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: zosyn / beta-blockers (beta-adrenergic blocking agts) attending: chief complaint: complex subglottic tracheal stenosis with shortness of breath. major surgical or invasive procedure: tracheal resection and reconstruction with infra-hyoid release. : 1. rigid bronchoscopy using the dumon green tracheoscope. flexible bronchoscopy. endotracheal tube removal. : percutaneous endoscopic gastrostomy tube placement. : flexible bronchoscopy history of present illness: ms. is a 65-year-old woman with a stenosis of the upper airway following a tracheostomy tube after prolonged intubation for sepsis. she had been treated with dilation and stenting. she now presents for definitive resection. on preoperative bronchoscopy there was stenosis from the level of the first ring stretching approximately 2 cm inferiorly and encompassing the level of the stoma. in addition, there was severe malacia at that location and also malacia further down in the airway. past medical history: trachael stenosis hospitalized prolongued vent had trach placed removed atrial fibrillation on warfarin ?osa on cpap no formal sleep study esrd on hd mwf has tunneled cath multinodular goiter s/p biopsy morbid obesity htn c difficile colitis cellulitis with "fat necrosis" requiring skin grafting, c/b sepsis peripheral neuropathy ?gbs following birth of 2nd child left leg weakness tracheomalatia chronic leg ulcers recurrent uti urinary stress incontinence iron deficiency anemia nephrolithiasis social history: the patient was living at home until hospitalized spring , at which point she was staying in pulmonary rehab r/t dialysis scheduling and rules regarding her trach. she denies smoking, etoh. married to dermatologist. daughter highly involved with mothers care. family history: noncontributory physical exam: vs: t 98.4, hr 79, bp 96/64, rr 18, o2 sats 96% ra physical exam: gen: pleasant in nad, voice hoarse neck: insision with stable erythema and swelling to the left of the incision. lungs: rhonchi on expiration. clear rul cv: irreg rate and rhythm, s1, s2, no mrg or jvd abd: soft, nt, nd intact. ext: warm, trace ble edema. stage iii coccyx wound. pertinent results: cultures: mini bal proteus sputum cx proteus mirabilis pansensitive blood cx negative : ; mrsa screen negative x 3 chest x-ray: only a single frontal view was obtained. right and left central venous catheters are identified and not substantially changed in appearance. there is no evidence of progressive accumulation of fluid or new parenchymal consolidation. heart size is at the upper limits of normal. line placement: 1. uncomplicated picc line exchange on the right; double-lumen picc measuring 50 cm with its tip in the lower svc; line is ready to use. 2. left internal jugular tunneled hemodialysis catheter exchange, uncomplicated; tip-to-cuff length is 23 cm; the tip is in the right atrium, and the line is ready for use. 3. venogram demonstrating mild narrowing at the left brachiocephalic vein and svc junction; this likely reflects patient's chronic indwelling catheter; if future vascular access is needed, an interventional procedure is recommended. 04:50am blood wbc-10.7 rbc-3.13* hgb-8.9* hct-29.7* mcv-95 mch-28.5 mchc-30.1* rdw-18.3* plt ct-395 05:30am blood wbc-12.9* rbc-3.13* hgb-9.3* hct-29.6* mcv-95 mch-29.7 mchc-31.3 rdw-18.4* plt ct-323 05:19am blood wbc-14.5* rbc-3.15* hgb-9.0* hct-30.4* mcv-97 mch-28.6 mchc-29.6* rdw-17.5* plt ct-421 06:00am blood pt-18.3* ptt-62.6* inr(pt)-1.7* 04:50am blood glucose-90 urean-39* creat-6.6* na-135 k-5.0 cl-96 hco3-24 angap-20 04:50am blood calcium-10.7* phos-2.6* mg-2.1 11:12am blood caltibc-182* ferritn-1621* trf-140* 11:12am blood triglyc-133 hdl-58 chol/hd-3.7 ldlcalc-128 09:10am blood pth-120* 07:30am blood vanco-28.4* 04:18pm blood type-art po2-118* pco2-42 ph-7.44 caltco2-29 base xs-4 brief hospital course: the patient was admitted to the thoracic surgery service, under dr. on , for planned tracheal resection and reconstruction for her complex subglottic tracheal stenosis. she was admitted a day early preoperative preparation. the patient underwent tracheal resection and reconstruction with infra-hyoid release; please refer to the operative note for details. the patient was transferred to the icu, where the patient was kept intubated for 10 days to allow her anastomosis to heal, along with proper neck positioning and chin-chest sutures. she received supportive icu cares. she eventually transferred to the floor on where she maintained stable airway. neuro: the patient remained intubated and sedated on until , at which time she was extubated in the operating room after her anastomosis was evaluated and appeared intact via rigid bronchoscopy. she received prn fentanyl with good effect and adequate pain control. cv: the patient remained in her baseline atrial fibrillation with rate control in the 70's, on qid diltiazem. this was held periodically for low bp mostly after hd. she required diltiazem drip for a couple days for rate control. on she was converted to her po dose with good rate control. her anticoagulation was held the week prior to her surgery and resumed , with heparin bridge. listed are the coumadin and inr trends: inr 1.0 heparin drip started inr 1.3 coumadin 2.5mg, heparin drip inr 1.2 coumadin 2.5mg, heparin drip inr 1.3 coumadin 2.5mg, heparin drip inr 1.2 coumadin 5mg, heparin drip inr 1.4 coumadin 3mg, heparin drip inr 1.5 couamdin 5mg, heparin drip inr 1.7- pt should get 5mg tonight, with no heparin bridge. close inr followup needed until inr's stable around for atrial fibrillation. pulmonary: the patient was extubated in the or on . she was watched closely over the next 24 hours with guarded pulmonary status, requiring cpap, trialed heliox, and q 6 hour atrovent and close nursing care. vital signs were routinely monitored. good pulmonary toilet, early ambulation and incentive spirometry were encouraged throughout hospitalization. the patient had bronchoscopy on which revealed intact anastamosis gi: given concerns over postoperative ability to , tube was placed in the or by dr. at the time of her extubation on . proton pump inhibitor was continued. nutrition: consult recommended nutren 2.0 3/4 strength with bene protein goal rate: 40 ml/hr. the patient tolerated such. she initially had problems with constipation. kub on ruled out ileus. speech & were consulted for a video- for absent laryngeal elevation hyoid release which was done which showed slight aspiration with thin liquids and laryngeal penetration with nectar. they recommend continuation of tube feeds as primary source of nutrition and nectar thick liquid with moist puree. they also recommend swallowing therapy upon return to rehab and repeat instrumental evaluation prior to upgrading diet. id: the patient's white blood count and fever curves were closely watched for signs of infection. she had a lung infiltrate and to prevent further complications she had bronchoscopy , at which time she was started on vanco and meropenum emperically. bal was sent and her culture grew proteus mirabilis which was pan sensitive. she was switiched to cefepime and ciprofloxacin, and vancomycin (for neck incision) until . endocrine: the patient's blood sugar was monitored throughout her stay; they were self maintained in low 100's, without need for insulin. hematology: heparin to coumadin bridge was started for her atrial fibrillation. her inr on discharge was 1.7. see above trends for further anticipated dosing. renal: hd was continued throughout her hospital course. last hd . no foley placed. straight cath yields 15-20 cc of urine, straight cath qweek, bladder scan 2x/weekly. phosphorus was watched closely and nephrology recommended renagel 800mg po tid with meals and uptitrate as needed. wound: she was followed by the wound care nurse throughout her hospital course. coccyx pressure ulcer: stage iii, approx. 5.5 x 1.5 cm with sloughing yellow tissue 90% yellow with red granular buds. wound care rn recommends covering this area with mepilex sacral foam border dressing, and changing every 3 days or prn. extending from her anus to the left gluteal there is an intact purple discoloration approx 0.3 x 5.5 cm. extending from the anus to the right gluteal there intact hyperpigmented tissue approx. 0.3 x 9.5 cm. these sites have no edema, induration, or fluctuance associated with the impairment. apply critic aid clear moisture barrier ointment daily. (see detail recommendations) line placement: 1. uncomplicated picc line exchange on the right; double-lumen picc measuring 50 cm with its tip in the lower svc; line is ready to use. 2. left internal jugular tunneled hemodialysis catheter exchange, uncomplicated; tip-to-cuff length is 23 cm; the tip is in the right atrium, and the line is ready for use. 3. venogram demonstrating mild narrowing at the left brachiocephalic vein and svc junction; this likely reflects patient's chronic indwelling catheter; if future vascular access is needed, an interventional procedure is recommended. disposition: dr. deemed the patient safe for transfer to rehab today. medications on admission: -coumadin 2.5mg (held) - diltiazem 90 mg po/ng qid - acetaminophen 325-650 mg po/ng q6h:prn pain - acetylcysteine 20% 1-10 ml neb q8h:prn - albuterol 0.083% neb soln 1 neb ih q6h:prn - senna 1 tab po/ng :prn - docusate 100 mg - aranesp 100 mcg/0.5 ml sln. 90 mcg every tuesday - omeprazole 20mg - renagel 1600mg with each snack - renagel 2400mg tid with meals - renal caps 1 every day discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). 2. docusate sodium 50 mg/5 ml liquid : ten (10) ml po bid (2 times a day): hold for loose stools. 3. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day): hold for loose stools. 4. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day) as needed for fungus. 5. ipratropium bromide 0.02 % solution : one (1) neb inhalation q6h (every 6 hours). 6. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 7. diltiazem hcl 90 mg tablet : one (1) tablet po qid (4 need adjusting. once stable discuss longer acting doseage with pcp. 8. acetaminophen 650 mg/20.3 ml solution : twenty (20) ml po q6h (every 6 hours) as needed for pain / fever. 9. lorazepam 0.25 mg iv q6h:prn anxiety 10. renagel 800 mg tablet : one (1) tablet po three times a day: with meals. follow phosphate closely and uptitrate as needed. 11. aranesp (polysorbate) 100 mcg/0.5 ml syringe : ninety (90) mcg injection once a week: on tuesdays. 12. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 13. coumadin 2.5 mg tablet : 1-2 tablets po at bedtime: md to order daily dose based on inr. monitor frequently until stable inr . should receive 5mg dose on night of . discharge disposition: extended care facility: hospital - discharge diagnosis: -complex subglottic stenosis with history of tracheostomy s/p tracheal resection and reconstruction with hyoid release. -stage iii coccyx pressure ulcer. -atrial fibrillation on warfarin -?osa on cpap no formal sleep study -esrd on hd mwf has tunneled cath -multinodular goiter s/p biopsy -morbid obesity -htn -hx of c difficile colitis -cellulitis with "fat necrosis" requiring skin grafting, c/b sepsis -peripheral neuropathy ?gbs following birth of 2nd child left leg weakness -tracheomalatia -chronic leg ulcers -recurrent uti -urinary stress incontinence -iron deficiency anemia -nephrolithiasis 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: -call dr. at if you have fevers greater than 101.5, chills, rigors, cough, shortness of breath, or difficulties with airway or managing secretions. -call your cardiologist if fast irregular heartbeat accompanied with dizziness. -monitor neck incision and calls if this becomes red, purulent, or drains. -followup with your cardiologist regarding coumadin dosing to keep inr around 2. followup instructions: follow up with dr. and dr. one week after you leave rehab. you will need a bronchoscopy with this visit. call to schedule appointments and bronchscopy. you will need to be npo after midnight prior to your bronchoscopy. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis percutaneous [endoscopic] gastrostomy [peg] arterial catheterization other repair and plastic operations on trachea bronchoscopy through artificial stoma other partial ostectomy, other bones phlebography of other specified sites using contrast material local excision or destruction of lesion or tissue of trachea removal of other therapeutic device from head and neck diagnoses: anemia in chronic kidney disease end stage renal disease obstructive sleep apnea (adult)(pediatric) atrial fibrillation mononeuritis of lower limb, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease morbid obesity long-term (current) use of anticoagulants pressure ulcer, lower back ventilator associated pneumonia proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site other diseases of trachea and bronchus nontoxic multinodular goiter mechanical complication of tracheostomy pressure ulcer, stage iii 

Answer: The patient is high likely exposed to