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: sulfonamides / morphine / ultram attending: chief complaint: cough and weakness major surgical or invasive procedure: r internal jugular central line history of present illness: 85f with complicated medical history significant for nhl s/p chemo, colon cancer s/p hemicolectomy, and asplenia who presents with 3 day history of wet but non-productive cough, progressive shortness of breath, and fevers and chills at home. patient denied abdominal pain, chest pain, rash. + nausea and vomiting x 1day. + contact- daughter with pneumonia. chronic low back pain is stable. patient received flu shot and pneumovax in . ed course: patient spiked a fever to 101.6 rectally, treated with tylenol, ceftriaxone 1g x 1 and azithromycin 500mg x 1. also treated with combivent and robitussin. patient became hypotensive to 77/42 which improved to sbp in 90s after 4l ivf, but then with increased o2 requirement. patient then placed on nrb, started on levophed for bp support and admitted to icu for further management. past medical history: 1. brain meningioma. 2. cll in , transformed to nhl, status post chop and . 3. hypogammaglobulinemia with recurrent sinopulmonary infections, improved with ivig replacement therapy. last ivig infusion . (: igg 1245, iga 183, igm 55) 4. colon cancer status post hemicolectomy (stage 3, t3n1m0). 5. motor vehicle accident, status post splenectomy. 6. svc clot in in setting of indwelling central line. 7. pneumonia complicated by adult respiratory distress syndrome in . pneumonia with prolonged intubation 8. ejection fraction greater than 60%, mild mitral regurgitation and mild pulmonary hypertension on an echocardiogram from . 9. chronic low back pain 10. interstitial lung disease; pfts : fev1 1.17 (108%pred), fvc 1.63 (94%pred), fev1/fvc 72 (116% pred) social history: the patient is a nonsmoker, nondrinker. she lives with her daughter family history: non-contributory physical exam: t99.8--> 101.6 rectal bp96/63 hr91 rr20 o2sat94% 3l-->100% nrb (ed) t100.6 bp99/43(levophed 0.1mcg/kg/min) hr74 rr28 o2sat 97% 2l () gen: frail, elderly woman, ill appearing but non-toxic. alert, oriented heent: perrl, eomi, op-clear, mmm. neck supple, no lad. r ij in place. chest: tachypneic, using accessory muscles; crackles the way up bilaterally, no wheezes. cv: regular rate, normal s1, s2. no murmurs. abd: soft, nontender, nondistended. + bs ext: no edema, good pulses. pertinent results: labs on admission: wbc 8.43, hct 38.3, mcv 83, plt 387 (diff: 58n, 4b, 29l, 8m, 1baso) pt 14.2*, ptt 32.8, inr(pt) 1.4 na 135, k 4.2, cl 98, hco3 24, bun 14, cr 0.6, glu 95 alt 17, ast 47*, ldh 299*, alkp 82, 66, tbili 0.2, lip 24 ck(cpk) 34, ck-mb 2, ctropnt <0.01 ca 8.4, phos 2.7, mg 1.5* cortsol 33.4* crp 39.7* abg: po2-87 pco2-38 ph-7.43 calhco3-26 base xs-0 freeca 1.14 lactate 1.2 . labs on discharge: wbc 11.7*, hct 28.7*, mcv 84, plt 432 ret 2.3 na 137, k 4.2, cl 98, hco3 32, bun 10, cr 0.4, glu 87 ca 8.7, phos 3.1, mg 1.7, fe 31, tibc 164, b12 1329, folate 12.5, ferritin 332*, trf 126* . micro: : urine culture (final ): enterococcus sp.. >100,000 organisms/ml.. gram positive bacteria. >100,000 organisms/ml.. alpha hemolytic colonies consistent with alpha streptococcus or lactobacillus sp. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ =>32 r chloramphenicol------- 8 s levofloxacin---------- =>8 r linezolid------------- 2 s nitrofurantoin-------- 32 s vancomycin------------ =>32 r . urine cx ngtd influenza a/b negative legionella urinary ag: neg for legionella serogroup 1 ag urine cx ngtd blood cx x2 ngtd . imaging: cxr : 1. patchy opacity in the left retrocardiac region, which could represent an early focus of pneumonia. 2. diffuse interstitial fibrosis. . cxr : right jugular cv line is in distal svc. no pneumothorax. there are low lung volumes. allowing for this, heart size is normal. there is a diffuse bilateral reticulo- nodular pattern consistent with a known chronic interstitial fibrosis. discoid atelectases are present at the left base but no definite new confluent pulmonary consolidation and no pneumothorax. . cxr : developing multifocal opacities possibly representing pneumonia. edema is also considered. . cxr : stable appearing multifocal opacities bilaterally, concerning for pneumonia. . cxr : a single ap upright view at 12:00 hours is compared to previous examination of . the lung volumes are low. there are bilateral diffuse parenchymal opacities with small pleural effusions without significant change since the previous exam. the findings are suggestive of pneumonia superimposed on patient's known interstitial lung disease. there is enlargement of both pulmonary arteries, indicating pulmonary hypertension. although the heart size is within normal limits there may be an element of interstitial pulmonary edema. . brief hospital course: # pna: ms. likely had community acquired pneumonia. she was ruled out for legionella and influenza, but was unable to provide an adequate sputum sample to determine causative organism. she was treated with ceftriaxone/cefpodoxime and azithromycin, which covered her for encapsulated organisms (patient is asplenic). she also likely had a component of pulmonary edema, as she had received 4l of ivf on admission due to her hypotension/sepsis. she began autodiuresing on her own, and became i/o negative during her last several days of hospitalization. she was able to be weaned off oxygen and her sats remained stable on ra. she was given albuterol/atrovent nebs for her breathing and robitussin prn for her cough. . # sepsis: on admission, she appeared to be in septic shock, likely from her pneumonia. despite receiving 4l of ivf in the ed, she remained hypotensive and was transferred to the on levophed for bp support. random cortisol level was normal, as was a cortisol stim test, so she was not felt to be adrenally insufficient. she was started on antibiotics (ceftriaxone and azithromycin) with improvement in her hemodynamics. blood and urine cultures from admission showed no growth. the levophed was eventually weaned and her bp remained stable. she was transferred out of the to the regular floor for continued monitoring and weaning of her o2 requirement. . # ild: ms. has known interstitial lung disease, with her last pulmonary evaluation being in . at that time, no further w/u was pursued as she was asymptomatic. per her primary outpt pulmonologist, she has been admitted multiple times in the past essentially for respiratory failure and has received steroids with improvement in her symptoms. pulmonary was consulted once the patient was stablized on the floor but they did not feel steroids were indicated at this time. her o2 sats were much improved, to 94-95% on , she was continued on her albuterol/atrovent nebulizers. she was switched to inhalers upon discharge. . # conjunctivitis: she developed conjuncitivitis and was treated with erythromycin ointment starting on . . # pain management: ms. had been on narcotics for chronic back pain as an outpatient but they were held after the patient was transferred to 11r as she began to develop an elevated bicarb and it was felt that the narcotics may be contributing to this. her pain was adequately controlled with tylenol and she was discharged without any narcotics. . # ? uti: ms. had a urine cx sent prior to discharge, from foley catheter, which grew enterococcus and gram positive bacteria, but she was asymptomatic at that time and still receiving cefpodoxime. the decision was made to not give any further antibiotics at this time, but her family was told that if the patient developed symptoms of a uti, to call her pcp for antibiotics for possible uti. . # fen: while in the , she was kept npo. ivf boluses were used prn based on cvp, bp and uop. once transferred to the floor, she kept to a regular, kosher diet. her electrolytes were checked daily and were repleted as needed. . # access: r ij . # ppx: she was on heparin sc and pneumoboots for dvt ppx. she had no history of gerd thus ppi was not indicated. she was given a bowel regimen to prevent constipation while on narcotics. . # comm: grandson . # code: full, confirmed with family. . # dispo: to home with services. she is to receive pt at home as well as oxygen, to keep her o2 sats >92%. medications on admission: fosamax qwk, propoxy n/apap 50/325 qid prn, fentanyl patch 12mcg/hr, flonase discharge medications: 1. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. disp:*1 bottle* refills:*0* 2. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day) for 7 days. disp:*1 diskus* refills:*0* 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for fever or pain. 4. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours). disp:*qs 30 days inhaler* refills:*2* 5. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). disp:*qs 30 days inhaler* refills:*2* 6. oxygen please provide one oxygen tank with nasal cannula for patient to use as needed for shortness of breath or oxygen saturation <90% on ra. discharge disposition: home with service facility: family & services discharge diagnosis: community-acquired pneumonia interstitial lung disease discharge condition: good. afebrile. bp 104/68, hr 80, rr 20, sats 97% on ra. discharge instructions: 1. please call your pcp or go to the nearest er if you develop any of the following symptoms: fever >101, chills, chest pain, shortness of breath, difficulty breathing, decreased energy level, nausea, vomiting, or any other worrisome symptoms. 2. please take all your medications as prescribed. you can resume taking fosamax as per your regular schedule. followup instructions: 1. please follow-up with your pcp, . , in weeks. his office number is . 2. please keep your appointment for a mammogram on at 3pm. if you have any questions or need to reschedule, please call: mammography at . 3. please call to make a follow up appointment with your pulmonologist, dr. , in weeks. her number is . procedure: venous catheterization, not elsewhere classified infusion of vasopressor agent diagnoses: pneumonia, organism unspecified acidosis unspecified septicemia severe sepsis other malignant lymphomas, unspecified site, extranodal and solid organ sites septic shock postinflammatory pulmonary fibrosis personal history of malignant neoplasm of large intestine hypovolemia lumbago diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to