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: this is a 76-year-old man well known to the neurological service. he was admitted on for an exacerbation of myasthenia . he was initially diagnosed in following an episode of dysarthria and dysphagia after being given a dose of metoprolol while on the medicine service. he at that time had a single-fiber electromyogram which was confirmatory for myasthenia and was treated with mestinon and prednisone and eventually required cellcept for immunosuppression as early as . he was also readmitted shortly after the initial admission when the diagnosis was made to receive five sessions of plasmapheresis for worsening bulbar function. he had approached full strength upon discharge on and it should be noted that that his beta was discontinued at that time for possible exacerbation of his myasthenia . he was readmitted on and underwent parental high-dose steroids as well as plasmapheresis with again improvement of his bulbar symptoms back toward baseline upon discharge on . he was discharged on mestinon 30 mg p.o. q. 8 hours, cellcept 1 gram b.i.d., and prednisone 60 mg p.o. q.d. three days after discharge from the neurology service he had a choking episode on the morning of admission as well as difficulty swallowing. he therefore is admitted to the neurology service for treatment of his myasthenia . he denies any new weakness in his extremities upon admission, no diplopia and no blurry vision. he also denies any dyspnea. he does report nasal speech and fatigue during the course of the day which increases the nasal quality of his speech. it should be noted also that he attempted to take an extra dose of mestinon at home to try to improve the symptoms but thereafter when he tried to take his other medications he did choke on them and he has also noted that he had increased saliva prior to coming into the hospital. past medical history: 1. myasthenia . 2. hypertension. 3. hyperlipidemia. 4. diabetes. 5. benign prostatic hypertrophy status post transurethral resection of the prostate. 6. spinal stenosis. 7. degenerative joint disease. 8. l5-s1 diskectomy. medications on admission: 1. mestinon 30 mg p.o. q. 8 hours. 2. glucovance 2.5/500 one pill in the morning, two pills at night. 3. zocor 40 mg p.o. q.d. 4. prednisone 60 mg p.o. q.d. 5. pepcid 20 mg p.o. b.i.d. 6. flomax 0.4 mg p.o. q.h.s. 7. cellcept 1,000 mg b.i.d. 8. sliding scale insulin. allergies: the patient has no known drug allergies. social history: he is married and living at home with his wife. there is no history of smoking or alcohol abuse. family history: noncontributory. physical examination: vital signs on admission were blood pressure 130/78, pulse 72, respiratory rate 18, oxygen saturation 98% on two liters. in general he was well nourished and in no acute distress. he had occasional coughing, sitting up in bed, secretions were essentially normal, complaining of a dry mouth. neck was supple. lungs were clear to auscultation. cardiovascular examination was regular rate and rhythm. neurological examination: mental status was awake and alert, cooperative with the examination, normal affect, oriented to person and date. attention was intact, said months of the year backward and forward. language was fluent and dysphonic with a frequent cough with a nasal quality to the speech. no paraphrasic errors and the naming was intact. his fund of knowledge was normal. he had no apraxia or neglect. was intact. cranial nerves: no diplopia on sustained upgaze, visual fields were full to confrontation. pupils were equally round and reactive to light, three to two mm bilaterally with light. extraocular movements were intact with old left exotropia, no nystagmus. facial sensation and facial movement was normal bilaterally. hearing was intact to finger rub bilaterally. tongue was midline with no fasciculations. sternocleidomastoid muscle and trapezius were normal bilaterally. the motor examination revealed normal bulk and tone bilaterally without any tremor. the neck flexors were and the neck extensors were . in his extremities he had essentially normal strength with the exception of some right-sided dorsiflexion at 4/5 as well as toe flexion at 4/5. he had no pronator drift. sensation was intact to light touch, pin, vibration, and proprioception. reflexes were 2+ and symmetric throughout. toes were downgoing bilaterally. coordination was normal with finger-to-finger and heel-knee-shin. gait was deferred. hospital course: 1. difficulty swallowing and choking: upon admission he was monitored closely with negative inspiratory force and vital capacities to monitor for respiratory compromise due to the myasthenia . he had a swallowing evaluation upon admission which revealed that he had overaspiration with his swallowing. he was increased on his prednisone to 80 mg p.o. q.d. and he was started on ivig for five days to treatment. he received the first of these transfusions on . he was increased on his mestinon to 60 mg q.i.d. with decrease of his prednisone, which was the equivalent of about 60 mg of prednisone in solu-medrol form due to the patient's inability to swallow his prednisone pill. on the morning of the patient had some respiratory distress with excess secretions of saliva. he felt that he was choking on his saliva and was found to have an oxygen saturation of about 82% on room air with suctioning of a moderate amount of saliva and increased oxygenation after a few deep breaths, to 95-98% on two liters nasal cannula. he did receive a dose of iv neostigmine 12 hours prior to this event and as mentioned, he had just been decreased on his steroids the previous day. the negative inspiratory force was measured on this morning and he was -24. his vital capacity was 1,300 cc. it was felt that at this point it was safer to transfer him to the intensive care unit to watch his respiratory status as his negative inspiratory force was concerning. he was kept there for two days for closer monitoring as his prednisone was increased back up to 80 mg p.o. q.d. and he continued to receive the remainder of his ivig treatments. he remained stable with improvement of his negative inspiratory forces and was transferred back to the floor on . he was monitored on the floor and did have some low negative inspiratory forces which was concerning for respiratory failure however his mestinon was increased to 75 mg q. 4 hours and he continued to do well on this. he gradually improved, both his negative inspiratory force and vital capacities, as well as phonation, as well as swallowing, as well as neck flexor weakness. he has remained on these doses since that time and recently passed a swallowing study on which enabled him to take soft moist foods and regular fluids. upon discharge his negative inspiratory force was -80 with a vital capacity of 3.7 liters. 2. hypoglycemia: the patient was initially very hypoglycemic with both high-dose steroids as well as tube feeds. once his tube feeds were discontinued he did not require large doses of nph insulin which were used to control his blood sugars, which had been anywhere from the 100 to 300 range. he is thus currently being controlled with regular insulin sliding scale until his p.o. intake increases. discharge diagnoses: 1. myasthenia exacerbation. 2. hypertension. 3. hypercholesterolemia. 4. diabetes mellitus. 5. benign prostatic hypertrophy. 6. spinal stenosis. 7. degenerative joint disease. 8. l5-s1 diskectomy in . 9. glaucoma. discharge medications: 1. docusate sodium 100 mg p.o. b.i.d. 2. regular insulin sliding scale. 3. artificial tears 1-2 drops ou t.i.d. 4. captopril 25 mg p.o. t.i.d. 5. glucovance 2.5/500 one tablet p.o. q.a.m. and two tablets p.o. q.h.s. 6. pyridostigmine 75 mg p.o. q. 4 hours. 7. pantoprazole 40 mg p.o. q.d. 8. prednisone 80 mg p.o. q.d. 9. cellcept 1,000 mg p.o. b.i.d. 10. lorazepam 0.5 mg p.o./iv q. 6 hours p.r.n. anxiety. 11. guaifenesin 5-10 mg p.o. q. 4 hours p.r.n. 12. heparin 5,000 units subcutaneous q. 12 hours. follow-up plans: the patient is to follow up with his neurologist, dr. in clinic on . discharge status: to rehabilitation. condition on discharge: good. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances diagnoses: pure hypercholesterolemia unspecified essential hypertension other pulmonary insufficiency, not elsewhere classified unspecified glaucoma other specified cardiac dysrhythmias diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled spinal stenosis, unspecified region 

Answer: The patient is high likely exposed to