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: history of present illness: this is a 61 year old male with a past medical history significant for throat cancer, status post surgery, radiation therapy and chemotherapy with a history of minor aspiration events, who presented to an outside hospital on , status post a mild choking episode while eating while in with cough, hypoxia, shortness of breath. he was found to have a severe right sided infiltrate on chest x-ray. he was ruled out for tuberculosis. he was transferred to icu on , and intubated for hypoxic respiratory failure. originally, he was on levofloxacin and clindamycin for aspiration pneumonia. he had persistent fevers in the icu. because of his significant travel history, serologies for coccidioides and strongyloides were sent. he also received vancomycin for a seven day course. there was a question of possible drug fever because of persistent fever and persistent elevated peripheral eosinophils. clindamycin was discontinued and he was on levofloxacin and flagyl upon transfer to the floor. malaria workup was negative. his arterial line grew coagulase negative staphylococcus and the line was discontinued. however, since transfer out of the unit, he has been afebrile for a total of two days. he was extubated on , with a slow wean likely secondary to his severe chronic obstructive pulmonary disease. he failed video swallow study on , and since then has been npo with a nasogastric tube in place. he was called out to the acove service and currently was without any complaints. he denied chest pain, shortness of breath, headaches, abdominal pain, nausea, vomiting, diarrhea, change in stool. he wanted to ambulate. past medical history: 1. throat cancer, status post resection with reconstruction surgery, chemotherapy and radiation therapy approximately two years ago, currently in remission. 2. chronic obstructive pulmonary disease. 3. history of minor aspirations. 4. status post percutaneous endoscopic gastrostomy removal in . 5. malaria. 6. sciatica. medications on transfer from sicu: 1. subcutaneous heparin. 2. famotidine 20 mg twice a day intravenously. 3. albuterol and atrovent inhalers. 4. flovent inhaler. 5. tylenol p.r.n. 6. colace. 7. lactulose p.r.n. 8. iron 325 mg three times a day. 9. aspirin 325 mg once daily. 10. intravenous levofloxacin 500 mg once daily. 11. flagyl intravenous 500 mg q8hours. 12. reglan intravenous p.r.n. 13. ativan p.r.n. 14. tube feeds via the nasogastric tube. allergies: no known drug allergies. social history: the patient lives with his girlfriend, in , . she is also his health care proxy. was a former smoker and denies current alcohol use. physical examination: temperature is 98.9, heart rate 83 to 100, blood pressure 107 to 125 over 54 to 60, respiratory rate 17 to 23, oxygen saturation 93 to 97% on four to five liters oxygen via nasal cannula. in general, the patient is alert, oriented times three in chair. head, eyes, ears, nose and throat - normocephalic and atraumatic. the pupils are equal, round, and reactive to light and accommodation. extraocular movements are intact. og tube in place. neck - 2+ carotids, supple, no lymphadenopathy. cardiovascular is regular rate and rhythm, no murmurs, rubs or gallops. respiratory - crackles at the right base greater than the left base, some bronchial breath sounds on the right upper border. the abdomen is normoactive bowel sounds, soft, nontender, nondistended. extremities no cyanosis, clubbing or edema. neurologically, cranial nerves ii through xii are intact with 5/5 strength in the lower extremities and upper extremities bilaterally. nonfocal examination. laboratory data: upon transfer to acove, white blood cell count had come down to 17.8, hematocrit 30.4, platelet count 1091. chem10 was unremarkable. alt 42, ast 28, alkaline phosphatase 160, total bilirubin 0.3. differential significant for 57% polys, 2 bands, 4 lymphocytes, 7 monocytes, 28 eosinophils, and 2 basophils. assessment: this is a 61 year old admitted to the intensive care unit from hospital for hypoxic respiratory failure and severe right sided pneumonia. past medical history is significant for throat cancer, status post resection/reconstructive surgery, chemotherapy, radiation therapy in remission, history of minor aspirations, chronic obstructive pulmonary disease, sciatica, malaria which recurs annually (former green beret). he was intubated shortly after his admission here and his chest x-ray was significant for infiltrate throughout the right lung. on transfer to the floor, his severe aspiration pneumonia was improving both clinically and radiographically. he was doing well on levaquin and flagyl. hospital course: 1. aspiration pneumonia - this was thought to be secondary to aspiration, however, given his travel history, he was worked up for coccidioidomycosis and histoplasmosis. at the time of this dictation, these serologies are still pending. he was intubated on , upon admission and extubated on , with a slow wean from the ventilator secondary to his severe underlying chronic obstructive pulmonary disease. radiographically, infiltrates have improved though a couple of areas on the cat scan appear to be possibly evolving abscesses. antibiotics were changed around though he was finally placed on levofloxacin and flagyl. his course in the icu was complicated by recurrent fevers of unclear etiology. drug reaction was considered given the peripheral eosinophilia and malaria was also considered but parasite smear was negative. the a line which grew out coagulase negative staphylococcus was pulled. while on the floor, he was continued on levaquin and flagyl. his white blood cell count continued to trend down. he remained afebrile and he was using an incentive spirometer at the bedside. he remained npo with an og tube for medications with a plan to be reevaluated by speech and swallow service on friday, . his reevaluation did demonstrate some improvement from the initial study of . the patient continues to present with severe to profound pharyngeal dysphagia. ent was consulted and they recommended as well to either place a percutaneous endoscopic gastrostomy tube for feeding and that he was at severe risk for aspiration, to npo. they recommended a ct scan of the oral cavity and neck with contrast to rule out tumor recurrence which was done and revealed no new mass. they also recommended an outpatient barium swallow to rule out esophageal mass or obstruction. he will need to follow-up with his ent as an outpatient for this. at this point, the conversation about percutaneous endoscopic gastrostomy tube placement was brought up with he patient and his girlfriend. was reluctant to have a percutaneous endoscopic gastrostomy tube placed since he had already experienced this in the past, however, since it was unsafe for him to take any food by mouth, he agreed to go ahead with a temporary percutaneous endoscopic gastrostomy tube placement. the procedure is planned for . for his pneumonia, he will continue on levofloxacin and flagyl to complete a four week course, i.e., . infectious disease service was also following the patient and they will be following up on the serologies that are still pending. 2. chronic obstructive pulmonary disease - he was continued on flovent, albuterol and atrovent inhalers. 3. eosinophilia - the patient was noted to have rising peripheral eosinophils up to the low 30s on . at around that time, he also developed maculopapular rash consistent with a drug reaction only on his abdomen. however, this resolved in a few days. the etiology of the eosinophils was unclear. the differential diagnosis included a drug reaction, however, he only had a rash for three to four days and it resolved while on levofloxacin and flagyl (vasculitis). serologies have been negative and he has no renal issues, a parasitic infection (parasite smear was negative, however, strongyloides is still pending), fungal, coccidioides and histoplasmosis workup are pending, hiv test was negative and a cortisol stimulation test was also negative. infectious disease was following the patient and they felt that the slow response to the antibiotics and the high grade eosinophilia despite withdrawal of beta lactam prompted consideration of atypical pathogens, example, strongyloides-related pneumonia, coccidioides (which can cause eosinophilia and cavities), histoplasmosis or just refractory pneumonia with superimposed eosinophilia from occult parasitic infestation, example strongyloides. they also felt that in concert with the thrombocytosis that he has that this reactive thrombocytosis and eosinophilia may be secondary to strongyloides or coccidioides. at the time of this dictation, those serologies are pending. hematology/oncology was consulted because of the eosinophilia and they felt that this was drug related since he had a typical rash and history of an antibiotic reaction, however, the patient was not sure which antibiotic he had a reaction to in the past. they felt that this would resolve in time and there was no treatment to be implemented at this time. 4. thrombocytosis - high platelets were noted which continued to climb despite clinical improvement of the infection. he was being treated with aspirin, however, he did thrombose his picc line on , and had to have tpa through the line. hematology/oncology was consulted and they felt that the thrombocytosis was reactive. they felt it required no special treatment though did not object to daily low dose aspirin. 5. elevated liver function tests - his liver function tests were elevated while in the intensive care unit. the etiology was not clear. however, they trended down to normal. right upper quadrant ultrasound was normal and hepatitis serologies were negative. 6. electrocardiographic changes on admission - it was noted by the icu resident that these electrocardiographic changes did resolve quickly and they involved some t wave and nonspecific st changes. because of this, he was started on aspirin. he may need an outpatient cardiology workup. 7. lines - he had a right picc line that was placed on . 8. physical therapy - he was evaluated by physical therapy throughout his stay and was ambulating with oxygen, however, was desaturating down to the 80s on four liters of oxygen with ambulation. therefore, they recommend that he be discharged home with home physical therapy, outpatient pulmonary physical therapy as well as oxygen to use at home. condition on discharge: fair to good. discharge status: the patient is to be discharged after percutaneous endoscopic gastrostomy placement on either , or . follow-up: he will need to follow-up with his ent doctor to obtain a barium swallow as an outpatient to rule out esophageal mass or obstruction. he will also need follow-up by speech and swallow in approximately two weeks in order to repeat an evaluation. i also recommend that he follow-up with his primary care physician. nutrition recommended that after his percutaneous endoscopic gastrostomy tube is placed he be started on bolus feedings with full strength ultracal to start on four cans per day on day one and then gradually advance to a goal of eight cans per day. medications on discharge: his discharge medications will be dictated in an addendum by the next intern who picks up this patient though i do know that he will be going home on levofloxacin and flagyl until . discharge diagnoses: 1. severe aspiration pneumonia complicated by hypoxic respiratory failure requiring intubation for approximately ten days. 2. thrombocytosis - likely reactive. 3. eosinophilia - likely a drug reaction though may be related to strongyloides or coccidioidomycosis with serologies pending at the time of dictation. 4. chronic obstructive pulmonary disease. 5. throat cancer in remission. , m.d. dictated by: medquist36 procedure: 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 percutaneous [endoscopic] gastrostomy [peg] barium swallow esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: chronic airway obstruction, not elsewhere classified acute respiratory failure pneumonitis due to inhalation of food or vomitus other complications due to other vascular device, implant, and graft staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus infection and inflammatory reaction due to other internal prosthetic device, implant, and graft unspecified diseases of blood and blood-forming organs arterial embolism and thrombosis of upper extremity malaria, unspecified 

Answer: The patient is high likely exposed to