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: cefepime / levaquin attending: chief complaint: sob major surgical or invasive procedure: none history of present illness: 53 year old male with history of refractory follicular lymphoma status post matched unrelated non-myeloablative allogenic stem cell transplant, who is admitted from the clinic with fevers and neutropenia. since his last hospitalization ( - ) when he was admitted with pseudomonas and mssa pneumonia and treated with 10 days of zosyn, he had initially felt relatively well until several days ago. he notes that about one week ago, he noted a worsening cough productive of green sputum. he also notes that he has been having worsening nasal congestion. he notes chills, generalized weakness and fatigue. he denies nausea, vomitting and diarrhea. he notes unchanged po intake. he was seen in clinic on and was started on augmentin for a 7 day course and despite this continued to have the above symptoms. . pt was initially seen in clinic on following a 7 day course of augmentin for his nasal congestion/productive cough. since his admission he was started on zosyn and vancomycin with improvement in his symptoms until the morning of when he began having significantly increased frequency in his cough as well as increased sputum production. he also began having hemoptysis (states it was the color of cranberry juice) which he had not had previously. his o2 requirement increased from nasal cannula to a non rebreather and he was transferred to the for increasing o2 requirement. in the he was noted to have a worsening pneumonia on cx-ray and was treated with aztreonam and zosyn for pseudomonas pneumonia. his o2 requirements have since decreased. his counts have also come up and he is now no longer neutropenic. he is on 4 l nc at time of transfer. he currently feels well and denies sob, palpitations, fevers, and chills. . ros: no chest pain, palpitations, difficulty breathing, dyspnea on exertion, pnd, orthopnea, hemoptysis, headaches, congestion, sore throat, difficulty swallowing. no n/v/d/c, abdominal pain. no gu symptoms. past medical history: oncologic history: patient underwent matched unrelated non-myeloablative allogenic stem cell transplant with fludorabine and cytoxan on . he was diagnosed with grade ii follicular lymphoma in after presenting with lymphadenopathy of the neck. his lymphoma was resistant to multiple courses of chemotherapy, and he then underwent transplant in . . his post-transplant course was complicated by tooth abscesses requiring extractment. while on antibiotics after extractment, he developed rashes, which were felt to be secondary to gvhd or drug-related. he also had several bouts of cmv viremia with colonic involvement causing diarrhea, which improved with valcyte, however he had difficulty tolerating this medication secondary to reduced cell counts. he has had repeated difficulty with rashes, and had another skin biopsy in that finally confirmed gvhd of the skin. over this time, he has been treated with steroids and had improvement of his rashes, however again has had recurrences of his cmv. he was most recently admitted last month for fevers and worsening cough, work-up for which was unrevealing. his primary oncology team has been using puva treatment for this while attempting to taper his steroids. . other past medical history: 1. follicular lymphoma as noted above. 2. cmv viremia, colitis 3. gvhd of skin and liver 4. left inguinal hernia 5. borderline positive hepatitis b core antibody 6. hypertension 7. hyperglycemia while on steroids social history: patient is married and has three children. he formerly worked as an electrician. he does not smoke or drink alcohol. family history: there is no family history of lymphoma or other hematologic diseases. physical exam: vs: t 98.3 hr 80 bp 145/85 o2 sat 94% 4 l nc gen: nad, aox3, appears comfortable heent: mm dry, op clear card: rrr, no m/r/g pulm: poor air movement, diffuse rales abd: soft, nt, mild distention, no masses ext: wwp, skin darkening and extreme dryness neuro: grossly normal pertinent results: lab results on admission: 10:25am plt smr-low plt count-95* 10:25am wbc-2.2*# rbc-3.49* hgb-10.6* hct-33.5* mcv-96 mch-30.4 mchc-31.6 rdw-18.1* 10:25am glucose-256* urea n-19 creat-0.9 sodium-134 potassium-3.5 chloride-99 total co2-21* anion gap-18 10:22pm lactate-2.2* 04:37pm pt-12.4 ptt-27.0 inr(pt)-1.0 . lab results on discharge: 12:00am wbc-5.1 rbc-2.90* hgb-8.6* hct-27.5* mcv-95 mch-29.7 mchc-31.2 rdw-19.0* plt ct-80* 12:00am neuts-81* bands-2 lymphs-15* monos-2 eos-0 baso-0 atyps-0 metas-0 myelos-0 12:00am gran ct-3620 12:00am glucose-152* urean-16 creat-0.7 na-136 k-3.6 cl-102 hco3-27 angap-11 12:00am alt-34 ast-16 alkphos-263* totbili-0.8 12:00am calcium-8.6 phos-2.5* mg-1.7 . ct sinuses (): 1. since , worsened paranasal sinus changes with air-fluid levels within the left maxillary sinus and sphenoid sinus which in the right clinical setting may represent acute sinusitis. worsened fluid/mucosal thickening involving the mastoid air cells bilaterally and the left middle ear cavity. 2. there is lucency surrounding the cochlea bilaterally consistent with otospongiosis. the differential, however, would also include otosyphilis. . ct chest (): mixed interval changes, with essential resolution of lingular abnormality and slight improvement of right basilar abnormality, but development of new foci of ground glass attenuation within the left lower lobe, superior segment right lower lobe and both upper lobes. although these findings may be due to infection, cryptogenic organizing pneumonia and graft- versus- host disease are additional considerations in the post-transplant setting. . brief hospital course: patient is a 53 year old male with past medical history of refractory follicular lymphoma, status post allogenic stem cell transplant in complicated by gvhd and cmv colitis, admitted with neutropenic fever, found to have an acute mssa and pseudomonas sinusitis and pseudomonas pneumonia. . # pneumonia: s/p bronch on last admission with pseudomonas and mssa pna sensitive to zosyn. on this admisison, again with pseudomonas pna sensitive to zosyn. also with pseudomonas and mssa sinusitis. initially started on vanc and zosyn. on third day of admission, o2 requirements increased, requiring non-rebreather and transferred to the unit. in the unit started on aztreonam in addition to zosyn and vanc until , aztreonam discontinued with continued clinical improvement and recovery of wbc. transferred back out to the floor with continued clinical improvement, and weaning of o2, deescalated antibiotics to just zosyn for 3-5course. prior to d/c ambulatory sat was 94% ra. continued pcp with atovaquone and posaconazole. . # sinusitis: with mssa and pseudomonas sinusitis. symptoms improved dramatically on zosyn. continued sinus care with ns irrigations tid. . # hyperbilirubinemia: with elevated bilirubin, with both direct and indirect components. no lab evidence of hemolysis. medications reviewed without new inciting . gvhd flare a possibility. trended down without intervention. . # neutropenia: unclear etiology, possibilities include infection and resultant marrow supression versus medication effect. valgancyclovir has been discontinued with negative viral load. counts recovered with improvement of pneumonia. . # hypotension: hypotensive on to sbp 70s, requiring 4 l volume resucitation. started stress dose steroids given chronic steroids for gvhd x 1 day. resumed on maintenance dose of prednisone. remains normotensive. . # lymphoma: on maintenance rituxan therapy as outpatient. - continued prophylaxis with posaconazole, atorvaquone,acyclovir . # gvhd: has known gvhd of both skin and liver. continued home regimen of prednisone as above. also continued cyclosporine. medications on admission: - augmentin 875/125 (day # 8) - atovaquone 1500 mg daily - calcitriol 0.25 mcg daily - clobetasol 0.05% cream - clonidine 0.1 mg - docusate sodium 100mg - neoral 50 mg - folic acid 1 mg daily - lamivudine 100 mg daily - pantoprazole 40 mg daily - pentamidine inhaled monthly (last dose ) - posaconazole 200mg/5ml tid - prednisone 30 mg - valcyte 450 mg daily - monthly ivig - multivitamin 1 qd - vitamin e 400 units daily discharge medications: 1. cyclosporine modified 25 mg capsule sig: two (2) capsule po q12h (every 12 hours). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. lamivudine 100 mg tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 6. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 7. ursodiol 300 mg capsule sig: one (1) capsule po daily (daily). 8. vitamin e 400 unit capsule sig: one (1) capsule po daily (daily). 9. hexavitamin tablet sig: one (1) cap po daily (daily). 10. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). 11. clonidine 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 12. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: 4.5 gm intravenous q6h (every 6 hours): last dose on . disp:*qs * refills:*0* 13. heparin flush 10 unit/ml kit sig: ml intravenous as directed: to each lumen prn following normal saline flushes per protocol. disp:*90 flushes* refills:*2* 14. normal saline flush 0.9 % syringe sig: ml injection as directed: please flush each lumen before and after each infusion and prn. disp:*90 flsuhes* refills:*2* 15. line care please perform line care per protocol. please perform central line dressing changes weekly and prn. 16. glipizide 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 17. acyclovir 200 mg capsule sig: two (2) capsule po q8h (every 8 hours). disp:*180 capsule(s)* refills:*2* 18. posaconazole 200 mg/5 ml suspension sig: two hundred (200) mg po tid (3 times a day). 19. atovaquone 750 mg/5 ml suspension sig: 1500 (1500) mg po daily (daily). 20. petroleum jelly gel sig: one (1) application topical daily (). 21. clobetasol 0.05 % cream sig: one (1) appl topical (2 times a day). 22. combivent 18-103 mcg/actuation aerosol sig: 1-2 puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*1* 23. one touch basic system kit sig: one (1) kit miscellaneous three times a day: please use glucometer to check blood sugar tid. disp:*1 kit* refills:*2* 24. lancets misc sig: one (1) lancet miscellaneous three times a day: please provide patient w/ compatible lancets to be used w/ glucometer tid. disp:*90 lancets* refills:*2* 25. one touch test strip sig: one (1) strip in three times a day: please provide patient w/ compatible strips, to be used w/ glucometer tid. disp:*90 strips* refills:*2* 26. nifedipine 60 mg tablet sustained release sig: one (1) tablet sustained release po once a day. 27. potassium chloride 10 meq capsule, sustained release sig: two (2) capsule, sustained release po twice a day. 28. mag-oxide 400 mg tablet sig: one (1) tablet po twice a day. 29. saliva substitution combo no.2 solution sig: thirty (30) solution mucous membrane four times a day. discharge disposition: home with service facility: critical care systems discharge diagnosis: primary diagnosis: - pneumonia - acute sinusitis secondary diagnoses: - graft-versus-host disease - lymphoma discharge condition: o2 sat 95% on ra cmv () not detected discharge instructions: you were admitted with a severe pneumonia and sinusitis. you were monitored in the intensive care unit for a short time for your high oxygen requirement. you have been started on antibiotics for treatment of your pneumonia. you will continue taking the antibiotic (called zosyn) at home until . . while here, you were also found to have elevated blood glucose levels, concerning for diabetes. this may be due to your steroids or to your infection. you were seen by who recommended starting on a medication called glipizide to help control your blood sugar. you will need to monitor your fingersticks at home to make sure your blood glucose level does not get too low. you should begin to follow a low carbohydrate, diabetic diet to help control your fingersticks. if your fingersticks are less than 75 or if you feel hypoglycemic, you should call your doctor, dr. , and discuss whether or not you should continue taking your medication. . you have several new medications: * you should continue taking the iv antibiotic (zosyn) until * you have also been started on glipizide, a medication to treat diabetes, which you should take daily. * you should no longer take valgancyclovir. instead, you will take acyclovir 400mg po three times a day until further notice from and dr. . * you have been given an inhaler called combivent to use as needed until you are better from your pneumonia. * you should resume your nifedipine upon your return home. * all your other medications are unchanged. . please contact dr. , your primary care physician, go to the emergency room if you experience any fever >100.0, chills, worsening cough, difficulty breathing, chest pain, palpitations, difficulty keeping down food or drink, diarrhea, rash or any other concerning symptoms. followup instructions: please follow up with: (in dr. office) on friday, at 11:30am. please call their office if you have any questions or concerns about this appointment. . dr. at on at 4:430pm. please call their office at phone number if you have any questions about this appointment. procedure: venous catheterization, not elsewhere classified diagnoses: unspecified essential hypertension hypotension, unspecified pneumonia due to pseudomonas 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 neutropenia, unspecified jaundice, unspecified, not of newborn acute sinusitis, unspecified nodular lymphoma, unspecified site, extranodal and solid organ sites unspecified disease of respiratory system 

Answer: The patient is high likely exposed to