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: compazine attending: chief complaint: hypercalcemia major surgical or invasive procedure: none history of present illness: ms. is a 47 year old woman who carries a diagnosis of htlv-associated adult t-cell leukemia/lymphoma who presents from routine clinic appointment with hypercalcemia, with a corrected calcium of 15.5. she received a liter of normal saline, but no bisphosphonate, and was subsequently admitted to the floor. . she was recently hospitalized from through , also for hypercalcemia with acute mental status changes, which was attributed to progression of her hematologic malignancy. following iv hydration and zometa, her calcium normalized, and she underwent treatment with cycle 1. her post-chemo course was unfortunately complicated by dic requiring multiple cryoprecipitate, c. dif colitis, cmv viremia, and a severe abdominal pain requiring bowel rest with tpn. she developed a lll pnuemonia towards the end of her hospitalization and was discharged on a 10 day course of levaquin in addition to home tpn. . since her discharge, ms. has been slowly regaining her strength, noting persistent fatigue which has acutely worsened today. she denies acute confusion or mental status changes which accompanied her previous hypercalcemic episode. she notes no pain or paresthesias or tetany. her last hospitalization was complicated by severe abdominal pain requiring bowel rest- she remains on home tpn and has been tolerating light meals due to a sense of fullness. she also had cxr evidence of lll pneumonia and had been discharged on levaquin, which she has taken. she had also developed c.dif, and cmv viremia, which had been maintained on po flagyl x 14d and valganciclovir in the outpatient setting. . on review of systems, the patient denies fevers, chills, nausea, vomiting, diarrhea, malaise, rigors, abdominal pain, blood in the stools, shortness of breath, cough, dysuria, hematuria, paresthesias, weakness. past medical history: stage mycosis fungoides (cutaneous t-cell lymphoma, stage iv 1a) with transformation to cd-30 positive large cell lymphoma and development of htlv-1 adult t-cell leukemia lymphoma . - : the patient developed a pruritic, papular rash. she was seen in the internal medicine and dermatology clinics on several occasions and was treated with antibiotics, triamcinolone, clobetasol, and iv triamcinolone w/ no improvement. - : skin bx 1: lle: superficial and deep perivascular lymphohistiocytic infiltrate with perivascular and interstitial eosinophils consistent with a hypersensitivity rxn. scabies neg. - : skin bx 2: atypical superficial and deep dermal lymphoid infiltrate containing cd30-positive cells and showing epidermotropism. pcr analysis for the t-cell receptor gamma gene showed two sharp bands with a migration pattern suggestive of a clonal rearrangement. - : clinic: wbc 10.6 with 57% lymphocytes s??????zary cells. immunophenotypic analysis -> expanded t-cell population with increased cd4:cd8 ratio (15) and loss of cd7. due to her high count of circulating s??????zary cells, she was felt to have stage mycosis fungoides. - ct scan: infiltrating, hypo-enhancing lesion in the r. kidney (?infiltrating neoplasm vs pyelonephritis) compatible w/ lymphomatous involvement of the kidney but was not present on a follow-up scan on . - : photopheresis therapy through an indwelling central venous catheter, placed due to poor venous access. - : skin bx 3: ctcl with large-cell transformation. - : interferon alpha at 3m units 3x/wk given w/ with photopheresis every other week and puva. - : interferon alpha increased to 6munits 3x/wk; puva was d/ced side effects. - : interferon alpha decreased to 4.5munits 3x/wk on b/c fatigued. photopheresis was d/ced when catheter removed due to a line infection (last treatment ). - : the patient presented for a follow-up evaluation with clear evidence of disease progression. interferon alpha was increased to 6m units three times weekly and bexarotene was started at 150mg daily, decreased to 75mg daily due to poor tolerability. - : mtx added to interferon alpha and bexarotene and the dose was up-titrated to 45mg weekly. - : hospital admission for severe lower extremity pain at the site of new, large, papular skin lesions. biopsy showed cutaneous t-cell lymphoma with large cell transformation, involving the panniculus with an unusual angiocentric pattern. the patient was prescribed vorinostat 400mg daily (started ) with continuation of interferon alpha 6m units tiw. due to thrombocytopenia, interferon alpha was decreased to 3m units 3x/wk. - : cycle 1 day 1 liposomal doxorubicin plus gemcitabine. vorinostat and interferon alpha were d/ced. side effect: severe palmar-plantar erythrodysesthesia to liposomal doxorubicin. - : cycle 1 day 1 bortezomib plus gemcitabine, dose-reduced during cycle 2 due to neutropenia. - 3m units tiw interferon alpha restarted - : due to the observation that peripheral t-cells contained floret-like nuclei, immunophenotypic analysis was performed on peripheral blood, revealing findings consistent with involvement by patient's known t cell lymphoproliferative disorder as well as cd25 co-expression in a significant population of the neoplastic cd3+ lymphocytes, suggesting a diagnosis of htlv-1 associated lymphoma. pcr for htlv-1 dna was positive. - : following a treatment break, the patient was started on pentostatin 4mg/m2 weekly x4 doses with reinitiation of interferon alpha at 3munits 3x/wkly , increased to 3m units 5x/wkly. she d/ced therapy after 2 cycles in in favor of a chinese herbal preparation she received in . - : evaluation in the clinic: good candidate for allo sct. - : ct scan: s/p 3 mo off therapy: stable to improved disease: lymph nodes in the chest, abdomen, and pelvis, are stable to decreased in size since , with no new pathologic lad identified. decreased size of the previously enlarged spleen, now within normal limits in size. - initiation of ontak therapy cycle 1 , cycle 2 , cycle 3 , cycle 4 , cycle 5 , cycle 6 - : 2 weeks of total skin electron beam therapy at the under the care of dr. . therapy was held through fatigue. she received a single dose on friday . - : hypercalcemia: ivf and zometa. - : treatment discussion: re: total skin electron beam therapy: progressive disease and difficulty tolerating therapy. decision to resume ontak therapy with intention of initiating auto-transplant as she demonstrates response. -: admitted for ams in the setting of hypercalcemia, which was thought to be due to progression of atll. started , complicated by c dif, cmv viremia, dic. social history: the patient is from . she moved to the u.s. 11 years ago. she is married and has two children. she denies past or current tobacco, etoh or illicit drug use. family history: mother had an mi. her father with cad. physical exam: vs: t98.9 bp128/86 p109 rr18 sa02100ra general: fatigued appearing female in no acute distress heent: eomi, perrla, white plaques along lateral left border of tongue, pharyngeal wall nonerythematous without exudates pulmonary: minimal bibasilar crackles, otherwise clear to auscultation cards: rrr, normal s1, s2, 3/6 systolic ejection murmur. no rubs or gallops. abdomen: soft, nondistended, positive bowel sounds, mild tenderness to palpation of the ruq which is chronic, no rebound tenderness or guarding. extremities: nonedematous, 2+ pt, dp pulses bilaterally neurologic: cn ii-xii intact bilaterally. strength 5/5 throughout though deconditioned. sensation to soft touch intact throughout. dtrs depressed. skin: no rashes or lesions appreciated. pertinent results: admission labs: . 11:30am pt-15.1* ptt-35.9* inr(pt)-1.3* 11:30am plt count-129*# 11:30am hypochrom-1+ anisocyt-2+ poikilocy-1+ macrocyt-2+ microcyt-normal polychrom-normal ovalocyt-1+ 11:30am neuts-38* bands-3 lymphs-45* monos-6 eos-0 basos-0 atyps-8* metas-0 myelos-0 11:30am wbc-16.9* rbc-2.57* hgb-8.5* hct-25.5* mcv-99* mch-32.9* mchc-33.2 rdw-17.9* 11:30am albumin-2.9* calcium-14.6* phosphate-7.2*# magnesium-2.2 11:30am alt(sgpt)-14 ast(sgot)-26 alk phos-209* tot bili-0.4 11:30am glucose-103* urea n-34* creat-1.1 sodium-145 potassium-3.8 chloride-105 total co2-31 anion gap-13 06:57pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 06:57pm urine color-straw appear-clear sp -1.007 09:48pm calcium-14.1* . imaging: cxr : cardiac size is normal. et tube tip is in a standard position 3.8 cm above the carina. right picc tip is in the mid svc. left subclavian catheter tip is in the proximal svc. there is no pneumothorax. new bibasilar opacities, left greater than right, are a combination of pleural effusions and atelectasis. superimposed infection on the left cannot be totally excluded. ng tube tip is in the stomach. . head mri : findings: there is mild prominence of sulci and ventricles inappropriate for patient's age. there is no midline shift or mass effect. there is no hydrocephalus. there is no acute infarct seen on diffusion images. following gadolinium, there is no abnormal parenchymal, vascular or meningeal enhancement identified. in particular, there is no leptomeningeal enhancement seen. soft tissue changes are visualized in the paranasal sinuses due to mucosal thickening. diffuse low signal is identified within the bony structures, which could be secondary to marrow hyperplasia. it should be noted that on flair images, increased signal identified at the sulci at the convexity is secondary to these images were obtained following gadolinium. impression: no acute infarcts or enhancing brain lesions are identified. no mass effect or hydrocephalus. other findings as described above. . portable abdomen : ng tube tip is in the stomach. there is no evidence of bowel obstruction. nondistended air-filled large bowel loops are seen. there are no pathologic intraabdominal calcifications. . ct torso: 1. no evidence of pulmonary embolus or acute aortic syndrome. 2. interval development of right middle upper lobe airspace consolidation most consistent with pneumonia, with additional focus of opacity in the left perihilar region, possibly representing additional focus of infection, although enlargement of left hilar lymph nodes is difficult to exclude. followup imaging following treatment to ensure resolution is recommended. 3. splenomegaly. 4. retroperitoneal adenopathy, grossly stable from . 5. no intra-abdominal explanation for fever. colon is diffusely fluid-filled but thin-walled and without associated inflammatory change. there is no loculated fluid collection or abscess identified. 6. diffuse soft tissue anasarca. . bronchial embolization: . impression: uncomplicated embolization of the right bronchial artery with 300-500 micron embospheres until stasis was achieved. . ct head . no acute hemorrhagic mass seen, nor large area of edema or mass effect on non-contrast head ct. however, for evaluation of subtle process, mri before and after iv gadolinium would be recommended for more sensitive evaluation. . peripheral blood analysis: flow analysis: interpretation more than 99% of the peripheral blood lymphocytes are cd4-positive subset with co-expression of cd3, cd2, cd5. they have loss of expression of cd7. about half of these t-cells also express cd25. these immunophenotypic findings and the presence of "floret-like cells" in peripheral blood smear are consistent with involvement by patient's known "adult t cell leukemia/lymphoma". . microbiology: major studies/findings listed here: 4:49 pm bronchoalveolar lavage gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. respiratory culture (final ): no growth, <1000 cfu/ml. legionella culture (final ): no legionella isolated. potassium hydroxide preparation (final ): test cancelled by laboratory. patient credited. this is a low yield procedure based on our in-house studies. if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (final ): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): no mycobacteria isolated. viral culture: r/o cytomegalovirus (final ): no cytomegalovirus (cmv) isolated. 1:43 pm bronchoalveolar lavage bronchial lavage, right middle lobe. gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): no growth, <1000 cfu/ml. potassium hydroxide preparation (final ): no fungal elements seen. this is a low yield procedure based on our in-house studies. test requested by pulmonary fellow . immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (final ): yeast. nocardia culture (final ): no nocardia isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): no mycobacteria isolated. . 11:31 am sputum site: expectorated source: expectorated. **final report ** gram stain (final ): <10 pmns and <10 epithelial cells/100x field. no microorganisms seen. quality of specimen cannot be assessed. respiratory culture (final ): rare growth commensal respiratory flora. yeast. rare growth. fungal culture (final ): yeast. . 11:24 am sputum source: endotracheal. **final report ** gram stain (final ): <10 pmns and <10 epithelial cells/100x field. no microorganisms seen. quality of specimen cannot be assessed. respiratory culture (final ): commensal respiratory flora absent. yeast. sparse growth. . 9:31 pm urine source: cvs. **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ 4 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r . test result reference range/units aspergillus antigen 6.5 h <0.5 . test ---- fungitell (tm) assay for (1,3)-b-d-glucans results reference ranges ------- ---------------- 358 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: in brief, ms. was a 47 year old lady with a diagnosis of htlv-1 associated adult t cell leukemia/lymphoma who initially presented with hyerpcalcemia. her hospital course was complicated by mental status changes which after ice therapy necessitating an admission to the icu without any acute evidence of an intracranial process. her hospital course at this time was also complicated by persistent atll, hypercalcemia, renal tubular acidosis, acute renal failure, c. diff colitis, and cmv viremia. subsequently she developed hypoxic respiratory failure secondary to invasive aspergillosis with pulmonary hemorrhage. she underwent a pulmonary embolization procedure and a second intubation and icu stay. upon returning to the floor, no additional therapeutic intervention was started for her atll. her mental status continued to deteroirate, and she stopped taking po. due to disease progression in addition to a persistent fungal infection and concern for aspiration goals of care were discussed with her family. due to her poor prognosis, she was made dnr/dni, and subsequently cmo. she passed peacefully on . medications on admission: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 3. valganciclovir 450 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 4. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours). disp:*28 tablet(s)* refills:*0* 5. lorazepam 0.5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for nausea, anxiety. 6. metoclopramide 10 mg tablet sig: 0.5 tablet po tid (3 times a day). 7. doxepin 25 mg capsule sig: capsules po once a day. 8. spironolactone 25 mg tablet sig: two (2) tablet po twice a day. 9. pyridoxine 100 mg tablet sig: four (4) tablet po once a day. 10. fexofenadine 60 mg tablet sig: one (1) tablet po twice a day. 11. allopurinol 300 mg tablet sig: one (1) tablet po once a day. 12. benadryl oral 13. levaquin 750 mg tablet sig: one (1) tablet po once a day for 9 days. disp:*9 tablet(s)* refills:*0* 14. line flush order sodium chloride 5-10ml pre- and post infusion heparin 10units/ml ml infused as a final flush 15. metoclopramide 5 mg tablet sig: one (1) tablet po three times a day as needed for nausea. discharge medications: none discharge disposition: expired discharge diagnosis: deceased. discharge condition: none discharge instructions: none followup instructions: none procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung parenteral infusion of concentrated nutritional substances insertion of endotracheal tube insertion of endotracheal tube fiber-optic bronchoscopy arterial catheterization closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus other endovascular procedures on other vessels injection or infusion of cancer chemotherapeutic substance diagnoses: pneumonia, organism unspecified acidosis acute kidney failure, unspecified hyposmolality and/or hyponatremia mycosis fungoides, unspecified site, extranodal and solid organ sites nausea with vomiting acute respiratory failure defibrination syndrome intestinal infection due to clostridium difficile antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use other encephalopathy do not resuscitate status cytomegaloviral disease other specified disorders resulting from impaired renal function aspergillosis pneumonia in aspergillosis hypercalcemia human t-cell lymphotrophic virus, type i [htlv-i] mucositis (ulcerative) due to antineoplastic therapy other specified aplastic anemias viremia, unspecified large cell lymphoma, unspecified site, extranodal and solid organ sites 

Answer: The patient is high likely exposed to