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: no known allergies / adverse drug reactions attending: chief complaint: dyspnea hypotension major surgical or invasive procedure: none history of present illness: the patient is an 86-yo cantonese speaking male who presents from his nursing home after an episode ofacute shorntess of breath and neurological changes. he has chronic lung disease on home 2l nc home o2. vitals on the scene were hr 100, bp 119/68 and o2 83 on 2l. glucose 173. according to the neurology consult service who spoke with the nh, "he was seen walking the halls around 8:30am, and was noted to be able to eat his breakfast without difficulty. he then went back to his room where they helped him shower and shave and he went back to bed. somewhere between 10:30 and 11am he was found in his room, lethargic and 'grey'. he was found at that time to have an sao2 of 83% on 2l nc, which only improved to 91% with 5l nc. he was also tachypnic to 22, hypotensive to 80/50 and tachycardic to 110." a cantonese speaking nurse reported that he "was slow to respond, and was soft spoken, but was able to provide appropriate responses." . on arrival to the ed he was hypoxic to 88% on ra and his systolic pressure in 80s. he was noted to be minimally responsive, with a question of possible decreased movement on his right side. a code stroke was called. . a cta of the head and neck and a ct brain perfusion were negative. he was persistently hypotensive and a central line was placed and norepi started. a formal echo did was not concerning for cardiogenic shock or right heart strain so a cta was not obtained for r/o pe. he was treated with vanc and zosyn for pna but vanc was stopped for red man syndrome. . on arrival, his son was interviewed with the interpreter. per the son, in the several days prior he had been complaining of palpitations. however, when asked if he had chest pain, the son stated that he actually had chest pain and not palpitations. the son denies any cough or increased sputum. past medical history: copd, htn, dm, pe s/p ivc filter, hearing loss bl, dementia social history: was at the rehab prior to transfer here. before rehab, was living at home with wife : listed as contact and hcp family history: nc physical exam: physical exam on arrival to the micu general appearance: no acute distress, thin heent: perrl, normocephalic cv: normal s1 and s2, no m/r/g resp: rhonchorous abdominal: soft, non-tender, bowel sounds present extremities: no edema, cyanosis, or clubbing, no edema msk: + muscle wasting, unable to stand skin: warm, no rash or jaundice physical exam on discharge from the micu general: alert, awake, answering questions appropriately cv: rrr, no m/r/g resp: diminished movements in the bases, continues to have crackles in the bases, more on the right, occasional inspiratory wheeze on the left abd: soft, nt, nd, bs+ extremities: warm, dry, no edema pertinent results: 01:30pm blood neuts-84.0* lymphs-11.0* monos-3.4 eos-1.0 baso-0.6 01:30pm blood wbc-9.7 rbc-4.60 hgb-13.9*# hct-42.9# mcv-93 mch-30.3 mchc-32.5 rdw-16.5* plt ct-406 01:30pm blood pt-12.7 ptt-21.6* inr(pt)-1.1 09:00pm blood glucose-42* urean-15 creat-0.6 na-144 k-3.7 cl-108 hco3-28 angap-12 05:48am blood alt-10 ast-13 ck(cpk)-46* alkphos-67 totbili-0.3 01:30pm blood probnp-1384* 01:30pm blood ctropnt-<0.01 05:48am blood ck-mb-2 ctropnt-<0.01 01:30pm blood calcium-8.8 phos-4.1 mg-2.5 05:48am blood albumin-3.0* calcium-7.5* phos-3.6 mg-2.1 04:52pm blood type- po2-50* pco2-42 ph-7.38 caltco2-26 base xs-0 intubat-not intuba 09:37pm blood type-mix temp-35.7 po2-104 pco2-54* ph-7.33* caltco2-30 base xs-0 intubat-not intuba comment-green top 01:45pm blood glucose-132* lactate-2.7* na-142 k-4.4 cl-101 calhco3-29 09:37pm blood lactate-1.0 05:48am blood wbc-11.3* rbc-4.30* hgb-12.9* hct-40.1 mcv-93 mch-30.1 mchc-32.2 rdw-16.3* plt ct-379 05:00pm urine color-straw appear-clear sp -1.014 urine legionella antigen negative ct/cta head/neck: findings: non-contrast head ct: there is no acute intracranial hemorrhage, large areas of edema, large masses, or mass effect. there is preservation of normal -white matter differentiation. prominence of the ventricles and sulci is consistent with age-related parenchymal atrophy. incidental note is made of cavum septum pellucidum, et vergae variant. the paranasal sinuses and mastoid air cells are clear, although there is under-pneumatization of the left mastoid air cells. soft tissues of the orbits are within normal limits. ct perfusion: the mean transit time, cerebral blood flow, and cerebral blood volume are within normal limits with no evidence of perfusion abnormality to suggest infarct. cta head: there is prominent calcified atherosclerotic disease of the cavernous portion of the left internal carotid artery likely causing some degree of narrowing, although the full extent is difficult to appreciate given the extensive calcification. milder calcified atherosclerotic disease is noted of the right cavernous ica. otherwise, there are no areas of significant stenosis, occlusion, or aneurysm formation measuring more than 2 mm. there is also calcified atherosclerotic disease of the intracranial portion of the vertebral arteries bilaterally without significant stenosis. cta neck: there is extensive severe atherosclerotic disease with diffuse areas of ulcerative plaque noted within the aortic arch, similar in appearance to the cta chest of . extensive atherosclerotic disease causes severe stenosis at the origin of the left common carotid artery and also severe stenosis at the origin of the left subclavian artery. the right common carotid artery demonstrates calcified atherosclerotic disease proximally but without significant stenosis. the right cervical internal carotid artery demonstrates a minimal diameter of 7.0 mm proximally and 4.0 mm distally. the left cervical ica demonstrates a minimal diameter of 6.5 mm proximally and 3.5 mm distally. the proximal left vertebral artery is occluded. there is poor reconstitution within the mid left vertebral artery, although adequate flow is seen in the distal artery beginning around the level of vertebral body c3. however, the direction of flow cannot be assessed on cta. ct chest there is severe emphysema. patchy opacities are noted within the left upper lobe concerning for aspiration and/or pneumonia. although not visualized on the axial ct portion, the coronal scout image also demonstrates areas of patchy opacity in the mid right lung. impression: 1. no acute intracranial process. no areas of perfusion abnormality to suggest infarct. 2. severe extensive atherosclerotic disease with diffuse ulcerative plaque within the aortic arch extending to the proximal great vessels with severe stenosis at the origin of the left common carotid artery and severe stenosis at the origin of the left subclavian artery. the proximal left vertebral artery is occluded but reconstitutes fully distally at the level of the vertebral body c3. the direction of flow cannot be determined on cta. there is also narrowing of the origin of the right vertebral artery. 3. extensive calcified plaque of the cavernous portion of the left ica with some degree of narrowing. however, it is difficult to characterize the degree of stenosis due to the extent of the calcification. 4. severe emphysema with patchy opacities in the visualized left upper lobe and right mid lung, concerning for pneumonia and/or aspiration. please refer to same day chest x-ray for further details. video oropharyngeal swallowing study: findings: there was penetration and aspiration of thin liquids. there was penetration with nectar-thick liquids with independent cough reflex which cleared the nectar preventing aspiration. impression: aspiration of thin liquids and penetration of nectar-thick barium with independent cough reflex. for further details, please refer to speech and swallow division note in omr. brief hospital course: 86yo m with h/o not clearly defined chronic lung disease presenting with acute onset hypoxemia and hypotension. # hypoxemia. most likely aspiration pneumonia/pneumonitis given acute presentation and as suggested by cta chest. pe was ruled out with cta of the chest. patient was kept npo. given he was in the rehab, patient was started with broad spectrum antibiotics, including vanc, zosyn, and levofloxacin. levofloxacin was discontinued as urine legionella was negative. given his clinical improvement with supportive care such as nebs and chest pt, antibiotics was narrowed to cover gram negatives/anaerobes with unasyn only and vancomycin for positive mrsa swab. speech and swallow confirmed presence of aspiration and recommended dysphagia pureed diet with nectar thick liquid. family meeting was held with the patient's family (son) regarding his prognosis and the cause of his frequent respiratory distress. it was clearly stated by the son that the patient enjoys eating and would not want to have any type of tube feeding understanding that tube feeding would not eliminate future aspiration. his o2 supplement was unable to be weaned below 40% face tent and 4l nc to maintain o2sat > 90%. baseline o2 supplement was 2l nc. chest pt may be helpful. continue antibiotics and nebulizers prn with home meds. # hypotension. most likely sepsis vs. distributive pneumonitis. unlikely cardiogenic given echocardiogram and exam. levophed was weaned on hd2. lactate normalized. resolved yoib discharge. # altered mental status. ct head without new changes other than significant atherosclerotic changes. consistent with delirium, enecephalopathy from hypoxemia, hypotyension. it resolved and improved to baseline per family. # copd. by imaging. patient was placed on scheduled nebulizers. no steroid was given as it was not consistent with copd exacerbation. he should continue with nebulizers until oxygen supplement improves. # dm2. metformin was held while in the hospital. he was on insulin sliding scale # access: left picc line transitional issue: chest pt physical therapy o2 supplement vancomycin trough before the 4th dose on . discussion with family regarding "do not rehospitalize" +/- hospice given outpatient pcp follow up upon discharge from ltac medications on admission: humalog insulin sliding scale 151-200: 2units, 201-300 lasix 20mg po daily spiriva lidoderm patch patch to each side of each ankle daily (2 patches) advair 100-50 docusate metformin 500 senna 2 tabs vit d 400 units dulcolax supp prn fleet enema prn tylenol prn discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) unit/ml injection tid (3 times a day). 2. metformin 500 mg tablet sig: one (1) tablet po twice a day. 3. humalog insulin sliding scale 4. 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. 5. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for sob or wheeze. 6. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation once a day. 7. lidoderm 5 %(700 mg/patch) adhesive patch, medicated sig: patch topical once a day: to each side of each ankle. 2 patches . 8. advair diskus 100-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day. 9. docusate sodium 100 mg tablet sig: one (1) tablet po twice a day as needed for constipation. 10. senna 8.6 mg capsule sig: two (2) capsule po twice a day as needed for constipation. 11. vitamin d 400 unit capsule sig: one (1) capsule po twice a day. 12. dulcolax 10 mg suppository sig: one (1) suppository rectal once a day as needed for constipation. 13. tylenol 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. 14. ampicillin-sulbactam 1.5 g iv q6h day 1 = 15. vancomycin 1000 mg iv q 24h 16. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for itchy back. 17. lasix 20 mg tablet sig: one (1) tablet po once a day. 18. oxygen titrate oxygen to o2 sat greater than 91%. discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses: - hypoxemia and hypotension secondary to aspiration pneumonia - delirium, resolved secondary diagnoses: - type 2 diabetes discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , it was a pleasure to take care of you while at . you were admitted because of trouble breathing and low blood pressure. your labs did not injury to your heart muscle. however, your chest films have showed new areas of infection and inflammation. you are on antibiotics to treat this. we have found that these areas are likely from aspiration of the food that you eat. speech and swallow specialists have recommended you to be on a pureed diet and nectar thickened fluid to prevent. however, even with these modification, aspiration can still occur. after speaking with your family, we understand that you would not want to have any feeding tube. it will be important for you to speak with your family about whether you want to return to the hospital in the future if the same symptoms occur. your ct head showed that you have significant atherosclerotic disease in your blood vessels. however, there is no bleeding in your head. the confusion that you had initially is probably due to the underlying infection. please note the changes of medications below. - start vancomycin until to complete total of 8 days - start unasyn until to complete total of 8 days - start albuterol nebulizer every 6 hours as needed for shortness of breath or wheeze - start ipratropium nebulizer every 6 hours as needed for shortness of breath or wheeze - start heparin 5000 units subcutaneously three times a day for deep vein thrombosis prophylaxis - sarna lotion was started for you for dry itchy back. followup instructions: follow up with primary care provider upon discharge from the ltac md procedure: central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin septic shock other emphysema personal history of venous thrombosis and embolism do not resuscitate status encephalopathy, unspecified other dependence on machines, supplemental oxygen dysphagia, oropharyngeal phase dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to