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: large left renal cell carcinoma with tumor thrombus in the inferior vena cava just below the hepatic vessels. major surgical or invasive procedure: left radical nephrectomy with inferior vena cavotomy and complete excision of renal vein with inferior vena caval reconstruction and removal of tumor thrombus. history of present illness: the patient presented to the emergency room with left sided pain and on further workup was noted to have a large left renal mass. further workup revealed inferior vena caval thrombus just below the level of the hepatic vessels in the inferior vena cava and the patient was also noted to have a pulmonary embolus. he and his family fully understand the procedure, alternative therapies, benefits, and risks including death, pulmonary embolism, need for reoperation, myocardial infarction, cva, embolism to other organs, need for long-term ventilation, damage to adjacent organs including spleen or pancreas, need for colon resection. they wished to proceed. past medical history: mr has a past medical history significant for iddm, htn, hyperlipidemia, right-sided claudication (scheduled for angiogram in early ), and depression. in his past surgical history, he has had a cholecystectomy. social history: mr is an ex-smoker of 20 years, with a previous 20-pack year status. he denies any recreational drug use, and intakes alcohol socially. family history: this patient's family history is negative for any genitourinary malignancy; his mother died of brain cancer and his father died of a myocardial infarction at the age of 59. pertinent results: . . echo: conclusions: 1. echogenic structure seen in ivc consistent with thrombus or tumor. this extends upto 4 cm below the junction of the hepatic vein and the ivc. flow is seen around the thrombus. 2. no atrial septal defect is seen by 2d or color doppler. 3. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). 4. right ventricular chamber size and free wall motion are normal. 5. the ascending aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. 6. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. 7. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. 8. there is a trivial/physiologic pericardial effusion. 9. prior to ivc cross clamping portion of the ivc thrombus no longer seen. rv function still appears good. no echogenic structures in the ra or rv. flow present in the main pa, left and right pas. . . cxr : there is no pneumothorax or pleural effusion. mediastinal widening is probably due to vascular engorgement in the supine position. tips of the right internal jugular catheter and endotracheal tube are at the upper margins of the clavicles, both at the thoracic inlet. nasogastric tube passes to the mid stomach. lungs low in volume but grossly clear. heart size normal. mediastinum midline. no significant free subdiaphragmatic gas. . . cxr : left lower lobe atelectasis and bilateral pleural effusion, small on the left and small-to-moderate on the right, which developed after are stable since . heart is normal size. et tube, right supraclavicular central venous line, and nasogastric tube are in standard placements. no pneumothorax. . . cxr : compared with , the tip of the ett appears to have been pulled back somewhat and now projects roughly 5 cm above the carina. the right lung remains grossly clear. there is diffuse haziness overlying the left lung which may be due to a left pleural effusion and associated linear perihilar densities may represent associated atelectasis. the apparent widening of the superior mediastinum is probably secondary to patient rotation to the right, with similar appearances seen on prior films from and . please correlate clinically. . . 9:40 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): gram negative rod(s). respiratory culture (final ): sparse growth oropharyngeal flora. . . 9:35 am swab site: rectal source: rectal swab. **final report ** r/o vancomycin resistant enterococcus (final ): no vre isolated. . . 9:35 am mrsa screen site: rectal source: rectal swab. **final report ** mrsa screen (final ): no staphylococcus aureus isolated. . . 8:18 am sputum site: endotracheal **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). 2+ (1-5 per 1000x field): gram positive rod(s). 2+ (1-5 per 1000x field): gram negative diplococci. 1+ (<1 per 1000x field): gram positive cocci. in pairs, chains, and clusters. respiratory culture (final ): moderate growth oropharyngeal flora. haemophilus influenzae, beta-lactamase positive. moderate growth. beta-lactamase positive: resistant to ampicillin. . . brief hospital course: mr. was admitted for his procedure on . he was prepared and consented for surgery as per standard. at this time, mr was aware of all potential risks and benefits of his procedure. his family was also aware, and it was noted that his wife is extremely supportive and involved in the situation. in the operating room, total estimated blood loss was approximately 5000 cc. the patient received a total of 6 units of packed red blood cells and 2 units of fresh frozen plasma during the case. there were no major intra-operative complications during the case. . mr then spent 6 days in the icu. over the course of 6 days, he was extubated, had his ngt removed, and his pressors (levophed and neo) were stopped. his anticoagulation medications were held during the duration of his icu care. he recieved supportive care, and was seen by the nutrition team. in addition, the renal team followed him to ensure adequate renal function. during his stay in the icu, he was started on broadspectrum antibiotics for a possible chest infection; the patient had thick copious secretions and a chest xray was obtained. his sputum was found to be gram stain positive, and hence, he was started on levaquin and vancomycin. . once mr was stable, he was transferred to the floor. on the floor, he was re-started on his coumadin with a target inr of 2.0 - 3.0. he appeared to be depressed by members of housestaff and his family. psychiatry was asked to see him, and they advised outpatient follow-up and adjusted his antidepressant medication dosages. . mr was seen by a social worker, where he was able to discuss his recent cancer diagnosis, and his recent surgery. it was felt this visit slightly lifted his spirits, as he began to ambulate more often with encouragement. he was seen by physical therapy to assist with ambulation. . upon discharge, mr was in a stable condition. his staples were removed, his foley removed and his pain under control. his coumadin levels are to be followed by his pcp, . . his family continued to be extremely supportive, with regular visits and discussions with members of housestaff regarding his progress. . he was discharged to a rehab facility. his expected duration of stay at this facility is less than 30 days. medications on admission: ativan 1 mg tablet . avandia 4mg tablet . humulin 70/30 70-30u/ml suspension . humulin n 100u/ml suspension . lisinopril 20 mg tablet . meclizine 12.5 mg tablet . remeron 15mg . simvastatin 40 mg tablet . wellbutrin sr 150mg tablet sustained release . discharge medications: 1. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 2. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 3. bupropion 150 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. meclizine 12.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for vertigo. 6. rosiglitazone 2 mg tablet sig: two (2) tablet po qpm (once a day (in the evening)). 7. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 10. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 11. promethazine 25 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed. 12. coumadin 2 mg tablet sig: one (1) tablet po at bedtime for 1 doses. disp:*1 tablet(s)* refills:*0* 13. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. disp:*20 capsule(s)* refills:*2* 14. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po four times a day as needed for flatulence for 3 days. disp:*12 tablet, chewable(s)* refills:*0* discharge disposition: extended care facility: house rehab & nursing center - discharge diagnosis: renal cell carcinoma. discharge condition: stable. discharge instructions: you are being prescribed a narcotic pain medication. do not drive or operate heavy machinery while taking this medication. it make you drowsy. contact a physician for fever >100.5, bleeding or increasing redness from incisions, difficulty swallowing or breathing, headache, nausea or vomiting, double or blurry vision, or any other concerns. please continue all home medications and those given to you by your surgeon. you are currently receiving coumadin therapy. the target inr range for you is 2.0-3.0. please visit your primary care physician to adjust your coumadin dosage as appropriate and to remain within a therapeutic range. please follow up with your pcp: , . in regards to your recent diagnosis, coumadin levels and antidepressant medications. followup instructions: please arrange a follow-up appointment with dr. calling (. . you should also arrange a follow-up outpatient appointment with a psychiatry service: please call ( outpatient psychiatry service). . please arrange a follow-up appointment with the oncology service - dr may be reached at (. . please follow up with your pcp: , . in regards to your recent diagnosis, coumadin levels and antidepressant medications. procedure: venous catheterization, not elsewhere classified arterial catheterization nephroureterectomy transfusion of packed cells other repair of vessel other excision of vessels, abdominal veins incision of vessel, abdominal veins diagnoses: pneumonia, organism unspecified unspecified pleural effusion unspecified essential hypertension acute kidney failure, unspecified atherosclerosis of native arteries of the extremities with intermittent claudication secondary malignant neoplasm of other specified sites malignant neoplasm of kidney, except pelvis pulmonary collapse iatrogenic pulmonary embolism and infarction accidents occurring in other specified places removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cyst of kidney, acquired other venous embolism and thrombosis of inferior vena cava 

Answer: The patient is high likely exposed to