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: unable to tolerate po major surgical or invasive procedure: none history of present illness: 64 m metastatic esophageal ca, af. initially presented to with 20 lb weight loss over 3 weeks, emesis, inability to tolerate pos. in ed, noted to be in af with rvr in 170-180s, sbp 90s. received dig bolus, and started on dilt gtt. approx 30-45 min later, spontaneously converted to sr in 80s. transferred to ed for further management. . in ed, ecg confirmed sr. however, bps noted to be mid-upper 80s systolic. received 2l ns bolus with improvement in bp to low 90s. started on levophed gtt. given vancomycin, cefepime, solumedrol 125 iv. past medical history: 1. esophageal cancer: presented wtih severe indigestion which progressed to difficulty swallowing. barium swallow demonstrated esophageal lesion--8 cm infiltrating carcionma of distal esophagus. biopsy demonstrated atpyical glandular proliferation. he started neoadjuvant 5fu and cisplatin and xrt from . demonstrated total esophagogastretcomy. pet showed multi-focal fdg avid left pleural nodular thickening and right medial upper pleural nodular thickening worrisome for metastatic disease. left lung base nodule and right upper lobe nodule both fdg avid. started cisplatin, irinotecan . currently on day 22 cis/irinotecan cycle. 2. history of diabetes but currently off insulin given significant weight loss. 3. hypercholesterolemia which has resolved at this time. 4. herniated disk. 5. djd. . past surgical history 1. operation for cholesteatoma at 2. multiple orthopaedics operations 3. laparoscopy, laparoscopic jejunostomy and port placement under fluorscopic guidance social history: he lives at a nursing home. he does not smoke or drink. he used to smoke a couple of packs a day for 40 years. he is currently on disability. he used to work for the city of in their sanitation department. family history: father died of lung cancer mother is and living in nursing home no other family history of malignancy physical exam: pe on admission: vs - t 95.4, bp 109/62, hr 88, rr 22, o2 sat 98% 2l nc general - cachectic male, in nad, speaking full sentences heent - op clr, mm sl dry cv - rrr, no mur chest - ctab abdomen - mild diffuse tenderness to palp, soft, no g/r extremities - no edema neuro - a&ox1 pertinent results: ct head w/o no acute intracranial process. please note that contrast- enhanced ct or mri is more sensitive for evaluating intracranial metastatic lesions. . ct abdomen/pelvis w/o : 1. no intra-abdominal source of fever identified on this limited non-contrast examination. 2. increased peribronchovascular opacities, centrilobular nodules and interstitial prominence within the visualized lower lobes. differential diagnosis includes infectious/inflammatory, interstitial edema or lymphangitic carcinomatosis. size of right pleural-based lesions may be slightly progressed since most recent examination. 3. fluid fecal material within the majority of the large bowel, which displays air-fluid levels. please correlate clinically for any signs of enteritis. . swallow study pt is safe to take a po diet of thin liquids and regular solids without oral or pharyngeal dysphagia . egd cervical esophagus/gastric anastomosis was patent. suture line with metal clips was seen. erythema and congestion in the stomach compatible with gastritis . gastric emptying study nearly no emptying within first hour and markedly delayed emptying at 4 hours involving the intrathoracic portion of the stomach. normal tracer movement once it passes through the diaphragm . complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 12:00am 6.0 3.14* 9.0* 28.1* 90 28.8 32.2 16.7* 319 12:00am 7.0 3.23* 9.3* 28.6* 89 28.7 32.4 17.0* 307 12:00am 4.8 2.42* 7.1* 21.3* 88 29.2 33.2 16.5* 250 07:45am 5.5 3.03* 8.7* 26.2* 86 28.9 33.4 16.6* 203 08:35am 5.8 3.40* 9.8* 28.6* 84 28.6 34.2 16.1* 194 10:05am 6.3# 3.39* 9.8* 29.7* 88 29.0 33.0 15.7* 200 05:49am 3.6* 2.82* 8.1* 24.4* 87 28.8 33.2 17.2* 195 09:00am 2.3* 2.69* 7.7* 23.4* 87 28.8 33.1 16.8* 237 01:45am 2.5* 3.16* 9.1* 26.9* 85 28.9 33.9 16.7* 217 . renal & glucose glucose urean creat na k cl hco3 angap 12:00am 116* 22* 0.6 135 4.8 106 22 12 12:00am 1121*1 19 0.8 130*2 7.0*3 1064 234 8 03:00pm 100 3* 0.8 134 4.1 102 26 10 08:15am 107* 4* 0.8 132* 3.6 100 27 9 07:29pm 119* 6 0.8 132* 4.0 101 28 7* 08:06pm 144* 32* 1.1 143 2.8*1 120* 11*1 15 09:00am 107* 45* 1.9* 137 3.6 111* 15* 15 01:45am 130* 58* 2.6* 134 3.8 103 15* 20 brief hospital course: assessment/plan: 64 yo m with esophageal ca, admitted with af w/ rvr, hypotension, and bandemia, initial micu stay, also with intractable emesis of unknown etiology at this point ?r/t progression of esophageal ca. . # emesis: pt admitted with progressively worsening heaving and inability to tolerate po's, regardless of if solid, liquids or softs. most recent barium study prior to admission without evidence of obstruction. swallowing study as well as egd were negative for cause of intractable emesis with associated nausea. pt improved gradually during admission as oral food and medications were held. tpn was initiated for nutrition. gastric emptying study showed slow emptying of stomach as possible etiology of emesis. at discharge, pt tolerating clear and full liquids, however would be unable to support pt nutritionally. pt was discharged home with hospice. tpn was at goal prior to discharge. . # aspiration pneumonia: in the setting of frequent vomiting, increased risk for aspiration, evidence of possible pneumonia on chest imaging. pt completed 10d course of levofloxacin. . # hypotension: appeared to be related to dehydration in the setting of volume depletion due to poor po tolerated r/t severe emesis. also r/t atrial fibrillation with rvr. there was a possibility of sepsis, thus pt was started on vancomycin and levofloxacin, but rapid improvement with fluid resusitation hence vancomycin was discontinued. hypotension resolved prior to transfer to omed service, no further episodes during admission. . # paroxysmal atrial fibrillation: initially admitted with symptomatic afib with rvr, resolved after initial treatment at outside hospital with diltiazem and fluid resusitation. pt remained in sinus rhythm during admission. no anticoagulation as pt with chronic disease and poor prognosis. . # dirrhea: initially worrisome for c.diff due to ?diarrhea, however pt unable to tolerate po's and since esophagectomy with pull through, has had loose stools. c.diff negative and pt denied diarrhea. . # anemia: chronic, consistent with anemia of chronic disease. pt with some blood transfusions due to low hct which he tolerated well. no other acute issues. . # esophageal cancer: after further discussion, no further treatment and pt was discharged with hospice. adequate pain control was provided with fentanyl patch as well as oral morphine. . # electrolyte imbalance: due to intractable emesis on admission with any oral intake, multiple electrolyte imbalances. aggressive lyte repletion was employted as well as some correction per tpn. . pt reached maximal hospital benefit, discharged home with hospice medications on admission: protonix 40 daily marinol 2.5 ativan 0.5 q6h prn kcl 20 meq po bid compazine 10 po tid oxycodone 10mg po q4h prn nystatin sol'n 5cc po qid megace 400mg po bid heparin 500 sq tid fentanyl patch 125 mcg/hr q72h discharge medications: 1. fentanyl 100 mcg/hr patch 72 hr sig: one (1) patch transdermal every seventy-two (72) hours. disp:*5 5* refills:*0* 2. morphine concentrate 20 mg/ml solution sig: 5-20 mg po q 2 h as needed for pain/shortness of breath. disp:*40 40ml* refills:*0* 3. hospice other medications provided per hospice discharge disposition: home with service facility: hospice care discharge diagnosis: atrial fibrillation with rvr intractable emesis recurrent esophageal ca discharge condition: fair discharge instructions: you were admitted with a fast, irregular heart rate, low blood pressure and inability to tolerate po's due to vomiting. these have all resolved. . you may follow up with your pcp or oncologist within 1-2 weeks of discharge. please discuss any concerns or questions you may have followup instructions: you may follow up with your pcp or oncologist within 1-2 weeks of discharge. please discuss any concerns or questions you may have. procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine diagnoses: diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified atrial fibrillation pneumonitis due to inhalation of food or vomitus pressure ulcer, lower back dehydration gastroparesis anemia in neoplastic disease personal history of malignant neoplasm of esophagus 

Answer: The patient is high likely exposed to