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: morphine / penicillins / hydromorphone attending: chief complaint: back/knee pain, "sickle cell crisis" major surgical or invasive procedure: exchange-transfusion 12 units history of present illness: mr. is a 21 y/o man with sickle-cell anemia who presents from osh with 2 days of severe pain, mostly localized to his lower back and knees bilaterally. he also has a headache that started this am, localized to the r occipital region. he states that the onset of pain began 2d ago when he was carrying water into the house from outside. he was dressed in a coat and denies feeling cold at that time. he denies traumatic injury from heavy lifting. he recalls that he drank alcohol on saturday, but did not feel dehydrated and has been drinking the "regular" amount of fluid. he attempted to treat the pain initially with oxycodone and excedrin, but it did not resolve. . hence on , he went to where he was evaluated and started on dilaudid and ivf. because of his elevate wbc count (20->25), and concern for meningitis he was transferred to for further w/u and pain management. . he states this pain is similar in location and severity to sickle-cell crises he has had in the past. on ros, he denied cp, sob, cough, sinus conjestion, sore throat, n/v, diarrhea, constipation, and urinary symptoms. ros otherwise normal. . his most recent crisis was approximately in . of last year. his regular triggers for sickle-cell crises include dehydration and sometimes cold. . in the ed, he was continued on dilaudid and evaluated with cxr and mri of the back. he was also given iv fluids and a dose of levofloxacin. past medical history: sickle cell anemia: treated last year with hydroxurea and folic acid, but that was stopped due to "swelling and pain" in feet. last crisis about 6 months ago. social history: attends college, studies computer engineering and technology. denies smoking/ivdu. occasional social alcohol. family history: parents in good health. two siblings, neither with sca. physical exam: vs t:99.0 p:98-101 bp:138-155/76-91 rr:16-18 o2sat:100% 4lpm nc general: young man lying in bed with eyes closed in moderate discomfort. skin: warm and dry throughout. some additional warmth over knees bilaterally. neck: supple, no lad. no rigidity. heent: normocephalic, sclerae white, perrl, eomi, visual fields full, no diplopia, mmm, op clear. heart: no carotid bruits bilaterally. +s1s2, tachycardic. holosystolic murmur best heard at lusb. lungs: ctab. thorax symmetric. normal diaphragmatic excursions and i:e of 1:3. abd: +bs soft, nt/nd, -hsm. ext: thin, -c/c/e. ppp ms: a&ox3. neuro: cns grossly intact. no focal deficits throughout. pertinent results: cxr admission: patchy right lower and possible patchy left lower lung opacities. mild cardiomegaly with vascular redistribution consistent with volume overload. . cxr portable : 1. bilateral lower lobe consolidations. pulmonary infarcts may be a possibility in this patient with sickle cell crisis 2. absence of splenic , be secondary to autosplenectomy. . cxr : 1. increased bibasilar pleural effusions and/or atelectasis. 2. diffuse increase in bony density. sclerotic changes in the right humerus which may represent prior bony infarcts. . cxr : progression of pneumonia and sickle crisis. . ct chest: multilobar pneumonia, with possible pneumococcal etiology. some of the consolidation may also be due to the sickle cell crisis. . mri lumbar/thoracic spine: 1. no evidence of epidural abscess. 2. heterogeneous signal within the l2 through l4 vertebral bodies, raising the possibility of bone infarcts. 3. evidence of t12-l1 laminectomy. . ekg: sinus tachycardia, rate 130. non-specific st-t wave abnormalities are present. no previous tracing available for comparison. . echo: the patient is tachycardic. normal biventricular size and systolic function. mild pulmonary hypertension. mildly elevated pulmonic valve velocity c/w trivial ps (vs high output). . kub: there are distended loops of large bowel, partially filled with stool. there is no definitive evidence of obstruction. the patient is rotated, limiting evaluation for stones or osseous abnormalities. osseous structures appear grossly unremarkable. . labs at osh: na 139 k 4.1 cl 106 hco3 30 bun 7 creat 0.6 glu 122 wbc 26 crit 28.6 platelet 331 75n 14l 11m 4nucleated rbcs ca 8.7 total bili 2.4 direct bili 0.4 alt 32 ast 47 alk phos 121 . labs on admission: . 05:07am pt-15.6* ptt-27.0 inr(pt)-1.4* 05:07am plt count-236 05:07am hypochrom-occasional anisocyt-1+ poikilocy-2+ macrocyt-1+ microcyt-1+ polychrom-1+ spherocyt-occasional ovalocyt-occasional sickle-1+ schistocy-occasional stippled-occasional how-jol-occasional pappenhei-occasional elliptocy-occasional 05:07am neuts-78* bands-7* lymphs-8* monos-1* eos-0 basos-1 atyps-1* metas-0 myelos-3* promyelo-1* nuc rbcs-15* 05:07am wbc-30.4* rbc-3.04* hgb-9.1* hct-26.0* mcv-86 mch-30.0 mchc-35.1* rdw-21.8* 05:07am caltibc-287 haptoglob-<20* ferritin-> trf-221 05:07am iron-77 05:07am ck-mb-2 probnp-515* 05:07am alt(sgpt)-37 ast(sgot)-64* ld(ldh)-933* ck(cpk)-143 alk phos-156* tot bili-2.5* dir bili-0.5* indir bil-2.0 05:07am glucose-120* urea n-9 creat-0.6 sodium-140 potassium-4.4 chloride-104 total co2-21* anion gap-19 05:44am ret man-20.9* 09:07am lactate-1.2 06:33pm urine rbc-0-2 wbc-0-2 bacteria-rare yeast-none epi-0-2 06:33pm urine blood-tr nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 06:33pm urine color-straw appear-clear sp -1.009 09:20pm plt count-206 09:20pm hgb a-0 hgb s-93.7* hgb c-0 hgb f-6.3* 09:20pm hypochrom-1+ anisocyt-2+ poikilocy-3+ macrocyt-occasional microcyt-occasional polychrom-3+ target-1+ sickle-3+ 09:20pm wbc-28.3* rbc-2.59* hgb-7.8* hct-21.6* mcv-84 mch-30.0 mchc-35.9* rdw-22.0* 11:29pm freeca-1.24 11:29pm o2 sat-94 11:29pm glucose-111* lactate-0.8 na+-138 k+-3.7 cl--104 11:29pm type-art o2-40 po2-105 pco2-45 ph-7.38 total co2-28 base xs-0 . labs at discharge: 05:22am blood wbc-13.8* rbc-3.25* hgb-9.8* hct-28.3* mcv-87 mch-30.0 mchc-34.5 rdw-17.1* plt ct-405# 05:22am blood plt ct-405# 05:22am blood ret aut-8.4* 05:22am blood glucose-87 urean-8 creat-0.6 na-140 k-4.2 cl-104 hco3-25 angap-15 05:22am blood ld(ldh)-378* totbili-1.4 05:22am blood calcium-9.3 phos-4.5 mg-2.0 05:22am blood hapto-157 brief hospital course: this is a 21 y/o man with sickle-cell anemia who presented with two days of severe pain in his lower back and knees similar to previous pain he has experienced during sickle-cell crises. his hospital course was complicated by respiratory distress, with concern for acute chest syndrome vs. pna. he received an exchange-transfusion of 12 units, three days of vancomycin and was started on a 14-day course of levofloxacin. he was discharged in stable condition, with good oxygen saturations and markedly reduced pain. . sickle-cell crisis: the pt.'s crisis was treated with iv fluid and pain was managed with narcotic medications. he was intitally started on a dilaudid pca, but this was switched to fentanyl when the pt. began to have a pruritic and myoclonic reaction. he tolerated the fentanyl well, and was switched to prn percocet with good pain control prior to discharge. . acute chest syndrome vs. pna: his wbc count trended up from initial presentation at osh. cxr showed patchy opacities. during his first hospital day, he experienced hypoxia to 78% on room air and 92% on 70% face mask. he was transferred to the micu for concerns of altered mental status and hypoxia. in the micu, the pt. was treated for hypoxic respiratory distress. he received a three-day course of vancomycin and was started on a 14-day course of levofloxacin for possible pna. he received 2 units of prbc. he was continued on o2 supplement by shovel face mask. tte showed normal ef and mild pulm hypertension likely to pna/acute chest indicating that chf was unlikely to be the cause of his hypoxia. ct chest confirmed pna/acute chest syndrome. with continuing abx, blood transfusion (2 units in the ccu), ivf, and pain control, the patient improved marginally; in discussion with heme/onc it was decided to place a r groin line and initiate exchange transfusion, with subsequent marked improvement clinically. he was weaned down to nasal cannula o2. the patient was started on clears and advanced diet as tolerated. the r groin line was pulled prior to transfer to the floor without difficulty, an occlusive dressing was left in place. back on the medicine floor, the pt. continued to improve, with clear lung sounds and a reduction in his leukocytosis at time of discharge. he was discharged on day of levofloxacin with instructions to finish the course. . ileus: the pt. had symptoms of abdominal pressure, as well as a kub concerning for obstruction vs. ileus. these symptoms were thought to be likely due to narcotic use. he was started on a standing bowel regimen. he had a large bm which relieved his symptoms and had no further episodes of constipation while in hospital. . coagulopathy: on admission, the pt. had an elevated inr of 1.4 with unclear etiology. this increased to 2.3, and the patient received one dose vit k. the inr was reduced to 1.2 at time of discharge. <br> anemia: pt. had a crit of 26.0 on admission that fell to 21.6 prior to first transfusion. this was likely due to long standing sickle-cell disease, and hemolysis labs were consistant with intravascular hemolysis. his retic count was markedly elevated at 20, but his baseline reticulocyte count was not known. the crit was much improved to 28.3, and trending up at time of discharge. hemolysis labs were also much improved. <br> 4) fen: pt. received house diet. he was maintained on aggressive ivf until the day prior to discharge. <br> 5) ppx: ambulate qid, bowel regimen prn. <br> 6) dispo: to home with hematologic f/u. medications on admission: oxycodone prn excedrin prn discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. disp:*36 tablet(s)* refills:*0* 3. levofloxacin 750 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days. disp:*7 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: acute chest syndrome, sickle-cell crisis discharge condition: vss, no o2 requirement. discharge instructions: please return to the emergency room if you feel shortness of breath, severe pain, severe cough, extreme fatigue, or other concerning symptoms. . make sure to attend your appointment with dr. . followup instructions: you have the following appointment scheduled: . , md. hematology. . . . thursday, . 2:30 pm. . to consider whether you could restart on hydroxurea. md procedure: transfusion of packed cells diagnoses: pneumonia, organism unspecified paralytic ileus hb-ss disease with crisis acute chest syndrome 

Answer: The patient is high likely exposed to