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: shortness of breath major surgical or invasive procedure: ivc filter placed history of present illness: this is a 73yo male with cad s/p cabg or stent?, hodgkins lymphoma, recent admission in for extensive bilateral femoral vein clots, who presents with dyspnea, cough, hypoxemia, found to have b/l pulmonary embolisms. of note, this patient was admitted to oncology from for bilateral dvts of common femoral, superficial femoral, politeal, and calf veins. at that time, he was started dalteparin (fragmin) daily for treatment of this. he reports that he had been compliant with this. the patient reports that he has been feeling short of breath for several months. when he left the hospital last , he was short of breath, and this has been worsening since then. he reports that his excercise tolerance has worsened progressively since being discharged from the hospital. he feels short of breath with mininal exertion. he also reports coughing nightly for the past few days. this morning, he "just couldnt take it anymore" and decided to come in. he denies any acute worsening in his breathing, and reports that it has been progressive. on review of systems. he denies chest pain, palpations. has cough, shortness of breath, dyspnea on exertion. denies fevers. reports chills and feeling cold all of the time. reports 10 pounds of unintentional recent weight loss. all other review of systems negative. in the er, intial vitals were 103/43, hr 96, rr 22, o2sat 77% on ra. reportedly altered when hypoxic, but mental status improved once on oxygen. a cta was done showing clot in right main pulmonary artery and branch arteries in the lll. he was started on heparin. he also remains hypoxemic. attempt was made to put him in 6l nc, but he became tachpyneic and , is now back on nrb. past medical history: - crohn's disease diagnosed in . - hypercholesterolemia. - hypertension. - carotid stenosis status post bilateral cea - barrett's esophagus. - cad s/p stent (was on plavix stopped ) - tia. - seizure disorder past surgical history: - s/p bilateral cea ~ 5 years ago - s/p l shoulder surgery social history: doesnt currently smoke, but quit 20 years ago. smoked 10 years, pack a day, so 5packyears. used to drink 1 glass wine daily, but hasnt in the past few months. lives with wife family history: parents had mis in old age. one granddaughter with asthma. physical exam: vitals: t: 98.2 bp: 98/56 p: 85 r: 25 18 o2: 95% on nrb general: alert, oriented, clearly short of breath with speaking heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: mostly clear to auscultation bilaterally, rhonchi clear with cough. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: b/l edema left worse than right. pertinent results: cta impression: 1. acute pe involving right main/branch and left lower lobe pulmonary arteries. no evidence of right heart strain. 2. diffuse bilateraly pulmonary ground-glass opacities may be due to pulmonary edema/ards, although infection/inflammation or hemorrhage not excluded. superimposed infarction cannot be excluded. 3. mediastinal and hilar lymph nodes may be reactive. ct chest: 1. diffuse bilateral pulmonary ground-glass opacities most likely represent infection or inflammation; however, the differential diagnosis also includes pulmonary edema, hemorrhage, or superimposed infarction. 2. stable mediastinal and hilar lymphadenopathy. 3. persistent pulmonary embolism involving the right main pulmonary artery extending into the right middle and lower lobes but with no evidence of right heart strain. 4. bilateral small pleural effusions with associated compressive atelectasis. 5. subcentimeter lesion in segment i/vi of the liver, too small to characterize, but may represents a hepatic cyst. recommend attention on followup. 6. clots in left external iliac vein, right common femoral, and left common femoral veins. 7. hypodensity in the upper pole of the right kidney is most consistent with a renal cyst. bilateral hypodensities are too small to characterize but likely represent renal cysts. : ct abd/ pelvis brief hospital course: when patient came to the ed on , his initial intial vitals were 103/43, hr 96, rr 22, o2sat 77% on ra. he was altered when hypoxic, but mental status improved once on oxygen. a cta was done showing clot in right main pulmonary artery and branch arteries in the lll. he was started on heparin. attempt was made to put him in 6 l nc, but he became tachpyneic and , he went back on a non-rebreather. he was then admitted to the . expired : - no escalation of care - atrius h/o aware and agrees - : -family meeting. -change in code status to dnr/dni : clinically deteriorated: febrile all day (never defervesed - t max 103.6), increased secretions and cough. less alert. desaturated on psv/cpap with 50% fio2 and sinus tachycardic to 150s-160s. pan-cultured. u/a negative. initially thought it was agitation/delirium - was given zyprexa. also thought pt had large cuff leak contributing to increased secretions and aspiration leading to vap. thoracics came back and was unimpressed. thought trach looked fine and was more concerned with clinical picture. still agitated, given versed for sedation. continued to be agitated, febrile and tachycardic. given fluid boluses. tachycardia persisted. cxr - increased haziness bilaterally from morning cxr; ekg: sinus tachycardia. continued to desaturate. placed on cmv (tv 500, rr 14, fio2 100%, peep 10). pressures began to drop to 80-90s systolic. more fluid given. not responsive. started on neo. a-line placed. abg: 7.43/35/82/27 on 100% fio2. deeply sedated with propofol and fentanyl. family made aware of clinical status and requested that we persist with current measures. - other considerations: changing ngt to ogt; starting antifungal 11-3am: attempts were made to wean patient off 100% fio2, however did not tolerate. patient pressure continued to drop. was thought increase in peep. fluid responsive. however maps not ideal so went up on pressor - now max'ed out. : -pt spiked fever in the afternoon -pt started on vancomycin, ciprofloxacin, and cefepime empirically -nurses suctioning bright red blood from trach- stopped heparin gtt for now -t- aware, asked to check hct, recommend bal tmrw; call them if bleeding worsens : -increased bb to 25 tid -got ct abd pelv : - rec'd picc today - sedation weaned, much more interactive - up titrated beta blocker although hr remains in 100s - attempted trach mask trials - increased secretions, likely fluid overload - given iv lasix 40mg - met goal of 1-2l negative - gi consulted for peg placement - no recs yet - rec'd valium - sbp dropped to 80s systolic responded with 250cc bolus - did not sleep all night : -weaning sedation -discussion ongoing for peg vs. dobhoff between oncologist dr. and t- dr. ; -plans for dobhoff tomorrow in ir -start coumadin tmrw : -hr still 100-130s -got trach placed , no immediate complications -agitated overnight, needed to increase sedation w/ fentanyl -back on iv heparin : -npo after mn for peg/ trach placement and heparin held at 4 am : - settings on ps , doing well : -plan is to have trach/ peg placed on monday between 8 am -12 pm. heparin and tube feeds must be stopped 4 hours prior. please contact anesthesia attending to make them aware of possible emergency airway -wife must sign consetns for trach and peg - anesthesia booked for monday between 8-10am, case # (booking called at ) - dilantin 6.6, corrected to 13.8 when account for albumin. continued current dosing. -hct 21, stable. check tomorrow, if low, give uprbc, guiac stools : -family meeting: proceeed with trach, peg tube -ct came and constented pt's wife over the phone for trach and peg placement. he may get his surgery tomorrow. they will page to let us know. we will need to stop tube feeds and heparin 4 hours prior. -onc: hodkins stable, nodes smaller -d/c bactrim, now on atovaquone -mucomyst given for secretions -abd ct: thickening of fundus and ascending colon- questionable worsening hodgkin's -discharge summary updated - ct chest ct/ abd/ pelvis ordered to eval for progression of hodgkin's -ct consulted re trach placement - bmt recs: switch bactrim to atovaquone (worry that bactrim allergy may be causing increased eos). done. - stool send for ova/ parasites (as source of eos) - family scheduled for 2 pm with entire family tommorrow - probably should get onc and bmt on board - onc will be present at , review scan with radiology prior : -go down on peep -cvp 10, give gently lasix 20 -family meeting: aware that this is chronic process, they want trach. will clarify tomorrow that this is definitely what he needs. -stopped bactrim because negative bal pcp x2 -nutrition consulted for recs to decrease fluid intake : resp took off ards net protocol, put patient on ps, rr went down into 20s, good sats, pco2 41 at 3 pm - spiked fever to 103 at 2 pm, tyylenol given and blood cultures sent - given 2 x 40 lasix boluses by 3 pm; peeing well over 2 l but still overall positive due to tube feeds; by 10 pm, maps in 70s, still slightly tach to 110s, will hold off on another bolus of lasix for now - was becoming tachycardic and tachypneic, went up to ps of 15 at midnight - talked to son about possibility of a trach and that he may not come off the vent -bcx, ucx, sputum cx sent -run of a. fib/ a. flutter (atrial ectopy hybrid) around 2200, started on digoxin. norepinephrine changed to phenylepinephrine (alpha agonist only, no beta agonist) - pt given 500 cc fluid bolus at 22:30 for hypotension, goal was to make fluid even over 24 hrs - tube feeds restarted -cta shows unchanged pe, sl. worse ground glass opacities, traction bronchiectasis suggestive of underlying interstitial fibrotic lung disease, new left pleural effusion with associated atelectasis - k, phos repleted with pot phos iv 15 ml/ 250 cc ns -b-lucan positive from labs on . 300s. started him on bactrim treatment. already getting steroids. -20 iv lasix x2 - increased resp distress with hypoxia on bipap this am- reintubated. - repeat cta- dictation- no new filling defects, sl worsened ground glass opacities, sm effusions. f/u final read. -tube feeds restarted after cta -metoprolol d/c'ed -solumedrol decreased from 50 to 40 -diet advanced to full thin liquids -tube feeds restarted at 20 ml/hr, advance to 50 ml/hr - metoprolol started at 12.5 mg q6h for htn, tachycardia (home dose 200 mg po qd) -f/u ecg, enzymes, lytes in pm - 3rd c diff negative - ngt placed -extubated, coughing, satting high 80-low 90 -c. diff neg x2, check last c.diff - hdyrocortisone 50 q12 -continue vanco, levo, cefepine for now and evaluate after 10 days -overnight, had episodes ot tachy (130s) and desats to mid 80s. went up on o2 to 35, started incentive spirometer use. -abg was in fact accurate showing resp alkalosis with a-a gradient of 119 suggesting pe, infection, - tube feeds started- nutren pulmonary full strength with beneprotein, 21 gm/day, rate started at 20 ml/ hr, advance rate by 10 ml q4hto goal of 40 ml/hr. (once propofol d/c'ed- increase to 50/hr and stop benefiber) - family meeting wiht pt's wife and daughter in afternoon for update on status -po flagyl started until c. diff ruled out -possible bleomycin toxicity, keep on room air unless pao2< 88 - tube feeds restarted - 500 cc bolus given for cvp of 5 : - sucralfate added for blood in og tube on - sedation decreased, pressors decreased - tachypnea during sbt, and increased secretions, will attempt to extubate tomorrow am - copious diarrhea, c. diff sent - 5 am, patient turned, became hypotensive to sbp to 70s, 2 l ns hung, pac bigemeny, low k, k repleted, pressure stabilized with fluid and decreased propofol - rsbi about 60, labile vitals on sbt : -worsened resp distress in am, despite improved cxr. -gentle diuresis to improve ventilation -more sedated. now on fent, versed, propofol 20, 1.3 neo. on 400/30, 25%, peep=8. -goal to stop propofol tomorrow morning and switch to psv and see what happens. -tried a-line but unsuccessful at several attempts 73 y/o w/ ivc filter, start on pcp to floor at 3:30 pm -dilantin level low. pt given loading dose of phenytoin of 500 mg iv at 7 pm and standing dose increased from 200 mg q8 to 250 mg q8. -check dilantin level in pm of -vanco changed from 1000 mg q12 to 100o q8 h. vanc trough ordered for - will get ivc filter placed at 8 am - weaned off propofol -new a-line placed -central line placed -worsening respiratory failure: received 10 l of fluids in last 24 hrs. around 8pm, respiraotory status worsened. mottled feet up to knees. blood gas shows metabolic acidosis. cxr showed increased bilateral opacities. ards vs fluid overload (causing non-ag met acidosis and worsening cxr), vs infectious process vs pe vs dah 2' rheum condition. -checked , anca, gbm, antiphopholipid ab syndrome (clot burden) -echo: normal ef, no signs of right heart strain -le u/s: no interval change of clot. femoral, superficial femoral, popliteal involvement bilaterally -metabolic acidosis -->met acidosis + resp acidosis after increasing peep and fio2 which improved oxygenation from 47 -->188. overnight - pt was requiring fio2 of 100% on cpap and was sating in mid-80's -intubated and placed on volume support - placed on vanco, zosyn and bactrim for ground glass findings on chest ct concerning for pneumonia and possible pcp phenytoin was changed to iv as pt unable to take po at this time medications on admission: medications: per wife: prednisone one pill in am and 2 pills at night (likely 10mg and 20mg, will check with pcp) vitamin d 800mg daily iron 325mg three times daily folic acid 1 g daily dalteparin 15,000 units sub q daily mesalamine 4 pills twice daily phenytoin 100 mg- 6 pills at night metoprolol 200 mg po daily isosorbide 60 mg po every morning discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube insertion of endotracheal tube interruption of the vena cava fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances arterial catheterization arterial catheterization temporary tracheostomy closed [endoscopic] biopsy of bronchus bronchoscopy through artificial stoma angiocardiography of venae cavae diagnoses: pneumonia, organism unspecified anemia, unspecified coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified essential hypertension unspecified septicemia hyposmolality and/or hyponatremia severe sepsis atrial fibrillation atrial flutter percutaneous transluminal coronary angioplasty status occlusion and stenosis of carotid artery without mention of cerebral infarction regional enteritis of unspecified site acute respiratory failure disorders of phosphorus metabolism septic shock hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites postinflammatory pulmonary fibrosis epilepsy, unspecified, without mention of intractable epilepsy personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits diarrhea hypovolemia occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction other pulmonary embolism and infarction barrett's esophagus personal history of antineoplastic chemotherapy dependence on respirator, status acute venous embolism and thrombosis of deep vessels of distal lower extremity antineoplastic antibiotics causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to