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: penicillins / sulfa (sulfonamide antibiotics) / erythromycin base / shellfish / motrin attending: chief complaint: aml major surgical or invasive procedure: picc placement bone marrow biopsy bronchoscopy intubation history of present illness: 55yo male with no known significant past medical history presents with new diagnosis of acute leukemia. . he has went to hospital outpatient clinic for evaluation for fatigue and redness of the left lower extremity. he had a cbc drawn and was asked to return to the er the same day for concerning blood work (cbc from hospital: wbc 15 with 53% blasts; h&h 6.8 & 20; plt 29k). he was transferred to er and then admitted to medicine service. his cbc at showed wbc 13 with 48% blasts. . patient was also started on vancomycin iv for cellulitis of the left lower extremity. . he reports that he noticed fatigue for several months now but got much worse over the past week. he couldn't exercise as he usually does. felt short of breath climbing stairs and carrying grocery bags. . no chest pain, fevers, chills, night sweats. no weight loss or headaches. no loss of appetite. no diarrhea or abdominal pain. no nausea or vomiting. no neurologic symptoms. past medical history: bph htn hl anxiety social history: work as a clerk at the . lives with his companian/girlfriend for the past ten years. no children. he has one sister (here with him today) who lives in . no history of smoking. does not drink alcohol. does not do illicit drugs. family history: father had prostate cancer in his 70's but died from congestive heart failure. mother deceased. sister healthy physical exam: admission exam: gen: aox3, in nad heent: perrla. mm dry. cards: rr s1/s2 normal. no murmurs/gallops/rubs. pulm: ctab no crackles or wheezes abd: bs+, soft, nt, no rebound/guarding, extremities: left lower leg cellulitis over the shin area. appears improved from initial marking. skin: dry, no rashes or bruising neuro: cns ii-xii intact. 5/5 strength in u/l extremities. gait wnl. . exam on transfer to vitals: t: 100.8 bp: 89/61 p: 168 r: 28 o2: 98% on 4l general: alert, oriented, appears comfortable despite increased respiratory rate heent: sclera anicteric, pale, dry mucous membranes lungs: rhochi throughout, rul more pronounced cv: tachycardic abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding gu: no foley ext: warm, well perfused, no clubbing, cyanosis or edema skin: resolving erythema over left lower leg, no tenderness or warmth, left sided picc- clean dressing, right upper neck with area of scale and erythema at site of former cvl, marker circling spot . exam on transfer back to bmt: vs: t 96.2, bp 136/68, hr 84, rr 24, o2 sat 96% on 2l nc. gen: sleepy, easily arousable; slow to answer but is appropriate heent: ncat, anisocoria (l>r) secondary to past cataract surgery but pupils react appropriately to light; mmm, op clear. cards: rrr, nl s1/s2, no m/r/g pulm: poor air movement throughout, decreased breath sounds in rul, no crackles or wheezes abd: +bs, nondistended, nontender to palpation gu: +foley draining clear urine extremities: dp 2+ bilaterally, no c/c/e skin: scab over r ij site, scab over r antecubital area; l picc line site c/d and without surrounding erythema or tenderness. neuro: cn ii-vii intact, follows commands slowly. exam on discharge: vs: t 96.2 bp 148/72 hr 76 rr 18 o2 97% ra gen: anxious, sitting up in a chair, nad heent: ncat, anisocoria (l>r) secondary to past cataract surgery but pupils react appropriately to light; mmm, op with mild thrush. cv: rrr, nl s1/s2, no m/r/g pulm: good air movement throughout, no crackles or wheezes abd: +bs, soft, nondistended, nontender to palpation gu: no foley extremities: trace peripheral edema, warm to palpation skin: l picc line site c/d and without surrounding erythema or tenderness. neuro: language intact, gait ok with cane. cn ii-xii intact. pertinent results: admission lab: 11:25pm comments-green top 11:25pm lactate-0.9 11:17pm glucose-124* urea n-15 creat-1.0 sodium-137 potassium-3.8 chloride-105 total co2-23 anion gap-13 11:17pm alt(sgpt)-25 ast(sgot)-24 ld(ldh)-506* alk phos-92 tot bili-0.3 11:17pm lipase-21 11:17pm albumin-4.1 calcium-8.4 phosphate-2.9 magnesium-1.9 11:17pm wbc-13.5* rbc-1.72* hgb-7.1* hct-19.8* mcv-115* mch-41.4* mchc-36.1* rdw-14.8 11:17pm neuts-26* bands-0 lymphs-21 monos-3 eos-2 basos-0 atyps-0 metas-0 myelos-0 other-48* 11:17pm hypochrom-1+ anisocyt-2+ poikilocy-normal macrocyt-2+ microcyt-normal polychrom-normal 11:17pm plt smr-very low plt count-30* 11:17pm fibrinoge-470* 11:17pm urine color-straw appear-clear sp -1.004 11:17pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg discharge lab: xxxxxxxxxxxxxxxxxxxxxx imaging: ======== ct head : impression: no acute intracranial hemorrhage or mass effect. . echo the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the aortic arch is mildly dilated.the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is high normal. there is no pericardial effusion. impression: normal biventricular cavity sizes with preserved global and regional biventricular systolic function. mild mitral regurgitation with normal valve morphology. . left lower extremity ultrasound impression: no evidence of dvt. . ct chest : right picc line tip is in the proximal right atrium. aorta is normal in diameter. main pulmonary artery is not enlarged, but right main pulmonary rtery is 3 cm in diameter, might be reflecting pulmonary hypertension. coronary calcifications are extensive. there is minimal amount of pericardial effusion, grossly unchanged since the prior study. small but new bilateral pleural effusion is noted. within the axilla, there are multiple minimally enlarged lymph nodes. there are no bone lesions worrisome for infection or neoplasm. airways are patent till the level of subsegmental bronchi bilaterally. right upper lobe consolidation seen on the prior ct and radiographs has significantly progressed since the prior study, currently involving the apical posterior aspect of the right upper lobe as well as superior aspect of right lower lobe. there is lucency within the lateral aspect of the consolidation in the right upper lobe, most likely representing still aerated lung and unlikely to represent cavitation although should be closely monitored. the left lung is clear except for basal opacities that in part might represent atelectasis and unlikely to represent infectious process. the progression of the consolidation has been also demonstrated on the chest radiograph when compared to , thus further followup of the abnormality can be obtained with chest radiographs. the differential diagnosis would include rapidly progressing bacterial pneumonia. the other options would be invasive aspergillosis (less likely) as well as massive aspiration (unlikely). . tte : the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic arch is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , the heart rate and estimated pulmonary artery pressures are higher. other findings are similar . ct torso impression: 1. continued interval worsening of multifocal pulmonary consolidations now involving most of the right upper lobe and majority of the lower lobe basal segments bilaterally. this process began only involving the posterior segment of the right upper lobe and has been slowly worsening over prior last 10 days. small bilateral pleural effusions have also increased. 2. no significant pathology noted within the abdomen and pelvis other than slight interval increase of soft tissue anasarca and mild amount of intra-abdominal ascites. there are no findings of ileus or obstruction. . liver and gallbladder us impression: limited right upper quadrant ultrasound demonstrates a normal gallbladder without evidence of acute cholecystitis. . ct chest as compared to the prior ct torso from , there is significant interval improvement in the right upper lobe consolidation and left lower lobe consolidation with improved aeration of both lobes. the consolidation which are currently present are still substantial and involve the posterior segment of right upper lobe as well as apical and part of the basal segments of right lower lobe. there is interval improvement of pleural effusion, small. in the left lung, there is interval resolution of left lower lobe consolidation with only minimal residual present. there are multiple mediastinal lymph nodes, but none of them pathologically enlarged. extensive coronary calcifications are present, unchanged. there is small amount of pericardial effusion, minimally increased since the prior study. there is evidence of anemia. the aorta is normal in diameter. airways are patent to the level of subsegmental bronchi bilaterally. the left picc line tip is at the cavoatrial junction level. right lung pulmonary nodules are noted in the previously consolidated area of the lungs, most likely representing residua of prior infection, with similar appearance in the left lower lobe and might be reevaluated in three months for documentation of resolution. no evidence of interstitial abnormality is present. ======================= micro: bcx: all sterile ucx: all sterile cryptococcal antigen: negative bal (): neg gram stain, commensal respiratory cx, neg for legionella/koh prep/pcp/fungus/nocardia/afb/mycobacteria/cmv bal (): gram stain +leukocyte, no microorganism; neg respiratory cx, neg for legionella/koh prep/pcp/fungus/nocardia/afb/mycobacteria/cmv mrsa screen negative respiratory viral cx (): negative c diff toxin (): negative brief hospital course: mr. is a 55yo male with no significant past medical history who presented with cellulitis and elevated wbc with high percentage of blasts and was diagnosed with aml-m2 carrying a (8:21) translocation. . # aml: patient presented for evaluation of cellulitis and was found to have wbc 22 with 85% blasts. he underwent bone marrow biopsy which showed new acute leukemia, aml-m2 with cytogenetics carrying translocations at eto at 8q21 which is considered a to be a good prognostic indicator. baseline echo showed mild mr and was otherwise unremarkable. he was treated with 7+3 induction chemotherapy and tolerated chemotherapy well. day 14 bone marrow biopsy was hypocellular consistent with ablated marrow. anc nadir was 0, and recovery began on day 18. his recovery bone marrow biopsy done on day 37 also showed complete remission. he will follow up with dr. for consolidation chemotherapy. . # pneumonia: patient developed productive cough in the setting of neutropenic fever, a ct chest showed a right upper lobe round infiltrate with surrounding ground glass opacities (halo sign). concern for invasive aspergilosis was raised, id was consulted and he was started on voriconazole (in addition to vancomycin and cefepime). he underwent broncheoalveolar lavage which revealed purulent material in the right upper lobe, cultures were taken which was unrevealing. he developed hypoxia and tachypenia and repeat ct showed progression of the previously seen right upper lobe infiltrate. his anc had begun to recover at this time and clinical deterioration was partly due to immunereconstitution. given tenuous respiratory status, he was transferred to the icu for close monitoring in the context of tachycardia and hypotension. he had persistently high work of breathing during his second night, and failed treatment with bipap necessitating intubation. repeat imaging showed worsening of his right upper lobe pneumonia, with opacities extending throughout the right hemithorax. as he failed to improve with broad spectrum antibiotics and fungal coverage, and as bal failed to reveal a microbial pathogen on culture, a lung biopsy was initially pursued, though eventually postponed due to elevated peep and for fear of inciting pneumothorax in a tenuous patient. flagyl and ciprofloxacin were added for c diff prophylaxis and additive gnr coverage, respectively. bal was repeated on and , which again failed to show any pathogenic culprit. he received a single dose of steroids on in treatment of questionable boop, though this was discontinued in discussion with the bmt team who felt that infection was still most likely. he was eventually extubated on to room air. he was transferred back to bmt on and his antibiotics were stopped slowly. he is being covered with posaconazole at the time of discharge, and will continue this medication until end of his consolidation chemotherapy. the repeat chest ct on showed significant improvement of pneumonia, but still significant consolidation of r lung and pulmonary nodules, likely infectious. . # leukocytosis/fever. thought to be infectious with most likely source being in the lungs based on clinical presentation, imaging, and bronchoscopy. see above for management of pneumonia. however, bal has not been revealing in terms of the causative microbe, but there is concern for fungal vs. bacterial pneumonia. he was started on broad spectrum antimicrobials. c. diff was also suspected given his ileus and rapid rise in wbc; therefore, he was started on iv flagyl and vancomycin enema, although he has been unable to tolerate vancomycin enemea. c. diff pcr was ordered for more definitive diagnosis, but he has not had bm. bmt service believes taht his leukocytosis and fever could be partly from robust return of his bone marrow s/p 7+3. after transfer back to the bmt service and with improvement of his pneumonia, he remained afebrile on the floor until discharge. . # atrial fibrillation/flutter: patient had new onset of atrial fibrillation with rapid ventricular response in the setting of sepsis from the above noted pulmonary infection. he was treated with metoprolol iv and po and went in and out of sinus rhythm. he was transferred to the icu as above in atrial fibrillation, though spontaneously converted soon after transfer in response to iv lopressor. he was placed on tid po lopressor though again reverted to a fast atrial flutter at 150bpm during his second icu night with hypotension to 80s systolic. he received bolus diltiazem and then diltiazem gtt with levophed support, and he eventually reverted to sinus rhythm. he began amiodarone loading to prevent further arrhythmia. he received iv amiodarone until because of concern for ileus, resumed po as bowel sounds returned, but ultimately stopped on as he was persistently in sinus rhythm and with increasing alkaline phosphatase, thought medications. his heart remained in normal rate at the time of discharge. . # hypotension: he had hypotension to 80s systolic while in the micu, which was initially fluid responsive. these pressures had occurred with his tachycardia and nodal blockade, and he was eventually placed on pressors as we struggled to control his hr. he remained hypotensive on high doses of fentanyl/midazolam to control agitation. while likely septic, his pressure improved with sedation weaning, suggesting a substantial iatrogenic source. he was weaned off pressors. he was eventually extubated, and his sbp remained in 110-130s on the floor. . # cellulitis: patient was presented with a left lower leg swelling and erythemia. ultrasound was negative for dvt. he was diagnosed with cellulitis and treated with vancomycin and cefepime for an extended course given neutropenia. he completed a 24 day course of antibiotics and his cellulitis resolved. . # rash: patient developed an erythematous, maculopapular non puritic rash over the extensor surface of his forearms bilatearlly. at the time, he had been treated with cefepime for 14 days and drug rash was considered possible. the rash was not severe and cefepime was continued given ongoing neutropenia. the rash resolved over time. . # social issues: the patient was very hesistant towards treatment throughout his stay and required encouragement to start chemotherapy. he benefited greatly from social work and chaplain support. . # ileus. tubefeeds restarted and now at 40 cc/ml. still no bowel movement. - off vancomycin enema as above - on mostly iv formulation for meds at this time - continue bisacodyl pr prn - continue tf, check residual medications on admission: trazodone aspirin 81mg terazosin alprazolam discharge medications: 1. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. disp:*30 tablet(s)* refills:*0* 2. posaconazole 200 mg/5 ml (40 mg/ml) suspension sig: 5 (five) ml po q6h (every 6 hours). disp:*600 ml* refills:*2* 3. xanax 1 mg tablet sig: one (1) tablet po at bedtime. disp:*14 tablet(s)* refills:*0* discharge disposition: home with service facility: , discharge diagnosis: aml (acute myeloid leukemia) pneumonia (infection of lung) discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (cane). discharge instructions: mr. , . it was a pleasure taking care of you in the hospital. you were admitted with new aml. you were treated with induction chemotherapy. we also treated cellulitis with antibiotics and this improved greatly. you developed neutropenia (low white cell counts) with chemotherapy and had fevers, for which you received antibiotics and had ct scan of your chest. ct scan of your chest showed pneumonia (infection of lungs) in your right lung, which was treated with antifungal medications. you also developed irregular, rapid heartbeat which were treated with medications, and your heartbeats are now normal. because you had difficulty breathing with your pneumonia, you had to be intubated and have help with breathing for a while. you came out of the icu, and did well on the floor with pt. you are still being treated with posaconazole for your pneumonia. you will continue taking this medication through the second round of chemotherapy. . we made many changes to your medications. please see attached list to know what medications you should be taking. . -started posaconazole suspension 200 mg by mouth every 6 hours for your pneumonia. please take this with fatty foods to increase the absorption of the medication. -stopped terazosin for your benign prostatic hypertrophy, you can restart this medication after discussing it with your primary care physician. aspirin, please do not start taking this medication before discussing it with dr. . followup instructions: department: hematology/oncology when: friday at 11:30 am with: , md building: sc clinical ctr campus: east best parking: garage . department: hematology/bmt; infectious diseases doctor when: thursday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances biopsy of bone marrow arterial catheterization closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus injection or infusion of cancer chemotherapeutic substance central venous catheter placement with guidance diagnoses: other iatrogenic hypotension anemia, unspecified unspecified essential hypertension unspecified septicemia severe sepsis atrial fibrillation atrial flutter hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) candidiasis of mouth dysthymic disorder other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure cellulitis and abscess of leg, except foot antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use paralytic ileus pressure ulcer, lower back other specified disorders of biliary tract hyperosmolality and/or hypernatremia other and unspecified infection due to central venous catheter drug induced neutropenia leukocytosis, unspecified other and unspecified mycoses pneumonia in other systemic mycoses mixed acid-base balance disorder pressure ulcer, stage ii cephalosporin group causing adverse effects in therapeutic use acute myeloid leukemia, without mention of having achieved remission adjustment disorder with anxiety antifungal antibiotics causing adverse effects in therapeutic use dermatitis due to food taken internally mucositis (ulcerative) due to antineoplastic therapy 

Answer: The patient is high likely exposed to