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: amoxicillin / bactrim attending: chief complaint: fever, vomiting, weakness, dyspnea major surgical or invasive procedure: endotracheal intubation history of present illness: 67yo man with h/o esoph ca dx'd on endoscopy after he presented with dysphagia and hematemesis, s/p chemo and xrt in , s/p esophagectomy , with recovery c/b poor nutrition requiring g-tube placement, who was doing well until 4d pta when he began to have fevers and dyspnea. he developed a productive cough with greenish sputum 3d pta, then began vomiting 1d pta with his wife noticing streaks in his mucus. when the streaking became worse on the am of admit, the patient's wife brought him into the for evaluation. wife reports recent uri and feels that the patient may have caught her illness. in ed, cxr showed rml and rll infiltrates with persistant small bilateral pleural effusions. the patient was given 2l of normal saline, as well as azithromycin and levaquin, and then transferred to the floor. past medical history: stage iia esophageal adenoca, t3n0m0 (pet positive) status-post mvr and cabg x 3 (lima to lad, svg to om, svg to pda) on status-post j-tube and portacath placement hypertension status-post pace-maker/defibrillator implantation on heartburn x 20 years atrial fibrillation hypothyroidism social history: the patient is married and lives in , ma. he has three children and is a former engineer. he has never smoked and denies ever drinking alcohol. he does not use recreational drugs. family history: denies any h/o cancer, cad. parents died when he was young, unsure of causes. physical exam: vitals: 97.5 116/64 88 28 66% on ra with hob at 10 deg, 100% on nrb with hob at 30 deg gen: thin, elderly asian man appearing older than stated age, in moderate to severe resp distress, with accessory muscle use, unable to speak except in one word sentences heent: perrl, eomi, anicteric sclera, mmm skin: warm and dry chest: diffuse rales throughout, decreased bs in r lower , no apparent wheezing or rhonchi cv: tachy, regular, soft s1 loud s2 click, syst murmur at apex, rads to abd abd: soft, pej tube in place, nt/nd, +bs ext: no c/c/e, no peripheral edema pertinent results: chest pa and lat: comparison with . the electrodes are unchanged. median sternotomy wires and clips and replacement valve are unchanged. stable cardiac and mediastinal contours. there is a stable left pleural effusion. there is probably also a small right effusion, stable. there is a new air space opacity in the right lower lobe and possibly right middle lobe. no pneumothorax. there is also probably atelectasis in the left retrocardiac region. the left subclavian central venous catheter remains unchanged. labs on admission: 10:06pm urine hours-random creat-17 sodium-53 10:06pm urine osmolal-319 10:06pm urine -lge nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 10:06pm urine rbc-195* wbc-0 bacteria-none yeast-none epi-<1 07:04pm glucose-118* urea n-24* creat-0.7 sodium-120* potassium-3.4 chloride-86* total co2-28 anion gap-9 07:04pm calcium-7.7* phosphate-4.5# magnesium-1.8 07:04pm tsh-0.55 07:04pm wbc-8.8 rbc-3.13* hgb-9.6* hct-28.5* mcv-91 mch-30.5 mchc-33.5 rdw-16.6* 07:04pm plt count-171 12:01pm lactate-1.4 11:30am glucose-111* urea n-25* creat-0.6 sodium-118* potassium-3.7 chloride-88* total co2-29 anion gap-5* 11:30am calcium-8.1* phosphate-2.9 magnesium-1.2* brief hospital course: 1. hypoxia/resp distress: r sided pna, flu, ?uip and chf. presently not felt to be related to heart failure as echo with no change in lv function and no evidence of pulm htn. creatinine and bun rising so aggressive diuresis aborted. feel that underlying respiratory distress may be related to interstitial pneumonitis. he initially presented on the floor, but subsequent respiratory distress necessitated transfer to the . his respiratory distress was thought to be multifactorial; due to chf (he was in afib, likely volume overloaded), influenza (tested positiv from nasal aspirate), ?pneumonia, and his underlying lung disease. although he has never had a lung biopsy, he has been radiographically diagnosed with uip. pulmonary followed him while in-house. they felt that the differential for his interstitial lung disease was uip, amiodarone toxicity, and boop. they recommended high dose steroids to be continued for a month (prednisone 60 mg). this will then be tapered, and he will follow up in pulmonary clinic. he was diuresed in the unit, started on broad spectrum antibiotics, and given supportive care. his empiric ceftriaxone/flagyl was stopped on . follow up ct scan showed improvement in the ground glass appearance, and he remained afebrile and without leukocytosis. he was also paced out of his afib/aflutter by electrophysiology. the irregular rhythm had probably been contributing to his chf and volume overload. he remained in normal sinus rhythm after this intervention and had not more problems with volume overload. he was kept even with respect to ins and outs. when clinically stable, he was transferred back to the floor where he remained afebrile, was saturating stably on 2 l nc. he did not require more aggressive ventilation. he was saturating well on room air at time of discharge. he will continue 60 mg prednisone daily until the beginning of when he will follow up with pulmonary clinic (steroids will likely be tapered at this time). he will also need to follow up with dr. after leaving rehabilitataion. in terms of volume status, he should still be kept even with respect to his ins/outs, for he gets volume overloaded very easily. 2. esophageal cancer (t3n0m0): he is s/p chemotherapy and radiation in followed by esophagectomy in . his recovery has been complicated by issues of nutrition. postoperatively, he had a j-tube placed to aid with nutrition, and he has not been able to take po's safely (has failed multiple speech and swallow evaluations). he failed video swallowing study repeatedly on this admission. he likley needs to regain more strength and then retry this study in a few weeks. he should be maintained solely on j-tube feeds until that time. 3. hypernatremia-he had some hypernatremia while in the which responded to free water boluses. he remained clinically euvolemic with normal sodium subsequently. 4. cv a) ischemia: he had a small troponin leak while in the unit, likely demand related. beta blocker, statin, and ace were started. he was discharged on a regimen of toprol, lisinopril, and digoxin. he will follow up with dr. . b)pump: ef 30%, mvr. he was aggressively diuresed in the unit (component of volume overload likely contributing to his respiratory distress and requiring stay). upon returning to the floor, he was kept even with respect to ins/outs and had no further problems with volume overload. c) valve: s/p mvr: he was kept appropriately anticoagulated on heparin and coumadin as necessary while in-house and discharged on coumadin. he will need to have his checked twice a week (goal 2.5-3.5), and his coumadin dose may need to be adjusted accordingly based on these results. d) rhythm: s/p + icd/h/o afib- on coumadin. required cardioversion initially in hospitalization and was paced out of afib . he remained in nsr throughout the remainder of his hospitalization. 5. anemia: he had somewhat stable hct in the range of 26-30; anemia was likely multifactorial (anemia of chronic disease). he was transfused as necessary for a hct<26. 6. hypothyroidism: he was continued on levoxyl throughout his hospitalization. 7. diabetes: he was continued on 40 u lantus and covered with sliding scale insulin while in-house. his sugars remained under good control with this regimen. 8. fen, s/p esophagectomy: he was continued on tube feeds via his j-tube. he failed speech and swallow evaluations on multiple occasions, and had a video swallowing study on where he failed thin and nectar thick liquids (frank aspiration noted with inappropriate coughing/clearing reflex). 9. disposition: he was quite physically debilitated at the conclusion of his hospitalization, and he required rehabilitation where aggressive physical therapy and occupational therapy can be continued. medications on admission: (per wife's report) coumadin 2mg qthfrsasu, 1.5mg qmotuwe levothyroxine 100mcg po qd amiodarone 200mg po bid zocor 10mg po qd impact w/fiber tube feeds, at 90cc/hr until this weekend, then 70cc/hr *** no longer taking lasix since his immediate post-op period in discharge medications: 1. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine sodium 88 mcg tablet sig: one (1) tablet po daily (daily). 3. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. ipratropium bromide 0.02 % solution sig: inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 5. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day) as needed for constipation. 6. senna 8.6 mg tablet sig: one (1) tablet po daily (daily) as needed for constipation. 7. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 8. prednisone 20 mg tablet sig: three (3) tablet po daily (daily): continue until early when you follow up in pulmonary clinic, and then taper as directed. 9. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 10. warfarin sodium 2 mg tablet sig: one (1) tablet po hs (at bedtime): please have your checked weekly. your coumadin dosing may need to be adjusted based on your 's. 11. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day: hold for sbp<95. 12. toprol xl 25 mg tablet sustained release 24hr sig: tablet sustained release 24hr po once a day: hold for sbp<95, hr<55. 13. heparin flush (10 units/ml) 5 ml iv prn 14. digoxin 125 mcg tablet sig: one (1) tablet po once a day. 15. lantus 100 unit/ml cartridge sig: forty (40) units subcutaneous qam: sugars should be checked twice daily, and he should be covered with regular ssi as necessary. discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses: 1. respiratory failure 2. interstitial lung disease 3. esophageal cancer 4. influenza secondary diagnoses: 1. coronary artery disease 2. congestive heart failure 3. s/p mitral valve replacement discharge condition: stable discharge instructions: 1. please take all your medications as prescribed and described in this discharge paperwork. we made the following changes to your medication regimen: - we added lisinopril, a medication to help your heart. please take 2.5 mg daily - we added toprol xl, a medication to help your heart. please take 12.5 mg daily - we added digoxin 0.125 mg daily - we added prednisone 60 mg. this should be continued for 1 month (until early ) or until you follow up in pulmonary clinic. they will instruct you how to taper these steroids when you follow up. - take 2 mg coumadin daily. you will have your checked regularly while at rehabilitation, and they may need to adjust your dosage. - we decreased your levoxyl dose to 88 mcg daily. - we discontinued your amiodarone. do not take this medication. - we added lansoprazole, a medication to help with symptoms of gi reflux and upset - we added lantus, 40 units, to be taken in the morning to help with control of your sugars. 2. please follow up with dr. , your pcp, clinic, dr. , as described below. 3. please call your pcp if you are experiencing chest pain, shortness of breath, fever, chills, difficulty breathing, or with any other concerns. followup instructions: . please follow up in pulmonary clinic with dr. on , 9:15 am. this is on the of the building in medical specialties (). 2. please follow up with dr. in cardiology on . first you should go to device clinic at 9:30 am and then dr. office at 10:00am. these are both in the building ( or ). 3. you should follow up with dr. in oncology. please call to schedule this appointment once you are discharged from rehabilitation () procedure: enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation transfusion of packed cells diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism atrial fibrillation aortocoronary bypass status heart valve replaced by other means acute respiratory failure postinflammatory pulmonary fibrosis pressure ulcer, lower back automatic implantable cardiac defibrillator in situ influenza with pneumonia personal history of malignant neoplasm of esophagus 

Answer: The patient is high likely exposed to