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: hydrochlorothiazide attending: chief complaint: fever and diaphoresis major surgical or invasive procedure: endotracheal intubation tracheostomy j tube placement bronchoscopy history of present illness: mr. is a 42 year old gentleman with a history of pilocytic astrocytoma (at age 2), multiple cvas, and a medullary cavernoma with persistent right hemiparesis, epilepsy, and aspiration who presents with with diaphoresis and fevers to 100.2 at home. he states that he has increased frequency of cough after being given a g tube 3 weeks prior due to recurrant aspiration pneumonia and difficulty swallowing, but that the cough has not worsened in the past few days. he feels otherwise well with no sensation of fevers/chills or increased sweating, but was brought into the ed due to concern from his group home caretaker. regarding his feedings, he gets them from 8pm to 5pm every day. they have been unable to increase the rate due to gastric residuals with feeding. the patient notes regurgitation 2-3x a day with a sensation of food coming up into his chest and sometimes into the back of his throat and into his mouth. he cannot be for certain whether the coughing is associated with his feedings. pt is without any complaints including chest pain, shortness of breath, dizziness, abdominal pain, nausea, vomiting, dysuria, or new swelling. he reports being constipated without a normal bms for the past 4-5 days. he has + flatulence and minimal burping. he was given an enema yesterday with minimal stool output. past medical history: medullary cavernoma in at site of radiation epilepsy (absence, complex partial, and generalized seizures) cerebellar pilocytic astrocytoma resection at age two s/p brainstem radiation presumed radiation-induced vasculopathy with multiple strokes strokes: left internal capsule/thalamus , left posterior cerebellum, left cerebellar peduncle , tia with facial droop, followed by dr. presumed xrt-induced bilateral hearing loss hypertension hyperparathyroidism bilateral kidney stones (thought to be due to parathyroidism, not topamax use) hypercalcemia osteopenia social history: he lives in a group home, and during the week goes to sports program, gateway arts, and massage. he uses a wheelchair to get around since his strokes, but does walk with assistance at his sports class. he denies cigarette or etoh use. family history: there is no family history of seizures. his sister died of multiple myeloma. physical exam: admission physical exam vs - 98.3 hr 104 bp 123/74 rr 20 96% on 3 lnc general: well-appearing man, not acutely distressed. speaking comfortably in full sentences heent: mucous membranes semi-dry. no cervical lymphadenopathy. soft palate elevates symetrically heart: heart sounds distant, rrr, normal s1 s2 lungs: clear to auscultation but limited by poor air movement due to poor respiratory effort. no evidence of respiratory distress or accessory muscle requirement. abdomen: soft and nontender except at the insertion of the g-tube. he does have a g-tube in position with scabing. no erythema or exudates. mildly distended (likely secondary to constipation). + bowel sounds in all 4 quadrants extremities: he does not have any edema of his lower extremities, + distal pulses, warm and well perfused. neuro: eomi, pupils are equal and reactive. no facial weakness. there is right hemiplegia. discharge physical exam physical exam: vs - tmax 98 tcurr 98 bp 112/80 hr 81 rr 18 100% pm 35%fm general - nad, comfortable, appropriate heent - sclerae anicteric, mmm lungs - mild coarse breath sounds throughout, good air movement, resp unlabored, no accessory muscle use heart - rrr, no mrg, nl s1-s2 abdomen - soft and nontender. g-tube in place with no erythema or exudates. non-distended. + bowel sounds in all 4 quadrants extremities - he does not have any edema of his lower extremities, + distal pulses, warm and well perfused. pneumoboots in place. neuro - awake, a&ox3, right hemiplegia pertinent results: admission labs: 01:30pm blood wbc-20.8*# rbc-4.46* hgb-14.3 hct-41.6 mcv-93 mch-32.0 mchc-34.3 rdw-12.9 plt ct-238 01:30pm blood neuts-89.1* lymphs-4.6* monos-5.9 eos-0.2 baso-0.2 01:30pm blood plt ct-238 01:30pm blood glucose-111* urean-32* creat-1.2 na-143 k-4.2 cl-107 hco3-25 angap-15 08:45pm blood alt-102* ast-99* ck(cpk)-274 alkphos-131* totbili-0.8 08:45pm blood ck-mb-2 ctropnt-<0.01 01:30pm blood calcium-9.8 phos-2.7# mg-1.9 01:30pm blood d-dimer-792* 03:10pm blood type-art temp-37.5 po2-55* pco2-31* ph-7.40 caltco2-20* base xs--3 intubat-not intuba comment-simple fac imaging: cta chest w&w/o c&recons, non-coronary and ct abd & pelvis with co 1. right middle, right lower, and left lower lobe consolidations compatible with pneumonia. 2. no pulmonary embolism. 3. no acute intra-abdominal process. 4. bladder trigone thickening may represent focal inflammation, less likely malignancy. chest xray findings: there is opacification of the right lower lobe seen both on frontal and lateral radiographs. in addition, the right heart border is obscured, worsened from . there is no pleural effusion or pneumothorax. the heart size is normal. the left lung is clear. impression: right middle and lower lobe pneumonia, possibly due to recurrent aspiration. portal ap chest xray impression: ap chest compared to through : tip of the endotracheal tube is no less than 7 cm from the carina. it could be safely advanced 2 cm for more secured seating. nasogastric tube passes into the stomach and out of view. bibasilar pneumonia has not changed appreciably overnight. there is no pneumothorax or pleural effusion. cardiomediastinal and hilar silhouettes are normal. ecg: sinus rhythm. right bundle-branch block. non-specific repolarization abnormalities. compared to the previous tracing of the quality of the tracing has improved somewhat. otherwise, findings are similar. discharge labs: 03:22am blood wbc-12.8* rbc-3.68* hgb-11.6* hct-34.0* mcv-92 mch-31.5 mchc-34.1 rdw-14.1 plt ct-357 03:22am blood plt ct-357 03:22am blood glucose-100 urean-15 creat-1.1 na-137 k-3.7 cl-104 hco3-21* angap-16 03:22am blood calcium-9.1 phos-3.0 mg-2.0 brief hospital course: mr. is a 42 year old gentleman with a history of pilocytic astrocytoma (at age 2), multiple cvas, and a medullary cavernoma hemorrhage with persistent right hemiparesis, epilepsy, and aspiration who presents with low grade fever, found to have likely aspiration pneumonia on cxr and chest ct. he deteriorated with hypoxia and was intubated and then recieved a tracheostomy. #mrsa pneumonia: the patient has a history of aspiration pneumonia given swallow dysfunction related to prior neurological disease. on the night of , he desaturated to the high 70s. given his concerning respiratory status which is unlikely to improve since it is due to neurologic dysfunction of pharyngeal muscles, he was transferred to micu, intubated and a tracheostomy was performed . ct scan suggestive of consolidations consistent with pneumonia. we initiated tube feeds on the night of which he seemed to tolerate without obvious regurgitation. however, there was continued concern over oral secretions and his tracheostomy cuff was left inflated. speech/swallow felt it would be best to avoid placing a speaking valve until his respiratory condition resolved in the short term. he completed an 8 day course of vancomycin for hcap. elevated wbc has resolved on discharge and he has remained afebrile for several days. #rll collapse: on pt began exhibiting worsening o2 saturations down to the high 70s on 35%tm. attempted aggressive respiratory suction with minimal removal of mucus. chest xray done on the bedside showed right middle and lower lobe collapse most likely attributable to a mucus plug. he was transferred to the micu for bronchoscopy which successfully removed mucus plug and reinflated his rll. post brochoscopy cxr showed reinflation of rll. following the procedure his o2 requirement improved and is respiratory status returned to baseline. he did require aggressive mucus suctioning to prevent further plugging. #tube feeds: we initially stopped tube feeds due to concern of regurgitation on admission along with aspiration of oral secretions. we contact and consulted both speech/swallow and nutrition for appropriate recommendations to optimize his g tube feeding. per their recommendations, we continued with 16 hrs cycled feeds with fibersource hn oral liquid 100 ml/hr g tube and ranitidine 15 mg/ml syrup 150 mg by mouth twice a day. per speech/swallow we initiated mouth rinses every 4 hours to prophylactically prevent oral secretion aspiration pneumonia. ir was able to successfully convert his g tube to a gj tube without complications on . #obstructive sleep apnea: suspected by pcp and from prior inpatient stays he had reports of snoring and nighttime desaturations. after his trach was placed, these resolved and he was more alert during the daytime. #transaminitis: bilirubin not elevated, but ast/alt above baseline. felt most likely due to drug effect, especially from the pip-tazo. trended down after pip-tazo was stopped. patient remained asymptomatic thoughout. chronic issues: #hx stroke / cavernoma hemorrhage / seizure disorder: stable neurologic exam during admission. had been in for pt and speech/. continued prednisone 17.5 mg daily with plan to taper by 2.5 mg weekly for cerebral edema. per pcp, had a clinical decline when this was tapered too quickly in the past. also, for risk modification of further strokes, continued simvastatin 80 mg daily, cilostazol 100 mg , aspirin 81 mg daily. for headaches and neurologic function, continued topiramate 200 mg , and trileptal 1500 mg . #hx right bundle branch block (rbbb): unclear cause. patient remains asymptomatic from a cardiac perspective. #hypothyroidism: stable. continued levothyroxine 88 mcg daily. #hypertension: stable. continued amiloride 5 mg daily. #hyperparathyroidism: stable. continued cinacalcet 30 mg . #depression: stable. continued citalopram 40 mg daily. #maintanence: patient received flu shot at last discharge visit 1 week ago. recieved pneumococcal vaccine this admission. transitional issues: #please taper prednisone dose by 2.5mg per week. can stop bactrim once dose is below 10mg per week. #consideration for down-sizing of his trach so that he can have a speaking valve and consider eating per goals of care of the patient #pt needs suctioning in order to prevent mucus plugging. mucus plugging is frequent but usual responds to respiratory therapy maneuvers. consider increasing nebulized saline frequency. #pt is dnr but can be intubated #please see discharge paperwork for patient's outpatient follow up appointments medications on admission: preadmission medications listed are correct and complete. information was obtained from patientfamily/caregiver. 1. amiloride hcl 5 mg po qam 2. cinacalcet 30 mg po bid 3. citalopram 40 mg po daily 4. folic acid 1 mg po daily 5. levothyroxine sodium 88 mcg po daily 6. oxcarbazepine 1500 mg po bid 7. prednisone 17.5 mg po daily 8. simvastatin 80 mg po daily 9. topiramate (topamax) 200 mg po bid 10. vitamin d 1000 unit po daily 11. vitamin e 400 unit po daily 12. ranitidine (liquid) 150 mg po bid 13. aspirin 81 mg po daily 14. miconazole powder 2% 1 appl tp tid:prn diaper rash 15. docusate sodium (liquid) 100 mg po bid per peg tube 16. lactobacillus rhamnosus gg *nf* 10 billion cell oral daily 17. fibersource hn *nf* (nutritional supplement - fiber) oral daily tubefeeding: fibersource hn full strength; starting rate: 100 ml/hr; do not advance rate goal rate: 100 ml/hr cycle?: yes, when at goal cycle start: 1900 cycle end: 1100 residual check: q4h hold feeding for residual >= : 250 flush w/ 30 ml water q8h 18. cilostazol *nf* 100 mg oral 19. polyethylene glycol 17 g po daily:prn constipation discharge medications: 1. amiloride hcl 5 mg po qam 2. aspirin 81 mg po daily 3. cilostazol *nf* 100 mg oral 4. cinacalcet 30 mg po bid 5. citalopram 40 mg po daily 6. docusate sodium (liquid) 100 mg po bid per peg tube. hold for loose stools 7. folic acid 1 mg po daily 8. levothyroxine sodium 88 mcg po daily 9. miconazole powder 2% 1 appl tp tid:prn diaper rash 10. oxcarbazepine 1500 mg po bid 11. polyethylene glycol 17 g po daily:prn constipation 12. prednisone 15 mg po daily please decrease this dose by 2.5mg per week 13. simvastatin 80 mg po daily 14. topiramate (topamax) 200 mg po bid 15. vitamin d 1000 unit po daily 16. vitamin e 400 unit po daily 17. lactobacillus rhamnosus gg *nf* 10 billion cell oral daily 18. fibersource hn *nf* (nutritional supplement - fiber) 0 oral daily tubefeeding: fibersource hn full strength; starting rate: 100 ml/hr; do not advance rate goal rate: 100 ml/hr cycle?: yes, when at goal cycle start: 1900 cycle end: 1100 residual check: q4h hold feeding for residual >= : 250 flush w/ 30 ml water q8h 19. ranitidine (liquid) 150 mg po bid 20. ipratropium bromide neb 1 neb ih q6h:prn sob/ wheeze 21. albuterol 0.083% neb soln 1 neb ih q6h:prn sob/ wheeze 22. sulfameth/trimethoprim ss 1 tab po daily prophylaxis can stop taking after prednisone dose is below 10mg daily 23. bisacodyl 10 mg po/pr daily:prn constipation 24. acetaminophen 650 mg po q8h:prn pain 25. chlorhexidine gluconate 0.12% oral rinse 15 ml oral 26. medication nebulized saline discharge disposition: extended care facility: hospital - discharge diagnosis: primary diagnosis chronic aspiration pneumonia due to stroke mucus plugging 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: dear mr. , it was a pleasure taking care of you at . you were admitted for difficulty breathing and found to have pneumonia most likely from aspirating food. you required intubation with a breathing tube to assist breathing and a tracheostomy was placed to help prevent further complications. you were treated with antiobiotics for you pneumonia and it improved. while you were recovering, you became short of breath due to a mucuc plug which caused collapse of your lung. we re-inflated your lung and your breathing returned to . we have made no changes in your medications. please decrease you dose of predisone by 2.5 mg per week after leaving the hospital. followup instructions: department: when: tuesday at 2:10 pm with: , md building: sc clinical ctr campus: east best parking: garage department: medical specialties when: thursday at 1 pm with: dr. building: campus: east best parking: garage department: neurology when: monday at 3:30 pm with: , m.d. building: campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube other intubation of respiratory tract other intubation of respiratory tract temporary tracheostomy closed [endoscopic] biopsy of bronchus percutaneous (endoscopic) jejunostomy [pej] diagnoses: obstructive sleep apnea (adult)(pediatric) unspecified essential hypertension unspecified acquired hypothyroidism depressive disorder, not elsewhere classified pulmonary collapse acute respiratory failure pneumonitis due to inhalation of food or vomitus late effects of cerebrovascular disease, hemiplegia affecting unspecified side epilepsy, unspecified, without mention of intractable epilepsy hyperparathyroidism, unspecified precipitous drop in hematocrit personal history of irradiation, presenting hazards to health disorder of bone and cartilage, unspecified gastrostomy status personal history of malignant neoplasm of brain inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation methicillin resistant pneumonia due to staphylococcus aureus other late effects of cerebrovascular disease, dysphagia dysphagia, unspecified body mass index between 19-24, adult foreign body in other specified parts bronchus and lung malnutrition of mild degree 

Answer: The patient is high likely exposed to