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: sulfa (sulfonamide antibiotics) / bacitracin attending: chief complaint: lbp, n/v/diarrhea, recently discovered rll mass major surgical or invasive procedure: upper endoscopy with biopsy bronchoscopy with biopsy history of present illness: yom with h/o htn, tobacco, and chronic lbp who presents with newly discovered 3.8 cm rll mass on outside ct as well as worsening fatigue, weight loss, decreased po, and recent n/v/d. the patient and his family report that over the past 2 months, he has experienced a decreased appetite. he has lost 17 lbs in the past 2 months. he has also become more weak over the same time period. he recently had a superimposed illness that started this past weekend with nausea, vomiting and diarrhea - his wife was also ill. . prior to the past 2 months the patient had an excellent functional status. he lives at home with his wife and 2 children and ambulated well with a cane. over the past week, however, he has had worsening lbp and difficulty walking - he requires assistance to go to the bathroom. he has spent most of his time watching tv sitting in a chair. he had 2 days of nonbloody diarrhea this past week and had multiple episodes of vomiting last weekend - he had dry heaves the past 2 nights. his son reports that the patient has been unable to sleep for the past 2 nights because of pain. the weight loss and pain prompted the patient's pcp to obtain ct scan, which showed a 3.8 cm rll mass. the pcp referred the patient to the ed for iv hydration and further evaluation of the lung mass. the patient and family report that if the mass is cancerous, they may pursue treatment. they are interested in further evaluation and fna/biopsy. . in the ed, initial vitals were 98 71 150/98 20 99% on ra. he was given 1 l ns as well as iv morphine, which provided some relief. labs showed hct 26.5, cr 1.6 (at baseline), and normal lfts and lipase. cxr showed density in the anterior lll or lingula, which may represent mass, atelectasis or pneumonia (wet read). . on the floor, vs 96.5 165/65 52 20 100% on ra. the patient is accompanied by his son and daughter who are very involved in his care. the patient is alert and oriented and states that his pain is still present but is under somewhat better control. he appears comfortable. he admits to recently decreased po and states that he will do "whatever the doctors think is " for his lung mass. . review of sytems: (+) per hpi (-) denies fever, chills, night sweats. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. no dysuria. denied arthralgias or myalgias. past medical history: hypertension chronic lbp tia - 25 years ago vit b12 deficiency - recently started b12 shots scc of the skin diverticulosis ckd hemorrhoids s/p back surgery for ruptured disc 5 years ago s/p appendectomy social history: retired, owned own liquor-packaging business and worked for post office. married with 8 children. lives with his wife and 2 of his grown children in a 2-family home in . ambulates with a cane. was relatively active until the last few months. 50-pack year tobacco history (quit age 40-50). no etoh. no illicit drugs. family history: father died age 50 from mi. physical exam: on admission: vs: 96.5 165/65 52 20 100% on ra general: elderly man with some temporal wasting and diffuse muscle wasting. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. pupils are small, equal, reactive. eomi. mmm - dry tongue. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple, neck veins are flat cardiac: rr, normal s1, s2. 2/6 systolic murmur heard best at rusb - radiates to carotids. no r/g. lungs: resp were unlabored, no accessory muscle use. dry crackles at bases bilaterally - dry crackle to mid base of r posterior lung fields. no wheezes or rhonchi. abdomen: soft, mild ruq tenderness. normoactive bs. no hsm or tenderness. back: no obvious deformities. no tenderness to palpation down spine. extremities: no edema. 1+ dp and rad pulses. cool hands/feet. neuro: cn ii-xii intact. full power in ue/le bilaterally. sensation intact. can state the days backwards. a&o x 3. pertinent results: 10:05am blood wbc-9.2 rbc-4.01* hgb-12.6* hct-36.5* mcv-91 mch-31.5 mchc-34.6 rdw-13.7 plt ct-253 09:25am blood wbc-11.4* rbc-2.43*# hgb-7.8*# hct-23.0*# mcv-94 mch-31.9 mchc-33.8 rdw-15.0 plt ct-237 07:45pm blood wbc-9.8 rbc-2.33* hgb-7.3* hct-22.6* mcv-97 mch-31.3 mchc-32.4 rdw-14.7 plt ct-245 11:44am blood hct-30.9* 04:28am blood wbc-9.6 rbc-3.53*# hgb-11.1*# hct-32.3* mcv-92 mch-31.4 mchc-34.3 rdw-16.0* plt ct-222 06:40am blood wbc-9.4 rbc-3.41* hgb-10.7* hct-31.3* mcv-92 mch-31.3 mchc-34.1 rdw-15.5 plt ct-211 05:50am blood hct-29.5* 01:04pm blood hct-29.1* 07:45pm blood pt-12.7 ptt-32.1 inr(pt)-1.1 10:05am blood glucose-120* urean-39* creat-1.6* na-136 k-3.8 cl-99 hco3-25 angap-16 09:25am blood glucose-136* urean-45* creat-1.3* na-144 k-4.0 cl-116* hco3-19* angap-13 06:40am blood glucose-91 urean-26* creat-1.3* na-142 k-3.7 cl-115* hco3-21* angap-10 09:20am blood albumin-2.3* calcium-7.5* phos-2.2* mg-2.1 06:40am blood calcium-7.7* phos-2.8 mg-1.6 07:20am blood tsh-1.3 studies: cxr : . findings: right picc line present, which appears to terminate at the cavoatrial junction. ill-defined focal opacity seen in the right suprahilar region, likely corresponding to known mass. the known destruction of the right posterior sixth rib is not as well seen. no other definite lesions. impression: right lung mass with destruction of the right posterior sixth rib. please see ct for further details brief hospital course: yom with h/o htn, tobacco, and chronic lbp who presents with newly discovered 3.8 cm rll mass on outside ct as well as worsening fatigue, weight loss, decreased po, and recent n/v/d . # rll lung mass: the patient presented at the request of his pcp. in the week, a 3.8 cm lung nodule had been discovered and the pcp requested further evaluation of the mass. outside ct scans were uploaded, which showed a rounded, pleural based mass in the superior segment of the right lower lobe. given the patient's smoking history along with recent weight loss and malaise, there was concern for malignancy. interventional pulmonology was consulted and scheduled the patient for biopsy on . biopsy of station 10r necrotic lymph node was performed and sent for biopsy; patient tolerated procedure well and was set up for outpatient pulmonary follow up. . # gi bleed - patient had melena on the floor; he was transferred to micu where he was transfused 3 units but had no significant hemodynamic instability. his postransfusion hct was 30.9 and on day of discharge hct was 29.1 - 29.5), he had received a total of 3u prbcs over - period. upon returning to the floor, he had egd performed which revealed a stenotic area near the gastro-esophageal junction potentially concerning for malignancy; several erosions were also seen in the antrum which were not bleeding. aspirin was discontinued (had been on this for tia 25 years ago). these lesions were biopsied and results are pending. h pylori serology was positive. we refrained from initiating h pylori treatment until biopsies come back given advanced age of patient. we deferred restarting aspirin given recent biopsies and gi bleed; primary care appointment is scheduled two weeks from now during which the need for aspirin can be reassessed. . # lower back pain: the patient reported worsening r flank/chest pain over the past 3 months that was especially worse over the past nights. he was given scheduled tylenol as well as his home medication gabapentin. iv morphine 2 mg every 3 hours as needed was added, which provided the patient with great relief. oxycodone 2.5 mg prn was added as the patient's nausea improved - stool softeners were also added to help prevent constipation. physical therapy was consulted and also worked with the patient. he was able to ambulate to the bathroom with assitance. pt recommended the patient be discharged to rehab. . # nausea/decreased po: the patient reported worsening nausea at home - he and his wife had recently been ill with a gastroenteritis-like illness. zofran iv/po was added to his regimen and helped to control the patient's nausea. he had one episode of emesis on am, but none after that episode. nutrition was also consulted and recommended ensure supplments. the patient was given ivf - both maintenance and bolus. . # htn: restarted lisinopril 10 mg qday once patient was rehydrated with ivf. . # anemia: hct was stable ~ 31. mcv 91. pt with known history of vitb12 deficiency. . # ckd: cr at baseline ~ 1.3-1.6. cr improved to 1.3 with iv hydration. lisinopril was restarted. urine culture was negative. nephrotoxins were avoided. . # the patient received subq heparin for dvt prophylaxis. communication was with (son) and (daughter) . . # code status - full . # dispo - to rehab facility planned for with pulmonary, gi, and pcp follow up scheduled. medications on admission: lisinopril 10 mg qday gabapentin 300 mg tid asa 81 mg qday vitb12 injections 1000mcg qmonth (1st shot on ) discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*3* 2. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 3. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 4. cyanocobalamin (vitamin b-12) 1,000 mcg/ml solution sig: one (1) ml injection once a month. 5. oxycodone 5 mg tablet sig: 0.5 tablet po every 6-8 hours as needed for pain. disp:*30 tablet(s)* refills:*2* 6. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*2* 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 8. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. disp:*30 tablet, rapid dissolve(s)* refills:*2* 9. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 11. vitamin b-12 1,000 mcg tablet sig: one (1) tablet po once a month. 12. ensure liquid sig: two (2) po once a day. discharge disposition: extended care facility: bear nursing center - discharge diagnosis: primary: back pain lung mass failure to thrive . secondary: hypertension transient ischemic attack chronic kidney disease 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 caring for you at . you were admitted because of recent dehydration and poor appetite as well as increased back pain. you were also admitted for further evaluation of the lung mass that was recently found on ct scan. we gave you iv fluids, improved your pain control, and your condition improved. we spoke with the interventional pulmonology doctors who looked at your ct scan and performed a biopsy to obtain a piece of the tissue. we made the following changes to your medications: (1) we started tylenol to be taken three times per day for pain (2) we started oxycodone 2.5 mg every 6 to 8 hours as needed for pain -> this medication can be constipating so it is important to take stool softeners -> we started colace and senna (3) we started zofran 4 mg to be taken every 8 hours as needed for nausea (4) started pantoprazole which helps protect you for further bleeding from your stomach. (5) started lidocaine patch for pain control. (6) stopped your aspirin - you should not restart this until your primary care doctor says you should restart it, because this increases your risk for gi bleeding. . you should continue to take ensure meal supplements. . your follow-up appointments are listed below. followup instructions: you are scheduled for a follow up appointment with interventional pulmonary on , at 2 pm with dr . this is located in the building in rm 116. . you have a follow up appointment with your primary care , md at 210 pm. . you have a follow up appointment with dr on at 1 pm. his office is located at the in the on the . md, procedure: esophagogastroduodenoscopy [egd] with closed biopsy closed endoscopic biopsy of lung biopsy of lymphatic structure central venous catheter placement with guidance diagnoses: acute posthemorrhagic anemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other b-complex deficiencies constipation, unspecified chronic kidney disease, stage iii (moderate) retention of urine, unspecified personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits hemorrhage of gastrointestinal tract, unspecified dehydration lumbago unspecified hereditary and idiopathic peripheral neuropathy enlargement of lymph nodes delirium due to conditions classified elsewhere malignant neoplasm of lower lobe, bronchus or lung helicobacter pylori [h. pylori] stricture and stenosis of esophagus malnutrition of moderate degree spontaneous ecchymoses 

Answer: The patient is high likely exposed to