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: sulfa (sulfonamides) attending: chief complaint: severe epigastric pain after belching and vomiting for roughly 30 minutes. major surgical or invasive procedure: 1. laparotomy, thoracotomy for esophageal repair. 2. laparotomy and placement of gastric and jejunal feeding tubes, placement of left groin central line. mid line lue history of present illness: 40m with signficant vascular and cardiac history was found by ems lying in bed with severe epigastric pain after belching and vomiting for roughly 30 minutes. pt. denied any radiating pain, decreased breathing or diaphoresis. sternum was tender to the touch. patient was then transferred to hospital. upon arrival to the , pt underwent a ct c/a/p which demonstrated an extensive pneumomediastinum surrounding a large hiatal hernia. there is extensive extraluminal air and debris within the mediastinum consistent with an esophageal rupture. the air dissects superiorly to the thoracic inlet and under the diaphragm. pt was then transferred to the . on transport patient maintained a 16-20 rr with 100% neb. with accessory muscle use. he was speaking in short-full sentences. there was no palpable abdominal mass. pt received 2l ns and placed in the ambulance in 100% . his vital signs remained stable although his lung sounds began to diminish at the bases l>r. he became increasingly discomforted with 5/5 epigastric pain and nausea. approximately mi. from , pt. developed respiratory difficulty with rr 28-30 and desaturations from 97%-91%. he noticed to have increased bilateral chest wall movements with subcutaneous emphysema. in the , surgery/cardiac surgery was consulted. patient was noticed to be in respiratory distress with a distended abdomen at the time of my examination. he was unresponsive to commands at this time and pressures fell to 60/5. he was intubated in the trauma bay and 2 large bore ivs were placed. pt. received a total of 6l of ivf past medical history: marfans syndrome, history of aortic dissection s/p aortic valve replacement and ascending aorta replacement in , history of postop deep vein thrombosis, history of post-op atrial fibrillation, asthma, gastroesophageal reflux disease, hiatal hernia, s/p hernia repair, s/p foot surgery social history: denies tobacco. admits to occasional etoh. he is married and lives with his wife. is an electrical engineer. family history: denies connective tissue disorders. no history of premature cad. physical exam: pe: 124-65/5-26-86 100% pt. in distress with belching motions of abdomen and use of accessory muscles to ventilate. heart sounds were distant and barely auscultated breath sounds were severely diminished and distant massive abdominal distention which worsened after intubation extremities were cold with poor capillary refill and nonpalpable pulses x4 pertinent results: count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:40am 9.8 3.13* 8.6* 26.4* 84 27.5 32.6 18.7* 1852*1 plt count 1852 : impression: pa and lateral chest compared to through . the large air and fluid collection at the base of the right chest present since at least is unchanged. a moderate left pleural effusion or pleural thickening and the postoperative mediastinum are stable in appearance. heart is not enlarged. left lower lobe atelectasis is probably due to persistent left pleural abnormality. right basal atelectasis is improving. upper lungs are clear. tip of the right pic catheter projects over the right clavicle, ending just outside the chest. tracheostomy tube is midline but the caliber appears small given the diameter of the trachea. aortic endoprosthesis is unchanged in appearance running from the mid ascending to the proximal descending aorta. no pneumothorax. ultrasound-guided right thoracentesis. history: 40-year-old male status post boerhaave rupture with air-containing fluid collection in the right lung base. impression: 1. 15 cc of serosanguineous fluid aspirated from the right pleural cavity and sent to microbiology for gram stain and culture. brief hospital course: pt was admitted intubated, sedated, vol resusitated and on epi and levo for hemodynamic stability .and taken emergently to the or for repair of ruptured esophagus and trach on . started on empiric vanco/zosyn per infectious disease. immed post op period was notable for lue mottled in the setting of previous right ax-fem graft. evaluated by vasc- circulation intact w/ weak doppler signal. pt remained intubated, sedated, on pressor support w/ cont'd cystalloid and colloid requirements. pt had 4 left chest tubes and 2 right chest tubes all w/ mod-large amount drainge. pod#1: pt noted to have large right pleural effsuion on cxr that was not being drained by the other 2 chest tubes on right side - a 3th right chest tube was placed. pod#2: con't ventilated and on pressor support. diuresis begun. chest tube drainage slowed. pod#3 started on tpn for nutritional support. doppler signals in lue much improved. pod#4 pressors weaned. vent support weaned to psv. spiking fevers on vanco/zosyn-fluc added to broaden coverage. lft's increasing (baseline elevated)-hepatology consulted and increase thought to be benign. pod# 5 g-j tube placed for enetral feeding. pod#6 hida scan- cholestasis. liver us w/ sldge -no cholecystitis. pod#7 left chest tube d/c'd. pt on trach collar. pod#8 ngt d/c'd and trophic tube feed started. pod# tpn d/c'd. tf increased. triple lumen d/c'd and mid line placed in left upper extrem. pod#11 pt placed on passey muir valve intermittantly. hematology consulted for elevated platelet count. cont on asa and no role for plavix at this time. fluc d/c'd and ceftriaxone d/c'd and cefepime started to decrease hepatotoxicity.. pod#12 2 right and 2 left chest tubes d/c'd. one remaining on each side to sxn w/ minimal drainage. pod#13 trach changed to #6 fenestrated cuffless. passed swallow eval and placed on clear liquid diet. pod#14 remaining chest tubes d/c'd. lft's improving slowly. working w/ pt/ot. pod#15 -17 noted to have small right pleural fluid collection-tapped under ultrasound guidance and culture sent-pending at time of this d/c summary. diet progressed to full liquids-continues on tube feed. cal counts done but not able to take sufficient calories to wean tube feed at this time. can progress to soft solids in one week and not advance until follow up w/ dr. . per id will need to be on 3 weeks total of ivab from date of -ending . medications on admission: none discharge medications: 1. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 2. ipratropium bromide 17 mcg/actuation aerosol : four (4) puff inhalation q6h (every 6 hours). 3. fluticasone 110 mcg/actuation aerosol : two (2) puff inhalation (2 times a day). 4. metoprolol tartrate 25 mg tablet : one (1) tablet po tid (3 times a day). 5. acetaminophen 160 mg/5 ml solution : one (1) po q4-6h (every 4 to 6 hours) as needed. 6. quetiapine 25 mg tablet : one (1) tablet po hs (at bedtime). 7. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 8. insulin regular human 100 unit/ml solution : one (1) injection asdir (as directed). 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 10. nph insulin 4 units nph insulin sq qam and qpm 11. fluticasone-salmeterol 100-50 mcg/dose disk with device : one (1) disk with device inhalation (2 times a day). 12. vancomycin in dextrose 1 g/200 ml piggyback : one (1) gm intravenous q 8h (every 8 hours) for 17 days: total 3 weeks-started . please check peak and trough serially. 13. cefepime 1 g recon soln : one (1) recon soln intravenous q12h (every 12 hours) for 17 days: total of 3 weeks started on . 14. heparin lock flush (porcine) 100 unit/ml syringe : two (2) ml intravenous daily (daily) as needed. discharge disposition: extended care facility: - discharge diagnosis: boehaave's esophageal rupture/repair via left thoracotomy. discharge condition: deconditioned. discharge instructions: call dr. office if you have any chset pain, problems swallowing, fever, chills, nausea, or vomitting. continue your tube feed and it may be cycled for convenience as . tube feed may be decreased as po intake increases. continue full liquids until then increase to soft solids. followup instructions: please follow up with dr. . please call his office, (, to arrange the appointment upon d/c from rehab. procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other enterostomy insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis temporary tracheostomy pulmonary artery wedge monitoring transfusion of packed cells other gastrostomy transfusion of other serum infusion of vasopressor agent repair of diaphragmatic hernia with thoracic approach, not otherwise specified other graft of esophagus diagnoses: diaphragmatic hernia without mention of obstruction or gangrene heart valve replaced by other means acute respiratory failure cardiac arrest other specified disorders of biliary tract personal history of venous thrombosis and embolism perforation of esophagus spontaneous tension pneumothorax essential thrombocythemia interstitial emphysema marfan syndrome 

Answer: The patient is high likely exposed to