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: hypotension major surgical or invasive procedure: none history of present illness: 71 yo male with metastatic esophageal carcinoma currently being docetaxil and bevacizumab. he underwent a bal on which showed strep pneumo. he was then recently admitted on - with dehydration and pneumonia, was treated, and discharged with an appointment for a video swallowing study on to evaluate for aspiration. he underwent this study today and per patient this went well. he then went back to his house, sat on the stairs because he felt weak, and then lost consciousness and slumped to the side witnessed by his son and wife. there was no head trauma or falls. he was also reported to have cyanotic lips and fingers and chills. his wife called ems to the . on arrival he had a temp of 100.8, hr in the 140 - 160s, bp 70 - 90 systolic. he had an elevated white count and a lactate of 8.9. sepsis protocol was instutited, rij was placed, and he was given vanco, ceftriaxone, azithromycin, cefepime, potassium repletion, and 2.5 liters of fluid. since his bp was labile, he was placed on levophed. his hb decreased from 12 to 8 after fluids and he was transfused 1 unti of prbc in the ed. during the past few weeks, the patient reports that he has not been eating due to lack of appetite. he denies n/v/d. he has not had a bm in 4 days. he has been drinking lots of water he reports. + rhinorrhea. past medical history: 1. metastatic adenocarcinoma of the ge junction t3/n1, s/p chemo (irinotecan and cisplatin-->carboplatin tox). chemo d/c'd 22 disease progression 2. emphysema/copd social history: quit tobacco 4 years ago, previously smoked one pack per day for 30 years, occasional etoh, no drugs, lives at home with his wife and is a retired air conditioning business owner. normally able to walk up stairs, however in the last few days, he has been requiring assistance walking around. family history: no cad, cancer, or pulmonary disease physical exam: vitals: t=100.8, hr = 115, bp = 120/60 -> 78/43 -> 100/60 with levophed, rr =20 , sao2 = 96% on 4l nc in er, 98% on ra in icu general: pleasant male, appears comfortable, nad. heent: normocephalic and atraumatic head, no nuchal rigidity, anicteric sclera, moist mucous membranes. neck: no thyromegaly, no lymphadenopathy, no carotid bruits. chest: chest rose and fell with equal size, shape and symmetry, lungs were clear to auscultation bilaterally, though with decreased breath sounds. no erythema around portacath, non tender. cv: pmi appreciated in the fifth ics in the midclavicular line without heaves or thrills, rrr, normal s1 and s1 no murmurs rubs, distant heart sounds abd: normoactive bs, nt and nd. no masses or organomegaly back: no spinal or cva tenderness. ext: no cyanosis, no clubbing or edema with 2+ dorsalis pedis pulses bilaterally integument: no rash neuro: cn ii-xii symmetrically intact, perrla. strength 5/5 throughout. pertinent results: 08:33pm glucose-87 urea n-12 creat-0.7 sodium-137 potassium-4.0 chloride-107 total co2-21* anion gap-13 08:33pm wbc-9.3 rbc-3.31* hgb-10.1* hct-30.8* mcv-93 mch-30.5 mchc-32.8 rdw-16.9* 12:24pm glucose-163* urea n-19 creat-1.1 sodium-137 potassium-7.1* chloride-97 total co2-16* anion gap-31* 12:24pm wbc-14.0* rbc-4.11* hgb-12.5* hct-40.8# mcv-99*# mch-30.4 mchc-30.6* rdw-16.1* chest (portable ap) reason: eval for right ij line placement, ptx medical condition: 71 year old man with s/p endoscopy with syncope reason for this examination: eval for right ij line placement, ptx indication: evaluate right ij placement, rule out pneumothorax. ap supine portable chest: comparison to ap upright chest of two hours . there has been interval placement of right-sided ij line, with its tip in the inferior svc. no pneumothorax. portacath tip unchanged in position. there has been no other significant interval change. impression: right-sided ij with its tip in the svc; no pneumothorax. no other significant interval change ct chest/abdomen/pelvis: impression: 1) interval development of small bilateral pleural effusions and free fluid within the abdomen and pelvis without abscess identified. 2) no significant interval change in previously described patchy pulmonary opacities. 3) unchanged liver lesions and celica axis and mesenteric lymph nodes. 4) no new lesions identified. 4) interval development of nonspecific colon wall thickening, which is not well distended. clinical correlation is recommended as this could represent an infectious colitis. ischemic colitis is considered less likely given distribution. brief hospital course: a/p: 71 yo male, h/o metastatic adenocarcinoma of the ge junction, s/p irinotecan/carboplatin, now on experimental chemotherapeutic regimen, admitted with hypotension (?sepsis), currently stable, being treated for ?pneumonia and poor po intake. . 1. hypotension: initially, sepsis by protocol was instituted in the setting of increased lactate, hypotension, hyperthermia, tachycardia, and an elevated white count. however, most likley not an infectious process, but rather dehydration from paucity of po intake. the patient was hypotensive in the ed which respondeed to fluid boluses. other causes: pneumonia, sinusitis, line infection, or autonomic dysfxn cisplain therapy. the patient was admitted to the . he was treated witht he sepsis protocol. his lactate continue to be low, his pressure increased with fluid boluses and his levophed was weaned to off. given his nasal conjestion, cough, and weakness, he was placed on precautions and evaluated for influenza which was negative. screening for adrenal insuffiency was negative. blood and urine cultures were also taken which were also negative. vancomycin, azithromycin, and cefepime was stopped and the levofloxacin was contined for strep pneumo coverage that had previously been documented via bronch. he completed his levaquin on . pt subsequently transferred to regular medical service from icu. on the floor the pt continued to be baseline hypotensive to the 80s systolic. review of the pt's omr chart shows that this was his baseline bp to any chemotx. . on the floor, he continued to be stable hemodynamically. the levofloxacin was continued until for empiric pneumonia coverage (and given history of strep pneumo on bronch recently). he was continued on ivf for poor po intake (was hemodynamically/had adequate sbp's). ct of the chest/abdomen/pelvis was negative for any obvious source of infection, and he remained afebrile with a normal wbc. . 2. syncope/orthostasis: there was a question of whether he syncopized on day of admission. he was persistently hypotensive (sbp's 80-100) while in-house, although this appears to be close to his baseline when old omr notes were referenced. he was maintained on telemetry with no significant events. pt also had tte showing mild diastolic dysfunction but o/w no signficant structural heart disease to account for syncope. later in hospital course, pt was found profoundly orthostatic with systolic pressure going from 100 to 50 w/ supine to standing. although syncope was not induced, pt was quite symptomatic w/ these changes. the etiology of this orthostasis remains unclear. as mentioned below, pt has had difficulties w/ adequate po intake secondary to anorexia - however, he was not felt to be profoundly dehydrated. it was theorized that there may be component of autononic dysfunction (for unclear reasons) causing orthostasis and tilt test was performed. preliminary results from the tilt were equivocal and after discussions w/ oncology, it was decided to start patient on florinef 0.1 mg po bid, with some objective decrease in the degree of his orthostatis. midodrine was added as well. plan for pt to go to rehab for further stabilization w/ neuro and autonomic f/u. . 3. esophageal cancer: team was in communication with dr. . torso ct was obtained to evaluate fo disease progression as his degree of ftt is out of proportion to his chemotherpy and known stage of his disease. ct did not show any significant interval change in his disease. chemotherpy has been held for a few weeks given his degreee of weight loss and lethargy (currently on ?experimental bevacizumab and doxetaxol; his irinotecan/carboplatin was stopped in secondary to disease progression). he was seen by oncology consult team while in-house but had no active oncologic issues. of note, the oncology team thought his level of anorexia was not likely solely due to his disease or chemotherapeutic regimen. he has been asked to call dr. following d/c for f/u to discuss further managment of esophageal cancer. . 4. anorexia: as per patient and his wife, he has had a problem with poor po intake. he was recently started on megace without much success. psychiatry was consulted and did not feel the anorexia was secondary to depressive symptoms. as above, oncology felt neither his disease nor chemotherapeutic regimen could account for his level of anorexia. nutrition was consulted, and ivf were continued as needed for poor po intake. psych had suggested remeron for improved appetite but oncology recommended on holding on further medications at this time. ultimately, pt has shown improved po intake over the remainder of his hospital course. nutrition has recommended continued supplement w/ carnation instant breakfast 3x day. . 5. ?colonic thickening with free fluid: this was seen incidentally on staging ct of chest and abdomen. pt had no symptoms of diarrhea or abdominal pain, and he had a benign abdominal exam. c. difficile sample was sent (given pt hospitalized, on antibiotics) and was negative. . 6. dispo: it was felt that an acute rehabilitation facility was more appropriate than returning home given pt's poor po intake, debilitation, and generalized wekaness. for this reason, will be transfered to rehab. . 7. code: full per initial discussions w/ wife. medications on admission: megace 40 qid compazine prn reglan 10 qid and prn ativan 0.5mg q8 prn advair 250-50 ipratrop 2puff qid levofloxacin 500 ending on colace, senna tylenol #2 tab prn discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. fludrocortisone acetate 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 8. megestrol acetate 40 mg/ml suspension sig: twenty (20) cc po daily (daily). 9. therapeutic multivitamin liquid sig: five (5) ml po daily (daily). 10. acetaminophen-codeine 300-30 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain, insomina. 11. heparin 5000 units sc tid while lying in bed discharge disposition: extended care facility: for the aged - acute rehab discharge diagnosis: hypotension, unclear etiology resolved orthotasis syncope presumed secondary to orthostasis metastatic esophageal carcinoma discharge condition: fair discharge instructions: please return to ed or md , chills, shortness of breath, palpitations, chest pain, syncope. please take medications as directed please be sure to rise slowly while standing. followup instructions: please call pcp . after d/c'd from rehab provider: , multi-specialty multi-specialty thoracic unit-cc9 where: clinical ctr. - 9th fl. multi date/time: 10:00 provider: , md where: neurology phone: date/time: 10:00 autonomic lab at 10am, palmes iii, , autonomic lab. repeat tsh in 6 weeks. procedure: venous catheterization, not elsewhere classified transfusion of packed cells other nonoperative cardiac and vascular measurements infusion of vasopressor agent diagnoses: hypotension, unspecified other emphysema other malignant neoplasm without specification of site syncope and collapse other malaise and fatigue pneumonia due to streptococcus, unspecified secondary malignant neoplasm of other digestive organs and spleen orthostatic hypotension anorexia nonspecific (abnormal) findings on radiological and other examination of gastrointestinal tract 

Answer: The patient is high likely exposed to