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: change in mental status. major surgical or invasive procedure: central line . history of present illness: history from son-in-law: - the pt. is an 86 yr old burmese-speaking male with a past medical history of severe parkinson's disease and type ii dm who p/w tachypnea and change in mental status. per family, over last 2 days pt has had decreased po intake and yesterday his bg was in the 40's. pt was given ensure and then his bg today was in 400-500s. he has also been having increased sputum production and cough over last several days but no tachypnea until today. denies f/c. he vomitted en route to ed but family denies any n/v/abd pain/diarrhea prior to that. in the ed, the pt was responsive to pain only and he was febrile to 102. he had a cxr showing multifocal pneumonia and he was started on levaquin/flagyl. he had an abg 7.42/30/68 and lactate of 2.1. other labs were notable for wbc of 6.3 w 70 % pmns and 22% bands,glc of 441 -> 10 units insulin, 1 liter ns and one banana bag, and ag of 15. - on arrival to micu, pt responds by opening his eyes but does not speak. he is moving all 4 ext. per family, this ms is improved from this am, but not completely at baseline. at baseline, he does speak some, but doesn't really walk. his pd has become severe recently. when admitted previously to nebh for dehydration he has had similar change in ms per son-in-law. past medical history: 1) dm2 2) parkinson's disease - has baseline increased stiffness per neuro eval note on at nebh 3) gi bleed: egd has shown peptic ulcers, gastritis, h. pylori pos. 4) anemia - microcytic 5) aseptic meningitis social history: lives with daughter, son, wife. . denies tobacco, alcohol. from . family history: no h/o cancer. physical exam: t f hr 90 bp 138/74 rr 20 95% on 3l nc gen opens eyes, repsonds to pain, in nad heent surgical pupil os, op very dry. no lad. atypical moles on face. no jvd. cve rrr, nml s1s2, -m/r/g chest clear to auscultation b/l ant abd guaiac +, soft, ? ruq/epigastric tenderness, nd, nabs ext 2+ distal pulses. warm to touch. neuro: moves all 4 ext. responds to pain. diffuse muscular rigigity ue>le. pertinent results: chest (portable ap) 8:33 am impression: worsening of multifocal consolidations, the most prominent one in the right lower lobe, associated with increasing pleural effusion and underlying chf. these findings are probably representing progressive multifocal pneumonia. ecg study date of 11:47:38 am sinus rhythm inferior t wave changes are nonspecific since previous tracing of , no significant change ct head w/o contrast 1:35 pm impression: no acute intracranial hemorrhage. chronic small vessel ischemic disease. labs on admission: 08:00pm wbc-7.2 rbc-4.84 hgb-9.9* hct-29.7* mcv-61* mch-20.4* mchc-33.2 rdw-16.2* 08:00pm plt count-194 08:00pm neuts-46* bands-39* lymphs-7* monos-6 eos-0 basos-0 atyps-0 metas-2* myelos-0 08:00pm glucose-202* urea n-33* creat-1.5* sodium-144 potassium-4.0 chloride-112* total co2-20* anion gap-16 08:00pm calcium-7.9* phosphate-2.5* magnesium-2.1 brief hospital course: micu course, by problem: 1. aspiration pneumonia: the pt. was found to have a multifocal pneumonia on admission x-ray, worst in the right lower lobe and felt to be consistent with an aspiration pneumonia. he was placed on levofloxacin and metronidazole. blood cultures were drawn and were negative. sputum culture was consistent with oropharyngeal flora. he was successfully weaned down in terms of oxygen requirement during his micu stay. 2. encephalopathy: ct of head on admission negative for acute bleed; he has evidence of chronic microvascular infarcts which appear to be unchanged from prior study in ' at nebh. as per family, this change is similar to what has happened before when admitted for dehydration. the patient improved significantly with intravenous fluid rehydration. in addition, he received antibiotics. change in mental status most likely secondary to dehydration in addition to underlying pneumonia and dehydration. 3. arf: was secondary to prerenal azotemia and improved with intravenous fluid hydration. 4. parkinson's diease: the pt. was maintained on carbidopa/levodopa and entacapone. 5. the pt was found to have guaiac positive stool. iron studies consistent with chronic disease. as the pt. has a history of gastric ulcers, he was maintained on a ppi. he received one unit of prbcs while in the micu. his hematocrit subsequently remained stable. 6. dmii: pt. takes amaryl 2 mg at home now with poor po intake. thus, oral hypoglycemics were held and the pt. was maintained on a ssi. . the patient was transferred to the floor after his oxygen requirement improved. his course on the medical floor was as below, by problem. # pneumonia - he was continued on levaquin and flagyl x14 days. his sputum cultures were consistent with oral flora. he was on 4l oxygen when transferred and at discharge is saturating 98% on room air. # encephalopathy - ct of head was negative for acute bleed - he has evidence of chronic microvascular infarcts which appear to be unchanged from prior study in ' at nebh. as per family, the change in his mental status is similar to what has happened before when admitted for dehydration. his mental status improved with antibiotics and ivf but the patient continued to wax and wane; of particular note, this was significant for increased a.m. somnolence and rigidity. an eeg was done to rule out status epilepticus. this showed diffuse slowing consistent with encephalopathy but no evidence of seizure. neurology also recommended an lp and mri if his mental status was unimproved. since he was afebrile the lp was deferred as was the mri as a brainstem lesion was also thought to be low on the differential diagnosis. his was started on an additional small dose of sinemet in the morning, resulting in significant improvement in his sleep/wake cycle and with mental status improving to baseline. his comtan was continued on a t.i.d. basis. . # arf- his creatinine remained stable after leaving the icu. . # anemia- guaiac+, microcytic, and has a history of ulcers. he was maintained on a ppi and his hct remained stable. iron studies were consistent with chronic disease. he and his family should consider an outpatient colonoscopy. . # dmii-as profound hypoglycemia and then hyperglycemia with inconsistent po intake was part of his initial presentation, his oral hypoglycemics were discontinued and he was maintained on sliding scale regular insulin. his fingersticks were labile and it was difficult to maintain euglycemia. nph was added to his morning insulin regimen. his po intake is still not consistent so his sliding scale and nph may regimen may continue to need adjustment. . # f/e/n: an ngt was placed in the and he was maintained on tube feeds. he passed a video swallow, although was still thought to be aspiration during the study. he is now getting honey liquids and ground solids and his tube feeds have been discontinued. he is at significant risk for aspiration and needs to be fed upright and with careful attention to minimize this risk. . # ppx: he was maintained on sc heparin for dvt propylaxis, ppi for gi prophylaxis as well as a bowel regimen for constipation * # comm: in law : family contact full code medications on admission: 1) protonix po 40mg daily 2) sinemet po 25/250 tid 3) amaryl po 2mg 4) comtan 200mg po tid discharge disposition: extended care facility: - discharge diagnosis: sepsis, resolved aspiration pneumonia, resolving delerium, resolved discharge condition: stable and improved, afebrile, at baseline mental status and oxygenating at room air discharge instructions: please seek immediate medical assistance if you experience worsening mental status, fever greater than 101, shaking chills or any other symptoms of concern to you. please take all your medications as directed followup instructions: please follow up with your pcp as needed. please follow up with your outpatient neurologist in 2 weeks please obtain an outpatient colonoscopy. procedure: enteral infusion of concentrated nutritional substances diagnoses: acute kidney failure, unspecified paralysis agitans pneumonitis due to inhalation of food or vomitus diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled dementia in conditions classified elsewhere without behavioral disturbance delirium due to conditions classified elsewhere unspecified deficiency anemia 

Answer: The patient is high likely exposed to