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: fentanyl attending: chief complaint: dypsnea, somnolence. major surgical or invasive procedure: trache collar change. history of present illness: 27-yo man with hajdu- syndrome and chronic obstructive + restrictive lung disease, chronically trached, using a ventilator at night and 4l through his trache during the day, recently admitted for vap pneumonia last month, now with increasing dyspnea and somnolence over the last week. he endorses increased subjective fevers and chills, with a measured temperature of 100.1f yesterday. he has also had increased cough with sputum production, a change to green colored sputum, and increased wheezing since yesterday, but no chest pain. today he called ems but was found to be unresponsive. on arrival to the ed, vs: temp 99.3, bp 100/p, hr 103, r 28, sao2 99% on 4l nc. he was still unresponsive and was placed on a trache collar, and he was already improving when an abg was drawn that returned: 7.30/89/97 on 40% trache collar. he was changed to mechanical ventilation, psv 10/5, 50% fio2, pulling tidal volumes ~500, and satting high-90s. lactate was 0.8, and cxr was un-interpretable. he was treated with albuterol and ipratropium mdi and methylprednisolone 125mg iv for hypercarbia, as well as vancomycin 1g iv, levofloxacin 750mg iv, and ceftriaxone 1g iv. he also transiently dropped his pressures to the 90s systolic, with improvement after a ns ivf 1000ml bolus. it was also noted by respiratory that the pt's trache had been established for the last 10 years, and they were unable to maintain a cuff pressure in the ed. this was thought to have been contributing to his respiratory distress, and it was recommended that he will likely need a trache change. he is being admitted to the micu for further care. . review of systems: (+) per hpi. (-) denies headache, chest pain, chest pressure, palpitations, weakness, nausea, vomiting, diarrhea, constipation, abdominal pain, changes in bowel habits, dysuria, arthralgias or myalgias, rashes or skin changes. past medical history: hajdu- syndrome chronic obstructive/restrictive lung disease h/o multiple pneumonias, including pseudomonas pna and vap social history: lives at home with his grandparents and brother. a home health aide. - tobacco: active tobacco use ( cigarettes a day) - alcohol: denies - illicits: denies family history: mother and brother with syndrome. physical exam: vitals: t: 97.6 bp: 142/100 p: 94 r: 17 o2: 98% general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, unable to assess jvp, no lad lungs: severely kyphotic and restricted chest wall; + rhonchi r > l, diffuse mild expiratory wheeze heart: rrr, normal s1 - s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: contracted right arm, scattered tattoos, 2+ pedal pulses pertinent results: complete blood count: 01:50pm blood wbc-11.1* rbc-3.84* hgb-10.3* hct-32.4* mcv-85 mch-26.8* mchc-31.8 rdw-14.2 plt ct-161 02:58am blood wbc-6.9 rbc-3.85* hgb-10.3* hct-31.7* mcv-82 mch-26.7* mchc-32.4 rdw-13.8 plt ct-175 04:06am blood wbc-9.8 rbc-3.65* hgb-9.9* hct-30.6* mcv-84 mch-27.0 mchc-32.2 rdw-13.9 plt ct-185 04:59am blood wbc-6.9 rbc-3.67* hgb-9.9* hct-30.7* mcv-84 mch-27.0 mchc-32.3 rdw-13.7 plt ct-166 03:12am blood wbc-6.6 rbc-3.81* hgb-10.2* hct-31.9* mcv-84 mch-26.9* mchc-32.1 rdw-13.6 plt ct-166 03:37am blood wbc-7.5 rbc-3.79* hgb-10.0* hct-31.2* mcv-82 mch-26.5* mchc-32.1 rdw-13.6 plt ct-199 01:50pm blood neuts-94.5* lymphs-3.6* monos-1.2* eos-0.5 baso-0 . coagulation profile: 04:59am blood pt-12.6 ptt-27.9 inr(pt)-1.1 01:50pm blood glucose-102* urean-24* creat-0.5 na-138 k-3.8 cl-91* hco3-39* angap-12 02:58am blood glucose-145* urean-25* creat-0.4* na-137 k-3.3 cl-93* hco3-38* angap-9 04:06am blood glucose-98 urean-20 creat-0.4* na-140 k-3.7 cl-95* hco3-40* angap-9 04:59am blood glucose-141* urean-22* creat-0.4* na-140 k-3.3 cl-95* hco3-44* angap-4* 03:12am blood glucose-133* urean-16 creat-0.4* na-141 k-3.5 cl-91* hco3-47* angap-7* 03:37am blood glucose-73 urean-22* creat-0.3* na-137 k-3.4 cl-89* hco3-45* angap-6* . 02:58am blood calcium-9.0 phos-3.1 mg-2.0 04:06am blood calcium-8.6 phos-3.2 mg-2.2 04:59am blood calcium-9.0 phos-1.9* mg-2.1 03:12am blood calcium-9.2 phos-2.3* mg-2.2 03:37am blood calcium-9.5 phos-2.0* mg-2.1 . 04:06am blood tsh-0.19* 04:06am blood free t4-1.2 09:09pm blood vanco-14.4 02:25pm blood type-art fio2-40 po2-97 pco2-89* ph-7.30* caltco2-46* base xs-13 comment-trach 10:26pm blood type-art fio2-40 po2-119* pco2-70* ph-7.36 caltco2-41* base xs-11 intubat-intubated 04:38pm blood type-mix po2-76* pco2-70* ph-7.33* caltco2-39* base xs-7 06:00am blood type-art temp-37.2 po2-86 pco2-90* ph-7.32* caltco2-49* base xs-15 intubat-intubated 02:07pm blood lactate-0.8 04:38pm blood lactate-0.7 06:00am blood lactate-1.0 06:00am blood o2 sat-95 06:00am blood freeca-1.23 04:06am blood vitamin d 25 hydroxy-pnd . micro: blood culture : pending . sputum culture : gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive rod(s). 1+ (<1 per 1000x field): gram positive cocci in pairs. respiratory culture (final ): moderate growth commensal respiratory flora. gram negative rod(s). sparse growth. . sputum culture : gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): moderate growth commensal respiratory flora. pseudomonas aeruginosa. moderate growth. predominating organism. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- =>64 r ceftazidime----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ 8 i meropenem------------- 8 i piperacillin/tazo----- =>128 r tobramycin------------ 2 s . ecg : sinus rhythm. intraventricular conduction delay. non-specific st-t wave changes. possible old inferior myocardial infarction. compared to the previous tracing of no definite change. . imaging: chest radiograph: impression: markedly limited exam due to marked spinal deformity without definite signs for acute intrathoracic process. . chest radiograph: impression: right lower lobe aspiration and/or pneumonia, worsened over three weeks. . chest radiograph: findings: widening of cardiomediastinal contours is unchanged and likely accentuated by portable supine technique and marked patient scoliosis. when compared to a similarly positioned chest x-ray of , an area of confluent opacity in the left mid lung region has nearly resolved. no new or worsening areas of lung opacification are identified. brief hospital course: this is a 27-yo man with hajdu- syndrome and chronic obstructive + restrictive lung disease, chronically trached using a ventilator at night and 4l during the day, recently admitted for vap pneumonia, now with pneumonia and wheeze, and a difficulty with his trach collar. . #. hypercarbic respiratory failure ?????? currently on trache mask. likely due to trache malfunction at home and now underventilation here in the hospital. the patient's vent was returned to home settings (cmv 400cc, rate 18, peep 5, 30% fio2)on tuesday evening. the patient reported feeling marmarkedly improved on the morning of . . #. bronchitis vs. pneumonia ?????? provides history of pneumonia. sputum gram stain with 2+ gprs and 1+ gpcs in pairs. recently admitted to micu with vap pneumonia, also has had multiple prior hospitalizations for pneumonia including h/o pseudomonas pna at . patient has improved, although now likely colonized with pseudomonas resistant to everything except tobramycin. the patient will continue cefepime at home, he is currently on day 6 of 8 at the time of discharge . . #. copd: acute on chronic. will initiate prednisone taper at the time of discharge. he will start 50mg of prednisone for 2 days starting and then proceed for 2 days at 40mg, then 2 days at 30mg and finally 20mg. the patient should continue taking 20mg prednisone daily until follow up with his outpatient pulmonologist to address future care. he will be discharged on home medications albuterol and ipratropium mdi / nebs, singulair, pulmicort, bactrim, calcium, and vitamin d3 ppx. . #. hajdu- syndrome - rare connective tissue disorder and osteolytic syndrome, with characteristic facies, skull deformities, osteoporosis, joint laxity, short stature, dissolution of distal phalanges. pt has considerable bone pain as a result. the patient will be discharged on his home pain medications which includemethadone, morphine, baclofen, gabapentin, and ibuprofen. he will also continue his home bowel regiment. medications on admission: - methadone 40mg po tid - morphine 60mg po q6hrs - senna 1 tab po bid - colace 100mg po bid - gabapentin 800mg po tid - baclofen 40mg po qam, 20mg po qpm, 20mg po qhs - ibuprofen 800mg po q8hrs - omeprazole 20mg po daily - bupropion 150mg po qam - lorazepam 1mg po daily - montelukast 10mg po daily - prednisone 20mg po daily - testosterone 5mg/24hr patch daily - sulfamethoxazole-trimethoprim 400-80mg po daily - calcium carbonate 500mg po tid w/ meals - cholecalciferol (vitamin d3) 800units po bid - furosemide 10mg po daily - budesonide 1mg/4ml nebs inhaled - combivent 18-103mcg 1-2 puffs inhaled q4-6hrs prn sob or wheeze discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. gabapentin 400 mg capsule sig: two (2) capsule po q8h (every 8 hours). 4. baclofen 10 mg tablet sig: four (4) tablet po qam (once a day (in the morning)). 5. baclofen 10 mg tablet sig: two (2) tablet po bid (2 times a day). 6. ibuprofen 400 mg tablet sig: two (2) tablet po q8h (every 8 hours). 7. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 8. morphine 30 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 9. methadone 40 mg tablet, soluble sig: one (1) tablet, soluble po tid (3 times a day). 10. bupropion hcl 150 mg tablet sustained release sig: one (1) tablet sustained release po qam (once a day (in the morning)). 11. lorazepam 1 mg tablet sig: one (1) tablet po hs (at bedtime). 12. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 13. testosterone 5 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 14. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). 15. calcium carbonate 500 mg tablet, chewable sig: three (3) tablet, chewable po bid (2 times a day). 16. lasix 20 mg tablet sig: 0.5 tablet po once a day. 17. budesonide 0.5 mg/2 ml suspension for nebulization sig: mls inhalation 4ml inhaled (). 18. combivent 18-103 mcg/actuation aerosol sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. 19. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po bid (2 times a day). 20. prednisone 10 mg tablet sig: as dir tablet po once a day: take 50mg on & , 40mg on & , 30mg on & , 20mg on , & . disp:*30 tablet(s)* refills:*2* 21. cefepime 2 gram recon soln sig: one (1) recon soln injection q12h (every 12 hours) for 2 days. disp:*5 recon soln(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: primary: pneumonia hajdu- syndrome chronic obstructive/restrictive lung disease history of multiple pneumonias, including pseudmonas pna and vap discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: it was a pleasure taking care of you at . you were admitted to the intensive care unit due to shortness of breath and somnolence. you were continued on a ventilator, treated with nebulizers, and given iv antibiotics. you were found to have difficulties with your trach collar, which was replaced during this admission. . we have made the following changes to your medications: -> you will start to taper your prednisone medication. take 50 mg of prednisone tomorrow and then 50 mg on friday. on saturday and sunday take 40 mg of prednisone daily. on monday and tuesday take 30mg daily and on wednesday and thursday take 20 mg daily until you have met with your pulmonologist. -> you have two more days of antibiotics today. take 2 grams iv on thursday and 2 grams iv on friday. -> please continue all of your other medications as previously prescribed prior to this hospitalization. . please follow up with your primary care physician, . (), within 1 week after discharge. followup instructions: please follow up with your primary care physician, . (phone: ), within 1 week after discharge. . provider: function lab phone: date/time: 8:40 . provider: , m.d. phone: date/time: 9:00 . provider: ,interpret w/lab no check-in intepretation billing date/time: 9:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified other chronic pain obstructive chronic bronchitis with (acute) exacerbation acute and chronic respiratory failure osteoporosis, unspecified scoliosis [and kyphoscoliosis], idiopathic mechanical complication of tracheostomy apnea surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other specified congenital anomalies 

Answer: The patient is high likely exposed to