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: cefepime / cipro cystitis attending: chief complaint: cough, malaise, hypotension major surgical or invasive procedure: none history of present illness: 56 year old man with a h/o aml s/p allo sct in c/b chronic skin and pulmonary gvhd treated with prednisone 10mg daily. he reports 5-6 days of uri symptoms, myalgias, cough productive of yellow sputum, decreased appetite, and poor po intake. no fevers, though he has been taking tylenol. he presented to heme/onc clinic today and reported headache and nausea with improved after 1l ns. he was afebrile but hypoxic to 90% on ra, which improved to 94% on 2l. nasal swab and blood cultures were sent. cxr was negative. he was given vancomycin/aztreonam (due to cefepime allergy) and admitted for further workup. . o2 sats were in the mid-80s on ra so he was placed on nasal cannula and then shovel mask. 6pm abg was: 7.46/37/69. lactate 1.1. . overnight pt became more hypoxic and tachypnic. febrile to 101.8. azithro was added to his abx. chest ct tree opacities and concern for brochiolitis/pneuonitis. bmt wanted to give ivig due to low igg, but pt was too hypoxic. eventually 86% on nrb. was called. pt given albuterol x 1, and cxr taken. pt c/o resp fatigue. transfered to icu. . ros: (+) as noted above. (-) no current chest pain, palpitations, sob, abdominal pain, n/v/d. past medical history: # pulmonary embolism x2 ( and dx in rml and rll): on warfarin # acute myeloid leukemia: - : diagnosed - : underwent a matched unrelated allogeneic stem cell transplant. - post-transplant course c/b bx-proven gvhd of the liver and an intermittent skin rash, s/p management with cyclosporine, mycophenolate, rituximab, and currently, steroids. # type 2 dm: steroid-induced # hyperlipidemia # bilateral hip avn # htn # nephrolithiasis: s/p lithotripsy and previous nephrostomy tube and emergent surgery to repair ureteral damage # bcc s/p excision # scc left cheek, s/p mohs' # multiple back surgeries: l5-s1 surgery x 3, and cervical spine fusion (bone graft, no hardware) # anterior cervical diskectomy and instrument arthrodesis at c5-c6 and c6-c7 for degenerative cervical spondylitic disease with spinal cord compression and foraminal stenosis at c5-c6 and c6-c7 # chronic numbness, neuropathic pain in left upper extremity # multilevel compression fractures t11, t12, l1 and mild compression l3 and l4 # osa: refused bipap at home social history: lives with his wife, and son. is retired, worked as a technician tobacco - 40 pk year hx, quit 5 yrs ago. etoh - denies drug use - denies. family history: mother died suddenly in her 70s. father died of unknown cancer. one sister has thyroid cancer. one brother has diabetes. one sister has . physical exam: admission physical exam vitals: 101.8 132/88 109 24 91% nrb fs 127 general: a&ox3 but appears sob, speaking full sentences heent: dry mmm, clear op, no scleral icterus neck: supple, no masses lungs: coarse breath sounds througout, no wheezes. cv: regular, nml s1/s2, no murmurs. abdomen: soft, nt, nd, +bs extrem: hands and feet warm and well perfused, no cyanosis, 2+ pedal pulses, no edema. neuro: cn grossly intact, strength and sensation grossly intact. physical exam: please refer to daily progress note. pertinent results: icu admission labs: ph 7.45, pco2 38, po2 50 hco3 27 from clotted sample ph 7.42 pco2 40 po2 75 hco3 27, on face mask 100% lactate:1.4 ca: 8.7 mg: 2.0 p: 2.7 alt: 22 ap: 94 tbili: 0.3 ast: 25 ldh: 292 mcv 108 wbc 3.1 plts 158 hct 41.9 n:79 band:3 l:9 m:8 e:0 bas:1 mb: 2 trop-t: <0.01 ================================================================ pertinent labs: 11:15am blood igg-61* iga-19* igm-15* 11:15am blood ck-mb-2 ctropnt-<0.01 09:57pm blood ck-mb-2 ctropnt-<0.01 06:00am blood ck-mb-2 ctropnt-<0.01 11:30am blood ck-mb-2 ctropnt-<0.01 probnp-223* 10:50am blood aspergillus galactomannan antigen- 0.1 10:50am blood b-glucan- <31 pg/ml 04:30am blood pt-37.8* ptt-40.1* inr(pt)-3.9* 04:04am blood pt-44.7* ptt-39.4* inr(pt)-4.8* 02:58am blood igg-523* 05:54am blood gran ct-5040 06:30am blood ld(ldh)-240 ================================================================ labs on : 06:00am blood wbc-6.0 rbc-2.76* hgb-10.0* hct-29.4* mcv-106* mch-36.3* mchc-34.1 rdw-16.5* plt ct-215 06:00am blood pt-19.6* ptt-25.7 inr(pt)-1.8* 06:00am blood glucose-167* urean-14 creat-1.0 na-140 k-3.8 cl-99 hco3-34* angap-11 06:00am blood calcium-8.4 phos-3.2 mg-1.9 ================================================================ microbiology: 12:00 pm rapid respiratory viral screen & culture source: nasopharyngeal swab. **final report ** respiratory viral culture (final ): test cancelled, patient credited. refer to respiratory viral antigen screen and respiratory virus identification test results for further information. respiratory viral antigen screen (final ): this is a corrected report. positive for respiratory viral antigens. previously reported as. negative for respiratory viral antigen . specimen screened for: adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. reported by phone to forest at 1135 . respiratory virus identification (final ): reported by phone to s. forest 11.35a . positive for influenza a viral antigen. viral antigen identified by immunofluorescence 11:17 am cmv viral load (final ): cmv dna not detected. 4:07 am urine legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. 6:10 pm sputum source: induced. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci. in clusters. respiratory culture (final ): heavy growth commensal respiratory flora. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (preliminary): yeast. 8:21 am influenza a/b by dfa source: nasopharyngeal swab. **final report ** direct influenza a antigen test (final ): negative for influenza a. direct influenza b antigen test (final ): negative for influenza b. ================================================================ imaging cta chest 1. bibasilar bronchiectasis, unchanged compared with yesterdays examination with mulktilobar peribronchovascular ground-glass opacity with a tree-in- configuration. this pattern is nonspecific infectious or inflammatory, and consistent with small airways infection, atypical infections including fungal infection such as aspergillosis. 2. there is no pulmonary embolism. echocardiography : poor image quality. the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is no ventricular septal defect. the right ventricular cavity is mildly dilated with normal free wall contractility. the ascending aorta is mildly dilated. the aortic valve is not well seen. there is no aortic valve stenosis. no aortic regurgitation is seen. no mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. brief hospital course: 56m with h/o aml s/p allo sct c/b chronic skin/pulmonary gvhd, who presented to clinic with uri symptoms, myalgias, and decreased po intake and was found to be hypoxic, admitted on and discharged on . # hypoxia: on admission was hypoxic to 90% on ra, febrile and w/o leukocytosis then rapidly developed more profound hypoxia on the floor. on transfer to the icu required 100% non rebreather mask. underwent cta which demonstrated multifocal tree- opacities consistent with bronchiolitis and ruled out pe. nasal swab dfa was positive for influenza. his high oxygen demand was thought to be multifactorial with viral bronchiolitis/pneumonitis and possibly exacerbation of underlying chronic pulmonary gvh. other contributing mechanisms were atelectasis, under-recruitment and sleep apnea as evidenced by his improved oxygenation with non-invasive positive pressure ventilation. significant heart failure was ruled out per and normal echocardiography. patient was treated with tamiflu 150mg and will complete 10 days of treatment on day of icu (this increased dose and prolonged dose is as per recent guidelines for flu treatment in bmt patients). d/t to his high risk of superinfection as well as possible lll infiltrate he was also covered with abx: vanco+aztereonem+azithro were started on , on aztreonem was changed to meropenem for more wide spectrum coverage. azithromycine was intially given and then restarted on and continued untill when urine legionella returned neg. on day of icu patient is thus on day 11 of vanco and day 5 of meropenem. patient's home prednsione dose of 10mg daily was increased to 40mg daily for suspected acute on chronic pulmonary gvhd, this was reduced back to home dose a day prior to icu . ivig was given on for hypogammaglobulinemia and influenza infection without complications. acyclovir and bactrim prophylaxis were continued. patient continued to require 60-80% of oxygen throughout most of his icu stay which we were able to wean to 50% on non-invasive ventilation, but patient did not tolerated this due to discomfort from the mask. over the final 24h of his icu stay his oxygemnation improved remarkably and on icu discharged o2 requirement is down to 4l through nasal canula with saturations >92%. he was then transferred to the floor with gradual improvement of his oxygenation as he completed the antiviral (, 10 day course) and antibiotics (, 10 day course). he declined cpap on the floor. his o2sat remained stable and he was discharged with home oxygen. he was instructed to have follow up appointment with his doctor to determine further need for oxygen requirement as his pneumonia improves. # aml: s/p sct (), c/b chronic gvhd of skin/lungs. patient was on higher dose of prednisone while in the icu which was tapered back to home dose of 10 mg by the time of transfer from icu to floor. he remained on home prednisone and id prophylaxis with acyclovir and bactrim. # hypogammaglobulinemia. he received 0.4g/kg of ivig on . igg on improved to 523. no additional ivig was given. his level can be monitored in the outpatient setting. # h/o pe: patient was intially supertheraputic d/t azithromycin therapy, recieved vitamin k and warfarine was held. he then became undertheraputic and was bridged with lovenox. warfarin was restarted on at 5mg daily, inr is 2.1 on day of icu and lovenox was discontinued. he continued with 5 mg warfarin with inr beteween 2.0-2.3 until when inr level dropped to 1.8 and he received a total of 7 mg warfarin on the evening of with inr still at 1.8. he was instructed to take 7.5 mg of warfarin on sunday and 5 mg of warfarin on with lab on tuesday in the outpatient setting, so that his inr can be followed up by his doctor. adjustment of his warfarin is likely given recent discontinuation of antibiotics. # type 2 dm. because of his poor po intake initially, nph was held. as his appetite improved, his insulin was readjusted to 10 unit nph and then to 12 unit nph with insulin sliding scale. patient reports that his home dose insulin is 12 units and not 10 units . he was discharged on home dose nph. # hypertension. he continued with home metoprolol tartrate 12.5 mg as at home. # hyperlipidemia. he continued with home atorvastatin 20 mg daily. # previous ekg changes: early in icu course patient noted to have transient lateral/posterior st depressions in v4-v6, i and avl. with ce x 3 neg. and no cp. this was likely demand ischemia in this patient with multiple coronary risk factors but no known cad. he continued statin and beta blocker. consider outpatient stress test. # fen. patient refused a diabetic diet and preferred regular diet while on the floor. # access: picc while in the hospital. # code status: full code, icu consent done with wife/hcp , h , c- medications on admission: medications: - acyclovir 400mg po tid - atorvastatin 20mg daily - budesonide 3mg tid - folic acid 1mg daily - gabapentin 300mg qhs - oxycodone er 40mg q8h - hydromorphone 4mg; 0.5-1 tablet daily prn - nph 10units - humalog ss - metoprolol tartrate 12.5mg - pantoprazole 40mg - prednisone 10mg daily - bactrim 400mg-80mg tablet daily - warfarin 2.5mg alternating with 5mg daily - calcium carbonate 648mg tid - cholecalciferol 1000unit daily . allergies: - cefepime - cipro medications: 1. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. gabapentin 300 mg capsule sig: one (1) capsule po hs (at bedtime). 4. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 5. acyclovir 400 mg tablet sig: one (1) tablet po twice a day. 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 7. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). 8. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). 9. warfarin 5 mg tablet sig: 0.5-1 tablet po once daily at 4 pm: please take 1.5 tablets (7.5 mg) on sunday and then take 1 tablet (5 mg) daily until your inr is above 2. further dosage adjustment per your healthcare provider. 10. calcium carbonate 648 mg tablet sig: one (1) tablet po three times a day. 11. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po once a day. 12. budesonide 3 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po three times a day. 13. insulin sliding scale use humalog insulin sliding scale as you have been at home. dosage per your healthcare . oxycodone 40 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po q8h (every 8 hours). 15. hydromorphone 4 mg tablet sig: 0.5-1 tablet po once a day as needed for pain. 16. vitamin b12 injection per month, dosage per your healthcare . insulin nph 10-12 units twice a day. dosage adjustment per your healthcare . home oxygen continuous oxygen 2-3l flow per minute via nasal cannula. pulse dose for portability. for pnuemonia. 19. outpatient lab work please have a pt and inr checked on tuesday, , and have the results faxed or called in to your pcp's office (dr. . phone , fax . disposition: home with service facility: oxygen diagnosis: primary diagnosis: - influenza a pneumonia secondary diagnoses: - chronic graft versus host disease- lung and skin - type 2 diabetes - history of pulmonary embolism condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. instructions: dear mr. , it was a pleasure to take care of you at . you were admitted to the hospital for cough and increased trouble with breathing. in the hospital, it was found that you have influenza pneumonia. because of your increased oxygen use, you were transferred to the intensive care unit for close monitoring. you were treated with an antiviral for the flu as well as antibiotics for possible bacterial pneumonia as well. you completed the course of the antiviral and antibiotics while in the hospital. please note the following changes in your medications: - please start supplemental oxygen at 2-3l/min, continuously, until your pneumonia and shortness of breath have resolved. your doctors when you can stop using oxygen. you will need to have your inr level checked on tuesday, , and have the results faxed to your pcp who manages your coumadin. it will be important for you to follow up with your doctors below. followup instructions: department: hematology/bmt when: thursday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/bmt when: thursday at 9:00 am with: , np building: sc clinical ctr campus: east best parking: garage department: dermatology when: at 3:30 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: injection or infusion of immunoglobulin central venous catheter placement with guidance diagnoses: obstructive sleep apnea (adult)(pediatric) unspecified essential hypertension adrenal cortical steroids causing adverse effects in therapeutic use other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure long-term (current) use of anticoagulants complications of transplanted bone marrow rash and other nonspecific skin eruption personal history of venous thrombosis and embolism backache, unspecified hypogammaglobulinemia, unspecified acute myeloid leukemia, without mention of having achieved remission chronic graft-versus-host disease secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified cystitis, unspecified influenza due to identified avian influenza virus with pneumonia 

Answer: The patient is high likely exposed to