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: patient recorded as having no known allergies to drugs attending: chief complaint: neck/chest/back pain major surgical or invasive procedure: resuspension aortic valve, supracoronary ascending aortic graft open g tube placement history of present illness: 83 year old male with known history of aortic aneurysm, followed at . patient admits to stopping lopressor a couple years ago. he presented to the er on with 9/10 chest/neck/back pain. ct of chest revealed type a aortic dissection. past medical history: hypertension hypothyroid benign prostatic hypertrophy s/p right ih s/p tur bladder tumor s/p turp social history: non-contributory family history: non-contributory physical exam: vs: hr 55 bp 111/69 perrla neuro: a&o x 3, non focal heent: eomi, perrla heart: rrr s1s2 iii/vi sem, faint diastolic rumble lungs: ctab with faint bibasilar rales abd: soft/nt/nd +bs -hsm ext: warm, well perfused, - edema, 2+ ldp/pt, 1+rdp/pt pertinent results: 04:34am blood wbc-11.5* rbc-3.35* hgb-11.0* hct-33.8* mcv-101* mch-32.8* mchc-32.4 rdw-15.6* plt ct-279 04:34am blood pt-14.0* ptt-26.4 inr(pt)-1.3 09:31am blood glucose-113* urean-28* creat-1.1 na-141 k-4.3 cl-111* hco3-24 angap-10 radiology preliminary report chest (pa & lat) 8:53 am chest (pa & lat) reason: eval free air medical condition: 82 year old man s/p dissection repair reason for this examination: eval free air indication: dissection repair. pa and lateral chest: comparison is made to the study performed one day prior. left picc catheter and sternal wires and clips are unchanged. as before, there is diffuse mediastinal widening, unchanged. there are persistent bibasilar atelectatic changes as well as a small left pleural effusion. suggestion of free intraperitoneal air overlying the mid abdomen and is not an unexpected finding in a patient with recent gastrostomy tube placement. impression: 1. no significant interval change in diffuse mediastinal widening. 2. persistent bibasilar atelectasis and small left pleural effusion. 3. probable free intraperitoneal air, unchanged. this is not an unexpected finding following gastrostomy tube placement. dr. dr. date: signed by , ccc,slp on affiliation: title: repeat videoswallow oropharyngeal videofluoroscopic swallowing evaluation history: mr. is an 83 year old man with known hx of aortic aneurysm who presented to the er with severe chest/back pain, found to have type a aneurysm, emergently brought to or for type a aortic dissection repair on . pt remained intubated until yesterday afternoon . pt has reportedly been coughing on thin liquids, ice chips but did take meds with applesauce. pt also complains of a "sore throat". a bedside swallowing evaluation and videoswallow were performed on . he failed both exams and it was recommended that he remain npo w/ng tube feedings. he pulled his ng tube, and we repeated the bedside swallowing evaluation on after he was transferred from the csru to 2. on that bedside evaluation, his voice was strong, and when he swallowed with his head over his left shoulder and with his chin tucked to his chest, he was able to clear one bite of applesauce from his throat with 2 swallows. when he swallowed with his head straight, he had to take multiple swallows and he had persistent throat clearing after the swallow, indicating residue and probable aspiration. we recommended that he take meds crushed in applesauce with a left head turn + chin tuck and 2 swallows but remain otherwise npo until we could complete a videoswallow. the videoswallow was scheduled for the next morning, . the videoswallow was cancelled on and on by the medical team, as the pt. was in afib, and he was not felt to be stable enough to leave the floor for the test. when the swallow was cancelled, we spoke with the medical team, and we recommeneded that they replace the ng tube. the pt.'s respiratory status changed and he was re-intubated and transferred back to the csru with presumed aspiration pneumonia. he was extubated on , and we were asked to repeat the swallowing evaluation to see if he might be able to take anything safely po. this morning, his voice was considerably more hoarse that prior to the second intubation. he had thick, bloody secretions that he coughed up into his mouth, and i removed with yankaur suctioning prior to starting the videoswallow. evaluation: an oral and pharyngeal swallowing videofluoroscopy was performed today in collaboration with radiology. two teaspoons of nectar- thick liquid were administered. the pt. was viewed in the anterior to posterior postion only. he swallowed both tsp. of nectar with his head turned over his left shoulder and with his chin tucked to his chest. results follow: anterior to posterior position: vocal cord motion was seen only on the right side upon phonation. however, when he coughed, he may have had some movement on the left vocal cord too, but i'm not sure. an ent consult would be helpful to evaluate his true vocal cords for left tvc paresis vs. paralysis. more residue was seen on the left side of his pharynx after the swallow, even when he was positioned to swallow only down the stronger, right side. 1st tsp. of nectar: he swallowed 3 times with a left head turn + chin tuck, and after 3 swallows with one tsp of nectar, 100% of the bolus remained in his valleculae, left > right. 2nd tsp of nectar: he swallowed 7 times with his head turned over his left shoulder and with his chin tucked to his chest. he then coughed and swallowed again twice. 10% of the material entered the esophagus. residue was noted in the vallecualae and pyriform sinuses, left > right, which then began to spill into his airway. he was asked to cough, and material was suctioned from his oropharynx via yankaur. the study was d/c'd. aspiration/penetration: aspiration of mild amounts of nectar thick liquid occurred after the swallow due to spillover of pocketed material from his pharynx into his airway. a delayed cough was partially effective in bringing up some of the aspirated material. summary: non-functional oropharyngeal swallow with severely impaired pharyngeal bolus propulsion and unilateral vocal cord and pharyngeal paresis on the left. aspiration occurs after the swallow due to residue spilling from the left pyriform sinus into the airway. even after 12 swallows, only 10 % of the thick liquid given actually entered his esophagus. therefore, he is not safe to take anything po at this time. recommendations: 1. remain strictly npo 2. consider peg placement for long term nutrition, hydration and medications. 3. ent consult to assess vocal cords for paresis vs. paralysis? 4. repeat videoswallow and swallowing therapy at rehab these recommendations were shared with the patient, the nurse and the medical team. ___________________________________ , m.s., ccc-slp pager # face time: 9:30-10:30 am total time: 120 minutes brief hospital course: mr. was taken emergently to the operating room where he underwent a resuspension of his aortic valve and supracornonary ascending aortic graft. he was transferred to the icu in critical but stable condition. he was extubated by pod #2. a swallow evalution revealed aspiration. a dobhoff tube was placed for enteral feedings. he was also evaluation by ent who recommmened outpatient followup. he had some atrial fibrillation post op for which he was placed on amiodarone. he converted to normal sinus rhythm. on post op day 10 he was reintubated for respiratory failure secondary to suspected aspiration. he had agressive respiratory therapy and was extubated on pod#10. he received a picc line for antibiotics. he received a open g-tube on . he aspirated after which a tracheostomy tube was placed on . he was discharged to rehab in stable condition on pod#30. medications on admission: synthroid 112 mcg po daily discharge medications: 1. levothyroxine sodium 112 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 2. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. lansoprazole 30 mg susp,delayed release for recon sig: one (1) po daily (daily). 5. albuterol sulfate 0.083 % solution sig: one (1) cc inhalation q6h (every 6 hours) as needed. 6. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily): x 2 weeks then 200mg qd. 7. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation q4-6h (every 4 to 6 hours) as needed. 8. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours). 9. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 10. levofloxacin in d5w 500 mg/100 ml piggyback sig: one (1) intravenous q24h (every 24 hours) for 10 days. 11 vancomycin 1gm q12 hrs x 2 weeks discharge disposition: extended care facility: - discharge diagnosis: type a aortic dissection s/p resuspension aortic valve, supracoronary ascending aortic graft hypertension hypothyroid benign prostatic hypertrophy failed swallow/vocal cord paralysis s/p open g-tube placement failed swallow/vocal cord paralysis discharge condition: good discharge instructions: shower, wash incision with mild soap and water, and pat dry. no lotions, creams or powders. call with fever, rednes or drainage from incision, or weight gain more than 2 pounds in one day or five in one week. no heavy lifting or driving. followup instructions: dr. 4 weeks dr. 2 weeks cardiologist 2 weeks ent after discharge procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy resection of vessel with replacement, thoracic vessels transfusion of packed cells revision of tracheostomy transfusion of other serum transfusion of platelets other repair of heart and pericardium diagnoses: unspecified essential hypertension unspecified protein-calorie malnutrition unspecified acquired hypothyroidism atrial fibrillation aortic valve disorders acute respiratory failure other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus hyperosmolality and/or hypernatremia dissection of aorta, thoracic other tracheostomy complications unilateral paralysis of vocal cords or larynx, complete 

Answer: The patient is high likely exposed to