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: ambien attending: chief complaint: dyspnea and stridor major surgical or invasive procedure: emergency tracheostomy, direct laryngoscopy, and rigid esophagoscopy. colonoscopy and esophagogastroduodenoscopy. history of present illness: 66 y/o m with hx of laryngeal ca with treatment by right hypopharyngeal excision and s/p chemo and xrt in presents with increasing sob, hoarsenss and stridors. in , the patient was noted to have some increasing sob and was taken to the operating room which revealed some airway edema and fungal infection. from biospy he is tumor free. he was treated with diflucan at that time for fungal infection. he was doing well but still continued to have some mild sob. starting 3 days prior to admission, the patient noted worsening symptoms and came to the ed today for evaluation. . in the ed, initial vs were stable and he was not hypoxic. he had audible stridor from the doorway. patient was given 10 mg of decadron. ent was consulted and he was taken to the or where he had a tracheostomy with local anesthesia. after the trach was placed he received general anesthesia through his tracheostomy. the visualizaiton showed some swelling of the false vocalcords. the true vocal cords themselves were quite edematous and somewhat inflamed. he was hypertensive with sbps in 170s to 200s while in the or. . of note, in the ed his hct was noted to be 24 from a baseline of 34. he was guiac positive. on the floor, he was guiac positive as well. . on the floor, the patient was unable to talk secondary to the new trach. he was coughing frequently with bloody sputum being expelled from his trach tube. he complains of pain around the trach site. he denies hx of black or bloody stools. no hx of gi bleed. he takes aspirin occassionally. does not take ibuprofen at home. recent egd in showing gastritis and duodenitis when he had his peg tube placed. no colonoscopy on record. past medical history: stage iii larygneal scc s/p right hypopharyngeal excision and cisplatin/xrt fungal laryngitis s/p peg tube htn social history: lives with brother. married. former 80 py smoker, quit last year. former social etoh use. retired iron worker. family history: no known family hx ca. physical exam: admission physical exam (per ent emergency dept. consult note) vs: hr 100 176/ 68 20 95 %/ shovel mask gen: mild retractions, + inspiratory and expiratory stridor voice: raspy and stridorous, +sob cranial nerves: cn ii ?????? xii intact eyes: perrla, eomi, no proptosis ear: r: nl auricle, nl eac, nl tm l: nl auricle, nl eac, nl tm nose: r: pink mucosa, no nasal discharge, no masses, septum midline l: pink mucosa, no nasal discharge, no masses oc/op: tongue mobile, no masses or lesions, fom soft, uvula midline, airway patent, quality of teeth:edentulous neck: full range of motion, mild radiation change to the neck, no palpable lad, mildly ttp on b/l level 3, no masses. ttp over laryngeal cartilage, can palpate cricoid cartilage, can extend neck well. foe: nose (see above), np no masses, eustachian tube patent bilaterally, epiglottis crisp, ae fold and arytenoids with some edema; the b/l vc are have whitish lesions on them and they are minimally mobile. there is a 1mm airway posteriorly. he has some pooling of greenish secretions in piriforms and post cricoid region. airway severely limited. pertinent results: 11:00am blood wbc-13.1* rbc-2.51*# hgb-8.2*# hct-24.8*# mcv-99* mch-32.7* mchc-33.1 rdw-15.9* plt ct-977* 11:00am blood neuts-82.5* lymphs-10.2* monos-5.5 eos-1.5 baso-0.4 04:54pm blood wbc-16.0* rbc-2.28* hgb-7.4* hct-23.0* mcv-101* mch-32.6* mchc-32.3 rdw-15.7* plt ct-799* 10:45pm blood hct-22.8* 06:04am blood wbc-12.2* rbc-2.37* hgb-7.7* hct-22.7* mcv-96 mch-32.7* mchc-34.0 rdw-17.0* plt ct-740* 10:09am blood hct-23.5* 06:15am blood wbc-14.2* rbc-2.47* hgb-7.9* hct-24.0* mcv-97 mch-31.8 mchc-32.8 rdw-17.1* plt ct-662* 06:15am blood neuts-89.2* lymphs-5.4* monos-4.3 eos-0.8 baso-0.3 06:00am blood wbc-11.2* rbc-2.50* hgb-8.2* hct-24.2* mcv-97 mch-32.7* mchc-33.8 rdw-16.7* plt ct-641* 06:00am blood wbc-10.4 rbc-2.46* hgb-8.0* hct-23.9* mcv-97 mch-32.6* mchc-33.5 rdw-16.1* plt ct-598* 11:00am blood glucose-95 urean-15 creat-0.8 na-133 k-4.3 cl-95* hco3-27 angap-15 06:00am blood glucose-87 urean-11 creat-0.8 na-135 k-4.0 cl-98 hco3-31 angap-10 06:15am blood alt-14 ast-19 alkphos-50 totbili-0.2 04:54pm blood caltibc-239* ferritn-91 trf-184* 11:08am blood lactate-1.0 . time taken not noted log-in date/time: 6:30 pm swab right retinoid. gram stain (final ): no polymorphonuclear leukocytes seen. 4+ (>10 per 1000x field): gram positive rod(s). 1+ (<1 per 1000x field): budding yeast. wound culture (final ): due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. fungal culture (preliminary): a swab is not the optimal specimen for recovery of mycobacteria or filamentous fungi. a negative result should be interpreted with caution. whenever possible tissue biopsy or aspirated fluid should be submitted. yeast, presumptively not c. albicans. saccharomyces cerevisiae. . 3:40 pm swab larynx. gram stain (final ): no polymorphonuclear leukocytes seen. 4+ (>10 per 1000x field): gram positive rod(s). 2+ (1-5 per 1000x field): budding yeast. 1+ (<1 per 1000x field): gram positive cocci. in pairs. respiratory culture (final ): moderate growth oropharyngeal flora. fungal culture (preliminary): a swab is not the optimal specimen for recovery of mycobacteria or filamentous fungi. a negative result should be interpreted with caution. whenever possible tissue biopsy or aspirated fluid should be submitted. yeast, presumptively not c. albicans. of two colonial morphologies. . portable cxr tracheostomy tube has been placed and its tip is 6.7 cm above the carina. there is no evidence of ptx and some right basilar atelectatic change is visualized along with a similar-appearing opacity adjacent to the right heart border. the latter may be due to scarring as it is quite similar to the film from . pulmonary vascular markings are normal and the remainder of the lungs is clear. . colonoscopy a single sessile 10 mm polyp of benign appearance was found in the ascending colon. a single-piece polypectomy was successfully performed using a cold snare. otherwise normal colonoscopy to cecum . egd antral gastritis and small superficial erosion in the stomach bulbar duodenitis and small superficial erosion duodenal biopsy to rule out celiac disease no active bleeding source identified otherwise normal egd to third part of the duodenum . portable cxr as compared to the previous radiograph, there is a ill-defined opacity at the medial bases of the right lower lobe. the pattern of opacity is peribronchial. there also is a minimal right-sided pleural effusion and a basal right atelectasis. overall, these findings suggest newly occurred pneumonia, potentially a complication of aspiration. newly appeared retrocardiac areas of hypoventilation. no signs of overhydration. the size of the cardiac silhouette is unchanged. . video oropharyngeal swallow: oral and pharyngeal swallowing study was performed today in collaboration with speech and swallow pathology. under video fluoroscopy, patient was observed to swallow barium of various consistencies. oral phase: oral phase was grossly normal with some trouble observed during mastication. there was mild premature spillover of thin liquid which penetrated the patient's laryngeal vestibule. pharyngeal phase: swallow initiation was timely and velar elevation was normal. however, laryngeal elevation and laryngeal valve closure were moderately reduced. reduced laryngeal valve closure contributed to the patient's penetration and aspiration. epiglottic anatomy was edematous and deflection was reduced. pharyngeal transit time was normal. mild residue was seen in the vallecular and piriform sinuses. bolus propulsion was moderately impaired with mild residue seen on the lower posterior pharyngeal wall. aspiration/penetration: material penetrated into the laryngeal vestibule during swallow due to impaired laryngeal valve closure and a small amount penetrated into the airway. patient aspirated a small amount of material into the laryngeal vestibule and material was not cleared with the patient's weak cued cough. impression: moderate pharyngeal dysphagia characterized by impaired laryngeal valve closure which resulted in penetration and trace aspiration. for full details and treatment recommendations, please refer to the speech pathologist note from the same day. . brief hospital course: #hypoxic respiratory failure - evaluted in the ed by ent who diagnosis limited vocal cord mobility, masses over the vocal cords bilaterally, and airway obstruction. he was taken to the or for emergent tracheostomy, direct laryngoscopy, and esophagoscopy which revealed postradiation changes throughout the laryngopharynx, no evidence of tumor in the hypopharynx or disease on the supraglottic surfaces, fixed arytenoids with limited ability to rotate, some ulceration near the right arytenoid which was biopsied, but no clear neoplastic changes. culture swabs were taken of the larnyx and right arytenoid and the patient was started empirically on unasyn and fluconazole. he was observed overnight in the micu and was stable for transfer to the floor on pod#1. unasyn was changed to augmentin on pod#2 as the patient was improving. cultures eventually grew oropharyngeal flora and saccharomyces cerevisiae. pmv was placed on pod#4 and the tracheostomy was changed on pod#5. he will continue on fluconazole to complete a 14-day course on . follow up with ent was arranged for two weeks after discharge. . #aspriation pneumonia - as the patient was afebrile and hemodynamically stable with a normal wbc#, augmentin was continued for coverage of aspiration pneumonia. he will complete a 14-day course on . . #acute blood loss anemia - the patient had an asymptomatic 10% decline in hematocrit over 1 month and guaiac positive stools on admission. he remained hemodynamically stable. flushing the peg tube did not produce a bloody or melanotic return. he received 1 u prbc on hd#2 for hct 22.7%. his hct remained stable ~24%. colonscopy revealed a benign-appearing ascending colonic polyp which was biopsied. egd revealed antral gastritis and duodenitis with superficial erosions, but no source of active bleeding. he will continue on ppi and will have a repeat hct soon after discharge. follow up with gi was arranged for 2 weeks after discharge. if his anemia does not recover over time, and his stools remain guaiac negative, he may benefit from an outpatient capsule endoscopy. . #nutrition - tube feeds were well-tolerated at goal rate, and eventually transitioned to bolus feeds 5 times daily. video oropharyngeal swallow study on revealed moderate pharyngeal dysphagia characterized by impaired laryngeal valve closure which resulted in penetration and trace aspiration. it was recommended that the patient remain npo due to the substantial aspiration risk. he understood the risks inherent in taking food by mouth, including pneumonia, respiratory failure, and death. the following recommendations were made if he accepts these risks and still chooses to eat: 1. ground solids w/ nectar-thickened liquids 2. head of bed at 45 degrees for po intake, 3. wear pmv for po intake, 4. supervision w/ meals, 5. meds crushed in puree or given via tube 6. oral care q4. . #hypertension - well-controlled on twice-daily metoprolol. medications on admission: megestrol 400 mg/10 ml suspension metoprolol 12.5 mg docusate sodium 50 mg/5 ml nutren pulmonary discharge medications: 1. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po twice a day. 4. amoxicillin-pot clavulanate 875-125 mg tablet sig: one (1) tablet po bid (2 times a day) for 9 days. 5. fluconazole 200 mg tablet sig: one (1) tablet po once a day for 9 days. 6. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day): hold for sbp<100, hr<55. 7. trazodone 50 mg tablet sig: 0.5-1 tablet po hs (at bedtime) as needed for insomnia. 8. acetaminophen-codeine 120-12 mg/5 ml elixir sig: 12.5-25 mls po q4h (every 4 hours) as needed for pain: hold for rr<12, oversedation. 9. oxycodone 5 mg/5 ml solution sig: ml po q4h (every 4 hours) as needed for pain: hold for rr<12, oversedation. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary 1) hypoxic respiratory failure 2) aspiration pneumonia 3) fungal laryngitis 4) acute blood loss anemia secondary 1) laryngeal squamous cell carcinoma 2) status post percutaneous gastrostomy tube placement 3) hypertension discharge condition: stable vital signs and respiratory status. discharge instructions: you were admitted to the hospital with airway obstruction, likely due to respiratory tract infection. you had a tracheostomy placed emergently on . please continue taking the antifungal medication as prescribed through friday, to treat your vocal cord infection. you were also diagnosed with pneumonia, most likely due to aspiration, which was partially treated with antibiotics. please continue taking the antibiotics as prescribed through friday, . you had another swallowing study which showed muscle weakness and a high risk for aspiration even with ground solids and nectar-thickened liquids. this means that eating could result in another pneumonia, respiratory failure, or death. it was therefore recommended that you take nothing by mouth and receive your nutrition only via tube feeds. if you accept these risks and choose to take food by mouth, please eat ground solids and nectar-thickened liquids, keep the head of the bed at 45 degrees and wear the passy-muir valve during meals, and perform oral care every 4 hours. please follow up with dr. on friday, at 11:00 am. please have your blood count (hematocrit) and liver function tests checked at this visit. the phone number is if you wish to reschedule. you had an upper endoscopy on which showed a small amount of irritation in the stomach and small intestine. for this reason, the acid blocker lansoprazole twice daily was recommended. however, no source of active bleeding was identified. colonoscopy showed a benign-appearing polyp which was nonetheless biopsied. please follow up with dr. of gastroenterology on wednesday, at 3:30 pm to review the results of your colon biopsy and discuss the role for capsule endoscopy. the phone number is if you wish to reschedule. please call your physician or return to the emergency department if you experience fever, chills, sweats, dizziness, lightheadedness, difficulty swallowing, chest pain, palpitations, cough, wheezing, shortness of breath, abdominal pain, vomiting, diarrhea, or bloody or dark stools. followup instructions: please follow up with dr. on friday, at 11:00 am. please have your blood count (hematocrit) and liver function tests checked at this visit. the phone number is if you wish to reschedule. please follow up with dr. of gastroenterology on wednesday, at 3:30 pm to review the results of your colon biopsy. the phone number is if you wish to reschedule. procedure: other esophagoscopy enteral infusion of concentrated nutritional substances temporary tracheostomy endoscopic polypectomy of large intestine esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of larynx diagnoses: acute posthemorrhagic anemia acute respiratory failure pneumonitis due to inhalation of food or vomitus hemorrhage of gastrointestinal tract, unspecified benign neoplasm of colon other candidiasis of other specified sites gastrostomy status other specified gastritis, without mention of hemorrhage benign essential hypertension personal history of malignant neoplasm of larynx dysphagia, pharyngeal phase acute laryngitis without mention of obstruction 

Answer: The patient is high likely exposed to