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: shortness of breath major surgical or invasive procedure: hypopharyngeal mass biopsy tracheostomy history of present illness: 74m esophogeal adenocarcinoma in situ (no nodes) s/p esophagogastrectomy and feeding jejonostomy (c/b pseudomonal pna, and trach ) admitted from osh with 24 hrs of worsening sob, productive cough and stridor. patient has had progressively worsening stridor and dysphagia - evaluated in clinic () in and sent for ct of neck that showed a large soft tissue neck mass. . in , pt was hypoxic requiring 3l nc; wbc 12.3 with a l shift and had a cxr showing rml pna. at that time, treated with flagyl, cefepime, levaquin, dexamethasone. ent saw pt in ed and on laryngoscope he had diffuse edema of b/l vocal cords but not epiglottitis with marked airway narrowing. he was intubated for respiratory distress/airway protection. . at nh had been noted to have increasing lethargy, confusion on with increasing cream colored sputum. pt denied cp/n/v/constipation/ diarrhea. . during his micu course, he was followed closely by ent and thoracic surgery regarding this large soft tissue neck mass. it was unclear if it was recurrence of his cancer or a complication of his surgery several months ago. underwent rigid bronchoscopy and biopsy to obtain tissue of this mass, which showed squamous mucosa with fibrosis and perivascular acute and chronic inflammation, no malignancy identified. also had egd at the same time, which showed a widely patent anastomosis, no masses, multiple gastric polyps. had ct chest to assess of new lymph nodes/metastatic disease, which showed chf/new ascites, but no metastases, lad. did show partial mass as seen on ct from . . on , went to or again for tracheostomy, direct laryngoscopy/biopsy of hypopharyngeal mass as it was felt they did not get enough tissue the first time, pathology still pending. had multiple episodes of hypotension, decreased uop. underwent echo which showed new decreased ef 30-35%, moderately dilated la/moderate regional lv systolic dysfunction with hk of basal wall. mild 1(+) mr/ar. moderate pulmonary htn. . was treated with 7 day course zosyn for pneumonia. has afib, anticoagulation held given multiple procedures, now restarted on warfarin. evaluated by cardiology given new echo findings/wma; needs cardiac work up including stress mibi once acute medical issues are resolved. now transferred to the floor. past medical history: 1. esophageal adenocarcinoma in situ s/p esophagogastrectomy with pull up 11/04 c/b 50 day hospital course for psuedomonal pna, pleural effusions, trach, j-tube 2. afib s/p pacemaker on coumadin 3. "hocm" echo : mild symmetric lvh; ef>60%, min as, +mr, 2+tr 4. prostate cancer 5. htn 6. osa 7. hypothyroid social history: retired truck driver. lives at . no tobacco/etoh/ivdu. family history: nc physical exam: pe: t 98.7 p 80 bp 132/73 rr 22 pox 98% fm general pleasant, nad heent eomi, perrl, op clear, trach in place heart irregularly irregular with no murmurs lungs cta b abd soft, nt, nd, bs(+) ext warm, no edema; 2(+) dp pulses neuro grossly non-focal skin no rashes brief hospital course: a/p: 74m esophageal adenocarcinoma admitted with sob, stridor found to have new hypopharngeal mass, now s/p tracheostomy for airway protection. . hospital course is as per the hpi. . to summarize: . 1. hypopharyngeal mass/tracheostomy-at this point, the etiology is still not clear. had an initial biopsy which did not show evidence of malignancy. given the rapid growing nature of the mass and his h/o esophageal adenocarcinoma, malignancy was high on the differential. he underwent a second biopsy for more tissue in hopes of a more definitive diagnosis; however, the pathology also did not show malignancy. he had a tracheostomy placed during his second biopsy as there was concern of the mass compromising his airway. the patient will follow up with dr. of ent at which time they will discuss how to treat the mass and how long he will need to have his trach. . 2. cardiomyopathy-patient has a h/o hocm and now new (since ) decreased ef 30-35% with lv hk, etiology unclear. further cardiac work up (wtih stress mibi) once acute issues are resolved. he was continued on asa 81 mg po qd, captopril 25 mg po tid, lopressor 25 mg po bid and digoxin 0.125 mg po qd as well as atorvastatin 10 mg po qd for h/o hypercholesterolemia. . 3. patient has a h/o atrial fibrillation-his coumadin was held for all his biopsies, but was restarted after consultation with ent. he needs to have daily inrs checked until he is therapeutic on his coumadin, with goal inr . please adjust his dose accordingly. . 4. anemia-patient appears to have an fe deficiency anemia, and would benefit from iron therapy. he was started on iron sulfate and was given one unit prbc transfusion. he should discuss age appropriate cancer screening including colonoscopy with his pcp. . 5. fen-j tube feedings for now. video swallow exam showed aspiration after swallowing thick and thin liquids. although nutrition felt he could take a po diet with special precautions, ent did not feel patient should eat because he is aspirating. po meds should be crushed via his j tube. continue current j tube feedings. . 6. of note, patient does not have h/o hypothyroidism prior to his recent hospitalizations. was evidently placed on levoxyl prior to admission at rehab. was not on levoxyl during his hospitalization. his tsh was checked and was wnl. needs to have his tsh checked after his acute medical issues are resolved. . 7. trach care-patient currently has a cuffed tracheostomy (to help prevent aspiration, as he is aspirating per swallow study). he should have a repeat swallow study in 2 weeks. if at that time he is not aspirating, he can be switched to a non-cuffed tracheostomy. he can continue with pmv trials as tolerated. the tracheostomy cuff should be taken down when he has these trials. trach skin care as per usual regimen. medications on admission: meds on admission from osh records: digoxin 0.125 mg qd lopressor 100 mg po bid flomax 0.4 mg qd prevacid 30 mg coumadin 3/2.5 mg alternating ativan prn . meds on transfer from micu: colace 100 mg po bid prn heparin 5000 units sc tid albuterol 2 puffs ih q6h prn riss asa 81 mg po qd lansoprazole 30 mg qd atorvastatin 10 mg po qd metoprolol 50 mg po/ng bisacodyl 10 mg pr hs:prn captopril 25 mg po tid digoxin 0.125 mg ng daily warfarin 5 mg po hs . discharge medications: 1. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 2. lansoprazole 30 mg susp,delayed release for recon sig: thirty (30) mg po daily (daily). 3. atorvastatin calcium 10 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 6. captopril 25 mg tablet sig: one (1) tablet po tid (3 times a day). 7. warfarin sodium 5 mg tablet sig: one (1) tablet po hs (at bedtime). 8. flomax 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po once a day. 9. ativan 0.5 mg tablet sig: 1-2 tablets po every 6-8 hours as needed for anxiety. discharge disposition: extended care facility: - discharge diagnosis: hypopharyngeal mass tracheostomy discharge condition: patient is urinating, having bowel movements. he is getting tube feeds. he should have a swallow evaluation to determine if he can take anything by mouth. he needs to work with physical therapy to get his strength back. discharge instructions: patient should seek medical attention if he develops fevers, shortness of breath or any other symptom of concern. he needs to have his inr checked to maintain a level between 2 and 3. his coumadin dose should be adjusted accordingly. followup instructions: provider: , orthopedic private practice where: orthopedic private practice date/time: 11:00 . patient should call dr. ( to make an appointment for next week. he needs to follow up with him regarding his hospitalization and to have a follow up ct scan. at that appointment they can discuss a long term plan for his tracheostomy and management of his mass. . please call dr. , your cardiologist, at ( to schedule a follow up appointment, stress test. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances laryngoscopy and other tracheoscopy temporary tracheostomy transfusion of packed cells pharyngeal biopsy pharyngeal biopsy diagnoses: congestive heart failure, unspecified unspecified acquired hypothyroidism atrial fibrillation other chronic pulmonary heart diseases paroxysmal ventricular tachycardia acute respiratory failure pneumonia due to pseudomonas unspecified sleep apnea long-term (current) use of anticoagulants iron deficiency anemia, unspecified cardiac pacemaker in situ other specified disorders of esophagus personal history of malignant neoplasm of esophagus edema of larynx status of other artificial opening of gastrointestinal tract unspecified disease of pharynx 

Answer: The patient is high likely exposed to