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: abdominal pain major surgical or invasive procedure: insertion of a central line history of present illness: the patient is a 41 year old male with no significant past medical history who presents with 1 day of increasing right abdominal/flank pain. he reports it started yesterday afternoon as a cramp in his right flank that persisted throughout the night. in the morning, he went to work but the pain did not subside so he presented to the emergency room. he describes the pain as a somewhat sharp pain "like a stick" but not as sharp as a knife. he has been able to tolerate pos although he hasn't eaten much today because of loss of appetite. he has had normal bowel movements and urination. he has not had nausea or vomiting except after receiving large doses of pain medication in the ed. he reports no subjective fever and was afebrile on arrival to the ed but then spiked a fever to 102.4 at 6pm. he has not noted any rashes or ecchymoses on any part of his body. he had a cold about a week ago accompanies by some cervical lymphadenopathy but this resolved before his abdominal pain started. he works as a federal prosecutor in an office that is sometimes frequented by prisoners. his only recent travel is to suburban . . in the ed, his labs were notable for a wbc of 21.7 and inr of 1.3. lactate was 1.9. lytes and lfts were normal. ua was negative. cxr was unremarkable. abdominal us showed a 4mm gallbladder polyp but was otherwise unremarkable. d-dimer was negative, but given the patient's continuing symptoms and new fever, a ct torso was done to look for signs of infection. this revealed an ill-defined wedge shaped area of low attenuation within the periphery of the right hepatic lobe, which was thought not to be of clinical significance; a neoplastic process or infection could not be entirely excluded, however. the patient received empiric levaquin and flagyl in the ed as well as a total of 6mg iv morphine and 4mg iv dilaudid. he was given 1g tylenol for fever and a total of 4l ivf. he remained tachycardic in the 100s-120s given the patient's fever and continuing pain, he was admitted for further workup and pain control. past medical history: none social history: just moved into new apartment in , works as a prosecuter,does not smoke, drinks 4-8 alcoholic drinks a week, denies illicit substance use. patient reports no recent sexual activity in months. mostly sexually active with women although male sexual contact >10 years ago. hiv test 6 months ago was negative per patient. recent travel to , and contact with young nipping dog. no recent exposure to caves. exposure to dirt in over . family history: non-contributory physical exam: vs: 103.3, 120, 114/60, 28, 95% 3l nc general: uncomfortable appearing, well-developed, well-nourished male lying in bed heent: perrl, eomi, mmm, op clear neck: no lad, supple lungs: ctab cv: tachy, rr, nl s1s2 abd: +bs, voluntary guarding, ttp rlq ext: no c/c/e . on admision to medicine floor vitals: 98.7, bp: 118/78, hr:84, rr:18, o2sat: 96-98% ra, pain . gen: younger than stated age, nad, a&0*3 heent: perrl, neck supple, single anterior right cervical lymph node <1 cm, op mild thrush on tongue, otherwise clear, eomi, perrl chest: cta b/l, good excursion, no w/r/r cardiac: rrr, s1, s2, no m/r/g abd: soft, nondistended, no hepatosplenomegaly, + bs, mild diffuse lower abdominal tenderness, no , mild cva tenderness ext: 2+ dp, 2+ radial, ue biceps, triceps, deltoids. le quads, hamstrings, plantar/dorsiflexion, no c/c/e pertinent results: studies: cxr bilateral patchy hilar opacities, increased vascular congestion, mild peripheral honeycombing and reticular nodular opacities. . ct chest : impression diffuse, multifocal ground-glass and nodular opacities, primarily in a perihilar distribution with associated bilateral pleural effusions, right greater than left. the primary differential diagnosis includes atypical infections such as mycoplasma pneumoniae. if the patient is immunocompromised, other infections such as pneumocystis jiroveci could be considered. although the pattern is less compatible with gram negative rod bacterial pneumonia, it remains a diagnostic consideration. if the findings are chronic, other diagnostic possibilities include interstitial lung disease. (not compared to ct torso ). . us guided drainage liver abscess : impression: 1. patient status post ultrasound-guided aspiration of a hepatic abscess without complication. . mri abdomen w w/o contrast : impression: 1. 1.9 cm right hepatic lobe abscess, demonstrating peripheral enhancement/hyperemia and central necrosis. 2. worsening effusions and airspace disease at the bases bilaterally, likely reactive. . u/s liver :impression:1. heterogeneous area in segment vi-vii of the liver, which is slightly smaller and corresponds with the previously aspirated abscess. no residual fluid collection identified. no new worrisome findings identified. 2. persistent right pleural effusion. . ct sinuses : impression: 1. visualized portions of the upper lungs demonstrate patchy opacities, pleural effusions, and septal thickening. while these findings may all be secondary to pulmonary edema, superimposed multifocal pneumonia is an important consideration and chest radiographs and/or cross sectional imaging is recommended. 2. mildly prominent adenoids and tonsils bilaterally without evidence for abscess. . neck ultrasound 1/2/08:1. limited neck ultrasound demonstrating patent internal jugular veins bilaterally without evidence of clot. 2. no soft tissue fluid collections detected in the neck at the level of the thyroid gland. . on admission: 12:15pm glucose-101 urea n-14 creat-1.1 sodium-141 potassium-3.5 chloride-104 total co2-27 anion gap-14 12:15pm estgfr-using this 12:15pm alt(sgpt)-26 ast(sgot)-25 alk phos-73 amylase-75 tot bili-0.6 12:15pm lipase-43 12:24pm lactate-1.9 12:15pm wbc-21.7* rbc-4.95 hgb-15.4 hct-44.7 mcv-90 mch-31.1 mchc-34.4 rdw-12.6 12:15pm neuts-74.9* lymphs-20.8 monos-3.2 eos-0.3 basos-0.8 12:15pm plt count-433 12:15pm pt-14.6* ptt-30.6 inr(pt)-1.3* 12:15pm d-dimer-123 12:45pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 12:45pm urine color-yellow appear-clear sp -1.020 . on discharge 05:25am blood wbc-9.4 rbc-4.18* hgb-12.6* hct-36.7* mcv-88 mch-30.2 mchc-34.3 rdw-12.9 plt ct-417 05:25am blood pt-14.8* inr(pt)-1.3* 05:25am blood glucose-80 urean-9 creat-0.7 na-144 k-3.9 cl-109* hco3-25 angap-14 05:25am blood alt-83* ast-64* alkphos-61 totbili-0.4 05:30am blood albumin-2.9* calcium-8.4 phos-3.5 mg-2.1 . work-up 11:05am blood caltibc-238* vitb12-648 folate-11.1 ferritn-287 trf-183* 11:05am blood crp-72.0* 12:15pm blood hbsag-negative hbsab-negative igm hav-negative 11:05am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 12:50pm blood esr-20* . microbiology abscess site: liver gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. acid fast culture (pending): fungal culture (preliminary): no fungus isolated. . cmv vl not detected, cmv igg +, cmv igm neg . 12:15 pm blood culture **final report ** blood culture, routine (final ): fusobacterium species. beta lactamase negative. anaerobic bottle gram stain (final ): reported by phone to rn. 02:55. gram negative rod(s). all other blood cultures negative. . , , sputum negative pjp. . 11:13 am stool consistency: soft source: stool. **final report ** microsporidia stain (final ): no microsporidium seen. cryptosporidium/giardia (dfa) (final ): no cryptosporidium or giardia seen. clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. (reference range-negative). . monospot negative . 13/20/07 throat no neisseria gonorrhoeae, +yeast . , urine cultures: negative brief hospital course: 41 year old male with no significant past medical history presented with abdominal pain found to have gram negative rod septicemia and increasing oxygen requirement. upon admission to medicine, he was treated with iv antibiotics, pain control and overnight decompensated with increasing oxygen requirement and sbp to 80s. he was transferred to the medicine intensive care unit and discovered to have gram negative rod sepsis. . medicine intensive care unit course: patient was admitted to the medicine intensive care unit. blood cultures were positive for gram negative rods, later speciated as fusobacterium, and the patient was treated with levofloxacin/flagyl and aggressive rehydration. an mri was conducted to evaluate the low attenuation wedge lesion in the right hepatic lobe of the liver which showed a 1.9 cm right hepatic lobe abscess, demonstrating peripheral enhancement/hyperemia and central necrosis. the patient continued to be febrile up to 104.5 and his antibiotics were broadened to vancomycin/zosyn/flagyl. subsequently the abscess was aspirated under ultrasound guidance , although the abscess cultures have been negative. the patient defervesced and felt much improved. the patient's pain in his right upper quadrant during this time was treated with oxycodone and he was weaned to tylenol and ibuprofen. . in the setting of this gram negative rod septicemia, the patient developed a worsening oxygen requirement and at one point he was maintained on a non-rebreather. patient's chest x-ray revealed cardiomegaly, evidence of vascular congestion and patchy infiltrates. it was felt that the congestions was due to a capillary leak syndrome in the setting of sepsis. the patient was gradually weaned off oxygen and has returned to 96-98% on room air. the pulmonary infiltrates remained a potential source for infection and serial sputum testing for pneumocystis jirvovecii was initiated which was negative. he was also evaluated with ct sinuses as possible source for pulmonary disease or liver abscess. the ct was negative for any sinus processes. . infectious disease and hepatology were consulting services. of note, the patient did develop oral thrush while in the unit. he has refused hiv testing; he reports a negative hiv test 6 months ago. the patient was transferred to the floor for further work-up of his pulmonary status and antibiotics management. at the time of transfer he was afebrile *24 hours, able to tolerate pos and had resolved his oxygen requirement. . upon transfer to floor, patient states he has been doing well. he feels weak from his illness. denies fevers, chills, vomiting, constipation, chest pain, shortness of breath. patient does have occasional nausea. endorsed loose stools per day. he continues to experience pain which he describes as diffuse and associates with his prolonged inactivity. patient is eager to go home to his new apartment. his father has traveled from to assist. . the patient's antibiotics were transitioned to levofloxacin and flagyl. the patient remained afebrile, and his white blood cell count continued to improve. the patient was discharged to complete a 30 day course of levofloxacin and flagyl for his liver abscess. the patient's neck was re-imaged by ultrasound given fusobacterium can be associated with vein thrombosis, but the imaging was negative. follow-up imaging revealed no drainable fluid collection and it was recommended that the imaging be repeated in 3 months. . given the improvement in the patient's status, his pulmonary disease was felt to be consistent with capillary leak with underlying lung disease. his pneumocystis jirvovecii work-up was negative. the patient did have a dry non-productive cough worse in the am and associate with post nasal drip which was treated with cough suppressants for a presumed viral etiology. he was discharged with repeat ct chest and pulmonary function tests in 6 weeks and pulmonary follow-up. . the patient was discovered to have an iron deficiency anemia raising suspicious for a gastrointestinal source for his fusobacterium sepsis. he also reports a 20 pound weight loss which he attributed the death of his dog. the patient will be scheduled for an outpatient colonoscopy by his primary care provider. was recommended that the patient start iron therapy after completing his antibiotic course to prevent a decreased in antibiotic effectiveness. . the patient reported loose stools after his medicine intensive care unit stay; however stool studies were negative for clostridium difficile, giardia, and cryptosporidium. the patient's loose stools resolved with a decease in his bowel regimen. the patient also developed oral thrush which was treated with nystatin. he will follow-up with his primary care provider for further of his immunologic status. . at the time of discharge the patient was afebrile, with stable vital signs and a good appetite. he has extensive follow-up with primary care, infectious disease and pulmonology. medications on admission: none discharge medications: 1. metronidazole 500 mg tablet sig: one (1) tablet po q 8h (every 8 hours) for 26 days. disp:*78 tablet(s)* refills:*0* 2. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 26 days. disp:*26 tablet(s)* refills:*0* 3. ibuprofen 600 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. 4. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 5. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. disp:*100 ml(s)* refills:*0* discharge disposition: home discharge diagnosis: gram negative rod sepsis pulmonary nodules liver abscess s/p drainage iron deficiency anemia oral thrush discharge condition: stable discharge instructions: you were admitted for abdominal pain and were found to have an infection in your blood and an abscess in your liver which was drained. you were treated with antibiotics and improved. during your hospitalization you had trouble breathing and were found to have an abnormal cat scan of your lungs. your breathing improved, but you will need to follow-up with a pulmonologist to have your lung function evaluated after this hospitalization. . please take all your medications as prescibed. please keep all your follow-up appointments. . if you develop fevers, chills, nausea, vomiting, increased abdominal pain, chest pain, shortness of breath or any other concerning symptoms please call your primary care doctor or go to the local emergency room. followup instructions: please follow-up with to establish primary care. you are scheduled to see provider: , md phone: date/time: 1:30 in the building. . please follow-up with infectious disease about your recent liver infection. provider: , md phone: date/time: 10:00. this appointment is in the on in the basement. . please follow-up with pulmonary to evaluate your lungs. please arrive half an hour early at 7:30 am for your appointment with provider: , m.d. phone: date/time: 8:00. this appointment is on the in on the . procedure: percutaneous aspiration of liver diagnoses: severe sepsis candidiasis of mouth abscess of liver iron deficiency anemia, unspecified other septicemia due to gram-negative organisms pulmonary eosinophilia 

Answer: The patient is high likely exposed to