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: zosyn / vancomycin / heparin agents attending: chief complaint: weakness major surgical or invasive procedure: ng tube placement history of present illness: 78m with h/o parkinson's disease, cad s/p cabg, h/o tia, s/p recent hospitalization for pna () now with worsening weakness. per pt's wife since he got sick with the pneumonia his parkinson's has been acting up and he has been having increasing trouble swallowing. she states he has been more weak and she has been having trouble having him transfer and walking him to the bathroom (his legs have been buckling under him). wife states he has had a worsening cough and has been feeling a little sob. denies fevers, chills, nausea, vomiting, diarrhea. . in the ed, initial vs were t: 99.8f bp: 171/109 hr: 102 rr: 18 sao2: 98% on 2l nc. initial labs were notable for leukocytosis to 17 (89% n). cxr demonstrated resolving rml and rll pna. pt was given tylenol 650mg po, aspirin 325mg po, vancomycin 1g iv, zosyn 4.5g iv, ticlid 250mg, carbidopa 25/levodopa 100, comtan 200mg. was also given metoprolol 75mg po and subsequently bp dropped to systolics in the 80's. he was then given boluses of 1l ns x 3 and bp improved to 120's and he was transferred to the micu. past medical history: 1. cad s/p cabg and nstemis (: lima-lad, svg->diag, om1, om2, svg->pda); s/p pci of proximal svg-d1-om 1-om2 with des in and pci of svg-om/d with des in . 2. chf: ef 30% 3. parkinson's disease 4. hypercholesterolemia 5. htn 6. h/o tia 7. bladder ca 8. osteoporosis 9. s/p right hip fracture, orif in social history: former prof at . the patient lives in . he lives with his wife on the same street as his daughter. has another daughter who lives in . he smoked until , smoking one pack a day for fifteen years. family history: positive for father, who died of a stroke, mother who had a stroke in her 90s and one brother had disease. physical exam: vs: t: 97.7 bp: 138/72 hr: 73 rr: 24 sao2: 100% on 2l nc. gen: pt very somnolent, awakens to voice but then falls asleep again. heent: perrl, eomi, op slightly dry. neck: no carotid bruit, + elevated jvp. heart: unable to ausculatate heart sounds due to loud respiratory noises. lungs: very noisy upper airway noises, slightly decreased bs's at r base. abdomen: soft, nt/nd, nabs, no masses or bruits. extremities: le's with trace edema. dps 1+. cns: not answering questions. + cogwheel rigidity. skin: +rash on knees pertinent results: cxr : two views of the chest demonstrate stable cardiomegaly, mediastinal contours, and sternal sutures. there has been significant improvement in airspace opacity of the right middle and lower lobes seen on . a small amount of residual opacity remains in these locales. the left lung is clear. there is no pleural effusion or pneumothorax. there has been no change from in multiple thoracic vertebral wedge deformities and associated kyphosis. impression: improving right middle and right lower lobe pneumonia. . ecg: nsr at 97. nl axis, borderline qt interval. q's in iii (old). st depressions in i, ii, avl, v3-6 (old), j point elevation in v1-2 (old). no sig changes from prior. . cxr: impression: 1. ng tube in proximal stomach. 2. progressive multifocal pneumonia. . head ct: findings: there is no intra- or extra-axial hemorrhage, mass effect, or shift of normally midline structures. irregular low attenuation foci in bilateral lentiform nuclei, left greater than right with associated volume loss are consistent with chronic lacunar infarction. scattered focal low attenuation lesions in the periventricular and subcortical white matter are consistent with chronic microvascular ischemia. the -white matter differentiation is preserved. the surrounding soft tissue and osseous structures are unremarkable. the visualized paranasal sinuses and mastoid air cells are clear. impression: no intracranial hemorrhage or mass effect. no change since . . cxr : impression: improved pulmonary edema. worsening left lower lobe pneumonia . right upper quadrant ultrasound: the liver is normal in echotexture with no focal masses. a nonshadowing gallstone or sludge ball is seen within the gallbladder measuring 8 x 7 x 5 mm. the common bile duct measures 4 mm. there is no biliary dilatation. the portal vein is patent with antegrade flow. there is no ascites. the right kidney measures 11.2 cm, and there is no hydronephrosis. impression: normal right upper quadrant ultrasound. brief hospital course: 78 yo m with parkinson's, cad, s/p recent admission for pna now with likely aspiration pna increased secretions . micu course involved, the patient had hypotension and was given ivf and zosyn/vanc (concern for pna/sepsis). the patient had angioedema and was switched to levo/flagyl. given his hypotension his lasix was held as were other bp meds. he failed his speech and swallow and had an ngt placed. he was normotensive and transferred to the floor. . floor course: # hypotension: the patient's hypotension resolved since receiving ivf. the cause was likely multifactorial including poor intake likely due to parkinsons's disease, increased diarrhea and finally possibly some sepsis as with white count and pneumonia. during the majority of the patient's course he was npo so ivf were continued and he was treated for his pneumonia. his blood pressure was normal on the floor and his blood pressure medications were reintroduced as tolerated. . # pneumonia: the patient had presumed aspiration pneumonia as the patient had increased secretions. in the micu he was on zosyn and vancomycin but had angioedema and due to this allergic reaction, he was switched to levofloxacin and flagyl. he continued to fail speech and swallow evaluations given his increased secretions. during his course he developed an increased white count, an increased work of breathing and tachypnea. his cxr showed worsening and he was presumed to have worsened aspiration pneumonia, especially given his ongoing risk of aspiration. he was put on daptomycin, flagyl and aztreonam and he improved, initially though he continued to aspirate and his continued aspiration made his pneumonia worse to the point where his prognosis was poor. the patient had an episode of hypoxia and tachycardia, which was attributed to his increasing secretions. he was aggressively suctioned and a scopalamine patch was placed, but given this and his poor prognosis the family decided to make the patient cmo. antibiotics were discontinued and the patient was given morphine and scopalamine for comfort. . # parkinson's: the family fears the patient's parkinson's is worsening, though the patient's recent decline in functioning and mentation could also be related to his infection. he was continued on his home doses of carbidopa/levodopa and entacapone, and he appeared less lethargic and bradykinetic as his infection improved. the patient's outpatient neurologist, dr. , was contact and he recommended keeping his medications at the same dose and having an inpatient neurologist see him. the inpatient team did not have any medication changes to add, though they recommended movement disorders consult as his dysphagia may have been related to progressive supranuclear palsy. during the patient's course he lost his ng tube and he had difficulty with oral intake to the point where he could not receive his parkinson's medications. the pharmacy did not carry the oral disintegrating sinemet, and neurology said they could not recommend alternative iv medications to treat his parkinson's. unfortunately without his medications the patient became more bradykinetic and as his pulmonary status worsened a g tube was declined and the patient was without medications. . # nutrition: the patient failed his speech and swallow in the micu and had an ng tube placed. he was kept on iv fluids and npo, while awaiting a second speech and swallow evaluation. once he failed this tube feeds were started. initially he received tube feeds, and when another speech and swallow was failed it was decided that since the patient was at risk with tube feeds and eating, he would try eating. he pulled out his ng tube, and at that point the family decided the patient would continue a modified diet, but would likely continue to have pneumonia based on his high risk of continued aspiration. palliative care was called in, and during a family meeting, the family with the help of the team decided to have a g-tube placed. the patient was found to have elevated inr, and the gi team felt his risk of bleeding was very high and despite reversal of his inr gi decided he was a poor candidate for a gtube given his worsening clinical status. the family decided against the g tube given the risks and the patient was made cmo. . # transaminitis: the patient developed a transaminitis that may have been related to his medications as with medication adjustment, his lft's improved. he had a hepatitis panel sent and ruq us sent, but the work-up was not completed as the patient was made cmo, and the patient's lft's were improving. . # elevated inr: the patient was noted to have elevated inr through his course this was likely multifactorial including from abx, poor nutrition and liver disease. he improved with sc vitamin k, though gi felt given this, his lft's and his pulmonary status the g tube should not be placed. the family was in agreement with this plan. . # melena: the patient was noted to have melena, and also blood in his ngt, given his repeated failed attempts at ng tube placement this was attributed to trauma, and his hematcrit was followed closely and remained stable. the patient never required blood products. . # thrombocytopenia: the patient developed a significant drop in his platelets during his course and the concern was for hit versus his antibiotics. hit antibodies were sent and all heparin products were held. his hit antibody was positive and with the holding of heparin products the patient's thrombocytopenia improved. . # altered mental status: the patient was very lethargic during his course, and this was attributed to his pneumonia as he improved when his infection improved. towards the end of his course as his aspiration worsened and he was not able to get his parkinson's medications the patient became somnolent and lethargic. he remained in this state, though was then made cmo and was comfortable. . # chf: on admission the patient had an elevated bnp and a recent ef of 30%. given his initial hypotension and then diarrhea, his lasix was held and his ins/outs and daily weights were followed. through the majority of the patient's course he was dry to euvolemic. once his diarrhea resolved, he became more overloaded and fluids were stopped and he was diuresed. diuresis and fluids were stopped though once the patient was made cmo. . # diarrhea: the patient had profuse diarrhea and this was concerning for c. difficile given antibiotic use. his cdifficile was negative and he was supported with iv fluids. . # history of cad s/p cabg: the patient had no active issues during his course. he was continued on asa, statin, beta-blocker, and his ace was added in once his pressure was stable. . # history of tia: the patient had no issues during his course and was continued on ticlid. . # dnr/dni: it was decided to make the patient dnr/dni. . # cmo: on the patient had hypoxia and tachycardia. his respiratory status was worse and he was having increased secretions. he was suctioned, and with many talks with family, family understood poor prognosis and cmo was initiated. palliative care was very involved and per their recommendations the patient was made comfortable with scopalamine and morphine. medications on admission: cholestyramine 4gm packet asa 325mg po qday ticlopidine 250mg po bid metoprolol 75mgpo lasix 60mg po qday lisinopril 10mgpo qday mvi qday ca with vit d zocor 40mg po qhs fosamax 70mg po qweek carbidopa/levodopa q3h entacapone with carbidopa/levodopa discharge medications: none discharge disposition: expired discharge diagnosis: 1. aspiration pneumonia 2. thrombocytopenia 3. chf 4. parkinson's disease 5. melena 6. hypotension discharge condition: deceased discharge instructions: none followup instructions: none procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances diagnoses: abnormal coagulation profile congestive heart failure, unspecified unspecified essential hypertension unspecified protein-calorie malnutrition coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status paralysis agitans hypotension, unspecified pneumonitis due to inhalation of food or vomitus osteoporosis, unspecified blood in stool personal history of malignant neoplasm of bladder calculus of gallbladder without mention of cholecystitis, without mention of obstruction hypoxemia anticoagulants causing adverse effects in therapeutic use dehydration hyperosmolality and/or hypernatremia accidents occurring in residential institution 

Answer: The patient is high likely exposed to