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: metoprolol attending: chief complaint: shortness of breath major surgical or invasive procedure: peg placement history of present illness: 84 m russian speaking, h/o cad (s/p rca and lad stenting ), dm2, htn, ckd, h/o recurrent aspiration pna, who presents with acute onset of sob from nh. pt was in usoh until yesterday when he was found to be acutely sob with sats down to the 80s. his son was present and provided most of the history. ems was called and pt was placed on a nrb with little improvement of his sats. he was brought to the ed for further management. . of note, pt was recently admitted from to for pneumonia with transient intubation/icu stay, found to have pan-sensitive pneumococcus growing from his sputum cultures. he completed a 10d course of ctx after initial broader coverage. he was also found to have positive c diff from and was started on po flagyl x14 days on . . in the ed, his vs on arrival were temp oral 99, rectal 101, hr 108, bp 110/62, rr 26, 97% on nrb. pt had diffuse rhonchi on exam. lactate was 3.3, wbc elevated at 14.8 with 17% bands. cxr showed new infiltrate in left lower lung. pt received 1x 1gm iv vanco (did not complete this as he developed hives during infusion), 750mg iv levo, 1 gram ceftriaxone and 500mg iv flagyl. he also received 1300 mg tylenol rectally. pt refused nasal suction and bipap but o2sats remained stable on nrb. rr was ranging from 18-38. 1x albuterol neb was given. hr went up from the 100s to 122. bp dropped to systolic 78. pt received 2l ns with improvement of bp to 122/81. of note, ekg showed new lateral twi. ce with flat ck-mb and trop of 0.04. cardiology was contact and felt that ekg changes were due to infection/tachycardia. the decision was made not to intervene unless ekg changes further. pt was admitted on nrb to icu for further management of suspected pneumonia. . on arrival in the icu, his vs were hr 99, t97.7 ax, 98% on 100% nrb, r 28, bp 109/59. via his son, pt was able to tell me that he was "so-so". he denied chest pain, palp, nausea, vomiting, abd pain, le swelling. he has has left sided rib pain since last admission. otherwise, ros negative. past medical history: - cad s/p rca and lad stenting . - pvd - s/p r ica stent () with a stable moderate left internal carotid artery stenosis. - ckd (baseline cre = 0.9-1.3) - dm2 - htn - hyperlipidemia - gerd - h/o radiation to the larynx in the soviet in the for presumed laryngeal cancer. - h/o aspiration pneumonia - h/o gastrojejunostomy tube; status post aspiration pna (removed) x 1 yrs to reduce need for oral feeds and prevent recurrent pneumonia. tube fell out and was not replaced in spring as he had been eating gradually more food and a trial of oral feeding was chosen. the cause of the aspiration pneumonia was thought to be disordered swallowing s/p xrt to his larynx yrs ago in the ussr. - spinal stenosis - s/p ? recent spinal injection. - h/o recurrent bronchitis - with restrictive defect on pfts . - h/o falls. social history: 40 yrs x 1 ppd tobbacco, denies alcohol, ivdu. lives in (elderly living), former mechanic. at baseline performs own adls. family history: nc physical exam: vs: temp 97.7 ax bp 109/59 hr 99 rr 28 o2sat 98% on 100% nrb gen: pleasant, comfortable, nad, tacchypneic with any movement heent: perrl, eomi, anicteric, mm dry, op without lesions neck: no supraclavicular or cervical lymphadenopathy, no jvd resp: diffuse rhonchi b/l r>l cv: rr, mildly tacchy s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e, cool, good pulses skin: no rashes/no jaundice neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. sensation grossly intact. pertinent results: cxr: new airspace opacities within the left lower lung most consistent with aspiration. although less likely, pneumonia should be considered. . tte - normal biventricular function. normal left ventricular diastolic function. no significant valvular abnormality seen. . ekg: lad, likely left ant fasicular block, tacchycardic, sinus rhythm, new lateral st depression compared to previous ekg. . on admission labs: 02:30am blood wbc-14.8* rbc-4.05* hgb-12.7* hct-39.4* mcv-97 mch-31.3 mchc-32.1 rdw-14.5 plt ct-328 02:30am blood neuts-71* bands-17* lymphs-2* monos-5 eos-1 baso-2 atyps-0 metas-1* myelos-1* 02:30am blood pt-13.7* ptt-25.2 inr(pt)-1.2* 02:30am blood glucose-324* urean-20 creat-1.5* na-143 k-4.8 cl-106 hco3-21* angap-21* 02:30am blood alt-29 ast-30 ck(cpk)-140 alkphos-75 amylase-92 totbili-0.3 02:30am blood ck-mb-6 ctropnt-0.04* probnp-748 10:12am blood ck-mb-6 ctropnt-0.03* 02:30am blood calcium-8.8 phos-2.1* mg-1.1* 02:50am blood lactate-3.3* brief hospital course: a/p: 84 m russian speaking, h/o cad, niddm, htn, ckd, h/o recurrent aspiration pna, who presents acute onset of sob, found to have pneumonia. . # pna: patient readmitted to with findings c/w pneumonia rll. patient has longstanding h/o aspiration pna, but recently hospitalized with pneumococcal pneumonia that may have been vent associated . started on vanc for mrsa and zosyn for gram negative, pseudomonas (given ? vent-assoc pna) and anerobic coverage. all cultures , will complete 8 day total course of antibiotics given clinical improvement. yesterday failed speech/swallow evaluation and pt refuses dobhoff. patient maintained on aspiration precations, kept npo, ppn for nutrition, and both surgery and gi were consulted for peg placement, with gi proceeding to peg placement on . this was completed without complication and tube feedings were resumed. . # htn: patient normotensive . was hypotensive in ed, stable on arrival in icu. hypertensive yesterday to sbp 150s. patient's antihypertensive regimen was adjusted to reach a goal of <130/80. . # dm: on admission patienthad ag acidosis and trace ketones with sugars in 370s. metoformin held, insulin gtt started. patient transitioned to insulin ssi with bg 90s - 140s. he was subsequently converted to and titrated on daily glargine insulin, with sliding scale lispro four times daily. . # cad: s/p rca and lad stenting . no cp, patient ruled out for an mi. continued asa, plavix, statin. beta blockers were not started due to a history of significant bradycardia per pcp. . # hyperlipidemia: continued statin. . # c diff: c diff positive during last admission. positive stool test on . continued flagyl to complete 14 day course . . # arf - resolved. baseline creatinine 1.2-1.3, but recently in the normal range. cr up to 2.0 on admission. likely prerenal, patient cr improved with 3 liters fluids. was restarted and his serum creatinine remained at baseline. medications on admission: medications (from recent dc summary from ): 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 4. ipratropium bromide 0.02 % solution sig: one (1) puff inhalation q6h (every 6 hours). 5. losartan 25 mg tablet sig: one (1) tablet po daily (daily). 6. clotrimazole 1 % cream sig: one (1) appl topical (2 times a day). 7. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed). 8. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) puff inhalation q4h (every 4 hours). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). 11. flagyl 500 mg po tid x 10 days prior to admission for c. dif discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 2. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) neb inhalation q4h (every 4 hours) as needed. 3. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 4. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed. 5. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 6. losartan 50 mg tablet sig: two (2) tablet po daily (daily). 7. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 8. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 9. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day) as needed for constipation. 10. aspirin 325 mg tablet sig: one (1) tablet po once a day. 11. clopidogrel 75 mg tablet sig: one (1) tablet po once a day. 12. insulin lispro 100 unit/ml solution sig: as directed by sliding scale (included) units, insulin subcutaneous qid insulin. discharge disposition: extended care facility: meadowbrook - discharge diagnosis: 1. aspiration pneumonia 2. chronic aspiration 3. type 2 diabetes mellitus 4. hypertension 5. 2-vessel cad s/p stent 6. peripheral arterial disease s/p stent 7. hyperlipidemia 8. gerd 9. s/p radiation therapy to the neck for laryngeal cancer 10. spinal stenosis discharge condition: stable discharge instructions: please contact your primary physician if you acutely develop shortness of breath, fevers, sweats, chills, vomiting or diarrhea. continue standard care for your gastrostomy tube. followup instructions: provider: , .d. phone: date/time: 9:30 provider: , m.d. phone: date/time: 10:20 provider: study phone: date/time: 2:00 procedure: enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified peripheral vascular disease, unspecified chronic kidney disease, unspecified other and unspecified hyperlipidemia other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus intestinal infection due to clostridium difficile other specified hypotension left bundle branch hemiblock long-term (current) use of aspirin feeding difficulties and mismanagement other dysphagia 

Answer: The patient is high likely exposed to