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: cough and tachycardia major surgical or invasive procedure: lymph node biopsy pleural drain history of present illness: this is a 45 year old male with no past medical history presenting with 3 - 4 weeks of cough. his symptoms began about a month ago when he noted the onset of a dry, paroxysmal, cough initially associated with one brief post-tussive syncope. no hemoptysis or sputum production. he also states he feels short of breath and "can't quite fill up his lungs with air." deep breaths tend to set off cough paroxysms. he has never experienced symptoms like these in the past, and denies prior history of asthma, allergies, or any other lung diseases. no history of gastroesophageal reflux. associated with cough and shortness of breath, he notes non-drenching night sweats and a lb weight loss. about 5 days prior to admission, he noted his shortness of breath got appreciably worse: while walking in his garden he noted significantly dyspnea. previously he has had normal exercise tolerance, able to play tennis, significant exercise. he saw his primary care doctor for these complaints on , who noted his heart rate to be in the 130s. his pcp sent him to the ed at for these complaints; he had a cxr there which showed left pleural effusion and widening of his mediastinum. cta showed no pe, but large pericardial effusion, left pleural effusion, and mediastinal adenopathy. vitals at this time were remarkable for hr in the 130s and tmax of 101.5. he had a bedside us done at which showed mild rv collapse at diastole but no hypotension was noted. pulsus unknown. at time of transfer to , his vitals were 113 114.89 20 100% on 2l nc. at , his vitals were 96.3 103 127/77 20 97. repeat bedside echo showed no echocardiographic evidence of tamponade physiology. there was no evidence of rv diastolic collapse. . ros: positive for non-drenching night sweats, recent weight loss of lbs, with no unusual bleeding/bruising, chest pain, palpitations, pnd, orthopnea. past medical history: none social history: just prior to current onset of symptoms, reports recent trip to st. / antilles, where he did explore a sea cave. he also spent some time in prior to the onset of these symptoms. no exposure to pets at home. no unusual work exposures; works in it for a pharmaceutical company. no known exposures to tuberculosis. no iv drug use, tobacco use. alcohol use 4 drinks / wk. lives with wife and 8 year old child; no sick contacts. than above travel history, no other recent travel. family history: no family history of malignancy, bleeding disorders, thyroid disease, autoimmune disease. physical exam: gen: sitting up in bed in nad neck: palpable left occiptal lymph node, no other adenopathy noted lymph: left occiptal lymph node, no other adenopathy noted cardiac: tachycardic, nl s1/s2, no distended neck veins noted, pulsus ~ 20 compared to pulsus ~ 6 noted in ed pulm: decreased breath sounds at left lung base abd: +bs, nontender, nondistended, no hepatosplenomegaly noted ext: no edema noted neuro: moving all extremities, alert + oriented x 3 pertinent results: admission labs: 02:45am blood wbc-7.5 rbc-4.77 hgb-13.5* hct-41.1 mcv-86 mch-28.2 mchc-32.8 rdw-13.0 plt ct-362 02:45am blood neuts-74.4* lymphs-14.1* monos-8.2 eos-2.9 baso-0.4 02:45am blood pt-14.7* ptt-26.8 inr(pt)-1.3* 02:45am blood glucose-110* urean-10 creat-0.8 na-138 k-4.3 cl-105 hco3-19* angap-18 02:45am blood alt-81* ast-68* ld(ldh)-791* alkphos-89 totbili-0.5 02:45am blood calcium-8.7 phos-3.7 mg-2.1 uricacd-5.9 02:45am blood tsh-4.3* 11:30am blood hcg-<5 11:30am blood afp-2.3 02:45am blood -negative 02:45am blood hiv ab-negative 02:45am blood brucella antibody, igg, igm-pnd . pericardial fluid: 04:30am other body fluid wbc-3456* hct,fl-4.5* polys-8* lymphs-69* monos-18* atyps-5* 04:30am other body fluid totprot-4.4 glucose-78 ld(ldh)-3000 amylase-25 albumin-2.9 . micro: blood culture: no growth to date pericardial fluid: propionobacterium acnes, bpcs. ebv and cmv pending 05:25pm blood coccidioides antibody, immunodiffusion-test 02:45am blood brucella antibody, igg, igm-test 05:00pm blood hcv ab-negative . discharge labs: 9:01 pm pleural fluid gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (preliminary): no mycobacteria isolated brief hospital course: this is a 45 year old male with no significant past medical history presenting with 3 weeks of dry cough, tachycardia, and subjective dyspnea who was found to have cardiac tamponade and primary mediastinal b cell lymphoma. . # pericardial/pleural effusion - developed in the setting of 3 weeks of indolent symptoms of cough, non-drenching night sweats, fevers. he was found on lymph node biopsy to have a primary b cell lymphoma. tamponade was noted and patient had drain placed in the icu with subsequent removal once tamponade physiology resolved. pt was found to have propionum bacterium acnes infection of pericardial fluid as well as staph epidermidis and was started on vancomycin while sensitvities were being awaited from . echo prior to discharge showed resolution of pericardial fluid. he also had large pleural effusions which were successfully drained with chest tube removed prior to discharge. it is recommended that a repeat echo is conducted within 1 month of discharge. patient will follow up with oncology and i.d as outpatient. depending on the p.acnes sensitivities he may be switched by i.d to penicillin and ceftriaxone. labs as recommended by i.d will be followed whilst on antibiotics. . hypodense liver lesions.he also had hypodense liver lesions that had been noted on abdominal ct.liver mri was limited, and liver lesions could not be assessed. repeat imaging may be considered as an outpatient. . # tachycardia - likely in setting of underlying effusion, resulting in reduction in cardiac output with compensatory tachycardia. patient also has increased insensible water loss due to night sweats. patient was given several liters of fluid this admission. should continue to drink large amounts of fluid as outpatient. . # cough - likely secondary to underlying effusion as noted above. patient was managed symptomatically with cough supressants. . # lymphadenopathy: ct shows extensive mediastinal lymphadenopathy. patient also had lymph node in his neck and had excisional biopsy while in the hospital which showed primary mediastinal b cell lymphoma. . medications on admission: none discharge medications: 1. vancomycin 1,000 mg recon soln sig: 1500 (1500) mg intravenous every twelve (12) hours for 4 weeks. disp:*84 recon solns* refills:*0* 2. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. disp:*100 ml(s)* refills:*0* 3. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. disp:*90 capsule(s)* refills:*0* 4. clotrimazole 1 % cream sig: one (1) appl topical (2 times a day) as needed for tinea corporis. disp:*1 tube* refills:*2* 5. zofran odt 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. disp:*30 tablet, rapid dissolve(s)* refills:*2* 6. outpatient lab work please check a cbc/diff, bmp, vancomycin trough, esr and crp every monday and fax results to (, attention dr 7. outpatient lab work please check cbc/diff twice a week and fax results to dr at 8. saline flush 0.9 % syringe sig: ml flush injection as needed : with administration of medications . disp:*84 doses * refills:*1* 9. heparin flush 10 unit/ml kit sig: five (5) ml flush intravenous as needed : with administration of medications. disp:*84 doses * refills:*1* discharge disposition: home with service facility: critical care systems discharge diagnosis: primary diagnosis: primary mediastinal b cell lymphoma. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital with tachycardia and cough. you had fluid that had built up around your heart (pericardial fluid) that was drained. this fluid was found to be infected and you were started on antibiotics. ct showed several lymph nodes as well as pleural and pericardial fluids in your chest and a biopsy was performed. you were found to have a primary mediastinal lymphoma and you were treated with chemotherapy and you improved. . the following changes were made to your medications: we added clotrimazole topical cream. we added guafenesin as needed for cough we added benzonatate as needed for cough we added zofran as needed for nausea. . you were started on vancomycin. the infectious diseases doctors contact if there needs to be a change made in your antibiotics. . you will need to have another echo to determine if there is any fluid reaccumulating around your heart. you will be called by our radiology department with the date and time of your appointment. followup instructions: provider: 2-hem onc 7f hematology/oncology-7f date/time: 9:00 , tel . . dr : infectious disease clinic . tel:( you will be contact with the date and time of your appointment which will be in the last week of . if you do not hear from the clinic by wednesday next week, please call to determine the date of your appointment. . echo suite radiology department , tel you will be called by our radiology department with the date and time of your appointment. if you do not hear from them on monday next week, please call the number above to determine the date and time of your study. procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified pericardiocentesis thoracentesis thoracentesis biopsy of bone marrow biopsy of lymphatic structure right heart cardiac catheterization injection or infusion of cancer chemotherapeutic substance diagnoses: pneumonia, organism unspecified other specified cardiac dysrhythmias other abnormal blood chemistry leukocytosis, unspecified neutropenia, unspecified cardiac tamponade fever presenting with conditions classified elsewhere other agents affecting blood constituents causing adverse effects in therapeutic use malignant pleural effusion other malignant lymphomas, intrathoracic lymph nodes 

Answer: The patient is high likely exposed to