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: cc: major surgical or invasive procedure: none history of present illness: 48 f with pmh ms (wheelchair bound) presented to hospital with complaints of fever on last fri. prior to presentation, pt had fevers and uti and was treated with 10 d of levo (completed ). initial cxr from demonstrated enlarged l pleural effusion. while at , had ct chest which demonstrated large pericardial effusion / l pleural effusion. was started on ceftriaxone/azithro to cover for strep pneumo. also spiked t101 at osh on . transferred to for diagnostic/therapeutic pericardiocentesis. . 220 ml serosanguinous fluid was removed from pericardial sac, pigtail was placed for continuous drainage. effusion was thought to be loculated. . pt has hx of basal cell ca on her nose, that was removed several years ago. she been having intermittent fevers for months. 20 lb unintentional weight loss in the last month. pt has been having mammograms since age 40, last in , all wnl. no past or present smoking hx. has not had colonoscopy since age 48, but no colon ca in family. ct chest showed no mediastinal or hilar lad. family hx of cancer on both sides. past medical history: multiple sclerosis (wheelchair bound) history of basal cell ca on her nose, removed social history: former pediatrician. she lives at home with her husband and has a home health aide. family history: father - skin ca. aunt - breast ca. physical exam: 99.7 / 111 / 128/77 / 16 / 98% 2l nc pulsus: 6 . gen: nad, lying in bed heent: no lad, jvd to 12 cm, op clear, cn2-12 intact, perrl lungs: dull posteriorly, rales diffusely heart: rrr, crescendo sem, clear s1/s2, no r/g, pericardial window clean, no erythema abdomen: thin, soft, +bs, nd, nt extr: no c/c/e neuro: motor only in head and lue; motor rue; 0/5 le bilaterally. sensation equal and intact bl. . pertinent results: pericardiocentesis : 1. baseline resting hemodynamics demonstrated mildly elevated right sided pressures (ra mean 10 mmhg), normal pulmonary, and normal left sided pressures with a normal cardiac index (3.3 l/min/m2). the initial pericardial pressure equaled the ra pressure (10 mmhg). 2. pericardiocentesis was performed and approximately 220 ml of sero-sanguinous fluid was removed until pericardial pressure was less than 0. it was not possible to remove more fluid despite posterior positioning of the catheter. ra pressure following the intervention was 5 mmhg. a pericardial catheter was left to drain and the patient left the laboratory in stable condition. . tte 7 pm: there continues to be a moderate to large pericardial effusion. no significant change compared to prior. no evidence of rv collapse in diastole to suggest tamponade. . ekg: nsr at 119, q in iii, twi i, low voltage . tte : ef 70-75%, 1+mr, 1+tr, large pericardial effusion, question of loculation, echodense, no tamponade, no rv collapse . ct chest : no mediastinal or hilar lad, l left pleural effusion, collapsed lll, small r effusion, no pneumonia. very large pericardial effusion, large left pleural effusion, and small right pleural effusion. compressive left lower lobe collapse secondary to the effusion. no pneumonia seen in the visualized aerated portions of the lungs. . esr 46 crp 7.2 . blood cx ngtd blood cx pend urine cx negative brief hospital course: 48 f with pmh ms (wheelchair bound) presenting with intermittent fevers, pericardial effusion and pleural effusion. . # pericardial effusion and cardiac: differential dx: possibilities for etiology of pericardial and pleural effusion include drug-induced hypersensitivity (increased serum eosinophil count), drug effect (patient was taking copaxone for years and zenapax for 4 months, both of which deviates t cells to a th2 response, which promotes an eosinophilic response), infection (gpc in broth from pericardial biopsy), and autoimmune disease (unusual presentation of lupus or vasculitis to have isolated effusions). . on admission, a tte showed a large possibly loculated pericardial effusion (greater posteriorly - 3.5 cm compared with anteriorly - 1.2 cm) that was echodense and consistent with blood, inflammation and cellular elements without evidence of tamponade. the patient was taken to the cath lab for pericardiocentesis with removal of 220 ml of serosanguinous fluid and placement of a pigtail catheter. another 200 cc drained on the floor before the catheter stopped draining and was pulled on . analysis of the fluid was consistent with an exudate (see pertinent results). cytology showed 79% lymphocytes, some activated forms consistent with a reactive process. microbiology studies showed no bacterial or fungal growth. acid fast culture continues to show ngtd, but the afb smear was negative. following pericardiocentesis and drainage, she continued to have a large circumferential pericardial effusion by tte without signs of tamponade. repeat pulsus checks were consistently 6. ct surgery performed vats to evacuate the pericardial effusion without complication. tte showed ef 70%, 1+ mr, 1+ tr. . all autoimmune and vasculitic markers checked returned negative. pericardial biopsy showed gram positive cocci only growing in broth, which may be contamination. biopsy showed lymphocytes, degranulating eosinophils, and a few scattered pmns. tissue culture needs to be followed after discharge, although the effusion is unlikely to be caused by a bacterial infection because the patient has clinically been asymptomatic other than fevers. . # pleural effusion: pt has had fevers and 20 lb weight loss over the last several weeks. to evaluate for a source of possible malignancy and l pleural effusion seen on cxr, she was sent for a ct with iv and oral contrast following the pericardiocentesis which showed a large left pleural exudative effusion, small right pleural effusion, indeterminant 1.4-cm adrenal nodule, dilated common duct measuring 7-8 mm with no obvious obstructing source. the l pleural effusion was tapped 1l by interventional pulmonology, revealing straw-colored, clear fluid. there was no pus noted in the pericardial or pleural fluid. patient was asymptomatic before and after procedure, with >95% o2 sat. . # fevers: etiology unknown. fevers up to 103 were intermittent, and patient would spike once a day and then remain afebrile for the remainder of the day. patient's fever improved after surgical evacuation of pericardial effusion, with maximum temp 99.5 during last day. . # multiple sclerosis: patient was advised to follow up with her neurologist and stop taking copaxone (glatiramer) hs and zenapax for life. patient will continue to take baclofen 60 . . # osteoporosis: fosamax and ca carb were held during admission, but may be continued after discharge. . # anxiety: paxil and zyprexa prn were continued during admission. . ppx: ppi, no heparin sc, pneumoboots code: full comm: (daughter), hcp: (husband), medications on admission: copaxone hs baclofen 60 paxil 10 qd colace 100 ca carbonate 650 fosamax 70 qweek zyprexa prn ceftriaxone/azithromycin (day 2) dulcolax discharge medications: 1. prescription home lift disp: 1 (one) refills: 0 (zero) 2. paroxetine hcl 10 mg tablet sig: one (1) tablet po daily (daily). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 5. baclofen 10 mg tablet sig: six (6) tablet po bid (2 times a day). 6. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary diagnosis: pericardial effusion, pleural effusion, fevers . secondary diagnosis: ms discharge condition: good. pt has no chest pain, no sob, satting 95% ra. discharge instructions: do not continue your copaxone or zenapax before discussing your pericardial and pleural effusion with your oncologist to see if these might be side effects from these drugs. followup instructions: please make a follow-up appointment with your primary care doctor, dr. at for within the next weeks. . please make a followup appointment with your neurologist within the next 1-2 weeks. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters pericardiocentesis thoracentesis thoracentesis other pleural biopsy pericardiotomy diagnoses: mitral valve disorders congestive heart failure, unspecified personal history of other malignant neoplasm of skin multiple sclerosis diastolic heart failure, unspecified diseases of tricuspid valve other specified diseases of pericardium pleurisy without mention of effusion or current tuberculosis 

Answer: The patient is high likely exposed to