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: hypoxia major surgical or invasive procedure: picc placement intubation history of present illness: patient is a 61 yo m with pmhx sig. for squamous cell carcinoma of the tongue with mets to lung, ribs, and hips who was transferred from ed for hypoxia. he recently moved to roscommon on the parkway. during his initial intake, he was found to be ppd+. he was seen at clinic and was felt not to have active tuberculosis but perhaps a community acquired pneumonia on cxr. he just finished a 10 day course of levaquin for pneumonia. he recently has loose stools, was found to have c. diff on , and was started on flagyl. at rehab, he became acutely sob with spo2 to 38%, rr20, hr 122, bp 86/60, and t100.5. per nh, his baseline a&ox2. he has poor appetite and refuses most meals. . he was taken to . bcxs were drawn and he received vanc and zosyn for presumed pneumonia. labs were sig. for wbc 5.1, 30% bands, 45% n, 14% l, cr 1.9, ca 15.9, ck 47, tropt 0.08, bnp 4936. abg was 7.53/35/57 on nrb. he was placed on bipap 13/8 with abg of 7.49/34/326. he was transferred him for icu care. . in the ed, initial vs were: t98.6, p87, bp 94/65, r 22, and o2 sat 93% on 4l. he was briefly hypotensive to sbp of 70s, responded to ivf bolus. labs were sig. for wbc of 4.6, 6%bands, cr 2.0, ca 13.4. ct head showed "lytic bone lesions in left occiput and right frontal likely represent lytic mets. pending reformations, but no obvious intracranial extension. no acute intracranial process." cxr showed patient was started on heparin gtt and he was given azithromycin. he has received a total of 2l ns. . review of sytems: difficult to obtain due to dysarthria. denied any headache, chest pain. his sob was improved. he had lower abdominal pain and diarrhea. past medical history: -squamous cell of the tongue, stage iv, metastatic to the zygomatic arch and skull -latent tuberculosis social history: unable to obtain family history: no significant history physical exam: vitals: t: bp: p: r: 18 o2: general: alert, oriented to self, , , no acute distress, extremely cachetic, dysarthric heent: sclera anicteric, mm dry, yellow exudate over upper palate and base of tongue neck: supple, jvp not elevated, no lad lungs: coarse lll crackles, no wheezes cv: regular rate and rhythm, no murmurs abdomen: normoactive bowel sounds, soft, tender in llq, no rebound or guarding gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 07:21pm urine color-yellow appear-clear sp -1.013 07:21pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-sm 07:21pm urine rbc-1 wbc-8* bacteria-none yeast-none epi-<1 07:21pm urine amorph-rare 07:21pm urine mucous-rare 07:21pm urine eos-negative 07:16pm ptt-81.7* 09:00am urine color-yellow appear-clear sp -1.017 09:00am urine blood-sm nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 09:00am urine rbc-0-2 wbc- bacteria-few yeast-none epi-<1 09:00am urine hyaline-* 09:00am urine mucous-few 08:38am comments-green top 08:38am glucose-106* lactate-3.1* na+-146 k+-4.4 08:38am hgb-10.6* calchct-32 08:30am glucose-109* urea n-95* creat-2.0* sodium-145 potassium-4.7 chloride-107 total co2-26 anion gap-17 08:30am estgfr-using this 08:30am alt(sgpt)-14 ast(sgot)-34 ck(cpk)-124 alk phos-139* tot bili-0.3 08:30am lipase-15 08:30am ctropnt-0.10* 08:30am ck-mb-6 08:30am albumin-3.3* calcium-13.4* phosphate-3.8 magnesium-2.2 iron-22* 08:30am caltibc-192* vit b12-795 folate-greater th ferritin-greater th trf-148* 08:30am wbc-4.6 rbc-3.64* hgb-10.9* hct-34.8* mcv-96 mch-30.0 mchc-31.4 rdw-16.2* 08:30am wbc-4.6 rbc-3.64* hgb-10.9* hct-34.8* mcv-96 mch-30.0 mchc-31.4 rdw-16.2* 08:30am neuts-49* bands-6* lymphs-29 monos-14* eos-0 basos-0 atyps-0 metas-1* myelos-1* 08:30am hypochrom-1+ anisocyt-1+ poikilocy-normal macrocyt-1+ microcyt-normal polychrom-normal 08:30am plt smr-normal plt count-203 08:30am pt-14.3* ptt-32.9 inr(pt)-1.2* . blood cx: ngtd urine cx: ngtd flu: negative legionella: negative . ct head: impression: 1. right frontal and left basilar occiput lytic metastatic lesions without intra-articular extension. 2. bilateral thalamic hypoattenuation may represent lacunar infarcts; however, metastases are not excluded. if the clinical concern exists, then an mr is recommended for further evaluation. . cxr: impression: right extrapulmonary mass, likely pleural-based. a chest ct may be acquired for further evaluation. . lenis: no dvt 03:57am blood wbc-13.9* rbc-3.16*# hgb-9.6*# hct-28.9* mcv-92 mch-30.6 mchc-33.4 rdw-18.7* plt ct-207 03:50am blood neuts-88.9* lymphs-6.8* monos-3.2 eos-0.8 baso-0.2 03:57am blood pt-13.4 ptt-36.6* inr(pt)-1.1 03:57am blood glucose-107* urean-19 creat-0.7 na-139 k-4.2 cl-109* hco3-23 angap-11 05:00am blood alt-8 ast-19 ld(ldh)-201 alkphos-120 totbili-0.1 03:57am blood calcium-9.4 phos-2.1* mg-1.9 05:00am blood pth-17 03:50am blood cortsol-18.9 05:00am blood parathyroid hormone related protein-pnd 05:00am blood vitamin d 25 hydroxy-pnd stool clostridium difficile negative stool clostridium difficile negative sputum acid fast smear-negative blood culture - pending blood culture -pending blood culture -pending urine culture-no growth sputum acid fast smear-negative sputum acid fast smear-negative blood culture -final negative blood culture -final negative urine -final negative urine legionella negative ct neck 1. patent airway with endotracheal tube in place. minimal soft tissue thickening at the level of cricoid and thyroid cartilage likely represents vocal cords, although further evaluation in this region is limited due to presence of the tube. a small area of ill-defined density anterior to the endotracheal tube just below the level of vocal cord (301b, 70) may represent synechia or scar tissue or secretion. 2. left cervical soft tissue thickening with adjacent fat stranding may represent post-surgical and radiation therapy change in this region. partial strap muscle resection and submental surgical clips evident on the left. 3. partial visualization of a large right chest wall mass extending into right lung with multifocal osseous metastasis. 4. multilevel degenerative disease in the cervical spine, concurrent metastasis cannot be excluded. 5. subcentimeter left thyroid nodule may be further evaluated by ultrasound on non-emergent basis as clinically indicated. 6. partially visualized endotracheal tube, nasogastric tube, and left approach central venous catheter appear to be in expected locations. brief hospital course: hospital course by problem: respiratory failure secondary to difficulty protecting airway from oropharyngeal squamous cell carcinoma: intially treated for pneumonia and ruled out for pe. echo was also performed as well which showed normal systolic function suggesting a non-cardiogenic cause. his respiratory status declined further after placement of a ng tube for oral vancomycin following a failed swallowing evaluation. he was noted to have very thick and purulent secretions from his upper airway and his respiratory failure was felt to be secondary to mucous plugging. he was intubated for airway protection. the possibility of tracheostomy and peg was considered and the patient was seen by the ent surgeon, but he elected to decline this intervention and to transistion to comfort-oriented care. c. difficile colitis: diagnosed at nursing home. he was continued on iv flagyl. po vanco was added for increasing leukocytosis. the infectious disease team recommended a 2 week course of iv flagyl and po vancomycin. he was transitioned to only iv flagyl to be completed on prior to discharge from the hospital because his ng tube was a source of discomfort. the flagyl may be discontinued if he loses iv access at any point. esophageal candidiasis: noted during intubation in the icu. have also contributed to profound leukocytosis. per id team recommendations, treated with fluconazole, initially po and then iv for a 2 week course from . his oral discomfort improved significantly while on this medication. once his ng tube was removed, he was transitioned to po clotrimazole troches on to complete an additonal 1 week course. anemia: gradual drop in hematocrit. has some blood loss from tumor, esophageal candidiasis. transfused 2 units. acute renal failure: pre-renal azotemia initially that resolved with ivf. metastatic squamous cell ca: per oncologist no further care that patient could tolerate or would be a candidate for. pain management was initiated with lidocaine patches to hips, fentanyl patch, and po morphine concentrate. please uptitrate fentanyl patch (increased to 25mcg/hr on ) and po morphine concentrate to acheive adequate pain control. hypercalcemia: s/p pamidronate x1 . secondary to malignancy vs bony mets. latent tuberculosis: history of positive ppd at . ruled out for tuberculosis with sputum negative for afb x 3. hypernatremia: improved with free water repletion. fen: dubhoff placed during inbutation to allow for gastric access and patient was transitioned from tpn to tube feeds. tube feeds were eventually stopped due to exacerbation of diarrhea. he may take food by mouth for comfort as desired. the patient elected to keep the dubhoff tube in place to continue receiving po vancomycin and other medications until the day of discharge from the hospital when it was removed for ongoing discomfort. goals of care: after multiple discussion with palliative care and the ent surgeon regarding option of tracheostomy the patient elected to change his code status from full to dnr/dni, with focus on comfort. he is being discharged to an inpatient hospice. medications on admission: morphine flagyl stool softeners discharge medications: 1. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 3. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 4. scopolamine base 1.5 mg patch 72 hr sig: one (1) patch 72 hr transdermal q3 days prn () as needed for secretions. 5. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 6. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 7. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for dryness. 8. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: one (1) bag intravenous q8h (every 8 hours) for 8 days: last day . discontinue if loses iv access. 9. fentanyl 25 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours) as needed for onc pain: titrate dose up prn. 10. morphine concentrate 20 mg/ml solution sig: 5-20 mg po q1h (every hour) as needed for pain, shortness of breath: may up titrate as necessary for pain control. 11. clotrimazole 10 mg troche sig: one (1) troche mucous membrane qid (4 times a day) for 7 days: may discontinue if unable to tolerate. discharge disposition: extended care facility: roscommon discharge diagnosis: primary: respiratory failure, clostridium difficile colitis, metastatic squamous cell carcinoma, positive ppd discharge condition: patient is alert and oriented, bed bound at baseline, hemodynamically stable with waxing and oxygen requirements. discharge instructions: you were treated for your difficulty breathing due to your metastatic squamous cell carcinoma of the tongue and clostridium difficile colitis. you were ruled out for active tuberculosis and did require a breathing tube as we sorted out whether any further treatment for your cancer was possible. after discussing with you that no further treatment was available for your cancer, the breathing tube was removed and your care was transitioned to hospice care with a goal of treating any breathing difficulty with oxygen, good oral care, and pain medications. followup instructions: please follow up with your primary oncologist at , dr. , as needed. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: pneumonia, organism unspecified acute kidney failure, unspecified acute respiratory failure cachexia pressure ulcer, lower back hypoxemia surgical or other procedure not carried out because of patient's decision secondary malignant neoplasm of lung secondary malignant neoplasm of bone and bone marrow nonspecific low blood pressure reading pressure ulcer, stage ii candidal esophagitis malnutrition of moderate degree malignant neoplasm of other sites of tongue 

Answer: The patient is high likely exposed to