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 61 year old female with a history of small cell lung cancer diagnosed in , status post chemotherapy, radiation therapy including prophylactic whole brain irradiation and stem cell rescue, also with a history of chronic obstructive pulmonary disease on home oxygen and recurrent right sided pleural effusion who presented to the clinic on the day of admission with increasing shortness of breath. the patient was sent to the emergency department from the clinic where she was found to be saturating in the 90s on 100 percent nonrebreathing. a right sided thoracentesis was done with removal of 600 cc of serous fluid which initially improved the patient's oxygen saturation. however, the patient subsequently desaturated again on the nonrebreather requiring intubation. the patient's daughter reported that she has had increased agitation and somnolence as well as green/ sputum over the past seven days. she had been started on levofloxacin without significant improvement in the sputum production. on the day prior to admission she developed increased somnolence and lethargy prompting her visit to clinic. she received ceftriaxone and azithromycin. past medical history: small cell lung cancer diagnosed in , status post radiation, chemotherapy, stem cell rescue, prophylactic brain radiation. chronic obstructive pulmonary disease. hypothyroidism. atypical pneumonia. recurrent right pleural effusion. mental status changes. social history: the patient has been married for 38 years. her daughter is a nurse . she is a former smoker and quit 70 pack years. she quit in . she denies any alcohol or drug use. family history: is significant for mother diabetes and father with hypertension. medications on admission: synthroid 100 mcg q.d., celebrex, serevent, atrovent, albuterol, home oxygen, levofloxacin 500 mg q.d. no known drug allergies. physical examination: on admission temperature 98, blood pressure 127/63, heart rate 126, respiratory rate 22, saturating 90 percent on 100 percent non-rebreather. in general this is an ill appearing woman in respiratory distress. head, eyes, ears, nose and throat examination: mucous membranes slightly dry, extraocular movements intact. jugular venous distension was 6 cm. cardiac examination: tachycardic with a regular rhythm, no murmurs, rubs or gallops. lung examination: coarse breath sounds throughout with decreased breath sounds on the right. abdomen was soft, nontender, nondistended with normoactive bowel sounds. extremities revealed 1+ lower extremity edema bilaterally. neurologically alert and responsive. laboratory data: on admission: cbc revealed a white count of 15.6 with 81 percent neutrophils, hematocrit was 39.1, platelet count 321. chem-7 revealed a sodium of 137 with potassium of 5.9, chloride of 93, bicarbonate of 38, bun of 18, creatinine of 0.4 and glucose of 106. pleural fluid showed 1335 white blood cells and red blood cells. total protein was 4.1, glucose was 111 and albumin was 1.1. electrocardiogram showed sinus tachycardia at 132 with normal axis and normal . there were no st or t wave changes. there were q waves in 3 and avf. chest x-ray showed a large right pleural effusion with right lower lobe collapse. her endotracheal tube was in place. hospital course by problems: 1. respiratory failure: patient was intubated in the emergency department. her respiratory failure was felt to be multifactorial with the pleural effusion and sizable lobar collapse playing a large role. she was also treated for possible pneumonia and had bronchoscopy with bal done on both and . bal grew pansensitive pseudomonas and she was treated for this initially with ceftriaxone and azithromycin and then subsequently with ceftazidime to complete a 14 day course. given her underlying lung disease including bronchiectasis and severe chronic obstructive pulmonary disease, it was felt that she would likely have a long wean off the ventilator. she therefore underwent tracheostomy on . she was initially maintained on pressure controlled ventilation and was eventually able to be weaned from pressure support mode. she is currently tolerating 10 of pressure support with 5 of peep and an fio2 of 0.4. on those settings she is pulling tidal volumes in the 300s and saturating 96 to 98 percent. we did consider chest tube placement to treat her effusion. however, the patient was oxygenating and ventilating well and this was therefore deferred. 1. pneumonia: as stated above patient was felt to likely have an underlying pneumonia as the source of her acute decompensation. she was treated with ceftazidine for pseudomonas pneumonia and will complete a 14 day course. she also received chest physical therapy and suctioning p.r.n. 1. small cell lung cancer: cytology from both her bal and from her pleural fluid were negative for malignant cells. at this time there is no evidence of disease recurrence. 1. hypothyroidism: the patient was continued on her home dose of synthroid. given her persistent tachycardia a tsh and free t4 were checked and are pending at the time of this dictation. 1. tachycardia: the patient was persistently tachycardic throughout her admission. this was initially felt to be secondary to volume depletion. however, this did not resolve with intravenous fluids. she underwent an echocardiogram which showed depressed left ventricular ejection fraction and was started on an ace inhibitor for afterload reduction. as mentioned above thyroid function tests were also checked given her history of hypothyroidism and are currently pending. 1. fluids, electrolytes and nutrition: the patient had a dobhoff tube placed and has been on tube feeds since admission. a speech and swallow evaluation is pending. 1. metabolic alkalosis: this is felt to be compensatory for the patient's primary respiratory acidosis from her chronic obstructive pulmonary disease. a urine chloride was checked and was 112 suggesting that her metabolic alkalosis was not chloride responsive. 1. access: patient had a right subclavian vein and right radial arterial line which were both discontinued prior to discharge. a picc line was placed by interventional radiology. 1. prophylaxis: the patient was maintained on subcutaneous heparin, venodynes and proton pump inhibitor. 1. hyperglycemia: the patient was on an insulin sliding scale with good glycemic control throughout her admission. discharge diagnoses: 1. respiratory failure. 2. history of small cell lung cancer. 3. recurrent pneumonia, now pseudomonas. 4. recurrent right pleural effusion. 5. chronic obstructive pulmonary disease. 6. hypothyroidism. discharge medications: ceftazidime 2 grams intravenous q 8 hours times four days, vibrazole 30 mg q.d., flovent 110 mcg 4 puffs b.i.d, atrovent 2 puffs q.i.d., albuterol 2 puffs q 2 hours, heparin subcutaneously 5,000 units b.i.d, levoxyl 125 mcg p.o. q.d., tylenol 325 mg 1 to 2 tablets p.o. q 4 to 6 ours p.r.n., colace 100 mg p.o., b.i.d, senna 1 tablet p.o. q.h.s., captopril 25 mg p.o. t.i.d., humalog insulin sliding scale. discharge plan: patient will follow up with her primary care doctor, dr. , and was instructed to follow up with her pulmonologist, dr. in one to two weeks. she is being discharged to rehabilitation where her ventilator will be weaned as tolerated. , dictated by: medquist36 d: 20:20:02 t: 21:22:44 job#: procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy closed [endoscopic] biopsy of bronchus diagnoses: acidosis unspecified pleural effusion unspecified protein-calorie malnutrition unspecified acquired hypothyroidism pulmonary collapse acute and chronic respiratory failure pneumonia due to pseudomonas alkalosis bronchiectasis with acute exacerbation 

Answer: The patient is high likely exposed to