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: vancomycin attending: chief complaint: i am here for chemotherapy major surgical or invasive procedure: none history of present illness: 67m with no significant past medical history who noted enlarged groin lymph nodes several weeks ago. one of these was excised and while the pathology was pending he became quite ill. he vomited 5 days ago and was noted to be jaundiced by his wife. was then admitted to for liver and renal failure. the pathology on his inguinal node is diffuse large b-cell lymphoma. he was transferred here for further evaluation and treatment. his most recent bilirubin is 21, cr 2.6, ldh 2500. past medical history: hypertension social history: married and lives with his wife, worked at air base, now retired. stopped smoking in , occasional etoh. family history: mother with hx unknown cancer, father with heart disease. physical exam: vitals: t:99.5 bp:126/60 p:101 r:38 o2: 95% 2l general: alert, oriented, no acute distress, jaundiced heent: sclera icteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs 07:24pm glucose-129* urea n-55* creat-2.4* sodium-127* potassium-4.0 chloride-96 total co2-16* anion gap-19 07:24pm estgfr-using this 07:24pm alt(sgpt)-85* ast(sgot)-264* ld(ldh)-2448* alk phos-820* tot bili-23.7* dir bili-18.9* indir bil-4.8 07:24pm albumin-2.2* calcium-7.9* phosphate-3.5 magnesium-2.9* uric acid-4.3 07:24pm pt-19.4* ptt-33.2 inr(pt)-1.8* 07:24pm fibrinoge-532* 07:14pm wbc-11.5* rbc-3.43* hgb-10.5* hct-31.4* mcv-92 mch-30.5 mchc-33.4 rdw-18.2* 07:14pm neuts-80* bands-0 lymphs-13* monos-7 eos-0 basos-0 atyps-0 metas-0 myelos-0 nuc rbcs-3* 07:14pm hypochrom-1+ anisocyt-2+ poikilocy-1+ macrocyt-1+ microcyt-1+ polychrom-occasional spherocyt-occasional target-occasional schistocy-occasional 07:14pm plt smr-low plt count-144* 07:12pm type-art po2-96 pco2-26* ph-7.42 total co2-17* base xs--5 07:12pm lactate-4.8* k+-4.0 07:12pm freeca-1.01* . discharge labs . 12:00am blood wbc-8.5 rbc-2.51* hgb-8.3* hct-24.2* mcv-97 mch-33.0* mchc-34.1 rdw-24.1* plt ct-138* 12:00am blood neuts-96.3* lymphs-1.4* monos-1.7* eos-0.6 baso-0.1 12:00am blood pt-12.2 ptt-19.8* inr(pt)-1.0 12:22am blood fibrino-423* 12:00am blood gran ct-3698 12:00am blood glucose-309* urean-33* creat-0.8 na-135 k-4.0 cl-100 hco3-24 angap-15 12:00am blood alt-64* ast-30 alkphos-213* totbili-2.7* 12:00am blood calcium-8.0* phos-3.4 mg-1.9 12:30am blood hbsag-negative hbsab-negative hav ab-negative 03:27pm blood smooth-negative 03:27pm blood -negative 12:05am blood hiv ab-negative 12:30am blood hcv ab-negative 12:00am blood anti-platelet antibody-test . cxr right internal jugular line tip is at the level of cavoatrial junction. the heart size is normal. mediastinum is normal. there is slight interval decrease in the right pleural effusion as compared to . there are no new focal consolidations worrisome for infectious process. there is no evidence of failure. if clinically warranted, further evaluation with cross-sectional imaging toexclude the possibility of occult infection. . ecg sinus tachycardia, rate 131. moderate baseline artifact. consider left atrial abnormality. late transition. no previous tracing available for comparison. . echo the left atrium and right atrium are normal in cavity size. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. left ventricular systolic function is hyperdynamic (ef>75%). there is a mild resting left ventricular outflow tract obstruction. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: small lv cavity size with moderate symmetric lvh and hyperdynamic lv systolic function. consequently, there is an intra-cavitary gradient which likely occurs at the mid-ventricular level.. mildly thickened mitral and aortic valves without significant stenosis or regurgitation. . ct torso contrast impression: 1. moderate right pleural effusion, and small left pleural effusion, and bibasilar atelectasis, worse on the right. 2. bilateral prominent axillary lymph nodes, and prominent hilar and mediastinal lymph nodes. 3. multiple liver hypodensity, suboptimally characterized due to size and single-phase contrast. 4. splenic hypodensities concerning for splenic lymphoma involvement, or splenic infarct. 5. large lymph nodes in periportal area. 6. multiple prominent lymph nodes in mesentery and retroperitoneum and along pancreas and splenic hilum. 7. bilateral prominent lymph nodes in inguinal and groin area. 8. small amount of ascites. 9. right groin fluid collection, could be evolving hematoma, seroma, or lypmhocele. correlate if history of recent biopsy/intervention in area. . abdomen u/s 1. diffusely increased hepatic echogenicity with multiple hypoechoic masses scattered throughout the liver. this appearance is highly suspicious for malignancy. further characterization of these findings with mr imaging is recommended. 2. multiple enlarged periportal lymph nodes as described. 3. mild splenomegaly. please note that a large left abdominal mass mentioned in the history was not identified with ultrasound and further evaluation could be obtained with ct if clinically indicated. 4. gallstones along with gallbladder sludge. no intra- or extra-hepatic biliary duct dilation. 5. small right pleural effusion. . cxr the right central venous line tip was repositioned and is currently at the low svc. there is slight interval increase in bilateral pleural effusions in the interim. mild vascular engorgement cannot be excluded. mediastinal widening in particular along the right paratracheal area at the level of the azygos vein as well as at the aortopulmonic window is unchanged and most likely consistent with diagnosis of b-cell lymphoma. brief hospital course: # diffuse b-cell lymphoma: mr was admitted with newly diagnosed diffuse large b-cell non-hodgkin's lymphoma. he received dexamethasone and mechlorethamine while in the icu on . his dexamethasone was changed to daily solumedrol upon return to the floor . a ct of his torso to evaluate the burden of his disease revelaed extensive para-aortic and hilar lymphadenopathy and intrahepatic involvement. rituxan was initiated on to decrease his tumor burden and was repeated on . tumor lysis labs were followed and mr. was continued on allopurinol therapy. the initiation of standard therapy could not be initiated until his liver function improved. his ast and alt eventually normalized, however his total bilirubin took longer to normalize. the goal to initiate therapy was a total bilirubin of 2, so as to not compromise standard therapy of r-chop through significant re-dosing. on , it appeared that mr. total bilirubin had plateaued at 3. mechlorethamine was administered, 10mg twice over two days. mr. tolerated the therapy well, he was treated with 5 days of high dose steroids after chemotherapy and experienced a slight increase in lfts likely as a result of the therapy. as mr. was clinically stable, it was decided to discharge him to home with regular follow-up for evaluation for future care. . # acute kidney injury: mr. was likely prerenal. he was transferred to the icu briefly after admission secondary to tachypnea likely from metabolic acidosis. his resolved with iv fluids and he was transferred back to the floor. . # hepatic failure: he was noted to have elevated liver enzymes with ldh of 2400 and t. bili of 24.0 on admission. his liver function tests continued to rise throughout his admission, maximally elevated at alt 128 and ast 264 with peak ldh 2448, maximal alkphos of 833 and total bilirubin of 26.3. his cholestatic liver disease began to improve on hd 6. rituxan was initiated on and . mr. encephalopathy improved throughout his hospital stay. he was clinically at baseline at the time of discharge. . # urinary tract infection: mr. began to develop symptoms of dysuria on hd 5. a urine culture grew coagulase negative staph aureas and mr. was started on po ciprofloxacin. mr. foley catheter was not removed or replaced at this time, because of significant edema, ongoing chemotherapy and the need to follow urine out-put during chemotherapy. on day 2, ciprofloxacin was changed to iv given mr. bowel edema to ensure adequate therapy. . # edema: mr. was admitted to the hospital with significant edema that initially worsened throughout his stay. evidence of bowel edema and mild ascities on ct. he responded well to iv lasix. his edema was significantly improved at the time of discharge. . # right inguinal node biopsy site: mr. developed poor wound healing at the site of his lymph node biopsy at an osh. the bx site was deep between skin folds. evidence of a hematoma or seroma was visualized on ct. general surgery was consulted to examine the wound, antibiotic therapy was deferred and wet to dry dressing was applied three times a day. wound culture grew mrsa, he was treated for several days with iv daptomycin, as mr. reportedly has a vancomycin allergy, which was discontinued as the culture appeared more consistent with a contaminant. a wound vacuum was applied for almost a week to help with wound healing. the vacuum was discontinued prior to discharge. mr. was discharged to home with nursing assistance to continue dressing changes. medications on admission: zofran 4 mg iv q 4 prn dilaudid 1 mg iv q 4 prn reglan 5 mg tid lovenox 30 mg q day protonix 40 mg q 12 iv levaquin 500 discharge medications: 1. allopurinol 300 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for groin skin changes. disp:*1 bottle* refills:*0* 4. acyclovir 400 mg tablet sig: one (1) tablet po q8h (every 8 hours). disp:*120 tablet(s)* refills:*2* 5. prednisone 5 mg tablets, dose pack sig: 4-1 tablets, dose packs po once a day for 3 days: take 4 pills on day 1 (), take 2 pills on day 2 () and take 1 pill on day 3 (). disp:*7 tablets, dose pack(s)* refills:*0* 6. outpatient physical therapy 67 year old gentleman with new diagnosis large b cell lymphoma with de-conditioning after a long hospital stay. 7. neupogen 480 mcg/1.6 ml solution sig: one (1) injection once a day for 10 days. disp:*10 syringes* refills:*0* discharge disposition: home with service facility: centrus home care discharge diagnosis: 1. large b cell lymphoma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted for initiation of treatment of large b cell lymphoma. your liver function was affected by the lymphoma preventing standard treatment, which requires normal liver function. you were given special chemotherapy treatments (mechlorethamine and rituxan) to help restore your liver function in hopes of initiating standard treatment. your treatment course was complicated by kidney failure, that required several days in the intensive care unit. your kidney is now functioning normally. your oncologist is dr. , who is the physician who admitted you. you will follow up in clinic on friday to check your blood counts and receive a third dose of rituxan. you have been started on a new medication, neupogen, on the day of your discharge to help with your counts. you also developed a wound at the site of your lymph node biopsy. our general surgeons were consulted. they treated the wound with a vacuum and eventually wet-to-dry dressing. a home nursing aid will change your dressing daily. you were started on several medications during your hospital stay, that people with lymphoma often take during treatment. please continue taking the allopurinol, ursodiol and acyclovir as directed. your blood sugars have been high for the last several days because of the high dose steroids you received over the weekend with the chemotherapy. we expect your blood sugars to return to normal on their own. your home nursing aid will check your blood sugars for you. we are also sending you home on a steroid taper to ease yourself off prednisone. followup instructions: 1. date/time: 9:00provider: bed 5-hem onc 7f hematology/oncology-7f 2. date/time: 3:00provider: , rnc phone: 3. (primary oncology) date/time: 3:00 provider: , md phone: procedure: venous catheterization, not elsewhere classified control of hemorrhage, not otherwise specified other incision with drainage of skin and subcutaneous tissue injection or infusion of cancer chemotherapeutic substance diagnoses: acidosis thrombocytopenia, unspecified hypocalcemia anemia, unspecified urinary tract infection, site not specified unspecified essential hypertension acute and subacute necrosis of liver acute kidney failure, unspecified gout, unspecified personal history of tobacco use candidiasis of mouth acute respiratory failure other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation fever, unspecified other ascites diarrhea seroma complicating a procedure obstruction of bile duct other and unspecified coagulation defects other diseases of spleen other malignant lymphomas, lymph nodes of multiple sites 

Answer: The patient is high likely exposed to