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 / cephalosporins attending: chief complaint: respiratory distress major surgical or invasive procedure: central venous catheter placement peg placement with upper endoscopy bipap ventilation history of present illness: 45 yo m with kearns- syndrome who presents upon transfer from icu where he was originally admitted with aspiration pna ] for further management of deteriating condition and respiratory distress. pt has a long standing history of neuromusc weakness 2/2 kearns- syndrome, however has done quite well and self functioning at baseline. , pt diagnosed with crohn's disease. in the process, underwent capsule endoscopy which per family was noticed in to be stuck causing an apparent bowel obstruction for which he underwent partial sb resection (). during these past months has sufferred from considered weight lost. pt tolerated surgery well and was discharged to home shortly thereafter. on day of initial admission, pt while c/o cough and dyspnea was found to have an aspiration pna. pt started on levo/flagyl and had what seems like an uncomplicated course. however attempted peg placement ] suspended tachycardia and hypoxia in setting of fentanyl/versed prompting short stay in icu. pt remained stable until day of transfer. pt found in acute respiratory distress with o2 saturations in 60's improved to 80's on nrb. transferred to for further eval. . upon arrival, pt found to be hypotensive with sbp 80's -> 60's as well as hypoxic (88%) on 100% nrb. pt unresponsive without spontaneous movements. family in room and clearly states that ms much worse than previous night. pt unable to express compliants; but family said that he felt fine prev night. . stabilized in micu and improved with diuresis & bipap. past medical history: *kearns- syndrome (neuromuscular disorder involving mtdna deletions that results in skeletal muscle weakness) *crohn's disease (dx'd 8/005) *s/p bowel resection for obstruction capsule endoscopy social history: lives alone, functional at baseline, no tob / rare etoh family history: no neuromuscular ds, no ibd physical exam: vs: (arrival) 92.5, 102, 94/58 -> 61/25, 18 - 89% nrb 100% gen- unresponsive, emmaciated, ill appearing in mod distress heent- proptosis, perrl, no voluntary eom, anicteric, dry mm neck-supple, no jvd, no lad, no cb cvs-tachycardic with regular ectopic beats, 2/6 sem, pmi non-displaced pulm- decreased bs at bases with course rhonchi thru/o, short/shallow breaths abd-soft, scaphoid, nt, nd, + bs, no hsm ext-no c/c/e, 2+ dps b/l skin-cool and clammy, no rash, eccyhmosis or other lesions neuro- eyes open but not responding to pain/verbal stimuli, no spontaneous movement, hyporeflexic, equivocal babinski pertinent results: 05:48am blood wbc-12.5* rbc-3.53* hgb-7.8* hct-25.4* mcv-72* mch-22.2* mchc-30.8* rdw-20.2* plt ct-250 05:14am blood wbc-13.1* rbc-3.41* hgb-7.8* hct-24.2* mcv-71* mch-22.8* mchc-32.1 rdw-21.0* plt ct-282 04:41pm blood hct-24.9* 05:52am blood wbc-12.2* rbc-3.08* hgb-7.0* hct-21.8* mcv-71* mch-22.7* mchc-32.1 rdw-20.5* plt ct-259 03:55am blood wbc-17.1* rbc-3.30* hgb-7.5* hct-24.0* mcv-73* mch-22.9* mchc-31.4 rdw-20.0* plt ct-285 03:15am blood wbc-22.7* rbc-3.60* hgb-7.9* hct-27.1* mcv-75* mch-21.9* mchc-29.2* rdw-18.9* plt ct-455* 04:44am blood wbc-15.5* rbc-3.09* hgb-6.7* hct-23.5* mcv-76* mch-21.8* mchc-28.7* rdw-18.8* plt ct-329 06:58am blood wbc-16.9* rbc-3.24* hgb-7.1* hct-24.3* mcv-75* mch-22.0* mchc-29.2* rdw-18.8* plt ct-315 04:01am blood wbc-15.3*# rbc-3.13*# hgb-6.8*# hct-23.3*# mcv-74* mch-21.6* mchc-29.1* rdw-18.9* plt ct-288 10:50pm blood wbc-65.7* rbc-4.96 hgb-11.0* hct-37.8* mcv-76* mch-22.1* mchc-29.0* rdw-18.6* plt ct-534* 03:42am blood wbc-70.8* rbc-4.54* hgb-10.2* hct-33.5* mcv-74* mch-22.5* mchc-30.6* rdw-19.4* plt ct-477* 04:01am blood wbc-15.3*# rbc-3.13*# hgb-6.8*# hct-23.3*# mcv-74* mch-21.6* mchc-29.1* rdw-18.9* plt ct-288 10:50pm blood neuts-94* bands-4 lymphs-1* monos-1* eos-0 baso-0 atyps-0 metas-0 myelos-0 nrbc-1* 05:48am blood pt-13.1 ptt-30.8 inr(pt)-1.1 10:34am blood pt-14.6* ptt-47.3* inr(pt)-1.5 03:55am blood pt-15.5* ptt-45.6* inr(pt)-1.7 05:48am blood glucose-96 urean-7 creat-0.1* na-134 k-3.4 cl-98 hco3-33* angap-6 05:14am blood glucose-119* urean-8 creat-0.1* na-137 k-3.6 cl-96 hco3-37* angap-8 05:52am blood glucose-153* urean-12 creat-less than na-135 k-3.9 cl-96 hco3-34* angap-9 03:55am blood glucose-126* urean-12 creat-0.2* na-138 k-3.9 cl-97 hco3-39* angap-6* 03:15am blood glucose-181* urean-22* creat-0.1* na-138 k-3.9 cl-104 hco3-28 angap-10 04:44am blood glucose-96 urean-19 creat-0.1* na-138 k-3.7 cl-107 hco3-29 angap-6* 06:58am blood glucose-132* urean-20 creat-0.1* na-137 k-3.6 cl-107 hco3-26 angap-8 04:01am blood glucose-135* urean-19 creat-0.1* na-136 k-3.5 cl-107 hco3-26 angap-7* 10:04pm blood glucose-103 urean-18 creat-0.1* na-138 k-3.6 cl-105 hco3-26 angap-11 03:42am blood glucose-103 urean-14 creat-0.1* na-129* k-4.5 cl-97 hco3-28 angap-9 10:50pm blood glucose-65* urean-18 creat-0.2* na-131* k-5.0 cl-96 hco3-27 angap-13 06:58am blood ld(ldh)-152 totbili-0.4 06:52pm blood ck(cpk)-55 03:42am blood ck(cpk)-22* 10:50pm blood alt-15 ast-25 ld(ldh)-241 ck(cpk)-33* alkphos-93 amylase-40 totbili-0.6 10:50pm blood lipase-33 06:52pm blood ck-mb-notdone ctropnt-0.01 03:42am blood ck-mb-notdone ctropnt-0.05* 10:50pm blood ck-mb-notdone ctropnt-0.08* . radiology final report -76 by same 5:24 pm chest (portable ap); -76 by same reason: ? hypoxia medical condition: 45 year old man with ? aspiration pna and acute respirtory failure now hypoxic reason for this examination: ? hypoxia history: hypoxia. single portable chest radiograph again demonstrates bibasilar pulmonary opacities and bilateral pleural effusions, unchanged. bilateral apical pleural thickening is similar in appearance as well when compared to radiographs obtained earlier the same day. left internal jugular central venous catheter is again noted with its tip in the svc. no pneumothorax. the previously noted gaseous distention of the stomach has improved. impression: interval improvement of air-distended stomach, otherwise no significant interval change from the radiograph obtained five hours earlier. dr. approved: 6:10 pm . radiology final report chest (portable ap) 5:24 pm chest (portable ap); -76 by same reason: ? hypoxia medical condition: 45 year old man with ? aspiration pna and acute respirtory failure now hypoxic reason for this examination: ? hypoxia history: hypoxia. single portable chest radiograph again demonstrates bibasilar pulmonary opacities and bilateral pleural effusions, unchanged. bilateral apical pleural thickening is similar in appearance as well when compared to radiographs obtained earlier the same day. left internal jugular central venous catheter is again noted with its tip in the svc. no pneumothorax. the previously noted gaseous distention of the stomach has improved. impression: interval improvement of air-distended stomach, otherwise no significant interval change from the radiograph obtained five hours earlier. dr. approved: 6:10 pm . radiology final report chest (portable ap) 12:34 am chest (portable ap) reason: ? infiltrate vs consoolidation medical condition: 45 year old man with ? aspiration pna and acute respirtory failure reason for this examination: ? infiltrate vs consoolidation history: question pneumonia. single portable chest radiograph demonstrates increased lung volumes. the heart is not enlarged. increased bibasilar opacities are present, worse on the right than the left. air bronchograms are identified on the right, indicating consolidation. the bilateral hemidiaphragm contours are obscured. costophrenic angles are blunted, bilaterally. the trachea is in the midline. there is tapering of the trachea just proximal to the carina. biapical pleural thickening is noted. regional osseous structures are unremarkable. impression: copd. basilar opacities, with right-sided air bronchograms. findings represent pneumonia. small bilateral pleural effusions. dr. approved: 5:30 pm . sinus tachycardia consider right atrial abnormality right axis deviation prominent precordial lead qrs voltages abnormal r wave progression diffuse nonspecific st-t wave abnormalities - cannot exclude in part ischemia findings are nonspecific but clinical correlation is suggested for possible biventricular hypertrophy and possible lateral myocardial infarct, age indeterminate no previous tracing available for comparison . egd for peg placement (): a 20fr percutaneous gastrostomy tube (peg) was placed successfully using standard techniques at the stomach body. impression: normal mucosa in the stomach, normal mucosa in the duodenum, normal mucosa in the esophagus. otherwise normal egd to second part of the duodenum. recommendations: clean peg site with h2o2 and change dressing daily, use one piece of drain gauze between peg bumper and skin for dressing brief hospital course: a/p: 45 yo m with kearns- syndrome, crohn's ds c/b sb resection who presents upon transfer from osh with aspiration pna and acute respiratory failure. . 1) hypercarbic respiratory failure: hypoventilation 2/2 underlying neuromuscular dysfunction in setting of aspiration pna. improved in icu with diuresis and bipap. continued bipap at night while on floor, with chest pt and nebulizer treatments. pleural effusions seen on cxr in icu but no tap was performed per family discussions. . 2) aspiration pna: completed 10 d course of levo/flagyl. switched to vanc & aztreonam on admission to icu and completed 10 day course (stopped ). all culture data negative. . 3) hypotension: likely volume depleted with septic shock. cvp 4-5 after central line placed in icu. started on neo on admission, changed to levo/vasopressin which was titrated off after fluid resuscitation. all cx negative. no more hypotensive episodes on floor . 4) hypothermia on arrival: concerns for sepsis vs myxedema; however likely little adipose tissue and outside exposure upon transfer. quickly resolved. random and tfts normal. stress dose steroids d/c'd. . 5) kearns- syndrome: neuromuscular disorder involving mtdna deletions that results in skeletal muscle weakness with basic understanding that there is no primary treatment. normal tte 4 months ago. neurology followed; recommended treatment ((coenzyme q10 300mg tid; riboflavin 100mg day; thiamine 100mg qd; vit c 1g qd; vit e 400 qd; carnitine 1g qd) started after peg placed. will follow-up with dr. per neurology recs and family wishes for transfer of care to . 6) crohn's disease: on arrival considered stable; pentasa held as pt npo. developed melena while hospitalized, but stable hematocrit and no lightheadedness/sob or abdomminal pain. no gastric/duodenal ulcers seen on egd. colonoscopy not performed while pt hospitalized. sb resection was by dr. (, ). crohn's medications not restarted while pt hospitalized. per osh records, on original admission regimen was pentasa 2g , azathioprine 50 mg qd, entocort 9 mg qd and prednisone 10mg qd. pt requests to transfer gi care to , f/u appt made with dr. . . 7) fen: failed s&s multiple times. peg placed by gi , tf started . on tpn until tf started. will need repeat s&s (with video swallow) at rehab to determine whether pt can tolerate po intake for pleasure (pt understands primary nutrition will come from peg). . 8) ppx: ppi, bowel regimen, heparin sc . 9) code status: dnr/dni; confirmed with hcp . 10) contacts: hcp ; sister ( or ) and sister (h or c) . 11) dispo: discharged to acute rehab () with gi, neurology and pcp at . ent follow-up at mass eye & ear (dr. , ) per family/pt wishes. medications on admission: on transfer: levo 500 qd (d8) flagyl 500 q8 (d8) lovenox tpn iss aolu-medrol 30 mg qd albuterol nebs mucomyst nebs clotrimazole troches vancomycin 1gm q12 (d1) discharge medications: 1. coenzyme q10 300 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for kearns- syndrome. disp:*90 capsule(s)* refills:*0* 2. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). disp:* units* refills:*2* 3. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. disp:*qs tablet(s)* refills:*0* 4. insulin lispro (human) 100 unit/ml solution sig: 1-10 units subcutaneous asdir (as directed): see attached sliding scale. disp:*qs units* refills:*2* 5. levocarnitine 330 mg tablet sig: 1000 (1000) mg po qd (). disp:* mg* refills:*2* 6. beclomethasone diprop monohyd 0.042 % aerosol, spray sig: one (1) spray nasal daily (daily). disp:*qs bottle* refills:*2* 7. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). disp:*1 bottle* refills:*2* 8. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed. disp:*qs neb* refills:*0* 9. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed. disp:*qs neb* refills:*0* 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 11. riboflavin 50 mg tablet sig: two (2) tablet po qd (). disp:*60 tablet(s)* refills:*2* 12. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*qs tablet(s)* refills:*2* 13. ascorbic acid 90 mg/ml drops sig: 1000 (1000) mg po daily (daily). disp:*qs mg* refills:*2* 14. vitamin e 400 unit capsule sig: one (1) capsule po daily (daily). disp:*qs capsule(s)* refills:*2* discharge disposition: extended care facility: - discharge diagnosis: aspiration pneumonia hypercarbic/hypoxic respiratory failure dysphagia gi bleed kearns- syndrome discharge condition: good discharge instructions: take all medications as directed. notify a nurse : * lightheadedness or dizziness * chest pain or difficulty breathing * nausea, vomiting, diarrhea or abdominal pain * change in vision or numbness/weakness/tingling * any other concerns followup instructions: 1) you have an appointment with dr. (ent) on , at 11:15am. go to the 11th floor (head & neck clinic) at , (mass eye & ear). the rehabilitation center will need to book an ambulance for you for this appointment. we also recommend a family member accompany you. if you need to change the appointment, call . 2) you have an appointment with dr. (general medicine) on , at 3:30pm. go to the atrium on the of the clinical center at , , (, ). the rehabilitation center will need to book an ambulance for you for this appointment. we also recommend a family member accompany you. if you need to change the appointment, call . 3) you have an appointment with dr. (gastroenterology) on , at 1:30pm. go to suite 8e () in the medical building at , (, ). the rehabilitation center will need to book an ambulance for you for this appointment. we also recommend a family member accompany you. if you need to change the appointment, call . 4) you have an appointment with dr. (neurology) on , at noon. go to the of the clinical center at , , (, ). the rehabilitation center will need to book an ambulance for you for this appointment. we also recommend a family member accompany you. if you need to change the appointment, call . 5) you have an appointment with dr. (hearing test) on , at 1:45pm. go to suite 6e () in the medical building at , (, ). the rehabilitation center will need to book an ambulance for you for this appointment; please arrive at 1:30pm. we also recommend a family member accompany you. if you need to change the appointment, call . procedure: parenteral infusion of concentrated nutritional substances non-invasive mechanical ventilation percutaneous [endoscopic] gastrostomy [peg] transfusion of packed cells diagnoses: acute posthemorrhagic anemia unspecified septicemia severe sepsis regional enteritis of unspecified site acute respiratory failure hypotension, unspecified pneumonitis due to inhalation of food or vomitus blood in stool septic shock pressure ulcer, lower back volume depletion, unspecified hypothermia nutritional marasmus disorders of mitochondrial metabolism 

Answer: The patient is high likely exposed to