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: history of present illness: mr. is a 61 year-old male with a one year history of nonsmall cell lung cancer who was transferred from an outside hospital to cardiothoracic surgery on . the patient originally presented to the outside hospital on with nausea and vomiting and found to have a small bowel obstruction. a ct of the chest also revealed a right sided pleural effusion as well as an obstructing right upper lobe mass. ct scan of the abdomen showed small bowel obstruction secondary to diffuse abdominal metastases and the patient underwent exploratory laparotomy with small bowel resection on . his postoperative course was complicated by fevers and he was initially treated with zosyn. by report all blood and urine cultures were negative. the patient was then transferred to on for further management of the right upper lobe obstructing mass. on admission the patient denies any chest pain, shortness of breath or dizziness. he did complain of a cough productive of clear sputum. past medical history: 1. stage four nonsmall cell lung cancer diagnosed in status post chemo/radiation with metastases to the abdomen. 2. paroxysmal atrial fibrillation. 3. small bowel obstruction secondary to abdominal mets status post small bowel resection. medications at home prior to hospital admission: prednisone 20 mg po q day started by the patient's primary care physician for shortness of breath. allergies: no known drug allergies. social history: the patient was an electrician with the national guard. he retired last year. he lives on . he has never been married and has no children. the patient has a 30 pack year cigarette smoking history. he quit in the . he drinks every once in a while and denies any intravenous or recreational drug use. family history: the patient denies any family history of cancer. physical examination on transfer to the medicine service: temperature max 98.9. current temperature 98.8. blood pressure 145/84. heart rate 97. respiratory rate 20. oxygen saturation 98% on 1 liter nasal cannula. in general, the patient is awake, alert, appears his stated age and in no acute distress. he is cooperative with the examination, but very grouchy. heent examination pupils are round and reactive to light. extraocular movements intact. sclera anicteric. oropharynx is clear. neck is supple. chest examination coarse breath sounds on the right greater then left, no wheezing, no dullness to percussion with decreased breath sounds at the right lung base. cardiovascular examination regular rate and rhythm. abdominal examination soft, nontender, nondistended with good bowel sounds. a well healing midline scar with mild erythema. extremities no lower extremity edema. neurological examination alert and oriented times three. cranial nerves ii through xii grossly intact. strength 5 out of 5 in the upper and lower extremities. sensation intact to light touch in the upper and lower extremities. laboratories on transfer from the cardiothoracic surgery service to the medicine service: white blood cell count is 4.4, hematocrit 26.4, platelets 399, creatinine 0.7, glucose 112. chest x-ray shows large medial right upper lobe mass with opacification at the right heart border due to collapse or consolidation of the right lower lobe. there is an irregular pleural thickening on the right apex as well as the chest wall. there is a hydropneumothorax at the right apex. the left lung is clear with gross interstitial markings. hospital course: 1. lung cancer: the patient was transferred from an outside hospital following small bowel resection for further management of the right upper lobe obstructing tumor. the patient was initially admitted to the thoracic surgery service. interventional pulmonary was consulted. on interventional pulmonary performed a rigid bronchoscopy with placement of the right upper lobe stent. a chest tube was also placed into the right chest wall for evacuation of the right pleural effusion. steroids, which had been started at the outside hospital were continued for the patient's wheezing and dyspnea. on the chest tube was removed following resolution of the pleural effusion. the patient's steroids were slowly tapered over the course of a week. zosyn had also been started at the outside hospital for postoperative fever and the patient was continued on zosyn intravenously. he was eventually switched to flagyl and levofloxacin po and received a total of 18 days of antibiotics. his postoperative fever was believed to be due initially to postoperative pneumonia, however, the patient continued to have low grade fevers to 100 despite antibiotics. multiple blood cultures and sputum cultures and urine cultures were obtained, which were all negative. it was believed that the continued fevers on antibiotics was possibly due to either tumor fever or a drug reaction to the antibiotics. following stent placement and chest tube removal the patient continued to have intermittent shortness of breath and worsening cough and he was taken by interventional pulmonary for a repeat bronchoscopy on for removal of mucous plug. following this repeat bronch the patient symptomatically felt better, but continued to require oxygen by nasal cannula at 2 liters. following discussion with the patient, interventional pulmonary decided to attempt photodynamic therapy. on he received his infusion of photofrin followed by light treatment on and finally a bronchoscopy to clean out necrotic tissue on . the patient tolerated this procedure well without any complications. throughout the hospital course the patient was continued on aggressive chest ct, incentive spirometry, albuterol nebulizers, atrovent nebulizers and cough syrup. a physical therapy consult was obtained and they determined that he would require outpatient chest physical therapy as well as home oxygen therapy. at the time of discharge the patient's cough and shortness of breath had much improved and he was arranged to follow up with outpatient chest physical therapy. 2. fever: the patient was transferred from an outside hospital on zosyn intravenously for postoperative fever. it was believed the cause of his fevers to be due to a post obstructive pneumonia. he was continued on zosyn intravenously initially in his hospital course and was eventually switched to po antibiotics when the patient was tolerating po well. he was started on flagyl and levofloxacin to complete the total 18 day antibiotic course. the patient continued to have low grade fevers to 100 despite these antibiotics. multiple blood cultures, urine cultures and sputum cultures all returned negative. it was believed the cause of his continued fevers to be due to either tumor fever or drug reaction. 3. atrial fibrillation: the patient has a history of paroxysmal atrial fibrillation, which was detected at the outside hospital. at the patient had one brief 10 second episode of what appeared to be atrial fibrillation. the patient was asymptomatic during this episode. the patient had no further episodes of atrial fibrillation throughout the remainder of the hospital course. 4. small bowel obstruction: the patient had a small bowel resection on at the outside hospital for small bowel obstruction due to lung metastases. at the time of transfer the patient was tolerating po and having bowel movements and he continued to have problem throughout the remainder of his hospital course. 5. diarrhea: the patient complained of multiple loose bowel movements - up to four bowel movements a day. multiple samples were tested for c-diff all of which returned negative and the patient's diarrhea eventually subsided. no cause was found for this diarrhea. 6. anemia: on transfer to the patient's hematocrit was 26. anemia studies were consistent with an anemia of chronic disease, although the patient was already on iron supplements. his hematocrit remained stable at 26 throughout most of the hospital course. on the day prior to discharge his hematocrit decreased to 23.5. a repeat hematocrit confirmed this decrease and the patient received 1 unit of packed red blood cells. the morning following his transfusion his hematocrit had appropriately increased. the patient's stool was also tested for blood, but found to be guaiac negative. he was discharged on his iron supplements. 7. methemoglobinemia: on while receiving his light treatment the patient's o2 sats dropped to 54%. an arterial blood gas showed 16% methemoglobinemia and the patient received methylene blue times one dose empirically. the cause for his methemoglobinemia was believed to be due to the lidocaine with a possible contribution for metoclopramide, which the patient had been taking for nausea and vomiting and from benzonatate, which the patient had been taking for his cough. the patient was transferred to the medical intensive care unit for observation following the procedure. his o2 sats remained stable and he developed no signs of symptoms of cyanosis, so the following day he was able to be transferred back to the medicine . condition on discharge: stable. discharge status: the patient is discharged back to his home in . his sister will be living with him and he will be receiving chest physical therapy as an outpatient. the patient was also discharged with home o2. discharge diagnoses: 1. malignant pleural effusion. 2. stage four nonsmall cell lung cancer status post right bronch stent placement and photodynamic therapy. 3. paroxysmal atrial fibrillation. 4. anemia of chronic disease. 5. methemoglobinemia. 6. small bowel obstruction status post small bowel resection. discharge medications: 1. iron polysaccharide complex 150 mg po b.i.d. 2. levofloxacin 500 mg po q day for two more days. 3. metronidazole 500 mg po t.i.d. for two more days. 4. metoprolol 125 mg po b.i.d. 5. lorazepam 0.5 mg po q 4 to 6 hours prn anxiety. 6. megestrol 40 mg po t.i.d. 7. guaifenesin/dextromethorphan syrup po q 4 hours prn cough. 8. albuterol one puff inhaled 4 to 6 hours prn. 9. ipratropium one puff q 6 hours prn. follow up plans: the patient is asked to follow up with his oncologist dr. at hospital for further chemotherapy. the patient prior to hospital admission had discussed with dr. trying another round of chemotherapy after the patient regained his strength. he is also asked to follow up with his primary care physician in one to two weeks. the patient was also given information concerning his outpatient chest rehab. , m.d. dictated by: medquist36 procedure: insertion of intercostal catheter for drainage other intubation of respiratory tract closed [endoscopic] biopsy of bronchus transpleural thoracoscopy endoscopic excision or destruction of lesion or tissue of lung endoscopic excision or destruction of lesion or tissue of lung endoscopic excision or destruction of lesion or tissue of lung diagnoses: anemia, unspecified atrial fibrillation secondary malignant neoplasm of other specified sites secondary malignant neoplasm of pleura pulmonary collapse iatrogenic pneumothorax malignant neoplasm of upper lobe, bronchus or lung bronchopneumonia, organism unspecified 

Answer: The patient is high likely exposed to