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: history of present illness: this is a 49-year-old male who was admitted with a chief complaint of mental status changes and unresponsiveness with admission to the medical intensive care unit for severe hypernatremia. the patient has a history of developmental delay who was recently admitted between to . the patient presents from a nursing home with acute mental status changes. he was found by the nursing home staff to be minimally responsive, diaphoretic, and cyanotic. vital signs revealed blood pressure was 90/60, heart rate was 113, respiratory rate was 28, oxygen saturation was 95% on room air. his hospital course during his previous admission was notable for mental status changes and decline; where he was previously living at home over the last two months, and he was found by emergency medical service to be surrounded by feces and urine bottles. his baseline (reported by his father) was functional. his supposedly attends dictation summary, but it is unclear what his true baseline is. he was noted to hypernatremic on admission at 159, but remained encephalopathic with an unremarkable magnetic resonance imaging of the head. an electroencephalogram was consistent with toxic metabolic encephalopathy. he was discharged to the nursing home facility for activities of daily living, feedings, and incoherence. he was treated for a urinary tract infection and community-acquired pneumonia. the nursing home reported that he required assistance for feeding and apparently had an altercation with his father who also assists with his feedings. on the three days prior to admission, he had been taking less than 25% of his meals. upon questioning the patient, the patient was unintelligible. the emergency department course was significant for aggressive intravenous hydration with normal saline. the admission blood pressure was 63/39, heart rate was 125; which responded to 4 liters of normal saline to a blood pressure of 121/64 and a heart rate of 96. past medical history: 1. juvenile rheumatoid arthritis. 2. questionable psychiatric disorder of unknown etiology. the patient apparently dropped out of school. medications on admission: 1. thiamine 100 mg p.o. q.d. 2. haldol 2.5 mg p.o. b.i.d. 3. nystatin cream as needed. 4. folate. 5. b12. 6. protonix. allergies: his allergies are to aspirin. social history: nursing home resident. formerly, he lived with his parents. family history: family history was noncontributory. physical examination on presentation: physical examination revealed temperature was 99.1, blood pressure was 121/64, heart rate was 96, respiratory rate was 20, oxygen saturation was 98% on 2 liters. he was disheveled and unkempt male lying in bed. he appeared agitated. head, eyes, ears, nose, and throat examination revealed mucous membranes were dry. pupils were equal, round, and reactive to light. the skin was dry. poor skin turgor. neck revealed no lymphadenopathy. lungs were clear to auscultation bilaterally and anteriorly with no wheezes. cardiovascular examination revealed normal first heart sound and second heart sound. a regular rate. no murmurs, rubs, or gallops. the abdomen revealed positive bowel sounds. soft, nontender, and nondistended. his extremities showed no edema. cranial nerves ii through xii were grossly intact. he moved all extremities. radial and posterior tibialis pulses were 2+ bilaterally. pertinent laboratory values on presentation: laboratories on admission revealed his white blood cell count was 15.9, his hematocrit was 38.7, platelets were 580, and mean cell volume was 98. differential with 88 neutrophils. his sodium was 171, potassium was 4.6, chloride was 135, bicarbonate was 20, blood urea nitrogen was 105, creatinine was 4.3, and blood glucose was 102. calcium was 8.7 and phosphate was 2.9. his ast was 29, alt was 11, ck was 59, amylase was 65, and total bilirubin was 0.4. albumin was 2.7. radiology/imaging: his chest x-ray was negative for infiltrate. his electrocardiogram showed a sinus rhythm at a rate of 102, with a normal axis and intervals. no acute st-t wave changes. hospital course by issue/system: the patient was admitted to the medical intensive care unit from to and then was admitted to the medicine service on through . 1. renal issues: his hypernatremia was corrected with both d-5 half normal saline to initially give him volume which was switched to d-5-w. his last sodium was 142. 2. hypotension issues: his hypotension which was most likely related to his hypovolemia which responded with aggressive intravenous fluid hydration. he did not require pressors. 3. acute renal failure issues: his acute renal failure was most likely secondary to prerenal from hypovolemia. his creatinine returned to baseline and resolved with intravenous hydration. 4. infectious disease issues: he had leukocytosis, but was never given any antibiotics since his chest x-ray was normal. his urinalysis did not show any signs of infection. he did have a stage iii sacral decubitus ulcer that was treated and seen by the plastic service. the patient was to continue dressing changes with dakin's wet-to-dry dressings b.i.d. and to place miconazole powder to keep the perineal/sacral area dry. if fever does develop, and he develops worsening leukocytosis, he should most likely have a magnetic resonance imaging of the lower spine at some point to rule out an osteomyelitis. 5. elevated inr issues: he had an elevated inr in the setting of poor oral intake. most likely, he had a vitamin deficiency. he received 10 mg of vitamin k for three days, and his inr returned to . 6. altered mental status issues: he was evaluated both by neurology and by psychiatry. neurology felt that this was most likely toxic metabolic, and the patient did improve with the resolution of his hypernatremia. however, he continued to have baseline paranoid hallucinations. psychiatry was following and initially suggested haldol 2.5 mg p.o. b.i.d. however, this caused severe somnolence and was held. he has been appropriate and has not required any sitters since the medical intensive care unit despite not having haldol. it will most likely need psychiatric followup. we are unsure of his underlying psychiatric condition since his father says he was relatively bright. however, given his social situation of dropping out of college early and living at home with his parents throughout his 40s, this likely represents some type of psychiatric disorder (possible schizophrenia or schizoaffective disorder). 7. nutrition issues: his nutritional status has been an issue; especially with his sacral decubitus ulcer, nutritional status is very important. we attempted to have a gastrojejunostomy/percutaneous endoscopic gastrostomy tube insertion on ; however, given the patient's anatomy of a high stomach interventional radiology attempt was unsuccessful. instead, the patient was put in for a peripherally inserted central catheter line on to start total parenteral nutrition as a supplement to his daily intake. he was to continue encouragement for increased oral intake and boost supplements, and also to continue multivitamin, thiamine, folate, and zinc supplementation for his sacral decubitus ulcer. 8. diarrhea issues: he continued to have diarrhea. stool culture have been sent off. his clostridium difficile was negative. however, his stool culture were still pending. would consider continuing of a low-fiber/low-residue diet until this resolves. he will also need hydration to maintain volume. condition at discharge: the patient's condition on discharge was stable. discharge disposition: the patient was to be discharged back to rehabilitation for physical therapy, and aid with his activities of daily living, and feedings, and his total parenteral nutrition. discharge diagnoses: (his discharge diagnoses included) 1. developmental delay. 2. possible schizoaffective disorder or schizophrenic disorder. 3. altered mental status. 4. hypernatremia. 5. toxic metabolic syndrome. 6. acute renal failure. 7. sacral decubitus ulcers. medications on discharge: (his discharge medications included) 1. miconazole powder 2% q.i.d. as needed (to keep sacrum and perineal area dry). 2. dakin's 1/4 strength b.i.d. with wet-to-dry dressings to sacral decubitus ulcer. 3. heparin 5000 units subcutaneously q.12h. 4. protonix 40 mg p.o. q.d. 5. cyanocobalamin 50 mcg p.o. q.d. 6. folate 1 mg p.o. q.d. 7. thiamine 100 mg p.o. q.d. 8. zinc sulfate 220 mcg p.o. q.d. (for two weeks). discharge instructions/followup: 1. he should have logroll precautions q.2h. 2. he needs boost supplements t.i.d., with a low-residue diet, and total parenteral nutrition. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of large intestine nonexcisional debridement of wound, infection or burn other gastrostomy diagnoses: acidosis other and unspecified noninfectious gastroenteritis and colitis acute kidney failure, unspecified candidiasis of other urogenital sites pneumonitis due to inhalation of food or vomitus hyperosmolality and/or hypernatremia polyarticular juvenile rheumatoid arthritis, chronic or unspecified 

Answer: The patient is high likely exposed to