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: the patient is a 75-year-old chinese male with a history of left mca cerebrovascular accident with resulting right hemiparesis on , who was transferred to from rehabilitation facility for treatment of recurrent aspiration pneumonia and possible tracheostomy placement for pulmonary toilet. the patient had been discharged from to skilled nursing facility and then transferred to facility. the patient continued to have aspiration and slight fevers despite the fact that he was treated with ceftazidime and vancomycin at . the patient was unable to clear his secretions on his own, and suctioning seemed to exacerbate his regurgitation and aspiration per transfer notes. the patient also reports a significant weight loss over the past several months. the patient had been guaiac positive last admission but, given the acuity of his stroke, did not undergo further workup for that at this time. family was interested in colonoscopy and further workup of the patient's weight loss. past medical history: significant for stroke as per history of present illness, chronic obstructive pulmonary disease, gout, hypothyroidism, asthma, hyperlipidemia. medications on transfer: ceftazidime 1 gram every eight hours started , vancomycin 1 gram every 12 hours started , protonix 40 mg by mouth twice a day, ritalin 100 mg by mouth twice a day, reglan 5 mg by mouth every six hours, and heparin 5000 units subcutaneously every 12 hours. allergies: no known drug allergies. physical examination: on presentation, the patient was febrile, with a temperature of 101.2, pulse 100, blood pressure 106/68, breathing 22 times a minute, oxygen saturation 93% on room air, 95% on 3 liters. generally, he is a cachectic male, nonverbal. head, eyes, ears, nose and throat: remarkable for dry oral mucosa. neck: the patient has flat neck veins and marked supraclavicular wasting. cardiovascular examination reveals a regular rate, normal s1 and s2, no murmurs appreciated. the patient had shallow respirations with coarse rales bilaterally at the bases. abdominal examination revealed a clean percutaneous endoscopic gastrostomy site with soft bowel sounds. extremities: there was no edema. feet were in waffle boots bilaterally. neurologic examination was remarkable for a left fixed pupil, patient unable to follow commands secondary to language barrier, marked right hemiparesis with contracture and cogwheeling of the patient's left upper extremity. laboratory data: on admission, white count was 26.8, hematocrit 36.3 which is stable, platelets 507. coags were all within normal limits. electrolytes: sodium 131, potassium 4.3, chloride 93, bicarbonate 28, bun 11, creatinine 0.4, glucose 93. chest x-ray revealed right middle lobe and left lower lobe opacities, consistent with pneumonia, and small bilateral pleural effusions. hospital course: this is a 75-year-old male with a right hemiparesis secondary to left mca infarct and recurrent aspiration pneumonia secondary to aspiration of food from gastrostomy tube. the patient is evaluated for further treatment of aspiration pneumonia and question of tracheostomy for pulmonary protection. 1. pulmonary: the patient had adequate oxygen saturation on room air upon transfer, but still with marked secretions that were difficult to suction and evidence of pneumonia on chest x-ray. the patient was treated with ceftazidime and clindamycin. vancomycin was stopped. the patient had some improvement over the next couple of days, however, on the morning of , the patient was found to be breathing at 40 to 45 times a minute. arterial blood gas at that time was most consistent with respiratory alkalosis. the patient's chest x-ray revealed increased pleural effusions, particularly on the left side, and the patient was sent for a pulmonary embolus protocol scan to rule out pulmonary embolus, which was negative. however, the scan did reveal an increased size of the patient's left pleural effusion with question of loculation. this effusion was tapped, and about 500 cc of turbid fluid was removed. this effusion proved to be consistent with a parapneumonic effusion, simple, uncomplicated. no further treatment was needed, and cytology was negative for malignant cells. cultures of this fluid remained negative. the patient's acute shortness of breath was treated with 20 mg of intravenous lasix, to which the patient had 1400 cc of urine output over four hours, with marked improvement in respiratory rate, down to the low 30s to high 20s. diuresis combined with tap of the parapneumonic effusion resulted in a much improved pulmonary status, and the patient was breathing comfortably in the 20s for the rest of his hospital stay, and had oxygen saturations of 95% on 3 to 4 liters nasal cannula. while in-house, the patient also was evaluated by interventional pulmonary for placement of a tracheostomy tube for more aggressive pulmonary toilet. the patient underwent this procedure on , tolerated the procedure well, and was able to be better suctioned once his tracheostomy tube was placed. 2. infectious disease: the patient had a white count of 26.8 on admission. the patient was switched from ceftazidime and vancomycin to ceftazidime and clindamycin. the patient was low-grade febrile for the first couple of days that he was in-house, however, after his left pleural effusion was tapped, the patient was afebrile for the rest of his stay. the patient's white count continued to decrease and was 9.6 on the day prior to discharge. the patient's ceftazidime was stopped on . the patient should continue to receive clindamycin for two more days to complete a ten day course. the patient's cultures remained negative throughout the course of his stay. 3. weight loss: the patient came with a history of profound weight loss over the last several months. the patient had chest and abdominal ct to assess for occult malignancy. these fortunately revealed no masses. thus the patient's weight loss is still somewhat of a mystery. 4. gastrointestinal: the patient came with a history of recurrent aspiration pneumonia secondary to vomiting tube feeds. the patient underwent gastrostomy tube advancement into his jejunum while in-house. the procedure was done by interventional radiology, tolerated well by the patient. the patient was restarted on his tube feeds on , and was tolerating them well and almost at goal at this time of this dictation. 5. hematology: the patient came with a history of being guaiac positive previously. the patient's hematocrit remained stable while he was in-house. given the patient's fluctuating respiratory status, we elected not to consult gastroenterology and have the patient undergo colonoscopy at this time, however, in the future the patient should probably have a colonoscopy. 6. endocrine: the patient had a history of being hypothyroid and was not on levothyroxine when he came in. his tsh was checked and found to be 4.2, within normal limits. thus he was not started on any thyroid hormone replacement at this time. the patient was discharged to on in stable condition. discharge diagnosis: 1. aspiration pneumonia 2. left parapneumonic effusion 3. chronic obstructive pulmonary disease 4. history of gout 5. history of hypothyroidism 6. status post left mca cerebrovascular accident 7. history of asthma discharge medications: 1. lansoprazole oral solution 30 mg per gastrostomy tube once daily 2. clindamycin 600 mg intravenously every eight hours for two more days 3. heparin 5000 units subcutaneously every 12 hours 4. methylphenidate hydrochloride 10 mg by mouth twice a day 5. reglan 5 mg by mouth every six hours while the patient is taking tube feeds 6. albuterol nebulizers every six hours as needed 7. morphine sulfate .5 to 1 mg every four to six hours as needed for air hunger 8. tylenol 325 to 650 mg by mouth every four to six hours as needed for pain or fever the patient should follow up with dr. , his primary care physician, also with dr. in neurology. , m.d. dictated by: medquist36 procedure: other enterostomy enteral infusion of concentrated nutritional substances thoracentesis temporary tracheostomy bronchoscopy through artificial stoma diagnoses: unspecified pleural effusion chronic airway obstruction, not elsewhere classified gout, unspecified other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus loss of weight late effects of cerebrovascular disease, hemiplegia affecting unspecified side other disorders of neurohypophysis 

Answer: The patient is high likely exposed to