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: heparin agents / codeine / zosyn / ceftriaxone attending: chief complaint: hypoxia and eosinophilia major surgical or invasive procedure: bronchoscopy history of present illness: the patient is a 47y/o f with a pmh of etoh abuse, recent hospitalization for pna presenting with hypoxia. the patient was hospitalized after presenting with fever, chills and sob. she had been staying at an etoh rehab facility on starting . she presented to hospital on with cp and fever to 102. cxr at that time demonstrated a pna and she was given a course of ceftriaxone->cefitin/azitro and prednisone taper. she then presented to with similar complaints. she was initially treated for cap with ceftriaxone and azithromycin however she began to have increased shortness of breath and leukocytosis. a ct with contrast was performed which showed worsening multi-lobar pneumonia. id and pulm consultation was obtained. antibiotic coverage was broadened to vancomycin and zosyn. she was ruled out for tuberculosis and legionella. blood cultures negative and induced sputum was of poor quality. she remained on vanc and zosyn from until her discharge on . after developing a rash with zosyn, she was discharged on levaquin to complete a 10 day course. . she now presents with complaints of sudden onset worsening dyspnea starting the night before admission. initial vitals: t 98.8, hr, sbp 109/64, rr 32, o2 80% on ra. her o2 saturation improved to 95% on 5l nc. cxr demonstated no acute process. cta demonstrated no evidence of pe and small areas of ground glass opacity likely atelectasis 4 mm left lingular pleural based nodule on prelim read. her bp dropped to 80s systolic following receipt of morphine 4mg iv. she received 1l ns with improvement in bp to 90s. she underwent fast us after drop in bp which was negative. cardiac enzymes were negative. she was given vancomycin 1g iv x1 and levaquin 750mg iv x1. morphine 4mg iv x 2, albuterol and atrovent nebs and methylprednisolone 125mg iv x1. labs demonstrated wbc 11.5 with 25% eosinophilia. lactate 1.8. . past medical history: past medical history: -hypothyroidism -biliary colic s/p lap chole in -multiple mrsa wound infections requiring hospitalization; most recent was in after lap chole -allergies/asthma (remote history) -recent tobacco use x2wks -etoh abuse s/p detox in social history: social history: -2 children aged 18 and 15 -divorced -alternates living with children and boyfriend -in touch with husband, -quit smoking when 17 y/o; restarted again 14 days ago with 1/2 ppd -denies all etoh abuse but was in detox for etoh use in -used to work for uptodate in ; now stays home to take care of her kids family history: family history: negative for pulmonary problems -mother died of lymphoma at age 69 -father died of stomach cancer when patient was 3-years-old physical exam: vitals: t=96.5, hr=84, bp=118/58, rr=26, o2 sat=96% on 2lnc gen: age appropriate female in nad heent: perrl, eomi, sclerae anicteric. mmm, op clear without lesions, exudate, or erythema. neck supple without lad. cv: nl s1+s2, no m/r/g. pain reproducible to palpation over mid-sternum. resp: decreased air movement bilaterally abd: s/nt/nd +bs ext: no c/c/e. skin: no rashes pertinent results: cxr, @ 0912 lungs are clear with no evidence of pneumonia or congestive heart failure. there is no pneumothorax or pleural effusion. old right 5th and 6th rib fractures are noted. cta chest, @ 1022 1. no pulmonary embolism. 2. near complete resolution of previously noted multifocal pneumonia. 3. mildly prominent mediastinal and hilar lymph nodes, likely reactive, slightly decreased in size from prior ct. 05:45am blood wbc-10.0 rbc-3.57* hgb-10.6* hct-32.8* mcv-92 mch-29.6 mchc-32.1 rdw-13.5 plt ct-381 05:33am blood wbc-11.2* rbc-3.51* hgb-10.4* hct-32.7* mcv-93 mch-29.5 mchc-31.7 rdw-13.1 plt ct-366 08:50am blood wbc-13.9* rbc-3.68* hgb-10.8* hct-33.5* mcv-91 mch-29.3 mchc-32.2 rdw-13.6 plt ct-425 09:05am blood wbc-11.5* rbc-4.35 hgb-12.8 hct-39.5 mcv-91 mch-29.4 mchc-32.3 rdw-13.2 plt ct-509* 05:45am blood neuts-25.8* bands-0 lymphs-25.9 monos-4.4 eos-43.3* baso-0.6 05:33am blood neuts-30* bands-0 lymphs-32 monos-2 eos-36* baso-0 atyps-0 metas-0 myelos-0 08:50am blood neuts-80.5* lymphs-12.4* monos-4.9 eos-2.0 baso-0.2 09:05am blood neuts-56.6 bands-0 lymphs-13.8* monos-3.8 eos-25.5* baso-0.3 08:50am blood pt-12.3 ptt-26.3 inr(pt)-1.0 05:45am blood glucose-100 urean-10 creat-0.5 na-144 k-4.1 cl-108 hco3-29 angap-11 05:33am blood glucose-84 urean-8 creat-0.4 na-143 k-4.4 cl-109* hco3-26 angap-12 08:50am blood glucose-111* urean-7 creat-0.5 na-142 k-4.0 cl-109* hco3-26 angap-11 09:05am blood glucose-126* urean-8 creat-0.6 na-140 k-4.1 cl-106 hco3-25 angap-13 10:15pm blood ck(cpk)-37 09:05am blood alt-17 ast-13 ld(ldh)-171 alkphos-44 totbili-0.4 10:15pm blood ck-mb-notdone ctropnt-<0.01 09:05am blood ctropnt-<0.01 09:05am blood ck-mb-2 05:45am blood calcium-8.4 phos-4.4 mg-2.1 05:33am blood calcium-8.2* phos-3.8 mg-1.9 08:50am blood calcium-9.0 phos-3.7 mg-1.9 03:17pm blood anca-negative b 01:45pm blood type-art po2-66* pco2-44 ph-7.38 caltco2-27 base xs-0 01:45pm blood lactate-1.6 01:59pm urine color-yellow appear-clear sp ->1.035 01:59pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-neg 10:57am other body fluid wbc-0 rbc-0 polys-pnd lymphs-pnd monos-pnd . . negative: blood culture blood culture, routine-pending emergency blood culture blood culture, routine-pending emergency urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. . . . cta chest final report reason for exam: shortness of breath. comparison: chest radiograph from same date, chest radiograph from , chest ct from . technique: multidetector ct images of the chest were obtained before and after administration of iv contrast as per routine pulmonary embolism protocol. coronal and sagittal reformatted images were also submitted for interpretation. findings: chest ct without iv contrast: the non-contrast ct demonstrates no intramural hematoma within the aorta. chest ct with iv contrast: there is no filling defect in the pulmonary arterial tree to suggest the present of a pulmonary embolism. the heart is normal in size and configuration. there is no pleural or pericardial effusion. previously noted pleural effusions have resolved. minimal atherosclerotic calcifications of the aorta is noted. the aorta is normal in course and caliber and there i no evidence of dissection. mildly prominent mediastinal and hilar lymph nodes are identified which measure up to 1- cm in short axis are likely reactive. compared to the prior ct, nodes are smaller and likely relate to resolving pneumonia. minimal soft tissue attenuating material within the anterior mediastinum may represent residual thymus. there is no pneumothorax. there has been near complete resolution of the ground glass opacities withi the lungs. there is minimal residual ground-glass patchy consolidation in the right middle lobe (3:77) and anterior segment of the right upper lobe (3:49). additional smaller foci of ground-glass nodularity are seen but compared to prior ct, there has been significant improvement. the upper abdominal organs including the partially visualized liver, spleen, pancreas and left adrenal appear grossly unremarkable. bone window: osseous structures demonstrate degenerative changes. there is no definite acute displaced fracture. again noted are right-sided sixth and fifth rib deformity which may represent old fractures. impression: 1. no pulmonary embolism. 2. near complete resolution of previously noted multifocal pneumonia. 3. mildly prominent mediastinal and hilar lymph nodes, likely reactive, slightly decreased in size from prior ct. the study and the report were reviewed by the staff radiologist. dr. dr. approved: mon 1:24 pm . . . pfts , l. f 47 pulmonary report spirometry, lung volumes, dlco study date of 12:59 pm spirometry 12:59 pm pre drug post drug actual pred %pred actual %pred %chg fvc 2.62 3.84 68 fev1 1.66 2.94 56 mmf 0.90 3.22 28 fev1/fvc 63 76 83 lung volumes 12:59 pm pre drug post drug actual pred %pred actual %pred tlc 5.97 5.89 101 frc 3.11 3.25 96 rv 2.88 2.05 141 vc 3.12 3.84 81 ic 2.86 2.64 108 erv 0.23 1.20 20 rv/tlc 48 35 139 he mix time 2.38 dlco 12:59 pm actual pred %pred dsb 23.92 21.53 111 va(sb) 4.81 5.89 82 hb 10.80 dsb(hb) 26.30 21.53 122 dl/va 5.46 3.65 149 notes: no online pulmonary notes available. (99-402s) . . . tte conclusions the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). transmitral doppler and tissue velocity imaging are consistent with normal lv diastolic function. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic arch is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: normal regional and global biventricular systolic function. normal diastolic function. mild mitral and mild to moderate tricuspid regurgitation. compared with the report of the prior study (images unavailable for review) of , the severity of tricuspid and mitral regurgitation have increased slightly. electronically signed by , md, interpreting physician 13:26 . . . cxr final report reason for examination: followup of the patient with parenchymal opacities. pa and lateral upright chest radiograph was compared to multiple prior studies dating back to . there is gradual improvement up to practically complete resolution of bilateral right more than left opacities with only minimal left basilar opacity seen on the current study and that might represent area of lingular atelectasis. there is no pleural effusion or pneumothorax and the cardiomediastinal silhouette is stable. dr. approved: wed 4:19 pm . . . final report type of examination: chest pa and lateral. indication: peripheral eosinophilia and questionable acute eosinophilic pneumonia. evaluate chest. findings: pa and lateral chest views were obtained with patient in upright position. available for comparison is the next previous pa and lateral chest examination obtained one day earlier. findings: heart size and mediastinal structures are stable. likewise, pulmonary vasculature without evidence of congestion. no signs of new parenchymal infiltrates. the minimal linear peripheral densities in the left lung base are still present, but comparison suggests that they have further regressed. further comparison demonstrates that the most prominent acute infiltrates in the right upper lobe area of have disappeared and not reoccurred. impression: stable chest findings with minimal peripheral thin atelectasis on left base. further followup is recommended to occur at longer intervals. dr. approved: 5:54 pm imaging lab brief hospital course: 47f with remote h/o asthma p/w progressive sob/doe, pleuritic cp, fatigue, and hypoxia with eosinophilia after recent admission for pneumonia treated with levofloxacin now with resolved infiltrates. . # hypoxic respiratory distress with peripheral eosinophilia: the patient has persistent hypoxia associated with palpable sternal chest pain which was also pleuritic. in the ed, she was hypoxic to 80% on ra improved to 95% on 5l nc. cxr and cta chest showed no significant infiltrate, pe, or other parenchymal lung disease, which was markedly improved from her last recent ct which showed multifocal pna. she had peripheral eos of 25, which resolved for one day after ed gave 1x steroids due to concern for asthma flare. notably, pt had reaction on prior admission to zosyn with rash, but this eosinophilia was felt to less likely related to that reaction given temporal history. otherwise, abg 7.38/44/66 was drawn on room air with a-a gradient 28, suggesting either a v/q mismatch, diffusion abnormality, or shunt. an acute diffusion gradient etiology is less likely given ct chest without significant pathology, although given peripheral eosinophilia, aep/cep was thought to be a possibility. anca was negative. her pleuritic cp was most consistent with an inflammatory vs post-infectious cause as cta did not show pe. the patient reported that her pain improved over the course of the day () with morphine, ketorolac, and acetominophen. she received albuterol and ipratropium nebs and her sats improved to room air without desats while walking. she had one episode of decreased bp overnight after 4 mg morphine, but she maintained good uop, normal mental status, warm extremities. tte showed mild/mod tr worsened from before but normal ef. pulmonary team recommended spirometry and they initially felt it was unclear if peripheral eosinophilia is related to pulmonary process but rapid response of eos as well as infiltrates suggest may be related. differential diagnosis of pulmonary eosinophilia includes aep,cep, css, parasitic infection, hp, abpa, and loffler's syndrome. recent 2 wk h/o smoking is also c/w cep. parasitic infection less likely given lack of travel history although transient oulmonary infiltrates and peripheral eos consistent with parasitic infection. coccidioides can also cause ep but has not had travel history. have had pna and then developed aep related to meds recieved at (ctx). abpa less likley given lack of bronchiectasis. hp possible given new environment since but had initial worsneing at rehab. on the medicine floor, the pt did not have any episodes of desat and was maintained comfortably on room air, with percocet, ibuprofen, tylenol with improved pain relief. eventually the pulm team bronched the patient after her peripheral eosinophil count increased to 27 despite her remaining asyx with clear lungs on cxr. bronch apparently (not on omr) showed thick mucous secretions and concern for aspergillous vs eosinophilic pna. her bronch fluid notably showed 30-40% eos. she had blood tests sent for aspergillous galactomannan antibody and ige were sent and are pending. she was started on 20mg prednisone for likely chronic eos pna (cep) with followup with pulmonary clinic which they will schedule. she will have review of her lung biopsies at that time as well. . # hypothyroid: continue home levothyroxine. . # psych: cont home fluoxetine, trazodone prn sleep . # etoh detox: pt recently completed detox program is drink free for a few weeks. no active issues. . # code: fullcode medications on admission: levothyroxine 75 mcg tablet 2 tablet po daily fluoxetine 20 mg capsule 2 capsule po daily trazodone 50 mg tablet 1 tablet po hs prn insomnia discharge medications: 1. levothyroxine 100 mcg tablet sig: 1.5 tablets po daily (daily). 2. fluoxetine 20 mg capsule sig: two (2) capsule po daily (daily). 3. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain: do not exceed 4g per day. 5. ibuprofen 400 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain: please take with food . 6. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain: please do not drive, operate heavy machinery, or perform any tasks requiring high level of skill while taking this medication. disp:*25 tablet(s)* refills:*0* 7. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). disp:*21 tablet(s)* refills:*0* 8. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puff inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*qs 21 days * refills:*0* discharge disposition: home discharge diagnosis: primary: chronic eosinophilic pneumonia . secondary: -biliary colic s/p lap chole - lap cholecystectomy complicated with presumed mrsa wound infection (treated with vancomycin inpt and then for 10 days on oral rifampin and doxycycline -multiple mrsa wound infections requiring hospitalization -allergies/asthma (remote history), has not used albuterol in >5 years -recent tobacco use -hypothyroidism - pna in (no h/o recurrent pulmonary infections prior to this) discharge condition: afebrile, stable vitals, tolerating pos, ambulatory, pain controlled discharge instructions: you were admitted due to worsening shortness of breath, dry cough, and some pain in your chest that was worse while breathing in. you were found to have a high peripheral eosinophil count, and although your lungs improved on chest xray, the pulmonary team was concerned that you might have developed eosinophilic pneumonia. your breathing improved during the hospitalization and you did not require any supplemental oxygenation at rest or while walking on discharge. you had a bronchoscopy performed which showed mucous secretions, and biopsies/fluid samples were obtained. you will be discharged on the following new medications percocet, tylenol, and ibuprofen for pain. you should also take prednisone for your eosinophilic pneumonia with albuterol/ipratropium inhaler as needed for shortness of breath. the pulmonary team will followup with you in the next 7-14 days. . please take all medications as prescribed. please attend all appointments below. please do not hesitate to return to the hospital for any concerning symptoms at all. . followup instructions: please followup with your pulmonary doctors for within the next 7-14 days. they will contact you with the time. (. procedure: closed [endoscopic] biopsy of bronchus diagnoses: unspecified acquired hypothyroidism hypoxemia pulmonary eosinophilia alcohol abuse, in remission 

Answer: The patient is high likely exposed to