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: history of present illness: this is a 63-year-old woman with a history of lung cancer (adenocarcinoma) status post resection, chronic obstructive pulmonary disease with multiple hospital admissions for pneumonia, insulin dependent-diabetes mellitus, who initially presented to the emergency room on the complaining of dyspnea. the patient was found to be hypoxic and hypotensive in the emergency room. she complained of increasing shortness of breath and a cough productive for a small amount of reddish-brown sputum for approximately one week prior to admission. she also complained of subjective fevers of approximately 101. review of symptoms: the patient complained of chills, nausea. denies vomiting and diarrhea. the patient reports that at baseline, she is fatigued and weak. the family notes a gradual decline in her physical function over the past six months. this morning the patient was found to be dramatically more short of breath and was transported to the emergency department by ems. her o2 saturations on room air were found to be 77% with an initial blood pressure of 120/90. her o2 saturations increased to approximately 90% on a nonrebreather, but her systolic blood pressure dropped to the 70's systolic. the patient was given 1-2 liters of iv fluid, and then was gently weaned off her nonrebreather on to a nasal cannula mask. patient was also found to have an anion gap of 21 and given her history of insulin dependent diabetes, was bolused with 5 units of insulin and started on an insulin drip. past medical history: 1. lung cancer (adenocarcinoma) status post bilateral upper lobe resection and radiation therapy in . 2. chronic obstructive pulmonary disease with her latest pulmonary function tests in showing a fvc of 72% of predicted value, a fev1 of 61% of predicted value, fev1/fvc of 85%, a dlco which was read as moderately to severely depressed. 3. diabetes type 1. 4. arthritis. 5. pseudogout. 6. hypothyroidism. 7. osteoporosis. 8. atrophic gastritis. 9. gastroesophageal reflux disease. 10. chronic right pleural effusion, status post vats. 11. depression. 12. nephrolithiasis. past surgical history: 1. lung resection in . 2. cholecystectomy. 3. appendectomy. 4. adenoidectomy. allergies: 1. penicillin. 2. flagyl. 3. erythromycin. 4. keflex. social history: she continues to smoke tobacco approximately half a pack per day. she has approximately 45 pack year history. she is a social drinker. she lives at home with her husband and son. initial laboratories: revealed a white blood cell count of 19, hematocrit of 43.3, platelet count of 505. inr of 1.1. her chem-10 shows a sodium of 140, potassium of 4.7, chloride of 98, bicarb of 21, bun of 18, creatinine of 0.9, glucose of 238, anion gap of 21. her initial blood gas was 7.33/42/35 on 6 liters of oxygen. medications at home: 1. bactrim double strength. 2. calcium/vitamin d. 3. colchicine 0.6 grams. 4. combivent. 5. compazine. 6. aspirin. 7. folic acid. 8. levothyroxine 75 mcg q day. 9. percocet. 10. protonix 40 q day. 11. vitamin b6 25 q day. 12. vitamin b1 1 gram q day. chest x-ray: revealed a right pleural effusion with associated collapse and consolidation at the adjacent line. a lateral decubitus was obtained showing a free flowing fluid. a linear opacity in the upper lung zone representing pneumonia versus skinfold. electrocardiogram: showed sinus tachycardia at 101 beats per minute with normal axis and normal intervals. q waves were noted in leads ii, iii, and avf, v2, v3. the q waves were new since her electrocardiogram dated . hospital course: this is a 63-year-old woman with a history of adenocarcinoma status post bilateral apical lung resection, chronic obstructive pulmonary disease, and diabetes mellitus, who presented initially with shortness of breath, hypoxia, hypertension, increased anion gap, acidosis, and a troponin leak. she was admitted to the micu for further evaluation. pulmonary: the patient's initial hypoxia attributed to be multifactorial to include chronic obstructive pulmonary disease, possible pneumonia, and atelectasis due to a large pleural effusion. she underwent a thoracentesis. the thoracentesis fluid revealed essentially a cellular specimen composed of predominantly lymphoid cells with some neutrophils and reactive mesothelial cells. it also revealed 667 white blood cells, 889 red blood cells, 39% polys, 53% lymphocytes, 6 monocytes, 1 eosinophil, and 1 basophil. total protein was 3.4 with 165 glucose and 145 for a ldh. the pleural ph was 7.34 and the cultures were negative. the patient was started up on levofloxacin due to possible pneumonia. her sputum cultures and blood cultures remained negative throughout her stay. she also remained on her inhalers. shortly after the thoracentesis, the patient's o2 saturation drastically improved, and the patient's pleural effusion remained stable throughout the course of her stay. she did not require intubation, and she was gradually weaned from the nonrebreather to nasal cannula and eventually on to room air with satisfactory o2 saturations. cardiac: patient was initially admitted with hypertension with a troponin leak of approximately 11 and flat cks. a stat echocardiogram revealed regional left ventricular wall motion abnormalities. specifically, revealed a mild anteroseptal wall that was akinetic; mid inferior wall was akinetic, mild inferolateral wall was akinetic; the mid anterolateral wall was akinetic; the septal apex wall was akinetic; the inferior apex was akinetic; the lateral apex was akinetic; and the apex was akinetic; there is also moderate tricuspid regurgitation (+2). ejection fraction was estimated to be about 20%. this showed dramatically decreased left ventricular function with new wall abnormalities and the patient was taken emergently to the cardiac catheterization laboratory for a catheterization. the catheterization revealed a cardiac output of 3.5, an index of 2.2, a systemic vascular resistance of 2,034 with a pulmonary vascular resistance of 320. her ejection fraction was estimated to be about 25%. the anterolateral apical and inferior wall were akinetic. the mid right coronary showed a 50% lesion. the proximal left anterior descending artery was with a 40% lesion. the resting hemodynamic measurements revealed systemic arterial hypertension which was responsive to iv dopamine. right heart filling pressures were normal. the wedge was slightly elevated at 17 mm hg and the left ventricular end diastolic pressure was 22 mm hg. there was moderate significant pulmonary hypertension. following the catheterization, the patient remained on the dopamine drip for pressure support. this was gently weaned over the next two days. she was then transferred to for further evaluation for her cardiomyopathy. the patient had multiple laboratories sent for further evaluation of her cardiomyopathy. the results of these laboratories were still pending at the time of dictation. specifically, a negative , a negative rheumatoid factor. her tsh was slightly elevated, but she had a normal t4. she had a negative hepatitis c antibody. her cmv igg antibody test was positive. igm antibody was negative. her - virus igg was positive. the igm was negative. her lyme serology was negative. it was thought that her new cardiomyopathy could be multifactorial. most importantly, it could be due to her poor nutritional status. it was attempted to add on an ace inhibitor while the patient was in-house, but unfortunately, the blood pressure remained less than 100 systolic and this was difficult to add on. she will be followed closely by her primary care physician. attempt to add this on and increase the dose. hematological: patient with an anemia. her calculated tibc was 146 with a ferritin of 241, and a trf of 112. her hematocrit was normal in the low 30s. she did consent to blood transfusions after having the risks explained to her and she did receive a total of 2 units of packed red blood cells throughout her stay. it was thought that her anemia could be due to her poor nutritional status and her chronic disease. she was started up on multivitamins, folate, and iron supplements. she will continue to have this followed up with her primary care physician. endocrine: patient with a history of hypothyroidism. her tsh was elevated at 6.8. her t4 was in the low normal range. most difficult, however, was controlling her diabetes. initially when she came in, she had an anion gap acidosis, which was initially thought to be possible diabetic ketoacidosis. she was given insulin in the emergency room along with an iv insulin drip and iv fluids. the anion gap which was 21 eventually closed and the patient was switched over to her home regimen of nph and regular insulin-sliding scale. the patient had several episodes of hypoglycemia, and her nph was reduced. following reduction of her nph, the patient experienced several episodes of severe hyperglycemia of approximately 400. this patient is a former employee at and is followed there. consult was obtained to assist with the management of this difficult patient. further education was provided along with a reasonable nph and regular insulin scale. patient was to followup with her attending in weeks for further adjustment. it is anticipated that the patient will continue to have some hyperglycemia in lieu of the fact that she will be receiving tube feeds at night due to her poor nutritional status. infectious disease: the patient was empirically started on levofloxacin for possible pneumonia. she completed a 10 day course of levofloxacin. a urinalysis revealed patient had a yeast infection and was given a dose of diflucan. nutrition: the patient was seen by the nutritional consult service for further evaluation. a calorie count was performed and it was deemed that the patient should have a nasogastric tube placed and receive supplemental nutrition at night. her primary care physician had noted that she had a significant weight loss in the past year with a thorough oncological workup was performed given her history of lung cancer on an outpatient basis, which yielded no clear source. the patient was also started up on remeron for her depression and appetite stimulant. she was also given reglan with all of her meals. over the course of her stay on the service, her appetite gradually improved. she was sent home with a nasogastric tube placed and was to have cyclic supplements at night. she is still encouraged to take as much po intake as possible. psychological: patient was depressed and she was started on remeron. her mood and affect were flat through most of her stay. it is recommended that she seek an outpatient assistance for her depression, but the patient appeared reluctant. she expressed no suicidal ideation or homicidal ideation. musculoskeletal: the patient presented with severe deconditioning. she was seen by the physical therapy team, who thought that the patient could be discharged home. of note, it was thought by many people on her healthcare team that the patient should go to a rehabilitation home to improve her status, but she was resistant to such efforts. discharge diagnoses: 1. cardiomyopathy with an ejection fraction of 25%. 2. chronic obstructive pulmonary disease. 3. insulin dependent-diabetes mellitus. 4. anemia of chronic disease. 5. osteoporosis. 6. gastroesophageal reflux disease. 7. lung cancer status post bilateral resection. 8. pseudogout. 9. hypothyroidism. 10. chronic right pleural effusion status post vats. discharge medications: 1. insulin 8 units of nph in the morning, 2 units of nph in the evening with a regular insulin-sliding scale, this was anticipated to change with the tube feeds. the patient is well educated on how to adjust her insulin dose, and will follow up with her primary endocrinologist. 2. magnesium oxide 400 mg po bid. 3. captopril 6.25 mg po tid, hold for systolic blood pressure less than 100. 4. combivent two puffs inhaled q6h. 5. multivitamin. 6. folic acid 1 mg po q day. 7. iron 325 mg po q day. 8. thiamine 100 mg po q day. 9. levothyroxine sodium 75 mcg po q day. 10. aspirin 325 mg q day. 11. levofloxacin 500 mg po q day for three days. 12. colace 100 mg po bid prn. 13. reglan 10 mg qid with meals. 14. nicotine patch 14 mg pd q day. the patient was instructed not to smoke with the patch and will discuss with her primary care physician about gradually decreasing the dose. 15. remeron 15 mg po q hs. 16. calcium/vitamin d. 17. colchicine 0.6 q day. 18. bactrim double strength one po q day. 19. protonix 40 mg po q day. 20. boost plus supplements with each meal and also in evening via tube feeds. follow-up instructions: 1. the patient was to followup with dr. at the clinic on the at 12:00 hours. 2. she also had a follow-up appointment with dr. in the heart failure clinic on the at 8 o'clock am. 3. she also has a followup with her primary endocrinologist, dr. at the institute. she was to call dr. for an appointment time in the next 1-2 weeks. discharge instructions: 1. the patient should return to the emergency room if she develops any chest pain, shortness of breath, heart palpitations, or difficulty breathing. 2. she should also contact her primary care physician if she develops any fever, difficulty eating. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures enteral infusion of concentrated nutritional substances thoracentesis arterial catheterization diagnoses: pneumonia, organism unspecified other primary cardiomyopathies unspecified pleural effusion congestive heart failure, unspecified systolic heart failure, unspecified cardiogenic shock diabetes with ketoacidosis, type i [juvenile type], not stated as uncontrolled primary pulmonary hypertension diseases of tricuspid valve 

Answer: The patient is high likely exposed to