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: latex attending: chief complaint: tachypnea, hypotension, respiratory distress major surgical or invasive procedure: tracheal intubation history of present illness: 45 m w metastatic rcc (papillary vs clear cell) to lungs & l pleural effusions s/p multiple chemo regimens (most recently cycle 10 of bevacizumab + erlotinib on ), presents after a recent admission to for pna with fevers, tachypnea, cough, sob. . the patient was most recently admitted from to for similar symptoms. he was started on a 14-day course of unasyn & doxycycline but was ultimately discharged on augmentin. he did not, however, complete a 14-day course; opting to stop antibiotics on in hopes of being considered for a clinical trial. . subsequent to his penultimate admission, he was screened for a clinical trial for a novel anti-pdl1 antibody that required him to hold his tarceva for 3 weeks. during this time, he appears to have clinically deteriorated. his current symptoms include dyspnea on exertion, chills, night sweats, extremely poor po intake. he notes that he woke from sleep two days earlier gasping for breath. during this time, his friends have been giving him ivf fluids. yesterday, he was set up with 5l home oxygen by face mask and he states that he has been sleeping comfortably. . the patient also reports several days of crampy abdominal pain & diarrhea. . today, the patient presented to heme/onc clinic for a follow up appointment with shaking chills and fevers. his oxygen saturation was noted to be 89% on ra. he was started on 5l oxygen via fm and his oxygen subsequently rose to 97%. bp was noted to be 81/39 with hr 117, temp 100.6. he denied dizziness and lightheadedness. he was given 1 l ns but his bp persisted in the 80s/40s. given his clinical picture he was referred to the ed for further evaluation. . in the ed, the patient was given a total of 4l of ivf. he was given 125 mg po vanco, 500 mg iv flagyl, 750 mg iv levofloxacin. he had a cxr and ct that showed enlarged pleural effusion on the left. as such, ip was called and a thoracentesis was performed. 250 cc of serous fluid was drained. . vital signs at the time of transfer: 97.4 108 99/56 27 94/ra . on arrival to the icu, the patient states that he is thirsty but that his breathing has improved dramatically. . review of systems: (+): as per hpi. also feels slight wheeze. coughing. (-): sob, chest pain, nausea, vomiting past medical history: past oncologic history - renal cell carcinoma ---> : microscoping hematuria ---> ct a/p: 4.5 cm l adrean & periadrenal mass ---> mri: l periaortic mass 4.6 cm ---> pet ct: lingular nodule, rp lesion adjacent to l adrenal - : underwent resection of mass & l adrenal nodule ---> pathology revealved metastatic adenocarcinoma of unknown origin ---> prominent papillary architecture w abundant eosinophilic or clear cytoplasm & high-grade nuclear features - pet : interval increase in size & update of pulmonary nodules - : 6 cycles carboplatin & taxotere ---> pet ct: improvement in l lung lesions - : enrolled in phase 1 trial of met/alk inhibitor ---> pet ct: progression of disease in l adrenalectomy bed & lungs ---> taken off trial - theros cancertype id molecular classification test revealed 90.9% probability that cancer is of kidney origin based on 92 gene expression profile - : sunitinib ---> post-ct: partial regression of adrenal bed lesion & stability in pulmonary nodules. ---> progressed after 6 cycles of sunitinib - : everolimus - : taken off everolimus for disease progression - : cyberknife radiation for mass invading psoas muscle ---> recovery c/b severe pain inflammation ---> fevers to 100-102, sob, r-sided cp. - : bronch revealed malignant cell ---> no abpa - : started pazopanib - : disease progression; taken off pazopanib - : s/p 10 cycles bevacizumab & erlotinib . past medical history: - nephrolithiasis (bilateral) - mitral valve prolapse - colon polyp - dysplastic nevus x3 - necrotic ln in left neck (never biopsied/cultured) social history: - anesthesiologist at - married with two young children. - lives in . - denies etoh/tobacco/illicits. family history: - father: died in his 60s from brain aneurysm. hypoplastic kidney - mother: alive in her 70s. - all 3 sisters healthy. physical exam: admission exam: gen: thin, nad. neck: no jvd. supple. no lad cor: +s1s2, rrr. pulm: coarse bs l > r. dullness bilbasilarly. wheeze l > : +nabs in 4q. soft, ttp in llq. no rebound or guarding ext: wwp. 2+ dp pulses bilaterally. no edema. neuro: maee. pertinent results: admission labs: 02:35pm blood wbc-8.6 rbc-3.21* hgb-8.4* hct-27.3* mcv-85 mch-26.0* mchc-30.6* rdw-18.4* plt ct-566* 08:05pm blood pt-19.3* ptt-29.6 inr(pt)-1.8* 02:35pm blood urean-13 creat-0.7 na-134 k-4.6 cl-96 hco3-25 angap-18 02:35pm blood urean-13 creat-0.7 na-134 k-4.6 cl-96 hco3-25 angap-18 02:35pm blood alt-114* ast-134* alkphos-143* totbili-0.7 08:05pm blood lipase-10 08:05pm blood albumin-1.6* calcium-7.0* phos-2.5*# mg-1.6 08:31pm blood lactate-1.6 05:15pm urine color-yellow appear-clear sp -1.015 05:15pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-2* ph-6.5 leuks-neg 05:15pm urine rbc-0 wbc-1 bacteri-few yeast-none epi-0 05:15pm urine mucous-mod 04:08am blood hapto-500* 04:08am blood ret aut-1.8 microbiology: blood cultures 4/11: pending pleural fluid culture : --gram stain with 1+ polys, no microorganisms --culture pending c diff negative legionella negative blood culture : pending blood culture : pending imaging: cxr : increasing opacity in the left lower lung, concerning for worsening consolidation and effusion. extensive metastatic disease within the chest. refer to subsequent ct for further details. cta chest/abd/pelvis : 1. extensive metastatic disease within the chest, including mediastinal and hilar lymphadenopathy and extensive pulmonary nodularity and both hilar and perihilar consolidations. increased consolidations in the left lower lobe, lingula and right lower lobe likely account for acute symptoms of tachypnea. slight increase in left loculated pleural effusion and interval development of a small right pleural effusion. 2. metastatic disease burden in the abdomen appears overall stable with retroperitoneal lymphadenopathy. small volume ascites is new from prior exam with mild bowel wall thickening along the distal colon, likely indicative of colitis (inflammatory versus infectious, versus ischemic). 3. no central pe identified. cxr : tip of the new left pic line projects over the low svc. severe consolidation in most of the left lower lung and in a smaller region of the right lower lung has improved slightly on the left, worsened slightly on the right. previous pulmonary edema has improved. extensive pleural mass surrounds the left lung and small pleural effusion and is collected in a nondependent fashion, probably unchanged in overall volume since the earlier study. small right pleural effusion layers dependently. heart size is normal, but mediastinal contours and the enlarged left hilum reflect extensive central lymph node enlargement. 8:18 pm stool consistency: soft source: stool. **final report ** fecal culture (final ): no enteric gram negative rods found. no salmonella or shigella found. campylobacter culture (final ): no campylobacter found. fecal culture - r/o vibrio (final ): no vibrio found. fecal culture - r/o yersinia (final ): no yersinia found. fecal culture - r/o e.coli 0157:h7 (final ): no e.coli 0157:h7 found. cryptosporidium/giardia (dfa) (final ): no cryptosporidium or giardia seen. 3:00 pm stool consistency: not applicable source: stool. **final report ** c. difficile dna amplification assay (final ): negative for toxigenic c. difficile by the illumigene dna amplification assay. (reference range-negative). brief hospital course: reason for icu admission: 45 m with metastatic rcc s/p multiple chemo regimens p/w fevers, cough, sob, hypotension as well as abdominal pain with diarrhea x 2-3 days. hospital course: # acute respiratory failure, with post obstructive pneumonia and progressive tumor burden, and pleural effusion: dr. presented with increased shortness of breath, with ct scan that revealed significant disease progression in his left lung, but no pulmonary embolism. he had been recently admitted for pneumonia, with bronchoscopy that was negative for pathogen, and he self-truncated his antibiotics course in order to be evaluated for a clinical trial. given his recent hospitalization and evidence of new l-lung consolidation, he was treated empirically for hcap. however, the findings on his chest ct were possibly infectious, but also most likely related to incresed tumor burden. he was seen by interventional pulmonology, with no recommendation for bronchoscopic treatment given distal nature of obstruction. he was also treated with small volume thoracentesis in the ed. his effusion met criteria for exudate in nature. pt was started on vanc/cefepime plan for an 8 day course. cultures from thoracentesis showed no growth. he was moved to levofloxacin (also got flagyl) and will complete 3 more days. # colitis: the patient had abdominal pain for the past several days as well as diarrhea. his ct showed evidence of distal descending & sigmoid colitis. given recent hospitalization and antibiotic administration there was c/f c.diff and he was started on iv flagyl and po vancomycin. however he had decreased stool output, and ultimately c.diff pcr was negative, so po vancomycin was discontinued. ct abdomen showed some mild bowel wall thickening along the distal colon, likely indicative of colitis (report said inflammatory vs infectious vs ischemic). it was felt this was not ischemic colitis. he was treated with flagyl, and cefepime was moved to levofloxacin, for presumed infectious colitis. other stool studies were negative. # renal cell carcinoma: the patient is on daily tarceva. he is now s/p multiple rounds of chemotherapy with progression of disease. home oxycodone 5-10 mg q4h prn and dilaudid for breakthrough pain were continued, and his oxycodone was renewed on discharge with #90 tablets. outpatient np was contact and per her direction he was continued on tarceva while in house. dr. (primary oncologist) was contact and saw patient prior to discharge. he will arrange f/u on (monday) for further treatment. i suggested to dr. that he consider offering further psychosocial support to patient who is dealing with a devastating disease while trying to support his family (wife and two children). # anemia: pt's hematocrit 24.3 (was in the 30s in ). no obvious source of bleeding. other cell lines are not involved, arguing against myelophistic process. could also be due to terceva. on pt was transfused 1unit prbcs with appropriate bump in hct up to 32, though this returned to baseline of mid-20s. # transaminitis/lft abnormality: pt with evidence of transaminitis in 100s on admission. alk phos also elevated. no elevation in bilirubin. could be med side effect vs. acute illness vs. hepatitis. lfts trended down prior to discharge : alt ast alkphos totbili 55* 79* 102 0.4. # coagulopathy: inr 1.8; pt not on coumadin. could be due to sepsis, acute illness, malignancy, poor nutritional vit k intake. inr was trended down when pt left the (1.6). # tachycardia; patient with borderine tachycardia that was fluid responsive prior to discharge. he was stable on ambulation and instructed to keep adequate fluid intake in. is at risk for volume depletion with decreased po intake. patient indicated a desire to go home. medications on admission: - oxycodone 5 mg q6h prn pain - tarceva 150 mg qd discharge medications: 1. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 2. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*90 tablet(s)* refills:*0* 3. erlotinib 150 mg tablet sig: one (1) tablet po daily (daily). 4. loperamide 2 mg capsule sig: two (2) capsule po once (once). 5. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain or fever. 6. levofloxacin 750 mg tablet sig: one (1) tablet po daily (daily) for 3 days. disp:*3 tablet(s)* refills:*0* 7. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 3 days. disp:*9 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: pneumonia renal cell cancer w/ metastasis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with respiratory failure, likely related to both post obstructive pneumonia and progressive metastatic disease to your lungs, as well as the pleural effusion. you have been moved to oral antibiotics (levofloxacin) and continue without fever. your ct scan showed mild colitis affecting the distal descending and sigmoid colon. stool studies were negative for infection. you were empirically treated with flagyl and should complete 1 week on . please continue supplemental ensure plus to support your nutrition. followup instructions: with your oncologist -- dr. will arrange to see you next monday afternoon . his office should be contacting you with information. procedure: venous catheterization, not elsewhere classified thoracentesis injection or infusion of cancer chemotherapeutic substance diagnoses: pneumonia, organism unspecified other iatrogenic hypotension anemia of other chronic disease other and unspecified noninfectious gastroenteritis and colitis mitral valve disorders acquired coagulation factor deficiency other pulmonary insufficiency, not elsewhere classified malignant neoplasm of kidney, except pelvis hypopotassemia antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use secondary malignant neoplasm of lung calculus of kidney tachycardia, unspecified examination of participant in clinical trial secondary and unspecified malignant neoplasm of intrathoracic lymph nodes personal history of antineoplastic chemotherapy personal history of colonic polyps nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] other dependence on machines, supplemental oxygen tachypnea antineoplastic chemotherapy induced anemia malignant pleural effusion nonspecific reaction to tuberculin skin test without active tuberculosis 

Answer: The patient is high likely exposed to