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: valium attending: chief complaint: sob/altered mental status c/b hypercarbic respiratory failure major surgical or invasive procedure: picc intubation history of present illness: as per micu admission note, patient is a yo male with h/o parkinsons and 3 prior admissions with aspiration pneumonia, requiring intubation on episode in , s/p placement, who presents from his nh with decreased oxygen saturation and altered mental status. history is obtained per nh/hospital records. per the patient's wife, the pt desatted to 82% 2 nights pta, returning to normal in the am prior to admission. pt subsequently desatted later in the day. pt was placed on 02 by rt with good effect. wife also reported low grade fevers to about 99.7 (baseline 97.0). per the nh notes, the patient has not had a cough, but has been productive of thick clear sputum. in addition, he has also been more somnolent than normal, speaking less than usual. of note, the patient's wife reported that though the most recent speech and swallow evaluation recomended nectar thickened liquids and ground solids, he has been eating a regular diet. . in the ed the patient's vital signs were: t:99.4 hr:68 bp:161/83 rr:24 sao2:100% on 3l. cxr showed lll infiltrate and ua was positive. the patient was given 1g vanco, 500mg levoflox, 500mg flagyl, sinemet x2, mirapex x1, and comptan x1. . within an hour after arrival to the floor, the patient was noted to be somnolent and tired, not responding to commands and appearing lethargic. abg was performed, showing a ph 7.22, pco2 104, po2 146, hco3 42. given concerns for his hypercarbic respiratory failure, the patient was transferred to the micu for urgent intubation. . while in the micu the patient was intubated for hypercarbic respiratory failure and was been given vancomycin/zosyn to cover both aspiration pneumonia and urinary tract infection. mild hypotension with sedation. . ros: done on admission: "per patient's wife, + sob, weakness, constipation. - f/c, wt change, visual/hearing changes, ha, n/v, dysphagia, cp, abd pain, dysuria." past medical history: 1. h/o aspiration pna - tx with levo, unasyn, vanco/zosyn in the past 2. h/o aspiration s/p swallow eval with swallowing difficulty, s/p placement on 3. parkinson's 4. osteoporosis 5. t11/12 compression fx 6. lle osteomyelelitis as a child/chronic osteomyelitis, quiescent. 7. granulomatous liver disease 8. lue rotator cuff tear 9. prostate cancer s/p orchiectomy in 10. s/p laminectomy l4-5 11. cataracts s/p surgery . glaucoma 13. hypertension social history: the patient has a sixty-pack-year history of tobacco. he quit in . he lives in a nh for the past 2 years. he is a retired history professor. he reports no alcohol intake. family history: non-contributory physical exam: vs: t 97 hr 54 bp 99/52 rr 10 o2 100% on vent vent: mmv 550 x10 fio2 of 30/peep 5, pressure support 10/peep 5 gen: somnolent,sedated, intubated heent: nc/at, mmm, et tube in place, anicteric sclera neck: supple, no lad lungs: coarse anteriorly heart: rr, with 3/6 systolic murmur at the ll-sternal border. abdomen:+b/s, soft, , in place, tubefeeds running extremities: 1+ pitting edema bilat. ext warm. neuro: sedated, intubated pertinent results: ekg: (from micu) nsr at 68, left axis, normal intervals, no concerning st-twave abnormalities. . cxr : chest, ap and lateral: cardiac, mediastinal, and hilar contours are stable. the aorta is calcified and tortuous. pulmonary vasculature is unremarkable. there is a left lower lobe consolidation as well as hazy opacities in the left mid lung and linear atelectasis. there may be a small left pleural effusion. bulky mediastinal adenopathy is again seen. osseous and soft structures are unchanged with compression deformity of l1. impression: left lower lobe consolidation concerning for pneumonia. . indication: respiratory distress, intubation. . cxr : chest, one view: comparison with examination of the same day, 12:04 a.m. endotracheal tube is seen in good position, however, the balloon appears over- inflated. bilateral layering pleural effusions and associated atelectasis. no significant change in appearance of mediastinum and heavily calcified mediastinal lymph nodes. no findings to suggest failure. osseous structures are unchanged. the extreme right costophrenic angle is excluded from the study. impression: 1. endotracheal tube in good position, however, tube balloon is over-inflated. 2. bilateral layering pleural effusions and associated atelectasis. brief hospital course: yo m with h/o aspiration pna, swallowing difficulty, parkinsons, granulomatous disease, and htn, presents with acute hypercarbic respiratory failure and mental status changes in the setting of lll pna and possible aspiration event. transferred now to for ongoing management. . 1. hypercarbic respiratory failure: likely due to a combination of restrictive lung disease (neuromuscular weakness causing decreased chest wall compliance) due to parkinson's plus pneumonia/aspiration. likely is chronically hypercarbic. also have component of metabolic alkalosis. opacity in lll on . likely some chf especially given fluid rescucitation, new effusions and troponin elevation. tried to optimize all of these parameters by treating with antibiotics, diuresis with lasix. he improved but rsbi's were recurrently high. it was felt that even when healthy he is a rapid shallow breather (possibly parkinson's?) pt was extubated on after abg's remained relatively stable while he was on an for several hours. it is felt that baseline co2s are likely in the 50's-60's. on the floor, his pneumonia was treated with broad spectrum abx (zosyn and vanco). . 2. pneumonia: likely aspiration exacerbated by underlying pd and baseline pulmonary disease. he was treated with vanco/zosyn and cipro per id recs (broadened to zosyn given decompensation requiring intubation). he completed 10 days of vanc/zosyn and will continue cipro to complete a full 10 days. he will continue to require aspiration precautions and chest pt. . 3. hypotension: pt became transiently hypotensive following bolus sedation after intubation, improved with ivf. subsequently would have hypotension at night when he was sleeping (bp's into the 70's) but then would improve to 110's once awakened. bp now more stable and we were able to add his lisinopril back on. . 4. anemia: pt with 9pt hct drop early in admission. baseline around 33. no active signs of bleeding. by the time of discharge, the hematocrit had returned to baseline. . 5. altered mental status: likely due to pco2 of 100. improved when pco2 decreased to 70s. also likely has superimposed component of infection. at time of discharge, his mental status was back to baseline according to his wife. . 6. elevated troponins: cycled and remained flat (0.04-0.10). no documentation of complaint of chest pain. ekg was unchanged. . 7. parkinson's disease: continued on home regimen during admission. neurology was consulted to determine if any changes in his medications could help with breathing mechanics. tried increasing pramipexole but no real improvement seen. . 8. glaucoma: continued on home regimen . 9. fen: need to address nutritional status. patient received video swallowing study before discharge, was read as silent aspiration with thin liquids and diet needs to be strictly nectar thickened liquids and regular food. . medications on admission: lorazepam 1mg q4h prn. hydrocodone-acetaminophen tab po q4h:prn acetaminophen 650 mg po q4h:prn milk of magnesia 30 ml po daily:prn senna 2 tab po bid fexofenadine 60 mg po bid trazodone 25 mg po hs vitamin d 400 unit po bid bisacodyl 10 mg po/pr daily:prn fluticasone propionate nasal 1 spry nu entacapone 200 mg q 5am, 8am, 11am, 2pm, 5pm, 8pm, 11pm pramipexole 0.125 mg q 5am, 8am, 11am, 2pm, 5pm, 8pm, 11pm carbidopa-levodopa (25-100) 2 tab po q5am, 8am, 11am, 2pm, 5pm, 8pm, 11pm docusate sodium (liquid) 100 mg po daily omeperazole 20mg po q24h aluminum-magnesium hydrox.-simethicone 30 ml po qid:prn @ guaifenesin-dextromethorphan 10 ml po q4h:prn artificial tears 1 drop both eyes tid chlorhexidine gluconate 15 ml po bid latanoprost 0.005% ophth. soln. 1 drop both eyes hs dorzolamide 2%/timolol 0.5% ophth. 1 drop both eyes albuterol 0.083% neb soln 1 neb ih q4h:prn fiber con 625 daily discharge medications: 1. fexofenadine 60 mg tablet : one (1) tablet po bid (2 times a day). 2. cholecalciferol (vitamin d3) 400 unit tablet : one (1) tablet po bid (2 times a day). 3. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 4. senna 8.6 mg tablet : 1-2 tablets po bid (2 times a day) as needed for constipation. 5. fluticasone 50 mcg/actuation aerosol, spray : one (1) spray nasal (2 times a day). 6. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po daily (daily). 7. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : one (1) drop ophthalmic tid (3 times a day). 8. chlorhexidine gluconate 0.12 % mouthwash : fifteen (15) ml mucous membrane (2 times a day). 9. latanoprost 0.005 % drops : one (1) drop ophthalmic hs (at bedtime). 10. dorzolamide-timolol 2-0.5 % drops : one (1) drop ophthalmic (2 times a day). 11. entacapone 200 mg tablet : one (1) tablet po asdir (as directed). 12. carbidopa-levodopa 25-100 mg tablet : two (2) tablet po asdir (as directed): q5am, 8am, 11am, 2pm, 5pm, 8pm, 11pm . 13. pramipexole 0.125 mg tablet : 1.5 tablets po asdir (as directed): give 0.1875 at 11pm . 14. pramipexole 0.125 mg tablet : one (1) tablet po asdir (as directed): every 5am, 8am, 11am, 2pm, 5pm, 8pm. 15. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). 16. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 17. lisinopril 5 mg tablet : two (2) tablet po daily (daily). 18. ciprofloxacin 400 mg/40 ml solution : four hundred (400) mg intravenous q12h (every 12 hours) for 3 days. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: aspiration pneumonia hypercarbic respiratory distress discharge condition: stable discharge instructions: you were admitted with respiratory failure and altered mental status that was felt to be due to aspiration pneumonia. you required intubation and antibiotics. you were seen by neurology who suggested an increase in your parkinson's meds. your breathing continued to be tenuous at times, and we are concerned for continued aspiration. you were discharged to the macu for continued monitoring. followup instructions: please follow up with your doctor rehab. . please call your pulmonologist dr. (, to schedule a follow up appointment. md, procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified personal history of malignant neoplasm of prostate paralysis agitans acute respiratory failure pneumonitis due to inhalation of food or vomitus alkalosis gastrostomy status 

Answer: The patient is high likely exposed to