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 / bactrim attending: chief complaint: diarrhea major surgical or invasive procedure: endotracheal intubation picc line placement history of present illness: 64 y/o s/p double cord blood transplant for aml presented with diarrhea and n/v. he initially had mild diarrhea for almost one month. the mild diarrhea could be well controlled by imodium. on , he received a colonoscopy for his diarrhea. other than a few polyps, his colon was normal. the random biopsies were normal too. he has used to use imodium 2 pills per day for the past one month or so. of note, on the last thursday, his prednisone was cut down to 15 mg from 20 mg daily however, on this sunday, he suddenly developed worsening diarrhea with no blood. he reported that he had copious watery non-bloody diarrhea associated with middle abd cramps. he had 3-4 episodes of watery diarrhea per day. he also reported n/v with no hematemesis or coffee-ground emesis. even after fasting, his diarrhea did not slow down. he denied heartburn, dysphagia, odynophagia, gas, bloating, and weight loss. he denied travel history or sick contacts. in ed, he received methylprednisolone sodium succ 40mg. upon arriving at floor, his diarrhea improved review of systems: (+) per hpi (-) review of systems: gen: no fever, chills, night sweats, recent weight loss or gain. heent: no headache, sinus tenderness, rhinorrhea or congestion. cv: no chest pain or tightness, palpitations. pulm: no cough, shortness of breath, or wheezing. gi: no hematochezia or melena. gui: no dysuria or change in bladder habits. msk: no arthritis, arthralgias, or myalgias. derm: no rashes or skin breakdown. neuro: no numbness/tingling in extremities. psych: no feelings of depression or anxiety. all other review of systems negative. past medical history: oncology history: -- history of hairy cell leukemia initially present with thrombocytopenia & splenomegaly in -- treated with one cycle of cladribine in with subsequent remission -- presented with flu symptoms in and was diagnosed with an aml m5b. -- induction chemotherapy with 7+3 and consolidation with hidac and he is planned for allogeneic stem cell transplant -- prior to transplant it showed disease recurrence with multiple cytogenetic abnormalities on bone marrow biospy -- reinduced with mec -- double cord blood transplant on -- conditioning regimen consisted of busulfan, fludarabine, thiotepa, and atg. -- *transplant course was complicated by fever and neutropenia, volume overload, questionable orchitis, and c. diff infection presently on chronic po vanc. . past medical history: 1. hypothyroidism 2. gerd 3. right frontal subdural traumatic injury on attic door, treated conservatively resolved spontaneously 4. interstitial pneumonitis rx with steriods 5. b/l hearing loss since childhood. uses hearing aids 6. hx multiple colonic polyps 7. gout 8. hyperlipidemia social history: works part time as a retired security guard. lives at home with his wife and daughter. quit smoking 8 yrs ago. social alcohol use, approximately 1 alcoholic beverage/ day, but has not had any alcohol use since he was started on chemo. family history: n/c physical exam: vs: 98.1 120/68 p 90 r 20 sao2 100 @ ra gen: aox3, nad heent: perrla. mmm. no lad. no jvd. neck supple. no cervical, supraclavicular, or axillary lad cards: rr s1/s2 normal. no murmurs/gallops/rubs. pulm: no dullness to percussion, ctab no crackles or wheezes abd: bs+, soft, nt, no rebound/guarding, no hsm, no sign extremities: wwp, no edema. dps, pts 2+. skin: no rashes or bruising neuro: cns ii-xii intact. 5/5 strength in u/l extremities. dtrs 2+ bl. sensation intact to lt, cerebellar fxn intact (ftn, hts). gait wnl. discharge exam: expired pertinent results: admission labs: 10:02pm pt-12.0 ptt-22.7 inr(pt)-1.0 08:53pm glucose-128* urea n-35* creat-1.5* sodium-139 potassium-4.6 chloride-107 total co2-20* anion gap-17 08:53pm alt(sgpt)-68* ast(sgot)-35 ld(ldh)-219 alk phos-79 tot bili-0.7 08:53pm albumin-3.9 08:53pm wbc-5.8 rbc-3.15* hgb-11.8* hct-32.5* mcv-103* mch-37.5* mchc-36.3* rdw-15.6* 08:53pm neuts-83.1* lymphs-10.3* monos-5.8 eos-0.1 basos-0.7 08:53pm plt count-167 2:42 pm rapid respiratory viral screen & culture bronchial lavage. **final report ** respiratory viral culture (final ): test cancelled, patient credited. refer to respiratory viral antigen screen and respiratory virus identification test results for further information. respiratory viral antigen screen (final ): positive for respiratory viral antigens. specimen screened for: adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. refer to respiratory virus identification for further information. respiratory virus identification (final ): reported to and read back by (4i) at 1159. positive for parainfluenza type 3. viral antigen identified by immunofluorescence. 2:42 pm bronchoalveolar lavage gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): ~1000/ml commensal respiratory flora. potassium hydroxide preparation (final ): test cancelled by laboratory. patient credited. this is a low yield procedure based on our in-house studies. if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): viral culture: r/o cytomegalovirus (final ): test cancelled, patient credited. reported to and read back by (4i) at 1425. 12:18 am bronchoalveolar lavage gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): ~1000/ml commensal respiratory flora. legionella culture (final ): no legionella isolated. potassium hydroxide preparation (final ): test cancelled by laboratory. patient credited. this is a low yield procedure based on our in-house studies. if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (final ): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): no mycobacteria isolated. viral culture: r/o cytomegalovirus (preliminary): no cytomegalovirus (cmv) isolated. 1:55 pm rapid respiratory viral screen & culture source: nasopharyngeal swab. **final report ** respiratory viral culture (final ): test cancelled, patient credited. refer to respiratory viral antigen screen and respiratory virus identification test results for further information. respiratory viral antigen screen (final ): positive for respiratory viral antigens. specimen screened for: adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. refer to respiratory virus identification for further information. respiratory virus identification (final ): reported to and read back by 2:30pm. positive for parainfluenza type 3. viral antigen identified by immunofluorescence. 8:50 pm blood culture peripheral. **final report ** blood culture, routine (final ): staph aureus coag +. consultations with id are recommended for all blood cultures positive for staphylococcus aureus and species. final sensitivities. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. staphylococcus, coagulase negative. isolated from only one set in the previous five days. sensitivity testing per dr. branch() on . staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | staphylococcus, coagulase negative | | clindamycin-----------<=0.25 s <=0.25 s erythromycin----------<=0.25 s <=0.25 s gentamicin------------ <=0.5 s <=0.5 s levofloxacin---------- 0.25 s 0.25 s oxacillin------------- 0.5 s <=0.25 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s anaerobic bottle gram stain (final ): gram positive cocci in pairs and clusters. reported to and read back by at 3:50pm on . aerobic bottle gram stain (final ): gram positive cocci in pairs and clusters. 11:45 am blood culture source: line-aline #1. **final report ** blood culture, routine (final ): this is a corrected report , 3:40pm. reported to and read back by , 3:42pm. enterococcus faecium. final sensitivities. high level gentamicin screen: susceptible to 500 mcg/ml of gentamicin. screen predicts possible synergy with selected penicillins or vancomycin. consult id for details. high level streptomycin screen: resistant to 1000mcg/ml of streptomycin. screen predicts no synergy with penicillins or vancomycin. consult id for treatment options. . previously reported as high level gentamicin screen: resistant to 500 mcg/ml of gentamicin. screen predicts no synergy with penicillins or vancomycin. consult id for treatment options on , 1:29pm. sensitive to daptomycin @ 1.5 mcg/ml, sensitivity testing performed by etest. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus faecium | ampicillin------------ =>32 r daptomycin------------ s linezolid------------- 1 s penicillin g---------- =>64 r vancomycin------------ =>32 r anaerobic bottle gram stain (final ): reported to and read back by @ 1843 on - 4i. gram positive cocci. in pairs and chains. octreotide scan : no abnormal focus of tracer uptake at 4 hrs to suggest carcinoid. pulmonary uptake is likely secondary to infiltrates. routine 24 hr and spect/ct images were not obtained secondary to patient clinical instability as above. cxr the et tube tip is at the carina, just above the origin of the main bronchi and should be pulled back for approximately 2.5 cm. the right picc line tip is at the level of superior svc. the ng tube tip is in the stomach. heart size is normal. lateral apical opacities, although might represent area of pulmonary edema, on the other hand can represent worsening of infectious process demonstrated on , radiograph. no appreciable pleural effusion is seen. no pneumothorax is noted. tte the left atrium is normal in size. the patient is mechanically ventilated. the ivc is small, consistent with an ra pressure of <10mmhg. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded, particularly in the inferior and lateral regions as these segments are not consistently well-visualized. overall left ventricular systolic function is mildly depressed (lvef= 45-50 %). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. physiologic mitral regurgitation is seen (within normal limits). the pulmonary artery systolic pressure could not be determined. there is a trivial/physiologic pericardial effusion. impression: limited study. mildly depressed global left ventricular systolic function. in the setting of suboptimal image quality may not rule out a regional wall motion abnormality, particularly in the inferior and lateral regions as these segments are not consistently well visualized. no clinically significant aortic or mitral valve stenosis or regurgitation. indeterminate pulmonary artery systolic pressure. trivial pericardial effusion. compared with the prior study (images reviewed) of , the global left ventricular systolic function appears to have improved slightly, although this may in part be secondary to tachycardia (hr 119 currently, 63 on prior). renal ultrasound: impression: normal renal ultrasound. ct torso with contrast: 1. diffuse ground-glass opacities involving the majority of both lungs with focal areas of nodularity. increased severity and extent compared to prior examination. differential is broad and includes infection (atypical or fungal) or possibly non-cardiogenic pulmonary edema (ie ards, trali, drug toxicity, etc.) 2. no acute intra-abdominal pathology or abscess. 3. stable chronic compression deformity of the superior endplate of l2. cxr : mild pulmonary edema has improved since . the large areas of bilateral pneumonia, which worsened on the right between and , are subsequently stable. small right pleural effusion and borderline cardiomegaly are unchanged. in addition to the dense area of left suprahilar consolidation, improved since and subsequently stable, there is suggestion of new nodularity in the right lung as well as new right pleural effusion. all of these findings could be infectious, including septic embolism. ct scanning should be helpful in evaluating these abnormalities. right internal jugular line ends approximately a centimeter below the estimated location of the superior cavoatrial junction. et tube is in standard position and a nasogastric tube ends in the lower stomach and out of view. brief hospital course: 64 yo m with aml s/p double cord transplant presenting with 3 days of watery diarrhea and abdominal pain. course: admitted to icu with an acute episode of worsening tachypnea to the 40s, shortness of breath, wheezing, and tachycardia to the 180s in the setting of walking to and from the commode. an ekg showed a supraventricular tachycardia. he was given 2mg of morphine and 40mg of iv lasix for concern of flash pulmonary edema and was transferred to the icu satting 100% on a nrb. on arrival to the icu, the patient was in acute respiratory distress, agitated, anxious, tachycardic, and tachypneic. he was asking for his oxygen to be turned up even further. given his distress, he was emergently intubated. respiratory distress thought to be in settting of parainfluenza type 3 pna as he had been dyspneic and wheezing for days since diagnosis. also thought to be in setting of flash pulmonary edema. cardiac enzymes were checked considering st segment changes, and he ruled in for nstemi. weaning from the vent proved difficult, as he would develop agitation and increased work of breathing during subsequent spontaneous breathing trials that were concerning for flash pulmonary edema. imaging showed a diffuse multifocal pneumonia. his antibiotics had already included vancomycin from a blood culture of coag positive and negative staph, though per bmt recs these antibiotics were re-expanded to vancomycin and cefepime on for fevers and hypotension. meropenem was substituted for cefepime on , and po vanco was added for empiric c dif coverage at that time as well. a bronchoscopy with bal was performed at that time for suspected pulmonary source of infection, demonstrating positive parainfluenza 3 though negative pcp, , bacterial cultures. multiple serum assays including adenovirus, cmv, ebv, hsv, hhv6 were negative. a galactomanan was positive x2 but was felt to represent a false positive due to recent ivig treatment. he underwent ct torso on due to worsening fever and leukocytosis, showing significantly worse diffuse bilateral groundglass increased in extent and confluent from , thickening bronchial walls, more dense consolidation in the right upper lobe, and left upper lobe concerning for diffuse infection with bacterial superinfection on atypical process. after failure to improve on vanco//voriconazole/acyclovir, he was started on ambisome for enhanced fungal coverage on , and fungal isolator cultures were sent which were negative. voriconazole was stopped, and vancomycin was discontinued in favor of linezolid at that time for a blood culture growing vre from . his respiratory status failed to improve. concerned for a post-viral boop, pulse dose steroids were started on at methylprednisolone 500 mg iv q24h x 3d, though his respiratory mechanics actually worsened somewhat with decreasing compliance concerning for a post-ards fibrosis. in light of a need for tracheostomy for continued support and failure to improve, a family meeting was thenheld on with the bmt and teams regarding our inability to liberate him from the ventilator. his wife expressed the patients wishes never to undergo prolonged supportive measures including tracheostomy, and elected to pursue terminal extubation with shift of care goals towards comfort measures. non-essential medications were discontinued, and he was continued on a fentanyl gtt. he was extubated with family at the bedside and died within an hour at 18:45 on . other icu events that were notable included an nstemi on , which the cardiology consult team felt was consistent with acute plaque rupture. he was treated medically with aspirin, plavix, lovenox, statin, beta blocker. catheterization was not pursued. tte showed no valvular disease or wma though the quality of the study was limited. patient also developed a metabolic acidosis thought likely to be renal tubular acidosis on . renal team was consulted who recommended sodium bicarb infusions, also recommended renal ultrasound which showed no evidence of hydronephrosis. he initially presented with diarrhea felt to be due to gvhd. he was kept on tpn. of note, and extensive diarrhea work up was iniitiated, including stool elastase, chromogranin, 5-hiaa, yersina, ttg/iga, gastrin, seratonin, and vip. he was found to have an elevated chromogranin-a level 42, and was therefore sent for an octreodtide scan to rule out carcinoid which was negative. his steroids were uptitrated and cyclosporine discontinued. steroids were tapered when his infectious picture worsened with parainfluenza, and were rapidly curtailed. he later underwent steroid pulse towards the end of his hospital stay without much mprovement in his pulmonary status. multiple cdif assays and a pcr were negative. patient also had lue swelling, us showed partially occlusive left ij thrombus. line was removed and he was started on lovenox and later heparin gtt for one month, which was then discontinued. he was also noted to have transaminits throughout admission which peaked then normalized, then peaked again. it was likely secondary to gvhd, especially in the setting of his diarrhea and skin changes. medications on admission: neoral 25 mg cap 1 (one) capsule(s) by mouth twice a day vancocin 125 mg cap 1 capsule(s) by mouth twice a day lorazepam 0.5 mg tab 1 tablet(s) by mouth every six (6) hours as needed for insomnia/anxiety mycophenolate mofetil 500 mg tab 1 tablet(s) by mouth twice a day lisinopril 2.5 mg tab 1 tablet(s) by mouth once a day omeprazole 20 mg cap, delayed release 1 capsule(s) by mouth daily (daily) prednisone 10 mg tab 1.5 (one and a half) tablet(s) by mouth once a day or as directed imodium a-d 2 mg tab 1 tablet(s) by mouth three times a day as needed for diarrhea potassium chloride er 20 meq tab, particles/crystals 1 tablet(s) by mouth once a day levothyroxine 100 mcg tab 1 tablet(s) by mouth daily (daily) mepron 750 mg/5 ml oral susp 10 ml by mouth once a day (1500 mg) acyclovir 400 mg tab 1 tablet(s) by mouth every eight (8) hours multivitamin cap 1 capsule(s) by mouth once a day folic acid 1 mg tab 1 tablet(s) by mouth once a day magnesium oxide 400 mg tab 1 tablet(s) by mouth once a day entocort ec 3 mg 24 hr cap 1 capsule(s) by mouth three times a day discharge medications: none/expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances diagnostic ultrasound of heart insertion of endotracheal tube arterial catheterization closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of large intestine injection or infusion of immunoglobulin injection or infusion of oxazolidinone class of antibiotics central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: acidosis subendocardial infarction, initial episode of care esophageal reflux acute kidney failure, unspecified unspecified acquired hypothyroidism gout, unspecified personal history of tobacco use pulmonary collapse other and unspecified hyperlipidemia peripheral stem cells replaced by transplant acute respiratory failure other specified cardiac dysrhythmias alkalosis complications of transplanted bone marrow diarrhea dehydration surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation staphylococcal septicemia, unspecified anemia in neoplastic disease influenza with pneumonia acute edema of lung, unspecified acute myeloid leukemia, without mention of having achieved remission acute venous embolism and thrombosis of internal jugular veins graft-versus-host disease, unspecified 

Answer: The patient is high likely exposed to