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: history of present illness: a 74 year old male with renal cell carcinoma metastatic to the lungs, embolic cerebrovascular accident history with residual left-sided paresis, atrial fibrillation, status post failed cardioversion times three, left ventricular hypertrophy, insulin dependent diabetes mellitus admitted to hospital on with nausea, vomiting, diarrhea and decompensated on the floor and was in severe respiratory distress and was intubated on . he had failure to wean since . workup at the outside hospital included a spiral computerized tomographic angiography which was negative for pulmonary embolism but showed bilateral mid bronchus mass that was narrowing the airways. an echocardiogram at the outside hospital showed an ejection fraction of 65%, biatrial enlargement, 2+ mitral regurgitation, and a small effusion. the patient there received radiation to the chest for two weeks and suffered radiation burns to his back. the patient was also treated for methicillin-resistant staphylococcus aureus, pneumonia and clostridium difficile there. he was transferred here for evaluation of placement of a stent palliatively. the patient's primary oncologist, dr. works here. on arrival to this hospital the patient was complaining of being hungry, no other complaints, no shortness of breath, no chest pain, no abdominal pain and no nausea. past medical history: metastatic renal cell carcinoma to the lungs diagnosed in , status post two cycles of il2 and status post nephrectomy, embolic cerebrovascular accident with residual left hemiparesis, atrial fibrillation status post unsuccessful cardioversion times three on lovenox for anticoagulation, left ventricular hypertrophy, insulin dependent diabetes mellitus, nasal polyps, thyroid disease not otherwise specified, adrenal nodules. allergies: no known drug allergies. medications on transfer: flovent 100 mcg inhaled b.i.d., cardizem 120, 60, 60 q.d., lipitor 10 mg p.o. q.d., 50 mg p.o. q.d., lovenox 80 mg subcutaneously b.i.d., the patient only on coumadin at home, reglan 10 p.o. q. 6, vancomycin 750 mg intravenously q. 12 hours, started course on and completed it at the outside hospital. flagyl 500 mg intravenously t.i.d., respalor tube feeds start , at the outside hospital, colace, senna, lasix 40 mg intravenously b.i.d., silvadene ointment to back, albuterol and albuterol nebulizers, morphine prn, milk of magnesia and ativan prn. social history: married with four children. physical examination: examination on admission revealed temperature 98.0, blood pressure 117/32, respiratory rate 23, pulse of 123, pulse oximetry 94% on ec ventilation 400 cc by 14 breaths per minute, positive end-expiratory pressure 5, 50% oxygen. in general, awake, alert and follows commands. intubated. head, eyes, ears, nose and throat: extraocular movements intact. pupils equal, round and reactive to light and accommodation. dry mucosal membranes. neck: no lymphadenopathy, no thyroid mass, no jugulovenous distension. chest: vented breath sounds on respirator, very decreased breath sounds on the left. heart: regularly irregular, s1 and s2, no murmurs, rubs or gallops. abdomen, nontender, nondistended, normoactive bowel sounds, no organomegaly. extremities: right picc line, dorsalis pedis 2+ bilaterally equal, no cyanosis, clubbing or edema. neurological, left hemiocclusion. normal left foot clonus, brisk left brachial radialis reflex. right side arm and leg strength. laboratory data: white count 13.4, hematocrit 37.7, platelets 408, pt 13, inr 1.1, sodium 148, potassium 3.9, chloride 107, bicarbonate 32, bun 51, creatinine 0.9. glucose 108, calcium 8.8, phosphorus 4.1, magnesium 2. arterial blood gases was 7.46 ph, pco2 46, and po2 was 97 on ac 400 by 14 by 5 by 50%. initial assessment: a 74 year old male with metastatic renal cell carcinoma to the lungs with right brachial and pulmonary artery compromised by tumor, transferred for evaluation for palliative set by the interventional pulmonary team here and to be primary oncologist. the patient has been intubated for three weeks with respiratory failure and failure to wean prior to transfer here. hospital course: 1. respiratory failure - we thought that the most likely cause of the respiratory failure was mucous plugging plus airway compression. dr. did an initial bronchoscopy the day after admission which showed extrinsic compression of the left main stem bronchus. the plan was to go on to stenting, however, the patient quickly decompensated once he got here, was febrile and hypotensive. he was started on a sepsis protocol with an initial lactate of 4.9, white count increased from 13.4 to 16.5 and the patient was in atrial fibrillation, atrial flutter. the patient was restarted on vancomycin, kept on flagyl and placed on ceftazidime to cover ventilator-associated pneumonia. the patient recovered from his septic episode relatively quickly. gram stain and sputum culture were sent off and came back positive for methicillin-resistant staphylococcus aureus. he is continued on his ceftazidime and vancomycin. as he began to do better in terms of his sepsis profile, his atrial fibrillation became the next issue preventing him from going to the operating room for his rigid bronchoscopy with stenting. the patient was in atrial fibrillation with rapid ventricular response felt to be secondary to lung disease plus sepsis plus hypoxemia. he was initially given fluid and was started on diltiazem and digoxin and anticoagulated with lovenox. on , he progressed into supraventricular tachycardia with aberrancy versus monomorphic ventricular tachycardia, slipping into and out of atrial fibrillation and atrial flutter. electrophysiology service was asked to see him and they recommended adding a beta blocker and checking an echocardiogram and discontinuing the digoxin. echocardiogram was done on , which showed an left ventricular ejection fraction of 70 to 80%, 1+ mitral regurgitation and 1+ aortic regurgitation and a small pericardial effusion. the beta blocker was added, lopressor 5 mg intravenously q. 6 hours, after which his atrial fibrillation remained under reasonable control with less rapid ventricular response and no more episodes of supraventricular tachycardia versus ventricular tachycardia and electrophysiology felt that he was stable to go to the operating room. the operative procedure was delayed until , secondary to anesthesia and timing issues. on , he received two stents, one to the left main stem bronchus and one to the right bronchus intermedius. he was also given a percutaneous tracheostomy at that time. he tolerated the procedure extremely well and returned back to us on the ventilator. he then proceeded to put out copious amounts of secretions and with initial attempts to wean the ventilator after the procedure were futile and he was kept on pressure support ventilation 15 and 5 with good ventilation at that time. however, as he was unable to tolerate being on his left side, he was kept on either his back or his right side with fair to good ventilation at that point. 2. clostridium difficile colitis - on flagyl, started . 3. fluids, electrolytes and nutrition - the patient was kept on tube feeds, respalor. 4. renal - creatinine was initially up to 1.4 from baseline of .9, likely due to sepsis. the patient was given fluids and the creatinine improved to .8. 5. tubes, lines and drains - right picc was placed on . the patient is on an orogastric tube on tube feeds, rectal tube, foley catheter and a left arterial line was placed on . 6. lingering issues - it is thought that the patient should have a percutaneous endoscopic gastrostomy placed prior to discharge to rehabilitation. percutaneous endoscopic gastrostomy may be placed next week. that will be dictated as a discharge summary addendum. discharge diagnosis: 1. renal cell carcinoma, metastatic to lungs with extrinsic airway compression. 2. status post interventional pulmonary procedure with placement of two bronchial stents, one in the left main stem bronchus and one in the right bronchus intermedius. 3. methicillin-resistant staphylococcus aureus pneumonia. 4. clostridium difficile colitis. 5. insulin dependent diabetes mellitus. 6. atrial fibrillation with rapid ventricular response. 7. status post cerebrovascular accident with left hemiparesis. discharge medications: 1. metoclopramide 10 mg intravenously q. 8 hours prn 2. simethicone 40 to 80 mg p.o. q.i.d. prn 3. metoprolol 20 mg p.o. t.i.d. 4. aquaphor ointment one application to back t.i.d. prn. 5. morphine sulfate 1 to 2 mg intravenously q. 2 hours prn. 6. combivent 2 puffs inhaled q. 4 hours. 7. lovenox 70 mg subcutaneous q. 12 hours. 8. vancomycin 1 gm intravenously q. 12 hours, started , last day should be . 9. ceftazidime 2 gm intravenously q. 8 hours, starting , last day should be . 10. nystatin ointment one application to affected areas q.i.d. prn. 11. nystatin swish and swallow 5 ml p.o. q.i.d. prn 12. regular insulin sliding scale. 13. 50 mg p.o. b.i.d. 14. metronidazole 500 mg p.o. t.i.d., last day of this should be . 15. lansoprazole 30 mg in nasogastric q.d. 16. ipratropium bromide mdi 6 puffs inhaled q. 4 hours 17. lorazepam 1 to 4 mg intravenously q. 4 hours prn anxiety discharge status: to rehabilitation. discharge condition: good. the rest of this discharge summary will be dictated as an addendum on the day of discharge. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances thoracentesis percutaneous [endoscopic] gastrostomy [peg] arterial catheterization other intubation of respiratory tract temporary tracheostomy closed [endoscopic] biopsy of bronchus transfusion of packed cells diagnoses: congestive heart failure, unspecified atrial fibrillation secondary malignant neoplasm of other specified sites methicillin susceptible staphylococcus aureus septicemia pulmonary collapse intestinal infection due to clostridium difficile methicillin susceptible pneumonia due to staphylococcus aureus secondary malignant neoplasm of lung chronic respiratory failure 

Answer: The patient is high likely exposed to