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: wellbutrin / oxycontin attending: chief complaint: fever major surgical or invasive procedure: none history of present illness: mr. is a 70 year-old gentleman w/ stage iv nsclc metastatic to brain/spine/kidneys, s/p cycle 3 of /taxol (last ), also with h/o emphysema on 2l home o2, pe on lovenox, now presenting after he developed a fever overnight. he felt nauseous as per usual after chemotherapy but felt more weak and feverish last night, checked temp and was was 101.7, for which he took two tylenol and defervesced. he also had a an episode of n/v which improved with zofran x 1. he had no increase in his baseline shortness of breath or cough. no abdominal pain, ongoing n/v, or diarrhea. this am however, he had an episode of urinary incontinence and had fever again. he then presented to the er. . in the ed: v/s 97.1 92 107/90 96%. pe with left basilar crackles (stable), blanching erythema ? contact dermatitis in groin. labs revealed lactate 3.0, wbc 10.9 with 95% pmns. spiked in the er. cxr showed no obvious infiltrate. ekg showed low voltage nonspecific twf in v4-v6, twi v3. nl axis, nl intervals. u/a wnl. bps dropped to the 80s he received vancomycin, cefepime, tylenol, zofran, 10mg iv dexamethasone, and 4 l ivf. a cvl was placed. his pressures normalized and he did not requires pressors. he was then admitted to the . most recent vs: 100/54 88 21 98%4l. . currently, . ros is positive for admission to for shortness of breath which was attributed to pneumonia, treated with a 7 day course of levofloxacin. prior to this he had fever, congestion, and cough x 1 week, given a 5-day course of azithromycin for presumed uri/bronchitis. he has chronic doe with only walking a few steps, and overall fatigue and malaise. he denies any chest pain, calf pain or leg swelling. he reports +productive cough yellow sputum, +nasal congestion. +nausea this morning. he denies any sick contacts, hemoptysis, hoarseness, headaches, sore throat, vomiting, abdominal pain, diarrhea, brbpr, dysuria or back pain. on further questioning patient also reports difficulty with ambulation the past few days and lightheadedness. he denies any vertigo or focal weakness or numbness of the extremities. he denies any back pain, urinary or stool incontinence. patient states he feels unsteady while he walks and that he has been feeling very weak as well. past medical history: past oncologic history: ====================== stage iv non-small cell lung cancer, s/p cycle 2 /taxol s/p whole brain irradiation . past medical history: ==================== diabetes mellitus type 2 hx of pulmonary embolus on lovenox emphysema asbestosis right rectus sheath hematoma, spontaneous coughing in left adrenal adenoma small sliding hiatal hernia bilateral pleural plaques social history: mr. is married and lives with his wife. his daughter is a er nurse and lives next door. he used to work in a navy yard for a year in , where he was exposed to asbestos. he retired 15 years ago from a middle management position in a defense company. tobacco: he smoked ppd x 50 yrs and has tried to quit several times. the last time he quit was on . he drinks two beers a day and denies having any history of alcohol abuse. he denies illicit drug use family history: his mother died from disease and his father had mesothelioma and died at age 58 from a heart attack. his father worked in a shipyard which was believed to be a contributing factor to his cancer. his paternal grandfather also died from lung cancer and used to work in the coal yards. he has one brother who is healthy and one sister, age 63 who has cervical cancer. he has two daughters who are healthy. physical exam: general: pleasant elderly gentleman sitting up in bed in nad skin: wwp, + erythematous blanching pruritic papular rash in inguinal area and underneath elastic underwear band c/w candidiasis vs. folliculitis heent: eomi, perrla, anicteric sclera, mmm neck: nontender supple neck, no lad, no jvd cardiac: rrr, s1/s2, no mrg lung: +crackles at bilateral bases l>r, decreased breath sound at bilateral bases, +mild expiratory rhonchi l base abdomen: soft, nd +bs, nt, no rebound/guarding ext: moving all extremities well, no cyanosis, clubbing or edema, no obvious deformities pulses: 2+ dp, pt, popliteal, radial, carotid pulses bilaterally neuro: a&ox3 cn ii-xii grossly intact and symmetric b/l; +some resting tremor of b/l ue most pronounced in hand/fingers; no asterixis; 2+ patellar and biceps reflexes b/l; 5/5 strength ue flex/ext, 4+/5 lle hip and knee extensors, lle hip/knee flexors, dorsiflexion and plantarflexion b/l; 5/5 strength rue & rle finger to nose intact, downgoing toes b/l, gait not assessed. pertinent results: . micro: gram stain (final ): pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): yeast(s). 2+ (1-5 per 1000x field): gram positive rod(s). 1+ (<1 per 1000x field): gram negative rod(s). respiratory culture (final ): sparse growth commensal respiratory flora. due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. yeast. sparse growth. of two colonial morphologies. gram negative rod(s). sparse growth. gram negative rod #2. rare growth. . 11:50pm cortisol-23.8* 10:51pm glucose-197* urea n-13 creat-1.0 sodium-137 potassium-3.9 chloride-111* total co2-18* anion gap-12 10:51pm calcium-6.6* phosphate-2.6* magnesium-1.7 10:51pm cortisol-8.4 10:51pm wbc-7.1 rbc-2.72* hgb-8.6* hct-26.6* mcv-98 mch-31.6 mchc-32.3 rdw-18.6* 10:51pm neuts-95.3* lymphs-2.5* monos-1.8* eos-0.3 basos-0.1 10:51pm plt count-240 10:51pm pt-17.1* ptt-70.1* inr(pt)-1.5* 06:29pm temp-37.1 po2-75* pco2-36 ph-7.33* total co2-20* base xs--6 intubated-not intuba 06:29pm lactate-1.4 05:55pm urine color-yellow appear-clear sp -1.032 05:55pm urine blood-neg nitrite-neg protein-25 glucose-neg ketone-tr bilirubin-sm urobilngn-neg ph-5.0 leuk-neg 05:55pm urine rbc-0-2 wbc- bacteria-rare yeast-none epi-0 05:55pm urine granular-0-2 hyaline-* 11:42am comments-green top 11:42am lactate-3.0* 11:30am glucose-151* urea n-14 creat-1.4* sodium-138 potassium-5.0 chloride-105 total co2-18* anion gap-20 06:40am blood wbc-3.9* rbc-3.10* hgb-9.6* hct-29.3* mcv-95 mch-31.0 mchc-32.8 rdw-18.4* plt ct-217 06:40am blood neuts-84.6* lymphs-11.7* monos-1.9* eos-1.8 baso-0.1 06:40am blood plt ct-217 06:40am blood glucose-107* urean-6 creat-0.9 na-140 k-3.9 cl-109* hco3-22 angap-13. . .mr head w & w/o contrast . impression: . 1. minimal increase in the right cerebellar lesion; minimal-mild decrease in the size of the right frontal parasagittal lesion. no obvious new lesions within the limitations of motion artifacts. 2. extensive paranasal sinus disease as well as mucosal thickening/fluid in the mastoid air cells on both sides. new since the prior study. . impression: upright ap view of the chest: again, there is a large mass overlying the left hilum, consistent with findings from prior chest radiographs and ct exam from , , consistent with the patient's history of lung cancer. the heart size is normal and stable. multiple smaller pulmonary nodules throughout the lungs are unchanged in appearance. stable mild opacification along the left base, most likely representing atelectasis. there are no new focal consolidations seen. there is no pneumothorax. there is mild blunting of the right costophrenic angle, which may represent a small pleural effusion. there is an old right rib deformity, seen on prior ct exam. brief hospital course: 70 year old male with hx of non small cell lung cancer, s/p cycle 3 /taxol on presenting with fevers, cough, sob found to have likely pna based on symptoms and infiltrate. . # fever - he was febrile on presentation to the ed raising concern for infection given wbc count, fever, and elevated lactate. he presented with cough however his cxr was equivocal for a pna. no clinical concern for sepsis as one episode of hypotension in ed likely volume depletion given poor po intake. he was given broad spectrum antibiotics with vanc/levo/cefepime. pt not neutropenic. he was dfa negative, legionella negative, stim test was within normal limits. he was discharged on cefpodoxime and azithromycin for a total antibiotic course of 14 days. . # # nsclc: he has known brain metastases and was s/p cycle 3 /taxol and was not neutropenic on presentation. mri head showed minimal increase in the right cerebellar lesion; minimal-mild decrease in the size of the right frontal parasagittal lesion. no obvious new lesions within the limitations of motion artifacts. future plan from oncologic perspective to be made as outpatient. he continued to take keppra, prophylactic bactrim and dexamthasone which was increased during his hospitalization from 1mg to 4mg daily. . # dm2 -metformin was held during his hospitalization, and he resumed taking this medication on discharge. . # : on presentation his creatinine was cr 1.4 from 1.1; likely secondary to volume depletion. he received ivf boluses with rapid correction of his creatinine which was within normal limits at the time of discharge. #. h/o pe: he continued to receive lovenox medications on admission: 1. acetaminophen 650 mg po q6h prn pain 2. enoxaparin 60 mg/0.6 ml sc q12h 3. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 4. levetiracetam 1000mg po bid 5. omeprazole 20 mg po daily 6. bactrim 160-800 mg 1 tab 3x wk (m,w,f) 7. home oxygen sig: two (2) continuous: 2l nasal cannula continuous, pulse dose for portability. 8. dexamethasone 1 mg po daily. 9. metformin 500 mg tablet sig: one (1) tablet po twice a day. 10. sertraline 50mg once daily discharge medications: 1. zofran odt 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours. disp:*90 tablet, rapid dissolve(s)* refills:*2* 2. megace oral 400 mg/10 ml (40 mg/ml) suspension sig: one (1) 10ml dose po once a day. disp:*30 doses* refills:*2* 3. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours): do not exceed 3000mg/day. 4. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 6. nystatin 500,000 unit tablet sig: one (1) tablet po q8h (every 8 hours). 7. enoxaparin 60 mg/0.6 ml syringe sig: one (1) syringe subcutaneous q12h (every 12 hours). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). 10. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 11. compazine 10 mg tablet sig: one (1) tablet po every six (6) hours. 12. dexamethasone 4 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 13. cefpodoxime 100 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 10 days. disp:*40 tablet(s)* refills:*0* 14. azithromycin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 10 days. disp:*10 tablet(s)* refills:*0* 15. ativan 0.5 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea: do not drink alcohol or perform activities that require a fast reaction time. cause sedation. disp:*90 tablet(s)* refills:*0* 16. metformin 500 mg tablet sig: one (1) tablet po twice a day. discharge disposition: home with service facility: vna discharge diagnosis: primary pneumonia secondary non small cell lung cancer discharge condition: stable, good discharge instructions: you were admitted to the hospital because you were having fevers. you were found to have a pneumonia and this was treated with antibiotics. . we added zofran 8mg dissolvable tablet every 8 hours as needed for nausea we added cefpodoxime 200mg every 12 hours for 10 days we added azithromycin 250mg daily for 10 days we added ativan 0.5 mg every 8 hours as needed for nausea we added megace 400mg daily we added dexamethasone 4mg daily . please return to the hospital or call your doctor if you experience any shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, headache, fever, chills, night sweats, muscle aches, joint aches, light headedness, fainting, blood in your stool, blood in your urine, or any other problems that are concerning to you. followup instructions: provider: mri phone: date/time: 11:55 provider: , md phone: date/time: 2:00 provider: , md phone: date/time: 9:00 md procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled depressive disorder, not elsewhere classified diaphragmatic hernia without mention of obstruction or gangrene nausea with vomiting secondary malignant neoplasm of brain and spinal cord malignant neoplasm of upper lobe, bronchus or lung unspecified disorder of kidney and ureter other emphysema personal history of venous thrombosis and embolism diarrhea asbestosis secondary malignant neoplasm of bone and bone marrow volume depletion, unspecified benign neoplasm of adrenal gland secondary malignant neoplasm of kidney 

Answer: The patient is high likely exposed to