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: reason for admission: the patient is a 60 year old white male with a past medical history of chronic myelogenous monocytic leukemia diagnosed in , chronic anemia, and hypertension. the patient presented to the hospital with several days of fevers as high as 102, night sweats, and cough for three weeks. this is also associated with rigors. the patient also reported decreased p.o. intake and symptoms consistent with orthopnea. on review of systems, the patient also complained of bilateral ankle and knee pain which began on the morning of admission. positive nausea, no emesis, positive chronic headaches, no abdominal pain or diarrhea, positive constipation and positive chronic low back pain. he had a three pound weight loss in the prior two weeks. past medical history: 1. chronic myelogenous monocytic leukemia diagnosed . 2. myelodysplastic syndrome diagnosed by bone marrow biopsy . 3. chronic fevers. 4. anemia. 5. hypertension. 6. history of right ankle fusion in . 7. gastroesophageal reflux disease. 8. history of cellulitis. medications on admission: 1. protonix 40 mg once daily. 2. celebrex 200 mg once daily. 3. colace 100 mg twice a day. 4. prednisone 10 mg twice a day. 5. hydroxyurea 500 twice a day. 6. fentanyl patch 75 mcg transdermally q2-3days. 7. oxycodone p.r.n. 8. allopurinol 100 mg once daily. 9. diovan 80 mg once daily. allergies: no known drug allergies. social history: the patient is married. forty pack year smoking history. he quit in . no current alcohol or drug use. physical examination: on presentation, the patient's vital signs are temperature of 98.2, blood pressure 130/70, pulse 82, respiratory rate 20. generally, the patient was in significant pain with movement. his oropharynx was clear. mucous membranes are dry. his neck had no lymphadenopathy. the heart was regular rate and rhythm without murmur, gallop or rub. the lungs were clear to auscultation bilaterally with no wheezes. the abdomen was soft, nontender, nondistended. extremities - the patient's knees were swollen and had effusion bilaterally. there was no erythema or warmth. his ankles were swollen bilaterally and tender to palpation, also without warmth or erythema. laboratory data: white blood cell count was 14.0, hematocrit 27.1, platelet count 282,000. he had 36% neutrophils and 27% bands and 39% lymphocytes. sodium was 130, potassium 3.9, chloride 92, co2 26, blood urea nitrogen 18, creatinine 1.4, glucose 176. coagulation studies were within normal limits. chest x-ray showed no active cardiopulmonary process. assessment: fever of unknown etiology. hospital course: the patient was admitted to the bone marrow transplant service for workup including pancultures and prophylactic antibiotics. the patient had an arthrocentesis of his right knee on , and it was sent for gram stain and culture. this showed no polys and no organisms. culture was pending. on hospital day two, the patient's steroids were increased. he was also seen by the rheumatology in consultation and they recommended continuing the current dose of prednisone as well as avoiding increasing the allopurinol dose. the patient was also evaluated by physical therapy on hospital day three and treatment was instituted. nursing note on , noted the patient's abdomen as being distended and firm, however, the patient's baseline. his abdomen was not tender on examination at this time. also the patient was transfused two units of packed red blood cells for a hematocrit of 22.8 which brought his hematocrit up to 27.0. on , the patient had his left knee tapped. this was also sent for gram stain and culture. this showed 6500 white blood cells and 13,000 red blood cells, 41% polys, 27% lymphocytes and 24% monocytes. his blood cultures were still no growth and pending at this point and his urine culture from , showed less than 10,000 organisms. his joint culture initially from the right knee showed no growth. on , the patient was seen by radiation oncology to evaluate his malignant knee effusion as cytology had confirmed this from prior arthrocenteses. on , the patient was started on low dose ara-c for palliation. the patient also noted on , increased swelling and pain involving the right elbow which was new. the patient was continued on this palliative chemotherapy with some symptomatic improvement. he underwent repeat bilateral arthrocentesis of both knees on . on , per the nursing note, the patient's abdomen was firmly distended with bowel sounds present. he was complaining of nausea which was treated with phenergan. poor p.o. intake due to nausea but otherwise his gastrointestinal assessment was unchanged from the patient's baseline. on , a surgery consultation was obtained due to abdominal pain. the patient began complaining of lower abdominal pain that morning. he described it as sharp and diffuse, nonradiating, associated with nausea and vomiting. the patient had no fever or chills. on examination, the patient was afebrile and his vital signs were stable. his abdomen was distended with guarding. he had diffuse tenderness to palpation although worse in the lower abdomen with positive rebound and peritoneal signs. his rectal examination was guaiac negative. chest x-ray upright showed no free air in the diaphragm and kub showed a few mildly dilated loops of bowel and no free air. the recommendations were to keep the patient npo, to start him on imipenem, to obtain a ct. assessment by the surgical attending, the patient has a surgical abdomen and he was deteriorating rapidly with a heart rate in the 160s, respiratory rate 32 on nonrebreather with oxygen saturation 90%. he was deemed too unstable to undergo a ct scan and taken to the operating room for emergency exploratory laparotomy. at the time, the patient was taken to the operating room he was on multiple pressors and nitroglycerin for hemodynamic instability. additionally, he had fluids going wide open. the family was advised of his grave prognosis and the patient was taken to the operating room where a perforated sigmoid colon was found. the patient underwent a sigmoid colectomy and sigmoid colostomy and mobilization of the splenic flexure and pouch. he had diffuse peritonitis and was hemodynamically unstable throughout the case. he had five liters of crystalloid and two units of packed red blood cells during the case. estimated blood loss was less than 400cc. the patient was transferred to the for a higher degree of intensive care unit care. at that point, he was on neo-synephrine drip, levophed drip, hydrocortisone 100 q8hours, ampicillin one q6hours, levaquin 500 mg once daily, flagyl 500 mg three times a day, acyclovir 400 mg three times a day. on postoperative day one, the patient was on dopamine 2 mcg/kg/ml, levophed 0.3 mcg/kg/minute, neo-synephrine 2.5 mcg/kg/minute. cardiac index was 3.5. his arterial blood gases showed acidosis of 7.29, pco2 39, po2 107 and base access of 6.0. his white blood cell count was 17.6 and hematocrit was 36.6. inr was 1.4. creatinine 0.9. lactate was 3.5. on examination, the patient's ostomy was dusky and had no output. later that day the patient showed deterioration with a base access of a nadir 10 and a blood pressure of 30. he was taken back to the operating room emergently for a decompressive laparotomy and lavage. the patient's hematology/oncologist was contact and advised 100 mg to control his likely cytokine release from his recent chemotherapy. the patient was decompressed and taken back to the intensive care unit in critical condition. on postoperative day two and one, the patient was on levophed 0.175, vasopressin 0.04, also on cefepime, flagyl, levaquin, ampicillin and acyclovir for his antibiotics. his white blood cell count at this point was 3.9, hematocrit 29.3, inr 1.6 and his creatinine was 0.7. the patient's abdomen was left open with a bag type dressing for closure. at this point, the patient was also developing multiorgan system failure with adult respiratory distress syndrome, and the patient was put on low protective ventilation. he was also in septic shock with a cvp of 22 and hyperdynamic with an index of 5.8 and svr of 400. later that day after discussion with the patient's oncologist as well as his family, we were all at the bedside, the patient's prognosis was felt to be nonsurvival given this catastrophic abdominal event in the setting of his recent chemotherapy and large cytokine response. it was felt that aggressive measures would be unable to salvage the situation and the decision was made with the family to change the patient's code status to comfort measures only. he was made comfortable with narcotics and his pressors were discontinued. the patient was pronounced dead at 1541 on . the patient was pronounced by dr. and the patient's family was at the bedside. report to medical examiner which waived the case. additionally, the patient's family was approached about a postmortem examination and they were inclined to do so at that point. discharge diagnoses/cause of death: 1. overwhelming sepsis secondary to chronic myelogenous monocytic leukemia. 2. gastroesophageal reflux disease. 3. hypertension. 4. anemia. 5. malignant joint effusions. , m.d. dictated by: medquist36 procedure: colostomy, not otherwise specified pulmonary artery wedge monitoring arthrocentesis arthrocentesis open and other sigmoidectomy other laparotomy injection or infusion of cancer chemotherapeutic substance diagnoses: acidosis unspecified septicemia perforation of intestine septic shock retention of urine, unspecified chronic lymphoid leukemia, without mention of having achieved remission unspecified peritonitis arthropathy associated with hematological disorders 

Answer: The patient is high likely exposed to