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: altered mental status major surgical or invasive procedure: debridement of stage 4 sacral ulcer muscle biopsy of right arm bronchoscopy history of present illness: 83 yo male with pmh cad, hocm, dysphagia, and recent hypercarbic respiratory failure (s/p trach/peg) initially admitted to micu from rehab for "altered mental status". . the pt originally underwent an elective egd to evaluate persistent dysphagia (negative for stricture or malignancy). he became hypoxic with oxygen sat in the 80's following procedure. pt was subsequently intubated for hypercarbic respiratory failure of unclear etiology, unable to wean from vent and trach/ peg placed. he also had evidence of respiratory muscle weakness with nifs around -6. . pt has undergone extensive w/u for neuromuscular dysfunction which included: -negative head ct, c-cpine ct -eeg: diffuse slowing in delta range and intermediate frontal sharp complexes -emg 1: moderately severe sensorimotor axonal polyneuropathy with concomitant median neuropathy at left wrist. -emg 2: suggestive of mild to moderate myopathy process affecting proximal muscles in the upper/lower extremities. not suggestive of generalized disorder of motor neurons (as seen in als). . labwork included: -rpr negative. csf: wbc 0, rbc 1600 negative for crypto, vdrl, hsv enterovirus negative. -acetylcholine receptor ab nl -spep: polyclonal c/w inflammation -neuron specific enolase 21.2 (nl 0-30) (released in neuroblastoma and small cell lung cancer) -fat pad bx - negative for amyloid -tsh: 2.2; ace 11; iron studies nl -heavy metal screen negative . while in the micu, patient was weaned off to trach mask and had a stable respiratory course. he was found to have chronic osteomyelitis of his sacrum secondary to stage 4 sacral ulcer which probed to bone, confirmed by bone scan . he was started on zosyn and vanco for broad antibiotic coverage. platics took patient to the or for debridement on . . from a neurologic standpoint, he was intially able to squeeze right hand, close eyes, and open mouth. his mental status was thought possibly due to overall picture of rapid neurologic decline. he was continued on a fentanyl patch but his neurontin, morphine, and ativan were held. without improvement, morphine was once again added for comfort. neurology consulted, and repetitive stimulation negative for myasthenia or syndrome. a trial of dantrolene was given for possible nms but no response, emg showed polyneuropathy and polymyopathy. sinemet started for possiblity of parkinson's. the pt was then transferred to a general medicine floor and id was consulted for fevers- rec fungal work-up and anti-fungal therapy started. pt also found to have b/l ue dvts, started on lovenox for anti-coagulation. pt also had runst of nsvts, evaluated by cardiology. . surgery was consulted for diagnostic muscle biopsy given persistent rigidity. he was taken to the or for bx of l biceps brachi. he had an episode of hemoptysis during the procedure, about 300 cc of blood. thoracics was consulted, underwent intra-operative bronch and washings. they did not localize a source of bleed. the patient was then transferred to micu for further eval and observation. . currently, patient is unresponsive to verbal stimuli, does not follow commands. he does respond to movement of his extremities with grimaces and fights against manual opening of his eyes. past medical history: hypercarbic respiratory failure (s/p trach/peg) gerd hocm ddi pacer cad prostate cancer (s/p brachytherapy -) dysphasia/achalasia/ htn gout glaucoma anemia afib hx svt depression social history: used to live alone with frequent aid of son. in / was able to ambulate, pay own bills, attend church, talk about current events. family history: 3 brothers with prostate cancer physical exam: pe: 96.8/ 66/ 101/46/ 99% saturation/ rr 15 gen: not responsive to questions or commands. trached. + spontaneous movement in all extremities w/ occasional grimacing heent: atraumatic, constricted pupils, anicteric, cv: + 3/6 systolic ejection murmur lungs: coarse bs b/l abd: distended, soft, hypoactive bs ext: + muscle rigidity in ue, r/l, with +cogwheeling. + tremor in rue. no neuro: not responsive to voices/ commands pertinent results: 04:15pm blood wbc-13.0*# rbc-3.60* hgb-10.3*# hct-30.7* mcv-85 mch-28.5 mchc-33.5 rdw-17.8* plt ct-469*# 04:15pm blood neuts-83.0* lymphs-10.3* monos-4.0 eos-2.5 baso-0.2 04:15pm blood pt-15.0* ptt-28.1 inr(pt)-1.3* 04:15pm blood glucose-120* urean-26* creat-0.8 na-139 k-4.4 cl-102 hco3-29 angap-12 04:30am blood calcium-8.2* phos-4.8* mg-2.5 03:45am blood alt-40 ast-44* ld(ldh)-254* alkphos-147* totbili-0.6 04:30am blood ck(cpk)-103 03:45am blood esr-115* 04:15pm blood iron-32* 04:15pm blood caltibc-185* ferritn-574* trf-142* 06:15am blood crp-104.4* 11:38pm blood type- po2-31* pco2-38 ph-7.47* caltco2-28 base xs-2 . . cxr : cardiac silhouette is moderately to severely enlarged. relatively mild perihilar opacification in both lungs is consistent with edema but there are two regions of more dense focal consolidation, the suprahilar right lung and the lateral left lung base, suggestive of multifocal pneumonia. small bilateral pleural effusion is present and there may well be pericardial fluid. transvenous pacer leads follow their expected courses to the right atrium and floor of the right ventricle. a second ventricular lead has a large loop in the region of the tricuspid valve, but its tip projects along the anticipated location of the floor of the right ventricle. there is no pneumothorax. the tracheostomy tube is slightly canted. clinical evaluation is recommended to confirm appropriate placement. . head ct : 1. atrophy. 2. prominence of the ventricles probably not out of proportion to the degree of overall atrophy, but the possibility of communicating hydrocephalus cannot be entirely excluded. 3. areas of white matter hypodensity, most suggestive of chronic small vessel ischemic disease. 4. vascular calcifications. 5. fluid throughout the right mastoid air cells, which could be seen in mastoiditis. . emg : abnormal study. there is electrophysiologic evidence for a generalized myopathic process with minimal denervating features. in addition, the findings are suggestive of a mild-to-moderate, generalized sensorimotor polyneuropathy with predominantly axonal features. there is no evidence for a pre- or post- synaptic disorder of neuromuscular transmission based on the repetitive stimulation studies performed. the reduced activation on needle electromyography also suggests a central component to the patient's weakness; however, this cannot be adequately assessed given the patient's reduced level of consciousness throughout the study. . us doppler : bilateral upper extremity dvts as described. . echo : these findings are consistent with hypertrophic non-obstructive cardiomyopathy (hcm). cardiac amyloidosis should also be considered. . muscle bx : preliminary results: preliminary diagnosis: left biceps muscle biopsy (formalin-fixed tissue only): scattered nuclear knots and scattered small, angulated myofibers, suggestive of denervation atrophy. moderate variation in myofiber size. increased internalized nuclei. no significant myofiber degeneration, regeneration, or myophagocytosis. no demonstrable endomysial infiltrating process. no significant lymphocytic inflammation. . chest ct : 1. airspace consolidation in right upper and right lower lobes, concerning for pneumonia. differential diagnosis includes multifocal aspiration and pulmonary hemorrhage. 2. large left and small right pleural effusions. 3. over-distention of fluid filled tracheostomy tube cuff; opacification of airway proximal to tube level, presumably due to retained secretions proximal to this level. correlation with results of recent bronchoscopy suggested. 4. cardiomegaly and moderate pericardial effusion. 5. slight narrowing of left lower lobe bronchus, difficult to assess in the setting of left lower lobe atelectasis adjacent to a large effusion. correlation with recent bronchoscopy results recommended. 6. left renal hilar fluid density structure, which may be due to parapelvic cyst or hydronephrosis. renal ultrasound is recommended for further characterization. brief hospital course: # altered mental status/rigidity: unknown etiology currently. has had extensive neurologic and infectious workup. ddx now includes amyloidosis, sarcoidosis, tentanus, parkinson's. neurology was following. please follow up on final results on muscle biopsy. limit sedating medications . # polyneuropathy/myopathy/rigidity: unclear cause currently but emg showed diffuse sensorimotor polyneuropathy as well as myopathy. many etiologies ruled out on prior work ups. cjd or other prion diseases possible given rapidly progressive course. syndrome possible, but repetitive stim test negative. neurology considered tetanus but id did not feel course was consistent with tetanus infection. echo findings suggestive of infiltrative cardiomyopathy without vegetations. please follow up on results of muscle biopsy, particulary to look for evidence of sarcoid and/or amyloidosis. *** please follow up with dr. from neurology as an outpatient (phone: ). . # respiratory failure: most likely secondary to respiratory muscle weakness related to pt's neuromuscular disorder. possibly secondary to amyloidosis or sarcoidosis. pending work up as above. pt is oxygenating well on trach mask. continue albuterol/atrovent nebs. continue suctioning prn. . # hemoptysis: episode occurred during muscle biopsy, bronchoscopy done inter-op non-revealing of source. diff dx includes trauma associated with trach or mass, although intra-operative bronchoscopy was unrevealing. he did not have any subsequent episodes of hemoptysis. his hematocrit remained stable. pe was on the differential but he could not get a cta due to poor access. he is put on heparin gtt for b/l upper-extremity dvts. . # ue dvt: ue ultrasound showed bilateral dvts. currently therapeutic on heparin gtt at ptt goal of 50-80. he will need to be transitioned to coumadin as an outpatient with target inr . . # id: pt has history of chronic osteolmyelitis, currently being treated with vanc and zosyn. started on fluconazole for fungal positive picc cath tip. surveillance blood cx have been negative to date. sputum cultures from +mrsa. continue treating pneumonia and chronic osteomyelitis for three weeks total, start date , end date . after three weeks, switch patient to chronic oral antibiotics: dicloxicillin 500 qid and cipro 500 . continue fluconazole for possible fungemia for 2 weeks, start date , end date . follow up blood cultures for beta-glucan, galactomannan. *** please follow up with dr. at clinic on at 9am (). . # ventricular tachycardia - patient has had multiple episodes of nsvt on telemetry, hemodynamically stable, asymptomatic. echo obtained suggested hocm. ddi pacer was placed for history of svt; he is not an icd candidate. ep interrogated pacemaker but could not determine whether vt or svt as atrial lead was shut off. pacer settings now changed to overdrive suppress svt. continue metoprolol 100 mg tid and aggressive lyte repletion . # sacral decubitus ulcer: debrided by plastics and was followed by wound care. . # htn: cont metoprolol for now . # anemia: baseline hct 30-33 during this admission. iron studies iron and elevated ferritin, consistent with anemia of chronic disease. . # glaucoma: no active issues. cont timolol, latanoprost drops. id also notes that patient should have an outpatient eye exam to rule out seeding in the eyes since his picc culture grew out . . # fen: tube feeds. cont aggressive electrolyte repletion, ivf as necessary for pressure support . # ppx- pneumoboots, ppi, pain control, bowel regimen. . # code- full, per primary team, confirmed by family meeting . . # dispo- pending stability, possibly call out to medicine floor in am. . # comm: hcp: dr. medications on admission: diamox 250mg qod ascorbic acid 250mg qd aspirin 325mg qd buproprion 75mg ceftazidime 1gm peridex tid coenzyme q10 100mg qd docusate esomeprazole 40mg qd fentanyl 100 mcg q72h ferrous sulfate 220mg qd lasix 100mg gabapentin 200mg latanoprost 0.005 opth solution lorazepam 1mg q8h lopressor 75mg tid morphine 5mg q4h sl miralax flagyl 500mg tid lovenox 40mg qd timolol ou vancomycin 1000mg qd zinc 200mg qd albuterol prn bisacodyl epinephrine prn atrovent prn morphine prn ativan prn tylenol zofran prn discharge medications: 1. vancomycin hcl 750 mg iv q 12h 2. 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. 3. fluconazole 200 mg iv q24h 4. piperacillin-tazobactam na 4.5 gm iv q8h 5. morphine sulfate 1-2 mg iv q4h:prn hold for sedation or rr<8 6. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 8. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 9. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 10. ipratropium bromide 17 mcg/actuation aerosol sig: six (6) puff inhalation qid (4 times a day). 11. albuterol 90 mcg/actuation aerosol sig: six (6) puff inhalation q6h (every 6 hours) as needed. 12. docusate sodium 150 mg/15 ml liquid sig: one y (150) mg po bid (2 times a day). mg 13. lansoprazole 30 mg susp,delayed release for recon sig: thirty (30) mg po daily (daily). 14. artificial tear with lanolin 0.1-0.1 % ointment sig: one (1) appl ophthalmic (2 times a day). 15. fentanyl 50 mcg/hr patch 72hr sig: one (1) patch 72hr transdermal q72h (every 72 hours). 16. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 17. insulin lispro (human) 100 unit/ml solution sig: as per sliding scale as per sliding scale subcutaneous asdir (as directed). 18. heparin (porcine) in d5w 100 unit/ml parenteral solution sig: as per sliding scale as per sliding scale intravenous asdir (as directed). discharge disposition: extended care facility: for the aged - macu discharge diagnosis: altered mental status of unknown etiology myopathy polyneuropathy fungemia pneumonia sacral ulcer sacral osteomyelitis hypercarbic respiratory failure (s/p trach/peg) hemoptysis gerd hocm ddi pacer cad prostate cancer (s/p brachytherapy -) dysphasia/achalasia/ htn gout glaucoma anemia afib hx svt depression discharge condition: hemodynamically stable, afebrile. discharge instructions: please take all medication as prescribed. keep all appointments listed below. if you have any chest pain or shortness of breath, please seek medical attention immediately. if you have fever please call your doctor. in general, call your doctor if you have any medical questions or concerns. followup instructions: primary care doctor: pcp: , . please follow up with your primary care doctor. appointment is set at 11:45am. neurology: please follow up with dr. from neurology (. appointment is set for at 9am. provider: . & phone: date/time: 9:00 --------------- infectious disease: please follow up with dr. at clinic on at 9am (). procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances nonexcisional debridement of wound, infection or burn bronchoscopy through artificial stoma open biopsy of soft tissue diagnoses: anemia of other chronic disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation personal history of malignant neoplasm of prostate unspecified glaucoma paroxysmal ventricular tachycardia methicillin susceptible pneumonia due to staphylococcus aureus pressure ulcer, lower back hyperosmolality and/or hypernatremia chronic respiratory failure other and unspecified mycoses mixed acid-base balance disorder chronic osteomyelitis, other specified sites other specified myoneural disorders unspecified nonpsychotic mental disorder following organic brain damage 

Answer: The patient is high likely exposed to