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: respiratory failure major surgical or invasive procedure: rigid bronchoscope history of present illness: 65 yo f copd, recurrent pna, non small cell lung cancer s/p chemo and radiation in , osa, worsening pulmonary function, increasing o2 requirement leading to intubation today at osh, sputum growing aspergillosis, and on flex bronchoscopy a fungal ball was visualized in left main stem bronchus. at osh she was admitted on for acute onset of respiratory distress. she was treated for bilateral lower lobe pneumonia with ceftriaxone and azithyromycin later changed to intravenous vancomycin and ceftazidime as well for a copd exacerbation with iv steriods and combivent nebs. she worsened and was put on high flow o2, she coughed a whitish mass that was shown to be aspergillus by histopathology. she was placed on po voriconazole. she then had worsening respiratory function and was switched to iv voriconazole. she continued wheezing and was intubated on and a felxible bronchoscopy was performed that showed extensive endobroncial whitish mass obsturcting mainly the left main stem bronchus aparently biopsies of this were consistent with the specimen that was coughed up. she also had a ct angio in order to determine if a pe was contributing to her symptoms. that scan showed no pe and extensive bilateral lower lobe infiltrates. she was transferred to where she had been previously treated in the micu for mrsa pna with bilateral infiltrates and copd in . past medical history: - stage iiib lung cancer diagnosed 3 years ago now s/p chemo & xrt - asthma/copd - disease s/p rai - gerd s/p nissen fundoplication - hypertension - sinusitis - type 2 diabetes - depression - anal fissure - tonsillectomy - hemorrhoidectomy - pilonidal cyst excision - ear plastic surgery - appendectomy social history: - retired - 30 pack year smoker, quit in - no etoh use - she is single and lives with her sister family history: - mother: htn, ttp, goiter - father: disease, cva, lung cancer - sister: ms - brother: psychiatric illness physical exam: physical exam on admission to micu: intial vital signs: t: 97.6 bp:119/91 p:57 r:15 o2:99% general: intubated, sedated and paralyzed heent: sclera anicteric, et tube in place, pupils 1mm neck: supple, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: scatterred wheezes, diminished at bases. abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley ext: warm, well perfused, 2+ pulses, mild edema in legs neuro: intubated, sedated, and paralyzed discharge physical: vital signs: t98.4 bp 137/75 p88 r22 o2 95 on 3l general: obese female in nad heent: sclera anicteric, no conjunctival pallor, mmm neck: supple, no lad cv: distant heart sounds, however no murmurs appreciated this am, regular rate lungs: prominent inspiratory wheezes worse at the base with improved end-expiratory wheezes bilaterally. abdomen: soft, non-tender, non-distended, bowel sounds present ext: warm, well perfused, minimal edema in lower extremities; upper extremities with 2+ edema. neuro: a+o x 3 pertinent results: 01:30am wbc-26.2*# rbc-4.45 hgb-11.1* hct-35.2* mcv-79* mch-24.9* mchc-31.5 rdw-18.3* 01:30am neuts-87* bands-2 lymphs-2* monos-7 eos-0 basos-0 atyps-0 metas-1* myelos-1* 01:30am cortisol-16.0 01:30am albumin-3.1* calcium-8.0* phosphate-4.6* magnesium-2.0 01:30am glucose-205* urea n-44* creat-1.1 sodium-133 potassium-4.6 chloride-95* total co2-29 anion gap-14 01:37am lactate-1.4 imaging: ct chest impression: 1. interval improvement in bibasilar consolidation, and multifocal solid and ground-glass nodules from . there is redemonstration of mild bronchiectasis, and marked irregular tracheal and bronchial wall thickening, with a large amount of inspissated debris within the left main stem bronchus and its tributaries. soft tissue situated in the subcarinal location is unchanged and may represent lymph node. 2. small airways disease with airtrapping. post-radiation changes to the left upper lobe are constant. labs on discharge: 11:00am blood wbc-8.0 rbc-3.77* hgb-9.7* hct-30.4* mcv-81* mch-25.7* mchc-31.9 rdw-19.8* plt ct-140* 11:00am blood glucose-188* urean-34* creat-1.2* na-135 k-3.4 cl-98 hco3-26 angap-14 11:00am blood alt-111* ast-44* alkphos-176* totbili-0.4 11:00am blood calcium-9.2 phos-4.5 mg-1.7 06:34am blood tsh-6.1* b-glucan test ---- fungitell (tm) assay for (1,3)-b-d-glucans results reference ranges ------- ---------------- 100 pg/ml negative less than 60 pg/ml indeterminate 60 - 79 pg/ml positive greater than or equal to 80 pg/ml brief hospital course: 65 yo f copd, recurrent pna, non small cell lung cancer s/p chemo and radiation in , osa was found to have invasive aspergilloma complicated by respiratory failure requiring intubation. active diagnoses #respiratory failure-improved. multifactorial etiologies of respiratory failure requiring intubation including copd, pna, and invasive aspergilloma. patient required bronchoscopy for removal of obstruction as well as respiratory support with mechanical ventilation. after being successfully extubated, patient was gradually weaned to 3l supplemental o2. #invasive aspergilloma: rigid bronchoscopy with debridment showed large fungus ball obstructing left mainstem bronchus. pathology proven aspergillus along with positive b-glucan indicative of invasive aspergilloma. started on voriconazole iv and switched to po form to avoid nephroxoticity. pt. then developed worsening lfts and was switched to ambisome iv, with subsequent improvement of her lfts. she is to continue ambisome until . #copd exacerbation: pt with chronic copd, requiring high dose steroids for nearly 2 months. patient has been tapered to steroid dose of 15mg po daily. will continue at 15mg po daily for 5 total days, then 10mg for 5 days, then 5mg for 5 days, then discontinue. patient was switched from albuterol and ipratropium nebulizers to mdis, with good control. #hcap: pt found to have pna at osh, completed 14 days of antibiotic therapy in house for suspected hcap. #venous acccess: non-occlusive thrombosis noted in left upper extremity after difficulty using left picc line. right picc was attempted, however was only able to get midline, which subsequently did not draw and then did not allow pushing fluids. at discharge, a midline was placed. #depression: patient had flat affect and psychomotor retardation throughout stay in hospital. it is highly advised that patient be followed up for depression -continue citalopram. #anxiety: patient was anxious daily during her hospital stay, sometimes causing tachycardia. patient responded well to ativan 0.5mg iv. would benefit from outpatient management of anxiety. chronic diagnoses #htn -pt was hypotensive during the course of her micu stay likely effects of sedation from propofol during intubation. levophed was required. cortisol levels normal. anti hypertensives were not required in house. patient should be re-evaluate for hypertension as an outpatient. #stage iiib non small cell lung cancer -pt diagnosed 3 years ago now s/p chemo & xrt. no acute relapse noted in this admission. #osa: -after extubation, pt continued to use cpap nightly as she does at home. #diabetes mellitus: -pt's po meds were held, she was managed on ssi. she was stabilized on 35 units lantus with sliding scale on top. #hld -continued on simvastatin. #hypothyroid pt remained stable, continued on outpatient levothyroxine. #gerd pt continued omeprazole. transitional issues -pulmonologist should follow up on ige levels pending in hospital for possible allergic bronchopulmonary aspergillosis. medications on admission: medications from osh: citalopram 20mg po doxycycline 100mg iv lovenox 80mg combivent propofol for vent nystatin units oral pantoprazole iv 40mg iv mom 1 lorazepam 1-3mg for vent levothyroxine 150mcg daily po insulin detemir 20 units daily subq methylprednisone 40mg daily iv voriconazole 500mg iv trimethoprim/sulfamethox- iv 500mg q8hr amlodipine 5mg daily po valsartan 80 daily po simvastatin 20 daily po medications from micu 1. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 2. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 3. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 4. glipizide 10 mg tablet sig: one (1) tablet po twice a day. 5. xopenex inhalation 6. levothyroxine 150 mcg tablet sig: one (1) tablet po once a day. (takes 2 tabs on sunday) 7. mom 50 mcg/actuation , non-aerosol sig: nasal once a day. 8. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 9. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 10. tiotropium bromide 18 mcg capsule, w/inhalation device sig: as directed inhalation as directed. 11. trazodone 100 mg tablet sig: two (2) tablet po hs (at bedtime). 14. fluticasone 50 mcg/actuation , suspension sig: one (1) 15. januvia 50 mg qd 16. diovan 80 mg qd 17 levemir 38 units qpm discharge medications: 1. albuterol inhaler 3 puff ih q4h:prn wheezing please use spacer with mdi. 2. citalopram 20 mg po daily 3. fluticasone-salmeterol diskus (500/50) 1 inh ih 4. levothyroxine sodium 150 mcg po daily 5. omeprazole 20 mg po daily 6. tiotropium bromide 1 cap ih daily 7. ambisome 450 mg iv q24h please space by 2 hours from platelet transfusions. 8. guaifenesin ml po q6h:prn cough 9. lorazepam 0.5 mg po q8h:prn anxiety/ dyspnea hold for sedation, rr<10 10. glipizide 10 mg po bid 11. simvastatin 20 mg po daily 12. trazodone 200 mg po hs:prn insomnia 13. prednisone 15 mg po daily duration: 4 days 14. prednisone 10 mg po daily duration: 5 days start: after 15 mg tapered dose. 15. prednisone 5 mg po daily duration: 5 days start: after 10 mg tapered dose. 16. glargine 35 units bedtime insulin sc sliding scale using hum insulin discharge disposition: extended care facility: discharge diagnosis: primary diagnosis: respiratory failure, aspergillosis secondary diagnosis: acute kidney injury, anxiety, copd discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. , you were treated at for respiratory distress and invasive aspergillosis. while here, you required having a tube to breath, and having a procedure where we were able to take out things that were blocking the airway of your lung. we started you on a medication to kill the infection, however it made your liver numbers worse. we then stopped that medication and started a different one, and your liver numbers improved. as you recovered, you have required less oxygen over time. you should continue to take the medications we prescribed you, and follow up with your primary care doctor in days and your pulmonologist within 1 week. followup instructions: name: , p. location: medical associates address: , , phone: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. name: , md department: pulmonary address: , , , phone: appointment: tuesday 2:45pm department: hematology/oncology when: thursday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: infectious disease when: friday at 3:30 pm with: , md building: lm campus: west best parking: garage department: infectious disease when: thursday at 11:00 am with: , md building: lm bldg () campus: west best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other bronchoscopy removal of intraluminal foreign body from trachea and bronchus without incision central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified obstructive sleep apnea (adult)(pediatric) esophageal reflux unspecified essential hypertension long-term (current) use of steroids diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism personal history of malignant neoplasm of bronchus and lung personal history of tobacco use depressive disorder, not elsewhere classified other and unspecified hyperlipidemia anxiety state, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure other complications due to other vascular device, implant, and graft obesity, unspecified chronic obstructive asthma with (acute) exacerbation personal history of antineoplastic chemotherapy personal history of irradiation, presenting hazards to health aspergillosis foreign body accidentally entering other orifice other and unspecified mycoses other diseases of trachea and bronchus foreign body in main bronchus nonspecific abnormal results of function study of liver antifungal antibiotics causing adverse effects in therapeutic use acute venous embolism and thrombosis of superficial veins of upper extremity 

Answer: The patient is high likely exposed to