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: patient recorded as having no known allergies to drugs attending: chief complaint: splenic rupture major surgical or invasive procedure: emergent splenectomy history of present illness: 76ym transferred from with history of myelodysplastic syndrome. he developed abdominal pain on after a severe coughing fit. ct scan at outside hospital showed a contained splenic rupture. he was transferred to nebh for management and planned elective splenectomy on . his mental status deteriorated and he became tachycardiac and hypotensive. he was transferred here for further management. cat scan: 20cm spleen with active contrast extrav and significant free fluid in the abdomen past medical history: mds dm type 2, niddm htn chf hypercholesterolemia physical exam: hr 123 bp 124/66 13 98% 4 liters aaox3, confused s1s2 no murmurs course breath sounds abdomen tight and tense, diffusely tender pertinent results: 11:59pm wbc-11.6* rbc-3.19* hgb-10.3* hct-29.7* mcv-93 mch-32.4* mchc-34.8 rdw-16.9* 11:59pm glucose-264* urea n-45* creat-2.5* sodium-138 potassium-5.2* chloride-106 total co2-19* anion gap-18 11:59pm calcium-6.9* phosphate-7.7* magnesium-2.2 12:00am lactate-1.7 11:59pm pt-14.0* ptt-30.1 inr(pt)-1.2* brief hospital course: patient was admitted to . he was immediately typed and crossed for multiple units of blood, platelets and ffp. he was taken to the or immediately for emergent splenectomy. operative report indications for surgery: this is a 75-year-old male who presented from an outside hospital with hemodynamic shock. his history of myeloproliferative disorder was known and he had a cat scan done at the outside institution which revealed severely injured and spontaneous rupture of his spleen, as well as significant amount of free fluid in the abdomen. upon arrival to the he had a hematocrit of 23, heart rate of 130 and blood pressure of 80/40. it was decided to bring the patient emergently to the operating room. procedure in detail: the patient was placed in the supine position on the operating room table. a left subcostal incision was used and brought over slightly to the right of the midline. dissection was carried down to the fascia to the muscles. the peritoneum was identified and opened up. approximately 2 l of old and new blood quickly was suctioned out from the abdomen. the spleen appeared to be significantly enlarged and was actively bleeding. it was clear that a portion of the spleen had ruptured. using left hand, the ligamentous attachment to the spleen to the diaphragm and the posterior peritoneum, as well as the kidney were bluntly dissected free. the stomach was then retracted medially and the gastrosplenic ligament was taken down. any of the vessels which were encountered in this ligament were tied in continuity with 3-0 silk ties. the lesser sac was also entered to aid in visualization. the remainder of the posterior attachments were taken bluntly with the left hand. the spleen was brought into the wound. the tail of the pancreas could be easily seen into the splenic hilum. the splenic hilar vessels were then taken using clamps. the vessels were doubly ligated with a 0 vicryl tie and then a 2- 0 suture ligature. care was taken not to injure the tail of the pancreas. some omental attachments were also taken off the spleen. the spleen was then removed and passed off the field. at this point, there was no evidence of any active bleeding. copious amounts of irrigation were used in the left upper quadrant. there was a mild diffuse ooze from the posterior abdominal wall. this was packed off. the remainder of the abdomen was inspected. there was free fluid over the liver which was old blood and was suctioned out and irrigated. there was some old blood in the pelvis which was suctioned out and irrigated. attention was then placed again to the left upper quadrant where there was still slight diffuse ooze. layers of surgicel were placed and the area was packed again. after examination in 2 minutes it appeared that the bleeding had stopped. the stomach was visualized. there was no evidence of any bleeding from the short gastrics. the pancreas was visualized and examined and there was no evidence of injury to the tail of the pancreas. the colon was examined where the splenocolic ligament was divided. there was no evidence of injury to the colon. the sponge and instruments were all removed. the abdomen was closed. the posterior layer of the fascia along with the peritoneum was closed with running #1 pds suture. the anterior fascial layer was closed with interrupted 0 vicryl suture. the skin was closed using staples. needle and sponge count were correct. dr. was present and scrubbed for the entire operation. the patient was transferred to the icu in guarded condition. post-op the patient was transferred to the icu for further management neuro: initially the patient was kept sedated until he was ready for extubation. post-extubation he did exhibit signs and symptoms of delirium. geriatrics was consulted and we followed their advice. we limited narcotics, benzos, and restraints. he gradually improved and was back to his baseline prior to transfer to the floor cardiovascular: post-op he was tachycardiac into the 160s. ekg showed what appeared to be multifocal atrial tachcardia. his rate was controlled with iv lopressor and then po once he was tolerating a diet. eventually his hr decreased to the 80s after titrating up his po lopressor significantly. pulm: he was extubated pod 1 and did well. he did require a few doses of iv lasix over the course of his hospital stay to decrease some pulmonary edema he developed from his aggressive resuscitation. eventually he was weaned to room air, and did not have any further complications. gi: he was kept npo with a ngt initially. once he began passing gas and moving his bowels, his ngt was removed. he was started on sips and slowly advanced to a regular diabetic diet. his abdomen became less distended and he was more comfortable. gu: foley was kept in place until we felt he had diuresed enough. the catheter was removed and his urine was sent multiple times for ua and culture due to the cloudy appearence of it. his cultures to date have all been negative. due to his questionably positive ua, he was treated emiprically with 3 days of po cipro. heme: his hematologist did see initially when he came into the hospital and made some recommendations. he did require a few more units of platelets due to his drifiting platelet count. once his bleeding risk was no longer high, we decreased our threshold for transfusion to 20,000 as he appeared to be at his baseline. he was vaccinated prior to discharge id: he was given a few doses of keflex for what appeared to intially be a wound infection but later appeared to be dependent erythema. he was also given 3 days of cipro for empiric uti treatment. he never had any positive cultures endo: initially was on ssi. once he was taking pos he was started back on his home regimen of glyburide and metformin. dispo: pt was consulted and they believed that he was strong enough to go home with a home safety evaluation and some home pt. he did not require rehab at this point. he was instructed to follow up with surgery and hematology in the next few weeks. pathology report diagnosis: 1. splenomegaly with extensive extramedullary hematopoiesis consistent with chronic myeloproliferative disorder. see note. 2. capsular disruption consistent with splenic rupture. 3. multifocal splenic infarctions, old. note: there is extensive extramedullary hematopoiesis. this finding, combined with massive splenomegaly, is consistent with a chronic myeloproliferative disorder. reportedly, the patient had previously been diagnosed with a chronic myeloproliferative syndrome, but no further clinical details were available at the time of admission or thereafter, as his routine health care is conducted at an institution outside of the network. further clinical and laboratory studies are required for a nosological diagnosis. flow cytometry report flow cytometry immunophenotyping the following tests (antibodies) were performed: hla-dr, fmc-7, kappa, lambda, and cd antigens: 2, 3, 5, 7, 10, 19, 20, 23, 45. results: three-color gating is performed (light scatter vs. cd45) to optimize lymphocyte yield. cd19-positive b-cells are scant in number precluding evaluation of clonality. interpretation non-diagnostic study. clonality could not be assessed in this case due to extreme paucity of numbers of b-cells. cell marker analysis was attempted, but was non-diagnostic in this case due to insufficient numbers of b-cells. correlation with clinical findings and morphology (see s07-) is recommended. flow cytometry immunophenotyping may not detect all lymphomas due to topography, sampling or artifacts of sample preparation medications on admission: actos glyburide glucophage procrit humalog neulasta folic acid vit b6 discharge medications: 1. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours). disp:*60 tablet(s)* refills:*0* 2. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 3. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain: use only if tylenol is not enough. disp:*20 tablet(s)* refills:*0* 4. metformin 500 mg tablet sig: one (1) tablet po daily (daily). 5. glyburide 5 mg tablet sig: two (2) tablet po bid (2 times a day). 6. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 days. disp:*4 tablet(s)* refills:*0* discharge disposition: home with service facility: home care services discharge diagnosis: myelodysplastic syndrome splenic rupture s/p emergent splenectomy discharge condition: stable. platelets and hematocrit low, but at baseline and stable prior to discharge. blood sugars slightly elevated but home medications restarted prior to discharge. discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * increased abdominal pain that is not improving within hours or becoming progressively worse, or inadequately controlled with the prescribed pain medication. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * if your belly is distended * change in bowel habits such as diarrhea or constipation * separation of wound edges, green or yellow drainage from the wound, or increased redness swelling, warmth or pain of the incision * shortness in breath * swelling of your legs * any serious change in your symptoms, or any new symptoms that concern you. you may resume all home medications. *pain: you will be treated with pain medications after discharge from the hospital, and this should relieve any discomfort that you may experience. as your discomfort lessens, you may switch to regular tylenol (acetaminophen). do not combine tylenol with your prescription pain medication (i.e. vicoden, percocet), as this already contains tylenol. if you need the prescription pain medicine, be sure to take it with food to prevent upset stomach. you should also take colace, a stool softener, while you are taking narcotics to prevent constipation. do not drive while taking narcotics. *incision: you have staples that will be removed at you hospital follow-up appointment. please call if you experience redness, drainage or separation at the incision site. *bathing: you may shower, but avoid prolonged water exposure (i.e baths and/or swimming). when you finish bathing or showering, be sure to "pat dry" the area of surgery. followup instructions: please call dr. office to schedule a follow up appt in 2 weeks. call ( to schedule an appt. you should also call your hematologist at and see them within the next 2 weeks md, procedure: total splenectomy diagnoses: pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled systolic heart failure, unspecified myelodysplastic syndrome, unspecified other specified cardiac dysrhythmias other shock without mention of trauma delirium due to conditions classified elsewhere other diseases of spleen 

Answer: The patient is high likely exposed to