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: latex attending: chief complaint: low urine output major surgical or invasive procedure: none history of present illness: this is a 51 year-old m w/ a h/o ms, quadraparesis, htn, lung disease, chronic constipation and sbos s/p ileostomy, multiple utis (also s/p suprapubic tube) presents with sbo and uti. of note he was just recently discharged from the on for an admission for a uti (negative cultures) treated with cipro, shingles treated w/ acyclovir and sbo evaluated by surgery but managed conservatively. he returns today as his home health aide had noticed his decreased urine output, 75cc overnight when he usually has about 1 liter overnight. his ostomy output has been high. the patient himself was not sure if he has had a change in his ostomy output or suprapubic output. . over the past two weeks he has had mild earaches, a sorethroat as well as some rhinorrhea. he has not noticed any watery / itchy eyes, any visual changes, or any new neurologic symptoms. he denies any abdominal pain and has not subjectively noticed any change in abdominal distention. he denies any pain in regards to his zoster (now or when diagnosed). denies cp, has an occasional cough that is not worsening. of note, his sister reports he does not report pain unless it is extreme. . in the ed, he was noted to be severely dehydrated on exam. his bp nadir was 79/43 and hr peak was 97. t 99 (he usually "runs low"), new arf 1.4 up from 0.6. rec'd levo / flagyl / vanc. seen by surgery who state the sbo is not high grade and he is losing fluid from ileostomy. ngt placed. rec'd 6l of fluids. vs prior to transport were: hr 72 bp 112/79 100% 4l nc (initially sating well on ra but may have aspirated w/ ngt plcmt- desat to 92% w/ coughing and sob). past medical history: -ms , le weaker than ue -htn - lung disease -obstructive sleep apnea, on nocturnal bipap (ipap 16, epap 14) -severe gastroparesis -chronic constipation s/p colectomy with ileostomy -recurrent utis with suprapubic cath (changed monthly) -hyponatremia -appendectomy -left axillary lumpectomy social history: lives at home with parents and sister; has home health aid. no alcohol. quit smoking in , with a 10-year tobacco history. family history: non-contributory physical exam: vitals: t: 95.5 bp: 132/68 hr: 77 rr: 12 o2sat: 98-100% on ra gen: well-appearing, well-nourished, no acute distress heent: perrl, sclera anicteric, no epistaxis or rhinorrhea, mmm, op clear neck: jvp 7-8cm, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline cor: rrr, 1/6 sem @ usb w/o radiation pulm: lungs l base rales abd: distended, bs hypoactive, mild llq tenderness. no rebound or guarding. suprapubic site looks c/d/i. ileostomy pink w/ bilious watery output. ext: no c/c/e, no palpable cords. neuro: alert, oriented to person, place, and time. cn ii ?????? xii intact. + rotatory nystagmus. ue: stregnth in grip, bicep, triceps, deltoid, and trapezius. le - inability to move lower extremities. significant bilateral clonus in lower extremities. reflexes 2+ ue bilat symmetrical, le 3+ bilat symmetrical. pertinent results: on admission: 10:25am wbc-15.7*# rbc-3.71* hgb-11.2* hct-33.4* mcv-90 mch-30.3 mchc-33.6 rdw-14.7 10:25am neuts-83.9* lymphs-8.9* monos-6.1 eos-1.0 basos-0.1 10:25am plt count-524*# 10:25am glucose-116* urea n-15 creat-1.4* sodium-128* potassium-5.1 chloride-94* total co2-23 anion gap-16 12:05pm urine rbc-* wbc->50 bacteria-many yeast-many epi-0-2 12:05pm urine mucous-mod 10:35am lactate-2.4* k+-4.8 12:05pm urine blood-mod nitrite-neg protein-tr glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-6.5 leuk-mod 12:05pm urine color-yellow appear-hazy sp -1.010 08:26pm urine hours-random creat-105 sodium-55 09:03pm lactate-0.9 brief hospital course: #. partial small bowel obstruction: within past 6 months he has had several admits with partial obstruction. presented with considerable ileostomy output and hypotension. kub and ct abdomen consistent with partial obstruction. surgery was consulted and felt either partial sbo or unchanged from prior admission given the amount of ostomy output. recommended to watch for cessation of output or signs of peritonitis, as these would be indications of worsening and surgery would be considered. at that time, there was no indication for surgery. an ng tube was placed for gut decompression, and the patient was kept npo and given ivf. we attempted to match ostomy output with iv fluids. per surgery recommendations, we consulted gi to consider placement of g tube, given the frequency of these episodes. consideration was given to opening this tube for decompression if he becomes obstructed again. he was evaluated by gi on , and they felt that g tube would not be appropriate in the setting of an acute partial obstruction, and we would re-address if this is something the family would want in the future. if so, they recommended that ir may be more appropriate for placement given his aspiration risks. . the possibility of undiagnosed crohn's disease accounting for distal small bowel strictures, which in turn have been contributing to sbos, was raised and discussed at length. if confirmed, gi would recommend a trial of empiric steroids. the gi team also contact pathology to re-cut tissue from frozen sections of colon, resected during prior surgeries, to look for evidence of ibd. of significant concern was that if mr. does have crohn's, starting him on steroids would be challenging. the risks could outweigh the benefits, and it would be unlikely that steroids would reverse the small bowel strictures already present. in addition, we would need to involve his pcp, . , and his neurologist, dr. , in the discussion. we would also need to readdress his overall goals of care, as his family has been considering hospice care. . given his prolonged npo status, he was started on tpn. mr. obstruction gradually improved with ngt to suction, and it was clamped on . his ostomy output increased and it was decided to proceed with small bowel mr enterography to look for evidence of bowel wall inflammation or strictures to support the diagnosis of possible ibd. there was no evidence of this. we concluded his recurrent sbos are most likely secondary to worsening multiple sclerosis. he continued to improve clinically, and his ngt was removed on . the following day he had a swallowing evalution, which showed no evidence of aspiration, and he was started on a regular diet. his family was eager to take him home to gradually advance his diet there. tpn was discontinued. . # uti: no fevers on admission but he had leukocytosis and hypotension, likely due to hypovolemia, as well as elevated lactate. prior pathogens have included pseudomonas, with a mic of 9 for cefepime and zosyn, and mrsa. he was initially empirically started on vancomycin and ceftazidime. urine culture grew few gram negatives (likely contaminant) and yeast. as his leukocytosis and hypotension improved, and given the above urine culture, ceftazidime was discontinued. . # hypotension: this was attributed to hypovolemic shock, and initially also possibly due to sepsis. this improved with ivf resuscitation. in addition, given his initial hyponatremia and hyperkalemia, a.m. cortisol was checked and found to be normal. . # acute renal failure: on admission. fena 0.6% indicating likely prerenal etiology. resolved with administration of ivf. . # osa: desatting to 60s without bipap. needs to be on bipap at night. has machine at home. . # anemia: hematocrit 27.8 on , down from 33.4 at admission. was likely hemoconcentrated on admission given dehydration. no evidence of acute blood loss. hematocrit was monitored daily, and he was maintained on his daily folic acid. . # hypertension: restarted on lisinopril per home regimen on . dose titrated up to 10 mg/day on as patient was persistently hypertensive. . # multiple sclerosis: methotrexate weekly given im. dose confirmed with neurologist. . #goals of care: patient lives with his supportive family, with his mother as his primary caretaker along with his sister who lives nearby. they are very devoted to him and recognize that his disease is quite advanced. discussions were held between the patient's mother and sister and the attending, dr. , who also spoke with the patient's pcp, . . they wish to take mr. home as soon as possible. they have a hospice program that is ready to accept him into their care when they are ready and know how to activate this benefit when they feel it is time. medications on admission: gabapentin 300 mg po q6hrs folic acid 1 mg po daily metoclopramide 10 mg po qid ac and hs erythromycin 250 mg po q6hrs modafinil 200 mg po bid memantine 10 mg tablet po bid lisinopril 5 mg po daily methotrexate sodium 15mg (6x2.5mg tablets) po q week on sundays acyclovir 800 mg po q8hrs, end date ciprofloxacin 250 mg po q12hrs x 3 days, last day prilosec guaifenesin 600 mg po bid discharge medications: 1. gabapentin 300 mg capsule sig: one (1) capsule po q6hrs (). 2. memantine 5 mg tablet sig: two (2) tablet po bid (). 3. modafinil 100 mg tablet sig: two (2) tablet po bid (). 4. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. methotrexate sodium 15 mg tablet sig: one (1) tablet po once a week: on sundays. 7. metoclopramide 10 mg tablet sig: one (1) tablet po four times a day: qac and qhs. 8. erythromycin 250 mg tablet sig: one (1) tablet po every six (6) hours. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 10. guaifenesin 600 mg tablet sustained release sig: one (1) tablet sustained release po twice a day. discharge disposition: home with service facility: gentiva discharge diagnosis: -- small bowel obstruction -- chronic constipation s/p colectomy with ileostomy -- multiple sclerosis -- hypertension -- lung disease -- obstructive sleep apnea on nocturnal cpap discharge condition: clinically stable, tolerating a regular diet. discharge instructions: you were admitted with recurrent small bowel obstruction. you were treated with bowel rest and decompression via nasogastric tube. you were followed closely by the gi consult team, and an mri enterogram did not show any evidence of inflammatory bowel disease. after your obstruction improved, we clamped and eventually removed your ng tube. you did well with a swallowing evaluation and can eat and drink whatever you'd like when you go home. followup instructions: please contact your office (dr. ) if you would like an appointment. md procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances diagnoses: obstructive sleep apnea (adult)(pediatric) urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia other shock without mention of trauma other constipation other diseases of lung, not elsewhere classified dehydration multiple sclerosis ileostomy status delirium due to conditions classified elsewhere unspecified intestinal obstruction quadriplegia, unspecified gastroparesis other cystostomy 

Answer: The patient is high likely exposed to