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: patient recorded as having no known allergies to drugs attending: chief complaint: respiratory distress major surgical or invasive procedure: endotracheal intubation history of present illness: 72 y/o m with hx of stage 4 squamous cell esophageal ca who has been on palliative chemo with xeloda and s/p recent radiation therapy who presents from home with respiratory distress. . per the ed and the family, he had been home about a week with plans to transition to home hospice and eventually recover enough to make it home to when he started having more , increasing morphine requirement for pain in his whole body and then the last two days, respiratory distress. they deny that he was coughing or choking, saying that he just doesn't swallow at all anymore. he had no other focal complaints. when his breathing reached a point they could not control anymore, ems was called and he was brought to the ed with the family following close behind. . in the ed, initial vitals were significant for tachypneia, hypoxia and an sbp in the 80s. after a brief discussion with the family, he was intubated. he received ivf boluses with a response in his bps. he was given vanco/flagyl in the ed and ordered for levofloxacin but did not receive it due to timing and access. over his ed course, he was noted to get more hypotensive with sbps in the 80s. he was no longer responding to ivf boluses, so l femoral cvl was placed and levophed was started. . on arrival to the floor, he was intubated and sedated and not withdrawing to pain or moving on his own. past medical history: 1. history of squamous cell esophageal cancer 2. history of hypertension for the last two years. 3. history of mild depression under control. 4. history of mild benign prostate hypertrophy. 5. history of mild elevated cholesterol levels and glucose levels. 6. the patient is status post significant burn with skin grafting in . he had major surgical procedures at that time . # stage ivb esophageal cancer of squamous cell histology: patient presented in with a three-month history of dysphagia to our clinic in . further workup disclosed a circumferential lesion in the mid third of the esophagus. a biopsy of the lesion disclosed a squamous cell carcinoma of the esophagus. additional findings included lymphadenopathy in the periesophageal area corresponding to a locally advanced cancer as well as additional lymphadenopathy in his right supraclavicular and cervical area. his pet ct scan demonstrated fdg uptake in all enlarged lymph node areas and biopsy of the supraclavicular node confirmed carcinoma. social history: 40-pack-year history of smoking. the patient also had a prior alcohol intake history of approximately seven drinks a week; however, quit completely over two years ago. the patient is originally from and lives in the city boa vista. his daughters live in the city of in . the patient currently has insurance through mass health. family history: noncontributory physical exam: general appearance: no acute distress, thin eyes / conjunctiva: perrl, pupils dilated head, ears, nose, throat: normocephalic, endotracheal tube cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: diminished), (left radial pulse: diminished), (right dp pulse: diminished), (left dp pulse: diminished) respiratory / chest: (expansion: symmetric), (breath sounds: no(t) clear : , rhonchorous: r > l) abdominal: soft, non-tender, bowel sounds present, gt in place extremities: right lower extremity edema: absent, left lower extremity edema: absent, cool extremities musculoskeletal: muscle wasting skin: not assessed neurologic: responds to: not assessed, movement: not assessed, sedated, tone: not assessed pertinent results: 9:10 pm urine site: not specified **final report ** urine culture (final ): enterococcus sp.. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml ________________________________________________________ enterococcus sp. | ampicillin------------ <=2 s nitrofurantoin-------- <=16 s tetracycline---------- =>16 r vancomycin------------ 1 s . . . . 9:10 pm blood culture **final report ** blood culture, routine (final ): streptococcus anginosus. isolated from one set only. susceptibility testing requested by # . clindamycin is sensitive at 0.12mcg/ml. sensitivity testing performed by sensititre. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ streptococcus anginosus | clindamycin----------- s erythromycin----------<=0.25 s penicillin g----------<=0.06 s vancomycin------------ <=1 s . . 06:02am blood glucose-151* urean-54* creat-0.7 na-140 k-4.5 cl-114* hco3-22 angap-9 03:21am blood glucose-127* urean-33* creat-0.6 na-142 k-4.4 cl-112* hco3-20* angap-14 03:55am blood glucose-121* urean-30* creat-0.5 na-143 k-4.1 cl-114* hco3-22 angap-11 03:39am blood glucose-111* urean-28* creat-0.5 na-146* k-3.7 cl-116* hco3-23 angap-11 02:34am blood glucose-133* urean-20 creat-0.5 na-139 k-3.6 cl-103 hco3-28 angap-12 . . 09:10pm blood wbc-4.9 rbc-2.56* hgb-8.4* hct-25.0* mcv-98 mch-32.9* mchc-33.7 rdw-16.4* plt ct-138* 04:22pm blood wbc-9.0 rbc-2.73* hgb-9.1* hct-25.0* mcv-92 mch-33.2* mchc-36.2* rdw-16.9* plt ct-104* 02:34am blood wbc-5.8 rbc-3.59* hgb-11.4* hct-32.8* mcv-91 mch-31.7 mchc-34.8 rdw-16.8* plt ct-69* brief hospital course: mr. was a 72 yo man with a hx of stage 4 squamous cell esophageal ca who presented with acute respiratory distress and hypotension, worrisome for aspiration pneumonia and septic shock. this was a week after he had been discharged home on home hospice, but in the ed his code status was reversed to full code. apparently the goal of his home hospice was to stabilize him enough to send him home to to die there. # hypoxic respiratory distress: given his recent hospitalization for dysphagia and increased cancer pain at home, most likely cause was aspiration pneumonia. he was started on an 8 day course of vanco/cefepime/flagyl for hap and aspiration coverage on . sputum gs showed 4+ gnr, 3+ gpc in pairs/chains, 2+ gp rods. pt continued to spike fevers until overnight on . he was kept on contact precautions for presumed mrsa. repeat chest x rays showed no significant change. initially, he was ventilated on assist control, but overbreathing on this setting and high autopeep prompted switching him to ps with increased sedation. he required 2-limb restraints to prevent self-extubation throughout his micu course. pt was kept on bronchodilators and sedated to comfort on versed and fentanyl drips with intermittent boluses for agitation. attempts to wean him off the ventilator were unsuccessful. pt was too agitated and weak to breathe adequately off the vent. he remained unresponsive. on , it was decided to remove ventilatory support, and the patient expired a day later. pt was kept npo for entire micu course. # sepsis without organ dysfunction: pt had positive blood cultures from of strep anginosus, but the validity and source of this bacteremia is not clear: the strep grew in only 1 out of 4 tubes, and the sputum culture from grew gnr. other than the lungs, other sources of infection include the urine, gi tract, and skin. urine culture on showed < enterococci, and u/a was negative. follow-up urine cx was negative. follow-up blood cultures have grown nothing to date. no sign of skin breakage or other potential skin source of infection on physical exam. pt did not have diarrhea in the unit, so bowel infection unlikely. the pt continued to spike on broad-spectrum antibiotics that should have covered all bacterial infections. furthermore, lactate was trending down. despite finishing an 8-day course of broad-spectrum antibiotics for aspiration pna/sepsis and improving in terms of infectious signs (pressures, wbc, lactate), pt's overall condition did not improve. # hypotension: most of this was probably due to his sepsis, but bleeding as evidenced by his continually dropping hct may also have been contributing. initially adrenal insufficiency was also in the differential: this became unlikely since stress-dose steroids in-house did not improve his pressures. pressures dropped as pressors were weaned, but urine output remained good, albeit decreased overall, with a stable cr of 0.5. pt received a considerable amount of fluids (+8.5l tbb) and was diuresed with lasix once off pressors and with stable sbp>100. # acute anemia: hct dropped from 40 to 25 in the week before admission; no evidence of frank bleed, guaiac positive in the ed. he was started on iv ppi at admission. pt??????s hct continued to drop: he received 2 units blood for a hct of 21 on with recovery to 27 and again on for a hct of 22. pt seemed to be bleeding, likely indolent gib from esophageal cancer, but other factors also contributing: hemodilution, anemia of acute illness. also have had underlying pancytopenia due to bone marrow infiltration of his cancer or suppression from extended course of palliative chemo. retics were inappropriately low. hemolysis was very unlikely given t bili of 0.4 at admission and lack of jaundice; this was confirmed by hemolysis labs that were negative. #thrombocytopenia: pt initially thought to have pancytopenia at admission, but leucopenia normalized after the first day of hospitalization ?????? likely due to acute infection ?????? and hct decreased steadily while thrombocytopenia remained stable. thus 3 lines probably had different reasons for being down, and bm infiltration from cancer seemed to be less likely after the first 2 days of his micu stay. the pt's new thrombocytopenia (138 at admission) was initially relatively stable and most likely due to sepsis. there was an acute drop in plt count to 69 mid-course that may have been drug-related. dic was unlikely given wnl and then elevated fibrinogen. d-dimer at admission was elevated, but that could also have been cancer or septic shock. #cancer (malignant neoplasm), esophageal: terminal, pt had been on home hospice with the plan of returning to to die. on 14 d on, 14 d off of palliative chemo (xeloda) since in , d/c??????ed at last admission (), no longer on chemo/radiation since then. pt was made dnr at a family meeting on . dr. communicated important information on , that pt's goals of care were not hospice per se but stabilization before returning to on commercial flight. pt's family seemed ready to keep him at intubated on a vent and sedated for an indefinite period. palliative care was consulted on . pt was made cmo on . . # arf: had new arf at admission, but cr returned to after receiving fluids and remained stably normal. likely pre-renal from septic shock with poor perfusion. creatinine and urine output were monitored during his hospitalization. . # hypothyroidism: no hx of hypothyroidism. tsh 0.23, follow up ft4 0.66 -> central hypothyroidism. could be sick euthyroid vs pituitary hypoperfusion from septic shock or (unlikely) metastasis. no role for synthroid initiation at that point. # depression: unclear baseline. on a tca and librium at home, which we held in the unit. . # hyperlipidemia: simvastatin held in the unit. medications on admission: isosource 1.5 cal, 5.5 cans daily with 1l flushes timolol 0.5% gtts fluticasone nasal spray dexamethasone 4 mg clomipramine 25 mg daily (tca) chlordiazepoxide 10 mg (librium) famotidine 40 mg/5ml 2.5 ml morphine 10mg/5ml 5 ml q6hrs prn zofran 4mg/5ml 5 ml daily allopurinol 300 mg daily simvastatin 20 mg daily discharge medications: expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: thrombocytopenia, unspecified pure hypercholesterolemia urinary tract infection, site not specified unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute posthemorrhagic anemia acute kidney failure, unspecified severe sepsis unspecified acquired hypothyroidism depressive disorder, not elsewhere classified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) constipation, unspecified other and unspecified hyperlipidemia acute respiratory failure pneumonitis due to inhalation of food or vomitus septic shock streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] encounter for palliative care hemorrhage of gastrointestinal tract, unspecified hyperosmolality and/or hypernatremia streptococcal septicemia other abnormal glucose secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck malignant neoplasm of middle third of esophagus 

Answer: The patient is high likely exposed to