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: penicillins attending: chief complaint: chief complaint: shortness of breath major surgical or invasive procedure: pericardiocentesis history of present illness: events / history of presenting illness: 58 year old male with metastatic renal ca to lung and bone (last chemo ), who presented to clinic on day of admission with 2 days of shortness of breath with occasional mild confusion, found to be hypoxic to high 80's on room air. wife states that for the past few weeks, he has had dyspnea on exertion, it had been attributed to anemia and he received prbc trasnfusions, however, shortness of breath became more pronounced over the past 2 days. in clinic, he was placed on 4l nasal canula and o2 sat increased to 93% with resp rate of 40. he denied any chest pain or abdominal pain. he complained of slight cough. per wife, he had fever to 101f at home the night prior to admission but afebrile in clinic. . ed: he was intubated and sedated with fentanyl/versed. given sodium bicarb, calcium chloride, insulin with d50 for k 6.8. ekg showed low voltage and bedside echo with pericardial effusion and tamponade physiology. cxr with pulm edema, bilateral pleural effusions. he was given levofloxacin 750mg iv x 1 for possible pneumonia. cardiology was consulted and he was taken urgently to cath lab where 1260cc straw colored fluid drained from pericardium. . review of systems limited by patient intubation/sedation. per records and discussion with family, there is no prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, hemoptysis, black stools or red stools. all of the other review of systems were negative. . *** cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. (+) shortness of breath/doe . past medical history: past medical history: cad s/p mi , s/p stent atrial fibrillation htn hypercholesterolemia gout anxiety right wrist fusion gerd bilateral hearing loss . onc hx: metastatic renal cell 1. nephrectomy for clear cell carcinoma in 09/. 2. resection of a right seventh rib metastasis, which revealed metastatic high-grade renal cell carcinoma. 3. high-dose il-2 therapy, which was complicated by the development of accelerated angina. he is now status post cardiac catheterization with coronary artery stent placement. 4. cyberknife therapy to a medial paramediastinal lung lesion. 5. sutent as a single begun in 09/. this was complicated by severe gi side effects and dehydration. the dose was reduced and despite this reduction, he was admitted in to a local hospital with rapid atrial fibrillation and associated syncope which resulted in an accident while driving. he sustained several rib fractures as a result. 6. currently, cycle 8 of sutent 2 weeks on/ 1 week off, plus gemzar begun because of disease progression. . social history: social history: married, grown children, lives with wife, 2 dogs, 1 cat, on disability from running shelter for homeless veterans in . family history: . family history: mother, 89 h/o ovarian ca, aunt w/ ovarian ca, father deceased 83 w/ cad . physical exam: physical examination: vs: t 96.9f hr 83 bp 122/79 rr 16 100% on ac 600x14/100%/5peep abg on ac settings: 7.31/44/130 gen: intubated, lightly sedated heent: intubated, ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: difficult to assess jvp cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no s4, no s3. chest: crackles at left base anteriorly, no wheeze. pericardial drain with small amount of straw colored fluid abd: soft, nd/nt, no abdominal bruits. ext: warm, trace ankle edema bilaterally. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: 2+ dp left: 2+ dp pertinent results: admission labs: () laboratory data: 130.|.100.|.18 121 --------------- 6.5.|.22.|.1.7 ca: 8.7 mg: 2.2 p: 4.6 d . 3:05 p.m. ck: 119 mb: 4 trop-t: 0.02 . wbc 9.4 hct 29.4 plt 250 mcv 103 n:86.1 l:6.7 m:6.9 e:0.2 bas:0.2 . pt: 16.5 ptt: 27.2 inr: 1.5 . studies: ekg: nsr hr 79, nl axis and slight pr prolongation 208msec. low voltage (although unchanged from is lower voltage than ) . cxr: limited study with marked cardiomegaly, pulmonary edema, and bilateral pleural effusions, new since the examination. a focal consolidation, particularly on the left, cannot be excluded. . echo (): large pericardial effusion. rv diastolic collapse, c/w impaired fillling/tamponade physiology. significant, accentuated respiratory variation in mitral/tricuspid valve inflows, c/w impaired ventricular filling. overall left ventricular systolic function is low normal (lvef 50-55%). rv systolic function appears depressed. . cardiac cath/ pericardiocentesis (): 1. pericardiocentesis revealed initial elevated pericardial pressure of 35mmhg subsequently decreasing to 13mmhg after drainage of 1.4 liters of serosanguinous pericardial fluid. . echo ( - s/p pericardiocentesis) lv wall thicknesses and cavity size are normal. mild regional left ventricular systolic dysfunction with inferior/inferolateral thinning and hypokinesis. overall left ventricular systolic function is mildly depressed (lvef= 40-45%). there is no pericardial effusion. . echo (): mild regional lv systolic dysfunction with inferolateral akinesis and inferior hypokinesis. overall lv systolic function is mildly depressed (lvef= 40-45 %). rv size normal. small to moderate sized pericardial effusion. there is significant, accentuated respiratory variation in mitral valve inflows, consistent with impaired ventricular filling. not right ventricular/right atrial collapse identified. compared with the prior study (images reviewed) of , left ventricular wall motion abnormlaity appears similar. respiratory variation in mitral inflow is unchanged. the pericaridal effusion is now slightly larger. . echo (): dilated. ra pressure is 5-10 mmhg. lv wall thicknesses and cavity size are normal. mild regional lv systolic dysfunction with focal akinesis of the basal half of the inferolateral wall and hypokinesis of the inferior wall. rv size and free wall motion are nl. no valvular disease. mild pulmonary artery systolic hypertension. there is a small to moderate sized circumferential pericardial effusion most prominent around the right atrium. brief right atrial diastolic collapse but normal transmitral doppler spectra. compared with the prior study (images reviewed) of , the size of the effusion is slightly greater around the right atrium, but transmitral doppler no longer suggests impaired filling. left ventricular systolic function is similar. brief hospital course: in summary, mr. is a 58 year old male with renal cell ca with metastases to the lung, bone, liver and right adrenal who presented with 2 days of increasing shortness of breath. in the er, he was hypoxic and found to have pericardial tamponade. he got a pericardiocentesis on with drainage of 1.2 l. . tamponade. patient was known to have a pericardial effusion by ct on (2 weeks prior to admission. echo showed intermittent rv collapse suggestive of tamponade and a significant pericardial effusion. on , cardiology drained 1300cc of straw colored fluid, which was sent for cytology. a repeat echo the morning after pericentesis showed resolution of the effusion. drain output decreased and so the pericardial drain was removed on . serial echocardiograms showed a gradual reaccumulation of pericardial fluid, but no acute signs of cardiac tamponade. consequently, a pericardial window procedure was not pursued at this time. on the day of discharge, he was asymptomatic, denied chest pain, shortness of breath, or lightheadedness and was displaying normal vital signs. he will go home with repeat echo on thursday () with close follow-up with his outpatient cardiologist. . mechanical ventilation. patient was found to be tachypneic and hypoxic in the ed. he was intubated in the ed. his repiratory failure was thought to be due to pulmonary edema from tamponade in addition to a questionable pnuemonia. patient had improvement of respiratory status after pericardiocentesis. patient quickly weaned from vent and extubated within 18 hours. he was requiring oxygen by nasal canula during stay which was titrated down with diuresis. . pulmonary edema. patient has cxr consistent with pulmonary edema, likely secondary to decreased cardiac output from pericardial tamponade. patient was given lasix with good response. . questionable pneumonia. patient had a fever to 101 on evening prior to admission and has possible infiltrate on cxr. he was started on levofloxacin on . on , he was febrile to 101, so antibiotics were broadened to aztreonam and flagyl, which was converted to levofloxacin and flagyl as an outpatient. . atrial fibrillation. patient went into atrial fibrillation with rvr on with a stable blood pressure. this was intially treated with iv lopressor. he was subsequently started on aspirin and standing metoprolol. he was loaded with iv amiodarone for 24 hours and then started on po amiodarone. he was started on a heparin drip on because he reamined in atrial fibrillation for 48 hours. he converted to normal sinus rhythm on the morning of and remained in such until discharge. . hyperkalemia. patient was initially hyperkalemic secondary to arf. this was treated with calcium gluconate, glucose and insulin, and kayexalate with resolution of hyperkalemia. . acute renal failure. arf is likely due to decreased cardiac output as a result of tamponade. baseline creatinine is 1-1.2. creatinine improved with drainage of pericardial fluid and gentle diuresis. . metastatic renal cell ca. patient has rcc with metastases to the lung, bone, right adrenal, and liver. lung metastases were treated with cyberknife. he is currently on gemzar and sutent with reportedly good response according to his oncologist. . anemia. patient was anemic on admission, likely due to myelosuppressive therapy with gemzar. . hypercholesterolemia. on zetia for hypercholesterolemia. medications on admission: current medications: loperamide 2 mg po qid prn diarrhea pantoprazole 40 mg po q24h lorazepam 1 mg po q8h prn anxiety clonazepam 2mg po qhs quetiapine 400 mg po qhs zolpidem 5 mg po hs prn ezetimibe 10 mg po daily discharge medications: 1. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 2. clonazepam 1 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 3. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 4. quetiapine 200 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 5. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 6. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed. 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. lorazepam 1 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety. 9. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 5 days. disp:*5 tablet(s)* refills:*0* 10. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 5 days. disp:*15 tablet(s)* refills:*0* 11. toprol xl 100 mg tablet sustained release 24 hr sig: 1.5 tablets sustained release 24 hrs po once a day. disp:*45 tablets* refills:*2* 12. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: pericardial tamponade atrial fibrillation renal cell cancer pneumonia discharge condition: good discharge instructions: you were admitted to the hospital with a build up of fluid around your heart which was treated with pericardial drainage. you also had a heart arrhythmia called atrial fibrillation which we are treating with aspirin and a new medication called amiodarone. . please continue to take all medicines as prescribed. your imdur was held while you were in the hospital due to low blood pressure. please speak to your cardiologist before restarting this medication. . we are also treating you for pneumonia. you were prescribed two antibiotics - levofloxacin and flagyl, and you will have 5 more days of each to complete the course. . if you have any chest pain, shortness of breath, heart palpitations or lightheadedness please seek immediate medical attention because this could be a sign of arrhythmia or of reaccumulation of fluid around your heart. . please go to the echocariogram lab on 3 to obtain copies of your echocardiograms before you leave and bring them with you to your cardiology appointment. . you have an echocardiogram scheduled for thursday () to look at the amount of fluid around your heart, your cardiologist will dr. will follow-up the results with you. please make sure to follow up with your oncologist and with your cardiologist; we have made appointments for you. followup instructions: please follow-up with your primary care provider . within one week of discharge from the hospital - please speak with your pcp about restarting synthroid and following up thyroid function tests. 1:00pm with your cardiologist dr. hospital . , phone: 9:00am echocardiagram at hospital. dr. . , phone: other appointments: provider: . phone: date/time: 1:00 provider: , rn phone: date/time: 1:30 provider: , md phone: date/time: 1:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube pericardiocentesis diagnoses: pneumonia, organism unspecified anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation unspecified disease of pericardium acute respiratory failure other and unspecified angina pectoris diarrhea secondary malignant neoplasm of lung secondary malignant neoplasm of bone and bone marrow kidney replaced by transplant acute idiopathic pericarditis 

Answer: The patient is high likely exposed to