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: delirium major surgical or invasive procedure: none history of present illness: mrs. is a 73 you woman with squamous cell head and nexk cancer currently undergoing xrt, copd, htn, cad s/p mi and stent implantation in who presents from rehab with delirium and fever. . she is a vague historian, but denies chest pain, fevers, cough, sputum production, shortness of breath, chest pain, le swelling, blood in her stool or urine. she denies abdominal pain or vomiting. . in the ed, her initial vss were 102.4, 116, 145/81, 14, 98%ra. she received ivf, levofloxacin and metronidazole. . past oncologic history: ====================== the patient noticed a right neck mass approximately in . she brought the mass to the attention of her physician who obtained ct of the neck, chest, abdomen, and pelvis at the . neck, chest, and abdominal ct on showed marked thickening of the right lateral oropharyngeal wall up to approximately 2 cm and a 4.5 x 3 cm lobulated, heterogeneous, right neck mass deep to the sternocleidomastoid muscle that displaced the right carotid artery. no other lymphadenopathy was visualized and there were no suspicious lung nodules. a 10 cm right adnexal mass was visualized. this right ovarian mass has been stable and was previously evaluated. neck ultrasound on at the showed a 5.5 x 4 cm neck mass suspicious for neoplastic process. on , dr. took the patient to the operating room for direct laryngoscopy and tonsillar biopsy. the right tonsil contained an ulcerative lesion, which was biopsied. the larynx and hypopharynx appeared normal. pathology was read at the as invasive moderately differentiated squamous cell carcinoma. she is currently undergoing radiotherapy. past medical history: past medical history: ==================== chronic obstructive pulmonary disease hypertension hypercholesterolemia pernicious anemia cad s/p mi and stent implantation in h/o gi bleed social history: etoh: doesn't drink tobacco: quit in , 60-75 py history family history: nc physical exam: vitals - t: 98.4 bp: 130/70 hr: 100 rr: 16 02 sat: 93%ra/ general: nad, alert and oriented x 2; "" heent: at/nc, eomi, perrla, anicteric sclera, pink conjunctiva, patent nares, no lad, no jvd, reactive change in pharynx in field of radiation. dry mm. cardiac: rrr regular skipped beats, normal s1/s2, no mrg appreciated lung: bronchial breath sounds and crackedin left middle lung field. abdomen: soft, large echymossis on llq, g tube with moderate amount of erythema surrounding it. 5 inch midline incision c/d/i m/s: moving all extremities well, no cyanosis, clubbing. s, no obvious deformities pulses: 2+ dp pulses bilaterally neuro: cn ii-xii intact. pertinent results: 05:50am blood wbc-10.6 rbc-3.06* hgb-9.5* hct-28.1* mcv-92 mch-31.1 mchc-33.9 rdw-18.6* plt ct-344 03:16am blood wbc-8.6 rbc-2.65* hgb-8.2* hct-24.6* mcv-93 mch-31.0 mchc-33.3 rdw-18.8* plt ct-249 02:25am blood wbc-8.9 rbc-3.63*# hgb-11.0*# hct-31.5*# mcv-87 mch-30.3 mchc-34.9 rdw-17.8* plt ct-195 05:00pm blood wbc-8.4 rbc-2.38* hgb-7.7* hct-23.4* mcv-98 mch-32.3* mchc-32.8 rdw-21.5* plt ct-244 05:20am blood pt-14.8* ptt-26.2 inr(pt)-1.3* 05:50am blood glucose-97 urean-10 creat-1.2* na-142 k-3.0* cl-104 hco3-29 angap-12 10:35am blood creat-0.9 na-141 k-3.7 cl-104 03:16am blood glucose-78 urean-8 creat-0.9 na-143 k-2.8* cl-105 hco3-26 angap-15 05:00pm blood ctropnt-0.15* 09:00am blood ck-mb-12* ctropnt-0.13* 07:20am blood ck-mb-8 ctropnt-0.12* 02:25am blood ck-mb-6 ctropnt-0.09* brief hospital course: patient was admitted from rehab on with delirium. she denied all symptoms. in the ed, she was found febrile and to have consolidation in her lll. additionally, she was then discovered to be in arf and anemic with a troponinemia and ekg with various territories of mild st depression. accordingly, she was treated for hap with vanc/zosyn. admitted on tele and transfused with two units. there was some concern for an aspiration pna. she passed a video-swallow and was put on a diet of thins and purees in which her pills were crushed. the patient proceeded to improve rapdily and in the am of , restarted xrt to the neck with dr. . she stayed in house, receiving iv abx and xrt. while in hospital, the patient was restarted on tube feeds to ensure proper nutrition and avoid the burden that po was placing on the friable mucosa of the pharynx in the field of the xrt. she will be discharged on 55 ml/hour of fibersource per nutrition consultation. the g tube site remained a persistent concern, however. accordingly, we asked consultants from both surgery and then gi to evaluate the g tube. there was leaking of a dark and viscous fluid from around the 20 french tubing. given how new it was and the fact that it was not placed by a practioner, the goals of gtube management shifted to wound care. while the site remained irritated and bled about a tea-spoon per day, it was stable and did not bother the patient. overnight on , the patient had three dark red bowel movements with a hct that trended from 26 to 24.4 to 19.5. the morning of , she had another large black tarry bowel movement and was tachycardic to the 120s from a baseline fo 90-100. her g-tube was also flushed and demonstrated coffee grounds, and was also noted to have an increase in bun from 16 to 26 from the prior day. the patient received 1.6l ivf and was ordered for 2 units prbc prior to transfer to the . on admission to the , the patient was evaluated for active bleeding and transfused 2 unites prbcs. endoscopy was performed to evaluate the bleeding around the g-tube site and clamping was attempted, but not successful. patient was sent for surgery where the bleeding artery was oversewn and the g-tube was replaced and re-sited with another g-tube. the patient recieved two more units of prbcs and was then transferred post-op back to the icu for monitoring. post-operatively, the pt had episodes of hypertension, which improved with pain control. on post-op day 1, the patient was hemodynamically stable the entire day. she was transferred back to the omed service on hemodynamically stable with hematocrit 29.3, pain well controlled. on the day of planned discharge, the patient began to experience some tachycardia by tele. she was asymptomatic and clinically better than ever before. nevertheless, an ekg was ordered that was improved when compared to the admission ekg and a unit of blood was transfused over three hours. on , the patient was transferred back to the for acute respiratory distress with increased oxygen requirements. a large mucus plug was suctioned from the patient's oropharynx and her respiratory distress resolved. a cxr showed no worsening infiltrate although there was possibly increased pulmonary edema/ atelectasis. the patient was continued on her antibiotic course for hap and was gently diuresed with fluid goal of -500 to -1l. during the night, the patient intermittently required increased oxygen for saturations down to 88%- this was thought to be related to inadequate clearing of oropharyngeal mucus plugs with a component of sleep apnea. the patient continued to have guiac positive stools, but this was felt to be residual from her gi bleed and her hct remained stable. overall, the patient's respiratory status improved and she was transferred back to the omed service on . on post-op day 2, the patient was noted to have a possible expressive aphasia. final review of a ct head showed a right parietal hypodensity. neurology was consulted and suspected a right temporal stroke. the patient's mental status improved, but the patient had possible left sided hypesthesia and mild left upper extremity motor weakness. asa was restarted but her plavix was held in light of the patient's recent gi bleed. initially there was concern that the right carotid artery may be compressed by tumor, so neurology recommended permissive hypertension until mra of neck and cns assessed patency of vessels. tte with bubble study showed no pfo or asd as possible source for emboli. carotid dopplers and mri looked good but official reads were pending. on the floor, we shifted focus and treated the patient for a chf exacerbation. after a negative balance of 1500 cc, she was markedly improved clinically and we prepared her for discharge to rehab. <b> summary </b> . 1. delirium - while the patient has some baseline dementia, she is fully oriented and interactive ( the paper) at baseline. she presents with delirium for pneumonia, chf, and gi bleed . 2. gi bleed - after the operative repair she is stable. it was related to an exposed vessel. continue tube feeding. . 3. arterial disease - patient should remain on aspirin and clopidogrel. also, continue lovenox. most likely, the patient did not have a cva. . 4. chf - this patient has an ef of 45-50%. she is sensitive to fluids. we used a short course of lasix to improve the balance . 5 respiratory failure - the patient had some trouble clearing secretions, requiring deep suction. we recommend regular nebulizer treatments, oral care and suctioning. . 6. head and neck cancer - the patient has completed her treatment at present medications on admission: enoxaparin 40 daily clopidogrel 75 daily hydrocodone-acetaminophen 5 mg-500 mg nystatin 100,000 unit/ml 5 ml by mouth tid aspirin 81 mg daily acetaminophen prn captopril 25 mg tid alprazolam 0.25 mg tid prn simvastatin 40 daily metoprolol tartrate 25 tid bisacodyl 10 mg prn albuterol prn lansoprazole 15 daily discharge medications: 1. enoxaparin 40 mg/0.4 ml syringe : one (1) subcutaneous q 24h (every 24 hours). 2. clopidogrel 75 mg tablet : one (1) tablet po daily (daily). 3. hydrocodone-acetaminophen 5-500 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for pain. 4. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed for thrush. 5. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 6. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for pain, fever. 7. captopril 25 mg tablet : one (1) tablet po tid (3 times a day). 8. alprazolam 0.25 mg tablet : one (1) tablet po tid (3 times a day) as needed for anxiety. 9. simvastatin 40 mg tablet : one (1) tablet po daily (daily). 10. metoprolol tartrate 25 mg tablet : one (1) tablet po tid (3 times a day). 11. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 12. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed for shortness of rbeath, wheeze. 13. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 14. vancomycin in dextrose 1 gram/200 ml piggyback : one (1) intravenous q 12h (every 12 hours) for 4 days. 15. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback : one (1) intravenous q8h (every 8 hours) for 4 days. 16. metoprolol tartrate 25 mg tablet : one (1) tablet po tid (3 times a day). 17. trazodone 50 mg tablet : 0.25 tablet po once mr1 (once and may repeat 1 time) for 1 doses. 18. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q4h (every 4 hours) as needed for wheezing or sob. 19. ipratropium bromide 0.02 % solution : one (1) inhalation q4h (every 4 hours) as needed for wheezing or sob. 20. pantoprazole 40 mg recon soln : one (1) recon soln intravenous q24h (every 24 hours). 21. outpatient physical therapy patient with deconditioning and requiring help in building strength/stability 22. outpatient lab work patient should have chemistry (sodium, postassium, chloride, bicarbonate, creatinine, bun) and cbc checked in pm of and am of and as directed by rehab physicians thereafter discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: squamous cell cancer of the head and neck secondary: sp gi bleed, s/p laparotomy and g-tube replacement copd, htn, hypercholesterolemia, pernicious anemia, cad s/p mi and stent implantation in , g-tube placed discharge condition: tolerating po and tube feeds, afebrile, hemodynamically stable discharge instructions: you were admitted with confusion and fevers. we discovered that you had a pneunomia, considered healthcare associated. we worried about aspiration pneumonia, so we ordered a video swallow test that showed you could tolerate purees and thin liquids. we treated you for this. we also transfused you with blood given your low blood count. your gastric tube was leaking, so we asked surgery and gastroenterology to help us manage it. eventually, you started bleeding from a large vessel around the tube and this required an operation. after the operation you went back and forth between the icu and the floor because we were worried about your breathing. you had a good deal of secretions in your lung but also extra fluid because your heart was overloaded. you were discharged to a rehab facility. appointments , return to the hospital if you develop confusion, fever or any other symptoms that concern you followup instructions: pcp: , oncologist md, procedure: enteral infusion of concentrated nutritional substances exploratory laparotomy endoscopic control of gastric or duodenal bleeding other gastrostomy other radiotherapeutic procedure dilation of esophagus closure of gastrostomy diagnoses: acidosis coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status acute respiratory failure pneumonitis due to inhalation of food or vomitus ostium secundum type atrial septal defect old myocardial infarction cerebral embolism with cerebral infarction hemorrhage of gastrointestinal tract, unspecified delirium due to conditions classified elsewhere stricture and stenosis of esophagus other esophagitis foreign body in larynx other gastrostomy complications malignant neoplasm of tonsil 

Answer: The patient is high likely exposed to