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: dyazide / norvasc / methimazole / propoxyphene n-acetaminophen attending: chief complaint: shortness of breath, dysphagia, weakness and fatigue major surgical or invasive procedure: none history of present illness: ms. is an 86 y/o right-handed woman who was referred to with complaints of dysarthria, dysphagia and fatigue, which her outpatient neurologist found concerning for myasthenia . ms. explained that over the year prior to admission she had noticed progressive weakness and fatigue, with difficulty swallowing and speaking, increased napping, and new-onset dyspnea. her weakness seemed to develop over her entire body simultaneously, with no discernable pattern of spread. symptoms are somwehat worse as the day goes on, and are not relieved by resting. she reports increasing dysphagia (solids>liquids) with a 20lb weight loss since the start of . she cannot drink through a straw. she has also had to start using a walker since . prior to begining to use the walker, she had three falls in the preceding year, including one in which she fractured her left wrist. additionally, ms. reports that she now naps much of the day, and as a consequence has been sleeping less at night--with trouble both falling asleep and staying asleep. she sleeps an average of 5 hours qnight. ms. that shortly before she began to feel week, she was hospitalized for pna, in (i have been unable to find mention of this in her online medical record). she thinks she initially recovered from that but is unsure she ever returned to baseline before she began developing her current symptoms. on ros, she admitted to dyspnea on exertion (such as taking a shower or getting dressed), and occasional dysuria, but denies chest pain, palpitations, cough, fevers/chills, abdominal pain, n/v/d, constipation, hematuri, melena and hematochezia. on neuro ros, she admitted to occasional diplopia (horizontal), which seems to come and go each day, as well as gait-unsteadiness, but denied vertigo and fasciculations. past medical history: past medical history: 1. paroxysmal atrial fibrillation requiring three prior cardioversions in the past and previously treated with amiodarone and now dronedarone starting 10/. 2. hypertension. 3. dyslipidemia. 4. disease. 5. hyponatremia. 6. rheumatoid arthritis. 7. tia s/p left cea 8. tah 9. gerd 10. cervical spondylosis 11. hx of falls, s/p left hip fracture (no surgery) 12. remote tuberculosis, s/p partial right lung lobectomy 14. fracture of left wrist s/p fall approximately 10 weeks ago 15. laryngitis from gerd social history: has her own but has recently been living with a boyfriend in his home. the two spent the past three months together in , as she typically does each winter. etoh: glasses wine qday, stopped 2 months ago due to dysphagia cigs: never smoked drugs: denies family history: no family history of neuromuscular disease, but both parents had cad. mother- died in her 50's "high blood pressure" father- died of mi in his 50's sister- 75, healthy physical exam: physical examination; vs; t 99.4 bp 145/64 rr 20 95% ra general: awake, frail elderly woman, cooperative, nad. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: no nuchal rigidity pulmonary: diffuse wheezes. able to count to 10 in one breath. cardiac: rrr, nl. s1s2 abdomen: soft, nt/nd extremities: no c/c/e bilaterally skin: no rashes or lesions noted. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. attentive, able to name doy backward without difficulty. language is fluent with intact repetition and comprehension. normal prosody. there were no paraphasic errors. pt. was able to name both high and low frequency objects. speech was not hypophonic and hoarse. able to follow both midline and appendicular commands. the pt. had good knowledge of current events. there was no evidence of apraxia or neglect. -cranial nerves: i: olfaction not tested. ii: perrl 3 to 2mm and brisk. vff to confrontation. iii, iv, vi: eomi without nystagmus. normal saccades. no diplopia or ptosis with sustained upgaze, although patient blinks frequently during attempts. v: facial sensation intact to light touch. vii: moderate bifacial weakness. 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: decreased bulk, tone throughout. no pronator drift bilaterally. no tremor, asterixis, myoclonus, or fasiculations. neck flexors , neck extensors delt bic tri wre ffl fe ip quad ham ta edb l 4 5- 5- 5 5 5- 4 5 5 5 5 4+ 4+ r 4+ 5- 5- 5 5 5- 4 5 5 4 5 4- 4- after repetitive stimulation of r deltoid (20 contractions) strength diminished from 4+ to 4- -sensory: intact to light touch, pinprick, and proprioception, diminished vibration at toes and medial malleolus. no extinction to dss. -dtrs: tri pat ach l 2 2 2 1 0 r 2 2 2 1 0 plantar response was flexor bilaterally. -coordination: no intention tremor, no dysdiadochokinesia noted. no dysmetria on fnf or hks bilaterally. -gait: mild wide-base but able to ambulate unassisted. discharge exam: diminished breath sounds at bases significant dysphonia 5-/5 neck flexor weakness pertinent results: 16:00 musk antibody test name --------- musk quantitative titers antibody musk antibody interpretation: negative this individual is negative for muscle-specific receptor tyrosine kinase (musk) antibodies that are associated with myasthenia syndrome (mg). technical results ----------------- musk antibody titer: <10 musk antibody reference range (titer) negative borderline positive <10 10 > or = 20 17:28 acetylcholine receptor antibody test result reference range/units acetylcholine rec binding <0.30 <=0.30 nmol/l reference range: negative: <=0.30 nmol/l equivocal: 0.31-0.49 nmol/l positive: >=0.50 nmol/l brief hospital course: ms. was admitted to the neurology service after progressive shortness of breath, fatigue, facial weakness and double vision developed over the last 6-12 months. based on her clinical exam (with neck flexor/extensor weakness, bifacial weakness, on diplopia on upgaze, shortness of breath with sentences all of which worsened over the course of the day), she was diagnosed with myasthenia . because of her tenous cardiac health and the need for anticoagulation, she was initially treated with 2 course of ivig and mestinon with mild improvement of her symptoms. after consulting with her primary cardiologist, it was determined that the potential benefits outweighed any risks for clot, so her coumadin was discontinued and she completed plasmapheresis x 5. her anti-achr antibodies and anti-musk antibodies were negative, suggesting that she has seronegative myasthenia . she had emg performed and dr. felt that there was a strong suggestion of myasthenia. she intermittently had labile blood pressures and required uptitration of her blood pressure medication. in addition, she developed sustained atrial fibrillation after the 2nd plasmapheresis cycle and was started on amiodarone on the recommendation of cardiology. she returned to sinus rhythm. psychiatry and palliative care were consulted when she expressed that she no longer wanted to continue with aggressive care. she had developed a pneumonia and urinary tract infection. a family meeting was held and she opted to not continue with aggressive care. she had taken out her ng tube and did not want it replaced. we offered her oral medications as she could tolerate, but she opted to go home with hospice. a prescription for cefpodoxime was given on discharge. she was given scripts for sl morphine and ativan. medications on admission: - carvedilol 6.25mg po bid - diltiazem 120mg po daily - levothyroxine 112ug 6 days/wk, 168ug on the 7th day - lisinopril 60mg po daily - losartan 100mg daily - omeprazole 20mg - warfarin 2mg po qd - zolpidem 5mg po qhs prn sleep - apap 325mg po tid prn - tums 2.5g po daily - vit d3 400u po daily - mvi daily discharge disposition: home with service facility: vna discharge diagnosis: myasthenia crisis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ms. you were admitted to the neurology service after you had months of progressive weakness, slurred speech, fatigue and double vision. you were diagnosed with myasthenia and treated for myasthenia crisis initially with ivig and then with plasmapheresis. although you showed some initial improvement, your course was complicated by difficulty with respirations and you required intermittent bipap for support. pulmonary was involved and recommended tracheostomy with mechanical ventilation but you were opposed to this. we'd asked palliative care and psychiatry to be involved and you felt strongly that you did not wish to continue aggressive measures. you were made cmo and hospice was arranged. you will be discharged with prescriptions for your medications and can take them with apple sauce if needed followup instructions: going home with hospice procedure: enteral infusion of concentrated nutritional substances arterial catheterization therapeutic plasmapheresis insertion of totally implantable vascular access device [vad] injection or infusion of immunoglobulin diagnoses: pneumonia, organism unspecified esophageal reflux urinary tract infection, site not specified unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation other and unspecified hyperlipidemia acute respiratory failure rheumatoid arthritis do not resuscitate status mixed acid-base balance disorder other severe protein-calorie malnutrition myasthenia gravis with (acute) exacerbation 

Answer: The patient is high likely exposed to