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: mr. was a patient who was referred to dr. by dr. for management of a new right middle lobe nodule. the patient was seen at the thoracic oncology multidisciplinary center on , for referral and evaluation. at that time, he was described by dr. as a pleasant and delightful 83-year-old gentleman who has been previously treated for low-grade lymphoma of the stomach, which had been discovered about nine to ten years previously. biopsy a year later was otherwise negative. a recent ct scan was performed to follow stable pulmonary nodules which demonstrated growth of the right middle lobe nodule. given the increase in size and its stellate pattern and a prior history of smoking, he was referred for evaluation and possible workup. at that time, he was not having any significant weight loss, no hemoptysis or sputum production, no chest pain, no musculoskeletal or neurologic complaints, and the remainder of his review of systems was otherwise negative. past medical history: significant for alzheimer's disease which is mild to moderate in severity, hypertension, hypercholesterolemia, hypothyroidism, and coronary artery disease. he is followed by dr. at . past surgical history: status post cholecystectomy and inguinal hernia repair. medications as an outpatient: protonix 40 mg once daily, hydrochlorothiazide 25 mg once daily, procardia xl 120 mg once daily, levoxyl .125 mcg once daily, lipitor 10 mg once daily, lopressor 50 mg once daily, zoloft 50 mg once daily, iron 325 mg once daily, vitamin e 400 iu once daily, vitamin b12, aricept 5 mg once daily, and exelon 6 mg by mouth twice a day. social history: he has recently moved to a retirement community with his wife. has not been happy about this, and has been somewhat withdrawn and not participating in the social events of the community. the decision was made to have him move in with his wife to the retirement community after his sons found him changing an electrical circuit with the electricity on, as well as other unsafe situations. he has smoked for 40 to 50 years, one-half pack per day. he has two sons, one of whom is a pediatric anesthesiologist at the department of anesthesia. physical examination: constitutional: the patient is a well-appearing, well-nourished, elderly male in no apparent distress. his mental status is jolly, and seemed appropriate. vital signs showed a temperature of 97.7, oxygen saturation 97% on room air, pulse 51, blood pressure 150/90, and weight 173 pounds. his sclerae were anicteric. ent examination demonstrated no supraclavicular or cervical or thyroid masses. the lungs were clear to auscultation. his heart was regular, with no murmur. the abdomen was soft, nontender, no masses. axillae and groin showed no adenopathy. the extremities showed no clubbing or edema. his skin showed no lesions. the thorax showed no asymmetry, masses or lesions. neurologic examination was grossly nonfocal. laboratory data: ct scan was performed at the thoracic oncology multidisciplinary center. ct of the chest performed on showed no evidence of right middle lobe lesions. on , the lesion first appeared and was noted to be .5 mm. on , the lesion had increased to 1.3 mm in greatest dimension, and finally the most recent ct scan of , the right middle lobe lesion was more spiculated and increased to the size of 1.9 mm in greatest dimension. there was no significant mediastinal lymphadenopathy, no pleural effusion seen. the visualized portions of the liver, adrenals and kidneys were otherwise normal. there was diffuse thickening of the gastric wall, which is unchanged from previous ct scans, consistent with the patient's prior history of gastric lymphoma. the remainder of the patient's pulmonary nodules were otherwise stable. impression: the patient was likely at significant risk for possible lung carcinoma. plan: he was therefore scheduled for right middle lobe lobectomy. the patient consented to the procedure. hospital course: he presented to the on . the patient underwent a bronchoscopy and mediastinoscopy, esophagogastroduodenoscopy, as well as right middle lobe lobectomy with pericardial patch that was completed on . the patient was extubated and sent out of the operating room. he received 1700 cc of crystalloid, and had minimal blood loss. he had an otherwise uneventful intraoperative course. postoperatively, the patient was seen by the eps service, was on an epidural for pain management, otherwise had no issues. at his postoperative check, he was doing well and had no complaints. temperature was 99.1, blood pressure 120/49, oxygen saturation 98% at that time on 4 liters. he was requiring chest physical therapy. he had no air leak on his chest tube. his urine output was adequate. he had good pain control. on , the patient had some significant secretions. he was noted to have a right lower lobe collapse by chest x-ray. the chest x-ray was obtained after the patient had significant signs of hypoxemia and tachypnea. additionally at this time, the patient was requiring neo-synephrine for blood pressure support, as postoperatively he did have some relative hypotension and anuria. after being supported with pressors and being volume resuscitated, his urine output seemed to turn around. the primary complaint and issues seem to be his secretion management and also this new right lower lobe collapse. he was ultimately bronchoscoped thereafter, which confirmed the right lower lobe collapse. the right middle stem bronchus was otherwise intact. he did have some serial bronchoscopy examinations on , which again showed significant secretions. he was placed in the intensive care unit for aggressive chest physiotherapy. this was carried out. his urine output seemed marginal at best. creatinine did bump to 2.1, which was up from an otherwise normal baseline. by , the patient had been seen by the infectious disease service for some fever spikes. he had also been intubated postoperatively at this point due to some respiratory failure and what was presumed to be adult respiratory distress syndrome vs aspiration event. the fever spikes, it was unclear if there was a septic etiology to them to explain why he presented with adult respiratory distress syndrome. ultimately at this time also it became clear that the patient suffered from a poorly-differentiated adenocarcinoma of the lung with a diffuse pulmonary infiltrate seen by chest x-rays with this fever spike, having persistent pressor requirements and severe hypoxemia and an adult respiratory distress syndrome net protocol for support. he was on broad-spectrum antibiotics as dictated by the infectious disease fellow, being treated with levofloxacin, vancomycin and clindamycin, although he did not suffer from a leukocytosis, as his white count at this point was 9000. his bun and creatinine were 54 and 2.2, and he was having persistent marginal urine outputs. over the next week of this patient's postoperative course, he had waxing and picture from a pulmonary standpoint. ultimately he was taken off of pressure control ventilation which had been utilized initially to manage his hypoxemia and also his adult respiratory distress syndrome. he was ultimately switched to assist control and then to cpap and pressure support, however, his pulmonary situation did not markedly improve, and he had persistent bilateral fluffy infiltrates. his chest roentgenography was always consistent with a possible picture of adult respiratory distress syndrome vs aspiration. he still required significant ventilatory support and, from a hemodynamic standpoint, he had had some intermittent atrial fibrillation requiring amiodarone bolusing and drips, as well as having blood pressure requirements with levophed support, ultimately to allow for some renal perfusion. during his postoperative course for his postoperative renal failure, he was seen by the renal service, which recommended keeping his blood pressure greater than 120 and to continue the lasix drip as we had been doing, to continue to ensure that the patient did not have any issue of pulmonary edema. the patient did have a swan-ganz catheter in place, which was not showing any significant hemodynamics concerning for any type of failure. over the ensuing days, the patient was weaned off sedation. his ventilatory support was intermittently changed from assist control to cpap and pressure support. it was clear that the patient was suffering from a neurologic deficit. his pupils seemed relatively nonreactive. the corneas had bilateral reflexes positive bilaterally. his oculocephalic reflexes were negative however. he was seen by the neurology service, and the impression was that his examination was remarkable for depressed cortical function with preserved brain stem function, with decreased level of consciousness, perhaps secondary to several factors. given the renal insufficiency, sedative and narcotic medications, an mri of the brain was recommended to exclude metastatic disease of the brain. this was recommended on . ultimately the family and the primary service declined to pursue the mr imaging. the patient was being supported nutritionally as well postoperatively with tube feeds, which he was tolerating at goal. over the ensuing days, the patient's course clinically deteriorated. the prognosis for this patient was grim at best. he was seen by the patient's family, particularly the patient's son, dr. , who is the pediatric anesthesiologist from the . he, in consultation with his brother, as well as the patient's wife, ultimately decided to withdraw care due to the bleak outlook and his poor prognosis from his poorly-differentiated adenocarcinoma, the adult respiratory distress syndrome, and respiratory failure, acute renal failure, and now cns depression and decreased cortical function, all consistent with possible multi-organ system failure. ultimately his ventilator support and pressor support were withdrawn. the patient was made comfort measures only at 1 a.m. on , at the request of the patient's family, the sons were at the bedside, including dr. , when they made this decision. this was done in consultation with dr. over the telephone. all parties were in agreement. the nursing staff and the csru, as well as myself, dr. , were aware and were executing the family's wishes at this time. the patient was placed on a morphine drip after being bolused with morphine as well as a propofol drip, and placed on t-piece and room air oxygenation. by 3:11 a.m., the patient was pronounced dead, after having been found in agonal rhythm and then ultimately to be asystolic. his sedatives and narcotics were removed and, after approximately a 35 minute hiatus without any sedation, his examination revealed that he had fixed and dilated pupils. he had no doll's eye reflex. he had no spontaneous respirations, no heart sounds, no carotid, no femoral pulses, no radial pulses. he was not responding to any painful stimuli. he had no corneal reflexes. his pupils were fixed and dilated as stated. his body was otherwise blue and cyanotic. i therefore pronounced the patient dead at 3:11 a.m. on . i notified the admitting office and his death certificate was therefore duly filled out. the medical examiner does not need to review this case, as this patient was in hospital for approximately two weeks and he was made comfort measures only. his cause of death is respiratory failure/adult respiratory distress syndrome. other diagnoses include poorly-differentiated adenocarcinoma of the right middle lobe status post right middle lobe lobectomy complicated by respiratory failure, adult respiratory distress syndrome, as well as acute renal failure, depressed cortical function with intact brain stem function prior to removal of support. post-support, the patient had no evidence of brain stem function, no evidence of cortical function. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube fiber-optic bronchoscopy closed [endoscopic] biopsy of bronchus esophagogastroduodenoscopy [egd] with closed biopsy pericardiotomy diagnoses: unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation pulmonary collapse other malignant lymphomas, unspecified site, extranodal and solid organ sites alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance malignant neoplasm of middle lobe, bronchus or lung 

Answer: The patient is high likely exposed to