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: erythromycin base / cefepime / zosyn attending: chief complaint: fevers, sob major surgical or invasive procedure: tlc placement left thoracentesis history of present illness: this is a 60 year old woman with cll/sll (chronic lymphocytic leukemia-small lymphocytic lymphoma), recently progressive (with lymphadenopathy and anemia), s/p treatment with fludarabine, cytoxan and rituxan (last cycle starting on , completed ) presenting with fever, diarrhea, and hypotension. she had two recent admissions for fever, with extensive negative workup. following her most recent hospital discharge, her temperature had been around 99 degrees. on saturday, she transiently had a temperature to 101.0, lasting only 15 minutes before returning to 99.4. on sunday, she awoke with mild abdominal cramping and had loose stools. later that afternoon, she developed chills, followed by a temperature spike as high as 103.6. this prompted her to come in to the ed. . other than the above, she denies uri symptoms, sore throat, n/v, cp, sob, cough, dysuria. she had a mild headache today which has now resolved. . initially in the ed, she was febrile to 102.3 and was tachycardic to 128, with bp 106/52. cxr showed b/l pleural effusions, but no definite infiltrate. ua was negative for infection. stool was sent for c. diff. she was given vancomycin 1g x 2 doses, flagyl 500mg x 2 doses, levofloxacin 750mg x1 dose. she was also given albuterol and atrovent nebs, tylenol, and toradol. she was given about 2500 cc ivf initially, and then became sob, felt to be flash pulmonary edema. sob improved with 10mg lasix and placement of cpap. bp continued to remain tenuous with sbp in 80s, tachy up to 140s, despite 3 l ns at that point. she was started on low dose of neo. l ij cvl placed was placed, cvp 9-10. over the course of the day neo was on and off. she was again given 250 cc/bolus x 1 and continued on 150 cc an hour of ns. neo was weaned off around 1pm, with bps high 90s-100s/50s, hr 80s, satting 100 % on 3l. . she was seen by ip and heme/onc in the ed. they recommended ct chest/abdomen/pelvis which showed pleural effusions but no consolidation and no abdominal process. echocardiogram was performed which ruled out pericardial effusion. she was transferred to the micu for further care. . of note, she has had several recent evaluations for fevers: - : t 101.7, eval at , bcx and ucx negative, sent home without abx. - : chest tightness, cxr with b/l pl effusions, treated with cipro 500mg given baseline ureteral obstruction and concern for predisposition to uti - : ongoing fevers, admitted for febrile neutropenia. started on cefepime, then changed to vanco/meropenem (stopped ). bcx, ucx, dfa for flu negative. - : returned with fevers. no other sx. b/l pleural effusions. r dx : exudative, cx neg. r vats with transudative fluid. both times cytology showed small mature lymphocytes and reactive mesothelial cells. no growth from pleural fluid cx. cultures and dfa flu negative. initially on vanc//azithro. completed 5d azithro, vanc was d/c'd, changed to augmentin for total 10d course. . past medical history: 1. chronic lymphocytic leukemia (small lymphocytic lymphoma). in 10/00, she had removal of a left inguinal lymph node showing cll/sll. in , she had excisional biopsy of a rapidly enlarging submental mass that showed small lymphocytic lymphoma without evidence of transformation. on , she was evaluated for a skin rash on her thighs. biopsies were obtained showing "palisading granulomatous dermatitis" c/w "granuloma annulare or annular elastocytic granuloma." she began topical steriods, with improvement in treated lesions. however, additional asymptomatic disc-shaped erythematous lesions appeared in crops on both thighs. torso ct scan showed extensive thoracic, abdominal, and pelvic lymphadenopathy consistent with progression of her known lymphoma; left ureteral obstruction by a retroperitoneal lymphomatous mass with hydronephrosis of the left kidney; massive retroperitoneal adenopathy encasing the aorta and part of the ivc; and multiple pulmonary nodules, the majority of which were unchanged from the prior study of 10/00, with at least two new pulmonary nodules up to 7 mm in diameter. these findings were felt to be consistent with progressive systemic adenopathy. in view of this, alongside development of moderate anemia, systemic chemotherapy was initiated last month as noted above. 2. reactive airways disease 3. osteoarthritis 4. vitamin b12 deficiency 5. right breast nodular opacity on mammogram that was not seen on ultrasound 6. anxiety social history: she lives at home with her husband and her adult daughter. she was born and raised in ma. she lived in for 18 months and has traveled to but has never left north america. she quit smoking cigarettes 20 years ago. she does not drink alcohol or use illicit drugs. family history: her husband was hospitalized with an mi last month. her granddaughter may have been diagnosed with rubella last month; the patient has not been in contact with this granddaughter since this diagnosis, although she was likely in contact with her soon before the diagnosis. physical exam: vs: 97.5, 87, 100/42, 100% on 3l nc general: nad at rest heent: perrl, anicteric, mm moist, op clear. neck: supple, lij in place. lungs: decreased breath sounds at bases l>r (1/2 up on l), no wheezes or rhonchi. cv: rrr, ii/vi systolic murmur at lsb. abdomen: +bs, soft, nd, very mild ttp at rlq with no rebound or guarding. extrem: warm, no edema. pertinent results: 09:00pm glucose-98 urea n-13 creat-0.8 sodium-141 potassium-4.5 chloride-112* total co2-21* anion gap-13 09:00pm alt(sgpt)-28 ast(sgot)-21 ld(ldh)-164 alk phos-52 tot bili-0.3 09:00pm albumin-3.0* calcium-7.9* phosphate-3.2 magnesium-2.0 09:00pm wbc-5.9 rbc-2.67* hgb-8.2* hct-24.2* mcv-91 mch-30.7 mchc-33.8 rdw-15.3 09:00pm plt count-487* 09:00pm pt-13.8* ptt-23.9 inr(pt)-1.2* 06:15am glucose-181* urea n-17 creat-1.0 sodium-138 potassium-4.1 chloride-108 total co2-21* anion gap-13 06:15am wbc-10.2 rbc-2.97* hgb-8.8* hct-26.6* mcv-90 mch-29.6 mchc-33.1 rdw-15.2 9:11 am pleural fluid pleural fluid. **final report ** gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): no growth. anaerobic culture (final ): no growth. 5:00 pm stool site: stool consistency: formed **final report ** clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. (reference range-negative). cytology from pleural fluid: pleural fluid (left pleural space): negative for malignant cells. predominantly blood with scattered mesothelial cells, histiocytes, and inflammatory cells. 60 year old woman cll recently admitted with fever and pleural effusions s/p vats p/w recurrent fever, hypotenion reason for this examination: r/o infection, worsening pleural effusions contraindications for iv contrast: none. clinical indication: 60-year-old woman with cll admitted for fever and pleural effusion status post vats. rule out infection or worsening pleural effusion. comparison: multiple ct chest and torsos, most recent dating . technique: mdct acquired images were obtained through the chest, abdomen, and pelvis after the uneventful administration of 130 cc of iv optiray contrast. multiplanar reformats were reviewed. ct chest with contrast: there is extensive axillary, mediastinal, and hilar lymphadenopathy, unchanged since . the largest right axillary node measures 2 cm in short axis. the largest left axillary lymph node measures 1.8 cm in short axis. there are numerous enlarged lymph nodes in the paratracheal area, the largest measuring 1.3 cm in short axis, and the largest subcarinal node measures 1 cm in short axis, unchanged since . the left pleural effusion has increased in size since , now large, with a significant subpulmonic component and associated relaxation atelectasis. the right pleural effusion has significantly decreased in size, now moderate with moderate amount of associated relaxation atelectasis and subpulmonic effusion. both pleural effusions measure between 16 and 20 hounsfield units, without evidence of loculation. ct abdomen with contrast: there is a marked decrease in size of the lymphadenopathy in the retroperitoneum (2:65) now measuring 7.9 x 4.4 cm (previously 11.2 x 7.2 cm, on ). the aorta and ivc are still partially encased by the mass, similar to . the proximal left ureteral obstruction caused by this nodal mass causes moderate left hydroureteronephrosis, unchanged since . numerous mesenteric lymph nodes have moderately decreased in size, the largest of which now measures 1.2 cm in short axis. there is no evidence of bowel obstruction, free fluid or free air. the visualized arterial and venous vessels are patent including the renal arteries and veins, ivc, portal vein, splenic veins and smv, though there is extensive portocaval adenopathy surrounding these vessels. ct of the pelvis with intravenous contrast: there are large bilateral inguinal and pelvic lymph nodes measuring up to 2.4 cm in short axis, the largest inguinal lymph node measuring 1.9 cm in short axis on the left. a large amount of stool is noted within the entire colon. the bladder is unremarkable except to not a foley catheter within it. bone windows demonstrate no suspicious lytic or blastic lesions. impression: 1. extensive thoraco-abdominal and pelvic lymphadenopathy has decreased in size since , particularly the retroperitoneal conglomerate nodal mass. 2. left ureteral obstruction by retroperitoneal lymphomatous mass is unchanged since . 3. interval worsening of left pleural effusion with subpulmonic component since with decreased size of right pleural effusion and its subpulmonic component, now moderate. 4. no inflammatory process in the abdomen or pelvis. 5. no evidence of consolidation. brief hospital course: this 60 yo female with cll and prior hospitalization for fever work up was admitted for recurrent fevers, transferred to the from the er after developing hypotension, shortness of breath and requiring transient pressor support. 1. fevers: the combination of fevers and hypotension was initially concerning for sepsis so the patient was placed on broad-spectrum abx and monitored in the unit. she was pan-cultured and a c. diff was obtained as the patient had reported loose stools prior to admission. the patient had no evidence of colitis on ct scan and no pna on cxr. her ua was negative. there was concern that a possible source for her infection could be the known left ureteral obstruction. she was subsequently evaluated by the urology consult service who felt that this was not a likey source of infection given repeated negative cultures and uas. it was felt that this was not likely a complete obstruction and no aggressive intervention was warranted at this time. the patient was transferred to the floor and was subsequently removed from broad spectrum antibiotic coverage and watched for 24 hours with no fevers. prior to her transfer to the floor the patient had a left thoracentesis with removal of 1300cc of fluid (culture negative). this was felt to also be a possible source of her fevers. 2. pleural effusions: the patient as described above, was evaluated by ip and a thoracentesis was performed on the left side while in the . no complications were observed and the patient's respiratory status improved markedly with no further supplemental oxygen requirement. she was ambulating at the time of discharge on ra with saturations of 98%. 3. cll: the patient will follow up with dr. next week for further evaluation and continued treatment. she was continued on her empiric coverage with bactrim and acyclovir. discharge medications: 1. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 2. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 3. glucosamine complex-msm capsule sig: one (1) capsule po twice a day. 4. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po qmowefr (monday -wednesday-friday). 5. hexavitamin tablet sig: one (1) cap po daily (daily). 6. lorazepam 0.5 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for anxiety, insomnia. 7. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for shortness of breath, wheezing. 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 9. cyclobenzaprine 10 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for muscle pain. 10. diclofenac sodium 25 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po bid (2 times a day). 11. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 12. acyclovir 800 mg tablet sig: one (1) tablet po q12h (every 12 hours). 13. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 14. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 15. vitamin b-12 500 mcg tablet sig: two (2) tablet po once a day. discharge disposition: home discharge diagnosis: cll sll fever pleural effusions hypotension anemia transient sepsis discharge condition: stable, afebrile, oxygen saturation of 95% on ra discharge instructions: you were admitted with fever and found to have low blood pressure and bilateral pleural effusions. you will need to follow up with dr. as listed below. please call your pcp or return to the er if you develop a fever >101, shortness of breath, or any new symptoms. followup instructions: provider: , md phone: date/time: 11:00 provider: , rn phone: date/time: 11:00 procedure: thoracentesis diagnoses: unspecified pleural effusion unspecified septicemia severe sepsis asthma, unspecified type, unspecified acute respiratory failure septic shock chronic lymphoid leukemia, without mention of having achieved remission anemia in neoplastic disease 

Answer: The patient is high likely exposed to