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: codeine / enalapril attending: chief complaint: chest pain, hemoptysis major surgical or invasive procedure: bronchoscopy history of present illness: 50 yo m with esrd secondary to amyloidosis on hd, h/o pulmonary aspergillosis (mycetoma), and multiple other medical problems p/w cp during hemodialysis. he had sscp, 1.5l into hd session, lasting 15 minutes, resolved spontaneously. he reported sob and diaphoresis. of note patient was recently admitted () for cp, hypotension and epistaxis/hemoptysis. . in the ed his vs were 97.9, 106, 104/67, 16, 100%ra. he was given aspirin 325mg. he was seen by the renal fellow. he then began coughing up frank blood. ip was contact and recommended a chest ct which was done. he was admitted to the micu. past medical history: esrd secondary to amyloidosis -failed lrrt in now on hd- r groin line ivc stent sarcoidosis pulmonary aspergillosis dm (diet controlled) chronic hcv hypertension sinusitis, paroxysmal atrial fibrillation, c. difficile mrsa line sepsis renal osteodystrophy adrenal insufficiency upper extremity dvt () pancreatitis bilateral bka right index and fifth finger amputations social history: smoked 1 ppd x 30 years but quit one year ago. no alcohol. previous drug use (ivdu). girlfriend is involved in his care. family history: mother, brother with diabetes. physical exam: vs: 98.3, hr: 100, 128/71, 25, 93-96% on ra gen: nad. answering all questions appropriately. heent: perrl, aniceric, dried blood on lips, no frank blood in op. neck: supple, no lad. lungs: few bibasilar crackles. no wheezes. heart: rrr, ii/vi systolic murmur throughout, loudest at llsb. abd: +bs. soft, nt/nd. extrem: s/p b/l bka. no edema. r femoral hd catheter, c/d/i, no drainage, redness, or fluctuance. left groin with pressure dressing. pertinent results: 04:15pm wbc-12.4* rbc-3.54* hgb-10.8* hct-34.5* mcv-98 mch-30.6 mchc-31.4 rdw-18.8* 04:15pm plt smr-normal plt count-253 04:15pm glucose-261* urea n-33* creat-6.9* sodium-138 potassium-4.3 chloride-100 total co2-20* anion gap-22* cardiac enzymes negative . chest ct: new, multifocal ground-glass opacification, both lungs, left greater than right, largely dependent suggesting this is aspiration neither of blood or esophageal contents. interstitial pneumonia, particularly pneumocystis should be considered, but not fungal infection. drug reaction is also in the differential diagnosis as is pulmonary hemorrhage. 2. although the intracavitary nodule at the upper margin of the chronic left apical consolidation and atelectasis is new since , there has been a suggestion of a cavity or bronchiectatic saccule in that location since ; whether the lesion is a mycetoma contained in a pre-existing space, or semi- invasive aspergillosis is open to question. . follow chest ct impression: 1. near complete resolution of multifocal ground-glass opacification within both lungs. 2. cavitary lesion at the upper margin of chronic left apical consolidation is likely unchanged. brief hospital course: 50m with esrd secondary to amyloidosis on hd, h/o pulmonary aspergillosis here with hemoptysis, epistaxis complicated by melena. . # hemoptysis: patient presented with one episode of hemoptysis. bronchoscopy showed no revealing lesion, but blood tinged mucus on left side, and patient had the single episode of hemoptysis without any recurrence. likely source of bleeding was thought to be left upper lobe at the fungal infection site. id has recommended to continue voriconazole. thoracic surgery was consulted and recommended no surgical intervention as he was a high-risk patient. hemoptysis resolved in house and pt will follow up with id as an outpatient. initial ct showed multi-focal ground glass opacities thought possibly due to aspiration/hemoptysis. cxr on reported possible rll infiltrate suggestive of aspiration and pt was started on broad spectrum abx. follow up ct on revealed resolution of ground glass opacities and pt was clinically improved with clear lungs & sating well on ra. abx were stopped on . . #acute blood loss: on patient developed epistaxis and melenic streaks in his stools. both the epistaxis and melenic stools worsened on , with at times profuse nose bleed and multiple bowel movements with dark maroon liquid stools. sbp was in the 80s but came back to 110s with ivf. hct dropped to 24 from 32 within a few hours. patient got an 18-gauge peripheral iv placed with ultrasound. labs were drawn from the femoral dialysis line. patient was initially clinically stable but slowly became somnolent and transferred to micu. gi was consulted and believed the melena was directly related to the epistaxis. he received 2uprbc and hct stabilized. no further intervention needed. ent was also consulted for epistaxis and packed his nose. he has received keflex for prophylaxis with packing. packing was removed successfully and there was no recurrence of epistaxis in house. hct was stable & pt was recommended to follow up with ent in 4-6wks. . # chest pain: cp resolved at admission, it had been right sided and sharp. ce were negative x 3 and pt was effectively ruled out for mi. there was no recurrence of cp during admission. . # paf: pt is not anticoagulated because of known bleeding tendency. pt was continued on metoprolol and had good rate control . # diarrhea: pt developped loose stools on . he had a c.diff checked but was started on empiric flagyl. plan is to continue a course of empiric flagyl. his loose stools were resolving at time of discharge. pt had received 2 doses of empiric antibiotics (vanc/) for aspiration seen on cxr with associated shortness of breath. subsequent ct scan was negative for infiltrate and demonstrated overall resolution of the changes seen at admission and antibiotics were discontinued. pt should continue flagyl 500mg tid for an additional 8 days for empiric coverage of c. diff given his relative state. . # end-stage renal disease on hemodialysis: hd per regular outpatient schedule t/h/sa . # dm: continued on insulin sliding scale with decent bs control . # mrsa/endocarditis/osteomyelitis: recently transitioned to tmp/smx suppressive therapy from vanco per id/pcp. by id and pt was continued on tmp/smx 4 tabs given after hd. . # adrenal insufficiency: continued on home low-dose prednisone. . # code: full code medications on admission: pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. b complex vitamins capsule sig: one (1) tablet po daily (daily). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 5. sevelamer hcl 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 6. cinacalcet 30 mg tablet sig: two (2) tablet po daily (daily). 7. prednisone 5 mg tablet sig: 0.5 tablet po qpm (once a day (in the evening)). 8. prednisone 5 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 9. megestrol 40 mg/ml suspension sig: one (1) 10ml po twice a day. ****patient cannot confirm that he is taking this**** 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. voriconazole 50 mg tablet sig: two (2) tablet po q12h (every 12 hours). 12. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 14. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 15. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: four (4) tablet po qhd (each hemodialysis). 16. insulin lispro 100 unit/ml solution sig: one (1) unit subcutaneous asdir (as directed). discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 2. sevelamer hcl 400 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 3. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 4. prednisone 5 mg tablet sig: 0.5 tablet po qhs (once a day (at bedtime)). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 7. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 8. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 9. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: four (4) tablet po qhd (each hemodialysis): please give after hd. 10. voriconazole 200 mg tablet sig: one (1) tablet po q12h (every 12 hours). 11. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). 12. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) unit injection tid (3 times a day). 13. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 14. insulin glargine 100 unit/ml solution sig: ten (10) unit subcutaneous at bedtime. 15. insulin lispro 100 unit/ml solution sig: per sliding scale subcutaneous four times a day. 16. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 8 days. 17. pramoxine-mineral oil-zinc 1-12.5 % ointment sig: one (1) appl rectal (2 times a day) as needed for irritation / pain. discharge disposition: extended care facility: healthcare- discharge diagnosis: primary diagnosis: hemoptysis epistaxis secondary diagnoses: esrd secondary to amyloidosis s/p lrrt (failed) diabetes history of recurrent mrsa bacteremia endocarditis of the mitral valve hepatitis c infection pulmonary aspergillosis, now on voriconazole, previously on itra until left common iliac stent sarcoidosis hypertension sinusitis paroxysmal atrial fibrillation c. difficile renal osteodystrophy adrenal insufficiency upper extremity dvt () pancreatitis bilateral bka right , left right index and fifth finger amputations discharge condition: stable discharge instructions: you presented to with low blood pressure and coughing blood. the source of the hemoptysis was likely from your fungal infection in the lung which is essentially stable on ct scan. the hemoptysis has improved. you also developed what appeared to be blood in your stool, but this was found to be due to a severe nosebleed. you were seen by ent who packed your nose and recommended follow up in 4-6wks. . please take all your medications as instructed. please resume your outpatient hemodialysis schedule. . if you develop recurrent coughing up blood, chest pain, shortness of breath, or any other concerning symptoms, please go to the nearest emergency room. followup instructions: you have a follow up appointment with ent on tuesday at 2pm in the medical building on the , suite 6e . please call your primary care physician, . at for an appointment within 2 weeks. . please keep the follow-up appointments: pulmonary function lab phone: date/time: 7:40 , m.d. phone: date/time: 8:00 . , m.d. (infectious diseases) , date/time: 11:00 procedure: fiber-optic bronchoscopy hemodialysis transfusion of other serum control of epistaxis by anterior nasal packing diagnoses: end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere chronic hepatitis c without mention of hepatic coma atrial fibrillation sarcoidosis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease diarrhea glucocorticoid deficiency below knee amputation status epistaxis aspergillosis other amyloidosis 

Answer: The patient is high likely exposed to