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: iodine-iodine containing / optiray 320 attending: chief complaint: admission for mud allo-sct major surgical or invasive procedure: lumbar punctures central line placement stem cell transplant history of present illness: mrs. is a 53-year-old woman with a history of high-risk aml who is being admitted today for her matched unrelated allogeneic transplant. she was discharged home after a nine week admission on . she was seen for follow up on and as her counts had recovered, she had her left sided picc removed. the plan is to move forward with an allogeneic transplant from an unrelated donor. the donor would be able to collect stem cells, but we could not guarantee a backup bone marrow should her stem cell collections not be adequate, so the decision was made to cryo-preserve the stem cells and mrs. admission was delayed until today. she is admitted today for her allogeniec transplant with busulfan and cytoxan conditioning. past medical history: 1. aml s/p 7+3 induction and then 5+2 reinduction 2. hypertension 3. hypercholesterolemia 4. impaired glucose tolerance 5. diverticulitis 6. uterine polyps 7. renal calculi 8. recurrent c. difficile infection 9. hernia repair at time of c-section in with steel mesh placed; patient cannot have mri with abdomen in scanner. social history: patient worked at hospital as a microbiology lab technician. she is married and has three daughters. she lives in , ma. she is a nonsmoker and drinks alcohol on rare occasions. family history: non-contributory physical exam: admission exam: vitals: t 97.6, hr 100, r 24, bp 100/62, wt 252.4 lbs, 97% ra. general: well-appearing female in no acute distress. heent: perrl with anicteric sclerae. eomi. oropharynx is moist without erythema, lesions, or thrush. neck: supple, without adenopathy. lungs: diffuse expiratory wheezes, no rales or rhonchi heart: distant heart sounds, no m/r/g appreciated abdomen: soft, obese, nontender without hsm or other masses appreciated, although difficult to examine due to body habitus. no bowel sounds heard but pt reports bm this am. extremities: 2+ dp/pt pulses bilaterally, no c/c/e skin: without rashes or lesions back: no pain or cva tenderness. . discharge exam: pertinent results: admission labs: 12:03pm blood wbc-7.7 rbc-3.73* hgb-11.7* hct-33.5* mcv-90 mch-31.4 mchc-35.1* rdw-16.5* plt ct-310 12:03pm blood neuts-72.4* lymphs-15.6* monos-7.2 eos-4.2* baso-0.6 12:03pm blood pt-13.1 ptt-19.9* inr(pt)-1.1 12:03pm blood gran ct-5590 12:03pm blood glucose-104* urean-13 creat-0.6 na-139 k-4.3 cl-104 hco3-22 angap-17 12:03pm blood alt-44* ast-27 ld(ldh)-218 alkphos-92 totbili-0.4 dirbili-0.1 indbili-0.3 12:03pm blood totprot-7.0 albumin-4.3 globuln-2.7 calcium-10.1 phos-4.5 mg-1.9 . pertinent labs: serum: 12:11pm blood t4-4.4* 12:11pm blood tsh-3.1 10:00am blood cortsol-13.5 12:00am blood tsh-2.3 fsh-2.5 12:00am blood prolact-33* 12:00am blood negative 12:00am blood rheufac <3 02:20pm blood igg-542* iga-75 igm-31* 12:21pm blood adenovirus dna not detected 02:30pm blood abs b1, b2, b3 elevated 02:30pm blood abs b4, b5, b6 not detected 12:09pm blood igg-829 iga-79 igm-26* . serum hhv-6 dna pcr: : <500 : 1,540,881 : 119,409 : <500 : <500 : 15,230 : 41,945 : 19,975 : 32,297 : 14,355 . serum bk dna pcr: : not detected : not detected : not detected . urine bk dna pcr: : >500,000,000 : >500,000,000 : >500,000,000 . csf: totprot-88* glucose-109 wbc-2 rbc-1* polys-0 lymphs-87 monos-9 macroph-4 ebv-pcr-neg hsv-neg virus-neg toxo-neg hhv-6 pos totprot-66* glucose-67 wbc-2 rbc-2* polys-0 lymphs-93 monos-7 hsv-neg hhv-6 pos (799 copies) . discharge labs: ................................................................ microbiology: urine cx: coagulase negative staph urine cx: coagulase negative staph urine cx: coagulase negative staph 6:15 pm blood culture blood culture, routine (preliminary): burkholderia (pseudomonas) cepacia. ................................................................ pathology: right leg skin biopsy: vacuolar interface and mild superficial perivascular dermatitis with epidermal and follicular dyskeratosis. the finding of follicular dyskeratosis is suggestive of early gvhd. a viral exanthem cannot be excluded, however, the follicular dyskeratosis would be unusual. the lack of significant numbers of eosinophils makes a drug eruption less likely. pas and gram stains are negative. . csf immunophenotyping: there appears to be an atypical population of cells that are not clustered in the cd45 vs. ssc histogram and demonstrate variable reactivity for cd13, cd33, and cd34. the concurrent cytospin slides are negative for involvement by an acute leukemia. while the above immunophenotypic findings may be non-specific, they are atypical and warrant clinical follow-up. . left flank skin biopsy: the sections show focal/patchy parakeratosis with "squamous cell activation," multifocal dyskeratosis, and mild spongiosis. the dermal-epidermal junction is involved by marked vacuolar changes, and apoptotic and colloid bodies are present. there is mild papillary dermal fibrosis with marked endothelial cell activation. the inflammatory response is paucicellular and comprised of predominantly mononuclear inflammatory cells with rare eosinophils. red blood cell extravasation and pigment incontinence are noted. overall, the findings are suggestive of a hypersensitivity type reaction such as to drugs, if compatible with clinical presentation. given the histopathological features and the clinical history, graft versus host disease cannot be entirely excluded. . bone marrow biopsy: the aspirate material is aspicular, precluding adequate differential counts. however, the core biopsy has a focus of immature mononuclear cells which are morphologically suspicious for blasts. by immunohistochemical staining these are cd34(-), however with strong expression of cd117. they are weakly immunoreactive for myeloperoxidase, and are glycophorin negative. taken together, the findings are highly worrisome for disease relapse. . left ankle skin biopsy: the findings of multiple intraepidermal vesicles with foci of reticular degeneration are suggestive of a viral infection, including those in the picornavirus family including virus. no definitive viral inclusions are observed. the subepidermal cleft may be due to prior interface change. a few neutrophils are observed in the epidermis, however, well formed pustules are not observed. there is minimal dermal inflammation. the findings favor a viral infection, however, an unusual finding is the degree of dysmaturation. while this may be a viral effect, due to the dysmaturation an underlying component of graft versus host disease (with a superimposed viral infection) cannot be excluded. gvhd may show subepidermal blisters and dysmaturation, however, the degree of intraepidermal vesicles would be unusual for gvhd alone and this finding favors a component of a viral infection. special stains (pas and gram) are negative for fungus and bacteria. . bone marrow biopsy: pending ................................................................ imaging: ct chest/abd/pelvis w/o con: 1. near-complete resolution of previously noted right lower lobe consolidation with some residual scarring. 2. resolution of previously noted sigmoid diverticulitis. 3. status post cholecystectomy. . ruq u/s: normal doppler ultrasound of the liver. prior cholecystectomy with no focal liver lesion or evidence of biliary obstruction. . ct head w/o con: 1. no intracranial hemorrhage. 2. old infarct in the right aca-mca watershed region. 3. right maxillary sinus mucus-retention cyst. . ct chest/abd/pelvis w/o con: 1. limited study without iv or oral contrast. 2. trace left pleural effusion. no evidence of pneumonia. 3. no free air, free fluid, or fluid collection in the intra-abdominal cavity. 4. interval development of "" mesentery, nonspecific, could be seen in patients with lymphoma, or in the appropriate clinical context, could represent mesenteric panniculitis. . v/q scan: matched perfusion and ventilation defect in the medial left lung base. low likelihood ratio for recent pulmonary embolism. . ct chest/abd/pelvis w/ con: 1. no evidence of infection on this ct scan. 2. mesentery previously seen on is no longer visualized on this study. . ct head w/o con: no evidence of acute intracranial abnormalities. . mri head w/o con: multiple scattered foci of flair hyperintensity involving predominantly cortical matter of the bilateral hemispheres, some of which demonstrate slow diffusion without significant mass effect or hemorrhage. these may represent changes related to encephalitis, encephalopathy, inflammatory/infectious etiology, subacute infarcts, less likely neoplastic involvement or related to medications used. evaluation of these findings is somewhat limited without intravenous contrast. . gu ultrasound: 1. thickened bladder wall, though it is not fully distended and therefore not fully evaluated, with bilateral mild pelvocaliectasis which may be mildly increased on the right from the previous ultrasound of . 2. there are no stones. brief hospital course: mrs. is a 53 year old woman with aml who was admitted on for matched unrelated allogeneic stem cell transplant with busulfan/cytoxan conditioning. hospital course was complicated by graft failure + gvhd, hhv-6 encephalitis, thrombotic microangiopathy, and numerous electrolyte abnormalities accompanied by acute kidney injury, as well as intense allodynia and pruritus. # icu stay: ms. was transferred to the icu on for hypotension. gram negative rods grew from her blood on that same day. she was given a total of 17 liters of fluid overnight as well as 4 units of prbcs and maximum bp support with 4 pressors maxed out (neo, levo, vasopressin, and epinephrine) and despite these measures her pressures remained in the 60s-80s systolic. she had increased work of breathing and began to desaturate on non-rebreather. she was intubated for respiratory distress. multiple phone calls and meetings were held with her husband and her primary team (hematology/oncology) and it was decided to make her cmo after maximal attempts to support her through her septic shock. after withdrawal of pressors and extubation, she passed peacefully within a few minutes. much of the rest of the hospital course is described below. . # aml and mud allo-sct graft issues: patient received an mud allo sct on . after reaching anc of 0, she was engrafting well until around 25-30 days s/p transplant when her ancs began to drop. initial concern was with hhv-6 infection/marrow gvhd/cyclosporine causing graft failure. foscarnet was started for hhv-6, the cyclosporine was discontinued, and steroids were increased, and ancs started rising again. the cyclosprine was later restarted but ancs again dropped, so the cyclosporine was again discontinued. she developed skin gvhd, so she was started on a low dose of tacrolimus, uptitrated to therapeutic doses with subsequent downtitration of her steroids. she was given pentamidine for pcp (unable to give bactrim considering ). she also received weekly checks for cmv vl, b-glucan, galactomannan, and hhv-6 vl after her acute infection. around day +68 she was noted to have increased peripheral blasts. she reached a peak absolute blast count of xxxxx. a bone marrow biopsy on was consistent with relapsed leukemia (chimerism showed increase to 45% recipient, 55% donor) so the tacrolimus was tapered and then stopped. prednisone was tapered as well. the patient was treated with 5 days of dacogen. her blast count continued to rise. she was treated with a cycle of mec followed by donor lymphocyte infusion. . # hhv-6 viral encephalitis: patient was noted to have altered mental status, and hhv-6 pcr returned at >1,000,000 on with csf also positive for hhv-6. she completed a 17-day course of foscarnet from and her mental status gradually returned to baseline. however, peripheral blood from revealed 15,230 copies of hhv-6 dna. the foscarnet was restarted on but was stopped on due to worsening . she remained clinically asymptomatic so the foscarnet was not restarted. . # febrile neutropenia: hospital course was complicated by febrile neutropenia with temperatures up to 105f. infectious disease was consulted and her antibiotics were changed multiple times and included aztreonam, ciprofloxacin, metronidazole iv, vancomycin iv and po, and micafungin. due to concern for nephrotoxicity and after being afebrile for a prolonged period of time, her antibiotics were gradually discontinued, with the exception fungal prophylaxis. after mec therapy (in peri-dli period) she again developed febrile neutropenia. she was started on cefepime after which she defervesced. she was then noted to have a vre uti and daptomycin was started. she was afebrile for many days until she spiked once again with new abdominal pain . # rash: patient developed a diffuse erythematous rash after starting daptomycin, which did not resolve following discontinuation. a biopsy of her left leg on was suggestive of gvhd so she was started on systemic and topical steroids. the rash initially improved, but again worsened despite steroids and there was concern that it was virally mediated considering her hhv-6 viremia. however, a repeat skin biopsy on was again suggestive of gvhd vs. a drug reaction. she later developed vesicles on her palms and soles and a biopsy on was suggestive of gvhd with a superimposed viral infection, likely virus. the skin gvhd was managed with iv and then po steroid as well as topical clobetasol. her skin worsened again, so tacrolimus and prednisone were weaned out of concern for worsening viral infection, perhaps or hhv-6. this initially improved her rash. however, after dli her rash acutely worsened and became quite weepy with several areas of skin breakdown and the sensation of an acute burn, suggesting a gvh picture. . # hyperesthesias/pruritis/allodynia: the patient reported diffuse itching and burning with allodynia. ct spine was unremarkable. dermatology and neurology were consulted, but did not feel that her symptoms were related to the hhv-6 or gvhd. she was treated with various medications including benadryl, hydroxyzine, and olanzapine with some improvement in her symptoms. . # thrombotic microangiopathy and frank hemolysis: around the time that the hhv-6 infection was detected, she began to show evidence of hemolytic anemia with low haptoglobin, high direct bili, high ldh, and . considering the anemia, thrombocytopenia, , and mental status changes, it was felt that ttp-hus had developed, likely secondary to the hhv-6 infection. an adamts-13 evaluation was sent, which was normal. as the hhv-6 was treated, these abnormalities resolved. . # hematuria: it was believed to be due to both bk virus in the urine and thrombotic microangiopathy. resolved with tapering of immunosuppression. . # : believed to be multifactorial, including the foscarnet, zosyn, vancomycin, ttp-hus, and bk virus detected in the urine. the resolved with discontinuation of these medications and resolution of ttp-hus. however, after restarting the foscarnet her kidney function again declined so the foscarnet was again stopped. with gentle hydration her cr improved to 1.3. . # hypernatremia/hyperglycemia: secondary to partial di and free water deficit. the sodium concentration in her tpn was decreased and she was started on d5w to correct her water deficit, which exacerbated her hyperglycemia. an osmotic diuresis due to elevated glucose may have also been contributing to this hypernatremia, so aggressive control of glucose was made a priority with the addition of lantus and an iss. . # hypertension: with only metoprolol on board, she developed htn in the setting of thrombocytopenia. it was also believed to be exacerbated by the cyclosporine and steroids. nifedipine was added and the cyclosporine was discontinued, and her bp was well controlled. eventually her nifedipine was able to be stopped and blood pressure was well controlled prior to discharge. . # diarrhea: patient had ongoing diarrhea throughout this admission, though repeated stool cultures including c.diff were all negative. considering her numerous antibiotics, she was started on po vancomycin which was later changed to prophylactic dosing. the diarrhea eventually resolved and the po vancomycin was discontinued. . # nutrition: patient struggled with nausea throughout the entire admission and initally had poor po intake, so she was started on tpn on which was eventually stopped when she was able to tolerate po intake. medications on admission: 1. acyclovir 400 mg q8h 2. lorazepam 0.5 mg tablet; 1-2 tablets q4h prn 3. metoprolol tartrate 25 mg tid 4. vancomycin 125 mg capsule q12h 5. voriconazole 200 mg q12h 6. docusate 100 mg 7. senna 8.6 mg tablet; 1-2 tablets qhs prn constipation 8. lovenox (held since for picc placement) discharge medications: not applicable discharge disposition: home with service facility: all care vna of greater discharge diagnosis: expired acute myelogenous leukemia graft versus host disease of skin hhv-6 encephalitis acute kidney injury discharge condition: expired discharge instructions: expired followup instructions: expired procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung spinal tap incision of lung parenteral infusion of concentrated nutritional substances insertion of endotracheal tube biopsy of bone marrow biopsy of bone marrow closed biopsy of skin and subcutaneous tissue closed biopsy of skin and subcutaneous tissue closed biopsy of skin and subcutaneous tissue injection or infusion of cancer chemotherapeutic substance injection or infusion of immunoglobulin allogeneic hematopoietic stem cell transpant without purging transplant from live non-related donor central venous catheter placement with guidance central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: acidosis pure hypercholesterolemia urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified severe sepsis acute respiratory failure defibrination syndrome septic shock infection with microorganisms without mention of resistance to multiple drugs complications of transplanted bone marrow acquired hemolytic anemia, unspecified diarrhea streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] hyperosmolality and/or hypernatremia surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other disorders of neurohypophysis examination of participant in clinical trial other specified disorders resulting from impaired renal function diabetes insipidus neutropenia, unspecified septicemia due to gram-negative organism, unspecified acute myeloid leukemia, in remission unspecified pruritic disorder acute graft-versus-host disease fever presenting with conditions classified elsewhere mucositis (ulcerative) due to antineoplastic therapy other specified diseases due to viruses human herpesvirus 6 encephalitis 

Answer: The patient is high likely exposed to