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: witnessed aspiration event major surgical or invasive procedure: endotracheal intubation. history of present illness: 77m pmh myelofibrosis and resulting anemia at hematology clinic the day of admission for his first ever blood transfusion for hematocrit 19. the transfusion was started at 10:50 am. he was tolerating the blood transfusion well until he aspirated a cup of juice. his saturation declined to 86% on room air, but subsequently rose to 99% on 2l nc, following suctioning of 50cc juice per notes. the patient states that he frequenly aspirates "but it's always ok." patient sent to the ed for further evaluation. . in the ed, vs: t: 98.6 bp: 112/46 hr: 76 rr: 22 o2: 99% 2l. patient given ns 1l, levofloxacin 750 mg iv, flagyl 500 mg iv. patient sent to floor. . vs on arrival to floor : 101.1 (ax) bp: 154/52 hr: 111 rr: 28 o2: 94% 2l. patient remained npo. patient noted to have increased work of breathing at 1857 o2 84% 6l, increasing to 100% with nrb. abg on nrb: 7.46 35 76. patient transferred to micu for further evaluation and treatment. . ros: patient feels "warm" but denies fever, chills, chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, dysuria. past medical history: 1. myelofibrosis with associated anemia 2. history of aspiration events per patient 3. significant macular degeneration and cataracts 4. depression 5. pruritis social history: he does not smoke and denies any alcohol abuse. he lives alone. he is a retired professor . family history: unknown. physical exam: vs: t: 101.2 bp: 126/48 hr: 110 rr: 28 o2: 100% nrb -> 97% 5l gen: speaking full sentences heent: at, nc, perrla, eomi, no conjuctival injection, anicteric, op clear, poor dentition, mm dry neck: supple, no lad, no carotid bruits cv: distant heart sounds, rrr, nl s1, s2, no m/r/g pulm: rhonchi throughout left lung, clear right abd: soft, nt, nd, + bs, no hsm ext: warm, dry, 2+ dp pulses bilaterally, excoriations throughout neuro: alert & oriented x 3, cn ii-xii grossly intact, moving all extremities well pertinent results: admission labs: |110|26 -----------<101 4.8|25|1.0 comments: k: hemolysis falsely increases this result estgfr: 72 / >75 (click for details) 7.9 11.4>--<272 25.0 d . n:75 band:7 l:11 m:1 e:5 bas:0 atyps: 1 nrbc: 1 hypochr: 2+ anisocy: 2+ poiklo: 3+ macrocy: 1+ microcy: 1+ polychr: occasional spheroc: 1+ ovalocy: 3+ schisto: occasional burr: occasional pencil: 1+ tear-dr: 1+ comments: manual . abdominal ultrasound . findings: liver is markedly enlarged, measuring approximately 17 cm. there is a small, 1.7 x 1.6 cm simple cyst seen in the periphery of the right lobe of the liver. adjacent to this is a small well-circumscribed lobulated echogenic lesion measuring 2.3 x 1.9 cm, which appears most consistent with a hemangioma. smaller cyst and adjacent 1-cm similar echogenic lesion most consistent with hemangioma are also seen in the medial aspect of the right lobe of the liver. there is no biliary ductal dilatation. there is a small amount of ascites seen around the liver, and in the lower pelvis. gallbladder, and pancreas are unremarkable. spleen is markedly enlarged, measuring 17.5 cm. the right kidney measures 10.9 cm. the left kidney measures 11.1 cm. large simple cyst is seen in the right kidney measuring 3.7 x 2.0 x 3.4 cm. a smaller adjacent 1.7-cm simple cyst is also seen in the mid pole of the right kidney. both kidneys are otherwise normal in appearance, without evidence of mass, stone, or hydronephrosis. note is made of marked enlargement of the prostate, which protrudes into the posterior aspect of the bladder. main portal vein is patent, with appropriate antegrade flow. impression: 1. marked hepatosplenomegaly. 2. multiple liver cysts and likely hemangiomas. 3. small volume ascites around the liver, and in the lower pelvis. 4. right renal cysts. 5. marked prostatic enlargement, bulging into the posterior aspect of the bladder. . tte the left atrium is mildly dilated. the interatrial septum is aneurysmal. no atrial septal defect is seen by 2d or color doppler (does not exclude). the estimated right atrial pressure is 0-10mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is moderate to severe pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. moderate pulmonary artery systolic hypertension most likely due to a primary pulmonary process. interatrial septal aneurysm. . video swallow indication: 57-year-old man with zenker's diverticulum and aspiration pneumonia. comparison: not available. findings: oropharyngeal swallowing videofluoroscopy was performed today in corroboration with speech pathology. various consistencies of barium were administered. oral phase: bolus formation, control, ap tongue movement, and oral transit time within functional limits. pharyngeal phase: swallow initiation, palatal elevation, laryngeal elevation, laryngeal valve closures, and epiglottic deflection were within functional limits. pharyngeal transit and bolus propulsion was within functional limits. no residue was seen in the valleculae or piriform sinuses immediately after the swallow. however, there was a significant backflow from a large diverticulum below the upper esophageal sphincter to the piriform sinuses. aspiration/penetration: no penetration or aspiration during the swallow, however, penetration was seen after the swallow from backflow from the diverticulum to the pharynx. ap position images demonstrate large collection in the midline with air-fluid level, which could represent known zenker's diverticulum. impression: penetration resulting from backflow from the large esophageal diverticulum, likely zenker's, otherwise functional oral and pharyngeal swallow. the diverticulum could be formally evaluated with barium swallow if clinically indicated and no prior studies performed. for further detail and treatment recommendations, please see speech pathology note dated . . micro 4:40 pm blood culture 2nd set. **final report ** blood culture, routine (final ): bacillus species; not anthracis. isolated from one set only. aerobic bottle gram stain (final ): reported by phone to macually grissith @ 0635 on . gram positive rod(s). anaerobic bottle gram stain (final ): gram positive rod(s). . 2:13 pm urine site: clean catch source: cvs. urine culture (preliminary): staphylococcus species. >100,000 organisms/ml.. brief hospital course: 77m pmh myelofibrosis and resulting anemia p/w witnessed aspiration event and hypoxia. . # aspiration pneumonia pt developed fever, bandemia, bilateral infiltrates on cxr in the setting of a witness aspiration event during blood transfusion. approximately 50 cc of cranberry juice was suctioned out of him at the time, and he was admitted for hyxpoxia. on the medical floor he triggered for sudden episode of hypoxia and required intubation in the micu for < 24 hrs. he was extubated and transferred to the medical floor. he was considered to have aspiration pneumonia, however trali and transfusion related volume overload were also considered. since the story was very classic for aspiration and initial cxr did not support trali, transfusion reaction was thought not to be likely at all. he was initially started on levofloxacin and flagyl on admission to the micu, but was then transitioned to simply flagyl. his oxygenation continued to improve and he underwent evaluation via pt, and was considered safe for home with home pt. he was discharged on total 16 day course of levofloxacin. he was also started on combivent to help with his breathing as well. . # zenker's diverticulum patient has been considered to have a zd given history of coughing up regurgited foods after eating. this was thought to contribute to his aspiration pneumonia. he was evaluated with speech and swallow, and a large diverticulum was discovered. he was scheduled to see ent as an outpatient to potentially operate on the zd. in the meanwhile, he was counseled to eat thickened foods and chew carefully as per s+s reccs to limit his risk of recurrent aspiration. . # anemia pt of dr. , and developed aspiration in the setting getting his first blood transfusions for transfusion dependent myelofibrosis. his full diagnosis remains unclear, as he does have a 20 q deletion which is sometimes seen in lyphomas and repeat bone marrow has been deferred. he was transfused with a total of 4 units of prbcs, and his hematocrit remained stable. he was thought not to have rbc lysis, but a component of sequestration from his hepato-splenomegaly was thought to contribute as well to anemia. he will cont to follow up with dr. . . # bacteremia his blood culture on admission showed bacillus not anthraxis. this was discussed with infectious disease, who thought that this may represent a contaminant (even though this is a very rare contaminant) given lack of positive repeat cultures and lack of risk factors (no ivda). however, levofloxacin is a secondary for bacillus, and his course of po levofloxacin was extended by 7-10 days to ensure adequate coverage if it was in fact a true pathogen. surveillance cultures remained negative. . # staph in urine culture this was considered also to be a contaminant, as his blood cultures were negative and ua at the time was bland. . # hypernatremia pt remained very thirsty and he develped hyrpernatremia in the setting of poor free water access. he was allowed to drink ad lib, and he was repleted with free water and his na declined and remained stable. . # sob / chf patient complained of orthopnea. several weeks prior to admission he reported leg and scrotal edema. bnp was elevated (could be pneumonia as well). a tte was checked, which showed moderate pulmonary hypertension and preserved ef. he likely has right sided chf. he was diuresed and felt better symptomatically. he was not discharged on new chf medications, but was counseled to follow up with his pcp, . # pruritis continued sarna lotion. . # liver dysfunction / coagulopathy increased inr / ptt, low albumin. on exam noted to have hepato-splenomegaly. an abdominal u/s showed enlargement of both organs. he was given po vitamin k and his inr trended down somewhat (1.4<--1.6). hepatitis b&c serologies were negative. this was considered to 1) right sided chf and 2) likely infiltration with underlying hematologic disorder. . #code: full . medications on admission: none discharge medications: 1. folic acid 800 mcg tablet sig: one (1) tablet po once a day. 2. ferrous gluconate 325 mg (27 mg iron) tablet sig: one (1) tablet po once a day: with juice, but not with calcium, food, or other medications . 3. combivent 18-103 mcg/actuation aerosol sig: two (2) puffs inhalation every six (6) hours. disp:*2 inhalers* refills:*2* 4. levofloxacin 750 mg tablet sig: one (1) tablet po once a day for 10 days. disp:*10 tablet(s)* refills:*0* 5. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day). disp:*1 bottle* refills:*2* 6. outpatient physical therapy discharge disposition: home discharge diagnosis: aspiration pneumonia esophageal diverticulum dysphagia transfusion depended myelofibrosis bacillus bacteremia nos staph uti chronic diastolic heart failure depression transient fecal incontinence nos pseuodogout discharge condition: stable, afebrile discharge instructions: you were admitted to the hospital for a blood transfusion. you were found to have a pouch in your throat which makes it hard for you to completely swallow you food. it is recommended that you follow up with dr. to discuss fixing this pouch. you were found to have pneumonia most likely due to food from the pouch in your throat traveling into your lungs. it is very important for you to complete the entire course of antibiotics. it is very important that you chew your food very carefully and eat very slowly to prevent another choking event. you have an appointment with dr. in two weeks on at 3 pm. it is very important that you keep your appointments with dr. and dr. so that your blood count can regularly be checked. please make sure you keep all of you follow-up appointments. you have been started on the following medications 1) levofloxacin for your urinary tract infection 2) sarna lotion for your itchy skin 3) combivent to help with your breathing please take all these medications as prescribed. you may continue to take your home medications. 1) iron 2) folic acid followup instructions: provider: , md phone: date/time: 2:30 provider: , rn phone: date/time: 2:30 provider: , .d. date/time: 2:10 provider: , md phone: date/time: 3:00 . you also have an appointment with dr. on at 4:30 pm at , . this will be an evaluation for your zancker's diverticulum procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube transfusion of packed cells diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) pneumonitis due to inhalation of food or vomitus bacteremia hyperosmolality and/or hypernatremia chronic diastolic heart failure other specified disorders of liver myelofibrosis with myeloid metaplasia diverticulum of esophagus, acquired 

Answer: The patient is high likely exposed to