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: sulfa (sulfonamides) attending: chief complaint: dysphagia - myasthenia crisis major surgical or invasive procedure: none history of present illness: ms. is a 58 yo woman with dm, esrd on dialysis, dm, chf and diagnosis of myasthenia presenting with worsening dysphagia and weakness for the past 10 days. patient has diagnosis of since (see below pmh for diagnosis history), having had 2 crisis with respiratory distress in the past and several admission for plasmapheresis. patient has been tried on several medications including corticosteroids, cellcept and cytoxan. patient is poorly compliant to treatment, she often misses her appointments and she has been off medications for the past 2 months. patient reports that for the past 10 days she has had progressive dysphagia, she chokes drinking water and has not been able to take pills po. she also reports that her legs have been weaker, not being able to walk for the past few days. she denied diplopia, ptosis or respiratory distress. patient was seen in clinic by dr. and dr. who recommended for her admission for plasmapherisis. in er, patient had nif -20/-15, vc 1 l in ed with poor effort past medical history: 1. : diagnosed with myasthenia in with a presentation with ptosis and episodic double vision. she subsequently developed dysarthria, dysphagia, and mild neck and limb weakness, and was initially evaulated by dr. at the , . her work-up included acteylcholine receptor antibodies which were positive. initially, she was treated with high-dose prednisone at 80 mg a day. the patient stated that on this dose of prednisone, she had an increase in her serum glucoses that were difficult to control because of her type 2 diabetes. she was then started on trials of various steroid-sparing agents, complicated by side effects, and has included: a. iv cytoxan, which she stated that she did not tolerate because of diarrhea. b. cellcept, which she could not tolerate because she could not swallow it. c. she thinks she has tried cyclosporine in the past as well dr. eventually put her on imuran, which she has been on for the last 12 years. 2. poorly controlled diabetes 3. esrd 4. neuropathy 5. htn 6. congestive heart failure. social history: she lives by herself, smokes 1 pck cigarette per day for the past 40 years, no alcohol use or illicit drug use. she used to work with medical trascription. family history: no hx of in the family, father died of lung cancer and mother had dm. physical exam: t 97 bp 182/69 hr 63 rr 23 gen: lying in bed, nad heent: nc/at, moist oral mucosa neck: no tenderness to palpation, normal rom, supple, no carotid or vertebral bruit back: no point tenderness or erythema cv: rrr, nl s1 and s2, lung: clear to auscultation bilaterally abd: ascitic, nontender ext: ulcer on l toe; warmth and mild erythma on lower extremities neurologic examination: mental status: awake and alert, cooperative with exam, normal affect. oriented to person, place, and date. attentive, says backwards. speech is fluent with normal comprehension and repetition; naming intact. no dysarthria. and writing intact. registers , recalls in 5 minutes. no right left confusion. no evidence of apraxia or neglect. cranial nerves: pupils: surgical on l eye and cataract on r eye. visual fields are full to confrontation. extraocular movements intact bilaterally, no nystagmus. sensation intact v1-v3. facial movement symmetric. hearing intact to finger rub bilaterally. palate elevation symmetrical. sternocleidomastoid and trapezius normal bilaterally. tongue midline, movements intact motor: normal bulk bilaterally. tone normal. no observed myoclonus or tremor no pronator drift tri wf we fe ff ip h q df pf te tf r 4- 5- 5 5 5 5 5 4- 5 5 5 5 5 5 l 4- 5- 5 5 5 5 5 4- 5 5 5 5 5 5 neck flexor: 4- sensation: decreased to touch, pinprick, vibration on lower extremities and proprioception throughout. no extinction to dss reflexes: trace to 1+ at the biceps and knees. gait: not checked, pt came in wheelchair today. coordination: finger-nose-finger normal, heel to shin normal, rams normal. gait: pt could not stand up pertinent results: 01:50pm blood wbc-10.3 rbc-4.40 hgb-13.0 hct-41.4 mcv-94 mch-29.6 mchc-31.4 rdw-16.3* plt ct-189 01:50pm blood glucose-90 urean-16 creat-3.2*# na-140 k-4.9 cl-97 hco3-38* angap-10 01:50pm blood ck(cpk)-29 01:50pm blood ctropnt-0.22* 08:00pm blood ctropnt-0.19* 04:23am blood ctropnt-0.22* 05:00am blood ctropnt-0.20* 01:50am blood %hba1c-6.9* 08:00pm blood tsh-2.3 06:27pm blood type-art po2-64* pco2-50* ph-7.46* caltco2-37* base xs-9 06:27pm blood lactate-1.8 echo : moderate left ventricular hypertrophy with preserved regional/global biventricular systolic function (lvef > 55%). moderate diastolic dysfunction with evidence of elevated filling pressures. right ventricular hypertrophy with normal function and evidence of rv pressure overload. at least moderate pulmonary hypertension (pcwp > 18mmhg). mild aortic stenosis and trivial regurgitation. mild to moderate mitral and tricuspid regurgitation. mild functional mitral stenosis from extensive mitral annular calcification. brief hospital course: patient is a 58 year old rhw with dm, esrd on dialysis, dm, chf and diagnosis of myasthenia in presenting with worsening dysphagia and weakness for the past 10 days after being off medications for the past 2 months due to running out of her meds. patient reports not being able to swallow solids nor to walk at home for the past few days but denied dyspnea, double vision or ptosis. patient is poorly compliant to treatment. neurological exam remarkable for weakness in lower extremities and in the er, patient had nif -20/-15, vc 1 l in ed with poor effort. she was admitted to icu initially given her serious condition and the possibility for need for intubation. she was monitored closely and was followed per dr. / throughout this admission. she was started on plasmapheresis on - morning after admission using her hd catheter and renal followed her as well for her esrd and hd. she was urgently dialyzed on after plasmapheresis. she tolerated both well without respiratory distress or hemodynamic instability. she was continued on imuran (50mg ) and mestinon 15mg daily. she was also started on prednisone (1mg/kg/day = 45mg/day). nif and vc were checked every 3~4 hrs and continued to improved especially after the 1st round of plasmapheresis. she was transferred to neuro step down on given that she was more stable. she received 5 cycles of plasmapheresis every other day and continued to get hd as recommended per renal who also recommended an echo which showed preserved ventricular function (lvef > 55%) but mild pulm htn with pcwp > 18mmhg. upon admission to the neurology team she had improved strength but was refusing to take her mediactions po. he imuran and steroids were changed to iv. she continued to have her nif's and vc checked on a q6-8hr basis. they continued to improve and stabilized around normal for age and wt (with some intermitent poor results due to poor effort.) she also began to take her mestinon more regularly, which also improved her strength. towards the end of her stay she was changed back to po meds and her imuran was increased to 100mg in am and 50mg in pm. she also began to take more doses of mestinon on a prn basis. as her strength improved, she began to eat more, and this mainly consisted of peanut butter and jelly sandwhiches. her fingerstick glucose checks began to consistently range in the 300-500 range. she was then started on 16 units of lantus on top of her sliding scale of regular insulin. this succesfully brought her to more acceptable ranges. she completed 5 sessions of plasma exhange with no complications. while admitted she continued her hemodialysis schedule. by time of discharge, he strength was much improved and she had less fatiguablilty. pt was consulted and determined she required no outpt services. social work was consulted as well and helped her get set up with support services in her area. she was scheduled to follow-up with dr. in clinic. medications on admission: medications (of note, she has taken none for the last 5 days and noted dose are what she was on when before she ran out 2 months ago): insulin imuran 150 mg daily. prednisone 30 mg a day alternating with 10 mg a day. lasix mestinon 15 mg (she can't tolerate more due to severe diarrhea). she was prescribed levsin but has apparently not taken it. discharge medications: 1. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 3. pyridostigmine bromide 60 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 4. hyoscyamine sulfate 0.125 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual (2 times a day) as needed for with mestinon to prevent diarrhea. disp:*60 tablet, sublingual(s)* refills:*2* 5. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 6. nitroglycerin 2 % ointment sig: one (1) transdermal q6h (every 6 hours). 7. insulin glargine 100 unit/ml solution sig: sixteen (16) units subcutaneous once a day. disp:*480 units* refills:*2* 8. prednisone 10 mg tablet sig: five (5) tablet po daily (daily). 9. azathioprine 50 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 10. azathioprine 50 mg tablet sig: two (2) tablet po daily (daily): take in the morning. disp:*60 tablet(s)* refills:*2* 11. pyridostigmine bromide 60 mg tablet sig: 0.25 tablet po hs (at bedtime). disp:*15 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: myasthenia diabetes end stage renal disease discharge condition: improved discharge instructions: you were admitted because your myasthenia was not well controlled. please continue to take your medications when you are discharged. if you start to have worsening weakness, please call your neurologist or come to the emergency room. followup instructions: please follow-up with dr. on at noon in the building procedure: hemodialysis therapeutic plasmapheresis diagnoses: end stage renal disease renal dialysis status mitral valve disorders congestive heart failure, unspecified aortocoronary bypass status polyneuropathy in diabetes long-term (current) use of insulin personal history of noncompliance with medical treatment, presenting hazards to health diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled other nonspecific abnormal serum enzyme levels diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled tricuspid valve disorders, specified as nonrheumatic myasthenia gravis with (acute) exacerbation 

Answer: The patient is high likely exposed to