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: history of present illness: mr. is a 74 year old caucasian gentleman who was initially diagnosed with diffuse large cell lymphoma in , when he presented with fatigue, fevers, sweats and a hematocrit of 25. a ct scan at that time showed diffuse adenopathy in the chest and abdomen and biopsy revealed large cell lymphoma. he was treated with chop which was completed in early . he subsequently received four cycles of weekly rituxan. a follow-up scan showed a significant response, although there was a question of residual adenopathy and by , there was definite evidence of progression by ct scan. he was then treated with times one cycle with disease stabilization. most recently, he has been considered for an anti-cd22 antibody treatment in the last month, however, he was being admitted with a near syncopal episode felt secondary to dehydration. more recently, he has developed thrombocytopenia which is concerning for progressive disease. he was on paxil 20 mg once a day and that was decreased to 10 mg once a day due to thrombocytopenia. he presented to the clinic on , to being treatment with his anti-cd22 antibody treatment. he reported feeling well prior to the visit, however, during the visit, he developed shaking chills and was observed to be unsteady on his feet. he admits to episodes of shaking chills intermittently over the last several weeks or months, but no definite fevers. he denied any sweats. he had some anorexia, but no significant weight loss. his breathing is comfortable at rest and he denies cough, but admits to some shortness of breath with exertion or walking up stairs. he denies any chest pain, lightheadedness or dizziness, no abdominal pain, nausea, vomiting, change in his stools or bleeding. no leg swelling or rashes. he was admitted to the 4-south for rule out infection before starting his chemotherapy. past medical history: 1. gastric stromal tumor, status post partial gastrectomy in . 2. chronic right hip and knee pain due to arthritis. 3. hypothyroidism. 4. hypertension. 5. peptic ulcer disease. 6. cholecystectomy. medications: 1. atenolol 25 mg p.o. q. day. 2. synthroid 0.125 mg p.o. q. day. 3. procardia xl 50 mg p.o. q. day. 4. folic acid 1 mg p.o. q. day. 5. paxil 10 mg p.o. q. day. 6. ambien 5 mg p.o. q. h.s. p.r.n. 7. salt tablets. allergies: no known drug allergies. physical examination: vital signs were temperature 100.6 f.; blood pressure 138/70; pulse 90; respiratory rate 18 to 20; weight 72.5 kilograms, height 180 centimeters. in general, he is an elderly gentleman who was shaking during the interview while sitting in bed. he did not appear to be in any acute respiratory distress. heent: extraocular movements are intact. anicteric sclerae. oropharynx clear. neck supple; no nodes palpable in the supraclavicular area or in the peripheral area. lungs clear to auscultation and percussion bilaterally. cardiac: s1 and s2, regular rate and rhythm, no murmurs, rubs or gallops heard. abdomen soft, nontender, nondistended, no hepatomegaly or splenomegaly noted. extremities with no significant edema or asymmetric swelling. neurology: awake and alert but having some difficulty expressing his thoughts. cranial nerves appear grossly intact. his motor strength is equal in the upper and lower extremities throughout. gait unsteady with walking, clinically more towards the right side and he was unsteady with turning. laboratory data: on admission, white blood cell count 3.4, hemoglobin 11.0, hematocrit 33.3, platelet count 77,000. sodium 135, potassium 3.4, chloride 101, bicarbonate 21, bun 18, creatinine 0.8, total bilirubin 0.3, alkaline phosphatase 191, alt 35, ast 42, ldh 469. hospital course: the patient was admitted and blood cultures, urine cultures, urinalysis and clostridium difficile toxin assay was sent. a chest x-ray and a ct scan of the sinus was done to find the source of infection. x-rays showed some bibasilar changes and so the patient was started on levaquin 500 mg once a day and acyclovir 400 mg three times a day because of a small ulcer found in the left nostril. on the next day, the patient developed rigors early morning, which was probably secondary to any infections, so we started the patient on ceftazidine 2 grams q. eight for pseudomonas coverage and he was also given a single dose of demerol 25 mg intravenously, which helped with rigors. also, the patient was scheduled to get another x-ray of his chest. ct scan of his sinus was found to be negative and his chest x-ray was also found to be not significant and the patient, at that time, was only kept on levaquin and for treatment of a possible urinary tract infection because his urinalysis showed some white blood cells and some bacteria. the patient was doing better throughout the next couple of days, however, on , the patient spiked another fever and he was disoriented. a ct scan of the head was done to rule out any masses or any intracranial hemorrhage and a lumbar puncture was done which was also found to be not very significant. the next day, the patient still had rigors and had urinary retention, so a foley catheter was inserted. a ct scan of the abdomen and pelvis was done without contrast to identify a possible source of abdominal infection secondary to an abscess, however, the ct scan of the abdomen and pelvis without contrast showed a splenic hemorrhage or splenic infarction leading to subscapular hemorrhage. infectious disease was consulted and the patient was started on zosyn 4.5 mg q. six and the levaquin was stopped right away. in addition, surgery was also consulted for management of the patient due to the splenic hemorrhage. surgery at that time thought that the patient was not an ideal candidate for surgery and so they recommended that he be transferred to the medical intensive care unit for management and also because hematocrit was waxing and . the patient was transferred to the medical intensive care unit on and he was transferred back on the medical intensive care unit on , when it was decided that he was not going to go for surgery and conservative management was going to be approached. during his medical intensive care unit stay, the patient's renal function began to worsen and the patient was becoming more confused and disoriented. he also had a bone marrow biopsy that was done on . after the patient was transferred back to the floor, he still remained confused and disoriented and so he was started on haldol and ativan to help calm him down. on , the patient was still confused and we decided to stop his zosyn in the morning because no significant source of infection was found and also as per recommendation of infectious disease, however, that evening he began to rigor and he developed fever and chills, and so the zosyn was started back on again. a family discussion was held on , about the status of this patient and that he was uncomfortable and nothing much could be done in terms of his disease and that it has progressed pretty significantly. the family decided that it would be best to take him home under hospice care. his wife, who was the health care , decided to make him "do not resuscitate" "do not intubate" after discussion with the fellow and with the attending. on , the patient was discharged to home with hospice care. laboratory: results on discharge, white blood cell count 1.7, red blood cells 3.48, hemoglobin 10.2, hematocrit 32.4, platelet count 18. pt 14.0, ptt 42.5, inr 1.4. granulocyte count 990, glucose 87, bun 46, creatinine 1.7. sodium 134, potassium 3.3, chloride 105, bicarbonate 20, alt 23, ast 25, alkaline phosphatase 180, total bilirubin 2.8. calcium 9.2, phosphorus 3.8, magnesium 2.0. condition at discharge: fair. the patient is still confused and disoriented. does not respond and is not interactive. discharge status: the patient was being discharged to home with hospice care. discharge diagnoses: 1. recurrent large cell lymphoma with progressive disease. 2. splenic hemorrhage/splenic infarction with subscapular hemorrhage. discharge medications: the patient was unable to tolerate anything p.o., including his medications and so his family decided that we should try to give him anything in the form of a liquid and in the form of a patch and anything else he needed p.o., they were going to withhold and as a result, the patient was actually sent home on: \ 1. augmentin suspension 5 mg per 5 ml, dispensing 120 ml for antibiotic coverage. 2. fentanyl patch to help for his pain control. 3. for breakthrough pain a prescription was given for roxanol 20 mg per ml, dispensing 30 ml. , m.d. dictated by: medquist36 procedure: spinal tap incision of lung biopsy of bone marrow diagnoses: acidosis thrombocytopenia, unspecified urinary tract infection, site not specified unspecified essential hypertension unspecified acquired hypothyroidism retention of urine, unspecified reticulosarcoma, unspecified site, extranodal and solid organ sites other diseases of spleen 

Answer: The patient is high likely exposed to