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: sulfa (sulfonamide antibiotics) / cefaclor / erythromycin attending: chief complaint: fevers, rigors, and abd pain major surgical or invasive procedure: none history of present illness: patient is a 27 year old male with history of polysubstance abuse who presented to the ed with fevers, chills, abdominal pain. on saturday, the patient was using oxycontin iv, on one occasion using toilet water to inject the drug. the next morning, woke up with a "tight" stomach. after drinking fluids, felt better and went out to a bar where he consumed ~16oz of rum. he felt weak, then was nauseous and had 4 episodes of vomiting, unsure if it was bloody or not. at this time, developed chills and abdominal pain radiating from the epigastrium to the back. . in the ed, initial vs were: t p 130 bp r o2 sat. he was noted to have a 1cm raised nonerythematous or fluctuant area in his right antecubital fossa with diffuse erythema. ecg was read as sinus tach. cbc with wbc 1. lactate 3.8. cxr normal. he received vanco/zosyn, 4l ns. spiked to 101.1 received motrin, 1g tylenol. has 18g piv x 2. 101.1 103 109/63 22 98%2l. . on the floor, patient still complains of abdominal pain, but no fevers or chills. of note, the patient does admit to a recent detox stay at hospital from heroin. he does admit to increased sleepiness and malaise prior to saturday. . review of systems: (+) per hpi - also positive for sob, difficulty urinating, drenching night sweats. (-) denies recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies shortness of breath, or wheezing. denies palpitations, or weakness. denies diarrhea, constipation, or changes in bowel habits. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: bipolar disorder hernia repair social history: - tobacco: 2ppd x 10 yrs - alcohol: 1 pint of rum/vodka per day - illicits: oxycontin - 7 30mg pills on saturday, prior history of cocaine and heroin iv. - sexual activity in past with men and women, no condom usage - denies jail time, has been homeless for 1 summer at age 18 family history: adopted pertinent results: 08:10pm blood wbc-1.0* rbc-5.39 hgb-16.0 hct-46.1 mcv-86 mch-29.7 mchc-34.7 rdw-13.4 plt ct-177 08:10pm blood neuts-68 bands-6* lymphs-25 monos-0 eos-1 baso-0 atyps-0 metas-0 myelos-0 03:00am blood wbc-11.4*# rbc-4.67 hgb-14.0 hct-39.6* mcv-85 mch-30.0 mchc-35.3* rdw-13.5 plt ct-119* 03:00am blood neuts-90* bands-4 lymphs-3* monos-1* eos-0 baso-0 atyps-0 metas-2* myelos-0 10:15am blood wbc-17.0* rbc-4.44* hgb-13.5* hct-37.3* mcv-84 mch-30.4 mchc-36.2* rdw-13.6 plt ct-111* 08:10pm blood hypochr-normal anisocy-normal poiklo-normal macrocy-normal microcy-normal polychr-normal 08:10pm blood pt-13.7* ptt-30.1 inr(pt)-1.2* 03:00am blood pt-15.1* ptt-36.5* inr(pt)-1.3* 08:10pm blood glucose-73 urean-16 creat-1.4* na-140 k-3.6 cl-101 hco3-24 angap-19 03:00am blood glucose-109* urean-15 creat-1.4* na-139 k-4.1 cl-110* hco3-21* angap-12 10:15am blood glucose-110* urean-13 creat-1.1 na-141 k-3.7 cl-109* hco3-20* angap-16 08:10pm blood alt-122* ast-326* ld(ldh)-413* ck(cpk)-157 alkphos-122 amylase-49 totbili-0.9 10:15am blood alt-99* ast-81* ld(ldh)-248 alkphos-92 totbili-0.9 08:10pm blood albumin-4.2 calcium-10.2 phos-1.6* mg-1.5* 03:00am blood calcium-8.6 phos-1.3* mg-1.3* 10:15am blood calcium-9.3 phos-2.2* mg-1.9 03:00am blood cortsol-20.6* 03:00am blood hbsag-negative hbsab-positive hbcab-negative igm hav-negative 03:00am blood hiv ab-negative 08:10pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 03:00am blood hcv ab-negative 08:57pm blood lactate-3.8* 10:55pm blood lactate-1.9 03:32am blood lactate-2.3* 11:45pm urine color-yellow appear-clear sp -1.012 11:45pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 11:45pm urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-pos . 8:10 pm blood culture left hand. blood culture, routine (pending): . 8:45 pm blood culture #2. blood culture, routine (pending): . 3:00 am immunology source: venipuncture. hiv-1 viral load/ultrasensitive (pending): . 2:56 am mrsa screen source: nasal swab. mrsa screen (pending): . 4:10 am urine n. **final report ** legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. . 3:00 am serology/blood chm s# s h/pylori added . helicobacter pylori antibody test (pending): . ecg: sinus tachycardia. no previous tracing available for comparison. . cxr (pa and lat): comparison: none. findings: there is increased opacity in the region of the right middle/lower lobe. the left lung is clear. no pneumothorax or pleural effusion is present. cardiac silhouette is top normal in size. hilar and mediastinal contours appear normal. impression: developing right middle/lower lobe opacity concerning for infection. . tte: the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 0-10mmhg. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50-55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). the right ventricular cavity is mildly dilated with borderline normal free wall function. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: low normal biventricular systolic function. mild right ventricular dilation. no vegetation seen. . cxr (portable): there is minimal interval progression of the interstitial prominence, findings that might be consistent with volume overload, especially given the distention of the azygos vein. the right lower lung opacity adjacent to the right cardiac border may be a part of the volume overload but it may represent focus of developing infection as well, and should be reevaluated after diuresis. the heart size is top normal which in part may be explained by the portable technique of the study. there is no pneumothorax. there is small amount of right pleural effusion present, better appreciated on the current study. impression: volume overload/mild interstitial pulmonary edema. those findings may potentially mask underlying infection and reevaluation of the patient after diuresis is highly recommended. . ct abd/pelvis w/contrast: ct abdomen: there are bilateral small nonhemorrhagic pleural effusions, with associated compressive atelectasis, right greater than left. interlobular septal thickening is also present, suggestive of volume overload. the heart is normal in size without pericardial effusion. the liver demonstrates no focal lesion. the gallbladder, spleen, a tiny splenule, pancreas, and adrenal glands appear unremarkable. bilateral kidneys enhance symmetrically without hydronephrosis or hydroureter. stomach, duodenum, small and large bowel loops are normal in caliber. there is no free air or free fluid. there is no mesenteric or retroperitoneal lymphadenopathy. great vessels are normal in caliber and patent. ct pelvis: the bladder is partially collapsed. the distal ureters, prostate gland, and rectum appear unremarkable. there is contrast progression into the transverse colon. there is no inguinal or pelvic lymphadenopathy. there is no free fluid within the pelvis. bone window: a bone island is noted in the right femoral head. no suspicious focal, lytic, or blastic lesions. impression: 1. pulmonary interlobular septal thickening and small bilateral pleural effusions with associated compressive atelectasis, right greater than left. these findings are suggestive of volume overload. 2. no evidence of acute process within the abdomen or pelvis. brief hospital course: micu course 27 y/o male with history of polysubstance abuse and msm who presents with fevers, chills, abdominal pain after shooting oxycontin with toilet water followed by a large amount of alcohol intake. # fevers, rigors, chest pain - the most concerning etiology was from infection after injection with toilet water, most likely bacteria include gnr and gpc, however, the timing of supposed injection of contaminated water and presentation of fever and chills was not consistent with ~24-36 hours in between events. the patient was started on vancomycin, zosyn, and levaquin to cover for gpc, gnr, atypicals, and anaerobes. his serum tox screen negative but urine tox screen positive for methadone. a tte was ordered to evaluate for any evidence of endocarditis, with a tee planned if the patient had positive blood cultures or was persistently febrile. the tte was negative, as was a ct abd/pelvis. the patient left ama with a rising white count. cultures were pending at the time the patient left ama. . # shortness of breath - this was thought to be secondary to bronchospasm from multiple possible etiologies including aspiration, asthma, septic emboli, pulmonary edema. a cxr showed evidence of pulmonary edema or early pneumonia. the patient was responsive to albuterol, which resolved his sob. he also auto-diuresed well and lasix was held for only if the patient became hypoxic or short of breath again. he left ama. . # leukopenia - the patient presented with a wbc of 1, which increased to 11 on repeat labs. the low wbc was concerning for hiv infection or sepsis. hiv serologies and viral load testing was sent (serologies negative and viral load pending). patient left with leukocytosis ama. . # abdominal pain - amylase and lipase were negative on admission. a ct a/p with po/iv contrast was obtained which did not show concerns for acute intraabdominal process. the patient's pain had resolved when he left ama. . # renal failure - unknown if this is acute or chronic as a baseline is unknown. the patient received n-ac and bicarb fluid hydration prior to his ct scan. cr had decreased to 1.1 from 1.4 at time of leaving ama. . # coagulopathy - patient has elevated inr. differential includes chronic liver disease, vitamin k deficiency. his lfts were trended and a hepatitis panel for a, b, and c was sent and returned without evidence of infection. . # alcohol abuse - patient reports intake of ~1 pint alchol daily, but denies history of withdrawal symptoms, including dts. he was started on valium for ciwa > 10. he left ama. . #opioid withdrawal - patient started on scale and given 10mg methadone for a score of 17. his symptoms improved and he was not given additional methadone in the micu. he received methadone on the floor and left ama. . # electrolytes - patient was hypophosphatemic and hypomagnesemic. differential included alcohol intake, poor po, chronic liver disease, legionella. he was repleted and his lytes were trended. . # the patient left ama despite being warned about rising white count while on broad-spectrum antibiotics raising concern for serious infection that may cause severe illness or death. he was able to understand and communicate these risks. he left ama. medications on admission: abilify 5mg trazodone 100mg clonidine 0.1 mg discharge medications: n/a discharge disposition: home discharge diagnosis: primary diagnosis: etoh and oxycontin abuse/withdrawal, right arm soft tissue infection, discharge condition: the patient left ama with a rising leukocytosis on broad spectrum antibiotics. he was instructed that by leaving ama he was placing himself at risk for severe illness and death. he communicated that he understood these risks and would leave ama regardless of the risk of death. discharge instructions: left ama. followup instructions: left ama. procedure: combined alcohol and drug detoxification diagnoses: abdominal pain, unspecified site acute kidney failure, unspecified opioid type dependence, continuous bacteremia disorders of phosphorus metabolism cellulitis and abscess of upper arm and forearm bipolar disorder, unspecified other and unspecified coagulation defects drug withdrawal alcohol abuse, continuous disorders of magnesium metabolism alcohol withdrawal leukocytopenia, unspecified shortness of breath 

Answer: The patient is high likely exposed to