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: this was an 82-year-old female with a history of non-hodgkin's lymphoma, history of splenectomy and history of colon cancer status post with a five-day history of fever, cough and shortness of breath. prior to this admission in , the patient had presented to her primary care physician with nonproductive cough. chest x-ray showed no infiltrate but chronic linear densities at the left lung base and fine reticular pattern at days with improvement, but five days prior to admission, she developed cough productive of yellow sputum and fevers to 101?????? with chills. she also noted some postural light-headedness and nausea. the patient was transferred to the medical intensive care unit for further care. past medical history: 1. cll which developed as non-hodgkin's lymphoma in status post course of melphalan and prednisone in , status post chop in and status post in when lymphoma recurred in jaw and orbit. 2. hypogammaglobinemia receiving monthly ivig up until one year ago with normal immunoglobins since then. 3. status post colon cancer, t3n1n0, status post hemicolectomy in . colonoscopy in with hyperplastic rectal polyp. 4. status post splenectomy at for unknown indication in . last pneumovax within the past five years. 5. history of hemophilus influenzae bronchitis. 6. history of svc clot in likely related to port-a-cath at that time, status post six months of anticoagulation, finished in (coumadin). 7. cervical spinal stenosis. 8. anxiety. 9. gastroesophageal reflux disease. 10. osteoporosis. 11. history of meningioma of the brain, no resection. 12. history of herpes zoster in . 13. history of leg cramp. medications on admission: alendronate 70 mg p.o. q.d., protonix 40 mg p.o. q.d. allergies: morphine which causes nausea and vomiting. social history: she lives with her daughter. two grandsons are involved with her care. she immigrated from in . she does not smoke. of note, the patient has never been married, and her daughter is adopted. she has a very large family through this adoption who are all very involved with her care. in the emergency department, the patient was given vancomycin 1 g iv and levofloxacin 500 mg iv. blood gas on 4 l nasal cannula was 7.33, 37 and 75. physical examination: vital signs: she had an elevated temperature of 100.6??????, blood pressure 108/58, pulse 96, oxygen saturation 94% on 4 l. general: she was an awake, non-english speaking (farsisis). lungs: crackles at bases, one-third to one-half up. no egophony. scattered wheezes of the anterior chest. laboratory data: white count 7.7, hematocrit 33.8, platelet count 258. chest x-ray was notable for multiple patchy opacities of the right lower lobe and left lower lobe consistent with focal consolidation. of note, blood cultures were drawn after all antibiotics were started. hospital course: the patient was transferred for further medical care. 1. pulmonary: over the course of the next three days, the patient was maintained on mask ventilation but persisted in having elevated carbon dioxide levels. over the course of the next three days, the patient continued to become more and more hypercapnic, and her mental status decreased. chest x-ray demonstrated no change with numerous patchy infiltrates and diffuse linear pattern consistent with infiltrate versus interstitial fibrosis. past chest x-rays demonstrated small amounts of interstitial fibrosis consistent with underlying lung disease. ct scan demonstrated ground-glass opacification mostly in the right upper lobe consistent with pneumonia. cystic changes were noted at her lung bases bilaterally and small bilateral effusions. multiple mediastinal lymph nodes were noted, the largest of which were 14 x 15 mm and 12 x 19 mm. a blood gas on demonstrated 7.38, 63, 106, in a woman whose baseline pco2 is in the 40s. on , in the morning, the patient was noted to have decreased mental status with unresponsiveness to sternal rub and pco2 in the high 70s. at this point, she was intubated. her blood gas normalized over the course of the next week. she met all criteria for ards including bilateral patchy opacities, po2/fio2 ratio of less than 200, and was not fluid overloaded. bronchoscopy was performed on the 13th, and cultures from that have been negative to date. all sputum cultures have also been negative to date, as well as legionella, influenzae and other viral cultures. she completed a 14-day course of ceftriaxone, 13-day course of levaquin and 10-day course of vancomycin. all antibiotics were discontinued on . at this point, the patient is recovering from her ards but has not had any further increases in her temperature or demonstration of sepsis. her vents have been weaned to pressure support 5 and 5, and her rsbi on the morning of is 85. she continues on chest pt, albuterol and serevent, and was diuresed yesterday with a lasix gtt for only 200 cc negative. if she continues to maintain her oxygen saturation on pressure support 5 and 5, extubation will be attempted today. if this fails, the patient may need tracheostomy. 2. infectious disease: the patient is with pneumonia status post 14-day course of antibiotics as above. in addition, the urine culture that grew gram positive cocci, was likely treated by the above antibiotics. also during her hospitalization, she developed diarrhea. c-diff times two was negative, but white blood cell count started to rise, flagyl was added empirically, and soon after her white blood cell count normal. she completed a day course of this medication. 3. cardiac: the patient has been noted to be in paroxysmal atrial fibrillation, but this is a rare and short-lived event. she also intermittently has had lo maps requiring fluid boluses for likely hypovolemia. she remains total body fluid overloaded but intravascularly depleted up until 2-3 days ago when her blood pressure stabilized. she tolerated diuresis on the 26th quite well with no decrease in her blood pressures. 4. neurological: it was difficult to evaluate mental status during the course of this hospitalization, as she does not speak english. at one point, she was not responding to deep sternal rub even though all sedatives had been discontinued 1-2 days prior to this. a lumbar puncture was performed which was negative for any bacteria or white blood cells. she did have somewhat of an elevated filling opening pressure and closing pressure, but this was felt to be secondary to coughing during the lumbar puncture. the patient was then started on versed drip once the lumbar puncture was negative and was maintained on this during the course of her hospitalization. she has been weaned down to 1 mg/hr and will be weaned to off in the next few days. her mental status has improve. she is awake and alert. 5. endocrine: the patient with relative adrenal insufficiency by corticotropin stimulation test and has been on hydrocortisone since which has been tapered as tolerated. 6. ob/gyn: the patient was noted have vaginal bleed with loss of significant amounts of blood at certain points. pelvic exam actually demonstrated that bleeding was not from her vagina but from her urethra. ob/gyn was consulted and felt this was secondary to urethral prolapse. also lower abdominal ultrasound demonstrated a leiomyoma which ob/gyn said is not a huge issue and that they would like her to follow-up with them as an outpatient. endometrial stripe was within normal limits for a woman of this age. the patient required blood transfusions at intermittent points during this hospitalization to maintain her hematocrit, but hematocrit has been stable for the last several days. 7. access: arterial line since , left subclavian line since . 8. fluids, electrolytes and nutrition: the patient has been maintained on tube feeds per her g-tube. she has required constant repletion of her phosphate. she remains total body fluid overloaded but occasional intravascularly dry. 9. hematology/oncology: immunoglobulins were within normal limits. we spoke to dr. who stated that the patient's cll has been in remission, and non-hodgkin's lymphoma has been in remission. he also stated that if her immunoglobulins were within normal limits, she did not need an ivig transfusion during this hospitalization. 10. code status: full. 11. prophylaxis: subcue heparin, h2 blocker and pneumoboots. 12. communication: has been with the family, in particular, the patient's grandson , who speaks english and translates for the rest of the family. the family is extremely supportive of their mother and extremely cooperative with the staff. they have been very worried, and communication has occurred daily with the family members. current medications: hydrocortisone 12.5 mg iv q.6 hours to be tapered in the next few days, albuterol 1 neb q.2 hours p.r.n., ativan 0.5-2.0 mg iv q.2-4 hours p.r.n., lansoprazole 30 mg p.o. b.i.d., miconazole powder 2% t.i.d. p.r.n., heparin 5000 u subq.12 hours, 2 puffs b.i.d., atrovent 1 neb q.2-4 hours p.r.n., neutra-phos 1 packet p.o. t.i.d., tube feeding is promote with fiber, full strength, at 60 cc/hr. dr., 12-697 dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of endotracheal tube arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified unspecified septicemia hypopotassemia acute respiratory failure intestinal infection due to clostridium difficile streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group a 

Answer: The patient is high likely exposed to