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: penicillins / milk attending: chief complaint: s/p ercp with acute mental status changes/aspiration pna major surgical or invasive procedure: ercp with sphincteroplasty peg tube placement (via interventional radiology) history of present illness: 77 y/o f with pmhx of developmental delay, copd, hl, htn and mirizzi syndrome who presented today for elective ercp. pt was felt to be functionning at baseline prior to procedure with mild agitation, pulling at pivs but interacting with staff. she was given fent/midaz for ercp with stent placement and was transferred to the post-ercp suite in stable condition. she had elevated bps during the procedure requiring labetalol and metoprolol. she was found mildly tachypneic/wheezing with emesis on her gown. it was felt likely that she had an aspiration event with low grade temp however, she was still moving all four extremities and responding appropriately to questions though mildly sedated prior to transfer to the floor. . on arrival to the floor, pt was minimally responsive to sternal rub and did not withdraw to focal stimuli. she was notably tachypneic and eyes were deviated to right side. she was able to track to left with stimuli and would intermittently open eyes to command. pt had an abg 7.4/36/92 with lactate of 3.5 and cxr showed a right lower lobe infiltrate. due to concern for acute intracranial hemmorrhage, she was taken down for a stat ct head. on return to the floor, pt was given narcan without any significant change in mental status. neuro was consulted for possible acute stroke and within a few minutes, she became more responsive, opening eyes spontaneously. by the time neuro came to bedside, pt was able to verbalize her name and was noted to be using the right arm and had left sided deficit. a code stroke was called and pt was taken for urgent cta head which did not show any vessel obstruction and tpa was felt unlikely to be helpful. perfusion images confirmed right temporal hypoperfusion consistent with clinical exam and likely right mca infarct. icu consult was initiated and pt's guardian was notified. pt was given vanc/cefepime and aspirin 300mg pr while awaiting icu transfer. she was lying flat per neuro recs and was noted to be spitting up bilious emesis. head of bed was elevated and pt was suctionned prior to transferred to the icu for closer monitoring of airway and management of acute pneumonia. past medical history: hypertension developmental delay mirizzi syndrome copd social history: at baseline, pt lives at a nursing home and is able to feed herself, undress and can transfer from chair to bed but is otherwise wheelchair bound. no smoking/etoh history documented. family history: none relevant to this hospitalization. physical exam: admission: t 101 bp 152/86 hr 86 rr 30 sats 94% ra gen: somnolent, open eyes to vigorous stimulous heent: eyes deviated to right, tracks to left with startle cv: rrr no apprec m resp: diffuse expiratory wheezes, moving air well abd: soft, bs, no rebound/guarding gu: foley in place extr: warm, minimal edema, toes upgoing neuro: minimally responsive, eyes deviated, no withdrawal to painful stimuli pertinent results: 04:02pm blood wbc-24.8*# rbc-6.40* hgb-13.9 hct-43.8 mcv-68* mch-21.6* mchc-31.6 rdw-14.3 plt ct-273 05:55am blood wbc-8.1 rbc-5.33 hgb-11.8* hct-38.1 mcv-72* mch-22.2* mchc-31.0 rdw-14.8 plt ct-399 06:05am blood glucose-113* urean-4* creat-0.5 na-141 k-3.5 cl-106 hco3-27 angap-12 06:05am blood calcium-9.8 phos-3.5 mg-1.9 04:02pm blood alt-92* ast-118* alkphos-247* totbili-1.4 04:42am blood alt-145* ast-277* alkphos-136* amylase-101* totbili-0.5 06:05am blood alt-50* ast-46* ld(ldh)-170 alkphos-144* totbili-0.3 06:36am blood triglyc-143 hdl-44 chol/hd-3.8 ldlcalc-93 06:36am blood %hba1c-9.4* eag-223* . ercp procedures: a plastic stent was removed. impression: 2 balloon sweeps were performed with a small stone, sludge and debris removed. a 1.5 cm biliary stricture in mid-cbd compatible with known cystic duct stone and mirrizi syndrome was visualized. a 10 f 5cm double pigtailed catheter was placed. otherwise normal ercp to third part of the duodenum. cxr impression: right lower lobe pneumonia with atelectasis or pneumonia at the left base. . cta head w&w/o c & recons impression: moderate-to-severe intracranial atherosclerotic disease with findings suggestive of decreased perfusion to the right mca/pca watershed region. the findings may represent cerebral ischemia in the setting of hypovolemia, hypotension or other causes of decreased cardiac output. . cardiac echo: impression: small lv cavity size with mild symmetric lvh and hyperdynamic lv systolic function. consequently, there is a mild to moderate lv outflow tract gradient. no pathologic valvular abnormality seen. . rue leni impression: partially occlusive thrombus in the right basilic and axillary veins at site of picc line. clot does not extend more centrally. . abdomen (supine only) port impression: limited view of the abdomen demonstrating no evidence for obstruction. bladder stone. coags: 06:05am blood pt-13.4 ptt-29.7 inr(pt)-1.1 05:55am blood pt-14.0* inr(pt)-1.2* (started warfarin 5 mg) brief hospital course: 77 y/o f with pmhx of developmental delay, copd, hl, htn and mirizzi syndrome who presented on for elective ercp. pt was noted to have emesis on her gown in the post procedure suite with diffuse wheezes and low grade temp. it was thought likely that she had an aspiration event and when she was arrived on the floor, she had a profoundly depressed mental status, tachypnea and fever to 101.9. further stat work up revealed evidence of aspiration pna, leukocytosis and elevated lactate. initial head imaging was unrevealing. however, she became more alert and was noted to have an acute left sided deficit. code stroke was called and cta/perfusion images confirmed right sided hypoperfusion likely consistent with right mca stroke. neuro felt there was no indication for tpa given patent intracranial vessels and on return to the floor, pt was noted to have bilious secretions that she was having difficulty clearing. she was transferred to the icu for airway monitoring overnight. pt was called out to the floor when she was able to cough and spit up secretions. she was noted to have a waxing and mental status, sometimes will respond to commands and other times will not. bp was allowed to autoregulate for the first 72 hrs post event and pt was continued on aspirin 300mg daily. she was noted to have recovery of left arm function and was answering yes/no to questions. she was seen by pt/ot who recommended ongoing therapy upon return to nh. after discussion with hcp/guardian, decision was made to avoid follow up mri as it was not likely to change care plan and pt was unlikely to tolerate the procedure. echo was performed to rule out cardioembolic source which did not show any thrombus. lipid panel showed ldl in the 93, and hgb a1c 9.4. she was hyperglycemic during the hospitalization, and she was started on lantus and sliding scale insulin. . aspiration pna: pt was noted to have aspiration event s/p procedure and was monitored in the icu for 24hrs given concern for her ability to protect airway . leukocytosis, lactate and fevers resolved after initiation of vanc/cefepime/flagyl. respiratory status improved and pt had a picc placed and she completed a course of antibiotics. upper extremity dvt- patient was subsequently developed a dvt associated with the picc line. the picc line was discontinued and she was started on lovenox. once a peg tube was placed, she was started on warfarin for a goal inr of . please follow inr closely and titrate prn. she received her first dose of warfarin 5 mg on . aspiration - pt was seen by speach/swallow on multiple occasions, which she grossly failed with aspiration. she was kept strictly npo, and she was maintained with iv medications and hydration. a dobhoff was placed for initiation of tube feeds, while waiting to see if she would regain her swallow function. it is/was hoped that her swallow function would improve, especially considering her significant recovery in her left arm movement, however, she did not show significant improvement on serial exams. in discussion with speech and swallow, however, there is some hope that she may recover her swallow on a long term basis, and swallow therapy may help with this recovery. they suggested an approximate 50% chance of recovery to the point of safe oral intake in the long-term. . diabetes-pt with uncontrolled hyperglycemia after the initiation of tube feeds. her lantus and insulin sliding scales were agressively increased. she is being discharged on 70 units of lantus, and a sliding scale. . mirizzi syndrome s/p ercp: pt with abnormal biliary anatomy who underwent stent and sphincteroplastyon for recurrent abd pain. she was noted to have an acute rise in transaminases post procedure and these trended down with normal tbili. pt was followed by ercp team while in house. . developmental delay: baseline confirmed with her guardian/mother and nursing home. . htn: held bp meds to allow autoregulation s/p stroke. she was subsequently treated with iv metoprolol, clonidine patch, and iv lasix, with benefit. after obtaining access via peg, a blood pressure medication regimen via peg was begun. i expect that she will benefit from further titration of medications as an outpatient. please note that she was also started on lisinopril; please follow up lytes in 1 week to ensure she tolerates. . hyperlipidemia: patient's simvastatin was held while patient was npo. this was resumed after obtaining access via peg. this medication dose was increased to 40 mg for goal ldl <70 considering diabetes and stroke. please follow up lft's to ensure tolerating, and lipid profile to ensure she meets her targets. . code: dnr/dni confirmed with guardian medications on admission: aspirin 81mg daily alendronate 70mg weekly multivitamin colace 100mg calcium/vit d metoprolol 50mg bisacodyl prn simvastatin 20mg daily vicodin/tylenol prn discharge medications: 1. enoxaparin 60 mg/0.6 ml syringe sig: one (1) inj subcutaneous q12h (every 12 hours): please continue until inr x 48 hrs, then discontinue. 2. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily): hold for loose stools. 3. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for no bm x 2 days. 4. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: please follow inr closely, and titrate prn for inr goal . please continue lovenox until inr >2 x 48 hrs. 5. clonidine 0.2 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qmon (every monday). 6. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 7. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily): please titrate prn. started . 8. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily): please titrate prn. started . 9. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 10. acetaminophen 650 mg/20.3 ml solution sig: six y (650) mg po q 8h (every 8 hours): would schedule q 8hr x 1 week, to treat for probable post-peg procedure pain. (then prn). 11. alendronate 70 mg tablet sig: one (1) tablet po once a week. 12. vitamin d-3 1,000 unit tablet, chewable sig: one (1) tablet, chewable po once a day. 13. simvastatin 40 mg tablet sig: one (1) tablet po at bedtime. 14. insulin glargine 100 unit/ml solution sig: seventy (70) units subcutaneous once a day: titrate prn. 15. humalog 100 unit/ml solution sig: as per sliding scale units subcutaneous four times a day: as per sliding scale provided. discharge disposition: extended care facility: healthcare center - discharge diagnosis: primary: biliary obstruction s/p sphincteroplasty middle cerebral artery stroke aspiration pneumonia dysphagia due to stroke . secondary: developmental delay hypertension discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: you were admitted for an ercp and had a aspiration event after the procedure. it was discovered that you had a stroke on and you will need to continue working with occupational therapy to continue recovering function. you were treated for an aspiration pna with antibiotics, which you finished in the hospital. your blood sugars were very elevated for this your insulin doses were increased. . please note that there were many changes to your medications as a result of this hospitalization. please follow your new medication list. followup instructions: department: neurology when: monday at 4:30 pm with: drs. & building: sc clinical ctr campus: east best parking: garage department: endo suites when: thursday at 8:00 am department: digestive disease center when: thursday at 8:00 am with: , md building: building (/ complex) campus: east best parking: main garage procedure: percutaneous [endoscopic] gastrostomy [peg] insertion of (naso-)intestinal tube endoscopic retrograde cholangiopancreatography [ercp] central venous catheter placement with guidance diagnoses: unspecified essential hypertension chronic airway obstruction, not elsewhere classified other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pneumonitis due to inhalation of food or vomitus peripheral vascular complications, not elsewhere classified other respiratory complications diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled do not resuscitate status obstruction of bile duct cerebral artery occlusion, unspecified with cerebral infarction acute venous embolism and thrombosis of upper extremity, unspecified other dysphagia wheelchair dependence unspecified delay in development 

Answer: The patient is high likely exposed to