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: sulfa (sulfonamides) attending: chief complaint: near syncope, weakness, and a fall major surgical or invasive procedure: none history of present illness: 85 yo male with multiple myeloma and known history of orthostasis thought to be secondary to dysfunction with recent admission in mid for syncope and uti in the setting of urinary obstruction requiring long term foley presents now again with weakness, and near syncope. pt states he has been feeling weak lately. in fact he has had half a dozen of syncope and falls. he states this usually occurs when he's trying to get up in a hurry. he denies any head injuries. this morning pt's visiting nurse noted he looks weak and unsteady on his feet and wanted to bring him into the hospital and therefore asked him to sit on a stool in the bathroom to clean himself. he then apparently slid down the chair and was caught by the nurse and lowered onto the floor. no actual loss of consciousness. no other complaints at the time. pt denies any fever, chill, rigor. no cough, hemoptysis. no headache, visual disturbances. no nausea, vomiting or diarrhoea. no chest pain, palpitation or orthopnea. in ed vitals stable, afebrile. labs are at baseline. urine does real possible uti. pt was therefore admitted for further managment. past medical history: mm, diagnosed , followed by heme, on velcade/mephalan/prednisone for past month , c/b lytic lesions/compression fractures bph dyslipidemia syncope x2 : reported normal echo, unremarkable holter per chart ivcd/lbbb-old lbp- pathological compression fx t12/l1 s/p choley 10years ago lung nodule s/p resection many years ago, reported benign social history: occupation: worked as job placement coordinator living situation: lives with wife of 55+ years and disabled daughter (cerebral palsy). he is the primary caretaker of his daughter. lives in single family home with approx three flights of stairs. bedroom is on . key relationships: wife, 2 daughters wife is hcp smoking, etoh: quit tobacco > 20yrs ago, denies etoh family history: mother died uterine ca, father died pna, has one brother/one sister who are alive and well at age 80s physical exam: 97.9, 147/89, 20/min, 89, 97% on ra gen: cachectic elderly male heent: eomi, perrl, sclera anicteric, no epistaxis or rhinorrhea, dry mm, op clear neck: no jvd, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline cor: rrr, no m/g/r, normal s1 s2 pulm: lungs ctab, no w/r/r abd: soft, nt, nd, +bs, no hsm, no masses ext: no c/c/e, no palpable cords neuro: alert, oriented to person, place, and time. cn iii ?????? xii grossly intact. moves all 4 extremities. strength 3/5 in upper and lower extremities proximally and 3+/5 distally. symetrical bilaterally. skin: no edema pertinent results: studies: cxr: no acute cardiopulmonary pathology. mri l-spine: again identified are extensive vertebral body signal intensity abnormalities compatible with a diagnosis of multiple myeloma. again seen is loss of height of the t12 and l1 vertebral bodies. these findings appear unchanged since the previous study. again seen is a spherical region of hypointensity on the short tr images in the l2 vertebral body. this is also unchanged. there is no evidence of cauda equina compression. alignment of the spine appears normal. axial images at t11-12, , , and demonstrate mild degenerative disc disease with no evidence of canal or foraminal encroachment. at l3-4, there is a protrusion of the intervertebral disc entering the right side of the spinal canal. this causes posterior displacement of the right l4 nerve root. the neural foramina appear normal. at l4-5, there is asymmetric bulge of the intervertebral disc with no evidence of nerve root compression. there is right-sided facet joint osteophyte formation. at l5-s1, there is a minimal bulge of the intervertebral disc with no encroachment on the thecal sac or neural foramina. signal intensity abnormalities compatible with the history of myeloma are also noted in the visualized portions of the sacrum and the iliac bones. ct head: there is no evidence of hemorrhage, edema, mass effect, or infarction. the ventricles and sulci are normal in caliber and configuration. the -white matter differentiation is preserved. again noted are carotid artery calcifications and a large mucus retention cyst in the left maxillary sinus. remainder of the paranasal sinuses and mastoid air cells are normally pneumatized and clear. mri/mra of the head: mri of the head: impression: there is no evidence of acute ischemic changes. after the administration of gadolinium contrast, there is no evidence of abnormal enhancement. no diffusion abnormalities are detected. prominence of the sulci and ventricles, likely age-related and involutional nature. mra of the head. impression: possible narrowing of the m2 and m3 segments bilaterally, more evident on the right, possibly arteriosclerotic in nature, however, artifact cannot be completely ruled out, correlation with cta of the head and neck is recommended if clinically warranted. carotid us: no evidence of hemodynamically significant stenosis. plaque formation involving the origin of the internal carotid arteries bilaterally. ct head: no acute intracranial hemorrhage or large acute infarction. labs: 04:05pm glucose-106* urea n-8 creat-0.6 sodium-136 potassium-3.5 chloride-103 total co2-24 anion gap-13 04:05pm calcium-9.1 phosphate-3.6 magnesium-1.8 04:31pm lactate-0.9 04:05pm wbc-7.1 rbc-3.54* hgb-11.2* hct-33.3* mcv-94 mch-31.7 mchc-33.6 rdw-14.2 04:05pm neuts-81.0* lymphs-12.8* monos-4.7 eos-1.4 basos-0.1 04:05pm plt count-306 04:05pm pt-12.7 ptt-32.1 inr(pt)-1.1 11:00am glucose-119* urea n-12 creat-0.8 sodium-134 potassium-3.9 chloride-99 total co2-26 anion gap-13 06:45pm urine color-yellow appear-hazy sp -1.012 06:45pm urine blood-sm nitrite-pos protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-tr 06:45pm urine rbc-* wbc->50 bacteria-mod yeast-few epi-0-2 brief hospital course: 85 yo man with multiple myeloma as well as a history neurogenic presyncope secondary to dysfunction presents with weakness, fall and near syncope. # near syncope/weakness/fall: the patient has a history of dysfunction with multiple similar episodes. there may have been other factors contributing to the episode such as dehydration and a possible uti. the patient was rehydrated with ivf, continued on his florief and salt tabs, kept with his hob > 30, and dressed with compression stockings. midodrine was added to the regimen, and thereafter, he had no further episodes of near syncope. he continued to have orthostatic blood pressure changes, with sbp falling from ~160 supine to ~100 standing, but he was asymptomatic and these were stable findings. because dysfunction in the setting of mm may be caused by amyloidosis, a bone marrow biopsy was done on which showed did not show evidence of amyloidosis. # confusion/aphasia: on the morning of the , he was participating in physical therapy when he was noted to have difficulty speaking with expressive aphasia. he was brought to bed and a supine blood pressure was systolic 90. (this was a change from his baseline sbp 170 supine, 120 standing. on further questioning of his daughter he had been more confused prior to this admission and having more difficulty with activities of daily living. his daughter stated that his orthostatic hypotension has also been worsening lately and on friday he had syncopized while in a chair.) for his hypotension, he was given 500cc of ns, sbp improved to 120, and his aphasia resolved. thereafter his sbp dropped to 110 and his aphasia returned. a code stroke was called and the patient was given an additional 500cc ns. he was transferred to the . in the , patient was volume rescucitated for hypotension and found to have uti with staph aureus. he was started initially on broad spectrum antibiotics with vanc/cefepime. mri and ct head without evidence of acute stroke. carotid ultrasound showed no significant stenosis. neurology consult saw the patient and felt that his mental status changes and hypotension in the acute setting were secondary to his infection rather than cva or dysautonomia. with treatment of the uti, supine hypotension and mental status changes resolved. he was transferred back to the service. the patient was stable and maintained sbp's above 110 over the days of . the afternoon of , the patient was woken from sleep and was found to be confused and slow to speak. his blood pressure was 80/60. he recieved a 500cc bolus with moderate improvement in his blood pressure to 115/65. the patient continued to be confused. ptt from the morning was noted to be 55 and so a stat head ct was obtained which was normal. he was again transferred to the for closer monitoring. with further fluid resuscitation and the addition of midodrine to his dysautonomia regimen, his symptoms resolved. he was transferred back to the floor on with baseline mental status. he had no further episodes of confusion. on discharge, the patient continued to have orthostatic blood pressure changes, with sbp falling from ~160 supine to ~100 standing, but he was asymptomatic and these were stable findings. # staph aureus uti: he was initially on vanc/cefepime for a catheter-associated uti. this speciated as mrsa, so he continued on vancomycin given sulfa allergy. the foley catheter was changed, and he completed a 10-day course of vancomycin. # urinary retention: the patient has a history of bph, but has had increased urinary retention since a recent hospitalization requiring an indwelling catheter at home. due to his increasing urinary retension, a mri of his l-spine was done which showed multiple signal abnormalities in the bones, but no cord compression. he failed multiple trials of void. indwelling catheter was continued. # multiple myeloma/chronic lower back pain: mr. was noted to have known malignant compression fractures due to mm. he previously had undergone 1 cycle of velcade, mephalan, and prednisone. this hospitalization he had 12 xrt treatments to his lower back, with some relief of pain. his pain was controlled with oxycodone prn. medications on admission: atorvastatin 10 mg daily docusate sodium 100 mg senna 8.6 mg tablet prn acetaminophen 325 mg tablet 2 tabs q6h prn latanoprost 0.005 % drops sig qhs dorzolamide-timolol 2-0.5 % drops oxycodone 5 mg tablet sig: 0.5 tablet po hs oxycodone 5 mg tablet sig: 0.5 tablet q6h prn sodium chloride 1 gram tablet tid finasteride 5 mg daily fludrocortisone 0.1 mg prn discharge disposition: extended care facility: - discharge diagnosis: primary - dysfunction urinary tract infection multiple myeloma secondary urinary retention discharge condition: stable, with orthostatic blood pressure changes discharge instructions: you were admitted to the hospital due to a presyncopal event associated with weakness. your known to have dysfucntion and this was likely the cause of your event. you had multiple episodes of confusion which were likely due to low blood pressure due to your dysfunction. you were started on midodrine and fludricortisone in addition to salt tabs. your supine blood pressures are elevated on the midodrine in order to keep your standing blood pressures at a safe level. you were also found to have a urinary tract infection and treated with iv antibiotics. you were started on midodrine. your atorvastatin was stopped. otherwise continue your outpatient medications as prescribed. call your primary oncologist, or if after hours call the page operator at and ask for the (bone marrow transplant) fellow on call if you experience fevers, chills, chest pain, shortness of breath, dizziness, bleeding which doesn't stop immediately, blood in your stool, or dark tarry stool. followup instructions: provider: , md phone: date/time: 2:00 urology unit phone: date/time: 10:00 provider: phone: date/time: 4:00 provider: study phone: date/time: 2:00 please also follow up with your primary care physician, . . if you prefer to follow up with dr. , you may also do that. the phone number for both is . procedure: biopsy of bone marrow other radiotherapeutic procedure diagnoses: urinary tract infection, site not specified toxic encephalopathy sepsis other and unspecified hyperlipidemia hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) retention of urine, unspecified multiple myeloma, without mention of having achieved remission aphasia neoplasm related pain (acute) (chronic) infection and inflammatory reaction due to indwelling urinary catheter methicillin resistant staphylococcus aureus septicemia orthostatic hypotension pathologic fracture of vertebrae unspecified disorder of autonomic nervous system 

Answer: The patient is high likely exposed to