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: heparin agents attending: chief complaint: night sweats, fevers, weight loss, abnormal cbc major surgical or invasive procedure: bone marrow biopsies (iliac crest and sternal) lumbar puncture and intrathecal chemotherapy cvc placement history of present illness: mr. is a 42-year-old gentleman with a history of anxiety who was in his usual state of health until roughly three weeks ago. at that time he started to feel increasingly fatigued. he noted that he was short of breath, even with minimal exertion, which was unusual for him. he also started to develop chills and drenching night sweats. about two weeks ago he started to notice a pain in his left side. last week he saw his pcp who thought he had a uri and a muscle strain and he was started on avelox and percocet. since then he has had intermittent nausea and vomiting. this was thought be secondary to the avelox so his antibiotics were switched two days ago (he cannot recall to what). he has continued to have nausea with minimal vomiting. his appetite and po intake have been poor. for the last week he has had fevers nightly to 100.2 and the drenching night sweats have continued. he returned to his pcp on day of admission who sent a cbc which was significant for anemia and thrombocytopenia, as well as a wbc of 16 with an abnormal differential. he was sent in the ed for further evaluation. per patient's report, he has had "normal blood work" in the past and has never been anemic. . prior to the last few weeks, he was feeling well. he has not had any other illnesses recently. he denies any headaches or visual changes. he has shortness of breath when climbing up the stairs or performing basic adls. he notes intermittent chest tightness that "comes and goes" which is more chronic for him. he had an episode of diarrhea yesterday. no blood in his stool. no urinary symptoms. no gingival bleeding or epistaxis. he has not noted any rash. no lower extremity edema. past medical history: anxiety and seasonal allergies social history: patient is divorced. he has two kids aged 16 and 14. he is from and lives in . he is self-employed and owns a concession in . he denies exposure to chemical, toxins, heavy metals. he has never smoked and drinks alcohol socially. he started using intra-nasal cocaine during the past year, last used in mid-. family history: father - cad, cabg at 43, died of sclc earlier this year mother - renal failure, s/p transplant 1 brother, 2 sisters - all healthy 2 children are healthy no other fh of malignancy, leukemia, lymphoma physical exam: : 100.8 hr: 90 bp: 119/71 rr: 18 sat: 93% ra, 95% 2l nc gen: nad, diaphoretic heent: perrla, eomi, sclerae anicteric. op - petechiae over posterior palate neck: supple lymph: no supraclavicular, submandibular, cervical or axillary lad resp: ctab cv: rrr, no mrg appreciated abd: + bs, soft, obese, ttp in luq extending around to l flank, + splenomegaly : non-tender to palp over spine, paraspinal muscles ext: no edema or calf tenderness skin: petechiae over lower extremities neuro: aao x 3, answering questions appropriately pertinent results: 12:00am glucose-100 urea n-16 creat-0.7 sodium-136 potassium-3.9 chloride-101 total co2-26 anion gap-13 12:00am alt(sgpt)-20 ast(sgot)-49* ld(ldh)-1755* alk phos-81 tot bili-0.8 dir bili-0.2 indir bil-0.6 12:00am albumin-3.7 calcium-8.3* phosphate-4.1 magnesium-2.1 uric acid-6.4 12:00am haptoglob-275* 12:00am wbc-10.0 rbc-2.40* hgb-7.5* hct-21.0* mcv-88 mch-31.1 mchc-35.5* rdw-17.6* 12:00am neuts-8* bands-3 lymphs-36 monos-0 eos-0 basos-0 atyps-4* metas-1* myelos-0 other-48* 12:00am hypochrom-normal anisocyt-1+ poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 12:00am plt smr-very low plt count-23* 12:00am pt-15.8* ptt-27.4 inr(pt)-1.4* 12:00am fdp-10-40* 12:00am fibrinoge-594* echo : the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef 60-70%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the ascending aorta is moderately dilated. the aortic arch is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. ct torso impression: 1. enlarged and fatty liver. 2. massive spleen. nonspecific hyperdensity in the posterior aspect of the spleen. 3. prominent lymph nodes in the porta hepatis, and portacaval lymph node, with a large number of small retroperitoneal lymph nodes. 4. left kidney is low positioned, but likely from an enlarged spleen. 5. small left fat-containing hernia. 6. transverse colon compressed below the tip of the spleen, of uncertain clinical significance, correlate with clinical symptoms (if any). mri head : impression: focal acute infarction which appears to be cortically-based, in a non-arterial vascular distribution involving the left frontal and parietal lobes. susceptibility artifact in the overlying veins and superior sagittal sinus is concerning for venous thrombosis. the findings likely represent acute venous infarction. a tiny focus of t1 hyperintensity in the left temporal lobe may represent a small focus of hemorrhage, which progresses rapidly to become much larger on the subsequent head cts. a wet was given by the resident to brit guims at 5:10 p.m. on stating "cortically based infarct dwi/adc abnormality in the left parietal area involving pre- and mainly post-central gyrus area consistent with acute infarct. gre blooming in the left m4 cortical branches may indicate clot and seen to vertex." an additional describing the venous nature of the acute infarct and acute thrombosis of cortical veins and the superior sagittal sinus was given to dr. (neurology service) at 11:00 a.m. on , and the findings were fully discussed with dr. , by dr. , shortly thereafter. ct head : large hemorrhagic transformation of left mca territory infarct with severe increased edema and rightward shift of midline structures to 7 mm, up to 4 mm. new hyperdense focus medial to existing hemorrhage measuring 4 x 5 mm. possible left uncal herniation also. ct head : stable extent of large hemorrhage in the left frontoparietal lobes with stable rightward shift of midline structures. no new areas of hemorrhage seen. ct head : 1. evolution of left frontoparietal hemorrhage with increased rightward shift from 6 to 12 mm. 2. no new hemorrhage. 3. basal cisterns are preserved. 4. enlargement of temporal of right lateral ventricle is suggestive of subfalcine herniation. ct abdomen and pelvis with contrast : 1. splenomegaly with a moderate-to-large wedge-shaped area of hypoperfusion and a smaller ovoid area posteriorly of hypoperfusion, both of which most likely represent splenic infarct. 2. minimally prominent bowel wall involving the descending colon with adjacent mesenteric stranding. this appearance is nonspecific, given the descending colon is entirely decompressed. however, this might be consistent with the patient's clinical history of c. diff colitis. brief hospital course: the patient is a 42-year-old gentleman with a history of anxiety who presented from hospital with fevers, night sweats, weight loss, and a peripheral smear showing 30% blasts. he was admitted to bmt service for work-up and treatment of all. . acute leukemia: patient with 30% blasts on peripheral smear and differential suggestive of acute leukemia. upon admission, mr. was started on ivf and allopurinol. he was treated supportively with red cell and platelet transfusions. serial cbcs, tumor lysis labs, and coagulation profiles were sent to rule out tumor lysis and dic. he underwent and echocardiogram, ekg, and screening ct scan; triple lumen was placed in right ij. bone marrow biopsy on day 1 of admission showed acute lymphoblastic leukemia. patient was offered enrollment in clinical trail df#06-254 for treatment of adult all, and he accepted. a sternal bone marrow aspirate was performed. on day #2 of trial, patient had lp with intrathecal ara-c, and he was started on methyl-prednisolone 27mg q8. he underwent treatment with vincristine, doxorubacin, peg l-asparaginase per protocol for all. upon discharge, he is day 48 of protocol. repeat bone marrow biopsy was not performed at this time given the patient's overall condition, and the fact that given his elevated liver enzymes, he would not be a candidate to undergo further therapy at this time. however, a repeat bone marrow biopsy may be performed in the future should the patient's condition improve. he will follow-up with his oncologist dr. on for further management. . central venous thrombosis /hemorrhagic conversion while on bmt service on in the morning, the patient was noted to be less responsive with global aphasia and right sided hemiparesis. mri at the time showed evidence for ischemic stroke in the left parietal lobe. upon transfer to the around 5pm, he was globally aphasic, making purposeless movements on the left side but not moving his right, with upgoing toes on right (+ babinksi). ct on arrival to icu revealed massive hemorrhagic transformation of left mca territory infarct with severe increased edema and rightward shift of midline structures. en route to the icu from ct, mr. became extremely flushed, diaphoretic and nauseous, likely secondary to increased intracranial pressure from massive bleed and edema, and he began vomiting. due to inability to protect his airway, he was intubated with anesthesia at the bedside. due to intense systolic hypertension at the time of intubation (sbp 223) he received 20mg iv hydralazine as well as sedation with fentanyl, propofol and midazolam which normalized his blood pressures. he received blood products, ffp, cryo, fibrinogen and factor vii. neurology and neurosurgery were consulted and neurosurgery considered placement of extraventricular drain to help relieve intracranial pressure and prevent impending herniation, but upon discussion with mr. family including his brother who is his health care proxy, the procedure was declined. the following day, neurology evaluation of imaging revealed superior sagginal sinus thrombosis and suggested 4 vessel angigraphy and possible angio-jet procedure to evacuate the thrombus. after discussing the long term prognosis with the family, the decision was made for the patient not to undergo the procedure. however, upon further discussion with neurosurgery and the bone marrow transplant team, a decision was made to start less invasive options -- hyperventilation and mannitol to see how the patient responds. over the next several days, the patient's condition stabilized. findings on ct of the head remained stable. the patient was successfully extubated on and was transferred back to bmt service on for further management. he was not anticoagulated due to his persistent thrombocytopenia and intracranial hemorrhage. repeat ct was performed after the patient's return to the floor and revealed worsening midline shift. however, the patient's neurological exam remained stable. neurological exam was performed every 4 hours. neurology stroke service was consulted and did not feel that radiolographic findings were more concerning. the patient continued to be able to follow simple verbal commands. however, he remained hemoplegic on the right side, other than occasional wiggle of the right toes. he also remained aphasic. however, he began to show more awareness of his environment in the last two days prior to his discharge. he was nodding appopriately to express his understanding of verbal communication. per discussion with neurology, anticoagulation is not indicated in this case and was not re-started. . hyperbilirubinemia and transaminitis: following chemotherapy, the patient was noted to have progressively increasing liver function tests and bilirubin levels. the patient was evaluated by liver consult. while etiology of hyperbilirubinemia and transaminitis were not clear, it was believed that vincristine was the most likely cause. liver biopsy was not performed given the patient's condition. total bilirubin levels peaked at 12.0, and gradually declined from there. at the time of discharge, total bilirubin levels are 2.5 and continue to decline. . fevers: in ed, patient was started on cefepime and vancomycin for neutropenic fever. blood cultures and urine cultures were negative. there was no indication of infection on ct. while in the icu, the patient also developed low grade fevers and was started on micafungin for antifungal coverage, which was subsequently switched to anidulafungin. broad spectrum antibiotics were stopped upon return to the bmt floor and resolution of patient's neutropenia as well as fevers. the patient remained afebrile. he developed low grade fevers two days prior to discharge associated with loose stools. repeat c. diff toxin test came back positive. urinalysis was also significant for 9 wbcs although no bacteria. cxr was performed and showed no evidence of acute pulmonary process. the patient was started on ciprofloxacin for empiric treatment of uti and oral flagyl plus vancomycin for treatment of c. diff colitis. urine culture came back negative and ciprofloxacin was discontinued prior to discharge. the patient should continue oral vancomycin for a 14 day total course. . anxiety: patient was continued on zoloft 200mg qd. he was given ativan prn for anxiety. . throat lesions: mr. complained of throat pain/soreness upon admission. inspection of the back of his throat revealed small nodules and erythema, suggestive of hsv reactivation. mr. was started on acyclovir for treatment of hsv. acyclovir is being continued upon discharge. . c. diff infection: while in the icu, the patient was noted to have loose stools and tested positive for c. diff infection. he underwent a 14 day course treatment with po flagyl, with resolution of his diarrhea. he again developed low grade fevers, abdominal pain and loose stools two days prior to discharge. repeat stool test for c. diff toxins came back positive. the patient was re-started on po vancomycin and po flagyl for empiric treatment of of c. diff. ct of abdomen was performed and revelealed mild wall thickening in the descending colon, but no clear evidence of colitis. he is scheduled to complete a 14 day course of po vancomycin and a 5 day course of po flagyl, after which he should be re-evaluated for persistent c. diff. oxycodone prn for given for pain contol. . splenic infarct: the patient has a ssignificant splenomegaly secondary to his all. he was noted to have two areas of splenic infarction on ct of abdomen and pelvis performed on . it is believed that infarction was caused by insufficient blood supply to his enlarged spleen. no intervention was performed. the patient was given oxycodone via g-tube as needed for pain control. . right ij vein clot: while in the icu, the patient was noted to have right upper extremity swelling. a right upper extremity ultrasound found a clot in the right internal jugular vein, which provoked by right subclavian central venous line. the patient was not anticoagulated given patient's chronic anemia and thrombocytopenia. cvl was removed. picc line was placed for hydration, tpn and administration of medications. . nutrition: the patient failed speech and swallow evaluation following his stroke. he was made npo and was transiently maintained on tpn. g-tube was successfully placed by interventional radiology service. the patient was started on eneteral nutrition by tube feeds, which he has tolerated well. medications on admission: zoloft 200mg qd discharge medications: 1. prochlorperazine maleate 10 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for nausea. 2. levetiracetam 100 mg/ml solution : five (5) ml po bid (2 times a day). 3. ursodiol 300 mg capsule : three (3) capsule po bid (2 times a day). 4. metronidazole 500 mg tablet : one (1) tablet po q8h (every 8 hours) for 4 days: last day = . 5. oxycodone 5 mg tablet : two (2) tablet po q4h (every 4 hours) as needed for pain. 6. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for fever. 7. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 8. vancomycin 250 mg capsule : one (1) capsule po q6h (every 6 hours) for 14 days: day 1 = last day = . discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: acute lymphocytic leukemia, central venous thrombosis with hemorrhagic conversion, hyperbilirubinemia and transaminitis, c. diff colitis. discharge condition: afebrile, vitals stable, aphasia and right hemiplegia able to follow simple verbal commands unable to ambulate discharge instructions: you were admitted to the hospital for treatment of your acute lymphocytic leukemia. you underwent treatment with chemotherapy per protocol. subsequently, you developed elevated liver function tests, which is a sign of liver inflammation. you also suffered a stroke (central venous thrombosis with hemorrhagic conversion) that left you paralyzed on right side of the body and unable to speak. you were intubated for protection of your airway and monitored closely in the intensive care unit, where you were treated with mannitol and hyperventilation to reduce your brain swelling. you neurological function slowly improved, but you continue to have many neurological deficits as a consequence of your stroke. you are now being discharged for neurological rehabilitation. we started you on the following medications: 1. prochlorperazine maleate 10 mg tablet po q6 hours as needed for nausea. 2. levetiracetam 100 mg/ml solution : five (5) ml po bid (2 times a day). 3. ursodiol 300 mg capsule : three (3) capsule po bid (2 times a day). 4. metronidazole 500 mg tablet : one (1) tablet po q8h (every 8 hours) for 4 days: last day = . 5. oxycodone 5 mg tablet : two (2) tablet po q4h (every 4 hours) as needed for pain. 6. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for fever. 7. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 8. vancomycin 250 mg capsule : one (1) capsule po q6h (every 6 hours) for 14 days: day 1 = last day = . you should continue to take nothing by mouth. you will receive nutrition via tube feeds. you have a follow-up appointment with dr. (see below). you should return to the emergency room should you develop any of the following: fevers over 101f, chills, unresponsiveness, severe pain not releaved by medications, new neurological deficits. followup instructions: you have an appointment with your oncologist dr. on at 1:00 pm in clinical center . md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] biopsy of bone marrow biopsy of bone marrow injection or infusion of cancer chemotherapeutic substance injection of other agent into spinal canal diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified anemia, unspecified anxiety state, unspecified intestinal infection due to clostridium difficile cerebral edema other disorders of neurohypophysis other malaise and fatigue aphasia acute lymphoid leukemia, without mention of having achieved remission jaundice, unspecified, not of newborn herpes simplex with other specified complications cerebral thrombosis with cerebral infarction dyspepsia and other specified disorders of function of stomach acute venous embolism and thrombosis of internal jugular veins hemiplegia, unspecified, affecting dominant side 

Answer: The patient is high likely exposed to