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: fever/leukocytosis major surgical or invasive procedure: thoracocentesis history of present illness: history of present illness: mr. is a 39 year old patient with nhl s/p allosct and dli , in remission but with gvhd-associated bronchiolitis obliterans and severe restrictive lung disease who was recently admitted with fever, hypoxia and respiratory distress and discharged to on . he is readmitted today for fevers up to 101.6 at rehab. . please see discharge summary from 7/210, and for details of his previous hospitalizations. in brief, the patient had pseudomonal infection of his lungs, he had been treated with 21 day course of colistin and meropenem, and was on colistin ih for suppression. additionally, he had an upper extremity dvt that was treated with fondaparinux 2.5mg, which was discontinued on last admission. . per rehabilitation notes, the patient spiked temperature to 101.6, and . he remained hemodynamically stable and asymptomatic. he was cultured, given tylenol and sent to the ed. of note, he was recently seen by his outpatient providers and had been doing well. . on arrival to the ed, vital signs were: t- 100.0, hr- 114, bp- 96/47 rr- 22, sao2- 98% on mv. wbc count of to 27.9. cxr showed bilateral pneumothoraxes (moderate on right, small on left). in addition, it showed multiple nodular bilateral opacities improved since prior but persistant suspicious for infection. he was seen by the ip team who placed a chest tube on the right sight (left sided ptx was too small to place chest tube). he remained stable there and on transfer to the vital signs were t- 98.4, hr- 94, bp- 110/81, rr- 23, sao2- 100% on mv with no respiratory complaints whatsoever. . on arrival to the the patient is comfortable. he denies chest pain, shortness of breath, dizziness, abdominal pain, dysurea, diarrhea, chills, nightsweats. reports fevers while at rehab. . past medical history: past oncologic history: - p/w fevers, night sweats, and weight loss in the setting of a left inguinal lymph node. - ct scan: 15x14x10cm mass in the luq. - bx grade ii/iii follicular lymphoma. - treated with six cycles of chop/rituxan with good response, but showed evidence for relapse in and was treated with mine chemotherapy for two cycles. - : underwent stem cell mobilization with cytoxan followed by autologous stem cell transplant in - : noted for disease recurrence. he was initially treated with a course of rituxan without response followed by zevalin with - : noted progression of his disease. he was treated with one cycle of followed by one cycle of eshap. - : nonmyeloablative allogeneic stem cell transplant with a hla-matched unrelated donor with campath conditioning - six-month follow-up ct noted for disease progression. - : received donor lymphocyte infusion in , complicated by acute liver/gi gvhd grade iv, for which required a prolonged hospitalization in the summer of . - multiple gi bleeds requiring icu admissions and multiple transfusions and embolization of his bleeding. - noted to have cns lesions felt consistent with ptld and this was treated with a course of rituxan. no evidence for recurrence of the ptld. - acute liver gvhd, on cellcept, prednisone, and photophoresis. - photophoresis was d/c'd due to episodes of bacteremia and eventual removal of his apheresis catheter. - restarted photopheresis on a weekly basis on , but then discontinued this again on as this was felt not to be making any impact on his liver function tests. - undergone phlebotomy due to iron overload with corresponding drop in his ferritin. he has continued with transient rises in his transaminases and bilirubin and has remained on varying doses of cellcept and prednisone which has been slowly tapered over the time. - cellcept discontinued. - admission due to increasing right hip pain. mri revealed edema and infiltrating process in the psoas muscle bilaterally. after extensive workup, this was felt related to an infection and required several admissions with completion of antibiotics in 03/. - : last scans showed no evidence for lymphom and he has remained in remission. - : uri and treatment with course of levaquin. - completed a 4 week course of rituxan to treat his gvhd. -in , noted to have tiny echogenic nodule on abdominal . mri of the liver also showed this nodule but was not as concerning on review and he is due to have a repeat mri imaging in early . -- gi varices and attempts at banding have been unsuccessful due to difficulty with passing the necessary instruments. he has been on a low dose beta blocker as well as simvastatin, which was started on to help with medical management of his varices. -on , worsening cough and was noted to have a small new pneumothorax in the left apical area. this has essentially resolved over time - issues with weight loss (followed by dr. ); multiple tests done with no etiology found; question malabsorption related to gvhd - has on and off respiratory infections and has been treated with antibiotics (now colistin inhaled and iv) for resistant pseudomonas. question underlying exacerbations of pulmonary gvhd in setting of his uris. - currently receives ivig every month. . other past medical history: 1. non-hodgkin's lymphoma s/p allo sct 2. grade 4 acute gvhd of gi/liver following dli with gi bleed, chronic transaminitis, portal htn with esophageal varices (not able to band) 3. history of intracranial lesions felt consistent with ptld. 4. extensinve chronic gvhd of lung, liver, skin, mucous membranes. 5. grade ii esophageal varices, intollerant to beta blockade. 6. hsv in nasal washing (completed course of valtrex) 7. hypothyroidism 8. hx of psoas muscle infection social history: smoke: never etoh: none currently; occassional use prior to nhl dx drugs: never born in and moved to the u.s. for college (). married in and lives in . no children. stays at home and writes (currently writing a book on being diagnosed with cancer at young age). family history: no lymphoma or other cancers in the family. father had cad s/p pci. physical exam: physical exam upon admission: vitals: t 97.9, hr 87, bp 130/90, rr- 23, sat 100% gen: cachectic male, dophoff in place. tracheostomy heent: sclera anicteric, mmm nec: trach in place cv: regular rate and rhythm no m/r/g pulm: coarse breath sounds bilaterally, no wheezes, crackles abd: soft, nt, nd, bowel sounds present ext: no peripheral edema pertinent results: 03:50pm blood wbc-27.9*# rbc-3.00* hgb-8.7* hct-26.8* mcv-90# mch-29.1 mchc-32.6# rdw-16.2* plt ct-432 05:53am blood wbc-13.0* rbc-2.37* hgb-6.9* hct-21.5* mcv-91 mch-29.2 mchc-32.2 rdw-16.9* plt ct-355 03:50pm blood neuts-81* bands-12* lymphs-7* monos-0 eos-0 baso-0 atyps-0 metas-0 myelos-0 04:24am blood neuts-66 bands-3 lymphs-18 monos-12* eos-1 baso-0 atyps-0 metas-0 myelos-0 04:44am blood pt-12.4 ptt-28.9 inr(pt)-1.0 05:53am blood glucose-106* urean-23* creat-0.4* na-141 k-4.3 cl-100 hco3-36* angap-9 09:47pm blood alt-113* ast-130* ld(ldh)-281* alkphos-609* totbili-0.5 04:42am blood alt-92* ast-120* alkphos-894* totbili-0.4 05:53am blood alt-77* ast-103* alkphos-836* totbili-0.4 05:53am blood calcium-8.8 phos-3.5 mg-1.7 iron-57 05:53am blood caltibc-339 ferritn-245 trf-261 06:30am blood igg-548* blood cultures: blood culture blood culture, routine-pending inpatient stool clostridium difficile toxin a & b test-final inpatient blood culture blood culture, routine-pending inpatient immunology (cmv) cmv viral load-final inpatient sputum immunoflourescent test for pneumocystis jirovecii (carinii)-final inpatient sputum gram stain-final; respiratory culture-preliminary {pseudomonas aeruginosa, pseudomonas aeruginosa}; fungal culture-preliminary inpatient urine urine culture-final inpatient blood culture blood culture, routine-final emergency sputum gram stain-final; respiratory culture-final emergency blood culture blood culture, routine-final emergency cxr: impression: 1. left-sided pleural effusion with focal left lower lobe consolidation, this could be compressive atelectasis with effusion; however, pneumonia is not excluded. 2. right pneumothorax. : findings: in comparison with the earlier study of this date, the right thoracostomy tube has been removed. no evidence of pneumothorax. the other monitoring and support devices remain in place. persistent opacifications in the right mid zone and especially in the left lower lung in the retrocardiac region, again consistent with multifocal pneumonia. discharge labs: brief hospital course: 39 yo male with nhl (now in remission, s/p allo ??????04, dli ??????05 complicated by multi-organ gvhd and bronchiolitis obliterans, s/p trach and multiple recent hospitalizations for multi resistent pseudomonas who presents now from with fever to 101.6 and increased leukocytosis; also found to have b/l peumothoraces on cxr in ed #pseudomonal pneumonia: the patient remained afebrile after admission to the icu. his white count trended down and was 13 the day prior to discharge. id was consulted and recommended 125 mg colistin iv, meropenem 1 g iv q8h. the stoppage date for these antibiotics is . they also recommended an indefinite course of of colistin 75 mg inhaled . blood and urine cultures were followed and showed no growth to date on the day of discharge with the exception of a sputum culture which grew pseudomonas. the patient was continued on his prophylactic regimen with bactrim, voriconazole and acyclovir. #bilateral pneumothoraces: on initial presentation in the ed, the patient's cxr revealed bilateral pneumothoraces. interventional pulmonology was consulted and placed a r anterior chest tube. their recommendations were followed and the tube was eventually clamped and removed. a repeat cxr showed resolution of the pneumothoraces. #anemia: the patient's hgb fell to a low of 6.2. it rebounded to 6.9 the day prior to admission. the patient did not receive rbc products. iron studies returned normal. his transfusion goal was to keep his hct>21. #ventilator dependent: the patient was maintained on pressure support ventilation during his admission. on the day prior to discharge, he was on pressure support of on an fio2 of 40%. he was given aggressive chest pt, mucomyst and pulmonary bundle. he chose not to participate with trach mask trials. #nhl s/p allo c/b gvhd: gvhd is underlying cause for patient??????s liver dysfunction (alkphos trending up, which transaminases stable, tuberculosis stable) and bronchiolitis obliterans. pt declined mri. he was maintained on his home regimen of prednisone 15 mg, mycophenolate 250 mg iv daily and well as prophylactic bactrim, acyclovir, and voriconazole. followed the patient whil in the icu. the patient also received a dose of ivig per his home regimen. #transaminemia: the patient's alkphos was elevated in the icu. this was thought to be to gvhd. the team wanted either an mri or mrcp to evaluate the cause, however the patient refused these tests. #tachycardia: the patient remained persistently tachycardic while in the icu. his urine output was monitored closely and his tachycardia was somewhat fluid-responsive. #hypothyroidism ?????? the patient received his home levothyroxine. nutrition: tpn, tube feeds dvt prophylaxis: pneumoboots, ambulation stress ulcer prophylaxis: ppi he remained full code while in the icu. discharge medications: 1. acetylcysteine 20 % (200 mg/ml) solution : one (1) miscellaneous q2h (every 2 hours) as needed for thick secretions. 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : two (2) puff inhalation q4h (every 4 hours) as needed for shortness of breath, wheeze. 3. dextromethorphan-guaifenesin 10-100 mg/5 ml liquid : mls po q6h (every 6 hours) as needed for cough. 4. fluticasone 50 mcg/actuation spray, suspension : one (1) spray nasal daily (daily). 5. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 6. lorazepam 0.5 mg tablet : 1-2 tablets po at bedtime as needed for insomnia. 7. prednisone 5 mg tablet : three (3) tablet po daily (daily). 8. sulfamethoxazole-trimethoprim 800-160 mg tablet : one (1) tablet po 3x/week (mo,we,fr). 9. zinc sulfate 220 (50) mg capsule : one (1) capsule po once a day. 10. ascorbic acid 500 mg/5 ml syrup : one (1) po daily (daily). 11. cyanocobalamin 250 mcg tablet : one (1) tablet po daily (daily). 12. ergocalciferol (vitamin d2) 50,000 unit capsule : one (1) capsule po once a week: please take every saturday. capsule(s) 13. ferrous sulfate 300 mg (60 mg iron)/5 ml liquid : one (1) po daily (daily). 14. insulin regular human 100 unit/ml solution : one (1) injection asdir (as directed). 15. simethicone 80 mg tablet, chewable : one (1) tablet, chewable po tid (3 times a day) as needed for indigestion. 16. colistimethate sodium 150 mg recon soln : one (1) recon soln injection (2 times a day). 17. levothyroxine 125 mcg tablet : one (1) tablet po 6x/week (six times a week). 18. meropenem 1 gram recon soln : one (1) recon soln intravenous q8h (every 8 hours). 19. colistimethate sodium 150 mg recon soln : one (1) recon soln injection q12h (every 12 hours). 20. mycophenolate mofetil hcl 500 mg recon soln : 0.5 recon soln intravenous (2 times a day). 21. acyclovir 200 mg/5 ml suspension : one (1) po every twelve (12) hours. 22. lorazepam 2 mg/ml concentrate : one (1) po every four (4) hours as needed for severe anxiety. 23. voriconazole 200 mg/5 ml (40 mg/ml) suspension for reconstitution : one (1) po every twelve (12) hours. discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses: pneumonia pneumothorax . secondary diagnoses non-hodgkins lymphoma graft versus host disease hypothyroidism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. : . it was a pleasure taking care of you while you were in the hospital. you were admitted for fevers. you have pneumonia and we have been treating you with antibiotics. we also found that you had some air around your lungs, which caused a partial collapse of your right lung. in order to reinflate the lung, a chest tube was placed to drain the air. when your lung re-inflated, we removed the chest tube. . the following changes were made to your medication regimen: ------started meropenem 1000mg iv every 8 hours. you will remain on this medication until . ------started colistin 125mg iv every 12 hours. you will remain on this medication until . ------started colistin 75mg inhaled. please remain on this medication indefinitely. ------stopped azithromycin. . no other changes were made to you medications. followup instructions: provider: , md phone: date/time: 2:00 provider: , phone: date/time: 1:00 provider: , md phone: date/time: 1:00 procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances thoracentesis diagnoses: portal hypertension other malignant lymphomas, unspecified site, extranodal and solid organ sites other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure complications of transplanted bone marrow accidents occurring in other specified places esophageal varices in diseases classified elsewhere, without mention of bleeding tachycardia, unspecified pseudomonas infection in conditions classified elsewhere and of unspecified site chronic respiratory failure tracheostomy status dependence on respirator, status other specified alveolar and parietoalveolar pneumonopathies acute on chronic graft-versus-host disease 

Answer: The patient is high likely exposed to