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 / penicillins / zestril attending: chief complaint: cp and sob major surgical or invasive procedure: thoracentesis history of present illness: 63 yo f with nsclc s/p chemo and radiation now presenting with worsening dyspnea and intermittent cp. pt reports that for the last 3-4 days has had decreased energy and feeling like her breathing has been shallow. +cough productive of clear/opaque white sputum and had a few episodes of vomiting after vigorous coughing. no fevers but had night sweats x several nights. states 2 days ago had one episode of cp in middle of chest which felt like an intense pressure/squeezing. occurred while she was watching tv. had no sob, n/v, diaphoresis at the time. took an aspirin and states the pain resolved after a few minutes and has not returned. states her sob has generally been a little better this week, but noticed that upon trying to get dressed to come to the ed it took her several hours b/c she kept having to stop to take breaks to catch her breath. . on arrival in the ed she had a temp of 100.4, hr 140, nml bp, rr 28, o2sat 91% on ra. recieved 1l ns, tylenol 1gm, levofloxacin 500mg iv, and flagyl 500mg iv. cta showed pe and heparin gtt was started. . onc history: in presented with cough x 1 month - cxr showed a lul mass. bronch showed adenocarcinoma that was felt to be unresectable as it was invading the mediastinum. has been treated by dr. in medical oncology. was treated with cisplatin and etoposide x 2 cycles and repeat ct's showed overall large mass having shrunk in size, but increase in the number of pulmonary nodules. thus, she was changed to taxotere and received 3 cycles but then developed a rash on her hands and feet, neuropathy, and increased sob so this was stopped. she has recently decided to enroll in a clinical trial but has not yet started chemotherapy treatment. this was due to start on thursday with alimta, bevacizumab, and oxaliplatin. she is on folic acid and received vitamin b12 shot last week in anticipation for starting therapy. . ros: also c/o white, non-painful spots in mouth for the last 2 days. had 3 episodes of diarrhea a few days ago - last was 2 days pta. last bm yesterday which was nml. denies hematemesis, dark stools, bloody stools. no other bleeding. past medical history: -nsclc as above -htn -hypercholesterolemia -seasonal allergies -pelvic inflammatory disease -lipoma -genital warts -seasonal allergies social history: works at as administrator, lives with son and grandson, mother of 2 with 4 grandchildren, no etoh use, +smoking, however down to 4-5cigs a day, not sexually active. family history: thalasemia, g6-pd defciency, breast ca in aunt at age 60, father died of lung ca, no cad/dm physical exam: vs: 99.2, hr 127, bp 138/71, rr 44 (19-40), o2sat 95% on 2l nc, wt 60.7kg. pulsus: (although difficult to auscultate given tachypnea) gen: sitting in bed, visibly tachypneic, becomes more sob upon talking. no use of accessory muscles. heent: perrl, mmm chest: + absent breath sounds over middle and lower l lung. crackles at base of r lung. cv: tachy, regular, no murmurs or rubs. no jvd. abd: soft nt/nd, +bs with +lipoma on right iliac crest ext: no edema. neuro: non-focal. pertinent results: cta: 1. pulmonary embolus at the right lower lobe. 2. increased bilateral pleural effusions, large on left. 3. diminished aeration of the left lung, obscuring known carcinoma. while there is certainly atelectasis present, coincident pneumonia cannot be excluded. 4. small right-sided pulmonary nodules minimally changed. 5. new areas of narrowing in the left main bronchus and the left upper lobe bronchus. 6. small pericardial effusion. . head ct: 1. no evidence of acute intracranial hemorrhage. 2. unchanged appearance of the brain compared to , with evidence of chronic microvascular infarction. . echo : 1. the left atrium is dilated. 2. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). 3. a huge pleural effusion is present. 4. there is a small, loculated (mostly anterior and medial) pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. . portable ap chest: there is near complete opacification of the left lower lobe and probably a combination of effusion and left lower lobe atelectasis. there is also opacification of the left upper lobe with probable increase in loculated effusion. partial aeration of the lingula. the right lung field is clear. heart size cannot be assessed. . ecg: sinus tachy at 135. nl intervals, nl axis, +lae, no st/t abnmlities. no rv strain. . cta 1. pulmonary embolus at the right lower lobe. 2. increased bilateral pleural effusions, large on left. 3. diminished aeration of the left lung, obscuring known carcinoma. while there is certainly atelectasis present, coincident pneumonia cannot be excluded. 4. small right-sided pulmonary nodules minimally changed. 5. new areas of narrowing in the left main bronchus and the left upper lobe bronchus. 6. small pericardial effusion . leni impression: no evidence of deep vein thrombosis. . pcxr there is continued large loculated left pleural effusion with near total opacification of the left lung. the patient's known carcinoma in the left lung is obscured. there is continued small right pleural effusion. the right lung appears clear, otherwise. no pneumothorax is identified. brief hospital course: 63 yo f with non small cell lung cancer (nsclc) status post chemo and radiation who presented with worsening dyspnea and intermittent chest pain. her dyspnea was multifactorial due to a diagnosed pulmonary embolism, increased left sided pleural effusions, left lung consolidation and a new area of narrowing noted in the left main bronchus that was initially concerning for external compression. 1. malignant effusion the ip team initially performed a thoracentesis that removed 1l of bloody fluid that was positive for malignant cells. the ip then subsequently performed a throscopy in order to attempt complete drainage of the pleural effusion and talc pleurodesis. during the procedure it was noted that the pt had multiple loculated effusions and an irregular appearing pleural surface which would make it ineffective for successful pleurodesis to occur. the procedure was complicated by a loculated hemothorax. ct surgery was consulted and subsequently the patient underwent a vats with removal of a large clot (coagulated blood from hemothorax), lysis of adhesions and placement of a chest tube and a pleurex catheter. the pt's oxygenation was noted to gradually improve but she was informed of the low likelihood of successful pleurodesis. the chest tube was removed, and with the pleurex catheter still in place, the pt was transferred to the . pt subsequently had her pleurex catheter drained twice while she was an inpatient, and was sent home with close follow up in ct clinic for prn pleurex catheter drainage as needed. . 2. pulmonary embolism: the pt was noted to have a filling defect at an early bifurcation to the posterior basilar segment of the right lower lobe on cta on initial presentation. this pe was likely secondary to her hypercoagulable state due to the underlying malignancy. the pt was treated with a heparin drip and was transitioned to lovenox. pt was started on coumadin, and due to complications with securing lovenox on her weekend of discharge, the patient was placed on a once daily fondaparinux 7.5mg qd bridge until therapeutic on her coumadin. pt was to have an inr check the monday after discharge. . 3. narrowing of l main bronchus: a chest ct on admission revealed a lul collapse with concern of left main bronchus compression. the consolidation/collapse could have represented atelectasis vs. post-obstructive pneumonia, and patient was placed on levaquin/flagyl for empiric post-obstructive pna coverage. the pt then underwent a flexible bronchoscopy which showed a near total collapse of the left main stem bronchus with passive exhalation (extrinsic) and complete collapse of left upper lobe bronchus which the ip team thought that was due to extrinsic compression of the bronchi by the pleural effusion. an attempt was made to aerate the lung by ip but the procedure was not successful. because patient remained afebrile with a normal wbc, her abx were discontinued as the consolidation likely represented atelectasis. . 4. echo dense pericardial effusion: the pt was noted to have a small, loculated (mostly anterior and medial) pericardial effusion. the effusion was noted to be echo dense, consistent with blood, inflammation or other cellular elements. patient had a normal pulsus paradoxus, and no rv strain or tamponade physiology was seen on echo. no further intervention was undertaken. . 5. persistant tachycardia: the pt was noted to have stable tachycardia (likely from pe and hypoxia) that persisted throughout her hospitalization. despite patient oxygenating well on 4l nc, her tachycardia persisted. pt was instructed to f/u with her pcp as an outpatient to ensure this resolves. . 6. history of htn: the pt's bp remained stable without medications. . 7. nsclc: in the pt presented with cough x 1 month. a cxr at the time showed a left upper lung mass. a bronchoscopy showed adenocarcinoma that was felt to be unresectable as it was invading the mediastinum. the pt has been treated by dr. (in medical oncology) with cisplatin and etoposide x 2 cycles and repeat ct's have shown an overall decrease in size of the mass, but increase in the number of pulmonary nodules. thus, the pt was changed to taxotere and received 3 cycles but then developed a rash on her hands and feet, neuropathy, and increased shortness of breath so this chemotherapeutic was stopped. she has recently decided to enroll in a clinical trial but has not yet started chemotherapy treatment. this new regimen comprises of alimta, bevacizumab, and oxaliplatin. she was on folic acid and received vitamin b12 shot a week prior to admission, in anticipation for starting therapy. however, it was decided that initiation of the new chemo regimen will be deferred to an out-patient follow-up with dr. . . dispo - full code. patient was discharged on 4l nc, and on fondaparinux bridge until therapeutic on coumadin. pt is to f/u with her oncologist dr. . medications on admission: meds at home: aspirin 325 daily b6 multivitamin tylenol prn . meds on transfer: ambien 5mg qhs prn dolasetron prn flagyl 500mg tid levo 50mg daily folate 1mg daily pantoprazole 40mg daily aspirin 325 daily nystatin suspension qid mvi acetaminophen heparin gtt discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. pyridoxine 50 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. multivitamin capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. disp:*30 tablet(s)* refills:*0* 6. warfarin 4 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 7. fondaparinux 7.5 mg/0.6 ml syringe sig: one (1) injection subcutaneous once a day for 1 weeks. disp:*7 injections* refills:*0* 8. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 9. home oxygen please provide a portable oxygen tank to provide home oxygen at 4liters/min discharge disposition: home with service facility: homecare discharge diagnosis: primary: non-small cell lung cancer pulmonary embolus lul collapse left pleural effusion s/p thoracentesis, thorascopy, vats c pleurodeisis, and pleurex catheter placement discharge condition: stable discharge instructions: plesae report to the nearest emergency department if you have fever, chills, nausea, vomiting, diarrhea, greater difficulty breathing or pain. . there has been a change in your medications - please take them as below. . you have been scheduled for some follow-up appointments. please have the vna check your inr (coumadin level) on monday - fax results to dr. office. followup instructions: provider: . (works with dr. ). date/time: at 4:00pm. . provider: . . phone: ( md procedure: insertion of intercostal catheter for drainage insertion of intercostal catheter for drainage fiber-optic bronchoscopy fiber-optic bronchoscopy thoracentesis thoracentesis thoracentesis thoracentesis other incision of pleura injection into thoracic cavity transfusion of packed cells transfusion of other serum diagnoses: pure hypercholesterolemia unspecified essential hypertension other pulmonary insufficiency, not elsewhere classified secondary malignant neoplasm of pleura pulmonary collapse other specified cardiac dysrhythmias malignant neoplasm of upper lobe, bronchus or lung hypoxemia other pulmonary embolism and infarction other specified diseases of pericardium secondary hypercoagulable state 

Answer: The patient is high likely exposed to