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: dyspnea on exertion major surgical or invasive procedure: bronchoscopy history of present illness: mr. is a 62m with metastatic prostate ca, cad, osa, and a history of mild doe with an unrevealing work-up who came to oncology clinic today with complaints of worsening doe over the past 5-6 days. he states it began this past weekend with no clear precipitant; he'd felt fine all last week. whereas normally he could walk 80-90 feet on level ground before feeling dyspneic, now it occurs at half that distance. he describes the sensation as one of having to work harder to , increased effort. there's been minimal cough, minimal sputum production, no hemoptysis, no wheezing, no orthopnea/pnd, no chest pain or palpitations, no uri sx. he also has no sick contacts, no exposure to dusts or other strange environmental phenomenon, no recent travel; his volunteer activities does include work with the homeless, but a large portion of this is office-related work, and he does not think anyone he's been around has had a cough. he further denies f/c (though had one temp to 100.1 at home), abd pain, n/v/d/c, melena/hematochezia, hematuria/frequency. his appetite has been decreased for the past few weeks but he's kept up with oral hydration. in the oncology clinic, hi o2 sats were in the mid 90's on room air at rest but he desatted to mid 80's with ambulation. past medical history: -metastatic prostate ca -- diagnosed after developing back pain, and his psa came back at 1567. he has multiple osseous metastases. the cancer is hormone refractory, and he was initially treated with lupron; when disease progression was demonstrated on this regimen, he underwent 28 cycles of taxotere/estramustine. then in he got mitoxantrone and prednisone. most recently he's had taxotere and carboplatin for 12 cycles with good response though complicated by acute colitis. as he continued to progress off chemotherapy, he was started on the ariad trial in 1/. -htn -cad -- nstemi , mibi in with mild, fixed defects -osa social history: mr. lives in with his wife and son. formerly worked for as a software engineer, working on the guidance system for the patriot missile; prior to that he was in the air force. he has an undergraduate degree in mis and an mba. he smoked 1ppd for 20 years but quit 20 years ago, has a glass of wine occasionally with dinner, and has never used illicit/injection drugs. he has a labrador retriever. family history: his mother seems to have a malignancy but bx's have been unrevealing thus far. physical exam: t 99.4, bp 160/88, hr 80, rr 18, spo2 96%ra gen- pleasant, mod obese male, looks slightly older than age, non-toxic, nad heent- anicteric sclera, op clear with mmm neck- no jvd/lad/thyromegaly cv- rrr, s1s2, 2/6 systolic murmur at ursb (no radiation) pul- no resp distress/accessory muscle use; moves air well, normal i:e, no w/r/r abd- soft, nt, nd, nabs, no hepatosplenomegaly back- no cva tenderness, no sacral edema, mild mid-thoracic vert pain (baseline per pt) extrm- no cyanosis/edema, warm/dry nails- no clubbing, no pitting/indentations, mildly discolored derm- erythematous, confluent rash on elbows, hands, feet neuro- a&ox3, no focal cn/motor deficits pertinent results: admission labs: 10:44am blood wbc-4.5 rbc-3.87* hgb-10.9* hct-31.0* mcv-80* mch-28.0 mchc-35.0 rdw-16.0* plt ct-163 10:44am blood neuts-66 bands-4 lymphs-15* monos-7 eos-5* baso-2 atyps-1* metas-0 myelos-0 10:44am blood hypochr-normal anisocy-normal poiklo-1+ macrocy-normal microcy-normal polychr-normal ovalocy-occasional tear dr 10:44am blood plt smr-normal plt ct-163 10:44am blood ret aut-0.7* 10:44am blood glucose-123* urean-21* creat-1.4* na-132* k-3.8 cl-100 hco3-24 angap-12 10:44am blood alt-34 ast-69* ld(ldh)-626* ck(cpk)-145 alkphos-67 totbili-0.9 dirbili-0.2 indbili-0.7 10:44am blood ck-mb-2 ctropnt-<0.01 08:00pm blood ck-mb-2 ctropnt-<0.01 12:00am blood ck-mb-2 ctropnt-<0.01 10:44am blood totprot-5.5* albumin-3.2* globuln-2.3 calcium-7.4* phos-2.3* mg-1.7 cholest-213* 08:00pm blood iron-35* 08:00pm blood caltibc-229* vitb12-1354* folate-14.6 ferritn-693* trf-176* 10:44am blood triglyc-230* . cxr: subtle right lower lobe posterior basilar opacity, which may be due to atelectasis or early pneumonia. followup chest radiographs would be helpful. linear retrosternal upper lobe opacity, likely atelectasis. . head ct: 1. new 2.0 x 1.3 cc cm focus of hypointensity in the right inferior frontal lobe. the appearance is nonspecific and contusion or age indeterminate infarction cannot be excluded. mri is recommended for further correlation. . lenis: no evidence of deep venous thrombosis. . cta chest: 1. multiple segmental pulmonary emboli. 2. patchy bilateral ground-glass opacities, likely consistent with pulmonary edema from congestive heart failure. an infectious process cannot be fully ruled out. . renal u/s: 1. no hydronephrosis. 2. possible tiny crystal in the mid portion of the right kidney. . cxr: interval worsening of multifocal bilateral hazy (ground glass) opacities, which is likely due to asymmetrical pulmonary edema or atypical infection. differential diagnosis includes hemorrhage and drug toxicity. . echo: the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). tissue velocity imaging demonstrates an e/e' <8 suggesting a normal left ventricular filling pressure. right ventricular chamber size and free wall motion are normal. the ascending aorta is moderately dilated. the aortic valve leaflets are mildly thickened. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is a very small pericardial effusion (seen posteriorly). there are no echocardiographic signs of tamponade. . cxr: no evidence of pneumothorax. slight worsening of parenchymal opacities. . bronchial washings: negative for malignant cells. . cxr: slight improvement in bilateral pulmonary opacities. . cta chest : ct of the chest with contrast, findings: current studies viewed in conjunction with the prior exam of . there are diffuse ground glass opacities throughout both lung fields, most marked in the upper lobes. there is relative sparing of the right lower lobe. there is no evidence of pulmonary embolism. there are no effusions appreciated. again appreciated is some scattered mediastinal lymphadenopathy. bone windows reveal some rarified areas within scattered vertebral bodies raising the question of metastatic foci, unchanged compared to the prior exam. small bilateral pleural effusions are appreciated and appear new since the prior study. . impression: 1. no evidence of pulmonary embolism. 2. marked progression in diffuse ground glass infiltrates with relative sparing of the right lower lobe. this is associated with development of new small bilateral effusions. 3. study is otherwise unchanged including multiple areas within the thoracic vertebral body raising the question of bony involvement by this patient's underlying malignancy. . wedge biopsies of lung, two: i. (right upper lobe): a. patchy organizing pneumonitis with features of bronchiolitis obliterans-organizing pneumonia (boop). b. marked accumulation of intraalveolar macrophages. c. subpleural fibrosis with intimal thickening of pulmonary arteries. . ii. (right middle lobe): a. metastatic adenocarcinoma consistent with prostate origin, microscopic focus (slide g). tumor cells are positive for psa and keratin cocktail and negative for psap, keratin 7 and 20. b. patchy organizing pneumonitis with features of bronchiolitis obliterated-organizing pneumonitis (boop). c. marked accumulation of intraalveolar macrophages. d. subpleural fibrosis with intimal thickening of pulmonary arteries. . brief hospital course: shortness of : this was initially felt to be pe given cta findings on admission. initial work up ruled out cardiac ischemia with a normal ekg and negative cardiac enzymes. infectious etiologies were also considered, including bacterial pneumonia, pcp (given that that the patient had been on chemotherapy), fungal infections, and tuberculosis. initially, the patient was treated with levofloxacin for community acquired pneumonia. this was discontinued at the recommendation of the infectious diseae service as it has some anti-tuberculosis activity, and we did not want to give monotherapy for tuberculosis until it was formally ruled out. when the patient continued to be febrile, ceftriaxone and azithromycin were started for community acquired pneumonia, and coverage was then broadened to zosyn and vancomycin to cover nosocomial pneumonia as the patient's infiltrates on chest xray were worsening while the patient was hospitalized. a viral antigen screen was negative, ruling out influenza and several other viral infections. . the pulmonary service was consulted, and a bronchoscopy with bal was performed. the gram stain from the bal showed no organisms, and the respiratory culture grew oropharyngeal flora. pcp and afb were negative. however, the pcp screen in patients with malignancy is not always reliable, so bactrim and steroids were started to cover pcp. patient was also continued on isolation precautions for tuberculosis until additional sputum samples could be obtained, for similar reasons. he was eventually ruled out for tuberculosis with 3 negative afbs. after pcp was ruled out steroids were d/ced. . thoracic surgery was consulted for a vats procedure to obtain tissue to help confirm the diagnosis. the main concern, other than the above differential, was lymphangitic spread of his tumor, which could be confirmed with tissue, as well as boop, which was a concern given recent chemo therapy with tor-inhibitor, which has a known association with boop. thoracics recommended repeat chest ct before considering vats, and when this showed improvement in ggo they recommended continuing antibiotics and steroids and deferring vats. . however pt had an episode of respiratory decompensation, requiring a transfer to the and non-invasive ventilation with bipap. pt. did not require intubation. it was felt that this decompensation was flash pulmonary edema. after pt. was stabilized and transferred back to the floor vats was again considered given uncertainty in the diagnosis (repeat cta had showed resolution of pes, however pt. was still very sob, and the team was not confident that his sob could be contributed to pulmonary edema and pe alone) it was also noted that pt's decompensation happened after steroids were d/ced, and so a steroid responsive process like boop was considered. . on pt. was taken for vats. pathology showed boop + evidence of metastatic prostate ca in the lung. . in the end pt's sob was felt to be multifactorial, from pe, lung mets from prostate ca, boop, which was most likely pt's recent chemotherapy regimen, and from chf with diastolic dysfunction. pt. improved with steroids and diuresis, and was discharged home with home o2 and close follow up with dr. , his oncologist. pt. was discharged on prednisone, lovenox and coumadin, a bb and ace, and home o2. . #acute renal insufficiency: pt. had 2 episodes where his cr became elevated. firt, shortly after admission was felt to be pre-renal and improved with hydration. a renal us at that point showed no obstruction. the second happened several days after bactrim was tarted and was felt to be ain from bactrim and resolved with discontinuation of this. cr was stable around 1 for several days prior to discharge. . #cad -- the patient was ruled out for mi on admission. he was monitored on telemetry for a few days with no significant events. we continued aspirin and ace inhibitor per his outpatient regimen, and added a beta blocker for better bp control. . #htn -- we continued lisinopril, and doxazosin, which the patient was on as an outpatient, and added a beta blocker for better bp control, particularly given the patient's history of coronary artery disease. . #anemia -- the patient's creatinine ranged in the high 20s, down from his baseline of mid to high 30's. there was no obvious source of blood loss or hemolysis. in the past, had no b12/fe/fol deficiency. the anemia was microcytic with a low retic count. the most probable cause seemed to be aocd with a contribution from chemotherapy. laboratory studies were consistent with this etiology. given the patient's hypoxia, it was decided to transfuse the patient to maintain hct around 30. he received 1 unit of prbc on and another on . . #hyponatremia -- this was considered to be likely siadh, given the ongoing pulmonary process. improved with fluid restriction. . #skin rash -- this was secondary to chemotherapy. we continued with silvadene per outpatient regimen. . #pain -- continued the usual outpatient regimen. celebrex was initially held due to elevated creatinine, but was restarted after a few days. medications on admission: -ec-aspirin 325 mg daily -omeprazole 20 mg daily -fentanyl patch 50 mcg every 48 hours -ditropan 10 mg b.i.d. -doxazosin 8 mg b.i.d. -lisinopril 20 mg daily -multivitamin daily -aldactone 50 mg b.i.d. -lupron every 3 months -percocet b.i.d. -celebrex 200 mg b.i.d. -silvadene cream twice daily discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 3. fentanyl 50 mcg/hr patch 72hr sig: one (1) patch 72hr transdermal q72h (every 72 hours). 4. multivitamin capsule sig: one (1) cap po daily (daily). 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. silver sulfadiazine 1 % cream sig: one (1) appl topical (2 times a day). disp:*1 bottle* refills:*2* 8. doxazosin 4 mg tablet sig: two (2) tablet po bid (2 times a day). 9. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*21 capsule(s)* refills:*0* 10. oxybutynin chloride 5 mg tablet sig: one (1) tablet po bid (2 times a day). 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 12. alprazolam 1 mg tablet sig: one (1) tablet po tid (3 times a day) as needed. disp:*90 tablet(s)* refills:*0* 13. prednisone 20 mg tablet sig: four (4) tablet po daily (daily). disp:*120 tablet(s)* refills:*0* 14. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 15. epoetin alfa 4,000 unit/ml solution sig: two (2) injection qmowefr (monday -wednesday-friday). disp:*24 ml* refills:*0* 16. warfarin 2.5 mg tablet sig: three (3) tablet po hs (at bedtime). disp:*90 tablet(s)* refills:*0* 17. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 18. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 19. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 20. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 21. enoxaparin 100 mg/ml syringe sig: one (1) ml subcutaneous (2 times a day). disp:*14 ml* refills:*0* 22. carvedilol 3.125 mg tablet sig: four (4) tablet po bid (2 times a day). disp:*240 tablet(s)* refills:*2* 23. home oxygen 3l continuous o2 nc- o2 98% on 3l, 83-84% on ra discharge disposition: home with service facility: care centrix discharge diagnosis: metastatic prostate cancer pulmonary embolus bronchiolitis obliterans organizing pneumonia (boop) flash pulmonary edema hypertension chf with diastolic dysfunction, preserved ef (65-70%) obstructive sleep apnea discharge condition: improved- breathing comfortably on 3l oxygen discharge instructions: if you experience fever, chills, shortness of , chest pain, or any other new or concerning symptoms, please call your doctor or return to the emergency room for evaluation. . please take all medications as prescribed. . please attend all followup appointments. . please limit your sodium intake to 2 g/day and your fluid intake to 2l per day. followup instructions: oncology: please call dr. and dr. office at about your follow up appointment next thursday. . pulmonology: please call dr. office at to set up a follow up appointment . primary care: please call dr. office at to set up a follow up appointment in the next 2-4 weeks. . please have your inr checked at a lab by your house and have the results faxed to dr. at . md procedure: non-invasive mechanical ventilation closed [endoscopic] biopsy of bronchus transfusion of packed cells other local excision or destruction of lesion or tissue of lung transfusion of other serum diagnoses: anemia of other chronic disease obstructive sleep apnea (adult)(pediatric) long-term (current) use of steroids acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified personal history of malignant neoplasm of prostate benign neoplasm of cerebral meninges old myocardial infarction antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use dermatitis due to drugs and medicines taken internally secondary malignant neoplasm of lung acute diastolic heart failure other disorders of neurohypophysis other pulmonary embolism and infarction secondary malignant neoplasm of bone and bone marrow disorder of bone and cartilage, unspecified unspecified hypertensive heart disease with heart failure other specified alveolar and parietoalveolar pneumonopathies 

Answer: The patient is high likely exposed to