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: progressive weakness major surgical or invasive procedure: 1. anterior cervical diskectomy, c4-c5 and c5-c6. 2. anterior cervical arthrodesis, c4-c5 and c5-c6. 3. anterior instrumentation, c4 to c6. 4. application, interbody device (vg2 graft), c4-c5 and c5-c6. history of present illness: mr. is a 68-year-old man with a history of cervical myelopathy and cidp who presents with worsening weakness. he has a long-standing polyradiculoneuropathy, which began in or with numbness over his right 4th finger. this has been most recently treated with prednisone. he has in the past been treated with cellcept, but this was ineffective, and imuran caused a flu-like reaction. he has also recently been treated with ivig, but this has had to be held due to an acute worsening of his chronic renal insufficiency - last treatment was . plasmapheresis has been tried in the past, as well, but this was also ineffective. he had been doing well in , and his prednisone dose was decreased at that time from 15 mg daily to 10 mg daily. however, at the beginning of , he developed tingling in his nose and hands, and his prednisone was increased to 10 mg daily alternating with 15 mg daily. this improved his symptoms. he was due for an ivig treatment on , but at that appointment, it was noted that his creatinine had risen up to 1.9, which had been a gradual increase over the prior 6 months. the decision was made then to hold his ivig until the etiology could be determined. he believes that he has been becoming progressively weak over the last 1-2 months, though it has been worse in the last week or so, with today being particularly bad. his proximal arm weakness was noted to be worse at his visit on . at the time, this was thought perhaps due to his cervical myelopathy. however, he has progressed further since that time to the point of being unable to get up the stairs to his apartment without assistance; as recently as one month ago he was walking up 46 steps at the t station without help. as his neuromuscular fellow points out, "all this has occured in the setting of prednisone weaning, making steroid induced myopathy less likely." he did have a c-spine mri last week that showed a large disk compressing the cord at c4/5. his orthopedic spine surgeon is aware of his admission. mr. headache, loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. difficulties producing or comprehending speech. focal weakness, numbness, parasthesiae. no bowel or bladder incontinence or retention. difficulty with gait. on general review of systems, he reports some recent diarrhea, consistent with his alternating constipation and diarrhea of ibs. he recent fever or chills. no night sweats or recent weight loss or gain. cough, shortness of breath. chest pain or tightness, palpitations. nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. arthralgias or myalgias. rash. past medical history: 1. chronic inflammatory demyelinating polyradiculoneuropathy (cidp) as above. 2. chronic renal insufficiency, baseline cr 1.2-1.4, but with elevation of his creatinine over the last month, now up to 2.0. 3. possible myelodysplastic syndrome (persistently low blood counts), followed by dr. 4. diabetes mellitus 5. t8 compression fracture. 6. squamous cell carcinoma 7. cervical myelopathy 8. irritable bowel syndrome, with chronic constipation alternating with diarrhea social history: he has a remote alcohol and smoking history, none now; and no illicits. formerly worked for the usps. family history: father died age 57 of cad, mother in 80s with alzheimers. no one with other neurologic disease. physical exam: vitals: t: 98.5 p: 64 r: 18 bp: 139/87 sao2: 99%ra fs 147 general: awake, cooperative, nad. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx. bandages over forehead lesion. slight edema around eyes. neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no c/c/e bilaterally, 2+ radial, dp pulses bilaterally. skin: no rashes or lesions noted. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. attentive. language is fluent with intact repetition and comprehension. normal prosody. there were no paraphasic errors. speech was not dysarthric. able to follow both midline and appendicular commands. good knowledge of current events. there was no evidence of apraxia or neglect. -cranial nerves: i: olfaction not tested. ii: perrl 2 to 1mm and brisk. vff to confrontation. iii, iv, vi: eomi with 3 beats of bilateral end-gaze nystagmus. normal saccades. v: facial sensation intact to light touch. vii: no facial droop, facial musculature symmetric. viii: hearing intact to finger-rub bilaterally. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii and scm bilaterally. xii: tongue protrudes in midline. -motor: normal bulk, tone throughout. subtle pronator drift bilaterally. no adventitious movements noted. no asterixis noted. delt bic tri wre ffl fe io ip quad ham ta edb l 5 5- 4+ 4+ 4+ 4 4 4 5 5 5 5 4 4+ r 5 4 5 5 5 5 5 4- 5- 4+ 5- 5 4 4 -sensory: diminished sensation to pinprick over medial forearm and medial fingers on right. diminished cold sensation and vibratory sense over bilateral feet to ankles. proprioception intact throughout. no extinction to dss. -dtrs: tri pat ach l 1 tr tr 0 0 r 1 tr tr 0 0 plantar response was flexor bilaterally. -coordination: no intention tremor, no dysdiadochokinesia noted. no dysmetria on fnf or hks bilaterally. -gait: good initiation. slightly wide-based with short stride. dorsiflexes toes while walking. unable to walk in tandem. romberg mildly positive. . micu txfer pe: vs - tm 102.7ax, tc 100.4, bp 112/54 (112-164/54-70), hr 106 (58-106), rr 20, sats 100% on nrb. fs 140 i/o: incont today i/o: : 240 po + 2275 iv/1485; : 480po + 1600/800 + bm x1; : 760 + 1800/1350 gen: obese, older male, in nad. in c-collar and using nrb. not dyspneic or tachypneic. talking in full sentences. oriented x3. heent: sclera anicteric. perrl. slightly edematous l eyelid. skin flushed. mmm. unable to assess for jvd due to collar. cv: tachy, regular, normal s1, s2. no murmurs appreciated but difficult to hear due to rhonchorous breath sounds. lungs: diffuse, rhonchorous breath sounds throughout the anterior chest. no crackles appreciated at the bases. abd: soft, ntnd. + bs. no masses. no hsm appreciated. ext: no edema. negative sign bilaterally. le in pneumoboots bilaterally. 2+ dp pulses. + erythema, warmth of l knee. pertinent results: radiologic data: mri c-spine: extensive degenerative changes of the cervical spine with severe canal stenosis at c4/5. although the cord is compressed at this level, there are no cord signal abnormalities. these findings are not significantly changed compared to . . bone marrow biopsy: : specimen: bone marrow aspirate and core biopsy: diagnosis: 1. fragmented bone marrow biopsy with maturing trilineage erythroid dominant hematopoiesis. 2. absent iron stores . renal us: limited liver ultrasound: the liver shows no focal or textural abnormalities. the gallbladder appears normal without evidence of stones on this non-fasting study. there is no intra- or extra-hepatic biliary dilatation; the cbd measures 4 mm in diameter. color doppler demonstrates patent and anterograde portal venous flow. patency is also demonstrated in the right and left portal veins, the hepatic veins, and the splenic vein. there is no ascites. impression: normal-appearing liver and gallbladder with patent portal veins. . cta chest: impression: 1. no pulmonary embolism. 2. bilateral lower lobe consolidation and small bilateral pleural effusions. patchy right upper lobe airspace opacity. differential diagnosis includes infectious etiology. followup is recommended. 3. mid thoracic vertebral body compression deformity of unknown chronicity. . ct neck: clinical information: patient with acute hypoxia and tachypnea. there is slight thickening of the right aryepiglottic fold identified. the trachea and subglottic space is well maintained. the nasopharynx is also well maintained. there are postoperative changes in the lower cervical region with patient status post anterior discectomy. there are degenerative changes visualized in the cervical spine. no definite focal abscess identified. soft tissue changes are seen in the partially visualized right sphenoid sinus and a retention cyst is seen in the left maxillary sinus. at the right lung apex, linear opacities are identified with opacities at the posterior lung base which could be due to atelectasis. correlation with chest ct recommended. impression: status post anterior discectomy. soft tissue changes identified at the level of upper aspect of the postoperative change with indentation on the posterior aspect of the oropharyngeal airway, thickening of the right aryepiglottic fold, and obliteration of the right piriform sinus could be related to surgery but are slightly unusual in position and direct inspection is recommended to exclude focal abnormality. this finding is new since the previous cervical spine mri of . . : cxr: comparison is made with prior study performed a day earlier. left lower lobe retrocardiac opacity has improved, right lower lobe atelectasis/consolidation is unchanged, ill-defined opacity in the right upper lobe is also stable. mild cardiomegaly is unchanged. small bilateral pleural effusions are stable. . 09:50am blood wbc-4.5 rbc-3.92* hgb-10.7* hct-33.0* mcv-84 mch-27.2 mchc-32.3 rdw-17.6* plt ct-96* 06:55am blood wbc-1.9* rbc-3.61* hgb-9.7* hct-30.1* mcv-83 mch-26.8* mchc-32.2 rdw-17.2* plt ct-67* 06:30am blood wbc-3.8* rbc-3.32* hgb-9.0* hct-27.6* mcv-83 mch-27.2 mchc-32.7 rdw-19.3* plt ct-72* 05:40am blood wbc-2.8* rbc-3.15* hgb-9.4* hct-26.5* mcv-84 mch-29.8 mchc-35.4* rdw-20.0* plt ct-85* 09:50am blood urean-40* creat-2.0* na-139 k-4.5 cl-106 hco3-24 angap-14 05:50am blood glucose-86 urean-21* creat-1.4* na-138 k-3.5 cl-101 hco3-29 angap-12 05:40am blood glucose-103 urean-16 creat-1.3* na-139 k-3.4 cl-104 hco3-28 angap-10 brief hospital course: mr. is a 68-year-old man with a history of cervical myelopathy and chronic inflammatory demyelinating polyradiculoneuropathy (cidp) who presents with progressive weakness over the last month. his neurologic exam is notable for diffuse weakness, worse distally than proximally though with bilateral ip involvement. he also has sensory loss distally. these findings are consistent with a neuropathy, although the progressive weakness may be a result of his myelopathy. 1. cervical myelopathy: the patient was admitted to the neurology service as his exam suggested an upper motor neuron pattern of weakness (consistent with spinal cord compromise more than his known cidp), for consideration of surgery. orthopedics evaluated him (dr. ) after an mri showed cord compression in the upper cervical cord. surgery was recommended, but as his platelets dropped during the admission, surgery was felt to be unsafe until his platelets could be stablized. eventually, after ivig infusions and transfusions of several packs of platelets immediately afterwards, his platelets rose to >100,000 and he was taken to the or on for anterior discectomy and fusion. stress dose steroids were given perioperatively. surgery was uncomplicated and blood loss was only 50cc. dilaudid pca was used postoperatively to control pain, then transitioned to oral narcotics. strength in the arms improved during admission (residual c7 weakness bilaterally) and strength in the legs also improved to 4+/5 at the right ip and at the left ip, 5-/5 at bilateral hamstrings. he was followed by the neuromuscular service while he remained in house. his platelets remained stable for 48 hours after the procedure (80-100,000 range) but on post-op day three dropped to 72,000... physical therapy followed him both pre- and postoperatively and recommended rehab. 2. cidp prednisone was continued initially at his home dose. lower motor neuron signs of weakness consistent with the cidp were quite mild throughout the admission, and in fact, as his renal function improved (initial reason ivig was stopped), ivig was re-initiated, both for cidp and for platelet dysfunction. stress dose steroids were given perioperatively, as above. he gets 35g ivig q day x 2 days every two weeks. he will be due for his next dose of ivig early next week. in the past he has been receiving his ivig infusinons at the infusion clinic at . the number for that clinic where he is known is : . if you are not able to get in contact with then, please call dr. at pager: , (however, the infusion clinic will be better able to assist with the specifics of his infusions). he is also maintained on prednisone for this, which at time of discharge is being administered at doses of 10mg and 15mg on alternative days (please restart this regimen on day #2 of as he is to get 1 more day of 40mg prednisone for a gout flare). 3. acute on chronic renal insufficiency fena was checked and was 0.3, suggesting an element of pre-renal failure, likely due to poor po intake and chronic diarrhea from ibs. he was hydrated and electrolytes normalized, as renal function overall improved. renal consults followed him initially and renal u/s was normal; they signed off once renal function improved with hydration.on discharge, his cr returned to its baseline. 4. respiratory illness on post-op day 3 following the discectomy and fusion (decompression of spinal cord), he was found to be febrile to 103.5 axillary, with low level of responsiveness and sats in the low 80s (80-82%), tachypneic on exam with rhonchorous lung sounds, and no improvement with high-flow nasal cannula. he was placed on non-rebreather o2 and sats increased to high 90s; abg was: ph 7.40 pco2 46 po2 123 hco3 30 basexs 2. he was started on broad-spectrum antibiotics (vanco, levaquin and flagyl), and maintained on nonrebreather as this was unable to be weaned without substantial drop in oxygen saturations. ctpa and ct of the neck were ordered which showed no post-surgical abscess and no pe but confirmed a bilateral consolidation consistent with a significant aspiration pneumonia. as he could not maintain his sao2 without the 100% non-rebreather, a micu consult was initiated and transfer to that service was effected. he was started on vancomycin, levofloxacin and flagl to cover for aspiration pneumonia and also to cover for mrsa given his long hospital course. he did not require intubation; his o2 requirement was decreased after 2 days in the icu and he was able to breath on room air >48 hours prior to discharge. we plan to continue him for 7 additional days with vancomycin and flagyl. the flagyl can be transitioned to po. 5. hematology/? myelodysplastic syndrome: platelets dropped during the admission and after consult with hematology, etiology was felt to be chronic itp, likely kept at bay with the ivig infusions he had received as an outpatient for the cidp. platelets were felt to be sequestered in the spleen, and he was advised to ambulate with nursing three times daily to limit this complication pre-op. platelets rose to an acceptable level for operation by and he was taken to the or after ivig and platelet infusion. platelets dropped to 72,000 on . in addition to his thrombocytopenia, he was anemic, felt to be severe iron deficiency-related. he was treated with iv fe gluconate. he had a bone marrow biopsy on this admission - this was not consistent with a myelodysplastic syndrome. 6. diabetes team held metformin in preparation for possible surgery and imaging studies, continued glyburide, while covering with iss. he was switched to glipizide at the recommendation of the renal team. blood sugars were within goal range, in general. 7. htn: the patient was changed from atenolol to metoprolol given his renal insufficiency. he was still hypertensive to the 160s-170s - hence amlodipine 5mg daily was added onto his regimen prior to discharge. 8. gout flare: post op he developed gouty flares in his l knee, l 1st mtp and l wrist. rheumatology was consulted who recommended: - 2 days of prednisone 40mg - colchicine 3x/week - recheck his uric acid level in 1 month (it was 7.1 on ) - by discharge, his knee and l 1st mtp were improved. 9. code: full medications on admission: atenolol 50 mg--1 tablet(s) by mouth a.m. caltrate-600 plus vitamin d3 600 mg-400 unit--1 tablet(s) by mouth twice a day glyburide 2.5 mg--2 tablet(s) by mouth daily lorazepam 0.5 mg--tablet(s) by mouth as needed for 3 times a day prn metformin 500 mg--2 in am; 3 in pm twice a day prednisone 10 mg--1 tablet(s) by mouth 10mg alternating with 15mg daily protonix 40 mg--1 tablet(s) by mouth a.m. terazosin 2 mg--twice a day one in the am and two at bedtime vitamin b-12 1,000 mcg--once in am once in pm twice a day xalatan 0.005 %--1 drip instill each eye at night allergies: penicillins discharge medications: 1. flagyl 500 mg tablet sig: one (1) tablet po three times a day for 7 days. 2. vancomycin in dextrose 1 gram/250 ml solution sig: one (1) intravenous twice a day for 7 days. 3. colchicine 0.6 mg tablet sig: one (1) tablet po 3x/week for 1 months: please give every other day. hold for diarrhea. . 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 8. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 9. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 10. glipizide 5 mg tablet sig: 0.5 tablet po bid (2 times a day). 11. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 12. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 13. cyanocobalamin 500 mcg tablet sig: two (2) tablet po bid (2 times a day). 14. terazosin 1 mg capsule sig: two (2) capsule po qam (once a day (in the morning)). 15. terazosin 1 mg capsule sig: four (4) capsule po hs (at bedtime). 16. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 17. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 18. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed. 19. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed. 20. lorazepam 0.5 mg tablet sig: one (1) tablet po q 8h (every 8 hours). 21. prednisone 20 mg tablet sig: two (2) tablet po daily (daily) for 1 days. 22. prednisone 5 mg tablet sig: three (3) tablet po qod: to restart alternating between 15mg and 10mg daily. to start after 1 more dose of 40mg is given. 23. prednisone 10 mg tablet sig: one (1) tablet po qod: to restart taking this. his typical prednisone dose is alternating between 10mg and 15mg. (he has to get 1 more dose of 40mg before enacting this regimen). 24. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 25. heparin, porcine (pf) 5,000 unit/0.5 ml syringe sig: one (1) injection tid (3 times a day). discharge disposition: extended care facility: & rehab center - discharge diagnosis: 1. cervical stenosis with myelopathy. 2. cervical spondylosis. 3. chronic inflammatory demyelinating polyneuritis. 4. thrombocytopenia with idiopathic thrombocytopenic purpura. discharge condition: stable to rehab discharge instructions: you were admitted for a fall and found to have compression of your spinal cord. you underwent surgery for this. during your hospitalization, you had an aspiration pneumonia. . please keep incision clean and dry. you may shower in 48 hours, but please do not soak the incision. change the dressing daily with clean dry gauze. if you notice drainage or redness around the incision, or if you have a fever greater than 100.5, please call the office at . please resume all home mediciation as prescribed by your primary care physician. followup instructions: please follow up the dr. at two weeks from the date of your surgery. if you need to make this appointment, please call . . you have the following premade appointments: provider: . & phone: date/time: 11:30 provider: , md phone: date/time: 1:00 procedure: biopsy of bone marrow other cervical fusion of the anterior column, anterior technique excision of intervertebral disc transfusion of platelets injection or infusion of immunoglobulin insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae diagnoses: diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified pulmonary collapse myelodysplastic syndrome, unspecified chronic kidney disease, stage iii (moderate) pneumonitis due to inhalation of food or vomitus other and unspecified coagulation defects immune thrombocytopenic purpura splenomegaly chronic inflammatory demyelinating polyneuritis cervical spondylosis with myelopathy dysphagia, unspecified 

Answer: The patient is high likely exposed to