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: indomethacin attending: chief complaint: right sided weakness major surgical or invasive procedure: none this hospitalization history of present illness: 75m with recently diagnosed metastatic esophageal cancer, presented to the ed this morning after experiencing sudden right sided weakness. he was diagnosed with metastatic esophageal cancer while vacationing in earlier this month. records were provided to his atrius oncologist with plan for further staging and plan for chemotherapy. he was scheduled for an endoscopic ultrasound today. while brushing his teeth this morning, he felt suddenly weak in his right arm and unable to hold the toothbrush. he initially went back to sleep, then woke up and called an ambulance. per ems his strength had recovered, but again in the ed he experienced weakness. . in the ed a code stroke was called. initial vs were: 84% on ra, 94% 4l, 98, 18, 98.9, 106/55. neurology noted mild r hand weakness. ct noted a perfusion defect. guaiac positive stools so neurology recommended starting heparin, no tpa. also found to have a pe on neck cta. he remained hemodynamically stable. . on the floor, he complains only of abdominal pain, which has been increasing for the previous few weeks. he has taken morphine with good resolution of his pain. he is also cognizant of his right handed weakness. he endorses early satiety and poor appetite, along with a 15lb weight loss over the last couple weeks. he has noticed some shortness of breath and chest tightness that began during his flight to and has been intermittent. the flight attendant had reported his breathing looked shallow. he also endorses an occasional cough. past medical history: 1) esophageal cancer (the patient was diagnosed esophageal adenocarcinoma in . provider ordered cta of abdomen and pelvis which showed a mass with and planned to biopsy ) 2) oral cancer treated with xrt at in 3) macular degeneration / b/l cataracts 4) migraine aura without ha 5) hypothyroidism 6) labyrinthitis social history: lives in the area alone. works part time for masshealth after retiring there, also works for theater. -smoking - quit , 2-3ppd for 20 years -etoh - quit , previously alcoholic -drugs - none family history: glaucoma brother - renal father nephrolithiasis mother macular degeneration physical exam: admission exam: . vs: 122/64 75 18 95% on 4l gen: cachectic and pale, fatigued heent: sclera anicteric, dry mucus membranes neck: supple, jvp to halfway up neck, no lymphadenopathy lungs: cta b/l, no wheezes, good inspiratory effort cv: rrr no m/r/g abd: soft, non-tender, non-distended, +bs, no masses palpable ext: no edema, arm vitiligo skin: warm and dry, pale neuro: cn 2-12 grossly intact, strength 4/5 in right arm and extensors, right flexors and left arm, bilateral legs, 3+ reflexes equal bilaterally pertinent results: american hospital in , endoscopy report: large mass in the distal esophagus and gastric cardia. . microbiology data: blood culture - no growth mrsa screen - negative blood culture - no growth urine culture - enterococcus, sensitive to vancomycin . imaging: ct head w/o contrast - no acute intracranial process. please refer to findings on subsequent cta head. . ct brain perfusion - acute ischemia in a small territory of the superior division of the left mca with increased mean transit time but no significant abnormality of blood volume; this represents a significant "ischemic penumbra." acute pulmonary embolism in the right upper lobar pulmonary artery branches, incompletely imaged. right hilar lymphadenopathy. . mr head w & w/o contras - small acute infarct in the left precentral gyrus. possible punctate acute infarct in the right occipital lobe. acute infarcts in bilateral cerebral hemispheres would suggest central embolic etiology. no evidence of intracranial metastatic disease. . 2d-echo - normal regional and global biventricular systolic function. early appearance of agitated saline bubbles in the left atrium/ventricle with the patient performing the valsalva maneuver. this finding is most consistent with a patent foramen ovale. lvef > 55% . video oropharyngeal swa - marked pooling within the valleculae with delayed hypopharyngeal transit. aspiration of pooled contents with nectar thick and thin liquids. . ct head w/o contrast - no acute intracranial process, with known embolic infarcts not identified. . chest (portable ap) - as compared to the previous radiograph, there is no relevant change. normal lung volumes. left-sided picc line. unchanged mild pulmonary edema. unchanged left pleural effusion with left basal and retrocardiac atelectasis. . chest (portable ap) - in comparison with the study of , there is continued enlargement of the cardiac silhouette with pulmonary edema. opacification at the left base is consistent with effusion and atelectasis. left picc line remains in place. . 05:20am blood wbc-7.5 rbc-3.46* hgb-9.8* hct-31.0* mcv-90 mch-28.4 mchc-31.7 rdw-13.5 plt ct-272 . 06:52am blood pt-13.9* ptt-75.4* inr(pt)-1.2* . 05:20am blood glucose-135* urean-21* creat-0.9 na-135 k-4.3 cl- 102 hco3-25 angap-12 . 06:18am blood alt-8 ast-14 alkphos-54 totbili-0.3 . 01:00pm blood ck-mb-1 ctropnt-<0.01 06:45am blood ck-mb-1 ctropnt-<0.01 02:21am blood ck-mb-1 ctropnt-<0.01 . 10:56pm blood lipase-25 . 05:20am blood calcium-7.6* phos-3.6 mg-2.0 . 05:20am blood triglyc-96 . 05:20am blood vanco-18.6 . 09:37pm blood lactate-1.5 brief hospital course: 75m with a pmh significant for recently diagnosed metastataic esophageal carcinoma, htn, hypothyroidism who presented with acute respiratory failure found to have left ischemic stroke with incidental pulmonary embolus undergoing heparinization complicated by hypoxemic respiratory failure requiring micu transfer due to presumed aspiration pna . plan: # metastatic esophageal carcinoma - originally diagnosed in at the american hospital with evidence of metastatic disease based on reports provided, although no tissue was provided. the patient's staging work-up was completed in - with ct imaging of the abdomen and pelvis, egd showing a distal obstructing mass extending to the gastric cardia region, and a colonoscopy which was reassuring. a ruq u/s performed at american hospital in was also performed. this admission, the patient initially had a gi evaluation for possible repeat endoscopy with biopsy, but this idea was aborted given the decision to transition to hospice without further oncologic intervention. his outpatient oncologist met with the medicine team and palliative care physicians on and at that time he opted to pursue hospice care. it was noted that even if he obtained a feeding tube and underwent rehabilitation, his clinical status would likely not be optimal to pursue systemic chemotherapy or radiation. in the transition to hospice, the patient's pain was controlled with liquid/po dilaudid, and lorazepam liquid po for anxiety regarding his condition. . # (?) aspiration pneumonia - there was a concern for an aspiration event this admission given his hypoxemic respiratory failure (from secretions, was npo at the time). a video swallow evaluation showed marked pooling within the valleculae with delayed hypopharyngeal transit. aspiration of pooled contents with nectar thick and thin liquids was noted. a cxr showed pleural effusion with left basal and retrocardiac atelectasis, with concern for aspiration. this event occurred on the medicine floor and required micu transfer given acute hypoxemic respiratory failure, requiring supplementation oxygenation without intubation. he was treated with 8-days of vancomycin and zosyn for aspiration pneumonia coverage. he was also given iv lasix given evidence of volume overload, to which he responded well with increased urine output. his hemodynamics stabilized, his fever curve was monitored and his wbc improved - he returned to the medical floor for further management. he completed his 8-days of antibiotics prior to discharge. . # enterococcus uti - the patient was without symptoms of dysuria or urinary frequency or urgency but given concern for sepsis in the setting of an underlying malignancy, his urine studies revealed an enterococcus uti, which was treated with 7-days of iv vancomycin. a foley catheter was also maintained given his history of hypotonic bladder. he completed antibiotics prior to discharge. . # nutritional concerns - speech and swallow performed a video swallow evaluation showing recurrent aspiration attributed to history of throat radiation from prior h&n malignancy. he was initially started on tpn supplementation with thin liquids only; however, once hospice was initiated, we allowed him to engage in regular po intake as tolerated with minimal iv fluid support. a feeding tube (g- or j-tube was not deemed safe given his clinical status; he was unfit for surgery). . # cva/stroke and patent foramen ovale - the patient initially presented with concerns of right sided weakness, found to have a left precentral gyrus ischemic infarct and the right occipital lobe was involved, per mr imaging of the brain. he endured some residual right hand weakness from the cva/stroke. given low ischemic infarct risk, a 2d-echo confirmed the suspicion of a patent foramen ovale with showering emboli from vte phenomenon; increased given his malignancy status. he was heparinized with a continuous infusion until discharge to hospice. there were no further deteriorations in his neurologic exam. he will go home with hospice with twice daily lovenox injections. . # pulmonary embolus - acute pulmonary embolism in the right upper lobar pulmonary artery branches was noted on brain perfusion study performed for his ischemic stroke event. given his underlying malignancy, this was not an unlikely finding. he was therefore anticoagulated with a continuous heparin infusion for both the pulmonary embolus, but also his ischemic stroke issues. . # hypothyroidism - he was continued on synthroid 75 mcg iv dosing given his npo status (home dose levothyroxine 150 mg po daily). . # hyperlipidemia - we continued his home dose of simvastatin 40 mg po daily. . transition of care issues: 1. twice daily lovenox injections for management of his pulmonary embolus and ischemic stroke issues 2. home hospice organized with hospice medications on admission: home medications (confirmed with patient) 1. mirtazapine 15 mg po qhs 2. asa 81 mg po daily 3. omeprazole 20 mg po daily 4. prochlorperazine 5. levothyroxine 150 mg po daily 6. simvastatin 40 mg po daily 7. presavision 8. morphine er 15 mg po bid 9. morphine ir 15 mg po q3 hours prn pain 10. fish oil 11. multivitamin 1 tab po daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*30 capsule(s)* refills:*0* 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*30 tablet(s)* refills:*0* 3. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. disp:*10 suppository(s)* refills:*0* 4. fentanyl 12 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). disp:*5 patch 72 hr(s)* refills:*0* 5. mirtazapine 15 mg tablet sig: 1.5 tablets po hs (at bedtime). disp:*30 tablet(s)* refills:*0* 6. zofran odt 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. disp:*15 tablet, rapid dissolve(s)* refills:*0* 7. lorazepam 2 mg/ml concentrate sig: 0.5-1 mg po every hours as needed for anxiety, shortness of breath, nausea, insomnia. disp:*20 ml* refills:*0* 8. dilaudid-5 1 mg/ml liquid sig: ml po q2 hours as needed for pain, shortness of breath. disp:*300 ml* refills:*0* 9. lovenox 60 mg/0.6 ml syringe sig: sixty (60) mg subcutaneous twice a day. disp:*28 syringes* refills:*2* 10. levothyroxine 150 mcg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: hospice care discharge diagnosis: primary diagnoses: 1. acute respiratory failure 2. aspiration pneumonia 3. urinary tract infection 4. cerebrovascular accident, acute ischemic stroke 5. patent foramen ovale 6. pulmonary embolus 7. metastatic esophageal carcinoma (presumed) . secondary diagnoses: 1. hypothyroidism 2. hyperlipidemia discharge condition: mental status: clear and coherent. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: patient discharge instructions: . you were admitted to the internal medicine service at on cc7 regarding management of your esophageal cancer and respiratory issues. after a long and thoughtful discussion involving you and the medical team (oncology, palliative care and medicine), you decided to pursue hospice. while you were admitted, you were treated with antibiotics for a pneumonia and urinary tract infection and anticoagulated for your stroke and clot burden in your lung. . please call your doctor or go to the emergency department if: * you experience new chest pain, pressure, squeezing or tightness. * you develop new or worsening cough, shortness of breath, or wheezing. * you are vomiting and cannot keep down fluids, or your medications. * if you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include: dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit, or have a bowel movement. * you experience burning when you urinate, have blood in your urine, or experience an unusual discharge. * your pain is not improving within 12 hours or is not under control within 24 hours. * your pain worsens or changes location. * you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. * you develop any other concerning symptoms. . changes in your medication reconciliation: * upon admission, we added: start: docusate 100 mg po bid start: senna 8.6 mg 1 tab po bid as needed for constipation start: bisacodyl 10 mg supp daily prn constipation we changed: increased your mirtazapine 15 to 22.5 mg by mouth at nighttime start: fentanyl patch 12 mcg/hr every 72 hours we changed: increased your mirtazapine to 22.5 mg by mouth at night start: zofran 4 mg odt every 8 hours as needed for nausea start: lorazepam 2 mg/ml (0.5-1 mg) every 4-6 hours as needed for shortness of breath, nausea or anxiety start: dilaudid-5 1 mg/ml ( ml) every 2 hours as needed for pain or shortness of breath start: lovenox 60 mg/0.6 ml syringe twice daily . * the following medications were discontinued on admission and you should not resume: discontinue: aspirin discontinue: omeprazole discontinue: prochlorperazine discontinue: simvastatin discontinue: morphine discontinue: fish oil discontinue: multivitamin discontinue: preservision (vitamin) . * you should continue all of your other home medications as prescribed, unless otherwise directed above. followup instructions: you will follow-up with your primary care physician as needed. procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances diagnoses: abdominal pain, unspecified site urinary tract infection, site not specified unspecified protein-calorie malnutrition unspecified acquired hypothyroidism hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) acute respiratory failure pneumonitis due to inhalation of food or vomitus ostium secundum type atrial septal defect retention of urine, unspecified nausea alone streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] cerebral embolism with cerebral infarction do not resuscitate status other malignant neoplasm without specification of site other pulmonary embolism and infarction migraine, unspecified, without mention of intractable migraine without mention of status migrainosus unspecified cataract malignant neoplasm of esophagus, unspecified site personal history of malignant neoplasm of other and unspecified oral cavity and pharynx shock, unspecified 

Answer: The patient is high likely exposed to