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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath major surgical or invasive procedure: thoracentesis x 2 bronchoscopy history of present illness: mr. is a 63 year old male with a history of poorly differentiated non-small cell lung cancer with known metastases to brain and liver, polycythemia , and rue dvt on lovenox who presents with worsening dyspnea. . he was diagnosed with stage iv non-small cell lung cancer in and has received cyberknife for brain lesions, carboplatin, pemetrexed, and pf- as part of a clinical trial. he discontinued this trial on because of clinical (worsening dyspena) and radiolographic evidence of cancer progression. he then started a new , alimta, on . . his recent history is notable for dsypnea over the last four weeks that has worsened over the past four days. he underwent right thoracentesis on with removal of 800cc of cloudy yellow fluid found to be a malignant effusion. he had some improvement in his dyspnea as a response but notes worsening over the past few days, even after starting home o2 (2-4l) on . he also notes having subjective fevers and chills and a nonproductive cough since starting alimta. he presented to the ed because of worsening symptoms. . vs on presentation were 97.9 128/60 97 28 94%ra. he had a cxr and a chest cta that was neg for pe but concerning for worsened pleural effusions bilaterally, lymphangetic spread of tumor, and a possible post-obstructive pneumonia. he was given vanc/zosyn and bronchodilators. he became increasingly dyspneic and hypoxic in the ed, satting 87% on ra, and was placed on a nrb (satting in the 90s and then bipap with significant improvement. he was then admitted to the micu for further management. . on arrival, he is with his family and appears comfortable on bipap. he has no complaints. . review of sytems: (+) per hpi (-) denies 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: 1. stage iv eml4-alk (e13a20 ?????? variant 1) nonsmall cell lung cancer diagnosed in , with known metastases to brain and liver 2. brain metastases diagnosed in . 3. deep vein thrombosis of the upper extremity diagnosed in (likely related to his stage iv nonsmall cell lung cancer). recurrence of thrombosis with portal vein thrombosis in and svc syndrome. now on low molecular weight heparin. 4. radiation necrosis of the right frontal lobe lesion in , status post surgical resection. 5. gerd past oncologic history: 1. status post stereotatic radiosurgery (cyberknife) to 2 brain lesions in . 2. status post 2 cycles of 1st line systemic chemotherapy with carboplatin 6 auc d1 and gemcitabine 1000 mg/m2 d1,8 of 3 week cycle in (had progressive disease). 3. status post 12 cycles of pemetrexed 500 mg/m2 d1 of 3 week cycle. started in (attained partial response). last dose of pemetrexed . 4. status post 9 cycles of pf- mg as part of clinical trial dfhcc 06-068. started in (attained partial response) and had recist-based progression in . continues to take study drug. social history: he has an eight pack year smoking history and stopped in . he does report significant second hand smoke exposure as a child. he is a retired vice-president of operations at a telecom company. he lives with his wife. does not currently drink alcohol or use illicit drug. . family history: mother had arthritis, osteoporosis, and aortic insufficiency. father had copd, bronchitis, enlarged prostate, and malaria. he has two healthy daughters. physical exam: vitals: 97.9 128/60 97 28 100% on bipap general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: decreased bs on left, scattered rhonchi, wheezing at lul cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no lesions, no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . pertinent results: labs: admission: pt-14.9* ptt-27.6 inr(pt)-1.3* . wbc-12.6* hct-41.5 mcv-70* neuts-91.6* lymphs-4.7* monos-1.8* eos-1.6 basos-0.2 . alt(sgpt)-246* ast(sgot)-81* ld(ldh)-355* ck(cpk)-94 alk phos-141* tot bili-1.5 albumin-2.5* . glucose-111* urea n-21* creat-1.0 sodium-134 potassium-4.3 chloride-100 total co2-27 . lactate-2.5* . discharge: wbc-8.3 hct-33.4* mcv-69* plt ct-87* . glucose-108* urean-17 creat-0.8 na-138 k-3.8 cl-103 hco3-29 . alt-80* ast-32 ld(ldh)-243 alkphos-148* totbili-1.3 . type-art po2-219* pco2-37 ph-7.46* caltco2-27 base xs-3 . . imaging: . cta : 1. no evidence of pe. 2. bilateral pleural effusions, right greater than left, slightly increased in size since the prior study. 3. increase in encasement of the right-sided airways by soft tissue density, likely representing tumor, with areas of increased consolidation in the inferior aspect of the right upper lobe and right middle lobe likely due to post-obstructive pneumonia, although increased tumor burden cannot be excluded. 4. diffuse bronchovascular and septal thickening consistent with lymphangitic spread of tumor. 5. stable left lower lobe lung mass. 6. stable diffuse bony metastases and hepatic metastases. . echo : the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . cxr : impression: relatively stable radiographic examination with slight accentuation of the interstitial markings most notably on the right. there is suspected mild volume overload on the background of lymphangitic carcinomatosis. at least partially loculated left pleural effusion again re-demonstrated. . brief hospital course: 63 year old man with metastatic non-small cell lung cancer admitted with dyspnea 1 week following right sided thoracentesis for pleural effusion, found to have reaccumulated pleural effusion on x-ray. . hypoxia: the pt was initially on non-rebreather in the ed, and was weaned to bipap in the icu. on am the pt was noted to be stable on 4l nasal cannula oxygen, and he did not have to go on bipap again. dyspnea was most likely due to fluid reaccumulation and progression of cancer, however vanc/zosyn was started for a 7 day course for possible post-obstructive pneumonia. on pt had a right thoracentesis with 1200 ml serous fluid removed. on pt had a left thoracentesis with 500 ml removed. pt will likely need pleurex catheter on the right if fluid reaccumulates again. pt tolerated both procedures well, and was transfered to omed on with interventional pulmonary planning to follow him on the floor. on the floor, patient looked well and was satting in the mid 90s at 4lnc. he felt well and was ready to go home. it was thought that even though he was above his baseline for o2, that because his prognosis was only weeks remaining that it would be best for him to go home to be with his family for his remaining days. he was to follow up with ip within 1 week for evaluation for pleurodesis and to see his oncologist on . . # non-small cell lung cancer: has known metastases to brain and liver, recent drainage of a malignant right pleural effusion, ?worsening lymphangitic spread on chest ct, and initiation of new chemotherapeutic in the setting of progression. unfortunately, his disease has progressed despite chemotherapy and his prognosis is quite poor with only weeks to live. . # right upper extremity dvt: has been on lovenox at home. we continued lovenox. . # polycythemia : stable, no active issues. . medications on admission: albuterol mdi lovenox 60 q12h keppra 500 ativan prn naratriptan prn omeprazole 20 daily ambien prn folic acid 0.4 mvi . discharge medications: 1. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). 2. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for sleeplessness. 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. levofloxacin 750 mg tablet sig: one (1) tablet po daily (daily): take for 3 days, last dose . disp:*3 tablet(s)* refills:*0* 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 7. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 2-4 puffs inhalation q4h prn () as needed for shortness of breath or wheezing. 8. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 9. ambien 5 mg tablet sig: one (1) tablet po qhs as needed for insomnia. 10. naratriptan 1 mg tablet sig: one (1) tablet po every four (4) hours as needed for headache: do not exceed 5mg in 24 hours. 11. home o2 cannister 12. lovenox 60 mg/0.6 ml syringe sig: one (1) subcutaneous twice a day. . discharge disposition: home with service facility: oxygen company discharge diagnosis: 1) pleural effusion 2) nsclc 3) community acquired pneumonia . discharge condition: stable, afebrile . discharge instructions: you were admitted to the hospital for shortness of breath. your symptoms were thought to be related to worsening of your lung cancer as well as a pneumonia. you were started on antibiotics for your pneumonia. we also drained fluid from the pleural space around your lungs. both of these interventions improved your symptoms and your fevers resolved. you will be discharged on a 3 day course of levofloxacin antibiotic to finish treating your pneumonia. you will also be sent home on supplemental oxygen to help your breathing. . we have made a change to your medications: start levofloxacin 750mg by mouth daily . please note your follow up appointments listed below. . please return to the emergency room if you experience worsening shortness of breath, chest pain, high fevers, or any other symptoms that are concerning to you. followup instructions: appointment with provider: clinic interventional pulmonary (sb) phone: date/time: 10:00 . appointment with provider: , md phone: date/time: 10:00 . appointment with provider: , md phone: date/time: 10:00 . md, procedure: fiber-optic bronchoscopy thoracentesis thoracentesis diagnoses: esophageal reflux malignant neoplasm of liver, secondary secondary malignant neoplasm of brain and spinal cord antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use long-term (current) use of anticoagulants malignant neoplasm of other parts of bronchus or lung personal history of venous thrombosis and embolism bronchopneumonia, organism unspecified polycythemia vera other specified aplastic anemias malignant pleural effusion 

Answer: The patient is high likely exposed to