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: penicillins attending: chief complaint: neck pain, thrombocytopenia major surgical or invasive procedure: cervical evacuation epidural hematoma history of present illness: is a 57-year-old right-handed man, with a history of tonsillar carcinoma in s/p radiation alone, who was recently admitted for progressive neck pain and r side hemiparesis and mri findings concerning for recurrence of his cancer versus radiation scarring. he is status post cervical laminectomy for tissue diagnosis which is still pending. also,he was incidentally found to have possible babeseosis for which has been started on azithromycin prophylactically. he had been at rehab doing well and reports that his neck pain has improved since surgery and he has increased range-of-motion of his neck. on routine labs he was discovered to have leukocytosis to the 31.2 and thrombocytopenia to 12 and was sent to ed for further evaluation. past medical history: past oncological history: - tonsillar carcinoma diagnosed and treated with xrt. other past medical history: - cervical myelopathy believed to be secondary to prior head and neck radiation - alcoholic cirrhosis with chronic thrombocytopenia and history of varices, and he is status post banding - anxiety - chronic back pain on long term opiates - babeseosis social history: social history: he lives with his wife and 9-year-old son. smoked 1.5 packs of cigarettes per day for 35 years; he stopped in . he drank alcohol heavily in the past but he stopped in . he used cocaine in the remote past. - tobacco: he smoked from age 13 to 48, 1.5 ppd, so 50+ pack years - alcohol: former heavy drinker, last drink was in . - illicits: used cocaine in the past, none recently. family history: family history: his father died at age 47 from smoking-related lung cancer. his mother is alive and healthy. his 2 brothers are deceased, one from leukemia and the other from drug abuse and psychiatric problems. his 2 sisters are healthy. he has 4 children and they are all healthy. physical exam: physical exam: o: 96.7 88 124/77 16 100 ra gen: wd/wn, comfortable, nad. heent: pupils: 3->2 bilaterally eomi bilaterally neck: supple. lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. neuro: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, and date. language: speech fluent with good comprehension and repetition. naming intact. no dysarthria or paraphasic errors. cranial nerves: i: not tested ii: pupils equally round and reactive to light, 3->2 bilaterally mm bilaterally. visual fields are full to confrontation. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric. viii: hearing intact to voice. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally - weaker on the right (5-), left is () xii: tongue midline without fasciculations. motor: normal bulk and tone bilaterally. patient continues to have r-sided weakness as follows: deltoid () biceps () wrist extension () grip () iliopsoas () quads () hamstrings () g/s () () l is throughout sensation: intact to light touch, propioception, pinprick and vibration bilaterally. reflexes: b t br pa ac right 3+ 3+ left 2+ 2+ toes downgoing bilaterally unable to assess pronator on r, no pronator drift on l exam on discharge: patient has full strength on left, but right strength is as follows: l deltoid, bicep, we, grip, tricep 2-3/5 lle has been 0-1/5 posterior neck incision has been draining serosang fluid and requires daily wound dressing changes and prn. pertinent results: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 1:07 pm 20 6:18 am 9.5 10.0 28.8 10 3.1* 2.48* 8.1* 24.0* 97 32.9* 33.9 18.8* 37* 11:45am 4.2 2.51* 8.6* 24.4* 97 34.4* 35.4* 18.1* 38* 09:26am 4.0 2.19* 7.4* 21.7* 99* 34.0* 34.3 17.7* 39* 04:48am 4.8# 2.59*# 8.9*# 25.6*#1 99* 34.3* 34.7 17.6* 28*# 03:33pm 31.2* 2 3.79* 13.1* 38.0* 100* 34.6* 34.4 17.7 12*# ct c-spine 1. large intermediate density collection at the site of laminectomy on the posterior cervical region. the lack of enhancement and density of this lesion suggests the presence of a hematoma. 2. extra-axial intermediate density material within the cervical canal causing leftward displacement of the cervical spine. the lack of enhancement of this material also suggests the presence of hematoma but abscess cannot be excluded. if clinically indicated, mri could be performed for better evaluation. mri c-spine : 1. large collection in the c1-c3 laminectomy beds, extending into the right posterior epidural space in the more inferior cervical spine, most consistent with a hematoma. no evidence of rim enhancement to suggest an abscess. the most severe mass effect on the spinal cord occurs at c2-3, where no cerebrospinal fluid is seen surrounding the cord. 2. essentially unchanged appearance of the rim-enhancing lesion in the upper cervical spinal cord, compatible with either tumor or radiation necrosis. biopsy results are pending. ct c-spine : s/p hematoma evacuation - no evidence of epidural hematoma ct c-spine : interval increased fluid reaccumulation at the laminectomy site and site of previous drain placement in overlying posterior cervical soft tissue. these areas demonstrate no rim enhancement to suggest abscess. video swallow : impression: trace aspiration was present on thin liquids. there is a large amount of residual barium material within the valleculae. minimal movement is present at the base of the tongue. there is a significant amount of retropulsion into the nasopharynx. for further details, please refer to the speech pathology report on omr. brief hospital course: mr. was admitted to on the nsurg service, and was kep in the pacu for close monitoring and q1 neuro checks, as no icu beds were available. he immediately began to receive platelet transfusions. his repeat plt level following 3 packs of platelet transfusion was 38. a threshold of 80 was set for the patient to be taken to the operating room. his strength in his left upper extremity began to slowly worsen. he additionally dropped his hct from 38 on admission to 21 on . several consults were obtained to aid in further working up of his pancytopenia, including heme, omed, gsurg, and gi. no obvious source of internal bleeding was identified on ct scan. he continued on platelet infusions and prbc infusions throught the day on , and following 8 packs of platelet transfusions and 2 , his platelets and hct were 23.8 and 84 respectively. he was then taken to the or evening for evacuation cervical epidural hematoma. he tolerated this procedure well, he remained intubated and went to sicu overnight for monitoring. ct of c-spine the next morning showed no epidural hematoma. patient was weaned to extubation on and tolerated this will. he reamined in the icu until ; his platelets remained in the 70s without transfusion, his hct was stable at 27, and the strength in his rue and rle improved to his pre-surgical state. on , he transferred out of the icu to the stepdown unit. his platelet count dropped again to 48; he was therefore transfused 1 unit (bringing total to 11 units). immediately following this, his jp was pulled. it was left open to drain, and it did so for approximately 3-4 days (serosanguenous fluid). he was noticed to have a stage i pressure ulcer to his coccyx, which was treated with cream and frequent monitoring and turns. the patient's platelet count was persistently less than 50 from through , and was subsequently given a transfusion for every low count. he received a total or over 20 units of platelets during his hospitilization, with the intent of keeping platelets higher than 50 to prevent reaccumulation into his epidural space. however, it was determined that this was futile, as his platelets count did not significantly rise despite numerous transfusions. the decision was made to keep the transufion threshold to 30, and to check his platelets only 2x/weekly weekly. this was a recommendation from the hematology service. on his decadron was tapered off. incision was noted to be draining serosang fluid but did not appear to be csf. wound was requiring daily wound dressing changes. on his platelet count was 10, and transfused with 1 pk of platelets. repeat plt was 20. insurance approval was obtained and patient was stable for discharge on to rehab. medications on admission: 1. docusate sodium 100 mg capsule : two (2) capsule po bid (2 times a day). 2. senna 8.6 mg tablet : one (1) tablet po daily (daily) as needed for constipation. 3. polyethylene glycol 3350 17 gram/dose powder : one (1) packet po daily (daily) as needed for constipation. 4. levothyroxine 112 mcg tablet : one (1) tablet po daily (daily). 5. nadolol 20 mg tablet : two (2) tablet po daily (daily). 6. cholecalciferol (vitamin d3) 400 unit tablet : two (2) tablet po daily (daily). 7. calcium carbonate 500 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 8. rifaximin 200 mg tablet : one (1) tablet po tid (3 times a day). 9. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). 10. oxycodone 5 mg tablet : one (1) tablet po q4h (every 4 hours) as needed for pain. 11. atovaquone 750 mg/5 ml suspension : seven y (750) mg po bid (2 times a day): 10 days. d1 to for babeseosis in a compromised host. 12. azithromycin 500 mg recon soln : 1000 (1000) mg intravenous q24h (every 24 hours): 10 days. d1 to for babeseosis in a compromised host . 13. dexamethasone 4 mg iv q6h 14. fentanyl 25 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 15. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 16. celexa 20 mg tablet : one (1) tablet po once a day. discharge medications: 1. calcium carbonate 500 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 2. citalopram 20 mg tablet : one (1) tablet po daily (daily). 3. fentanyl 25 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 4. multi-vitamins w/iron tablet, chewable : one (1) tablet po daily (daily). 5. levothyroxine 112 mcg tablet : one (1) tablet po daily (daily). 6. nadolol 20 mg tablet : two (2) tablet po daily (daily). 7. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for pain. 8. oxycodone-acetaminophen 5-325 mg/5 ml solution : 5-10 mls po q6h (every 6 hours) as needed for severe pain. 9. rifaximin 200 mg tablet : two (2) tablet po tid (3 times a day). 10. lactulose 10 gram/15 ml syrup : thirty (30) ml po tid (3 times a day). 11. famotidine 20 mg tablet : one (1) tablet po q12h (every 12 hours). 12. miconazole nitrate 2 % powder : one (1) appl topical tid (3 times a day) as needed for skin irritation. 13. spironolactone 100 mg tablet : one (1) tablet po daily (daily). 14. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 15. potassium chloride 20 meq packet : two (2) packet po x2 (). 16. metoprolol tartrate 5 mg/5 ml solution : one (1) intravenous q4h (every 4 hours) as needed for hr>110. 17. methocarbamol 500 mg tablet : one (1) tablet po tid (3 times a day). 18. cephalexin 500 mg capsule : one (1) capsule po q12h (every 12 hours) for 10 days: started on . discharge disposition: extended care facility: & rehab center - discharge diagnosis: epidural hematoma thrombocytopenia cirrhosis - end stage liver disease stage i pressure ulcer (coccyx) discharge condition: stable discharge instructions: ?????? do not smoke. ?????? keep your wound(s) clean and dry / no tub baths or pool swimming for two weeks from your date of surgery. ?????? you have staples in place ?????? no pulling up, lifting more than 10 lbs., or excessive bending or twisting. ?????? limit your use of stairs to 2-3 times per day. ?????? have a friend or family member check your incision daily for signs of infection. ?????? you may only shower with the collar or back brace on. ?????? take your pain medication as instructed; you may find it best if taken in the morning when you wake-up for morning stiffness, and before bed for sleeping discomfort. ?????? do not take any anti-inflammatory medications such as motrin, advil, aspirin, and ibuprofen etc. unless directed by your doctor. ?????? increase your intake of fluids and fiber, as pain medicine (narcotics) can cause constipation. we recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? clearance to drive and return to work will be addressed at your post-operative office visit. call your surgeon immediately if you experience any of the following: ?????? pain that is continually increasing or not relieved by pain medicine. ?????? any weakness, numbness, tingling in your extremities. ?????? any signs of infection at the wound site: redness, swelling, tenderness, and drainage. ?????? fever greater than or equal to 101?????? f. ?????? any change in your bowel or bladder habits (such as loss of bowl or urine control). ** you have been placed on keflex as a precaution, please continue as prescribed** followup instructions: follow up with dr. on at 10:45 for appointment and staple removal follow up with a hepatologist at liver center for your cirrhosis within 2 weeks after your discharge. the hepatology service recoomends a low na diet for your acites, to continue on lasix 40mg everyday and aldactone 100mg everyday for 1-2 months. while one these medications you will need to have your electrolytes and cbc drawn once every week this should be faxed to your primary care physician and the liver center. you should have a ct of the chest with contrast as an outpatient with your pcp to exclude exclude an enhancing soft tissue lesion that was suspicious on a non contrast ct scan. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other exploration and decompression of spinal canal diagnoses: thrombocytopenia, unspecified alcoholic cirrhosis of liver atrial fibrillation hematoma complicating a procedure anxiety state, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation pressure ulcer, lower back other ascites hepatic encephalopathy varices of other sites backache, unspecified precipitous drop in hematocrit personal history of irradiation, presenting hazards to health pressure ulcer, stage i alcohol abuse, in remission personal history of malignant neoplasm of other and unspecified oral cavity and pharynx hemiplegia, unspecified, affecting dominant side unspecified disease of spinal cord 

Answer: The patient is high likely exposed to