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: chronic back pain. major surgical or invasive procedure: anterior-posterior lumbar fusion on and history of present illness: 43 y/o female admitted on to the ortho service for a anterior-posterior lumbar fusion being transferred to the medicine service for further management of aspiration pna. pt underwent anterior-posterior lumbar fusion at the l4-s1 level without complication on and (staged procedure). she did have a significant amout of pain following the operation so a pain service consult was obtained. per their recs, she is currently on a scheduled oxycontin and prn percocets. on , the pt spiked a temperature to 104 and became hypoxic to 87% on ra. her oxygen saturation improved to 97% on 2 l nc. at this time, the pt was reporting sharp right cp and a cough productive of greenish/brown sputum. wbc count was elevated at 17.1. cxr was obtained which showed an illdefined opacity in the right upper lobe that was concerning for a pneumonia. the pt was started on levofloxacin at that time. on , a medicine consult was obtained to further evaulate the pt. flagyl was added to the pt's regimen. a cta was obained to rule out pe. it was negative for pe but showed an acute pneumonia predominantly involving the posterior segments of the right upper and lower lobes. there were also additional patchy opacities within the posterior aspect of the left upper lobe. on , the pt continued to be febrile and had an increased oxygen requirement so the decision was made to transfer her to the medicine service. on discussion, pt denies sob. continues to have occasional sharp pains in her right chest. is bringin up greenish sputum. past medical history: 1. chronic low back pain 2. h/o nephrolithiasis 3. carpal tunnel surgery in social history: pt lives at home with her husband. she has not been able to work since hurting her back in 03/. no etoh since that time as she has been on pain medications. she drank rarely before that time. pt quit smoking one month ago. no drugs. family history: nc physical exam: 100.6 tm- 104.4 110/70 (106-133/65-81) 109 20 89% 2l nc increased to 95% on 4 l nc i/o: 1200/675 gen- alert and oriented. resting in chair but appears very uncomfortable. cardiac- tachycardic. regular rhythm. no m,r,g. pulm- decreased breath sounds throughout with crackles throughout the right middle and upper lobes. abdomen- soft. tenderness along area of incision. mildly distended. positive bowel sounds. extremities- no c/c/e. neuro- cn ii-xii intact. pertinent results: 12:32pm blood wbc-23.9* rbc-3.20* hgb-9.6* hct-28.4* mcv-89 mch-30.0 mchc-33.8 rdw-12.6 plt ct-423 12:32pm blood plt ct-423 lumbar pathology (): diagnosis: intervertebral disc, l4-l5 and l5-s1: cartilage with degenerative changes; small fragments of bone. clinical: lumbar disc degeneration. gross: the specimen was received fresh labeled with ", " and "disc l4-5, l5-s1" and multiple fragments of white dense connective tissue measuring 4.2 x 4.1 x 1.9 cm in aggregate. the specimen is represented in a. chest (portable ap) (): the study is somewhat limited due to overpenetration. the cardiac and mediastinal contours are within normal limits. note is made of illdefined opacity in the right upper lobe, probably representing pneumonia. no chf is noted. no pleural effusion noted. gas is slightly dilated in the left upper quadrant. impression: illdefined right upper lobe opacity, probably representing pneumonia. correlate clinically and with follow up study. cta chest w&w/o c &recons (): ct of chest with iv contrast/ct angiogram: there are no intra-arterial filling defects suggestive of pulmonary emboli. the heart, pericardium and great vessels are unremarkable. noted are scattered prevascular, mediastinal, subcarinal and hilar lymph nodes, none of which meet the ct criteria for pathologic enlargement. lung windows show focal areas of consolidation, with intervening air bronchograms, predominantly involving the posterior aspects of the right upper and lower lobes. there are also scattered ground glass opacities involving both upper lobes and the posterior aspect of the left lower lobe. multiple subpleural blebs are seen within both lung apices, right side greater than left. the central airways are widely patent. bone windows show no suspicious osseous abnormalities. within the imaged portion of the lower neck, there is a partially-visualized enlarged left lobe of the thyroid gland, with inferior nodularity measuring 2.1 x 1.8 cm. within the imaged portion of the upper abdomen, there is diffuse low attenuation of the liver parenchyma, without evidence of focal lesions. there is a small calcification within the peripheral aspect of the right hepatic lobe, likely representing a calcified granuloma. noted is a replaced left hepatic artery, which originates from the left gastric artery. the partially-visualized adrenal glands, left kidney, pancreas and spleen are unremarkable. multiplanar reformatted images were helpful in confirming the above findings and in the delineation of the above-described anatomy. impression: 1. no evidence of pulmonary embolism. 2. findings suggestive of an acute pneumonia predominantly involving the posterior segments of the right upper and lower lobes. additional patchy opacities within the posterior aspect of the left upper lobe are also suggestive of an acute infectious process. correlation with the patient's surgical history is recommended, as these findings could be found following an aspiration event. follow-up imaging to ensure resolution is recommended. 3. diffuse fatty infiltration of the imaged portion of the liver parenchyma. 4. partially imaged thyroid gland shows an enlarged and nodular left lobe. correlation with the patient's clinical exam and a dedicated thyroid ultrasound, if clinically warranted, may be helpful. brief hospital course: 43 y/o female admitted on to the ortho service for a anterior-posterior lumbar fusion being transferred to the medicine service for further management of aspiration pna. 1. aspiration pna- as above, pt became febrile and had a new oxygen requirement on . she was found to have an aspiration pna and medicine was consulted. on , due to worsening oxygen requirement, pt was transferred to medicine. at that time, her antibiotics were changed from levofloxacin and flagyl to levofloxacin and clindamycin. one difficulty in clearing the pneumonia was the pt's impaired ability to take deep breaths and cough secondary to her post op pain. this was very concerning as pt could develop an abcess or other collection of infection if she can not mobalize the sputum. she was had a brief micu stay for increased monitoring delirium and hypoxia w/ rapid improvement. she received 1 day of vancomycin, and her final course of antibiotics was levofloxacin and clindamycin. she was d/c'ed on a 2 week course. . 2. s/p l4-s1 anterior-posterior fusion- pain service was involved for management of post-op pain. she used a dilaudid pca and was eventually transitioned to 60mg po bid oxycontin w/ 5-10mg po q3-4h prn for breakthrough. she also had withdrawal from her benzos and was eventually restarted on her valium 2mg po tid and alprazolam 0.5mg po tid. . 3. fen- regular diet. agressive electrolyte replacement. . 4. proph- pneumoboots; ppi; bowel regimen. . 5. dispo- to home pending resolution of aspiration pna and stability from surgical standpoint. medications on admission: 1. alprazolam 0.5 mg tid prn 2. compazine 10 mg tid prn 3. oxycontin 60 mg 4. peri colace 2 tabs daily 5. percocet tab q4-6h prn 6. protonix 40 mg daily 7. diazepam 10 mg qhs prn 8. diazepam 2 mg tid prn 9. welbutrin sr 150 mg 10. nicotine patch 21 mgs daily discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. disp:*60 tablet(s)* refills:*0* 5. bupropion hcl 150 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). disp:*60 tablet sustained release(s)* refills:*2* 6. tylenol 325 mg tablet sig: two (2) tablet po four times a day. disp:*240 tablet(s)* refills:*2* 7. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day). disp:*2700 ml(s)* refills:*2* 8. diazepam 2 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*0* 9. oxycodone hcl 40 mg tablet sustained release 12hr sig: 1.5 tablet sustained release 12hrs po q12h (every 12 hours). disp:*90 tablet sustained release 12hr(s)* refills:*0* 10. levofloxacin 500 mg tablet sig: one (1) tablet po once a day for 2 weeks. disp:*14 tablet(s)* refills:*0* 11. tolterodine tartrate 1 mg tablet sig: one (1) tablet po daily (daily). disp:*7 tablet(s)* refills:*0* 12. clindamycin hcl 300 mg capsule sig: three (3) capsule po every eight (8) hours for 2 weeks. disp:*42 capsule(s)* refills:*0* 13. alprazolam 0.5 mg tablet sig: one (1) tablet po three times a day for 1 weeks. disp:*21 tablet(s)* refills:*0* 14. oxycodone hcl 5 mg tablet sig: 1-2 tablets po q3-4h () as needed for 1 weeks. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: , discharge diagnosis: primary diagnosis: anterior-posterior lumbar fusion secondary diagnosis: aspiration pneumonia discharge condition: stable discharge instructions: 1. please take all medications as prescribed. 2. please keep all follow up appointments. 3. seek medical attention for fevers, chills, chest pain, shortness of breath, pain at the incision site, or other concerns. followup instructions: primary care: please follow up with dr. ,tzvetan in 1 week. ortho: please follow up with dr. as scheduled. procedure: lumbar and lumbosacral fusion of the anterior column, posterior technique excision of bone for graft, other bones transfusion of packed cells lumbar and lumbosacral fusion of the anterior column, anterior technique insertion of catheter into spinal canal for infusion of therapeutic or palliative substances systemic to pulmonary artery shunt insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae insertion of recombinant bone morphogenetic protein diagnoses: mitral valve disorders pneumonitis due to inhalation of food or vomitus lumbosacral spondylosis without myelopathy displacement of lumbar intervertebral disc without myelopathy 

Answer: The patient is high likely exposed to