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: alcohol attending: chief complaint: referred to ed for dvt, admitted for fever major surgical or invasive procedure: intubation, extubation, lumbar puncure history of present illness: 56-year-old male with metastatic rectal cancer with ongoing chemo--c6d15 of folfox on --s/p brain radiation, s/p resection in , presented with an alleged thrombus in right common iliac vein seen on routine staging ct. he was referred to the ed by his outpatient oncologist. patient reports no symptoms at home--no respiratory difficulty, no leg swelling or warmth or swelling--besides his mild fatigue that has been going on for months. a few days ago he had a fever that then spontaneously resolved. no coughs, no dysuria. no sick contact. chills, headache, visual changes, chest pain, shortness of breath, abdominal pain, diarrhea, constipation, weakness, numbness, tingling. in the ed, initial vitals were t 99.8, hr 87, bp 121/76, rr 16, 100%ra. exam was unremarkable. lenis were negative. he was about to be discharged when he spiked a fever to 102f. wbc was 10.5 with 16% bands--patient received neulasta on and had 24% bands last week. cxr, urinalysis was unremarkable. received vanco and cefepime in the ed. admitted for further management. past medical history: rectal adenocarcinoma: - diagnosed in - neoadjuvant capacitabine and radiation from mid- to by , m.d., followed by surgical resection and a colostomy; completed 4 cycles of adjuvant capacitabine on - chest ct on showed pulmonary metastases, and a right lung biopsy showed adenocarcinoma, treated with bevacizumab and folfox since - headache in summer , head ct and mri on disclosed a 2-3 cm mass in the right cerebellum, resected by on , followed by cyberknife radiosurgery to the resection cavity on social history: cantonese-speaking. he is married. lives with wife and son in . he does understand some english, speaks little english. family history: non-contributory physical exam: gen: middle-aged chinese man in no acute distress heent: eomi, perrl, sclerae anicteric, op moist without lesion neck: supple, no lad lungs: ctab cv: normal rate, regular rhythm, normal s1/s2, no m/r/g abd: soft, nontender, nondistended, bs present ext: no swelling, no warmth, no tenderness, 2+ bilateral pedal pulses neurological exam on first evaluation by neurology team : neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty (via interpreter on telephone). language is fluent with intact repetition and comprehension. normal prosody. able to follow both midline and appendicular commands. there was no evidence of apraxia or neglect. -cranial nerves: i: olfaction not tested. ii: perrl 4 to 2mm and brisk. vff to confrontation. iii, iv, vi: eomi without nystagmus. normal saccades. v: facial sensation intact to light touch. vii: no facial droop, facial musculature symmetric. viii: hearing intact to finger-rub bilaterally. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii and scm bilaterally. xii: tongue protrudes in midline. -motor: normal bulk, tone throughout. no pronator drift bilaterally. no adventitious movements, such as tremor, noted. no asterixis noted. full strength of neck flexors and extensors. delt bic tri wre ffl fe io ip quad ham ta edb l 5 5 5 5 5 5 5 5 5 5 5 5 5 5 r 5 5 5 5 5 5 5 5 5 5 5 5 5 5 -sensory: decreased proprioception at toes bilaterally and decreased vibration (5-6 seconds). patient reported pinprick intact throughout. -dtrs: 1+ at biceps, triceps, brachioradialis, 0 at patellars and achilles bilaterally. however, patient was unable to relax legs appropriately for testing despite repeated attempts. plantar response was flexor bilaterally. -coordination: no intention tremor, no dysdiadochokinesia noted. no dysmetria on fnf or hks bilaterally. no truncal ataxia. -gait: good intiation. wide-based, unsteady. short stride. falls in all directions. romberg positive. neurological exam: awake, alert, appears ill. his rr is 22-24, and his sao2 is 100%. speech is fluent. perrl 3->2 mm bilaterally, eomi bilaterally without nystagmus, bifacial weakness, palate elevates symmetrically, tongue midline movements intact. he reports feeling diffusely weak, with some giveway weakness and other real weakness. he can keep his bilateral arms lifted above gravity, but both drift down to the bed. no myoclonus or tremor. decreased pinprick sensation in his bilateral legs to way up the lower leg, normal in the bilateral hands. trace reflexes in the bilateral brachioradialis, otherwise 0 and symmetric in the biceps, triceps, knees, and ankles. tri we fe ip h q df r 4- 4 5- 4- 3+ 3- 3+ 5 3- l 4- 4 5- 4- 3+ 3- 3+ 5 3- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - neurological exam at time of discharge: cognitively intact, no limitations mild bifacial weakness, l>r, otherwise cranial nerves normal reflexes diffusely absent strength: at least in all muscle groups. deltoids, biceps, triceps, gastrocs are 4+ to 5-, some effort dependence pertinent results: 04:55pm wbc-10.5# rbc-3.84* hgb-11.9* hct-35.7* mcv-93 mch-31.0 mchc-33.4 rdw-16.4* 04:55pm neuts-51 bands-16* lymphs-14* monos-9 eos-0 basos-0 atyps-2* metas-2* myelos-5* promyelo-1* 04:55pm plt smr-low plt count-142* 04:55pm pt-12.1 ptt-27.4 inr(pt)-1.0 04:55pm glucose-151* urea n-7 creat-1.2 sodium-140 potassium-3.2* chloride-103 total co2-28 anion gap-12 imaging studies: # lenis : no dvt # head ct : there has been previous right occipital craniectomy with slight interval increase in hypodensity within the cerebellar resection bed. there is no hemorrhage, mass effect, shift of midline structures, or evidence of major vascular territorial infarction. unchanged bilateral basal ganglia calcifications. there is mild right maxillary sinus mucosal thickening (3:2). impression: 1. no hemorrhage or mass effect. 2. apparent increase in hypodensity at right occipital craniectomy site. mri w/ gadolinium recommended to evaluate for tumor recurrence. # cxr : (prelim) no acute cardiopulmonary process # mri spine : evaluation of the cervical spine demonstrates no evidence for osseous metastatic disease. multilevel spondylosis is seen including a disc osteophyte complex at c5/c6 and c6/c7. there is also a left paracentral disc protrusion which is broad-based at c6/c7 extending into the foramen. there is moderate stenosis at these two levels. there is a small nonspecific lesion in the right thyroid lobe measuring approximately 7 mm. there is no epidural disease seen. evaluation of the thoracic and lumbar spine demonstrates mild marrow hypointensity. there is high signal within the sacrum which may be related to prior radiation to the rectum. no convincing evidence for epidural or intradural metastatic disease is seen. there is a central to left paracentral disc protrusion at l4-l5 causing left lateral recess narrowing and then abutting the left l5 nerve root. there is heterogeneous appearance to the iliac wings bilaterally which again may be related to prior radiation. the pre- and para-vertebral soft tissues are unremarkable. impression: no evidence for metastatic disease. degenerative changes in the cervical and lumbar spine as detailed. probable post-radiation sequela in the sacrum. emg: clinical interpretation: abnormal study. the electrophysiologic abnormalities are most consistent with a moderate generalized neuropathy with demyelinating and axonal features. the sural nerve is spared. given the time course of progression, the findings are consistent with an acquired neuropathy such as syndrome. the low amplitude motor responses may or may not be due to axonal involvement; a follow-up study would clarify the extent of axonal involvement if indicated. prior studies: # torso ct : 1. new dvt in the r common iliac v, appears to emanating from the r internal iliac v. the thrombosis extends to near the confluence of the common iliac. recommend urgent dvt ultrasound in the lower extremities. 2. interval decrease of lung disease burden. decrease of mediastinal and hilar lad. 3. post-radiation changes in the perirectal region. no bowel obstruction. brief hospital course: 56m with rectal carcinoma s/p resection, chemoradiation who was referred to ed for r common iliac dvt and was found to be febrile. he was treated with lovenox, empiric antibiotics, however developed progressive weakness initially concerning for spinal cord compression (mri pan spine showed no cord compression, while mri of head showed a stable cerebellar herniation through craniotomy site without evidence of infection). his exam progressed to bilateral leg weakness, worsened bilateral hand and lower leg numbness, tongue numbness, and dysphagia to liquids and solids and patient developed progressive loss of reflexes. he underwent lp and was diagnosed with gbs. he was transferred from medicine service to neurology service on . # gbs patient with ascending weakness, loss of reflexes and csf with albuninocytologic dissociation. his nif and vital capacity apparently declined while in medical icu and he was intubated on based on above and in setting of tachypnea. completed 4 days of ivig on . his strength slowly improved, however there remained mild assymetry of l > r weakness (including face) as well as more proximal vs. distal weakness. he has made steady improvement throughout his recovery phase, and is at least antigravity strength in all muscle groups at the time of discharge. # weakness and parathesias: overnight patient developed neurologic sxs concerning for cord compression of the low cervical or high thoracic vertabrae, however normal spinal mri without compression. also be complicated by cerebellar mets and chemo induced neuropathy. neurology and neurosurgery followed the patient and he was maintained on standing dexamethasone which was subsequently discontinued given negative imaging. he failed a speech and swallow and was determined to be likely aspirating on so was changed to levo/flagyll. he subsequently proved to have steadily improving oropharyngeal control, and was taking all calories po at the time of discharge. of note, at admission the patient did have diarrhea, though he was camplobacter negative. also on the patient developed dyspnea with a rr to the low 20s and maintance of oxygen saturation in the 90s on ra. he developed urinary retention (bladder scan with 500cc) though also may have been holding in his urine due to physical difficulty using urinal. he developed difficulty managing his secretions with nifs -20 to -30 and was then transferred to the icu. a bedside lp was attempted on and was unsuccessful. on the patient had an ir guided lp revealing elevated protein with 1 wbcs. a diagnosis of gbs was made based on progressive weakness and loss of reflexes (see above for gbs management). # dvt: r common iliac thrombus seen on outpatient ct. lenis showed no lower clot. enoxaprin was initially started and then held starting for an lp. he was switched to heparin sc tid during that interval and changed back to lovenox on . he continues on treatment doses of lovenox. # fever: given recent chemotherapy, was initially concerning for infection. however, patient was not neutropenic. bandemia reflects recent neulasta administration. no evidence of sepsis. cxr, u/a, ucx were unremarkable. fever might also be related to dvt or chemo itself. at admission patient was maintained on cefepime/vanc. after switch to levofloxacin he spiked and was thus changed back to cefepime/vanc before being changed to levo/flagyll as above with plan to continue for 7 days. following completion of this course he remained fever-free. all of infectious evaluations proved to be unrevealing including bcx, ucx, stool cx, c.diff assay, legionella antigen, sputum and bal washings. antibiotics were thus discontinued on . he continued to have intermittent low grade fevers (101f) which were attributed to dvt. # rectal cancer: no intervention done this admission. patient should follow up with dr. office one month following discharge from the hospital. this appointment has already been made. # elevated blood glucose: hemoglobin a1c of 6.5 suggests glucose intolerance. he was maintained on an insulin sliding scale. it is suggested that metformin be started discharge. # full code (confirmed with interpreter at admission) and confirmed with dr. (outpatient oncologist) medications on admission: ranitidine 150 mg discharge medications: 1. enoxaparin 80 mg/0.8 ml syringe : 0.7 ml subcutaneous q12h (every 12 hours). 2. sodium chloride 0.65 % aerosol, spray : sprays nasal qid (4 times a day) as needed for dry nose. 3. senna 8.6 mg tablet : 1-2 tablets po bid (2 times a day) as needed for constipation. 4. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 5. acetaminophen 650 mg tablet : one (1) tablet po every four (4) hours as needed for fever or pain. 6. metoprolol tartrate 25 mg tablet : one (1) tablet po bid (2 times a day). 7. heparin flush (100 units/ml) 5 ml iv prn de-accessing port indwelling port (e.g. portacath), heparin dependent: when de-accessing port, instill heparin as above per lumen. 8. heparin flush (10 units/ml) 5 ml iv prn line flush indwelling port (e.g. portacath), heparin dependent: flush with 10 ml normal saline followed by heparin as above daily and prn per lumen. 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). discharge disposition: extended care facility: - discharge diagnosis: primary: syndome secondary: pelvic dvt additional: rectal adenocarcinoma, metastases to the cerebellum s/p resection. discharge condition: mental status - intact strength - diffusely weak, distal > proximal. at least in all muscle groups, with scattered 4/5s in bilateral /tri/gastrocs. near-daily improvement in exam throughout his recovery period. reflexes diffusely absent sensory - intact to fine touch, position, temperature. discharge instructions: you were admitted to with a clot in your left leg and fevers. you were evaluated for multiple causes of the fever, but they were negative. you were temporarily treated with antibiotics, but in the end were treated for the blood clot with a blood thinner. you also developed progressive weakness in your arms and legs, and difficulty swallowing, and were diagnosed with syndrome (also known by the acronym aidp). for this you were treated with ivig (immunoglobulin) and required temporary intubation (breathing tube to make sure you do not suffocate). your weakness improved somewhat, but will likely require several weeks (perhaps as long as 12 weeks) to return to normal. in addition, while at the hospital, you were found to have signficantly elevated blood sugars. this may be related to stress or an underlying early diabetes. you should follow up with your primary care doctor regarding this. please follow up with all of your appointments. should you develop any symptoms concerning to you or some of the listed below, please call your doctor or go to the emergency room. followup instructions: neurology: dr. , at 2pm. building, , . call ( with any questions. oncology: dr. and dr. on , 3:30pm. call ( with any questions. pcp: your pcp within week of discharge from rehab to review the many changes to your medical care over the last few weeks. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of endotracheal tube fiber-optic bronchoscopy injection or infusion of immunoglobulin diagnoses: acute respiratory failure pneumonitis due to inhalation of food or vomitus secondary malignant neoplasm of brain and spinal cord fever, unspecified diarrhea secondary malignant neoplasm of lung colostomy status acute infective polyneuritis other specified retention of urine acute venous embolism and thrombosis of deep vessels of distal lower extremity personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus 

Answer: The patient is high likely exposed to