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: valium attending: chief complaint: mixed respiratory failure major surgical or invasive procedure: intubation history of present illness: yo man with h/o parkinson's disease, multiple prior admissions for aspiration pneumonia most recently , who presents again from rehab after the staff there had "trouble waking him up" this am, and found him to be in mixed respiratory failure. on the prior admit, the pt was diagnosed with a lll pna and treated with vancomycin/zosyn. per his wife, the patient was doing relatively well last week, still in the macu at rehab since his recent discharge from but with a plan to transition to the regular floor soon. his abg on was 7.34/69/55 on room air, which is close to his baseline pco2. on saturday 2d pta, the pt's wife noted that he was congested more than baseline, initially unable to cough, but then improved after neb treatments with the production of brown-pink secretions. he had hyperglycemia to fs 223, which per wife he has never had before (no h/o dm). by saturday night though he was doing well, less congested and speaking clearly. then, sunday am, he was congested again and though he received nebs he was not able to cough out the secretions. per the pulmonologist note from sunday pm, he was then found to be poorly arousable, with rr 30, shallow breathing, lungs clear, o2 sat 90% on pulse oximeter. abg performed, 7.20/107/44, o2 sat 68% on abg, presumably on room air though unclear. bipap was written for (ipap 16, epap 3), though it is not clear if this was started. he was shortly thereafter intubated after the pulmonologist confirmed his full code status with the pt's wife. after intubation, it was noted that he had copious thick yellow secretions in his trachea, which were felt to be the culprit causing obstruction and hypercarbia/hypoxemia. with suctioning his breathing improved, and he was transferred to for further work up. the patient remained awake the whole time. he was noted to have a temp of 100.4f this am. . upon arrival to the ed, he appeared to be in no respiratory distress. his initial abg was 7.34/67/315. he was found to be febrile to 100.4f, with hr 60s-70s, sbps ranged 60s-80s. his cxr was concerning to the ed staff for rul/rll processes (though appears to have only persistent lll , and he was given ctx, vanc, and flagyl out of concern for nosocomial vs. aspiration pna. his urine was leuk esterase (+) on ua, culture pending. blood cultures were also sent. he received 1l ns for hypotension, and subsequently his pressures were still low so he was started on a dopamine drip via a newly-placed rij (per report, sterile placement via ultrasound in the er). he also had a 18g piv placed, and has a picc line from rehab that is of unclear age or indication (felt to be from prior need for iv abx). his ecg was notable for q-wave in v1, st elevations laterally, concerning for ischemia. tnt 0.10, ck 22, mb not done. lact 0.6. he was given asa 325mg pr. his wife confirmed that he is full code. past medical history: 1. h/o aspiration pna - tx with levo, unasyn, vanco/zosyn in the past 2. h/o aspiration s/p swallow eval with swallowing difficulty, s/p placement on 3. parkinson's 4. osteoporosis 5. t11/12 compression fx 6. lle osteomyelelitis as a child/chronic osteomyelitis, quiescent. 7. granulomatous liver disease 8. lue rotator cuff tear 9. prostate cancer s/p orchiectomy in 10. s/p laminectomy l4-5 11. cataracts s/p surgery . glaucoma 13. hypertension social history: the patient has a sixty-pack-year history of tobacco. he quit in . he lives in a nh for the past 2 years. he is a retired history professor. he reports no alcohol intake. family history: non-contributory physical exam: pe: vs: t 97 hr 77 bp 124/96 rr 14 o2 100% on vent vent: ac 550 x14 fio2 of 50/peep 5 gen: sedated, intubated heent: nc/at, mmm, et tube in place neck: supple, no lad; rij presep cath in place without bleeding/hematoma lungs: coarse throughout, decreased bs at l base heart: rr, with 3/6 systolic murmur at the ll-sternal border. abdomen: +b/s, soft, , in place without erythema or discharge extremities: 1+ pitting edema bilat. ext warm. picc in r upper arm, piv in r forearm pertinent results: upon admission: 5.3 >-------<205 30.5 133 | 99 | 29 | ---------------<134 4.8 | 32 | 0.6| lactate: 0.6 cardiac enzymes negative. cultures: 1:36 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): gram positive cocci. in pairs. respiratory culture (final ): rare growth oropharyngeal flora. yeast. sparse growth. 10:45 am urine site: clean catch **final report ** urine culture (final ): yeast. 10,000-100,000 organisms/ml.. blood: negative studies: 10:22 ekg: nsr at 65 with freq pacs, lad, normal intervals, q in ii/iii/avf, poor r-wave progression, 0.5mm st elev in i,avl,v1-v3, twi in iii. c/t prior ecg , q waves old, poor r-wave prog old, st elev new. . cxr: indications: -year-old man with parkinson's disease, pneumonia, and left effusion, intubated. chest, ap supine: comparison is made to . the patient is now intubated. the endotracheal tube terminates approximately 4 cm above the carina near the thoracic inlet. the lung volumes are low. the cardiac and mediastinal contours are similar. markedly calcified subcarinal lymphadenopathy is again noted. there is persistent left lower lobe opacity with an effusion, as well as a new mild congestive heart failure or pulmonary venous hypertension. impression: 1. status post endotracheal intubation. 2. persistent left lower lobe opacity. 3. mild congestive heart failure or fluid overload. . axr: single supine ap: part of the left hemipelvis is not included in the study. the study is also centered around the pelvis rather than including the whole abdomen. the visualized portion of the abdominal cavity demonstrate normal bowel gas pattern with stool noted within the ascending colon and sigmoid colon. the bone and soft tissues structures are unremarkable. impression: no acute abdominal pathology is identified. no evidence of obstruction or free intra-abdominal air is noted. . cxr: worsening right lower lobe opacity, suspicious for pneumonia. brief hospital course: yo m with h/o aspiration pna, swallowing difficulty, parkinsons, who p/w acute hypercarbic respiratory failure. followed by stress ekg negative for ischemia. patient extubated and is planned to transition to rehab . . 1. respiratory failure: mixed hypercarbia and hypoxemia likely from mucus plugging in setting of poor reserve from underlying restrictive lung disease and lll pna. he has a history of hypercarbia possibly due to neuromuscular weakness of respiratory muscles due to parkinsons. cta neg for pe. . during his stay the patient has an 8 day antibiotic treatment for nosocomial pna with ceftaz and vancomycin as he was found to have gram positive cocci in pairs in his sputum. he continued on his albuterol and ipratroprium nebulizers on nasal cannula. a neurology consult on suggested that the patient should see neuromuscular in follow up and a decision can be made at that time whether any further emg studies are needed but no further eval at this time with regards to investigating a neuromuscular source of his hypercarbia. in addition the patient had transient pulmonary edema that improved with lasix admiinstration. . while in house, the patient was given an overnight trial of bipap as the patient is chronically hypercarbic with weak respiratory muscles secondary to parkinson's disease. while he did not tolerate the procedure well we believe that he may benefit from a repeated trial when he is healthier 2-3 months discharge. . 2. parkinsons: the patient was continued on his home regimen of parkisons medication including cabidopa/levidopa and mirapex while in house . 3. glaucoma: the patient was continued on his home regimen of drops. . 4. hypertension: controlled with lisinopril 20 and lasix as needed. . 5. osteoporosis: osteoporosis drugs were held during this admission. the patient should be reevaulated for possibly re-starting an anti-osteoporosis regimen as an outpatient. . 6. chest pain: the patient described chest pain but had a negative ekg. it improved during his hospital stay and a spontaneous breathing trial followed by stress ekg to evaluate for ischemia was negative. medications on admission: -insulin ss q6h prn -ipratropium nebs q6h -lisinopril 10mg qday -mvi qday -hydrocodone-acetaminophen 1 tab po q6h:prn -senna 2 tab po qhs -fexofenadine 60 mg po bid -fluticasone propionate nasal 1 spry nu -entacapone 200 mg q 5am, 8am, 11am, 2pm, 5pm, 8pm, 11pm -pramipexole 0.125 mg q 5am, 8am, 11am, 2pm, 5pm, 8pm -pramipexole 0.1875 mg @ 11pm qday -carbidopa-levodopa (25-100) 2 tab po q5am, 8am, 11am, 2pm, 5pm, 8pm, 11pm -docusate sodium (liquid) 100 mg po bid -omeperazole 20mg po q24h -artificial tears 1 drop both eyes tid -chlorhexidine gluconate 15 ml po bid -latanoprost 0.005% ophth. soln. 1 drop both eyes hs -dorzolamide 2%/timolol 0.5% ophth. 1 drop both eyes -albuterol 0.083% neb soln 1 neb ih q4h:prn -calcium/vit d 500mg -hep 5000 sq tid discharge medications: 1. heparin (porcine) 5,000 unit/ml solution : one (1) injection injection tid (3 times a day). 2. hexavitamin tablet : one (1) cap po daily (daily). 3. carbidopa-levodopa 25-100 mg tablet : two (2) tablet po 7x/d (). 4. pantoprazole 40 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po once a day. tablet, delayed release (e.c.)(s) 5. latanoprost 0.005 % drops : one (1) drop ophthalmic hs (at bedtime). 6. polyvinyl alcohol 1.4 % drops : 1-2 drops ophthalmic tid (3 times a day). 7. docusate sodium 50 mg/5 ml liquid : po bid (2 times a day). 8. lisinopril 20 mg tablet : one (1) tablet po daily (daily). 9. albuterol sulfate 0.083 % (0.83 mg/ml) solution : two (2) nebs inhalation q4h (every 4 hours) as needed. 10. calcium carbonate 500 mg tablet, chewable : one (1) tablet, chewable po bid (2 times a day). 11. cholecalciferol (vitamin d3) 400 unit tablet : one (1) tablet po daily (daily). 12. entacapone 200 mg tablet : one (1) tablet po 7x/day (). 13. ipratropium bromide 0.02 % solution : two (2) nebs inhalation q6h (every 6 hours). 14. lactulose 10 g/15 ml syrup : thirty (30) ml po q8h (every 8 hours) as needed for constipation. 15. aspirin 325 mg tablet : one (1) tablet po daily (daily). 16. fluticasone 50 mcg/actuation aerosol, spray : one (1) spray nasal (2 times a day). 17. pramipexole 0.125 mg tablet : one (1) tablet po six times per day (). 18. dorzolamide-timolol 2-0.5 % drops : one (1) drop ophthalmic (2 times a day). 19. senna 8.6 mg tablet : 1-2 tablets po bid (2 times a day). 20. fexofenadine 60 mg tablet : one (1) tablet po bid (2 times a day). 21. pramipexole 0.125 mg tablet : 1.5 tablets po qday (). 22. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. discharge disposition: extended care facility: center discharge diagnosis: respiratory failure aspiration pneumonia parkinson's disease anemia chronic respiratory failure discharge condition: stable discharge instructions: please take your medications as prescribed. if you develop shortness of breath, fever, or any other concerning symptoms please contact a health care provider . followup instructions: provider: , md phone: date/time: 2:30 provider: , md phone: date/time: 9:30 md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances infusion of vasopressor agent diagnoses: acidosis anemia, unspecified unspecified essential hypertension personal history of malignant neoplasm of prostate unspecified glaucoma paralysis agitans acute and chronic respiratory failure other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus other shock without mention of trauma osteoporosis, unspecified gastrostomy status foreign body in respiratory tree, unspecified 

Answer: The patient is high likely exposed to