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: unasyn attending: chief complaint: neck swelling major surgical or invasive procedure: intubation/extubation incision and drainage of deep neck space infection surgical drain placement and removal history of present illness: 29f w/ hx of neutropenia p/w parapharyngeal abscess w/ associated extensive cellulitis now s/p neck exploration and drainage of parapharyngeal and carotid sheath abscesses on . on thursday, developed flu-like illness with nausea, vomiting, fatigue, myalgias and fevers. saturday, patient noting nicreasaed swelling of her neck and associated sore throat on sunday. presented to osh ed on and was given percocet and naproxen. began to have significant trouble swallowing and some subjective shortness of breath so re-presented to pcp . found to have positive rapid strep so was given pcn and ketorolac at that time. labs at that time showed wbc 2.0 with 40%n and 4% bands, h/h 12.1/34.3, plt 192. finally, pt re-presented to on day of admission w/worsening pain and inability to tolerate po. per husband, prior to this pt had been in usual state of health having recovered from an extended sinus infection with associated post-nasal drip requiring antibiotics in early . . in the ed, vitals were t98.3 bp 110/66 hr 126 rr 20 o2 98%ra 9/10 pain. pt was speaking in full sentences and able to maintain her airway without stridor but unable to move neck due to swelling. seen by ent in ed who noted pus at l tonsillar pillar, and tenderness and swelling of left anterior neck. labs notable for wbc 1.6 (77%n, 7% bands, 1% metamyelocytes and myelocytes), plt 173, h/h 10.3/30.4, na 131, cr 1.3. neck ct in ed revealed extensive edema of deep cervical spaces in the neck l>r with extension into superior mediastinum. pt received 3l ns, vanc, unasyn, clinda, and morphine. . patient was intubated and taken to or overnight for debridement and washout by ent who found murky fluid in rp space but no pus or necrosis. transferred to t/sicu post-op where patient was quickly weaned off levophed. continued on vanc/unasyn/clinda and id was consulted. thoracics also consulted to evaluate for possible chest/mediastinal extension of infection. past medical history: #neutropenia of unknown etiology - diagnosed 2 years ago, baseline wbc 1.8, had serial blood tests in for 8 weeks and as wbc stayed stable no treatment was initiated, had mri at the time but no bone marrow, has been told she has splenomegaly, no history of prior serious infections or hospitalizations aside from her pregnency though per husband she does take longer to recover from minor infections # disease - diagnosed 2 years ago #fe deficiency anemia - not currently on iron supplementation #hx of mononucleosis infection #warts on feet - on ranitidine, followed by dermatology #ovarian cystectomy social history: born in new but has lived in ma for six years. married with no children (had child with hypoplastic left heart syndrome who died at age of 2 days in ). works as jet blue flight attendant. non-smoker. drinks/month. no drugs. family history: father with syndrome, history of mono mother died of lupus in aunt with severe ms grandfather had cancer no history of immune disorders, clotting or bleeding disorders physical exam: admission exam: discharge exam: vitals - 98.9 106/67 87 16 97%ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, swelling over draiange site is significantly improved lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 09:00pm blood wbc-1.6* rbc-3.40* hgb-10.1* hct-30.4* mcv-90 mch-29.7 mchc-33.2 rdw-14.4 plt ct-173 09:00pm blood neuts-77* bands-7* lymphs-11* monos-2 eos-1 baso-0 atyps-0 metas-1* myelos-1* 09:00pm blood hypochr-occasional anisocy-normal poiklo-normal macrocy-occasional microcy-normal polychr-normal 09:10pm blood pt-15.8* ptt-35.0 inr(pt)-1.5* 09:00pm blood glucose-109* urean-28* creat-1.3* na-131* k-3.9 cl-96 hco3-23 angap-16 09:00pm blood alt-57* ast-28 alkphos-95 totbili-0.8 01:41am blood calcium-7.5* phos-2.4* mg-1.7 discharge labs: 05:43am blood wbc-3.2* rbc-2.97* hgb-8.5* hct-26.4* mcv-89 mch-28.7 mchc-32.3 rdw-15.2 plt ct-380 05:43am blood neuts-76.1* lymphs-20.7 monos-1.1* eos-1.5 baso-0.7 06:15am blood hypochr-occasional anisocy-normal poiklo-1+ macrocy-normal microcy-normal polychr-occasional tear dr 06:56am blood pt-12.5 ptt-23.7* inr(pt)-1.2* 05:43am blood glucose-105* urean-6 creat-0.5 na-136 k-3.9 cl-102 hco3-25 angap-13 05:43am blood alt-99* ast-40 alkphos-193* totbili-0.4 05:43am blood calcium-8.8 phos-4.4 mg-1.8 other labs: 02:12am blood gran ct-590* 05:49am blood gran ct-1144* 05:58am blood gran ct-1494* 05:27am blood gran ct-2422 05:27am blood ret aut-2.0 06:00pm blood ck-mb-1 ctropnt-<0.01 09:00pm blood albumin-3.0* 01:41am blood vitb12-513 ferritn-322* 01:41am blood triglyc-110 05:16am blood hbsag-negative hbsab-positive 06:15am blood hcg-<5 05:16am blood -negative 01:41am blood igg-1739* iga-82 igm-153 05:16am blood hcv ab-negative micro: 11:54 pm abscess site: neck deep neck abcess. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. smear reviewed; results confirmed. wound culture (final ): beta streptococcus group a. moderate growth. anaerobic culture (final ): propionibacterium acnes. sparse growth. fungal culture (final ): no fungus isolated. 11:57 pm swab carotid sheath left. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram positive cocci. in pairs and singly. wound culture (final ): beta streptococcus group a. moderate growth. anaerobic culture (final ): propionibacterium acnes. rare growth. fungal culture (final ): no fungus isolated. a swab is not the optimal specimen for recovery of mycobacteria or filamentous fungi. a negative result should be interpreted with caution. whenever possible tissue biopsy or aspirated fluid should be submitted. 5:16 am blood (cmv ab) chm s# h - added . **final report ** cmv igg antibody (final ): positive for cmv igg antibody by eia. 179 au/ml. reference range: negative < 4 au/ml, positive >= 6 au/ml. cmv igm antibody (final ): negative for cmv igm antibody by eia. interpretation: infection at undetermined time. a positive igg result generally indicates past exposure. infection with cmv once contracted remains latent and may reactivate when immunity is compromised. if current infection is suspected, submit follow-up serum in weeks. greatly elevated serum protein with igg levels > mg/dl may cause interference with cmv igm results. 5:16 am blood (ebv) chm s# h - added . **final report ** - virus vca-igg ab (final ): positive by eia. - virus ebna igg ab (final ): positive by eia. - virus vca-igm ab (final ): negative <1:10 by ifa. interpretation: results indicative of past ebv infection. in most populations, 90% of adults have been infected at sometime with ebv and will have measurable vca igg and ebna antibodies. antibodies to ebna develop 6-8 weeks after primary infection and remain present for life. presence of vca igm antibodies indicates recent primary infection. imaging: ct neck : 1. extensive inflammation and edema involving the superficial and deep cervical spaces of the neck, left greater than right. extension of inflammation into the superior mediastinum. the distal extent is not assessed in this study. findings are concerning for infectious fasciitis of the neck, possible necrotizing. 2. asymmetric thickening of the epiglottis, left aryepiglottic fold, and the false cords. 3. retropharyngeal hypodensity may represent retropharyngeal fluid; however, an abscess cannot be excluded. if further characterization is needed, an mri with contrast can be performed. cxr : there is a right lower lobe faint opacity, likely representing atelectasis. the cardiomediastinal silhouette and hila are normal. there is no pleural effusion and no pneumothorax. echo: borderline normal lv systolic function without regional wall motion abnormalities. preserved rv systolic function. ct chest: 1. mediastinal and lower neck fluid appears similar compared to prior study of 1 day earlier without evidence for new large fluid collection. 2. small bilateral pleural effusions and adjacent basilar atelectasis. ct neck: 1. two upper left neck drains end in the parapharyngeal space (medial to the carotid), lower neck drain ends between the left ij and common carotid at the level of the lower pole of the thyroid gland. 2. only minimal decrease of the retropharyngeal fluid. 3. unchanged edema of the epiglottis, left aryepiglottic fold and supraglottic soft tissues narrowing the airway. 4. unchanged edema in the left carotid space. stable edema of the left sternocleidomastoid and stranding of the surrounding fat. 5. no new fluid collections. ct neck: 1. overall, there has been little interval change in comparison to prior study with stable retropharyngeal fluid and stable edema of the epiglottis, left aryepiglottic fold, and supraglottic soft tissues, narrowing the airway. some of the venous tributaries are not well seen; there is narrowing of the left internal jugular vein, as before. 2. unchanged edema in the left carotid space. 3. two upper left neck drains are again visualized, with the first drain slightly retracted with the tip now located anterior to the carotid and adjacent to the hyoid bone that was posteromedial to the carotid previously and the lower neck drain remaining in stable position between the left internal jugular and common carotid. 4. new bilateral moderate pleural effusions. neck u/s: 1. no thrombus identified in a short segment of the very distal left jugular seen just above the left jugular subclavian junction. the remainder of the left jugular vein cannot be visualized due to the patient's open wound. 2. occlusive thrombus seen within the left cephalic vein in the region of the antecubital fossa. 3. the remainder of the deep veins of the left arm do not demonstrate any thrombus. mrv/mra neck: in comparison with the prior neck ct dated , , there are relatively stable diffuse fluid collections on the left side of the neck, with tissue enhancement in the left carotid space and posterior cervical and paraspinal spaces as described in detail above. there is evidence of soft tissue edema surrounding the fluid collections on the left side of the neck, causing mass effect on the mid cervical segment of the internal jugular vein and slow flow with a possible adherent non-occlusive thrombus. the common, internal, and external carotid arteries are patent. brief hospital course: summary prior to floor transfer per medicine team (no summary available from ticu): 29 yo f with pmh idiopathic neutropenia who presented with neck swelling and pain after sore throat and constitutional symptoms, found to have infection and fluid collections in deep neck spaces (retropharyngeal and carotid sheath spaces). she was intubated for airway protection and taken to or for debridement and drainage of dishwater-colored fluid which has grew gas on culture. pt had 3 drains placed and 1 drain removed prior to transfer from ticu. she had been on unasyn, vanc, and clinda consistently since admission for abx coverage at the time of transfer to floor. she also received 2 doses of ivig per id recs. extubated . pt febrile over weekend to 102s but decision was made to watch and wait. fever curve subsequently trended down and she was feeling better at transfer. her last big fever spike was to 102.1 at 0200 on . repeat imaging the evening showed significant improvement in fluid collections and ent thought pt could continue to be managed with drains and abx (no further or) unless clinical picture changed. there was some concern for mediastinitis due to rash on chest and edema seen on ct, but that improved by continuing antibiotics and did not recur. heme was consulted and placed pt on g-csf for neutropenia. her wbc count ranged 0.6 - 1.6 during ticu course. etiology of cytopenia was uncertain and heme felt this was an inappropriate time to work this up due to complicating factor of infection. pt had not had significant prior work up, but her mother did die of lupus. she admitted to rash on le "red spots" intermittently that she had difficulty characterizing, but no h/o other rashes, joint pains, oral ulcers, photosensitivity. hospital course 29 yo f with pmh idiopathic neutropenia who presenting with deep neck space infection s/p debridement and drainage. # neck space infection: culture growing gas. pt had sore throat prior to development of other symptoms and positive rapid strep at pcp office which is the likely source of infection. pt was s/p drainage by ent with clinical improvement on abx. 2 drains still in place when pt called out to floor and pt was on vanc/unasyn/clinda. drains were removed by ent and replaced with wicks. she continued to improve clinically on abx and s/p drain removal. one fever spike on to 101, after which she remained afebrile. u/a neg and blood cx neg at the time of spike. id suspected drug fever unasyn because her lfts bumped at the same time as well. also suspected immune reconstitution as anc had increased significantly that day. unasyn was stopped and lfts trended down. no further fevers. clinda stopped once 10 doses had been given once anc was > 1000 and pt was kept on vanc monotherapy. mri obtained to try to eval for jugular venous clot in setting of fever noted above but only showed sluggish flow and could not definitely rule it out. decision was made not to anticoagulate. pt had also had previous ct's of neck that did not show clot. pt will follow up in opat and get weekly labs. will also f/u with ent. # neutropenia: heme suspects this is whim syndrome, a gene mutation in cxcr4 that leads to sequestration of neutrophils in bone marrow. also characterized by warts, hypogammaglobulinemia, and recurrent infection. recommended outpatient work up. pt given gcsf until neutropenia resolved, then this was stopped. negative. will follow up with heme as outpatient # coagulopathy: thought to be nutritional deficiency due to neck space infection and recent illness. lfts unremarkable. improved to s/p vitamin k transitional issues: - follow up with clinic and cont iv abx per their recs - follow up with heme/onc re: neutropenia - follow up with ent medications on admission: ranitidine discharge medications: 1. picc line care per protocol 2. outpatient lab work weekly cbc with differential, bmp diagnosis: deep neck space infection, vancomycin therapy please fax results to in clinic: fax # 3. bismuth subsalicylate 262 mg/15 ml suspension sig: thirty (30) ml po qid (4 times a day) as needed for diarrhea. 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. hydromorphone 2 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*21 tablet(s)* refills:*0* 6. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. disp:*21 tablet(s)* refills:*0* 7. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 8. ertapenem 1 gram recon soln sig: one (1) grams intravenous once a day. disp:*30 doses* refills:*0* 9. colace 100 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*0* 10. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation. disp:*60 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: deep neck space infection idiopathic neutropenia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure to take care of you at ! you came to the hospital because you had swelling and pain in your neck. you were found to have an infectious fluid collection. you were intubated to protect your airway and the area of infection was debrided and drains placed to help remove the fluid. you were also started on antibiotics. you did well so you were extubated. the drains were removed and you should continue applying and changing the wicks twice a day as instructed by the ear nose and throat (ent) doctors. you will be continued on iv antibiotics (ertapenem) to treat any remaining infection. you should follow up with the clinic as instructed below. you will need to get weekly lab draws to monitor your blood counts and electrolytes while on ertapenem. prior to your discharge, it was noted that there may be a small clot in one of the veins in your neck. at this time, it is thought that the risks of blood thinner medications are greater than the benefit. however, if you were to experience new shortness of breath it is important that you return to the emergency department immediatly. your new medication list is attached. - start ertapenem 1g iv once every 24hrs, continue this medication until directed to stop by your infectious disease doctors - start bismuth 30ml by mouth 4x each day as needed for diarrhea - start a multivitamin daily - start hydromorphone 2-4mg every 4-6hrs as needed for pain - start compazine 1 tablet every 6hrs as needed for nausea - start tylenol 500mg eveyr 6hrs as needed for pain (use before hydromorphone) - start docusate 100mg by mouth twice each day while taking hydromorphone - start senna 1 tablet by mouth twice each day as needed for constipation - stop ranitidine followup instructions: follow up with the clinic in one week: dr. office phone: ( please follow in the infectious disease (opat) clinic with dr. on dr. wednesday, . this is on the ground floor of the building. the hematology department will contact you with a follow up appointment. if you have not heard from their department by wednesday, please call to set up an appointment with dr. . they would like to see you within 1-2 weeks. if you have a fever of 100 or greater, call clinic or come to the er immediately. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours incision of mediastinum open biopsy of soft tissue injection or infusion of immunoglobulin incision and drainage of tonsil and peritonsillar structures pharyngoscopy diagnoses: acute kidney failure, unspecified acquired coagulation factor deficiency other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure dehydration phlebitis and thrombophlebitis of superficial veins of upper extremities hepatitis, unspecified mediastinitis disorders of bilirubin excretion hypogammaglobulinemia, unspecified retropharyngeal abscess penicillins causing adverse effects in therapeutic use acute venous embolism and thrombosis of internal jugular veins cellulitis and abscess of neck streptococcal sore throat other dysphagia streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group a cellulitis of pharynx or nasopharynx cellulitis and abscess of oral soft tissues peritonsillar abscess other pancytopenia other specified viral warts other neutropenia dysphonia 

Answer: The patient is high likely exposed to