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: levofloxacin / lisinopril / diphenhydramine attending: chief complaint: s/p arrest in the or during ip stent procedure. major surgical or invasive procedure: left main stem stent placement. endotracheal intubation. left femoral tripple lumen catheter placement. history of present illness: 69 y/o f with pmhx of copd and small cell lung cancer (diagnosed ) s/p xrt/chemo/tumor debridement/r mainstem bronchus stent placement () and recent lue dvt on coumadin who initially presented to hospital on with 3-4 episodes of hemoptysis, increased cough, wheezing and shortness of breath. she was started on iv solumedrol 125mg iv q6hrs, nebs and tessalon pearles. she was supratherapeutic with an inr of 4.1 and coumadin was held. cta was negative for pe and revealed right mainstem stent with distal intraluminal narrowing or tumor effusion, mediastinal and subcarinal confluent metastatic lymphadenopathy. decision was made for transfer to for bronch and ip evaluation. . pt was admitted to and was continued on steroids, nebs and cough suppressants. she went for flexible bronchoscopy on which revealed normal trachea, extensive tumor at carina obstructing both mainstem bronchi, extrinsic mediastinal compression of l mainstem and unable to visualize stent in right mainstem due to intraluminal tumor. pt was taken to the or on and had stent placed in the left mainstem with good result. there was attempted argon plasma coagulation inside of the right stent to remove intraluminal obstruction. during this procedure, pt became progressively hypoxic, bradycardic and loss of pulse at approx 3:38pm. cpr was started immediately and pt received a total of 2mg of epi. after approximately 2-3minutes of cpr, rhythm was checked and there was a palpable pulse with hr >100 and sbp >180. tee was performed and showed bubbles in the right atrium suggestive of apc related air embolism but no rv dilation suggestive of acute pe. oxygen sats recovered into the 90s, right femoral a-line and left femoral cvl was placed. pt was given an additional bolus of midazolam and some neosynephrine for bp support prior to transfer to the icu. . on arrival to the icu, pt was intubated and sedated with hr >100 and bp 140/90s. sedation was rapidly weaned and pt was clearly responding to commands and moving all extremities. past medical history: 1. small cell lung cancer - diagnosed in and recurred in . initially started 6 weeks of xrt, followed by multiple regimens of chemo. has been off chemo for the last 4 months "because ct scans have been stable." last bronchoscopy was in - small amounts of granulation tissue seen in stent. 2. recent lue dvt (mid-) - l arm port was changed, after which she developed dramatic swelling from shoulder to wrist; uenis confirmed lue dvt. coumadin 5mg was started. 3. copd - longstanding, unknown date of diagnosis 4. lupus - diagnosed 8 years ago after work-up for painful knee and finger joints (l finger joints > r finger joints) - treated with "pills" but not prednisone 5. shingles infection in t10 dermatome in - treated with acyclovir and recovered within 1 week 5. anxiety/insomnia past surgical history: 1. right eye cataract surgery 2. bronchial stent placement in by dr. 3. lung cancer tumor debridement and ablation in by dr. social history: she lives in with her husband. she has 4 children and 7 grandchildren who live within a mile of her house. she worked as a homemaker. she smoked tobacco for approximately 20 pack years (1 pack per day for 20+ years) and quit in the . she does not know of any asbestos exposure. she drinks alcohol only on social occasions and uses no other drugs. family history: she reports no family history of lung cancer, sle, or cad. her mom died of "stomach cancer" at 51yo and her niece has breast cancer. her son has . physical exam: vitals: t: 98.1 bp: 130/84 p: 117 r: 22 o2: 98% on 3 l general: alert, oriented, not in acute respiratory distress, sitting upright in bed watching tv with audible upper airway inspiratory and expiratory stridor. heent: sclera anicteric, pupils equal round & reactive to light, mucous membranes moist, no jugular venous distention, mucous membranes moist, oropharynx clear without thrush, no oropharyngeal source of bleeding seen neck: supple, jvp not elevated, no lymphadenopathy, no carotid bruits, loud and harsh inspiratory upper airway stridor heard, trachea not deviated lungs: nasal cannula intact, patient sitting upright with audible upper airway inspiratory and expiratory stridor. patient appears comfortable and is not using any accessory muscles of inspiration. respiratory rate is mildly elevated. scattered anterior inspiratory and expiratory wheezes. left-sided bronchial breath sounds bases>apices. right-sided bronchial breath sounds with fine crackles at bases. scattered inspiratory and expiratory wheezes but not consistently. cv: tachycardic with regular rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, no clubbing, cyanosis or edema skin: no skin rash or ecchymoses noted, dressing over left anterior pectoral region covering old portacath. neuro: alert & oriented x 3, extraocular movements intact, cns ii-xii grossly intact and patient moving all four extremities spontaneously on discharge: vs: 98.8 126/70 108 18 95% 2l gen: ill appearing female, appearing older than stated age. cv: tachycardic, no rubs, gallops, murmurs. lungs: diffuse rhonchi, few wheezes, scant basilar rales on the left. moderate movement abd: soft, nd, nt abs ext: wwp with palpable dp pulses neuro: alert and oriented, eomi, patient moving all extremities spontaneously pertinent results: 09:50pm wbc-9.8# rbc-3.21* hgb-10.0* hct-28.9* mcv-90 mch-31.1 mchc-34.5 rdw-18.7* 09:50pm neuts-94.3* lymphs-3.6* monos-1.9* eos-0.1 basos-0.1 09:50pm plt count-256 09:50pm pt-24.0* ptt-34.8 inr(pt)-2.3* 09:50pm glucose-224* urea n-30* creat-1.0 sodium-138 potassium-4.6 chloride-102 total co2-24 anion gap-17 09:50pm calcium-8.6 phosphate-2.1* magnesium-1.8 . radiology chest (portable ap) known treated right upper lobe mass with expected post-treatment change and soft tissue density seen in a right paramediastinal location is stable. new mild bilateral pleural effusions. otherwise no significant interval change with no focal consolidation, and pulmonary vascularity within normal limits. no new abnormality involving cardiomediastinal contours. stable appearance of bilateral bronchial stents and port with tip terminating within the upper svc. no evidence of pneumothorax. radiology mr head w & w/o contras there is a linear region of decreased diffusion within the right frontal lobe, predominantly involving the cortex and subcortical white matter, as well as multiple additional punctate foci of decreased diffusion within the biparieto-occipital lobes, including extending into the splenium of the corpus callosum on the right. there is an additional focus of abnormal slow diffusion within the inferior aspect of the right cerebellar hemisphere, measuring 1.5 cm, with associated brisk enhancement. there is enhancement over the right frontal lobe signal abnormalities described above. all of the regions of decreased diffusion have associated t2 signal abnormality. there are no regions of abnormal marrow replacement, despite limitations by motion artifact. focus of susceptibility artifact along the posterior focus likely represents a small calcified dural plaque. there are multifocal regions of punctate post-embolic encephalomalacia within the left cerebellar hemisphere suggesting chronic embolic disease. impression: 1. multifocal regions of abnormally decreased diffusion, most prominent within the right frontal lobe, which has an appearance suggestive of watershed infarction. the more punctate foci of decreased diffusion posteriorly suggest multiple small emboli. 2. well-defined 15 mm focus of enhancement and decreased diffusion within the right cerebellar hemisphere may represent a subacute enhancing infarct, but is more concerning for a metastatic lesion in this patient with lung cancer. consideration could be given to neck mra or cta to evaluate the cervical circulation, though the pattern suggests a proximal source. radiology bilat lower ext veins p grayscale and color doppler images of bilateral common femoral, superficial femoral, and popliteal veins were performed. there is normal compressibility, flow and augmentation. cardiology echo the estimated right atrial pressure is 10-15mmhg. left ventricular systolic function is hyperdynamic (ef>75%). right ventricular chamber size is normal with mild global free wall hypokinesis. there is a small to moderate sized pericardial effusion. there are no echocardiographic signs of tamponade. cardiology echo no atrial septal defect is seen by 2d or color doppler. right ventricular chamber size is normal. with borderline normal free wall function. the aortic valve leaflets (3) are mildly thickened. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. mild (1+) tr. upon initial placement small air bubbles visualized in ascending aorta. no air visualized in la/lv. no lv wall motion abnormalities. no thrombus visualized in ra, rv, pa. right pa appears compressed by large mass but still patent. arrest possibly secondary to left sided intracardiac air/coronary air embolism but unable to determine given time between event and images. pe also on the differential but no signs of significant rv failure, however inotropes (epinephrine) were administered. pathology tissue: bronchus intermedius. small cell carcinoma radiology venous dup ext uni (map grayscale, color and doppler images were obtained of the left subclavian ij axillary, brachial, basilic, and cephalic veins. there is normal flow, compression and augmentation seen in all of the vessels. . brief hospital course: 69 y/o f with pmhx of large mediastinal scc s/p right mainstem stenting who presented with recurrent compressive symptoms who underwent or placement of left mainstem stent and right mainstem apc complicated by hypoxia and pea arrest. . pt thought to have had pea arrest after rigid bronchoscopy was removed, subsequent to l main stent placement for sclc and use of argon anticoagulation. she underwent cpr immediately for <1 minute. the etilogy was thought to be air emboli secondarely to argon coagulation vs. hypoxia. tee was not done during procedure due to technical difficulties secondarely to the mediastinal mass. however, tee done after arrest showing air bubbles in l atrium. on admission the a-a gradient with po2 was of >450 on 100% fi02 and lactate was 1.7. she was moving all extremities and following commands. ce were negative x2. repeat tte was normal. anticoagulation was initially held (for dvt) and patient was extubated succesfuly 3 days after initial intubation. her ventilatory support was minimal, risbi was <105 with air leak and she was extuabted 24 hours after procedure. unfortunately, she developped stridor and increase number of secretions in the upper airways with respiratory rate in the 40s and spo2 in 70s. she required emergent re-intubation. high-dose steroids (methylprednisolone 125 mg q 6hrs) were started and continued for 48 hours and patient was succesfully extubated on day 3. steroids were slowly down-tapered. due to long standing disease with e/o hyperinflation on cxr and report of bronchospasm on presentation, she was also treated for copd exacerbation with standing and prn nebulizers. after several days on the medical floor, patient's respiratory status was not improving. interventional pulmonology was reconsulted. pt was taken for flexible bronchoscopy which showed significant mucus, some of which was removed, and on the vocal cords. thoracentesis was also performed. 800cc were removed and sent for culture. culture was still pending at time of discharge. lue dvt: per psh report, pt had portacath associated upper extremity dvt and has been on coumadin, p/w supratherapeutic inr. however, ultrasound on did not show any dvt. lenis were negative. anticoagulation was held prior to procedure and re-started 24 hours afterwards (with lovenox) given her malignancy and higher bleeding risk. during her hospitalization there was concern of a cerebellar metastasis of sclc. per radiology, pt should undergo a repeat mri in 6 weeks for further characterization. due to h/o dvt and atrial fibrillation as well as evidence of embolic stroke, anticoagulation was continued upon discharge. primary oncologist, dr. was informed of this and he agreed with the plan. tachycardia / svt : pt has remained tachycardic since admission, suspect some component of dehydration and underlying malignancy. cta neg for pe at osh prior to transfer. lenis were negative. patient was hydrated and tachycardia did not improve. then, she had episodes of atrial fibrillation up to 140-150 bpm with stable bp. she was started on metoprolol and it was titrated up to 50 mg tid which maintained a hr of 100 as monitored on telemetry. metoprolol was not further uptitrated as sinus tachycardia was thought to be secondary to her illness. she was discharged on this regimen. would consider uptitration of metoprolol if rate requies better control. she was diltiazem prior to this admission, but it did not control her heart rate adequately. sclc: pt with sclc s/p chemo/radiation and now with l and r main bronchus metal stents. given that she has already received max radiation doses plan is to do brachitherapy and chemo as outpatient. she will need follow up mri in 6 weeks for further charactization of a potential brain metastasis. outpatient providers will also have to reassess whether or not to continue anticoagulation. plan for patient to follow up with dr. ( medical center) for hdr ?????? brachytherapy in the bronchus intermedius in the next week. follow up with primary oncologist within 2-3wks with a repeat mri head and ct chest. and follow up with dr. in ip in 4 wks for return visit and flex bronch. bacteremia: pt grew staphylococcus, coagulase negative from a-line, which was removed <24 after positive blood culture and started on vancomycin (day 1 ). then, patient grew mrsa from sputum and plan was to treat with vanc for 2 weeks given endovascular infection. . uti: pts urine was growing gnrs so ciprofloxacin was started. speciation showed enterobacter cloacae pan-sensitive. she was switched to bactrim to continue treatment for 7 days (d1 ). medications on admission: aspirin 81 mg po daily warfarin 5 mg po daily diltiazem 240 mg po daily magnesium oxide 400 mg po daily lorazepam 0.5 mg po bid benzonoatate 100 mg po 1 tab tid spiriva inhaler (tiotropium) discharge medications: 1. magnesium oxide 400 mg tablet sig: one (1) tablet po once a day. 2. lorazepam 0.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety. 3. prednisone 10 mg tablet sig: three (3) tablet po daily (daily): for two days then reduce to 20 mg daily for two days, then reduce to 10mg daily for 2 days. 4. enoxaparin 60 mg/0.6 ml syringe sig: one (1) syringe subcutaneous q12h (every 12 hours). 5. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 6. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day). 7. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day): pt should also gargle with this medication for treatment of her sore throat (). 8. guaifenesin 1,200 mg tab, multiphasic release 12 hr sig: one (1) tab, multiphasic release 12 hr po bid (2 times a day). 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb neb neb inhalation q6h (every 6 hours). 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb neb inhalation q2h (every 2 hours) as needed for sob. 11. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation every six (6) hours as needed for sob. 12. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for sleep. 13. menthol-cetylpyridinium 3 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed) as needed for sore throat. 14. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po bid (2 times a day): last dose is evening of . 15. vancomycin 1,000 mg recon soln sig: one (1) gram intravenous twice a day: please resume on after checking vanco trough to ensure level is not supratherapeutic. goal 15-20. last day of treatment is . 16. outpatient lab work please check vanco trough every third dose. please check on trough on prior to resuming vancomycin administration. 17. port a cath please deaccess permanent catheter after antibiotic regimen is complete. 18. heparin flush (10 units/ml) 5 ml iv prn line flush indwelling port (e.g. portacath), heparin dependent: flush with 10 ml normal saline followed by heparin as above daily and prn per lumen. 19. heparin flush (100 units/ml) 5 ml iv prn de-accessing port indwelling port (e.g. portacath), heparin dependent: when de-accessing port, instill heparin as above per lumen. 20. metoprolol succinate 100 mg tablet sustained release 24 hr sig: 1 and half tablet daily tablet sustained release 24 hr po once a day: 150mg daily. 21. outpatient lab work please check weekly cbc and chem 10 to ensure no major abnormalities discharge disposition: extended care facility: discharge diagnosis: primary: small cell lung cancer pea arrest copd exacerbation pulmonary effusion atrial fibrillation mssa bacteremia enterobacter uti secondary: hypertension h/o dvt anxiety discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ms. - it was pleasure to care for you during your hospitalization. you were admitted for hematemesis. you were to have one of your stents reopened and have another stent placed in your lungs. however, shortly after the procedure you developed very low blood pressure and required icu hospitalization. you were intubated twice. upon extubation you had swelling in your neck impairing your breathing, as well as severe wheezing. you were treated with steroids and nebulizers. unfortunately your breathing did not improve so you underwent another bronchoscopy which showed alot of mucus, some of which was removed. you had fluid removed from your lungs also. your vocal cords show a candidal infection (thrush) so you should continue to gargle with nystatin swish and swallow. you will require oxygen for some time until your lung function improved. also during your hospitalization you were found to have staph aureus infection of your blood stream and possibly a staph aureus pneumonia. you will complete a 14 day course of vancomycin (antibiotic). you were also found to have a urinary tract infection for which you are on a second antibiotic called bactrim. you were also treated for atrial fibrillation (irregular heart rhythm) which requires medication to control the heart rate and continuation of blood thinners to prevent strokes. you were previously on coumadin and this is being switched to lovenox. unfortunately, to complicate this matter, a small abnormality was found in your brain that may be a metastasis of the lung cancer. this is not entirely clear. if it is, you could potentially have a bleed in the brain. on the other hand, if you do not continue with the lovenox treatment, you could have a stroke from a blood clot formed in the heart, which you may have already had in the past. the present plan is to continue you on blood thinners until we can obtain a repeat mri to confirm a metastatic brain tumor. at that time, the matter of continuing blood thinners can be readdressed. regarding treatment - you should discuss further treatment of your lung cancer with your pulmonologists and your primary oncologist. many medications were changed during this hospitalization: - you will start prednisone taper, ipratropium and albuterol for treatment of copd - guifenessin has been added to break up mucus - bactrim and vancomycin have been added for treatment of urinary tract infection and blood stream infection - nystatin swish and swallow for treatment of oral and vocal throat infection (yeast). please gargle with this medication for most effective treatment. - metoprolol has been started for better heart rate control. stop taking diltiazem - lovenox has been started to thin the blood. stop taking coumadin. - aspirin has been discontinued due to increased risk of bleeding. - lorazepam may be used as frequently as every 6 hrs as needed. followup instructions: please make the following appointments. name: , address: , , phone: appointment: thursday 11:15am department: interventional pulmonary when: tuesday at 11:30 am building: de building ( complex) campus: west best parking: garage department: chest disease center when: tuesday at 12:00 pm building: building ( complex) campus: west best parking: garage we are working on a follow up appointment with dr. in the pulmonary department at medical center within 2 weeks. the office will be contacting you at home with an appointment. if you have not heard or have any questions please call . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified diagnostic ultrasound of heart insertion of endotracheal tube thoracentesis other bronchoscopy arterial catheterization other intubation of respiratory tract closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus cardiopulmonary resuscitation, not otherwise specified endoscopic excision or destruction of lesion or tissue of lung endoscopic excision or destruction of lesion or tissue of bronchus bronchial dilation diagnoses: systemic lupus erythematosus unspecified pleural effusion urinary tract infection, site not specified unspecified essential hypertension cardiac complications, not elsewhere classified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation personal history of tobacco use candidiasis of mouth other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure unspecified disease of pericardium acute respiratory failure other specified cardiac dysrhythmias cardiac arrest bacteremia other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of anticoagulants malignant neoplasm of other parts of bronchus or lung other diseases of lung, not elsewhere classified personal history of venous thrombosis and embolism hypoxemia infection and inflammatory reaction due to other vascular device, implant, and graft staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus accidents occurring in residential institution air embolism as a complication of medical care, not elsewhere classified oliguria and anuria other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms edema of larynx methicillin resistant pneumonia due to staphylococcus aureus 

Answer: The patient is high likely exposed to