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: methotrexate attending: chief complaint: c3-c4 spinal cord compression major surgical or invasive procedure: c4 corpectomy with allograft and plate intubation and mechanical ventilation history of present illness: this is a 68 year old man, with a pmh significant for a. fib with rvr, lower gi bleed 3 weeks prior to admission, severe lung disease including idiopathic pulmonary fibrosis, believed to be rheumatoid arthritis, pulmonary hypertension, and copd admitted to hospital on after 1 day of moderate shortness of breath and cough productive of yellow sputum as well as two weeks of progressive difficulty walking. he was treated for hap with levofloxacin, pip/tazo, and vancomycin. a blood culture was positive for ecoli x 1, sensitive to pip/tazo and ceftriaxone. he improved symptomatically, and his antibiotics were narrowed to pip/tazo alone for unclear reasons. his pulmonary status returned to baseline by report, but then he went into atrial fibrillation with rvr to the 180s. he was started on digoxin in addition to his home dronaderone and diltiazem, and returned to sinus. while working with pt in anticipation of discharge he was found to be increasingly weak. he also complained of escalating neck pain. a spinal mri was obtained which showed severe c3-c4 spinal compression with cord edema. he was transferred to for neurosurgical eval by dr. . . on the floor here at he was comfortable on 4l nc, and by report was at his baseline from a pulmonary standpoint. he was taken to surgery the following day. his surgical course was uncomplicated. . in the micu he was intubated and sedated. he was transferred to the micu to remain intubated due to his underlying pulmonary issues and concern from his pulmonologist that if he were extubated too early and needed to be reintubate, it would be very risky given his underlying spinal pathology. he was extubated successfully on , but had difficulty swallowing pills so speech and swallow was consulted. on he converted from normal sinus rhythm to afib with rates in the 90s-100s, but was asymptomatic and hemodynamically stable. past medical history: - extensive emphysema, especially of the upper lungs - asthma since childhood - rheumatoid arthritis (diagnosed ; "rheumatoid lung" may contribute to interstitial lung disease) - coronary artery disease, s/p large anterior wall mi , s/p bms to lad with ~50% restenosis noted in - sleep apnea - off cpap - uip interstitial lung disease s/p wedge resections in - interstitial lung disease - chronic renal insufficiency (estimated gfr = 47 ml/min/1.73 m2) - ischemic cardiomyopathy - systolic chf with lvef of 35-40%, hypokinesis of the anterior septum, anterior free wall,lateral wall and apex - pulmonary hypertension - percutaneous coronary interventions: ami in and underwent cardiac catheterization here where he subsequently had a stent to his mid lad. he returned for cardiac catheterization on , where he was noted to have two-vessel cad, mild mr, moderate lv dysfunction, mild pulmonary htn. none of the lesions was > than 50% so he was medically managed. most recent cath from showed ~50% restenosis of stent in lad, but no intervention undertaken. social history: lives with wife (she has not completed hcp , but pt intends her to serve as his proxy). he has 4 children and 8 grandchildren. semi-retired (this is his first semester out of work) as a foreign language teacher, most recently at . -tobacco history: 30-40 pack-year history; quit 25 years ago -etoh: none recently family history: father died age 37 of "asthma" - family was later told that studies done at showed evidence that he may have had mild cystic fibrosis. mother died age 59 of complications of breast cancer including heart failure. one sister has breast cancer, another sister has copd, a living brother has a valve replacement (patient does not know circumstances), recently-deceased brother died of heart-related illness; he also had ra. one daughter with (age 33), another daughter with angioedema. patient has been tested for genetics related to hereditary angioedema but was negative. no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death. physical exam: on admission: vitals: t: 97.8 bp: 130/74 p: 72 r: 24 o2: 90 in 4 l general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated lungs: diffusely rhonchorous to anterior auscultation cv: regular rate and rhythm, distant heart sounds, no murmurs appreciated abdomen: soft, non-tender, non-distended, hyperactive bowel sounds, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, 2+ pitting edema in ankles and hands. diffuse ecchymoses on both arms. neuro: a & o x3, appropriately conversant cn grossly intact. motor: 3 in lower extremities and r deltoid. 4 in all other upper extremity muscles bilaterally. sensation: intact to light touch in upper and lower extremities. position sense impaired in both upper and lower extremities. dtr: 3+ throughout. several beats of clonus in r foot. withdrawal to babinski bilaterally. on admission to micu: gen: intubated and sedated, nad heent: dry mm, l ij, anterior surgical scar with serosanguinous exudate cv: rr, nl s1 s2, possible s4, no mrg pulm: coarse breath sounds throughout abd: bs+ ntnd, no masses or hsm extremities: clubbing, 2+ upper and lower extremity edema neuro: pupils are 2mm and minimally responsive, reflexes are 3+ on the l patella and achilles tendons, 2+ on the l biceps tendons, and 1+ on the r achilles, patellar, and biceps tendons. skin: stage 2 sacral decubitous ulcer, chronic hyperpigmentation of the upper extremities, ecchymosis of the l hip pertinent results: on admission: 135 98 16 agap=7 ------------ 96 4.2 34 0.7 estgfr: >75 (click for details) ca: 7.9 mg: 2.1 p: 2.3 dig: 1.2 9.8 10.2 ----- 286 30.2 vit-b12:502 folate:8.5 other blood chemistry: iron: 115 caltibc: 274 ferritn: 117 trf: 211 on discharge: wbc-9.2 rhgb-8.8* hct-28.7* mcv-98 mch-30.0 mchc-30.7* rdw-18.4* plt ct-287 glucose-81 urean-23* creat-0.6 na-141 k-4.1 cl-100 hco3-35* angap-10 imaging: mri c-spine : multilevel degenerative disc disease versus calcification of the left aspect of the posterior longitudinal ligament, worse from c3-c4 through c5-6, with severe spinal canal narrowing at c3-c4 and moderate spinal canal narrowing at c4-5 and c5-c6. there is increased signal within the cervical cord at c3-c4, which may represent cord edema versus myelomalacia. if differentiating between disc disease and calcified ligament is of clinical importance, cervical spine ct may be helpful. ct c-spine : 1. no evidence of immediate hardware complication or change in hardware alignment since the radiographs done this am, with persistent angulation of the anterior cervical bracket plate. expected post-operative changes including marked edema and emphysema of the prevertebral and deep cervical soft tissues. 2. c5-6: residual marked spinal canal narrowing, largely due to segmental ossification of the posterior longitudinal ligament. 3. multilevel neural foraminal narrowing with likely exiting nerve root impingement, unchanged from the pre-op mr study. speech/swallow exam : penetration with thin liquid consistency. brief hospital course: 68 year old man, with a pmh significant for afib with rvr, lower gi bleed 3 weeks prior to admission, severe lung disease including ipf, pulmonary htn, and transfered to the micu for observation after c3-4 laminectomy for cord compression. . # c3-c4 cord compression s/p laminectomy: the patient was admitted to for neurosurgical consultation, due to his severe c3-c4 spinal compression with cord edema as above. he underwent laminectomy and was extubated after sugery in the micu without incident. per the surgery team, there are no restrictions on the pt's activity; however, he should wear the c-spine collar until he follows up with neurosurgery. pt was consulted, who recommended that he be discharged to a rehab facility. . # pulmonary disease: the patient is known to have copd, ild, and pulmonary hypertension, which was recently complicated by pneumonia. by report, he had been started abx for this infection on . he was additionally continued on his home regimen of bactrim (for pcp ), home nebulizers, and fluticasone. as the patient had been receiving methylprednisolone sodium succ 20 mg iv q24h, he was given stress dose steroids for the 2 days following surgery with methylprednisolone sodium succ 40 mg iv q6h and before being returned to his home dose of prednisone. . #bacteremia: upon transfer to the , the patient was continued on ceftriaxone 1 gm iv q24h (in place of pip/tazo) for his ecoli bactermia. . # afib w/ rvr: the patient was monitored on telemetry and continued on his home regimen of diltiazem, dronedarone, and digoxin. he entered afib with normal ventricular rate several times while in the micu. at discharge, the patient was in -- rhythm. . # dysphagia: patient was having difficulty swallowing pills and was choking on food, so speech and swallow was consulted. his difficulties are thought to be secondary to edema from surgery. speech and swallow recommends that he continue on a dysphagia diet with 1:1 assist until his swallowing improves. they predict full recovery of swallowing function. . # cad and chf: the patient is s/p anterior wall mi , s/p bms to lad with ~50% restenosis noted in . known ef of 30-40%. his aspirin was held, pending nsurg clearance. he was continued on his home statin. lasix was held. . # history of gi bleed: cbc stable this admission so far. - - continue pantoprazole 40mg daily - continue po iron - iron studies pending . # hyperglycemia: caused by ongoing steroids. - continue hiss if blood sugars remain elevated. . medications on admission: 2l oxygen lipitor 10mg qd symbicort 80/4.5 atrovent nasal leflunomide 20mg po qd xopenex 1.25mg per .5ml neb q 4 hours prn for sob protonix 40mg po qd triamcinolone acetonide .1% to cracked skin bactrim 160/800 dronaderone 400mg po bid ferrous sulfate 825mg po bid aspirin 325mg qd diltiazem 30mg po tid lasix 20mg qd methylprednisone 8mg po qd senna 1 tab po bid colace 100mg po bid erythromycin 500mg po bid discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. dronedarone 400 mg tablet sig: one (1) tablet po bid (2 times a day). 3. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical q24hr () as needed for neck pain. 4. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 5. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 6. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po bid (2 times a day). 7. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 8. triamcinolone acetonide 0.1 % cream sig: one (1) appl topical (2 times a day). 9. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 10. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). 11. methylprednisolone 8 mg tablet sig: one (1) tablet po daily (daily). 12. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 13. diltiazem hcl 30 mg tablet sig: one (1) tablet po tid (3 times a day). 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 15. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 16. leflunomide 10 mg tablet sig: two (2) tablet po daily () as needed for ra. 17. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 18. symbicort 80-4.5 mcg/actuation hfa aerosol inhaler sig: two (2) inhalation twice a day. 19. xopenex 1.25 mg/3 ml solution for nebulization sig: one (1) inhalation every four (4) hours as needed for shortness of breath or wheezing. 20. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q4h (every 4 hours) as needed for wheeze. 21. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours). 22. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po qhs (once a day (at bedtime)) as needed for constipation. 23. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po bid (2 times a day). 24. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed). 25. morphine 15 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 26. supplemental oxygen supplemental oxygen to keep o2 90-94 27. aspirin 325 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: hospital of & islands - discharge diagnosis: cervical spondylotic myelopathy discharge condition: stable. alert, oriented, limited mobility discharge instructions: you have been seen for a spinal cord compression caused by an outgrowth of bone from your vertebra. we have made the following changes to your medications: please follow up with your pcp, rheumatologist, and with your neurosurgeon as outlined below. followup instructions: please follow up with dr. office in 2 weeks. 10:45am spine center please follow up with dr in 6 weeks, you will need xrays at this appt - please call to schedule. 10:45 am spine center rheumatology provider: , md phone: date/time: 2:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other cervical fusion of the anterior column, anterior technique excision of intervertebral disc fusion or refusion of 2-3 vertebrae diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) anemia, unspecified coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified adrenal cortical steroids causing adverse effects in therapeutic use atrial fibrillation other chronic pulmonary heart diseases personal history of tobacco use percutaneous transluminal coronary angioplasty status candidiasis of mouth chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease bacteremia old myocardial infarction postinflammatory pulmonary fibrosis chronic systolic heart failure other complications due to other cardiac device, implant, and graft pressure ulcer, lower back other constipation rheumatoid arthritis surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation chronic obstructive asthma, unspecified other abnormal glucose emphysematous bleb pressure ulcer, stage ii cervical spondylosis with myelopathy dysphagia, unspecified vascular myelopathies intervertebral disc disorder with myelopathy, cervical region rheumatoid lung 

Answer: The patient is high likely exposed to