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: penicillins attending: chief complaint: concern for cervical spine metastasis. major surgical or invasive procedure: laminectomy lumbar puncture paracentesis history of present illness: is a 57-year-old right-handed man, with a history of tonsillar carcinoma in , s/p radiation, who presented to with worsening right arm and right leg weakness. his symptoms started approximately in with progressive neck pain and weakness on the right side. he also describes left thoracic parathesias that resolved. an mri of the cervical spine for concern for cervical meylopathy showed some sort of inflammatory changes and he was started on therapeutic steroids with some improvement in his symtpoms. he was able to move his right side and his spasticity completely resolved. over the past 5 days, prior to transfer to his symptoms have escalated to the point that he was no longer ambulatory. he was admitted to for further management. at , his steroids were increased from dexamethasone 4 mg po bid to 4 mg iv q4h. repeat mri showed enhancement at c2-3 level within the spinal cord, which is concerning for tumor in the cervical spine. a lumbar puncture was performed which had mildly elevated protein but negative cytology for malignant cells. oncology was consulted and was concerned that his present illness could be due to a recurrence of his past tonsilar carcinoma. cea and ca -9 were sent and they were within normal limits. he was transfered to for further management. on the floor here, he reports the above history. he has no pain at this time. he is frustrated with his persistent right-sided weakness. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations. denies cough, shortness of breath, or wheezes. denies nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denies arthralgias or myalgias. denies rashes or skin breakdown. no numbness/tingling in extremities. no feelings of depression or anxiety. all other review of systems negative. past medical history: past oncological history: - tonsillar carcinoma diagnosed and treated with xrt. other past medical history: - cervical myelopathy believed to be secondary to prior head and neck radiation - alcoholic cirrhosis with chronic thrombocytopenia and history of varices, and he is status post banding - anxiety - chronic back pain on long term opiates - babeseosis social history: social history: he lives with his wife and 9-year-old son. smoked 1.5 packs of cigarettes per day for 35 years; he stopped in . he drank alcohol heavily in the past but he stopped in . he used cocaine in the remote past. - tobacco: he smoked from age 13 to 48, 1.5 ppd, so 50+ pack years - alcohol: former heavy drinker, last drink was in . - illicits: used cocaine in the past, none recently. family history: family history: his father died at age 47 from smoking-related lung cancer. his mother is alive and healthy. his 2 brothers are deceased, one from leukemia and the other from drug abuse and psychiatric problems. his 2 sisters are healthy. he has 4 children and they are all healthy. physical exam: vital signs: temperature 97.1 f, blood pressure 154/78, pulse 51, respiration 20, and oxygen saturation 98% on room air. gen: nad, pleasant skin: scattered bruises heent: dry mm, adentulous, no cervical lad cardiovascular: rrr, nl s1s2 no s3s4 mrg pulmonary: ctab with prolonged expiratory phase and generally distant bs abdomen: bs+, soft, ntnd, collaterals present, palpable splenomegaly 3cm below the costal margin extremities: contractures of the r hand and r foot drop, +clubbing neurological examination: his karnofsky performance score is 50. he is awake, alert, and oriented times 2. his thinking process is tangential and easily distracted. there is no right/left confusion or finger agnosia. his calculation is fair. his language is fluent with good comprehension, naming, and repetition. short-term recall seems intact. cranial nerve examination: his pupils are equal and reactive to light, 3 mm to 2 mm bilaterally. extraocular movements are full. visual fields are full to confrontation. he has increased left palpebral fissue or ptosis on the right. facial sensation is intact bilaterally. his hearing is intact bilaterally. his tongue is midline. palate goes up in the midline. sternocleidomastoids and upper trapezius are strong. motor examination: his muscle strengths are at all muscle groups on the left side. but the right side has 0/5 handgrip, at right finger and right wrist extensors, at right biceps, but 0/5 at right deltoid. his right lower extremity has 3/5 strength in right ileopsoas, 4+/5 at right quadriceps, right hamstrings, right tibialis anterior, and right . he has a right foot drop. muscle tone is decreased on the right side. his reflexes are 3+ on the right side and 2+ on the left. his ankle jerks are absent. his right is up while the left is down. sensory examination is intact to touch and proprioception; but there is hemisensory deficit to temperature from c5 on distally on the left side. coordination examination does not reveal appendicular dysmetria on the left side. he cannot walk. pertinent results: admission labs: 09:30pm blood wbc-14.1* rbc-4.00* hgb-13.4* hct-40.4 mcv-101* mch-33.4* mchc-33.1 rdw-17.1* plt ct-21* 09:30pm blood pt-15.2* ptt-27.8 inr(pt)-1.3* 09:30pm blood glucose-119* urean-23* creat-0.6 na-137 k-4.4 cl-105 hco3-24 angap-12 09:30pm blood alt-24 ast-40 ld(ldh)-217 alkphos-83 totbili-0.9 09:30pm blood albumin-3.5 calcium-8.6 phos-3.3 mg-2.3 uricacd-3.3* discharge labs: 07:25am blood wbc-4.2 rbc-2.78* hgb-9.5* hct-27.3* mcv-98 mch-34.2* mchc-34.8 rdw-16.4* plt ct-54* 07:25am blood pt-15.5* ptt-29.9 inr(pt)-1.4* 07:25am blood glucose-123* urean-17 creat-0.4* na-135 k-4.2 cl-105 hco3-24 angap-10 07:25am blood alt-16 ast-24 ld(ldh)-179 alkphos-64 totbili-1.4 07:25am blood albumin-3.8 calcium-8.7 phos-2.2* mg-2.3 csf studies: 03:00pm cerebrospinal fluid (csf) wbc-1 rbc-1* polys-0 lymphs-60 monos-40 03:00pm cerebrospinal fluid (csf) totprot-58* glucose-70 ld(ldh)-36 misc-cea = less 03:00pm cerebrospinal fluid (csf) csf-pep-no oligocl 03:00pm cerebrospinal fluid (csf) beta 2 microglobulin-wnl 03:00pm cerebrospinal fluid (csf) tuberculosis - pcr-test not detected 03:00pm cerebrospinal fluid (csf) cytology: negative for malignant cells blood parasite smear positive less than 1% parasitemia mr w& w/o contrast study date of 10:12 pm findings: image quality is yet again degraded by patient motion. accounting for this, there is again seen a ring-enhancing lesion centered at the c2-3 level, with a linear component that extends towards the cervicomedullary junction, with the lesion again measuring approximately 3.0 cm in si dimension and approximately 0.8 cm in ap dimension. there is extensive t2 hyperintensity surrounding this lesion and extending from the inferior aspect of the medulla to the c5 level. on the axial images, there is some enhancement, also extending towards the right aspect of the spinal cord inferiorly to the c3-4 level. there is no definite other focus of abnormal enhancement. the visualized posterior fossa is unremarkable. compared to the outside studies, the cord edema and enhancement have decreased. vertebral body height and alignmentt is preserved. again noted is diffuse increased t1 and t2 signal intensity throughout the vertebral bodies, with a few foci of slightly decreased signal intensity. the findings likely represent the sequela of prior radiation exposure. c2-3: there is no significant spinal canal or neural foraminal narrowing. c3-4: there is no significant spinal canal or neural foraminal narrowing. there is a mild disc bulge, which minimally flattens the ventral aspect of the thecal sac. c4-5: there is a mild disc bulge, without significant spinal canal or neural foraminal narrowing. c5-6: there is a minimal central disc protrusion, without significant spinal canal or neural foraminal narrowing. c7-t1: unremarkable. impression: ring-enhancing lesion centered at c2-3, with surrounding increased t2 hyperintensity. thiese findings have decreased compared to the outside study of . this indicates improvement. the lesion can be due to metastasis or otherwise in proper clinical stttings it can also be due to radiation necrosis. brief hospital course: is a 57-year-old right-handed man, with a history of tonsillar carcinoma in and status post radiation alone, who presents with progressive neck pain and r side hemiparesis and mri findings concerning for recurrence of his cancer versus radiation scarring. he is status post cervical laminectomy for tissue diagnosis. also, incidentally found to have possible babeseosis. he has ongoing dysphagia post operatively. (1) hemiparesis: etiology may be due to tumor involving the spine, but may also be related to inflammatory spinal process such as transverse myelitis or necrosis related to history of neck radiation treatment. steroids would be helpful in all of the above cases, so his improvement on steroids is not diagnostic. he is status post c1-3 laminectomies for open biopsy of intradural intramedullary spinal cord lesion. repeat c-t-l spine mri with and without contrast showed a diffuse increased signal intensity in the upper cervical cord, with a focal area of ring enhancement centered at the c2-3 level. there is edema in the surrounding cord which could be due to mets vs radiation scarring. he is on dexamethasone 4 mg iv q6hrs for now. biopsy and cytology pending, but preliminary likely to be due to radiation complication. he will see neuro-oncology and neurosurgery within the next 2 weeks. pt was working with patient, oob to chair with assist. (2) status post laminectomy: as noted above, patient had c1-3 laminectomies for open biopsy of intradural intramedullary spinal cord lesion. he is on pod#3. his post-op course was complicated by onset of atrial fibrillation with rvr which was self limited with bb as per op note. he was also very lethargic but arousable last few days now back to baseline. this was likely due to narcotics. he is on fentanyl 25 mcg patch in place of oxycontin. (3) dysphagia/odynophagia: patient with difficulty swallowing pills and apple sauce. this could be due to endotracheal intubation or due to posterior cervical neck surgery with limitation of neck motion. as per physical examination, he does not have any cranial nerve deficits. he passed speech and swallow today for grounded foods and crushed pills. he is on aspiration precautions. he will likely improved progressively and need speech and swallow reevaluation. (4) tonsillar squamous cell carcinoma: he is status post radiation in . his work up of cns disease is as above. (5) cirrhosis: this is based on pe and osh records, is cirrhotic. he has a history of varices, which have been banded but never bled. denies any history of encephalopathy. he reports that has secondary thrombocytopenia (see below) from his cirrhosis. meld score of 9. abdomen examination improved after paracentesis yesterday. he had 2.6l removed no sbp and he received total of 50 gm of albumin post tap. he was continued on nadolol 40 mg po daily. pantoprazole 40 mg daily was changed to prevacid dissolving tablet due to swallowing issues. he started rifaximin 200 mg po tid to prevent encephalopathy in the context of acute illness and cirrhosis. this can be discontinued as appropriate. (6) thrombocytopenia: per patient due to liver disease, which is plausible given his splenomegaly and cirrhosis causes a relative deficiency of thrombopoeitin. baseline at around 20,000. as per lab report he had ring enhancing on rbc, questionable for babeosis. final result pending. he was started on azithromycin 1000 mg iv q24h and atovaquone suspension 750 mg po/ng for the questionable babeosis until we have final result. (7) chronic pain: his oxycontin 40 mg po tid was held due to sedation. he was restarted on oxycodone 5-10mg po q4h prn with fentanyl patch 25 mcg. pain is well control on current regimen. (8) spasticity: baclofen and benzodiazepines were held for now to monitor for response to steroids. (9) hypothyroidism: tsh and free t4 were within normal limits. he should continue levothyroxine 112 mcg po daily. (10) fen: grounded foods and crushed pills, oncology repletion scales. (11) prophylaxis: pain control with oxycodone, bowel regimen, dvt prophylaxis with pneumoboots. (12) communication: with patient. (13) code: full. medications on admission: home medications: - valium 10mg podaily - folic acid 1mg po daily - levothyroxine 112 mcg po daily - mvi po daily - nadolol 40mg po daily - oxycodone 5-10mg po q6h prn pain - oxycontin 40-80mg q8h - pantoprazole 40mg po daily - dexamethasone 4mg po bid medications on transfer: - baclofen 3mg po tid - dexamethasone 4mg iv q4h - colate 100mg po bid - oxycontine 40mg po q8h - folic acid 1mg po daily - levothyroxine 112 mcg po daily - mvi po daily - nadolol 40mg po daily - oxycodone 5-10mg po q6h - pantoprazole 40mg po daily discharge medications: 1. docusate sodium 100 mg capsule : two (2) capsule po bid (2 times a day). 2. senna 8.6 mg tablet : one (1) tablet po daily (daily) as needed for constipation. 3. polyethylene glycol 3350 17 gram/dose powder : one (1) packet po daily (daily) as needed for constipation. 4. levothyroxine 112 mcg tablet : one (1) tablet po daily (daily). 5. nadolol 20 mg tablet : two (2) tablet po daily (daily). 6. cholecalciferol (vitamin d3) 400 unit tablet : two (2) tablet po daily (daily). 7. calcium carbonate 500 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 8. rifaximin 200 mg tablet : one (1) tablet po tid (3 times a day). 9. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). 10. oxycodone 5 mg tablet : one (1) tablet po q4h (every 4 hours) as needed for pain. 11. atovaquone 750 mg/5 ml suspension : seven y (750) mg po bid (2 times a day): 10 days. d1 to for babeseosis in a compromised host. 12. azithromycin 500 mg recon soln : 1000 (1000) mg intravenous q24h (every 24 hours): 10 days. d1 to for babeseosis in a compromised host . 13. dexamethasone 4 mg iv q6h 14. fentanyl 25 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 15. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 16. celexa 20 mg tablet : one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary: likely radiation necrosis of the spine, babeosis. secondary: tonsilar squamous cell carcinoma, cirrhosis, chronic thrombocytopenia, anxiety, chronic back pain. discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: out of bed with assistance to chair or wheelchair discharge instructions: you were admitted to the for weakness on your right side and evaluation of your spine. an mri showed an area in your spine of either scarring from previous radiation or cancer. neurosurgery biopsied the site. you were also treated with steroids, and your neurological problems stabilized. we also diagnosed you with an infection called babeosis. you are on antibiotics for this. we have made several changes to you medications. please refer to you medication list for your updated regimen. of note, we have switched you to a fentanyl patch rather than swallowing your oxycontin pills. followup instructions: at 1100am at , , ma provider: , md phone: at 9:30am at center, ma provider: , md phone: at 1115am , ma provider: , md phone: procedure: spinal tap incision of lung percutaneous abdominal drainage biopsy of spinal cord or spinal meninges diagnoses: thrombocytopenia, unspecified alcoholic cirrhosis of liver acquired coagulation factor deficiency unspecified acquired hypothyroidism cardiac complications, not elsewhere classified atrial fibrillation other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other ascites esophageal varices in diseases classified elsewhere, without mention of bleeding other specified paralytic syndrome late effect of radiation radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure personal history of malignant neoplasm of other and unspecified oral cavity and pharynx babesiosis other myelopathy 

Answer: The patient is high likely exposed to