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: benadryl / morphine / ativan / compazine / lisinopril attending: chief complaint: neck pain. major surgical or invasive procedure: anterior and posterior revision of instrumented fusions. history of present illness: is a 65-year-old male with a long history of end-stage renal disease on hemodialysis who originally presented to dr. in with a cervical spine collapse into kyphosis who was subsequently treated with a discectomy and then later a staged anterior and posterior cervical spine reconstruction. he was discharged from the hospital, but represented approximately 5 weeks later after having fallen on the ice and found to have failure of his construct with migration of his anterior and posterior hardware, as well as dislodgement of his anterior fibular graft. the structure was reassessed with imaging and planned to undergo a revision anterior and posterior cervical spine reconstruction with deformity correction in a surgical setting. past medical history: 1. coronary artery disease: mi in , nstemi in , s/p rca and lcx stenting () 2. chf: ef 20% 3. diabetes mellitus ii: > 20 years, c/b nephropathy 4. hypertension 5. esrd on hd: mwf schedule, r av fistula 6. pvd: s/p r pfa to bk bypass graft with vein, s/p l 1-5th toe and 1-3rd toe amputation, s/p left cfa to ak with ptfe 7. hypothyroidism 8. atrial fibrillation 9. copd- by report, last pfts here in w/ nl fev1 and fev1/fvc 10. hepatitis c- last vl 623,000 in 11. chronic pancreatitis 12. peptic ulcer disease 13. right perinephric hematoma; status post embolization 14. obstructive sleep apnea on cpap 15. ruptured right groin abscess; recurrent right groin abscess 16. status post l inguinal hernia repair 17. status post umbilical hernia repair 18. status post cervical discectomy and corpectomy social history: lives in with wife. : 1 ppd x 60 yrs. he is still smoking, unclear how much. etoh: denies illicits: h/o narcotic abuse. should avoid iv pain medications, especially dilaudid, morphine. family history: non contributory physical exam: physical exam: gen: wd/wn, comfortable, nad. neck: in hard collar though apparent kyphosis lungs: bibasilar decreased bs bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. neuro: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, and date. : d b t fe ff ip q at g sensation: intact to light touch bilaterally. pertinent results: ct c-spine 2/15/08:1. since , progression of focal kyphotic angulation with the apex of the curve at the c4 level causing at least moderate canal stenosis. new fracture of the c6 spinous process and further distraction of the left c5/6 facet joint. further destructive changes of the c3 and c6 vertebral bodies and the lateral masses of c6. 2. ventral epidural soft tissue extending from c4/5 to the c6/7 level which may represent hematoma or phlegmon. 3. anterior displacement of the anterior fixation plate and screws as well as fracture, angulation, and displacement of the bone graft. there has been further inferior displacement of the fixation plate and bone graft since . . 11:30am pt-12.7 ptt-32.8 inr(pt)-1.1 11:30am wbc-7.0 rbc-3.74* hgb-11.7* hct-38.6* mcv-103* mch-31.3 mchc-30.3* rdw-15.4 11:30am plt count-448* 11:30am urea n-34* creat-6.0*# sodium-137 potassium-4.7 chloride-97 total co2-26 anion gap-19 11:30am -10.0 phosphate-5.4* magnesium-2.4 . echo: lvef 23%, no evidence of endocarditis. dilated left ventricle with severe regional/global systolic dysfunction. mild right ventricuilar systolic dysfunction. at least mild aortic stenosis. mild pulmonary hypertension. . ct scan: no hardware malalignment or fracture. expected postoperative findings include air in the soft tissues as well as soft tissue swelling with loss of fat planes. . picc placement: uncomplicated ultrasound and fluoroscopically guided single-lumen picc line placement via the left basilic venous approach. final internal length is 42 cm, with the tip positioned in svc. the line is ready to use. . labs on discharge: 05:00am blood wbc-11.9* rbc-2.93* hgb-9.1* hct-29.6* mcv-101* mch-31.1 mchc-30.9* rdw-18.4* plt ct-515* 05:00am blood plt ct-515* 05:00am blood glucose-140* urean-23* creat-5.0* na-137 k-4.1 cl-97 hco3-27 angap-17 05:00am blood -8.2* phos-3.1 mg-2.1 brief hospital course: mr. is a 65 y.o. m with esrd on hd, cad, chf, renal cervical spondyloarthropathy s/p anterior cervical discectomy in admitted to the neurosurgery service with increasing shoulder pain found to have cervical hardware failure treated with surgical revision of anterior/posterior cervical fusion (c3-c6). his course has been complicated by respiratory failure, vap and hypotension requiring several transfers to the micu. . 1. renal cervical spondyloarthropaty s/p surgical revision of anterior posterior fusion: he was admitted due to hardware failure of prior anterior/posterior cervical fusion. he was readied for the or and brought there on where under general anesthesia he revision anterior and posterior cervical spine reconstruction with deformity correction, removal of anterior plate, removal of posterior lateral mass screws, removal of anterior intervertebral graft, revision corpectomy c3, c4,c5, c6, revision anterior interbody allograft strut, arthrodesis anterior c2-c7, interior plate instrumentation c2-c7, posterior wound culture, posterior revision arthrodesisc2-t1, hardware removal posterior cervical spine, revision instrumentation c2-t1, revision posterior arthrodesis with local autograft, allograft chips and in fuse bone morphogenic protein supplementation. he tolerated this well and remained intubated and was transferred to the icu for close monitoring. he had drains placed intraop - posterior and anterior - output was monitored. he was moving all 4 extremities well post-op. incisions were cdi. on #3 he tolerated extubation and drains were removed. he was transferred to the floor, seen in consultation by pt/ot. on # 5 he had respiratory distress requiring intubation and transfer back to icu. following intubation a ct of the c-spine was obtained showing good hardware alignment. he was treated for pain with standing tylenol and low dose oxycodone 2.5 - 5mg as needed. he was advised to continue wearing the cervical collar at all times for at least the next three months. he will be advised by dr. when he can remove the cervical collar. his posterior staples were removed during his inpatient stay and he was scheduled for follow up with dr. prior to discharge. . 2. respiratory failure: he was transferred to the micu on two separate occasions, the first for hypercarbic respiratory failure requiring intubation thought due to vap/aspiration pneumonia and, obstructive sleep apnea, and hypercarbic from narcotics. he may have also had a component of edema in soft tissues surrounding airway from c-spine surgery. his second micu transfer was for difficulty clearing secretions and macroglossia, he did not require intubation the second time. he was treated with vanocmycin and zosyn to complete a 14 day course of treatment for vap/aspiration pneumonia. since transfer out of the micu on he has been breathing comfortably on room air, and doing well on cpap overnight. on he was cleared by speech and swallow video study for thin liquids, soft solids, drink by cup only, no straws, crushed meds with purees, no mixed consistency foods. he tolerated this diet well without any evidece of aspiration. . 3. esrd: no acute issues during this admission, he was continued on hemodialysis mwf. he was continued on nephrocaps, cinacalcet, and lanthanum. he was given vancomycin with dialysis to complete a 14 day course for pneumonia as above. . 4. hypertension: normotensive during admission with dialysis mwf. the patient was continued on his current dose of metoprolol 12.5mg , which was held on dialysis days. prior to discharge he was changed back to metoprolol xl 25mg daily. . 5. cad: chronic systolic heart failure with ef 23%. significant cardiac history. no active issues during his admission. the patient was continued on low dose aspirin 81mg daily, atorvastatin, and metoprolol. lisinopril was stopped due to history of recent angioedema. . 6. atrial fibrillation: throughout his admission he remained in normal sinus rhythm and rate controlled. he was continued on aspirin, amiodarone, and metoprolol. he is not on coumadin due to prior bleeding episodes. . 7. type 2 diabetes: diet-controlled. no acute issues. he was continued on humalog insulin sliding scale and diabetic diet. . 8. copd: no active issues. he was continued on albuterol, atrovent and mucomyst nebs as needed. . 9. hypothyrodisim: no active issues. he was continued on levothyroxine. . 10. smoking history: no active issues. he was given a nicotine patch while in hospital. . 11. fen: cleared by speech and swallow video study for thin liquids/soft solids, replete lytes prn. cardiac/diabetic diet. . 12. code status: full medications on admission: albuterol 0.083% neb amiodarone 100 mg po daily citalopram hydrobromide 20 mg po daily atorvastatin 10 mg po daily levothyroxine sodium 50 mcg po daily pantoprazole 40 mg po q24h cinacalcet hcl 60 mg po daily sevelamer 1600 mg po tid w/meals gabapentin 200 mg po q48h tizanidine hcl 2 mg po bid metoprolol xl 25mg daily discharge medications: 1. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 2. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 3. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 4. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 6. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 7. levothyroxine 50 mcg tablet sig: one (1) tablet po once a day. 8. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 9. lanthanum 500 mg tablet, chewable sig: one (1) tablet, chewable po tid w/meals (3 times a day with meals). 10. aspirin 81 mg tablet sig: one (1) tablet, chewable po daily (daily). 11. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 12. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for indigestion. 13. amiodarone 100 mg tablet sig: one (1) tablet po once a day. 14. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 15. cinacalcet 30 mg tablet sig: two (2) tablet po daily (daily). 16. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 17. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 18. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 19. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed. 20. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4h (every 4 hours) as needed. 21. psyllium 1.7 g wafer sig: one (1) wafer po daily (daily). 22. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours). 23. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 24. heparin flush cvl (100 units/ml) 1 ml iv daily:prn 10ml ns followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen qd and prn. inspect site every shift 25. piperacillin-tazobactam 2.25 gram recon soln sig: 2.25 g intravenous q8h (every 8 hours): last day . 26. insulin lispro 100 unit/ml solution sig: inject as directed according to sliding scale subcutaneous asdir (as directed). 27. oxycodone 5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for neck pain. 28. vancomycin 1,000 mg recon soln sig: per hd intravenous qhd: last day . discharge disposition: extended care facility: northeast - discharge diagnosis: primary: 1. cervial spine hardware failure 2. hypercarbic respiratory failure 3. aspiration pneumonia . secondary: 1. coronary artery disease 2. systolic heart failure 3. diabetes mellitus type 2 4. hypertension 5. end-stage renal disease on hemodialysis: mwf schedule, r av fistula 6. peripheral disease 7. hypothyroidism 8. atrial fibrillation 9. chronic obstructive pulmonary disease 10. hepatitis c 11. chronic pancreatitis 12. peptic ulcer disease 13. right perinephric hematoma 14. obstructive sleep apnea on cpap 15. ruptured right groin abscess 16. status post left inguinal hernia repair 17. status post umbilical hernia repair 18. status post cervical discectomy and corpectomy discharge condition: stable. discharge instructions: you were admitted to the hospital because you were having worsening shoulder pain and had surgery to revise a prior anterior/posterior cervical fusion. your hospitalization was complicated by respiratory failure and very low blood pressure requiring intubation and transfer to the icu. you were also thought to have a pneumonia likely from aspiration, which is when food/stomach contents get into your airway. . you are undergoing treatment for aspiration pneumonia. you should continue vancomycin at hemodialysis and zosyn every 8 hours to complete a 14-day course. you will complete your courses of vancomycin and zosyn . . discharge instructions for spine cases ?????? do not smoke ?????? keep wound clean / no tub baths or pools until seen in follow up/ take daily showers ?????? you have steri-strips in place on the front of your neck. do not pull them off. they will fall off on their own or be taken off in the office ?????? no pulling up, lifting> 10 lbs., excessive bending or twisting for two weeks. ?????? limit your use of stairs to 2-3 times per day ?????? have a family member check your incision daily for signs of infection ?????? you are required to wear cervical collar at all times ?????? take pain medication as instructed; you may find it best if taken in the a.m. when you wake for morning stiffness and before bed for sleeping discomfort ?????? do not take any anti-inflammatory medications such as motrin, advil, aspirin, ibuprofen etc. for 3 months ?????? increase your intake of fluids and fiber as pain medicine (narcotics) can cause constipation call your surgeon immediately if you experience any of the following: ?????? pain that is continually increasing or not relieved by pain medicine ?????? any weakness, numbness, tingling in your extremities ?????? any signs of infection at the wound site: redness, swelling, tenderness, drainage ?????? fever greater than or equal to 101?????? f ?????? any change in your bowel or bladder habits followup instructions: you have an appointment scheduled to follow up with your neurosurgeon, dr. , on . please arrive at 10:00am and have an xray prior to your appointment. the xray will be taken in the clinical center building at . your appointment with dr. will be at 10:45am. please call if you need to reschedule. . please call and schedule an appointment to follow up with your primary care doctor within one to two weeks of discharge from rehab. . you have a previously scheduled appointment: provider: , .d. phone: date/time: 11:20 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube hemodialysis non-invasive mechanical ventilation insertion of other (naso-)gastric tube removal of implanted devices from bone, other bones other excision of joint, other specified sites other cervical fusion of the anterior column, anterior technique transfusion of packed cells fusion or refusion of 2-3 vertebrae fusion or refusion of 2-3 vertebrae insertion of recombinant bone morphogenetic protein refusion of other cervical spine, posterior column, posterior technique diagnoses: end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery tobacco use disorder congestive heart failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified unspecified viral hepatitis c without hepatic coma atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure pneumonitis due to inhalation of food or vomitus surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation chronic systolic heart failure accidents occurring in other specified places surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus accidents occurring in residential institution chronic pancreatitis atherosclerosis of native arteries of the extremities, unspecified diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction infection and inflammatory reaction due to nervous system device, implant, and graft other mechanical complication of other internal orthopedic device, implant, and graft other kyphosis (acquired) 

Answer: The patient is high likely exposed to