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: babesiosis major surgical or invasive procedure: intubation history of present illness: the patient is a 53 year old gentleman, patient of dr. , with medical history of hypertension, hyperlipidemia, alcohol and tobacco abuse who now presents with one week of subjective fevers, chills, malaise, diarrhea and fatigue. the patient reports that about one week ago he started having symptoms initially of minor left earache. he then progressively started having feelings of fatigue, arthralgias/myalgias, weakness. he started developing diarrhea over this week that is described as loose watery stools, non-bloody, with associated nausea and occasional vomiting of non-bloody non-bilious fluid. the patient reports poor appetite and inability to keep down much in the way of food or fluids over this time. this morning the patient went to the bathroom and had diarrhea. after getting out of the bathroom this morning the patient called to his wife because he felt dizzy. she found him leaning against a wall and tried to help him to the ground. they both fell but he did not hit his head, no loc. the patient presents to the ed for evaluation of his symptoms. in the ed the patient was found to have a transaminitis, new anemia and of note rbc parasites noted on a diff with confirmation on peripheral blood smear. the patient reports he was in 2 weeks ago on a fishing trip where he notes he was also in/near the bushes cleaning his fish. . ed course: vitals: 102.6 bp: 100-110, hr: 70s. patient was found to be orthostatic in the ed sbp 108 -> 83. patient was given tylenol in ed and 4l ns. seen by id. blood and urine cultures collected past medical history: - hypertension - hyperlipidemia - alcoholic steatosis - gastroesophageal reflux - intermittent symptoms - tobacco abuse - ppd. has successfully quit for months in the past, but always returns. - alcohol abuse - currently 4-5 beers/day, previously 6 beers/day. he has tried to cut back. - chronic low back pain - has been treated with many modalities, some of which work for some period of time before ceasing to work. - s/p r foot fracture - fxure base 5th metatarsal 2/. - normal colonoscopy in physical exam: vitals: t- 98.3 bp: 110/68 hr: 68 rr: 18 o2: 99% on ra . general: patient is a pleasant african american male, tired appearing but in nad heent: ncat, eomi. conjunctiva pale, sclera anicteric op: poor dentition, mm mildly dry neck: supple, no lad. jvp relatively flat chest: few scattered expiratory rhonchi. fine crackles at left base clear with deep inspiration cor: rrr, normal s1/s2. no m/r/g abdomen: soft, non-tender in all quadrants. +bs rectal: guaiac negative in ed extremity: no c/c/e pertinent results: 03:00pm parst smr-pos 03:00pm plt count-91*# 03:00pm hypochrom-normal anisocyt-occasional poikilocy-normal macrocyt-occasional microcyt-normal polychrom-normal target-occasional 03:00pm neuts-51 bands-3 lymphs-30 monos-9 eos-0 basos-0 atyps-5* metas-0 myelos-0 other-2* 03:00pm wbc-7.6 rbc-3.28* hgb-10.7* hct-30.8* mcv-94 mch-32.7* admit data mchc-34.7 rdw-13.5 03:00pm haptoglob-<20* 03:00pm alt(sgpt)-153* ast(sgot)-193* ld(ldh)-433* alk phos-47 amylase-53 tot bili-2.5* dir bili-1.4* indir bil-1.1 03:00pm glucose-126* urea n-16 creat-1.3* sodium-125* potassium-3.3 chloride-90* total co2-26 anion gap-12 06:45pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-1 ph-7.0 leuk-neg . ecg: nsr, 76. nml axis, nml intervals. no acute st/tw changes. . imaging: portable chest - findings: single bedside ap examination labeled "upright at 1635" is compared with remote study dated ; the overall appearance is unchanged. no abnormality is seen in the heart, mediastinum, lungs or bony thorax. specifically, there is no pneumonic infiltrate. discharge labs 04:55am blood wbc-10.5 rbc-2.88* hgb-9.1* hct-26.1* mcv-91 mch-31.5 mchc-34.6 rdw-16.8* plt ct-527* 04:55am blood plt ct-527* 05:50am blood parst s-negative 04:55am blood urean-7 creat-0.7 na-134 k-4.3 cl-102 hco3-25 angap-11 05:50am blood alt-44* ast-28 ld(ldh)-241 alkphos-57 totbili-0.4 04:55am blood calcium-8.1* phos-2.7 mg-2.0 radiology report chest (pa & lat) study date of 2:50 pm impression: persistent lower lobe opacities with improved upper lobe opacities, but more prominent interstitial abnormalities and architectural distortion. given the patient's radiographic appearance over time, this likely represents evolution of ards/aip into the fibrotic stage, assuming that the patient met criteria for this condition. superimposed infectious process is not excluded. cardiology report echo study date of impression: normal biventricular cavity sizes and regional/global systolic function. mild mitral regurgitation with normal valve morphology. small right pleural effusion. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data brief hospital course: assessment/plan: 53 year old man with history of hypertension and hyperlipidemia presents with 1 week of fever, myalgias, diarrhea with transaminitis/anemia and peripheral blood smear revealing for babesiosis. . micu course: patient was transferred to the micu on for increasing oxygen requirement. patient was felt to be in volume overload and was aggressively diuresed. this resulted mild improvement of overall symptoms. however, chest ct showed findings that could be consistent with either capillary leak or volume overload. additionally the patient was evaluated for trali. appropriate studies are pending, but given time course it seems less likely. it is possible however, given time course that the patient had taco and thus should have lasix administration with any future blood transfusions this hospitalizations as needed to limit volume overload. . #. babesiosis: parasite burden was 1.6% at maximum. he was treated with clindamycin 600mg q8hr and quinine 648mg q8hr. pt was not g6pd deficient. he was also treated with doxycycline 100mg for possible lyme coinfection. pt did not have ehrlichiosis, lyme serologies are still pending. patient continued to have undulating fevers, vomiting (possibly due to antibiotics), and diarrhea throughout hospitalization. patient's hematocrit was 30.8 at admission, and dropped to 20 twice, on which occasions he was transfused 1 unit prbcs. patient was orthostatic in the ed, and was aggressively hydrated. hydration was stopped on day 2 of his hospitalization due to concerns of volume overload. alt/ast were elevated on admission, but these decreased over the admission, which was possibly related to alcohol abstention. ldh was high (400x-600s) throughout hospitalization. patient's albumin decreased throughout the admission from 2.5 to 2.1, likely due to poor po intake due to vomiting. tbili decreased from 2.5 at admission (max of 2.8) to 1.2. . # cough/tachypnea - pt developed a new nonproductive cough on day three of admission, with low o2sats (89-91% ra), bilateral bibasilar coarse breath sounds, and tachypnea without reported dyspnea. ddx volume overload, given aggressive fluids he has received, or pulmonary edema secondary to low oncotic pressure. bnp is 2544, making this likely. he responded to 2 doses of 10mg iv lasix, with decreased rr and improvement in lung sounds. it is possible he has developed pneumonia, given read of cxr. initially added 1g ceftazidime q8h for coverage of hospital-acquired pneumonia, however this was later discontinued as no other signs of infection. . # anemia w/ low reticulocyte count: pt??????s retic count of 1.7-1.9 is inappropriately low, given the stimulus of anemia and hemolysis. raised reticulocyte count is expected in babesiosis. seen by hem/onc, who believe anemia is likely related to alcohol abuse. pt does not have hiv, so the severity of disease may be related to alcohol-related bone marrow suppression, another as yet unknown cause of immunodeficiency, or may be a severe form in a normal host. direct coomb's, tsh, homocysteine normal. . # renal function - cr was 1.3 admission, and decreased to 0.9 with aggressive hydration. bumped to 1.4 on day 5 of admission following lasix administration (two days prior to bump) and 400mg dose of ibuprofen. urinalysis showed hyaline casts and was positive for "blood", without any rbcs, likely due to hemoglobinuria. . # substance abuse ?????? pt did not exhibit any signs of withdrawal, and reported no history of withdrawal symptoms or seizures. pt had not had any alcohol for the week prior to admission. pt declined nicotine patch. he was seen by social work, who recommended that a physician tell pt drinking is contraindicated. intern and med student told pt on multiple occasions that alcohol was likely contributing to clinical situation, especially his ability to respond to the infection. . #. hypertension - patient volume depleted and orthostatic on admission and anithypertensives were held. . #. hyperlipidemia - we held his tricor given elevated lfts and cr bump. we held his aspirin given his low platelets, restarted at time of discharge. . #. transaminitis: above normal baseline, likely parasitemia, basline transaminitis likely etoh abuse, fatty liver seen previously. management of babesia as above, outpatient evaluation there after . # low back pain ?????? this is pt??????s known chronic back pain, though more severe than usual. pt reports ambulation is most helpful treatment. internal medicine floor course: the following treatments were done once the patient was transfered out of the micu. . problem list . #) fevers- although the patient has been treated with full course of abx with id signing-off, the patient has continued to spike fevers >101.4. id was re-consulted and they felt that the fevers were from resolving ards. the patient was only treated with tylenol with the fever spikes. he was discharged off antibiotics. blood cultures, urine cultures and stool for c. diff were sent but were unrevealing at time of discharge. . #) babesiosis: estimated parasite burden 1.2%; smear negative x 9 days. mangagement as above, no further abx on the floor. . #) anemia. patient continued to have anemia while on the floor, but the patient's values were trending up. the patient was discharged with hematology follow-up. gp6d studies were negative for g6pd def. . #) hypoxia on ambulation. the patient was initially thought to be fluid overloaded. the patient was diuresed with minimal effect. cxr showed persistent lower lobe opacities with improved upper lobe opacities, but more prominent interstitial abnormalities and architectural distortion. this likely represents evolution of ards/aip into the fibrotic stage. this was thought to be the cause of the patient's hypoxia with ambulation. the patient was satting in the upper 90s at rest on ra. he desats to the mid 80s with ambulation. he was discharged with supplemental o2 with ambulation. medications on admission: aspirin 81mg daily hydrochlorothiazide 25mg daily lisinopril 20mg daily naproxen 250mg prn back pain amlodipine 5mg daily omeprazole 20mg fenofibrate145 mg tablet mvi chlorpheniramine/acetaminophen otc prn flu symptoms/ear pain vitamin e 400iu daily omega 3 fish oils: 1200mg daily vitamin c 1000mg daily discharge medications: 1. home oxygen please have home oxygen 2l via nc 2. fenofibrate micronized 145 mg tablet sig: one (1) tablet po daily (). 3. hexavitamin tablet sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. folic acid 1 mg tablet sig: five (5) tablet po daily (daily). disp:*150 tablet(s)* refills:*2* 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. aspirin 81 mg tablet sig: one (1) tablet po once a day. 8. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical qday prn pain (): shoulder. discharge disposition: home with service facility: discharge diagnosis: primary: babesiosis anemia secondary: hypertension hyperlipidemia discharge condition: good, requires oxygen with ambulation. discharge instructions: you were admitted to the hospital with babesiosis, which is a parasite infection of red blood cells. we treated you with antibiotics, and gave you blood transfusions because your blood levels (hematocrit) were low. we also started you on some vitamins to help you make new red blood cells. you should not drink alcohol any more because it damages your liver and also makes it harder for your body to make new red blood cells. please take your medications as instructed. because of your long stay, significant changes were made to your home medication regimen. please take the medications prescribed at discharge and dispose of your old medications. please call your doctor if you have any new symptoms. if you have fevers you can take tylenol however if you have diarrhea, shortness of breath, nausea, abdominal pain, vomiting or productive cough please the emergency room. followup instructions: you will follow-up with dr. in infectious disease, who will continue to monitor your babesiosis. you should also follow-up with a hematologist regarding your anemia from the babesiosis. you can call to set up the appointment. following appointments have been made for you: provider: , md phone: date/time: 3:00 provider: , md phone: date/time: 9:30 provider: , m.d. date/time: 12:20 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: anemia, unspecified esophageal reflux tobacco use disorder unspecified essential hypertension hyposmolality and/or hyponatremia other and unspecified hyperlipidemia acute respiratory failure other and unspecified alcohol dependence, unspecified babesiosis 

Answer: The patient is high likely exposed to