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: ciprofloxacin / flomax / hydrochlorothiazide / biaxin / atenolol / lisinopril / levaquin / ativan attending: chief complaint: nausea, vomiting, abdominal pain. major surgical or invasive procedure: paracentesis and . stripping of clot from port . paracentesis . history of present illness: patient is a 70 y m with stage iv colon cancer and extensive portal vein thrombosis who presents from the er with severe nausea and vomiting. he began modified folfiri on , and after he experienced severe nausea and vomiting. he was unable to take anything po and went to the er on where he received fluids, antiemetics, and felt well enough to go home. since that time, he has had continued nausea and non-bilious vomiting where he is barely able to keep down water. he has also had full body shakes without fever or chills. he notes inceased abdominal girth and a 6lb weight gain over the past week. he notes difficulty urinating but no urinary incontinance or hematuria. he has pain in his abdomen that is worse with inspiration but decreases to with po morphine. vitals in the er: afebrile 98 148/87 16 95% ra; he received 2l ns, iv morphine, zofran and was transfered to the floor for further management. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss. denies blurry vision, diplopia, loss of vision, photophobia. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations, lower extremity edema. denies cough, shortness of breath, or wheezes. denies diarrhea, constipation, 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: oncologic history: he presented in with abdominal pain. he had a cecal cancer with no evidence of metastatic disease by ct. at the time of open colectomy, there was evidence of miliary studding and he underwent resection of at least one metastatic macroscopically visible omental nodule. folfox chemotherapy was begun in because of symptomatic left lower quadrant pain related to disease progression. we switched to an every three-week basis in because of myelosuppression, especially thrombocytopenia. a repeat ct after four courses showed slight progression. he had restless legs that was felt to represent oxaliplatin toxicity and he was subsequently switched to short-term infusional 5-fu and leucovorin according to the de gramont schedule in 07/. cts since then have shown gradually progressive disease. his last ct scan two weeks ago showed increasing ascites and the decision was made to discontinue 5-fu and leucovorin and proceed with folfiri. he received c1 d1 of modified folfiri on . . other past medical history: 1) hypertension 2) hyperlipidemia 3) osteoarthritis 4) extensive portal vein thrombosis extending up the right hepatic vein on lovenox since 5) bph 6) s/p tonsillectomy 7) s/p traumatic finger amputation of left hand at age 4 8) nephrolithiasis social history: lives with his wife. 2 sons who live nearby and nine grandchildren. works 6 days a week as a furniture maker along with his son. denies tobacco or etoh use. family history: mother had lung cancer. no other family history of malignancy. physical exam: admission exam: vs: t 98.2 bp 139/71 hr 96 rr 16 sao2 97 ra gen: elderly man in nad, awake, alert heent: eomi, sclera anicteric, conjunctivae clear, op dry and without lesion neck: supple, no jvd appreciated cv: reg rate and rhythm, normal s1, s2. no m/r/g. chest: resp unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: very firm and distended but no rebound or guarging, minimal tenderness, bowel sounds present msk: normal muscle tone and bulk ext: no c/c/e, 2+ dp/pt bilaterally skin: no rash, warm skin neuro: oriented x 3, normal attention, no focal deficits psych: appropriate pertinent results: admission labs: 01:36pm lactate-1.2 01:30pm glucose-118* urea n-22* creat-0.9 sodium-137 potassium-4.4 chloride-100 total co2-27 anion gap-14 01:30pm alt(sgpt)-39 ast(sgot)-24 alk phos-84 tot bili-1.1 01:30pm lipase-23 01:30pm calcium-8.5 phosphate-2.9 magnesium-2.5 01:30pm wbc-5.4 rbc-4.12* hgb-11.9* hct-36.6* mcv-89 mch-29.0 mchc-32.6 rdw-16.9* 01:30pm neuts-88.2* lymphs-9.5* monos-0.7* eos-1.2 basos-0.3 01:30pm plt count-168 . cxr: findings: as compared to the previous examination, there is no relevant change in extent of the known bilateral pleural effusions. the effusions are better appreciated on the lateral than on the frontal radiograph. minimal subsequent areas of atelectasis but no evidence of pneumonia. unchanged size of the cardiac silhouette. unchanged left port-a-cath. . ct abdomen: 1. interval increase in the abdominal ascites since . stable peritoneal metastatic disease. 2. stable main and left portal vein thrombosis. 3. bilateral small pleural effusions, now larger. 4. mild right hydronephrosis, but no obstructing stone seen. . cxr: impression: essentially unchanged left greater than right small pleural effusions. . le doppler u/s: impression: no evidence of dvt. . kub: impression: 1. non-obstructive bowel gas pattern. 2. no free air. . u/s abd: impression: 1. small volume ascites. 2. right pleural effusion. . cxr: impression: extensive new consolidation in the right lower lung on the current study subsequently improves. this could represent the changes of acute aspiration rather than pneumonia resolving from it. small-to-moderate bilateral pleural effusions are unchanged since the prior study. left lower lobe atelectasis has improved. heart size is normal. infusion port catheter ends in the mid svc. no pneumothorax. . echo: lvef>55%. unremarkable. . ue doppler u/s: impression: no evidence of dvt. right cephalic vein not visualized. . cta chest: impression: 1. probable subsegmental right middle lobe pulmonary embolus without evidence of heart strain. no additional pulmonary emboli are identified, although this study is limited by respiratory motion artifact. 2. small ground-glass opacities within the right upper lobe are likely infectious or inflammatory in etiology. 3. small-to-moderate bilateral pleural effusions slightly increased from ct. 4. large volume ascites as before. 5. cholelithiasis without evidence of acute cholecystitis. . cxr: impression: mild to moderately severe consolidation in the right lower lobe has worsened compared to , not as severe as on . the variability suggests atelectasis is largely responsible, and there is accompanying small right pleural effusion. question of pneumoperitoneum was raised on the interpretation of study. there is no evidence of free air either in the abdomen or pleural space. upper lungs are clear. heart size is normal. pulmonary vasculature is not engorged. . discharge labs: : wbc 13.7, hb 10.3, hct 31.3, mcv 91, plt 257. : pt 18.3, ptt 41.4, inr 1.7. : anti-factor xa (lmwh) level 0.81. : glu 105, bun 13, creat 0.7, na 141, k 3.9, cl 112, co2 24. : alt 15, ast 9, ldh 147, alp 57, t bili 0.9. : albumin 2.2, ca 7.0, phos 1.9, mg 2.0. : galactomannan negative, beta glucan 93. , , : c. diff toxin x3 negative. brief hospital course: 70yo man with stage iv colon cancer and portal vein thrombosis on enoxaparin admitted for severe nausea, vomiting, and increased ascites. he was transferred to the icu for hypoxia and aspiration pneumonia. . # nausea/vomiting: due to chemotherapy. kub showed no obstruction. given fosaprepitant, however will avoid this in the future given his hiccup-reaction to aprepitant in the past. anti-emetics prn. - avoid fosaprepitant and aprepitant due to hiccups. . # febrile neutropenia: due to 1st cycle folfiri. started g-csf (neupogen). low-grade fever to 100.7f, pan-cultured. started on vancomycin/cefepime and metronidazole in setting of low bps and hypoxia worrisome for sepsis. c. diff negative. he had another temp to 101.3 while in the icu. cxr and ct scan revealed rll pneumonia suggesting aspiration. . # aspiration rll pneumonia and hypoxemic respiratory distress: vancomycin stopped. swallow eval normal; aspiration occurred during unremitting vomiting. galactomannan negative. positive beta glucan 93, unlikely significant given his clear clinical course with aspiration pneumonia and resolution with antibiotics. id fellow also pointed out that some medications/antibiotics can falsely elevate beta glucan. changed cefepime and metronidazole to amoxicillin/clavulanate at discharge to complete a ten day course (only three days of amoxicillin/clavulanate needed). - f/u cultures. . # metastatic colon cancer with peritoneal carcinomatosis: s/p modified folfiri x1 cycle . paracentesis x2 and drained 3+4l. acites saag consistent with malignant ascites. cytology: atypical cells highly suspicious for malignancy. he will need to continue chemotherapy, but with changes to his regimen (dose-reduction vs. folfox) considering current complications. family meeting yesterday discussed treatment options. mr. seems likely to opt for additional chemotherapy after rehab. therapeutic paracentesis repeated : 3l drained. . # hiccups: likely due to diaphragmatic irritation from peritoneal mets. avoided metoclopramide due to recent diarrhea. mild improvement with chlorpromazine. starting baclofen. could also consider haloperidol or scheduling prochlorperazine. . # mental status changes: likely due to meds lorazepam and/or olanzapine plus infection. per family, mr. has not tolerated lorazepam in the past. tolerating chlorpromazine for hiccups. - avoid benzodiazepines. . # sinus tachycardia: due to infection, volume depletion, and small pe. ecg unremarkable. cardiac enzymes negative. le doppler u/s negative. already on enoxaparin. . # pe: continue enoxaparin; no changes given the very small size of the pe, its indeterminant age (no previous cta), and the negative ue/le doppler u/s. anti-factor xa level therapeutic at 0.81. . # neutropenia: due to chemo. resolved; d/c'd g-csf (now leukocytosis from g-csf). afebrile. hypotension and tachycardia with aspiration pneumonia. antibiotics as above. . # diarrhea: likely due to antibiotics. severe, resolving. c. diff toxin x3 negative. guaic stool negative x3. loperamide prn. . # port clot: angio study and stripping of fibrin sheath done . . # urethral obstruction: secondary to bph and probably tumor/ascites. continued outpatient alfuzosin (uroxatral); allergy to tamsulosin. . # portal vein thrombosis: saag not c/w portal htn and ct did not show progression of clot burden. continued enoxaparin. . # pleural effusions and acute pulmonary edema: given furosemide 20mg iv x1 in icu. weaned off o2. . # htn: (formulary substitution) stopped because of hypotension. . # hypercholesterolemia: stopped etezimibe and pravastatin based on family meeting agreement . . # pain (abdomen): continued prn morphine. stopped mscontin due to well controlled pain. therapeutic paracentesis x3 (, , and ). . # hypernatremia: volume depleted due to diarrhea, recent n/v, and poor po intake. resolved. stopped iv fluids with new dyspnea and pulmonary congestion. . # fen: regular diet, normal swallow eval. iv fluids stopped. repleted hypokalemia and hypophosphatemia (worsened from diarrhea). metabolic acidosis also due to diarrhea, now resolved. . # gi ppx: ppi. bowel regimen on hold with diarrhea. . # dvt ppx: enoxaparin for portal vein thrombosis and pe. . # precautions: none. . # full code. medications on admission: alfuzosin 10 mg po once a day enoxaparin 100 mg/ml syringe - inject 100 mg sq ezetimibe 10 mg po once a day fluticasone 50 mcg suspension 1 spray nasally prn congestion irbesartan 300 mg po once a day lidocaine-diphenhyd--mag- 400 mg-400 mg-40 mg-25 mg-200 mg/30ml mouthwash - swish and swallow q2-3hr prn morphine 15 mg extended release po bid morphine 15 mg po q3-4hr prn pain omeprazole 20 mg po daily pravastatin 80 mg po once a day prochlorperazine maleate 10 mg po q8hr prn nausea zolpidem 6.25-12.5 mg ext release multiphase po qhs. zofran prn aspirin 81 mg delayed release (e.c.) po once a day discharge medications: 1. alfuzosin 10 mg extended release 24 hr po daily. disp:*30 tablet extended release 24 hr(s)* refills:*2* 2. fluticasone 50 mcg/actuation, sig: one (1) spray nasal daily prn congestion. 3. morphine 15 mg extended release po q12h. 4. morphine 15-30 mg po q4h prn pain. 5. omeprazole 20 mg po daily. 6. prochlorperazine maleate 10 mg po q6h prn nausea. 7. aspirin 81 mg po daily. 8. enoxaparin 100 mg/ml sc q12h. 9. zofran odt 4-8 mg rapid dissolve po q8hr prn nausea. disp:*30 tablet, rapid dissolve(s)* refills:*0* 10. imodium a-d 2 mg po q6hr prn diarrhea x5 days. 11. lidocaine-diphenhyd--mag- 200-25-400-40mg/30ml mouthwash sig: 30ml mucous membrane qid prn pain. 12. zolpidem 6.25-12.5mg po qhs prn insomnia. 13. acetaminophen 325-650mg po q6h prn pain. 14. loperamide 2 mg po qid prn diarrhea. 15. baclofen 10 mg po q8h prn hiccups. 16. pantoprazole 40 mg po q24h. 17. potassium & sodium phosphates 280-160-250 mg powder in packet po tid: neutra-phos. 18. augmentin 875-125 mg po bid x3 days. discharge disposition: extended care facility: discharge diagnosis: nausea with vomiting. ascites (fluid in the abdomen). metastatic colon cancer. portal vein thrombosis (blood clot in the abdomen). neutropenia (low white blood cell count). blocked port (fibrin sheath). aspiration pneumonia. hiccups. altered mental status (acute delirium, confusion). pulmonary embolus (blood clot in lung). diarrhea. hypertension (high blood pressure). hypotension (low blood pressure). hypokalemia (low potassium level). hypophosphatemia (low phosphorous level). discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital for severe nausea, vomiting, and abdominal pain. the nausea/vomiting was a likely complication of your recent chemotherapy for metastatic lung cancer. ct scan of the abdomen showed increased fluid in your abdomen (ascites) and you underwent a paracentesis (drainage of fluid from the abdomen). since you still had pain and fluid in the abdomen, you underwent a second paracentesis. both procedures removed a total of 7 liters of fluid. nausea and vomiting worsened despite nausea medication and you then aspirated some vomit (going down the wind-pipe into the lungs) causing a severe pneumonia. you had an episode of low blood pressure and were satrted on iv antibiotics. because your oxygen was dangerously low, you were transferred to the intensive care unit and needed oxygen support for several days. a ct scan of the chest showed a pulmonary embolus (blood clot in the lung) in addition to the pneumonia. the blood clot was very small and its age was unclear. therefore, you remained on the current dose of enoxaparin (lovenox). your white blood cell count was low due to chemotherapy and a medication called g-csf (neupogen) was given to help this. you also became temporarily delirious (confused) because of a dose of lorazepam (ativan) given for nausea. you should never take this medication again. a swallow evaluation was normal. lastly, you developed severe diarrhea, possibly from the antibiotics. tests for infection were negative. after iv fluids, electrolyte replacement for low potassium and low phosphorous, and loperamide (immodium), the diarrhea improved. you will need to complete a course of antibiotics for the pneumonia. more fluid from the abdomen (ascites) was drained the day you left the hospital. . medication changes: 1. viscous lidocaine/maalox/diphenhydramine for mouth/throat pain as needed. 2. baclofen 10 mg 3x a day as needed for hiccups. 3. neutra-phos 3x a day for low phosphorous levels. your phosphorous levels should be monitored and this can be stopped when it is normal. 4. amoxicillin/clavulanate (augmentin) 2x a day for three days to complete the antibiotic course for aspiration pneumonia. 5. do not take lorazepam (ativan). followup instructions: department: hematology/oncology when: wednesday at 1 pm with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: wednesday at 2:00 pm with: , rn building: campus: east best parking: garage procedure: percutaneous abdominal drainage percutaneous abdominal drainage irrigation of vascular catheter diagnoses: unspecified pleural effusion unspecified essential hypertension hypopotassemia nausea with vomiting other and unspecified hyperlipidemia hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) pneumonitis due to inhalation of food or vomitus antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use long-term (current) use of anticoagulants hyperosmolality and/or hypernatremia drug induced neutropenia mechanical complication of other vascular device, implant, and graft secondary malignant neoplasm of retroperitoneum and peritoneum portal vein thrombosis malignant neoplasm of other specified sites of large intestine personal history of pulmonary embolism hiccough urinary obstruction, unspecified 

Answer: The patient is high likely exposed to