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: no known allergies / adverse drug reactions attending: chief complaint: respiratory distress major surgical or invasive procedure: bronchoscopy () intubation () history of present illness: ms. is a 53 year old female with no signifcant past medical history who presented to on with shortness of . the patient was in her usual state of health one month ago. about 3 weeks prior to presentation, she went on a trip to and returned to america on . on , she had a lgt of 100.9 and also started developing shortness of without a cough. she saw her pcp, which time she was noted to be saturating 90% on ra. she received nebulizer treatments with modest improvement. she had a chest xray that showed diffuse infiltrates, prompting evaluation in the emergency room. a ct scan of the chest at that time reportedly did not show evidence of a pulmonary embolism. what was seen was moderately severe diffuse interstitial penumonitis versus atypical bacterial pneumonia or other interstitial pneumonia. given persistent shortness of and hypoxemia, she was admitted. at the osh, her wbc increased from to 29.8k with left shift. her hct was 41, and platelets were . legionella pneumoniae antigen was negative as well as rapid influenza antigen. she had blood cultures drawn that were negative x 2days. she had c. difficile pcr checked that was negative. troponins were also checked that were negative for acs. ekg showed sinus tachycardia with inverted p waves in v1/ flat in v2, with rightward axis deviation. no st changes were noted. she was started on ceftriaxone, azitghromycin, and doxycylcine for empiric coverage for pneumonia. pulmonary consult was obtained and also considered ards as a potential etiology of her lung disease. she was transferred to micu for further workup. on arrival to the micu, patient was tachypnic to the 30's satting 95% on 5l. she was intubated. past medical history: osteopenia cesarean section tonsillectomy laparoscoopy for infertility issues. social history: from originally, but moved to the us about 20 years ago. lives in with her husband and 14 son. quit smoking in the late 's. has occassional alcohol use daily. no illicit drug use. worked as a lawyer in and currently works as a substitute teacher. family history: no family history of pulmonary disease or cardiovascular disease. physical exam: admission exam vitals: t:98.1 bp: 102/79 p: 84 r:34 o2: 96% 5l general: moderate respiratory distress and diaphoretic. alert, oriented. heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, bilateral shoddy anterior cervical lad cv: tachycardic otherwise normal s1 + s2, no murmurs, rubs, gallops lungs: low volume sounds with dry crackles auscultated in the mid lung fields r>l. abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: clear urine ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact discharge exam vs: 98.5 130/70 75 20 96%ra gen: stable-appearing female of stated age neck: supple without lad pulm: clear in all lung fields without wheeze or rhonchi cor: rrr (+)s2/s2 without m/r/g abd: soft, non-distended, non-ttp, nabs le: trace le edema b/l neuro: aox3, mentating well, asking appropriate questions pertinent results: imaging: cxr findings: there are bilateral confluent parenchymal opacities, most dense in the right lower lobe and bilateral upper lobes with some sparing of the apcs.the heart size is normal. due to the parenchymal opacities, it is difficult to tell if effusion is present. this could be pneumonitis or infection.compared to the reference exam, the appearance is much worse. tte impression: normal biventricular size and systolic function. probably normal diastolic function. mild mitral regurgitation. mild tricuspid regurgitation. normal pulmonary arterial systolic pressures. cxr findings: in comparison with the study of , the monitoring and support devices are essentially unchanged. there has been some improvement in the diffuse bilateral pulmonary opacifications, though a substantial residual persists. this suggests that much of the previous appearance was due to pulmonary vascular congestion. bronchial lavage, right middle lobe: atypical. occasional clusters of atypical degenerated epithelial cells. abundant macrophages, neutrophils, eosinophils and lympho- cytes. bronchial lavage, left lower lobe: negative for malignant cells. abundant macrophages, neutrophils, eosinophils and some lymphocytes. admission labs 08:50pm pt-12.5 ptt-30.9 inr(pt)-1.2* 08:50pm plt count-294 08:50pm neuts-83.1* lymphs-8.7* monos-4.4 eos-3.5 basos-0.2 08:50pm wbc-18.6* rbc-4.09* hgb-12.5 hct-38.3 mcv-94 mch-30.5 mchc-32.5 rdw-13.4 08:50pm calcium-8.7 phosphate-1.9* magnesium-1.9 08:50pm alt(sgpt)-24 ast(sgot)-11 ld(ldh)-215 alk phos-67 tot bili-0.5 08:50pm estgfr-using this 08:50pm glucose-100 urea n-8 creat-0.5 sodium-143 potassium-3.8 chloride-105 total co2-29 anion gap-13 08:59pm lactate-1.2 08:59pm type- temp-37.1 rates-/34 o2-5 po2-32* pco2-44 ph-7.43 total co2-30 base xs-3 intubated-not intuba comments-nasal 05:45am blood -negative 05:45am blood rheufac-15* relevent labs 04:26am blood wbc-15.8*# rbc-3.55* hgb-10.8* hct-33.5* mcv-94 mch-30.4 mchc-32.2 rdw-14.1 plt ct-391 03:37am blood wbc-23.3* rbc-3.53* hgb-10.9* hct-33.2* mcv-94 mch-30.8 mchc-32.8 rdw-14.1 plt ct-460* 04:08am blood wbc-22.9* rbc-3.47* hgb-10.4* hct-32.3* mcv-93 mch-30.1 mchc-32.3 rdw-13.7 plt ct-499* 02:31am blood neuts-80.1* lymphs-14.1* monos-2.5 eos-3.1 baso-0.2 03:37am blood neuts-82.7* lymphs-8.1* monos-7.8 eos-1.0 baso-0.4 04:08am blood neuts-57 bands-0 lymphs-14* monos-7 eos-17* baso-0 atyps-0 metas-1* myelos-4* 04:26am blood glucose-203* urean-18 creat-0.5 na-141 k-4.2 cl-104 hco3-33* angap-8 03:37am blood glucose-167* urean-23* creat-0.5 na-143 k-3.8 cl-102 hco3-33* angap-12 12:06pm blood glucose-117* urean-19 creat-0.5 na-142 k-4.7 cl-104 hco3-30 angap-13 03:37am blood alt-40 ast-16 ld(ldh)-276* alkphos-76 totbili-0.2 04:08am blood calcium-7.7* phos-3.1 mg-2.3 12:06pm blood calcium-8.1* phos-2.8 mg-2.4 05:45am blood -negative 05:45am blood rheufac-15* 10:15am blood type-art temp-37.3 po2-97 pco2-46* ph-7.48* caltco2-35* base xs-9 06:03pm blood type-art temp-38.3 po2-65* pco2-43 ph-7.50* caltco2-35* base xs-8 intubat-not intuba 08:14am blood type-art temp-37.2 po2-82* pco2-39 ph-7.54* caltco2-34* base xs-9 02:52am blood lactate-1.0 02:30pm blood lactate-2.2* 04:05am blood lactate-2.0 discharge labs 07:20am blood wbc-24.8* rbc-3.50* hgb-10.6* hct-32.6* mcv-93 mch-30.4 mchc-32.6 rdw-14.0 plt ct-477* 07:20am blood neuts-51 bands-1 lymphs-8* monos-6 eos-30* baso-0 atyps-0 metas-0 myelos-3* promyel-1* 07:20am blood hypochr-normal anisocy-normal poiklo-normal macrocy-normal microcy-normal polychr-normal 07:20am blood glucose-80 urean-13 creat-0.5 na-140 k-3.6 cl-104 hco3-28 angap-12 03:37am blood alt-40 ast-16 ld(ldh)-276* alkphos-76 totbili-0.2 brief hospital course: the patient was a 53 yo female presenting from osh with hypoxemia, found to have an interstitial pulmonary process on imaging, and further characterized to be eosinophilic pneumonia on bronchoscopy. . #acute eosinophilic pneumonia: the patient arrived in the micu and was intubated for concern of ards. a bronchoscopy was performed and elevated eosinophils were found from the bal in the rml. this was consistent with acute eosinophilic pneumonia. she was started on empiric treatment for cap with ceftriaxone and azithromycin and was started on solumedrol for the eosinophilic pneumonia. collagen-vascular processes, hiv, and acute cardiac processes were considered, but were ruled out. the patient was extubated on and did very well with decreasing oxygen requirements. on her foley and arterial line were discontinued and she was transfered to the general medicine floor. upon transfer to the floor, the patient was on 4l of oxygen by nasal canula, but over the next 3 days, the patient was completely weaned off. the patient was transitioned to prednisone by mouth and a taper schedule was implemented. the patient was seen by physical therapy, and within 3 days, the patient was able to ambulate on the floor and on stairs without oxygen or assistance. . #leukocytosis: patient found to have a low grade fever (in the setting of steroid use that may blunt a fever), leukocytosis of ~23.0 (beyond a leukocytosis of ~15.0 that was ascribed to steroids and demarginlization) while in the micu. a consolidation on the right base that remained despite the resolution of her eosinophilic pnemonia was concerning for a ventilator aquired pneumonia. a mini bronchioalveolar lavage gram stain was negative. she was started on empiric antibiotics on . given the patient's improving clinical condition on the floor without fevers, it was decided in conjunction with the pulmonary team that a vap was unlikely. the antibiotics were discontinued. . #anemia: the patient's h/h had trended down over the course of her brief hospitalization. there was no evidence of acute blood loss and her progressive anemia was likely due to critical illness and phlebotomy. her h/h was trended. . #hyperglycemia: the patient had elevated blood sugars while inpatient. there were likely elevated in the setting of high dose steroids. as her steroid dose was tapered, her blood glucoses trended down. . #transitional issues: clinic was contact for an appointment, patient was tentatively scheduled for , but will be contact for a sooner appointment as it becomes available. patient was instructed to continue 10mg of prednisone daily (after the taper) until the time of appointment. she will need a follow-up cxr before the office visit. -patient was started on a steroid taper while hospitalized, and discharged with explicit instructions for taper. these instructions can be found at the end of this document. medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. multivitamins 1 tab po daily discharge medications: 1. prednisone 10 mg po daily duration: 35 days start: after 20 mg tapered dose. please continue taking until you see the pulmonologist. rx *prednisone 20 mg tablet(s) by mouth daily disp #*10 tablet refills:*0 rx *prednisone 10 mg 1 tablet(s) by mouth daily disp #*35 tablet refills:*0 2. multivitamins 1 tab po daily discharge disposition: home discharge diagnosis: primary diagnosis: acute eosinophilc pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ms. , you were admitted with "eosinophilic pneumonia". while in the icu, you were on a ventilator to support your breathing and were started on steroids. while in the icu, there was concern that you had a bacterial infection and were started on antibiotics. once your breathing was better, you came off the ventilator and your antibiotics were stopped. please taper your steroids as follows: 60mg daily for 4 days ( through ) 40mg daily for 4 days ( through ) 20mg daily for 4 days ( through ) 10mg daily until you see pulmonology please make sure you get a chest xray (xray will be setup by pulmonology) before you see the doctor. if you are feeling increased shortness of , not hesitate to contact your primary care doctor to the er. it has been a pleasure taking care of you, best of luck. thank you for choosing . followup instructions: ***our pulmonary dept. is working on a sooner follow up appt for you and will call you at home with the appt change. if you dont hear from the office by tuesday, please call them direcdtly to book at department: pulmonary function lab when: monday at 1:10 pm with: pulmonary function lab building: campus: east best parking: garage department: pft when: monday at 1:30 pm department: medical specialties when: monday at 1:30 pm with: dr. /dr. building: sc clinical ctr campus: east best parking: garage name: ,suetta m. location: medical associates address: , , phone: ***please call dr office on monday morning to book a follow up appt within one week of discharge. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization closed [endoscopic] biopsy of bronchus central venous catheter placement with guidance diagnoses: acidosis anemia, unspecified mitral valve disorders hypopotassemia acute respiratory failure pulmonary eosinophilia disorder of bone and cartilage, unspecified other abnormal glucose 

Answer: The patient is high likely exposed to