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: patient recorded as having no known allergies to drugs attending: chief complaint: metastatic breast cancer major surgical or invasive procedure: nasogastric tube placement history of present illness: patient is a 71 year old female with metastatic breast cancer to liver, bone, and brain/spine with h/o cord compression, treated in , who presents from for worsening ble weakness. history is from medical records and daughter. she came from for xrt; she had completed chemo in . her daughter brought her to . mri performed in reportedly showed) showed multiple small metastases and likely leptomeningeal spread. on , she was seen in rad clinic. the patient is having more difficulty walking (which has been since , treated with xrt to spine), facial droop since early , difficulty with vision on l side early . the patient started whole brain radiation that visit. after wbt, she started to have slurred speech, difficulty swallowing, and hallucinations. then the patient was referred to the ed for spine scans, iv hydration and a swallowing study. dr. from medical oncology has already met with the patient and will be the consult attending upon admission. xrt will continue daily wbrt and follow the patient while in-house. in the ed, initial vs were: 98.3 80 112/87 18 97. exam was notable for l facial droop, inability to gaze upward on r side, bilateral weakness in lower extremities, good rectal tone. labs were notable for wbc 19.7. mri showed "incomplete exam, patient unable to tolerate study. limited images through the cervical and most of the thoracic spine demonstrate no gross cord compression or canal stenosis. limited assessment of spinal cord itself, with no large area of signal abnormality. multiple vertebral body lesions are compatible with known metastatic disease, with mild anterior wedging of t7 but no large fracture identified." ct head showed "no ich or infarct (mri more sensitive for acute infarct). stated brain mets not well evaluated. fluid or mucosal thickening right sphenoid air cell, otherwise clear sinuses." she is now delirious. of note, she received ativan for her mri. u/a was neg. cxr showed possible pneumonia. the patient received ctx. dr. to be consulted in am. vitals prior to transfer to the floor were: 96.9, 77, 132/82, 95% on 2l for comfort. on , code blue was called while patient was in the rad-onc suite. she was found unresponsive in a wheelchair with some vomit on the side of her mouth. carotid pulse could not be felt initially but once flat had a good pulse and was moving around. bp 128/86, p 80s sat 100% on nrb. upon arrival to the icu, she denied pain, shortness of breath, nausea, or other symptoms. she remembered vomiting in the radiation oncology suite, but did not remember losing consciousness. her daughter felt her mental status was clearer than the prior day. . in the icu, her abx regimen was vancomycin, cefepime, and metronidazole for aspiration pneumonia. she was able to converse with her daughter. a showed ?question sbo although it showed contrast in tranverse colon. her abdomen was tender on the morning of but the tenderness then resolved. an ngt was placed. she was kept npo and received ivf. she was continued on dex 4 mg q6h for her brain mets. speech and swallow was consulted and recommended a video swallow, which has not been done. she has had mild hyponatremia, thought to be due to siadh. past medical history: per omr, - metastatic breast cancer, r, dx in , "treated with modified radical mastectomy, right breast at by dr. followed by reconstruction by dr . had consults with dr and dr . chemo recommended, done in . developed bone pain in back and legs, no scans done. ct abd revealed liver mets. further workup in , widespread mets to bones, liver, brain. chemo started. had back pain and bilat leg weakness. treated with xrt to t-7 to ls spine - . daughter visited to assess status of mother. noted left sided facial droop, speech changes. brain scan , brain mets worsening. both flew back to mass for further treatment." - hypercholesteremia - htn - "irreg heart rhythm" not atrial fibrillation social history: she is of descent. she has two grown children, four grandchildren. she lives in , , and is presently living with daughter and family in . she does not smoke. she was a social drinker prior to her diagnosis. family history: sister with breast cancer. maternal grandmother brain cancer. mother died young of unknown cause. physical exam: vitals: 96.9, 133/87, 75, 14, 100ra gen: asleep, extremely difficult to arouse heent: per, l constricts less to light compared to r, unable to assess eom, cannot pry open mouth, sclera anicteric, not injected neck: no lad cardiovascular: rrr normal s1, s2, no murmurs appreciated respiratory: clear to auscultation bilaterally, no wheezes, rales or rhonchi abd: normoactive bowel sounds, soft, non-tender, non distended extremities: no edema, 2+ dp pulses neurological: noncooperative, babinski down-going bilaterally integument: warm, moist, no rash or ulceration pertinent results: admission labs: 08:20pm wbc-19.7*# rbc-5.00 hgb-14.4 hct-45.9 mcv-92 mch-28.9 mchc-31.4 rdw-17.8* 08:20pm neuts-84* bands-0 lymphs-10* monos-6 eos-0 basos-0 atyps-0 metas-0 myelos-0 08:20pm plt smr-high plt count-490*# 08:20pm glucose-151* urea n-25* creat-0.7 sodium-131* potassium-4.2 chloride-94* total co2-26 anion gap-15 01:15am lactate-1.9 mri spine--prelim: incomplete exam, patient unable to tolerate study. limited images through the cervical and most of the thoracic spine demonstrate no gross cord compression or canal stenosis. limited assessment of spinal cord itself, with no large area of signal abnormality. multiple vertebral body lesions are compatible with known metastatic disease, with mild anterior wedging of t7 but no large fracture identified. ct head: impression: 1. no intracranial hemorrhage or evidence of acute infarct. mri is more sensitive for the detection of acute infarct. 2. known brain metastases not well evaluated. multifocal hypodense region in the convexities may represent edema in the setting of occult metastasis. recommend correlation with outside hospital imaging if available, or further evaluation with mri. 3. fluid or mucosal thickening within the right sphenoid air cell, with a chronic appearance. ct abdomen/pelvis:impression: 1. exam interpretation limited by dense barium within the entire colon. there is hydronephrosis and hydroureter on the right, increased compared with comparison outside ct, with a point of relative decompression at the pelvic inlet. recommend urologic consultation for further management. 2. multiple hypodensities seen within the liver, similar in appearance in comparison with prior. vessels are seen coursing through this, which is not a typical appearance for metastasis, and recommend correlation with prior imaging studies if available. these imaging findings may represent treated disease. 3. air in bladder, recommend correlation with recent instrumentation. 4. small bilateral pleural effusions. 5. diffuse osseous metastases. video swallow:impression: penetration is seen on nectar and thin liquids. no aspiration seen. for further details, please refer to full report on omr. brief hospital course: aspiration pna: admitted for altered mental status with possible aspiration pneumonia. she was started on broad spectrum antibiotics vanc, cefepime, and continued on flagyl for colitis. she was kept npo after she failed a speech and swallow exam. she remained hemodynamically stable and an cxr from showed interval improvement from the previous study. dysphagia: patient originally failed speech and swallow, but passed videography study of speech and swallow. she was kept npo, and given maintenance fluid. she started eating well, but kept npo due to intractable nausea. hospice care was ok with her going with ng tube. hyponatremia: thought to be siadh and secondary to brain mets. this resolved over the course of hospital stay once the patient was transferred out of icu. # constipation: patient is constipated upon admission, with exam tenderness to palpation, as well as by abdominal x-ray, which appears to show retained contrast from a prior study within the colon, as well as a dilated loop of bowel. she had one episode of bilious emesis, and her ngt was placed on suction. a study had been suggestive of possible obstruction, but she passed stool prior to being transfered to the floor. while on the floor ng tube was pulled for a trial because suregery did not feel that this was sbo, but etiology was not clear and could be secondary to diffuse metastatic disease. patient is to go to hospice care with ng tube in place. # metastatic breast cancer: patient started to receive radiation therapy as an inpatient. # recent colitis: had been on a 12 day course of cipro/flagyl, started on and completed it prior to discharge. patient will go to hospice care from this facility. medications on admission: dexamethasone 4 mg q 6 hrs metoprolol 25 mg daily triamterene-hctz 37.5-25 mg daily metronidazole 500 mg q8 for "irritable colitis," started x 12 days cipro 500 mg asa 81 mg daily zofran 8 mg prn culturelle discharge medications: 1. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for sleep. disp:*7 tablet(s)* refills:*0* 2. lidocaine hcl 2 % solution sig: twenty (20) ml mucous membrane tid (3 times a day) as needed for mouth pain. disp:*150 ml(s)* refills:*0* 3. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every 6-8 hours as needed for nausea. disp:*20 tablet, rapid dissolve(s)* refills:*0* 4. bisacodyl 10 mg suppository sig: one (1) suppository rectal once (once). disp:*7 suppository(s)* refills:*0* 5. reglan 10 mg tablet sig: one (1) tablet po every six (6) hours. disp:*30 tablet(s)* refills:*0* 6. dexamethasone 4 mg tablet sig: one (1) tablet po once a day. disp:*7 tablet(s)* refills:*0* 7. zofran odt 4 mg tablet, rapid dissolve sig: tablet, rapid dissolves po every eight (8) hours as needed for nausea. disp:*21 tablet, rapid dissolve(s)* refills:*0* 8. hospice please screen and admit to hospice discharge disposition: home with service facility: hospice discharge diagnosis: metastatic breast cancer/aspiration pneumonia discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , you have been admitted to our facility for the treatment of your possible pneumonia after you were found unresponsive while receiving radiation therapy. your abdominal discomfort, complicated with nausea/vomiting has been treated medically, as well as by placing a nasogastric tube into your stomach to prevent you from vomiting again. the tube will stay in place for now. a decision was made to transition your care to hospice. your daughter will be taking you to hospice care today. the following changes have been made to your medication regimen: 1. trazodone 50 mg tablet at bedtime as needed for sleep. 2. lidocaine hcl 2 % solution twenty (20) (3 times a day) as needed for mouth pain. 3. olanzapine 5 mg tablet, rapid dissolve one (1) tablet every 6-8 hours as needed for nausea. 4. bisacodyl 10 mg suppository one (1) suppository rectal as needed for constipation. 5. reglan 10 mg tablet sig: one (1) tablet po every six (6) hours. 6. dexamethasone 4 mg tablet sig: one (1) tablet po once a day. 7. zofran odt 4 mg tablet, rapid dissolve tablet, every eight (8) hours as needed for nausea. please take these medications as prescribed. followup instructions: hospice care md, procedure: other radiotherapeutic procedure diagnoses: malignant neoplasm of liver, secondary unspecified essential hypertension long-term (current) use of steroids personal history of malignant neoplasm of breast other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus secondary malignant neoplasm of brain and spinal cord paralytic ileus hypoxemia other disorders of neurohypophysis chronic vascular insufficiency of intestine secondary malignant neoplasm of bone and bone marrow personal history of antineoplastic chemotherapy paroxysmal supraventricular tachycardia coma communicating hydrocephalus myelopathy in other diseases classified elsewhere unspecified psychosis dysphagia, oropharyngeal phase facial weakness late effects of cerebrovascular disease, disturbances of vision unspecified visual disturbance other musculoskeletal symptoms referable to limbs other speech disturbance neoplasm of unspecified nature of bone, soft tissue, and skin 

Answer: The patient is high likely exposed to