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: altered mental status/fever major surgical or invasive procedure: none history of present illness: pt is a 71 y/o male with pmh significant for plasma cell leukemia/multiple myeloma dx in after presenting with diffuse bony pain in the setting of a recent mva. he was treated with velcade and decadron and has recently completed his 6th course about 2wk ago. his treatment has been complicated by invasive aspergillosis treated with tiw ambisome and a recent hospital admission on for febrile neutropenia. . he presented to the ed on with change in mental status/lethargy along with chills/fever. he was noted to have an elevated lactate and transferred to the for presumptive sepsis along with hypercalcemia. he had been in his usual state of health prior to this episode and denied any sick contacts, cp, sob, abdominal pain, n/v, diarrhea, ha, weakness, or palpatations. . in the , his bcx grew mrsa and his port was d/c and replaced w/ piv. his mental status changes were thought to be more due to his hypercalcemia than his infection but he has failed to normalize completely despite correction of his hypercalcemia w/ pamidronate and treatment of his infection w/ ivf, vanco, and ambisome. . he was called out to the floor where he was started on cefepime for febrile neutropenia. he received an lp which was normal other than demonstrating plasma cells in the csf. his mental status improved during his stay here and he was aao x2 on the day after call-out rather than aao x1. on the day after call-out, however, the patient was seen to be hypotensive to the 90s. he responded to a 1l bolus but then quickly became hypotensive again. he was transfered back to the unit hemodynamic instability. . on , he was again called out to the floor by the . during his stay in the icu, his major problems included infection for which he was continued on his antibiotics (vanco, ambisome, flagyl, acyclovir, adn , coagulopathy requiring product transfusion, continued hypotension complicated by significant peripheral edema, and continued diffuse bony pain. he remained well from a respiratory standpoint. his code status was changed to dnr/dni after discussion between his proxy and dr. . . onc hx: pt presented in for evaluation of diffuse bone pain, at which time he was noted to have an increased bun, creatinine, and was hypercalcemic. treated at this time with iv fluids, steroids, velcade and an injection of pamidronate. bone marrow bx was done on , showing extensive involvement by plasma cell myeloma with 80-90% cellularity. a skeletal survey at that time showed probable multiple myeloma, and a beta 2 microglobulin level was 22.0. he has a igg kappa monoclonal protein, and presented to dr. with stage iiib myeloma/plasma cell leukemia. he has been on the velcade protocol since . past medical history: 1. diabetes mellitus type 2 2. multiple myeloma: dx , treated w/ velcade; c/b pancytopenia 3. hx of invasive aspergillosis dx in , on ongoing tiw ambisome treatment 4. baseline creatinine since diagnosis 1.8-2.3 5. hypertension 6. hyperlipidemia 7. s/p mva 8. s/p tonsillectomy at age 19 social history: retired, previously worked as a florist. he lives with his daughter who is involved in his care. he has a history of 15 years of cigarette smoking, stopped 20 years ago. no recreational drug use. social alcohol. family history: sister with dm. no family history of cancer or heart disease. physical exam: 97.9, 102/50, 67, 19, 95% gen: sedated minimally arousable aa man in nad heent: proptosis, pupils small, mmm, no lad chest: crackles at the bases cv: rrr, s1/s2 intact, 2/6 systolic murmur at apex abd: +bs, soft, nontender, nondistended ext: 2+ dp, no edema, diffuse pain w/ any movement . cultures: staph aureus (bcx ); all others w/ ngtd . ct head w/o contrast : no mass effect or hemorrhage. multiple lytic areas in the skull likely secondary to patient's history of multiple myeloma. . ct chest w/o contrast : 1) multiple new diffuse nodular opacities, with a dominant right upper lobe cavitary lesion. many previously evident areas of consolidation have improved with evolving cystic cavities. new lung findings most likely represent recurrence of known invasive aspergillosis. a secondary infectious process, such as other fungal organisms, septic emboli, nocardia, or pseudomonas, is an additional differential consideration. 2) increasing mediastinal lymphadenopathy. 3) small bilateral pleural effusions. 4) diffuse osseous metastases, unchanged. . tte : the left atrium is elongated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is a small pericardial effusion. there are no chocardiographic signs of tamponade. no vegetation seen (cannot exclude). . cxr: new generalized, moderately severe interstitial abnormality accompanied by increasing mediastinal vascular caliber and interval enlargement of the cardiac silhouette is due to pulmonary edema, which could be cardiac or volume related or response to transfusion or even drug administration. there is no appreciable pleural effusion or pneumothorax. cavitary consolidation in the right lung apex, which developed between and is partially obscured by the generalized lung process, and there may be another focus of new consolidation in the right mid lung laterally. right subclavian catheter tip projects over the svc. tach at 101; nl axis; no st t-wave changes. . csf: single prominent band seen in gamma region which corresponds to band seen in serum no oligoclonal banding seen pertinent results: 10:55am blood wbc-2.3* rbc-3.23* hgb-9.5* hct-27.2* mcv-84 mch-29.2 mchc-34.7 rdw-16.0* plt ct-30*# 12:00am blood wbc-0.6* rbc-3.35* hgb-9.8* hct-28.1* mcv-84 mch-29.3 mchc-34.9 rdw-16.8* plt ct-19* 10:55am blood neuts-17* bands-2 lymphs-68* monos-1* eos-1 baso-0 atyps-11* metas-0 myelos-0 nrbc-1* 10:55am blood pt-16.5* ptt-32.1 inr(pt)-1.9 10:55am blood plt ct-30*# 12:00am blood pt-16.6* ptt-34.2 inr(pt)-1.9 12:00am blood plt ct-19* 03:37pm blood fibrino-396 d-dimer-374 05:13am blood gran ct-420* 12:00am blood gran ct-100* 10:55am blood glucose-116* urean-35* creat-2.5* na-130* k-5.0 cl-102 hco3-16* angap-17 12:00am blood glucose-158* urean-32* creat-1.3* na-147* k-3.2* cl-119* hco3-18* angap-13 10:55am blood alt-54* ast-25 ld(ldh)-222 alkphos-190* totbili-0.6 12:00am blood alt-20 ast-12 ld(ldh)-209 alkphos-140* totbili-3.6* 10:55am blood albumin-2.4* calcium-10.6* phos-4.1 mg-1.9 uricacd-7.6* 12:00am blood albumin-2.3* calcium-7.0* phos-2.1* mg-1.7 uricacd-5.3 12:20am blood hapto-269* 10:55am blood osmolal-301 12:00am blood igg-4422* 05:03pm cerebrospinal fluid (csf) wbc-0 rbc-0 polys-0 lymphs-40 monos-0 macroph-60 05:03pm cerebrospinal fluid (csf) totprot-130* glucose-84 ld(ldh)-13 05:03pm cerebrospinal fluid (csf) csf-pep-single pro brief hospital course: a/p: 70 y/o man with multiple myeloma/plasma cell leukemia, htn, hypercholesterolemia, dm type 2, who was admitted with change in mental status. admitted to the then called out to the floor. . 1. change in mental status: on arrival to hospital, change in mental status thought to be due to hypotension/sepsis given that mental status improved markedly with fluids resuscitation. pt also w/ marked hypocalcemia on labs that was corrected. pt was then found to be altered with a normal bp after fluid resuscitation so an lp was done which demonstrated plasma cells in the csf. the patient's family was informed of the diagnosis of cns plasma cell leukemia and decided to make the patient cmo. his antibiotics were stopped and the patients mental status cleared somewhat. he was able to participate in the planning of his hospice care and remained happy with the plan. . 2. sepsis: pt was admitted with hypotension and ams. his initial blood cx grew out mrsa and he was started on vancomycin/cefepime and his line was removed. his lp and urine did not show signs of infection. he was started on stress dose steroids. he was given ambisome for ct findings demonstrating likely worsening invasive aspergillosis and acyclovir for a history of disseminated zoster. after the lp showed cns involvement of his plasma cell leukemia, the patient was made cmo. his antibiotics and steroids were stopped and further cultures/temperatures were not taken. . 3. mm/plasma cell leukemia: his last dose of velcade was on . lp showed cns involvement of his disease in the cns. his extremely poor prognosis was discussed with the family and the decision was made to make the patient cmo. as the patient's sensorium cleared, he became actively involved in his hospice planning and the patient was eventually discharged home to receive home hospice services. his pain was well controlled with a lidocaine patch and prn morphine. his cbc was followed and he was transfused prn until he was made cmo. medications on admission: 1. ambisome 320mg tiw (last dose on ) 2. allopurinol 100 mg qd 3. prednisone 10mg qd 4. omeprazole 20mg qd 5. velcade (last treatment last week) discharge medications: 1. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). disp:*30 adhesive patch, medicated(s)* refills:*2* 2. ativan 4 mg/ml syringe sig: 0.5-2 mg injection q2-4h as needed for anxiety/restlessness/seizure. disp:*15 ml* refills:*2* 3. levsin/sl 0.125 mg tablet, sublingual sig: 1-2 tablets sublingual every 4-6 hours as needed for congestion. disp:*30 tablets* refills:*2* 4. morphine concentrate 20 mg/ml solution sig: 5-20 mg po q1-2h as needed for pain. disp:*10 ml* refills:*0* 5. amicar 25 % syrup sig: ten (10) ml po every four (4) hours as needed for oral bleeding: swab mouth with solution to stop oral bleeding. disp:*100 ml* refills:*1* 6. supplies one semi-electric bed discharge disposition: home with service facility: discharge diagnosis: plasma cell leukemia - multiple myeloma discharge condition: stable discharge instructions: please take your medications as directed followup instructions: pt d/c home for hospice care - not to return to the hospital procedure: venous catheterization, not elsewhere classified spinal tap incision of lung incision with removal of foreign body or device from skin and subcutaneous tissue transfusion of packed cells transfusion of other serum transfusion of platelets diagnoses: acidosis abnormal coagulation profile diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis infection with microorganisms resistant to penicillins methicillin susceptible staphylococcus aureus septicemia alkalosis septic shock multiple myeloma, without mention of having achieved remission infection and inflammatory reaction due to other vascular device, implant, and graft aspergillosis hypercalcemia person awaiting admission to adequate facility elsewhere open wound of chest (wall), without mention of complication 

Answer: The patient is high likely exposed to