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: keflex / cefepime attending: chief complaint: urosepsis, major surgical or invasive procedure: none history of present illness: 85m with h/o cll and many recent admissions to , recently for pneumonias (aspergillus and citrobacter) and recurrent utis (pseudomonas, vre, e.coli), presenting from rehab facility with urinary retention, lethargy, and fever. foley came out 2 days ago, and the rehab was unable to replace it. today, by report, bladder scan showed 700cc. additionally, patient noted to be febrile to 101.8, tachycardic in 110s-120s, and systolics 90s-100s. on most recent discharge on , his uti was initially treated with linezolid and zosyn. his urine culture grew pseudomonas which was pan-sensative. he was discharged on fosfomycin 3g q48hrs for a total of 14 days (appears to have ended on ). following this course, he was instructed to resume taking fosfomycin every 10 days, for prophylaxis. in ed, vs initially were: 99.6 112 110/61 15 99% 2l nc. on exam, patient was noted to be lethargic, but oriented to place, person, and time. complains of mild abdominal pain and overall feeling "bad." labs significant for wbc 32.6 (85%l), hct 29 (baseline), plt 129 (baseline), na 148 (baseline 140), cl 109, cr 1.5 (baseline 1.0), glucose 61, lactate 2.2, ua grossly positive (large leuks, >182wbc, large blood, positive nitrites, epis 0). cxr showed left basal opacity consistent with effusion with probably worsening infiltrate. urine and blood cultures sent. he was given vancomycin and just started getting 1l ns. ed was planning on giving levofloxacin iv given his cefepime allergy, however they did not place a second iv, and so could only run 1 thing in at a time. vs prior to transfer: 97.5 108 96/55 29 100%2l. in the micu, patient is tachypneic and fatigued, but otherwise comfortable. wife is at the bedside and states he has declined significantly from yesterday. past medical history: oncologic history: : diagnosed with cll : 6 cycles of fludarabine : 4 cycles of rituxan/fludarabine : 4 cycles of r-cvp : 4 cycles of r-chop : 1 cycle cytoxan/rituxan : 1 cycle of r-chop : 1st cycle of fcr : 2nd cycle of fcr : enrolled in protocol 08-052 a phase i open label multiple-dose, dose-escalation study of mdx-1342 in patients with cd19 positive refractory/relapsed chronic lymphocytic leukemia. received 4 doses, last dose : fludarabine/cytoxan : fludarabine/cytoxan/ rituxan : cycle 1 bendamustine : cycle 2 bendamustine/rituxan : cycle 3 bendamustine (80 mg/m2 days 1&2) : cycle 4 bendamustine (80 mg/m2 days 1&2) : cycle 5 bendamustine (80 mg/m2 days 1&2) and rituxan. : cycle 6 bendamustine (80 mg/m2 days 1&2) and rituxan to alemtuzumab 30mg 3x/week for 6 weeks. -not receiving any current therapy-on supportive care and focusing on qol other past medical history: - cll (see above) - bladder stones-->cystoscopic removal-->e coli sepsis - hypertension - afib - bronchiectasis and asthma, followed for both by dr . - hearing loss - macular degeneration - bph - ascites - le edema - cmv adrenalitis - h/o citrobacter pneumonia - cmv adrenalitis with adrenal insufficiency - aspergillosis pneumonia on chronic voriconazole - admission from from to for kyperkalemia to 7.7, secondary to urinary obstruction requiring foley placement, and anemia secondary to cll which required 2 units of prbcs - pseudomonas aeruginosa uti social history: he had been living with his wife and dog and continued to work as a patent lawyer until recently. he has been at rehab for the last few weeks. he denies tobacco use, alcohol use, or drug use. he is a founding partner of a large patent law firm, the largest in that deals with biomedical and technological patents. he has two sons. family history: his mother died of colon cancer at years. father died at 62 of a stroke (in context of hypertension). physical exam: admission exam: vitals: t: 99.0, bp: 117/58, p: 112, r: 31, o2: 99% 3l nc general: alert, oriented, tachypneic, lethargic, cachectic heent: sclera anicteric, dry mm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: tachycardic, irreg irreg, normal s1 + s2, no murmurs, rubs, gallops lungs: tachypneic, exp wheezes posteriorly, rales at bases posteriorly, rhonchi anteriorly abdomen: soft, non-tender, distended with fluid wave, bowel sounds present, no rebound gu: foley with minimal dark urine ext: cool feet, 1+ pulses, no clubbing, cyanosis. minimal pedal edema. blanching erythema of abdomen along belt line access: rue picc line, nonerythematous pertinent results: admission labs: 05:30pm blood wbc-32.6*# rbc-3.12* hgb-9.8* hct-29.3* mcv-94 mch-31.4 mchc-33.5 rdw-16.7* plt ct-128* 05:30pm blood neuts-2* bands-0 lymphs-85* monos-3 eos-0 baso-0 atyps-10* metas-0 myelos-0 05:30pm blood hypochr-2+ anisocy-1+ poiklo-1+ macrocy-1+ microcy-1+ polychr-occasional ovalocy-1+ tear dr acantho-occasional 03:59am blood pt-25.4* ptt-43.5* inr(pt)-2.3* 05:30pm blood glucose-61* urean-34* creat-1.5* na-148* k-4.7 cl-109* hco3-28 angap-16 05:30pm blood calcium-8.4 phos-2.7 mg-1.9 05:45pm blood lactate-2.2* 05:40pm urine color-red appear-cloudy sp -1.020 05:40pm urine blood-lg nitrite-pos protein->300 glucose-neg ketone-15 bilirub-mod urobiln-1 ph-5.0 leuks-lg 05:40pm urine rbc->182* wbc->182* bacteri-few yeast-none epi-0 03:59am urine hours-random urean-309 creat-48 na-19 k-greater th cl-66 calcium-0.3 03:59am urine osmolal-333 micro: urine culture: blood cultures: imaging: cxr: limited exam with left basal opacity, increased from prior, concerning for effusion with probable consolidation which may represent worsening pneumonia. brief hospital course: 85m with h/o cll and many recent admissions to , recently for pneumonias (aspergillus and citrobacter) and recurrent utis (pseudomonas, vre, e.coli), presenting from rehab facility with lethargy and fever, found to have pseudomonas bacteremia. # sepsis/pseudomonas bacteremia: patient has grown vre and pseudomonas (pansensitive) in his urine the last couple of months. on admission, ua was grossly positive however urine culture returned with no growth. patient was admitted to the icu for hypotension, responsive to ivfs. initially patient was covered with linezolid, ciprofloxacin and meropenem (double coverage), given his urine culture history. he was also initially administered stress dose steroids (hydrocortisone 100mg q8h) given hypotension. a blood culture from admission grew pseudomonas, sensitive to ceftazidime and ciprofloxacin (not or cefepime), and so antibiotics were switched to ceftazidime. linezolid was discontinued given thrombocytopenia. daily blood cultures from the picc were obtained and remained negative. given unclear source, lfts checked and as were wnl, this was not suggestive of hepatobiliary course. picc remained in place given poor access and gnr bacteremia (not gpcs). per the family discussion regarding goals of care (see below), patient was continued on antibiotics for a two-week course of ceftazidime to end on . # : patient was initially transferred for urinary retention, however with placement of foley only minimal fluid was drained. urine lytes initially suggested kidneys were able to concentrate urine, however ivf resuscitation did not improve urine output. patient became oliguric, not responsive to lasix. urine was spun and muddy brown casts were seen, suggestive of atn. atn was believed to be due to hypotension from sepsis. urine eos were negative. creatinine continued to worsen through admission. # afib: this admission he was started on amiodarone for persistent atrial fibrillation with rapid ventricular response and often accompanied by low blood pressures. he intermittently required a diltiazem drip for rate control despite this medication. at the time of transfer from the icu, he was in atrial fibrillation with blood pressures in the 80s but per discussion with the family (see below) no further medications were administered as this was not in keeping with his goals of care. # cll: diagnosed in s/p multiple treatments most recently initiation of campath, discontinued . treatment is now focused on quality of life and per wife, she understands patient's prognosis is poor so goals of care are to continue current treatment but not to escalate care any further. he was continued on his home regimen of bactrim, voriconazole and valganciclovir for prophlaxis. # goals of care: patient was having waxing and levels of alertness during his last few days in the icu and expressed some desire to be left alone so discussion was initiated with the family regarding goals of care. wife described the lengthy battle he has fought with his underlying cll and understood that his prognosis at this time was quite poor. she agreed that minimizing unnecessary interventions, such as lines and lab draws, new medications, or icu transfers would not be in keeping with his wishes. he was transferred to the floor as dnr/dni, no escalation of care. palliative care was consulted, and the decision was made to transition to inpatient hospice. iv antibiotics were continued per the family's wishes, but oral medications were discontinued as his mental status declined, and focus was on comfort and symptom management. he died in his sleep on . medications on admission: 1. albuterol 0.083% neb soln 1 neb ih qid 2. albuterol inhaler 2 puff ih q4h:prn sob 3. aluminum-magnesium hydrox.-simethicone 30 ml po q4h 4. aspirin 325 mg po daily 5. diphenoxylate-atropine 1 tab po bid:prn diarrhea 6. docusate sodium 100 mg po bid:prn constipation 7. furosemide 80 mg po bid 8. ipratropium bromide neb 1 neb ih qid 9. metoprolol tartrate 12.5 mg po bid 10. sulfameth/trimethoprim ss 1 tab po daily 11. valganciclovir 450 mg po q24h 12. vitamin d 1000 unit po daily 13. voriconazole 200 mg po q12h 14. loperamide 2 mg po bid 15. potassium chloride 40 meq po tid duration: 24 hours 16. pulmicort *nf* (budesonide) 0.5 mg/2 ml inhalation 17. fludrocortisone acetate 0.1 mg po daily 18. hydrocortisone 20 mg po qpm 19. hydrocortisone 50 mg po daily 20. morphine sulfate (concentrated oral soln) 4 mg po q6h:prn pain please hold for rr<12 or sedation 21. fosfomycin tromethamine 3 g po every 10 days discharge disposition: expired discharge diagnosis: chronic lymphocytic leukemia sepsis discharge condition: deceased procedure: injection or infusion of oxazolidinone class of antibiotics diagnoses: thrombocytopenia, unspecified anemia, unspecified acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified unspecified essential hypertension severe sepsis atrial fibrillation asthma, unspecified type, unspecified hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) acute respiratory failure pneumonia due to pseudomonas septic shock macular degeneration (senile), unspecified retention of urine, unspecified unspecified accident other ascites encounter for palliative care do not resuscitate status gross hematuria injury to bladder and urethra, without mention of open wound into cavity glucocorticoid deficiency chronic lymphoid leukemia, without mention of having achieved remission neutropenia, unspecified septicemia due to pseudomonas edema of male genital organs 

Answer: The patient is high likely exposed to