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: cocaine attending: chief complaint: thoracic back pain and leg weakness major surgical or invasive procedure: t4 laminectomy history of present illness: 51 yo man w/ pmh of esophageal ca s/p chemo and radiation w/ known progressive disease presented to osh for evaluation of new onset le paralysis. he had upper back pain for 2 days prior to admission. on the day of presentation he woke up and noted lle weakness. over the course of the day he developed rle weakness and came to the ed for further evaluation. his ros is significant for reporting no bowel movements or urination for 1-2 days. . team was concerned for spinal cord compression, but could not get mri as pt has surgical clips after traumatic head injury. ct myelogram showed occlusion of spinal canal at t4, so taken emergently to or. found epidural abscess, which was washed out. . on pod#2, pt became acute dyspneic and hypoxic to 77% after nasotracheal suctioning. abg 7.40/40/43 on 100% fm. on arrival to micu, sats ranged from 85-95% on nrb + 6l nc; briefly placed on bipap, but oxygenation actually decreased with this. after repositioning and chest pt, sats stabilized between 90-96% on 6l nc. past medical history: -esophageal ca s/p chemo and radiation- oncologist is dr. stenting after radiation induced esophageal stenosis -suicide attempt () w/ a circular saw, surgically repaired injury w/ l eye ptosis and brain clips, treated at -gerd -htn -former etoh -mi's x 2 (, ?) social history: homeless; lived in shelter before diagnosis of cancer, but has been living with his mother since being treated for cancer. -tobacco: 1ppd (80 pyh) -"off and on" etoh use, occasional marijuana, history of cocaine use family history: noncontributory physical exam: t: 96.4 bp: 112/74 hr: 101 r 22 o2sats 86-96% on 6l + nrb; pulsus 8 mm hg gen: able to speak words between breaths, wearing nrb and 10l nc neck: supple. lungs: bronchial breath sounds, left lower and mid fields; rhonchorous r field. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. neuro: mental status: awake and alert, cooperative with exam, normal affect.orientation: oriented to person, place, and date. language: speech fluent with good comprehension. no dysarthria or paraphasic errors. cranial nerves: ii: pupils round and reactive to light w/ mild anisocoria (r>l) iii, iv, vi: extraocular movements intact bilaterally with few beats of nystagmus, ptosis of l eye v, vii: facial strength and sensation intact and symmetric. viii: hearing intact to voice. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. motor: no pronator drift. normal bulk and tone bilaterally in ue. le decreased muscle bulk. no adventitious movements, no tremor, no asterixis. d t b wf we fif ip gl q h af ae tf te right 5 - - - - - - - > 0 - - - - - - - - - > left 5 - - - - - - - > 0 - - - - - - - - - > reflexes: toes: mute bilaterally b t br pa pl right 2+ 2+ 2+ 0 0 left 2+ 2+ 2+ 0 0 sensory system: -light touch: symmetric and intact in ue; sensation in legs intact to deep pressure only -pinprick: absent until t3-t4 bilaterally (l side is slightly higher than r), pt able to feel touch very faintly at t12 posteriorly coordination: nl in ue gait: unable to access pertinent results: 08:04am wbc-10.1 rbc-4.12* hgb-13.4* hct-40.1 mcv-97 mch-32.7* mchc-33.5 rdw-14.9 08:04am neuts-70.9* bands-0 lymphs-5.1* monos-23.9* eos-0.1 basos-0.1 08:04am hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-1+ microcyt-normal polychrom-normal 08:04am plt smr-normal plt count-235 08:04am glucose-142* urea n-17 creat-0.9 sodium-136 potassium-4.3 chloride-98 total co2-29 anion gap-13 08:04am alt(sgpt)-6 ast(sgot)-13 ld(ldh)-163 alk phos-75 amylase-24 tot bili-0.6 10:40am cerebrospinal fluid (csf) wbc-92 rbc-31* polys-42 lymphs-4 monos-54 10:40am cerebrospinal fluid (csf) protein-670* glucose-59 ld(ldh)-52 ct myelogram (pre-op): contrast flowed readily from the injected level (l3/4) through the lumbar spine and extending cephalad to the thoracic spine. there is complete block of contrast material at the thoracic vertebral body level. the post- myelogram ct of the thoracic and cervical spine reconfirmed that there is complete block of contrast within the subarachnoid space at the t4/5 level. bedside echocardiogram: there is a moderate sized pericardial effusion most prominent anterior to the right atrium with brief right atrial diastolic collapse. a promient echogenic area is seen overlying the right ventricular free wall which likely represents epicardial fat (cannot exclude thrombus or tumor if this is clinically suggested). there is but no right ventricular diastolic collapse with relatively minimal fluid anterior to the right ventricle. there is mild eccentuation of transmitral doppler e wave suggesting increased pericardial pressure. serial evaluation is suggested. cxrs have shown intermittent, recurrent opacification alternately of the left and right lungs. chest ct on showed debris in the distal l mainstem bronchus consistent with aspirated material. cta was negative for pe. brief hospital course: 51 yo man with esophageal cancer s/p chemo and xrt presenting with abrupt onset lower extremity flacid paralysis found to have t4 epidural abscess, s/p operative debridement, now with acute onset respiratory distress . # respiratory distress: acute dyspnea with severe hypoxemia and tachycardia on hd#3, now maintaining adequate saturation on high flow nebulizer mask. ruled out dvt and pe with lower extremity dopplers and cta. the combination of locally advanced esophageal cancer and weakened chest muscles leading to poor cough predispose to recurrent, significant aspiration. this was discussed at length with the patient, and he wishes to continue chest pt and other non-invasive measures to augment his cough and support his breathing. if non-invasive measures cease to be effective, he has stated clearly that he would want to be made comfortable. he has continued to affirm that he should not be intubated. - aggressive chest pt & nebs since cough is very weak due to t4 spinal lesion. - supplemental o2 as needed to keep spo2>90%, currently requiring hi flow venti mask; titrate up to non rebreather if needed - dnr/dni; if noninvasive means to support oxygenation are ineffective, pt would want to transition to hospice . # pericardial effusion: given cardiomediastinal enlargement on cxr, stat echo was obtained, which showed moderate pericardial effusion with invagination of ra, equivocal respiratory variation of rv movement, but no collapse of rv. given low/normal pulsus and no signs of tamponade by echo, this effusion is likely not the cause of his respiratory decompensation. . # t4 epidural abscess: s/p open debridement on , wound cultures growing strep milleri, but wound gm stain also showed a gm neg coccobacillus, suspect mouth flora. ceftriaxone 2gm q24h for once-daily dosing regimen to cover strep milleri, and metronidazole 500mg tid for anaerobes. will plan to continue course for 6 weeks given serious cns infection. after 6 week course is complete, recommend suppressive therapy with amoxicillin 500mg daily indefinitely, as the locally advanced esophageal cancer will remain a risk for thoracic spine infection. - tlso brace while out of bed, multipodis boots to prevent heel breakdown - neurology consult indicated that patient will most likely not recover meaningful motor function of his legs, ie, ambulation is unlikely. any recovery of motor function will be limited and gradual. . # esophageal ca: s/p chemo and xrt, with stenting for stenosis. pain control. patient's goals for treatment have been to be able to eat; oncologist dr has indicated that further chemo or xrt will likely not help in this regard but continue to follow. pain control. . # gerd: continue protonix . # nutrition: pt cannot tolerate solid foods. ensure supplements, soft foods only. . # tobacco dependance: nicotine patch . # prophylaxis: -heparing subcutaneous, pneumoboots, and protonix . # code status: dnr/dni, discussed with patient and family including hcp (mother) medications on admission: -percocet -prilosec -unknown bp med -stool softener discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 3. thiamine hcl 100 mg/ml solution sig: one (1) injection daily (daily). 4. folic acid 5 mg/ml solution sig: one (1) injection daily (daily). 5. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed. 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) syringe injection tid (3 times a day). 7. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed for copd. 8. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed for copd. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 11. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 6 weeks. 12. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 13. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed. 14. zofran odt 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po three times a day as needed for nausea. 15. acetylcysteine 10 % (100 mg/ml) solution sig: one (1) ml miscellaneous q6h (every 6 hours) as needed for shortness of breath or wheezing. 16. methylphenidate 5 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 17. diazepam 5 mg tablet sig: two (2) tablet po hs (at bedtime) as needed. 18. ceftriaxone-dextrose (iso-osm) 2 g/50 ml piggyback sig: two (2) grams intravenous q24h (every 24 hours). discharge disposition: extended care facility: & rehab center - discharge diagnosis: esophageal cancer t4 epidural abscess, polymicrobial, with spinal cord compression and paraplegia discharge condition: fair, although with tenuous respiratory status. discharge instructions: you had surgical decompression of a t4 epidural abscess and will need 6 weeks of antibiotics to treat this. you may or may not regain much motor function in your legs because of the spinal cord compression injury. for your respiratory status, the combination of esophageal cancer and weakness have predisposed you to aspirating and prevent you from coughing effectively. continue with aggressive chest physical therapy and mie as long as patient feels subjective benefit. supplemental o2. followup instructions: dr , , friday , 2:00pm. (oncology) md procedure: imageless computer assisted surgery excision or destruction of lesion of spinal cord or spinal meninges other exploration and decompression of spinal canal other exploration and decompression of spinal canal other exploration and decompression of spinal canal other exploration and decompression of spinal canal diagnoses: esophageal reflux tobacco use disorder unspecified essential hypertension pneumonitis due to inhalation of food or vomitus intraspinal abscess paraplegia malignant neoplasm of other specified part of esophagus acute pericarditis, unspecified 

Answer: The patient is high likely exposed to