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: presented with 3 day history of constipation with flatus and abdominal distention and pain. major surgical or invasive procedure: : subtotal colectomy hartmann's pouch, end ileostomy, insertion of gastrointestinal feeding system. history of present illness: 76 yo m with pmhx sig for parkinson's and history of constipation who presents with no stools for the past four days and abdominal pain and distention for the past few days. pain was initially in the lower abdomen, became increasingly severe, which caused the patient to come to the er. kub in the er demonstrated sigmoid volvulus - ct scan confirmed, and the patient was admitted to the sicu for decompression. past medical history: parkinson disease s/p deep brain stimulator placement hypertension hyperlipidimia social history: non contributory family history: non contributory physical exam: vs: 122/68 p 86 rr 29 96% on fio2 50% (after aspiration in ed) heent: nc/at, perrla, eomi cv: pulses 2+ bilaterally, rrr, no m/r/g lung: bilateral crackles and rhonchi abd: obese, distended, firm, +bs ext: able to mae 5/5 strength bilaterally, notable parkinsonian tremor pertinent results: admission labs --------------- 05:15pm urine sperm-few 05:15pm urine hyaline-* 05:15pm urine rbc-0-2 wbc-0-2 bacteria-few yeast-none epi-0-2 05:15pm urine blood-tr nitrite-neg protein-tr glucose-100 ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 05:15pm urine color-yellow appear-clear sp -1.036* 05:30pm pt-11.9 ptt-26.0 inr(pt)-1.0 05:30pm plt smr-normal plt count-293 05:30pm hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-1+ microcyt-normal polychrom-normal 05:30pm neuts-92.8* bands-0 lymphs-4.3* monos-2.4 eos-0.2 basos-0.3 05:30pm wbc-13.7*# rbc-4.54* hgb-14.7 hct-45.2 mcv-100* mch-32.4* mchc-32.5 rdw-13.6 05:30pm calcium-9.5 phosphate-2.4* magnesium-3.3* 05:30pm alt(sgpt)-45* ast(sgot)-44* alk phos-143* amylase-35 tot bili-0.8 05:30pm estgfr-using this 05:30pm glucose-189* urea n-21* creat-1.2 sodium-137 potassium-4.0 chloride-97 total co2-26 anion gap-18 05:44pm lactate-2.7* k+-3.9 08:27pm type-art temp-37.2 po2-124* pco2-43 ph-7.39 total co2-27 base xs-1 intubated-intubated . . date: signed by , md on affiliation: cosigned by , md on movement disorders consult note: i have seen mr today as requested by the neurology consult team for advice on management of his treatment for parkinson's disease. the plan of care was discussed with dr , md, movement disorders attending, and the plan reflects her thoughts and recommendations. . current pd medication: sinemet 25/100: 6:30 9:00 11:30 14:00 16:30 19:00 21:00 1 tuberculosis 1.5tb 1.5tb 1.75tb 1.5tb 2tb 1tb . : 6:30 9:00 11:30 14:00 16:30 2mg 2 mg 3mg 2mg 3mg . artane 2 mg in am . dbs ipg's investigated by me at bedside: left: 2-, case+, 2.6v, 120mcs, 135 hz, continuous stim with no interruptions since reset of , impedances ok with no short- or open-circuits, battery voltage 3.72 right: 0-, 2+, 3v, 150mcs, 185hz, continuous stim with no interruptions since reset of , impedances ok with no short- or open-circuits, battery voltage 3.72 exam: s/p abdominal surgery, g tube in place, continuous feeds run. drowsy but easily arousable. follows simple commands only. not oriented to time or place. able to answer yes, no, and simple one-item questions. evaluation limited by complete aphonia. unable to see pupils due to forceful voluntary and reflex eye closure. increased tone diffusely with cogwheeling and some spasticity. no resting tremor, but tremor of lue and lle emerges when the stimulator turns off mom while checking impedances. agile repeated hand movements, unable to do a full pd motor exam. responds normally to pain. toes r up, l down, dtr's increased, b/l ankle clonus present. impression and plan: patient with advanced pd s/p dbs surgery, now in icu post-op. limited data on prior history. attempted to contact dr at bu at , awaiting call back after page. evidence of some encephalopathy and systemic impairment, both confounding exam. it is expected that pd signs will be worse with the major intercurrent stressor, but adjusting medication and especially dbs settings is not appropriate in this environment. would plan first for resolving the acute condition, and taking measures to improve and prevent delirium. to maximize gain from sinemet, please hold feeds at least 30 min before and after giving sinemet to increase absorbtion. continue current dose. continue . dbs working normally, will not change settings now, and there is evidence of good benefit at least on the tremor. doubt significant benefit from artane, and tremor controlled by dbs. reduce dose to 1 mg daily for 3-4 days, then d/c artane, as it is likely to contribute to some of the confusion. if after improving the patient's general condition he remains delirious, contact us re: reducing the dose temporarily. in response to the question regarding use of reglan from neuro consult resident, please note that this medication is likely to worsen the parkinsonian symptoms. only use if vital and no alternative, and only for short term. umn signs of unclear origin, possibly part of encephalopathy, to be addressed by neuro consult plan communicated to dr of neurology and neurology consult resident. we will gladly remain involved in management at the primary team's request. , md . date: bedside swallowing evaluation: summary / impression: there were no overt signs or symptoms of aspiration at the bedside today. by patient and family report, the pt is doing well with thin liquids and puree, and repeat cxr shows "gradual improvement of bilateral upper lobe consolidations". it appears safe for the pt to continue on this diet. he will likely be discharged to a rehab facility, and if he continues to tolerate these consistencies it may be appropriate to introduce trials of soft solids. however, "silent" aspiration cannot be ruled out at the bedside. if there are any persistent concerns regarding aspiration, we would be happy to perform a videoswallow evaluation. recommendations: 1. continue po trials of thin liquids and puree consistency solids. 2. 1:1 assistance for feeding. 3. the pt should only be fed when he is most alert and awake. 4. feeding trials should be discontinued if the pt demonstrates any overt signs of aspiration such as coughing or significant desaturation after eating or drinking. 5. if the patient continues to tolerate this diet without problems, it may be appropriate to introduce trials of soft solids. , ms . chest (portable ap) 7:46 am reason: f/u on pneumonia impression: gradual improvement of bilateral upper lobe consolidations. discharge labs -------------- 07:00am blood wbc-9.1 rbc-3.81* hgb-12.2* hct-37.5* mcv-99* mch-32.0 mchc-32.5 rdw-15.0 plt ct-577* 07:00am blood wbc-9.1 rbc-3.81* hgb-12.2* hct-37.5* mcv-99* mch-32.0 mchc-32.5 rdw-15.0 plt ct-577* 02:28am blood neuts-88.5* bands-3.1 lymphs-2.1* monos-3.1 eos-2.1 baso-0 metas-1.0* 02:28am blood hypochr-1+ anisocy-1+ poiklo-1+ macrocy-1+ microcy-2+ polychr-normal 01:20pm blood urean-30* creat-0.9 k-5.0 07:00am blood glucose-135* urean-29* creat-0.9 na-142 k-5.2* cl-107 hco3-26 angap-14 01:00am blood alt-12 ast-58* alkphos-424* amylase-47 totbili-0.9 07:00am blood calcium-9.1 phos-4.1 mg-2.2 02:21am blood caltibc-163* ferritn-369 trf-125* 02:42am blood type-art temp-37.2 fio2-96 po2-78* pco2-41 ph-7.45 caltco2-29 base xs-3 aado2-580 req o2-93 intubat-not intuba 08:13am blood k-3.6 08:13am blood k-3.6 brief hospital course: hd#1 - presentation to ed. sigmoid volvulus evident on radiography, aspirated in ed, requiring intubation, hypotensive - thought secondary to aspiration moreso than bowel necrosis from volvulus; transferred to sicu for volvulus reduction hd#2 - required levophed drip overnight to maintain blood pressure, sedated on propofol, intubated on 100% fio2, preop'ed for surgery (subtotal colectom for sigmoid volvulus), returned from surgery - sedation maintained, levophed drip continues with sbp's in 100s. lactate 5.5 for which patient received 1l saline bolus abdominal wound left open with 10 wicks for granulation tissue promostion and consolidation of granulous tracts. hd#3 - patient continues to wean off levophed, sedation continues, maintains intubation, lactate level decreasing from 5.4->3.5 hd#4 - patient continues to wean off levophed, sedation continues (levophed drip @ 0.030, propofol drip @ 20), intubated on cpap (50 fio2) with attempts to extubate today if able to wean off pressors; neurology saw patient and recommended restarting home meds by g tube hd#5 - patient weaned from propofol, sedated on versed for agitation. following commands spontaneously but not purposefully, trophic tube feeds 25cc/hr. oxygenation with pao2 70s-80s and spo2 94-96 - peep required increase to 12, cpap+ps continue for ventilation. fio2 increased that afternoon to 70% due to pao2 in 60's on peep 14 hd#6 - lasix drip at 5.0/hr continues on antibiotics zosyn, flagyl, vancomycin, diflucan (sputum culture grew out yeast), generalized edema noted, diuresis continues, trophic tube feeds continue, respiratory status - fio2 wean attempts continue but required 70% fio2 hd#7 - lasix drip continues at 5/0/hr continues on antibiotics, no vent changes, map > 60, right a-line changed, difficulty maintaining ostomy seal, sedation on versed maintained intermittently hd#8 - patient changed to aprv to maintain oxygenation with improved abg, able to wean fio2 down to 50%, with pao2 in the low 100s. in the evening - remained intubated on psv 8/18, bronched x 2 for copious, thick, yellow secretions. sedated on propofol drip hd#9 - patient weaned off all pressors, lungs appear stable although cxr still demonstrates diffuse infiltrates. bal demonstrates ngtd, tube feeds increased to 45 with goal of 80 @ 3/4 strength. antibiotics continue for aspiration pneumonia hd#10 - white count decreasing with serial bronchs. stoma producing excellent stool output. cxr clearning. pt advanced to goal tube feeds. hd#11 - pt remaines intubated/sedated on psv, diuresis continues overnight, oxygenation improving with a peep of 2 in the am hd#12 - patient was extubated, lungs sound clear, remained on 12l/min oxgyen and sat was 97%. continued to increase lopressor to maintain rate and blood pressure. patient continued to be diuresis. insulin requirements were increased based on the fingersticks ranging from 148-164. patient received a ct scan of the head per neurolog recommendation to evaluate for bleed, which was negative. hd13 - neuro status continued to improve and patient is followed by the neurology service. hd16 - patient was transferred to the floor from icu with 1:1 sitter in place to maintain patency of j-g tube and iv lines. neurology continued to follow with recommendations to hold tube feedings 30minutes pre and post parkinson's medications, decrease troheyphenidyl to 1 mg for next 4 days and then d/c. patient was evaluated by speech and swallow for aspiration, they recommended starting on thin liquids and puree diet. screening process started for rehab per physical therapy recommendations. hd17 - parkinson's: neurologically continues to improve and has follows commands appropriately with purposeful movement, hypophonia, patient should contact primary neurology as an outpatient (dr. . continue to wean off artane as planned. hemodynamically that patient has remained stable and afebrile. aspiration pneumonia - patient has remained on 3liters via nasal cannula and saturation maintaining sats of >94% and slightly tachypnea with a rate of 26-29. surgical incision has been maintained via vac dressing system @ 125mmhg of suction. nutrition - patient's tube feeding started to be cycled for 16hours daily at a rate of 100cc/hr and he is tolerating liquid oral intake. ostomy - followed by et nurses throughout hospitalization, the stoma is located in the rlq, size is 1 x 1 inch, slightly protruding and red, the postion of the os is center. the mucocutanous junction is intact and the stool is pasty brown. patient was seen by the et nurses on the day of d/c. skin - patient has a small right heel decubitus that has been treated with vista and elevation, otherwise skin is unremarkable. patient was evaluated by physical therapy and felt it was appropriate to d.c patient to a rehab facility. medications on admission: sinemet 7 times a day 2''3' trihexyphenidyl 1' zoloft75' lipitor20' vesicare5' patanol 2' dulcolax10' remeron 15' folplex 2.2' seroquel 25mg restasis protonix 40' florinef (new) discharge medications: 1. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po daily q0630 (): crushed down g-tube . 2. lansoprazole 30 mg susp,delayed release for recon sig: one (1) tablet,rapid dissolve, dr daily (daily). 3. trihexyphenidyl 2 mg tablet sig: 0.5 tablet po daily (daily) for 4 days. 4. acetaminophen 500 mg tablet sig: two (2) tablet po q 8h (every 8 hours) as needed for fever. 5. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic q2h (every 2 hours). 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 8. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 9. potassium & sodium phosphates mg packet sig: two (2) packet po prn (as needed) as needed for phos<3.0. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: aspiration pneumonia, sigmoid volvulus discharge condition: stable, off ventilator and all drips/pressors, able to tolerate liquid/puree diet s/p swallow eval, afebrile, hemodynamically stable; feeding tube sites functional and otherwise without problem discharge instructions: you, the patient, are to be discharged to an extended care facility (rehabilitation) before returning home to your residence. you are to follow-up with dr. in his clinic for a post-operative visit. you are to also follow-up with your outpatient primary care physician for follow-up appointment. please return to the hospital (emergency room) for the following: * fevers > 101/5 * increasing abdominal pain * pus from wound * bleeding from wound * blackening of ostomy site * pus from any feeding tube site * any concerns or problems regarding your health status followup instructions: you, the patient, are to be discharged to an extended care facility (rehabilitation) before returning home to your residence. you are to follow-up with dr. in his clinic for a post-operative visit. you are to also follow-up with your outpatient primary care physician for follow-up appointment. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other enterostomy enteral infusion of concentrated nutritional substances other bronchoscopy other and unspecified partial excision of large intestine temporary ileostomy closed [endoscopic] biopsy of bronchus colonoscopy anastomosis to anus diagnoses: pure hypercholesterolemia unspecified essential hypertension cardiac complications, not elsewhere classified perforation of intestine paroxysmal ventricular tachycardia paralysis agitans pneumonitis due to inhalation of food or vomitus pressure ulcer, heel volvulus unspecified vascular insufficiency of intestine 

Answer: The patient is high likely exposed to