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: past medical history: 1. myasthenia . 2. diabetes mellitus. 3. right l5 radiculopathy, status post l5-s1 diskectomy. 4. old right exotropia. 5. glaucoma. 6. high cholesterol. 7. hypertension. 8. bph, status post turp. admission medications: 1. calcium carbonate 500 mg p.o. t.i.d. 2. glyburide 5 mg p.o. q.d. 3. metformin 1 gram p.o. b.i.d. 4. protonix 40 mg p.o. q.d. 5. lisinopril 10 mg p.o. q.d. 6. paxil 10 mg p.o. q.d. 7. zocor 40 mg p.o. q.d. 8. flomax 0.4 mg p.o. q.h.s. 9. nystatin swish and swallow. 10. lumigan 0.03% drops. 11. ativan 0.5 mg p.r.n. 12. insulin sliding scale. 13. cellcept 1,500 mg p.o. b.i.d. 14. prednisone 100 mg p.o. q.d. 15. mestinon 75 mg p.o. q.i.d. 16. mestinon time span 180 mg p.o. q.h.s. allergies: the patient has no known drug allergies. physical examination on admission: vital signs: temperature 97.7, heart rate 112, blood pressure 122/43, respiratory rate 20, 02 saturation 97% on room air. general: he was uncomfortable appearing with perfuse secretions. lungs: his lung sounds were coarse throughout. his negative inspiratory force was -12 and his fvc was 550. cardiovascular: tachycardiac without murmurs. abdomen: benign. neurologic: he was awake and alert. his voice was very nasal and of very low volume. he was able to count to 45 in one breath. there was no diplopia or ptosis. he had mild neck flexor weakness. there was mild bilateral deltoid weakness. the rest of the examination was deferred at that time due to his worsening pulmonary status. hospital course while in the icu: he was admitted to the intensive care unit for close monitoring. his icu course by system is as follows. 1. neurologic: the etiology of his worsening myasthenia symptoms was unclear. however, it was found that he did have a pneumonia which may have triggered his worsening symptoms. his mestinon was changed to neostigmine 1.5 mg q. three hours. his prednisone was changed to solu-medrol 80 mg iv q.d. his status remained relatively stable over the first few days in the icu. he was noted to have increased secretions and his neostigmine dose was decreased and scopolamine was briefly added but this did not seem to help with his secretions. his respiratory status declined slowly and then more acutely on requiring intubation. because of his worsening status, he received plasmapheresis. this was started on and he received five rounds of plasmapheresis every other day. in addition, cyclosporin was added to his regimen on at a dose of 50 mg b.i.d. his goal level is 100 with a plan to increase very slowly at 0.5 mg per kilogram per day every month up to an approximate goal dose of 150 mg b.i.d. with the plasmapheresis and cyclosporin, his neurologic examination quickly improved in the icu. he was able to be extubated on . his neostigmine was converted back to pg mestinon. he was continued on his other myasthenia medications. 2. cardiovascular: the patient had intermittent tachycardia at times in the icu of unclear etiology. in the setting of his respiratory distress and emergent intubation, his systolic blood pressure decreased into the 80s and he was briefly on neo-synephrine drip to maintain his blood pressures. he also had episodes of bradycardia in relation to the neostigmine and this resolved when he was converted back to his mestinon. 3. pulmonary: on admission, his negative inspiratory force was -12, fvc 550, and he was able to count to 42 in one breath. chest x-ray on admission showed retrocardiac opacity. chest ct showed bilateral lower lobe consolidation, left greater than right consistent with aspiration pneumonia. he was initially started on ceftriaxone without significant improvement and, therefore, was changed to levofloxacin and then flagyl and received a total of ten days of antibiotics. on , he had increasing respiratory distress with markedly elevated carbon dioxide and was, therefore, placed on cpap. on , he had an acute desaturation into the 70s with a possible aspiration event and required emergent intubation. he was placed on imv with trials of cpap and was ultimately extubated on . 4. infectious disease: the patient was febrile at times in the icu with a presumed source of his aspiration pneumonia. he received antibiotics for a total of ten days, initially ceftriaxone and then levofloxacin and flagyl. 5. gastrointestinal: the patient underwent peg tube placement on due to his inability to provide adequate nutrition orally. egd at this time showed a single 4 mm ulcer in the stomach. he was placed on a proton pump inhibitor and h. pylori titers were checked which were negative. in the icu, he later developed anemia. he, therefore, underwent repeat egd on which showed healing of the previously seen ulcer. however, there were multiple erosions and ulcers in the second part of the duodenum. this was thought possibly to be related to his prednisone and cellcept. however, given his tenuous neurologic status these medications were not changed. he was continued on the proton pump inhibitor. the gi service recommend a follow-up egd in approximately six to eight weeks to check on the status of these erosions and ulcers. 6. heme: on , his hematocrit dropped to 26.2. he was transfused 2 units of blood. his workup included stool guaiac which were negative, egd, as above, and abdominal ct scan which was negative for retroperitoneal bleed. his ptt was also markedly elevated to as high as 126. this seemed to be related to subcutaneous heparin as it resolved after this was discontinued. the patient was, therefore, continued on pneumoboots for dvt prophylaxis. 7. fluids, electrolytes, and nutrition: the patient was kept on an insulin sliding scale. he briefly required an insulin drip. nph was added to his regimen. electrolytes were followed closely and repleted as needed. the nutrition service followed the patient and recommended tube feedings which the patient was tolerating. 8. dermatology: the patient had a penile ulcer which was treated with sulfadiazine. 9. access: for access, the patient had a left subclavian quinton catheter placed on . with the patient's improved neurologic and respiratory status after the plasmapheresis and cyclosporin, the patient was transferred to the neurology floor on . at that time, he felt much improved. his only complaint at that time was hypophonia. he felt that his swallowing and breathing were at about baseline. physical examination upon transfer: general: the patient is a chronically ill appearing man in no acute distress. lungs: he had coarse breath sounds bilaterally. cardiac: regular rate and rhythm without murmurs, rubs, or gallops. abdomen: benign. the g tube site was clean, dry, and intact. neurologic: he was awake and alert. on cranial nerve examination, he had a right exotropia. his pupils were equal, round, and reactive to light. his extraocular movements were intact without nystagmus. there was mild bilateral facial weakness. he was able to fully close his eyes but these could be opened by the examiner. his tongue was midline. his tongue strength was decreased. on motor examination, there was mild 5- weakness of the triceps bilaterally. sensation was intact to light touch. his reflexes were 2+ and symmetric. his toes were downgoing. his finger-nose-finger was normal. hospital course while on the neurology floor: 1. neurology: the patient was continued on mestinon, prednisone, cellcept, and cyclosporin. he received his fifth and final round of plasmapheresis on . his neurologic examination continued to slowly improve. his facial strength improved and he was able to press his lips and whistle. the volume of his voice continued to improve. on , his cyclosporin dose was increased to 100 mg b.i.d. per the neuromuscular service. the plan of the neuromuscular service at this time is to continue on his current medications and then to perform iv ig every two weeks with the next round being on . he has a scheduled follow-up in the clinic on at 4:00 p.m. 2. cardiovascular: there are no significant issues at this time. 3. pulmonary: the patient continued to have increased secretions but was able to clear these with coughing and suctioning. his chest x-ray on revealed a small left pleural effusion and stable left lower lobe consolidation. as the patient was afebrile with a stable respiratory status, antibiotics were not restarted. 4. infectious disease: the patient had a low-grade fever to 99.3 and a mildly elevated white count. urinalysis was negative. urine culture was consistent with contamination. chest x-ray was stable, as above. stool c. difficile was negative times two and a third sample was pending. he subsequently had temperatures in the normal range. 5. gastrointestinal: the patient was continued on a proton pump inhibitor and his tube feeds. he had no significant issues. he had a swallow study on which cleared him for a pureed solid and thin liquids, extra sauces. 6. heme: the patient's hematocrit was stable. 7. fluids, electrolytes, and nutrition: the patient's sugars continued to remain high in the 200s and his nph was gradually increased. physical examination on discharge: similar to as described above with moderate improvement in his facial strength. most recent laboratory data: white blood cell count 10.2, hematocrit 31, platelets 283,000. sodium 139, potassium 3.7, chloride 102, bicarbonate 32, bun 22, creatinine 0.7, glucose 224, calcium 8.2, magnesium 2.1, phosphorus 2.1. cyclosporin 57. the patient has a cbc and chemistries pending from . the most recent chest x-ray is as above. condition on discharge: stable. neurologic follow-up with dr. discharge status: to hospital. discharge diagnosis: 1. myasthenia crisis. 2. aspiration pneumonia. 3. diabetes mellitus. discharge medications: 1. tylenol 325 to 650 mg pg p.r. q. four hours p.r.n. pain. 2. lidocaine jelly 2% one application p.r.n. 3. silver sulfadiazine 1% cream applied to penile ulcer b.i.d. 4. lorazepam 0.5 to 1 mg iv q. four hours p.r.n. anxiety. 5. lansoprazole 30 mg pg q.d. 6. cellcept 1,500 mg pg b.i.d. 7. prednisone 100 mg pg b.i.d. 8. mestinon 75 mg pg q. six hours and q.h.s. 9. paxil 20 mg p.o. q.d. 10. cyclosporin 100 mg pg q. 12. 11. neutra-phos one packet p.o. t.i.d. 12. zinc sulfate 220 mg pg q.d. started on with a planned duration of 14 days. 13. vitamin c 500 mg p.o. b.i.d. 14. nph insulin 14 units q. 12 hours. 15. insulin sliding scale (please see nursing sheet). 16. tube feeds probalance full-strength 70 cc per hour, free water flushes 30 cc q. four hours. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other endoscopy of small intestine other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] arterial catheterization diagnoses: anemia, unspecified pure hypercholesterolemia unspecified essential hypertension unspecified protein-calorie malnutrition unspecified glaucoma pneumonitis due to inhalation of food or vomitus gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction 

Answer: The patient is high likely exposed to