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: bactrim ds attending: chief complaint: pain crisis major surgical or invasive procedure: right internal jugular central venous catheter placement history of present illness: 46 yo f with sickle cell anemia, multiple admission for pain crises who presented with an acute onset bilateral knee, shoulder, hip, and chest pain, consistent with prior pain crises. the patient experienced the acute onset of knee pain the morning of her admission, while brushing her teeth, about 20 minutes after getting up. this was followed by chest, shouler, and hip pain bilaterally. given the severe pain, the patient presented to the emergency room. in the ed, initial vital signs were 98.2 95 133/81 20 100% 4l/nc. the patient was given normal saline 1 liter and dilaudid 1 mg iv x 3. there was concern that she was developing acute chest and she was admitted to the micu. she complained of significant pain when she arrived the the icu. past medical history: 1) sickle cell disease- hgb ss: diagnosed at age 3 with complications including avascular necrosis of r hip, acute chest syndrome, and pulmonary infarction. spleen autoinfarction. -pneumococcal vaccine -influenza vaccine -h flu & meningococcal vaccine 2) hepatitis c- genotype 1b. dx in 's, believed to be due to frequent transfusions. liver biopsy , stage iii fibrosis. in , was on peg interferon & ribavarin, but d/c'd due to neutropenia. 3) s/p cholecystectomy for gallstones in 's 4) s/p appendectomy in 's 5. proteinurea- started lisinopril 2.5 mg 1 po daily social history: married, works as executive assistant for housing development. social smoking in high school, none currently. rare etoh use, only on holidays. denies drug use. family history: multiple family members on mother's side of family with sickle cell disease. physical exam: admission physical exam vital signs: 99.2 114/70 100 18 100%/2l gen: appears uncomfortable, complain in diffuse arthalgia. heent: nc/at. anicteric sclerae. moist mucous membranes. op clear. neck: supple. resp: normal respiratory effort. ctab. cv: rrr. normal s1 and s2. no m/g/r. abd: +bs. soft. nt/nd. no rebound or guarding. ext: warm and well-perfused. radial and dp pulses 2+ bilaterally. neuro: a+ox3. perrl. eomi, with no nystagmus. face symmetric. palate elevates symmetrically. tongue protrudes in midline. strength 5/5 throughout upper and lower extremities. discharge physical exam vital signs: tc: 98.7 bp 100/60 (98/58-108/70) hr 83 (78-90) o2 98% ra gen: appears more comfortable and in nad, heent: nc/at. anicteric sclerae. moist mucous membranes. op clear. neck: supple. resp: normal respiratory effort. ctab. cv: rrr. normal s1 and s2. no m/g/r. abd: +bs. soft. nt/nd. no rebound or guarding. ext: warm and well-perfused. radial and dp pulses 2+ bilaterally. neuro: a+ox3. perrl. eomi, with no nystagmus. face symmetric. palate elevates symmetrically. tongue protrudes in midline. moving all extremities. pertinent results: admission labs: . 09:35am blood wbc-11.8* rbc-2.67* hgb-9.4* hct-28.7*# mcv-107*# mch-35.2* mchc-32.7# rdw-16.0* plt ct-425 09:35am blood neuts-62.3 lymphs-29.2 monos-6.4 eos-1.4 baso-0.8 09:35am blood glucose-99 urean-8 creat-0.5 na-138 k-4.9 cl-105 hco3-24 angap-14 03:45pm blood ck(cpk)-84 03:56am blood alt-25 ast-53* ld(ldh)-615* alkphos-58 totbili-6.4* dirbili-1.7* indbili-4.7 09:35am blood calcium-8.9 phos-3.0 mg-1.9. micro labs urine culture : 10,000-100,000 organisms/ml.. alpha hemolytic colonies consistent with alpha streptococcus or lactobacillus sp. urine : no growth blood culture , , , : no growth final throat strep : negative cxr : 1. since the recen radiograph one day prior, there has been development of new bilateral diffuse pulmonary infiltrates, likely pulmonary edema, however infection and infarction cannot be excluded. 2. development of marked cardiomegaly and findings consistent with heart failure. 3. multiple loops of distended large bowel incompletely imaged on this radiograph. cxr : a right ij central line is present, tip over right atrium, relatively low. clinical correlation regarding possible retraction is requested. there are low inspiratory volumes. there is probable enlargement of the cardiomediastinal silhouette, even allowing for this. there are diffuse patchy opacities throughout both lungs, increased retrocardiac density consistent with left lower lobe collapse and/or consolidation, and equivocal small effusions. again seen is diffuse increased density of the bones, likely related to the patient's sickle cell. increased density at the right humeral head could be due to osteonecrosis.compared with at 2:04 a.m. and allowing for technical differences, no definite interval change. tib/fib x-ray : findings: in comparison with the study of , there is little overall change. again there are areas of sclerosis involving the distal femur, proximal and much of the shaft of the tibia, and the talar dome. findings areall consistent with bone infarcts consistent with the patient's known diagnosis of sickle cell anemia. echo : the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the left ventricular ejection fraction is somewhat lower. discharge labs 05:35am blood glucose-140* urean-7 creat-0.4 na-133 k-3.9 cl-99 hco3-26 angap-12 05:35am blood alt-16 ast-40 ld(ldh)-450* alkphos-54 totbili-1.7* 05:35am blood calcium-8.3* phos-3.6 mg-1.8 brief hospital course: 46 yo f with sickle cell anemia, multiple admission for pain crises, who presented with the acute onset bilateral knee, shoulder, hip, and chest pain. she developed hypoxia and bilateral pulmonary infiltrates, requiring micu transfer for exchange transfusion. #sickle cell disease/acute chest syndrome: the patient presented with severe pain. her initial chest x-ray was normal. ekg was normal, and mi was ruled out with serial cardiac enzymes. the patient was treated with oxygen, iv fluids, and iv dilaudid for presumed vaso-occlusive pain crisis. the day after admission, she developed fever to 101.8 and a progressive oxygen requirement, with cxr showed bilateral infiltrates and a massively dilated heart. due to concern for acute chest syndrome, she was transferred to the micu. she was started on ctx/azithro for coverage of community-acquired pneumonia. in the micu, given the patient's high-grade hemolysis and acute chest syndrome she underwent exchange transfusion on with a total of 6 units of prbc's infused, with a goal of getting her hemoglobin s concentration under 30%. a right internal jugular central venous catheter was placed for access. her post exchange transfusion hematocrit was 24.5, and initially remained stable until the morning of when it dropped to 21.1, she was given 1 unit of prbc's with improvement only to 22, with a goal hemoglobin of over 8. she was given another unit of prbc's and her hct stabilized around 28. the patient had a lot of difficulty with pain-control, requiring an iv dilaudid pca and bolus doses of iv dilaudid for breakthrough pain. the pain service was consulted, and assited with management. after exchange transfusion the patient was significantly better controlled on the hydromorphone pca and prn iv hydromorphone. she was transferred back to the floor on . she was was subsequently placed on a po dialudid regimen. she was discharge with 24 extra tabe of dilaudid. # fever: she spiked fever to 101 shortly after leaving icu and had another low grade temp however fever curve improved. cxr improved and she was asymptomatic. urine and blood cultures were negative. she noted that she typically has low grade temps during her crises. she was started on a 7 day course of levofloxacin. she will complete her course on . # constipation: she had not had a bowel movement since . she noted that she has gone 2 weeks previously without a bowel movement. she was on colace and senna but was resistent to trying any other . she did have a bowel movement prior to discharge and never had notable pain, distension, or nausea. # proteinuria: patient with a history of proteinuria and was started on lisinopril 2.5mg as an outpatient. initially held but was restarted prior to discharge. # left lower extremity growth: this was noted during her previous hospitatlization which was closely monitored. x-ray was done to check for possible osteo which was negative. x-ray did show findings consistent with bone infarction. # hepatitis c- genotype 1b. chronic, stable. diagnosed in early 's, likely chronic transfusions. liver biopsy with stage iii fibrosis. in , was on peg interferon & ribavarin, but d/c'd due to neutropenia. transitional issues: 1. hemoglobin electophersis was pending upon discharge and will need to be followed up medications on admission: lisinopril 2.5 mg daily hydroxyurea 1000 mg folic acid 5 mg daily hydromorphone 2 mg po q2h prn pain discharge medications: 1. docusate sodium 100 mg po bid rx *docusate sodium 100 mg twice a day disp #*60 capsule refills:*0 (zero) 2. folic acid 1 mg po daily 3. hydromorphone (dilaudid) 2-4 mg po q3h:prn pain hold for sedation, rr<12 rx *hydromorphone 2 mg q3h disp #*24 tablet refills:*0 (zero) 4. hydroxyurea 1000 mg po bid 5. levofloxacin 750 mg po daily start: in am rx *levofloxacin 750 mg daily disp #*2 tablet refills:*0 (zero) 6. lisinopril 2.5 mg po daily start: in am hold if sbp<90 7. senna 1 tab po bid:prn constipation rx *sennosides 8.6 mg twice a day disp #*60 tablet refills:*0 (zero) 8. amoxicillin-clavulanic acid 875 mg po q12h temp higher than 100.4 then, go to emergency room right away discharge disposition: home discharge diagnosis: primary: - sickle cell vasoocclusive pain crisis - sickle cell acute chest syndrome - pneumonia secondary diagnoses - proteinuria - hcv discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you came to the hospital with a sickle cell pain crisis. you developed acute chest syndrome, and were transferred to the intensive care unit. a central line was placed, and you treated with exchange transfusion. following exchanged transfusion, your condition improved significantly. you developed a fever and were treated with antibiotics for pneumonia. you will continue taking antibiotics (levofloxacin 750mg) until . your pain was managed with a pca pump temporarily and you were successfully transitioned to oral medications. you will be discharged on dilaudid 2-4mg every 3 hours as needed until your appointment with dr. on . please call your pcp if your pain is not adequately managed on this regimen. you heart was noted to be enlarged on a chest x-ray. you had an echocardiogram to assess the function of your heart which was normal. medication changes continue levofloxacin 750mg daily you can take your dialudid 2-4mg every 3 hours as needed until you meet with dr. on . start docusate 100mg start senna 8.6mg as needed you came to the hospital with a sickle cell pain crisis. you developed acute chest syndrome, and were transferred to the intensive care unit. a central line was placed, and you treated with exchange transfusion. following exchanged transfusion, your condition improved significantly. you developed a fever and were treated with antibiotics for pneumonia. you will continue taking antibiotics (levofloxacin 750mg) until . your pain was managed with a pca pump temporarily and you were successfully transitioned to oral medications. you will be discharged on dilaudid 2-4mg every 3 hours as needed until your appointment with dr. on . please call your pcp if your pain is not adequately managed on this regimen. you heart was noted to be enlarged on a chest x-ray. you had an echocardiogram to assess the function of your heart which was normal. medication changes continue levofloxacin 750mg daily you can take your dialudid 2-4mg every 3 hours as needed until you meet with dr. on . start docusate 100mg start senna 8.6mg as needed followup instructions: department: post clinic when: thursday at 4:30 pm with: dr building: sc clinical ctr campus: east best parking: garage note: this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up. department: hematology/oncology when: tuesday at 2:00 pm with: md/ , rn building: campus: east best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified chronic hepatitis c without mention of hepatic coma other constipation fever, unspecified hypoxemia other acute pain jaundice, unspecified, not of newborn proteinuria localized superficial swelling, mass, or lump hb-ss disease with crisis acute chest syndrome 

Answer: The patient is high likely exposed to