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: no known allergies / adverse drug reactions attending: chief complaint: shortness of breath/fatigue major surgical or invasive procedure: pleurex drain placement by interventional pulmonology history of present illness: patient is a 44yof with congenital developmental delay who presented to osh with fevers, shortness of breath, weight gain, and lower extremity swelling for several weeks. patient's parents noted lower extremity swelling, left greater than right for last several months. presented to her pcp 1 week ptp who felt she may have heart failure and started empiric diuresis (patient is adverse to testing and becomes very anxious) started on 40 mg po lasix daily at that time with moderate improvement in her le swelling. . regarding her fevers, temperatures reported to be in the 101 region intermittingly for about last 2 weeks. additionally having sore throat, copious rhinorrhea, dry cough, which per report appeared to improve. three days ptp however became febrile again. per patient's family, she has had no changes in baseline mental status, and has not had any vomiting, chest pain, abd pain, diarrhea, or dysuria although patient is a poor historian. no sick contacts. . at the osh found to be hypoxic at 89-92%. improved on 5l nc and treated empirically with lasix and levofloxaicn. osh xray showed diffuse underlying interstitial lung disease, a new large l pleural effusion, small r pleural effusion, mild congestive failure, lll consolidation, ?rll consolidation as well. ct chest at showed interstitial edema, lll collapse, b/l pleural effusions, and small pericardial effusion. the patient was transferred from to for further evaluation . in the ed, patient was afebrile satting 97% on 5l. she was given vancomycin 1gm iv for possible pneumonia and was admitted to the micu for possible thoracentesis and further management. . in the icu, patient was diuresed with 20 mg iv lasix. thoracentesis was considered but deferred given patients stability and anticipated difficulty for performing thoracentesis in this patient with mental retardation. her vitals remained stabily in the high 90's/low 100's. she continued to saturate in the 90-95% range on 2l nc. she was diuresed for a total volume of 720 cc's negative. bp's ran in the high 90's/low 100's systolic (her baseline). an echo was performed which failed to show evidence of heart failure (ef 55%), but did confirm trivial pericardial effussion as well as possible small pfo. . on call out to the floor patient was afebrile, hr of 101, bp 98/51, rr 26-33, satting 95% on 2l nc. . review of systems (conducted with assistance from patient's mother and father). (+) per hpi (-) denies chills, night sweats. denies headache, sinus tenderness. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - developmental delay - born with "x,y male chromosome" per her mother's report. no records to review. had surgical correction so that she is brought up as a female. - seizure disorder (last seizure ) on phenobarb since age of 18 - ckd (had bilateral kidney dysfunction due to congenital bladder valve) unknown creatinine baseline - osteoporosis - mvr - allergic rhinitis - asthma social history: - tobacco: none - alcohol: none - illicits: none lives at a group home during the week with five other tenants, and lives with parents on the weekend. family history: per omr and parents -> f: htn, high cholesterol, prostate cancer. : dm. mgf: heart disease. maternal great grandmother mastectomy in 50's. physical exam: admission physical exam: vitals: t: 97 hr of 101, bp 98/51, rr 26-33, satting 95% on 2l nc. general: alert, interactive, able to follow simple commands, no acute distress. heent: sclera anicteric, mmm, oropharynx clear neck: supple, well circumscribed nontender 1cm subcutaneous nodule in left supraclavicular area. cv: tachycardic, normal s1/s2, no murmurs or rubs lungs: right sided sounds with mild rhonchi in upper lung fields with mild crackles at bases and decreased bs at the lower bases. left lung is mildly rhonchoruous in ulf, very decreased breath sounds starting at the mid lung field. no wheezes. abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, equal and palpable pedal pulses b/l, no clubbing, cyanosis, trace pitting pedal edema b/l l>r with no ttp. neuro: not answering questions consistently, but able to follow commands. family confirms this is patient's baseline neurologic function. . discharge physical exam: vitals: no morning vitals, rr 22, 89% 5l and shovel mask general: sitting up in bed, occassional cough, not verbal but interactive heent: op clear cardiac: rrr, s1/s2, no mrg lung: diffuse rhonchi, l>r m/s: moving all. extremities well, +cyanosis, +pitting edema pertinent results: admission labs: 11:33pm blood wbc-8.8 rbc-5.09 hgb-14.5 hct-41.9 mcv-82 mch-28.6 mchc-34.7 rdw-13.8 plt ct-241 11:33pm blood neuts-84.3* lymphs-8.9* monos-5.5 eos-1.0 baso-0.2 11:33pm blood glucose-114* urean-16 creat-1.1 na-139 k-4.2 cl-100 hco3-26 angap-17 11:33pm blood alt-11 ast-17 ld(ldh)-206 ck(cpk)-72 alkphos-108* totbili-0.3 11:33pm blood ck-mb-3 ctropnt-<0.01 11:33pm blood totprot-6.9 albumin-3.5 globuln-3.4 calcium-9.0 phos-3.8 mg-2.1 11:33pm blood phenoba-27.3 11:33pm blood tsh-1.3 10:23pm urine color-yellow appear-clear sp -1.013 10:23pm urine blood-sm nitrite-neg protein-neg glucose-tr ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-neg 10:23pm urine rbc-5* wbc-<1 bacteri-few yeast-none epi-0 . micro: , blood culture no growth to date urine culture no growth final respiratory viral screen negative pleural fluid gram stain and culture negative . cytology: 03:30pm pleural wbc-2750* rbc-5750* polys-31* lymphs-44* monos-0 eos-1* meso-3* macro-20* other-1* 03:30pm pleural totprot-5.1 glucose-100 ld(ldh)-397 albumin-2.7 positive for malignant cells, consistent with metastatic adenocarcinoma. . imaging: tte: the left atrium and right atrium are normal in cavity size. a few microbubbles are seen in the left heart very late after intravenous injection c/w transpulmonic passage (small pfo cannot be fully excluded, but less likely). the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is high normal. there is a trivial/physiologic pericardial effusion. very prominent bilateral pleural effusion. impression: suboptimal image quality. normal biventricular cavity sizes with preserved global biventricular systolic function. prominent bilateteral pleural effusion. . bilateral lenis: grayscale, color, and pulse doppler son imaging was performed of the bilateral common femoral, superficial femoral, popliteal, peroneal and posterior tibial veins. normal compressibility, flow, and augmentation was demonstrated. impression: no dvt in either lower extremity. . video swallow: barium passes freely through the oropharynx without evidence of obstruction. there was no gross aspiration or penetration. for details, please refer to speech and swallow division note in omr. impression: no aspiration of thin and nectar-thick liquids in exam limited by patient cooperation. . ct neck, thorax, abdomen, pelvis: ct chest with contrast: there are multiple bilateral supraclavicular nodes, the largest on the left, measuring 16 x 16 mm (3:10). the thyroid gland is normal in appearance. there is a 17 x 15 mm upper paratracheal node (3:18). there are multiple prevascular lymph nodes, the largest measuring 28 x 14 mm (3:25). there is a lower right paratracheal node measuring 15 x 12 mm (3:27) and a subcarinal lymph node measuring 39 x 19 mm (3:35). there is bilateral hilar adenopathy with a left-sided hilar node measuring 16 x 14 mm (3:31) and a right-sided hilar lymph node measuring 19 x 14 mm (3:32). there is no evidence of pulmonary embolism. there is interlobular septal thickening bilaterally and diffuse alveolar ground glass opacity consistent with diffuse pulmonary edema. the trachea, right main bronchus and segmental and subsegmental branches of the right main bronchus are patent. the left lower lobe bronchus is abruptly narrowed (400b:33). there is dense consolidation of the left lower lobe with hypoattenuating areas within the lung parenchyma which may be due to ischemia or hypoperfusion. there is right lower lobe consolidation. there are diffuse peribronchovascular nodular areas within the lungs bilaterally, predominantly within the mid and lower zones. no dominant pulmonary mass is identified to suggest a lung primary. no endobronchial lesion is identified. there are large bilateral pleural effusions. the heart is normal in size. no pericardial effusion. ct abdomen: the liver is normal in appearance without focal liver lesion. there is no intra- or extra-hepatic ductal dilatation. both adrenal glands, spleen and pancreas are normal. the portal veins and hepatic veins are patent. both kidneys enhance and excrete contrast symmetrically without evidence of hydronephrosis. there is an 11 mm caliceal diverticulum within the upper pole of the left kidney (3:67). there is a cortical scar in the lower pole of the left kidney (3:75). there is no retroperitoneal or mesenteric adenopathy. there is no free air or free fluid. the aorta is of normal caliber. ct pelvis: there is apparent thickening of the cecal tip, which is of doubtful significance (3:105). there is no pathologically enlarged mesenteric, intrapelvic or inguinal adenopathy. urinary bladder is normal in appearance. the rectum and sigmoid are normal in appearance. the uterus is not identified. there is no free fluid or free air. osseous structures: no suspicious lytic or sclerotic lesion identified. moderate degenerative changes of the left si joint with some joint space narrowing present. moderate degenerative changes with anterior osteophyte formation at t11-l1. congenital cervical vertebral fusion noted of c5-c7. impression: 1. diffuse pulmonary abnormalities including ground glass opacity and septal thickening and nodular and peribronchovascular densities. the findings are consistent with pulmonary edema and additional neoplastic and/or infectious airspace disease. in the setting of positive pleural cytology, mediastinal adenopathy and obstructive disease in left lower lobe, findings are concerning for diffuse malignancy. pulmonary edema may be noncardiogenic or due to lymphatic obstruction. 2. while no definite dominant mass is identified to suggest a lung primary, abrupt narrowing of the left lower lobe bronchus with dense left lower lobe consolidation is noted suggesting a focal or endobronchial mass at that location. hypoattenuating areas within the left lower lobe consolidation suggest infarction/hypoperfusion. 3. large bilateral pleural effusions. 4. cecal wall thickening which is of doubtful significance. a definite primary neoplastic lesion is not identified in the abdomen or pelvis. discharge labs: as patient was cmo, no labs were drawn daily on discharge. brief hospital course: ms. is a 44 year old female with congenital developmental delay who presented initially to with fever, shortness of breath, weight gain, and lower extremity swelling then transferred to the micu for with suspicion of bilateral pneumonia and left sided pleural effusion. she was later found have adenocarcinoma of unknown primary (likely lung versus breast) with likely lymphangitic spread to lung. . # adenocarcinoma: found in pleural fluid, unknown primary. oncology service was consulted and are following. ct torso showed likely lymphangitic spread rather than pneumonia. possible primary in lung with many enlarged lymph nodes in neck, no evidence for primary cancer in abdomen. no mets to liver. egfr testing was never sent per decision of initial oncology evaluation team and the fact that there was not enough tissue in the initial cell block. . # possible healthcare associated pneumonia: upon admission, patient had a ct scan from the outside hospital which was concerning for multifocal, bilateral pneumonia. she was initially treated with levofloxacin and unasyn. however, after repeat ct and the discovery of adenocarcinoma in the pleural fluid, the thought was that this may actually be lymphangitic spread of adenocarcinoma. she did have a leukocytosis and spiked a low grade fever x1. thus, she was continued on the unasyn. a video swallow was performed to rule out aspiration as a cause of pneumonia. sputum, pleural fluid, and blood cultures as well as respiratory viral panels have been negative. . # hypoxia: her saturations remained chronically 90-93% on 6l nasal cannula and 100% by facemask during the first parts of her admission. by ct and physical exam, her lung function is severely compromised. furosemide iv helps some, however, she does not have much room in her blood pressure to titrate this and it is not proven to be effective in malignancy. she was transferred to the for further management of ongoing hypoxia with oncology and interventional pulmonology following. she was transferred out of the with cmo measures, satting 81-83% at times on 15l. . # pulmonary effusions: pleural fluid results positive for adenocarcinoma of unknown primary. initial thoracentesis performed removed 1200 ml fluid, however, effusions reaccumulated quickly. interventional pulmonology placed a pleurex drain (on left). the drain put out an initial 2l, but then was non-productive for 36 hours and at the request of the family was removed for comfort of the patient. . # borderline hypotension and tachycardia: during admission, she was persistently with systolic blood pressures 90s-100s. her parents report that this is the baseline for her. there was not concern that this represented sepsis as she did not have other signs pointing toward an infection. . # elevated international normalized ratio (inr): upon admission, she had an elevated inr, possibly from poor po intake. repleted with vit k. . # chronic kidney disease (ckd): present on admission, creatinine remained stable. . # osteoporosis: continued vitamin d and calcium supplementation. . # distant history of seizure disorder: phenobarbital level within normal limits. continue home dose. . # history of thyroid nodule: tsh wnl. no masses seen on ct neck to explain source of adenocarcinoma. outpatient follow-up was recommended. . transitional issues: the decision for the patient to remain dnr/dni with comfort care measures only was discussed at length in a family meeting on . there was clear confirmation from the family that the patient would not want to be in the hospital anymore, that she would not want the pleurex drain in, nor would she want blood draws, chemotherapy side effects, or anymore invasive investigations into the origin of her malignancy. arrangements were made with old hospice for the family to transition home with the appropriate materials for comfort care. medications on admission: lasix - 40mg po qam potassium chloride - unknown dose phenobarbital - 97.2 mg tablet - at 7 am and 7 pm calcium - 500 mg tablet po bid cholecalciferol (vitamin d3) - 1,000 unit po daily discharge medications: 1. home o2 please provide home oxygen for ms. with nasal cannula for delivery. o2 at 15 liters continuous. this is for comfort measures to aid with air hunger at end of life. 2. docusate sodium 50 mg/5 ml liquid sig: one (1) tablespoon po bid (2 times a day) as needed for constipation. disp:*30 ml* refills:*2* 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*0* 4. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough, dyspnea. disp:*1 bottle* refills:*0* 5. ipratropium bromide 0.02 % solution sig: one (1) nebulizer treatment inhalation q6h (every 6 hours) as needed for sob, cough. disp:*14 nebulizer treatment* refills:*0* 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer treatment inhalation q4h (every 4 hours) as needed for cough, sob. disp:*14 nebulizer treatment* refills:*0* 7. lorazepam 0.5 mg tablet sig: 0.5-2 mg po q4h (every 4 hours) as needed for agitation/restlessness/insomnia. disp:*60 tablets* refills:*0* 8. phenobarbital 97.2 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 9. morphine concentrate 100 mg/5 ml (20 mg/ml) solution sig: five (5) mg po q4h (every 4 hours). disp:*60 ml* refills:*0* 10. morphine concentrate 100 mg/5 ml (20 mg/ml) solution sig: 5-20 mg po every 4-6 hours as needed for pain or air hunger. disp:*60 ml* refills:*0* discharge disposition: home with service facility: old hospice discharge diagnosis: primary diagnosis: cancer (primary unknown, likely lung) pneumonia discharge condition: level of consciousness: alert and interactive. activity status: ambulatory - independent. mental status: confused - always. (baseline cognitive delay) discharge instructions: dear ms. , . you were admitted to the hospital because you were having difficulty breathing. you were found to have pneumonia and also an accumulation of fluid around your lungs--called a pleural effusion. we gave you antibiotics for your pneumonia. you have a special type of iv--called a picc line--which can stay in for extended periods of time to complete your antibiotics. . unfortunately, when we drained the fluid from around your lungs, we found cells of cancer. you underwent a ct scan of your body to find the cancer was likely from your lungs. . the following changes were made to your medications: hospice care medication list included in this discharge packet. followup instructions: none scheduled at this time, patient may see pcp as often as desired during hospice care procedure: insertion of intercostal catheter for drainage thoracentesis central venous catheter placement with guidance diagnoses: abnormal coagulation profile mitral valve disorders unspecified protein-calorie malnutrition chronic kidney disease, unspecified hypotension, unspecified osteoporosis, unspecified malignant neoplasm of other parts of bronchus or lung epilepsy, unspecified, without mention of intractable epilepsy hypoxemia encounter for palliative care do not resuscitate status tachycardia, unspecified secondary and unspecified malignant neoplasm of intrathoracic lymph nodes infantile cerebral palsy, unspecified secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck bacterial pneumonia, unspecified extrinsic asthma, unspecified other conditions due to sex chromosome anomalies malignant pleural effusion other specified delays in development 

Answer: The patient is high likely exposed to