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: levaquin / azithromycin / bactrim attending: chief complaint: fever major surgical or invasive procedure: bone marrow biopsy transfusion of 2 units of blood history of present illness: is a 40 year old woman with metastatic non-small cell lung cancer, admitted with febrile neutropenia. ms. was first diagnosed with squamous cell nsclc in when she presented with chest pain, shortness of breath, and back pain, and was found to have a malignant pleural effusion. she underwent pleural biopsy on at osh that showed metastatic nonsmall carcinoma of pulmonary origin with suggestion of squamous differentiation. she was treated with carboplatin/gemcitabine from to . in disease progressed and she was treated with two additional cycles carboplatin/gemcitabine. in she developed neurologic symptoms of headache, dysarthria, and difficulty with fine motor skills, and brain imaging diagnosed multiple brain metastases. she completed whole brain radiation as of and was then treated with two cycles navelbine. she then developed lft abnormalities. keppra and dexamethasone were held, adn she then had a seizure. she was admitted to neuro-oncology service /09. keppra and dexamethasone were restarted. she was hospitalized again /09 with pulmonary embolism and was started on enoxaparin. ct raised concern for progressive disease in her liver, and on she began treatment on erlotinib. she was last seen in clinic on at which time she was noted to be neutropenic. bactrim was discontinued out of concern this was marrow suppression from drug effect. ms. presented to the ed today with fever 102.8. in the ed t 98.0 hr 108 bp 99/69 rr 20 98%ra. past medical history: * non-small cell lung cancer diagnosed via biopsy in with known metastasis to t11. she underwent chemotherapy with gemcitabine and carboplatin from to , again to . she presented in to with brain metastases. no neurosurgery intervention deemed appropriate and was set up for whole brain xrt by radiation oncology at from /09. she also had ~2 weeks of vinorelbine on , stopped for elevated lfts. started erlotinib * malignant l pleural effusion, s/p multiple thoracenteses. s/p chest tube, talc pleurodesis * seizures secondary to brain mets. occurred , while off keppra due to elevated lfts. * bilateral pes - lobar pe in rul, segmental pe in lll * steroid myopathy social history: she lives with her husband and 3 children (girl 15, boys 12 and 7 all healthy). she denies smoking, alcohol or drug use. she did not have recent travel, or change in diet. she used to work in a medical office in the medical records depparment. family history: there is no family history of cancer including lung, ovary, colon and breast. her father is alive at age 77 with hypertension. her mother is alive at age 68 healthy. she has 2 healthy sisters. there is no history of premature cad or stroke or diabetes. physical exam: general 97.2 101 83/69 24 99% on 2l nc heent sclera white, conjunctiva pink, oropharynx without lesions, cushingoid facies neck supple, no adenopathy pulm lungs with few fine rales bilaterally, no wheezing cv regular s1 s2 no m/r/g appreciated abd obese nontender +bowel sounds no hsm appreciated gu no perirectal abscess extrem warm no edema palpable distal pulses derm no rash or jaundice neuro alert and interactive, moving all extremities, has difficulty sitting up in bed due to weakness lines/tubes/drains no port pertinent results: admission labs: 10:10pm blood wbc-1.3*# rbc-3.08* hgb-6.3*# hct-19.7*# mcv-64* mch-20.6* mchc-32.1 rdw-18.2* plt ct-256# 10:10pm blood neuts-4* bands-0 lymphs-82* monos-11 eos-0 baso-0 atyps-3* metas-0 myelos-0 nrbc-7* 10:10pm blood hypochr-1+ anisocy-2+ poiklo-2+ macrocy-occasional microcy-2+ polychr-occasional ovalocy-1+ schisto-occasional tear dr2+ 10:10pm blood pt-15.5* ptt-44.5* inr(pt)-1.4* 10:10pm blood gran ct-52* 10:10pm blood glucose-127* urean-10 creat-0.5 na-139 k-3.9 cl-103 hco3-27 angap-13 10:10pm blood alt-96* ast-40 ld(ldh)-532* ck(cpk)-12* alkphos-159* totbili-0.7 10:10pm blood hapto-285* imaging: echo : the left atrium is normal in size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and noaortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. there is an anterior space which most likely represents a fat pad. impression: normal global and regional biventricular systolic function. no pericardial effusion. borderline pulmonary hypertension. cxr (): portable upright chest radiograph: cardiomediastinal contours are unchanged, with prominent left mediastinal fat pad. left-sided pleural thickening or tiny fluid in the fissure is not changed. known multiple lung masses are not as well seen. however, no new consolidation or pulmonary edema is seen. the rounded sclerotic focus in t10 is redemonstrated, consistent with known metastasis. impression: no acute findings such as pneumonia or pulmonary edema seen. micro: blood cx : ngtd urine cx : >100k lactobacillus legionella ag : negative sputum: viral neg bone marrow biopsy pending brief hospital course: 40 yo female with metastatic nsclc on dexamethasone for brain mets, and recent admission for pe returned with febrile neutropenia. # febrile neutropenia: she was admitted to the micu due to a borderline bp initially, which improved with fluids. bp settled in 95-105 systolic. she did not require pressors/cvl in the micu. she was given stress dose steroids x24hrs before returning back to her normal deacron dose. no clear infectious source found on history or culture data. the suddent onset could be compatible with influenza, however her urine cx showed >100k lactobacillus which is likely cotamination. other cultures remained negative. her cxr showed no evidence of infection. she was was broadly covered with cefepime and vanco while she remained neutropenic. once her counts rose with an anc > 500 these were stopped and she was started on cefpodoxime to complete a 7-day course. she remained afebrile. she will follow up with dr. later this week. # neutropenia: patient found to become neutropenic in mid-. differential for her neutropenia included marrow suppression/infiltration from her disease vs medication effect vs infection affecting her bone marrow. patient's bactrim was stopped on and her counts were found to be depressed on the next lab check she had after starting the bactrim. during her hospitalization her keppra was stopped and she was started on topamax instead as keppra was also suspected of causing marrow suppression. she underwent a bone marrow biopsy and these results were pending at the time of discharged. by time of discharge her anc had rose to 1216 and wbc was 1.9. as her counts recovered so quickly, her neuropenia was likely secondary to medication-effect, likely bactrim as this was temporally related to the onset of neutropenia. bactrim was added as an allergy to omr and she was instructed not to take bactrim again. # anemia: hct was 19.5 on admission, though no obvious signs of bleeding. though there was abnormalities on her differential, there was otherwise no obvious sign of hemolysis. she was given 2 units prbcs with mostly appropriate bump in her hct. iron studies showed anemia of chronic disease and vitamin b12 and folate have recently been normal. her hct prior to discharge remained in the mid-20's. # metastatic nsclc with brain mets: patient has known brain mets s/p xrt which have resulted in seizures. she was continued on gabapentin 300 mg po q8h. as above her keppra was stopped and she was started on topiramate 100 mg po bid for seizure prevention. a topiramate level was sent on and was pending at time of discharge. she was asked to follow up with dr. in weeks. she is on dexamethasone to decrease cerebral edema. after the day of stress dose steroids as above she was continued on the dexamethasone taper as outlined by dr. : on will decrease to 0.5 mg every other morning and on with stop. she was being treated with erlotinib prior to admission. this was held on admission (even though it is not known to cause marrow suppression). upon discharge she was asked to restart it at her home regimen as an outpatient. # ekg with inf/lateral twi: admission ekg showed twi, but she had no clinical evidence of ischemia. she was ruled out for mi with 3 sets of negative cardiac enzymes. an echo was without evidence of wall motion abnormalities. # recent pe: patient was recently diagnosed with bilateral pes on and is on lovenox. she was continued on lovenox 90 mg sc q12h. # lower extremity leg weakness: patient has a known steroid myopathy. her weakness was stable. she was discharged with home pt. # transminitis: patient at basline has had a transaminitis, this remained stable/improved during this hospitalization. # code: full code medications on admission: lovenox 90mg dexamethasone 1mg daily erlotinib 100mg daily neurontin 300mg tid levetiracetam 500mg ibuprofen prn tylenol prn discharge medications: 1. enoxaparin 100 mg/ml syringe sig: ninety (90) mg subcutaneous q12h (every 12 hours). 2. dexamethasone 0.5 mg tablet sig: one (1) tablet po daily (daily): take 1 tablet daily until , then take 1 tablet every other day until . stop taking dexamethasone on . disp:*11 tablet(s)* refills:*0* 3. gabapentin 300 mg capsule sig: one (1) capsule po q8h (every 8 hours). 4. topiramate 100 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. cefpodoxime 200 mg tablet sig: one (1) tablet po twice a day for 4 days. disp:*8 tablet(s)* refills:*0* 6. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain: do not drive while taking this medication. disp:*30 tablet(s)* refills:*0* 7. compazine 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. disp:*40 tablet(s)* refills:*0* 8. tarceva 100 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: discharge diagnosis: primary - febrile neutropenia acute on chronic anemia secondary - metastatic non-small cell lung carcinoma history of seziures recent pulmonary emboli steroid myopathy discharge condition: stable, afebrile discharge instructions: you were admitted to the hospital due to fevers. your blood counts were found to be low so you were monitored closely and treated with broad spectrum antibiotics. you underwent a bone marrow biopsy to examine your bone marrow; these results are pending. you were also given blood transfusions due to low blood counts. your counts improved and you were changed to oral antibiotics and remained without evidence of infection. it is thought that your low counts were due to an uncommon side effect of the antibiotic bactrim. you should not take bactrim in the future and it has been added to your drug allergy list in our records. medication changes: 1. you will need to finish 4 days of cefpodoxime 200 mg twice daily. 2. your dexamethasone is being tapered: take 1 tablet daily until , then take 1 tablet every other day until . stop taking dexamethasone on . 3. your keppra was stopped and you were started on topomax 100 mg twice daily. 4. you should restart your tarceva as prescribed upon discharge. 5. for pain you can take 1 percocet every 4 hours as needed. do not drive while taking this medication. 6. for nausea you can take 10 mg of compazine every 6 hours as needed. continue to take your outpatient medications as prescribed. call your primary doctor, or go to the emergency room if you experience fevers, chills, dizziniess, shortness of breath, inability to tolerate oral intake, blood in your stool, black stool, or other concerns. followup instructions: you will be called by dr. office () tomorrow with an appointment to be scheduled sometime for thursday, . please call if you don't hear from his office by tomorrow afternoon. you will need to follow up with dr. () within the next 1-2 weeks. please keep your previously scheduled appointment: provider: , phone: date/time: 12:00 md procedure: biopsy of bone marrow transfusion of packed cells diagnoses: malignant neoplasm of liver, secondary secondary malignant neoplasm of pleura other convulsions secondary malignant neoplasm of brain and spinal cord malignant neoplasm of bronchus and lung, unspecified cerebral edema personal history of venous thrombosis and embolism secondary malignant neoplasm of bone and bone marrow neutropenia, unspecified anemia in neoplastic disease fever presenting with conditions classified elsewhere 

Answer: The patient is high likely exposed to