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: sulfonamides / a.c.e inhibitors / angiotensin receptor antagonist / keflex attending: chief complaint: agitation major surgical or invasive procedure: right thoracentesis history of present illness: 72 m with myelofibrosis with hepatic infiltration of extramedullary hematopoiesis, recurrent cellulitis, pvd; sent from nursing facility today with abnormal behavior and agitiation. per family, patient has had decreased energy and more fatigue, ??????not himself?????? in past couple days. no specific localizing symptoms or complaints, though did note mild nonproductive cough and c/o shortness of breath last night; also with intermittent c/o ruq pain today. per notes, patient today alert but confused, apparently threw a diaper full of stool into the hallway. also resistant to adl care and taking meds. temp mildly elevated to 100 axillary at today. noted to have worsening leukocytosis on routine labs (gets frequent lab checks due to myelofibrosis history), 23k on . visited pcp . discussed starting interferon alpha for myelofibrosis with hepatic infiltration; this has not yet been started. . patient seeing neuropsych providers for ongoing fluctuating mental status; antipsychotic meds being titrated. unclear if this is dementia vs. ??????subacute delirium?????? of unknown cause. at heme visit on , noted to be a/o x3 but per hematologist, during visit intermittently confused and thinking that he was at his office, working. . in the ed, t98.3 (spike to 101.1), hr 89, bp 131/89, r22, 97% on ra. never o2 requiring. cxr with rll pneumonia. abdominal ultrasound and abdominal ct done given pain. 1.5 l given, also received vanco and zosyn. received morphine 4, haldol 2, olanzapine 10, ativan 1 for agitation and premed prior to ct abdomen. past medical history: # myelofibrosis: jak2 mutation (v617f) positive myeloproliferative neoplasm, (mpn)followed since # portal hypertension, no clear etiology, ?related to hepatic infiltration of extramedullary hematopoiesis. # ckd, stage iv - baseline around 2.0 # paf, now dependence after av nodal ablation (currently with thera single chamber programmed in the vvir mode at 75 beats per minute). # schf ef 45% on echo # recurrent le cellulitis, with h/o mrsa # venous stasis ulcers # htn # hyperlipidemia # h/o recurrent c diff colitis # hypothyroidism # diverticulitis # bph # pvd # h/o sarcoid per records # s/p penile prosthesis # gastritis # insomnia # hypogonadism s/p hormonal treatment # pancreatitis c/b pseudocyst # diverticulitis s/p subtotal colectomy ( per pt) # s/p cholecystectomy # s/p appendectomy social history: home: nursing home occupation: retired trial lawyer : smoked for 40yrs, quit in etoh: previously heavy, quit in drugs: denies family history: father died of mi at 56. brother in late 60s with cad, parkinson's, and renal failure. mother died of aortic stenosis in her late 80s extensive family h/o alcohol abuse physical exam: admission: general appearance: well nourished, no acute distress, lethargic but easily arousable. somewhat noncooperative with exam. eyes / conjunctiva: perrl, nc/at, sclera anicteric head, ears, nose, throat: normocephalic, poor dentition lymphatic: cervical wnl cardiovascular: (s1: normal), (s2: normal), ( sm at lusb. peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: diminished), (left dp pulse: diminished) respiratory / chest: (percussion: no(t) resonant : ), (breath sounds: crackles : r mid lung fields and base, l base, no(t) wheezes : , diminished: and poor effort) abdominal: soft, bowel sounds present, distended, no(t) tender: , obese, + hsm extremities: right: 1+, left: 1+ edema. bilat legs with healing ulcers scattered. no drainage, + surrounding erythema. some with central necrotic eschars. warm to touch. skin: not assessed neurologic: oriented to person, not to place or time (not responding to these questions). moving all extremities spontaneously. . discharge general appearance: afebrile, well nourished, no acute distress, awake, alert,cooperative eyes / conjunctiva: perrl, nc/at, sclera anicteric head, ears, nose, throat: normocephalic, poor dentition lymphatic: cervical wnl cardiovascular: (s1: normal), (s2: normal), ( sm at lusb. respiratory / chest: mildly diminished in right lung base, altherwise clear abdominal: soft, bowel sounds present, nd/nt, + hsm extremities: right: 1+, left: trace edema. bilat legs with healing ulcers scattered. no drainage, + surrounding erythema. some with central necrotic eschars. warm to touch. neurologic: oriented to person, place and time. answers questions appropriately 80% of the time, but does demonstrate mild confusion at night pertinent results: cbc 09:47am wbc-38.9*# rbc-3.74* hgb-8.9* hct-30.3* mcv-81* mch-23.7* mchc-29.3* rdw-22.5* plt ct-482* 03:47am wbc-45.9* rbc-3.39* hgb-8.2* hct-27.5* mcv-81* mch-24.3* mchc-30.0* rdw-22.5* plt ct-427 04:02pm wbc-62.9* rbc-3.41* hgb-8.4* hct-30.6* mcv-90 mch-24.6* mchc-27.5* rdw-22.2* plt ct-482* 05:50am wbc-36.7* rbc-3.63* hgb-8.5* hct-30.9* mcv-85 mch-23.5* mchc-27.7* rdw-22.4* plt ct-467* 07:20am wbc-21.9* rbc-4.00* hgb-9.3* hct-34.7* mcv-87 mch-23.2* mchc-26.7* rdw-20.8* plt ct-560* 06:40am wbc-16.1* rbc-3.76* hgb-8.8* hct-31.8* mcv-85 mch-23.4* mchc-27.7* rdw-22.2* plt ct-495* 06:50am wbc-13.8* rbc-3.94* hgb-9.5* hct-33.3* mcv-85 mch-24.1* mchc-28.6* rdw-21.1* plt ct-497* 09:47am neuts-94* bands-1 lymphs-3* monos-2 eos-0 baso-0 atyps-0 metas-0 myelos-0 nrbc-1* 02:05am neuts-96.6* lymphs-2.4* monos-0.9* eos-0 baso-0.1 06:50am neuts-86.2* bands-0 lymphs-9.8* monos-1.6* eos-1.5 . coags 09:47am pt-17.9* ptt-30.1 inr(pt)-1.6* 03:47am pt-20.9* ptt-35.2* inr(pt)-2.0* 02:05am pt-19.0* ptt-30.2 inr(pt)-1.8* 06:55am pt-18.1* ptt-33.7 inr(pt)-1.7* 06:50am pt-16.9* ptt-34.3 inr(pt)-1.5* 06:50am plt smr-high plt ct-497* 09:47am ret man-5.3* . chem 7 09:47am glucose-91 urean-73* creat-1.9* na-133 k-5.2* cl-98 hco3-21* angap-19 03:38pm glucose-127* urean-85* creat-2.5* na-136 k-4.9 cl-105 hco3-15* angap-21* 04:02pm glucose-161* urean-93* creat-2.5* na-136 k-5.8* cl-109* hco3-8* angap-25* 05:50am glucose-62* urean-91* creat-2.2* na-149* k-4.0 cl-113* hco3-20* angap-20 05:00am glucose-81 urean-51* creat-1.7* na-146* k-4.3 cl-116* hco3-18* angap-16 06:55am glucose-72 urean-35* creat-1.4* na-144 k-4.3 cl-114* hco3-22 angap-12 06:40am glucose-71 urean-27* creat-1.2 na-140 k-4.1 cl-113* hco3-19* angap-12 06:50am glucose-61* urean-22* creat-1.2 na-140 k-4.3 cl-108 hco3-22 angap-14 . lft's 09:47am alt-39 ast-60* ld(ldh)-427* ck(cpk)-76 alkphos-216* totbili-2.5* dirbili-1.5* indbili-1.0 03:28am alt-38 ast-66* ld(ldh)-457* alkphos-185* totbili-1.7* 05:50am alt-45* ast-69* ld(ldh)-387* alkphos-158* totbili-1.3 06:50am alt-42* ast-62* alkphos-217* totbili-1.0 09:47am lipase-23 . misc 09:47am ck-mb-notdone 09:47am ctropnt-0.04* 03:47am ck-mb-3 ctropnt-0.05* probnp-* 10:09pm ck-mb-3 ctropnt-0.05* 09:47am albumin-4.1 calcium-9.4 phos-4.4 mg-2.5 06:20pm calcium-8.7 phos-6.2* mg-3.0* 05:40pm totprot-5.4* albumin-3.3* globuln-2.1 06:50am albumin-3.3* calcium-8.5 phos-3.1 mg-2.2 02:05am vanco-10.5 09:47am free t4-1.1 09:47am ammonia-26 09:47am hapto-162 09:52am lactate-1.8 05:26am lactate-2.1* 10:30pm lactate-2.0 . pleural fluid: wbc rbc polys lymphs monos eos meso macro 369* 148* 14* 28* 0 1* 9* 48* totprot glucose creat ld(ldh) amylase albumin 2.3 111 1.5 244 32 1.5 ph 7.451 . cultures ua neg cx: neg rapid viral screen: neg cx: neg . imaging studies: . ecg : ventricularly paced rhythm. underlying rhythm is atrial fibrillation. compared to the previous tracing of there is no significant diagnostic change. . cxr : impression: new opacity within the right lung base, worrisome for pneumonia. . ruq us: impression: patient status post cholecystectomy. mild ascites and pleural effusion. . ct-head: impression: no acute intracranial process. . ct-abd/pel: impression: 1. limited study due to lack of oral and iv contrast demonstrating interval increase in size of right- sided pleural effusion. 2. ascites. 3. splenomegaly with extensive perisplenic, perigastric, and retro-peritoneum collateral circulation. 4. no evidence of bowel obstruction or pneumatosis. no free air. 5. unchanged urinary bladder stone. . cxr : impression: right effusion. right lower lobe opacifications persist consistent with pneumonia. . cxr : impression: no significant change. . renal us : impression: 1. no hydronephrosis. 2. right pleural effusion and ascites. 3. splenomegaly. . cxr : comparison is made to and 23, exams. given differences in semi-upright to upright technique, the moderate right pleural effusion with adjacent opacity reflecting either underlying pneumonia or compression atelectasis is likely not significantly changed from but has clearly progressed from . more oblong density projecting over the right hemithorax is consistent with worsened lower lobe and likely middle lobe atelectasis/collapse. . cxr : post-thoracentesis: impression: interval decrease in right-sided pleural effusion with no pneumothorax. patchy right upper lobe consolidation. . cxr : comparison is made to the prior study from . the heart is markedly enlarged. mediastinum is within normal limits, but aortic arch is calcified. there is a small right pleural effusion, which has increased since the prior study. there is right lower lobe atelectasis. there is continued right middle lobe consolidation consistent with pneumonia, containing air bronchograms. left lung is relatively clear. right-sided is present with dual leads in right atrium and right ventricle. brief hospital course: 72 m with myelofibrosis and extramedullary/liver hematopoiesis, pvd, recurrent cellulitis; admited with acute on chronic altered mental status and pneumonia. he was intially admitted to the icu but was transfered out after three days. he did not require intubation or ventilatory support. . # pneumonia. fever, leukocytosis, infiltrate on cxr. o2 sats excellent and hemodynamically stable. cap vs. hcap (lives in nursing home and frequent hospital exposure) vs. aspiration. localized likely to rll. vanc/zosyn and levofloxacin given empirically. levofloxacin was discontinued after 2 days, when legionella antigen found to be negative. the patient received a 8 day course of vanc/zosyn. his fever and leukocytosis improved. 6 days into his hospital stay he complained of positional sob worse when lying down. he was found to have a unilateral right sided effusion that had developed since admission. a thoracentesis was performed: 1800cc clear, light yellow fluid removed, no empyema, transudate, culture negative. the etiology of his pleural effusion is somewhat unclear but may be ivf in the micu, heart failure or ascites. since thoracentesis, the patient has had no difficulty breathing. he has had o2 saturations 97-100% on ra and did not require oxygen at any time. . # altered mental status. an ongoing issue for several months, has seen outpatient neurobehavioral specialist. he has had recurrent delerium atrributed to narcotics and various infections, most frequently cellulitis. on admission, he was lethargic and disoriented, thought to be due to pneumonia. hepatic encephalopathy was also considered given hepatic infiltration of extramedullary hematopoiesis and ascites although the patient had no asterixis or clonus. he was started on lactulose without improvement and with worsening metabolic acidosis in the icu; lactulose was stopped. he was noted to have a minimal amount of ascites that appears to be attributed to portal hypertension. he did not have a paracentesis given the small amount of ascitis and the fact that he was treated with zosyn. however, he should have a paracentesis to rule out sbp the next time he is admitted with ams. he also developed hypernatremia to npo status several days into admission. he was treated with ivf d5 with resolution. as his mental status improved, he was cleared by speech and swallow to eat. he was then able to drink normally, allowing his sodium remain wnl. his delerium improved during his hospital and at the time of discharge his mental status was at baseline per his family. . # cellulitis. bilat les with erythema, edema, warmth. scabs over legs as above. has severe pvd, seen vascular in the past as well as wound consult. received clindamycin during last admit in late . it is unclear if he truly had cellulitis vs venous status during this admission. however, the antibiotic for hcap would also have treated cellulitis. he was followed by the wound care nurse. . # leukocytosis. treating for pneumonia and cellulitis as above. given history of c.diff and recent clindamycin use, c.diff was considered although the patient only had diarrhea once with lactulose. patient also with history of myelofibrosis and extramedullary hematopoiesis. per hematologist, often tends to spike high wbc counts in times of stress and infection due to disordered cell production. hydroxyurea was continued at the current dose. his leukocytosis trended down from a high of 60 to 13 (which is his baseline). . # myelofibrosis/anemia: hydroxyurea and epogen continued. patient also has iron deficiency that may be contributing to anemia. he had been on a course of ferrlecit infusions as an outpt. he received one dose while here on 11/31. interferon was held during acute illness, but he should restart. . # chf, systolic dysfunction: initially lasix and metoprolol were held in the setting of possible sirs physiology. these were restarted soon after he was transfered from the micu to the floor. not on acei or due to angioedema. . # arf on ckd. baseline cr of 2.0, increased up to 2.3-2.5. urine lytes suggested prerenal. urine eos negative. renal u/s w/o acute pathology. his cr improved to 1.2 over his hospital stay. . # metabolic acidosis. worsening metabolic acidosis (bicarb as low as 8), likely secondary to worsening renal failure and to diarrhea from lactulose. lactate wnl. his acidosis and bicarb resolved. . # hepatitis. ?cirrhotic physiology with chronically elevated inr, ast>alt; mildly elevated bilirubin (not seen in recent past). has ascites on imaging. thought to be due to infiltration of extramedullary hematopoeitic cells given severe myelofibrosis. he has had intermitted low level elevations in transaminases over the past year. he should have this followed as an outpt. an appointment with his gastroenterologist was made. . # vitamin d deficiency: vit d in 17 but does not appear to have been placed on vit d supplements or received replacement therapy. he should have 50,000 units vit d. once a week for 8 weeks. he was given one dose on . he was also started on vit d 400units . medications on admission: - vit c 500 - vit b complex daily - pentoxyfylline 400 tid - oxycodone 5 q6h prn - simvastatin 10 daily - seroquel 25 mg at 8pm, 12.5 qam, 12.5 prn agitation - bisacodyl 10 daily prn - mom prn - compazine prn - mvi - levothyroxine 125 daily - allopurinol 100 daily - asa 81 daily - feso4 325 daily - hydroxyurea alternating 500 mg/1000mg daily - epogen 4000 units qmonday - lasix 40 mg daily - interferon alfa-2b - 1.5 million units mwf at hs. - metoprolol 25 mg daily no antibiotics x one month per family (per notes, ?on clinda in early ) discharge medications: 1. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 2. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 3. pentoxifylline 400 mg tablet sustained release sig: one (1) tablet sustained release po tid (3 times a day). 4. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 7. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 10. hydroxyurea 500 mg capsule sig: one (1) capsule po every other day (every other day). 11. hydroxyurea 500 mg capsule sig: two (2) capsule po every other day (every other day). 12. epoetin alfa 2,000 unit/ml solution sig: 0.5 ml injection qmowefr (monday -wednesday-friday). 13. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 14. quetiapine 25 mg tablet sig: 1.5 tablets po qpm (once a day (in the evening)). 15. quetiapine 25 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 16. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed. 17. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 18. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 19. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 20. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 21. compazine 5 mg tablet sig: one (1) tablet po twice a day as needed for nausea. 22. iron (ferrous sulfate) 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day. 23. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 24. interferon alfa-2b 6,000,000 unit/ml solution sig: 1.5 million units injection three times a week, qhs on mwf. 25. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po 1x/week (sa) for 7 weeks: start on . 26. vitamin d-3 400 unit tablet sig: one (1) tablet po twice a day. discharge disposition: extended care facility: - discharge diagnosis: primary: delirium pneumonia acute renal failure, resolved transudative pleural effusion secondary: myelofibrosis anemia vitamin d deficiency chronic systolic chf, lvef 45% chronic kidney disease hx small ascites discharge condition: stable for rehab discharge instructions: you were admitted to the hospital because of your pneumonia and change in your mental status. you have been treated with antibiotics for pneumonia and you have improved. your mental status improved slowly. you had fluid in your right lung that was drained and tested. please call your doctor or go to the emergency room for: -fever or shaking chills -shortness of breath -chest pain -change of mental status -any new or concerning symptoms followup instructions: provider: , .d. phone: please call dr. , your pcp for follow up appointment in the next weeks. provider: , m.d. phone: date/time: 9:30 provider: , md phone: date/time: 9:00 provider: , md phone: date/time: 9:00 provider: , .d. phone: ( date/time: 8:00am md procedure: thoracentesis diagnoses: pneumonia, organism unspecified acidosis congestive heart failure, unspecified acute kidney failure, unspecified chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation cellulitis and abscess of leg, except foot chronic systolic heart failure pressure ulcer, buttock cardiac pacemaker in situ atherosclerosis of native arteries of the extremities, unspecified hepatitis, unspecified myelofibrosis unspecified vitamin d deficiency pressure ulcer, stage i ulcer of calf 

Answer: The patient is high likely exposed to