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 right neck swelling right upper quadrant pain major surgical or invasive procedure: none history of present illness: 75 yo m who was at for weeks in icu with botulism and was discharged to 3 weeks ago. his rehab goals were --improved vent function, was intubated and on ac at dc --neuromuscular recovery --improved in fucntional status --improvement in gut motility, nutrition yesterday they noted that his metal status was poor (his son disagrees with that though). they also noticed he had r neck swelling, tenderness, edema. sent here for eval past medical history: 1. htn 2. depression 3. bph 4. high cholesterol 5. botulism toxin poisoning 6. s/p tracheostomy 7. hyponatremia (?siadh from ssris) social history: -lives in by himself -muslim -no tobacco or etoh use as per son family history: no known family history of neurologic disease as per son. physical exam: t 98.8, hr 80, bp 130/70, rr 10, 100% on vent gen - comfortable, trach in place, nad heent - bilateral ptosis, perrl, dry mm right neck - 2x5cm lymph node, surrounding erythema, tender to palpation card - rrr, normal s1 s2, no m/g/r resp - ctab abd - soft, nd, ruq tenderness, no sign, no rebound or guarding exts - no edema neuro - unable to follow commands, unable to move eyes pertinent results: 06:15pm pt-12.6 ptt-26.6 inr(pt)-1.0 06:15pm plt count-286# 06:15pm hypochrom-1+ 06:15pm neuts-86.3* lymphs-7.2* monos-4.7 eos-1.7 basos-0.1 06:15pm wbc-13.0*# rbc-2.89* hgb-8.0*# hct-26.0* mcv-90 mch-27.8 mchc-31.0 rdw-15.1 06:15pm glucose-112* lactate-1.0 k+-4.9 06:15pm calcium-8.7 phosphate-2.8 magnesium-1.7 06:15pm ck-mb-notdone ctropnt-<0.01 06:15pm lipase-26 06:15pm alt(sgpt)-151* ast(sgot)-53* ck(cpk)-29* alk phos-709* amylase-103* tot bili-2.1* 06:15pm glucose-103 urea n-21* creat-0.4* sodium-131* potassium-4.9 chloride-92* total co2-35* anion gap-9 06:30pm urine blood-sm nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-sm urobilngn-0.2 ph-5.5 leuk-sm 06:30pm urine color-yellow appear-clear sp -1.025 07:11pm type-art po2-213* pco2-39 ph-7.53* total co2-34* base xs-9 09:39pm type-art po2-153* pco2-48* ph-7.44 total co2-34* base xs-7 intubated-intubated brief hospital course: a: 75 year old man recently discharged from after a prolonged course of botulism, s/p tracheostomy who presented with changes in mental status, right neck swelling, and ruq pain. change in mental status: according to the family members and nursing staff who took care of the patient on his prior admission, his mental status was at base line or better when he arrived in the micu. ct head on admission was normal. parotitis: purulent discharge was expressed from duct by the ent consultant. cultures were taken of the discharge and were pending at the time of discharge. he was empirically started on vancomycin, levofloxacin, and flagyl. during his stay he remained afebrile and had a normal wbc count. he received iv hydration, warm compressed to right neck, and massage. ruq pain: the patient presented with mild ruq pain and elevated lfts (alt 151, ast 53, ap 790, 103, tuberculosis 2.1). ruq u/s done on showed sludge filling an otherwise unremarkable-appearing gallbladder. a non-contrast abdominal ct from showed a distended gall bladder without signs of cholecystitis, a minimal amount of ascites, and an ill-defined sclerotic lesions within the iliac bones bilaterally. his abdominal pain resolved during his hospital stay and his lfts were trending downward. at the time of discharge his lfts were alt 86, ast 36, ldh 167, ap 631, 126, tuberculosis 1.0. the patient's abdominal exam and lfts / can be followed as an out patient. discharge medications: 1. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 2. morphine sulfate 1-5 mg iv q2h:prn hold for sedation 3. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 5. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. 6. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q6h (every 6 hours) as needed. 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 8. senna 8.6 mg tablet sig: two (2) tablet po hs (at bedtime). 9. vancocin hcl 1,000 mg recon soln sig: one (1) gram intravenous twice a day for 10 days. 10. heparin sodium (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 11. levofloxacin in d5w 500 mg/100 ml piggyback sig: five hundred (500) mg intravenous q24h (every 24 hours) for 10 days. 12. docusate sodium 150 mg/15 ml liquid sig: one hundred (100) mg po bid (2 times a day). 13. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: five hundred (500) mg intravenous q8h (every 8 hours) for 11 days. 14. medication insulin sc sliding scale: breakfast lunch dinner bedtime regular regular regular regular glucose insulin insulin insulin insulin 0-50 4 oz. juice 4 oz. juice 4 oz. juice 4 oz. juice 51-150 0 units 0 0 0 151-200 2 2 2 2 10 10 > 400 notify m.d. discharge disposition: extended care facility: & rehab center - discharge diagnosis: parotitis botulism toxin poisoning s/p tracheostomy htn bph depression high cholesterol discharge condition: stable discharge instructions: take all your medications as prescribed continue physical therapy call you doctor or go to the er if you are having increasing fevers, throat swelling, trouble breathing / talking / swallowing, abdominal pain, vomitting, or any other worrisome symptoms. followup instructions: please contact the micu a intensive care unit: at on monday, to obtain final sensitivies from pending microbiology data in order to further tailor antibiotic therapy. monitor for signs of dehydration (ie weigh loss, dry mucous membranes, decrease urine output, decrease bp) and bolus 250 cc as necessary. thank you. please follow-up with neurology, dr. , call to schedule a convenient time 4 months from now. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances transfusion of packed cells diagnoses: anemia, unspecified pure hypercholesterolemia unspecified essential hypertension depressive disorder, not elsewhere classified tracheostomy status sialoadenitis 

Answer: The patient is high likely exposed to