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: codeine / keflex / clindamycin attending: chief complaint: dysphagia, poor po intake, weight loss major surgical or invasive procedure: peg tube placement history of present illness: this is an 82 y/o f with two and a half years of dysphagia, who had a feeding tube placed in . it remained in until of 06, after her weight improved. about 6-8 months ago, she began to have trouble swallowing again. she decribes it as feeling asa if her throat is clogged. she does not feel food getting stuck. dhe does not drink thin liquids. she has trouble with most foods. she denies the feeling that food is going into her trachea. she reports weight loss from 115 lbs to 99lbs over the last eight months. she also has two and a half years of hoarseness/laryngitis which comes and goes. on ros, she denies headache, fevers, chills, chest pain, back pain, dyspnea at rest or with exertion, abdominal pain, diarrhea. she does have some constipation. she denies joint pain. she does have rosacia for a long time. past medical history: atrial fibrillation s/p ablation dilated ascending aorta osteoporosis dysphagia for several years with weight loss history of pna requiring vats pleural effusion drainage and decortication on the right side diverticulosis/diverticulitis history of bowel obstruction with temporary colostomy prolapsed uterus s/p repair s/p hysterectomy cerebral palsy macular degeneration ventral hernias rosacia status post removal of bowel obstruction due to diverticulitis requiring a temporary colostomy status post surgical repair of a prolapsed uterus status post total hysterectomy status post abdominal surgery secondary to complications of prolapsed uterus surgery - the patient developed multiple hernias. status post surgery for exposed keratoses social history: non smoker. lives alone in . totally independent, but recently has not been going to the gym because of weakness for the last several months. family history: noncontributory physical exam: general: extrememly cachectic female in no acute distress. very throaty voice, very fatigueable. vitals: t 98.1 hr 77 bp 110/68 rr 20 sat 94%ra skin: thin and tenting. heent: sunken eyes, unable to close eyelids completely, erythematous conjunctiva, cornea with some opacification bilaterally. eomi. pupils equal. sclera anicteric. neck: no stiffness, no masses, no lad, palpable carotid pulses chest: no supraclavicular or axillary lad, decreased breath sounds at right base. heart: regular with palpable 4/6 systolic murmur over entire precordium. back: no spinal tenderness abdomen: massive ventral hernia with audible bowel sounds. midline scar. nt. no guarding, no rebound. ext: some dip nodules bilaterally. bilateral pitting edema of legs to the knee. right heel ulcer. neuro: ms oriented to person, place, time cn ii-xii intact muscle strength rue lue lle rle pertinent results: 07:00am blood wbc-7.0 rbc-3.33* hgb-10.8* hct-33.6* mcv-101* mch-32.4* mchc-32.1 rdw-14.4 plt ct-186 07:05am blood wbc-6.9 rbc-3.63* hgb-11.9* hct-36.2 mcv-100* mch-32.8* mchc-32.8 rdw-14.3 plt ct-148* 09:20pm blood wbc-7.1 rbc-3.46* hgb-11.4* hct-34.2* mcv-99* mch-33.1* mchc-33.4 rdw-14.0 plt ct-186 07:50am blood neuts-84.9* lymphs-9.0* monos-4.4 eos-1.4 baso-0.3 03:54am blood neuts-88.0* lymphs-7.4* monos-3.6 eos-0.8 baso-0.2 07:00am blood plt ct-186 07:05am blood plt ct-148* 07:05am blood pt-13.6* ptt-31.6 inr(pt)-1.2* 03:54am blood pt-13.0 ptt-34.5 inr(pt)-1.1 09:20pm blood plt ct-186 09:20pm blood pt-14.0* inr(pt)-1.2* 05:45am blood glucose-150* urean-10 creat-0.4 na-139 k-3.9 cl-98 hco3-38* angap-7* 06:35am blood glucose-115* urean-9 creat-0.4 na-141 k-4.0 cl-99 hco3-39* angap-7* 07:05am blood glucose-88 urean-9 creat-0.4 na-140 k-3.9 cl-96 hco3-37* angap-11 07:15am blood glucose-68* urean-13 creat-0.5 na-142 k-4.8 cl-101 hco3-35* angap-11 09:20pm blood glucose-98 urean-14 creat-0.5 na-145 k-3.9 cl-103 hco3-35* angap-11 06:35am blood alt-18 ast-32 ld(ldh)-212 alkphos-44 totbili-0.5 09:20pm blood alt-18 ast-20 alkphos-58 amylase-46 totbili-0.7 06:35am blood calcium-7.9* phos-2.4* mg-1.9 07:05am blood calcium-8.5 phos-1.9* mg-1.9 iron-52 09:20pm blood albumin-3.3* calcium-9.2 phos-3.0 mg-1.8 07:05am blood caltibc-212* vitb12-1545* folate-greater th ferritn-137 trf-163* 01:30pm blood type-art po2-90 pco2-67* ph-7.39 caltco2-42* base xs-11 01:22pm blood type-art po2-117* pco2-70* ph-7.31* caltco2-37* base xs-6 11:04am urine color-straw appear-hazy sp -1.010 11:04am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-10 bilirub-neg urobiln-neg ph-7.5 leuks-sm 11:04am urine rbc-1 wbc-11* bacteri-few yeast-none epi-1 transe-1 11:04am urine hours-random urean-299 creat-40 na-94 cl-66 . cxr - bibasilar airspace opacities consistent with aspiration. . arterial study - right lower extremity mild arterial occlusive disease. left- sided ankle-brachial indices are normal at rest. there is evidence of some tibial level disease on segmental pressure readings. . cxr - a single ap chest radiograph compared to shows increased bibasilar opacities. rounded lucency within the left lung base likely represents residual aerated lung. tip of the ng tube is seen within the stomach. . ekg - sinus rhythm. a-v conduction delay. left anterior fascicular block. compared to the previous tracing of the limb lead voltage is more prominent. the axis is more leftward. otherwise, no diagnostic interim change. brief hospital course: 82 y/o f with a two and a half year history of dysphagia and intermittant voice hoarseness presented with dysphagia, cough, and weight loss, had unsuccessful peg placement attempt by gi due to hypercarbia, with resultant peg placement by surgery under general anesthesia on with tube feeds, transferred to rehab. 1. dysphagia - video swallowing study x2 suggestes primary swallowing problem (intrinsic swallowing muscles), other differential possibilities central cn problem vs. internal esophageal obstruction vs. external compression of esophagus. further work-up not performed during this stay can include chest ct to assess for compression on esophagus. patient was kept npo, initially had tube feedings through a dobhoff/ngt. egd being performed by gi was unsuccessful due to ?oversedation with hypercarbia and unresponsiveness. peg tube placement was then successfully attempted with general anesthesia by surgery on . nutrition was consulted and patient was transitioned to continues peg tube feeds on until time of discharge. patient will need follow-up speech and swallow evaluation, either at rehab or at . . 2. somnolence/apnea - as above, patient had somnolent, apneic period in setting of medication for egd, with resultant hypercarbia, transferred to micu then called out after 2 days. patient was fully awake and alert during the last 5 days of her hospitalization. ble, satting well on 2l nasal cannula with good mental status. cxr demonstrated possible rml/rll pneumonitis vs. pneumonia (aspiration, likely after initial episode of somnolence), but now afebrile. . 3. respiratory/aspiration - pt had hx of aspiration, cxr was suggestive of aspiration. since patient was afebrile with normal wbc, no antibiotics were administered. patient was never intubated but required oxygen during the hospitalization, specifically 2 liters of o2 during the last 5 days of her stay. she did continue to have mild secretions with rhonchi on her exam. patient will continue to need chest pt, oob, incentive spirometry, yankauer suctioning, hob > 30 degrees, aspiration precautions at rehab. . 4. right heel wound - stage ii ulcer, arterial studes performed with results as above. patient was treated with duoderm and waffle boots. she will continue to require barrier cream for elbows and buttocks and lotion to bilateral legs daily to prevent further skin breakdown. . 5. cardiovascular/atrial fibrillation - s/p ablation, was well rate controlled during her stay on metoprolol. her systolic blood pressures ranged from 90-125 with metoprolol being held one day during her last 5 days due to relative hypotension. . 6. hoarse voice - could be vocal cord paralysis, but cords moving normally on video swallow. recurrent laryngeal nerve involvement from dilated aorta possible. consider further workup as outpatient. . 7. hypothyroidism - continued on levothyroxine. . 8. macular degeneration - continued eye drops. . 9. osteoporosis - continued vitamin d and calcium. family was requesting boniva iv treatment while inpatient as she would be missing her treatment as outpatient on monday, . our inpatient pharmacy did not have this medication and it is not on our inpatient formulary. . 10. cerebral palsy - had been on diazepam previously, now continuing to hold given oversedation. . 11. fen - peg tube feeds were initiated on with nutren pulmonary feeds (due to metabolic alkalosis/high bicarb - lowest carbohydrate feedings available). there were no discreet recommendations on when to transition patient to bolus feedings from continuous. due to surgical placement, would opt to continue continuous tube feedings for 7 days, then transition to bolus feedings. she will need a nutrition consult to aid in appropriate tube feeding regimen, monitoring of lytes - specifically acid-base status given respiratory issues, and will need monitoring of peg tube placement and stability. she should also have an appointment scheduled with surgery to follow the peg tube sometime within the next 4-6 weeks. . 12. - pt was treated with heparin subq and a bowel regimen. she was able to urinate on her own, but her output was not robust on a daily basis and bladder scans did show >600cc on one occasion, but patient able to void. . 13. pt - pt spent most of the days in bed and oob to chair. will need physical therapy while at rehab. . 14. code: full medications on admission: aspirin 81 mg daily diazepam 2 mg daily erythromycin 5 mg/gram ointment - 1 application eyes at bedtime gatifloxacin 0.3 % drops - 1 drop eyes mon-wed-fri ibandronate - 3 mg injection every three months levothyroxine 50 mcg daily metoprolol tartrate 25 mg multivitamins daily calcium citrate-vitamin d3 - 250 mg-200 unit tab discharge medications: 1. erythromycin 5 mg/g ointment sig: one (1) application ophthalmic hs (at bedtime). 2. boniva 3 mg/3 ml syringe kit sig: one (1) injection intravenous every 3 months. 3. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 4. multivitamin tablet sig: one (1) cap po daily (daily). 5. citracal + d 250-200 mg-unit tablet sig: one (1) tablet po twice a day. 6. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 7. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 8. ciprofloxacin 0.3 % drops sig: one (1) drop ophthalmic mwf (monday-wednesday-friday). 9. acetylcysteine 20 % (200 mg/ml) solution sig: one (1) ml miscellaneous q6h (every 6 hours). 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: inhalation q6h (every 6 hours). 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 12. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 13. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 14. insulin lispro 100 unit/ml solution sig: asdir subcutaneous asdir (as directed). 15. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp<95. 16. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: one (1) drop ophthalmic tid (3 times a day) as needed for dry eyes. 17. aspirin 81 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: for the aged - discharge diagnosis: primary: 1. dysphagia 2. aspiration - peg tube placement . secondary: atrial fibrillation s/p ablation dilated ascending aorta osteoporosis dysphagia for several years with weight loss history of pna requiring vats pleural effusion drainage and decortication on the right side diverticulosis/diverticulitis history of bowel obstruction with temporary colostomy prolapsed uterus s/p repair s/p hysterectomy cerebral palsy macular degeneration ventral hernias rosacia discharge condition: stable, tolerating peg tube feeds. discharge instructions: you were admitted because of trouble swallowing and significant weight loss. you had a gastric tube placed for feeding. if you acquire chest pain, shortness of breath, nausea, vomiting, or any other issue that is out of the ordinary for you, please call 911 or seek medical care. followup instructions: provider: , md phone: date/time: 10:00 provider: ,nurse date/time: 3:00 provider: ,chair three rooms date/time: 11:15 you should call your pcp to set up an appointment within the next 2-3 weeks for an appointment. you will need an appointment with the general surgeons here to have your peg tube followed within the next 4-6 weeks (or sooner if any issues arise with its placement). procedure: other esophagoscopy enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] other oxygen enrichment diagnoses: unspecified protein-calorie malnutrition unspecified acquired hypothyroidism atrial fibrillation acute respiratory failure pneumonitis due to inhalation of food or vomitus loss of weight cachexia disorders of phosphorus metabolism osteoporosis, unspecified macular degeneration (senile), unspecified other specified hypoglycemia adult failure to thrive ulcer of heel and midfoot ventral, unspecified, hernia without mention of obstruction or gangrene other ill-defined cerebrovascular disease apnea other voice and resonance disorders other dysphagia 

Answer: The patient is high likely exposed to