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: the patient is a 68 year old male smoker with a history of stage 3 nonsmall cell lung cancer who was admitted to on after having 500 cc of hemoptysis and associated shortness of breath that morning. of note, the patient was treated with radiation and taxol/carboplatin from through with a seemingly good response. one day prior to admission at the , he was seen in hematology/ clinic for a complaint of increasing lethargy and shortness of breath; a chest x-ray done at that time demonstrated a new left lung air/fluid level. a bronchoscopy done at demonstrated blood in the trachea, minimal right-sided blood without active bleeding, and white, friable mucosa in the left main stem bronchus with narrowing of the lumen, significant enough to prevent passage of the bronchoscope; blood was seen distal to the obstruction. at the end of this procedure, the left main stem bronchus was obstructed with a bronchial balloon. on , a bronchial artery angiogram was performed with a goal of embolizing the bleeding source. given the complex vascular supply of the tumor, however, the procedure was aborted. on the night prior to transfer to the , the patient had an additional 300 cc of hemoptysis with an associated drop in his systolic blood pressure to the 80s and was therefore started on a dopamine drip. past medical history: 1. stage 3a nonsmall cell (squamous type) lung cancer diagnosed in , status post taxol/carboplatin as above, status post radiation, status post bone scan (no metastases), pulmonary function tests with a fev 1 of 1.0 (not a surgical candidate); 2. hypothyroidism; 3. hypercholesterolemia; 4. gastroesophageal reflux disease; 5. congestive heart failure; 6. blood loss anemia secondary to gastritis. allergies: no known drug allergies. medications on transfer: midazolam gtt titrated to sedation; dopamine gtt at 10 mcg/hr; metronidazole 500 mg intravenously q. 8 hours; ceftriaxone 1 gm intravenously q. day; ranitidine 50 mg intravenously q. 8 hours; albuterol metered dose inhaler 10 puffs q. 1 hr prn; epotropium 10 puffs q. 4 hours prn. social history: 100 pack year smoking history, no ethyl alcohol. lives in , retired supermarket clerk. married with four children. family history: mother died of lung cancer at age 57, father died secondary to coronary artery disease at age 70, brother died secondary to coronary artery disease at age 55, sister with breast cancer. physical examination: on initial physical examination the patient's temperature was 98.0?????? f., his temperature maximum from earlier in the day was 102, heartrate 69 to 97, blood pressure 99 to 110/50 to 60, and mean blood pressure of 66 to 99. he was on a mechanical ventilator set at assist control 350/20/0.50/5, and arterial blood gases done on those settings was 7.34/38/82. his peak pressure was 20 and his plateau pressure was 14. in general, he was sedated, and on a ventilator. head, eyes, ears, nose and throat examination, his conjunctivae were clear, and his pupils were pinpoint. his neck was soft and supple and there was no lymphadenopathy. his heart was regular rate and rhythm, there were normal s1 and s2 heartsounds. there was a ii/vi systolic ejection murmur at the bilateral upper sternal border and there were no rubs or gallops. his lung sounds were coarse anteriorly. there were faint breathsounds over the left anterior chest wall. his abdomen was soft, nontender, nondistended, and there were normoactive bowel sounds. his extremities were warm, there were 2+ radial pulses. dorsalis pedis pulses were dopplerable, and there was no edema. he had no skin rashes or lesions, laboratory data: initial laboratory evaluation demonstrated a white blood cell count of 4.4, hematocrit of 34.8 and platelets of 237,000. his inr was 1.4. initial serum chemistries demonstrated sodium 140, potassium 3.5, bicarbonate 21, chloride 111, bun 6, creatinine 0.5 and glucose 126. his calcium was 6.1, magnesium 1.7, phosphate 1.2 and ionized calcium 0.98. a bronchoscopy done on admission demonstrated an oropharynx within normal limits; trachea deviated to the left but otherwise within normal limits; right airways within normal limits; left main stem bronchus obstructed by tumor versus clot, this area was suctioned, and argon beam coagulation destruction and airway debridement was performed. a 10 by 40 ultraflex left lower lobe stent and a 12 by 40 polyflex left main stem bronchus stent were placed with visualization into good position; the patient was reintubated bronchoscopically with the endotracheal tube at 25 cm following this procedure. the post procedure chest x-ray demonstrated some aeration of the left lung, right lower lobe effusion versus infiltrate. an outside chest x-ray reportedly demonstrated left lung opacification and right lower lobe effusion versus infiltrate. hospital course: 1. hemoptysis - there was active bleeding seen at the time of initial bronchoscopy, of which the most likely source was the patient's malignancy. this bleeding likely originated either from erosion of the tumor into small pulmonary vessels or from erosion or trauma to the vascular supply to the tumor itself. the patient had some mild post procedural hemoptysis, although his bloody secretions rapidly tapered off. he had no further significant clinical hemoptysis during this hospitalization. 2. post obstructive pneumonia - the fluid that was released following the tumor destruction and airway debridement in the initial bronchoscopy did not have the appearance of frank blood, but rather had a somewhat purulent appearance, (slightly yellowish). this gross finding raised the possibility of a post obstructive anaerobic pneumonia. although the patient did not have an elevated white blood count, he was febrile to 102 prior to admission. he was therefore started on clindamycin 600 mg intravenously q. 8 hours for anaerobic coverage; this antibiotic was continued throughout his hospitalization. he was also continued on the ceftriaxone 1 gm intravenously q. 24 hours that had been started at the outside hospital. his white blood cell count remained normal throughout his admission and he also remained afebrile throughout his admission. 3. airway obstruction - the patient had a significant airway obstruction from his tumor that was largely relieved by the tumor destruction and airway debridement during the initial bronchoscopy as noted above; in addition, two stents were placed in an attempt to maintain airway patency. a post procedural chest x-ray demonstrated increased aeration of the left lung, and breathsounds were heard over the left anterior chest wall following this initial procedure. on hospital day #4, the patient underwent a second bronchoscopy, during which his proximal stent was repositioned 1.5 cm proximally. the patient continued to have improved air movement following this repositioning of the stent. he was successfully extubated on , and remained on oxygen by nasal cannula ranging from 4 to 6 liters following his extubation. he required minimal suction with the yankauer catheter following his extubation; the patient was capable of clearing his own secretions with this catheter. his oxygen saturation remained between 94 and 98% on 4 to 6 liters of nasal cannula following his extubation. 4. hypotension - the patient reportedly became hypotensive on the morning of , after having a second episode of massive hemoptysis at the outside hospital and he subsequently required dopamine to maintain his blood pressure. he was transfused a total of 4 units of packed red blood cells at the outside hospital, and he did not have evidence of hypovolemia on admission to the . he was gradually weaned off of the dopamine drip during his hospitalization and he required no further blood transfusions, as his hematocrit remained above 30 throughout this hospitalization. at the time of discharge, the patient's systolic blood pressure was stable in the 140s to 150s. 5. blood loss anemia - the patient had a drop in his hematocrit following his hemoptysis at the outside hospital; following transfusion of 4 units of packed red cells at the outside hospital, the patient's hematocrit improved to 32.5. he remained stable throughout this admission. 6. coagulopathy - the patient had a mild coagulopathy with an inr of 1.4 on admission. he was administered vitamin k times one with resolution of his coagulopathy. 7. electrolyte abnormalities - the patient required repletion of his phosphate, potassium, magnesium, and calcium on multiple occasions throughout this admission. 8. code status - once the patient was more awake and alert following his bronchoscopy, a discussion regarding the patient's code status was addressed with both the patient and his family at the bedside. both the patient and the family agreed that once the patient had been taken off of the dopamine drip and once he was prepared for extubation, the patient would be made do-not-resuscitate/do-not-intubate. neither the patient nor the family wished for any further aggressive interventions in terms of his medical care. therefore, once the patient was successfully extubated on , his code status was changed to do-not-resuscitate, do-not-intubate. arrangements were then made on for the patient to be transferred to home medical care following his discharge from the hospital. disposition: at the time of discharge from the hospital the patient was aspirating all foods and liquids he attempted to consume, however, given that the decision had been made to transfer the patient to home hospice medical care, the patient was sent home only on medications as needed for pain as well as scopolamine for minimization of oral secretions. he was not sent home on any oral antibiotics given his inability to take p.o. discharge condition: do-not-resuscitate, do-not-intubate to home hospice care. discharge placement: home medical care with hospice. discharge diagnosis: 1. stage 3 lung cancer 2. hemoptysis 3. hypotension 4. post obstructive pneumonia 5. blood loss anemia 6. status post bronchoscopy times two with placement of stent into the left lower lobe and left main stem bronchus discharge medications: 1. scopolamine patch q. 72 hours prn for excessive oral secretions 2. fentanyl patch 25 mcg/hr q. 72 hours as needed for pain 3. sublingual lorazepam 1 mg tablets to 2 mg tablets every 2 to 4 hours as needed for agitation 4. yankauer suction unit as needed for excessive oral secretions instructions: the patient was discharged home with vista care hospice from medicine intensive care unit. , m.d. dictated by: medquist36 procedure: other bronchoscopy other intubation of respiratory tract other intubation of respiratory tract closed [endoscopic] biopsy of bronchus other local excision or destruction of lesion or tissue of lung diagnoses: pneumonia, organism unspecified esophageal reflux pure hypercholesterolemia acute posthemorrhagic anemia unspecified acquired hypothyroidism other and unspecified coagulation defects malignant neoplasm of main bronchus 

Answer: The patient is high likely exposed to