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 / aspirin / cefazolin / flavor / nut flavor / grape / sulfa (sulfonamides) attending: chief complaint: transferred from va for interventional pulmonary procedure major surgical or invasive procedure: bronchoscopy with excision/apc of tumor in lll history of present illness: this is a 72yo m with history of inoperable bladder cancer and right ureteral tumow s/p stent placement, ischemic cardiomyopathy with ef 25% s/p 2 imi(last ), s/p cabg in and icd placement, diabetes with triopathy who presented to va with hemoptysis and acute renal failure. his renal failure resolved with hydration and his creatinine was back to basline at 2-2.4. he was intially treated with zithromax for possible bronchitis. ent was unremarkable. ct revealed lll mass for which he had a bronchoscopy on which showed a large exophytic mass engulfed in clot(old, no active bleed) at lll bronchus at the level of secondary carina. brush and endobronchial biopsy was performed. the mass was friable. on that evening, he became hypoxic(low 80s on 4l) and tachypneic with unchanged ekg. cxr showed pulmonary edema with no collapse/ptx. he was treated with lasix with good outcome. he again desatted to low 802 on 4l. abg showed 7.41/30/68 on 100%nrb. portable chest x ray showed lll collapse. past medical history: bladder ca, s/p turp, s/p bcg, xrt, ureteral stent placed in (stents changed q 3 months) cri, baseline cr 2.1-2.6 cad s/p mi, s/p cabg ischemic chf, ef 25-30% h/o vt, s/p aicd dm-2 hypercholesterolemia anxiety d/o gerd hypertension social history: smokes 4 ppd for 40 years, denies alcohol has never been married, has no kids, no family member veteran at korean war family history: noncontributory physical exam: bp 102/79 p87 98% on nrb gen-anxious looking elderly gentleman heent-anicteric, mucous membrane dry, neck supple, no cervical/axillary lymphadenopathy, jvp 9cm cv-rrr, no r/m/g, faint heart sounds resp-poor air entry bilaterlly, crackles at right base, ?bronchial breath sounds on left base -nt/nd, soft, active bs ext-no edema, dp 1+ b/l pertinent results: see osh for detailed ct chest report: large mass posterior to the left mainstem bronchus, c/w with lung carcinoma metastatic to hilar lymph nodes 07:28pm blood wbc-11.0 rbc-3.79* hgb-10.0* hct-31.0* mcv-82 mch-26.4* mchc-32.3 rdw-14.9 plt ct-228 05:10am blood wbc-8.9 rbc-3.74* hgb-10.0* hct-30.8* mcv-82 mch-26.7* mchc-32.4 rdw-15.0 plt ct-205 06:11am blood wbc-12.5* rbc-4.04* hgb-10.5* hct-33.4* mcv-83 mch-25.9* mchc-31.4 rdw-14.6 plt ct-227 04:00am blood wbc-12.0* rbc-3.48* hgb-9.1* hct-28.9* mcv-83 mch-26.2* mchc-31.5 rdw-14.6 plt ct-163 04:40am blood wbc-8.9 rbc-3.58* hgb-9.3* hct-29.9* mcv-83 mch-26.1* mchc-31.3 rdw-14.8 plt ct-166 04:14am blood wbc-7.6 rbc-3.62* hgb-9.5* hct-30.2* mcv-83 mch-26.4* mchc-31.7 rdw-14.9 plt ct-160 05:10am blood pt-14.6* ptt-43.0* inr(pt)-1.4 06:11am blood pt-14.2* ptt-62.3* inr(pt)-1.3 12:10pm blood pt-14.2* ptt-70.4* inr(pt)-1.3 04:00am blood pt-14.2* ptt-99.7* inr(pt)-1.3 04:40am blood pt-13.6* ptt-71.6* inr(pt)-1.2 08:26am blood pt-13.2 ptt-41.5* inr(pt)-1.2 01:20pm blood thrombn-65.0* 07:28pm blood glucose-115* urean-27* creat-2.4* na-145 k-4.3 cl-115* hco3-19* angap-15 05:10am blood glucose-103 urean-33* creat-2.9* na-143 k-4.0 cl-113* hco3-21* angap-13 06:11am blood glucose-198* urean-41* creat-3.3* na-144 k-4.5 cl-113* hco3-19* angap-17 04:00am blood glucose-129* urean-47* creat-3.2* na-144 k-4.6 cl-119* hco3-17* angap-13 04:40am blood glucose-111* urean-49* creat-3.3* na-146* k-4.6 cl-118* hco3-17* angap-16 04:14am blood glucose-126* urean-46* creat-2.8* na-155* k-4.0 cl-122* hco3-21* angap-16 05:10am blood ck(cpk)-269* 01:15am blood ck(cpk)-406* 06:11am blood ck(cpk)-485* 05:10am blood ck-mb-3 ctropnt-0.03* 01:15am blood ck-mb-3 ctropnt-0.03* 06:11am blood ck-mb-3 ctropnt-0.03* 01:15am blood albumin-3.0* 01:15am blood cortsol-19.0 02:20am blood cortsol-41.6* 09:29pm blood type-art po2-49* pco2-33* ph-7.39 calhco3-21 base xs--3 10:30pm blood type-art temp-38.7 fio2-100 o2 flow-15 po2-91 pco2-41 ph-7.32* calhco3-22 base xs--4 aado2-591 req o2-96 intubat-not intuba 01:37am blood type-art temp-38.1 o2 flow-15 po2-83* pco2-44 ph-7.29* calhco3-22 base xs--4 intubat-not intuba comment-non-rebrea 12:15pm blood type-art temp-37.2 fio2-70 po2-84* pco2-48* ph-7.24* calhco3-22 base xs--6 intubat-not intuba 01:49pm blood type-art temp-37.2 fio2-50 po2-72* pco2-40 ph-7.28* calhco3-20* base xs--7 intubat-intubated 04:15pm blood type-art temp-36.7 fio2-50 po2-85 pco2-40 ph-7.29* calhco3-20* base xs--6 intubat-not intuba 08:17am blood type-art temp-38.1 fio2-100 o2 flow-15 po2-128* pco2-42 ph-7.24* calhco3-19* base xs--8 aado2-558 req o2-90 comment-non-rebrea 06:01pm blood type-art temp-37.1 fio2-40 o2 flow-10 po2-86 pco2-38 ph-7.30* calhco3-19* base xs--6 intubat-not intuba comment-nebulizer 04:54am blood type-art temp-37.0 fio2-40 po2-85 pco2-38 ph-7.29* calhco3-19* base xs--7 intubat-not intuba comment-nebulizer 03:07pm blood type-art temp-35.6 rates-/27 fio2-50 po2-75* pco2-42 ph-7.28* calhco3-21 base xs--6 intubat-not intuba 11:21pm blood type-art temp-37.0 po2-88 pco2-41 ph-7.34* calhco3-23 base xs--3 04:35am blood type-art temp-36.2 po2-61* pco2-42 ph-7.33* calhco3-23 base xs--3 09:29pm blood lactate-1.5 cxr : the radiograph is markedly suboptimal in technique and motion of the patient. the heart is enlarged. there is consolidation of the left lower lobe with mass in the left hilar area. there is probably a small bilateral pleural effusion. the patient has prior cabg and median sternotomy. combined aicd and pacemaker leads probably terminate in the right atrium and right ventricle, which is obscured by the motion. cxr : limited chest x-ray demonstrating cardiac enlargement and findings suggestive of congestive heart failure. it is difficult to fully exclude underlying pneumonia. in this patient with history of lung mass, there is a questionable opacity at the right apex for which standard pa and lateral chest radiographs are suggested as well as comparison to the patient's outside films. cxr : interval placement of right ij central venous catheter in satisfactory position with no pneumothorax seen on this supine radiograph. persistent chf and left lower lobe consolidation/collapse. ecg: sinus rhythm, right bundle branch block, prior inferolateral myocardial infarct pathology: pathology examination name birthdate age sex pathology # , 72 male report to: dr. gross description by: dr. /mtd specimen submitted: endobronchial bx, left mainstem tumor, endobronchial bx f/s. procedure date tissue received report date diagnosed by dr. . fu/cma?????? diagnosis: 1. endobronchial biopsy (a): predominantly necrotic tissue with rare atypical cells. 2. left mainstem tumor (b-d): poorly-differentiated non-small cell carcinoma, favor adenocarcinoma, with extensive necrosis. clinical: airway obstruction; endobronchial biopsy and left mediastinum tumor. gross: the specimen consists of three tissue fragments measuring up to 1.0 cm in greatest dimension. the entire specimen is frozen. frozen section diagnosis made by dr. as: "endobronchial biopsy; extensive necrotic tissue; few atypical cells, suspicious for malignancy. respiratory type epithelium with mild atypia". the frozen section remnant is submitted in cassette a. part 2 of the specimen is additionally labeled as "left main stem tumor" and consists of multiple fragments of hemorrhagic shiny tissue that measure in aggregate 4 cm x 3.6 cm x 0.5 cm. it is entirely submitted in cassettes b-d. bronch: operative report , signed electronically by , on 11:09 am name: , unit no: service: med date: date of birth: sex: m surgeon: , procedure: 1. rigid bronchoscopy. 2. flexible bronchoscopy. 3. tumor excision, left lower lobe. 4. tumor destruction and argon plasma coagulation. assistant: , md preoperative diagnosis: left mainstem tumor. postoperative diagnosis: tumor eminating from the basilar left lower lobe. description of procedure: informed consent was obtained from the patient. indications and possible complications to the procedure were explained to the patient, after which he was brought to the operative theater number 12. general anesthesia was instituted. once an adequate level of anesthesia was reached, the patient was intubated easily with a bronchoscope 12-13mm and thorough examination of the tracheobronchial tree was done flexibly. findings: the vocal cords were normal in structure. the trachea was patent. the carina was splayed, suggestive subcarinal lymphadenopathy. the right mainstem, right upper lobe, bronchus intermedius and lower lobes are patent. the left main stem proximally is patent, but there was 85% distal obstruction from a tumor eminating from the lower lobe. the lower lobe was completely obstructed, and the left upper lobe is patent. the rigid scope was advanced into the left mainstem and under direct vision, using the rigid forceps, biopsy and tumor excision was done. at that moment, the left lower lobe was opened and there was evidence of tumor emanating mostly from the basilar segments. tumor destruction was also done with argon plasma coagulation and hemostasis was accomplished. the superior segment of the left lower lobe was patent. blood loss: approximately 150 ml. the patient was extubated and he was transferred to the medical icu. note that a frozen section pathology was done on the slides which showed necrotic tissue, highly suggestive of carcinoma. final pathology is pending. , brief hospital course: 1. hypoxia: the pt was felt to be hypoxic secondary to a post-obstructive pneumonia (lll consolidation on cxr), superimposed on lungs damaged by copd. he did not appear to be in chf and actually appeared volume depleted on exam. he was weaned from a non-rebreather to a 40% face tent. his baseline o2 sat is probably in the high 80s-low 90s, and so his oxygen was titrated to that. he underwent a bronchoscopy which revealed a lll tumor completely obstructing his bronchus. they excised the tumor and destroyed it with apc, wiht resultant patent airways (did not require a stent.) after the procedure he was extubated in the or without complication. he intermittently became hypoxic to the 70s-low 80s, which was felt to be due to his pneumonia and copd. he was treated with levofloxacin and metronidazole for his post-obstructive pneumonia, for a total 14 day course (last day will be .) he was continued on atrovent and albuterol nebulizers as well as a salmeterol inhaler. he has been stable on 6 l nc and occasoianally deasturates and needs a nrb facemask. 2. hypotension: he became hypotensive and febrile a day after admission, and was transferred to the micu. he was fluid resuscitated, vancomycin was added to the levofloxacin and metronidazole, and begun on dopamine. he was weaned off the dopamine on . his -stim test was appropriate (19-->41). his blood cultures were negative to date, and a urine culture was negative. by the day of transfer back to the va, he was actually hypertensive in the 140s-150s, and was restarted on his home regimen of atenolol. he was not given an ace due to his renal failure. he continued to require iv fluid boluses for a low cvp (1-5 range). 3. hx of ischemic cardiomyopathy: his ace was held due to renal failure. he was restarted on his atenolol once his bp stabilized. he was continued on his atorvastatin. he had no signs of failure on his exam here, although one night his sats acute dropped to the low 80s and he was given lasix. he put out 3 liters, and the next morning appeared volume depleted (with na 155), and so he likely is not in failure. 4. bladder cancer: the foley was kept in throughout his admission. 5. acute on chronic renal failure: his baseline is 2.1-2.6, but peaked at 3.3. he was down to 2.8 by discharge. this was felt to be due to prerenal physiology. 6. anemia: he was anemic in the low 30s throughout his stay, and dropped to a low of 28. given his cad, he was transfused one unit, but responded only to 29. the next day, he had an episode of melena/dark red blood per rectum. his hematocrit was checked and was stable. he needs a gi workup once he is back at the va. he remained hemodynamically stable throughout. 7. endocrine: he was kept on an insulin sliding scale. 8. electrolytes: he developed hypernatremia to 155 after he was given lasix and put out 3 liters in a day. this resolved with free water boluses. 9. mental status: this appeared to wax and wane. he would intermittently become confused (knew he was in a hospital, didn't know the city). it was likely due to icu delirium vs. hypernatremia. on discharge, he was still delerious. 10. nutrition: the patient needs to be on a pureed diet. he mainly ate isce cream during this admission. he needs a nutrition consult once transferred and may need a peg at some point depending on his goals of care. 11. code status: this was discussed repeatedly on this admission. the patient was never very articulate about his goals of care. he understands that her has a terminal illness and at times said he did not want to be intubated or rescusiated. however, he then said he wanted to "go for broke." therefore he was full code here, but this needs and a health care proxy needs to be addressed by his oncologist or pcp. medications on admission: atenolol 50 daily captopril 25 tid lovastatin 20 mg daily nitro sublingual prn lasix 40 mg daily omeprazole 20 mg daily oxybutynin 5 mg daily buspiron 10 mg tid ferrous gluconate 325 mg daily codeine prn gatifloxacin 200 mg daily ipratropi8um 2 puffs tid guaifenesin prn discharge medications: 1. lorazepam 0.5 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 2. buspirone hcl 10 mg tablet sig: one (1) tablet po tid (3 times a day). 3. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 6. ipratropium bromide 0.02 % solution sig: one (1) nebulizer treatment inhalation q6h (every 6 hours). 7. atorvastatin calcium 40 mg tablet sig: one (1) tablet po daily (daily). 8. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. oxybutynin chloride 5 mg tablet sig: one (1) tablet po bid (2 times a day). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 11. albuterol sulfate 0.083 % solution sig: one (1) nebulizer treatment inhalation q4h (every 4 hours). 12. salmeterol xinafoate 50 mcg/dose disk with device sig: one (1) puff inhalation q12h (every 12 hours). 13. levofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days: last dose . 14. flagyl 500 mg tablet sig: one (1) tablet po every eight (8) hours for 7 days: last dose . tablet(s) 15. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 16. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day). 17. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 18. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed. 19. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 20. captopril 12.5 mg tablet sig: one (1) tablet po tid (3 times a day). 21. dolasetron mesylate 12.5 mg/0.625 ml solution sig: 12.5 mg intravenous q8h (every 8 hours) as needed. 22. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed): sliding scale insulin. discharge disposition: extended care facility: discharge diagnosis: lung ca pneumonia ischemic cardiomyopathy acute renal failure discharge condition: stable, o2 saturations in low 90s with 40% face tent discharge instructions: call your doctor or come back to the emergency room if you experience dizziness, palpitations, coughing up blood, shortness of breath, chest pain, nausea/vomiting, diarrhea, abdominal pain, decreased urine output, or any other concerns. followup instructions: follow up per the instructions of your doctor at the va. procedure: transfusion of packed cells endoscopic excision or destruction of lesion or tissue of lung infusion of vasopressor agent diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified chronic airway obstruction, not elsewhere classified aortocoronary bypass status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin blood in stool automatic implantable cardiac defibrillator in situ hyperosmolality and/or hypernatremia secondary and unspecified malignant neoplasm of intrathoracic lymph nodes diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled malignant neoplasm of lower lobe, bronchus or lung malignant neoplasm of other specified sites of bladder 

Answer: The patient is high likely exposed to