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: hemoptysis (pt is a poor historian and all information was gleaned from conversation w/ overnight nurses) major surgical or invasive procedure: bronchoscopy history of present illness: 75y/o f w/ pharyngeal cancer s/p trach/peg placement now undergoing chemotherapy/xrt presenting with progressive bloody trach secretions and fever at her nursing home. per report, she had been in her usoh until the day of admission when she developed fevers and had progressive bloodly secretions from her trach. she apparently had been having some bloody trach secretions for some time since she had started her xrt/chemotherapy but these increased yesterday. she was hemodynamically stable at her nh and was evaluated by the md there who started her on vancomycin and sent her to the hospital for further evaluation. no one at the nh was present during her episode and they were unable to confirm the acuity or volume of the reported hemoptyis. . in the ed, she was initially febrile to 102.8 but had no complaints and was satting well on ra but was put on o2 because of increased secretions. she was initially tachycardic to the 140s but decreased to the low 100 after 2l of ns. her labs were significant for hyponatremia and borderline neutropenia and she received cefepime (had already received vancomycin at her nh). cta showed only known metastatic pulmonary disease w/out infiltrate or obvious source of her bleeding. blood and urine cultures were sent and she was admitted to the icu for further management. . in the icu, she denied any difficulty breathing, n/v, abdominal pain, chest pain, ha, difficulty with vision, diarrhea, dysuria, or weakness. she did complain of some neck and mouth pain. past medical history: 1. pharyngeal cancer (currently undergoing daily xrt and weekly cetuximab) 2. dementia nos 3. etoh abuse 4. hypertension social history: former tobacco and etoh abuse with unclear last use. lives in . has guardian ( or ). nurses at report she has no family. family history: n/c physical exam: pe: 99.6, 152/62, 103, 17, 99% on 10l 40% fm gen: sitting up in bed in nad, pleasant but inconsistent story, speaking in full sentences, copious secretions heent: swollen erythematous lips w/ dried blood, o/p w/ significant erythema and apthous ulcers, trach in place but surrounding skin erythematous and irritated, 1cm x 2cm stage 1 ulcer underneath trach pad anteriorly cv: tachycardic, palpable heave, no obvious m/r/g lungs: copious pink/yellow secretions yield rhonchi w/ deep inspiration, prolonged expiratory phase, no crackles, clear w/ normal inspiration abd: s/nt/nd, +bs, g tube in place and non-erythematous, no hsm, ecchymoses scattered over abdomen at injection sites ext: no peripheral edema, no cyanosis/clubbing, 2+ le pulses, wwp, midline in place in rue w/out erythema or tenderness neuro: oriented to self and place, inconsistent history when crosschecked against records, moving all extremities, intact distal sensation to light touch skin: heent exam as above, blanching pinpoint erythematous rash on shins, chest, arms, and upper back pertinent results: 10:00pm pt-12.7 ptt-25.0 inr(pt)-1.1 10:00pm plt count-357 10:00pm hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 10:00pm neuts-48* bands-18* lymphs-10* monos-13* eos-6* basos-2 atyps-1* metas-2* myelos-0 10:00pm wbc-2.3* rbc-3.24* hgb-9.9* hct-29.3* mcv-90 mch-30.6 mchc-33.9 rdw-14.6 10:00pm lactate-1.9 10:00pm albumin-3.0* calcium-8.5 phosphate-1.7* magnesium-1.9 10:00pm lipase-71* 10:00pm alt(sgpt)-24 ast(sgot)-50* alk phos-90 amylase-43 tot bili-0.3 10:00pm estgfr-using this 10:00pm glucose-152* urea n-18 creat-0.5 sodium-132* potassium-5.5* chloride-96 total co2-27 anion gap-15 10:40pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-8.0 leuk-neg 10:40pm urine color-yellow appear-clear sp -1.019 05:34am pt-12.7 ptt-23.9 inr(pt)-1.1 05:34am plt smr-normal plt count-320 05:34am hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 05:34am neuts-56 bands-6* lymphs-13* monos-18* eos-7* basos-0 atyps-0 metas-0 myelos-0 05:34am wbc-2.6* rbc-2.88* hgb-8.8* hct-25.9* mcv-90 mch-30.5 mchc-33.8 rdw-14.8 05:34am calcium-7.4* phosphate-1.9* magnesium-1.6 05:34am glucose-123* urea n-11 creat-0.3* sodium-135 potassium-3.1* chloride-104 total co2-24 anion gap-10 . cxr : no acute cardiopulmonary process. . cta : 1. no evidence of pulmonary embolism. no definite cause for hemoptysis identified. 2. multiple pulmonary nodules consistent with metastatic disease. 3. asymmetric soft tissue thickening of supraglottic larynx may relate to known malignancy but is incompletely evaluated on this chest ct. . bronchoscopy : no endobronchial lesions seen; hemoptysis presumed secondary to oropharyngeal mucosa brief hospital course: 75y/o f w/ pharyngeal cancer s/p trach/peg placement now undergoing chemotherapy/xrt presenting with progressive bloody trach secretions and fever at her nursing home; found to have fever here in the ed. . 1. bloody trach secretions: non-massive. hct currently 29 which is unlikely to be significantly lower than her baseline. no frank hemoptysis currently and no pe; no infection seen on ct. no obvious metastatic lesion eroding into a pulmonary vessel. no clear source seen on bronchoscopy. etiology presumed to be oropharyngeal mucusitis. given oral care for mucusitis. . 2. fever: febrile on arrival to the ed but afebrile once arrived in unit. received cefepime/vancomycin. anc ~ 1100 currently and on xrt and chemotherapy. ua negative and cta not showing an obvious infiltrate. abdominal exam benign. lactate negative and bp stable. fever is a known complication of cetuximab but last dose was 5 days ago. he should continue on vancomycin and cefepime to complete a total course of 7 days even if cultures are negative. should call the microbiology lab () to follow up blood and sputum cultures. . 3. pharyngeal carcinoma: followed at meei per report and currently undergoing chemo/xrt. primary oncologist dr. to be contact regarding her admission here. she will return to to resume xrt/chemotherapy per regular schedule. . 4. hypertension: continued clonidine. . 5. rash: erythematous blanching non-pruritic diffuse rash. unclear chronicity. no eosinophil elevation to suggest allergy. known cetuximab related rashes tend to be actinoform in nature. platelet count normal. fever but no other abnormalities to suggest dic and rash not c/w this diagnosis. redman's syndrome was also entertained, but she did not develop a rash after her second dose of vancomycin. . 6. hyponatremia: ddx hypovolemia vs. siadh in setting of pulmonary mets. received 1l ns in icu, with improvement of sodium from 132 to 135. . 7. dementia: continued galantamine. medications on admission: albuterol inh q6h aspirin 325mg daily cetuximab weekly (last dose thursday) clonidine patch 0.2mg daily dalteparin 5000u daily advair 250/50mg diflucan 100mg daily (last dose 1/15 - ? source) zyprexa 2.5mg qhs galantamine 8mg daily protonix 40mg daily vancomycin 1g (1st dose 1/15 in pm) ativan prn percocet prn benadryl/compazine/zantac/tylenol prn chemotherapy discharge medications: 1. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) neb inhalation every six (6) hours. 2. cefepime 2 gram recon soln sig: two (2) grams intravenous every eight (8) hours for 6 days. 3. aspirin 325 mg tablet sig: one (1) tablet po once a day. 4. cetuximab 2 mg/ml solution intravenous 5. clonidine 0.1 mg tablet sig: two (2) tablet po once a day. 6. dalteparin (porcine) 5,000 unit/0.2 ml syringe sig: one (1) inj subcutaneous once a day. 7. advair diskus 250-50 mcg/dose disk with device sig: one (1) inh inhalation twice a day. 8. diflucan 100 mg tablet sig: one (1) tablet po once a day: unclear if patient taking or if course complete; defer to rehab to determine whether to take. 9. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 6 days. 10. olanzapine 2.5 mg tablet sig: one (1) tablet po hs (at bedtime). 11. galantamine 4 mg tablet sig: two (2) tablet po daily (). 12. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 13. acetaminophen 325 mg tablet sig: 1-2 tablets po every hours as needed for chemo. 14. ativan oral 15. percocet oral 16. zantac oral 17. compazine oral 18. benadryl oral discharge disposition: extended care facility: & rehab center - discharge diagnosis: pharyngeal cancer (currently undergoing daily xrt and weekly cetuximab) discharge condition: stable, satting 100% on trach mask. discharge instructions: you were admitted with hemoptysis. a bronchoscopy was performed to look for a source of bleeding, and nothing was seen. the bleeding was presumed secondary to oral and pharyngeal mucusitis from radiation and chemotherapy. in addition, you had a fever to 102.8f in the emergency room; cultures were taken from blood, urine, and sputum, and no clear infection was identified. you should continue to get antibiotics for a total of 7 days. . please take all of your medications as directed. if you develop worsening cough, fever, chills, coughing up blood, or other concerning symptoms, please seek medical attention immediately. followup instructions: please follow up with your oncologist as planned. md procedure: fiber-optic bronchoscopy diagnoses: unspecified essential hypertension hyposmolality and/or hyponatremia other persistent mental disorders due to conditions classified elsewhere secondary malignant neoplasm of lung gastrostomy status tracheostomy status radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure chronic ulcer of other specified sites other tracheostomy complications mucositis (ulcerative) due to antineoplastic therapy malignant neoplasm of pharynx, unspecified 

Answer: The patient is high likely exposed to