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: fevers, tachycardia major surgical or invasive procedure: none history of present illness: 50 yo m w/ afib and pontine strokes w/ central fevers p/w afib and fever. pt. is s/p long admission w/ exhaustive workup for fevers which resulted in removal of several teeth and eventual resolution of his fevers for several days. he was discharged yesterday to and spiked to 104.8f. in the ed, initial vs: 50 yo m w/ hx of cva and central fevers discharged from yesterday presenting w/ decreased uop and fevers. febrile, tachycardic not making much urine, had rvr in the 140s going as high as 170s. ct chest no pe, ? pna. got vanc/zosyn in ed. u/a dirty. ucx and blood cultures pending. bcx were drawn before abx. initially was not making urine then got 3l of urine and now has made 225cc/6hrs and his hr has come down. cr. noted to be up to 1.1 from baseline of 0.7. ros: unobtainable. past medical history: -multiple pontine and cerebellar infarcts -atrial fibrillation -cad s/p stent placement x6 -htn -chf with diastolic dysfunction -morbid obesity -alcoholism with ?enlarged liver -dm (borderline - not on medications) -sleep apnea -r eye blindness since childhood -s/p stent placement (at ) -r cea (at ) social history: long-standing alcoholic and smoker, daughter unable to quantify. family history: -multiple pontine and cerebellar infarcts -atrial fibrillation -cad s/p stent placement x6 -htn -chf with diastolic dysfunction -morbid obesity -alcoholism with ?enlarged liver -dm (borderline - not on medications) -sleep apnea -r eye blindness since childhood -s/p stent placement (at ) -r cea (at ) physical exam: (per admitting resident) general: alert, trach mask on, able to nod yes/no (does not seem to answer appropriately all the time), non-vocal, nad heent: normocephalic, atraumatic. perrla/eomi. l eye with scleral injection. tongue protruding from mouth. moves eyes on command. cardiac: irregular rhythm. no m/r/g appreciated. lungs: lungs diminished but clear anteriorly. abdomen: obese. bs present. soft, non-tender. extremities: some slight pitting edema noted in the lower extremities. unable to palpate pedal pulses. pneumoboots present on lower extremities. neuro: alert; nods yes/no (however, unclear if pt always answers questions appropriately); pt is able to follow commands (move eyes as instructed). pt moves left hand (but not right hand or either foot) on command. pertinent results: admission labs: 06:25am blood wbc-11.8* rbc-3.37* hgb-10.8* hct-31.7* mcv-94 mch-32.1* mchc-34.1 rdw-15.9* plt ct-448* 01:10pm blood neuts-84.3* lymphs-12.3* monos-2.6 eos-0.5 baso-0.4 06:25am blood pt-17.9* ptt-33.5 inr(pt)-1.6* 06:25am blood glucose-105 urean-19 creat-0.7 na-131* k-5.2* cl-93* hco3-25 angap-18 01:10pm blood alt-44* ast-28 totbili-2.0* 08:27pm blood ld(ldh)-268* 01:10pm blood lipase-60 01:10pm blood probnp-2428* 06:25am blood calcium-9.0 phos-5.2* mg-2.1 01:20pm blood lactate-2.0 . additional studies: 05:05pm blood acth - frozen-test - 15 (normal) 08:45am blood dexamethasone - pending 09:31pm urine catecholamines-test - normal 09:31pm urine metanephrines-test - normal 05:48am urine catecholamines - pending 05:48am urine cortisol - pending 05:48am urine metanephrines - normal . discharge labs: 06:28am blood wbc-5.9 rbc-3.04* hgb-9.7* hct-31.1* mcv-102* mch-31.9 mchc-31.2 rdw-18.5* plt ct-545* 06:28am blood pt-22.0* ptt-48.5* inr(pt)-2.1* 06:28am blood glucose-111* urean-6 creat-0.4* na-136 k-3.7 cl-96 hco3-33* angap-11 06:20am blood alt-139* ast-73* ld(ldh)-187 alkphos-56 totbili-0.3 06:22am blood lipase-19 06:28am blood calcium-8.3* phos-4.3 mg-2.3 . . microbiology: blood cultures from , , no growth (final); no growth to date urine cultures from , , , , no growth influenza a and b negative and c. difficile toxin a and b negative . . studies: ap cxr - impression: unchanged cardiomegaly. progressive airspace opacities right greater than left, which may reflect atelectasis or infection. the patient will be undergoing ct for further evaluation. . ct head : 1. multiple areas of hypodensity as described above compatible with prior infarcts. if there is continued clinical concern for acute infarction, an mri should be obtained. 2. no intracranial hemorrhage. . ct chest/abdomen/pelvis : impression: 1. no acute intrathoracic or intra-abdominal pathology. 2. enlarged main pulmonary artery. please correlate clinically for pulmonary hypertension. 3. cardiomegaly, small pericardial effusion. 4. small hiatal hernia. 5. 1.4 cm right adrenal nodule, stable since though of indeterminate etiology. consider mri to further characterize. . ap cxr - findings: as compared to the previous radiograph, the transparency of the lung parenchyma at the right lung base has increased, suggesting improved ventilation. unchanged is the moderate retrocardiac opacity and the moderate cardiomegaly. no evidence of interval occurrence of new parenchymal opacities. unchanged size of the cardiac silhouette. . ruq us: 1. unremarkable right upper quadrant ultrasound. 2. no cholelithiasis or cholecystitis. . cxr: there is unchanged cardiomegaly. there is a tracheostomy with the distal lead tip at the level of the clavicles. there is a left retrocardiac opacity and left-sided pleural effusion. there is also pulmonary edema, which has worsened since the previous study. . kub: gj tube appears in the appropriate position. . cxr: findings: in comparison to the study of , there is little overall change. opacification at the left base behind the heart persists with blunting of the costophrenic angle. again, this is consistent with atelectasis or consolidation with associated pleural effusion. the degree of pulmonary vascular prominence is less on the previous study. tracheostomy tube remains in place. brief hospital course: mr. is a 50 year old male with pmhx significant for atrial fibrillation, cad, htn, chf, dm, obesity, and recent pontine and cerebellar infarcts recently discharged after a prolonged hospitalization complicated by fevers who presented with fevers and tachycardia and was initially admitted to the micu. # fevers - the patient had almost daily fevers (typically in the early evening) that were felt to likely have a central component to them. initially, he was started on vancomycin and cefepime, which were stopped after cultures were negative. he was also started on flagyl, which was stopped after he was negative for c.diff. ct torso did not reveal any acute pathology. of note, the patient was noted to have stenotrophomonas in his sputum during his previous hospitalization. he was treated with a 14-day course of bactrim, which ended on . the patient continued to have episodes of fevers (typically 101-103) with temperatures that returned to 98-99 in between fevers with negative cultures. he was treated with cooling blankets and around the clock tylenol. he occassionally required iv fluid boluses for dehydration/hypotension. # atrial fibrillation - he was also noted to be in atrial fibrillation with rvr on presentation and was admitted to the micu. while in the micu, his metoprolol was decreased to 12.5 mg tid secondary to hypotension. on the floor, however, he was noted to have episodes of tachycardia. his metoprolol was increased to 50mg tid. the patient was loaded and placed on digoxin. the patient's coumadin was briefly held in the setting of a suspected gib, however, this was restarted with a goal inr of . as his inr remained subtherpeutic, he was started on lovenox. he remained rate controlled for at least a week prior to discharge and his metoprolol was decreased to 12.5 mg because he continued to have transient hypotension. # hypotension: the patient had several episodes of hypotension while on the floor. some were in the setting of fever spikes and af with rvr to the 140s but others occured as isolated events. there was improvement with iv hydration and also increased free water flushes via his g-tube to account for the free water losses from his body surface area especially with fevers. his urine output increased and became much less concentrated. he continued to have occasional hypotension to 75-80/d. he remained alert through these episodes and did not show any evidence of hypoperfusion. his blood pressure normalized at his baseline (around 100 systolic) usually within 15 minutes without any intervention. this further supported a central process. his metoprolol dose was lowered from 50 mg tid to 12.5 mg . if he develops additional episodes of afib with rvr, his beta-blocker dose will need to be increased again. # anemia, hematrocrit drop - initial labs revealed a decreased hct (thought to be dilutional as pt received 7 liters of ivf's initially) and mildly guaiac positive stool (with no evidence of active bleeding). in the micu, he was transfused with 1 unit of prbc's. his hematocrit remained stable but remained below baseline. on the floor, the patient received an additional 2 units of prbc's. gi was consulted. as there was no evidence of acute gi bleeding, they felt that urgent colonoscopy was not indicated. they did recommend an outpatient screening colonoscopy when his condition is improved. of note, a haptoglobin was checked and found to be <5 (however after 2 units of prbc) and the patient had an elevated ldh. however there were no schiztocytes seen on peripheral smear, nor an increase in the total bilirubin, thus hemolysis was not suspected. his hematocrit remained stable subsequently. # left eye conjunctivitis - the patient was seen by ophtho, who felt that this was consistent with exposure keratitis. he was given erythromycin eye drops and lacrilube and is being discharged with lacrilube. # right adrenal nodule - the patient's ct scan revealed a right adrenal nodule, which was stable since scans from . the patient had a 1 mg dexamethasone supression test that was abnormal. serum acth and cortisol, as well as 24 hour urine cortisol, metanephrines, and catecholamines were sent. acth, metanephrines, and urine catecholamines were normal. urine cortisol was on the high range of normal but likely appropriate in the context of his severe illness. # diabetes mellitus type ii - patient was initially continued on his prior insulin regimen. as his blood sugars remained above 150 most of the time his nph was increased to 32 units and his sliding scale adjusted with finger sticks between 100 and 150. # skin lesion on forehead - the micu team felt that this may represent a bcc. he should see a dermatologist at some point. this is non-urgent as long as the lesion is stable. # eczematous dermatitis of face - patient has a history of eczema per family. this was treated with hydrocortinsone 1%. # abdominal pain - the patient intermittantly endorsed abdominal pain during his hospital stay. at times his responses to questions were inconsistent, making this difficult to assess. he did have mildly elevated lfts that improved or remained stable during his course. ruq ultrasound was without evidence of cholecystitis. ct torso showed no evidence of intra-abdominal pathology. due to concern of movement of the gj tube, placement was confirmed with abdominal x-ray. # anticoagulation - the patient was kept anticoagulated given his atrial fibrillation and recent strokes. his coumadin was briefly held in the setting of concern for gib. it was restarted, but remained subtherapeutic. lovenox was started to bridge the patient until warfarin was therapeutic (goal inr 2.0-3.0). his inr reached 2.1 on the morning of discharge. he can be continued on lovenox for an additional day and then it can be stopped if inr remains in goal range. # recent pontine and cerebellar strokes - no acute issues. he opens his eyes to verbal stimuli and can follow simple commands such as moving his left hand and l toes. he cannot move his right hand or foot to command. he seems to cognitively understand most of what is going on around him. he was evaluated by both pt and ot. he was also evaluated by speech and swallow and tolerated a passy-muir valve well and was able to vocalize "yes" and "ah". it appears the patient is clinically "locked-in" but susequent speech and swallow evaluation suggests improvement. he would benefit greatly from aggressive rehab. # thrombocytopenia: the patient's platelets dropped to the 90s, without signs of bleeding, toward the end of his 2-week bactrim course. upon discontinuation of the bactrim, his counts recovered. # coronary artery disease, s/p stenting - no acute issues. continued metoprolol, aspirin, and simvastatin. fen: tube feeds ppx: -dvt ppx: pneumoboots, coumadin/lovenox -bowel regimen: lactulose code status: full, confirmed at recent family meeting emergency contact: (daughter); (sister) medications on admission: 1. chlorhexidine gluconate 0.12 % mouthwash : one (1) ml mucous membrane (2 times a day). 2. bisacodyl 10 mg suppository : one (1) suppository rectal once a day as needed for constipation. 3. acetaminophen 500 mg tablet : 1-2 tablets po three times a day as needed for fever or pain: do not exceed 4 grams in a 24-hour period. 4. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : drops ophthalmic prn (as needed) as needed for dry eyes. 5. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 6. miconazole nitrate 2 % cream : one (1) application topical twice a day. 7. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 8. glucagon (human recombinant) 1 mg recon soln : one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 9. ibuprofen 400 mg tablet : one (1) tablet po q8h (every 8 hours) as needed for pain/fever: do not excees 3200 mg per day. 10. metoprolol tartrate 25 mg tablet : one (1) tablet po tid (3 times a day): hold for sbp<100 or hr<60. tablet(s) 11. prochlorperazine 10 mg iv q6h:prn nausea 12. simvastatin 40 mg tablet : two (2) tablet po daily (daily). 13. trimethoprim-sulfamethoxazole 160-800 mg tablet : five (5) tablet po tid (3 times a day): to complete a 14-day course, ending on . 14. nph insulin human recomb 100 unit/ml suspension : thirty (30) units subcutaneous twice a day: please administer 30 units of nph at breakfast and at dinner. 15. humalog 100 unit/ml solution : as directed subcutaneous qachs: please follow humalog sliding scale. 16. therapeutic multivitamin liquid : five (5) ml po daily (daily). ml(s) 17. warfarin 1 mg tablet : three (3) tablet po once daily at 4 pm. discharge medications: 1. glucagon (human recombinant) 1 mg recon soln : one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 2. miconazole nitrate 2 % powder : one (1) appl topical prn (as needed) as needed for rash. 3. chlorhexidine gluconate 0.12 % mouthwash : one (1) ml mucous membrane (2 times a day). 4. multivitamin tablet : one (1) tablet po daily (daily). 5. simvastatin 40 mg tablet : two (2) tablet po daily (daily). 6. acetaminophen 160 mg/5 ml solution : six y (650) mg po q6h (every 6 hours). 7. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 8. digoxin 125 mcg tablet : one (1) tablet po daily (daily). 9. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 10. enoxaparin 150 mg/ml syringe : one (1) subcutaneous (2 times a day): until inr is therapeutic. 11. white petrolatum-mineral oil ointment : one (1) application ou ophthalmic once a day as needed for dry eye. 12. nph insulin human recomb 100 unit/ml suspension : thirty two (32) units subcutaneous twice a day. 13. insulin regular human 100 unit/ml solution : per sliding scale injection every six (6) hours. 14. lactulose 10 gram/15 ml syrup : thirty (30) ml po tid (3 times a day): hold for high frequency stools. 15. cortisone 1 % cream : one (1) appl topical qid (4 times a day). 16. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 17. metoprolol tartrate 25 mg tablet : 0.5 tablet po bid (2 times a day): hold for sbp<100, hr<60. 18. warfarin 5 mg tablet : two (2) tablet po once daily at 4 pm. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary central fevers strokes stenotrophomonas infection anemia conjunctivitis thrombocytopenia secondary to bactrim secondary atrial fibrillation coronary artery disease, s/p stenting hypertension congestive heart failure morbid obesity diabetes mellitus discharge condition: mental status:usually clear, but sometimes appears confused level of consciousness:alert and interactive activity status:bedbound discharge instructions: you were brought to the hospital after a recent long hospitalization because you were continuing to have fevers. it seems that your fevers likely have to do with your recent strokes and not an infection or other cause. while you were in the hospital, you completed a course of antibiotics for bacteria that was found in your lungs. you also were treated for an irritation in your eye. you were treated for a fast heart rate as well. you had a ct scan that incidentally showed an adrenal adenoma. this is unchanged in size since and your levels of enzymes produced by this gland are normal. you are being transfered to a facility to work on rehabilitation after your strokes. changes to your medications: 1. you were started on digoxin 2. you were started on around the clock tylenol to control your fevers 3. ibuprofen was stopped to reduce damage to your stoamch 4. metoprolol dose was decreased to 12.5mg twice a day followup instructions: provider: ,one phone: date/time: 7:00 provider: west outpatient radiology phone: date/time: 8:30 procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) atrial fibrillation hypotension, unspecified other late effects of cerebrovascular disease morbid obesity dehydration other disorders of neurohypophysis chronic diastolic heart failure other and unspecified alcohol dependence, continuous gastrostomy status tracheostomy status acute conjunctivitis, unspecified fever presenting with conditions classified elsewhere 

Answer: The patient is high likely exposed to