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: cough, hoarse voice major surgical or invasive procedure: g/j-tube placement per interventional radiology on . intubation history of present illness: mr. is a 78 year-old man with a 3-year history of als, for which he receives care at . over the past few months he has had a progressive cough, but over the past 4 days it has gotten much more severe, and last night he did not sleep at all because he was coughing all night. his daughter stayed over at his house and confirmed this history. he rarely brought up yellowish-white sputum. he also described feeling a blockage in his throat. sometimes this is a little fluid that he has not been able to swallow, but if he cannot cough up the sputum he coughs so "you can hear across the block". during these coughing fits he feels very short of breath and dizzy, but he describes no fevers or chills. in addition to the cough he has a sore throat and feels that his voice has gotten more hoarse in the past few weeks. he has significant dysarthria from his als, but this is a change in the quality of his voice. he takes guaifenesin to try to loosen his secretions, and recently his daughter has brought a saline nebulizer home, which seemed to be helping. according to his daughter, mr. was recently seen at the va, where he was told that his vc was 1.3l. if it goes down to 1l he will be a candidate for a tracheostomy. he is on 3l of oxygen continuously at home, and is on a soft food and thickened liquid diet. . in the ed his vitals were t 98.1, hr 77, bp 135/90, rr 20. o2 sat 96%3l, dropped down to 92% on 3l when talking. his nif was measured and found to be good at 38. his ekg showed nsr at 81, rbbb, q iii/f, twi iii/f and v1-v4, with no prior to compare it to. he recieved an abg that was normal, a chest x-ray that showed no signs of acute pulmonary process, v-q scan was limited but showed no signs of pe. past medical history: 1. als: mostly bulbar and respiratory troubles, but has been dependent on a walker for past few months, has had 2 bad falls in the last month. 2. htn 3. cervical stenosis social history: pt is a former boxer, was in the navy and worked for the fire department for much of his life. he has 10 children and about 30 grandchildren. he currently lives in his house with his wife, who is ill with copd. one of his daughters lives next door and his a nurse, and she does most of the caretaking. his granddaughters do the cooking, though mr. still tries to do some cleaning around the house. he has never smoked, never drank, no illicit drugs. family history: father had lung cancer, does no know any other history of cancer, diabetes or heart disease. no history of neurologic disease. physical exam: vitals: tc:97.9 bp:190/98 hr:70 rr:20 o2:99% 3l, resting general: awake in bed, alert, no distress heent: head nc/at, perrla (pupils 2->1.5). eomi, vf intact. neck: no palpable lymph nodes, no palpable thyroid nodules/swelling card: nl s1s2, rrr, no m/r/g. pmi non-displaced lungs: expiratory wheezes throughout, inspiratory squeeks in lower lobes bilaterally, lung volumes decreased, no basilar crackles. abd: +bs, distended, tympanic, non-tender, no masses ext: no cyanosis or edema, 2+ pedal pulses. neurologic: mental status: alert, oriented x 3. able to relate history without difficulty. attentive. severe dysarthria. language is fluent with intact repetition and comprehension. there were no paraphasic errors. able to follow both midline and appendicular commands. there was no evidence of neglect. cranial nerves: i: olfaction not tested. ii: perrl 2 to 1mm os and 1.5 to 1 mm od and brisk. iii, iv, vi: eomi without nystagmus. v: facial sensation intact to light touch. vii: no facial droop, facial musculature symmetric, though some weakness of orbicularis oculi bilaterally viii: hearing slightly diminished to finger-rub bilaterally. ix, x: palate elevates symmetrically but delayed gag reflex : 5/5 strength in trapezii and scm bilaterally. xii: tongue protrudes in midline; no fasciculations noted. motor: severe wasting of ues most notably in intrinsic hand muscles bilaterally. fasciculations present in l biceps and triceps. spasticity of all 4 ext. no tremor noted. delt bic tri wre wrf ffl fe io ip quad ham ta edb l 4+ 5 4+ 5 5- 5 0 2 4 5 5 5 5 4 4 r 4+ 5 4 5 5- 5 0 2 4 5 5 2 5 4 4 sensory: no deficits to light touch, pinprick, cold sensation, proprioception throughout. dtrs: tri pat ach l 3 3 3 3 4 r 3 3 3 3 4 3 beats of clonus at bilateral ankles plantar response was flexor on the right, extensor on the left. coordination: no intention tremor, no dysdiadochokinesia noted. no dysmetria on fnf bilaterally. gait: good initiation. narrow-based, but short, shuffling stride. pertinent results: labs on admission: abg: po2-100 pco2-41 ph-7.42 caltco2-28 base xs-1 glucose-106* urean-29* creat-2.2* na-143 k-4.4 cl-107 hco3-26 angap-14 calcium-9.3 phos-2.8 mg-2.1 wbc-9.7 rbc-4.51* hgb-13.2* hct-39.4* mcv-87 mch-29.3 mchc-33.6 rdw-14.0 plt ct-275 neuts-73.6* lymphs-17.1* monos-4.4 eos-4.5* baso-0.3 ctropnt-0.02* lactate-0.9 lung scan - impression: no evidence of interval pulmonary embolism compared to study of . ct head: 1. no acute intracranial hemorrhage. 2. interval increase in right maxillary and right anterior ethmoid sinus mucosal thickening, likely representing chronic inflammatory disease. video oropharyngeal swallow - impression: 1. moderate oral dysphagia. 2. reflux from the esophagus into the pharynx with subsequent penetration into the airway seen. brief hospital course: 78 year-old man with a 3-year history of als who has recently become more compromised in terms of mobility presents with 4 days of worsening minimally productive cough, sore throat and hoarse voice without fever or leukocytosis. #cough: according to pts report he has had a cough for a few months, but over the last 4 days it got progressively worse, with minimal yellow-white sputum production. pneumonia seemed less likely in the setting of a normal chest x-ray and no focal finding on lung exam, as well as lack of fever of leukocytosis. considered diagonoses were uri or continued aspiration, overlying muscle weakness and difficulty clearing secretions. his home o2 (3l) was continued, as well as his cpap at night. he was started on ipratroprium and albuterol nebulizers, as well as dextromethorphan and codeine for cough suppression. we have iv fluids, as his daughter reported that he has low po intake, and this may have been adding to his thick secretions. iv protonix 40 was started in case there was an element of regurgitation. speech and swallow consult was called to assess whether he was aspirating more than he had previously. #als: pt appeared to have decompensated in the past several months, and it was unclear if this presentation was just a manifestation of and als "exacerbation". home riluzole and tizanidine were continued, as well as his previously prescribed died of soft food and thickened liquidsa. pt consult was ordered. . # ckd: cr was 2.2 on admission. . # htn: quite hypertensive on admission to floor, but down to 155 systolic after several hours. continued to monitor bp and give home metoprolol and terazosin. . # ppx: pt was put on his some bowel regimen; started on a ppi, and given heparin sc. . ...... micu course: mr. was transferred to the micu as a result of progressive metabolic acidosis and respiratory distress. . #als - the patient's increased dyspnea and acidosis on transfer likely represent a progression of his underlying als. the patient was intubated on so that he could get his affairs in order after a lengthy discussion with both the patient and his daughter/hcp and reviewing his goals of care. efforts to minimize sedation were made so that the patient could be alert. the patient self-extubated on the morning of and maintained his o2 sats alternating between a face tent and bipap support. the palliative care team continued to follow the patient and assist him in meeting his goals. . #obstipation ?????? on transfer to the micu the patient had severe constipation. he was given an aggressive bowel regimen and began stooling again. his tube feeds through his gj tube were subsequently resumed. . #hypertension - prior to his micu transfer the patient was having significant episodes of htn up to 190's-210, likely secondary to respiratory distress and holding of his bp meds. he was continued on hydralazine iv and his regular antihypertensives were resumed via his gj tube when his obstipation resolved. . #anion gap metabolic acidosis ?????? on transfer the patient had an anion gap acidosis, likely secondary to ketosis and progressive respiratory muscle fatigue with progression of his als. he may have also had a component of non gap acidosis from receiving ns ivf. he was given ivf with d5 with 3 amps of sodium bicarbonate for fluid repletion. his acidosis subsequently resolved. medications on admission: *metoprolol tartrate 25 mg po twice a day *miralax po once a day *riluzole 50 mg po twice a day *terazosin 4mg hs *tizanidine 2 mg po twice a day *aspirin 81 mg po once a day *docusate sodium 100 mg capsule po twice a day *guaifenesin 400 mg po four times a day *percocet 1 tab hs discharge medications: 1. fibersource liquid sig: 60 cc/hr po 24 hours per day: please provide 30 day supply with 5 month refills - feed via g/j tube. disp:*180 cans* refills:*5* 2. riluzole 50 mg tablet sig: one (1) tablet po bid (2 times a day). 3. tizanidine 2 mg tablet sig: one (1) tablet po bid (2 times a day). 4. terazosin 1 mg capsule sig: four (4) capsule po hs (at bedtime). 5. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup sig: five (5) ml po q6h (every 6 hours). 6. phenol 1.4 % aerosol, spray sig: one (1) spray mucous membrane q4h (every 4 hours) as needed. disp:*2 bottles* refills:*5* 7. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 8. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day). disp:*2 bottles* refills:*5* 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*30 tablet(s)* refills:*2* 10. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. disp:*30 suppository(s)* refills:*2* 11. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day) as needed for constipation: hold if having bowel movements. disp:*1 bottle* refills:*5* 12. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed. 13. duoneb 0.5-2.5 mg/3 ml solution for nebulization sig: one (1) inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*60 * refills:*5* 14. nebulizer & compressor for neb device sig: one (1) miscellaneous as directed. disp:*1 unit* refills:*0* 15. nebulizer accessories misc sig: one (1) miscellaneous as directed. disp:*1 set* refills:*0* 16. humidified o2 sig: one (1) as directed. disp:*1 * refills:*5* 17. suction equipment sig: one (1) set q2-6h as needed. disp:*1 set* refills:*1* 18. face tent sig: one (1) set as needed. disp:*1 set* refills:*1* discharge disposition: home with service facility: vna discharge diagnosis: amyotrophic lateral sclerosis hypertension discharge condition: afebrile, requiring supplemental oxygen to maintain o2 sats. discharge instructions: you were admitted on with increased coughing, difficulty swallowing hence interfering with your nutrition and weakness. initially, you were admitted to the medicine service to rule other possible infection or blood clots that may be causing your increased coughing but the evaluations were normal hence you were transferred to neurology service for further evaluation and treament of your als. you were eventually transfered to the medical icu service because of worsening shortness of breath due to progression of your als. after palliative consult and consultation with dr. , your neurologist at , you had g-tube placed per interventional radiology with conscious sedation and without complications. you were also intubated briefly to allow you to settle some legal matters. your tube feed has been recommended per nutrition consult and you are discharged home with home hospice service. please note the changes that have been made with your medications. followup instructions: dr. at the va will be contacting you for follow-up. he has been informed of your admission and plan of care. please follow-up with your primary care provider. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrojejunostomy diagnoses: acidosis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified acute respiratory failure amyotrophic lateral sclerosis spinal stenosis in cervical region 

Answer: The patient is high likely exposed to