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: initially admitted for: fever and neutropenia transferred to for: a fib and hypotension major surgical or invasive procedure: a-line thoracentesis bronchoscopy bone marrow biopsy mediastinoscopy with ln biopsy history of present illness: mr. is a 52 year old cuban-american man who has resided in the us for 25 years. for the past year he has experienced aches and pains, especially worse in the past six months on stairs. he was working and feeling genrally well until the beginning of when he developed daily fevers to 102. these were associated with chills and body aches but no rigors or nightsweats. he went to his clinic and had a cxr which was negative but was put on antibiotics and analgesics. he remained well for a few weeks but then suffered 2 syncopal attacks on and was admitted to hosputal that day. at lgh, the patient was found to be neutropenic with 72% lymphocytes and a wbc of 0.5. he was also anemic with a hct of 17 and was transfused 2 units of prbcs. further lab tests upon admission included a leukemia/lymphoma eval which yielded abundant myeloblasts with a probable diagnosis of aml. in addition, >100,000 colonies of e.coli were found in his urine resistent to bactrim. id put him on zosyn, vancomycin and diflucan by . at lgh, he had a negative ct scan of the head done for dizziness. ct of the chest and abdomen was performed as part of the lymphoma workup with the following key findings: 1) r paratracheal mass (3.2cm)with bl pleural effusions. 2) multiple small liver and splenic lesions of intermediate nature. 3) small pancreatic lesion (1.6cm) 4) bl inguinal hernias. thoracic surgery was consulted and recommended a mediastinoscopy under general anesthesia when the patient was feeling better. he was subsequently transferred to on for further workup at the request of his wife. past medical history: wisdom teeth extracted. hypertension treated with toprol xl 100mg daily at home for some time. no other medical issues or surgeries. social history: born and raised in . came to us 25 years ago. lives with his wife and 3 children (14, 13, 11). works as a machinist. family history: mother died age 53 of a heart attack. father died in late 60's of unknown cause. 4 siblings, all living and all well. physical exam: vitals: t 99.2 hr 120-130 rr 25 bp 90-100/70-80 100% o2 ra gen: diaphoretic heent: perrla, no discharge from eyes, ears, nose. eomi. anicteric. normal conjunctiva. neck: no lad, no jvd, midline trachea. normal sized thyroid with no palpable nodules. chest: decreased breath sounds bilaterally cv: irregular, irregular, ii/vi sm abd: bs normoactive, nontender, nondistended, increased adiposity of gut. ext: no c/c/e nontender calves neuro: cn ii-xii intact, a and o x 3. skin: no visible lesions. no tender nodules. pertinent results: at : ct of the chest and abdomen was performed as part of the lymphoma workup with the following key findings: 1) r paratracheal mass (3.2cm)with bl pleural effusions. 2) multiple small liver and splenic lesions of intermediate nature. 3) small pancreatic lesion (1.6cm) 4) bl inguinal hernias. ct head was normal admission labs at lgh ) wbc 0.5, 8%n, 72%l, 6%b alt 69, ast 39 alb 2.7 alk phos 159 t bili 0.7 d bili 0.22 hiv neg parvovirus neg >100,000 e. coli in urine discharge labs () wbc 0.8, 4%n, 72%l, 17%m, 5%b, 1.3% eo rbc 3.13, platelets 183. labs lactate 2.5 na 141 k 3.1 cl 105 hco 21 bun 22 creat 1.2 gluc 110 ca 8.1 mg 1.6 p 2.4 alt 37 ap 288 t bili 0.5 ast 53 ldh 461 wbc 11 (neutro 65%, 8% lymph 21 % mono) hct 34 plt 264 pt 16.4 ptt 28.7 inr 1.8 fibrinogen 912 uric acid 7.8 u/a tr bld 12:40pm blood wbc-5.3# rbc-2.91* hgb-9.1* hct-26.9* mcv-92 mch-31.2 mchc-33.7 rdw-18.9* plt ct-83* 12:40pm blood gran ct-4770 12:40pm blood glucose-117* urean-23* creat-0.8 na-133 k-3.6 cl-102 hco3-18* angap-17 12:40pm blood alt-29 ast-30 alkphos-186* totbili-0.2 12:40pm blood albumin-3.0* calcium-8.6 phos-3.1 mg-1.8 uricacd-5.4 08:49pm blood hbsag-negative hbsab-positive hbcab-positive igm hav-negative 04:14am blood hiv ab-negative 05:03pm pleural wbc-750* rbc-* polys-49* lymphs-40* monos-11* 05:03pm pleural totprot-3.6 glucose-97 creat-1.0 ld(ldh)-271 amylase-77 albumin-1.8 brief hospital course: 1.) aml: leukemia/lymphoma evaluation at outside hospital yielded probable aml. bmt done at confirmed leukemia (aml) and pt decided to undergo 7+3 induction treatment here. day 1 was , bm bx completed three times, with the latest report from showing no evidence of leukemic cells. patient will need maintenance chemo, but was awaiting stabilization of id status prior to starting further chemo. . 2.) fever and neutropenia/id: high fevers persisted, pt had multiple imaging studies including a ct chest, abd pelvis that revealed multiple splenic and liver nodules and mediastinal lad. pt was seen by id and pulm (for rll effusion and mediastinal lad seen on ct scan). id thinks probably infectious source of liver, spleen nodules and mediastinal lad. they asked for several cultures including acid fast bacilli, legionella, etc. pulm completed bronch on , negative for malignant cells. patient developed some diarrhea, c.diff sent, which was negative on multiple occasions. stool also tested for cryptosporidium/o and p/campylobacter- all of which were negative. patient underwent thoracentesis on , which showed exudative fluid that grew afb in cultures, although the afb smear was negative. all other cultures negative. repeat thoracentesis failed to show further afb growth in culture, was also negative for cmv. ct chest on revealed stable nodules but new pericardial effusion. patient started on 4 drug anti-tuberculosis regimen on . afb in blood was sent to state lab and pending. repeat afb smears were neg x 3 and patient was taken off precautions. the patient was transferred to icu . when patient returned to bmt, he was placed on rifabutin, ethambutol, pyridoxine, clarithromycin for mac coverage, as tuberculosis+ blood cxs likely mac vs. tuberculosis, anti-tuberculosis meds d/ced, other atypical mycobacteria was also a consideration. patient was started on vanc empirically on as blood cultures from returned gram + cocci=coag neg staph and those from . on , patient underwent a tee, which was negative for endocarditis, and a mediastinal ln biopsy, which was positive for afb on smear and culture. patient placed back in respiratory isolation. in addition, pleural fluid from returned tuberculosis pcr positive, therefore patient's abx regimen changed back to 4 drug anti-tuberculosis coverage. vanc was discontinued as the +blood cultures were thought to be likely contaminates. , , afb smear neg x 3. remains in isolation room as w/ likely disseminated tuberculosis w/ pulm nodules. patient underwent repeat thorax ct, which showed enlarging abdominal ln and an increasing number of splenic and liver lesions. amikacin was added to help potentiated anti-tuberculosis drug effects, however this was later discontinued, along with the clarithromycin, so that patient was only on anti-tuberculosis coverage. patient underwent a repeat echo and chest x-ray which showed a small to moderate pleural effusion and a small decrease in the mediastinal lad. the patient was placed on an 11 week steroid taper (beginning with 60mg prednisone daily) per id recs to help lessen risk of constrictive pericarditis. patient was arranged with follow-up in the clinic in , and will be followed by the state center for tuberculosis as well for medication administration. . 3.) cardiology: patient developed afib w/ rapid response to 180's, and unstable bp (sbp=90's) - therefore was transferred to the icu on where he underwent unsuccessful attempts at cardioversion x3. the pt became more tachypneic and went into hypoxic respiratory failure. he was intubated and brought to the . he was found to be hypotensive, probably due to the decreased preload in the setting of intubation and the use of propofol for intubation. bp improved when he was switched over to fentanyl for sedation. he was put on ac, 600, 18, 40% and was tolerating the ventilation well. an cxr showed an increased interstitial and alveolar infiltrate especially on the r side with positive air bronchograms on the r side. he was started on levofloxacin, flagyl and vancomycin for tx of an suspected pneumonia. an emergent echo showed no signs of cardiac tamponade. a therapeutic thoracentesis was done the next day and respiratory state improved significantly. pt was extubated and supported it well. abxs were stopped as repeat cxr did not show any signs of infection and wbc was back to normal. acute respiratory failure was thought to have happened in the setting of intravascular fluid depletion with decreased preload leading to tachycardia and tachypnea, worsening the preload even more. in addition a pulmonary edema and an increasing pleural effusion pressing on the lund might have contributed. the arf resolved within a day and was attributed to intravascular fluid depletion. pt was then started and maintained on admiodarone, metoprolol, captopril per cards recs. diagnosis per cards was mfat w/ initial rate >200. cardiology also recommended continued diuresis for pleural and pericardial effusions. patient was decreased to 200mg of daily amiodarone on , with monitoring of lfts and tsh, which were normal. echo on echo w/ ef=30%, global lv hypokinesis, and repeat on shows small-moderate pleural effusion. . 4.) splenic/liver lesions initially thought to be mets, lymph nodes, or other primary cancer contributing to recent development of changes in blood glucose levels. pt also experienced chronic ruq abd pain during his hospitalization. ct abd showed 1. necrotic lymph nodes in the superior mediastinum and in the periportal region. 2. multiple tiny areas of low attenuation in liver and spleen. although non-specific, these could represent microabscesses from hematogenous spread of infection, including tuberculosis or fungal infections. mri on confirmed ct findings and showed potential renal involvement. given afb + in blood from , thought to be possibly disseminated tuberculosis. follow-up ct on showed an increased number of lesions in both liver and spleen (all < 1cm), still thought to be dissemintated tuberculosis. . 5.) pulmonary nodules: observed on first ct (approx 3mm in size) - thought related to other ct findings at the time (necrotic lns in mediastinum, liver pancreas and spleen lesions). a repeat chest ct showed increased size of pulm nodules 3mm->5mm. read as likely infectious in nature, and assumed to be related to disseminated tuberculosis per mediastinal ln washings (see above). a repeat ct on showed no change. . 6.) elevated blood glucose despite no prior history of dm, this patient has consistently had elevated glucoses on fs in the past week. patient was monitored by glucose fs tid and covered with riss and lantus. on pt seen by team and recs for bg control changed, scale adjusted and fs levels improved. followed patient throughout hospitalization and upon discharge, patient was given diabetic education by nurse monitoring and insulin administration. as it was a concern that his sugars would be difficult to control give his long term steroid use and change in food intake (from tpn to normal diet), the patient's blood glucose levels will be monitored closely when he returns for oncology follow-up. an appointment was made at in (which was the first available). . 7.) sob: on pt experienced acute episode of sob. cxr demonstrated pulmonary congestion, which was likely due to receiving a couple units of blood on the day prior. given his increasing o2 requirements and increased work of breathing, he was intubated in the icu. stayed in icu w/ an uncomplicated hospital course, and was successfully extubated and transferred back to the floor on where his oxygen saturation remained 98% on room air throughout the remainder of his hospitalization. . 8.) fen the patient was initially eating a normal diet, but on he had lost 10lbs in the last 2 weeks due to inadequate food intake. a picc was therefore placed and pt was started on tpn w/ boost supplementation and liberal po intake as tolerated. a calorie count on per nutrition showed that patient was eating 1450 calories per day, and tpn was discontinued on . . 9.) coagulopathy: pt w/ persistently elevated inr, pt. given vit k w/ minimal/no decrease in inr. as such, on a mixing study was sent (elevated pt), vit k given - mixing study negative. still unknown etiology of coagulopathy, but remained stable. medications on admission: riss temazepam 30mg qhs po glargine 10u daily sc zosyn 3.375g iv q6 robitussin ac prn loperamide 2mg po prn ibuprofen 600mg po q4 discharge medications: 1. ethambutol 400 mg tablet sig: four (4) tablet po daily (daily). disp:*148 tablet(s)* refills:*0* 2. isoniazid 300 mg tablet sig: one (1) tablet po daily (daily). disp:*37 tablet(s)* refills:*0* 3. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. pyrazinamide 500 mg tablet sig: three (3) tablet po daily (daily). disp:*111 tablet(s)* refills:*0* 5. rifampin 300 mg capsule sig: two (2) capsule po q24h (every 24 hours). disp:*74 capsule(s)* refills:*0* 6. pyridoxine 50 mg tablet sig: two (2) tablet po daily (daily). disp:*74 tablet(s)* refills:*0* 7. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 9. prednisone 10 mg tablet sig: three (3) tablet po twice a day. disp:*180 tablet(s)* refills:*0* 10. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 11. humalog mix 75-25 75-25 unit/ml suspension sig: twenty five (25) units subcutaneous twice a day. disp:*qs units* refills:*2* 12. glucometer glucometer: dispense 1 refills : 0 13. one touch ii test strip sig: one (1) strip miscell. twice a day. disp:*100 strips* refills:*2* 14. lancets,thin misc sig: one (1) lancet miscell. twice a day. disp:*100 lancet* refills:*2* 15. syringe syringe sig: one (1) syringe miscell. twice a day: insulin syringes . disp:*100 syringe* refills:*2* discharge disposition: home with service facility: home health services vna discharge diagnosis: aml tuberculosis a-fib htn discharge condition: good discharge instructions: we have prescribed you a number of new medications. please take these and all of your medications as directed. you have a number of follow-up appointments scheduled. please maintain all of these appointments. please return to the of building on the tomorrow at noon. please call your doctor or return to the hospital if you develop fever/chills/nausea or vomiting. please make sure to check your blood sugar and administer insulin as instructed. followup instructions: provider: /onc,inpt hematology/oncology-7f where: hematology/oncology-7f date/time: 12:30 provider: , cc-5 where: center phone: date/time: 10:30 provider: , md where: lm disease phone: date/time: 9:00 you have been scheduled for a follow-up appointment with the clinc for your diabetes on at 8:30 am. however, you may call to try and arrange an earlier appointment. please call to schedule an appointment with a cardiologist at the earliest time available. please follow up as instructed with the state center for tuberculosis. procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart insertion of endotracheal tube thoracentesis thoracentesis thoracentesis biopsy of bone marrow biopsy of bone marrow biopsy of bone marrow closed endoscopic biopsy of lung closed endoscopic biopsy of lung biopsy of lymphatic structure transfusion of packed cells mediastinoscopy closed biopsy of skin and subcutaneous tissue closed biopsy of skin and subcutaneous tissue injection or infusion of cancer chemotherapeutic substance transfusion of platelets diagnoses: other primary cardiomyopathies unspecified pleural effusion diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation other chronic pulmonary heart diseases systolic heart failure, unspecified unspecified disease of pericardium acute respiratory failure blood in stool intestinal infection due to clostridium difficile other and unspecified coagulation defects other specified diseases of hair and hair follicles acute myeloid leukemia, without mention of having achieved remission tuberculosis of intrathoracic lymph nodes, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically 

Answer: The patient is high likely exposed to