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: penicillins / keflex attending: chief complaint: dizziness, pleuritic chest pain major surgical or invasive procedure: none. history of present illness: 68m last chop for t-cell 2 weeks ago, lle dvt, h/o melanoma and nephrolithiasis p/w fevers, joint aches, no localizing sx x 2 days. patient reports that he was feeling "generally unwell" and he took his temperature this afternoon and found it to be 101.7. he called the oncology dept that advised her come into the ed. patient reports some subjective chills and dizziness, but no other symptoms. he denies fevers, nausea, vomitting, diarrhea, headaches, neck pain, abdominal pain, chest pain and shortness of breath. . review of systems is otherwise negative. . in the emergency department labs were notable for leukocytosis. urinalysis and cxr were unremarkable. patient had a transient episode of hypotenstion to the 70s that responded with fluids to the 90s. vs on transfer hr 85, rr 10, 97 2l, bp 95/49. other than 2l ns, patient received vanco 1gx1, aztreonam 2 g x1, and tylenol. past medical history: oncologic history: mr. is a 68 yo male who developed left inguinal swelling in while in , where it was attributed to a hernia. upon his return to the us in early , his pcp suspected left inguinal lymphadenopathy and arranged for excisional biopsy of a part of a lymph node. this revealed reactive changes. he was admitted to the on with worsening left groin swelling and pain related to worsening lymphadenopathy, abdominal pain and nausea. laboratory data remarkable for elevated ldh and significant eosinophilia (as high as 30%.) ct imaging demonstrated bilateral basilar pulmonary nodules and significant lymphadenopathy involving the retroperitoneal, pelvic, and left iliac chains. infectious disease work-up was unremarkable. the ct findings, along with elevated ldh, raised concern about a lymphoproliferative disorder. spep revealed monoclonal gammopathy, which was comprised of igg lambda and constituted 1600 mg/dl. pet scan demonstrated intensely fdg avid in the left cervical (suv 18), right axillary (suv 5), left supraclavicular (suv 17), left paratracheal (suv 13), retroperitoneal (suv 22,) and left inguinal (suv 25) lymph node groups. . mr. repeat excisional biopsy of an fdg-avid inguinal lymph node on . flow cytometry revealed atypical lymphohistiocytic infiltrate highly suggestive of peripheral t-cell lymphoma nos. on histological examination, the lymph node architecture was completely effaced with a background of epithelioid histiocyte granulomatoid aggregates. intermingled was an atypical lymphoid population that stained positive for cd2, 3, and 5 with dual loss of cd4 and cd8 and loss cd7. the combined morphologic and immunophenotypic picture was most consistent with peripheral t-cell lymphoma, nos. staining was negative. igh gene rearrangement failed to show monoclonality. tcr rearrangement, on the other hand, was monoclonal. . other past medical history: 1. melanoma, right arm excised in . 2. question of history of histoplasmosis. 3. right shoulder surgery for fracture and dislocation . 4. kidney stones 40 years ago. social history: typically splits his time between , and . spent the majority of the past five years in where his wife of several years works as a physician. frequently traveled to over the past 25 years. patient also has a strong social support network of friends in . patient has traveled to western europe; used to smoke a pipe, 5 bowls per day x30 years. currently living with his son and in law plus their children here in . he used to be an alcoholic but has been sober since . he is a retired school teacher and used to teach in , . he has one healthy pet dog in who "plays rough" after roaming the streets/markets of . his son and daughter in law have a dog he is not intimately involved with and mainly licks. family history: breast cancer in mother, throat cancer in father, and coronary artery disease in brothers. physical exam: t=100.5 bp= 85/53 hr=75 rr=17 o2= 94% ra general: pleasant, well appearing man in nad heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. op clear. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . lungs: crackles right base abdomen: nabs. soft, nt, nd. no hsm extremities: no edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. chest midline in place c/d/i skin: no rashes/lesions, ecchymoses. neuro: a&ox3. appropriate. cn 2-12 grossly intact. pertinent results: urine color-yellow appear-clear sp -1.024 urine blood-lg nitrite-neg protein-25 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-neg urine rbc-0-2 wbc-0-2 bacteria-few yeast-none epi-0-2 . glucose-109* urea n-15 creat-1.0 sodium-131* potassium-4.6 chloride-96 total co2-24 anion gap-16 . wbc-25.7*# rbc-3.73* hgb-11.8* hct-34.2* mcv-92 mch-31.6 mchc-34.5 rdw-15.5 neuts-78* bands-3 lymphs-8* monos-4 eos-0 basos-0 atyps-1* metas-3* myelos-2* promyelo-1* nuc rbcs-1* plt count-277 . pt-12.6 ptt-31.6 inr(pt)-1.1 . 6:50 pm blood culture blood culture, routine (final ): capnocytophaga species. presumptive identification. . cta, abdomen and pelvis: impression: 1. no evidence of acute pulmonary embolism. 2. bilateral lower lobe consolidation, likely representing pneumonia, right more than left. diffuse nodular and patchy opacities throughout the lungs, especially in the middle lobes, consistent with infectious or inflammatory etiology. 3. emphysema. 4. precarinal, left paratracheal and right hilar lymph nodes measuring about 1.2 cm in short axis. 5. left renal cyst. 6. left inguinal partially imaged cystic lesion, this may represent a lymphocele. clinical correlation is recommended. 7. left seminal vesicle with minimal surrounding fat stranding which measures up to 3.6 x 2.7 cm. clinical correlation for acute pain is recommended. . chest ultrasound: impression: small bilateral pleural effusions, right greater than left. superinfection cannot be excluded. . ct chest: 1. increased size of mediastinal nodes likely reactive. pre-existing micronodules have become more confluent and consolidative. this is most likely an infective process and the differential includes an acute (bacterial) on chronic (atypical - for example, atypical mycobacterial) infection. recommend followup ct scan after treatment. 2. new small pericardial effusion. brief hospital course: 68 yo m with t cell lymphoma (+ monoclonal gammopathy), recent lle dvt (now on anticoagulation) presents with fevers/chills, arthralgias/myalgias, headaches and now diarrhea with epigastric pain and abnormal cxr. patient was hypotensive but responsive to fluids in the ed, called out of the after uneventful overnight stay (spiked temp of 102.8). . while in the , the patient was started on vancomycin, aztreonam and oseltamavir. oseltamavir was discontinued when the patient's influenza swabs returned negative. bactrim was continued for pcp . . #. sirs/hypotension: most likely infectious etiology given fevers, myalgias/arthralgias, leukocytosis. patient was likely also hypovolemic in the ed, . patient was continued on intravenous fluids as his blood pressures would dip into sbp85-90s whenever intravenous fluids were discontinued. by wednesday, , patient's ivf were discontinued as he had a new oxygen requirement the weekend prior felt partially due to fluid overload. patient was initially continued on vancomycin and aztreonam. when he continued to spike temperatures, his coverage was broadened to voriconazole. patient continued to spike temperatures through thursday, so levofloxacin was added. on friday, , blood cultures drawn on the second day of hospitalization came back positive for gram negative rods, likely capnocytophaga. infectious disease, who was already following the patient, recommended ceftriaxone or clindamycin (given patient's allergies to penicillin and keflex). upon initiation of clindamycin, patient's fever curve decreased and resolved within two days. patient was sent home on clindamycin and levofloxacin. of note, capnocytophaga is a gram negative rod organism found in canines which has been found to cause fulminant sepsis in asplenic patients. it has also been found to infect other immunocompromised populations. upon further questioning, the patient has a dog at his son's home where he lives which he does not interact much with; the dog mainly licks. the patient has a dog in , however, who plays rough. it routinely roams the city's meat/fish/fruit markets and then comes home to bite the patient. . #. pneumonia: chest xrays and ct chest confirmed evolving pneumonia. it is unclear if capnocytophaga was the cause of the pneumonia, as only 20 such cases have been documented. patient developed tachycardia, hypotension, oxygen requirement and low-grade temperatures on saturday, . cta was negative for pulmonary embolism and ct abdomen/pelvis did not show interval change in lymphadenopathy suggestive of worsening disease. pulmonary was consulted and patient bronchoalveolar lavage on monday, which did not yield any infectious etiology. patient was negative for fungi, legionella, pcp . chest ultrasound showed that the patient's pulmonary effusions were trace/small and non-tappable. patient was continued on levofloxacin with good effect and repeat ct chest showed interval improvement in bibasilar consolidations. . # visual disturbances/hallucinations: patient was started on voriconazole for broad pulmonary infection coverage and the day after initiation, he complained of bright white spots and auras around black window frames, words etc. he also described non-threatening visual hallucinations, such as people standing by his bed. as patient continued to have these visual changes, ct head was ordered which did not show any acute changes. neurology was consulted, who revealed a history of ecstacy and other illicit drug use. it was felt that voriconazole and possible, iv morphine was causing patient's visual changes. voriconazole was discontinued with good effect. patient's morphine use was also minimized. . # insomnia: patient had frequent difficulty sleeping. after trying various combinations of medications, patient appeared to respond best to ativan 1 mg and oxycontin 10mg before bed. . #. diarrhea: given recent antibiotics use, chemotherapy and elevated white count, concern for c.diff. patient was ordered for cdiff stool toxin assays which were negative and patent's diarrhea resolved. . #. dvt: patient was continued on his home lovenox without any issues. . #. t cell lymphoma: patient received his fifth cycle of chop-14 on tuesday, after resolution of his infectious process. patient tolerated chop-14 well without any nausea. . code status: full code, discussed with patient (would not want prolonged intubation) medications on admission: enoxaparin - 100 mg/ml syringe - 1 syringe(s) sc daily lorazepam - 0.5 mg tablet - tablet(s) by mouth every 6 hours as needed for nausea ondansetron hcl - 8 mg tablet - 1 tablet(s) by mouth three times a day as needed for nausea oxycodone - 5 mg capsule - capsule(s) by mouth every 6 hours as needed for pain prednisone - 50 mg tablet - 1.5 tablets with chemo prochlorperazine - 10 mg tablet - 1 tablet(s) by mouth every 6 hours as needed for nausea medications - otc bisacodyl - 5 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day as needed for constipation docusate sodium - 100 mg capsule - 1 capsule(s) by mouth twice per day as needed for constipation senna - (prescribed by other provider) - 8.6 mg tablet - 1 tablet(s) by mouth twice a day discharge medications: 1. enoxaparin 100 mg/ml syringe sig: one (1) injection subcutaneous daily (daily). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 3. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po qmowefr (monday -wednesday-friday). 4. levofloxacin 750 mg tablet sig: one (1) tablet po once a day for 5 days: last day: monday, . disp:*5 tablet(s)* refills:*0* 5. lorazepam 1 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. disp:*30 tablet(s)* refills:*0* 6. prednisone 50 mg tablet sig: two (2) tablet po daily (daily) for 3 days: last day: saturday, . disp:*3 tablet(s)* refills:*0* 7. compazine 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. disp:*20 tablet(s)* refills:*0* 8. zofran 8 mg tablet sig: one (1) tablet po three times a day. disp:*12 tablet(s)* refills:*2* 9. clindamycin hcl 150 mg capsule sig: three (3) capsule po four times a day for 9 days: last day: thursday, . disp:*108 capsule(s)* refills:*0* 10. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po qhs (once a day (at bedtime)) as needed for insomnia. disp:*30 tablet sustained release 12 hr(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: pneumonia, blood stream infection secondary diagnosis: peripheral t cell lymphoma, history of melanoma and histoplasmosis discharge condition: improved. vital signs are stable and patient has been afebrile. patient ambulating and taking po. discharge instructions: -you were admitted with chills, shortness of breath, pain with breathing and general aches. you were found to have a pneumonia and an infection of the blood stream (capnocytophaga). you were treated with antibiotics for both, with improvement in your symptoms. while you were in the hospital, we also gave you your fifth cycle of your chop chemotherapy which you tolerated well. . -it is important that you continue to take your medications as directed. please resume your lovenox injections, bactrim ds (taken every monday/wednesday/friday), protonix. we added the following medications: --> continue prednisone 100mg daily for 3 more days (last day: saturday, ) --> continue levofloxacin 750mg daily, for 5 more days (last day: monday, ) --> continue clindamycin 450mg every 6 hours, for 9 more days (last day: thursday, novmber 26) --> start zofran 8mg three times a day, even if you are not nauseated --> start compazine 10mg every 6 hours as needed for nausea --> start lorazepam 1mg before bed as needed to help you sleep --> start oxycontin 10mg before bed as needed to help you sleep . -contact your doctor or come to the emergency room should your symptoms return. also seek medical attention if you develop any new fever, chills, trouble breathing, chest pain, nausea, vomiting or unusual stools. followup instructions: you have an appointment to with drs. and on friday, at 11 am. you will get your neulasta at that appointment. the heme/ clinic is in the clinical center, . you can reach their office at: . . you also have another appointment with dr. on tuesday, at 11 am. ** please discuss with dr. on friday if you need to make this appointment. ** procedure: closed [endoscopic] biopsy of bronchus injection or infusion of cancer chemotherapeutic substance diagnoses: pneumonia, organism unspecified other opiates and related narcotics causing adverse effects in therapeutic use sepsis antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use other emphysema long-term (current) use of anticoagulants other septicemia due to gram-negative organisms personal history of venous thrombosis and embolism diarrhea hypovolemia personal history of malignant melanoma of skin insomnia, unspecified antifungal antibiotics causing adverse effects in therapeutic use drug-induced psychotic disorder with hallucinations polyneuropathy due to drugs peripheral t cell lymphoma, lymph nodes of multiple sites 

Answer: The patient is high likely exposed to