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: fatigue major surgical or invasive procedure: intubation history of present illness: 75 year old male with a history of a cerebral vascular accident, chronic back pain and sarcoidosis who was found down by his son in his living room. the patient does not recall how he fell. he states he does not recall what parts of his body hit the floor. he recalls trying to pull himself up and being unable. he remembers hearing acceptance speeches from the nh primary. when he woke up he found he was soiled with feces. he does believe he lost consciousness. he denies any prior similar episodes. brought in by family because of continued generalized weakness. he states that since wednesday afternoon he has had a dry productive cough and had trouble "getting a deep breath". of note of the day he fell, he went to his pain doctor after the fall and was told it may have been vasovagal. . in ed, 95.8, 81, 121/63, 18 96%ra. his spine was noted to be diffusely tender. imaging of ct cervical spine indicative of c3-c4 ligamentous injury, and c7 ? acute fracture for which patient has been placed in a c-collar. patient noted to have a mildly elevated bun, and anemia. he was admitted for further work-up of this event. . review of systems: + constipation, +cough, +shortness of breath, +dysphagia, +weight loss (40 lbs, 8 months), +chronic lower back pain. patient denies fevers, chills, nausea, vomiting, headache, vision changes. past medical history: sarcoid, on chronic prednisone gerd, on omeprazole dyspagea, on limited diet, but refuses any of the thickened liquids cva, 1 yr ago, residual left foot drop, memory difficulty hypertension anemia chronic back pain, on fentanyl patch social history: retired physician, , 2 grandchildren. son-in-law very supportive. divorced from wife, who recently died. patient does not/has never smoked. patient rarely consumes alcohol. patient lives alone at senior life. his meals are provided for him, he does go shopping on his own and is quite active. he ambulates without a cane. family history: nc, no family history of sarcoid physical exam: gen alert and oriented *3 skin: rash, left macular-papular irregular areas (6)of hyperpigmentation roughly oval with center darkening heent: perrl, eomi, cn ii-xii intact, no nystagmus cv: rrr, nl s1, s2, no m/r/g pulm: cta b/l, no w/r/r back: kyphotic, tender diffusely in t-spine. no l spine tenderness. abd: s/nt/nd +bs no hepatosplenomegaly ext: no c/c/e, 2+ dp neurological: ue biceps , triceps , deltoids 5-/5, le: hamstrings , hip flexors , knee flexors 5-/5, knee extensors 5-/5, plantarflexion , dorsiflexion l r . dtrs 1+, no clonus. able to stand and balance. rectal tone good per ed. pertinent results: studies mri c spine: 1. ligamentous injury adjacent to an old c7 spinous process fracture. 2. tiny abnormality of the ligament anterior to c3-4, without findings suggestive of acute disruption. 3. degenerative disease of the cervical spine as detailed above. diffuse idiopathic skeletal hyperostosis (dish). . ct l spine:1. no evidence of acute fracture of the lumbar spine. 2. multilevel degenerative changes, most severe at l4-5 and l5-s1, with central canal encroachment by a disc osteophyte complex at l4-5. . ct t spine 1. no evidence of fracture within the thoracic spine with preservation of vertebral body height throughout. 2. findings compatible with diffuse idiopathic skeletal hyperostosis (dish). 3. right adrenal myelolipoma. . ct c spine:1. widening of the anterior disc space at c3-4 which may be chronic; however, ligamentous injury cannot be excluded. recommend mri for further evaluation. 2. irregularity and disruption of the spinous process at c7 which could represent an acute fracture. an underlying lytic lesion cannot be excluded. 3. diffuse idiopathic skeletal hyperostosis (dish) and multilevel degenerative changes. 4. right upper lobe pneumonia. . cxr: focal, increased parenchymal opacities involving the right upper lobe which may represent aspiration and/or pneumonia. . ct head: no evidence of intracranial hemorrhage or edema. . bilateral hips: 1. degenerative changes of both hips which are mild, as well as moderate degenerative changes of the lumbar spine. 2. no signs for acute bony injury. . cta chest . technique: axial volumetric images have been obtained through the chest, abdomen and pelvis. iv contrast was administered according to the pe protocol. comparison: there is a chest ct for comparison. findings: the main pulmonary artery is enlarged measuring 4 cm.this is highly suggestive of pulmonary hypertension. the segmental and subsegmental arteries appear to be prominent, which is unchanged compared to previous. again noted are the airspace changes within the right upper lobe as well as within the left lower lobe, which appear unchanged, compared to previous.there is a soft tissue density associated with atelectasis around the right hilum which is unchanged compared to previous. right basal atlectasis is also present. there are bilateral pleural effusions. the airway is patent with no evidence of significant lymphadenopathy. abdominal and pelvic ct: there are no suspicious hepatic lesions. the spleen appears unremarkable. there is evidence of cholelithiasis and the cbd is prominent measuring 1.5 cm. no evidence of intrahepatic biliary duct dilatation. the pancreas appears unremarkable. within the right adrenal gland, there is a rounded hypodense fatty lesion measuring 3.5 x 4 cm, most likely in keeping with adrenal myelolipoma. the left adrenal appears unremarkable. there is a left upper pole renal cyst. otherwise, the bilateral kidneys appear unremarkable with no evidence of hydronephrosis. the small and large bowel appear unremarkable with no evidence of dilatation or wall thickening. there is no evidence of pneumatosis, free air or free fluid. there is no significant retroperitoneal lymphadenopathy. the abdominal aorta is atherosclerotic. the bladder appears unremarkable with evidence of foley catheter in place. there are multilevel degenerative changes within the lumbosacral spine. there are no suspicious bony lesions. impression: 1. no evidence for pulmonary embolism. evidence for pulmonary arterial hypertension with prominent peripheral pulmonary vessels, especially on the left, which is unchanged from previous. 2. no significant change in the airspace disease within the bilateral lungs with persistent soft tissue density within the right hilum, which is concerning for an underlying mass lesion obscured by the airspace disease or resulting in obstructive airway changes and thus followup is recommended. 3. cholelithiasis. 4. left adrenal myelolipoma. findings were discussed with dr. from team medicine on the same day. . on admit: 11:30am blood wbc-6.4 rbc-3.79* hgb-11.8* hct-34.7* mcv-91 mch-31.2 mchc-34.1 rdw-13.2 plt ct-304 11:30am blood neuts-88.0* bands-0 lymphs-6.9* monos-4.4 eos-0.4 baso-0.4 11:30am blood pt-13.1 ptt-26.8 inr(pt)-1.1 11:30am blood glucose-99 urean-27* creat-1.2 na-140 k-4.4 cl-100 hco3-30 angap-14 07:05am blood calcium-8.9 phos-3.5 mg-2.1 iron-12* 07:05am blood caltibc-182* vitb12-304 folate-8.0 ferritn-1122* trf-140* . at discharge . complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:45am 12.0* 3.52* 11.3* 32.5* 92 32.1* 34.8 13.7 354 differential neuts bands lymphs monos eos baso atyps metas myelos 08:28am 86.2* 0 10.3* 2.9 0.5 0.1 source: line-picc red cell morphology hypochr anisocy poiklo macrocy microcy polychr 08:28am normal 1+ normal normal normal 1+ source: line-picc basic coagulation (pt, ptt, plt, inr) pt ptt plt smr plt ct inr(pt) 06:45am 354 06:45am 13.11 30.2 1.1 1 note new reference range as of 12:00a miscellaneous hematology esr 12:40pm 55* 05:46am 22* esr added 12:20pm brief hospital course: 75 year old male with past medical history significant for sarcoid on chronic low dose predisone was brought by son to for generalized weakness following a syncopal episode with loss of consciousness. the patient's syncope was felt to be in the setting of the patient self regulating his pain medications including starting neurotin. he woke up surrounded by feces. . 1) syncope: it is unclear if the patient lost bowel or bladder function during the event or if it was a result of his prolonged immobility. he has a history of chronic back pain and degenerative disk disease. ct imaging done in emergency department revealed no evidence of acute event. his neurological examination was benign. no disturbances in electrolytes noted. the patient was monitored on telemetry and was noted to have 18 beats of atrial tachycardia which spontaneously resolved. the patient was restarted on his hydrochlorothiazide every other day, then transitioned to daily. he had no syncopal or seizure episodes in house. he did become quite delirious with visual hallucinations a few days into his admission. he refused to be examined. thought doctors , and said he would not do anything until the government issued a report. a psychiatry consultation was obtained. he was felt by the psy team not to be psychotic, but delirious in the setting of prolonged hospital stay, and narcotics. rpr and b12 were ordered to complete the labs, results pending at time of discharge. however, within 48 hours he returned to baseline, where he is conversant with some logic but has obvious obsessions, reiterations, a monotone speech, flat affect and lack of eye contact and insight. he is otherwise very cooperative, with his thought content focused on his pain control and his ability to handle thin liquids. his cultures remained negative. however, he had findings of pna for which he is on a 14 day course of aztreonam and vancomycin, 3 days left. . 2) fall: when the patient syncopized, he fell to the floor. apparently he remained on the floor for a significant period of time. he was treated for mildly elevated bun with fluids. multiple imaging modalities were used to evaluate him status post fall and he was noted to have a c 7 ligamentous injury by mri and several old cervical spinal fractures. ortho was consulted, with the recommendation to wear a cervical collar for one month. . 3) pulmonary infiltrate: in the micu the patient had persistent hypercarbic hypoxia. by chest x-ray the patient had a question of a rul pna. the patient had a nonproductive cough. he is a known aspiration risk and this may represent an aspiration event and pneumonitis, although infection could not be excluded. the patient cough likely also occured after he spent likely >7 hours on the floor and he could have aspirated while unconscious. he was noted to have a mild left shift in his white blood cell count with no leukocytosis. patient was also noted to have no fever. on the morning after admission, the patient was noted to have development of diffuse rhonchi with a need for 2 liters of nasal cannula oxygen to keep oxygenation at >95%. patient at this time was presumed to have pneumonia. he was given the pneumovax vaccine and continued on levofloxacin/flagyl for therapy, then switched to aztreonam and vancomycin as stated above. subsequently, his oxygen requirements increased to 5 l while on antibiotics with lung exam significant for rhonchi. a sarcoid flare was suspected and his dose of prednisone was increased to 40 mg daily. within two days of this regimen, with chest pt and nebulizers, he was able to completely wean off oxygen, satting in the high 90s on room air. he also benefitted from gentle diuresis although edema was felt to be a small contributor to his hypoxia. . 4) chronic back pain: patient was restarted on his home pain medication per his primary care physician, . overnight post admission, he developed acute pain. this was felt to be due to his recent fall and due to the fact that he was liberally self medicating at home. the patient threatened to leave against medical advice. after a detailed discussion with the patient and his daughter, the patient made clear his preference for improved pain control, even if this means he will be very sleepy. after consultation with the pain service the patient was started on pca morphine pain control. he was eventually transitioned to a fentanyl patch, initially 50 micrograms with percocet for breakthrough. at discharge, he is on a fentanyl patch 100 micrograms with which his patient seems to be well controlled, on no other narcotics. . 5) sarcoid: as stated above, his sarcoid was felt to be contributing to his hypercarbic hypoxia, as his oxygenation improved dramatically on increased steroids. it is unclear if he has a component of neurosarcoid which is affecting his mental status. he is reiterative at baseline, with obsessive thoughts and tangential. . 6)cerebral vascular accident: thombotic event. patient notes residual left foot drop. unclear if dysphagia result of cva but patient has noted difficulty since cva. he was kept on asa. . 7) dysphagia: the patient had significant dyspagia which has been evaluated by ent and revealed aspiration, perhaps a residual deficit from stroke. in the setting of this dysphagia he has lost weight. speech and swallow evaluations were challenging for the patient, who insisted to be placed on thin liquids. he initially did not collaborate with speech and swallow evaluations, but was placed on thickened liquids, nectar diet with crushed pills. on the day of discharged, he agreed to a speech and swallow evaluation given that his sensorium was clearer. the recommendations are to keep him on thick liquids, nectar pureed foods, and crush his pills. . 8) dish: disease of spine/bones which results in osteophytes. this may be causing esophageal compression/tortuousness seen by egd. this might be contributing to his dysphagia and his pain. . full code . fen: he was kept on special diet as above, repleted lytes as needed . contact: and -- his daught and son-in-law, live in , recently moved mr. to be nearer to family. cell #s or medications on admission: metoprolol 25 mg po bid aspirin 325 mg po daily miralax *nf* 17 gram (100 %)hs benefiber clear 3 gram/3.5 tbsp by mouth at bedtime mixed with water donepezil 5 mg po hs oxycodone (immediate release) 10 mg po q4h:prn pain docusate sodium 100 mg po bid pantoprazole 40 mg po q24h fentanyl patch 50 mcg/hr tp q72h start: sat am potassium chloride 10 meq po bid duration: 24 hours fluticasone-salmeterol (100/50) 1 inh ih gabapentin 300 mg po 1-4 tablets daily: patient has been taking more than once a day hydrochlorothiazide 12.5 mg po every other day: patient has been taking daily simvastatin 20 mg po daily losartan potassium 50 mg po daily thiamine 100 mg po daily methylprednisolone 4 mg po 1-3 tablets daily : patient had been varying dose and taking more than prescribed discharge medications: 1. senna 8.6 mg tablet sig: two (2) tablet po hs (at bedtime). 2. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. psyllium packet sig: packets po tid (3 times a day) as needed for constipation. 5. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day) as needed for constipation. 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 8. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual asdir (as directed). 9. fentanyl 100 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 10. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) neb inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 11. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 12. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 13. prednisone 20 mg tablet sig: two (2) tablet po daily (daily). 14. donepezil 5 mg tablet sig: one (1) tablet po hs (at bedtime). 15. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 16. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) inhalation inhalation (2 times a day). 17. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po every twenty-four(24) hours. 18. 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. 19. aztreonam 1 gram recon soln sig: two (2) grams injection q8h (every 8 hours) for 3 days. 20. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 3 days. 21. sliding scale insulin as needed while on steroids discharge disposition: extended care facility: rehab discharge diagnosis: hypercarbic respiratory failure syncope chest pain aspiration pneumonia sarcoidosis c7 ligamentous injury dysphagia discharge condition: breathing well on room air discharge instructions: admitted with syncope and cervical ligament injury, developed respiratory failure and pneumonia. had to be intubated in the micu. the pneumonia was treated with antibiotics (still needs two more days) and the sarcoidosis with prednisone. you need to discuss when to stop the prednisone with your doctors. there was also some fluid in your lungs which we treated with lasix. . your speech and swallow evaluation has concluded that you need to continue on the thick liquids, as you run the risk of a pneumonia otherwise. you can be reevaluated again. please discuss with dr . . take the medications in the list below and return to the ed if you experience any concerning symptoms. followup instructions: ct chest at 10:45 ( building) provider: . phone: date/time: 8:30 provider: function lab phone: date/time: 10:40 provider: ,interpret w/lab no check-in intepretation billing date/time: 11:00 with dr within 2-3 weeks. please call orthopedics: at 2: 25 pm. building md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: anemia, unspecified unspecified essential hypertension unspecified fall sarcoidosis acute respiratory failure pneumonitis due to inhalation of food or vomitus pressure ulcer, buttock diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled syncope and collapse c5-c7 level with unspecified spinal cord injury 

Answer: The patient is high likely exposed to