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: cough major surgical or invasive procedure: picc line placement history of present illness: mr. is 64-year-old man with liver cirrhosis nash, dm, htn, chf ef 40%, cad, sizure disorder who p/w cough. per report from his nursing home, he has had cough, low grade fever x 3 days. today, he had an episode of likely aspiration while using mouth wash, had a coughing fit and during this episode desat'ed to 80's. his family reports that he has been on small amounts of oxygen at the nursing home, which he has been on chronically since rehab for unclear reasons. they state that he has had a ratteling cough for several days but has not appeared unwell. they also note that he has normally waxing and mental status, that he is not "chatty" normally and that his mental status appears to be at baseline. per the patient, he feels relatively well and denies sob. he was biba from his nh, enroute ems had a difficult time obtaining a good pleth/sats and reported variable o2 sats in high 80's. . in the ed: the patient was thought to be ill appearing and "dry". his vital signs were temp 100.0, hr 107, bp 120/80's, rr 22-26, sa 96% 2lnc. ekg unchanged, trop 0.06.cxr was noted to have hazy rll and lll. he received vanc and ctx. past medical history: 1. seizure disorder with history of status epilepticus with recent admission for recurrent seizures & 2 prior admission in & for status requiring intubation. he has been on multiple antiepileptic drugs 2. nash, cirrhosis, hepatocellular carcinoma, recently removed from list chronic illness 3. diabetes. 4. hypothyroidism. 5. hypertension. 6. chf with ejection fraction of 40% on an echo in . 7. coronary artery disease status post cardiac catheterization in w/o stenting. 8. history of upper gi bleed status post tips in . 9. stage iv sacral decubitus ulcer. social history: prior to his illness, he was living with wife; remote tobacco, no etoh or drug use. he now resides at nursing home. family history: non-contributory. physical exam: general: awake, alert, nad. heent: nc/at, perrl, eomi without nystagmus, no scleral icterus noted, mmm, no lesions noted in op neck: supple, no jvd or carotid bruits appreciated pulmonary: lungs cta bilaterally cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no c/c/e bilaterally, 2+ radial, dp and pt pulses b/l. lymphatics: no cervical, supraclavicular, axillary or inguinal lymphadenopathy noted. skin: sacral ulcer, heel ulcers neurologic: -mental status: waxing and between, persistently alert but oriented to person only at times and occasionally a&ox3. -contractures in hands and arms. pertinent results: labwork on admission: 09:45am blood wbc-5.2 rbc-3.63* hgb-12.5* hct-37.6* mcv-104*# mch-34.4* mchc-33.2 rdw-15.1 plt ct-65* 09:45am blood neuts-81.1* lymphs-12.2* monos-5.2 eos-1.4 baso-0.2 09:45am blood glucose-178* urean-50* creat-1.1 na-150* k-4.1 cl-110* hco3-34* angap-10 09:45am blood alt-27 ast-23 ck(cpk)-53 alkphos-124* totbili-0.3 10:35am blood ammonia-73* 09:45am blood tsh-0.77 09:45am blood free t4-1.9* . labwork on discharge: 07:45am blood wbc-2.2* rbc-2.95* hgb-9.9* hct-30.7* mcv-104* mch-33.7* mchc-32.4 rdw-14.6 plt ct-59* 07:45am blood glucose-72 urean-22* creat-0.8 na-146* k-3.9 cl-109* hco3-34* angap-7* . chest (portable ap) study date of formal report pending, but right upper and lower lobe consolidations present. . chest port. line placement study date of preliminary report !! pfi !! tip of picc catheter 8 cm from svc will need to be withdrawn. brief hospital course: 64 year-old man with cirrhosis, type 2 diabetes, coronary artery disease, hypertension, congestive heart failure with ef 40%, and seizure disorder presenting with cough, fevers, and consolidations on chest x-ray consistent with pneumonia. . 1. pneumonia: chest x-ray from admission showed right middle and lower lobe consolidations. his oxygen saturations remained above 92% on room air. he was monitored in the intensive care unit overnight and transferred to a general medical floor the morning after admission. he was started on vancomycin and ampicillin-sulbactam to complete a two-week course for hospital-acquired versus aspiration pneumonia. a picc line was placed for intravenous access to complete the course of antibiotics, ending . . 2. hypernatremia: asymptomatic and due to free water depletion. his free water flushes were increased to 400 cc q4h with improvement in sodium. his sodium should be monitored intermittently and his free water flushes should be adjusted accordingly for hypernatremia. . 3. question urinary tract infection from nursing home: the patient was on nitrofurantoin on admission, and it is unclear whether this was for treatment or prophylaxis of urinary tract infection. this was discontinued when the above antibiotics were started for pneumonia. he can restart nitrofurantoin if this was being given for prophylaxis when the course of vancomycin and unasyn is complete. . 4. mental status: it was believed that the patient was delirious on admission, however, after discussion with the patient's wife and the nursing home his mental status was thought to be at baseline. he was treated for pneumonia as above. he was frequently redirected. . 5. history of nonacloholic steatohepatitis/cirrhosis: the patient is status post tips. he is not candidate currently due to his multiple comorbiditis. his meld score was 5 on admission. he was continued on rifamixin and lactulose. . 6. chronic systolic congestive heart failure: ef is 40%. his metoprolol was continued during admission. the patient was hypovolemic on admission and lasix was held. lasix was restarted prior to discharge. . 7. seizure disorder: no active issues. the patient was continued on keppra, topomax and zonisamide. there was initial confusion regarding his dose of keppra, and the patient was initially given 2250 mg on admission, however, this was subsequently changed to his home dose of 500 mg twice daily. . 8. type 2 diabetes: no active issues. the patient was continued on glargine 100 units twice daily as per his outpatient regimen. he received humalog sliding scale insulin as needed. . 9. coronary artery disease: no active issues. the patient was continued on metoprolol. he is not on aspirin or statin at baseline, likely due to his liver disease, and this can be readdressed as an outpatient. 10. hypothyroidism: the patient was continued on his outpatietn dose of levothyroxine 400 mcg daily. during admission, his t4 was elevated to 1.9 with normal tsh. his laboratories should be checked after resolution of this acute illness and his dose of levothyroxine adjusted accordingly. . 11. sacral decubitus ulcer: the patient was followed by the care nurse. . 12. pancytopenia: his blood counts were at baseline during admission. his pancytopenia is believed secondary to liver disease. this should be monitored intermittently. medications on admission: topiramate 100 mg po bid metoprolol 25 mg po bid levetiracetam po bid zonisamide 500 mg daily levothyroxine po daily fluocinolone 0.025 % cream lactulose 10 gram/15 ml syrup rifaximin po tid lorazepam 0.5 mg po daily furosemide 40 mg po daily heparin (porcine) 5,000 unit/ml multivitamin po daily folic acid 1 mg po daily lansoprazole 30 mg thiamine hcl 100 mg po daily polyvinyl alcohol 1.4 % drops discharge medications: 1. topiramate 100 mg tablet : one (1) tablet po bid (2 times a day). 2. metoprolol tartrate 25 mg tablet : 0.5 tablet po bid (2 times a day). 3. levetiracetam 500 mg tablet : one (1) tablet po bid (2 times a day). 4. zonisamide 100 mg capsule : five (5) capsule po daily (daily). 5. levothyroxine 100 mcg tablet : four (4) tablet po daily (daily). 6. lactulose 10 gram/15 ml syrup : thirty (30) ml po tid (3 times a day). 7. rifaximin 200 mg tablet : two (2) tablet po bid (2 times a day). 8. lorazepam 0.5 mg tablet : one (1) tablet po once a day. 9. furosemide 40 mg tablet : one (1) tablet po once a day. 10. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 11. multivitamin tablet : one (1) tablet po daily (daily). 12. folic acid 1 mg tablet : one (1) tablet po daily (daily). 13. omeprazole 40 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po once a day. 14. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily). 15. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : drops ophthalmic q6h (every 6 hours). 16. ferrous sulfate 325 mg (65 mg iron) tablet : one (1) tablet po daily (daily). 17. insulin glargine 300 unit/3 ml insulin pen : one hundred (100) units subcutaneous twice a day: plus novolin sliding scale. 18. tramadol 50 mg tablet : one (1) tablet po three times a day: hold for oversedation and confusion. 19. scopolamine base 1.5 mg patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 20. ascorbic acid 500 mg tablet : one (1) tablet po bid (2 times a day). 21. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q4h (every 4 hours). 22. ipratropium bromide 0.02 % solution : one (1) inhalation q4h (every 4 hours). 23. nystatin 100,000 unit/ml suspension : five (5) ml po tid (3 times a day). 24. heparin, porcine (pf) 10 unit/ml syringe : one (1) ml intravenous prn (as needed) as needed for line flush. 25. ampicillin-sulbactam 3 gram recon soln : one (1) recon soln injection q6h (every 6 hours): continue until . 26. vancomycin in dextrose 1 gram/200 ml piggyback : one (1) intravenous q 12h (every 12 hours): continue until . discharge disposition: extended care facility: discharge diagnosis: primary diagnoses: pneumonia (hospital acquired versus. aspiration) hypernatremia delirium secondary diagnoses: 1. seizure disorder with history of status epilepticus with recent admission for recurrent seizures & two prior admission in & for status requiring intubation. he has been on multiple antiepileptic drugs 2. nonalcholic steatohepatitis, cirrhosis, hepatocellular carcinoma, recently removed from list due chronic illness 3. diabetes - insulin dependent 4. hypothyroidism 5. hypertension 6. congestive heart failure with ejection fraction of 40% on an echo in 7. coronary artery disease status post cardiac catheterization in w/o stenting 8. history of upper gi bleed status post tips in 9. stage iv sacral decubitus ulcer discharge condition: afebrile, vital signs stable discharge instructions: dear mr. , you were transferred to the hospital with fevers and a cough. you were found to have a pneumonia and picc line was placed in your arm so that you can complete a two week course of antibiotics (12 more days). you were also noted to have high levels of sodium in your blood, and this is probably because you were not getting enough water in your diet. you are being given more water with your tube feeds. we did not change any of your medications (except adding those two antibiotics for two weeks). your thyroid levels were high, and they should be re-checked and the dose of your thyroid medicine may need to be adjusted. if you develop increased difficulty breathing or any other symptoms which seriously concerns you, please return to the hospital. followup instructions: previously scheduled appointments: provider: laboratory phone: date/time: 10:00 provider: lab phone: date/time: 1:00 provider: clinic phone: date/time: 10:20 . you should try to see your primary care provider 2 weeks. pcp: , . procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism pneumonitis due to inhalation of food or vomitus grand mal status chronic systolic heart failure pressure ulcer, lower back malignant neoplasm of liver, primary hyperosmolality and/or hypernatremia gastrostomy status pressure ulcer, stage iv other chronic nonalcoholic liver disease 

Answer: The patient is high likely exposed to