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: neck and left arm numbness and tingling major surgical or invasive procedure: cervical laminectomy and fusion, acdf c3-6 history of present illness: mr. is a 68 y/o male with hyperlipidemia, htn, cervical radiculopathy, who was admitted to the orthopedics service on for a cervical laminectomy and c3-c6 anterior/posterior fusion. he underwent the procedures successfully and was recovering on the ortho service, when on he had an episode of hypotension with sbp's in the 60's and tachycardia with confusion. this resolved spontaneously, work-up was initiated, and his opiate dose was decreased. however, a similar episode of hypotension occured again at approximately 10 pm on the same day, resulting in a code blue, intubation for airway protection and transfer to the tramua icu on . he was started on vancomycin and zosyn and levophed. cxr was significant for infiltrates. he underwent a bronchoscopy and bal on and was noted to have copious secretions in lul and lll. he had a bump in his troponin on with peak to 0.37. he was extubated successfully on . . of note, his course was complicated by a troponin leak from 0.04 to >0.39. cardiology was consulted and felt that the patient likely sustained an nstemi in the setting of his hypotension, recommendation was for medical management. . past medical history: 1. cervical radiculopathy s/p cervical laminectomy and c3-c6 fusion 2. htn 3. hyperlipidemia 4. remote history of stroke with residual mild left-sided hemiparesis 5. gout social history: he lives alone. previously worked at a meat cutter. smokes about half pack per day for over 40 years. history of heavy alcohol use in the past. denies drug use. family history: n/c physical exam: nad rrr cta b abd soft nt/nd bue- good strength at right biceps, triceps, wrist extension and flexion, finger extension and flexion and intrinsics, left sided weakness 4/5 from previous stroke; sensation diminished in left arm c5-7 dermatomes; hyperreflexic at biceps, triceps and brachioradialis; + bilaterally ble- good strength at hip flexion and extension/abduction/adduction, knee flexion and extension, ankle dorsiflexion and plantar flexion, /fhl; sensation intact distally; reflexes diminished at quads and achilles; + clonus; equivical babinski . on transfer out of the micu: physical exam: vs:t 98.6 122/80 hr 92 rr 18 84% ra -> 88% 2l -> 94% 3l general: awake, alert, resting comfortably in bed, nad heent: nc, at, eomi no scleral icterus neck: supple, no lad, steri-strips in place on left anterior neck and posterior neck, no erythema or exudate at operative sites cv: rrr s1 s2 no appreciable murmur chest: coarse crackles diffusely, loudest at bases, no wheezes abd: soft, nt nd bs hyperactive ext: no le edema, dp's 2+ bilaterally . pertinent results: wbc-23.8* rbc-3.31* hgb-10.0* hct-28.2* mcv-85 mch-30.1 mchc-35.3* rdw-13.6 plt ct-316 pt-15.5* ptt-29.4 inr(pt)-1.4* glucose-71 urean-19 creat-0.9 na-136 k-3.8 cl-99 hco3-25 angap-16 ck(cpk)-208* <- 304 <- 467 ck-mb-6 <- 9<- 15 tropnt-0.27* <-0.39 <- 0.37 ct neck and chest: status post c3-6 laminectomy and anterior cervical fusion with large low- attenuation fluid collection anterior to this region with thin enhancing rim, likely representing post-operative change; however, superimposed infection cannot be excluded. the fluid collection extends into the superior mediastinum at the thoracic inlet. 2. multiple lymph nodes are noted in the neck, mediastinum, and hila. 3. air space opacity in the left upper lobe suggestive of pneumonia. bilateral subsegmental atelectasis noted. 4. left upper lobe 3-mm pulmonary nodule. comparison with prior imaging is suggested if available to establish stability; otherwise, follow-up imaging with ct chest to assess for stability in a few months can be considered based on risk for thoracic malignancy. 5. opacification of left maxillary sinus and air- fluid level in the sphenoid sinus may relate to recent endotracheal tube placement. 6. 1-cm enhancing soft tissue nodule in right axilla of uncertain etiology; this may represent a node; however, clinical correlation is recommended. echo: the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 0-10mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) transmitral doppler and tissue velocity imaging are consistent with grade i (mild) lv diastolic dysfunction. there is no ventricular septal defect. the aortic root is moderately dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the left ventricular inflow pattern suggests impaired relaxation. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. ct head: no evidence of acute intracranial hemorrhage. mri with diffusion-weighted images is a more sensitive evaluation for acute ischemia/infarct and for vascular detail. lung scan, perfusion images only: low likelihood ratio for recent pulmonary embolism. heterogeneous perfusion is compatible with the pulmonary congestion. intraoperative cspine xr: two intraoperative radiographs of the cervical spine were obtained without a radiologist present. these demonstrate localization of c5-c6 and subsequent anterior spinal fusion. for additional details, please consult the operative report. brief hospital course: mr. is a 68 yo m with pmh htn, hyperlipidemia who was initially admitted to the service of dr. for an anterior/posterior cervical decompresion and fusion c3-6. #. cspine sponylosis s/p anterior/posterior cervical decompresion and fusion c3-6: he was consented for the procedure and elected to proceed with dr. . please see operative note for procedure in detail. post-operatively he was administered antibiotics and pain medication. he was afebrile and his incisions were clean and dry. his post op course was complicated by the details below, however he was ultimately seen by physical therapy, cleared for discharge to rehab, and should wear brace when out of bed at all times until his follow up appoitnment with dr. in one month. #. pneumonia: postoperatively, he became confused and experienced hypotension. a stat ekg was performed which was unchanged from previous. his confusion cleared and hypotension resolved after a 500ml blous of fluid. a second episode of hypotension and difficulty breathing occurred and a code was called. he was subsequently intubated and transferred to the t/sicu. in the t/sicu he required pressors for his hypotension and continuous mechanical ventilation. an echo was performed which was unchanged from that . v/q scan revealed a low likelihood ratio for recent pulmonary embolism. neck and chest ct showed a post-operative seroma without evidence of gas pocket or infection. chest x-rays revealed a left lower lobe pneumonia and vancomycin/zosyn were started. a brochoscopy was performed and revealed copious secretions in the lul and lml which were cultured. he was subsequently extubated and transferred out of the t/sicu and to the medical service. sputum cultures and bal cultures with pan-sensitive e. coli, klebsiella and enterobacter all sensitive to ciprofloxacin so vancomycin and zosyn were discontinued and ciprofloxacin was started to complete 10 day course of antibiotics (last day ). polymicrobial nature of growth concerning for aspiration pna so he was seen by speech and swallow who recommended nectar thickened liquids with plan for re-evaluation once further out from his surgery. he was re-evaluated on the day of discharge with video swallow study and was cleard for regular diet with thin liquids. #. nstemi: he had an nstemi with positive troponin while hypotensive and in the icu. he was seen by cardiology who medical management. he was treated with metoprolol, asa, simvastatin and lisinopril. he had no recurrence of hypotension during this admission and will follow up with dr. as an outpatient. (phone number given, please call for next available appointment.) echocardiogram without evidence of new wall motion abnormality, normal ef. #. ct chest with nodule: as part of the above workup for pneumonia, ct chest was performed and revealed an incidental left upper lobe 3-mm pulmonary nodule. it is recommended that this be re-imaged with follow up ct scan in approximately 6 months to assess for stability. this should be followed by pcp. , an axillary nodule was seen, however on examination this was consistent with a large sebaceous cyst, which the patient says has been stable for "20 years." the patient is stable for discharge to rehab, where he should work with pt/ot due to deconditioning in setting of complex stay. he should continue ciprofloxacin until . he should wear his neck brace at alltimes while out of bed until he sees dr. in one month. please also call for an appointment to see dr. in cardiology in the next 1-2 weeks to follow up for his mi. medications on admission: acetaminophen-codeine - 300 mg-30 mg tablet - 1 to 2 tablet(s) by mouth q 6 h prn asa 325 mg gabapentin 900 mg tid hydrochlorothiazide 25 mg daily hydrocodone-acetaminophen - 5 mg-500 mg tablet - 1 (one) tablet(s) by mouth q 6-8 h prn indomethacin 25 mg daily lisinopril 20 mg tablet 1 (one) tablet(s) by mouth once a day omeprazole 20 mg simvastatin 10 mg daily b complex - tablet - one by mouth every day diphenhydramine hcl - 25 mg qhs discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 4. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 5. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 6. metoprolol succinate 25 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po daily (daily). disp:*90 tablet sustained release 24 hr(s)* refills:*2* 7. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 8. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 4 days: last day of antibiotics . disp:*8 tablet(s)* refills:*0* 9. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours) as needed for dyspnea. 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 11. aspirin 325 mg tablet sig: one (1) tablet po once a day. 12. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day): may stop if pt ambulates tid. discharge disposition: extended care facility: - discharge diagnosis: cervical spondylosis non-st segment elevation mi pneumonia hypotension ======= s/p cva with mild left hemiparesis htn hyperlipidemia gout discharge condition: good discharge instructions: you were admitted to the hospital because you were having scheduled surgery for an anterior/posterior cervical fusion. you had no complications during your surgery however following your surgery you had very low blood pressure and you lost consciousness. you were intubated and transferred to the icu. you had a bronchoscopy which showed likely pneumonia in your left lung. you were treated with antibiotics. you did well and were extubated and continued on antibiotics. you had a small heart attack while most likely when your blood pressure dropped. you were evaluated by the cardiology doctors and should follow up with them in clinic. wound care: keep the incisions dry. you may shower as long as you cover the incisions with band-aids. do not take a bath or submerge the incisions under water. you need to wear the brace whenever you are out of bed. you do not need the brace when you are in bed. do not lift anything heavier than a gallon of milk. do not bend or twist from the neck. do not smoke. medications: 1)you were started on metoprolol which is a blood pressure medicine that you should take to protect your heart. 2) you will need to finish your course of ciprofloxacin, an antibiotic for your pneumonia please call your doctor or return to the emergency department if you have a fever over 101f or if you have an increase in pain or discharge from the incisions, or if you have chest pain, light headedness, fainting or any other worrisome symptoms. followup instructions: you have an appointment scheduled to follow up with dr. (orthopedic surgeon) on at 10:30. the phone number for the office is . the clinic is located on the of the building of the . please wear your neck brace whenever you are out of bed until your follow up appointment. you should also follow up with dr. of cardiology as you did have a small heart attack during your admission when your blood pressure was low. please call to schedule this appointment. you have an appointment scheduled to follow up your pcp, . on , at 12:15. please call if you need to reschedule this appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube closed [endoscopic] biopsy of bronchus other cervical fusion of the anterior column, anterior technique excision of intervertebral disc excision of intervertebral disc excision of intervertebral disc other cervical fusion of the posterior column, posterior technique fusion or refusion of 2-3 vertebrae fusion or refusion of 2-3 vertebrae diagnoses: subendocardial infarction, initial episode of care unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia cardiac complications, not elsewhere classified gout, unspecified personal history of tobacco use other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus pneumonia due to escherichia coli [e. coli] late effects of cerebrovascular disease, hemiplegia affecting unspecified side other diseases of lung, not elsewhere classified surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation seroma complicating a procedure pneumonia due to klebsiella pneumoniae cervical spondylosis without myelopathy 

Answer: The patient is high likely exposed to