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: increased secretions major surgical or invasive procedure: trach change history of present illness: patient is a 78y/o f with t3n0 supraglottic scca currently undergoing chemo/xrt, and s/p tracheotomy on , who presents from w/ increased and thickened secretions with resultant difficulty breathing. she notes progressive increased and thicker secretions over the past 2 weeks, worse yesterday and today. she has difficulty breathing when the trach gets plugged with thick secretions, and this is relieved w/ multiple suctioning passes. she reports her last trach change was at , approximately 4 weeks ago. she has been tolerating chemo xrt reasonably well, and reports she has only 5 remaining xrt sessions and 1 remaining treatment of chemotherapy with reduced dose taxol and carboplatin. she has had some reddness over the anterior neck x several weeks and throat pain since starting xrt. denies fever, chest pain, n/v, abd pain. she takes nothing by mouth, and receives all nutrition per g tube. at she had an episode of stridor and was given solumedrol 125mg x2 and albuterol/atrovent nebs, however she continued to have sob. given concern for edema/airway obstruction she was transferred to for evaluation. . in the ed vs were t 97.7 hr 62 bp 117/46 rr 18 97%4l. she was evaluated by ent in ed. fiberoptic exam showed erythema but no airway edema. ent recommended stopping passe-muir valve, humidified tc, saline nebs qid, tracheostomy tube change, and speech and swallow evaluation. currently the patient reports that she feels tired and is complaining of a sore throat. she denies chest pain, sob, n/v, abdominal pain. she reports that her secretions have improved. past medical history: laryngeal scca s/p trach , s/p g tube, currently undergoing chemo/xrt afib w/ rvr h/o aspiration pna htn copd dyslipidemia social history: she has a 50-pack-year smoking history but quit smoking seven years ago. currently living at rehab since her trach placement. family history: non-contributory physical exam: vs: t 97.7 bp 120/43 hr 55 rr 14 99%35% tm general: pleasant, well-appearing woman, no acute distress heent: mmm, eomi, perrl neck: trach, erythema surrounding trach site heart: bradycardic, regular, no m/r/g lungs: ctab abdomen: soft, nt/nd, +bs, no masses ext: 1+ edema, warm, well-perfused neuro: aaox3 pertinent results: chest, pa and lateral: a tracheostomy tube appears in appropriate position. a rounded opacity at the left cardiophrenic angle which causes opacity posteriorly on the lateral film is consistent with fat herniating the diaphragm as seen on previous chest ct. no focal pulmonary opacities to indicate pneumonia are seen. there is flattening of the diaphragm and pruning of the pulmonary vasculature in the apices consistent with known emphysematous changes. there is biapical scarring. there is a convex right thoracolumbar scoliosis. impression: no acute cardiopulmonary disease. . ent- fiberoptic exam via nose: np - no mass, posterior pharyngeal wall - no edema, valleculae w/ some pooled secretions, epiglottis slightly thickened (c/w xrt) with diffuse erythema, left tvf - not mobile, moderate thickened and erythematous mucosa over bil arytenoids, pooled thick yellow secretions in post cricoid space and piriforms . fiberoptic exam via trach: trach in good position, tracheal rings visible with normal mucosa . ecg: atrial fibrillation with rapid ventricular response. left anterior fascicular block. compared to the prior tracing of atrial fibrillation has appeared. 05:00pm wbc-0.9*# rbc-2.95* hgb-9.2* hct-26.8* mcv-91 mch-31.1 mchc-34.2 rdw-14.9 plt ct-249 05:30am wbc-1.5*# rbc-3.09* hgb-9.7* hct-28.5* mcv-92 mch-31.3 mchc-34.0 rdw-14.5 plt ct-180 05:15am wbc-2.2* rbc-3.11* hgb-9.7* hct-28.7* mcv-92 mch-31.4 mchc-34.0 rdw-15.3 plt ct-265 05:05am wbc-2.1* rbc-3.13* hgb-9.8* hct-28.4* mcv-91 mch-31.3 mchc-34.4 rdw-15.2 plt ct-264 05:00pm neuts-74* bands-5 lymphs-1* monos-20* eos-0 baso-0 atyps-0 metas-0 myelos-0 nrbc-1* 05:00pm pt-11.8 ptt-21.6* inr(pt)-1.0 05:30am gran ct-730* 05:15am gran ct-1480* 05:00pm glucose-157* urean-13 creat-0.4 na-143 k-4.7 cl-105 hco3-31 angap-12 05:05am glucose-97 urean-9 creat-0.4 na-143 k-3.5 cl-103 hco3-32 angap-12 brief hospital course: assessmen/plan: 78y/o f with t3n0 supraglottic scca currently undergoing chemo/xrt, and s/p tracheotomy on , who presents from w/ increased and thickened secretions with resultant difficulty breathing. . # sob/increased secretions: airway evaluated by ent in ed and showed no evidence of edema. increased secretions likely secondary to radiation-induced scarring of upper airway and/or use of passe-muir valve and lack of humidified air through trach. however we could not rule out infection as source of increased secretions. levo/flagyl started at switched to zosyn, as well as improved trach care with humidified o2, q1-2hr suctioning, and trach change with inner cannula allowing frequent cleaning. all these interventions led to significant improvement in respiratory status. she should continue zosyn for 4 additional days for a total 7 day course. she should continue trach care as above with constant humidified o2, frequent suctioning and cleaning of inner canula, and spiriva nebulizers. she should not use a passe-muir valve as this inhibits clearing of secretions. for the next 4-5 days she should keep the trach cuff continously inflated. after this time, she may deflate it intermittently to speak. she should then have speech and swallow evaluation for aspiration risk. when previously seen by speech and swallow at at last admission, she was deemed to be an aspiration risk, but this may have improved after radiation and chemotherapy. until that evaluation, she should not take po food. follow-up with dr. of ent has been arranged. sputum gram stain showed 3+ gram positive rods, cultures are still pending at this time. the gram positive rods are not considered to be pathogenic at this time. . # laryngeal ca: patient is currently undergoing chemo/xrt. received 3 doses of xrt while inpatient. she should continue chemo and xrt as per her primary oncologist dr. . . # anemia: stable low hematocrit. no evidence of active bleeding . # neutropenia: white count low on admission at 0.9 with anc of 780, this increased to 1480 on hd2. this made interpretation of white count difficult in determining presence of infection. . # a fib: admitted in nsr. went into what was initially called atrial fibrillation during chest pt and converted to sinus spontaneously. ekg done near that time showed p waves of several morphologies, raising the possibility of mat although the patient was not tachycardic. review of prior ecgs does not clearly show atrial fibrillation. this diagnosis was made in , during a prior icu stay and again reverted to sinus spontaneously. she was rate-controlled but not anti-coagulated at that time. she should see a cardiologist as an outpatient to consider holter monitor/further diagnosis of atrial fibrillation vs. mat, as well as consider anticoagulation for paroxysmal afib. #hypertension: bp well-controlled with ace-inhibitor and beta-blocker . # hyperlipidemia: continued statin . # copd: no acute issues, continued spiriva and albuterol . # code status: full code (patient reports that she does not what to be on "life support" however she currently is intubated via trach) medications on admission: tylenol 1 tab q3hrs lipitor 10mg qhs flagyl iv 500mg q8hrs last at 2pm mvt miralax qam (missed this am) benadryl/lidocaine/maalox swish and spit fluconazole 200mg pgtube for two more days insulin ss (not really needing) nystatin swish and spit 5cc prevacid 20mg levaquin 500mg iv qhs until lisinopril 10mg daily lopressor 25mg tid spiriva daily discharge medications: 1. atorvastatin 10 mg tablet : one (1) tablet po hs (at bedtime). 2. hexavitamin tablet : one (1) cap po daily (daily). 3. medication maalox/diphenhydramine/lidocaine 15-30 ml po tid:prn swish and spit 4. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed. 5. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 6. lisinopril 10 mg tablet : one (1) tablet po daily (daily). 7. metoprolol tartrate 25 mg tablet : one (1) tablet po tid (3 times a day). 8. tiotropium bromide 18 mcg capsule, w/inhalation device : one (1) cap inhalation daily (daily). 9. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). 10. albuterol sulfate 0.083 % (0.83 mg/ml) solution : one (1) inh inhalation q4h (every 4 hours) as needed. 11. piperacillin-tazobactam 4.5 g recon soln : one (1) recon soln intravenous q8h (every 8 hours): day 1=, last day=. 12. acetaminophen 160 mg/5 ml solution : two (2) vials po every 4-6 hours as needed for pain: please do not exceed 4 grams of tylenol daily. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: respiratory distress tracheostomy laryngeal cancer atrial fibrillation . discharge condition: good - no respiratory difficulty, vital signs stable, tolerating g-tube feeding. needs speech and swallow evaluation at discharge instructions: you were admitted for increased secretions into your tracheostomy tube. these may have been due to a combination of infection perhaps due to aspiration, drying of secretions due to radiation therapy, lack of humidified air through the trach, and use of passe-muir valve. your tracheostomy was changed to one with an inner canula which will allow for more frequent cleaning. you were seen by ent and speech and swallow services who recommended stopping the passe-muir valve for at least the next 4-5 days, after which you can use it for short periods when you need to talk. when not speaking you should keep the trach cuff inflated and have continuous humidified oxygen running through the tubing. you should be evaluated by speech and swallow services at for aspiration risk. when previously seen by speech and swallow at it was felt that you were aspirating secretions, but that may have improved now with radiation and chemotherapy. you had an episode of atrial fibrillation, you should be evaluated by a cardiologist. we have included information below for you to schedule an initial evaluation. you were started on an iv antibiotic called zosyn which you should continue for 4 more days. this is to treat a possible infection causing increased secretions. please return to the hospital if you experience worsening respiratory difficulties, fevers, chills, or any other new or concerning symptoms. instructions: follow-up with dr. on thursday at 11:30am. phone: (. address: , , . please follow up with dr. of cardiology to discuss management of possible atrial fibrillation: , . phone: date/time: 9:00 location: 10 on of procedure: laryngoscopy and other tracheoscopy replacement of tracheostomy tube tracheoscopy through artificial stoma diagnoses: unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation other and unspecified hyperlipidemia gastrostomy status anemia in neoplastic disease other tracheostomy complications malignant neoplasm of supraglottis other neutropenia 

Answer: The patient is high likely exposed to