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: small bowel obstruction & sepsis pneumonia major surgical or invasive procedure: none history of present illness: this is a 71 year old male with history of severe pd, mild cognitive impairment, copd and htn who presents with 12 hours of abdominal pain and vomiting of 1000cc of black emesis. he was in his usoh until one day pta when he complained of some abdominal pain and lack of appetite. later that night he was discovered to have black (coffee ground?) emesis on his chest. he was brought to an osh where there were no icu beds available, and transferred to . on arrial o2 sat was 85% ra, he was in some respiraory distress, lactate was 4.7, creatinine 2.6, normal wbc with 48% bands, bcx taken, ekg done, ct scan of the abdomen without contrast was performed, he was intubated for ct scan then extubated. final read of ct scan showed small bowel obstruction. also had a patchy opacity at the right base. given cefepime, vanco and flagyl. received 4mg iv morphine. he was given iv ppi for ugib. surgery evaluated the patient and diagnosed him with small bowel ischemia. the patient's daughter and daughter in law are both physicians, understood his poor prognosis and made the pt . several hours later upon learning of the final radiology read of the ct abdomen which did not see evidence of bowel ischemia, the family wanted the patient to be reassessed and code status was reversed. after much discussion with the surgical team, medical team, and medical icu team, the family had decided to opt for medical management, and forgo future surgical procedures. he was made dnr/dni with the plan to observe him for improvement in the icu. past medical history: htn severe parkinson's disease copd depression anxiety hip replacements bilaterally mild cognitive decline b12 deficiency hx lacunar infarcts on imaging no hx abdominal surgery social history: recently arrived from . daughter is an internal medicine physician from who has not practiced since arriving in the us. son-in-law is a practicing physician in us. schooled in ; fluent in english. does not smoke or drink alcohol. family history: noncontributory. physical exam: tmax: 38.6 ??????c (101.4 ??????f) tcurrent: 38.3 ??????c (101 ??????f) hr: 101 (98 - 112) bpm bp: 105/54(70) {71/40(51) - 108/54(71)} mmhg rr: 28 (18 - 34) insp/min spo2: 96% gen: responsive to name, spontaneous eye opening, in some distress heent: mmm lungs: decreased breath sounds at bases bilaterally, transmitted upper airway sounds, has mild expiratory wheezes at midnight but none appreciate this am. cor: heart sounds distant, tachycardic, normal rhythm, no m/r/g abd: rare hypokinetic bowel sounds, distended but not taught, no rebound appreciated. ext: warm, was diaphoretic on admission. 2+ peripheral pulses throughout. pertinent results: initial () wbc 9.6 hb 15.9 hct 48.3 plts 268 48% bands inr 1.2 144 109 40 -------------------< 80 4.6 22 2.0 lfts wnl ca 7.1 phosphate 2.8 mg 1.8 lactate 7.3 (up from 4.7 on admission) ua: hyaline casts, 2+ bilirubin lactate 7.3 second septic episode () wbc 20.0 hb 10.7 hct 31.5 plts 213 peaked at 13% bands () 134 98 33 4.0 24 2.0 alb 2.3 lactate peak 5.2 (on ) micro: bcx: negative mrsa screen: negative bcx: negative cdiff: negative hpylori: negative ucx: negative bcx: no growth to date ucx: negative ucx: negative cdiff: negative cdiff: negative imaging: cxr: the lungs are clear. trace left pleural effusion is noted. there is no pneumothorax. heart size is normal. there is tortuosity of the thoracic aorta with atherosclerotic calcification. the mediastinal silhouette is otherwise unremarkable. hilar contours and pulmonary vasculature are normal. nasogastric tube follows a normal course projecting over the left upper abdomen but the distal end is not visualized. ct abd/pelvis: 1. multiple dilated fluid-filled loops of small bowel with fecalization. limited evaluation, but no definite evidence of pneumatosis. no definite transition point, although the bowel tapers in the right mid abdomen. findings suggest small-bowel obstruction. no confirmatory signs of bowel ischemia (wall thickening/pneumatosis) identified within confines of noncontrast enhanced ct. 2. patchy opacity at the right lung base could represent aspiration or infection. 3. compression deformity of the l4 vertebral body, likely chronic. 4. atherosclerotic disease in the coronary arteries and abdominal aorta. kub: 1. nonspecific mild bowel dilation are improved compared to prior. however, persistent small-bowel obstruction cannot be definitively excluded. 2. enteric tube with tip overlying the stomach. ct torso: 1. interval worsening of bibasilar opacities with development of small bilateral pleural effusions. this is suggestive of worsening pneumonia, possibly related to underlying aspiration. some scattered pulmonary nodules are noted, which should be followed up in months given size and underlying moderate centrilobular emphysema. 2. resolved small-bowel obstruction with normal appearance to the bowel. 3. atherosclerotic disease involving the aorta with dense calcification of the coronary arteries. 4. bilateral gynecomastia of unclear etiology. cxr: rotated positioning. an ng type tube is in place, tip extending beneath the diaphragm. there is a small left effusion with left lower lobe collapse and/or consolidation, similar to . the effusion may be slightly larger. again seen is atelectasis in the right cardiophrenic region. no chf or right-sided effusion is identified. ununited right clavicular fracture again noted. discharge labs: 05:08am blood wbc-16.4* rbc-2.97* hgb-8.4* hct-25.1* mcv-84 mch-28.1 mchc-33.3 rdw-15.7* plt ct-250 05:08am blood plt ct-250 05:08am blood glucose-133* urean-35* creat-2.0* na-136 k-3.6 cl-97 hco3-35* angap-8 05:08am blood calcium-7.3* phos-3.2 mg-1.9 brief hospital course: mr. is a 71yo man with advanced parkinson's disease, htn and copd who presented with small bowel obstruction and sepsis, then developed a pneumonia from which he did not recover. . # abdominal pain: ct scan on admission indicated ischemic bowel initially, but hten was confirmed to be a small bowel obstruction. it was decided to be managed medically. it resolved after suction ngt decompression and being held npo for 24 hours. he put out a large quantity of liquid stool which was guaiac negative and c diff toxin was negative. he tolerated tube feeds during the hospitalization and sbo eventually resolved. pt's tube feeds were eventually discontinued after a discussion with family regarding pt's goals of care. . # sepsis: pt had an elevated lactate which trended down quickly with ivf and antibiotics. he was started on vanc/cefepime/metronidazole for a presumed abdominal infection and microperforation. he received 12l fluid over the first 24 hours of hospitalization. he was hypotensive and managed with pressors peripherally for his first 12 hours on the floor, at which point he was weaned and he continued to improve. his lactate and wbc trended down eventually. antibiotics were narrowed to vanc/unasyn for presumed intraabdominal infection. on hd#10 however he became newly septic; a ct scan suggested aspiration pneumonia and showed no abdominal processes. he was then empirically treated with vanc/cipro/zosyn for a hospital acquired pneumonia. his lactate increased to 5.2 and he had a 9% bandemia. his blood pressure was tenuous over 48 hours but he did not require pressors. his clinical status did not improve in spite of the antibiotcis. after discussion with family regarding goals of care at this point, antibiotics were discontinued. . # hypoxia: after sepsis and the sbo resolved, pt was noted to have large amounts of secretions which required frequently suctioning and nursing attention. pt has o2 desaturations to 70-80% on room air. he is currently satting well on 50% face mask. his chf required diuresis when he was not receiving fluid resuscitation for hypotension. he received iv doses of lasix as needed. . # mental status change: pt was agitated, anxious and nonverbal for the first two days of hospitalization, after which his agitation resolved. the family indicated his mental status was improving. however, during the second septic episode he became minimally responsive. his mental status has not recovered. it is likely multifactorial, but most likely a toxic-metabolic encephalopathy vs. parkinson's related dementia. ammonia levels, lfts, and other lab testing did not reveal a reversible etiology. . # parkinson's disease: pt recently was brought to the us by his family for evaluation of his parkinson's disease. his pre-admission regimen included bromocriptine, amantadine and ropinorole. a neurology consultation was pursued and they recommended beginning sinemet, which the pt was receiving through the ng tube. however, once the artificial feeds were discontinued, pt was not receiving the medication. pt was also maintained on iv valproate for myoclonic jerks. pt was switched to iv keppra 250mg in preparation for discharge as iv valproate not available on ltac formulary. . # . pt's creatinine on presentation was 2.0, and decreased to 0.8 over the first several days of hospitalization. during his second septic episode, his creatinine spiked to 2.2. although a fena was suggestive of a prerenal cause, atn was favored due to lack of response to fluids. cr improving slowly on discharge to 2.0. . # htn: pt's hypertensive regimen was held throughout his hospitalization, except lasix that was used in iv form to manage his volume overload state. lasix was eventually discontinued after discussion with family regarding goals of care. . # gib: initial ngt suctioning was guaiac positive and his hct dipped slightly at admission. however, it quickly stabilized at 35. this was thought to be either due to some luminal bleeding at site of sbo or due to gastric irritation/tears with retching. a workup demonstrated a positive h pylori antibody, however, treatment was deferred regarding given poor clinical prognosis. . # code status: pt was initially full code, then transitioned to dnr/dni given sepsis and poor recovery in the icu. after transfer to the floor, a family meeting was held to discuss overall goals of care in the setting of pt's unresponsiveness and poor prognosis. family confirmed that pt is . pt's daughter and son-in-law were present at the meeting and later discussed the decision with wife. family did enquire about possibility of resuming tube feeds for nutrition, however, after hearing that it would not improve pt's chances for full recovery, they agreed not to pursue it. medications on admission: amantadine bromocriptine norvasc aldactone plavix ppi risperdal citalopram valproic acid (500mg qam 750 qhs) daily for myoclonus discharge medications: 1. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po tid (3 times a day): ok to hold if unable to tolerate po. 2. scopolamine hbr 0.25 % drops sig: one (1) drop ophthalmic qid (4 times a day). 3. scopolamine base 1.5 mg patch 72 hr sig: one (1) patch 72 hr transdermal every 3 days (every 3 days). 4. hyoscyamine sulfate 0.125 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual qid (4 times a day). 5. morphine 5 mg/ml solution sig: one (1) injection q2h (every 2 hours) as needed for shortness of breath, discomfort. 6. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q2h (every 2 hours) as needed for wheezing. 8. acetylcysteine 20 % (200 mg/ml) solution sig: one (1) ml miscellaneous q6h (every 6 hours) as needed for secretions in lung. 9. keppra 500 mg/5 ml solution sig: two y (250) mg intravenous twice a day. 10. pantoprazole 40 mg recon soln sig: forty (40) mg intravenous once a day. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: small bowel obstruction healthcare-associated pneumonia parkinson's disease discharge condition: level of consciousness: lethargic and not arousable. occasionally opens eyes however nonverbal and unresponsive. activity status: bedbound. discharge instructions: dear mr. , . it was a pleasure taking care of you here at . you were admitted for abdominal pain, vomiting, and distention, which was caused by a small bowel obstruction. with decompression of your bowels and bowel rest, your obstruction resolved without the need for surgical intervention. . meanwhile, you developed a serious infection, likely aspiration pneumonia given that you are unable to clear your secretions. in spite of broad spectrum iv antibiotics, you deteriorated clinically and your mental status did not recover. antibiotics and other medications were eventually discontinued, while other measures were started to ensure comfort. you were then discharged to another facility where your comfort-focused care will be continued. . the following changes were made to your medication regimen: #. stop amantadine and bromocriptine, per neurology #. sinemet was started for parkinson's, however, you are not able to tolerate anything mouth currently. if he regains swallowing capacity, it can be given. #. the rest of your home medications are also on hold because you are not able to tolerate anything by mouth. # start scopolamine eye drops, scopolamine patch and hyoscyamine sublingual tablets to help control secretions # start morphine 5 mg iv every 2 hours as needed for shortness of breath, discomfort # change your home valproate tablets to keppra (leviteracitam) 250mg iv every 12 hours # start ipratropium, albuterol and acetylcysteine treatments as needed for wheezing followup instructions: if leaves ltac, follow up care can be arranged by hospice. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization arterial catheterization diagnoses: pneumonia, organism unspecified toxic encephalopathy unspecified essential hypertension acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified unspecified septicemia depressive disorder, not elsewhere classified sepsis paralysis agitans anxiety state, unspecified pneumonitis due to inhalation of food or vomitus alkalosis personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits encounter for palliative care do not resuscitate status hematemesis unspecified intestinal obstruction other abnormal glucose hip joint replacement mild cognitive impairment, so stated unspecified cerebrovascular disease 

Answer: The patient is high likely exposed to