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: the patient was an 80-year-old male with a history of chronic obstructive pulmonary disease and a recent diagnosis of vasculitis, possibly wegener's vasculitis. his vasculitis had been diagnosed 3-4 months prior to admission when the patient was admitted to for a presumed pneumonia. while in the hospital the patient apparently developed myalgias and elevated erythrocyte sedimentation rate, elevated creatine kinase levels and elevated white blood cell count and signs of liver and renal failure. two lymph node biopsies and skin biopsies were performed and the results were thought to be consistent with a lymphocytoblastic vasculitis, possibly wegener's vasculitis. the patient was, at this time, begun on cytoxan and high dose steroid therapy with good results and was discharged home. approximately 6 weeks prior to his admission. on the day prior to his admission he noticed worsening shortness of breath. he visited his pcp and routine cbc showed a white blood cell count of 1,000. at this time the patient was asked to stop taking his cytoxan, however, he noted worsening shortness of breath and was transported to the emergency room by ambulance on . at presentation he was found to have interstitial infiltrates on chest x-ray, a white blood cell count of 0.2 with no neutrophils and in the emergency room was begun on ceftazidime, bactrim and solu-medrol and was admitted to the micu for close observation of respiratory status. past medical history: included chronic obstructive pulmonary disease, wegener's vasculitis, steroid induced diabetes mellitus, no history of coronary artery disease. medications: on admission, cytoxan 50 mg q d, prednisone 50 mg q d, glucophage 850 mg tid, prevacid 30 mg q d, rocaltrol 25 mg q d, procrit, glyburide 5 mg tid which had recently been discontinued. allergies: the patient reported an allergy to penicillin. family history: the patient was unable to provide a family history. social history: the patient reported that his lived with his wife in . the couple had no children. substance abuse: notable for a 100 pack year history of tobacco use with the patient having quit smoking approximately 30 years ago. review of systems: notable for three days of dyspnea on exertion and fevers and chills on the day prior to admission. there had been no recent weight changes, no change in the patient's urinary habits, no change in the patient's bowel movements and no nausea or vomiting. physical examination: at the time of admission the patient was noted to be an elderly, thin white male lying in a stretcher in mild distress. his vital signs showed a temperature of 100.2, heart rate 130, blood pressure 100/63, respiratory rate 24. oxygen saturation was 94% on a 12 liters o2 face mask. his head, eyes, ears, nose and throat exam was notable for pupils which were 3 mm and minimally reactive. there was no cervical lymphadenopathy. his lungs revealed coarse breath sounds on the right side, rhonchi and faint coarse wheezes bilaterally. there were coarse crackles at both lung bases with crackles greater on the right than on the left. his cardiac exam revealed tachycardic rhythm and normal s1 and s2, no murmurs were appreciated and there was no jugulovenous distension. his abdominal exam showed a soft abdomen with active bowel sounds. there was no tenderness or abdominal distention noted. on extremity exam there was no lower extremity edema and fair distal pulses bilaterally. neurologic exam showed the cranial nerves ii through xii were intact. strength was throughout all four extremities. deep tendon reflexes were 2+ and symmetric throughout and the patient was alert and oriented times three. laboratory data: on admission showed white blood cell count of 0.2, hematocrit 41.9, platelet count 330,000. on the differential there were no neutrophils, 75 lymphocytes, 19 monocytes and 6 others. his electrolytes were notable for sodium of 137, potassium 4.8, chloride 96, co2 23, bun 36, creatinine 1.3 and glucose of 224. ck level was 16. troponin level was less than 0.3 and arterial blood gas showed a ph of 7.40, pco2 40 and po2 of 77 taken on 12 liters face mask. an ekg showed a rate of 180 beats/minute, possibly with suggestions of multifocal atrial tachycardia. there was no ability to assess the st-t waves secondary to wandering baseline on the ekg. his chest x-ray, as mentioned, showed bilateral interstitial opacity and blunting of the right costophrenic angle. hospital course: the patient was admitted to the medical intensive care unit for monitoring of respiratory status with diagnoses of pneumonia and neutropenia. at the time of admission the following major issues were addressed: 1. pneumonia. the patient was placed on broad spectrum antibiotic coverage for pneumonia including ceftazidime and bactrim. induced sputum were obtained for gram stain culture and analysis for pcp. 2. cardiac. the patient was placed on verapamil to control his heart rate. 3. neutropenia. at the time of admission the patient's neutropenia was thought to be attributable to his cytoxan and prednisone use. these two medications were held at the time of admission and hematology was consulted to assess the benefit of beginning the patient on gcsf to assist in resolution of his neutropenia. 4. endocrine. given the patient's prolonged outpatient steroid course of several months, there was concern that he might be developing some adrenal insufficiency. the patient was therefore placed on prednisone at a dose of 50 mg daily at the time of admission. over the course of the next several days the patient continued to develop worsening respiratory status. he was on neutropenic precautions and was begun on gcsf. his antibiotic coverage was broadened to include vancomycin beginning on . on the patient was placed on bi-pap to assist in his breathing. an echocardiogram was also obtained on this date to assess the role of potential congestive heart failure in contributing to his shortness of breath. the echocardiogram showed a relatively well preserved ejection fraction of between 45 and 55%. on a hematology consult concurred that the patient's neutropenia was likely secondary to his outpatient cytoxan use and recommended that this medication should continue to be held during the hospital course. at this time the patient's platelet count was also noted to be 48, down from 330 at the time of admission, several days previous. on a rheumatology consult was obtained. rheumatology recommended continuing the patient's steroid dose and also assisted in obtaining outside hospital records to clarify the patient's diagnosis of vasculitis. also on the patient had a bronchoscopy performed. bronchoscopy showed friable airways with mucopurulent discharge. a bronchoalveolar lavage was also obtained. overnight, however, on the patient's respiratory and cardiopulmonary status further declined. the patient was placed on dopamine to support his blood pressure and he ultimately required intubation overnight. on the patient's bactrim was discontinued out of concern that this medication may as well be contributing to his thrombocytopenia and the patient was placed on pentamidine to treat possible pcp . a chest ct performed that day showed a multifocal pneumonia. on the patient spiked new fevers in the micu and cultures were obtained. in addition, an induced sputum culture from returned results that showed yeast in the sputum. the patient was begun on ambisome and infectious disease consult was obtained. infectious disease recommended continuing ambisome as the yeast was suspicious for invasive aspergillosis. infectious disease also recommended continuing the patient on vancomycin and levofloxacin but discontinuing the patient's ceftazidime at this point. the antibiotic course was to be continued for 14 days after the recovery of the patient's neutropenia and in fact, the patient's absolute neutrophil count was noted to be greater than 500 on . at this time a swelling was also noted in the patient's right upper extremity and his right arm was noted to be diffusely warm and erythematous. on , right upper extremity ultrasound was obtained which showed a deep venous thrombosis extending from the forearm to the axilla in one of the brachial veins. at this time the question was posed to hematology as to whether it would be safe to anticoagulate the patient with a platelet count of 29. heparin induced thrombocytopenia antibody studies were pending at this time. overnight on , unfortunately the patient's condition again deteriorated. he was placed on dopamine and given fluid boluses to support his blood pressure. he remained intubated and his ventilation settings were changed from pressure support to assist control. in addition, blood culture bottles drawn on returned positive for yeast. the patient was therefore continued on his ambisome course out of concern for fungemia. on the patient was transfused one unit of platelets in preparation for a new femoral line insertion. on the morning after transfusion, his platelet count was noted to have improved to 69 and at this time the decision was made that it would be safe to anticoagulate the patient for his right upper extremity dvt and the patient was begun on a heparin iv drip. in addition, an ophthalmology consult was obtained to assess for fungal endophthalmitis. ophthalmologic examination by the ophthalmology consult showed no evidence of endophthalmitis. on the patient's cardiopulmonary status continued to decline and he was begun on neo-synephrine. the neo-synephrine rate was increased and he was eventually weaned off of dopamine. however, the patient continued to suffer from hypotension despite pressor support. in order to assess for the possibility of any other possible infectious source, an abdominal ct was obtained. this showed evidence of homogenous liver and spleen but no focal abdominal abscesses. on the patient remained intubated and on pressor support of neo-synephrine. she was noted to be increasingly acidotic. a family decision was made that the patient's care status should be changed to comfort measures only. the patient at this time was continued on a morphine and ativan drip for sedation. all other medications were discontinued at this time and the ventilator settings were turned down. shortly before midnight on the patient became bradycardic and ultimately went into cardiopulmonary arrest. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube arterial catheterization diagnoses: acute posthemorrhagic anemia acute kidney failure, unspecified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation methicillin susceptible pneumonia due to staphylococcus aureus aspergillosis pneumonia in aspergillosis arteritis, unspecified 

Answer: The patient is high likely exposed to