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 / sulfur / demerol / amphotericin b / allopurinol / vicodin / percocet attending: chief complaint: neutropenic fever and hypotension major surgical or invasive procedure: peripherally inserted central venous catheter removal. tunneled central venous line insertion. nephrostogram and nephrostomy tube replacement/capping. history of present illness: ms. is 50 yo f with aml s/p allo-bmt in , now with relapsed aml awaiting repeat sct, currently s/p high-dose ara-c on , who presented to hospital with diarrhea (on flagy ~1 week) and fatigue. at the osh, she was found to be hypotensive with sbp's 60's-70's and had temp of 100.3. she got 2-3l of ivf, meropenem, vancomycin, and was tran, and was then transferred to the ed. in the ed, she received 1l ns, and sbp improved from the 70's to low 100's. she was admitted to the . she was continued on meropenem, vanco, given 2l ns and started on stress dose steroids. she spiked to 101.7 so blood cultures were again drawn and she was started on flagyl for possible cdiff. blood cx from osh came back positive for coag negative staph. her blood pressures improved and her temperature curve decreased until prior to transfer to the floor when she was 101. she remained hd stable so was transferred. . at the time of interview, the patient felt hot, sweaty, and fatigued. she denied chills. she denied chest pain, shortness of breath, cough. she noted only 2 episodes of diarrhea with lomotil. she denied melena, hematochezia. she denied ha, sinus congestion. she denied dysuria, urinary urgency or frequency. . ros: otherwise negative. no lightheadedness, palpitations. no mouth pain. no myalgia/arthralgia. . onc history: acute myelogenous leukemia - status post allogenic transplant : 5 of 6 matched family member (father) allogenic bmt. mid- found to have peripheral blasts and host cells in marrow, suggestive of aml. mec protocol started . she tolerated the chemo well. of note she was found to have anti hla b7 and b27 antibodies so required matched platelet transfusions during her nadir. she underwent dli on . she relapsed with cytogenetically different aml (monosomy 7). she then underwent reinduction with mec in . she received high-dose ara-c starting . she currently has a matched donor and is awaiting transplant. past medical history: - allergic rhinitis - depression - right-sided hydronephrosis secondary to fibroid uterus/retroperitneal fibrosis thought secondary to paraneoplastic syndrome, status post stent , removed - left-sided hydronephrosis, status post nephrostomy tube placement - history of lactobacillus bacteremia treated with meropenem during admission - gastroesophageal reflux disease - chronic fatigue social history: married, lives with her husband (who is a nurse) and three children ages 14, 9, 7. worked as a controller. no tobacco or alcohol use. family history: both parents living. mother with hypertension, myocardial infarction, systemic lupus. father (donor) with hypertension, recently had myocardial infarction. siblings with hypertension. physical exam: vitals: t 99.4 bp 108/68 hr 100 rr 18 o2 99% 1l nc gen: sleepy, nontoxic, flushed heent: perrl. sclera anicteric. mmm. no oral lesions. neck: jvd 7 cm. no lad. cv: tachycardic, regular, nl s1, s2, no m/r/g resp: ctab abd: soft, ntnd, +bs, no rebound/guarding. l nephrostomy tube in place - no drainage, d/c or tenderness. ext: no c/c/e skin: no rash neuro: a&ox3 pertinent results: 12:00am blood wbc-1.6* rbc-3.46* hgb-10.5* hct-30.1* mcv-87 mch-30.3 mchc-34.8 rdw-15.9* plt ct-91* 12:00am blood neuts-84* bands-1 lymphs-3* monos-1* eos-0 baso-0 atyps-1* metas-0 myelos-0 blasts-10* 07:00am blood pt-12.8 ptt-89.2* inr(pt)-1.1 12:00am blood gran ct-1270* 12:05am blood gran ct-1260* 12:10am blood gran ct-1090* 12:00am blood glucose-210* urean-16 creat-0.5 na-139 k-4.0 cl-99 hco3-29 angap-15 . percutaneous nephrostogram- left-sided nephrostography was performed over-the-guide wire, which depicted a normal right-sided pelvocaliceal tree. the left ureter is seen to be patent to the urinary bladder. no intraluminal filling defect is seen. the caudal third of the ureter demonstrates a moderate segmental stenosis and lateral displacement of the course of the ureter seemingly draped along a mass located medial to the lower third of the ureters course. the upper two thirds of the ureter appears unremarkable. based upon the nephrostogram obtained, decision was made to exchange the nephrostomy tube. the preexistent tube was then removed over the guidewire leaving the guidewire in situ in exchanged for a new 8-french nephrostomy tube. the retention pigtail was formed within the left renal pelvis and locked in place. the catheter was secured using an 0-silk retention suture at the skin entry site, reinforced with an 8-french statlock device. the puncture site in the drainage catheter was dressed with drain sponges, overlaid with tegaderm transparent semi-occlusive dressing patches. the estimated blood loss was minimal. no complications were encountered. the catheter was capped and left in place. impression. 1. segmental stenosis of caudal of left ureter. no obstruction of the left ureter is observed. 2. status post over-the-wire exchange of left-sided 8-french nephrostomy tube, which was left capped. 3. no hydronephrosis. brief hospital course: mrs. is a 50 yo woman with aml who is s/p allogenic bmt five years ago, and presented recently with a donor cell aml and is s/p reinduction with mec and then hidac on who was admitted with hypotension and gram positive sepsis. . #) hypotension/ pt was admitted with sbp's in low 80's responsive to iv fluid boluses. she was admitted to the intensive care unit for close monitoring of her volume status. given the patient's chronic steroid use and hypotension she was started on stress dose steroids for relative adrenal insufficiency. her symptoms of diarrhea and abdominal pain raised suspicion for an intrabdominal source, however her r picc line was notably painful and erythematous and therefore thought to be the most likely source of infection. her right axillary vein picc line was removed on admission. and she was started on vancomycin iv serial blood cultures later grew coagulase positive staphylococcus sp sensitive to vancomycin. she was transferred to the bmt floor where an upper extremity doppler ultrasound revealed total occlusion of the axillary vein extending into the cephalic vein. the patient was transfused hla matched platelets for goal greater than 50,000 and anticoagulated with heparin gtt. she was continued on vancomycin iv after reviewing senstivities and speciation data. she conituned to have fevers to 103 thought secondary to poor antibiotic penetration into the infected thrombus. her antifungal coverage was broadened to voriconazole. tte was obtained and did not reveal any valvular vegetations. once afebrile for 48hrs she was switched to po linezolid. she was changed back to fluconazole for antifungal prophylaxis. . #) nephrostomy- extensive discussion between providers of risks and benefits of nephrostomy tube going into transplant. etiology of ureteral obstruction was thought secondary to fibroid uterus vs. retroperitoneal fibrosis as paraneoplastic syndrome. urology consultation recommended leaving the nephrostomy in place. prior to discharge, a nephrostogram revealed caudal stenosis, and was the tube was capped and left in place. pt tolerated capping of tube overnight and was discharged with instruction that if she tolerated the capping that it could be removed in 48-72hrs at the discretion of her primary oncologist in consultation with the urology and interventional radiology services. . #) diarrhea- thought to be due to chemotherapy. improved with loperamide. c. difficile negative x 3. stool cultures were negative for cyptococcus, giardia, microsporidia. ct scan revealed perinephric fat stranding . #) aml- patient is status post hidac on . awaiting matched unrelated donor transplant. bone marrow aspirate revealed wide spread infiltration with blast cells and peripheral smear prior to discharge revealed 10% blast cells. the patient was discharged with plan for further chemotherapy within a few days of discharge, with a second attempt at allogenic transplant to follow. . #) heme- found to have anti-hla b7 and b27 antibodies and required matched platelet transfusions. pt did respond to 1 unit of unmatched platelets given prior to he central venous catheter insertion. pt was transfused with 1 unit hla matched platelets prior to discharge. . #) depression: continued celexa . #) chronic fatigue: continued ritalin. . #) f/e/n- started on tpn during admission + neutropenic diet. advanced to regular low bacteria. given regular ivf's. . #) intravenous pt has very difficult venous access. peripheral iv's only lasted <24hrs. a repeat picc line was attempted on the left arm, but was unsuccessful due to vasospasm. she was later given a left subclavian triple lumen catheter. two days prior to discharge with negative surveillance blood cultures and after being afebrile for 48hrs a left sided tunneled internal jugular venous catheter was placed. . #) communication: husband () (, (, cell ( medications on admission: fluconazole 200mg q12h acyclovir 400mg q12h citalopram 20mg qd methylphenidate 10mg qam loratadine 10mg qd olanzapine 5mg prn prednisone 30mg qd levoflox 500mg qd (day #) beconase aq 42mcg sprays prn loperamide 2mg q4h prn meropenem (reportedly had one dose at osh) discharge medications: 1. acyclovir 200 mg capsule sig: two (2) capsule po q12h (every 12 hours). 2. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 3. methylphenidate 10 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 4. loratadine 10 mg tablet sig: one (1) tablet po daily (). 5. beconase aq 42 mcg (0.042 %) aerosol, spray sig: one (1) nasal sprays (). 6. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 10 days. disp:*30 tablet(s)* refills:*0* 7. mupirocin calcium 2 % cream sig: one (1) topical qd (). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 9. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 days. disp:*14 tablet(s)* refills:*0* 10. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). disp:*10 tablet(s)* refills:*0* 11. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed. 12. hickman catheter care central venous catheter care per protocol 13. fluconazole 200 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*60 tablet(s)* refills:*2* 14. loperamide 2 mg capsule sig: one (1) capsule po pt self dose up to 12mg per day (). discharge disposition: home with service facility: iv clinical network of discharge diagnosis: primary: central venous line infection secondary: acute myelogenous leukemia discharge condition: stable. discharge instructions: you were admitted for a central venous line infection following treatment for acute myelogenous leukemia. please take all of your medications as prescribed. call dr. or 911 if you experience any fever, uncontrolled bleeding, worsening diarrhea or abdominal pain, back pain, decreased urine output or any other concerning symptoms. followup instructions: you should follow up with dr. on monday. please call his office at anytime with any other questions. procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances transfusion of packed cells transfusion of platelets replacement of nephrostomy tube diagnoses: severe sepsis septic shock other complications due to other vascular device, implant, and graft antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use complications of transplanted bone marrow diarrhea infection and inflammatory reaction due to other vascular device, implant, and graft volume depletion, unspecified other staphylococcal septicemia acute myeloid leukemia, without mention of having achieved remission other ureteric obstruction 

Answer: The patient is high likely exposed to