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: patient recorded as having no known allergies to drugs attending: chief complaint: weakness, shortness of breath major surgical or invasive procedure: , ct-guided drainage of sigmoid fluid collection right internal jugular central line placement arterial line placement intubation with mechanical ventilation x 2 extubation x 1 dobhoff placement oral-gastric tube placement history of present illness: mr. is a 58 year old man with anca-negative vasculitis with a history of pulmonary hemorrhages, on chronic supplemental oxygen, high dose prednisone therapy s/p recent admission earlier this month () for perforated diverticular disease managed conservatively with bowel rest and antibiotics, now admitted with worsening weakness. patient reports that since he first received the rituxan in early , his weakness has worsened. he feels tired all the time, has no energy and decreased exercise tolerance. he can no longer walk from his wheelchair (motorized) to the bathroom (a matter of a few steps) due to dyspnea. he denies fevers, chills, change in his cough or hemoptysis. he has daily hemoptysis that is no different from baseline. he has had some pain in his mouth that he attributes to thrush. he started on nystatin swish and swallow a few days ago and that has helped considerably. his abdominal discomfort is much improved. he is tolerating a normal diet and taking in pos. he has been on 6l of oxygen for the past month or so, but adds a face mask with additional oxygen when ambulating to the br. this is a significant worsening for him per his report, in the not too distant past, he reports, he could at times go without supplemental oxygen. he does not wear cpap or bipap. ros is negative for chest pain, edema, rash, fevers/chills, nausea, no urinary frequency or dysuria. positive for: diarrhea - loose stools since diverticulitis flare. also with some chronic visual changes limiting his ability to read easily. says he saw a ophthamologist for this and was told it was due to ischemic damage. past medical history: alveolar hemorrhage/anca negative vasculitis. never had a biopsy. presented as dad in . several hospitalizations for same since then. atrial fibrillation status post ablation. type 2 diabetes mellitus. dvt with pe s/p filter cad status post stenting to the lad in . mild pulmonary hypertension. obesity. sleep apnea. nash. hyperlipidemia. hypertension. bilateral torn rotator cuff. bph. gerd, consistent with barrett's esophagus. anxiety. spinal stenosis. social history: mr. lives with his wife and has 2 children that live in . he has a history of smoking 2-3pk per day x 25 yrs and quit 5 yrs ago. he also has a history of alcohol use but no illicits. per omr, prior job in auto-body repair. at baseline, he uses an electric wheelchair to get around. family history: no known family history of blood clots or bleeding. physical exam: admission exam gen: obese, -oid appearing man, appears comfortable at rest, with dyspnea with full-sentences vs: t 96.5 po, 156/91 85 22 100% on 6l nc gen: nad. oriented x3. heent: ncat. sclera anicteric. right pupil 4--> 3 mm, left pupil 3--> 2 mm. eomi. op with upper and lower dentures in place, + white exudate on tongue and posterior o/p. neck: supple, jvp not seen due to habitus. cv: rrr distant chest:no accessory muscle use. ctab, no rales, wheezes or rhonchi. diminished breath sounds throughout abd: obese, soft, ntnd. unable to appreciate hsm ext: no c/c/edema. skin: no stasis dermatitis, ulcers, scars neuro: alert and appropriate pertinent results: admission labs ============================================= 01:09am lactate-1.9 01:00am glucose-67* urea n-25* creat-0.6 sodium-138 potassium-4.0 chloride-101 total co2-30 anion gap-11 01:00am alt(sgpt)-46* ast(sgot)-23 ck(cpk)-27* alk phos-47 tot bili-0.8 01:00am ctropnt-<0.01 01:00am lipase-28 01:00am wbc-4.8 rbc-2.98* hgb-9.8* hct-29.4* mcv-99* mch-33.0* mchc-33.5 rdw-15.8* 01:00am pt-11.3 ptt-19.9* inr(pt)-0.9 reports ============================================= ct abdomen w/contrast study date of 1. feculent collection adjacent to loop of sigmoid colon at site of previous episode of diverticultis consistent with perforated diverticulitis. this has progressed in size from the prior examination and is localized to the perisigmoid region although there is not a well defined wall about this gas and stool containing collection. 2. extensive colonic diverticulosis. 3. paraumbilical hernia containing nonobstructed, nondilated loops of small bowel. 4. stable scarring at bilateral lung bases with fibrotic changes. 5. stable hypodensity in the pancreas, which could represent an impn or pancreatic cyst. mrcp would be recommended for further evaluation. cta chest w&w/o c&recons, non-coronary study date of 1. persistent diffuse ground-glass opacities superimposed on interstitial abnormality. as previously described, this may be due to pulmonary hemorrhage, exacerbation of underlying interstitial disease, or infection. no pleural effusions. 2. no pulmonary embolus. 3. sigmoid colon abscess drainage catheter in place. no reaccumulation of fluid or new abdominal collections. chest (portable ap) study date of in comparison with the study of , there are lower lung volumes and increasing pulmonary vascular congestion. the possibility of supervening pneumonia must be considered. monitoring and support devices remain in place with the metallic portion of the dobbhoff tube just below the esophagogastric junction. 4:55 pm blood culture **final report ** blood culture, routine (final ): morganella morganii. final sensitivities. viridans streptococci. isolated from one set only final sensitivities. susceptibility testing requested by dr. . sensitivity testing performed by sensititre. sensitivities: mic expressed in mcg/ml _________________________________________________________ morganella morganii | viridans streptococci | | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s clindamycin----------- <=0.25 s erythromycin---------- 0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s penicillin g---------- 0.06 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r vancomycin------------ 1 s anaerobic bottle gram stain (final ): gram negative rod(s). gram positive cocci in pairs and chains. reported by phone to at 1415. aerobic bottle gram stain (final ): gram positive cocci in pairs and chains. brief hospital course: upon admission the weekend of , patient's cellcept and rituxan were halted. ct scan of abdomen and pelvis showed enlarging sigmoid fluid collection consistent with an abscess. pulmonary, surgery (dr. , id and ir were all consulted. additional blood cultures were drawn and zosyn started. surgery was felt to be high-risk given his 450 mg-per-day prednisone dosing. a plan was made for ir drainage of the fluid collection after a platelet transfusion -- after a platelet transfusion for his thrombocytopenia -- while simultaneously changing his steroids over to hydrocortisone 200 mg tid and attempting to wean that down to 80 mg tid. on , his blood cultures were reported positive for strep viridans and morganella. linezolid was d/discontinued. on , he was intubated, a central line was placed, and ir placed a drain in the abscess that post-procedure was returning brown feculent material. post-procedure his vent and sedation were weaned, and he received iv ig. he had a foley placed prior the procedure that was traumatic in placement, and urology came to place a coudet. urology recommended the foley until when he could have a voiding trial. on , a tte was ordered given strep viridans-positive cultures. his steroids were tapered from 200 tid to 180 tid. he was extubated. he had some minimal bleeding in his tracheal secretions and a hematocrit of 19, for which he was transfused 1 unit of blood with a good response. on , attempts to wean him to hydrocortisone 160 mg tid led to him reporting an increase in his chronic hemoptysis, so his steroid dose was pushed back up to 180 mg tid. he was called out of the icu to the floor at this point. the patient developed increasing oxygen requirement on the floor and frank blood on suctioning. he was transferred back to the icu and shortly re-intubated. patient's rebleed was felt likely due to attempted decreasing of his steroids so per rheumatology, hydrocortisone was increased to 500 mg three times daily. patient also briefly developed neutropenia. his ett tube also tended to migrate above carina, have cuff leaks requiring repositioning by anesthesia. patient developed thrombocytopenia (20-30s) requiring transfusions; in consultation with heme/onc, it was felt this was not due to hit but acute disease and patient's large body habitus. he was transfused platelets and bumped appropriately. cmv/ebv/parvovirus viral loads were negative. peripheral blood smear negative for dic. ultimately, patient underwent plasmapheresis (5 sessions) and another round of ivig (5 days) to optimize his healing potential and immunological status. his hydrocortisone was slowly weaned down and then transitioned to solumedrol (60mg iv three times daily). in the meantime, continued to monitor patient's insulin sliding scale and fixed dose regimens on steroids. repeat ct abdomen/pelvis showed dramatically improving/shrinking abscess and good drainage. he did require one replacement of his drain when it fell out overnight on . infectious disease continued to follow patient and recommended meropenem (cipro/linezolid felt redundant given sensitivity/speciation of abscess microbes). there was brief concern of sirs in the setting of relative hypotension. patient was initially kept npo with parenteral feedings to provide bowel rest for his known sigmoid abscess and perforated diverticulitis. eventually, a dobhoff was placed and his diet slowly advanced. intermittently he had ileus and tube feeds were held. throughout patient's remaining hospital course, his pulmonary ventilation status was difficult to manage until he was started on airway pressure release ventilation. patient was also found to have anasarca with +14 l length of stay. he was started on active lasix diuresis which he responded well to (~-6 l daily on occasion). he was also briefly on acetazolamide for metabolic acidosis. patient was gradually transitioned to pressure support and then weaned/extubated. once extubated the second time, patient complained of significant back and left shoulder pain. he has chronic back pain from spinal stenosis and known left rotator cuff tear. his baseline pain level is from these two issues. during his hospitalization, however, shortly after extubation, he was also noted to be hyperalgesic likely in setting of prolonged benzodiazepine/narcotic use for sedation/intubation. patient was trialed on standing tylenol, lidocaine patches and fentanyl boluses. the patient unfortunately did not tolerate extubation and was re-intubated 1 week later after becoming agitated, tachypneic and acidotic. he remained intubated for the remainder of his hospital course. over the final week of hospitalization, all efforts were made to optimize mr. nutritional and respiratory status. on a final burst of high dose steroids with rapid taper was trialed in an effort to improve his respiratory status. other ongoing issues included sigmoid abscess with external drain that ultimately resulted in an enterocutaneous fistula. fistula output was mostly feces but intermittently with maroon stools concerning for gi hemorrhage. despite this, he did improve from an infectious stand point with several days of being afebrile. additionally, his renal function worsened until he was anuric with worsening metabolic acidosis. on , patient had an episode of rapid decompensation with hypotension, fever and respiratory distress. this resolved with fluid bolus and broadening antibiotics. after multiple family meetings to discuss mr. grim prognosis and prolonged hospital course, his family opted to not pursue further interventions which the patient would not have wanted. thus, tracheostomy, feeding tube placement and hemodialysis were not pursued. on , mr. was terminally extubated with his family at his side. he expired soon after. an limited autopsy of his lungs was planned upon his death. medications on admission: atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). sotalol 80 mg tablet sig: two (2) tablet po bid (2 times a day). prednisone 20 mg tablet sig: 3 tablets po tid (2 times a day). paroxetine hcl 20 mg tablet sig: three (3) tablet po daily (daily). omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). ropinirole 0.25 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po mwf (-wednesday-friday). colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). alendronate 70 mg tablet sig: 0.5 tablet po qmon (every ). mycophenolate mofetil 500 mg tablet sig: two (2) tablet po bid (2 times a day). docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). insulin metformin 1000 mg po qam, 500 mg po qpm rituxan , mg per treatment nystatin swish and swallow bactroban nasal ointment discharge medications: patient expired. discharge disposition: expired discharge diagnosis: anca-negative vasculitis with pulmonary vascular involvement intra-abdominal abscess, recent h/o diverticulitis managed conservatively with antibiotics type 2 dm, uncontrolled anemia thrombocytopenia renal failure discharge condition: expired. discharge instructions: expired. followup instructions: expired. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified 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 insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous abdominal drainage other bronchoscopy arterial catheterization other nonoperative replacements other nonoperative replacements closed [endoscopic] biopsy of bronchus other cystoscopy therapeutic plasmapheresis therapeutic plasmapheresis therapeutic plasmapheresis therapeutic plasmapheresis therapeutic plasmapheresis insertion of indwelling urinary catheter injection or infusion of immunoglobulin diagnoses: acidosis thrombocytopenia, unspecified anemia of other chronic disease hypocalcemia obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) severe sepsis percutaneous transluminal coronary angioplasty status candidiasis of mouth hypopotassemia other and unspecified hyperlipidemia anxiety state, unspecified acute respiratory failure disturbance of skin sensation septic shock other septicemia due to gram-negative organisms rash and other nonspecific skin eruption hyperosmolality and/or hypernatremia streptococcal septicemia spinal stenosis, unspecified region diabetes with other specified manifestations, type ii or unspecified type, uncontrolled barrett's esophagus diverticulosis of colon (without mention of hemorrhage) umbilical hernia without mention of obstruction or gangrene fistula of intestine, excluding rectum and anus neutropenia, unspecified other specified diseases of pulmonary circulation restless legs syndrome (rls) diverticulitis of colon (without mention of hemorrhage) other dependence on machines, supplemental oxygen disorders of bursae and tendons in shoulder region, unspecified abscess of intestine pallor 

Answer: The patient is high likely exposed to