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: penicillins / clindamycin / nickel / sulfa(sulfonamide antibiotics) / mycins attending: chief complaint: "s/p esophageal stent placement with htn urgency." major surgical or invasive procedure: egd with esophageal stent placement history of present illness: 71 yo female with history of multiple malignancies (breast, ovarian, colon) and recent diagnosis of esophageal mass() who presented to for esophageal stent placement. patient notes approx one week of dysphagia/odynophagia prior to evaluation at where egd was performed on and esophageal stricture was dilated. symptoms recurred and patient eventually presented to again on where egd revealed poorly diff malignancy involving the stomach/esophagus. ct chest was performed and revealed likely metastases. pet scan performed approx one week aggo revealed lung, liver, brain mets. mri of brain with left temporal lobe (1.2cm) brain met. started on decadron and met with radiation onc. got one dose of xrt to brain. she has not started chemotherapy though port is placed in anticipation. she was transferred to for esophageal stent placement on . after stent placement she has continued to have upper abdominal pain which is acute on chronic but worse since stent placement. po intake makes pain worse. she has lost approx 40 lbs since the start of these symptoms. patient has been noted to be chronically aspirating and cxr was performed during admission which identified changes consistent with chronic aspiration. patient had low grade temperature on and started on levofloxacin. no bowel movement in the last 3 days. passing gas. kub with evidence of mild small bowel distention. patient has intermittently been hypertensive requiring iv hydralazine. morning of transfer to icu patient was noted to be tachycardic. ekg showed atrial fibrillation with lateral st depressions at rate of 158. patient was given metoprolol iv 5mg x4 and metoprolol 25mg daily with improvement in rates to 120s. patient was given full strength aspirin. troponin was checked and negative. blood pressure transiently decreased to systolic of 100s. during this time patient was asymptomatic. patient was transfered to the icu given potential need for diltiazem gtt as patient unable to tolerate po currently. on arrival to the micu, patient's vs 129/61, 140, 20, 96 2l (93ra). tmax 99.9 last 24 hours. patient notes no chest pain or shortness of breath, no dizziness. she continues to not some abdominal discomfort in the center of the belly which has been present for the last month. past medical history: -h/o cva at age 38 yo- to htn per patient-no residual deficits -htn -hld -h/o tachycardia -asthma -copd, no on home oxygen -h/o aspiration pna -gerd -history of congenital kidney dysfunction (congenital solitary kidney) and renal biopsy -colon adenocarcinoma s/p resection- -uterine cancer s/p oopherectomy and fallopian tube removal- -right breast cancer s/p mastectomy- -esophageal carcinoma-diagnosed 1 week ago, also s/p port placement for anticipated chemotherapy -h/o anemia -djd -constipation social history: etoh-none tobacco-quit in , 50 py history adl's-independent living situation-had lived with sister in prior to her admission, was at for 5 days prior to her admission here family history: father-h/o suicide mother-chf, dm physical exam: admission pe vs 162/76 68 20 100 ra general: aaox3, in nad but does retch multiple times during exam, appears older then stated age heent: op clear, mm somewhat dry endocrine/lymph: no lad, no obvious thyroid masses cv: distant hs, rrr, no rmg lungs: ctab, no wrr abdomen: ttp in epigastrum and suprapubic area, active bs, no hsm, no rebound extremities: bue are cool to touch (patient reports this is chronic), pulses 1+ and equal, no edema neuro: cn and ms, strength and sensation wnl derm: no obvious rashes psyc: mood and affect wnl discharge pe: 156/71, 93, 20, 96% on 3liters general: aaox3, nad heent: op clear, mm dry endocrine/lymph: no lad, no obvious thyroid masses cv: rrr, no mrg lungs: rhonchi at bilateral bases abdomen: ttp in epigastrum and suprapubic area, active bs, no hsm, no rebound extremities: bue are cool to touch (patient reports this is chronic), pulses 1+ and equal, no edema neuro: cn and ms, strength and sensation wnl derm: no obvious rashes psyc: mood and affect wnl pertinent results: labs: cbc: 08:45pm blood wbc-11.6* rbc-4.59 hgb-12.5 hct-39.7 mcv-86 mch-27.3 mchc-31.6 rdw-15.3 plt ct-220 06:25am blood wbc-11.2* rbc-4.60 hgb-12.4 hct-39.2 mcv-85 mch-27.1 mchc-31.7 rdw-14.3 plt ct-227 06:33am blood wbc-15.6* rbc-4.30 hgb-12.0 hct-36.1 mcv-84 mch-28.0 mchc-33.3 rdw-15.3 plt ct-259 04:21am blood wbc-11.4* rbc-3.78* hgb-10.4* hct-32.0* mcv-85 mch-27.4 mchc-32.4 rdw-15.0 plt ct-227 coags: 06:25am blood pt-12.0 ptt-19.5* inr(pt)-1.1 06:33am blood pt-15.9* ptt-28.6 inr(pt)-1.5* 08:45pm blood glucose-107* urean-12 creat-0.6 na-136 k-3.0* cl-102 hco3-22 angap-15 electrolytes: 06:25am blood glucose-96 urean-10 creat-0.6 na-136 k-3.1* cl-99 hco3-22 angap-18 07:30pm blood glucose-95 urean-12 creat-0.6 na-138 k-3.8 cl-102 hco3-24 angap-16 06:33am blood glucose-93 urean-13 creat-0.6 na-138 k-3.1* cl-100 hco3-21* angap-20 02:44pm blood glucose-238* urean-16 creat-0.6 na-134 k-3.5 cl-101 hco3-19* angap-18 04:21am blood glucose-122* urean-20 creat-0.6 na-140 k-3.2* cl-108 hco3-20* angap-15 08:45pm blood calcium-8.9 phos-3.0 mg-1.6 06:25am blood calcium-8.4 phos-3.0 mg-1.6 07:30pm blood calcium-8.3* phos-2.7 mg-1.8 06:33am blood calcium-8.4 phos-1.9* mg-2.1 02:44pm blood albumin-2.8* calcium-7.6* phos-1.8* mg-2.0 04:21am blood calcium-7.8* phos-1.6* mg-1.9 03:20pm blood lactate-1.2 . cxr ():the patient obviously has received an esophageal stent. the proximal part of the stent projects over the middle third of the esophagus, the distal part of the stent is at the gastroesophageal junction. there is no evidence of pneumomediastinum. left pectoral port-a-cath in situ. relatively widespread bilateral parenchymal opacities, left more than right, presumably being the result of chronic aspiration. no pulmonary edema. mild cardiomegaly. no pleural effusions. kub (): impression: mild small bowel dilatation, suggestive of ileus. no evidence of pneumoperitoneum. egd: --a very narrow malignant appearing stricture was noted in the distal esophagus about 30 cm. the scope could not traverse the lesion. --a 450 jag wire was passed under fluoroscopic vision through the stricture into the stomach. --a 125mm by 23mm wallflex tm esophageal fully covered metal stent (ref: 1674, lot: ) was placed successfully under fluoroscopic vision. --otherwise normal egd to esophagus ekg: : sinus 93, na, borderline pr prolongation, q wave iii, withou concerning st-t wave changes : atrial fibrillation 158, st depressions v4-v6 -6:48: atrial fibrillation 124, interval resolution of st depressions 02:44pm blood tsh-2.0 brief hospital course: 71 yo female with history of multiple malignancies (breast, ovarian, colon) and recent diagnosis of esophageal mass() who presented to for esophageal stent placement. found to have aspiration pneumonia and small bowel illeus. started on levofloxacin/metronidazole. transferred to icu on for atrial fibrillation with rvr. patient is now rate controlled and will be transferred to (dr. for continued oncology care. #. atrial fibrillation with rvr: patient developed atrial fibrillation with rvr on . despite iv and po metoprolol patient was unable to be rate controlled. patient was briefly placed on a diltiazem gtt before returning to sinus rhythm. she was continued on oral diltiazem. she remained in sinus rhythm for the remaining time in the intensive care unit. anticoagulation was not started given brain mets and likelihood for further procedures in the near future. tsh was within normal range. cardiac enzymes were cycled and negative. #. metastatic ca, unknown primary: mass identified in esophagus creating a stricture. patient transferred to for esophageal stent which was placed. pet scan with known lung, liver, brain mets. patient was continued on decadron during hospitalization given brain met and associated edema. patient will be transferred back to dr. at for ongoing treatment. #. aspiration pneumonia: patient appears to be chronically aspirating which is likely secondary to esophageal obstruction. recent low grade fever and rise in white blood cell count concerning for pneumonia. patient started on levofloxacin/metronidazole. at patient should have a speech and swallow evaluation. #. small bowel dilation suggestive of illeus: currently passing gas however has not moved bowels in several days. patient was continued on clears/sips as tolerated and abdomen was serially examined. bowel regimen was continued however at the time of discharge patient had not yet moved her bowels. management of this should be continued at the time of discharge. #. copd: continued advair, albuterol, tiotroprium #. hld: continued simvastatin once tolerating pos #. ho cva: continued aspirin 81mg code status: dnr/dni transitional issues: 1. continued oncology care: oncologist dr 2. telemetry monitoring for recurrent atrial fibrillation 3. complete 10 day course of levofloxacin/metronidazole for aspiration pneumonia 4. monitoring/treatment of mild small bowel illeus and constipation 5. nutrition assessment and discussion of feeding tube 6. speech and swallow evaluation given concern for chronic aspiration dispo: plan for transfer to in am for continued treatment for ileus, start of brain radiation. medications on admission: list acquired from pharmacy advair 250/50 amlodipine 5 qd carafate 1 g simvastatin 80 qhs meloxicam 15 qd lisinopril 10 qd proair prn spiriva qd discharge medications: 1. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 3. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 4. dexamethasone sodium phosphate 4 mg/ml solution sig: two (2) injection twice a day: 2 mg iv bid. 5. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 6. meloxicam 7.5 mg/5 ml suspension sig: fifteen (15) mg po qd (). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. diltiazem hcl 30 mg tablet sig: one (1) tablet po qid (4 times a day). 9. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. levofloxacin 750 mg iv q24h 13. morphine sulfate 1-8 mg iv q4h:prn pain hold for sedation 14. ondansetron 8 mg iv q8h:prn nausea 15. promethazine 6.25 mg iv q6h:prn nausea may repeat times one, hold for sedation 16. pantoprazole 40 mg iv q24h 17. heparin flush (10 units/ml) 5 ml iv prn line flush indwelling port (e.g. portacath), heparin dependent: flush with 10 ml normal saline followed by heparin as above daily and prn per lumen. 18. heparin flush (100 units/ml) 5 ml iv prn de-accessing port indwelling port (e.g. portacath), heparin dependent: when de-accessing port, flush with 10 ml normal saline followed by heparin as above per lumen. 19. metronidazole (flagyl) 500 mg iv q8h discharge disposition: extended care discharge diagnosis: primary: esophageal mass with stricture, s/p stent placement atrial fibrillation hypertension ileus copd discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ms. , you were admitted to hospital for placement of a stent in your esophagus to open up the blockage caused by your cancer. while here, we found that you had an ileus, or that your gut was not moving and propelling food and contents forward. this somtimes happens when people take pain medications. you found to have a aspiration pneumonia and were started on iv antibiotics. finally, you were found to have atrial fibrillation (a fast irregular heart rate) which was controlled with a new medication called diltiazem. you are being transferred to for further oncology care. when you are discharged from you will be provided with a updated list of medications you should take at home. it was a pleasure caring for you. followup instructions: follow up will be arranged at the time of discharge from . procedure: insertion of permanent tube into esophagus diagnoses: esophageal reflux malignant neoplasm of liver, secondary unspecified essential hypertension atrial fibrillation personal history of malignant neoplasm of breast personal history of malignant neoplasm of other parts of uterus pneumonitis due to inhalation of food or vomitus secondary malignant neoplasm of brain and spinal cord paralytic ileus personal history of malignant neoplasm of large intestine personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits chronic obstructive asthma, unspecified do not resuscitate status secondary malignant neoplasm of lung chest pain, unspecified malignant neoplasm of lower third of esophagus stricture and stenosis of esophagus renal agenesis and dysgenesis 

Answer: The patient is high likely exposed to