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: levofloxacin attending: chief complaint: "trach fell out" major surgical or invasive procedure: 1. rigid bronchoscopy. 2. flexible bronchoscopy x 2. 3. percutaneous tracheostomy placement 4. endotracheal intubation with subsequent tracheostomy placement history of present illness: 65 yo male with cad s/p cardiac arrest and ?vocal cord dysfunction who presented to from his nursing home after he accidentally knocked his trach out and they were unable to replace it. he was then transferred to for ent replacement of the trach as they were unsuccesful at . he has had the trach for any between 7 to 17 months, and has reportedly not been on a vent in greater than 4 months. it is unclear why it is still in but the patient states that it was due to come out next week anyways. he initially complained of cough with mucus production in the ed but denies it currently. he has noted some increasing doe and swelling of his le recently. he also states that he has put on weight and feels "heavy" but is unclear on how much over how long. denies fever, chills, rash, or dysuria. denies abdominal pain, chest pain, or pleuritic pain. denies orthopnea or pnd. . in ed, t 96.6 bp 160/74 hr 110 o2sat 93-94% on 28% venti mask. received levaquin for possible pneumonia (elevated wbc count, productive cough). seen by general surgery who felt that he did not need the trach replaced as he seemed to be fine without it. . on presentation to medicine floor, reports trach was placed months ago emergently. since that time has experienced lower extremity swelling. reports mild sob. denies fever, cough, chest pain. reports unsteady gait. . ros: negative for fevers, chills, nightsweats, chest pain, shortness of breath, cough, abdominal pain, nausea, vomiting, diarrhea, melena, hematochezia, hematemesis, dysuria. no ha/dizziness/paresthesias or weakness past medical history: morbidly obese cad s/p cardiac arrest idiopathic vocal cord paralysis schizophrenia hypertension osa social history: lifelong non-smoker, distant etoh use, no illicits. lives in nursing home. family history: noncontributory physical exam: t 96.6; bp 158/90; p 109; rr 20; 87% ra; 100% on 50% vm gen: well-appearing, nad, obese; difficult to understand heent: tracheostomy dressed; clean, dry, nonerythematous; eomi; oropharynx nonerythematous neck: no jvd appreciated cv: rrr, normal s1s2, no murmurs, rubs or gallops pulm: normal work of breathing; decreased breath sounds; cta bilaterally; no wheezes, rales, rhonchi abd: normoactive bowel sounds; obese; soft, nontender, not distended ext: 1+ bilateral le edema; radial pulses 2+ pertinent results: cxr pa/lat (): gross cardiomegaly with prominence of pulmonary vasculature suggestive of pulmonary venous hypertension without evidence of frank cardiac failure. cta chest (): 1. limited study, no main or lobar pe. 2. 5 mm right middle lobe pulmonary nodule, in absence of risk factors, dedicated chest ct is recommended for followup at 12 months. abg (8:56am): po2-118* pco2-105* ph-7.21* caltco2-44* base xs-9 abg (10:49am): po2-76* pco2-105* ph-7.21* caltco2-44* base xs-9 brief hospital course: 65m with tracheostomy since placed for vocal cord dysfunction following intubation for respiratory and ?cardiac arrest transferred from outside hospital after trach tube accidently fell out. on arrival to emergency department, patient was satting 93-94% on 28% venti mask. hypoxia was thought to be secondary to poor air movement due to vocal cord dysfunction and loss of trach. per patient's ent doctor (pieter nordzig at ), trach was placed in for vocal dysfunction following intubation for respiratory failure. respiratory failure was thought to be secondary to obesity hypoventilation syndrome and osa. per ent attending, patient keeps trach open at night, closed during day time. plan was to have trach removed in weeks as patient was improving. surgery was consulted in ed; it is unclear regarding their evaluation of the patient, and trach was not replaced. given lower extremity edema and mildly elevated bnp, patient was also given furosemide 80mg iv x1. given concern for pe, cta was done and found to be without pe. treated for pneumonia in ed and continued on floor given productive cough and leukocytosis. no clear infiltrate on radiograph. pt also developed a diffuse reticular erythematous and pruritic rash on all 4 extremities, abd, and chest. it was thought that the levaquin may have been contributing to rash, in addition, there no infiltrate on cxr to treat, so it was stopped in the icu. the rash did improve following discontinuation. on morning preceding transfer to icu, patient desaturated to 70s while sleeping and was difficult to arouse. trigger was called. patient was placed on nasal cannula 3-4l and moved to chair; o2 saturation quickly improved. blood gas was drawn and showed acidosis with severe co2 retention. repeat blood gas was similar but with worsening pco2 and rr of 40. patient was intubated and transferred to the micu. trach was replaced in or the next day (). patient was gradually weaned of the vent. and prior to discharge, he was off of the ventilator for 48 hours and only required supplemental oxygen intermittently via a trach collar. ## leukocytosis: unclear source. be related to a possible pneumonia, which was transiently treated with levofloxacin (started ) however patient developed a rash and the levoquin was stopped. ua normal. urine and blood cultures with no growth thus far. sputum only grew op flora. started empirically on flagyl but 2 c.diff toxins were neg. flagyl discontinued prior to discharge. ## hyponatremia: on presentation, serum sodium was 127. clinical scenario most consistent with hypervolemic hyponatremia. una 87 and fena 0.5%, indicating prerenal physiology. on floor, furosemide dose was decreased to 40mg daily. on transfer to micu, hyponatremia was resolving and resolved eventually. ## cad: two negative sets of cardiac enzymes. while npo, d/c'ed all heart meds while npo. pt developed tachycardia thought to be beta blocker withdrawal and thus restarted iv beta blocker. once able to take po, transitioned iv bb to po and restarted ace and asa. pt was admitted on atenolol but was discharged on metoprolol, equiv dose, to easier titration given tachycardia. ## fluid overload: while in the micu, goal net neg 1 l each day. received 40mg iv lasix until transitioned to 80mg po lasix with goal to be net even. ## altered mental status: has schizophrenia at baseline but per nursing home physician he has not been delusional. at discharge, he appears to be at his baseline. ## thrombocytosis: per nursing home physician, medications on admission: (per nursing home records) albuterol inh qid prn bisacodyl suppository 10mg prn mylanta 30ml po prn tylenol prn lasix 80mg po daily - changed from 40mg daily on atenolol 25mg po daily prilosec 20mg po daily asa 81mg po daily colace liq 100mg daily kcl 10meq po daily lisinopril 40mg po daily combivent 2puff qid senna 2 tabs po qhs discharge medications: 1. furosemide 80 mg tablet sig: one (1) tablet po daily (daily): hold if sbp < 90. 2. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 3. acetaminophen 325 mg tablet sig: 1-2 tablets po every hours as needed for fever or pain: max dose 4 g daily. 4. mylanta 200-200-20 mg/5 ml suspension sig: thirty (30) ml po every six (6) hours as needed for indigestion. 5. bisacodyl 10 mg suppository sig: one (1) suppository rectal once a day as needed for constipation. 6. omeprazole 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp < 100, hr < 60. 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. multiple vitamin tablet sig: one (1) tablet po once a day. 10. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 11. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily): hold for sbp < 100. 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 13. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) u injection tid (3 times a day): until fully ambulatory. 14. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical daily (daily) as needed for dry skin. 15. combivent 18-103 mcg/actuation aerosol sig: two (2) puffs inhalation four times a day. 16. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. 17. potassium chloride 20 meq packet sig: ten (10) meq po once a day. discharge disposition: extended care facility: - discharge diagnosis: respiratory distress secondary to tracheostomy displacement status post replacement, resolved hyponatremia, resolved secondary: hypertension history of coronary artery disease discharge condition: afebrile, normotenisve, trach collar to room air discharge instructions: you have been treated for your respiratory distress. your tracheostomy tube was replaced, and you improved. you will have a follow up appointment with dr. , one of the interventional pulmonologists, in one week to re-evaluate the tracheostomy tube. please take your medications as prescribed. please contact your physician or return to the emergency room should you develop any of the following symptoms: fever > 101, chills, difficulty breathing, chest pain, or any other concerns. followup instructions: please follow up with dr. on tuesday, at 11:00 am. please do not eat or drink anything that morning prior to your appointment. please call if there is a problem with this appointment. otherwise, please follow up with your primary care physician. md, procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy temporary tracheostomy closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified acidosis obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension hyposmolality and/or hyponatremia acute and chronic respiratory failure other specified cardiac dysrhythmias morbid obesity dermatitis due to drugs and medicines taken internally acute on chronic systolic heart failure other specified antibiotics causing adverse effects in therapeutic use attention to tracheostomy paralysis of vocal cords or larynx, unspecified essential thrombocythemia schizophrenic disorders, residual type, chronic 

Answer: The patient is high likely exposed to