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: no known allergies / adverse drug reactions attending: chief complaint: disseminated fusarium, vre bacteremia major surgical or invasive procedure: bone marrow biopsy bone marrow biopsy bone marrow biopsy skin biopsy history of present illness: the patient is a 61yo m with a pmh of biphenotypic leukemia on outpatient treatment with ambisome and voriconazole for disseminated fusarium and recent admission to the on for fever and abdominal pain, now being admitted for a new lesion on congenital oral mass concerning for persistent and worsening fungal . patient had been going to outpatient clinic daily for iv infusion of ambisome. today patient noted a sore on the congenital mass on the roof of his mouth that has been persistent for the past 4-5days. lesion on roof of mouth, under dentures, pain improved without dentures in place. has not taken pain medication for it, does not believe it is worsening. denies fevers/chills, night sweats. max temperature in the last 5 days, per patient, has been 99.0f. no cp, sob, trouble breathing, wheezing, ha, nausea. bms unchanged. patient was admitted from clinic for work up of this oral lesion. . also, of note patient developed painless nonpruritic erythematous blanching patches on his shins bilaterally within the last day. . review of systems: (+) per hpi (-) denies recent weight loss or gain (currently 155, has ranged from 145-155, though was 185 in ). denies sinus tenderness, rhinorrhea or congestion. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: past oncologic history: biphenotypic leukemia - initially prsented with "autoimmune pancytopenia" treated with steroids and ivig. in his cytopenias worsened and he was noted to have about 90% blasts and he was transferred to . preliminary bone marrow biopsy was suspicious for a biphenotypic leukemia and therapy was initiated with hypercvad. his day 14 marrow showed persistent disease and his regimen was changed to 7+3. day 14 and two subsequent marrows all continued to show persistent involvement with leukemia. further chemotherapy was held as he was found to have disseminated fusarium in the setting of prolonged neutropenia. he was ultimately discharged on g-csf and daily ambisome infusions. he was admitted to the on for neutropenic fever and abdominal pain of unknown etiology. while hospitalized he was treated with a 10-day course of decitabine without complications. . other pmh: disseminated fusarium ():treated with ambisome and voriconazole h/o hepatitis b (on lamivudine) s/p appendectomy s/p umbilical hernia repair social history: currently on disability. wife is a retired physician. from . nonsmoker, no etoh, no ivdu. family history: one brother died of all. denies dm, cad, strokes, other cas physical exam: admission exam: vs: t 98.5, bp 120/76, hr 69, rr 16, spo2 100%ra gen: pleasant elderly male in nad. oriented x3. mood, affect appropriate. : ncat. sclera anicteric. perrl, . mmm, op with petechiae on posterior palate and 1x0.5cm submucosal hardened/firm lesion on anterior roof of mouth with 2mm ulcer over center. missing teeth. neck: supple, no cervical lymphadenopathy. cv: rrr with normal s1, s2. no m/r/g. chest: ctab without crackles, wheezes or rhonchi. no use of accessory muscles abd: normal bowel sounds. soft, nt, mildly distended. + splenomegaly. ext: wwp. digital cap refill <2 sec. no c/c/e. distal pulses intact radial 2+, dp 2+, pt 2+. skin: petechiae on lower abdomen around waist line, diffusely on legs and feet. 1-4cm erythematous, blanching patches on anterior shins with superficial ulcerations bilaterally. neuro: a&o x3. discharge exam: pertinent results: admission labs: 10:01am wbc-0.3* rbc-2.98* hgb-9.0* hct-24.8* mcv-83 mch-30.0 mchc-36.2* rdw-14.7 plt ct-10* 10:01am neuts-0* bands-0 lymphs-67* monos-0 eos-0 baso-0 atyps-5* metas-0 myelos-0 blasts-28* 10:01am hypochr-1+ anisocy-2+ poiklo-normal macrocy-normal microcy-2+ polychr-normal ovalocy-1+ 10:01am plt smr-rare plt ct-10* 12:10am pt-15.2* ptt-31.7 inr(pt)-1.3* 10:01am urean-25* creat-1.1 na-142 k-3.4 cl-108 hco3-25 angap-12 10:01am alt-33 ast-24 ld(ldh)-148 alkphos-218* totbili-0.6 10:01am calcium-8.5 phos-3.8 mg-1.7 cultures: culture: vre culture x2 negative culture x2 negative imaging: mri soft tissue head: no evidence of enhancing soft tissues or fluid collection identified in the neck. there is minimal soft-tissue thickening in the partially visualized maxillary sinuses. the patient previously had maxillary sinus disease on prior sinus ct. if further evaluation of sinuses is clinically indicated, consider a repeat sinus ct. echo: the left atrium is mildly dilated. 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) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is a small to moderate sized pericardial effusion. there is right ventricular diastolic collapse, consistent with impaired fillling/tamponade physiology. dr. was notified by telephone on at 4:35 pm. compared with the prior study (images reviewed) of , the pericardial effusion is now larger and there is now right ventricular diastolic collapse. left ventricular systolic function appears slightly more vigorous. echo: overall left ventricular systolic function is mildly depressed (lvef= 50 %) with inferior hypokinesis. right ventricular chamber size and free wall motion are normal. there is a small to moderate sized pericardial effusion. the effusion appears circumferential. no right ventricular diastolic collapse is seen. there is brief right atrial diastolic collapse suggestive of elevated intrapericardial pressure without overt tamponade. compared with the prior study (images reviewed) of , no change. ruq us: 1. no biliary obstruction or other explanation for abnormal lfts. 2. trace perihepatic ascites. 3. right pleural effusion. 4. moderate pericardial effusion. cxr: ap chest compared to through : moderate-to-severe enlargement of the cardiac silhouette which enlarged between and is unchanged subsequently. mediastinal and pulmonary vascular engorgement are essentially unchanged since , and edema is minimal, if any, difficult to distinguish from relatively symmetric infrahilar opacification which could also be due to mild-to-moderate atelectasis. there is no pulmonary edema or consolidation in the upper lungs. echo: normal lv size with low-normal systolic function. normal right ventricular chamber size and systolic function. moderate sized circumferential pericardial effusion with evidence of early hemodynamic effect in inversion of the right atrium, consistent with increased intrapericardial pressure. no definitive signs of pericardial tamponade. in the setting of elevated right sided pressures, echocardiographic evidence of tamponade may be absent. mild-moderate mitral regurgitation and mild-moderate tricuspid regurgitation. compared with the findings of the prior study (images reviewed) of , the effusion is slightly larger and there is slightly more pronounced diastolic inversion of the right atrium. cxr: in comparison with study of , there is continued substantial enlargement of the cardiac silhouette with less prominent vascular congestion that may reflect the pa rather than supine ap technique. opacification at the left base in the retrocardiac region could merely reflect atelectasis, though in the appropriate clinical setting supervening pneumonia would have to be seriously considered. there is left and possibly also right pleural effusion. scattered streaks of atelectasis are seen especially at the left base. pathology: left shin biopsy: the sections shows patchy superficial and mid-dermal hemorrhage. no primary vasculitis/microthrombotic vasculitis are seen. there is no evidence of malignancy in this specimen. hemosiderin-laden macrophages are present in the superficial dermis, compatible with relative chronicity of this hemorrhagic episode. the pas, gms, and tissue gram stains are negative for microorganisms. overall, the findings in this biopsy are non-specific and are suggestive of purpura (e.g. secondary to trauma, etc.). culture growing enterococcus bone marrow biopsy: immunophenotypic findings consistent with involvement by persistent involvement by patient's known acute leukemia. as reported previously, the blasts express myeloid markers (cd117, cd13) along with b-marker cd19, as well as cd7. persistent acute leukemia with mixed lineage phenotype (see note). note: blasts comprise 81% of aspirate differential and a majority of the core cellularity (overall cellularity 90-100%). compared to the previous biopsy (s11-36436r, m11-540 dated ), the current marrow shows a significant increase in both overall cellularity and blast count. brief hospital course: mr. is a 61 yo m with refractory biphenotypic leukemia and history of disseminated fusarium , on ambisome and voriconazole in the setting of prolonged neutropenia from induction chemotherapy. he was recently transferred to the ccu for pericardio-centisis on and pericardial drain (pulled ). . # biphenotypic leukemia: initial therapy was included hypercvad. his day 14 marrow showed persistent disease and his regimen was changed to 7+3. two subsequent marrows all continued to show persistent involvement with leukemia. further chemotherapy was held as he was found to have disseminated fusarium in the setting of prolonged neutropenia. he then received 10 days of decitabine (c1d41, ). continued home neupogen to stimulate wbc in setting of fusarium . patient remained persistently neutropenic. bm biopsy showed extensive disease. the patient then received mec (c1d1 ). following this the patient was noted to have persistence of blasts in periphery and continued to be pancytopenic. bm on day 21 () showed >80% blasts. he was discharged with plan to discuss possible outpatient chemotherapy trials with primary oncologist dr. . patient was maintained on the following ppx regimen: bactrim (switched from atovaquone ) and atovaquone. . # febrile neutropenia, bacteremia: pt with low-grade fevers on admission. derm biopsy of left shin showed chronic changes, and culture grew out enterococcus (likely seeded from , derm). culture from grew vre. no new murmurs. echo showed no signs of endocarditis. patient was started on daptomycin for vre. repeat culture on negative. patient's legs stable without tenderness. biopsy site of left shin healing well, still with erythema. bilateral changes appear chronic. he spiked a fever in the ccu on after placement of pericardial drain ( problem #4), at which point empiric vancomycin and cefepime were started. per id recs, daptomycin was discontinued. negative infectious workup, including ucx, bcx, pericardial fluid cx, and quantiferon gold. on , antibiotics were tapered to po levofloxacin. he was discharged on levoquin for ppx as outpatient, given his chronic neutropenia. . # disseminated fusarium : occurred in the setting of neutropenia after induction chemotherapy. voriconazole held during chemo on . fusarium sensitivities are >4 for ambisome, >16 for vori. on , ambisome discontinued with goal of pt returning home shortly not on ambisome infusions. patient was discharged on voriconazole. most recent beta glucan and galactomannan are negative. . # afib with rvr: on , pt developed new onset afib with rvr to the 140s in the setting of low potassium (has chronically low potassium ambisome). cxr wnl, electrolytes repleted, trops neg x2. managed initially with diltiazem, then switched to metoprolol and diltiazem per cardiology recs, ultimately titrated up to metoprolol 37.5mg po q6 hours and diltiazem 60mg po q6 hours. hr in low 100s after that, pt asymptomatic. pt not anticoagulated as he is thrombocytopenic. . # pericardial effusion: pt with evidence of cardiac tamponade in early , found on hospitalization to have worsening pericardial effusion and rv collapse. repeat echo showed persistent effusion without signs of tamponade. repeat echo unchanged, with elevated pulmonary artery pressures (therefore, rv pressures are likely high, even if no rv collapse/frank tamponade). on pt had pericardiocentesis with placement of pericardial drain, in the setting of starting anthracycline with potential for cardiotoxicity and worsening ef. he tolerated the procedure well, with inital output around 500-700 cc and he was transferred to the ccu. while in the ccu the patient's pericardial drain output eventually started decreasing and it was pulled. pulsus remained normal throughout. analysis of fluid revealed transudate with reactive inflammatory cells; cx (including mycobacteria and fungi) and cytology were negative. however, this was still felt to be most likely malignant effusion. repeat tte on showed persistence of small effusion. . # pleural effusions: pt developed significant bl pleural effusions of unknown etiology, most likely cardiac given pulm vascular congestion. while pt had no respiratory compromise and maintained normal o2 saturations, there was concern for eventual compromise of lung expansion given severity of effusion. bl chest tubes placed on , with drainage of about 2l on each side. pleural fluid analysis showed transudate with reactive inflammatory cells; bacterial/mycobacterial/fungal cultures and cytology negative. removed r chest tube , unclamped and removed l chest tube on . on , left pleural effusion showed interval worsening. on , cxr showed slightly improved r atalectasis, stable l pleural effusion. pt intermittently clinically volume overloaded during hospitalization, likely his cardiopulmonary issues as well as fluid overload from chemo. he received iv lasix and po spironolactone, transitioning to po lasix and then ultimately discharged on only spironolactone 20mg po daily. . # rv strain on tte: after the pericardial drain was place and then later pulled, echocardiogram showed new significant rv strain and volume overload. pe was high on ddx. negative lenis and vq scan (performed in lieu of cta rising creatinine and thrombocytopenia). . # acute renal failure: while in the ccu, the patient developed acute renal failure, with creatinine trending up to 2.1 in the context of spiking a fever. found to be prerenal in etiology as well as from atn, improved somewhat with iv fluids. meds renally dosed, nephrotoxins avoided. . # anemia/thrombocytopenia: leukemia, as well as autoimmune destruction and splenic sequestration (pt with massive splenomegaly). patient requiring frequent (q1-2 days) and platelet transfusions. goal hct>25, platelets>20 (or >20 if having nosebleed). . # hepatitis b: patient with positive surface and core antibodies in . patient is maintained on lamivudine. pt with mildly elevated lfts during hospitalization, which improved after bactrim was discontinued. bactrim then restarted without issues. . # mechanical fall: pt had mechanical fall while walking from the bathroom on the evening of with minor head trauma and no other injuries. given his thrombocytopenia, received immediate transfusion 2 units platelets. stat head ct showed no acute hemorrhage, edema, mass effect or skull fracture but was notable for left frontal subgaleal hematoma. serial neurologic exams wnl. follow up head ct one week later revealed resolving left frontal subgaleal hematoma. pt suffered no consequent disabilities as a result of this incident. . # oral lesion: located under patient's dentures. it is unclear how long it has been present for, but seems to be chronic mass (possibly congenital) that is newly irritated x4-5days by dentures. mr showed no evidence of enhancing soft tissues or fluid collection. mass does not appear infected and was only monitored on admission. . # mood instability: patient has a history of mood instability, managed on olanzapine. this was continued during hospitalization. medications on admission: acyclovir ambisome folic acid lamivudine levofloxacin olanzapine oxycodone potassium chloride bactrim voriconazole magnesium oxide-mg aa chelate centrum omega 3- fish oil discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. voriconazole 200 mg tablet sig: 1.5 tablets po q12h (every 12 hours). disp:*90 tablet(s)* refills:*2* 3. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours). disp:*30 tablet(s)* refills:*2* 4. lamivudine 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. metoprolol succinate 50 mg tablet extended release 24 hr sig: three (3) tablet extended release 24 hr po once a day. disp:*90 tablet extended release 24 hr(s)* refills:*2* 7. acyclovir 400 mg tablet sig: one (1) tablet po q8h (every 8 hours). disp:*90 tablet(s)* refills:*2* 8. diltiazem hcl 60 mg tablet sig: one (1) tablet po q6h (every 6 hours). disp:*120 tablet(s)* refills:*2* 9. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). disp:*12 tablet(s)* refills:*2* 11. multivitamin tablet sig: one (1) tablet po daily (daily). 12. lorazepam 0.5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for nausea/anxiety/insomnia. disp:*120 tablet(s)* refills:*0* 13. ipratropium bromide 0.02 % solution sig: one (1) neb treatment inhalation every four (4) hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*2* discharge disposition: home with service facility: all care vna of greater discharge diagnosis: primary diagonsis: disseminiated fusarium, vre bacteremia secondary diagnosis: biphenotypic leukemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , it was a pleasure taking care of you in the hospital. you were admitted because your doctors suspected your was worsening. your treatment for the fungal was continued. you were found to have a bacteria (called enterococcus) growing in your and on skin biopsy and so you were treated with an antibiotic called daptomycin. you got several imaging studies of your heart because we were worried about the fluid around it. you were given small doses of lasix to manage the extra fluid in your body and to help you breathe more easily. you also had irregular and rapid heart beat (atrial fibrillation) which we treated with diltiazem and metoprolol. finally, you had a repeat bone marrow biopsy that showed persistent leukemia. after discussion with your family and dr. , it was decided that you would be discharged home with outpatient followup to determine how to proceed with your care. please attend the follow-up appointments with dr. and nursing listed below. we made the following changes to your medications: 1. started diltiazem 60mg by mouth every 6 hours 2. started metoprolol succinate 150mg by mouth once daily 3. started spironolactone 25mg by mouth daily 4. started bactrim ds (double strength) on mondays, wednesdays and fridays 5. started ipratropium nebulizer 1 treatment every 4 hours as needed for wheezing/shortness of breath 6. increased voriconazole to 300mg by mouth twice daily (from 300mg by mouth once daily) followup instructions: department: bmt chairs & rooms when: tuesday at 12:00 pm department: hematology/bmt when: tuesday at 12:00 pm with: , rn building: sc clinical ctr campus: east best parking: garage department: hematology/bmt when: tuesday at 2:30 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: pericardiocentesis thoracentesis biopsy of bone marrow biopsy of bone marrow closed biopsy of skin and subcutaneous tissue injection or infusion of cancer chemotherapeutic substance central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified acidosis acute kidney failure with lesion of tubular necrosis unspecified pleural effusion atrial fibrillation hypopotassemia pulmonary collapse cellulitis and abscess of leg, except foot bacteremia long-term (current) use of other medications infection with microorganisms without mention of resistance to multiple drugs antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use family history of ischemic heart disease streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] hyperosmolality and/or hypernatremia drug induced neutropenia chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta examination of participant in clinical trial other specified diseases of pericardium other and unspecified diseases of the oral soft tissues heart disease, unspecified acute pericarditis, unspecified other diuretics causing adverse effects in therapeutic use other fluid overload unspecified episodic mood disorder fever presenting with conditions classified elsewhere antifungal antibiotics causing adverse effects in therapeutic use neutropenia due to infection long-term (current) use of antibiotics other pancytopenia opportunistic mycoses other specified leukemia, without mention of having achieved remission 

Answer: The patient is high likely exposed to