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: fever, cough major surgical or invasive procedure: arterial line placement picc placement and removal central venous line placement x2 peg tube placement midline placement stoma intubation history of present illness: 85 y.o. male w/ papillary thyroid ca s/p thyroidectomy with radioactive iodine ablation, scc of the larynx s/p total laryngectomy w/ modified radical neck dissection with stoma, metastatic prostate cancer with metastatic lesions to the bone presenting to the ed with 2day history of fevers, chills, fatigue, poor po intake and non-productive cough. via translation with pt's family member 2 days ago pt felt "unwell", fatigued with some chills and subjective fevers. pt also noted some abdominal discomfort, rt sided chest pain, dizziness. unfortunately after spending several days not feeling hungry due to his fatigue he called his son to take him to the hospital on the morning of admission. he also endorses several episodes of brbpr for the past 2 days. per his son he has had problems with brbpr over the past few months. upon arrival to the pt was noted to be febrile with a rectal temp of 104.4, tachycardic at 102, copious secretions with saturation after suctioning in the mid 90s on a trach mask. a chest x-ray was obtained, notable for rll pna. pt was also noted to go into a-fib into the rate of 200, pt was given 20mg iv diltiazem which reduced his rate to 150s and with additional fluids 130s. pt received levofloxacin, cefepime, vancomycin as well as 5l ns fluid in the ed, bld cultures x 2 drawn. prior to transfer to the floor pt was noted to have desaturations and was intubated through his stoma. levophed was also initiated due to an sbp in the mid 90s following versed and fentanyl for intubation. ros was otherwise essentially negative. the pt denied headaches, vomiting, hemoptysis, hematemesis, coffee-ground emesis, dysuria, hematuria. past medical history: anemia metastatic lesions to the bone prostate adenocarinoma on lupron s/p thyroidectomy and radioactive iodine ablation for papillary thyroid ca() total laryngectomy w/ right modified radical neck dissection for scc of the larynx () h.o. + afb sputum at () h.o. + mrsa sputum cultures social history: pt lives by himself although for the past few months he has found it harder to take care of himself. he has past smoking history of 30 pack year history but quit in . denies any current etoh use. pt was born in and and lived in . he migrated to the us after the viet took over. he used to work as a business man and would travel to for his business. family history: nc physical exam: on presentation: vitals: t:37.2 bp:124/73 p:124 r:30 sao2: 99% general: slightly tired appearing elderly asian male intubated via stoma cooperative. heent: perrl, eomi, no scleral icterus, mmm neck: supple, no significant jvp pulmonary: rt mid thorax down bs are diminshed, course. rt mid thorax up bs are course. left hemithorax is clear. cardiac: s1 s2, tachy (100), irregularly irregular abdomen: soft, nt, nd, normoactive bowel sounds, no masses or organomegaly noted extremities: no edema, 2+ radial, dp pulses b/l neurologic: able to relate history through son who was translating. cranial nerves ii-xii intact pertinent results: 03:25pm glucose-108* urea n-43* creat-1.8* sodium-138 potassium-3.5 chloride-104 total co2-17* anion gap-21* 03:25pm calcium-7.6* phosphate-4.2 magnesium-2.1 03:25pm alt(sgpt)-9 ast(sgot)-32 ck(cpk)-276* alk phos-62 tot bili-0.8 03:25pm lipase-12 03:25pm ck-mb-2 ctropnt-<0.01 03:25pm wbc-12.6*# rbc-2.81* hgb-7.1* hct-24.0* mcv-85 mch-25.3* mchc-29.7* rdw-17.8* 03:25pm neuts-46* bands-37* lymphs-15* monos-0 eos-0 basos-0 atyps-0 metas-1* myelos-1* 03:25pm hypochrom-2+ anisocyt-1+ poikilocy-2+ macrocyt-normal microcyt-1+ polychrom-normal ovalocyt-occasional schistocy-occasional burr-occasional teardrop-occasional acanthocy-occasional 03:25pm plt smr-normal plt count-355 03:25pm pt-16.6* ptt-41.5* inr(pt)-1.5* 03:10pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 03:10pm urine rbc-0-2 wbc-0-2 bacteria-occ yeast-none epi-0-2 03:30pm lactate-6.1* 03:41pm lactate-4.6* 07:37pm lactate-1.9 10:30pm hct-15.9*# 11:19pm hct-18.9* 11:54pm type-art po2-61* pco2-34* ph-7.31* total co2-18* base xs--8 intubated-intubated imaging: cxr (): infectious pneumonia involving the right middle lobe and right upper lobe. followup to resolution is recommended to exclude underlying malignancy. tte (): the left atrium is mildly dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. the pulmonic valve prosthesis is not well seen. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. mild aortic regurgitation. mild pulmonary hypertension. biatrial enlargement. upper extrem us (): 1. near complete occlusive thrombus surrounding the left picc line in the left brachial and axillary veins. occlusive thrombus also noted within a second left brachial vein. 2. subcutaneous edema. ct abd/pelvis (): 1. moderate-sized right rectus abdominis hematoma corresponding to palpable abnormality as discussed with dr. at the time of dictation. 2. large right and moderate left pleural effusions with patchy opacities consistent with infectious process within the right middle and lower lobes. lingular opacity reflects infection and/or atelectasis. 3. new hypoattenuating lesions within the liver are not well evaluated on this non-contrast enhanced study however consistent with new metastatic disease. small amount of ascites surrounds the liver. 4. anasarca. 5. progression of sclerotic metastasis within the spine without evidence of spinal canal encroachment. brief hospital course: 85 yo m, cantonese-speaking only with pmh of tracheostomy s/p laryngectomy, met prosate ca, thyroid ca, who presented with fever, hypoxia and new a-fib with rvr. # sepsis: on admission to the icu the patient was septic meeting sirs criteria with tachycardia, temperature of >104, tachypnea and white blood count with bandemia with a suspected pulmonary source, pneumonia. in the ed his lactate level was initially noted to be 6.1. in the pt was started on pressor support with levophed, intubated through his stoma for continued hypoxia, and an initial antibiotic regimen of levofloxacin, cefepime, vancomycin. antibiotic regimen was then changed to vancomycin, zosyn, levofloxacin during his first night of admission. following 2 days of fluid resuscitation pt was weaned of pressor support. following a negative mrsa screening pt's antibiotic regimen was narrowed to zosyn and levofloxacin and he completed a 10 day course of these antibiotics on . pt's leukocytosis reached a maximum of 16.4 and then trended down to 10.1 prior to discharge. urine cultures, blood cultures and fluid cultures were drawn and ultimately negative. # pleural effusions: pt's ct scan showed bilateral pleural effusions, following completion of pt's antibiotics regimen and wean to minimal ventilatory support, diuresis therapy was initiated to aid with pleural effusion resorption. pt was started on 40mg po bid furosemide for a goal of -500 to -1l for 24hr i/o balance. # hypotension: pt was hypotensive with sbp in the mid 70s, pt was started on levophed therapy, hypotension was likely secondary to sepsis. following 2 days of fluid resucitation pt was able to wean off his vasopressor. he had to briefly be placed back on levophed, however he was quickly able to be weaned off again with iv fluid support. # anemia: on reivew of his past medical history mr. was noted to have a history of anemia, prior hcts late last year showed an approximate baseline of 23. on admission pt was noted to have a hct of 15 and was transfused 2u of prbcs and then another 2 units the day after admission. pt and pt's family gave a history of a lower gi bld from hemorrhoids. guaiaics were obtained and were ultimately negative, following transfusion pt's hct was stable at 28-30. during hospitalization pt was noted to have a tender rlq abdomen a ct abdomen was obtained which showed a large 12 cm craniocaudal x 6.5 cm transverse x 2.8 cm anterior- posterior rectus sheath hematoma. anticoagulation with heparin sc was held following this finding. patient was transfuse an addition 1 unit prbc for a 2 day down trend of hematocrit to 23 with an appropriate bump. # pneumonia: admission chest x-ray in ed notable for severe rll and rml pna, pt was also noted to have volumous secretions from his trach requiring suctioing. after initially receiving cefepime x 1 dose, several dasys of vancomycin pt showed improvement on a narrowed regimen of zosyn and levofloxacin. given his clinical improvement a antibiotic course of 10 days was decided for iv levofloxacin and zosyn. mr. was initially intubated through his stoma on an ards protocol however given the large lung volumes he was taking he was then switched to assist control and finally pressure support. prior to discharge pt was able to be weaned to minimal pressure support. # new onset a-fib: pt was in the ed to be in new a-fib with rvr in the rate of 200s, pt's heart rate reverted to sinus rhythm following diltiazem 10mg iv x 2, fluid administration and metoprolol 12.5mg po x 1. pt's a-fib most likely secondary to pt's hypovolemic, septic state. an echo was obtained following admission and showed mild symmetric lvh with preserved global and regional biventricular systolic function, mild aortic regurgitation, mild pulmonary hypertension, and biatrial enlargement. did not anticoagulate as pt risk of bleeding outweigs the benefits of anticoagulation. # acute renal failure: pt's creatinine noted to be elevated upon admission to a maximum of 3.0 from a baseline of 1.1-1.2. urine electrolytes reflected to be pre renal most likely secondary to his sepsis. following aggresive fluid administration creatinine and urine output improved. # upper extremity thrombus: on the patient's left upper extremity was noted to be swollen and an ultrasound showed a near complete occlusive thrombus surrounding the left picc line in the left brachial and axillary veins. occlusive thrombus also noted within a second left brachial vein. his picc was removed, however anticoagulation was not started given a rectal sheath hematoma which was diagnosed the same day as well as bleeding around the site of a recently placed central line. long term anticoagulation was discussed and with his comorbidities, bleeding risk, and presentation of gi bleeding, it was decided not to start him on anticoagulation at any time in the future as the risk of bleeding is so high. # nutrition: pt's albumin on admission noted to be low at 1.9, prior to admission to the hospital per pt and his family member he had poor po intake several days before admission. pt lives by himself however, per his son, he has decompensated and become more weaker during the past few months. as pt was intubated and septic pt was initially started on tube feeds via ngt. given his poor nutritional status after discussion with the family a peg was placed and tube feeds were ordered. # cancer: pt has a history of papillary thyroid carcinoma s/p thyroidectomy and radiocative iodine ablation (), squamous cell carcinoma of the larynx s/p total laryngectomy () and recently metastatic prostate cancer (extensive osseous metastatic disease on pet scan in ). pt currently receiving lupron therapy at with dr. . his next round of lupron will be due -. # hypotyhroidism: pt was continued on his home regimen of levothyroxine. # code status: dnr/dni # communication: persons of contact: (primary person of contact) home cell work daughter () medications on admission: lisinopril 10 mg daily levothyroxine 75 mcg daily ferrous sulfate 325 mg tid lorazepam 5 mg qhs discharge medications: 1. levothyroxine 75 mcg tablet : one (1) tablet po daily (daily). 2. ferrous sulfate 325 mg (65 mg iron) tablet : one (1) tablet po tid (3 times a day). 3. docusate sodium 50 mg/5 ml liquid : po bid (2 times a day). 4. senna 8.8 mg/5 ml syrup : one (1) tablet po bid (2 times a day). 5. amlodipine 5 mg tablet : one (1) tablet po daily (daily). 6. fentanyl 50 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 7. chlorhexidine gluconate 0.12 % mouthwash : one (1) ml mucous membrane (2 times a day). 8. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : two (2) puff inhalation q4h (every 4 hours) as needed. 9. ipratropium bromide 17 mcg/actuation aerosol : two (2) puff inhalation qid (4 times a day). 10. metoprolol tartrate 25 mg tablet : 0.5 tablet po bid (2 times a day). 11. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 12. lactulose 10 gram/15 ml syrup : thirty (30) ml po q8h (every 8 hours) as needed for constipation. 13. insulin lispro 100 unit/ml solution : one (1) subcutaneous asdir (as directed): per sliding scale. 14. ferrous sulfate 300 mg (60 mg iron)/5 ml liquid : one (1) po tid (3 times a day). 15. trazodone 50 mg tablet : 0.5 tablet po hs (at bedtime) as needed for insomnia. 16. furosemide 40 mg tablet : one (1) tablet po bid (2 times a day). discharge disposition: extended care facility: - discharge diagnosis: primary: sepsis pneumonia respiratory failure secondary: metastic prostate cancer upper extremity deep vein thrombosis acute renal failure anemia atrial fibrillation discharge condition: fair, vitals stable. discharge instructions: you were admitted to the hospital for a severe pneumonia. in the emergency room you had a lot of difficulty breathing and you needed to be intubated. you also needed medications to elevate your blood pressure. whilst you were in the intensive care unit you were able to be weaned down to only minimal support on the ventilator. you are being discharged to a rehabilitation facility and they will manage your medications and ventilation there. it was a pleasure meeting you and particiapting in your care. followup instructions: oncology: , md,phd: date/time: 11:00 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] arterial catheterization transfusion of packed cells diagnoses: malignant neoplasm of liver, secondary unspecified pleural effusion acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism atrial fibrillation personal history of malignant neoplasm of prostate other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure other complications due to other vascular device, implant, and graft hypoxemia nontraumatic hematoma of soft tissue anticoagulants causing adverse effects in therapeutic use hyperosmolality and/or hypernatremia accidents occurring in residential institution tachycardia, unspecified secondary malignant neoplasm of bone and bone marrow tracheostomy status anemia in neoplastic disease hemorrhage of rectum and anus personal history of malignant neoplasm of thyroid benign essential hypertension bacterial pneumonia, unspecified duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation, without mention of obstruction 

Answer: The patient is high likely exposed to