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: airway monitoring major surgical or invasive procedure: none history of present illness: 56 y/o m admitted to for respiratory distress. he noted the onset of respiratory sx's ~6 months ago and weight loss, which lead to a laryngeal biopsy noting laryngeal ca dx . arrangements had been made to start chemo and xrt on at va. . prior to presentation, the patient was brushing the snow from his car when he became sob and presented to with stridor. he also noted mildly increased cough with phlegm production, as well as 3-4 days of subjective chills. there a ct scan noted a large enhancing l paraglottic mass w/ an airway lumen of 3x6 mm with multiple metastatic nodes and question of esophageal extention. pt was given combivent nebs and solumedrol 125 in the ed. a trach was then placed percutaneously, and the pt was transferred to as no beds were available at va. past medical history: -lanyngeal ca dx on larygeal bx, w/o h/o radiation or node dissection -s/p g-tub -h/o r thumb amputation -htn -h/o lyme dx and babesiosis treated this past summer social history: worked as a carpenter, stopped smoking 2 weeks ago family history: sister w/ dm physical exam: vs:t=98.2, bp=114/62-141/71,hr=66-95, rr=13-22, o2=98-100% on 40%trach gen: pt thin appearing but in nad heent: nonicteric, mucosa slightly dry, trach in good position; oropharynx difficult to visualize but no erythema chest: transmitted upper airway sounds but no wheezes, whales cv: distant hs, rrr abd: scaphoid, soft, nt, nd, g-tube ext: no le edema; +clubbing skin: facial telangectasias pertinent results: cxr: the patient is status post tracheostomy. the tracheostomy tube appears to be in good position. the heart, mediastinal and hilar contours appear to be within normal limits. the pulmonary vascularity is normal. there is no evidence of chf. lung fields are grossly clear without evidence for pneumonia. impression: no evidence of pneumonia. status post tracheostomy. 10:27pm glucose-144* urea n-13 creat-0.6 sodium-136 potassium-5.1 chloride-97 total co2-29 anion gap-15 10:27pm calcium-9.1 phosphate-4.3 magnesium-1.8 10:27pm wbc-21.1* rbc-3.86* hgb-12.3* hct-36.0* mcv-93 mch-31.8 mchc-34.1 rdw-12.6 10:27pm neuts-95.1* bands-0 lymphs-4.5* monos-0.3* eos-0.1 basos-0 10:27pm plt count-616* 10:27pm pt-13.0 ptt-26.7 inr(pt)-1.1 6:00am wbc-23.3 hct-32.2 plt count-593 dipstick urinalysis blood nitrite protein glucose ketone bilirub urobiln ph leuks 03:59pm neg neg neg neg neg neg neg 8.0 neg oropharyngeal videofluoroscopic swallowing evaluation evaluation: an oral and pharyngeal swallowing videofluoroscopy was performed today in collaboration with radiology. thin liquid, nectar-thick liquid, honey thick liquid and pureed consistency barium were administered. results follow: oral phase: bolus control was within normal limits. he could form a bolus with liquids, but no ground or solid consistencies were tested. premature spillover was seen. mild tongue weakness was noted with difficulty transporting material from the front to the back of his mouth. pharyngeal phase: there was a mild to moderate delay in initiation of the pharyngeal swallow. once started, palatal elevation was normal. laryngeal elevation was moderately to severely reduced. epiglottic deflection was absent. upper esophageal sphincter relaxation was also reduced. after the swallow, a moderate amount of residue remained in his pharynx. this mixed with secretions pooling in his throat, and spilled into the airway leading to aspiration after the swallow. anterior to posterior position: vocal cord movement was reduced on the left side. pharyngeal contraction was better on the right, and food and liquid tended to go down the right side. more residue remained on the right side, as there was no space in the valleculae or pyriform sinuses on the left due to the presence of the mass. aspiration/penetration: aspiration occurred with all consistencies; thin liquid, nectar thick liquid, honey thick liquid and pudding. aspiration occurred before the swallow due to premature spillover and swallow initiation delay; during the swallow due to reduced vocal cord closure, and after the swallow due to spillage of residue mixed with secretions into the airway. no cough was produced upon aspiration. a cued cough was effective in reducing but not in eliminating the aspiration. treatment techniques: his most functional swallow with the least amount of aspiration occurred when he swallowed with a chin tuck, used the swallow-cough-swallow technique, and alternated between one bite and one sip. aspiration was reduced but not eliminated. summary: mr. aspirates all consistencies due to his laryngeal mass and the excess secretions in his oropharynx. we were able to reduce but not to eliminate the aspiration when he swallowed with a chin tuck, used the swallow-cough-swallow technique and alternated between bites of puree and sips of nectar-thick liquid. recommendations: 1. remain strictly npo for now with peg feeds for nutrition, hydration and medications 2. suggest medically treating his secretions to reduce them with something like a scopolamine patch 3. repeat videoswallow once his secretions have decreased to see if he might be able to take small amounts of nectar-thick liquids and pureed foods po for pleasure using a chin tuck, swallow-cough-swallow and alternating consistencies these recommendations were shared with the patient, the nurse and the medical team. 10:19 am sputum source: endotracheal. gram stain (final ): <10 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci. in pairs. 1+ (<1 per 1000x field): multiple organisms consistent with oropharyngeal flora. quality of specimen cannot be assessed. respiratory culture (preliminary): sparse growth oropharyngeal flora. streptococcus pneumoniae. moderate growth. being isolated for sensitivities. brief hospital course: 1) respiratory failure - pt appears to have extensive involvement of his tumor and had stridor upon presentation to osh. he is much improved after trach placement, and is now comfortable with normal sats. cxr's show no pna. -cont frequent suctioning. . 2) leukocytosis: unclear etiology. initially was ascribed to steroid treatment at osh, but wbc count has remained elevated for several days. pt denies diarrhea. sputum culture shows strep pnuemo colonization vs. tracheitis/pna. -will treat for suspected respirtory infection for 7 days with ceftriaxone. . 3) laryngeal carcinoma: -pt is due to start chemo/radiation at va on wed, . -pt has received a bed at va and will transfer the patient to start recieving treatment . 4) tachycardia: likely slight volume depletion and low grade fevers. responds to ivf. . 5) htn - continue lisinopril, monitor bp. . 6) fen - continue tf's. failed s&s video study. . 7) ppx - placed on sq heparin, bowel regimen, taking tf's . 8) access - piv. medications on admission: ibuprofen prn, 2 tabs at night lantus 55u qam humalog iss actos 15mg qd zetroretic (? antihypertensive) discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 2. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily): hold for sbp<100. 3. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 4. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 5. nicotine 14 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). 6. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed. 7. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 8. docusate sodium 150 mg/15 ml liquid sig: one y (150) mg po bid (2 times a day). 9. acetaminophen 160 mg/5 ml solution sig: 325-650 mg po q4-6h (every 4 to 6 hours) as needed. 10. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 11. rocephin in dextrose (iso-osm) 1 g/50 ml piggyback sig: one (1) intravenous q24h (every 24 hours). disp:*qs for 7 days * refills:*2* discharge disposition: extended care facility: va discharge diagnosis: laryngeal cancer discharge condition: stable discharge instructions: please continue to instruct pt with suctioning trach often. please follow fever curve and monitor tachycardia. followup instructions: please followup with your cancer doctors as previously and get your chemotherapy and xrt. md procedure: enteral infusion of concentrated nutritional substances diagnoses: tobacco use disorder unspecified essential hypertension personal history of other infectious and parasitic diseases acute respiratory failure pneumococcal pneumonia [streptococcus pneumoniae pneumonia] hypovolemia gastrostomy status person awaiting admission to adequate facility elsewhere secondary malignant neoplasm of other respiratory organs secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck attention to tracheostomy family history of diabetes mellitus malignant neoplasm of larynx, unspecified 

Answer: The patient is high likely exposed to