented with fevers and hypoxia, strep viridans positive blood cultures, klebsiella uti and chest imaging concerning for atypical/interstitial pulmonary infection. her course was complicated by worsening respiratory distress following bronchoscopy and platelet transfusion, with likely transfusion reaction. 1)neutropenia, fever, dyspnea, hypoxia: she had persistant fevers throughout the first week of her admission concerning for infectious process most likely from a pulmonary source. history, exam, and imaging consistent with atypical/interstitial pulmonary process. her blood cultures from admission had one set positive for strep viridans and her urine culture was growing klebsiella > 100k(pansensitive except for nitrofurantoin). all blood and urine cultures since starting antibiotics were negative. she had bronchoscopy to attempt to obtain a culture diagnosis and to evaluate for tuberculosis. bacterial cultures from bal were negative, afb culture still pending however the smear was negative so tuberculosis precautions were discontinued. post bronchoscopy she had exacerbation of her reactive ariways with incrased oxygen requirement and poor air movement. she was treated with a oxygen by nrb and albuterol and ipratropium nebulizers. in addition, she developed respiratory distress following platelet transfusion consistent with acute tranfsuion reaction and was transferred to the intensive care unit. her respiratory status slowly improved over the next several day with diuresis and she returned to the floor and remained stable from a respiratory standpoint throughout the rest of her hospitalization. she was discharged to a nursing facility to complete a 14 day course of cefepime, azithromycin, and vancomycin given neutropenia, last day of antibiotics should be . at the time of discharge she was breathing comfortably, still with oxygen requirement of 3l by nasal cannula. 2)paroxysmal nocturnal hemoglobinuria: eculizumab held throughout admission and on discharge in light of fevers. she became progressively pancytopenic during her admission most likely due to acute illness vs. mds transformation of her bone marrow. her granulocyte count reached a low point of 50 during her admission and trended back up to 580 prior to discharge. she was transfused a total of 4 units of prbc to maintain a hematocrit >18 and 2 units of platelets for platelet count <10. her second plt transfusion was complicated by likely an acute transfusion reaction characterized by acute respiratory distress, rigors and fever requiring micu transfer. by the time of discharge her granulocytes were slowly trending up, and were 580 on last check. after extensive conversation with mrs. she decided that she no longer wished to have transfusions given that she most likely would be transfusion dependent. she understood and accepted the risks of not being transfused prbc and platelets and opted to no longer have routine lab draws. as she was competent and understood the risks and options, this was respected and labs draws were stopped. she was continued on danazol, folic acid and cyanocobalamin on discharge. she will follow up with dr. and in oncology clinic two weeks after discharge. she should not have routine blood work at her nursing facility. 3) htn: stable throughout her admission. she was continued on her outpatient regimen of norvasc and lasix. 4)diabetes mellitus: she has a history of brittle diabetes, complicated by retinopathy and nephropathy. she had been having symptomatic hypoglycemic episodes in the early morning so her pm dose of 70/30 was decreased from 15 to 10 units. her morning dose was continued at 10 units. she may require up titration of her evening insulin dose as she recovers from her acute illness and her appetite improves. she was also treated with humalog sliding scale. 5)crf: creatinine at baseline of 1.9-2.0. her medications were renally-dosed. 6) ppx: thrombocytopenia - no sqh or pneumoboots, defer ppi given risk of bm suppression, bowel reg. 7)fen: reg diet, monitor lytes 8)code: dnr/dni, she no longer wants transfusions or routine blood draws medications on admission: 1. norvasc 10 mg daily. 2. cholestyramine 4 grams daily. 3. danazol 200 mg b.i.d. 4. flovent two puffs b.i.d. 5. folic acid 5 mg daily. 6. lasix 40 mg daily. 7. calcium citrate 500 mg b.i.d. 8. vitamin b12 mcg daily. 9. colace 100 mg b.i.d. 10. vitamin d 400 units b.i.d. 11. insulin 70/30 25 units q.a.m., 15 units q.p.m. discharge medications: 1. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 2. danazol 200 mg capsule sig: one (1) capsule po bid (2 times a day). 3. folic acid 1 mg tablet sig: five (5) tablet po daily (daily). 4. cyanocobalamin 500 mcg tablet sig: four (4) tablet po daily (daily). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 7. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. 8. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 9. menthol-cetylpyridinium 3 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed). 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 11. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. 12. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed. 13. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 14. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 15. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours). 16. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 17. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 18. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 19. insulin asp prt-insulin aspart 100 unit/ml (70-30) solution sig: as directed subcutaneous twice a day: inject 27 units qam and 10 units qpm. 20. insulin lispro 100 unit/ml solution sig: as directed subcutaneous four times a day: inject as directed according to sliding scale. 21. azithromycin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 5 days: last day of antibiotics is . 22. cefepime 1 gram recon soln sig: one (1) g injection q24h (every 24 hours) for 5 days: last day of antibiotics is . 23. vancomycin in dextrose 1 gram/200 ml piggyback sig: 1000 (1000) mg intravenous q 24h (every 24 hours) for 5 days: last day of antibiotics is . discharge disposition: extended care facility: senior healthcare - discharge diagnosis: primary: - gpc bacteremia - uti - febrile neutropenia - pancytopenia . secondary: - pnh - type 2 diabetes mellitus. - hypertension. - hypercholesterolemia. - diabetic retinopathy. - chronic kidney disease. discharge condition: fair hct on discharge 17.8, patient does not want further transfusions, is aware of risks satting 100% on 3l nc at rest legally blind petechial rash on buttocks discharge instructions: you were admitted with fevers, shortness of breath, and low oxygen saturations that were thought to be caused by a viral infection versus a pneumonia. you were also put on several antibiotics to cover for bacteria in the blood as well as a urinary tract infection. during the admission your blood counts were also found to be low, likely due to a combination of your infection and due to progression of your pnh and possible effect on your bone marrow. you were admitted to the intensive care unit during your admission due to a reaction that you had to platelets that you were given. you were treated with high flow oxygen and steroids and you slowly improved. you decided during your admission that you no longer wanted blood transfusions even though your blood count was low. please continue to take all of your medications as prescribed. please attend all of your follow-up appointments. . if you experience any fevers > 100.5, chills, shortness of breath, palpitations, bleeding, chest pain, swelling, or any other concerning symptoms please contact your pcp or go to the er for further evaluation. followup instructions: you have the following appointments scheduled to follow up: provider: , md phone: date/time: 2:30 provider: , md phone: date/time: 2:30 provider: imaging phone: date/time: 1:10 provider: , m.d. phone: date/time: 1:30 md, procedure: closed [endoscopic] biopsy of bronchus transfusion of packed cells transfusion of platelets diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified congestive heart failure, unspecified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified myelodysplastic syndrome, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure bacteremia diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled epistaxis diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy neutropenia, unspecified candidiasis of skin and nails transfusion related acute lung injury (trali) hemoglobinuria due to hemolysis from external causes 

Answer: The patient is high likely exposed to