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: compazine / bactrim / pentamidine isethionate / vancomycin hcl attending: chief complaint: shortness of breath, headache major surgical or invasive procedure: none (chest tube placed at osh) intubation, a line placement history of present illness: 25 male with aml s/p bmt in , gvhd, recent ptx medically managed, presented to hosp from with sob, n/v, and an enlarged hydropneumothorax. he was seen at and discharged about one week ago for a left hydropneumothorax that was medically managed. he noted the onset of shortness of breath yesterday at rest, was hypoxic, and found to have a larger pneumothorax. he was taken to hosptial where he was given pain control and had a chest tube placed in his left 5th intercostal space. he was symptomatically improved, and was transferred here for further care. he has not had recent f/c, though has been vomiting daily. he has not had diarrhea. . he also has had shingles on his left leg, and has been on valtrex for this. his immunosuppression was recently decreased due to voriconazole. . ed course: he was given iv dilaudid in the ed, seen by thoracic surgery, and admitted to medicine for workup. . on the floor, he was noted to have a serum bicarb of 45 and was somnolent. an abg was done which was 7.23/112/144. cxr from 1 am showed increased left pneumothorax. he was brought to the ccu for further management of his chest tube. . review of systems: nausea and vomiting, rash on left leg, poor appetite, decreased energy. past medical history: aml s/p transplant ? gvhd gtube depression social history: lives at rehab, no tobacco or etoh. single. family history: nc physical exam: gen- cachectic, pale, ill appearing male, uncomfortable heent- mmdry, blood in mouth and nares, anicteric neck- supple, no lad cor- tachy, regular, s1,s2 chest- breath sounds bilateral, rhonchorous anteriorly; chest tube draining serosanguinous fluid, no bleeding at site abd- soft, tender at g tube site, no g/r. pos bs. ext- no c/c/e neuro- aao 3, drowsy skin- open excoriated lesion on left thigh pertinent results: admission labs: 05:53pm glucose-99 urea n-19 creat-0.6 sodium-134 potassium-4.7 chloride-88* total co2-42* anion gap-9 05:53pm wbc-15.4* rbc-2.89* hgb-9.9* hct-31.0* mcv-108* mch-34.2* mchc-31.8 rdw-16.9* 05:53pm neuts-83.2* lymphs-9.7* monos-6.6 eos-0.3 basos-0.2 05:53pm plt count-289 . imaging ct head - findings: no hemorrhage, mass lesion, shift of normally midline structures or evidence of major territorial infarction is apparent. there is no hydrocephalus. the orbits are grossly normal in appearance. there is opacification of multiple ethmoid air cells and mild mucosal thickening in bilateral maxillary sinuses consistent with inflammatory changes. no abnormalities are noted within the bony structures. impression: 1. no acute intracranial abnormality detected. 2. opacification of multiple ethmoid air cells and mild mucosal thickening in bilateral maxillary sinuses consistent with inflammatory changes. - upright portable chest radiograph. findings: there is a mild-to-moderate left hydropneumothorax with a left-sided chest tube running along the lateral chest wall in an apical direction. the sideport was unable to be visualized due to overlying ribs. obscuration of the left hemidiaphragm is noted likely reflective of atelectasis from overlying fluid. mild right basilar atelectasis is present. there is no evidence of focal parenchymal infiltrate or pulmonary edema. cardiomediastinal silhouette and hilar contours are within normal limits. impression: mild-to-moderate left hydropneumothorax with lateral apical chest tube in place. sideport unable to be visualized. chest ct without iv contrast : technique: mdct was used to obtain contiguous axial images through the chest without administration of iv contrast. standard and lung algorithm images as well as coronal reformats were obtained. this study was compared with chest radiograph of , , and . the image quality of this study is compromised by respiratory motion. a moderate left hydropneumothorax is similar in size to the chest radiograph. associated atelectasis is most pronounced at the left lower lobe; coronal reformats show a 3.7 cm ovoid extrapulmonary fluid collection contiguous with loculated pleural fluid laterally, probably a fibrin clot. vague ground-glass and centrilobular opacities, most pronounced in the right middle lobe, medial left upper lobe, and in dependent portions of both lower lobes, along with bronchial wall thickening, most pronounced in the right upper lobe and left lower lobe, all reflect endobronchial infection. a small volume of consolidation in the left lower lobe adjacent to the extraparenchymal loculated fluid is the only candidate for active pneumonia, and that could be atelectasis. the left chest tube enters between the sixth and seventh ribs anterolaterally, courses to the lung apex; it is not contiguous with the loculated fluid at the left lung base. a small, layering, nonhemorrhagic, right pleural effusion is also present. there is no pericardial effusion. right picc terminates in the cavoatrial junction. no mediastinal lymph nodes are larger than an 8 mm precarinal node (4:90). this study was not designed to examine the abdomen, however, no mass lesions are seen in the imaged portion of the liver, spleen, adrenals, kidneys, or pancreas. a gastrostomy tube is only partially imaged. there are no bone findings suspicious for malignancy or infection impression: 1. moderate left hydropneumothorax, including basal fluid loculations not traversed by pleural drain. 2. minimal left lower lobe consolidation. mild, multifocal bronchitis and bronchiolitis. 3. small right pleural effusion. pleural fluid cytology: neg for malignant cells emg : findings: motor nerve conduction study (ncss) of the left median nerve were normal, including f waves. motor ncss of the left ulnar nerve showed normal distal latency, moderate reduction of response amplitudes, and normal conduction velocity; f response minimum latency was normal. motor responses of the left peroneal nerve, recording extensor digitorum brevis and tibialis anterior, were absent. motor ncss of the left tibial nerve showed normal distal latency, moderate reduction of response amplitude, and mild slowing of conduction velocity. slow (3-hz) repetitive nerve stimulation of the left ulnar nerve, recording abductor digiti minimi, showed no decremental response at baseline, immediately after 1 minute of maximal voluntary contraction, or at 1-minute intervals following maximal voluntary effort out to 5 minutes. slow (3-hz) repetitive nerve stimulation of the left spinal accessory nerve, recording trapzeius, showed no decremental response at baseline, immediately after 1 minute of maximal voluntary contraction, or at 1-minute intervals following maximal voluntary out to 4 minutes, though the study was technically limited by movement. concentric needle electromyography (emg) of the left vastus lateralis showed motor unit potentials (mups) of mildly short duration, small amplitude and increased polyphasia with early recruitment. emg examination of the tibialis anterior and medial gastrocnemius was normal. emg of right vastus lateralis showed mups of mildly short duration, small amplitude and increased polyphasia with early recruitment. emg examination of the left deltoid, biceps, and first dorsal interosseous was normal. emg examination of the right deltoid showed a mixed population of normal mups and mups of mildly short duration, small amplitude and increased polyphasia with early recruitment. the study was prematurely terminated due to the patient's increasing respiratory distress. further needle emg of proximal muscles and single-fiber emg was not performed. impression: abnormal, limited study. there is electrophysiologic evidence for a mild, generalized myopathic process without denervating features, as can be seen in critical illness myopathy. the findings also suggest the possibility of a mild sensorimotor polyneuropathy with predominantly axonal features. there is no definite electrophysiologic evidence for a disorder of neuromuscular transmission, but the limited nature of the study precludes exclusion of this diagnostic possibility. **microbiology: aerobic bottle (preliminary): . enterococcus sp.. preliminary sensitivity. further identification to follow. sensitivities: mic expressed in mcg/ml enterococcus sp. | ampicillin------------ r levofloxacin---------- r vancomycin------------ s anaerobic bottle (preliminary): enterococcus sp.. identification and sensitivities performed from aerobic bottle. pleural fluid 10:26 am gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): no growth. anaerobic culture (preliminary): no growth. fungal culture (preliminary): no fungus isolated. transfer labs: 02:45am blood wbc-12.6* rbc-3.00* hgb-10.0* hct-30.7* mcv-102* mch-33.3* mchc-32.6 rdw-17.4* plt ct-250 02:45am blood neuts-70 bands-0 lymphs-10* monos-17* eos-0 baso-0 atyps-0 metas-1* myelos-2* nrbc-1* 02:45am blood hypochr-1+ anisocy-1+ poiklo-normal macrocy-1+ microcy-normal polychr-normal stipple-1+ 02:45am blood plt smr-normal plt ct-250 02:45am blood glucose-126* urean-26* creat-0.8 na-135 k-4.5 cl-88* hco3-43* angap-9 02:45am blood alt-14 ast-36 ld(ldh)-176 alkphos-223* amylase-28 totbili-0.4 02:45am blood albumin-3.1* calcium-10.4* phos-4.2 mg-2.3 05:28pm blood type-art temp-36.3 rates-30/ tidal v-300 peep-5 fio2-40 po2-83* pco2-79* ph-7.33* caltco2-44* base xs-11 -assist/con intubat-intubated 09:12am blood type-art temp-35.2 rates-30/ tidal v-300 peep-5 fio2-40 po2-88 pco2-84* ph-7.27* caltco2-40* base xs-8 -assist/con intubat-intubated 06:41am blood type-art temp-35.7 peep-5 po2-137* pco2-110* ph-7.25* caltco2-51* base xs-15 intubat-intubated 05:30am blood type-art temp-35.7 tidal v-300 peep-5 po2-71* pco2-122* ph-7.17* caltco2-47* base xs-10 intubat-intubated albumin 3.1 tsh 0.48 brief hospital course: impression/plan: 25 male with h/o aml s/p bmt in , gvhd, now with new pneumothorax and hypercarbic respiratory failure. # hypercarbic respiratory failure: though pt has no established history of lung disease, suspect that his hypercarbia has been a chronic issue. his pco2 of 112 caused ph of only 7.29, and serum bicarb of 45, suggesting chronic process. possible causes of hypercarbia considered include sedation from meds--pt had been getting fentanyl, dilaudid and ativan; question of myopathy/neuromuscular disease (? steroid myopathy or chemo-induced myopathy); and/or obstructive lung disease. his pain meds were decreased without much effect on his respiratory status. he was evaluated by neurology regarding question of neuro-muscular disease. an emg was performed which which showed mild, generalized myopathic process without denervating features; however, the study was limited. ptx was treated w/ chest tube on , pt noted to be increasingly tachypnic and fatigued. gas showed worsening hypercarbia (see results section). ct chest was performed, which showed persistent hydro-pneumothorax as well as non-specific ground-glass opacities & tree & structures. he was tried on bipap w/o improvement in respiratory status. thus, in early am of , he was intubated. he was started on ac 300 x 26, with some improvement in his co2@ to the 80's. he was maintained on light sedation. an a-line was placed. his pulonary physiology was consistent with severe obstructive process (high peak pressures, low plateaus, and auto-peep of ~13). pt does not have h/o reactive airway disease or copd. question of gvhd related lung disease raised. infectious process also possible cause (? pcp/viral (partic adeno, cmv)/fungal). pt was started on linezolid and zosyn for coverage of possible pna, though no clear infiltrate on ct. # pneumothorax: no history of this before. pt had chest tube placed at hospital and transferred to (as on divert). he was admitted to the micu team. ct surgery consulted. they adjusted chest tube with initial improvement in respiratory status & improvement of cxr. chest tube placed to suction. small air leak noted. pleural fluid studies sent. gram stain negative as were cultures. fluid bloody. tube draining >150cc daily until , day of transfer, when it was putting out more ~20 cc of bloody fluid. he needs to have chest tube evaluated by thoracics to see if it needs to be readjusted or pulled. . # aml: he is s/p bmt, apparently in remission. spoke to his oncologist, dr at . immunosuppresive medications were continued as were his prophylactive anti-biotics, atovaquone & voriconazole. question of gvhd. lfts were checked for ? of gvhd as well (see results). hematology consulted for question of gvhd in lung. they felt like this was certainly possible and recommended bronchoscopy/vats to get tissue diagnosis. # pain: low dose dilaudid and fentanyl patch. # leukocytosis: appears be a chronic issue per rehab notes. he just finished a course of levo/flagyl for unclear reasons, and no cultures were positive there. here his bld cx was positive for enterococcus, sensitive to vancomycin. however, since he was allergic to this he was started on linezolid. while on this medication, his counts will need to be monitored. zosyn was also started for concern of pna as an infectious source. # r. corneal tear: diagnosed prior to admission. pt continued on cipro eye gtt. # depression: continue celexa and remeron # nausea: his tube feed have recently been on hold due to high residuals. these were slowly restarted day prior to transfer and he is still below goal. cont to increase tf's and check residuals; can use reglan as needed to help w/ motility. . # tachycardia: has been on metoprolol. unclear if related to ptx, pain, hypoxia or a combination. # fen: tube feeds as tolerated; regular diet, reglan # ppx: sc heparin, tums # code: full # communication: father medications on admission: atovaquone, calcium, cipro eye gtt, citalopram, colace, fentanyl patch, folate, lasix, neurontin, levoflox, ativan, reglan, lopressor, mirtazapine, mvi, mmf, prednisone, senna, tacro, zosyn, urodiol, valtrex, vori, albuterol/ipratrop, lactulose, dilaudid discharge medications: 1. atovaquone 750 mg/5 ml suspension sig: five (5) ml po bid (2 times a day). 2. ciprofloxacin 0.3 % drops sig: one (1) drop ophthalmic daily (daily). 3. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 4. voriconazole 50 mg tablet sig: two (2) tablet po q12h (every 12 hours). 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 6. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) inhalation q4h (every 4 hours) as needed. 7. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 8. collagenase 250 unit/g ointment sig: one (1) appl topical daily (daily). 9. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 10. fentanyl citrate (pf) 0.05 mg/ml solution sig: 25-100 mcg/hr injection infusion (continuous infusion). 11. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 12. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 13. hydromorphone (dilaudid) 0.5-1 mg iv q6h:prn hold for rr<12, sedation 14. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 15. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 16. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 17. linezolid 600 mg iv q12h 18. magnesium oxide 400 mg tablet sig: one (1) tablet po bid (2 times a day). 19. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). 20. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 21. midazolam 5 mg/ml solution sig: 0.5-2mg injection titrate to (titrate to desired clinical effect (please specify)). 22. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 23. therapeutic multivitamin liquid sig: five (5) ml po daily (daily). 24. mycophenolate mofetil 200 mg/ml suspension for reconstitution sig: 500mg po bid (2 times a day). 25. ondansetron 4 mg iv q8h:prn 26. piperacillin-tazobactam na 4.5 gm iv q8h 27. senna 8.6 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 28. tacrolimus 0.5 mg capsule sig: one (1) capsule po q12h (every 12 hours). 29. ursodiol 300 mg capsule sig: one (1) capsule po tid (3 times a day). 30. valacyclovir 500 mg tablet sig: one (1) tablet po daily (daily). 31. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care discharge diagnosis: 1. hydropneumothorax 2. hypercarbic respiratory failure secondary: 1. aml s/p bmt discharge condition: critical discharge instructions: transfer to micu for respiratory failure and care under his primary hematologist, dr. . followup instructions: please f/u with dr. of procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization transfusion of packed cells injection or infusion of oxazolidinone class of antibiotics diagnoses: depressive disorder, not elsewhere classified bone marrow replaced by transplant gastrostomy status chronic respiratory failure other specified alveolar and parietoalveolar pneumonopathies acute myeloid leukemia, in remission 

Answer: The patient is high likely exposed to