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: a 51-year-old male, without any significant past medical history, who was transferred from an outside hospital for cellulitis and adenitis that was not responsive to antibiotics, resulting in hypotension. the patient stated that he was in his usual state of health until tuesday, when he first noted some left upper groin pain. the groin pain became progressively worse over the next several days, and also he noted an area of erythema. he developed fevers on . he went to an outside hospital emergency department the following day. at that time, he was diagnosed with cellulitis and adenitis, and was given 2 gm of ceftriaxone, and was discharged to home. he continued to have persistent fevers to 103 and returned the following morning to the outside hospital emergency department where he was admitted for cellulitis and adenitis. he was started on ancef, but developed a diffuse erythroderma rash the day after initiation of ancef therapy, which was felt to be due to a drug rash. on , the day of transfer to , the patient was still persistently spiking fevers, had an elevated white blood cell count with a bandemia, and became hypotensive despite iv antibiotics, including vancomycin, clindamycin and levaquin. his blood pressure dropped to 70 systolic, and he was given iv fluids and started on peripheral dopamine. at this time, arrangements were made to transfer the patient to . on arrival to , the patient was no longer on the dopamine drip and was normotensive with blood pressure's in the 100's to 110's/60's to 70's. the patient reported that 3 to 4 days prior to the onset of his symptoms on , he had been doing work at a family member's house and had been trying to close-off openings that rodents were using to get into a house. he also, at that time, removed a dead squirrel from the chimney. he noted that during his work that day there were a lot of bugs and spiders. he, however, does not remember being bitten by any insect. the patient lives in a heavily wooded area, has deer in his backyard, and also has a pet dog. he has not had any recent travel outside of . he has had no sick contacts. past medical history: history of prior wrist and hand surgery. allergies: possible allergy to ancef causing a rash. medications: none. medications on transfer: 1. vancomycin. 2. clindamycin. 3. levaquin. 4. zofran. 5. vicodin. family history: no family history of early coronary artery disease, or diabetes. social history: the patient has a remote tobacco history. he quit smoking in the 's. he drinks occasionally only socially. the patient lives in with his wife and children. he has a dog and lives in a heavily wooded area. physical exam on arrival: temperature 98.6, heart rate 106, blood pressure 108/67, respiratory rate 24, oxygen saturation 96 percent on 2 liters. general: in no acute distress, alert and oriented x 3. heent: pupils equal, round and reactive to light. supple neck. clear oropharynx. no cervical lymphadenopathy. anicteric sclerae. extraocular muscles intact. no facial asymmetry. lungs: clear to auscultation bilaterally. cardiovascular exam: tachycardic, irregular. abdomen: soft, nontender, normoactive bowel sounds, no hepatosplenomegaly. extremities: no lower extremity edema. 2 plus dorsalis pedis pulses and posterior tibialis pulses bilaterally. left groin: with several large, palpable subcutaneous nodules and an erythema over the left upper thigh extending from several inches above the knee to just below the inguinal crease. the area of erythema was warm and tender to palpation. the subcutaneous nodules were nontender to palpation. neurologic exam: cranial nerves ii through xii intact bilaterally. strength 5/5 in upper and lower extremities bilaterally. laboratory data: white blood cell count 19.8 with 94 percent polys, 0 bands, 3 percent lymphs, hematocrit 35.3, platelets 201, inr 1.3, ptt 30.7, esr 100, reticulocyte count 1.7, sodium 137, potassium 3.8, chloride 103, bicarbonate 21, bun 12, creatinine 0.7, alt 64, ast 27, ldh 81, ck 153, alkaline phosphatase 127, amylase 12, total bilirubin 1.7, direct bilirubin 1.0, lipase 12, troponin-t less than 0.01, albumin 3.3, uric acid 3.0, haptoglobin 328, tsh 0.36, lyme serology 160:, negative. chest x-ray: showed increased interstitial markings, possibly suggesting fluid overload. ekg: showed sinus tachycardia with first degree av block with a pr interval of 0.218. hospital course: 1. groin erythema and subcutaneous nodules: the patient's groin erythema was clinically consistent with a cellulitis. given the patient's possible allergy to ancef, he was continued on iv vancomycin and clindamycin. blood cultures were sent which did not reveal any organism. the patient remained hemodynamically stable and did not require any further pressors. the subcutaneous nodules had been previously ultrasounded and sampled with fine needle aspiration at the outside hospital on the day of admission. the ultrasound at the outside hospital revealed only lymphadenopathy. the gram stain showed 2 plus polys but no organisms. a repeat ultrasound at showed only left groin enlarged lymph nodes. no evidence of an abscess or fluid collection. the surgical service was consulted for biopsy of the left upper thigh lymph nodes, as the patient continued to spike fevers and had a persistently elevated white blood cell count despite vancomycin and clindamycin. an excisional biopsy was attempted; however, no lymph node was obtained. after approximately 3 to 4 days, the patient's cellulitis was clinically improving, he was no longer spiking fevers, and his white blood cell count was decreasing. given his extremely low risk for mrsa, and the fact that his cultures did not reveal any organisms, the patient's antibiotic coverage was changed to po clindamycin. there was also concern for possible streptococcal infection with his diffuse erythroderma rash, possibly representing the rash seen as scarlet fever. the patient never reported any pharyngitis, but given his complaints of diffuse arthralgias, myalgias, migrating neuropathic pain, there was some concern of rheumatic fever, as the patient had 2 aso screens performed which were both negative. 1. myalgias, arthralgias and neuropathic pain: the patient complained of bilateral shooting neuropathic-like pain, migrating arthralgias, swelling in the fingers and toes, and pleuritic chest pain. given the patient's exposure to multiple insects and animals, there was initially concern over tick-borne illnesses, including lyme disease and tularemia. tularemia titers were sent to the state lab and were pending at the time of transfer out of the intensive care unit. the patient was started on doxycycline to cover tularemia and lyme disease. however, with the patient's clinical improvement on antibiotics, it was felt that his clinical course was not consistent with tularemia. the patient did develop a significant amount of pleuritic chest pain that was relieved with nsaids and iv toradol. he also developed a pericardial friction rub. an echocardiogram revealed a normal ejection fraction and no pericardial effusion, and lyme titers were initially negative. however, given the patient's clinical evidence of pericarditis, newly prolonged pr interval, and migratory arthralgias and neuropathic pain, there was a significant concern for lyme disease and lyme carditis despite lack of serologic evidence. therefore, the decision was made to complete a 1 month course of doxycycline, and to repeat lyme serologies in weeks. on , the patient was transferred out of the intensive care unit to the general medical floor. the remainder of this discharge summary will be dictated by the covering intern on the general medicine floor. , procedure: other incision with drainage of skin and subcutaneous tissue diagnoses: unspecified septicemia sepsis unspecified disease of pericardium cellulitis and abscess of leg, except foot lyme disease lymphadenitis, unspecified, except mesenteric 

Answer: The patient is high likely exposed to