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: bronchoscopy history of present illness: pt is a 74 y/o male with a h/o right rcc s/p nephrectomy () with subsequent mets to lung s/p xrt and left mainstem bronchus stenting (-) on study chemotx who presents with three days of worsening shortness of breath, productive cough, and fever. he has been dyspneic for months now, but this began to worsen over the past few days. he was to be admitted today for a blood transfusion, but in the clinic was found to be tachycardic to 130, hypotensive to the 90's, and hypoxic to 80% on 2l-nc with a temp of 96.6. he was sent to the ed for evaluation. . in the ed, he was in significant respiratory distress and persistently hypoxic, so he was intubated. dopamine was begun to support his bp. vanco/levo/flagly were initiated for presumed pneumonia with sepsis. a chest x-ray showed a left mid-lung zone infiltrate and right mid-lung zone increased interstitial markings, no pleural effusions, felt to be consistent with his metastatic disease with a post-obstructive pneumonia. past medical history: 1.)right renal cell carcinoma: diagnosed with nephrectomy in , no recurrence until when found to have metastatic disease to lung, underwent xrt then left mainstem bronchial stent with subsequent argon plasma coagulation distal to sent for bleeding friable mucosa. currently on sorafenib experimental chemotherapy protocol, started cycle 2 ; ct-chest on showed progression of disease. 2.)bph 3.)nephrolithiasis 4.)peptic ulcer disease 5.)squamous cell cancer 6.)rheumatic fever as a child 7.)bilateral cataract surgery social history: rev is a jesuit priest and former literature proffersor at . family history: his mother died of an mi at 81, and his brother from prostate cancer at 65 physical exam: t 97.5, bp 114/66, hr 82, rr 15, spo2 100% gen- intubated, sedated male, looks stated age heent- anicteric sclera, op clear cv- rrr, s1s2, no m/r/g pul- moves air well, diffuse rhonchi, bronchial bs over left lung abd- soft, nd, nabs, no organomegaly back- no sacral edema extrm- no cyanosis/edema, warm/dry nails- no clubbing, no pitting/color changes/indentations neuro- sedated, does not respond to stimuli, cn intact pertinent results: 04:10pm wbc-22.9*# rbc-3.22* hgb-8.6* hct-27.2* mcv-84 mch-26.6* mchc-31.6 rdw-15.9* 04:10pm neuts-92* bands-6* lymphs-1* monos-1* eos-0 basos-0 atyps-0 metas-0 myelos-0 04:10pm pt-14.9* ptt-35.6* inr(pt)-1.5 04:10pm plt smr-very high plt count-887*# 04:10pm albumin-2.6* 04:10pm glucose-98 urea n-46* creat-1.5* sodium-137 potassium-5.3* chloride-101 total co2-23 anion gap-18 04:10pm alt(sgpt)-17 ast(sgot)-22 alk phos-170* amylase-54 tot bili-0.4 04:18pm lactate-2.5* 04:45pm urine granular- coarse & fine granular casts* hyaline-0-2 04:45pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-sm urobilngn-neg ph-5.0 leuk-neg 09:01pm calcium-6.5* phosphate-5.0* magnesium-1.6 ........... cxr impression: area of consolidation in the left mid lung zone with prominent interstitial markings in the right mid lung zone. the lung findings are consistent with the given history of metastatic disease within the chest with post-obstructive consolidation. ............ ekg sinus tachycardia lateral st-t changes may be due to myocardial ischemia repolarization changes may be partly due to rate low qrs voltages in limb leads since previous tracing, lateral st-t wave changes - consider ischemia ............... renal u/s impression: 1. status post right nephrectomy with no definite mass or fluid collection identified in the nephrectomy bed. 2. left-sided extra renal pelvis without hydronephrosis or mass. 3. incidental note is made of gallstones and sludge with questionable gallbladder wall edema. please correlate with patient's symptoms. if there is clinical concern for cholecystitis, this could be further evaluated with a dedicated gallbladder ultrasound or with hida scan. 4. right pleural effusion. .............. ct chest impression: significant interval progression of both metastatic renal cell carcinoma and widespread intrathoracic infection as follows: 1. new large cavitary abscess involving the left lower paraspinal pleural space, probably due to lower lobe bronchopleural fistula. 2. despite interval decrease in size of a large subcarinal mass (that nevertheless infiltrates and probably occludes the esophagus) and preserved patency of the stented, tumor-encased left main bronchus, increasing right hilar adenopathy and multiple new lung nodules represent increased metastatic burden. 3. right upper lobe cavity and new multifocal consolidation represents widespread infection. 4. left bronchial stent is patent but tissue extending from its proximal extent threatens to occlude the right main bronchus .............. bronchoscopy indications for procedure: evaluation of airway patency. description of procedure: lidocaine was instilled through the reverend endotracheal tube to suppress cough. the patient received sedation per icu protocol. the bronchoscope was then inserted into the airways and airway inspection was performed at the level of the carina. there was noticed to be significant tumor burden, which was occluding right main stem bronchus. the tumor was partially occluding the left main stem bronchus orifice as well. the bronchoscope was then navigated around the tumor in the left main stem bronchus where the stent was identified, which was widely patent. distal airways were all patent. bronchoscope was then carefully navigated around the tumor into the right main stem bronchus, which showed distal patency distal to the proximal tumor occlusion. findings: 1. tumor at the level of the carina. 2. tumor at the level of the carina obstructing right main stem bronchus approximately 80%. 3. tumor at the main stem carina obstructing the left main stem bronchus approximately 40% to 50%. 4. stent in left main stem bronchus widely patent. 5. distal airways, distal to proximal obstruction, patent. specimens obtained: none. complications: none. brief hospital course: 74 y/o male with metastatic renal cell carcinoma s/p left mainstem stenting admitted with pneumonia and resultant sepsis and respiratory failure. . #respiratory failure - initially the respiratory failure was thought to be d/t either a cap or postobstructive pna, and the patient was treated with levofloxacin, vancomycin, and flagyl for possible aspiration pna. gram stain showed gpc in prs, chains, and clusters, as well as gnr's. respiratory culture grew op flora and moderate growth of beta streptococci, not group b. metronidazole was stopped and the patient was treated with levofloxacin and vancomycin for a total of 7 days. addidionally, the patient was wheezy on physical exam and was given albuterol and atrobent nebulizers, as well as steroids in the setting of hypotension and an inadequate stim. the patient was difficult to wean from the vent, and the ventilator readings suggested an element of resistance. a ct scan was done to assess progression of metastatic rcc, and found cancer had progressed while on sorafenil study drug. a bronchoscopy was performed which showed 80% stenosis of right main and 40-50% stenosis of left main. a discussion was held with the patient's sister, brother, and health care proxy, as well as the bc communinty of priests, and it the decision was made to withhold futher aggressive measures such as stent placement in the right bronchus in the setting of known progression of disease. this decision was made taking into account the best interests of the patient and his presumed wishes. antiobiotics and steroids were stopped, and the patient was extubated at 1 p.m. on with family and friends present. morphine was started prior to extubation and titrated to patient comfort. the patient slowly become hypoxic with hypertension and tachycardia. over the course of four hours his respirations slowed, he became progressively hypoxia and hypotension ensued. approximately 15 close family and friends were present, praying and playing music, and the patient expired surrounded by loved ones. . #sepsis - the patient presented with an elevated white count, fevers, tachycardia, tachypnea, and hypotension. fluid boluses and phenylephrine were used to maintain map >65. after adequate fluid resuscitation, the patient's pressure stabalized. however, he had sustained aflutter causing hypotension and levophed was needed until the aflutter was controlled/resolved (see below). after resolution of aflutter, the patient remained normotensive until his death. the white count trended down, he became afebrile, and gram stain of blood cultures was negative and there was no growth on blood cultures. on the day of his death antibiotics and steroids were stopped. . #metastatic rcc - interval progression on ct of with new pulmonary nodules and cavitary lesions. bronchoscopy showed evidence of right bronchus stenosis of 80% and left bronchus stenosis of 40-50%. hem/onc spoke with the patient/family/health care proxy and were unable to offer any further treatment options. with the known progression of disease while on study drug, the decision was made to make the patient cmo. the patient was extubated as above. . #aflutter - the patient had no history of aflutter prior to this hospital admission. initially the flutter was controlled intermittently with iv lopressor and diltiazem, but was unsuccessful. amiodarone was started transiently but stopped per recommendation of cardiology d/t it's ability to make aflutter worse. d/c cardioversion was attempted and successful, but the patient only remained in nsr for approx 36 hrs. a diltiazem drip was started for rate control, and this was successful. the patient was transitioned to po dilt and was not tachycardic until after extubation. . #arf - initially renal failure was thought to be due to prerenal etiology, and fena was consistent with this. however, renal funciton continued to worsen and urine was spun and muddy brown casts were seen, leading to a diagnosis of atn. renogel was started for an elevated phosphorous, and renal followed the patient daily. no indication for hd and no further intervention. . #fen - patient had an ogt in place and he received tf's with little residuals. the ogt was d/c'd when the patient was extubated. . #access - right ij . #comm -- with hcp, father , phone # medications on admission: doxazosin ranitidine zolpidem lorazepam albuterol flunisolide discharge medications: none discharge disposition: expired discharge diagnosis: metastatic renal cell carcinoma pneumonia discharge condition: deceased discharge instructions: none followup instructions: none procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances other electric countershock of heart transfusion of packed cells infusion of vasopressor agent diagnoses: pneumonia, organism unspecified acute kidney failure with lesion of tubular necrosis unspecified septicemia atrial flutter acute and chronic respiratory failure pneumonitis due to inhalation of food or vomitus cardiac arrest septic shock secondary malignant neoplasm of lung personal history of malignant neoplasm of kidney empyema with fistula 

Answer: The patient is high likely exposed to