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 / morphine / cefepime attending: chief complaint: admit for scheduled chemothearpy major surgical or invasive procedure: none history of present illness: 43yo gentleman with aml here for scheduled admission for cycle 3 hidac. patient has aml-m5a diagnosed when he presented with septic arthritis of the right knee and dental infections. he was found to have clonal loss of y (usually considered a favorable cytogenetic finding) and no other cytogenitic abnormalities (npm neg, flt3 neg) and was treated with 7+3 daunorubicin (90mg/m2) and cytarabine (100mg/m2/d x 7dci) on . induction was complicated by multifocal pna and effusive and constrictive inflammatory pericarditis. day 30 marrow was negative for disease and he was started on consolidation with hidac on . this was complicated by a morbilliform rash and there was some thought that this was due to cytarabine and the dose was reduced on days 3 and 5 to 2 g/m2. cycle 2 of high dac was at full dose (3gm/m2 q12 day 1,3,5 ) he had a minor rash but otherwise tolerated it well with a brief admission during his nadir for neutropenic malaise and chills at home (no temperature recorded). he was treated with broad spectrum antibiotics until his counts recovered and he was discharged home. vitals on arrival: t97.6, bp 130/84, hr 97, rr 18, 100%ra currently patient feels well, reports that his energy level is much improved from when he was discharged . he complains of mild constipation, denies fevers, chills, sweats or malaise. ros: per hpi, denies headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, brbpr, melena, hematochezia, dysuria, hematuria. past medical history: aml s/p induction with ara-c/ and c2 of hidac gerd right meniscal tear, s/p right knee arthroscopy, meniscectomy, and synovectomy recent jaw infection () social history: lives at home with wife and daughter. as parts manager. - tobacco: quit . previously smoked ppd since childhood. - alcohol: rare use (less than once per month). - illicits: remote history of marijuana use. no ivdu. family history: mother deceased from metastatic breast cancer. uncle deceased from lung cancer. physical exam: admission physical exam: vs - t97.6, bp 130/84, hr 97, rr 18, 100%ra general - male in nad appears older than chronologic age heent - nc/at, perrl, eomi, l eye strabismus, sclerae anicteric, mmm, op clear neck - supple, no thyromegaly, no jvd lungs - lungs are clear to ausculatation bilaterally, moving air well and symmetrically, resp unlabored, no accessory muscle use heart - pmi non-displaced, rrr, s1-s2 clear and of good quality without murmurs, rubs or gallops abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps); knees without effusion or tenderness, full rom bilaterally neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout, dtrs 2+ and symmetric discharge physical exam: t 97.6 bp 124/70 p 102 rr 18 100%ra general - male in nad appears lying in bed, appear tired heent - nc/at, perrl, eomi, anicteric, mmm, op clear neck - supple, no thyromegaly, no jvd lungs - lungs ctab moving air well. heart - nl s1 s2 no m/r/g abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps); knees without effusion or tenderness, full rom bilaterally skin- no rash or lesions neuro - awake, a&ox3, cns ii-xii grossly intact pertinent results: admission labs: 10:35am blood wbc-6.9 rbc-2.91* hgb-9.4* hct-26.6* mcv-91 mch-32.4* mchc-35.4* rdw-20.1* plt ct-115* 10:35am blood neuts-64.5 lymphs-17.6* monos-14.5* eos-2.5 baso-0.8 10:35am blood urean-11 creat-1.2 10:35am blood alt-20 ast-17 ld(ldh)-184 alkphos-64 totbili-0.3 relevant labs: coritsol stimulation test 04:29am blood cortsol-1.1* 05:45am blood cortsol-1.0* 07:00am blood cortsol-11.9 07:22am blood cortsol-15.9 ----------- 01:45pm blood cortsol-3.4 02:30pm blood cortsol-13.6 03:00pm blood cortsol-17.5 ----------- 05:08am blood lactate-3.1* 10:10am blood lactate-1.5 05:30pm blood lactate-1.7 09:50pm blood lactate-1.5 --------------- discharge labs: 06:35am blood wbc-4.8 rbc-3.17* hgb-10.3* hct-28.3* mcv-89 mch-32.4* mchc-36.3* rdw-17.6* plt ct-44* 06:35am blood neuts-44* bands-1 lymphs-24 monos-11 eos-20* baso-0 atyps-0 metas-0 myelos-0 06:35am blood glucose-81 urean-15 creat-0.9 na-140 k-3.6 cl-102 hco3-31 angap-11 06:35am blood alt-12 ast-11 ld(ldh)-163 alkphos-42 totbili-0.4 06:35am blood calcium-9.4 phos-4.2 mg-2.0 --------------- pertinent imaging: ct abomen/pelvis type of the exam: ct of the abdomen and pelvis. technique: multiple axial slices were obtained within the abdomen and pelvis after administration of intravenous contrast and ingestion of oral contrast. coronal and sagittal reconstructions were obtained. reason for the exam: 43-year-old man with aml, now with fever, rigors, hypertension and abdominal pain. please evaluate for acute intra-abdominal process. comparison studies: ct of the abdomen and pelvis, performed on . findings: imaged through the lung bases demonstrate presence of bilateral pleural effusions, tiny, however, new compared to the prior study. there are hypoventilatory changes to the lung bases. partially seen a central venous catheter that terminates within the right atrium. there is no cardiomegaly. there is no pericardial effusion. abdomen: liver enhances homogeneously with no evidence of focal masses. there is no intrahepatic biliary dilatation. gallbladder is normal in appearance with no evidence of focal masses or pericholecystic fluid. common bile duct is normal in size. spleen, pancreas and bilateral adrenals are normal in appearance. both kidneys enhance and secrete normally with no evidence of suspicious masses, hydronephrosis, nephrolithiasis or urinary obstruction. again seen multiple small mesenteric lymph nodes within the mid abdomen with some stranding of the mesentery, unchanged from the prior study. there is some new mucosal enhancement within the cecum and ascending colon with no significant wall thickening. no significant pericolonic inflammatory stranding is seen. there is no evidence of abscess or perforation. pelvis: the urinary bladder contains a foley catheter and is collapsed. the prostate gland is normal in size. there is minimal amount of fluid within the dependent pelvis. no evidence of lymphadenopathy. rectum, sigmoid, descending, ascending and transverse colon are unremarkable in appearance. osseous structures: no evidence of destructive lytic lesions. there is no evidence of blastic metastasis. impression: 1. minimal mucosal enhancement within the cecum and ascending colon, new from the prior study, which may represent a mild/developing typhlitis. there is no pericolonic stranding or abscess. there are no signs of perforation. 2. unchanged appearance of fat stranding and small multiple nodules within the mid mesentery compared to the prior study, which may represent mesenteric panniculitis. pertinent micro: blood culture, routine (final ): no growth. blood culture, routine (final ): no growth. mrsa screen (final ): no mrsa isolated. urine culture (final ): no growth. picc wound culture (final ): no significant growth. c. difficile dna amplification assay (final ): negative for toxigenic c. difficile by the illumigene dna amplification assay. brief hospital course: 43m with aml-m5a admitted for scheduled cycle 3 hidac consolidation chemotherapy who was transferred to the of day2 for hypotension, fever tachycardia, # acute myelogenous leukemia (monocytic): aml-m5a diagnosed when he presented with septic arthritis of the right knee and dental infections. clonal loss of y and no other cytogenitic abnormalities (npm neg, flt3 neg). had 7+3 dauno and cytarabine induction, and initiated cycle 3 hidac this admission with the following. course complicated by transfer for fever, hypotension, and tachycardia ? sepsis from developing typhilits ( see below) and diffuse macular puritic rash most likely secondary to cytarabine ( see below). given complicated course this admission, cycle 3 was discontinued. the patient will follow up with outpatient oncologist dr. to discuss further chemotherapy course. # sepsis- the patient was transferred to the on ( day 2 of his hidac) with hypotension ( sbps as low as 70s), fever 101.6, and tachycardic to the 140s, with associated rigors. wbc was 13.2 and lactate 3.1 he received agressive fluid resuscitation. his pressures were stabilized in the after 13 l ivfs, and did not require pressors. a ct abdomen/pelvis from was signficant for mild/developing typhilitis as the possible infectious source. his picc was removed given concern for possible line infection, the tip was sent for culture, and was ultimately negative. blood and urine cultures were negative as well. he was started on vancomycin, and meropenem, remained afebrile, hemodynamically stable, and transferred back to the floor on . his vancomycin was discontinued on and meropenem was discontinued on . the patient was transitoned to po ciprofloxacin and flagyl for treatment of typhilitis for which he will complete a 5 day course. during the work up of his hypotension in the the patient was evaluted for adrenal insufficency. he had a cortisol stimulation test on with a borderline suboptimal response, and low baseline cortisol, and was started on stress dose steroids. on transfer to the floor the patient was formally evaluated by endocrine, who recommended a repeat cortisol stimulation test, since the patient had received dexamethasone prior to the first test. his stress dose steroid were also discontinued and a repeat cortisol stimulation test was done 24hours after the patient's last stress dose steroids. the repeat cortisol stimulation test on was normal, making adrenal insufficiency an unlikely cause of the patient's hypotensive episode. #rash: the patient had puritic, diffuse, macular rash, after his third dose of hidac. of note the patient did not receive dexamethasone prior to this dose. the rash was most likely a reaction to the cytarabine, as the patient reported similar reactions in the past while receiving cytarabine. the patient used topical triamcinolone cream and diphehydramine prn and the rash ultimately resolved prior to discharge ----------- chronic stable issues #anal fissure: improved per patient, no signs of fissure or peri-rectal abscess on exam. continued with bowel regimen # chronic knee pain: patient had intermittent worsening of chronic knee pain but symptoms and physical exam were not concerning for septic joint. continued home oxycodone as needed. # gerd: continued ppi. medications on admission: preadmission medications listed are correct and complete. information was obtained from patientwebomr. 1. docusate sodium 100 mg po tid 2. lorazepam 0.5 mg po q6h:prn nausea 3. ondansetron 8 mg po q8h:prn nausea 4. oxycodone (immediate release) 5-10 mg po q4h:prn pain 5. pantoprazole 40 mg po q12h 6. senna 2 tab po bid 7. dimenhydrinate 50 mg po q6h:prn nausea 8. lidocaine-hyalur ac-aloe- *nf* 2 %-4 topical tid:prn mouth pain 9. oxycodone sr (oxycontin) 10 mg po hs 10. potassium chloride 20 meq po bid 11. prochlorperazine 10 mg po q6h:prn nausea 12. lidocaine 5% ointment 1 appl tp prn bowel movement apply small amount externally to affected area prior to bowel movement 13. acyclovir 400 mg po q8h 14. polyethylene glycol 17 g po daily:prn constipation discharge medications: 1. acyclovir 400 mg po q8h 2. docusate sodium 100 mg po tid 3. lorazepam 0.5 mg po q6h:prn nausea 4. ondansetron 8 mg po q8h:prn nausea 5. oxycodone (immediate release) 5-10 mg po q4h:prn pain 6. oxycodone sr (oxycontin) 10 mg po hs 7. pantoprazole 40 mg po q12h 8. polyethylene glycol 17 g po daily:prn constipation 9. potassium chloride 20 meq po bid 10. senna 2 tab po bid 11. dimenhydrinate 50 mg po q6h:prn nausea 12. lidocaine 5% ointment 1 appl tp prn bowel movement apply small amount externally to affected area prior to bowel movement 13. lidocaine-hyalur ac-aloe- *nf* 2 %-4 topical tid:prn mouth pain 14. prochlorperazine 10 mg po q6h:prn nausea 15. ciprofloxacin hcl 500 mg po q12h total course of 5 days (last day ) rx *ciprofloxacin 500 mg 1 tablet(s) by mouth 12h disp #*8 tablet refills:*0 16. metronidazole (flagyl) 500 mg po q8h total course of 5 days (last day ) rx *metronidazole 500 mg 1 tablet(s) by mouth 8h disp #*12 tablet refills:*0 discharge disposition: home discharge diagnosis: primary: acute myelogenous leukemia secondary: gastroesophageal reflux disease chronic knee pain discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory discharge instructions: dear mr. , it was a pleasure taking part in your care during your hospitalization at . you were admitted for scheduled chemotherapy for your acute myelogenous leukemia. on day 2 of your chemotherpay you had low blood pressure, fever, and a fast heart rate concerning for an infection (sepsis). you were transferred to the icu, started on antibiotics, and given a lot of iv fluids to help increase your blood pressure. a ct scan was done, which showed a developing infection in your bowel ( typhilitis), for which you will need 5 days of antibiotics. you also had a rash, which was most likley from the cytarabine, and has resolved on discharge.you were unable to complete your third cycle of chemotherapy, and will need to follow up with your primary oncologist dr. to discuss your treatment plan. followup instructions: you should receive a call from dr. office to schedule a follow up appointment. if you do not receive a call by wednesday, please call the office to schedule an appointment. # procedure: venous catheterization, not elsewhere classified injection or infusion of cancer chemotherapeutic substance diagnoses: acidosis thrombocytopenia, unspecified anemia of other chronic disease esophageal reflux acute kidney failure, unspecified unspecified septicemia severe sepsis personal history of tobacco use other specified cardiac dysrhythmias pain in joint, lower leg septic shock antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use dermatitis due to drugs and medicines taken internally acute vascular insufficiency of intestine anal fissure acute myeloid leukemia, without mention of having achieved remission abdominal pain, right lower quadrant encounter for antineoplastic chemotherapy 

Answer: The patient is high likely exposed to