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: patient recorded as having no known allergies to drugs attending: chief complaint: cough and dyspnea on exertion major surgical or invasive procedure: cardiac catheterization, pericardiocentesis, pleurocentesis and hickman line placement. history of present illness: 24m w/o significant pmhx w/ 4-5d of productive cough, doe and l axillary mass. also reported tender left axillary mass and associated discomfort which he noticed 2 days pta. for the past week, he has had prod cough w/ thick yellow sputum and sore throat. he denies f/c. after a few days of coughing, developed pain with coughing and deep inspiration. doe when walking up 3 flights of stairs. at baseline, no physical limitations. has had intermittent, mild l arm pain for the past couple of days. ros: denies fevers, chills, fatigue, weight loss, decreased appetite. he denies nausea, vomiting, abdominal pain, diarrhea, constipation, dysuria, urinary symptoms. ed: pericardial tamponade by echo (ra diastolic collapse and rv compression) with pulsus paradoxus of 18-20 and tachycardia. had successful pericardiocentesis (removal of 600cc of straw colored fluid) and drain placement. past medical history: mva () with lumbar myofascial inflammation social history: . lives with mom and sister. at stop and shop warehouse as a selector. previous marijuana use. drinks 3-4 beers/week. no cigarettes. no other illegal drug use. family history: cousin had leukemia. mother and sister have seizure disorders. father had prostate cancer and mi (age 57). grandmother had breast cancer. physical exam: r99 hr110 bp125/47 rr30 os96%ra gen: mild resp distress. heent: mmm. clear op. neck: multiple enlarged anterior cervical lymph nodes. cv: tachycardic. nl 21/s2. ii/vi sem at lsb. resp: no breath sounds on left. right basilar crackles. abd: s/nt/nd. pos bs. groin: no lad or bruits. ext: no cce. dp 2+ b/l. neuro: a&ox3. cnii-xii grossly intact. strength v/v and sensation to lt intact throughout. pertinent results: bone marrow flow cytometry (): peripheral smear: smear quality is acceptable. red cells show minimal anisocytosis and rare nucleated red blood cells. wbc count is increased. differential shows 10% segmented neutrophils, 1% metamyelocyte, 1% myelocyte, 2% monocytes, 7% lymphocytes, 1% eosinophils, and 78% blasts. occasional blasts have cytoplasmic granules. platelet count appears normal; occasional large forms are present. aspirate smears: the aspirate material is adequate for evaluation. it consists predominantly of variably-sized blasts with scant cytoplasm, irregular convoluted nuclei with fine chromatin and multiple nucleoli. in the residual hematopoietic cells, m:e ratio is 0.7:1. myeloid cells appear decreased. erythroid maturation is normoblastic. granulocyte maturation is normal. megakaryocytes are decreased in number; many immature hypolobated forms are present. differential shows: blasts 90%, promyelocytes <1%, myelocytes <1%, metamyelocytes 1%, bands/neutrophils 2%, plasma cells 1%, lymphocytes <1%, erythroid 6%. addendum: immunostains reveal the blasts are positive for tdt, and negative for cd1a. scattered cells show membranous staining for cd3.flow results: three color gating is performed (light scatter vs. cd45) to optimize blast yield. cell marker analysis demonstrates that the majority of the cells isolated from this peripheral blood express lymphoid-associated antigens cd5, 7, 8 (dim) and 71. they lack cd2, 3, 4, 10 (calla), 11c, 13, 14, 15, 19, 20, 33, 34, 41, 56, 64, 117, hla-dr, glycophorin a, kappa and lambda. blast cells comprise ~50% of total analyzed events. interpretation: immunophenotypic findings consistent with involvement by acute lymphoblastic leukemia, t-cell type. cxr (): chest, pa & lateral: there are no prior films for comparison. there is a large left pleural effusion. minimal aeration is present at the left apex. there is right upper lobe and right lower lobe atelectasis. the heart appears mildly enlarged. the right lung is clear. the osseous structures are unremarkable. impression: 1) large left pleural effusion. 2) enlarged cardiac silhouette. this may be due to cardiomegaly vs. pericardial effusion. ct chest (): impression: 1) anterior mediastinal mass extending along the paracardium and to the left lung pleura with superior mediastinal, supraclavicular, with left axillary lymphadenopathy and with large pericardial and pleural effusions. potential etiologies include lymphom and germcell tumor. a primary thymic tumor is possible but considered less likely given the lymphadenopathy and the patient's age. 2) hepatomegaly and a small amount of pericholecystic fluid. this is a non-specific finding. echo/tte (): lvef>55%. the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal and systolic function is normal. the right ventricular cavity is small/compressed. right ventricular systolic function is normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is a large pericardial effusion. there is sustained right atrial collapse, consistent with low filling pressures or tamponade. there is right ventricular compression. these findings are consistent with tamponade. clinical correlation recommended. card cath/pericardiocentesis (): final diagnosis: 1. severe pericardial tamponade. 2. removal of 600 cc of pericardial fluid. comments: 1. resting hemodynamics deomonstrated elevated right and left sided pressures with blunted y descent and elevation of pericardial pressures with equalization of ra and pericardial pressures (18 mmhg) consistent with tamponade. upon removal of pericardial fluid, ra pressure decreased 8 mmhg, and pericardial pressure decreased to 0 mmhg. the cardiac index improved from 1.9 l/min/m2 to 3.1 l/min/m2 with removal of pericardial fluid. 2. pericardiocentesis was performed in one pass with withdrawl of approximately 600 cc of straw colored fluid. echo/tte (): 1. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. 2. there is a small pericardial effusion with fibrin deposits on the surface of the heart. there are no echocardiographic signs of tamponade. 3. compared with the findings of the prior report (tape unavailable for review) of , the pericardial effusion is almost gone. cxr (): pa & lateral views chest: the left hilar mass is unchanged. there is interval slight improvement in the left pleural effusion and left lower lobe opacity. no evidence of pneumothorax. impression: interval improvement in left pleural effusion and left lower lobe opacity. 02:50am ipt-done 02:50am pt-14.3* ptt-23.9 inr(pt)-1.3 02:50am plt smr-normal plt count-157 02:50am hypochrom-1+ anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-1+ 02:50am neuts-19* bands-0 lymphs-7* monos-2 eos-1 basos-1 atyps-3* metas-0 myelos-0 blasts-66* plasma-1* 02:50am wbc-38.4*# rbc-5.22 hgb-15.5 hct-44.2 mcv-85 mch-29.6 mchc-35.0 rdw-13.5 02:50am albumin-4.3 calcium-9.8 phosphate-3.7 magnesium-2.0 uric acid-6.0 02:50am lipase-29 02:50am alt(sgpt)-55* ast(sgot)-35 ld(ldh)-313* alk phos-105 amylase-42 tot bili-0.8 02:50am glucose-102 urea n-11 creat-0.9 sodium-143 potassium-4.2 chloride-106 total co2-25 anion gap-16 09:15am fibrinoge-266 09:15am fdp-0-10 09:15am pt-14.4* ptt-24.4 inr(pt)-1.3 09:15am plt smr-normal plt count-153 09:15am hypochrom-normal anisocyt-1+ poikilocy-normal macrocyt-occasional microcyt-2+ polychrom-1+ 09:15am neuts-12* bands-0 lymphs-8* monos-2 eos-0 basos-0 atyps-0 metas-0 myelos-0 blasts-78* 09:15am wbc-38.1* rbc-5.07 hgb-15.1 hct-42.9 mcv-85 mch-29.7 mchc-35.2* rdw-13.8 09:15am haptoglob-65 09:15am calcium-9.4 magnesium-1.9 09:15am ld(ldh)-244 09:15am glucose-107* urea n-11 creat-0.9 sodium-142 potassium-3.8 chloride-106 total co2-25 anion gap-15 11:48am bone marrow ipt-done 02:15pm other body fluid wbc-* rbc-4950* polys-0 lymphs-18* monos-0 other-82* 02:15pm other body fluid tot prot-5.4 glucose-47 ld(ldh)-349 amylase-23 albumin-3.5 06:16pm fibrinoge-250 06:16pm pt-14.7* ptt-23.6 inr(pt)-1.4 06:16pm plt count-172 06:16pm wbc-53.1* rbc-4.90 hgb-14.2 hct-41.8 mcv-85 mch-28.9 mchc-33.9 rdw-13.5 06:16pm tot prot-6.1* calcium-9.0 phosphate-2.9 magnesium-1.8 uric acid-5.3 06:16pm glucose-123* urea n-10 creat-0.9 sodium-141 potassium-3.8 chloride-107 total co2-25 anion gap-13 10:44pm fibrinoge-291 10:44pm pt-15.0* ptt-24.0 inr(pt)-1.4 10:44pm plt count-155 10:44pm wbc-22.2*# rbc-5.18 hgb-15.0 hct-44.5 mcv-86 mch-29.0 mchc-33.8 rdw-13.7 10:44pm hiv ab-negative 10:44pm calcium-9.3 phosphate-3.0 magnesium-1.8 uric acid-5.4 10:44pm glucose-180* urea n-10 creat-1.1 sodium-139 potassium-3.8 chloride-101 total co2-29 anion gap-13 brief hospital course: mr was admitted to with shortness of breath and pleuritic chest pain which were caused by pleural and pericardial effusions secondary to mediastinal t-cell acute lymphocytic leukemia. 1. t-cell all: the patient had no significant medical history on admission. he presented with shortness of breath and pleuritic chest pain secondary to large pleural and pericardial effusions. upon therapeutic drainage, the pericardial effusion was deemed malignant by cytology (the pleural effusion was not). admission labs revealed a wbc of 38 with 60% blasts. chest ct imaging revealed a left-sided mediastinal mass adjacent to the pericardium, as well as supraclavicular and left axillary lymphadenopathy. a bone marrow biopsy confirmed t-cell acute lymphocytic leukemia. the patient underwent the hyper-cvad chemotherapeutic regimen. soon after hyper-cvad initiation, his cells lines fell. he was continued g-csf and his anc recovered to >700 on discharge. he had reached a nadir of <100. he was also given one dose of intrathecal mtx and one dose of intrathecal ara-c. there was no cytologic evidence of malignancy in his cerebrospinal fluid. he was maintained on levofloxacin, fluconazole, acyclovir and allopurinol for prophylaxis and had no fevers throughout his course. he was discharged with oncologic follow-up and a future allogenic bone marrow transplant was planned. 3. malignant pericardial effusion: again, the patient had symptomatic tamponade on admission. he underwent successful pericardiocentesis and drain placement, which was later removed. thereafter, he remained asymptomatic and stable. follo-up echocardiograms were essentially unremarkable. a repeat echo in two to three months was recommended. 4. left pleural effusion: again, he had a large left pleural effusion on admision, causing partial colapse of the left lung. this had essentially resolved after thoracentesis. he had no respiratory distress and was without an oxygen requirement throughout the remainder of his course. medications on admission: none discharge medications: 1. fluconazole 200 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 2. levofloxacin 500 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 3. acyclovir 400 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*0* 4. line check vna: please attend to picc according to protocol. discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: t-cell acute lymphoblastic leukemia. secondary diagnosis: malignant peridcardial effusion, non-malignant pleural effusion. discharge condition: good/stable. discharge instructions: 1) return to the er, call the on-call oncologist at ( main number: ), or your primary doctor, if you have any shortness of breath, chest pain, cough, bruising, bleeding, sore throat or any other concerning symptoms. 2) please avoid contact with anyone with a cold, diarrhea, or any other possible infection. ensure that you wash your hands regularly and that those whom you live with due the same (after using the bathroom, cooking, touching their faces, etc.). please purchase and over-the-counter hand sanitizer for this purpose. please also avoid close contact with small children or people coming from hospitals or nursing homes. followup instructions: 1) please follow up with dr. for the following appointment on monday, at 12:00pm: , md where: hematology/oncology phone: date/time: 12:00 2) please return to the bone marrow transplant tomorrow () and every day thereafter until instructed to do otherwise. your blood counts will be checked and you will be given an injection of neupogen to boost your white blood cell count. please come to the of the building on the between 10:00 am and 3:00 pm. you may call the bmt floor at if you have any questions. 3) please see your primary doctor in the next one to two weeks: , l. (). procedure: venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization pericardiocentesis thoracentesis biopsy of bone marrow injection or infusion of cancer chemotherapeutic substance injection of other agent into spinal canal diagnoses: hemopericardium acute lymphoid leukemia, without mention of having achieved remission elevated blood pressure reading without diagnosis of hypertension 

Answer: The patient is high likely exposed to