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: augmentin attending: chief complaint: fever major surgical or invasive procedure: central line placement history of present illness: mr. is a 78m with stageiv nsclc on palliative tarceva who presents from his nursing facility with fevers x2d as high as 103.6f. per paperwork from rehab, he was given levofloxacin 500mg. . of note, he was recently admitted to the omed service, having presented with fevers and discharged on on cefpodoxime and azithromycin for suspected pneumonia. . in the ed, initial vs were t98 p 73 bp 86/51 rr 22 98% on . he was given vancomycin, cefepime, flagyl, acetaminophen, zofran, and started on peripheral dopamine. awake and mentating, making small amounts of dark urine. ct abdomen done for h/o 1day of diarrhea, noncontrast showed ?of colitis. got 5l of saline. bp remains 70's systolic on 15mcg dopamine and levophed. . on the floor, he denies any complaints - though initially reported some abdominal pain to the rn. review of systems otherwise negative, though unclear if patient's history is reliable. past medical history: past medical history: 1. hypertension 2. atrial fibrillation 3. copd 4. h/o bilateral hernia repair 5. aspiration . oncologic history: (per omr note by dr. 1. stage iib nonsmall cell lung cancer (adenocarcinoma) s/p surgical resection and adjuvant chemotherapy. 2. fdg avid left lower lung nodule with non-malignant biopsy in . 3. stage iv nonsmall cell lung cancer (bone and lung recurrence)diagnosed in . treatment: 1. status post right thoracotomy with right lower lobectomy, mediastinal lymph node sampling in . 2. status post 4 cycles of carboplatin 5auc and pemetrexed 500mg/m2 every 21 days of a 3 week cycle today. started in and last dose was given . 3. status post 3000 cgy of radiotherapy to left hip lesion completed in . 4. started erlotinib 150 mg/day in . 5. h/o mets to sacral spine s/p radiation, on narcotics for pain control social history: 70+ year h/o smoking. currently at rehab facility. family history: unknown cause of death of mother or father. the patient does have siblings that are alive. no recurrent cancers in the family. physical exam: on admission: vitals 96.3 102 101/58 21 100% on 4l general chronically ill appearing man, appears anxious heent sclera anicteric, dry mmm neck supple pulm lungs with few bibasilar rales l>r cv tachycardiac regular s1 s1 no m/r/g abd soft +bowel sounds tender to palpation throughout without rigidity or guarding extrem warm tr bilateral edema palpable distal pulses neuro awake and interactive, oriented to hospital in , does not know date derm no rash or jaundice lines/tubes/drains foley with yellow urine, rij pertinent results: on admission : wbc-10.9 rbc-3.71* hgb-10.3* hct-32.1* mcv-87 mch-27.8 mchc-32.2 rdw-17.1* plt ct-410 neuts-55 bands-27* lymphs-6* monos-10 eos-0 baso-0 atyps-0 metas-2* myelos-0 pt-17.9* ptt-33.4 inr(pt)-1.6* glucose-143* urean-35* creat-1.6* na-130* k-4.1 cl-94* hco3-26 angap-14 alt-17 ast-34 alkphos-60 totbili-0.7 albumin-2.6* calcium-7.6* phos-3.7 mg-2.0 feces positive for c. difficile toxin by eia ekg: probable sinus rhythm with low amplitude p waves (visible in lead v1) versus ectopic atrial rhythm. right bundle-branch block. left anterior fascicular block. q-t interval prolongation. compared to the previous tracing of p waves are less apparent. q-t interval is more prolonged. cxr: 1. stable post-surgical changes in the right lung from prior right lower lobectomy and upper wedge resection due to known non-small cell lung cancer. 2. hazy opacity in the left lower , reflect atelectasis. ct abd/pelvis: 1. bibasilar lung consolidations, worse when compared to prior exam. differential diagnosis includes infectious etiologies as well as a slow growing lesion such as bronchoalveolar carcinoma. clinical correlation is recommended. 2. no evidence of small bowel obstruction. colon appears relatively featureless with air-fluid levels and possibly pericolonic fat stranding versus third spacing. these findings may suggest a colitis. 3. extensive vascular calcifications. 4. large prostate. 5. s1 vertebral body fracture with buckling of the superior cortex, worse when compared to prior exam. left leni: impression: no left lower extremity dvt. kub: findings: small bowel loops containing air are seen without distension. there is a paucity of air in the left lower quadrant which might be due to liquid stool within the descending colon. no free air is seen on the right lateral decubitus film. the visualized osseous structures are unremarkable. the right lung base is not well seen with the dome of the diaghragm being pushed superiorly. this correlates with the right lower atelactasis on the corresponding ct. impression: no distended loops of bowel seen. brief hospital course: mr. is a 78m with stage iv nslc who presents with fevers from his rehab facility. . * hypotension: patient presented with hypotension concerning for sepsis. he was briefly on levophed and was taken off of pressors when sbp 100s-110s. his hypotension was probably due to hypovolemia from diuresis but severe hypotension in setting of developing sepsis was also considered. lactate down to 1.0 from 1.3 on admission with svo2 73. on the floors, his sbp's ranged in the 130's to 140's and he was restarted on his home doses of lasix was held for the several days prior to discharge because he was autodiuresing. he needs to be re-evaluated regularly for whether lasix needs to be restarted. he will likely need his lasix restarted at some point at rehab. his pressures remained stable throughout hospitalization. . * fever: patient's fever likely caused by c diff as patient is toxin positive, although aspiration pneumonia was also considered a possibility given evidence of dysphagia on prior video swallow. his underlying pulmonary malignancy predisposes him to a post-obstructive pneumonia. however the absence of cough or hypoxia made a pulmonary etiology less compelling. blood and urine cultures are negative. his c difficile colitis was originally treated with po vancomycin and iv flagyl. prior to discharge, as diarrhea began to resolve, he was switched to po flagyl alone, to be continued for a two week course (until ). . * l leg swelling and pain: patient had lower extremity pain edema greater on left than right after receiving fluid resuscitation in the icu. leni showed no evidence of dvt. he was diuresed with lasix until his fluid output was negative. he was autodiuresing on discharge so his lasix was held. his fluid status should be reassessed daily to determine if he needs to be restarted on lasix. * hyponatremia: patient's hyponatremia resolved after intravenous fluids, which supports hypovolemia as cause on admission. review of omr shows na's running ~130. at last discharge, thought to have a component of siadh. * acute renal failure: patient had creatinine elevated to 1.4 and fena was 0.1 on admission. creatinine has improved to 0.7-0.8 (his baseline). his acute renal failure has resolved and was likely pre-renal as it improved with ivf. * anemia: his hematocrit is down from admission but suspect this was secondary to hemoconcentration. his anemia is consistent with baseline. * nsclc: advanced disease, on palliative chemotherapy. social work and palliative care were consulted throughout this hospitalization and discussed goals of care with the family. erlotinib will be restarted on and should be taked every other day. he will follow up with dr. . * atrial fibrillation: his sotalol was restarted now that his hypotension resolved. # nutrition ?????? patient has aspiration risks and is unable to swallow pills easily. he was evaluated by nutrition and kept on a pureed diet with tid ensure. he also had an elevated inr despite not being on anticoagulation which possibly could be due to malnutrition. inr improved after administration of one dose of vitamin k. # oral thrush: patient failed nystatin swish and swallow. he was loaded with 400mg fluconazole and should continue 200mg daily until . #pain control: patient was maintained on methadone and diluadid prn during hospitalization. his methadone should be tapered and pain reassessed daily while in rehab. medications on admission: at rehab: erlotinib 100mg daily simvastatin 10mg daily lasix 20mg daily sotalol 80mg nifedipine 30mg daily methadone 15mg tid folate lidoderm patch , , mom, dulcolax, lactulose, senna, guiafenesin, colace, tylenol all prn zofran prn neurontin 300mg q12h heparin 5000 units sq tid discharge medications: 1. heparin (porcine) 5,000 unit/ml solution : one (1) injection injection tid (3 times a day). 2. metronidazole 500 mg tablet : one (1) tablet po q8h (every 8 hours): continue util . 3. neurontin 300 mg capsule : one (1) capsule po every twelve (12) hours. 4. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day) as needed for constipation: once diarrhea subsides, please start taking as standing dose . 5. methadone 10 mg tablet : one (1) tablet po tid (3 times a day). 6. simvastatin 10 mg tablet : one (1) tablet po daily (daily). 7. acetaminophen 325 mg tablet : 1-2 tablets po q4h (every 4 hours) as needed for pain: no more than 4g in 24 hours. 8. sotalol 80 mg tablet : one (1) tablet po bid (2 times a day). 9. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily): 12 hours on, 12 hours off. 10. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day). 11. nifedipine 30 mg tablet sustained release : one (1) tablet sustained release po daily (daily). 12. folic acid 1 mg tablet : one (1) tablet po daily (daily). 13. therapeutic multivitamin liquid : five (5) ml po daily (daily). 14. oral wound care products gel in packet : one (1) ml mucous membrane tid (3 times a day) as needed. 15. miconazole nitrate 2 % powder : one (1) appl topical tid (3 times a day) as needed for fungal rash-groin. 16. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 17. simethicone 80 mg tablet, chewable : one (1) tablet, chewable po qid (4 times a day) as needed for gas. 18. dilaudid 2 mg tablet : 1-2 tablets po every four (4) hours as needed for pain. 19. senna 8.6 mg tablet : two (2) tablet po twice a day as needed for constipation: please start taking after diarrhea has resolved. 20. polyethylene glycol 3350 17 gram (100 %) powder in packet : one (1) dose po once a day as needed for constipation: please use as needed after diarrhea has resolved. 21. dulcolax 10 mg suppository : one (1) rectal once a day as needed for constipation: please start using as needed after diarrhea has resolved. 22. zofran 4 mg tablet : one (1) tablet po every eight (8) hours as needed for nausea. 23. ambien 5 mg tablet : one (1) tablet po at bedtime as needed for insomnia. 24. fluconazole 200 mg tablet : one (1) tablet po q24h (every 24 hours): continue until . 25. erlotinib 100 mg tablet : one (1) tablet po qod. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: 1. clostridium difficil colitis 2. dehydration 3. hyponatremia 4. hypotension secondary diagnosis: 1. non small cell lung cancer discharge condition: stable, afebrile bm's per day. discharge instructions: you were admitted to the hospital on with fevers secondary to clostridium dificile colitis (an infection in your colon). you are being treated with an antibiotic called flagyl. you need to continue this antibiotics until . you should stop taking lasix (water pill). your body has been eliminating excess fluid well without the lasix. your doctors your fluid status at rehab and decide whether or not you need lasix in future. you can continue to take methadone with dilaudid as needed for breakthrough pain. your doctors at rehab taper your methadone as needed. never drive while taking these medications or perform any activities requiring a fast reaction time. never drink alcohol with these medications. once your diarrhea stops, you should start taking colace and senna daily to prevent constipation, which is a common side effect of narcotics. you also had thrush in your mouth. continue to take fluconazole 200mg daily until . you should restart your erlotinib on and take it every other day. use miconazole for the fungal rash in your groin. apply it four times a day. please return to the emergency room if you have worsening diarrhea >10 bm per day, bloody/black stools, fever>100.4, chest pain, shortness of breath, or any other symptoms concerning to you. followup instructions: please follow up with dr. in weeks. md, procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnoses: anemia, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia hyposmolality and/or hyponatremia severe sepsis chronic airway obstruction, not elsewhere classified atrial fibrillation candidiasis of mouth septic shock intestinal infection due to clostridium difficile malignant neoplasm of other parts of bronchus or lung secondary malignant neoplasm of bone and bone marrow 

Answer: The patient is high likely exposed to