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: penicillins / keflex attending: chief complaint: upper extremity weakness major surgical or invasive procedure: c5-c6 anterior cervical decompression and fusion, c1 tumor removal history of present illness: 55-year-old man with diabetes mellitus type 2, hypertension, severe peripheral disease s/p r sfa stent angioplasty and l sfa stent placement, congenital pulmonic valve stenosis, cad s/p bms stents, diastolic chf, atrial fibrillation s/p ablation on warfarin, stage 3 diabetic nephropathy, intradural tumor compressing his spinal cord at c1/c2, who was admitted on to neurosurgery for anterior cervical decompression at c5/6 fusion () and extradural tumor removal of c1 intradural tumor (). the patient was post-operatively managed in the icu with a dexamethasone taper. he developed a small subdural hematoma () with no new neurologic symptom. aspirin and heparin sc were restarted. clopidogrel, for l sfa stent, is scheduled to be restarted on pod#5, , and warfarin, for atrial fibrillation, to be restarted on . patient was extubated on , and is coming off a furosemide drip for dchf. is following the patient for a mottled right foot and his recent procedures. patient's other medical issues diabetes, htn, ckd (cr 1.1), atrial fibrillation (hrs 70s-80s), cad s/p stent and "chronic hyponatremia" (na 138) have been stable. transfer is requested for ongoing management of diastolic chf. on evaluation in the sicu before transfer, patient was sleeping but arousable, complaining of old back pain and of constipation. vital signs were stable with o2 saturation 98% on 3l. past medical history: (1) type 2 diabetes mellitus, requiring insulin, and the complications from years of poor glycemic control: -hypertension -severe peripheral disease -peripheral neuropathy -pressure, venous stasis, and neuropathic ulcers on his right and left lower extremities -stage 3 diabetic nephropathy -renal insufficiency (baseline creatinine 1.5 to 1.7) (2) atrial fibrillation status post ablation and , on coumadin (3) congenital pulmonic valve stenosis status post two childhood surgeries -history of rv failure -history of peripheral edema and anasarca (4) chronic hyponatremia (5) chronic low back pain status post car accident (6) spinal cord meningioma compressing his spinal cord at c1/c2 (7) copd (8) coronary artery disease status post stenting (bare metal stent by dr. ()) and repeat stenting at in (bare metal stent - see d/c summary ) (9) mi in social history: the patient is married and has two adult sons who do not live at home. he lives in , ma. his wife works 60 hours a week, and he is left at home for most of the day. he has been bedbound for several years. a visiting nurse can only come once a week to change the dressings on his lower extremity ulcers. his sons struggle with alcoholism and heroin abuse. his younger son has recently threatened suicide and homicide (against the patient's wife), a source of much stress at home. he used to work as a "bouncer" and in construction, and enjoyed riding his motorcycle. the patient says he tries to keep a positive attitude about his condition. he says he feels depressed, but says he is not interested in therapy or medication for depression. he has not seen his primary care physician 2 years because he will only travel in an ambulance but his pcp's office is in touch with the patient and wife weekly. - has a 2 pack per year smoking history for "several years" -he drinks alcohol occasionally, and has never had a problem with alcoholism -he denies recreational or iv drug use family history: heart disease in unspecificed family members. physical exam: physical exam on admission: gen: obese, deconditioned, pain with movement of extremities. extrem: b le edema neuro: mental status: awake and alert, cooperative with exam. language: speech fluent with good comprehension and repetition. naming intact. no dysarthria or paraphasic errors. motor: patient with severe bilateral wasting of muscles of hand. ue's: fi's: we 4+/5 grip 4+/5 bi4+/5 tri 4+/5. rle: pf/df 0/5 lle: ip3/5 pf/df 0/5 pertinent results: 12:10pm glucose-94 urea n-42* creat-1.2 sodium-133 potassium-4.4 chloride-95* total co2-28 anion gap-14 12:10pm estgfr-using this 12:10pm wbc-7.6 rbc-3.91* hgb-9.7* hct-30.5* mcv-78* mch-24.9* mchc-31.9 rdw-13.6 12:10pm plt count-206 imaging studies: # c-spine xray : single lateral view of the cervical spine obtained portably in the or, labeled #1. c1 through the c4/5 disc space is visualized. the c5 vertebral body is faintly seen -- bony structures lower than this are obscured by overlying soft tissues. however, surgical markers are seen overlying the anterior aspects of the c4-5 and c5-6 disc spaces, from an anterior approach. support tubing and temperature probles noted. # c-spine ct : 1. new interval c5-c6 anterior fusion with intervertebral disc spacer, no immediate hardware complication. post-surgical changes in the soft tissue with subcutaneous emphysema mostly in the right submandibular region. 2. mass at c1 level with associated cord compression consistent with known meningioma better described on recent mri. 3. soft tissue thickening at the right lung apex, not fully characterized on the current ct. in comparison with ct neck from , it has increased in size. ct chest is recommended to evaluate this further, if clinically warranted. # head ct : 1. new interval left frontal subdural hyperdense extra-axial fluid collection with new interval subdural subfalcine extra-axial hyperdense fluid collection, indicating subdural hemorrhage, likely post-surgical but clinical correlation recommended. 2. pneumocephalus with distribution at the basilar cisterns, mostly at the left sylvian fissure, and bifrontally at the falx, likely post-surgical, and additionally in the posterior fossa near the site of the occipital craniotomy. 3. post-surgical changes with left craniotomy at the occipital bone and laminectomy at c1 with subcutaneous emphysema and hyperdense products, likely post-surgical. 4. soft tissue hyperdensity at the posterior parietal, occipital soft tissue region, could be small post-surgical hematoma. . # c-spine mri : status post resection of c1 extradural tumor, likely meningioma with expectorated postoperative changes. no large intraspinal hematoma seen. there remains some persistent narrowing of the spinal canal at c1 level with indentation on the posterior aspect of the spinal cord. continued followup recommended. mild spinal cord atrophy could be secondary to chronic myelomalacia. . # le arterial duplex : the peak systolic velocity involving the native right common femoral artery is 104 cm/sec. velocities within the superficial femoral artery range from 85 to 234 cm/sec and that within the popliteal artery on the right, is 25 cm/sec. on the left, peak systolic velocity within the common femoral artery is 132 cm/sec, sfa, velocities range from 146-75 cm/sec and that within the popliteal artery is 85 cm/sec. impression: findings as stated above which indicate widely patent common femoral, superficial femoral and popliteal arteries bilaterally. . pathology: # c1 tumor : cervical medullary junction tumor: meningioma, psammomatous subtype (who grade i). the tumor is composed of meningothelial cells with numerous psammoma bodies and collagen deposition with no typical features or mitotic activity. brief hospital course: 55-year-old man with diabetes mellitus type 2, severe peripheral disease, cad, diastolic chf, atrial fibrillation, presented for planned anterior cervical decompression at c5-6 and removal of c1 meningioma. # cervical myelopathy and meningioma: patient underwent anterior cervical decompression and c5/6 fusion on and removal of c1 meningioma on . the patient was post-operatively managed in the icu with a dexamethasone taper. he developed a small subdural hematoma on with no new neurologic symptom. per neurosurgery recommendations, aspirin and heparin sc were restarted. clopidogrel, for recent left sfa stent, was restarted on pod#5, , and warfarin, for atrial fibrillation, is to be restarted on . of note, there was some concern that he had developed le weakness after his procedure, but after re-evaluation with the neurosurgery team they felt that his strength in his legs were his baseline and this was not a change. he continued to work with pt during his hospitalization. # diastolic heart failure: the patient experienced an acute exacerbation of his diastolic heart failure likely secondary to significant fluid administration during surgery. he was placed on a furosemide gtt in the sicu, which was transitioned to his home dose of lasix on the floor. at discharge he was slightly under his admission weight of 115kg with o2 sats in the mid 90's on room air. # peripheral disease. the patient recently underwent bilateral sfa angioplasties and left sfa stenting. in preparation for his neurosurgery, the plavix was held pre-procedure and was subsequently re-started on . he underwent bilateral arterial ultrasound on which demonstrated patent sfa and femoral arteries. # atrial fibrillation: the patient was not in atrial fibrillation during his hospitalization. given his need for neurosurgery his coumadin was held. it is scheduled to be restarted 10 days post-procedure (). he was well rate controlled at the time of discharge. # dm ii. the patient's insulin regimin was adjusted to 50 units of insulin glargine nightly with humalog insulin sliding scale and achieved good control of his blood sugars (fsbs 100-180). # pressure ulcers. the patient has a 2x2cm right heel full thickness ulcer that was without odor or drainage. a right dorsum small 1x1cm partial thickness ulcer. wound care nursing consult was obtained. pressure ulcer care was performed by repositioning, skin cleansing and conditioner application, and cover with abd and kerlex. # coping. the pt expressed to some staff members that his mood was poor and he was not coping well after his surgery. he never expressed suicidal ideations. he further expressed that he was extremely frustrated with his hospitalization and his inability to walk and function independently. discussed the possibility of talking to psychiatrists in the hospital, but he declined. he felt that if these feeling persisted he would pursue further psychiatric care. a number for psychiatric services was provided to him on discharge. # chronic pain syndrome: the patient was continued on his home regimen of dilaudid 4mg po q3h:prn # chronic hyponatremia. the patient had a history of chronic hyponatremia although his sodium remained between 130-140 during this admission. medications on admission: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid: prn as needed for constipation. 2. furosemide 10 mg/ml solution sig: sixty (60) mg injection (2 times a day): hold for sbp<100. 3. ascorbic acid 500 mg tablet sig: one (1) tablet po twice a day. 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp<100 or hr<60. 6. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever. 8. petrolatum ointment sig: one (1) appl topical daily (daily): please apply to leg wounds per wound care orders. thank you! . 9. methocarbamol 500 mg tablet sig: two (2) tablet po qid (4 times a day). 10. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h: prn as needed for shortness of breath or wheezing. 11. hydromorphone 4 mg tablet sig: one (1) tablet po q3h (every 3 hours) as needed for pain: hold for rr<12 or sedation. 12. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 14. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po q6h: prn as needed for itching. 15. polyethylene glycol 3350 17 gram/dose powder sig: seventeen (17) g po bid: prn as needed for constipation. 16. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation: hold for diarrhea. 17. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for anxiety. 18. menthol-cetylpyridinium 3 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed) as needed for dry mouth, sore throat. 19. ketoconazole 2 % cream sig: one (1) appl topical (2 times a day): please apply to upper forehead and scalp for seborrheic dermatitis (day 1 = ). also, please apply to wound on left shin for overlying fungal infection(day 1 = ). thank you! . 20. glycerin (adult) suppository sig: one (1) suppository rectal prn (as needed) as needed for constipation. 21. hydrocodone-acetaminophen 5-500 mg tablet sig: one (1) tablet po daily (daily) as needed for headache: hold for somnolence. 22. heparin drip heparin iv sliding scale (please see included scale): diagnosis: dvt/a-fib, patient weight: 114.76 kg, initial bolus: 0 units ivp, initial infusion rate: 1450 units/hr, target ptt: 60 - 100 seconds, . ptt <40: 4600 units bolus then increase infusion rate by 450 units/hr, ptt 40 - 59: 2300 units bolus then increase infusion rate by 250 units/hr, ptt 60 - 100*:, ptt 101 - 120: reduce infusion rate by 250 units/hr, ptt >120: hold 60 mins then reduce infusion rate by 450 units/hr, 23. insulin sliding scale glargine 46 units at bedtime; humalog sliding scale per included sliding scale. discharge medications: 1. hydroxyzine hcl 25 mg/ml solution sig: one (1) intramuscular q6h (every 6 hours) as needed for pruritis. 2. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). 3. furosemide 40 mg tablet sig: 2.5 tablets po bid (2 times a day). 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 6. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 7. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 8. ascorbic acid 500 mg tablet sig: one (1) tablet po twice a day. 9. methocarbamol 500 mg tablet sig: 1.5 tablets po q4h (every 4 hours). 10. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: inhalation every 4-6 hours as needed for shortness of breath or wheezing. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. dilaudid 4 mg tablet sig: one (1) tablet po q3hr:prn. 13. simvistatin 10mg qday 14. petrolatum ointment sig: one (1) appl topical daily (daily). 15. ketoconazole 2 % cream sig: one (1) appl topical (2 times a day). 16. outpatient lab work chem 10 to monitor electrolytes and creatinine while taking lasix 17. turn and reposition off back prn and limit sit time to 1hour at a time using pressure redistribution cushion. cleanse skin with wound cleanser or ns then pat dry nad apply aquafor to gluteals and legs and feet daily 18. for heel and lateral foot ulcer apply thin layer of duoderm wound gel, cover dorsum and lateral wound with adaptic and heel with gauze followed by abd pad, wrap iwth kerlix and change daily 19. headrest to occiput with frequent repositioning 20. please remove sutures from posterior neck on tuesday 21. please start warfarin on (post op day 10) and monitor inr prn 22. check weight qday discharge disposition: extended care facility: northeast - discharge diagnosis: cervical myelopathy c1 tumor with cervical myelopathy acute on chronic diastolic heart failure discharge condition: stable, afebrile discharge instructions: you were admitted to on for worsening upper extremity weakness due to your spinal tumor. you underwent an operation to remove the tumor. you also underwent an operation to decrease the pressure on the spinal cord in your neck. you will need to have the staples out from your surgical site on , which they will do at your rehab facility. an appointment was made for you to follow up with dr. in 6 weeks. please return to the emergency department for fever, chills, difficulty breathing, worsening upper extremity weakness, or worsening symptoms. followup instructions: 1. lab , surgery phone: date/time: 3:15 2 , md lm , surgery phone: date/time: 4:15 3. dr. address: phone: appointment: 1:15pm 4. psychiatry clinic psychiatry clinic please call the bottom number to schedule an appointment if your mood is sad or you are not taking pleasure in life: procedure: venous catheterization, not elsewhere classified imageless computer assisted surgery excision or destruction of lesion of spinal cord or spinal meninges other exploration and decompression of spinal canal other cervical fusion of the anterior column, anterior technique excision of intervertebral disc insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae diagnoses: coronary atherosclerosis of native coronary artery unspecified pleural effusion congestive heart failure, unspecified hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified atrial fibrillation acute on chronic diastolic heart failure diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes percutaneous transluminal coronary angioplasty status chronic kidney disease, stage iii (moderate) old myocardial infarction long-term (current) use of anticoagulants obesity, unspecified pressure ulcer, heel subdural hemorrhage diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled stenosis of pulmonary valve, congenital cellulitis and abscess of foot, except toes gastroparesis iatrogenic cerebrovascular infarction or hemorrhage hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled peripheral angiopathy in diseases classified elsewhere myelopathy in other diseases classified elsewhere pressure ulcer, stage iii suicidal ideation benign neoplasm of spinal meninges intervertebral disc disorder with myelopathy, cervical region 

Answer: The patient is high likely exposed to