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: the patient is a 37 year-old female without a prior medical history with a current complaint of worsening shortness of breath and cough. the patient first began feeling ill roughly one year ago with symptoms of shortness of breath, lethargy and decreased ability to talk. the shortness of breath tends to worsen at night and in the morning. per the patient the shortness of breath was initially a 4 out of 10 during onset a year ago, continued to progress and peak at 8 out of 10 in severity during before she was admitted to an outside hospital. she presented to several outside hospitals total in five admissions in the past year with multiple outside imaging studies. of note the patient was in a coma per the patient's mother for two and a half weeks and intubated times two during last admission at an outside hospital, which lasted eight weeks. during the admission the patient was told her right lung collapsed and her left lung had decreased lung function. the patient is currently on 3 liters of o2 nasal cannula at home. the sputum production has decreased over time. the patient has an additional complaint of night sweats at rate of four times per week for the past several months, weight loss up to 25 pounds unintentional over the past year, fevers and chills about three times a week over the past week with fevers up to 103 for the past two days. right sided focal chest pain that is located at the level of the tenth rib, which worsens with cough and is more severe on inspiration versus expiration. the right sided chest pain began two days ago during a severe bout of coughing when the patient heard a snap in the chest and "could not move for a short period of time." the patient denies any recent sick contacts or travel (went to the bahamas three year ago), denies nausea, vomiting, constipation, diarrhea, hemoptysis, hematemesis, melena, hematochezia or dysuria. on further questioning the patient noted that she had a upper respiratory infection roughly a month before the onset of her current one year shortness of breath. past medical history: none. medications: 1. fluconazole. 2. guaifenesin. 3. pantoprazole 40 mg b.i.d. 4. iron 325 mg b.i.d. 5. zoloft 100 mg q day. 6. ciprofloxacin 750 mg b.i.d. 7. combivent two puffs q 6 hours. 8. o2 via nasal cannula 3 liters. vaccines: nothing beyond childhood. allergies: codeine, which gives hives. family history: father died at 52 years from pancreatic cancer. was also told (he had a poor immune system). mother who is alive and healthy. the patient has five children, which are also healthy with no current respiratory problems. social history: the patient is married and lives with her husband and five healthy children. she has been a housewife and a mother. the patient stopped smoking six months ago and has used cigarettes on and off for about ten years. she admits to the use of intranasal cocaine and smoked marijuana for about one year roughly 20 years ago and has never injected any drugs. she reports regular exercise until a few months ago when her condition started to decline. there is no known sexual risk for hiv as the patient has had only one partner, her husband, since years of age. physical examination: in general, no acute distress. vital signs temperature current 98.2. temperature max 98.2. blood pressure 118/87. heart rate 91. respiratory rate 20. 93% on room air with a second sat of 95% on room air. head and neck examination normocephalic, atraumatic. extraocular movements intact. pupils are equal, round and reactive to light. no thyromegaly. oropharynx is clear. jvd was flat. pulmonary examination decreased air movement throughout. no rales. positive wheeze, positive rhonchi, diaphragmatic contraction was even. dull to percussion at the right apex. cardiac examination s1 and s2 were normal. no murmurs, rubs or gallops. regular rate and rhythm. abdomen examination tender in the right upper quadrant at the level of the approximately the tenth rib in the midaxillary line, soft, nondistended, no organomegaly, normoactive bowel sounds. positive flatus. rebound was negative. no peritoneal signs. extremities/vascular examination moves all extremities times four. distal pulses are +2 bilaterally. no clubbing, cyanosis or edema. neurological examination alert and oriented times three. cranial nerves ii through xii are intact. data: from an outside hospital on , the ct of trachea without intravenous contrast was done, which showed that there were bilateral breast implants. there is thickening of bilateral maxillary sinuses. there is few small mediastinal lymph nodes. there is diffuse circumferential thickening of the entire tracheal wall extending from the subglottic area to the proximal bronchi. there is slight asymmetry of the thickening with nodularity and marked narrowing of the trachea throughout the course of the trachea. the diameter of the cervical trachea is 7 by 10 mm. the diameter of the intrathoracic portion of the trachea is 5 by 6 mm representing a high grade stenosis of this portion. the caliber of the main bronchi is preserved. the wall thickening is up to 7 mm at the level of the thoracic inlet. there is a component of trachea malacia with a tracheal volume that goes from 88 square mm in inspiration to 26 square mm during dynamic breathing. there is no evidence of bronchial malacia. there is a tiny area of calcification in the left wall of the cervical trachea at the level of the thyroid gland. there is a tiny calcification of the calcified granuloma in the right upper lobe. multi and 3-d reformats again demonstrated marked narrowing of the trachea with circumferential thickening and nodularity. it demonstrated the severe trachea malacia. on spirometry was also performed, svc was 59% predicted, fev1 was 20% predicted, mms 13% predicted, fev1/fvc ratio was 34% of predicted, tlc was 103, frc 142, rv 183, vc 69, ic 60, erv 86 and rv/tlc ratio of 178. the results demonstrated the fvc was moderately reduced while the fev1 and fev1/fvc ratio were markedly reduced. there was blunted inspiratory and expiratory flow. the tlc was normal. frc/rv/rv/tlc ratios were elevated. the dlc was mildly reduced. these results were consistent with marked obstructive ventilatory defect and a blunted flow volume contour consistent with airway obstruction. admission laboratories: white blood cell count 6.3, hematocrit 39.5, mcv 91, platelets 279, pt 12.2, ptt 29.1, inr 1.0. differential neutrophils 55.1%, bands 0%, lymphocytes 6.8%, monocytes 5.6%, eosinophils 1.2%, basophils 1.3%. chem 7 was found have a sodium of 142, potassium 4.3, chloride 105, bicarb slightly elevated at 30, bun 12, creatinine 0.6, glucose 91 with an anion gap of 11. hospital course: the patient is a 37 year-old female without prior significant past medical history with a current complaint of worsening shortness of breath. outside hospital endoscopy, mucosal biopsies demonstrated a positive aspergillosis infection. the patient has per report failed caspofungin and itraconazole. the patient was recently put on miconazole for which she has currently run out of the medication. per report the last endoscopy performed at the outside hospital demonstrated no further indications of aspergillosis. the patient was referred to the to be worked up through interventional pulmonary. the primary concern was to address her worsening pulmonary status. the patient was started on intravenous fluids at 1:30 a.m. on and was made npo overnight for procedure the following morning with interventional pulmonary and ent. the patient was also put on 2 liters nasal cannula o2 to maintain saturations. the patient underwent surgery for potential stent placement in the bronchial airways, however, intraoperatively the patient was noted to have a fused larynx and ent was consulted. ent then placed a tracheostomy tube to address the acute airway tracheomalacia. the surgical plan at the time was changed to a three staged series of procedures, the first one being placement of the tracheostomy and to allow ventilation. number two lysing of the anterior and posterior portions of the fused larynx via ent and number three rigid bronchoscopy/flexible bronchoscopy via interventional pulmonary with possible stenting of the airways. postoperatively, the patient was in the micu for a 24 hour period to watch the newly placed tracheostomy tube. there were no other significant events during the micu stay. the patient was then transferred to the floor the following day. a swallow was then consulted. the patient then failed a passing air valve test. the patient was put on npo until clearance via speech and swallow studies. intraoperative two punch biopsies of the four tracheal rings were obtained. preliminary pathological results included no abnormal cartilage, no bacteria, no fungal elements, no aspergillosis. gram stain revealed no pmns, no microorganisms and anaerobic culture was negative. acid fast smear was negative and acid fast culture was pending at the time of dictation. the fungal culture was pending. micro laboratories were sent with the tracheal biopsy, which demonstrated alpha strep, which grew from broncho only and rare lactobacillus growth. infectious disease was consulted and discontinued the fluconazole and started amphotericin b. respiratory care was consulted and recommended continuing a cool mist on the tracheostomy site 40%. the patient was noted to have continued and worsened vocal cord dysfunction without voice production. the patient remained npo. social work was consulted to help with coping. a picc was placed in the right arm and subsequent chest x-ray status post picc placement demonstrated that the picc was lined in good position. on an allergy consult was obtained. nutrition was consulted as well regarding tube feeds versus total parenteral nutrition regarding the fact that the patient remained npo secondary to aspiration risk. the patient underwent a bed side speech and swallow examination, which was failed and subsequently underwent a video swallowing study through radiology. the oropharyngeal fluoroscopic swallowing evaluation demonstrated aspiration with thin and nectar thickened consistencies likely due to delayed swallowing reflex inability to completely closed vocal cords. chin tuck with nectar consistency prevented aspiration. silent aspiration occurred during swallow with thin plus nectar thick liquids. there was no spontaneous cough reflex. on the ciprofloxacin was discontinued secondary to lack of evidence of current empyema. the patient was started on thick liquid po and solid foods with chin tuck. physical therapy was consulted for evaluation regarding home safety and risk of fall. potassium was noted to be 3.1. the patient was given a one time bolus of 40 mg of potassium po. the morphine pca was discontinued and the patient was started on dilaudid 2 to 8 mg po q 4 hours prn for pain after a pain management consultant was obtained. ent reexamined the patient at the bedside and confirmed that the trach position was okay and no infection was at the site. ucon records were obtained. hiv 1 and 2 were found to be negative, was negative, anca was normal, crp was slightly elevated at 2.5, ch 50 was slightly elevated at 216, ferritin was slightly elevated at 750, cd4 slightly elevated at 1288, total protein down to 5.4, c3 was slightly elevated at 173. an allergy and immunology consult was obtained with recommendations of potential diagnoses including a defect of t cell function and/or neutrophil chemotaxis. infectious disease recommendations at the time were to discontinue the ambazone and start amphotericin d 1 mg per kilogram q 24 hours prehydrated with 500 ml of normal saline. data came back with igg levels at 843, iga 201, igm 63, all within normal limits. on a ct sinus was read as having one, mucosal thickening slightly polypoid in nature, left greater then right involving the left maxillary sinus. two, middle and inferior turbinates that were not visualized well secondary to surgical resection versus erosion. three, sphenoid sinuses and frontal sinuses are clear. four, no air fluid levels and bony destruction. five, no capitation in the ethmoid sinus. six, no acute sinusitis. seven, partial calcification of the right mastoid sinus, which was only partially visualized, which would suggest mastoiditis. the evaluation at the time suggested that the patient had a high likelihood of physical recovery, but recommended daily ambulation and discharge to home as soon as possible. on the patient's pain management was addressed and the dilaudid was changed to 12 mg q 3 hours prn pain with tylenol t.i.d. a rheumatological consult was obtained. interventional pulmonology discussed the plan and decided that the phase of the three phases of surgery would begin the following week. a psychiatric consult was obtained secondary to the patient's depressed mood. the patient's depressed mood seemed more then and out of proportion given the current circumstances. the infectious disease consult called the ucon id department and obtained the mucosal biopsies for further review at . the punch biopsies read at from the intraoperative trach placement on were sent to for a second review as well. the rheumatological consult felt that diagnoses of the following wegener's was unlikely given no hemoptysis, no renal involvement and negative anca. sarcoid was possible, however, mediastinal lymph nodes were likely reactive secondary to pulmonary infection and pulmonary function tests are usually restricted in pattern. amyloid is likely given normal liver and positive renal function. relapsing polychondritis remained possible, can have frequent involvement, and the biopsy will rule this out. septal perforations are probably secondary to past cocaine use. recommendations included biopsies that should not be done during inflammatory. if strong clinical suspicion for relapsing polychondritis was felt. tracheomalacia was likely secondary to persistent fungal infection or repeated intubations. ige came back as 93.3 within normal limits. sputum samples from the trachea site demonstrated gram positive cocci in pairs and clusters, gram stain greater then 25 pmns, however, there were also greater then 10 epithelial cells per field consistent with contamination. respiratory cultures preliminary were pending and fungal cultures were pending at the time of dictation. an or of the sinuses done as well demonstrated dissection of the nasal turbinates and the nasal septum as per the ct. nonspecific soft tissue thickening in the maxillary sinuses and to a lesser extent in the anterior ethmoid air cells with no evidence of bony destruction or soft tissue edema surrounding the sinuses. the sphenoid sinus and frontal sinuses were well aerated. there is opacification of the right mastoid air cells. tympanic cavity appears well aerated. no edema in orbits or inferior to the skull base and/or brain parenchyma. ct of the chest was also read with worsening diffuse peritracheal and proximal bronchial circumferential wall thickening, scarring at bilateral lung bases, 5 mm subpleural ground glass opacity nodule in the left lower lobe, several small mediastinal lymph nodes without change and do not have or meet criteria for pathology. given the findings on the mri and ct sinus, ct chest and fourth tracheal ring biopsies, pathologies and micro, negative for aspergillosis, the amphotericin d was discontinued per id's recommendations. id pulmonology also removed the tracheal sutures not the stay sutures. this was done through lead tension at the tracheostomy site secondary to patient's continuous complaint of pain. respiratory care continued to note copious amounts of white sputum production. condition on discharge: pending. discharge status: pending. discharge diagnoses: pending. discharge medications: pending. follow up plans: pending. , m.d. dictated by: medquist36 procedure: laryngoscopy and other tracheoscopy laryngoscopy and other tracheoscopy temporary tracheostomy open biopsy of larynx or trachea replacement of tracheostomy tube other excision or destruction of lesion or tissue of larynx sinusectomy, not otherwise specified diagnoses: anemia of other chronic disease aspergillosis stenosis of larynx 

Answer: The patient is high likely exposed to