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: history of present illness: the patient is a 73-year-old male with history of atrial fibrillation, chronically infected fistula tract in his left hip who presents with three to four day history of fatigue, malaise, tachypnea, anorexia, decreased po intake and watery diarrhea of six to seven bowel movements per day. he was in his usual state of good health until approximately one week prior to admission when he noted watery diarrhea without cramping, blood, melena, however, he did complain of dry heaves and anorexia. two to three days prior to admission, he noted increasing dyspnea, cough, production of yellow nonbloody sputum and subjective fevers. he did not document his fevers. he denies night sweats. he attempted to keep up with his fluid loss by a po intake, however, on the day of admission complained of dry mouth and decreased urine output. on arrival to the emergency room, he was hypoxic with oxygen saturation in the mid 80% on ten liters nonrebreather. he was hypotensive at 70/30, however, he responded to intravenous fluids and oxygen. initial electrocardiogram showed atrial bigeminy but repeat was in sinus tachycardia. review of systems: patient denies exertional chest pain, melena, bright red blood per rectum, hematuria, obstructive voiding symptoms. denies recent increase in drainage of his left hip sinus. past medical history: significant for hypertension, basal cell carcinoma of his right anterior shin, atrial fibrillation, motor vehicle accident in , complicated by left hip fracture, status post rod placement, chronic methicillin-sensitive staphylococcus aureus infection on suppressive dicloxacillin. last documented in to be methicillin sensitive staph aureus. echocardiogram showed mild left atrial enlargement, ejection fraction greater than 55%, mild aortic regurgitation, mild mitral regurgitation, normal pulmonary artery pressures, hypercholesterolemia and status post appendectomy. medications: he is on coumadin, trandolapril 1 mg, amiodarone 200 q.d. and prn viagra. allergies: no known drug allergies. social history: quit tobacco ten years ago. two or more packs a day. lives with his wife in . he is a publisher. physical examination: vitals: temperature maximum 99.7. pulse 146 decreased to 120 after fluid resuscitation. blood pressure 127/52, after fluid bolus breathing 25, saturating 92-93% on ten liters. in general, he is tachypneic on nonrebreather. head, eyes, ears, nose and throat showed pupils equal, round and reactive to light and accommodations. extraocular muscles were intact. sclerae are anicteric. oropharynx clear without lesions. mucous membranes were dry. neck was supple. there was no lymphadenopathy, 8 cm jugular venous distention. lungs: left lung showed rhonchus breath sounds, but good air movement. right lung decreased breath sounds at the bottom one half of lung fields. positive e-a changes at right base. heart was normal s1, s2, distant heart sounds. abdomen was obese, soft, nontender, nondistended. extremities showed no edema and cyanosis. distal pulses were 2+ bilaterally. left hip fistula drainage tract was draining serosanguinous fluid. there was no odor, no pus, no erythema. neurological exam was nonfocal. laboratories: white blood cell count of 15.1 with 31% neutrophils, 51% bands, 5% lymphocytes, 6% monocytes. hematocrit of 45.3, mcv of 94, platelets of 740,000. pt of 21.6, ptt of 40.7, inr of 3.3. sodium 137, potassium 4.3, chloride 99, bicarbonate 19, bun 33, creatinine 1.8, baseline creatinine 0.9, glucose 208, acetone was negative, legionella urinary antigen was negative. urinalysis was amber, cloudy 1.030, small blood, greater than 32 protein, small bilirubin, urobilinogen was 1.0 with no cells. arterial blood gases were 7.34, pco2 of 38, pa02 of 60, bicarbonate 21, lactate was 2.2. first electrocardiogram showed sinus tachycardia at 108, left axis deviation, qrs at .144, poor r wave progression, persistent s in v6, t wave inversion in v2, v3. nonspecific intraventricular conduction delay. chest x-ray showed large right lower lobe infiltrate with volume loss, small pleural effusion on right. patchy infiltrates in the left lower lobe, however, could still see the left hemidiaphragm. this 73-year-old male was admitted to the medical intensive care unit with severe community acquired pneumonia. hospital course: by systems: 1. hematology: the patient was noted to be in mild dic as evidenced by elevated ptt on admission, however, his platelets were fine. there was no evidence of consumptive coagulopathy. coumadin was held. ptt normalized over the course of stay. 2. pulmonary: patient with tobacco history and severe community acquired pneumonia. sputum cultures were repeatedly sent which did not grow out a predominance of any specific respiratory pathogen. early on the morning of his third hospital stay, he desaturated to the 80s and then began to fatigue with arterial blood gases of 7.23, 61, 64. he was intubated and sedated at that point. his chest x-ray was unchanged. his small right side effusion was tapped which was shown to be exudative with a ph of 7.35, 2.6 grams of total protein, 112 glucose, 279 ldh. serum ldh at that time was 180. had 5,750 white blood cells with 64% polys, 3% bands, 30% lymphocytes, 3% monocytes, 35,750 red blood cells. gram stain was unrevealing. patient, on the following day, patient was stable on the ventilator, still requiring mechanical ventilation. chest x-ray unchanged. a bronchoscopy was performed which showed normal airways, sputum in the right lower lobe and right middle lobe. bal was negative for acid fast bacilli, pcp, , and rsv. there was positive . gram stain showed 2+ polys, 1+ squamous cells, 1+ oropharyngeal flora. on the fifth hospital day, the patient required increased fio2 to 90% to maintain oxygenation. at this point, there was some concern given his low p-f ratio, that he had possibly progressed to acute lung injury and/or adult respiratory distress syndrome, however, it was likely he remained just with significant community acquired pneumonia. on the fifth hospital day, infectious disease consult recommended a ct to evaluate further for processes as he remained without microbiological diagnosis. this showed extensive alveolar consolidation involving nearly the entire right lung and to a lesser degree the left lower lobe. heterogeneous enhancement attenuation suggested necrotizing pneumonia, though, no abscesses are evident at this time. multiple predominantly ill-defined nodules throughout the remaining irradiated lobes most likely areas of early consolidation, however, follow-up ct after appropriate antibiotic therapy and serial chest x-ray are recommended to exclude true lung nodules. 2. parapneumonic effusion, small on the left, moderate on the right. 3. pleural calcification on the left lower hemithorax and tiny right posterior pleural calcification, question of history of asbestosis exposure, right adrenal lesion measuring 2 cm, possibly an adenoma. recommended follow-up mri. patient was again bronched on the fifth hospital day which showed edematous airway. culture data was still unrevealing at this point, and so on the 19th, the sixth hospital day, the patient underwent open lung biopsy. preliminary frozen section was likely to be infectious etiology versus malignancy, however, on the seventh hospital day the pathology came back showing definite adenocarcinoma, as well as alveoli polymorphonucleocytes, lymphocytes and atypical cells. 2. infectious disease: the patient was started on vancomycin and levofloxacin for community acquired pneumonia and concern that it was colonized to the methicillin resistant staphylococcus aureus given his chronic methicillin-sensitive staphylococcus aureus infection and suppressive dicloxacillin. despite two bronchoscopies with bal and culture and multiple blood cultures, sputum cultures, no microbiologic diagnosis was ever made, however, the pleural fluid grew out presumptive peptostreptococcus, rare growth, two colonies. infectious disease consult on the third hospital day recommended addition of imipenem to his regimen which is done. patient tolerated antibiotics without difficulty, however, the microbiologic diagnosis is still unclear at the time of death. 3. cardiovascular: the patient was in atrial fibrillation with stable ventricular response throughout the hospitalization until the night of intubation, the third hospital night, when he went to atrial fibrillation with rapid ventricular response which broke easily with 10 mg of diltiazem. echocardiogram obtained the next day showed mild left atrial enlargement, however, showed global left ventricular hypokinesis with an ejection fraction of 25-30% where as it had been greater than 55% in . also noted on the second echocardiogram was a focal apical right ventricular akinesis. on the sixth hospital day, the patient underwent a swan-ganz catheterization to estimate his cardiac status and fluid status. his cardiac output was found to be 4.83, index 2.12, svr 878, pulmonary capillary wedge pressure was 15. his peep was set at 10. based on this, it was felt that patient was not in fact fluid overloaded and congestive heart failure was not a component to his poor oxygenation. at this point, patient was fluid bolused. patient remained on increasing doses of levophed from the fifth hospital day until his death on the seventh hospital day. 4. disposition/day of death: patient's family was concerned of lack of response to antibiotics. when the pathology from the lung biopsy came back positive for adenocarcinoma of the lung, the family made the patient "do not resuscitate" and approximately three hours later, patient had a decreased response to pressors on 100% fio2 and he passed away at 6 p.m. on . he was pronounced dead by dr. . consent for postmortem examination was obtained by the family. date of death: . , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis other bronchoscopy arterial catheterization open biopsy of lung diagnoses: pneumonia, organism unspecified unspecified pleural effusion unspecified essential hypertension unspecified septicemia atrial fibrillation acute respiratory failure personal history of other malignant neoplasm of skin malignant neoplasm of other parts of bronchus or lung 

Answer: The patient is high likely exposed to