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: dyspnea, hypoxia major surgical or invasive procedure: none history of present illness: hpi: 62 yof w/ a h/o multiple sclerosis x 28 years now quadraplegic and bedbound who presented to hospital with shortness of breath. patient began to notice shortness of breath beginning 4 days prior to presentation. she denies any chest pain, subjective fevers, chills, or night sweats. denies any cough, nasal congestion, sputum, hemoptysis, weight loss, palpitations. no worsening of her chronic lower extremity swelling and no lower extremity discomfort. no prior history of heart disease. on presentation, she did note a sensation of chest heaviness over the last 4 days. denies any nausea, diaphoresis, or lightheadedness. . of note, at baseline, she does have some difficulty breathing while laying flat and wears o2 at night but has never had a formal sleep study. no pnd. she noted steady progression of her symptoms over the 4 days pta. in the past she has required hospitalization for respiratory distress in the setting of uris, however she had not been hospitalized for 3 years prior to this. she has never required intubation. . upon arrival to , vs 97.4, 117, 156/68, 24, 85% on 3lnc. patient reported to have made 1600 cc or uop following lasix in route to ed. exam was significant for moderate respiratory distress and decreased bs over r lung fields. cxr was obtained showing what was thought to be a large r sided pleural effusion. ecg showed sinus tachycardia. abg was 7.42/45/53/29 on 3lnc. patient placed on 50% ventimask w/ o2 sats increasing to 94% and improvement in sob. bnp was normal at 68. d-dimer was mildly elevated at 524. first set of cardiac enzymes were negative. patient was transferred to for potential thoracentesis and intensive care monitoring. . in transit, patient o2 sats remained 87-92% on 50% ventimask. hrs remained tachycardic in 120s. upon arrival to , o2 sats high 80s on 50% ventimask --> mid 90s on nrb. . she was admitted to the micu at for further management of her respiratory distress. during her course there, she underwent tte which showed preserved lvef, no significant valvular dz and no intracardiac shunt. a cta chest was obtained out of concern for pe which was negative for pe, but did show extensive mucoid impaction in the distal trachea and the lower lobe bronchi with complete collapse of the right lower lobe and segmental collapse of the left lower lobe. thus, she underwent aggressive pulmonary toilet with chest vest and deep suctioning with significant improvement in her o2 sats so that she is maintaining o2 sats on 2.5l nc prior to transfer to the floor. she reports she is nearly back to her respiratory baseline. past medical history: # multiple sclerosis x 28 years - functionally quadraplegic - bedbound with transfers to wheelchair - on 2l home o2 at night # h/o stage 1 breast cancer found on mammogram s/p biopsy, not pursued per patient preference (thinks was on left) # chronic le edema # chronic indwelling foley on suppressive antibiotics # s/p oopherectomy # s/p t+a as child social history: sh: lives in with her husband. home health aides. she is quadriplegic and bedbound. former 2 ppd smoker. quit 20 years ago. 40 pk/yr hx. no etoh or drugs. . family history: fh: father had emphysema. also had cad s/p mi in 50s and cabg. died of mi in 70s. no fam hx of cancer physical exam: pe: t: 97.8 bp: 112/68 hr: 108 rr: 20 o2 sat 97% 2.5l gen: pleasant, laying in bed, no accessory muscle use or retractions, speaking in full sentences heent: no conjunctival pallor. no icterus. mmm. op clear. neck: supple, no lad. cv: regular, do not appreciate mrg lungs: rhonchi anteriorly likely transmitted upper airway moreso abd: obese. + bs. baclofen pump in llq. soft, nt, nd. no hsm ext: wwp. + le edema. 2+ dp pulses bl skin: no rashes/lesions, ecchymoses. neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. no spontaneous motor activity. increased tone in l shoulder. 0/5 strength throughout. muscle atrophy of intrinsic muscles of the hand. plantar contraction of feet bilat. pertinent results: medical condition: 62 year old woman with quadriplegia secondary to multple sclerosis with poor peripheral iv access reason for this examination: pls place picc for access picc line placement indication: iv access needed. the procedure was explained to the patient. a timeout was performed. radiologists: dr. and dr. performed the procedure. dr. , the attending radiologist, was present and supervised the entire procedure. technique: using sterile technique and local anesthesia, the right basilic vein was punctured under direct ultrasound guidance using a micropuncture set. hard copies of ultrasound images were obtained before and immediately after establishing intravenous access. a peel-away sheath was then placed over a guidewire and a single-lumen picc line measuring 45 cm in length was then placed through the peel-away sheath with its tip positioned in the svc under fluoroscopic guidance. position of the catheter was confirmed by a fluoroscopic spot film of the chest. the peel-away sheath and guide wire were then removed. the catheter was secured to the skin, flushed, and a sterile dressing applied. the patient tolerated the procedure well. there were no immediate complications. impression: uncomplicated ultrasound and fluoroscopically guided 4 french single-lumen picc line placement via the right basilic venous approach. final internal length is 45 cm, with the tip positioned in svc. the line is ready to use. ------------------- cta chest w&w/o c&recons, non- reason: eval for pe, eval for anatomic cause of elevated r hemidiaph contrast: optiray medical condition: 62 year old woman with chronic multiple sclerosis, bedbound p/w 4 days increasing sob reason for this examination: eval for pe, eval for anatomic cause of elevated r hemidiaphragm contraindications for iv contrast: none. history: 62-year-old female with chronic multiple sclerosis, bed bound now presenting with 4 days of increasing shortness of breath to rule out a pulmonary embolism. technique: ct of the chest was performed without intravenous contrast followed by ct of the chest post-administration of intravenous contrast, reconstructions were performed in the axial, sagittal and coronal planes. comparison: chest radiograph of . findings: ct chest with and without intravenous contrast: there is a 7 mm low-attenuation focus in the left lobe of the thyroid gland, this may be assessed further with a thyroid ultrasound. there is atelectasis present at the lung bases with almost complete collapse of the right lower lobe and subsegmental collapse of the left lower lobe. there are bronchial secretions almost completely occluded in the bronchus intermedius and the bronchus supplying the right lower lobe. there are secretions also present in the collapsed segments of the left lower lobe as well as distal trachea. there are ill-defined patchy opacities present in both lungs likely infectious or inflammatory. there are scattered mediastinal lymph nodes. there is no central pulmonary embolism, however, given the extent of lower lobe collapse, a subsegmental pulmonary embolism cannot be excluded in the lower lobes. there are multiple hepatic hypodensities, these are too small to characterize and likely represent cysts and hemangiomas. there are multiple bilateral renal hypodensities, again these are too small to characterize and likely represent cysts. musculoskeletal: there are multilevel degenerative changes present in the spine. conclusion: 1) extensive mucoid impaction in the distal trachea and the lower lobe bronchi with complete collapse of the right lower lobe and segmental collapse of the left lower lobe. 2) no central pulmonary emboli, however, given the extent of the lobar collapse, subsegmental pulmonary emboli cannot be excluded. tte the left atrium is normal in size. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast at rest. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis or regurgitation. the mitral valve leaflets are structurally normal. no mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is an anterior space which most likely represents a fat pad. impression: no intracardiac shunting seen. preserved global biventricular systolic function. no significant valvular disease. brief hospital course: 62 yof w/ h/o ms, untreated breast cancer who was transferred to for worsening sob found to extensive mucous plugging and lobar collapse. . # respiratory distress: secondary to mucous plugging and lobar collapse. the patient was initally admitted to the icu for aggressive pulmonary toilet and significantly improved in respiratory status maintaining o2 sats on 1-2l nc which is her baseline. pt was continued on supplemental o2, and should wean off oxygen during day (uses 2.5 l at night as outpatient). she was continued on standing alb/atrovent nebs and levofloxacin (day on day of discharge). discharged to rehabilitation hospital for further optimization of aggressive pulmonary toilet. . # uti: evidence of uti on osh u/a. here with many bacteria, +nitrites, no leuk est, 9rbcs, 9wbcs; colonization vs true infection. on macrodantin suppression at home. levofloxacin was continued for both uti and possible pna for 7 days as above (day on day of discharge). . # multiple sclerosis: quadriplegic. has baclofen pump with only minimal spasticity on exam. continued baclofen pump, po baclofen and diazepam prn. . # stage 1 breast cancer: patient did not pursue further treatment after biopsy. no records regarding this in our system. outpatient follow up. . # code: dnr/dni. confirmed w/ patient. . # comm: , daughter/hcp. medications on admission: baclofen 20 mg tid diazepam 2 mg q4h prn prozac 20 mg macrodantin 100 mg qday miacalcin nasal spray qam lasix 20 mg albuterol q4h prn ibuprofen prn mom prn dulcolax qod metamucil qpm discharge medications: 1. baclofen 10 mg tablet sig: two (2) tablet po tid (3 times a day). 2. diazepam 2 mg tablet sig: one (1) tablet po every four (4) hours as needed for anxiety. 3. fluoxetine 20 mg capsule sig: one (1) capsule po bid (2 times a day). 4. macrodantin 100 mg capsule sig: one (1) capsule po once a day. 5. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 4 days: last day . 6. miacalcin 200 unit/actuation aerosol, spray sig: one (1) nasal once a day. 7. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). 8. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) inhalation q6h (every 6 hours). 9. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 10. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. 11. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed. 12. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 14. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 15. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 16. metamucil powder sig: one (1) po at bedtime. discharge disposition: extended care facility: & rehab center - discharge diagnosis: respiratory failure multiple sclerosis discharge condition: stable, baseline oxygenation status discharge instructions: you were admitted with respiratory failure secondary to mucuc plugging. cat scan did not show clots in your lung. you were treated for a lung and urine infection with antibiotics. you are being discharged to a rehab facility to optimize your respiratory status before you return home. return the the er if any further worsening respiratory distress which does not respond to suctioning and oxygen, or any worrisome symptoms. followup instructions: follow up with your pcp . within the next 2-4 weeks for post hospitalization follow up. procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified pulmonary collapse acute respiratory failure multiple sclerosis quadriplegia, unspecified foreign body in respiratory tree, unspecified malignant neoplasm of other specified sites of female breast 

Answer: The patient is high likely exposed to