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: valium / elavil / niaspan / zithromax / levaquin attending: chief complaint: fever, cough major surgical or invasive procedure: 1. central line placement - r ij history of present illness: 89 yo male with a history of cll s/p multiple treatments, most recently pentastatin (last dose ) complicated by f+n so stopped and reassessed (no further treatment at that time and acyclovir/aerosolized pentamidine started for ppx) chronic hypogammaglobulinemia(treated intermittently w/ ivig, last ) who was admitted for febrile neutropenia. relevant admission history included productive cough at home, two recent falls without apparent loss of consciousness, progressive weight loss, recurrent aspirations, strep viridans bacteremia (as below) and ongoing diarrhea. . of note, recent admission , diagnosed with strep viridans bacteremia treated with broad spectrum abx and gcsf for neutropenia. tee was negative for vegetations. prior to d/c, antibiotics changed to clindamycin according to sensitivities, and he was discharged to rehab to complete a 14 day course. he was a known aspiration risk at that time (failed video swallow) but refused peg. he was continued on thickened liquids with aspiration precautions. patient signed himself out of rehab. it is unclear whether he completed a complete course of antibiotics. . patient was seen by pcp for chills, cough, s/p mult falls (no loc) and was referred to ed. in the er, he was found to have a t 100.3, hr 109, and o2 sat of 91% ra 94% on o2. cxr showed a ?rll pna and he was started on levaquin 750mg. . on the floor, antibiotics were broadened to cefipime and sbp's were running 110's. in the am of , the patient had a syncopal episode while in the bathroom and bp was found to be in the 70's. aggressive ivf's were started and bp returned to 100's. then, that afternoon, bp back to 80's despite ivf's. ecg unremarkable. repeat cxr demonstrated no infiltrates. abg 7.34/34/60 on 2 liters oxygen. patient was admitted to the icu. . in the icu, sbp dropped to 70s and temp spiked to 104.6. antibiotics were broadened to cefipime/vancomycin/flagyl. a central line was placed and patient required dopamine x 36 hours which was eventually weaned off . no culture data could be obtained to guide treatment. c diff negative x 3 (, , ). blood cxs and pending. urine xc and negative. sputum from grew op flora. however, source presumed to be aspiration pna. heme/onc consulted and recommended giving ivig at 400 mg/kg and gcsf at 300 mg sc qd. received treatment (per heme/onc should receive q4-5 wks). a doboff was placed for tube feeds. also transfused 1 unit prbcs on for hct 21 (-> 25). also complained of rue swelling/pain. rue u/s and xr both unremarkable. vancomycin d/c'ed . intermittently required iv lasix 20 mg for volume overload with good response. at the time of transfer, bps had stabilized off pressors, fever curse declining on broad spectrum antibiotics (but off vanco), and anc improving on gcsf. . currently, patient feels breathing is improved. denies any chest pain, sob, fevers, chills, abdominal pain. resting comfortably. past medical history: # cll- - s/p induction with chlorambucil at 6 mg/day x 3 weeks in . - s/p cycle of maintainence chlorambucil 24 mg /day x 5 days in (--> low counts). - s/p 4 cycles maintainence chlorambucil at 24 mg/daily, for five days/month starting in . - s/p 2 cycles of maintainence chlorambucil at 12 mg/day for 5 days every months in and . - intermittently on pentostatin, re-started on following approx 2 month hiatus. # cad - s/p cath in with ptca and pci of lad and d2. # hyperlipidemia # anemia # bph # osteoarthritis # diverticulosis # dementia # h/o chronic low back pain # prostate ca - s/p turp # recurrent aspiration pneumonitis # s/p appy # s/p tonsillectomy # s/p b/l inguinal hernia repair # anxiety # h/o malaria social history: lives alone in . widowed with four children. family history: non contributory physical exam: t: 98.2 bp: 112/58 hr: 84 rr: 24 o2 97% 3lnc gen: chronically ill appearing gentleman, laying flat in bed, nad heent: no conjunctival pallor. dry mms. op clear. doboff in place neck: supple. bilateral cervical adenopathy. no jvd. r ij in place. cdi cv: rrr. nl s1, s2. holosys murmur at apex lungs: bibasilar crackles, l>r abd: nabs. soft, nt, nd. no hsm ext: wwp. 1+ rue swelling. trace le edema. no splinter hemorrhages, osler nodes, lesions skin: multiple ecchymoses on forearms neuro: alert. oriented x3. cn 2-12 grossly intact. preserved sensation throughout. moving all extremities. pertinent results: r humerus xr: no fracture detected involving the right humerus. although subtle marrow involvement might not be detected radiographically, no obvious evidence for marrow involvement or osteolysis is detected. . ue u/s: no evidence of right upper extremity dvt. . cxr: allowing for technical differences, there has been no significant change since the previous study of . heart size is normal with tortuosity of the thoracic aorta and coronary artery stent in situ. no definite pulmonary consolidation or pleural effusions. slight prominence of the right hilum, likely vascular related to the relatively high position of the right hemidiaphragm. impression: no evidence for pneumonia. . cxr: the cardiomediastinal silhouette is unchanged. the lungs are clear. no pleural effusions or pneumothoraces are identified. the hilar structures are normal. the aorta is unfolded. impression: no acute cardiopulmonary process identified. . 08:50pm blood wbc-15.3* rbc-2.95* hgb-10.0* hct-30.9* mcv-105*# mch-33.9* mchc-32.4 rdw-15.9* plt ct-282# 01:23pm blood wbc-8.9 rbc-2.56* hgb-9.2* hct-26.3* mcv-103* mch-35.8* mchc-34.8 rdw-15.6* plt ct-223 05:20am blood wbc-12.4* rbc-2.65* hgb-9.1* hct-27.9* mcv-105* mch-34.4* mchc-32.7 rdw-15.7* plt ct-207 04:57am blood wbc-6.2 rbc-2.26* hgb-7.8* hct-23.3* mcv-107* mch-34.4* mchc-32.1 rdw-15.4 plt ct-174 04:08am blood wbc-8.9 rbc-2.35* hgb-8.0* hct-23.8* mcv-101* mch-34.0* mchc-33.6 rdw-16.8* plt ct-134* 05:35am blood wbc-13.4* rbc-2.49* hgb-8.4* hct-25.1* mcv-101* mch-33.7* mchc-33.3 rdw-17.0* plt ct-111* 05:29am blood wbc-17.4* rbc-2.40* hgb-8.4* hct-25.1* mcv-105* mch-34.9* mchc-33.4 rdw-16.5* plt ct-95* 05:45am blood wbc-21.6* rbc-2.35* hgb-8.0* hct-24.7* mcv-105* mch-34.1* mchc-32.5 rdw-16.5* plt ct-93* 08:50pm blood neuts-3* bands-3 lymphs-88* monos-1* eos-1 baso-0 atyps-4* metas-0 myelos-0 05:20am blood neuts-9* bands-4 lymphs-79* monos-3 eos-0 baso-0 atyps-3* metas-2* myelos-0 03:00am blood neuts-5* bands-0 lymphs-92* monos-1* eos-1 baso-0 atyps-1* metas-0 myelos-0 07:50am blood pt-13.0 ptt-25.4 inr(pt)-1.1 07:50am blood gran ct-1020* 03:00am blood gran ct-520* 04:08am blood gran ct-780* 05:35am blood gran ct-970* 08:50pm blood glucose-164* urean-18 creat-1.0 na-137 k-4.3 cl-102 hco3-26 angap-13 01:23pm blood glucose-110* urean-22* creat-1.0 na-142 k-4.6 cl-108 hco3-24 angap-15 03:00am blood glucose-94 urean-24* creat-1.0 na-139 k-3.4 cl-112* hco3-21* angap-9 05:23am blood glucose-119* urean-20 creat-0.9 na-144 k-3.3 cl-112* hco3-26 angap-9 05:29am blood glucose-98 urean-13 creat-0.7 na-146* k-4.2 cl-112* hco3-29 angap-9 01:23pm blood alt-8 ast-12 ck(cpk)-39 alkphos-66 totbili-1.9* 01:23pm blood ck-mb-3 ctropnt-<0.01 07:50am blood caltibc-282 ferritn-562* trf-217 03:00am blood hapto-174 03:00am blood cortsol-14.6 12:37pm blood type-art po2-62* pco2-34* ph-7.43 caltco2-23 base xs-0 08:56pm blood lactate-2.0 12:37pm blood lactate-3.5* 08:44pm blood lactate-1.5 brief hospital course: 89 yom w/ a h/o cll s/p multiple treatments, h/o hypogammaglobulinemia (intermittently treated with ivig), cad who p/w febrile neutropenia attributed to presumed aspiration pna, admitted to the micu for hypotension, now on broad spectrum antibiotics without clear source of infection. . # febrile neutropenia: neutropenic and febrile on admission. possible sources include aspiration pneumonia, bacteremia (unknown if completed course for strep viridans), c diff (given diarrhea post clindamycin), skin(given small decub), sbe, uti, cns infection. pulmonary source seems most likely given cough although no culture data guiding treatment currently. c diff negative x 3. decub only small so unlikely source. urine negative. sbe unlikely w/ negative blood cultures and no stigmata of endocarditis. vanco d/c'ed . no evidence to support cns infection. neutropenia resolved with filgastrim treatment and filgastrim d/c'ed. patient received a dose of ivig per heme/onc recs. afebrile on broad spectrum antibiotics. patient completed a 10 day course of cefepime/flagyl and was changed to cefpodoxime and flagyl oral at the time of discharge to complete 4 more days. as described elsewhere, it was decided by the patient and family that he would go to rehab with an eventual goal of going home with hospice once services were in place. he was continued on acyclovir until discharge and was then discontinued to minimize po medications. . # hypotension: presumed secondary to sepsis in the setting of aspiration pna. briefly required pressors in micu but stabilized on broad spectrum antibiotics and was weaned off. am cortisol normal. bps otherwise remained normal for the remainder of admission. . # cll: s/p multiple treatment regimens. near neutropenic at baseline and was neutropenic on admission. patient had a h/o hypogammaglobulinemia, intermittently treated with ivig. as above, he was treated with ivig and filgastrim. per heme onc there were no other treatments available for his cll. . # h/o aspiration: failed speech and swallow last admission but refused peg placement. he had a doboff placed in the icu and received tube feeds. however, after discussions with the family it was clear that the patient wanted to leave the hospital with a focus more on comfort measures. he continued to refuse a peg tube. it was decided that patient would be discharged to rehab with a goal of going home with hospice. therefore, the doboff was removed for patient comfort and a a soft solid, thickened liquid diet was started to allow feeding for comfort and patient happiness. . # rue swelling: unclear cause. per family, fell and hit that arm. possibly secondary to trauma with fall. u/s and xr unrevealing. improved during course of admission. . # agitation: agitation in icu requiring restraints. per family, patient has a history of sundowning. seroquel started. alprazolam weaned down. however, once goals of care were focused more on comfort, family requested increasing patient's xanax which was done. he was continued on seroquel and zyprexa to help aid with continued evening agitation throughout admission. . # cad: no active issues. continued on his aspirin and beta blocker throughout and remained asymptomatic. . # anemia: baseline hct high 20s to low 30s. transfused 1 unit prbcs for hct 21 with appropriate resonse while in the icu. his hematocrit then remained stable. . # thrombocytopenia: patient initially had significant drop in his platelets soon after admission. however, did not become thrombocytopenic until more than a week after admission. however, given concern for potential hit, all heparin products were stopped and a hit antibody was sent but was pending at the time of discharge. his platelets were 97 at discharge which is stable. . # fen: tubefeeds via doboff then discontinued and restarted on soft solid, thickened liquids for comfort. . # ppx: heparin sc until platelets dropped. heparin d/c'ed and pneumoboots placed. . # code: dnr/dni, do not transfer to icu, no central lines, no pressors following meeting with healthcare proxy on . plan for comfort measures without rehospitalization. medications on admission: aspirin 81 mg daily acyclovir 400 mg q8h finasteride 5 mg daily folic acid 1 mg daily benzonatate 100 mg tid prn alprazolam 0.25 mg tid as needed for anxiety. albuterol sulfate 0.083 % q 8h ipratropium bromide 0.02 % solution sig: one q8h clindamycin hcl 150 mg q6h for 7 days. fluconazole 100 mg q24h for 14 days. aranesp discharge medications: 1. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po bid (2 times a day) as needed for agitation. 2. quetiapine 25 mg tablet sig: one (1) tablet po bid (2 times a day). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. alprazolam 0.25 mg tablet sig: one (1) tablet po three times a day. 5. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 7. finasteride 5 mg tablet sig: one (1) tablet po once a day. 8. atenolol 25 mg tablet sig: one (1) tablet po once a day. 9. cefpodoxime 100 mg/5 ml suspension for reconstitution sig: two hundred (200) mg po twice a day for 4 days. 10. flagyl 500 mg tablet sig: one (1) tablet po three times a day for 4 days. discharge disposition: extended care facility: nursing home - discharge diagnosis: primary: 1. aspiration pneumonia 2. neutropenia secondary: 1. cll 2. cad 3. anemia 4. dementia 5. anxiety discharge condition: stable o2 sats on room air. vitals stable. aspirating on minimal soft solids and thickened liquids. agitated at times at night improved with zyprexa. discharge instructions: please continue to take all medications as prescribed. please note that your acyclovir, folic acid, fluconazole, and aranesp have been discontinued. you have been started on quetiapine and you have been given olanzapine to be used as needed for agitation. you should also continue taking oral antibiotics for the next 4 days. please continue to work with rehabilitation until you are ready to return home. followup instructions: please follow up with your primary physicians as needed. procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances transfusion of packed cells injection or infusion of immunoglobulin diagnoses: coronary atherosclerosis of native coronary artery mitral valve disorders unspecified septicemia severe sepsis percutaneous transluminal coronary angioplasty status candidiasis of mouth other persistent mental disorders due to conditions classified elsewhere other and unspecified hyperlipidemia anxiety state, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus septic shock intestinal infection due to clostridium difficile hypoxemia dehydration hyperosmolality and/or hypernatremia chronic lymphoid leukemia, without mention of having achieved remission 

Answer: The patient is high likely exposed to