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: fever, chills, night sweats major surgical or invasive procedure: none history of present illness: mr is a 39 year old gentleman with history of cml in undifferentiated blast crisis. mr. had recurrence recently after being in remission for 3.5 years. he is s/p 4 doses of radiation therapy to a painful lytic lesion in his cervical spine. he has received a donor lymphocyte infusions x 2. for the past few days patient has had a low grade fever (100.4 at home) along with some chills, night sweats, and a new cough. he has also been vomiting x 1 day with decreased po intake. he was found to be profoundly pancytopenic, and weak in clinic today. he is being admitted for probable chemo and managment of his blast crisis. past medical history: cml in undifferentiated blast crisis dm2 hypertension social history: lives with wife at home. has two children aged 12 and 5. family history: n/c physical exam: t 101.5 bp 125/78 p 125 o2 97% ra general: in no acute distress. heent: sclerae anicteric, perrla. no sinus tenderness, lesion at tip of tongue, moderate mucositis moderately tender in right subscapular region- area of previous biopsy, also mildly tender in l shoulder, increased range of motion, no meningeal signs. tongue is dry. neck: no cervical, supraclavicular, or occipital adenopathy, no axillary adenopathy. lungs: clear to percussion and auscultation. heart: regular rate. no murmurs, rubs, thrills, or gallops. abdomen: nontender without hepatosplenomegaly, no inguinal adenopathy. extremities: no focal bony tenderness. skin: no cutaneous lesions. pertinent results: admission labs: 01:25pm wbc-4.0# rbc-2.05*# hgb-6.8*# hct-18.3*# mcv-90 mch-33.2* mchc-37.0* rdw-14.3 01:25pm plt count-8*# 01:25pm neuts-13* bands-1 lymphs-42 monos-3 eos-0 basos-4* atyps-5* metas-7* myelos-18* promyelo-4* blasts-3* nuc rbcs-1* 01:25pm glucose-243* urea n-19 creat-0.7 sodium-137 potassium-2.8* chloride-94* total co2-36* anion gap-10 01:25pm albumin-3.2* calcium-8.8 magnesium-1.6 01:25pm alt(sgpt)-27 ast(sgot)-29 ld(ldh)-2976* alk phos-95 tot bili-0.4 dir bili-0.2 indir bil-0.2 . bone marrow: chronic myelogenous leukemia in blast phase (acute myelogenous leukemia) . radiology: cxr: note is made of widened superior mediastinum, which can be due to projection, however, can represent mediastinal lymphadenopathy in this patient with blastic crisis. the heart is normal in size. bilateral lungs are clear. . echo: the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). 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. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is no pericardial effusion. impression: preserved global and regional biventricular systolic function. . ct c-spine: there is a large infiltrating paraspinal mass extending at least from the c3 level through t2, and may extend even more inferiorly. no penetration of the thecal sac, but some evidence of osseous erosion of c3 through c6 spinous processes. there is also a left skull base soft tissue mass. it would be extremely helpful to have prior studies for comparison. sinus opacification and general subcutaneous lymphedema. the possibility of superinfection in an immunocompromised patient cannot be determined on this noncontrast ct and should be correlated clinically. . ct chest: impression: 1) mediastinal, hilar, and axillary lymphadenopathy, consistent with the given history of cml. 2) small bilateral pleural effusions. multifocal areas of atelectasis within the right lung and additional tiny area of focal patchy opacity in the right lung, nonspecific. 3) two tiny nodular opacities within the left upper lobe. given the history of malignancy, these can be followed with ct in three months. 4) fracture of the right eighth rib, healing. additional possible old trauma of the left fifth rib. 5) trace coronary artery calcifications. . right upper extremity ultrasound: upper extremity venous ultrasound with doppler: no prior studies are available for comparison. there is occlusive thrombus involving the entire cephalic vein. this extends in close proximity to the subclavian vein, but does not involve it. the right internal jugular, subclavian, axillary, and brachial veins demonstrate normal compressibility, color flow, and doppler waveforms. there is no dvt. impression: findings consistent with a cephalic vein thrombophlebitis. . ct head: impression: 1) no acute hemorrhage, mass effect, or cerebral edema. 2) likely leptomeningeal or parenchymal 3-mm metastatic lesion in the right temporal lobe. mri with gadolinium is suggested to evaluate for other lesions when the patient is stable. 3) moderately enhancing soft tissue mass in the left petroclival region with associated bone destruction, which abuts the dura adjacent to the left pons and medulla without mass effect on the pons or medulla. no change compared to and . 4) stable paranasal sinus and mastoid air cell disease. . brief hospital course: ## pt presented with blast crisis. initially started on solumedrol 100mg iv qd changed to 30 mg on . he was started on allopurinol, hydroxyurea and a bone marrow aspirate was done. treated with an uncomplicated 7 day course of low dose ara-c (day 1 ) with hydroxyurea, without response. this was followed by mec. completed course of xrt on for brain chloroma. on pt was started on neupogen for persistent neutropenia 2 weeks after completion of chemotherapy. counts began to rise on and patient remained clinically well. on discharge, wbcc 2.3, hct 27, plt 37. . ##fever- initially thought it was secondary to blast crisis. also, thought possibly secondary to mouth source, since he had mucositis and a tongue lesion. therefore, he was started on 1 gram cefepime and flagyl for anaerobic coverage. vanco and caspo were added for subsequent fever spikes. culture data remained negative. c spine ct showed large infiltrating paraspinal mass from c3 to t2 and left skull base soft tissue mass. question of tumor fever vs. drug fever. id consulted on . ct sinus showed sinus opacification: fungal infx vs. tumor. fungal swab pending rue u/s showed thrombophlebitis, but no dvt. on , pt became septic w/ gnr bacteremia. initially started on meropenum and gentamycin. rescusitated in micu with 11l ivf, levophed x 24 hours. found to have esbl e coli bacteremia sensi to gent, meropenum, imipenum, tobra; gent discontinued on . most likely source of bacteremia is rectal mucositis and rectal fissures, with associated rectal cellulitis. pt defervesced around . maintained on meropenum until discharge, approx 6 days after counts began to rise. decision to discharge w/o further abx therapy was discussed w/ id who felt it was appropriate. . ##anal fissure: likely source of gnr sepsis. baths, stool softeners, pain control. started on dilaudid pca . made npo w/tpn on for bowel rest . ##chloroma pain- initially had severe pain, likely from chloroma. morphine pca was started for pain control and a ct cspine was done due to increased pain requirements. ct showed increased size of right paraspinal mass and base of skull lesion. radiation oncology felt that he would not be a good candidate for radiation. patient was treated with chemo and pain medications. chloroma pain resolved. on , pt developed acute mental status change and received a course of whole brain radiation. . ##neuro/ms change: pt has soft tissue mass with associated bone destruction in area of l clivus and petrous bone lymphoma. on , pt p/w episode of sudden transient nausea, dry heaves, face twitching, eyes rolling to side which initially resolved on it's own within minutes. this was followed by significant mental status change with aggitation, confusion, tongue deviation (l) on neuro exam. pt had stat head ct which showed new 3mm right temporal lobe mass, but no change in l clivopetrous region. given decadron with improvement in mental status. pt had urgent whole brain radiation, and completed course of xrt. evaluated by neurology who did not think etiology was seizure activity; possible toxic-metabolic. mental status returned to baseline and stable over the 10 days prior to discharge. continuing to taper steroids on discharge (last decreased on ) and blood sugars remained elevated. pt was discharged on low dose glargine to help control bs in setting of steroid taper. . ##blood product reaction: hx of bad rxn to plts. on got ffp for line placement and became tachycardic, tachypnic and febrile. ffp stopped. bld tx reaction protocol started. responded to demerol, benadryl, tylenol. needs pre-medication for all blood products. . ppx- he rec'd pentamidine on , acylovir and fluconazole. . discharge medications: 1. pramoxine-mineral oil-zinc 1-12.5 % ointment sig: one (1) appl rectal q4 h prn () as needed for rectal pain. disp:*1 tube* refills:*0* 2. oxycodone hcl 10 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po q12h (every 12 hours). disp:*15 tablet sustained release 12hr(s)* refills:*0* 3. insulin glargine 100 unit/ml solution sig: fifteen (15) subcutaneous at bedtime. disp:*150 units* refills:*0* 4. oxycodone hcl 5 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. disp:*20 tablet(s)* refills:*0* 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 6. bisacodyl 5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 7. ativan 0.5 mg tablet sig: one (1) tablet po every 4-6 hours. disp:*15 tablet(s)* refills:*2* 8. acyclovir 200 mg capsule sig: two (2) capsule po q8h (every 8 hours). disp:*180 capsule(s)* refills:*2* 9. dexamethasone 2 mg tablet sig: one (1) tablet po daily (daily): take one tablet by mouth for three days, then stop . disp:*5 tablet(s)* refills:*0* 10. aloe vesta 2-n-1 cleanser solution sig: one (1) topical twice a day. disp:*qs for one month* refills:*2* 11. aloe vesta 2-n-1 protective ointment sig: one (1) topical twice a day. disp:*qs for one month* refills:*2* 12. double guard cream sig: one (1) topical twice a day. disp:*qs for one month* refills:*2* 13. duoderm bandage sig: one (1) topical twice a day. disp:*qs for one month* refills:*2* discharge disposition: home discharge diagnosis: 1) cml- blast crisis 2) e. coli sepsis 3) rectal fissure discharge condition: good, vital signs stable, afebrile discharge instructions: 1) please take your medications as directed. 2) please attend your follow up appointments. 3) return to medical care immediately if you develop any fever. 4) you must check your finger sticks twice daily, before breakfast in the morning and at bedtime. if any finger stick is greater than 300 or less than 75, call dr. at . 5) you will be taking dexamethasone for three days and then should stop. followup instructions: 1) you need to call dr. () to make an appointment to be seen this week. 2) you need to call dr. office to be seen in his clinic on thursday, . procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances biopsy of bone marrow transfusion of packed cells injection or infusion of cancer chemotherapeutic substance transfusion of platelets other radiotherapeutic procedure other diagnostic procedures on nasal sinuses infusion of vasopressor agent diagnoses: other specified disorders of pancreatic internal secretion adrenal cortical steroids causing adverse effects in therapeutic use sepsis candidiasis of mouth bone marrow replaced by transplant septic shock other specified disorders of biliary tract diarrhea septicemia due to escherichia coli [e. coli] disorder of bone and cartilage, unspecified other chronic sinusitis chronic myeloid leukemia, without mention of having achieved remission anal fissure myeloid sarcoma, without mention of having achieved remission 

Answer: The patient is high likely exposed to