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: history of present illness: mr. is a 48-year-old male resident at rentham developmental center, who has a problem with chronic severe aspiration. this problem was first noticed around eight years ago. he had a gastrostomy tube placed in . he continued to have reflux, however, with aspiration and recurrent pneumonia. in , he developed right pleural effusion. he had a thoracoscopy and chest tube placement. the fluid was an exudate with no infection or malignancy. due to the recurrent nature of the problem, he was scheduled for a tracheoesophageal separation by total laryngectomy with dr. on . past medical history: 1. chronic aspiration. 2. pulmonary fibrosis secondary to macrodantin. 3. chronic constipation. 4. acne. 5. pre-procedural anxiety. 6. contractures. 7. hypothyroidism. 8. hypothermia. 9. atypical psychosis/frontal lobe syndrome. 10. seizure disorder. 11. dysphagia. 12. history of urinary tract infections. 13. mental retardation. hospitalizations: 1. at hospital for respiratory distress, pleural effusions, pseudomonas urinary tract infection. 2. on returned to hospital for vomiting with respiratory distress. allergies: ampicillin that causes swelling and rash. medications: 1. calcium carbonate 1250 mg q day. 2. dilantin 300 mg q day. 3. keflex 500 mg q6h. 4. metronidazole 250 mg q8h. 5. olanzapine 2.5 mg q day. 6. senna four tablets daily. 7. levothyroxine 25 mcg q day. 8. milk of magnesia 60 cc daily. 9. topamax 250 mg . 10. fludrocortisone 0.1 mg q day. 11. albuterol/ipratropium nebulizers qid. 12. dulcolax suppository qod. 13. fleet's enemas q2-3 days prn. diet: his diet includes 3/4 strength 2-cal hn 70 cc/g tube q hour with 1/4 strength jevity plus x12 hours q day along with two tablespoons of promod . family history: maternal parents colon cancer. paternal parents significant cardiac disease. father died of transient ischemic attack and stroke. mother developed diabetes in her 60s. brother and maternal aunt diagnosed with multiple sclerosis. on examination, preoperative: in general, this is a 48-year-old male with multiple physical handicaps, who is alert, nonverbal, and cooperative. skin: good turgor, scattered scars including permanent scar in right hip. eyes: left exotropia. pupils are equal, round, and reactive to light. visual acuity appears intact. fundoscopic examination limited, but grossly normal. ears normal, hearing acuity with bilateral cerumen. nose: nares patent. dental hygiene fair. no abnormal tongue movements. neck is supple, no thyromegaly or lymphadenopathy. cyst noted at base of the skull. lungs: occasional rhonchi, decreased breath sounds at bases. heart: normal sinus rhythm, no audible murmurs. abdomen is soft, protuberant, bowel sounds active in all quadrants, no hepatosplenomegaly, no tenderness or masses. g tube in place mid abdomen. g site clean. rectal examination deferred. extremities: light contractures of right upper extremity. significant contractures of the left upper extremity with left hand flexed. no skin breakdown. all four limbs can be extended left greater than right. neurologic: mental status: alert, minimally verbal, follows simple requests. cranial nerves ii through xii intact except for exotropia. deep tendon reflexes hyperreflexive lower extremities, normal reflexes upper extremities. preoperative chest x-ray: showed pleural thickening with no acute consolidation or change. preoperative electrocardiogram: within normal limits, rate 80, normal sinus rhythm, no change since previous electrocardiogram in . patient underwent a total laryngectomy on with dr. . there were no complications. he received 4800 cc of crystalloid. urine output 425 cc, 200 cc estimated blood loss. he was transferred to the intensive care unit postoperatively. hospital course and treatment: 1. otolaryngology: the patient had bacitracin applied to his wounds throughout his stay. they continued to heal well. staples were removed prior to discharge. he received humidified o2 by trache collar which was gradually weaned to 35% fio2. he was on aspiration precautions throughout his stay to prevent reflux. postoperative laboratories included a white count of 6.9, hematocrit of 29.7, which subsequently rose to 31.9. he continued to improve throughout his stay. his ionized calcium postoperatively was 1.15, which dropped to 0.97 and returned to 1.15 prior to discharge. he was transferred to the floor on postoperative day three, . his drains were originally to wall suction with high output around 100 cc a day until and 2nd when they are switched to bulb suction, and the output came down to between 50-70 cc a day. jp #2 was removed on after putting out 30 cc over 24 hours. jp #1 was removed on prior to discharge. 2. neurologic: the patient's dilantin level postoperatively was 4.3. he was loaded with 500 mg iv x1 and then placed on a maintenance dose of 100 mg tid. he did have seizure activity during his stay. his dilantin level rose to 12.9, which was in the therapeutic range, and he was continued on the maintenance dose. his atypical psychosis and mr throughout his stay. 3. gi: immediately, postoperatively the g tube was placed to gravity. his tube feeds were resumed on , postoperative day one with a nutrition team following him. he had very low residuals and no problems with aspiration into the oropharynx. 4. infectious disease: the patient was afebrile throughout his stay. he was on ancef and flagyl after the surgery. he had a urinalysis that was positive and was placed on cipro throughout the length of his stay. 5. respiratory: he continued to have thick secretions requiring frequent suctioning and chest pt. he received respiratory care multiple times a day. wheezing was controlled with albuterol and atrovent nebulizers. 6. endocrine: he had a tsh of 0.78 postoperatively. he received his normal dose of synthroid. no changes were made. he was on an insulin-sliding scale throughout his stay. on , staples and drains were discontinued. the patient was in good condition with continuing needs for frequent suctioning. he was discharged to rentham with antibiotics, pain medication, and instructed to followup with dr. in weeks. , m.d. dictated by: medquist36 procedure: enteral infusion of concentrated nutritional substances complete laryngectomy diagnoses: esophageal reflux urinary tract infection, site not specified unspecified acquired hypothyroidism other convulsions postinflammatory pulmonary fibrosis severe intellectual disabilities gastrostomy status 

Answer: The patient is high likely exposed to