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: patient recorded as having no known allergies to drugs attending: chief complaint: found down, xferred to osh, then to major surgical or invasive procedure: central venous line placement intubation/extubation with invasive ventilation history of present illness: mr. is a 69 yo with iddm, pvd, cva (no residual deficits), esrd () dm, not on hd, with a h/o of multiple episodes of hypoglycemia taken emergently to osh after this wife found him unresponsive in bed, surrounded by empty coke cans. blood glucose was 6. wife states that the patient has not been feeling well for the last couple of days prior to event, having increased , colored, foul smelling diarrhea. pt denieed fevers, chills, abdominal pain, but has not been eating well. wife reports more incontinence. patient has had dm for decades and is on nph and regular insulin followed by . worsening renal fx reportely over the past year, with multiple discussions with his nephrologist, dr. about initiation of hd. yesterday am, the patient was more confused, reportedly, then was found unresponsive by his wife. with a bg of 6. pt was given 1 amp of dextrose in the field. the patient reportedly did not fall, and did not complain of any cp, sob, dizziness, lightheadedness or diaphoresis. he does not remember feeling shaky before the episode. . pt was taken to osh emergently, was intubated in the field. prior to intubation, the patient apparently vomited and aspirated a large amount of particulate matter (witnessed by paramedics). particulate matter was aspirated from his ett. when brought to the ed, the patient was not responding to any commands. head ct was done at osh was reportedly negative, showing an old infarct, but no acute process. blood sugar was reportedly in the 20s. laboratory studies revealed an non-ag metabolic acidosis, renal insufficiency but normal lactate levels. per osh records, the patient had a transient episode of hypotension of unkown etioology, but rebounded back quickly with 500ccs bolus. per the patient's wife, the patient did administer his nph this am. patient with h/o dm and found unresponsive with significant hypoglycemia. intubated for airway protection but not waking up (etomidate, ativan given). exam shows brainstem function (gag) but not much else. paitent hd stable, on vent. to come to tonight to micu green as patient is usually cared for at for dm and renal failure. . prior to xfer from osh, received a call from md reporting that the patient was becoming more awake, following commands. pt unlikely able to protect airway, so kept intubated and xferred to . in the micu, he became more awake, but continued to have problems with aspiration. cxr noted bilateral effusions and infiltrates c/w aspiration pna. past medical history: 1. ischemic colitis , s/p ex lap and rigid sigmoidoscopy without evidence of ischemic bowel. 2. pvd: s/p right popliteal to dorsalis pedis bypass and left femoral-popliteal and popliteal-anterior tibial bypass, r cea, and right sfa stent. 3. type i diabetes mellitus - brittle diabetic; episodes of severe hypoglycemia and dka 4. status post cva >10 yrs ago. 5. history of chf with preserved ef 6. copd- no pfts in system 7. hypertension 8. glaucoma 9. ckd-baseline cr 2.1-2.4 (cr clearance of 25-30, stage 4)is preparing for pd with dr. at 10. h/o duodenal ulcer but on egd above not seen 11. anemia of chronic disease. 12. esophageal dysmotility. 13. h/o vre uti 14. rectal ca-dx no surgery due to comorbidities; s/p palliative xrt 15. secondary hyperparathyroidism social history: lives with his wife. smoked for >50yrs at most 2ppd. now smokes 1ppd. remote heavy etoh use in past (3+ drinks per day), quit 2-3 years ago. no recreational drug use. used to work in greenhouse supply business, then sold real estate now disabled. sleeps up to 22 hours per day per wife's report. does not allow visitors to house. admits to lack of motivation. . wife, (h), (c) family history: mother colon cancer. father with throat cancer. brother died of colon cancer at age 62. physical exam: vitals: tmin 95.7; tc95.7, hr 50-61; bp 123-182/49-57; rr 16 on ac 550x16; fio2 of 0.5; peep 5. gen: chronically ill appearing, somnolent elderly male, intubated, sedated. heent: pupils irregular, assymetric and non-reactive; eomi, b/l periorbital edema, mm dry neck: supple, no lad, no jvp elevation, +linear well-healed scar over right cartoid cardio: pmi inferiorly displaced and diffuse, rrr, nl s1/s2, no murmurs or rubs appreciated resp: ctab, no exp wheezes abd: + bs, soft/nt/nd, no hsm, no masses ext: no c/c/e; b/l le w/ significant atrophy. multiple scars. dopplerable pulses bilat. neuro: intubated, sedated on boluses, but responding to commands when waking up pertinent results: ekg: sinus tachycardia. right bundle-branch block. left axis deviation. left anterior fascicular block. compared to previous tracing of heart rate is increased. otherwise, multiple abnormalities as previously noted persist without major change. . cxray: right internal jugular vascular catheter terminates in the proximal superior vena cava. cardiac contour and vascular pedicle width have slightly increased and are accompanied by worsening vascular engorgement, diffuse perihilar haziness and interstitial opacities, likely due to increased volume status and fluid overload. superimposed secondary process such as aspiration is difficult to exclude in the setting of diffuse edema. bilateral layering pleural effusions are noted. brief hospital course: a/p 69m,esrd, cad, pvd, brittle type i dm with very labile sugars taken emergently to osh after being found unresponsive by his wife with a blood glucose of 6. . 1) hypoglycemia: this was likely the effect of nph, lantus with decreased clearance (worsening renal fx, decrease po intake and increased diarrhea). pt has had very labile blood sugars in the past, with multiple episodes of hypoglycemia. patient taking nph/regular at home in am. notes, the patient takes lantus as well. patient was initially maintained on an insulin drip whiel in the icu, but later transitioned to lantus 4 units with riss coverage at meal time. . 2) respiratory failure: patient was intubated for airway protection in the field, with visible aspiration and suctioning back of particular matter. he was extubated following transfer to . he was started on levofloxacin and flagyl as empiric therapy for aspiration pneumonia. . 3) pvd: patient has known severe peripheral vascular disease, s/p multiple bypass surgeries and vein harvesting. patient is due back fro r sfa angioplasty some time soon to save the patient's right leg. there has to be a discussion between renal and vascular surgery about risk of contrast dye and the risk of starting the pt on hd. he was continued on aspirin, and dr. made aware of admission. . 4) diabetes mellitus, type i: patient has exocrine and endocrine pancreatic insufficiency given type i dm, presenting with -colored stools. he was continued on pancreatic replacement enzymes. was consulted and patinet was maintained on a regimen of lantus 4 units + riss. . 5) renal insufficiency: mild acute on chronic at time of presentation, likely prerenal in the setting of poor po intake. creatinine returned to baseline of ~4 with hydration. planning is in progress for eventual hemodialysis. renal function is likely declining due to progression of disease. patient has a non-gap metabolic acidosis, and was started on sodium citrate prior to discharge. he was continued on a regimen of epo, calcitriol, lanthanum, and calcium acetate. . 6) nutrition: patient underwent a speech & swallow evaluation with report of ongoing aspiration with thin liquids with coughing after drinking. he also appeared to have residue in his throat of which he is unaware given that he coughed up juice and eggs from earlier this morning when he aspirated. therefore, he was recommended to be put on a diet of ground solids & nectar thick liquids if he alternates between bites and sips and if he ends his meal w/several sips of nectar to clear residue from his pharynx. the following recommendations were made: -diet of nectar thick liquids & ground consistency solids using the following: a) slow rate of intake b) small bites and sips c) alternate between bites and sips d) end meal w/several sips of nectar thick liquid to clear residue from his throat e) po medications crushed with purees patient refused thick liquids for duration of hospitalization and subsequently had very poor po intake of liquids. . 7) depression: social work consult was obtained, and patient was started on lexapro 5 mg daily (renally dosed). . 8) code status: full code, confirmed with patient repeatedly during this hospitalization. medications on admission: norvasc 2.5 mg as directed 1 tab qd fosrenol 1000 mg chew one with each meal. lasix 40mg 1 per day glucagon emergency kit 1mg phoslo 667mg three times a day 2 tablets hectorol 0.5mcg twice a day hydralazine hcl 50mg twice a day neurontin 100mg two at bedtime. procrit 4000 u/ml as directed twice a week. ferrous sulfate 325mg 1 time per day folic acid 1mg 1 time per day lantus ? dose humulin ? dose lipram 20-4.5-25 four times a day 2 tabs metoprolol tartrate 100mg twice a day () losec 20mg 1 time per day foltx 1-2.5-25mg 1 time per day asa 325 qd discharge medications: 1. aspirin 325 mg tablet : one (1) tablet po daily (daily). 2. calcium acetate 667 mg capsule : one (1) capsule po tid w/meals (3 times a day with meals). 3. heparin (porcine) 5,000 unit/ml solution : one (1) injection injection tid (3 times a day). 4. lanthanum 500 mg tablet, chewable : one (1) tablet, chewable po tid (3 times a day): please give with meals. 5. amylase-lipase-protease 20,000-4,500- 25,000 unit capsule, delayed release(e.c.) : one (1) cap po tid w/meals (3 times a day with meals). 6. calcitriol 0.25 mcg capsule : one (1) capsule po daily (daily). 7. escitalopram 10 mg tablet : 0.5 tablet po daily (daily). 8. sodium citrate-citric acid 500-334 mg/5 ml solution : fifteen (15) ml po bid (2 times a day). 9. epoetin alfa 4,000 unit/ml solution : one (1) ml injection qmowefr (monday -wednesday-friday). 10. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 11. lantus 100 unit/ml solution : four (4) units subcutaneous at bedtime. 12. levofloxacin 250 mg tablet : one (1) tablet po q48h (every 48 hours) for 2 days. 13. metronidazole 500 mg tablet : one (1) tablet po tid (3 times a day) for 2 days. 14. folic acid 1 mg tablet : one (1) tablet po once a day. 15. norvasc 2.5 mg tablet : one (1) tablet po once a day. 16. insulin regular human 300 unit/3 ml insulin pen : per sliding scale subcutaneous qachs. 17. metoprolol tartrate 100 mg tablet : one (1) tablet po twice a day. 18. hydralazine 25 mg tablet : one (1) tablet po four times a day: uptitrate dose as needed . discharge disposition: extended care facility: discharge diagnosis: hypoglycemia aspiration pneumonia respiratory failure depression diabetes mellitus, type i acute renal failure end-stage renal disease secondary hyperparathyroidism pancreatic insufficiency discharge condition: stable glucose levels and vital signs. discharge instructions: you were admitted to the hospital with hypoglycemia. it is important that you adhere to a diabetic diet with frequent oral intake to prevent high/low blood glucose levels. . you have been treated for an aspiration pneumonia which occurred due to respiratory failure when your blood glucose level was low at home. you have a 9-day course of antibiotics remaining. . you have been started on a medication called lexapro for symptoms of depression. . you should return the hospital if you are experiencing chest pain, shortness of breath, fevers, or uncontrolled blood glucose levels. followup instructions: you should follow-up with your nephrologist dr. at the clinic next week, as previously scheduled. . provider , dpm phone: date/time: 12:45 . provider vascular lab phone: date/time: 10:30 . provider , md phone: date/time: 11:15 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube diagnoses: acidosis anemia in chronic kidney disease congestive heart failure, unspecified acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified peripheral vascular disease, unspecified pneumonitis due to inhalation of food or vomitus personal history of other diseases of circulatory system secondary hyperparathyroidism (of renal origin) diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus diabetes with other specified manifestations, type i [juvenile type], not stated as uncontrolled 

Answer: The patient is high likely exposed to