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: no known allergies / adverse drug reactions attending: chief complaint: elective admission for tracheal stent major surgical or invasive procedure: pericardiocentesis pulmonary stenting history of present illness: mr. is a 65 yom with h/o hyperlipidemia, s/p pacemaker, hep c ( to ivdu 30 yrs prior and untreated), h/o ptx, alcohol abuse, and smoking p/w sclca s/p 6 cycles etop/cisplatin, large mediastinal masses with critical obstruction to the lul who was admitted for elective stent placement and is being transferred to the ccu for pericardial effusion with early tamponade physiology. per the outside report, he had progressive cough and voice changes over the past few months and reports trouble with both solids and liquids. he has had weight loss of approximately 15-20 lbs during this time as well. biopsy of his left upper lung mass was consistent with small cell lung cancer in . ct brain with contrast was negative for mets. pet scan showed b/l subcarinal nodes but no more distant disease. he was recently noted to have very bulky with lul collapse and partial occlusion of the left pulmonary artery. patient presented for direct admit for stent placement but ct scan showed pericardial effusion and pulsus was reportedly measured on the floor to be 15-20. cardiology fellow was called for evaluation. bedside echo showed rv collapse with signs of tamponade. transfer to ccu for monitoring with plan for pericardiocentesis in am. . on review of systems, s/he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. s/he denies recent fevers, chills or rigors. s/he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: -sclc: - sclca diagnosed, had etoposide/carboplatin with 6th cycle given (good tolerance). and : rt done : showed regression in most areas. : reduction in mass, persistent subtotal central occlusion of lul bronchus, reduction in constriction of pulmonary artery to the lul and reduction in central adenopathy, reexpansion of lul. : last chemo : pet showed reduction in all areas, no new areas. : hemoptysis of teaspoon 5cc brb. ct scan noted for new infiltrate showing encasement of artery to lul and subtotal occlusion of the bronchus to the lul. smoking was continued at this point 2ppd. bronchoscopy by dr was suspiciuous for tumor. : continued worsening of hoarseness, paroxysmal cough, left anterior chest dsicomfort, increased dyspnea, no other pain or headache, no addtional bleed. ct: increasing central adenopathy, narrowing of left mainstem bronchus to of the right bronchus, complete obliteration of the lul bronchus with collapse of lul with compromise of left pulmonary artery. bronchus to lll, lingular were compromised. started on: etoposide and carboplatin - 2 cycles, progressive disease noted, has a pericardial effusion. - continued to be symptomatic dyspnea, no dysphagia, continued anorexia. presented for paliative treatment. hyperlipidemia pacemaker h/o hep c untreated ivdu 30 yrs ago spontaneous ptx cigarette addiction significant alcohol intake tendon repair 4th finger on the right hand social history: 2 drinks daily, smoke ppd or more till , started a nicotine patch. married to . working 12-14 hr days. family history: father: died in 50's, emphysema mother: dies in 100's, natural causes sister 1: 68 yrs sister 2: 66 yrs has two grown children physical exam: vs: t=99 bp=128/80 hr=102 rr=20 o2 sat=93% ra pulsus=6 general: nad. oriented x3. depressed mood. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 10cm. chest: device in place in l upper chest cardiac: muffled heart sounds. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: diffuse expiratory rhonchi with decreased bs at l apex abdomen: soft, ntnd. no hsm or tenderness. extremities: trace pitting edema b/l. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: admission labs: 07:45pm blood wbc-13.5* rbc-2.99* hgb-10.3* hct-29.4* mcv-99* mch-34.4* mchc-35.0 rdw-16.0* plt ct-229 07:45pm blood neuts-83* bands-2 lymphs-5* monos-7 eos-0 baso-0 atyps-0 metas-2* myelos-1* 07:45pm blood pt-15.0* ptt-29.1 inr(pt)-1.3* 07:45pm blood glucose-128* urean-13 creat-0.7 na-134 k-3.9 cl-95* hco3-30 angap-13 07:45pm blood alt-80* ast-94* ld(ldh)-271* alkphos-69 totbili-0.5 07:45pm blood albumin-2.7* calcium-8.4 phos-3.4 mg-1.4* discharge labs: 06:27am blood wbc-13.9* rbc-2.65* hgb-8.8* hct-26.1* mcv-99* mch-33.1* mchc-33.6 rdw-16.0* plt ct-209 06:27am blood glucose-119* urean-14 creat-0.5 na-135 k-3.5 cl-101 hco3-29 angap-9 06:27am blood alt-70* ast-105* alkphos-55 totbili-0.4 06:27am blood calcium-7.7* phos-2.5* mg-1.9 studies: portable tte (focused views) done at 9:10:48 pm conclusions overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is unusually small. with normal free wall contractility. the mitral valve leaflets are mildly thickened. there is a moderate to large sized pericardial effusion. no right ventricular diastolic collapse is seen. there is brief right atrial diastolic collapse. impression: moderate to large pericardial effusion located mostly at the lv apex and lv inferolateral wall. there is relatively little fluid overlying the right ventricular free wall. apical approach to pericardiocentesis likely better. no frank echo evidence of tamponade although both ventricles are small and patient is tachycardic. cardiac cath study date of final diagnosis: 1. successful pericardiocentesis with 240 cc of serosanguinous fluid removed with access obtained under echocardiographic guidance and pericardial drainage bag secured and sutured into position. (refer to comments section) 2. monitor drainage with plan for removal of drain in 24-36 hours chest (portable ap) study date of 5:22 pm findings: the patient is intubated, the tip of the endotracheal tube projects 4.5 cm above the carina. massive volume loss in the left lung due to fibrosis and consolidations. subsequent elevation of the left hemidiaphragm. a central airway stent is visible. no pathological changes in the right lung. portable tte (focused views) done at 12:00:00 pm conclusions overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is no pericardial effusion. there are no echocardiographic signs of tamponade. impression: prior to tap, moderate to large circumferential pericardial effusion is seen. post-tap, there is minimal fluid with normal biventricular function. brief hospital course: 65yo m with metastatic sclc admitted for tracheal stent placement, found to have pericardial effusion with concern for early tamponade physiology on tte, hemodynamically stable now. # pericardial effusion: he presented with reported shortness of breath. he had a pulsus paradoxus of 15-20. he had questionable tamponade physiology on echo. he was hemodynamically stable, however, needed to drain the effusion prior to bronchial stenting. in the ccu his pulsus was less than ten. he was taken to the cath lab on and had 260cc's. a drain was kept overnight, with drainage overnight. after multiple hours of no output, the drain was pulled. a post procedure echo showed minimal effusion, and echo the following day () showed minimal increase from post procedure, after minimal output from the drain. his pulsus remained less than ten after the procedure. # small cell lung ca: he is undergoing palliative measures as an outpatient. he was admitted for elective tracheal stenting. after pericardiocentesis, he was taken for bronchial stenting. they did not observe there to be any purulence posterior to the obstruction, however there was extensive invasion and necrosis from tumor, including into the . he was very sedated after the procedure, and required intubation overnight, for airway protection post procedurally. there were minimal secretions suctioned the morning after the procedure. he was extubated successfully. he was well oxygenated (sats in the high 90s) throughout his stay. # transaminitis: be chronic untreated hcv infection given concomitant elevated inr and low albumin. also possibly a component of alcoholic cirrhosis/hepatitis, though ast not significantly more elevated than alt. metastatic disease also on the differential. unclear etiology while an inpatient, and could be worked up as an outpatient. # leukocytosis: wbc elevated with left shift. his wbcs increased post procedurally to 22.6. treatment was started with levaquin for postobstructive pneumonia. his wbcs trended down to 13 at discharge. # follow-up: mr. has a few pending labs that will need to be followed-up by his primary care physician or service and faxed to his pcp : blood cultures - no growth to date respiratory culture - no growth to date broncoalveolar lavage fluid cultures - no growth to date medications on admission: megace es 625mg prn atenolol 25mg qd aspirin 325 prn mucinex 600mg prn guaiatussin ac 20-200 prn discharge disposition: home with service facility: angels visiting nurse discharge diagnosis: primary: left main bronchus obstruction small cell lung cancer pericardial effusion secondary: hld alcoholism hepatitis c discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , it was a pleasure taking part in your care. you were admitted to have a procedure called a pulmonary stenting. this was to open the airway to your left lung. on admission you were found to have fluid surrounding your heart, which was causing mild shortness of breath. you had a procedure called a pericardiocentesis. the cardiologists drained the fluid from around your heart and the pulmonologists took you for the stenting. you tolerated the procedure well. you required intubation (a breathing tube) overnight to help you rest and breath. you were extubated the following day and did very well. on discharge you were doing well, and your breathing was improved. however, you may need oxygen at home to help you breathe better. a visiting nursing service will evaluate you for this at home. you should continue to take antibiotics for a total 10-day course, for what we believe may be a pneumonia. we have made the following changes to your medications: 1) start levofloxacin 750mg daily until 2) stop atenolol and aspirin, until advised to restart by your physicians 3) start percocet at night as needed for pain. it is important that you do not drive while taking a sedating medication like this. please use a different over-the-counter pain reliever if . followup instructions: please call to schedule follow-up with your primary care doctor. you will be contact by interventional pulmonology for outpatient follow-up in the next 2 weeks. please call your oncologist for follow-up. procedure: pericardiocentesis other intubation of respiratory tract closed [endoscopic] biopsy of bronchus diagnoses: chronic hepatitis c without mention of hepatic coma other and unspecified hyperlipidemia unspecified disease of pericardium malignant neoplasm of upper lobe, bronchus or lung cardiac pacemaker in situ do not resuscitate status bronchopneumonia, organism unspecified cardiac tamponade 

Answer: The patient is high likely exposed to