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: penicillins / iron attending: chief complaint: shortness of breath major surgical or invasive procedure: femoral line intubation/extubation lumbar puncture tracheal stent history of present illness: 70 y/o female with copd, htn, alcoholism who presents with worsening stridor now intubated for enlarging mediastinal mass eroding into the trachea. pt was recently evaluated by her pcp for worsening dysphagia and weight loss. given her history of tracheostomy and high risk of head and neck malignancy with smoking and etoh she was referred to ent. she was seen by ent on who noted true vocal cord paralysis on larygoscopy and planned to have her evaluated with neck and upper chest ct for mass which was perfrormed . ct scan revealed pulmonary nodules with an esophageal mass(report not available)concerning for metastatic esophageal ca. she continued to have mild dysphagia but began developing worseing sob and decreased voice. on she presented to ed and was found to be anxious, tachycardic, and short of breath with stridor with no hypoxia. cxr revealed upper mediastinal mass and pulmonary nodules, so cta was performed to better characterize them. ct revealed a new rll mass, lll atelactasis, enlarging left infrahilar mass, and enlarging esophageal mass which is now eroding into the trachea. she was treated with levofloxacin, solumedrol, ativan, seroquel and nebulizers. she was transferred to for further evaluation. in the ed she continued to be stridulous and was seen by thoracic surgery who reported that she was not an operative candidate as the mass dissected through multiple planes. due to risk of worsening erosion of this mass she was intubated by anesthesia. she was also given a dose of flagyl to cover aspiration pna given osh ct findings. past medical history: hypothyroidism pneumonitis requiring tracheostomy pna copd peptic ulcer disease irritable bowel colon polyps alcoholic pancreatitis alcoholism htn polio vertebroplasty right elbow fx deafness decreased vision osteoporosis ? liver disease with hepatic encephalopathy social history: cont to smoke 1ppd which she has done for 54 years, hx of etoh withdrawal and heavy abuse in past. she is separated with 1 grown child. previously taught at . . family history: ovarian ca and cva but unclear which fam members . physical exam: t 99.0 hr 110 bp 120/75 ac 450/20 peep 5 fio2 50% gen-sedated and intubated heent-perrl, no elev jvp, mmm, no ant or post cerv lad hrt-tachy rr, ns1s2 no mrg lungs-cta bilat abd-soft, nt, nd, no hsm extrem-2+rad and dp pulses, no cyanosis or clubbing neuro-withdrawing to pain, absent reflexes but not compliant with exam skin-no rashes or lesions pertinent results: labs and studies- ph 7.34 pco2 43 po2 104 hco3 24 na:142 k:3.5 cl:109 tco2:24 glu:170 lactate:2.3 . trop-t: <0.01 chem 7 139 108 11 191 agap=14 3.5 21 0.9 . ck: 59 mb: notdone . wbc 13.4 hgb 10.1 plt 487 hct 29.9 n:95.5 band:0 l:3.4 m:0.3 e:0.7 bas:0 . pt: 14.4 ptt: 30 inr: 1.3 . ecg-sinus tachy at 110, tw flat in ii,iii,avf with st dep 1mm v3-6 . cxr-lll infiltrate, left hilar fullness, multiple pulmonary nodules. . chest ct: diffusely infiltrating soft tissue density mass centered in the esophagus and extending from the cricopharyngeus muscle approximately 10 cm inferiorly. evidence of invasion into the posterior trachea, and aorta. severe tracheal narrowing to about half the normal luminal caliber. the endotracheal tube is positioned above the most severe segment of narrowing. multiples metastases within the imaged lungs, mediastinal, and portacaval lymphadenopathy. . ue u/s: limited study without demonstration of basilic and cephalic veins, however, no evidence of dvt. . ct head: probable minor degree of chronic small vessel infarction without other findings to account for the patient's stated unresponsiveness. . mr : minor cervical spondylosis with demonstration of presumed esophageal mass causing esophageal obstruction. . mra brain: 1. no definite evidence for acute brain ischemia. 2. probable anterior communicating artery aneurysm. limited study. within these severe limitations, there is demonstration and confirmation of the suspected small (3-mm) anterior communicating artery aneurysm. no other definite vascular abnormalities are seen, again allowing for the very limited resolution provided by this study. the right vertebral artery appears to be the dominant vessel. . eeg: this was an abnormal routine eeg due to the slow and disorganized background with generalized bursts of slowing as well as generalized suppression. these findings are consistent with a moderately severe encephalopathy. there were also bursts of generalized sharps or sharp and slow wave complexes predominantly in the frontocentral regions, which may be seen with in patients with severe encephalopathy, but may also suggest cortical irritability in the frontal regions. no clear electrographic seizures were seen. if the mental status does not improve, a repeat study may be beneficial. . cxr: 1. status post tracheal stent placement, centered at approximately the level of the clavicular heads and 2.2 cm from the distal tip of the endotracheal tube. it is 1.5 cm from the carina. 2. improvement of bilateral basilar atelectasis with stable appearance to retrocardiac opacity and small bilateral pleural effusions. brief hospital course: 70 y/o female with copd, htn, alcoholism who presented with worsening stridor, tubated for enlarging mediastinal mass eroding into the trachea. . * mediastinal mass: ct showed esophageal mass eroding into trachea as well as into aorta. osh biopsy demonstrated a squamous cell ca. cancer likely esophageal with pulmonary mets given location and smoking and etoh history. patient was intubated on for worsening stridor. s/p tracheal stent for airway protection by ip. cxr confirmed position of stent. stent of esophagus by gi was considered, but gi deferred stent given proximity to aorta and pt's mental status -> patient's daughter supported decision for no procedures. dnr status was decided upon, but with re-intubation if necessary. extubation was attempted , but patient did not do well and was re-intubated within hours. on goals of care were re-addressed and decision was made for terminal extubation/cmo. . * ms changes: patient had remained very sedated after having been off sedation for several days. then later improved somewhat. head ct, lp and mri of the head did not demonstrate a source for the sedation. ammonia and b12 levels normal. rpr negative. had uti which may have contributed. patient later appeared to be slightly more arousable, suggesting this was due to a problem with medication clearance or metabolic derangements. eeg showed moderately severe encephalopathy. neurology consult followed. sedating medications were held as muhc as possible. lactulose was also given daily (which had apparently been helpful in the past for confusion). . * leukocytosis: likely secondary to klebsiella uti, treated with ceftriaxone. no evidence of underlying pneumonia. blood cultures were negative and 2 c. diff toxins negative. resolved. . * anemia: hct trending down over several days to 23-24. no sign of active bleeding. bleeding at site of mets invading aorta was considered as etiology. hct stabilized around this level. . * metabolic acidosis: non-gap acidosis initially. improved. thought to be due to saline and possibly a small component of hypoperfusion. . * htn: bp was controlled with iv metoprolol. . * etoh abuse: pt was initially considered at risk for withdrawal. ciwa scale was ultimately dc'd to sedation/intubation. folate and thiamine were given. . * hypothyroidism: tsh normal, free t4 slightly low, felt to be euthyroid sick syndrome in setting of acute illness. continued on outpt synthroid but as iv at 1/2 of po dose. . * depression: zoloft held due to npo . on , another family meeting was held with the patient's daughter who decided on terminal extubation and cmo. the patient expired on at 1704h while cmo and on a morphine gtt. medications on admission: . meds- toprol xl 50mg qd fosamax 70mg weekly synthroid 75mg qd naltrexone 25mg qd protonix 40 zoloft 50mg qd questran 4mg qd mvi calcium discharge medications: n/a discharge disposition: expired discharge diagnosis: esophageal cancer, with mass eroding into trachea and aorta respiratory failre due to airway obstruction by mass klebsiella urinary tract infection hypertension hypothyroidism depression discharge condition: expired discharge instructions: n/a followup instructions: n/a procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of endotracheal tube fiber-optic bronchoscopy other intubation of respiratory tract diagnoses: tobacco use disorder urinary tract infection, site not specified toxic encephalopathy unspecified essential hypertension unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified secondary malignant neoplasm of other specified sites alcohol abuse, unspecified pulmonary collapse acute respiratory failure secondary malignant neoplasm of lung secondary malignant neoplasm of mediastinum secondary malignant neoplasm of other respiratory organs anemia in neoplastic disease other diseases of trachea and bronchus malignant neoplasm of esophagus, unspecified site 

Answer: The patient is high likely exposed to