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: sulfa (sulfonamide antibiotics) attending: chief complaint: cough, dyspnea major surgical or invasive procedure: 1. bronchoscopy 2. g tube placement 3. vocal cord injection history of present illness: mr. is a 57-year-old man with a history of metastatic egfr positive nsclc with mets to brain, kidney, liver, on erlotinib, with recent discharge for pneumonia, who presents with worsening sob, cough productive of greenish sputum, low-grade fever, and fatigue. per report, he has also had poor po intake for the past 2 days. he completed course of meropenem yesterday () for pna. no f/c/sweats/cp/n/v. sent from rehab for wbc 24 today. he has had normal bowel movements, no diarrhea. he is unable to cough up any sputum. in ed, initial vitals were: pain 5 t 97.7 hr 89 bp 98/67 rr 18 98%. exam was significant for cachectic appearing male, with lungs clear with good air entry and dry cough. labs were significant for wbc to 24 with 90% pmn's. cxr showed lul consolidation largely unchanged. lactate reassuring at 1.5. increasing parenchymal opacification with volume loss on left, cavitation, which may be associated with increased extent of infection. blood cultures were sent. he was given 1g iv vancomycin x1 in addition to nebs. pt given tylenol as well for chronic back pain. final vitals prior to transfer were 99.1 ??????f (37.3 ??????c), pulse: 94, rr: 14, bp: 100/56, o2sat: 97. review of systems: (+) per hpi + wt loss, (-) denies fever, chills, night sweats. denies blurry vision, diplopia, loss of vision, photophobia. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations, lower extremity edema. denies nausea, vomiting, diarrhea, constipation, abdominal pain, melena, hematemesis, hematochezia. denies dysuria, stool or urine incontinence. denies arthralgias or myalgias. denies rashes or skin breakdown. no numbness/tingling in extremities. all other systems negative. past medical history: nsclc, s/p lul resection and chemo/xrt, with metastatic disease to brain diagnosed in s/p xrt and steroid treatment stg radiation-esophagitis malnutrition previously receiving tpn at home via picc stopped h/o pilonidal cyst . past oncologic history: - : developed a cough, progressed to voice hoarseness 11/. - : ct showed left upper lung mass and left-sided lymphadenopathy - : pet scan showed a large left upper lung spiculated mass measuring 4.2 x 3 cm with an suv of 24.2 and a left hilar conglomerate of lymph nodes with an suv of 9.3 - : flexible bronchoscopy with ebus. brushings from this bronchoscopy were positive for adenocarcinoma lesion. lymph node stations 4l, 7 and 11l were positive. the tumor stained positive for ck7 and ttf-1 and negative for p63 and ck5/6. - : head mri negative - : started cisplatin 50 mg/m2 days 1, 8, 29, 35 with etoposide 50 mg/m2 given on days 1 through 5 and 29 through 33, with concomitant xrt. - : cycle 2 cisplatin/etoposide - : completed xrt - : admitted with twitching, loss of control of left arm, found to have seizures; mri showed multiple supratentorial sites of metastatic disease as well as 2 cerebellar lesions. - : started whole brain radiation - : pet scan with multiple sites of metastatic disease in and muscle. - egfr positive. - : started erlotinib social history: currently residing at rehab, windgate in . he has a sister nearby who is very involved in his care. non smoker, no alcohol. lived in the home of a physician with ms, whom he has helped with daily activities up until recently. he recently stopped working doing home repair. non smoker, no alcohol. family history: his mother had breast cancer at the age of 54, which was treated and then recurred and died at age 60. his father had cancer in his 70s and also had several types of skin cancer, possibly melanoma. he has two sisters who are with him today and one brother without any history of malignancy. he is not married and lives alone. he has no children. physical exam: admission: vitals - t: 98.5 bp: 98/65 hr: 93 rr: 24 02 sat: 96% ra general: cachectic, mildly tachypnic, speaks slowly heent: + facial wasting, eomi, perrla, anicteric sclera, pink conjunctiva, patent nares, dry mm, nontender supple neck, no lad, no jvd cardiac: reg, s1/s2, no murmurs, gallops, or rubs lung: decreased bs diffusely, particular on left abdomen: thin, nondistended, +bs, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly extremities: moving all extremities , no cyanosis, clubbing or edema, no obvious deformities pulses: 2+ dp pulses bilaterally neuro: cn ii-xii intact, slow speech but oriented and appropriate skin: warm and well perfused, no excoriations or lesions, no rashes discharge: vitals - tc-98.1, tm- 98.9, hr 60-90s, bp 90-110s/60-70s, rr 16-21, 95-97% ra i/o: 1664 (po) +1006 (tf)/ 800 general: cachectic, slow speech with hoarse voice, in nad heent: + facial wasting, dry mucous membranes without evidence of mucositis or thrush cardiac: reg, s1/s2, no murmurs, gallops, or rubs lung: l sided rales heard best at base, clear on the right abdomen: thin, nondistended, +bs, nontender, g tube in place with overlying dressing, pink macular rash around dressing extremities: moving all extremities, no edema neuro: 5/5 strength in ue with exception of decreased l grip strength, which is improving skin: macular acneiform rash on face, neck, and shoulders pertinent results: admission: 03:25pm wbc-24.4*# rbc-3.49* hgb-9.7* hct-29.4* mcv-84 mch-27.9 mchc-33.1 rdw-15.1 03:25pm neuts-90.7* lymphs-2.3* monos-3.5 eos-3.5 basos-0.1 03:25pm plt count-455* 03:25pm glucose-78 urea n-33* creat-0.7 sodium-136 potassium-4.1 chloride-102 total co2-25 anion gap-13 03:39pm lactate-1.5 03:25pm ctropnt-<0.01 imaging: cxr : persistent extensive left upper lobe consolidation including a large cavitary component. although a left-sided pleural effusion is probably reduced, there is increasing parenchymal opacification with volume loss at the left base, which may be associated with increased extent of infection. clinical correlation is suggested. ct chest : while there has been improvement in left-sided moderate pleural effusion, there are now confluent opacities at the left lower lobe suggestive of progression of multifocal pneumonia in this region. otherwise, there is stable appearance of consolidation involving the left upper lobe, left lower lobe, and lingula with little change in the appearance of left upper lobe cavitary lesion. ct abdomen/pelvis : 1. advancement of disease, marked by increased size of a hepatic lesion and an increase in the lytic components of known osseous disease. no new metastatic foci identified. 2. significant fecal load. 3. likely unchanged metastatic disease to the kidneys, comparison is difficult given contrast timing. 4. left lower lobe consolidation with volume loss consistent with known pneumonia. microbiology: aspergillus galactomannan antigen (bronchoalveolar lavage) test result reference range/units aspergillus antigen 1.2 h <0.5 blood cultures : negative cxr : worsening lll pna discharge labs: 04:03am blood wbc-17.4* rbc-3.14* hgb-8.6* hct-26.3* mcv-84 mch-27.5 mchc-32.8 rdw-16.9* plt ct-352 04:03am blood glucose-121* urean-19 creat-0.7 na-136 k-4.3 cl-103 hco3-27 angap-10 04:03am blood calcium-8.1* phos-2.4* mg-2.1 brief hospital course: mr. is a 57-year-old man with a history of metastatic egfr positive nsclc with mets to brain, kidney, liver, on erlotinib, with recent discharge for pneumonia, who presents with worsening sob, cough productive of greenish sputum, and significant leukocytosis secondary to complicated lll pna. # complicated pna: pt had complicated course during last admission with continued lul cavity. patient presented with a new lll consolidation on ct despite recently completing treatment course of meropenem. ct read as lll pna and continued lul cavity. aspiration event was likely given his vocal cord dysfunction. he was started on vancomycin and meropenem per id recs. he was evaluated by pulmonary and a bronchoscopy was performed on which showed a large amount of secretions but no obstruction. bal was aspergillus ag positive and grew yeast, but serum aspergillus ag and beta glucan were negative. pt started on voriconazole on . vanc d/c'ed and pt maintained on /vori. pt with supplemental o2 requirements and cxr noted to have increase in lll pna. and vanc restarted. vori continued. changed to zosyn . will stop iv antibiotics on discharge. # care: pall care consult initiated at request of pt's sister, . pt expressed wishes to focuse on and stop iv antibiotics. family meeting with dr. . pt to be discharged to residential hospice. pt desires to continue tube feeds. spoke with him regarding voriconazole by g tube and he wanted to continue for time being. # cachexia/malnutrition: patient continued to have poor po intake for multiple reasons. he has difficulty and pain with swallowing with known vocal cord dysfunction, pain in his back that makes it uncomfortable for him to sit up and eat, and overall poor appetite. ct abdomen showed possible progression of cancer which may indicated decreased response to tarceva. attempted dobhoff placement but pt did not tolerate well. patient underwent g-tube placement and vocal cord injection on after being cleared and consented by anesthesia. tube feeds were started , pt tolerated tube feeds well at goal and wishes to continue tube feeds in hospice center. # anemia: hct remained chronically low in low 20s. he was transfused 2 units prbcs on prior to going to or for hct of 20. there were no signs of frank bleeding and hct remained stable. pt received 3u prbcs . h/h remained stable after transfusion. # left vocal cord paralysis: noted on last admission. he underwent vocal cord injection with dr. on . the patient was transferred to the icu overnight s/p l vocal cord injection with poor abduction of r cord and concern for possible airway obstruction secondary to b/l medialization of the cords. the patient did well overnight and was given 10 mg iv decadron. he was then transferred to the oncology team. pt unable to get repeat l sided vocal cord injection for 4-6wks per ent team. with hospice in place, will not f/u with ent as op unless he chooses to set it up with goal of quality of life. chronic issues: # dysphagia/odynophagia: likely secondary to radiation therapy and tumor. he was able to tolerate soft solids; po medications were changed to iv whenever possible. however, given long-standing dysphagia that pt reported was worsening, gi was curbsided regarding possibility of upper endoscopy. pt ended up getting g tube as opposed to peg so endoscopy was not pursued to evaluate esophagus for cause of odynophagia. we will not pursue further workup in setting of hospice care. # nsclc, egfr positive: mets to brain, kidney, liver, on erlotinib. repeat ct abdomen/pelvis showed advancement of disease in liver and lytic components. he was continued on erlotinib for his lung cancer and keppra for seizure prophylaxis. palliative care was consulted per request from pt's sister, . pt opted for measures with residential hospice. will go off erlotinib at time of discharge since progression while on med and focus on . # back pain: chronic. likely due to axial metastatic lesions. he was continued on liquid oxycodone and a fentanyl patch was added. # coccyx ulcer: wound consult was initiated and recommendations for wound care were followed by nursing. # gerd: he was continued on ranitidine. transitions of care: 1. code status: dnr/dni 2. contact: sister 3. discharge to residential hospice. medications on admission: discharge medications: 1. ranitidine hcl 150 mg tablet sig: one (1) tablet po hs (at bedtime): at 1700. 2. clindamycin phosphate 1 % gel sig: as directed topical once a day: apply to infected area once daily. 3. erlotinib 150 mg tablet sig: one (1) tablet po daily (daily). 4. levetiracetam 500 mg/5 ml (5 ml) solution sig: ten (10) ml po twice a day. 5. acetaminophen 500 mg tablet sig: 1-2 tablets po four times a day as needed for pain. 6. multivitamin tablet sig: one (1) tablet po daily (daily). 7. meropenem 500 mg recon soln sig: five hundred (500) mg intravenous q6h (every 6 hours) for 8 days: last day = . 8. megestrol 400 mg/10 ml (40 mg/ml) suspension sig: four hundred (400) mg po daily (daily). discharge medications: 1. acetaminophen (liquid) 650 mg po q6h:prn pain, fever please contact ho if giving for fever rx *acetaminophen 650 mg/20.3 ml 650 mg by g tube every 6 hours disp #*1 liter refills:*0 2. ranitidine (liquid) 150 mg po daily rx *ranitidine hcl 15 mg/ml 150 mg by g tube daily disp #*1 liter refills:*0 3. levetiracetam oral solution 1000 mg po bid rx *keppra 1,000 mg 1 tablet by g tube twice daily disp #*60 tablet refills:*0 4. megestrol acetate 400 mg po daily:prn low appetite rx *megace oral 400 mg/10 ml (40 mg/ml) 400mg suspension(s) by g tube daily disp #*1 liter refills:*0 5. benzonatate 100 mg po tid:prn cough rx *benzonatate 100 mg 1 capsule(s) by mouth three times daily disp #*90 capsule refills:*0 6. docusate sodium (liquid) 100 mg po bid:prn constipation rx *diocto 50 mg/5 ml 100 mg by g tube twice daily disp #*1 liter refills:*0 7. fentanyl patch 25 mcg/hr tp q72h rx *fentanyl 25 mcg/hour 25mcg/hr patch every 72 hours disp #*10 transdermal patch refills:*0 8. nystatin oral suspension 5 ml po qid:prn thrush rx *nystatin 100,000 unit/ml 5 ml by mouth four times daily disp #*100 milliliter refills:*0 9. polyethylene glycol 17 g po daily hold for loose stools rx *clearlax 17 gram/dose 17 g(s) by g tube daily disp #*30 packet refills:*0 10. senna 1 tab po bid hold for diarrhea rx *senna 8.8 mg/5 ml 5 ml by g tube twice daily disp #*100 milliliter refills:*0 11. voriconazole 200 mg po q12h rx *vfend 200 mg 1 tablet(s) by g tube every 12 hours disp #*60 tablet refills:*0 12. hospice eval please screen and admit to hospice. 13. morphine sulfate (concentrated oral soln) 5-10 mg po q2h:prn pain rx *morphine concentrate 100 mg/5 ml (20 mg/ml) 5-10 mg(s) by g tube every 2 hours disp #*30 milliliter refills:*0 14. lorazepam 0.5 mg sl q2h:prn anxiety rx *ativan 0.5 mg 1 tablet(s) by g tube every 2 hours disp #*100 tablet refills:*0 discharge disposition: extended care facility: hospice discharge diagnosis: primary: -pneumonia -severe malnutrition -vocal cord paralysis secondary: -metastatic egfr positive nsclc discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , it was a pleasure taking care of you during this admission. you were hospitalized for a recurrent pneumonia and treated with antibiotics. you were also not eating well, so a tube was placed in you stomach to help supplement you with nutrition. you also received a vocal cord injection for your vocal cord paralysis. some changes have been made to your medications. please see the attached list. you have decided to focus on , you will be transferred to a residential hospice center. we will stop your iv antibiotics. followup instructions: you will follow-up with the hospice physicians. md, procedure: enteral infusion of concentrated nutritional substances injection or infusion of other therapeutic or prophylactic substance laryngoscopy and other tracheoscopy closed [endoscopic] biopsy of bronchus other gastrostomy injection or infusion of cancer chemotherapeutic substance injection of larynx diagnoses: anemia, unspecified esophageal reflux malignant neoplasm of liver, secondary personal history of malignant neoplasm of bronchus and lung pneumonitis due to inhalation of food or vomitus secondary malignant neoplasm of brain and spinal cord pressure ulcer, lower back hyperosmolality and/or hypernatremia secondary malignant neoplasm of bone and bone marrow aspergillosis pneumonia in aspergillosis pressure ulcer, stage ii nutritional marasmus secondary malignant neoplasm of kidney bilateral paralysis of vocal cords or larynx, partial other speech disturbance 

Answer: The patient is high likely exposed to