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: albuterol attending: chief complaint: shortness of breath major surgical or invasive procedure: thoracentesis history of present illness: this is a 72 year old male with pmh significant for cutaneous scc metastatic to left axilla and lung, s/p resection (), adjuvant xrt, chemotherapy (most recently on phase i protocol of torisel and neratinib), atrial fibrillation on coumadin, hypertension, and dyslipidemia who presents from clinic with two days of shortness of breath and weakness. patient was seen in clinic for c5d15 of torisel and neratinib, which has been on hold since secondary to grade 2 mucositis. there he was complaining of shortness of breath and weakness. his vs in clinic were notable for t 99.8, o2 79% on transferring to bed which increased to 89% w/ deep breathing on ra and 94% on 3l nc. patient states that his shortness of breath started two days ago. he endorses a light non-productive cough at night. he denies any fevers, chills, chest pain, nausea, vomiting, diarrhea, or abdominal pain. he has baseline mucositis with throat pain. in the ed, initial vs were: 99, 112/77, 75, 28, 97% on 4l. his exam was notable for tachypnea despite breathing mid 90s on 4l nc. a rectal temp was 101.4. labs were notable for 91% pmns, but no leukocytosis (wbc 5.6), and a subtherapeutic inr 1.3. cxr was concerning for rll infiltrates. cta was negative for pe but evident for new right pleural effusion and rll consolidation. ct head was negative for acute bleed. blood cx were drawn and patient received iv vanc and zosyn, tylenol, and 1l ns. in the ed, his patient and wife expressed that should his respiratory status decompensate he is agreeable to intubation. he was transferred for further monitor of his hypoxia. on the floor, patient stated breathing much improved. review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: -htn -hyperlipidemia -severe, extended course of shingles -urinary retention, frquently self-catheterizes -a. fib on coumadin -utis -gout -right inguinal hernia repair at in - -repair of "broken nose." -right knee anterior meniscal tear with fluid drainage and cortisone injection in -enlarged prostate (biopsy negative) -hiatal hernia -14-year history of skin cancers, including "a dozen" basal cell cancers, one scc of the chin, and one "0.8 mm deep" melanoma of the left forearm () . oncology history: initially presented in with a left anterior chest lesion. -on , he underwent surgical resection of squamous cell carcinoma with an advancement flap. specimen measured 3.4 x 2.5 cm and extended to a depth of 1.1 cm. pathology- moderately differentiated squamous cell carcinoma with focal lymphatic and perineural invasion. -, he developed swelling involving the left axilla. on , fna of this lymphadenopathy was positive for malignant cells consistent with metastatic squamous cell cancer. -, complete axillary lymph node dissection, lymph nodes were involved with metastatic squamous cell carcinoma measuring up to 3.9 cm in greatest dimension with foci of extracapsular extension. , adjuvant radiation therapy to the left axilla- 5094 cgy to the left axilla with left chest wall boost of 3000 cgy, completed on . -, bilateral small pulmonary nodules which increased in size; -biopsy confirmed metastatic squamous cell cancer. in , the patient received carboplatin at an auc of 5 combined with paclitaxel 175 mg/m2. he completed four cycles and subsequently was treated with capecitabine and most recently six cycles of single gemcitabine completed on . - currently on phase i protocol #09-066. cycle 5 day 15 of his drugs were held in the setting of grade ii mucositis and thrush. social history: patient lives at home with his wife. is a retired investment banker. he endorses drinking glasses of wine weekly. he denies a history of smoking or illicit drug use. family history: mother deceased cva. father deceased mi. sister deceased from renal failure r/t dm. physical exam: general: elderly caucasion male, speaking in full sentences heent: sclera anicteric, oropharynx w/ mucositis, mmm neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: irregularly irregular, tachycardic, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: alert and oriented x3, cn2-12 intact, plantar/dorsiflexion, moving all extremities . on discharge: no foley pertinent results: admission labs: 11:22am blood wbc-5.6 rbc-3.85* hgb-10.1* hct-30.6* mcv-80* mch-26.3* mchc-33.1 rdw-18.2* plt ct-212 11:22am blood neuts-91.0* lymphs-6.2* monos-2.1 eos-0.7 baso-0.1 11:40am blood pt-14.6* ptt-28.1 inr(pt)-1.3* 11:22am blood glucose-126* urean-15 creat-0.7 na-135 k-4.3 cl-100 hco3-25 angap-14 11:22am blood alt-46* ast-33 ld(ldh)-222 alkphos-73 totbili-0.4 11:22am blood totprot-6.0* albumin-2.9* globuln-3.1 calcium-8.5 phos-2.8 mg-1.9 12:58pm blood glucose-113* lactate-1.2 09:34pm urine color-straw appear-clear sp -1.033 09:34pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.5 leuks-lg 09:34pm urine rbc-4* wbc-189* bacteri-few yeast-none epi-0 microbiology: urine culture x 2 negative mrsa screen negative urine legionella antigen negative respiratory viral screen x 2 - no virus cultured blood cultures - ngtd ekgs: atrial fibrillation, average ventricular rate 82. moderate baseline artifact. compared to the previous tracing of the rate has slowed from 135 to 82 and the rhythm has changed from atrial flutter with 2:1 block to atrial fibrillation. in addition, the current tracing has regression of the st-t wave changes noted in leads ii, iii, avf and v3-v6 at that time. imaging: ap cxr - impression: increased pulmonary edema, cannot exclude bibasilar consolidation. known pulmonary metastases. ct head - prelim - no acute bleed or sig change from prior cta chest - impression: 1. no definite evidence of pulmonary embolism, slightly limited by respiratory motion. 2. interval increase in size of multiple bilateral pulmonary metastases. 3. increase in mediastinal adenopathy. 4. right basilar pleural thickening and nodularity with a new moderate right pleural effusion, associated with atelectasis and consolidation of the right lower lobe. 5. patchy opacities in the right middle and left upper lobes, may be infectious or inflammatory. transthoracic echo - the left atrium is markedly dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is considerable beat-to-beat variability of the left ventricular ejection fraction due to an irregular rhythm/premature beats. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with normal global and regional biventricular systolic function. mild to moderate mitral regurgitation. moderate pulmonary hypertension. substantial biatrial dilatation. brief hospital course: mr. is a 72 year old male with scc metastatic to left axilla and lung, a fib, htn, hld, who presented with shortness of breath and weakness. # hypoxia, shortness of breath - most likely secondary to pleural effusion and pneumonia. cta was negative for pe and patient is therapeutic on coumadin for afib. he was also treated for healthcare associated pneumonia with vancomycin, zosyn, and levofloxacin starting on for a 10 day course that was transitioned to augmentin alone after his levofloxacin dose on . his shortness of breath improved, however, he remained hypoxic on room air. a thoracentesis was done and showed an exudative effusion. pleural fluid was sent for cytology and this was pending at the time of discharge, gram stain had 4+ pmns, no organisms. pending at the time of discharge: pleural fluid cultures and cytology . # atrial fibrillation/atrial flutter - on admission the patient was placed on shorter acting forms of metoprolol and diltiazem due to concern for possible sepsis and hypotension. the patient intermittantly had heart rates of up to 150 that responded to his usual medications. pt was discharged on prior diltiazem sr dose and metoprolol tartrate 37.5 was increased to toprol 150 daily. pt's coumadin was held in preparation for thoracentesis but restarted without bridge after thoracentesis was completed. . # mucositis and thrush: secondary to chemotherapy and improved significantly with course of fluconazole. pt was discharged on magic mouthwash (maalox/diphenhydramine/lidocaine). . # metastatic scc: cutaneous squamous cell carcinoma, with metastasis to left axilla (s/p left axillary dissection) and pulmonary nodules. patient is s/p resection, xrt, and currently undergoing phase i clinical trial treatment with torisel and neratinib (though this has been held since given mucositis). per his oncologist, pt may resume this regimen on discharge. this is to be discussed further c pt's oncologist as outpt. pt recieved oxycodone for pain, ativan for anxiety and magic mouthwash for mucositis. . # htn: well controlled on diltiazem and metoprolol . # hyperlipidemia: continued home statin . # gout: continued allopurinol . full code medications on admission: acetaminophen-codeine 300 mg-30 mg tablet(s) q 4-6 prn allopurinol 300 mg daily chlorhexidine gluconate 0.12 % mouthwash 15ml dexamethasone 0.5 mg/5 ml elixir one teaspoon daily diltiazem 180 mg sr daily kaopectate/benadryl/visc xylocaine 5ml qid prn lorazepam 1-2 mg prn metoprolol 37.5 mg nystatin 4 ml qid percocet 5 mg-325 mg tablet(s) q4h prn simvastatin 40 mg daily warfarin 2.5 mg daily ergocalciferol (vitamin d2) 400 unit daily multivitamin psyllium ranitidine hcl 150 mg discharge medications: 1. home oxygen home oxygen 3l continuous via nasal cannula pulse oximetry for portability 2. allopurinol 300 mg tablet sig: one (1) tablet po daily (daily). 3. lorazepam 1 mg tablet sig: one (1) tablet po every eight (8) hours as needed for anxiety, insomnia. 4. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) 15 ml mucous membrane twice a day. 5. dexamethasone 0.5 mg tablet sig: one (1) tablet po once a day: elixir. 6. diltiazem hcl 180 mg capsule, sustained release sig: one (1) capsule, sustained release po once a day. 7. percocet 5-325 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain. 8. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 9. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm. 10. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 11. multivitamin tablet sig: one (1) tablet po daily (daily). 12. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 13. psyllium packet sig: one (1) packet po daily (daily) as needed for constipation. 14. lidocaine-diphenhyd--mag- 200-25-400-40 mg/30 ml mouthwash sig: one (1) 30ml mucous membrane every six (6) hours as needed for heartburn. disp:*1 bottle* refills:*0* 15. augmentin 875-125 mg tablet sig: one (1) tablet po twice a day for 3 days. disp:*6 tablet(s)* refills:*0* 16. toprol xl 50 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po once a day. disp:*90 tablet sustained release 24 hr(s)* refills:*0* 17. outpatient lab work please check pt/inr on friday , monday and wednesday . please call results in to dr at . please ask if any dose adjustment is necessary in pt's coumadin. after please discuss with dr whether it would be ok to space inr checks out to once a week (every wednesday). 18. coumadin 2.5 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: discharge diagnosis: primary: bacterial pneumonia, atrial fibrillation with rapid ventricular response discharge condition: mental status: confused - sometimes level of consciousness: alert and interactive activity status: ambulatory - requires assistance or aid (walker or cane) discharge instructions: you were admitted to hospital because of shortness of breath and low oxygen in your blood. we thought this was from pneumonia and treated you with antibiotics. you also had a lot of fluid around your lungs that could be from pneumonia or from your cancer. we drained the fluid and your breathing got better. we are still waiting to hear from pathology about the final results from the fluid. dr can tell you more about the fluid next time you see her. when you get home please continue your regular medicines. the following changes have been made to your medications: stop your metoprolol tartrate (lopressor) start metoprolol succinate (toprol) 150 mg once a day start the antibiotic augmentin for 3 more days . please continue to get your coumadin level checked, as you have been. since you are on the antibiotics you should get your coumadin level checked frequently. followup instructions: you have the following appointments scheduled: provider: 3-hem onc 7f hematology/oncology-7f date/time: 8:30 provider: , md phone: date/time: 8:30 provider: 1-hem onc 7f hematology/oncology-7f date/time: 8:30 procedure: venous catheterization, not elsewhere classified thoracentesis diagnostic ultrasound of other sites of thorax diagnoses: mitral valve disorders unspecified pleural effusion unspecified essential hypertension gout, unspecified atrial fibrillation other chronic pulmonary heart diseases atrial flutter candidiasis of mouth other and unspecified hyperlipidemia hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) personal history of other lymphatic and hematopoietic neoplasms antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use long-term (current) use of anticoagulants retention of urine, unspecified hypoxemia other postprocedural status secondary malignant neoplasm of lung personal history of malignant melanoma of skin bacterial pneumonia, unspecified personal history of malignant neoplasm of other sites mucositis (ulcerative) due to antineoplastic therapy 

Answer: The patient is high likely exposed to