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: dyspnea major surgical or invasive procedure: pleurex catheter placement (right) - history of present illness: this is a 44 year old female with a history of metastatic lung cancer w lg clot burden sp ivc/svc picc who presents with 2 days of increased sob and worsened facial swelling since recent discharge. she was admitted from to for recurrent pleural effusion with l sided pleurex placement, pericardial effusion s/p balloon pericardiotomy then 2 pericardial windows w internal drainage, and extensive clot burden. vna removed 150cc from pleurex cath yesterday. her vna drained additional 200cc from the pleurex yesterday with some improvement, but her symptoms worsened today. . in the ed, initial vs were: 98.6 118 128/72 20-30 97% 2l nc. cxr showed new r sided pleural effusion. echo showed small effusion. ip and cardiac surgery were consulted and recommended pleurex placement in am. labs showed wbc 28.3 w bandemia. blood cultures sent x1. she was given cefepime, vancomycin and levofloxacin. access includes 22 gauge in l shoulder. ed vitals prior to transfer: afebrile, 124/93, 125, 28, 93% 2l. . on the floor, pt reports no increase in o2 use in the last couple days. she reports doe but feels comfortable at rest. denies fever, chills, n/v/d, abd pain, chest pain, oral lesions/ulcers, rashes or worsened extremity swelling. per pt, planning for outpt chemotherapy in 3 weeks. past medical history: - lung adenocarcinoma with known mets to brain, dx ; metastatic to brain s/p cyberknife therapy, malignant pleural and pericardial effusions s/p pericardiocentesis - dvts s/p ivc and svc filters - malignant pleural effusion s/p drainage - pe s/p ivf on chronic lovenox and s/p ivc filter - mycobacterium gordonae - s/p ccy - s/p pericardiocentesis social history: she is originally from the in , lives with husband. married. worked at . husband works in shipping warehouse. no smoking, alcohol, or illicit drug use. . family history: mother with diabetes. no family hx of cancer. physical exam: admission exam: vitals: t:99.8 bp:117/79 p:124 r:25 o2:96%/2l nc general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: dullness to percussion over r lower lung field, decreased breath sounds over lower third of r lung, clear to auscultation over l lung, occ rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley cath ext: warm, well perfused, 2+ distal pulses, diffuse extremity swelling rue>lue, no clubbing or cyanosis pertinent results: labs on admission: 12:30pm blood wbc-28.2* rbc-2.93* hgb-9.8* hct-28.0* mcv-96 mch-33.4* mchc-35.0 rdw-15.6* plt ct-300 12:30pm blood neuts-60 bands-18* lymphs-10* monos-7 eos-1 baso-0 atyps-1* metas-2* myelos-0 promyel-1* nrbc-4* 12:30pm blood pt-12.5 ptt-32.1 inr(pt)-1.0 12:30pm blood glucose-175* urean-17 creat-1.1 na-132* k-3.8 cl-95* hco3-25 angap-16 12:30pm blood alt-24 ast-37 alkphos-146* totbili-0.4 12:30pm blood calcium-8.7 phos-3.4 mg-1.9 labs on discharge: 07:10am blood wbc-17.5* rbc-3.26*# hgb-10.5*# hct-33.0*# mcv-101* mch-32.2* mchc-31.9 rdw-18.1* plt ct-246 07:10am blood glucose-83 urean-14 creat-0.9 na-136 k-5.5* cl-100 hco3-23 angap-19 07:10am blood calcium-8.1* phos-3.4 mg-2.1 microbiology: pleural cx: no growth urine cx: no growth blood cx: pending mrsa screen: negative echo: overall left ventricular systolic function is normal (lvef>55%). there is a small pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. there are no echocardiographic signs of tamponade. the echo findings are suggestive but not diagnostic of pericardial constriction. compared with the prior study (images reviewed) of , no definite change. cxr: 1. large right-sided pleural fluid collection with differential attenuation in apex. given recent preceding study demonstrating small pneumothorax and no intervening cxr demonstrating resolution, a small component of resideual pleural air cannot be excldued. however, given there is no air-fluid level on upright view, if present, it is unlikely to be significant. 2. opacity within right upper lung likely reflects known hilar mass. however, a concurrent infectious process cannot be excluded. lenis: impression: no evidence of dvt in the bilateral lower extremities. mrv chest: 1. partial occlusion of the right internal jugular vein from thrombus, left internal jugular vein is diminutive but patent. 2. patent right and left subclavian veins. 3. ivc filter and svc stent are patent. 4. extensive right upper lobe mass, atelectasis and bilateral pleural effusions, right more than left. extensive necrotic mediastinal and right supraclavicular necrotic lymph node masses. bone metastasis in the t2, 3, 4, 5 and manubrium. brief hospital course: 44 w with history of lung adenocarcinoma complicated by brain metastases presenting with two days of dyspnea on exertion, found to have large right-sided pleural effusion .. # right-sided pleural effusion: the patient presented with two days of increased dyspnea and worsening facial swelling since her recent discharge. a large r-sided pleural effusion was seen on imaging and the patient was admitted to the for pleurex catheter placement by interventional pulmonology on . lovenox was held prior to the procedure, and restarted afterwards. pleural fluid studies showed wbc 1000, 74% neutrophils. the pleural fluid culture returned with no growth. the patient was discharged home with instructions to drain the pleurex catheter (on r) every other day or for symptoms until her follow-up with ip. . # leukocytosis: likely secondary to a recent four day course of filgrastim. in the emergency department she was given a dose of levofloxacin, vancomycin, and cefepime; however, these agents were not immediately continued in the because of the patient's lack of systemic symptoms and complaints supporting infection. pleural fluid, expectorated sputum culture, urine cultures revealed no growth. blood cultures obtained in the were pending at the time of discharge. she remained afebrile throughout her hospital course. . # metastatic lung adenocarcinoma: patient with adenocarcinoma of the lung discovered in , metastatic to right temporal lobe and status-post stereotactic radiotherapy. recently completed 4 day course of filgrastim. she was also continued on dexamethasone and started on bactrim ss tab for pcp . . # history of dvt: she is on chronic lovenox and status-post svc/ivc filter placement. lovenox was held overnight prior to r sided pleurex cath placement on and restarted immediately afterwards. . # access: history of multiple dvts including r ij and cephalic, small non-occlusive residual clot in l lower ij. r picc was placed on recent hospitalization and discontinued prior to discharge (). bilateral lower extremity ultrasonds were obtained in case of need for femoral line placement and revealed no clot. she underwent mrv imaging of her upper thorax in anticipation of outpatient placement of a port to durable access. she was scheduled with ir port placement in the week following discharge. . # thrush: patient started on four day course of fluconozole given throat pain/discomfort and evidence of thrush on exam. . # code: full (discussed with patient) medications on admission: 1. oxygen please provide 2-4l oxygen by nasal cannula when ambulating prn 2. dexamethasone 2 mg tablet sig: one (1) tablet po once a day. 3. ranitidine hcl 150 mg 4. docusate sodium 100 mg capsule 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain 6. acetaminophen 325 mg tablet 7. benzonatate 100 mg capsule sig: one (1) capsule po tid 8. folic acid 1 mg tablet 9. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours) 10. senna 8.6 mg tablet sig: one (1) tablet po bid 11. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 12. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po q6h 13. enoxaparin 60 mg/0.6 ml syringe sig: sixty (60) mg subcutaneous q12h (every 12 hours). 14. polyethylene glycol 3350 17 gram/dose powder sig: seventeen (17) grams po daily (daily) as needed for contstipation. 15. filgrastim 300 mcg/ml solution sig: three hundred (300) mcg injection q24h (every 24 hours) for 4 days. 16. morphine 15 mg tablet sig: two (2) tablet po every seventy-two (72) hours as needed for pain: to be used for pain from pleurex drainages; do not drive or operate machinery. discharge medications: 1. oxygen please provide 2-4l oxygen by nasal cannula when ambulating prn 2. dexamethasone 2 mg tablet sig: one (1) tablet po daily (daily). 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain. 6. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day). 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 8. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation every six (6) hours. 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 11. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 12. enoxaparin 60 mg/0.6 ml syringe sig: one (1) injection subcutaneous q12h (every 12 hours). 13. morphine 15 mg tablet sig: one (1) tablet po every twenty-four(24) hours as needed for pain: to be used for pain from pleurex drainages; do not drive or operate machinery. . 14. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 2 days. disp:*2 tablet(s)* refills:*0* 15. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: - pleural effusion - pericardial effusion secondary diagnosis: - metastatic lung adenocarcinoma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure taking care of you at . you were admitted to the hospital with facial swelling and shortness of breath. you were found to have fluid building up around your right lung. you had a catheter placed in order to drain this fluid. your symptoms improved significantly during the course of your hospital stay. please start the following medications after discharge: fluconozole for 2 more days bactrim ss daily (while you are taking the dexamethasone) on tuesday, , you will undergo placement of a port (through which they give medications and draw blood). please check-in on the , , in an area called the radiology care unit. please do not eat or drink after midnight on the night before your procedure. please do not take your lovenox the night before or the morning of your procedure. on the evening before, you will also need to take the "pre-operative" shower that was discussed in the hospital with the nursing staff. please do not take aspirin, nsaids (advil or aleve), fish oil, or vitamin e prior to your scheduled procedure. please continue all other medications as they have been prescribed. if you experience any symptoms that concern you after leaving the hospital, please call your oncologist or return to the emergency room as soon as possible. followup instructions: you will receive a call from dr. office on , with details about your follow-up appointment. department: radiology care unit when: tuesday at 8:00 am building: de building ( complex) campus: west best parking: garage department: mri when: at 1 pm with: mri building: cc clinical center campus: west best parking: garage department: neurology when: at 2:30 pm with: , md building: sc clinical ctr campus: east best parking: garage you will receive a call from dr. (pulmonary) office at some point next week regarding a follow-up appointment for your pleurex drains. they will see you back in clinic in two weeks time. md procedure: insertion of intercostal catheter for drainage diagnoses: candidiasis of mouth secondary malignant neoplasm of brain and spinal cord malignant neoplasm of upper lobe, bronchus or lung long-term (current) use of anticoagulants personal history of venous thrombosis and embolism other specified diseases of pericardium secondary malignant neoplasm of bone and bone marrow leukocytosis, unspecified malignant pleural effusion 

Answer: The patient is high likely exposed to