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: hypotension major surgical or invasive procedure: none history of present illness: hpi: 81 y/o m w/copd on home o2, dchf, myelodysplasia w/excess blasts, recently admitted to for hypoxia from . per d/c summary, pt initially went to for leg pain. at that time he was found to be in arf w/elevated ck, and had "evidence of chf and copd flare" as well as pancytopenia with 15% blasts. here he was initially in the for hypoxia (93% on ra) and concern for blast crisis. he did well, tolerated fluid resuscitation, and did not require intubation. he was seen by heme-onc, who felt he did not have aml but had myelodysplasia with excess blasts. his renal failure resolved with hydration (0.8 on d/c, from 2.1). per the family's request, he was transferred back to on , and was discharged to home from there on . he finished a course of antibiotics on . he was discharged home on 2 liters oxygen although he had not been on this prior. he was doing well post-d/c per his daughter, but over the past few days has been more lethargic, decreased po intake, increasing shortness of breath. he was febrile to 102 last pm. his mental status remained at baseline (alert, oriented, interactive) with the exception of one episode of confusion last pm which resolved within minutes. he has no dysuria but per the daughter has had diarrhea and urinary/fecal incontinence over the past 3-4 weeks with inability to tell when he is stooling or urinating. he had no focal weakness, nausea, vomiting, abdominal pain, cough, or other symptoms. at the osh ed, he was tachypneic in 40s with o2 sat 80s, and was placed on bipap. he was transferred here for further w/u. in our ed, he was febrile to 101.9, hypotensive to the 70s/50s, with o2 sat 99% on bipap. has had 20 cc uop. past medical history: 1. copd 2. htn 3. chf (muga with lvef 61%; tte w/"depressed" systolic fxn but diff to assess, tte on was ef 50%, inferobasilar hk, mild mr) 4. cad s/p cabg x2 (, ) 5. h/o prostate ca, s/p turp 6. hyperparathyroidism 7. pancytopenia (baseline hct during prior hosp low-mid 30s, platelets 40s-50s, wbc 2) 8. myelodysplasia w/excess blasts (dx last hospitaliz) 9. colonic perforation s/p sigmoid resection (at ) 10. carotid artery stenosis s/p cea in social history: lives at home with his wife. smoked ppd for 60 yrs, quit 6 yrs ago. family history: fam hx: identical twin brother died from leukemia physical exam: pe: p: 76 bp: 104/78 r: 24 100% on bipap gen: uncomfortable male, not in acute distress, with bipap mask in place heent: nc, at, perrl, anicteric, conjunctivae noninjected. neck: supple, jvd difficult to assess but appears flat. lungs: good air movement throughout, no wheezes, rhonchi, or crackles, no dullness to percussion cv: rrr, no m/r/g abd: soft, nt/nd, +bs. rectal: large external hemorrhoid, decreased rectal tone. ext: no clubbing, cyanosis, or edema skin: no rash neuro: perrl, eomi, tongue midline, strength 5/5 x4, decreased rectal tone as above. pertinent results: 08:50pm urine color-amber appear-hazy sp -1.022 08:50pm urine blood-lg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-sm urobilngn-4* ph-5.0 leuk-tr 08:50pm urine rbc-* wbc- bacteria-mod yeast-none epi- 08:50pm urine mucous-few 07:45pm lactate-2.1* 07:20pm glucose-161* urea n-30* creat-1.3* sodium-133 potassium-3.8 chloride-100 total co2-22 anion gap-15 07:20pm alt(sgpt)-50* ast(sgot)-61* ld(ldh)-1174* ck(cpk)-48 alk phos-99 tot bili-0.5 07:20pm ctropnt-0.03* 07:20pm ck-mb-notdone probnp-9466* 07:20pm calcium-8.6 phosphate-2.6* magnesium-1.5* 07:20pm haptoglob-375* 07:20pm cortisol-376.5* 07:20pm wbc-2.4* rbc-2.41*# hgb-7.6*# hct-21.6*# mcv-90 mch-31.4 mchc-35.0 rdw-16.1* 07:20pm neuts-55 bands-5 lymphs-27 monos-2 eos-0 basos-0 atyps-0 metas-0 myelos-0 blasts-11* nuc rbcs-14* 07:20pm hypochrom-2+ anisocyt-2+ poikilocy-2+ macrocyt-2+ microcyt-2+ polychrom-1+ ovalocyt-2+ schistocy-occasional teardrop-2+ bite-occasional 07:20pm plt smr-very low plt count-40* 07:20pm pt-15.1* ptt-26.0 inr(pt)-1.5 . mr l spine findings: there is a transitional vertebra between the lumbar spine and the sacrum. for the purposes of this dictation, the most inferior disk will be referred to as s1/2, and the transitional vertebra will be referred to as partially lumbarized s1. bone marrow signal is diffusely abnormal, consistent with diffuse bone infiltration by tumor. there is a suggestion of cortical destruction in the posterior inferior endplate of l3, posterior superior endplate of l4, posterior inferior endplate of l5, and posterior superior endplate of s1. mild compression deformities are seen in all of the visualized vertebrae from t12 through s1, likely secondary to pathologic fractures. there is no bone marrow edema on the stir images to suggest that these fractures are acute. the conus terminates at l1. no compression of the conus is noted. at l3/4, there is a disc bulge and a more focal right paracentral herniation, which displaces the nerve roots medially and posteriorly. in addition, there is a shallow, small epidural mass extending from the posterior vertebral body into the right neural foramen, which may represent epidural tumor or a mottled osteophyte- ct could provide differentiation between the two etiologies. there is only mild associated narrowing of the right neural foramen. at l4/5, there is facet spondylosis and a disc bulge with mild associated central stenosis and lateral recess narrowing bilaterally. at l5/s1, there is a disc bulge and facet spondylosis with mild central stenosis and bilateral lateral recess narrowing. lenticular epidural structures are noted extending from l3 through l5 posterior to the vertebral bodies and anterior to the thecal sac, with high signal on t1- and t2-weighted images. these likely represent epidural fat, and less likely distended epidural veins. this appearance is not consistent with epidural tumor. the following preliminary report was given by dr. to a resident caring for the patient at 12:30 a.m. on : abnormal signal in vertebral bodies. disc herniation impinging on the thecal sac on the right at l3/4. no spinal cord compression. the final report was discussed with dr. at 1:45 p.m. on . impression: 1. diffuse bone marrow infiltration by tumor, with probable cortex destruction at multiple levels. probable epidural extension of tumor into the right l3/4 neural foramen with mild foramen narrowing. 2. small right paracentral disc herniation at l3/4, which displaces the nerve roots. 3. mild central stenosis and lateral recess narrowing at l4/5 and l5/s1. brief hospital course: a/p: 1. hypotension: patient was likely hypotensive from dehydration secondary to diarrhea. once he was fluid resucitated his bp returned to . he was then normotensive for the remainder of the admission. cortisol stim test was normal. anti htn meds were held. 2. fever/diarrhea: be related in that patient has c.diff from recent abx course and profound diarrhea. c diff was neg x 2 but patient was treated with empiric flagyl. sent home to complete a 14 day course. rectal tube placed in micu. by the third day the diarrhea had resolved (either spontaneously or due to the flagyl). he had no diarrhea for the rest of the admission. 3. urinary and bowel incontinence: patint was incontinent of urine and feces during the admission. by report of his family the urine is baseline for the patient since his radical prostatectomy. the stool was likely due to the diarrhea. however it was noted that the patient had poor rectal tone. there were no other neurological findings. an mri was negative for nerve impingement or cord compression. 4. myelodysplasia:h/o mds with xs blasts. patient evaluated by heme/onc. transfused to hct > 28. patient will have heme onc follow up in with dr. . 5. prostate cancer - patient with negative psa. however mri did demonstrate tumor spread. will follow up with dr. as an outpatient. 6. arf: resolved to normal with fluids. cr 0.6 at discharge. code status: dni medications on admission: 1. protonix 40 po daily 2. trazodone 50 qhs prn 3. ipratropium 4. colace 5. isosorbide mononitrate sr 120 mg daily 6. fluticasone 2 puffs 7. albuterol 8. metoprolol 75 mg po bid 9. lisinopril 10 daily 10. ?prednisone discharge medications: 1. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 8 days. disp:*24 tablet(s)* refills:*0* 2. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 8 days. disp:*8 tablet(s)* refills:*0* 3. fluticasone propionate 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*1 nebulizers* refills:*2* 4. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 5. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed). 6. albuterol sulfate 0.083 % solution sig: one (1) treatment inhalation q3-4h () as needed. disp:*qs 1 month treatment* refills:*6* 7. ipratropium bromide 0.02 % solution sig: one (1) treatment inhalation q6h (every 6 hours). disp:*120 treatments* refills:*2* 8. colace 100 mg capsule sig: one (1) capsule po three times a day. disp:*90 capsule(s)* refills:*2* 9. bisacodyl 5 mg tablet sig: one (1) tablet po once a day as needed for constipation. disp:*qs 1 month tablet(s)* refills:*3* discharge disposition: home with service facility: vna inc discharge diagnosis: primary: hypotension . secondary: copd chf diastolic cad h/o prostate cancer urinary incontinance myelodysplasia with excess blasts discharge condition: on oxygen 2l (baseline at home)eating wellwalking with walkerhemodynamically stable discharge instructions: please take all medications and make all follow-up as indicated in the discharge paperwork. if you have any chest pain, shortness of breath, abdominal pain please call your doctor or go to a hospital. also monitor you bowel movements. if you are not having bm x 3-5 days or develop abdominal pain/swelling seek medical attention. note that we stopped all of your blood pressure medicines (imdur, metoprolol, lisinopril) please don't take these until you see your primary care provider. followup instructions: please follow up with your primary care provider . in 1 week . he will need to set you up with appropriate follow up for your pulmonary disease. you will also need follow up for you myelodysplasia by a hematologist/oncologist. call dr. and set up an appointment in weeks. procedure: insertion of rectal tube diagnoses: thrombocytopenia, unspecified pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified personal history of malignant neoplasm of prostate coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status peripheral vascular disease, unspecified intestinal infection due to clostridium difficile diastolic heart failure, unspecified other specified hypotension urinary incontinence, unspecified 

Answer: The patient is high likely exposed to