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: patient recorded as having no known allergies to drugs attending: chief complaint: eyelid droop and weakness major surgical or invasive procedure: ivig infusion. history of present illness: hpi: patient is a 81 yo rhm with hx of htn, dm, hyperlipidemia and chronic lbp here with question of myasthenia . patient reports that 1 month ago, he suddenly awoke with l sided hearing loss. he also reported numbness of the l ear to touch and occasional clicking noise in the l side in addition to complete hearing loss that occurred overnight. he was seen per dr. (ent) who evaluated him with mri of brain that did was not revealing (no mass) and treated him with 1 week of oral steroids with no improvement. then about 2 weeks ago, patient was noticed to have l ptosis per son and developed vertical diplopia (items afar seem to be on top of each other). this diplopia is not present when he awakes but it starts within minutes after waking up. he was also noticed to be more fatigued and easily tired although still able to continue most of his daily activities including laundry, walking up/down the stairs and etc. around 3 days ago, patient noticed that he was having trouble swallowing food/water in large gulps. if he drank or ate more than teaspoon at a time, things would come out his nose. he also felt that food was getting stuck in his throat and he had trouble expectorating. he also started to need to cut up his pills because he had trouble swallowing them whole. he went to see his pcp, . for his monthly b12 shots and upon hearing his symptoms, referred the patient to dr. for myasthenia evaluation and treatment. patient reports that he has not taken any meds today. ros otherwise negative including recent fever/chills, n/v/d, falls, ha or sick contact. at baseline, patient occasionally uses a cane for additional support but completely independent in all his adls including iadls. of note, patient underwent open cholecystectomy for failed ercp in with no post-operative complications including awaking from the anesthesia. past medical history: h/o facial basal cell carcinoma chronic lower back pain aortic stenosis hypertension hyperlipidemia diabetes mellitus left biliary duct stent placement for left duct stricture (jaundiced) open cholecystectomy social history: patient was in the navy and worked on boats his entire life. he is married and lives with his "bride". he denies tobacco, alcohol or drug use. he has a history of asbestos exposure. family history: no family history of malignancy. physical exam: t 97.7 bp 117/64 hr 77 rr 16 o2sat 100% ra - able to count to 20 in one breath. nif -14 with mask and vc 900. gen: lying in bed, nad neck: no carotid or vertebral bruit cv: rrr, 2/6 sem best heard lusb lung: clear anteriorly abd: +bs, soft, nontender ext: no edema neurologic examination: mental status: awake and alert, cooperative with exam, normal affect. oriented to person, place, and date. attentive - able to do dow backwards. speech is fluent with normal comprehension and repetition; naming intact. no dysarthria. intact. no right left confusion. no evidence of apraxia or neglect. cranial nerves: ii: pupils equally round and reactive to light, 4 to 2 mm bilaterally. visual fields are full to confrontation. iii, iv & vi: extraocular movements intact bilaterally, no nystagmus. develops transient vertical ptosis in 20 seconds. v: sensation intact to lt and pp. vii: l ptosis. viii: hearing intact to finger rub only on r. x: palate elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline, movements intact motor: normal bulk and tone bilaterally. no observed myoclonus or tremor. no asterixis or pronator drift - fatigable r delt -> weakens to 4- from 5-. weak neck flexor but intact extensor. tri we fe ff ip h q df pf r 5- 5- 5 5 5- 5 5- 5 5 5 5 l 5 5- 5 5 5- 5 5- 5 5 5 5 sensation: intact to light touch, pinprick, and cold but decreased vibratory sensation in both big toes and decreased proprioception, worse on r than l. reflexes: 2s for ue and patellar but none for achilles. toes upgoing on l only. coordination: ftn, ftf and htss normal. gait: deferred. pertinent results: 02:50pm wbc-4.4 rbc-4.82# hgb-14.1 hct-42.9# mcv-89# mch-29.2# mchc-32.8 rdw-13.9 02:50pm plt count-145* 02:50pm tsh-1.3 02:50pm tot prot-7.4 albumin-4.1 globulin-3.3 calcium-9.1 magnesium-2.1 02:50pm alt(sgpt)-23 ast(sgot)-29 alk phos-50 tot bili-0.8 02:50pm estgfr-using this 02:50pm urea n-18 creat-0.8 sodium-141 potassium-3.9 chloride-100 total co2-31 anion gap-14 02:50pm glucose-218* 10:45am plt count-129* 10:45am neuts-69.0 lymphs-22.5 monos-6.3 eos-0.8 basos-1.4 10:45am wbc-4.7 rbc-4.75 hgb-13.9* hct-41.8 mcv-88 mch-29.3 mchc-33.2 rdw-14.5 10:45am glucose-175* urea n-19 creat-0.9 sodium-141 potassium-3.5 chloride-103 total co2-31 anion gap-11 04:10pm pt-13.0 ptt-29.5 inr(pt)-1.1 brief hospital course: the patient was admitted and the initial goal had been to start plasmapheresis, however given the significant aortic stenosis, this was deferred in favor of an initial attempt to treat with ivig. he was also started on pyridostigmine. his baseline nif and vc were low at -40 and 800, however he did not appear to be able to fully cooperate with testing and thus these numbers were thought to be partially artifically decreased. he had some minor improvement in his strength after 5 days of ivig. prior to initiation of steroid therapy, he was checked for a urine infection and incidentally found to have a urinary tract infection, and thus he was treated with antibiotics for a 5-day course initially with ceftriaxone, transitioned to ampicillin once sensitivities returned. he failed a speech and swallow evaluation, but initially refused to have an ng tube placed, thus he fed himself purees over the weekend . he did not have any overt aspiration, however on there continued to be extreme concern for aspiration, thus he did agree to an ng tube being placed and on he began ng feeds. on he developed acute onset of oxygen requirement and lethargy accompanied by a fall in his nif and vital capacity to -20 and 400 cc. given concern for acute respiratory failure, he was transferred to the medical intensive care unit. an abg immediately prior to transfer was notable for a carbon dioxide level of 58, lower than was expected based upon the clinical picture. in the micu, he was treated with bipap for one day with substantial improvement, and no alternative etiology was identified for his acute change in mental status. a pheresis catheter was placed due to the potential need to initiate plasmapheresis despite his aortic stenosis if he were not to regain his strength and require further respiratory support. however, he made a substantial improvement over the course of 24 hours, and was transferred back to the floor on on 2l nasal cannula, again able to ambulate with a normal mental status. he was also found to have an elevated ptt due entirely to subcutaneous heparin (based on hepzyme test), thus he was no longer given subcutaneous heparin instead ambulation and pneumoboots for prophylaxis. he was started on prednisone 10 mg daily on which was briefly held for his urinary tract infection and reinitiated on . by day of discharge, this increased to prednisone 40 mg daily. he continued to have stable nif and vc. his feeds were advanced to an oral diet after evaluation with video swallow study. he received physical therapy. he was discharged home with plan to receive physical therapy as an outpatient as well. medications on admission: 1. pantoprazole 40mg 2. propranolol 80 mg daily 3. enalapril maleate 5 mg daily 4. hydralazine 50 mg 5. niaspan 1000mg daily 6. aspirin 325 mg daily 7. vitamin d 8. centrum silver 9. alendronate 70 - every wednesday 10. b12 shots - monthly discharge medications: 1. hydralazine 25 mg tablet sig: two (2) tablet po bid (2 times a day). 2. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for t>100.4 or pain. 3. enalapril maleate 5 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 6. multivitamin tablet sig: one (1) tablet po daily (daily). 7. pyridostigmine bromide 60 mg tablet sig: one (1) tablet po q8h (every 8 hours). disp:*90 tablet(s)* refills:*2* 8. niacin 500 mg tablet sig: one (1) tablet po bid (2 times a day). 9. prednisone 20 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 10. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. discharge disposition: home with service facility: all care vna of greater discharge diagnosis: myasthenia . discharge condition: stable, normal neurologic exam. discharge instructions: your were admitted for eyelid droopiness and diagnosed with myasthenia , treated with ivig. the myasthenia causes it to be difficult ot swallow, and you required an ng tube to feed and take medications. before discharge, your feeds were advanced to an oral diet. you briefly had difficulty breathing and so were transferred to the micu for observation and treated with bipap support. your breathing improved and were transferred back to the general floor. you received physical therapy. you were treated with prednisone which you will continue after discharge. 1. take all medications as directed. 2. if you experience new or worsening symptoms, please contact your physician or if urgent, please proceed directly to the nearest emergency room. followup instructions: provider , m.d. phone: date/time: 9:00 provider: , md phone: date/time: 4:30 procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation injection or infusion of immunoglobulin diagnoses: acidosis anemia, unspecified urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled aortic valve disorders other and unspecified hyperlipidemia acute and chronic respiratory failure personal history of other malignant neoplasm of skin osteoporosis, unspecified streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] lumbago leukocytopenia, unspecified dysphagia, oropharyngeal phase diplopia myasthenia gravis with (acute) exacerbation sensorineural hearing loss, unilateral myogenic ptosis 

Answer: The patient is high likely exposed to