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: no known allergies / adverse drug reactions attending: chief complaint: hypoxia major surgical or invasive procedure: none history of present illness: 65-year-old m with als, bipap dependent with baseline o2 presenting with lethargy o2, sat in the 50s. per nursing facility, pt was found gasping for air and desatted to 50s. he has secretions at baseline but was unable to spit them out. per report, baseline sat 70-80s; noted to be more lethargic today with sats noted to be in 50s. no witnessed aspiration event. in the ed, initial vs: afebrile 119 128/100 84% on bipap. lactate 3.8. received 1l ns. cxr with bibasilar atelectasis however in setting of desaturation and leukocytosis to 16.4. no additional obvious source of infection. given vanc, cefepime, levo. sent cultures. vs prior to transfer: bp: 154/99 hr: 109 90s on bipap at home setting . past medical history: als g-tube anxiety vitamin d deficiency constipation chronic edema htn hl pvd hemorrhoids right shoulder pain social history: social history: he lives at secure nursing facility. - tobacco: no documented use - alcohol: no current use - illicits: no documented use family history: non-contributory physical exam: on admission: vitals: t:96.3 bp: 164/120 p: 104 r: 18 o2: 92% bipap general: alert, well-nourished, labored breathing, currently nonverbal heent: sclera anicteric neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: rhonchi and wheezes bilaterally abdomen: soft, non-tender, non-distended, bowel sounds present gu: no foley ext: warm, well perfused, 2+ pulses on discharge: vitals: t:98.9 bp: 146/ 97 p: 94 r: 18 o2: 97% bipap general: alert, well-nourished, breathing comfortably on nasal bipap, responds appropriately, following commands heent: sclera anicteric neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: transmitted upper airway sounds abdomen: soft, non-tender, non-distended, bowel sounds present ext: warm, well perfused, 2+ pulses, no edema pertinent results: admission labs: 02:45am blood wbc-16.4* rbc-4.89 hgb-13.0* hct-39.6* mcv-81* mch-26.5* mchc-32.8 rdw-14.2 plt ct-538* 02:45am blood neuts-83.4* lymphs-9.2* monos-4.8 eos-1.8 baso-0.7 02:45am blood plt ct-538* 02:45am blood glucose-200* urean-12 creat-0.3* na-132* k-5.9* cl-90* hco3-26 angap-22* 02:45am blood alt-20 ast-54* alkphos-35* totbili-0.3 09:48am blood ck(cpk)-29* 02:45am blood albumin-3.7 calcium-10.1 phos-4.9* mg-1.9 02:59am blood lactate-3.8* 09:53am blood lactate-1.2 discharge labs: 03:12am blood glucose-159* urean-6 creat-0.2* na-132* k-3.5 cl-91* hco3-27 angap-18 01:00pm blood wbc-11.4*# rbc-4.41*# hgb-12.1*# hct-35.9* mcv-81*# mch-27.4 mchc-33.6# rdw-14.1 plt ct-543*# brief hospital course: 65-year-old m with als, bipap dependent with baseline o2 presenting with lethargy, hypoxia, likely mucous plugging vs aspiration pneumonitis. # acute respiratory failure: patient reportedly had an acute hypoxic event that rapidly resolved. differential diagnosis includes transient mucuous plugging vs aspiration vs pneumonia. a nurse from his facility was concerned him having difficulty swallowing, although there was no documented aspiration event. his chest xray does not show an obvious infection. he was started on empiric treatment for hcap with vancomycin, levaquin, and ceftriaxone on . his hypoxemia improved rapidly and white count decreased. he remained afebrile throughout his stay with respiratory status consistent with bipap. lactate decreased from 3.8 on admission to 1.2 the following morning. antibiotics were dced on discharge. o2 sat in mid to high 90s on home setting nasal bipap. outpatient issues -- admission blood cultures are still pending on . # als: patient is followed by als specialist at . nursing facility had little information regarding his status and functional capacity. per email from als providers, they need to discuss goals of care with pt. outpatient issues: -- goals of care discussion # htn: antihypertensives were held on admission given concern for possible sepsis. patient remained hemodynamically stable throughout hospitalization. plan to restarted anti-hypertensives at rehab. # depression: celexa, ativan, and trazodone were continued while pt was in house. # transitional issues: goals of care discussion with als care team consider speech and swallow study pending goals of care discussion restart antihypertensives medications on admission: losartan 50 mg daily hctz 25 mg daily docusate 100 mg citalopram 30 mg daily bismuth subsalicylate 15 ml tid tamsulosin 0.4 mg qhs sodium chloride nasal spral spray tid asa 81 mg daily albuterol nebs q4h prn sob ipratropium nebs q6h prn sob lorazepam 1mg po qid lorazepam 1mg po q6h prn tramadol 50-100mg q6h prn pain trazodone 100mg po qhs trazodone 50mg po qhs prn insomnia after 100mg dose discharge medications: losartan 50 mg daily hctz 25 mg daily docusate 100 mg citalopram 30 mg daily bismuth subsalicylate 15 ml tid tamsulosin 0.4 mg qhs sodium chloride nasal spral spray tid asa 81 mg daily albuterol nebs q4h prn sob ipratropium nebs q6h prn sob lorazepam 1mg po qid lorazepam 1mg po q6h prn tramadol 50-100mg q6h prn pain trazodone 100mg po qhs trazodone 50mg po qhs prn insomnia after 100mg dose discharge disposition: extended care facility: for living discharge diagnosis: hypoxia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: mr. , it was a pleasure taking care of you during your hospitalization. you were admitted to the intensive care unit because you had low oxygen levels. we think this is caused by either excess mucous in your lungs or food going down the wind pipe. your oxygenation improved and you will return to for living. followup instructions: please arrange follow up with your primary care physician and als specialist once you return to md procedure: non-invasive mechanical ventilation diagnoses: unspecified essential hypertension peripheral vascular disease, unspecified dysthymic disorder acute respiratory failure amyotrophic lateral sclerosis gastrostomy status edema 

Answer: The patient is high likely exposed to