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 attending: chief complaint: fever, scapular pain, sepsis major surgical or invasive procedure: arterial line central venous line history of present illness: this is a 73 year old woman with a history of squamous cell lung ca s/p chemo and xrt who presents with fever to 102 and back pain. last chemotherapy was 1 week ago. she first noticed l scapular pain about 1 week ago. this was initially worse with movement and improved with nsaids. however, the pain is now pleuritic and worse with coughing. she has had a chronic cough related to her lung cancer, and this has been stable. she produces small amounts of clear sputum, not yellow or green. she denies sob. the scapular pain has progressed over the last week, becoming intolerable over the last day and prompting her to come to the ed. she also had a new fever to 102 last night. she denies cp, abdominal pain, n/v, diarrhea, dysuria. she tends to be constipated at baseline but has been having regular bms. she denies any recent uri symptoms. no sick contacts. recent travel. she lives at home (not in a nursing home). . in the ed, she was treated by must protocol for sepsis. sbps were initially in the 70s and did not respond to 2l ivf. she was then started on levophed. per report, only 2l total of ns was given, although documentation is not clear. rij line was placed. she was given ceftriaxone and azithromycin and was given morphine 2mg and dilaudid 4mg for back pain. past medical history: -squamous cell lung ca (diagnosed , presented with symptomatic hypercalcemia, stage iiia vs. iiib; s/p chemo with taxol and carboplatin and xrt) -retinitis pigmentosa with loss of peripheral vision -cataracts -herniated disk -h/o shingles social history: widowed, has ten children. worked as a secretary. she smoked two packs per day for 55 years, quit about 6 months ago when diagnosed with lung ca. she drinks alcohol occasionally. she lives with her daughter. she ambulates at home without difficulty, but since she has significant visual impairment she requires some assistance outside the home. family history: her mother died at age 76 of a stroke and heart attack. her father died at age 58 of throat cancer (smoker). she has one living sister aged 89. she had a brother who died of a heart attack at age 65, a brother who died of prostate cancer at age 60, and a brother who died of an aneurysm at age 69. she also has a sister who died at age 35 of a blood disorder. physical exam: vs: 98.9, 104/36, 101, 18, 99-100% on 5l nc gen: nad, lying comfortably in bed, not using accessory respiratory muscles, speaking in full sentences heent: perrl, eomi, mm dry, op clear neck: supple, jvp 6-7 cm lungs: bronchial breath sounds in l upper lung field, no wheezes or crackles heart: rrr, no m/r/g abd: +bs, soft, nt/nd back: no spinal tenderness or cva tenderness extrem: no edema, 2+ dp pulses pertinent results: 11:00am plt smr-normal plt count-230 11:00am hypochrom-normal anisocyt-1+ poikilocy-1+ macrocyt-1+ microcyt-normal polychrom-normal ovalocyt-1+ 11:00am neuts-92.1* bands-0 lymphs-3.1* monos-3.6 eos-0.8 basos-0.4 11:00am wbc-9.6 rbc-3.26* hgb-10.1* hct-29.6* mcv-91 mch-31.1 mchc-34.2 rdw-16.4* 11:00am crp-131.9* 11:00am cortisol-45.1* 11:00am albumin-3.8 calcium-8.2* phosphate-2.0* magnesium-1.8 11:00am ck-mb-notdone ctropnt-<0.01 11:00am lipase-15 11:00am alt(sgpt)-31 ast(sgot)-51* ld(ldh)-306* ck(cpk)-42 alk phos-72 amylase-85 tot bili-0.4 11:00am glucose-124* urea n-13 creat-0.8 sodium-131* potassium-4.2 chloride-100 total co2-21* anion gap-14 11:07am lactate-1.1 k+-3.8 12:20pm urine rbc-0-2 wbc-0-2 bacteria-few yeast-none epi-0-2 01:35pm lactate-0.6 01:35pm lactate-0.6 02:00pm pt-12.8 ptt-37.8* inr(pt)-1.1 02:00pm plt count-212 02:00pm hypochrom-normal anisocyt-1+ poikilocy-1+ macrocyt-1+ microcyt-normal polychrom-normal ovalocyt-1+ 02:00pm neuts-91.0* bands-0 lymphs-5.5* monos-3.3 eos-0.1 basos-0.2 02:00pm wbc-8.5 rbc-2.96* hgb-9.2* hct-27.5* mcv-93 mch-31.0 mchc-33.4 rdw-16.6* 02:19pm hgb-9.6* calchct-29 o2 sat-87 02:19pm lactate-0.7 02:19pm type- po2-53* pco2-41 ph-7.25* total co2-19* base xs--8 04:06pm lactate-1.1 04:06pm comments-green top 05:27pm pt-12.8 ptt-28.4 inr(pt)-1.1 05:27pm plt count-249 05:27pm wbc-7.8 rbc-2.98* hgb-9.5* hct-26.9* mcv-90 mch-31.8 mchc-35.3* rdw-16.3* 05:27pm calcium-6.6* phosphate-2.2* magnesium-1.6 05:27pm glucose-137* urea n-9 creat-0.7 sodium-139 potassium-4.2 chloride-112* total co2-19* anion gap-12 05:41pm freeca-1.03* 05:41pm o2 sat-75 05:41pm lactate-1.2 k+-4.0 05:41pm type- ph-7.27* 09:58pm cortisol-39.9* 10:41pm cortisol-41.2* brief hospital course: pt was admitted to the icu for further care pneumonia: large consolidation in lul with cavitation and smaller consolidation in lll seen on ct. this likely explains fever, scapular pain, and hypotension/early sepsis. most likely severe bacterial pneumonia, rather than tuberculosis (no risk factors) or other etiology of cavitation. wbc not elevated, but there is a left shift without bands. patient is s/p recent chemo but is not neutropenic. pt treated broadly for pneumonia with vanco, cipro, and flagyl to cover community acquired pneumonia, possible post-obstructive vs. aspiration, as well as s. aureus given large cavitation. pt started on nc o2. cvl and a-line placed to monitor hemodynamics. pt was bolused ivf to maintain a cvp of 8. she also received a 7d course of iv hydrocortisone without taper. pt responded well to fluids and antibiotics, did not spike a fever while in the icu. in the ed, she was treated by must protocol for sepsis. sbps were initially in the 70s and did not respond to 2l ivf. upon arrival in icu, she was then started on levophed, rij line was placed, and she was given ceftriaxone and azithromycin. she was switched to vanc/zosyn for obstructive pna based on ct scan showing attenuation of l bronchus from increasing hilar mass. pressors were weaned and withdrawn on , and pt. has been afebrile since the day of admit. given hd stability, pt. was transferred to floor, requiring 95% on 3-4l nc. on transfer to the floor, she was switched from vanc/zosyn to levofloxacin (day 1 abx was ) for community-acquired pna, as has been stable. she was stable, afebrile on oral abx. and discharged with an rx. for full 14d course. she was weaned to 2l of oxygen and was sent home with home oxygen services for 2l nc. as the tumor was compressing the l bronchus, ip placement of stent was considered. dr. spoke with dr. of ip and after reviewing imaging, did not recommend ip intervention at this time. . # lung ca: last chemo 1 week ago. further treatment was deferred until reassessment as outpt. . # hypocalcemia: formerly treated for hypercalcemia related to her squamous cell lung ca. was somewhat hypocalcemic and hypophosphatemic, despite repletion, likely previous zomeda tx. asymptomatic, and repleted lytes as necessary. vna was arranged to draw electrolytes and replete prn . # anemia: likely acd due to malignancy, as fe low, ferritin high, tibc, transferrin low. anemic compared to baseline on admit: hct was 29(bl 31-33), and nadired at 23 during admission. we advised pt. to have transfusion, but pt. refused after clearly explaining risks and benefits. she had no guaiac positive stools and her hct rebounded on its own to 27 at time of discharge. # code: dnr/dni, pressors ok, confirmed with pt and hcp. however, if reversible respiratory decompensation occurs due to pneumonia, may need to readdress dni status with patient. she was discharged home with scripts for home oxygen, vna services, and 7d of abx. medications on admission: motrin prn tylenol with codeine prn discharge medications: 1. docusate sodium 100 mg capsule sig: capsules po bid (2 times a day) as needed for constipation. disp:*60 capsule(s)* refills:*0* 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 3. hydromorphone 2 mg tablet sig: one (1) tablet po every hours as needed for pain. disp:*90 tablet(s)* refills:*0* 4. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*0* 5. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days. disp:*6 tablet(s)* refills:*0* 6. oxygen-air delivery systems device sig: one (1) device miscell. x1. disp:*1 unit* refills:*0* 7. oxygen continuous oxygen at 2l. for portability, pulse dose system. 8. guaifenesin ac 10-100 mg/5 ml liquid sig: 5-10 mls po q6h (every 6 hours) as needed for cough. disp:*1 qs* refills:*0* discharge disposition: home with service facility: hospice and vna discharge diagnosis: commuity acquired pneumonia sepsis squamous cell lung cancer discharge condition: good, ambulating without assistance, tolerating pos, satting well on 3l oxygen discharge instructions: please return should you develop fever or increased shortness of breath. please also seek medical attention should you develop chest pain, shortness of breath, abdominal pain, decreased po intake or decreased urine output. take all your medications exactly as prescribed and call dr. office on monday for a follow up appointment. you will be taking your antibiotic levofloxacin for 1 more week. followup instructions: call dr. office at ( on monday for a follow up appointment md procedure: venous catheterization, not elsewhere classified diagnoses: hypocalcemia unspecified septicemia severe sepsis septic shock malignant neoplasm of other parts of bronchus or lung bronchopneumonia, organism unspecified anemia in neoplastic disease 

Answer: The patient is high likely exposed to