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: unasyn attending: chief complaint: hemoptysis post-egd. major surgical or invasive procedure: endoscopy on , , and . history of present illness: mr. is a 58yo -speaking m with a pmh of stage iiic esophageal ca on warfarin for hx of pes who presents after an outpatient egd done today because of inability to swallow secretions and concern of progressive disease after xrt and 4 cycles of cisplatin/5-fu. egd revealed an area of friable and necrotic tissue, concerning for residual disease and a biopsy was taken. after the procedure, pt had an episode of hemoptysis, approx 75cc of brb per nurse it. labs were found to be significant for inr 4.5. pt was transferred to the for close monitoring. . on arrival to , vs: hr 84, bp 115/42, rr 21, 92% ra. pt is coughing up small amounts of blood-tinged sputum.pt remained in teh and was transferred to the oncology floor. past medical history: oncologic history: - stage iiic or iv (ct4b cn1 mx) squamous esophageal cancer, initially presented with 6 month history of ~40 pound weight loss, dysphagia, worsening nausea/emesis with up to 6 episodes of emesis per day,and po intolerance. he had been able to tolerate liquids and well-chewed solids, with larger pieces of food getting stuck in his throat. - egd done with pathology showing scc, also revealing esophageo-pulmonary fistula. stent placed at that time. - pet ct without evidence of mets, underwent treatment, planned for 28 days, 2050 grays total. - started chemo-rad on , past medical history: rll abscess in setting of esophageal rupture. multiple pe's diagnosed in -on coumadin gout latent tuberculosis social history: speaking only. understands some mandarin. lives with daughter and son-in-law. drank and smoked heavily when younger. denies illicits. family history: no family h/o cancer. physical exam: physical exam on admission: general: alert, conversing appropriately with aid of an interpreter. nad, appears comfortable. heent: sclera anicteric, moist mucus membranes, oropharynx clear lungs: diffuse expiratory crackles, more pronounced at the bases. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, hyperactive bowel sounds, mild distention, no rebound tenderness or guarding ext: warm, well perfused . physical exam on transfer out of icu: general: alert, conversing appropriately with aid of an interpreter. nad, appears comfortable. heent: sclera anicteric, moist mucus membranes, oropharynx clear lungs: diffuse expiratory crackles, more pronounced at the bases, especially present on r>l. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, hyperactive bowel sounds, mild distention, no rebound tenderness or guarding ext: warm, well perfused. no cyanosis, clubbing, or edema pertinent results: admission labs: 02:00pm blood wbc-9.3 rbc-3.33* hgb-10.3* hct-31.8* mcv-96 mch-31.0 mchc-32.5 rdw-16.1* plt ct-286 07:15am blood neuts-74.7* lymphs-12.2* monos-9.2 eos-3.6 baso-0.4 12:05pm blood pt-46.0* inr(pt)-4.5* 02:00pm blood urean-32* creat-0.7 na-144 k-4.0 cl-105 hco3-30 angap-13 02:00pm blood alt-41* ast-43* alkphos-148* amylase-152* totbili-0.3 dirbili-0.1 indbili-0.2 08:52am blood calcium-8.6 phos-2.4*# mg-1.7 . egd: the previously placed partially covered metal stent was seen from 29 cm to 39 cm from the incisors. the lumen at the upper end of the stent was narrowed but was able to be traversed by the regular gastroscope. the stent was patent. friable tissue and necrotic tissue were seen at the distal end of the stent suspicious for residual cancer. the lumen was partially obstructed. the regular gastroscope did not traverse. cold forceps biopsies were performed from the friable tissue at the distal end of the stent for pathology. . biopsy of esophageal mass: active esophagitis with ulceration; stain for fungi will be sent as an addendum; multiple levels taken (see note). note: the squamous epithelium shows atypicality which is considered to be reactive. addendum: stains for fungi (a) are negative; controls satisfactory. . cxr: left lower lobe opacities have increased worrisome for aspiration. cardiomediastinal contours are unchanged. right lower lobe and right mid lung opacities are more chronic and stable. there is no pneumothorax or pleural effusion. a catheter projects in the left upper quadrant. . egd: a large bulk of friable tissue was seen within the stent at the distal end. it suggested cancer tissue. some blood clots were also seen. the lumen was near complete obstruction. the blood clots were fragmented with combination of snare and spiral basket. they were completely aspirated out. an argon-plasma coagulator was applied for the tumor tissue destruction with majority of tissue within the stent successfully coagulated. more than half circumference of the stent was patent. friable tumor tissue and necrotic tissue was also seen distal to the metal stent. the lumen was partially obstructed. the lumen at the upper end of the stent was narrowed but was able to be traversed by the regular gastroscope. . lle doppler u/s: impression: no evidence of deep vein thrombosis in the left lower extremity. the patient reported intense knee pain during the study, exacerbated by flexion. barium esophogram: impression: 1. no obstructing mass. 2. opacification of the trachea with barium indicating either aspiration or tracheoesophageal fistula at the level of the carina (proximal end of the stent), as described above. . video swallow: impression: no evidence of aspiration. . cxr: interval appearance of the left lower lobe consolidation and left pleural effusion concerning for pneumonia . egd: impression: the old stent seen from 30 cm to 39 cm from the incisors. two large pieces of tumor-appearing tissues seen within the stent. retrieved with net for pathology. near complete obstruction by malignant-appearing tissues, suggesting remaining cancer, at the distal end of the stent. a 153 mm x 18 mm fully covered wallflex esophageal metal stent successfully placed under fluoroscopic guidance. the proximal end of the new stent was at 24 cm, 7 cm proximal to the fistular opening. it was patent. . discharge labs: brief hospital course: 58yom with stage iii esophageal ca and pes on warfarin s/p egd and bx of mass in the setting of supratherapeutic inr who was admitted to the icu for observation after he vomitted 75cc of brb post-procedure. s/p vitamin k 10units iv x1 and 2 units ffp, stable and transferred to the floor on the evening of . . # hematemsis: pt had one episode post-procedure in the setting of supratherapeutic inr and was hd stable. had 2 pivs placed and received ivfs in gi suite.he was given 3 additional units of ffp on , prior to repeat egd adn again 2 units of ffp prior to egd on . he had no recurrent episodes of hematemesis or melena.h/h remained overall stable .given evidence of esophagitis on biopsy of esophagus , pt was started on iv protonix . . # hx of pes: multiple pes seen on cts in . has been therapeutically anticoagulated for at least three months.warfarin was initially held, and after the egd on pt was restarted on coumadin after cleared by the gi-ercp service. . # esophageal ca: pt underwent an egd on because of inability to swallow his saliva or liquids. egd showed evidence of a mass causing near complete obstruction. biospies were aobtained and showed esophaigitis and atypical cells. repeat egd done on and mass in the stent was coagulated. pt underwent a third egd on and a new stent was placed to cover the te fistula and new biopsies obtained. repeat biopsies show.....case was reviewed by thoracic surgery and pt not a surgical candidate. . # pna /te fistula: pt with cough after drinking post egd on .barium esophogram shows evidence of te fistula. new stent placed to cover fistula ( old stent migrated). cxr on showed evidence a new lll infiltrate and pt started on cefepime/vancomycin and flagyl. he completed..... . #gout : pt with gout flare with knee pain and rt shoulder, bilateral toe pain. rheumatology consulted and . pt started on colchicine , given 1.2 mg laoding dose 6/28 and then 0.6mg for 3-5 days. low dose allopurinol was continued.. . #anemia: stable. likely due to chemotherapy/inflammation. anemia panel c/w ........ . # hx of latent tuberculosis: con't inh/b6 . medications on admission: - oxycodone 5 mg po q6h prn pain - isoniazid 300 mg po daily - allopurinol 100 mg po daily - pyridoxine 50 mg po daily - ondansetron 4-8mg rapid dissolves po q8hr prn nausea - nepro 0.08-1.80 gram-kcal/ml liquid : one can po q6hr: please flush with 250 cc of water after each feeding. check for residuals >200 cc. - senna 1 tab po bid - warfarin 2mg po daily discharge medications: 1. tube feeds nepro tube feeds 4 cans per day ( 240cc) free water flushes 50cc pre and post each can 2. oxycodone 5 mg/5 ml solution : five (5) mg po q6h (every 6 hours) as needed for pain. 3. isoniazid 300 mg tablet : one (1) tablet po daily (daily). 4. allopurinol 100 mg tablet : one (1) tablet po daily (daily). 5. pyridoxine 50 mg tablet : one (1) tablet po daily (daily). 6. prochlorperazine maleate 5 mg tablet : 1-2 tablets po every six (6) hours as needed for nausea. disp:*20 tablet(s)* refills:*1* 7. ondansetron 4 mg tablet, rapid dissolve : tablet, rapid dissolves po every eight (8) hours as needed for nausea. disp:*20 tablet, rapid dissolve(s)* refills:*1* 8. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 9. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 10. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). disp:*60 tablet,rapid dissolve, dr(s)* refills:*2* 11. colchicine 0.6 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 12. warfarin 3 mg tablet : one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*5* 13. tramadol 50 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service discharge diagnosis: esophageal cancer gastrointestinal bleeding tracheo-esophageal fistula (connection between airway and esophagus) aspiration pneumonia gout flare discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , you were admitted to the hospital after vomiting blood after an upper endoscopy. the endoscopy was done because of diffulty swallowing and showed an obstructuion of your esophagus. after the procedure you bled, so you were transferred to the intensive care unit for close monitoring. a barium esophogram showed a possible connection (fistula) between the trachea (airway) and your esophagus. you had two repeat endoscopies in which biopsies were taken and a new stent was placed. you also developed a left lower lobe pneumonia, possibly due to aspiration from the fistula. this pneumonia was treated with iv antibiotics. . change in medications: 1. colchicine once a day until seen by your rheumatologist. 2. increase warfarin dose to 3mg daily. 3. lansoprazole 30mg 2x a day (this medication takes the place of omeprazole (prilosec) because it dissolves in your mouth and avoids having to swallow another pill that might have difficulty passing the esophageal stent). followup instructions: pcp : tuesday, at 1pm with: ,md location: address: , , phone: ** be sure to get inr checked at this appointment . hematology/oncology: pending with: dr. phone: **we are working on a follow up appointment with dr. for the week of . you will be called at home with the appointment. if you have not heard within 2 business days or have questions, please call . . department: rheumatology when: wednesday at 3:00 pm with: , md building: lm bldg () campus: west best parking: garage . please call oncologist dr. at ( for a follow-up appointment. procedure: enteral infusion of concentrated nutritional substances endoscopic excision or destruction of lesion or tissue of esophagus closed [endoscopic] biopsy of esophagus removal of intraluminal foreign body from esophagus without incision insertion of permanent tube into esophagus diagnoses: personal history of tobacco use constipation, unspecified hemorrhage complicating a procedure pneumonitis due to inhalation of food or vomitus other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation accidents occurring in residential institution acute gouty arthropathy stricture and stenosis of esophagus tracheoesophageal fistula personal history of pulmonary embolism status of other artificial opening of gastrointestinal tract malignant neoplasm of esophagus, unspecified site antineoplastic chemotherapy induced anemia nonspecific reaction to tuberculin skin test without active tuberculosis 

Answer: The patient is high likely exposed to