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 / biaxin / codeine attending: chief complaint: generalized weakness. major surgical or invasive procedure: c4-c5 anterior cervical discectomy and fusion. history of present illness: pt is 65yom with h/o mmp including dm with retinopathy/neuropathy, htn, s/p renal transplant, cad< pvd, and complicated lumbar disease who is transferred from clinic with 3 weeks of worsening generalized weakness(prox>distal). he has had difficulty walking for ~10 years for multiple reasons including neuropathy, fractures, and complicated spinal surgeries. he has needed a cane for this time. however, for the last 3 weeks, he has required a walker as well. this came on acutely, as he woke up one morning with arm pain bilaterally and right leg pain. he also felt too weak to get out of bed. he went to the ed due to concerns for mi. he was found to not have this but was clearly not walking normally, so he was given a walker in the ed by pt and sent home. since then, he reports he has generally been very weak and needing help with things such as dressing and even picking up fairly light objects. he has also been using a wheelchair at times. during this, he has not had visual or hearing changes. no bowel/bladder changes, no dysarthria, no sob, no dysphagia. the pain has resolved, but the weakness remains. he has intermittent foot numbness at baseline. he also has baseline paresthesias and numbness in his fingers. there is a question of a 5 pound weight loss in the past 3 weeks. past medical history: 1.insulin dependent diabetes mellitus 2.nephropathy s/p renal transplant in 04/98 3.peripheral vascular disease s/p stent placement in common iliac, external iliac, proximal sfa, repeat angioplasty of right common iliac and sfa, right common femoral to popliteal artery bypass graft. 4.aortic stenosis ?????? valve area 1.3, peak gradient 32, mean gradient 20 5.coronary artery disease in rca, lad, cfx s/p stent in left cfx in . 6.diastolic dysfunction (ef>55%) 7.hypertension 8.retinopathy s/p bilateral cataract removal surgery 9.charcot foot 10.cervical stenosis s/p fusion of c3-5 11.otitis externa 12.hearing loss social history: lives with his wife. originally from . smoked 20 pack years, but quit 12 years ago. no etoh/drugs. family history: mother: mi and dm. died in 80s. siblings: healthy living siblings. one brother died at age 21 of unclear cardiac issue. physical exam: vitals:97.8, 150/66, 59, 18, 100% on ra. fs=292-278-59--217 gen:nad. heent:mmm. sclera clear. op clear cv: rrr, nl s1 and s2, no murmurs/gallops/rubs lung: clear to auscultation bilaterally ext:no cyanosis/edema neurologic examination: mental status: awake and alert, cooperative with exam, normal affect orientation: oriented to person, place, and date attention: attentive to exam language: fluent with good comprehension. naming intact. no dysarthria or paraphasic errors no apraxia, no neglect able to tell a coherent story. follows commands cranial nerves: i: not tested ii: pupils equally round and reactive to light, 4 to 3mm bilaterally. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric. viii: hearing decreased to finger rub bilaterally. ix, x: palatal elevation symmetrical : trapezius normal bilaterally. xii: tongue midline without fasciculations, intact movements motor: severe atrophy in ue and le bilaterally. no fasciculations seen today. severely restricted delt mov't r>l. intrinsic hand muscles severely wasted. neck flex/ext normal. no tremor d t b we fif ip q h df pf te() right 4- 5 5 * 5 4 5- 5 5 * 5 * left 4 5 5 5- 5 4+ 5 5 5- 5 5 5 *-pt unable due to old injury. sensation: intact to light touch throughout. vib in legs to ankle on left and to midshin on right. temp in similar distribution. pp was hyperesthetic to knees bilaterally and to elbows bilaterally. reflexes: b t br pa ankle right 3 3 3 2 0 left 3 3 3 2 0 toes were mute bilaterally gait: not tested pertinent results: 09:00pm blood wbc-9.4 rbc-4.71 hgb-13.8* hct-40.7 mcv-86 mch-29.2 mchc-33.8 rdw-14.1 plt ct-276 09:00pm blood neuts-62.3 lymphs-27.0 monos-4.2 eos-6.0* baso-0.5 09:00pm blood pt-11.9 ptt-25.8 inr(pt)-1.0 09:00pm blood glucose-237* urean-25* creat-1.2 na-134 k-4.5 cl-95* hco3-29 angap-15 09:00pm blood alt-38 ast-37 ld(ldh)-195 ck(cpk)-100 alkphos-80 amylase-12 totbili-0.4 06:10am blood lipase-14 09:00pm blood albumin-3.9 calcium-10.2 phos-3.4 mg-1.5* 09:00pm blood tsh-1.6 06:20am blood fk506-6.6 ----- l-spine plain film:1. metallic stent in common iliac artery. no other radiopaque foreign body is identified. 2. severe degenerative changes at l4-5 disc space. 3.there is a deformity of the right femoral head, and shallow right superior acetabulum indicating right hip dysplasia. ----- cxr:hyperinflation, chronic and moderately severe is not as pronounced on today's study, perhaps by virtue of lordotic positioning. the heart size is normal but has increased since prior examinations and there is vascular engorgement in the upper lung suggesting cardiac decompensation. mild peribronchial infiltration in the right upper lung could be asymmetric edema or coexistent small airway inflammation. there is no consolidation to suggest a bacterial pneumonia and no pleural effusion is present, but this could be a focal atypical (viral, pcp, mycoplasma) pneumonia. ----- mri c-spine: impression: status post laminectomies. soft tissue thickening posteriorly at c4-5 level along with a large central and left paracentral disc herniation at c4-5 level result in severe spinal stenosis at this level. multilevel degenerative changes are seen at other levels. myelomalacia within the spinal cord with mild spinal cord atrophy at c3-4 level. ----- tte:the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. left ventricular systolic function is hyperdynamic (ef>75%). a mid-cavitary gradient is identified. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is moderate aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is mild mitral stenosis. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. . chest ct : impression: 1. diffuse bilateral pulmonary opacities consistent with ards or multifocal pneumonia. moderate bilateral pleural effusions. 2. ng tube tip now in the mid esophagus. 3. cholelithiasis. 4. no acute intra-abdominal pathology identified. brief hospital course: a/p: 65 y/o m s/p kidney transplant, cad, pvd, dmi, cervical hematoma, p/w nstemi and sepsis/resp failure pna after diskectomy . 1. cervical spinal stenosis: he was transferred from clinic with 3 weeks of worsening generalized weakness(prox>distal). his picture was initially unclear as this may represent a myopathy, a dysfuntion of multiple nerve roots, or a cervical cord lesion. as it was an acute event, we wanted to rule out cord pathology first. he also had a normal ck. an mri of the cervical spine showed a severe canal stenosis with cord impingement at l4-l5. he also had some cord damage evidenced on the mri. this stenosis was felt to be the cause of his current acute on chronic weakness. he also had some urinary frequency which was likely the result of a spastic bladder which is typical of upper spinal cord compression. he was seen by the neurosurgery service and the patient elected to have surgical decompression of the area. given his multiple medical problems, a medical consult was called to provide clearance and risk assessment. we also involved cardiology and renal teams given his past problems. they recommended an echocardiogram. immunosuppressant levels were checked and followed. in addition, his asa and plavix had to be stopped before surgery, but were restarted on and respectively. he was kept well hydrated before surgery to decrease his risk of cardiac complications from the procedure. however, post operatively, ecg changes were indicative of mi. patient remained asymptomatic and his vs were stable. he was kept on o2 (4l), restarted on asa and beta blockers immediately. cardiac enzymes were cycled and confirmed cardiac ischemia. cardiology was consulted. on pod1, he was restarted on plavix, heparin sc. the ecg was back to baseline, but cardiac enzymes kept rising. he was transferred to the step-down unit. . 2. respiratory failure: the patient's post-operative course was complicated by respiratory distress, for which he was transferred to the icu. this was assessed as multi-factorial, related to acute chf as well as pna. he was treated with vanc, levo, flagyl for a multi-focal pneumonia, and required face mask for oxygenation. his respiratory distress and hypoxia improved over a couple of days with this treatment without the patient requiring mechanical ventilation. he was transferred out of the micu to the medical floor for several days, although his respiratory status decompnesated and he returned to the micu on . at this point, the cxr c/w non-cardiogenic edema/ards like picture. also likely presumed aspiration pna given cxr findings and hx of emesis. chf was assessed to be contributing as well, given his cardiac history. he was in apparent signnificant respiratory distress, which did not appear that this will be rapidly reversible. the plan was to persue maximal medical therapy with antibiotics, steroids, nebulizers, realizing that the patient would at this point almost certainly requre a prolonged recovery of days to weeks with the aid of mechanical ventilation. on the afternoon of the physician team discussed this prognosis with the patient and is family. the patient decided that he did not wish to be intubated and put on mechanical ventilation. the patient and family demonstrated that they understood the implications of this decision and the plan was to pursue comfort care, stopping all medical treatments other than comfort treatments. the antibiotics as well as other medications were discontinued. the patient expired on the following morning. . 3. nstemi: he was noted to have elevated enzymes and ecg changes. ck peak was 571 on . tnt peak was 1.38. twi were noted in lateral leads. echo showed no new wall motion abnormalities. there is a history of cad s/p pci in '. metoprolol, lisinopril, asa, plavix were continued until the status change to cmo. . 4. s/p renal transplant: the patient was followed by the renal transplant team. daily fk-506 levels were followed per renal. cellcept and prograft as well as calcitriol were continued until the status change to cmo. . 5. dm1: his glucose levels were monitored and regulated carefully. was consulted by the surgical team. in the medical icu, he required insulin drip when the steroids were started. he was otherwise on glargine and riss. . 6. ppx: heparin sc, bowel regiminen, ppi . ## fen: tube feeds were continued for nutrition. electrolytes were monitored and repleted as necessary. medications on admission: ambien aspirin 81mg daily cellcept plavix pepcid lantus lipitor lopressor prograf celexa calcitrol discharge medications: not applicable discharge disposition: expired discharge diagnosis: respiratory failure multifocal pneumonia sepsis chf exacerbation nstemi cervical spinal stenosis discharge condition: deceased discharge instructions: not applicable followup instructions: not applicable procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances other cervical fusion of the anterior column, anterior technique excision of intervertebral disc transfusion of packed cells transfusion of platelets insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care unspecified septicemia severe sepsis cardiac complications, not elsewhere classified polyneuropathy in diabetes pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin acute diastolic heart failure diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled kidney replaced by transplant intervertebral disc disorder with myelopathy, cervical region 

Answer: The patient is high likely exposed to