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: macrolide antibiotics attending: chief complaint: agitation, shortness of breath major surgical or invasive procedure: none history of present illness: 79yo man with laryngeal scc s/p trach/peg tx. with chemo and radiation, recently diagnosed lung adenoma in ., copd, cad, with shortness of breath, hypoxia, increased agitation and increased trach secretions from . he was recently hospitalized at , where he has received all his medical care, in with pseudomonas pna, treated initially with zosyn x 10d, then when repeat cx. showed pseudomonas, he was started on meropenem and transitioned to cipro after sensitivities returned. at that admission also had ct-guided bx. diagnosing adenoca. of note also was treated during this hospitalization with keflex for peg tube superficial infection and flagyl presumptively for c. diff. despite negative c. diff tests. he has recently completed his radiation treatments and was transferred ~10d ago to from . . in ed, t 98, tachy to 110s, bp 140s/60s, 14, 98% 10l tm, with thick tan sputum suctioned from trach. ekg w/ no st/t changes. cxr with what was thought to be lul, had abg of 7.37/58/116/35 on 10l tm, and admitted to micu for closer monitoring and trach suctioning. past medical history: tuberculosis, treated in , s/p cva with r hemiparesis hypertension copd on home o2 cad h/ unclear history of dementia chronic kidney disease bl cr 1.4-1.6 rectal bleeding at last hospitalization, nl 3 yrs ago. depression anemia laryngeal scc s/p trach/peg adenocarcinoma of lung social history: had lived with daughter in past, was at prior to admit. family history: non-contributory physical exam: physical exam on admission: . vitals: temp 98.6 , bp 130/48 hr 69, rr 31-->23, sao2 98% on 15l trach mask general: well appearing man in nad, with trach, coughing up sputum productively heent: anicteric sclera, trach in place, tongue automations. cv: distant hs, rrr, nls1s2, no murmurs, jvp flat pulm: rhonchi bilaterally on post. exam. + wheezes throughout all lung fields abdomen: soft, nondistended, non-reproducible ttp in llq. g-tube in place, no erythema, warmth, bleeding ext: no edema, 2+ dps neuro: aa&ox1, knows he's in "america", cn iii-xii intact, good cough.4+/5 strength in rue, in lue. nl strength elsewhere, pill-rolling tremor on left. skin: multiple ecchymoses on forearms bilaterally. pertinent results: glucose-140* urea n-35* creat-1.2 sodium-137 potassium-4.7 chloride-100 total co2-31 anion gap-11 . albumin-3.0* calcium-8.4 phosphate-4.3 magnesium-2.3 . alt(sgpt)-30 ast(sgot)-23 ck(cpk)-33* alk phos-96 amylase-28 tot bili-0.3 lipase-14 . wbc-6.4 rbc-3.77* hgb-10.6* hct-32.9* mcv-87 mch-28.2 mchc-32.4 rdw-17.9* . lactate-1.0 . type-art rates-/14 po2-32* pco2-59* ph-7.38 total co2-36* . urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg . cxr ap portable upright chest: no prior studies available for comparison. there is a tracheostomy tube in place. right-sided subclavian central line with its tip in the mid svc. although this radiograph is somewhat difficult to interpret due to patient positioning and low position of the left scapula/clavicle, there is a left apical airspace opacity with volume loss and traction bronchiectasis, likely chronic. remainder of the lungs are clear. there may be a component of underlying emphysema. impression: left apical opacity with volume loss and traction bronchiectasis, likely chronic. (is there a history of malignancy, prior radiation, or tuberculosis?) in the correct clinical setting, this could represent acute pneumonia, but this is thought less likely. correlation with prior studies would be helpful and follow up to resolution if warranted. . cxr :impression: 1. new left basilar ill-defined opacity may reflect an evolving pneumonia. 2. stable left apical opacity, unclear if this is a chronic or an acute on chronic process, prior examinations would be useful. recommend a follow up to resolution. . ekg:sinus tachycardia. normal tracing, except for rate. no previous tracing available for comparison. . brief hospital course: mr. is 79 year-old man with laryngeal cancer s/p trach/peg tx. with chemo and radiation, recent diagnosis of lung adenoca in ., copd, cad, p/w shortness of breath, hypoxia, increased agitation and increased trach secretions found to have pneumonia. . # respiratory distress: at presentation this seemed to be more consistent with a copd exacerbation and likely had mucus plug that has cleared in ed with aggressive suctioning. he was continued on supplemental oxygen via trach mask. he was started on a short course prednisone 60mg for 4 days as well as vancomycin and zosyn for copd exacerbation, dosed per crcl (day 1 ). vancomycin stopped on , zosyn stopped . pt completed 7 day course. repeat cxr suggested pna. a sputum culture was sent, mucinex given to loosen secretions. he was started on chest pt and continued on his home regimen of spiriva, albuterol/atrovent nebulizer treatment. respiratory care followed the patient daily. he was placed on 35% tm for humidity to help with secretions. . # abdominal pain: initially had some left lower quadrant tenderness on exam. serial exams were performed and no further abdominal pain was elicited. peg tube site, c/d/i without discharge. . # laryngeal squamous cell carcinoma/adenocarcinoma of the lung with chronic pain: he was continued on his fentanyl patch and prn magic mouthwash. he has a trach and peg for feeding as he is unable to tolerate po as per swallowing evaluation. . # palliative care consult for discussion regarding further care of scc and lung adenocarcinoma. a family meeting was held on to discuss goals of care and code status. family decided that they wanted the patient to return to for rehab with the hopes that he may be able to return home one day with services. pt's family declined palliative/hospice care at this time and decided that pt would see his oncologist next week otherwise he has an appointment on . . # anemia: he was continued on supplemental iron. aranesp was held as this medication is non-formulary. hct was trended and remained stable. . # depression/psych: he was continued on his home dose celexa, risperdal. he received several doses of haldol for agitation. olanzapine given prn. . # cad: he was continued on his statin and started on low dose aspirin. . # fen: jevity 1.2 tfs as prior to admit. # access: portacath (not accessed) and 2 pivs # dvt prophylaxis: heparin sc . # code status: full code . # contact: daughter, hcp (h) (cell) medications on admission: atorvastatin 20 qdaily celexa 20mg qdaily hep sc aranesp 150sc qmonday cardura 4mg qdaily fentanyl patch 50mcg q 72h feso4 350mg qhs advair q12h prevacid 30mg daily metoprolol 50bid nilstat 10,000 qid bicarb qdaily spiriva 18mcg qdaily mucomyst 10% q4h prn risperdal 0.25qhs . albuterol nebs q4h prn colace 100mg prn atrovent nebs prn magic mouthwash q4hprn imodium prn maalox 30ml prn mom 30mol qod prn zofran 4mg q8hprn tylenol prn ativan 0.5 po bid prn jevity 1.2 285ccq4h discharge medications: 1. heparin (porcine) 5,000 unit/ml solution : one (1) ml injection three times a day. 2. atorvastatin 10 mg tablet : one (1) tablet po daily (daily). 3. citalopram 20 mg tablet : one (1) tablet po daily (daily). 4. doxazosin 4 mg tablet : one (1) tablet po hs (at bedtime). 5. fentanyl 50 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 6. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 7. metoprolol tartrate 50 mg tablet : one (1) tablet po bid (2 times a day). 8. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed. 9. tiotropium bromide 18 mcg capsule, w/inhalation device : one (1) cap inhalation daily (daily). 10. guaifenesin 100 mg/5 ml syrup : 5-10 mls po q6h (every 6 hours). 11. risperidone 0.5 mg tablet : one (1) tablet po hs (at bedtime). 12. albuterol sulfate 0.083 % (0.83 mg/ml) solution : one (1) neb treatment inhalation q6h (every 6 hours) as needed. 13. ondansetron 4 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 14. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 15. aranesp 150mg sc qmonday 16. olanzapine 5 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po bid (2 times a day) as needed for agitation. 17. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours). discharge disposition: extended care facility: - discharge diagnosis: primary: 1.) chronic obstructive pulmonary disease flare secondary: 2.) laryngeal squamous cell carcinoma 3.) adenocarcinoma lung 4.) pneumonia 5.) cad 6.) htn 7.) depression discharge condition: stable, afebrile discharge instructions: you were admitted to the hospital because of low oxygen saturation and respiratory distress. this was treated with aggressive suctioning, oxygen, antibiotics and steroids, with significant improvement. additionally, you were seen by a swallowing specialist who recommended no food or drink by mouth due to excess secretions. this could be reevaluated in the future. . if you develop fever, chills, shortness of breath, chest pain, abdominal pain, nausea, vomiting, please contact your doctor or go to the emergency room. . please take your medications as prescribed and follow up with the appointments below. followup instructions: follow-up with primary care provider per rehab/nursing home physicians oncologist as already scheduled. procedure: enteral infusion of concentrated nutritional substances diagnoses: coronary atherosclerosis of native coronary artery acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified obstructive chronic bronchitis with (acute) exacerbation chronic kidney disease, unspecified pneumonia due to pseudomonas late effects of cerebrovascular disease, hemiplegia affecting unspecified side malignant neoplasm of other parts of bronchus or lung gastrostomy status tracheostomy status anemia in neoplastic disease neoplasm related pain (acute) (chronic) personal history of malignant neoplasm of larynx 

Answer: The patient is high likely exposed to