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: aspirin / zantac / ciprofloxacin / taxol / oxycodone attending: chief complaint: t4-5 lesion major surgical or invasive procedure: t4-t5 corpectomy/cage, t3-6 lami,post instrumented fusion t2-t7, iliac crest bone harvest history of present illness: patient is a 75m electively admitted on for planned thoracic fusion and resection of vertebral body lesion. patient has stage iv nslc with brain and spinal mets underwent t4-t5 corpectomy/cage, t3-6 laminectomy, post instrumentation and fusion t2-t7 on . post procedure course was complicated by afrvr and transient hypotension. patient was called out of the sicu on to step down unit. . he continued to be in atrial fibrillation. he was treated initially with zosyn which was switched to cefepime per id recs for a hospital acquired pneumonia. the patient was then found to be diaphoretic and unresponsive at 2 am. his fs was found to 24. he had received glyburide while npo peri-procedure. his bp was 124/62, hr 85, t 92.7. he recieved amp of dextrose and his bs increased to 175. patient was also placed on a bear hugger. his temp eventually recovered early morning and has been normal since. patient currently denies chest pain, shortness of breath, abdominal pain, n/v/d, dysuria, , chills, nightsweats, headache, focal weakness, numbness, change in vision or hearing. his wife was present during the presentation and helped with history as the patient was delerious. she states that patient has had similar confusion symptoms during past hospitalization which resolves with discharge and going back home. past medical history: atrial fibrillation hypertension prostate cancer in treated with resection and radiation benign parotid tumor resected in bladder diverticula requiring resection nasal polyps inguinal hernia social history: heavy smoking until quit in , occasional alcohol, no drug use. good family support-wife. children. family history: both parents with lung cancer, father with brain tumor as well. physical exam: vs: t 97.4 hr 90 afib 91 bp 120/62 rr 20 100% on 6lnc gen: nad. pleasant gentleman, delerious. oriented to only self. able to follow commands. heent: ncat. sclera anicteric. perrl. op clear, no exudates or ulceration. neck: supple, jvp difficult to assess. cv: s1s2 irreg irreg, ii/vi mid peaking systolic murmur at best at b/l sternal border chest: resp were unlabored, no accessory muscle use. diminished bs in b/l bases (anteriorly) abd: soft, ntnd. ext: no c/c/edema. neuro: cn iii- intact, strength 5/5 b/l pertinent results: labs on admission: 09:20pm blood wbc-11.9* rbc-3.91* hgb-11.2* hct-33.9* mcv-87 mch-28.5 mchc-32.9 rdw-15.8* plt ct-307 07:00pm blood pt-14.5* ptt-26.9 inr(pt)-1.3* 07:00pm blood fibrino-416* 09:20pm blood glucose-192* urean-19 creat-0.8 na-137 k-5.1 cl-104 hco3-24 angap-14 09:20pm blood calcium-8.4 phos-3.3 mg-1.6 imaging: ct t-spine : findings: again seen is a compression fracture of the t5 vertebral body. again seen is a small amount of retropulsed bone that encroaches on the spinal canal and indents the spinal cord. the posterior margin of the vertebral body is fractured, and this fracture extends into the pedicles bilaterally. the facet joints appear intact. there is a small vacuum phenomenon anteriorly in the vertebral body, and tiny vacuum phenomenon in the t4-5 and t5-6 intervertebral discs. images of the remaining vertebral bodies included in this study demonstrate osteoporosis, but no evidence of fracture. conclusion: t5 compression fracture with kyphotic angulation and bone retropulsed into the spinal canal compressing the spinal cord. ct t-spine : findings: the patient is status post recent posterior fusion of t2 to t7 with placement of posterior fusion construct and bony fusion material, and intervertebral cage placement at t4-t5, and extensive post-surgical changes in the region. there is marked metallic streak artifact, significantly limiting the evaluation of the spinal canal. there is subcutaneous emphysema, post- surgical. at t2 level, there is tiny hyperdense focus within the spinal canal (2:), which could relate to the streak artifact; however, hemorrhage cannot be excluded. there are ng and et tubes in situ. right lower lobe consolidation and effusion, incompletely imaged, and underlying emphysema are similar in overall appearance to the recent study. impression: immediately status post posterior fusion, from the t2 to t7 level, with t4-t5 partial corpectomy and intervertebral cage placement, and significant streak artifact limiting evaluation for epidural hemorrhage, with: 1. focal hyperdensity in the right posterolateral aspect of the spinal canal, at about the level of t2, likely relates to the streak artifact; however, hemorrhage is difficult to exclude entirely. 2. no residual retropulsed bony fragment in the spinal canal. 3. other than expected surgical result, no acute change in alignment. 4. the tips of the right-sided transpediculate screws, at the t3 and t6 levels transgress the anterior vertebral cortex. lenis : findings: grayscale and color doppler son were performed of the bilateral common femoral, superficial femoral, and popliteal veins. these demonstrate normal flow, compressibility and augmentation. impression: no evidence of dvt. cta of chest : ct of the chest with iv contrast: there are no filling defects within the pulmonary arterial vasculature. there is evidence of prior right lower lobe lobectomy including shift of the mediastinal structures to the right with right lung volume loss and right upper lobe expansion. there is less than expected enhancement of the inferior right upper lobe concerning for consolidation (3:74). a moderate right pleural effusion has increased in size compared to the pet ct. circumferential thickening of the pleural surface, particularly at the right lung base, likely reflects chronic pleural effusion. there is evidence of advanced metastatic disease including an irregular area of nodular pleural thickening seen at the right lung apex posteriorly abutting lytic destruction of an adjacent thoracic vertebral body status post posterior fixation (3:32). multiple abnormal lymph nodes evident within the lower posterior mediastinum with the largest measuring 1.9 x 1.87 mm (3:100). there are a few solid-appearing mediastinal lymph nodes, however, none meet criteria for pathology by ct. extensive emphysematous changes, most evident in the hyperexpanded right upper lobe and right middle lobe are evident. multiple soft tissue metastatic nodules within the left upper and lower lobes have increased in size compared to the pet ct of concerning for disease progression. for example, soft tissue nodule abutting the major fissure measures 1.5 x 1.5 cm, previously 1.1 x 1.1 cm (3:58). there is a small left pleural effusion with associated atelectasis. the imaged portions of the upper abdomen demonstrate prominence of both adrenal glands better assessed by recent pet ct. patient is status post posterior fusion of multiple upper thoracic vertebral bodies and introduction of inner body spacers. there is no ct evidence of hardware loosening. no new lytic osseous metastases are present. impression: 1. no pulmonary embolism. 2. right upper lobe pneumonia, most evident at the right lung base. 3. worsening widespread thoracic metastatic disease compared to the pet ct of . 4. chronic moderate right pleural effusion with smaller left pleural effusion, increased in size compared to the pet ct. surface echo : the left atrium is mildly dilated. the estimated right atrial pressure is 10-20mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50-55%). the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets are moderately thickened. there is moderate aortic valve stenosis (valve area 1.0-1.2cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the estimated pulmonary artery systolic pressure is higher and the severity of aortic stenosis has progressed. biventricular systolic function is similar. clinical implications: the patient has moderate aortic stenosis. based on acc/aha valvular heart disease guidelines, if the patient is asymptomatic, a follow-up echocardiogram is suggested in years. microbiology: 12:11 pm swab source: left upper back lesion. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. wound culture (final ): due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. staphylococcus, coagulase negative. sparse growth. anaerobic culture (final ): no anaerobes isolated. 3:00 am blood culture **final report ** blood culture, routine (final ): staphylococcus, coagulase negative. isolated from one set only. sensitivities performed on request.. anaerobic bottle gram stain (final ): reported by phone to @ 1440, . gram positive cocci in clusters. labs day prior to discharge: 140 99 17 ===========< 132 3.7 33 1.0 ca: 8.5 mg: 2.2 p: 3.1 12.3 > 8.3 / 26.8 < 520 pt: 14.2 ptt: 28.4 inr: 1.2 brief hospital course: 1. metestatic nscl: patient underwent t4-t5 corpectomy/cage, t3-6 laminectomy, post instrumentation and fusion t2-t7 on . post procedure course was complicated by afrvr and transient hypotension, severe hypoglycemic course and rul pna on cefepime. details of the post-op course are provided below. the patient needs pt/ot and ultimately rehab when stable clinically. he has staples/sutures in place which may be removed in follow up with neurosurgery shortly after discharge. he may bear weight but must not lift more than 10 pounds. 2. altered mental status: after transfer to the floor patient developed an altered mental status with concern for seizures, brain mets, hypercapnia. at transfer he was only oriented to person which apparently wasn't far from baseline. wife did not routine check his oreintation at home but confirmed that he was often confused and usually can't remember things from earlier in the day. at transfer he was pleasant and conversant but had no idea where he was or what month it was, and was at the same level of orientation on sunday morning. if mental status declines would consider hypoglycemia, infection, medications, brain mets, and delirum as likely causes. b12 high, folate and tsh both wnl. wife confirms significantly different from baseline. concern for myoclonus (right arm), nph. head mri showed vasogenic edema, slightly worse, but no new mets. it was agreed not to start to keprra at this time. thiamine was started. an eeg was performed, the results of which were pending at the time of discharge. 3. dyspnea/pulmonary/hypercapnia: patient had a new increased oxygen requirement after surgery, which was most likely secondary to a rul pneumonia on top of progressive metastatic lung disease. he required 6l o2 at first, which gradually decreased to 3l. prior to admission he was 95% on room air. no evidence of pe on cta , and repeated cxrs showed an evolving pna on top of underlying neoplastic disease. the patient remained afebrile. for his pneumonia he was started on broad coverage with cefepime, vancomycin with concern for hospital acquired pneumonia. towards the end of his hospitalization there was some concern over hypercapnia given the patient's mental status changes. blood gases showed co2 retention with a mixed acid-base disorder. pulmonary was consulted and the patient was started on nppv to improve ventilation (bipap 12/5) a 3-day course of acetazolamide and albuterol/atrovent nebs. the patient did not tolerate bipap well, however his hco3 consistently trended downwards in the final days of his hospitalization. 4. bacteremia: two weeks into his admission the patient developed acute mental status changes and hypotension concerning for sepsis. he was started on broad coverage including cefepime and vancomycin with concern for pneumonia. blood cultures from eventually grew out coagulase negative staphylococcus in bottles, likely a contaminant. coverage was eventually narrowed to cefepime for coverage of pneumonia, which was changed to cefpodoxime upon discharge, for a total of 10 days of antibiotics. 5. dmii: patient had a hypoglycemic episode shortly after surgery. endocrinology was consulted for assistance with management of the patient's blood sugar control including the use of insulin and hypoglycemic medications. he was discharged on 5mg glyburide every morning and 2.5mg glyburide every evening. 6. anemia: the patient has had chronic anemia. during his admission he had a brief episode of frank hematuria after attempting to remove his own catheter. urology was consulted and a 2-way catheter was placed. a total of approximately 500cc of blood was lost. the patient's hematocrit remained stable but anemic, in the range of 25-28%. prior to discharge he was given 1 unit pcbcs. 7. atrial fibrillation: patient has a history of chronic af rate controlled on metoprolol and verapamil. shortly after surgery the patient went into af with rvr and susequently became tachypnic, likely multifactorial in etiology, including post-operative state, metastatic nslc and possible pna. anticoagulation was originally held due to brain metasteses but was restarted on lovenox after surgery. discharge lovenox dose is 80mg every 24 fhours. medications on admission: doxazosin 4 mg',enoxaparin,flovent 2puffs',glyburide'',metoprolol 50'', percocet,verapamil 120',colace',senna',mvi' discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for , pain. 2. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 5. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 6. doxazosin 4 mg tablet sig: one (1) tablet po hs (at bedtime). 7. glyburide 5 mg tablet sig: three (3) tablet po daily (daily). 8. quetiapine 25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 10. enoxaparin 80 mg/0.8 ml syringe sig: one (1) subcutaneous daily (daily). 11. glyburide 2.5 mg tablet sig: two (2) tablet po daily (daily). 12. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 13. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) puff inhalation q4h (every 4 hours). 14. verapamil 40 mg tablet sig: 2.5 tablets po q8h (every 8 hours). 15. cefpodoxime 100 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 3 days. disp:*12 tablet(s)* refills:*0* 16. glyburide 2.5 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 17. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). 18. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 19. fluticasone 110 mcg/actuation aerosol sig: one (1) puff inhalation (2 times a day). 20. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 21. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. 22. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. discharge disposition: extended care facility: - discharge diagnosis: primary: 1. nsclc with brain/spine mets 2. pna 3. bacteremia 4. osa secondary: 1. dm-ii 2. htn 3. atrial fibrillation discharge condition: neurologically stable, stable discharge instructions: ?????? do not smoke. ?????? keep your wound(s) clean and dry / no tub baths or pool swimming for two weeks from your date of surgery. ?????? no pulling up, lifting more than 10 lbs., or excessive bending or twisting. ?????? limit your use of stairs to 2-3 times per day. ?????? have a friend or family member check your incision daily for signs of infection. ?????? take your pain medication as instructed; you may find it best if taken in the morning when you wake-up for morning stiffness, and before bed for sleeping discomfort. ?????? do not take any anti-inflammatory medications such as motrin, advil, aspirin, and ibuprofen etc. unless directed by your doctor. ?????? increase your intake of fluids and fiber, as pain medicine (narcotics) can cause constipation. we recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? clearance to drive and return to work will be addressed at your post-operative office visit. call your surgeon immediately if you experience any of the following: ?????? pain that is continually increasing or not relieved by pain medicine. ?????? any weakness, numbness, tingling in your extremities. ?????? any signs of infection at the wound site: redness, swelling, tenderness, and drainage. ?????? greater than or equal to 101?????? f. ?????? any change in your bowel or bladder habits (such as loss of bowl or urine control). followup instructions: follow up instructions/appointments ??????please return to the office in days (from date of surgery) for removal of your staples/sutures and a wound check. this appointment can be made with the nurse practitioner. please make this appointment by calling . if you live quite a distance from our office, please make arrangements for the same, with your pcp. ??????please call ( to schedule an appointment with dr. to be seen in 6 weeks. ??????you will not need x-rays/ct-scan prior to your appointment, as this was done during your acute hospitalization. procedure: other cystoscopy other excision of joint, other specified sites excision of bone for graft, other bones transfusion of packed cells dorsal and dorsolumbar fusion of the posterior column, posterior technique repair of vertebral fracture insertion of indwelling urinary catheter insertion of interbody spinal fusion device fusion or refusion of 4-8 vertebrae diagnoses: other iatrogenic hypotension obstructive sleep apnea (adult)(pediatric) anemia, unspecified congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation personal history of malignant neoplasm of prostate aortic valve disorders surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled osteoporosis, unspecified cerebral edema malignant neoplasm of other parts of bronchus or lung personal history of venous thrombosis and embolism gross hematuria acute diastolic heart failure ventilator associated pneumonia delirium due to conditions classified elsewhere secondary malignant neoplasm of bone and bone marrow secondary malignant neoplasm of other parts of nervous system radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure mixed acid-base balance disorder pathologic fracture of vertebrae other ill-defined cerebrovascular disease tachypnea generalized nonconvulsive epilepsy, without mention of intractable epilepsy 

Answer: The patient is high likely exposed to