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: percocet attending: chief complaint: shortness of breath major surgical or invasive procedure: pericardial window history of present illness: 54 yo man with aml s/p allo-sct (mrd) now day 370 c/b gvh of liver and skin, disseminated tuberculosis, cmv viremia, hematuria and most recently admitted for tamponade secondary to large pericardial effusion accumulation, s/p pericardial drain now with chest tube pod #4. in brief originally, he has a history of aml diagnosed in , s/p induction and consolidation with ara-c. during induction he developed neutropenic fever and was diagnosed with widely disseminated tuberculosis with splenic, pancreatic, and pulmonary lesions as well as bilateral pleural effusions and pericardial effusion. cultures from blood, pleural fluid, lymph node biopsy as well as sputums to the time of his discharge all ultimately grew mtb from culture despite have negative afb smear. at that time he was started on four drug therapy and long steroid taper. his pyrazinamide was discontinue on month 5, however shortly thereafter he was diagnosed with a tuberculous paraspinal abscess at the level of the right kidney in that required drainage. levofloxacin was added to his regimen at that time. in his ethambutol was discontinued secondary to optic neuritis. he has since had drainage of pulmonary tuberculomas and pleural effusion at . at the time of his allo bmt it was decided that inh, rifampin and levofloxacin would be continued for 12 months. approximately 9 months after transplant on his medications were discontinued for elevated lfts. prior liver biopsy was consistent with gvhd, and his lfts continued to be elevated since discontinuation of his tuberculosis meds. he was received pentostatin, rituxan and photopheresis for his gvhd which has affected his mouth, eyes, gut, skin, +/- bladder. the patient was recently admitted for symptoms of volume overload. he was found to have a large pericardial effusion with tamponade physiology. he pericardial drain for 1300 cc of serosanguinous fluid. glucose level was normal, gram stain, afb smear and culture, tuberculosis pcr and adenovirus pcr were negative. his drain was pulled. the etiology of his effusion was undetermined, however viral infection vs tuberculosis vs gvhd vs medication effect (tacrolimus?) were considered. during this admission he also had a chest ct which revealed bilaterally upper lobe infiltrates with nodules and tree-in- appearance. sputums were negative for afb smear but poor sampling precluded concentrated smear. the patient refused bronchoscopy at that time, and the plan upon discharge was repeat ct scan in one week. he was not started on tuberculosis meds. incidentally he was diagnosed with vre and morganella utis and completed a course of daptomycin and cefpodoxime. beta d glucan checked on day prior to discharge was resulted to 170. he was seen in the clinic by dr. who ordered a repeat level which remained elevated to 152. she started him on treatment doses of atovaquone for concern of smoldering pcp given worsening chest xray findings. azithromycin was also started for atypical pathogens. sputum cultures were negative for pcp on dfa (although these were poor samples), however bacterial cultures were positive for stenotrophomonas. he was started on bactrim on , atovaquone was discontinued. per the patient's wife, he was at baseline in regards to shortness of breath and had not been able to lay flat since discharge. his cough has been improving in the past few days. yesterday he complained of fatigue and back pain, and at 3am this morning he developed chest pain radiating to his left arm. 911 was called and the patient was taken to . cta was performed which did not reveal pe; however a large pericardial effusion and bilateral effusions as well as mild ascites and cystic mass in pancreatic head. tte at the osh was reportedly negative for tamponade, although the patient did have one episode of hypotension with sbp to the 70s which responded to a 500 cc bolus. his platelet count was noted to be 17. he was transferred to the ed where he was tachycardic to 110, hypotensive to 80-90s systolic. bedside tte at our institution revealed tamponade physiology with collapsing rv. he was taken emergently to the or where a minithoracotomy was and pericardial window was performed. per verbal report approximately 400 cc of dark blood was drained. a left sided chest tube was placed. he was transferred to the ct icu where he remains intubated. he received cefazolin perioperatively and 4 units of platelets. ros per wife was negative for fever, chills, sick contacts, uri symptoms. past medical history: onc history (per omr): 1. diagnosed in early with nightly fevers. bm bx revealed aml. flow cytometry showed aberrant expression of cd2, cd7, hla-dr, cd 34, dim cd33, cd 117, and cd 71. ct scan revealednecrotic lymph nodes in the superior mediastinum and periportalregion, and multiple low attenuation lesions in the liver and spleen concerning for microabscesses from a disseminated infection. 2. : induction chemotherapy with cytarabine and idarubicin complicated by persistent fevers and extensive workup ultimately revealing disseminated tuberculosis infection. his course was also complicated by rapid atrial fibrillation and hypotension and the development of a severe cardiomyopathy. 3. s/p one dose of high-dose ara-c at 1.5 mg per meter squared, lowered dose due to his disseminated tuberculosis, and then he received a second course of hidac at 3 gram per meter squared dose and developed acute onset of gait instability. no further chemotherapy given. 4. relapsed in 7/. re-induction with me on . noted for pulmonary nodules which were suspicious for aspergillus and empirically treated with voriconazole with improvement noted on ct. 5. admitted on for maintenance therapy while awaiting bmt. however, upon admit he was again found to have blasts. he proceeded with idarubicin and cytarabine(7+2) butdid not achieve a remission. 6. s/p high dose ara-c with remission. 7. sibling related allo transplant on . allo course c/b increased lfts of unclear etiology, possibly from chemotherapy, renal failure attributed to csa, and received only 1 dose of mtx due to mucositis. 8. post transplant course complicated by asymptomatic cmv viremia and viral/uri syndromes. 9. in developed diarrhea with e/o gvh on endoscopy. he also had hematuria, but no evidence of bk virus. he started photopheresis. diarrhea abated but lfts rose. therapy attempted for gvh of liver using pulse of prednisone and increase in cellcept with stabilization but no significant improvement. 10. received 1mg of pentostatin on . 11. liver biopsy c/w gvhd. started rituxan for 4 weeks in 5/. non-onc pmh - disseminated tuberculosis - s/p treatment with inh, levofloxacin and rifabutin - hypertension and a heart murmur - diabetes mellitus type 2 - chemo related heart failure and cardiomyopathy, ef 35-40% - h/o atrial fibrillation, recent ekgs in nsr - cmv viremia () social history: he is married and lives at home with his wife & children. he is a machine operator, but is currently not working. he immigrated from in early . he smoked approximately 3 cigarettes per day for 20 years and stopped 1 year ago. he does not drink alcohol. family history: notable for mother who passed away of myocardial infarction. his father passed away of liver disease. he has four living brothers and two living sisters, all in good health. physical exam: t: 96.7 p: 92 r: 18 bp: 134/72 on simv 16/550/100%/5 general: chronically ill appearing, nad heent: dry mm, injected conjunctiva, ecchymosis and chronic gvhd in mouth. neck: no lad cardiovascular: rrr nl s1, s2, no m/r/g. respiratory: atelectasis at bases bilaterally, coarse sounds lower right, otherwise cta bilaterally. gastrointestinal: + bs, soft, no masses musculoskeletal: trace edema skin: dry, flaky. left thorax dressing, left chest tube dressing intact, draining serosanguinous fluid. l sc triple lumen line without significant erythema, bilateral ej lines and left peripheral ue iv. pertinent results: 12:05am blood wbc-4.1 rbc-2.60* hgb-9.6* hct-29.4* mcv-113* mch-36.9* mchc-32.6 rdw-21.1* plt ct-32*# 12:00am blood wbc-2.8* rbc-2.35* hgb-8.8* hct-26.5* mcv-113* mch-37.6* mchc-33.3 rdw-21.2* plt ct-21* 12:20am blood neuts-76.0* lymphs-16.7* monos-6.7 eos-0.5 baso-0.1 12:00am blood neuts-82* bands-2 lymphs-12* monos-3 eos-0 baso-0 atyps-0 metas-1* myelos-0 . 12:05am blood plt ct-32*# 12:00am blood plt ct-21* . 12:05am blood glucose-65* urean-19 creat-1.2 na-136 k-4.7 cl-107 hco3-19* angap-15 12:00am blood glucose-96 urean-20 creat-1.2 na-136 k-4.6 cl-107 hco3-21* angap-13 . 12:05am blood alt-158* ast-146* ld(ldh)-335* alkphos-1085* totbili-0.9 12:00am blood alt-143* ast-131* ld(ldh)-295* alkphos-1024* totbili-0.8 . 12:05am blood calcium-8.4 phos-2.6* mg-1.7 12:00am blood calcium-8.6 phos-2.4* mg-1.8 . 08:00pm blood hgb-9.7* calchct-29 o2 sat-93 . chest (portable ap) 1:18 am chest (portable ap) reason: r/o acute process medical condition: 54 year old man with increased serosanguenous drainage from prior ct site with pain reason for this examination: r/o acute process reason for examination: increased drainage from chest tube. portable ap chest radiograph compared to . there is no significant change in large left subcutaneous emphysema. there is overall improvement in bibasilar opacities, especially in the right lower lobe. there is no change in the cardiomediastinal contour and the position of the left central venous line with its tip terminating in mid-svc. . echo: pre-pericardial window: 1. no atrial septal defect is seen by 2d or color doppler. 2. overall left ventricular systolic function is moderately depressed (lvef= 30-35 %). 3. right ventricular chamber size and free wall motion are collapsed due to loculated effusion. 4. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. no thoracic aortic dissection is seen. 5. the aortic valve leaflets (3) are mildly thickened. mild to moderate (+) aortic regurgitation is seen. 6. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. 7. the tricuspid valve leaflets are mildly thickened. 8. there is a circumeferential large pericardial effusion with more around the right atrium and right ventricle. itmeasures approximately 5.0cm in size post-pericardial window: 1. the right ventricular chamber size and wall motion appear to be normal. 2. the size of the loculated effusion has decreased to 1.7cm after pericardial window. 3. there is improvement of lvef (35-40%). . brief hospital course: 1) pericardial effusion: the patient had a pericardial window placed as described in the hpi. the etiology of his effusion was thought to be secondary to gvhd as workup for other infectious etiologies was negative. after being extubated and followed without incident on the cardiac surgery service he was transferred to bmt for further management. he had a chest tube placed at the time of surgery that was removed of pod #3 after its drainage decreased. the patient had episodes of serosanguinous discharge from the site of his chest tube after the chest tube was removed but this was determined to be normal per ct surgery and resolved prior to discharge. 2) infectious disease: the patient was initially on vancomycin for ? gpc in his pericardial fluid, but this was discontinued once it grew staph epi. the patient complained of dysuria and was found to have vre that was treated with a 3 day course of daptomycin per id recommendation. he completed his bactrim for pcp treatment and will be discharged on a prophylaxis dose. in addition he took his posaconazole and acyclovir per home regimen. 3) aml s/p all-sct with gvhd: the patient refused to have photopheresis. his cellcept was increased from 250 to 500 per dr. . he also continued on his prednisone 20 qd. he continued on his outpatient eye drops for eye gvhd and on dexamethasone mouthwash for mouth gvhd. 4) pain: the patient was pain-free on morphine sr with ir for breakthrough. 5) lft elevations: the patient had elevated lfts upon admission that were thought to be secondary to shocked liver in the context of his pericardial tamponade. these improved throughout his stay but never achieved baseline; they are likely a result of his chronic gvhd but should be followed as an outpatient. medications on admission: bactrim ds 800 mg-160 mg--2 (two) tablet(s) q8h acyclovir 400 mg--1 tablet(s) by mouth twice a day artificial saliva --30 solution(s) q2h prn bacitracin zinc 500 unit/gram--topically qid prn penile pain benzonatate 100 mg--1 capsule(s) po tid prn cough dexamethasone 0.5 mg/5 ml--5 mlpo swish and spit. docusate sodium 100 mg--1 capsule(s) by mouth twice a day ergocalciferol (vitamin d2) 50,000 unit--1 q fri folic acid 1 mg--2 (two) tablet(s) by mouth once a day humalog 100 unit/ml--per sliding scale insulin glargine 100 unit/ml--14 units sq daily lumigan 0.03 %--1 drops(s) in the right eye at bedtime both eyes metoprolol tartrate 25 mg--3 tablet(s) by mouth twice a day mycophenolate mofetil 250 mg--1 capsule(s) by mouth twice a day nystatin 100,000 unit/ml--5 ml by mouth q6h swish and spit omeprazole 20 mg--1 capsule(s) by mouth once a day oxycodone 5 mg--1 tablet(s) by mouth q6h prn pain oxycontin 10 mg--2 (two) tablet(s) by mouth twice a day pred mild 0.12 %--1 (one) drop in each eye prednisone 20 mg--1 tablet(s) by mouth once a day pyridium 200 mg--1 (one) tablet(s) by mouth once a day posaconazole 200 mg/5 ml--1 suspension(s) by mouth tid pyridoxine 50 mg--2 tablet(s) by mouth once a day restasis 0.05 %--1 (one) drop in each eye twice a day saliva substitution combo no.2 --30 ml to mucous membrane q2 vitamin e 400 unit--1 capsule(s) by mouth daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. 3. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day). 4. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). 5. posaconazole 200 mg/5 ml suspension sig: one (1) po tid (3 times a day). 6. pyridoxine 50 mg tablet sig: two (2) tablet po daily (daily). 7. vitamin e 400 unit capsule sig: one (1) capsule po daily (daily). 8. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 9. humalog 100 unit/ml cartridge sig: one (1) unit subcutaneous four times a day: per sliding scale. 10. insulin glargine 100 unit/ml solution sig: fourteen (14) units subcutaneous qam. 11. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 12. toprol xl 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 13. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 14. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 15. dexamethasone 0.1 % drops, suspension sig: one (1) drop ophthalmic q6h (every 6 hours). 16. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po monday-wednesday-friday. disp:*15 tablet(s)* refills:*2* 17. cyclosporine 0.05 % dropperette sig: dropperettes ophthalmic (2 times a day). 18. morphine 15 mg tablet sustained release sig: one (1) tablet sustained release po twice a day. disp:*60 tablet sustained release(s)* refills:*2* 19. morphine 15 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*100 tablet(s)* refills:*0* 20. petrolatum ointment sig: one (1) appl topical tid (3 times a day) as needed. 21. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 22. dexamethasone 0.5 mg/5 ml solution sig: one (1) 5ml swish po bid (2 times a day): spit out solution, do not swallow. disp:*1 bottle* refills:*2* 23. heparin flush (100 units/ml) 2 ml iv daily:prn flush with 10 cc ns followed by 2ml of 100u heparin to each lumen. blue and red ports for only but need daily flush if not used. 24. acyclovir 400 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 25. artificial saliva 0.15-0.15 % solution sig: one (1) swish mucous membrane prn as needed for dry mouth. discharge disposition: home with service facility: critical care systems discharge diagnosis: cardiac tamponade vancomycin resistant enterococcus urinary tract infection s/p allogenic bmt chronic gvhd of gut, skin, mouth, bladder chemotherapy-induced cardiomyopathy discharge condition: stable discharge instructions: you were admitted to the hospital with cardiac tamponade. you had a surgery that opened up the pericardium (a tissue surrounding your heart) to drain the fluid. this surgery relieved the pressure on your heart and improved your shortness of breath. you had a chest tube after the surgery to drain the fluid from your chest. this tube was removed once the drainage from your chest decreased. in addition you were treated with daptomycin for a urinary tract infection. you will need to follow up with your physicians as directed below. please take your medications as prescribed. if you develop shortness of breath, fevers, chills, or any other concerning symptom please contact a physician . followup instructions: please follow up with your physicians: oncology: 11:00a , e. , hematology/oncology-sc 11:00a , , hematology/oncology-sc eye: 01:00p ball, l. , optometry heart surgeon: 01:00p ct, lm , cardiac surgery lmob 2a procedure: pericardiotomy transfusion of packed cells diagnoses: urinary tract infection, site not specified unspecified essential hypertension acute and subacute necrosis of liver acute kidney failure, unspecified atrial fibrillation antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use complications of transplanted bone marrow surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms cardiac tamponade acute myeloid leukemia, without mention of having achieved remission secondary cardiomyopathy, unspecified heart failure, unspecified other specified miliary tuberculosis, unspecified 

Answer: The patient is high likely exposed to