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: dyspnea major surgical or invasive procedure: ct guided needle biopsy intubation arterial cannulation, a-line placement central line placement history of present illness: pt is a 53 y m with hx of dm2, htn who is transferred from after being hospitalized from - with bilateral pneumonia and concern for new malignancy. 2 weeks prior to admission to the osh, he was experiencing cold-like symptoms and received azithromycin without relief. this was switched to levaquin, again without improvement. he claimed that for these 2 weeks, he was basically bed-bound and extremely tired. at the end of that time, he was coughing to where "my face turned " and had some sputum production and low-grade fevers. he received a cxr which showed bilateral pna; he was admitted to the icu for hypoxic respiratory failure and pneumosepsis. on he started ceftriaxone, azithromycin, and iv steroids for supposed concurrent copd exacerbation. he also received 1 dose of vancomycin. he could not tolerate bipap and was given nasal o2. his respiratory status stabalized and was transferred to the floor requiring 4l of nc. he claims that during his hospital stay, he did not feel that his breathing had improved. urinary legionella ag and strep ag were negative as were mrsa screen and blood cultures drawn on . ctpa was negative for pe but did reveal mediastinal and retroperitoneal adenopathy. ct of the abdomen and pelvis a 6.3x4.8cm mass, "concern for a renal cell carcinoma vs. lymphoma." the patient was agreeable for transfer to for work-up of this potential malignancy. . on arrival, he mentions orthopnea and le edema which began around the time he started his cold and has worsened. he also mentions that the afternoon of transfer, he experienced 1 minute of blurry vision where his daughter noted his left pupil was bigger than the right but resolved spontaneously without any associated headaches, nausea, confusion, or vomiting. . review of systems: (+) per hpi; 11 lb weight loss in 3 weeks (-) denies chills, night sweats. denies loss of vision, photophobia. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations. denies nausea, vomiting, diarrhea, constipation, abdominal pain, melena, hematemesis, hematochezia. denies dysuria, stool or urine incontinence. denies arthralgias or myalgias. denies rashes or skin breakdown. no numbness/tingling in extremities. all other systems negative. . past medical history: pmh: bilateral pna dm2 on metformin htn hyponatremia atypical chest pain with a normal stress test in hyperlipidemia asthma as a child osa seasonal allergies social history: works in it. lives at home with daughter and wife. denies tobacco, etoh, illicits. family history: there is no family history of premature coronary artery disease or sudden death. father with cabg x4 in his 60s. physical exam: admission exam vs: t 97.4 bp 144/90 hr 98 rr 18 sao2 93% on 3l nc rr 18 gen: nad, awake, alert heent: eomi, sclera anicteric, conjunctivae clear, op moist and without lesion, perrla at 3mm neck: supple, cannot appreciate jvd cv: reg rate, normal s1, s2. no m/r/g. chest: resp slightly labored, crackles at bases with expiratory wheezes from bases to apices. abd: soft, obese, nt, nd, no hsm, cannot palpate kidney; bowel sounds present msk: normal muscle tone and bulk ext: no c/c, 1+ edema bilaterally, normal perfusion skin: no rash, warm skin neuro: oriented x 3, normal attention,no focal deficits, intact sensation to light touch psych: appropriate . pertinent results: 10:14pm glucose-130* urea n-16 creat-0.5 sodium-132* potassium-4.3 chloride-96 total co2-28 anion gap-12 10:14pm alt(sgpt)-18 ast(sgot)-14 ld(ldh)-188 alk phos-66 tot bili-0.3 10:14pm tot prot-5.3* albumin-3.3* globulin-2.0 calcium-9.2 phosphate-3.8 magnesium-1.6 uric acid-3.5 10:14pm wbc-13.2*# rbc-4.84 hgb-13.9* hct-39.6* mcv-82 mch-28.7 mchc-35.2* rdw-13.4 10:14pm neuts-81.8* lymphs-8.6* monos-8.4 eos-1.1 basos-0.1 10:14pm plt count-294 10:14pm pt-13.3* ptt-25.8 inr(pt)-1.2* 10:14pm fibrinoge-413* 10:14pm ret aut-1.4 09:45pm urine hours-random creat-42 sodium-33 potassium-13 chloride-21 tot prot-6 prot/crea-0.1 10:14pm ret aut-1.4 09:45pm urine color-straw appear-clear sp -1.008 09:45pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg . cxr from : bilateral pna with pleural effusions. images not available for viewing . ct chest findings: the thyroid gland is unremarkable. there is no supraclavicular or axillary lymphadenopathy. there is extensive mediastinal and hilar lymphadenopathy, similar in extent to the prior study from only a few days earlier. for example, right anterior mediastinal node measuring 1.5 x 1.5 cm, previously measured 1.6 x 1.4 cm (4:11); 2.2 x 1.2 cm right precarinal node (4:20), previously measured 1.2 x 2.3 cm; more inferiorly, 2.5 x 1.9 cm node (4:23), previously was 2.5 x 2.0 cm. multiple nodes are seen in the prevascular station which also are similar in appearance to the prior exam. right paraesophageal nodal conglomerate is unchanged and measures 4.9 x 3.7 cm (4:33). large right hilar nodal conglomerate, measures 4.9 cm in maximal dimension (4:28) compared to 4.8 cm. left hilar adenopathy measures 4.1 cm (4:29) compared to 4.3 cm. there is resultant compression of the right main stem bronchus (4:27) and bronchus intermedius as well as the right lower lobe bronchus. the heart has a rounded appearance with a small pericardial effusion. this concerning for pericardial constriction from underlying process involving the lungs and mediastinum. lungs: in the right upper lobe there are multiple foci of consolidation, multiple nodules, ground-glass opacities and interlobular septal thickening. this pattern is also seen in the right lower lobe but is less extensive. more frank consolidation with air bronchograms are present in the right middle lobe and left lower lobe. within the left upper lobe there are innumerable predominantly sub-centimeter discrete rounded nodules. there are bilateral pleural effusions greater on the right, similar in extent compared to the prior study. these findings are suggestive of primary lung malignancy, lymphoma, possible infection such as tuberculosis and less likely vasculitis. there is no pneumothorax. this study is limited for evaluation of subdiaphragmatic structures but demonstrates extensive retroperitoneal lymphadenopathy, better assessed on the recent outside hospital scan with iv contrast, however, the overall extent appears unchanged. for example, right retroperitoneal node measuring 1.7 x 2.8 cm (4:63), previously measured 1.4 x 2.7 cm on the prior study; epigastric node measuring 1.8 cm, is similar to the prior study (4:57); left paraaortic nodal conglomerate measures 3.2 x 2.3 cm compared to 3.2 x 2.1 cm on the prior study. osseous structures: there are no suspicious bony lesions. impression: 1. multifocal process within the lungs with frank consolidation in the right middle and left lower lobes, severe multifocal opacities with nodules, centrilobular septal thickening in the right upper lobe and less extensive in the right lower lobe with multiple nodules in the left upper lobe. extensive mediastinal and hilar lymphadenopathy, unchanged from the prior exam. possible etiologies include primary lung cancer, lymphoma, infection such as tuberculosis and less likely vasculitis. 2. associated compression of the right main stem bronchus, bronchus intermedius and right lower lobe bronchus from lymphadenopathy. 3. rounded appearance to the heart, with small pericardial effusion suggesting pericardial constriction from this underlying process. recommend clinical monitoring. 4. bilateral pleural effusions, worse on the right, unchanged from the prior exam. 5. extensive retroperitoneal and paraaortic lymphadenopathy, similar in appearance to the prior study. . mr findings: the study is limited by motion artifact. there is no evidence of hemorrhage. there are areas of increased flair signal corresponding to punctate foci of slow diffusion within the bilateral parietal lobes, the left frontal lobe, and the left temporal and occipital lobes. there is also a focus of slow diffusion within the left cerebellar hemisphere. there is no evidence of mass lesion or hemorrhage. there are no definite areas of abnormal enhancement. the visualized paranasal sinuses, mastoids, and orbits are unremarkable. impression: study is limited by motion artifact. multiple foci of slow diffusion in both cerebral hemispheres, as well as in the left cerebellar hemisphere, without enhancement. these are compatible with acute/subacute ischemia, likely from a central embolic source. consideration might be given to nbte ("marantic endocarditis"), in this setting. . tissue biopsy pathology pleural fluid, cell block: consistent with metastatic poorly-differentiated carcinoma (see note). note: immunohistochemical stains reveal that the tumor cells show patchy positivity for ck20, ck7 (focal), and p504s and are negative for ttf-1, p63, and b72.3. -31 shows focal dim staining in rare tumor cells. calretinin appears to stain tumor cells (patchy) and mesothelial cells. wt-1 highlights background mesothelial cells. the patient's prior pathology specimen s12-33153p was also reviewed for comparison. the morphologic and immunophenotypic findings are consistent with poorly-differentiated carcinoma similar to that described in the patient's para-aortic node specimen (s12-33153p). the immunoprofile is not specific but may be compatible with renal cell carcinoma; however, other sites cannot be entirely excluded. clinical correlation is required. please also see the corresponding cytology c12-. brief hospital course: mr. was transferred to from after being hospitalized from - with bilateral pneumonia and concern for new malignancy. on he started ceftriaxone, azithromycin, and iv steroids for supposed concurrent copd exacerbation. urinary legionella ag and strep ag were negative as were mrsa screen and blood cultures drawn on . ctpa was negative for pe but did reveal mediastinal and retroperitoneal adenopathy. ct of the abdomen and pelvis a 6.3x4.8cm mass, "concern for a renal cell carcinoma vs. lymphoma." he reported that orthopnea and le edema began around the time he started his respiratory symptoms. he was transferred to for further care. while in house, he had left para-aortic lymph node biopsy which showed poorly differentiated carcinoma with clear cell features. his oxygen demand was initially 3l on nasal cannula with saturation in the 90's. this gradually worsened to 6l on nc to 6l nc plus shovel mask with saturation maintaining 90-95%. leni's negative bilaterally in the lower extremities. mri brain was concerning for acute/subacute ischemia from central embolic source with no vegetations on tte. tee was recommended by neurology consult team however given his poor current status this has been deferred. he is on iv heparin for this with goal ptt of 50-70 to avoid bleeding. on cxr was suggestive of superimposed pneumonia (vanc and zosyn were started for nosocomial pneumonia on that day) in addition to underlying pulmonary metastases and new mild pulmonary edema. vs on the floor prior to micu transfer were: afebrile, saturating mid-high 80's to low 90's on nasal cannula and shovel mask sitting in chair and looking exhausted with the head bowed down. per hospitalist, this was definitely different from what he was on admission. bp was 103/65, hr 105, rr 30's. on arrival to the micu, patient's vs. t 97.7, hr 105, bp 90's/50's, rr 28, sat 88% on nrb. he was put on face mask ventilation but continued to have increased work of breathing and worsening respiratory status. repeat abgs showed respiratory acidosis and failure with ph 7.09-7.14 pco2 55-60 po2 56-82 and hco3 19-21. patient was intubated. femoral line and a-line were placed. patient suspected to be in pneumosepsis, and became hypotensive and required pressor support with levophed and vasopressin. continuing hypotension required additional support with phenylephrine. given decompensation, family meeting was held at midnight on . mr. wife decided dnr with no escalation of care. he expired peacefully overnight. medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. fluticasone propionate 110mcg 2 puff ih :prn dyspnea 2. fenofibrate *nf* 200 oral daily can substitute forumlary med 3. atorvastatin 80 mg po hs 4. lisinopril 30 mg po daily 5. omeprazole 20 mg po daily 6. chlorthalidone 12.5 mg po daily 7. metformin (glucophage) 1000 mg po bid 8. aspirin 81 mg po daily discharge medications: n/a discharge disposition: expired discharge diagnosis: cardiopulmonary arrest discharge condition: expired discharge instructions: n/a followup instructions: n/a procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube thoracentesis arterial catheterization biopsy of lymphatic structure diagnoses: pneumonia, organism unspecified acidosis obstructive sleep apnea (adult)(pediatric) esophageal reflux unspecified pleural effusion unspecified essential hypertension acute kidney failure, unspecified hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified malignant neoplasm of kidney, except pelvis other and unspecified hyperlipidemia acute respiratory failure cardiac arrest diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled do not resuscitate status secondary malignant neoplasm of lung secondary and unspecified malignant neoplasm of intrathoracic lymph nodes endocarditis, valve unspecified, unspecified cause cerebral thrombosis with cerebral infarction diplopia 

Answer: The patient is high likely exposed to