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: sulfa (sulfonamides) / percocet attending: chief complaint: fever, neutropenia, and swollen, painful left elbow major surgical or invasive procedure: picc line placement history of present illness: 61-year-old right-handed woman with glioblastoma multiforme, s/p subtotal resection on , involved-field cranial xrt, and chemotherapy (last taken on ). she developed a fever to 102 f, hypotension to sbp 90s today, and came to our emergency room. husband first noted left elbow 3-4 weeks ago which resolved in 2 days after application of neosporin (there was a question of spider bite). then 3 days ago she noted erythema which increased and associated with increasing edema and tenderness. today, the patient was practically unable to move elbow due to pain. she experienced fever and chills that began yesterday, but she did not take her temperature. her review of system is notable for a new dry cough x 6 days. she also developed diarrhea but stopped 3 days ago when she stopped taking colace. she has fatigue but no sob, congestion, abdominal pain, dysuria, bright red blood per rectum, or melena. there was no trauma to elbow. there was no recent sick contacts or travel. regarding her oncologic history, her symptoms began in late with headache, word-finding difficulties, memory loss, and confusion. she was found to have a left parietal brain lesion. after subtotal resection on , underwent involved-field xrt with concurrent temozolomid. she also received 1 treatment with cyberknife radiosurgery to an enhancing lesion in the right occipital lobe, together with temozolomide. in the emergency room, her temperature was 102.6 f, hr 130s (sinus tachycardia), and systolic bp 90s-100s (baseline sbp 120s-130s). her wbc was 0.3 with no neutrophils or bands. her u/a showed no wbc but there was nitrates and bacteria. her serum lactate was 3.9. blood and urine cultures were sent. her chest cta was negative for pulmonary embolism, but there was mild left lung apical patchy ground-glass opacity; there was a question of atelectasis versus pneumonia. she received oxygen at 7 liters via nasal cannula in the emergency room but her systolic bp persisted in 90s-100s. emergency department did not start on sepsis protocol because her serum lactate was not > 4 and she was responsive to fluid, despite the elevated temperature, heart rate, and wbc. past medical history: glioblastoma multiforme of left temporoparietal lobe anxiety social history: never smoked, drinks alcohol on rare occasions. lives with husband. worked as secretary. family history: father had lung cancer. mother had disease. her siblings are all healthy. she has 1 son and 1 daughter, and both of them are healthy. physical exam: physical examination: vital signs: temperature 102.6 f in emergency department; current temperature 100.2 f; heart rate 108; blood pressure 106/56; respiratory rate 16; oxygen saturation 99% on 2 liters. gen: cushingnoid faced woman, fatigued appearing, otherwise in no acute distress lying in bed heent: perrla, eomi, anicteric, pale conjunctival membranes, dry mucous membranes, +scars on scalp from prior neurosurgery neck: no lad cv: rrr tachycardic, nl s1, s2 no m/r/g pulmonary: cta bilaterally abdomen: nabs, soft, nt/nd, well-healed vertical incision extremities: lue elbow has 5-cm area of erythema, warmth, mild fluctuance, and tenderness to palpation. she is unable to abduct at elbow more than 5 degrees secondary to pain. her lower extremities are cool, without c/c/e. she has 2+ dorsalis pedis pulses bilaterally neurologic examination: her mental status is intact. she is awake, alert, and oriented x 3. her language is fluent with good comprehension. cn ii-xii are intact. her motor strength is motor in rue; lue examination limited due to pain at elbow. in the lower extremities, she has 4-/5 strength bilaterally at thigh flexors, 5/5 strength at quadriceps, hamstrings, foot dorsiflexion, and plantar flexion. her reflexes are 2- but her ankle jerks are absent. she has downgoing toes. sensory examination reveals normal sensory examination. coordination examination does not reveal dysmetria. her gait is steady. she does not have a romberg. pertinent results: 12:10pm wbc-0.3* rbc-4.61 hgb-14.8 hct-41.3 mcv-90 mch-32.1* mchc-35.8* rdw-13.9 12:10pm neuts-0* bands-0 lymphs-65* monos-35* eos-0 basos-0 atyps-0 metas-0 myelos-0 12:10pm hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-normal microcyt-1+ polychrom-occasional 12:10pm plt smr-low plt count-140* 12:10pm pt-13.5* ptt-24.5 inr(pt)-1.2 12:10pm sed rate-70* 12:10pm glucose-114* urea n-14 creat-0.6 sodium-138 potassium-3.4 chloride-101 total co2-24 anion gap-16 12:10pm alt(sgpt)-35 ast(sgot)-22 alk phos-88 tot bili-0.6 01:05pm lactate-3.9* 01:07pm ck-mb-notdone ctropnt-<0.01 01:07pm crp-67.5* 01:07pm ck(cpk)-11* 02:08pm urine rbc-0 wbc-0 bacteria-mod yeast-none epi-0-2 02:08pm urine blood-neg nitrite-pos protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 02:08pm urine color-straw appear-clear sp -1.023 l elbow xray : four radiographs of the left elbow demonstrate no joint effusion. no fracture. no cortical fragmentation to suggest osteomyelitis. regional soft tissues are unremarkable. impression: unremarkable radiographs, left elbow. mri of l elbow: mr left elbow without contrast: there is a moderate elbow joint effusion. the bone marrow appears normal in signal intensity characteristics. there is circumferential edema within the subcutaneous tissues about the elbow. there is fluid signal intensity in the region of the olecranon bursa, suggestive of bursitis. there is more confluent high signal intensity surrounding the musculature at the elbow joint. it is not clear if this represents dense edema or frank fluid, as this study is limited without intravenous contrast. also noted is diffuse increased signal intensity within the musculature about the elbow, suggestive of myositis. impression: 1. moderate elbow joint effusion. 2. diffuse increased signal intensity within the musculature about the elbow, consistent with nonmyositis. 3. olecranon bursitis. 4. edema within the subcutaneous tissues about the elbow, suggestive of cellulitis. ct of the chest: there are no significant axillary, mediastinal, or hilar lymph nodes. there is a small hypodense area in the left lobe of the thyroid measuring 1.2 x 0.8 cm. ultrasound could be performed for further evaluation. there is no pericardial effusion. the heart is of normal size. the great vessels are unremarkable. there is no evidence of aortic dissection. there is fluid in the pericardial recess anterior to the aorta, which is unchanged when compared to prior study. the pulmonary artery is normal size. there are no filling defects in the pulmonary artery branches. there is no evidence of pulmonary embolism. the airway is patent to level of subsegmental bronchi. there are subsegmental atelectasis in the right middle lobe and lower lobes. there are emphysematous changes in the lungs. there is a patchy ground-glass opacity in the left upper lobe near the apex that is new when compared to the prior study and of unclear significance. it most likely represents an area of pneumonia. there are no pleural effusions. limited images of the upper abdomen do not reveal significant abnormality. impression: 1. no evidence of pulmonary embolism. 2. emphysema. 3. subsegmental atelectasis. 4. small patchy ground-glass opacity in the left apex of unknown clinical significance. it could representa small focus of pneumonia. it is new when compared to the prior study from , . attention on follow to confirm resolution is recommended. ekg : sinus tachycardia modest diffuse nonspecific st-t wave abnormalities since previous tracing of , sinus tachycardia rate slower and st-t wave abnormalities are less prominent 1:20 pm swab source: left elbow bursa pus. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. wound culture (final ): staph aureus coag +. rare growth. please contact the microbiology laboratory () immediately if sensitivity to clindamycin is required on this patient's isolate. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin-------------<=0.25 s penicillin------------ =>0.5 r anaerobic culture (final ): no anaerobes isolated. bcx : no growth (final) bcx : no growth (final) brief hospital course: this is a 61-year-old woman with glioblastoma multiforme, s/p involved-field xrt, surgery, involved-field cranial irradiation, and chemotherapy presented with neutropenic fever, left elbow bursitis/cellulitis, uti, and possible pneumonia on chest ct. 1. neutropenic fever/hypotension: in the , the patient was aggressively fluid resuscitated, and her blood pressure responded without any pressor. sources of infection included left elbow bursitis/cellulitis, pneumonia, and uti. in the setting of neutropenic fever, the patient was started on broad spectrum antibiotics with vancomycin, ceftazidime, and azithromycin (for atypical pneumonia), as well as gentamicin x 1 dose in context of continued destabilization and need for double gram negative coverage. central venous pressure improved to over the course of 48 hours, and blood pressures stabilized. patient had no more fever. patient received stress dose steroids as well as neupogen. orthopedics was consulted for her left elbow bursitis/cellulitis. x-ray and mri did not reveal osteomyelitis. orthopedics felt that possible bursitis; however, symptoms improved with antibiotics. on transfer to the omed service, the patient was afebrile and hemodynamically stable. she was continued on neupogen, vancomycin, ceftazidime, and azythromycin. on , given her enterococcal uti is pansensitive and the patient no longer neutropenic, vancomycin and ceftazidime were discontinued and cefazolin iv was started to cover both enteroccocus and left elbow cellulitis. neupogen was discontinued on . azythromycin was discontinued after completion of 7 day course on . also, on , the left elbow had increased warmth and erythema as well as enlargement of fluid sac. also, patient's wbc increased despite the discontinuation of neupogen was disproportionately high with a presence of dohl bodies and toxic granulations on smears suggestive of undertreated or persistant infection. thus, cefazolin was discontinued, and vancomycin was restarted on . the left elbow responded well to vancomycin and the fluid sac broke open spontaneously, draining pus. the patient had a picc line placed in her right arm and was discharged with 10 more days of vancomycin to finish a 2 week course. 2. hypoxia: the paitnet required o2 supplement temporarily. cxr showed small bilateral pleural effusions and atelectasis. with incentive spirometry use, the patient's sat improved to 95% on ra. 3. glioblastoma multiforme: chemotherapy was held. continued on keppra and decadron. given on steroids, fs blood glucose was checked 4 times daily and they were mostly in the 100's, not requiring a long acting insulin. 4. transaminitis: she had elevated ast and alt from . rechecked and was normal. 5. anxiety: lorazepam prn helped. 6. prophylaxis: sliding scale insulin and finger stick blood glucose given on steroids; ppi, subcutaneous heparin, and bowel regimen were administered as well. 7. fen: regular diet 8. full code: patient does not want prolonged intubation if m.d.s think poor recovery. medications on admission: decadron 4 mg p.o. tid keppra 1000 mg p.o. protonix 40 mg p.o. colace 100 mg p.o. lorazepam 1 mg p.o. p.r.n. percocet 1-2 tablets p.o. p.r.n. g-csf 300 mcg x 10d, started 2d ago pentamidine, aerosolized temodar chemotherapy discharge medications: 1. saline flush 0.9 % syringe sig: five (5) ml injection sash as needed for flushing for 10 days. disp:*qs for 10 days * refills:*0* 2. heparin flush 100 unit/ml kit sig: three (3) ml intravenous sash as needed for iv abx therapy for 10 days. disp:*qs for 10 days * refills:*0* 3. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. dexamethasone 4 mg tablet sig: one (1) tablet po q8h (every 8 hours). 7. vancomycin 1,000 mg recon soln sig: one (1) gm intravenous q 12h (every 12 hours) as needed for for cellulitis/bursitis for 10 days. disp:*qs for 10 days gm* refills:*0* discharge disposition: home with service facility: healthcare discharge diagnosis: left elbow bursititis/cellulitis urinary tract infection dehydration glioblastoma multiforme discharge condition: afebrile, no longer neutropenic, improved left elbow and feeling good. discharge instructions: return to the emergency department or call dr. if you develop fever, chills, nausea, vomiting, worsening pain or redness in your left elbow, chest pain, shortness of breath, or any other concerning symtpoms. take your medications as instructed. keep your follow up appointments. followup instructions: provider: mri phone: date/time: 12:15 provider: , md phone: date/time: 2:00 procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified anemia, unspecified urinary tract infection, site not specified unspecified septicemia sepsis pulmonary collapse anxiety state, unspecified malignant neoplasm of parietal lobe cellulitis and abscess of upper arm and forearm antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use dehydration home accidents effusion of joint, upper arm 

Answer: The patient is high likely exposed to