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: fatigue and pancytopenia major surgical or invasive procedure: bone marrow biopsy history of present illness: mr. is a 57 year old with a pmh significant for hiv with a recent admission at for pancytopenia. per nightfloat admission history and physical, the patient states that he initially started experiencing symptoms of dry cough and fatigue at the end of . prior to this he has felt otherwise well in good health. the patient has been hiv positive since , stable until 3 weeks ago when presented to s. hospital with fevers and pancytopenia. he also endorses low grade fever at that time. he denies having , , sinus congestion, cp, n/v/d, abd pain, rash, or lower ext swelling. he thus presented to s hosp on . there he was found to be pancytopenic with wbc 1.9, hct 16.5, plt 11. his bili, ast/alt were also mildly elevated. he was therefore admitted there for 2+ weeks for further work up. he presumably underwent bronch which was neg for pcp (per patient). ct chest/abd was only notable for fatty infiltration of the liver, spenomegaly, and mild atelectasis. other infectious work up was neg. he received multiple transfusions, and underwent a bone marrow biopsy before being discharged home. his bone marrow bipsy was thought to be myelodysplasia. upon follow up on , he was found to be persistently pancytopenic. after discussion with dr. and his pcp, was thus transferred for further work up. of note, he denies travel though he lives on . he denies sick contacts. has lost 10lbs since this began. while there, he received multiple transfusions, bone marrow bx preliminary dx was myelodysplasia and he was discharged to home approximately a week ago. repeat labs performed the day prior to admission at demonstrated wbc 1000 (wbc 1000 - 23 poly, 65 lymph, 12 mono, 1 nuc.rbc), hgb 7.9, hct 22.8, platelets 21. he was readmitted and transferred to for further evaluation of pancytopenia. of note, bone marrow biopsy slides were sent to for further read. in the ed, t 98.1, hr 100, bp 107/70, rr 18, 96%ra. labs confirmed pancytopenia/neutropenia. pt subsequently spiked to 101.3. pt was given cefepime 2g iv x1, vanco added upon initial transfer to the floors. currently, he states that he is fatigued but otherwise resting comfortably without complaints. on further questioning, he states that he has been febrile in the past week up to 101-102. past medical history: hiv since , cd4 471 vl <50 cop/ml h/p pcp pna six ago htn hyperlipidemia ? of childhood blood disorder social history: currently unemployed. denies tobacco, admits to occational etoh, denies recreational drug use/ivdu. msm. currently lives on family history: both parents died of lung ca. sibling is alive and well. physical exam: vs tm 99.3 tc 100.7 105/26 92 20 99%ra gen: nad, lipodystrophy changes heent: perrl, eomi, sclerae anicteric, mmm, op clear without lesions, erythema, or exudate. neck supple. cv: nl s1+s2, no m/r/g pulm: ctab abd: s/nt/nd +bs, spleen tip palpable. ext: 1+ dp b/l, no c/c/e skin: no rashes or other observed lesions. pertinent results: studies: cxr the cardiomediastinal silhouette is unremarkable. the lungs are clear. there are mild degenerative changes seen in the mid thoracic spine. ekg: nsr, nl axis, intervals, early r wave progression, non-specific stt changes. no priors for comparision bone marrow bx : hypercellular marrow showing erythro hyperplasia with left shift, myeloid left shift. no evidence of lymphoma. cd117 focally positive. gph-a postive tte : the left atrium is mildly dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) transmitral and tissue doppler imaging suggests normal diastolic function, and a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. labs: 06:43pm glucose-103 urea n-10 creat-0.6 sodium-137 potassium-4.9 chloride-101 total co2-25 anion gap-16 06:43pm ld(ldh)-1258* tot bili-1.5 06:43pm haptoglob-<20* 06:43pm lactate-2.2* 06:43pm wbc-1.4*# rbc-2.55* hgb-7.9*# hct-21.1*# mcv-83# mch-30.8# mchc-37.3* rdw-17.1* 06:43pm neuts-6* bands-0 lymphs-91* monos-3 eos-0 basos-0 atyps-0 metas-0 myelos-0 06:43pm hypochrom-normal anisocyt-1+ poikilocy-occasional macrocyt-normal microcyt-1+ polychrom-normal ovalocyt-occasional 06:43pm pt-16.1* ptt-29.6 inr(pt)-1.4* 06:43pm fibrinoge-664* d-dimer-1102* 06:43pm gran ct-270* 06:43pm ret aut-0.6* 06:43pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-4* ph-6.0 leuk-neg brief hospital course: a/p: mr. is a 57 year old gentleman with a pmh significant for hiv diagnosed in transferred from for further diagnostic evaluation of pancytopenia found to have leukemia. # pancytopenia: the patient was intially worked up for multiple infectious etiologies and a bone marrow biospy was reobtained to evaluate for cancer. he had an inital bone marrow biospy at the osh which was inconclusive. leading diagnoses included ehrlichiosis (so he was started on doxycyline empirically while the test was pending) and parvovirus (for which he received two treatments of ivig). during workup for pancytopenia, dic labs were sent and were negative, as were peripheral smear for schistocytes, as well as hemolysis labs which were consistent with a moderate amount of hemolysis. pcr of parvovirus returned negative and igg ab was found to be positive and igm was negative. ehrlichiosis serologies were still pending at time of admission from osh records. smear for babesia x 3 was negative. on the bone marrow biopsy results returned without evidence of parvovirus infection and with evidence of erythroleukemia so he was transferred to the oncology service for initiation of chemotherapy. # neutropenic fevers: the patient was intially started on cefepime for his fevers, however id felt this was not needed and it was stopped. # sob/hypoxia: likely secondary to anemia versus pulmonary process. a chest ct in the osh has shown no airway disease. the patient was transfused two times since admission for a hct less than 21. he remained only mildly symptomatic on exertion. pt progressively became more hypoxia, requiring 4l o2 by nc at one point. on , pt underwent bronchoscopy for the evolving hypoxia. on , pt became acutely dyspneic while maintaining his sats. abg performed at the time was relatively unchanged from prior, showing a respiratory alkalosis and possibly worsened a-a gradient (po2 83.) cxr showed no consolidation/pneumothorax. pt wa placed on a nrb and given nebulizer treatment with improvement of dyspnea. he was transferred to the for further management. in the , he transitioned back to 4lnc, satting 96% with reassurance by his partner and nursing, suggesting a likely anxiety component to his acute sob, as respiratory rate improved from 40s to high 20s. cta was obtained to rule out pe. unfortunately, he again became increasingly hypoxic and chest x-ray on showed rather rapid progression of bilateral parenchymal densities and his respiratory state decompensated to the point of needing intubation and vent dependency. he also became extremely confused and agitated likely secondary to extreme hypoxic state. after intubation. during this time he also had dramatic arf indicated by rapidly rising bun/cr and ldh levels > and markedly rising lfts indicating rapid multi-system organ failure. the patient's family had several meetings with the attending physician and residents in during this difficult time and ultimately the patient's partner and family decided that the patient should be made comfortable and cmo / comfort measures only routine care was adopted. patient was made comfortable with pain medications, all transfusions and ivfs were stopped and patient expired on . # hiv: haart therapy was initially continued. # hyperlipidemia: the patient was continued on zetia. medications on admission: atripla 600mg/200mg/300mg daily zetia 10mg daily atenolol 50mg daily discharge disposition: expired discharge diagnosis: patient expired on while in icu shortly after cmo decision was made by patient's hcp and partner. discharge condition: patient expired discharge instructions: patient expired followup instructions: none procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube biopsy of bone marrow closed [endoscopic] biopsy of bronchus transfusion of packed cells injection or infusion of cancer chemotherapeutic substance injection or infusion of immunoglobulin diagnoses: pneumonia, organism unspecified anemia, unspecified coronary atherosclerosis of native coronary artery unspecified essential hypertension human immunodeficiency virus [hiv] disease myelodysplastic syndrome, unspecified other and unspecified hyperlipidemia anxiety state, unspecified acute respiratory failure other specified cardiac dysrhythmias encephalopathy, unspecified mixed acid-base balance disorder acute myeloid leukemia, without mention of having achieved remission 

Answer: The patient is high likely exposed to