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: no known allergies / adverse drug reactions attending: chief complaint: chief complaint: leaky j-tube . reason for micu transfer: ventilator management major surgical or invasive procedure: none history of present illness: 78y/o m with history of bronchoalveolar carcinoma s/p rt upper lobectomy in , aspiration pneumonia c/b l sided empyema s/p thoracentesis and chronic respiratory failure s/p tracheostomy transferred from osh for j tube evaluation. . in , patient was diagnosed with bronchoalveolar carcinoma and underwent a lobar resection. this hospitalization was complicated by a prolonged hospitalization, prolonged chest tube, and malnutrition. given malnutrition and h/o esophageal stricture, a j-tube was placed. pt also has h/o partial gastrectomy and bilroth ii procedure and thus j tube was considered over g-tube. after this hospitalization, pt was d/c'ed ltac at . . ltac reported that j tube was leaky and patient subsequently underwent 2 revisions on and by general surgery at osh. per osh surgeons, cause of leak was poor wound healing from malnutrition. . recent health has been complicated by aspiration pneumonia which led to chronic respiratory failure requiring trach, which was completed 3 days ago. this pna was also complicated by mrsa empyema which was drained by pigtail catheter placed over past weekend. pigtail catheter fell out yesterday however repeat ct showed interval improvement of pleural effusion. patient was started on imipenem empirically for aspiration pneumonia was due to finish treatment on . additionally, patient was started linezolid, today being day 4. . patient was significant improving from ventilation stand point and was due to be sent back to rehab however j-tube remained leaky which prompted transfer for further evaluation. . on micu, patient was in no acute distress and had no complaints. patient however did not appear to be inattentive. past medical history: - mild dementia - spinal stenosis - esophageal strictures - bronchoalveolar carcinoma s/p rulobeectomy, c/b pneumothorax requiring month long chest tube - copd - pernicious anemia - pud, s/p billroth type ii - h/o tia - states was "age related" and noted on a ct scan and denies any h/o daughter denies any residual deficits - malnutrition, requiring j-tube social history: unable to obtain family history: unable to obtain physical exam: vitals: 97.8 171/87 80 98% on cpap 12/5 50% f102 general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 12:51am blood wbc-4.9 rbc-3.32* hgb-9.7* hct-29.0* mcv-87 mch-29.1 mchc-33.3 rdw-18.7* plt ct-130* 12:51am blood neuts-87.0* lymphs-9.7* monos-3.0 eos-0.2 baso-0.1 12:51am blood pt-13.2 ptt-33.2 inr(pt)-1.1 12:51am blood glucose-101* urean-23* creat-0.5 na-144 k-4.1 cl-112* hco3-26 angap-10 12:51am blood alt-35 ast-18 ld(ldh)-255* alkphos-92 totbili-0.6 12:51am blood albumin-2.3* calcium-8.1* phos-2.6* mg-2.2 micro: 5:27 am sputum source: endotracheal. **final report ** gram stain (final ): this is a corrected report on . reported to and read back by dr. , e () on at 14:09 pm. >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram negative diplococci. previously reported on as:. >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci in pairs. 2+ (1-5 per 1000x field): gram negative diplococci. respiratory culture (final ): rare growth commensal respiratory flora. acinetobacter baumannii complex. moderate growth. "note, for amp/sulbactam, higher-than-standard dosing needs to be used, since therapeutic efficacy relies on intrinsic activity of the sulbactam component". sensitivities: mic expressed in mcg/ml _________________________________________________________ acinetobacter baumannii complex | ampicillin/sulbactam-- =>32 r cefepime-------------- =>64 r ceftazidime----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ <=1 s imipenem-------------- =>16 r levofloxacin---------- =>8 r tobramycin------------ <=1 s trimethoprim/sulfa---- 2 s imaging: ct chest: findings: thyroid is normal in appearance. there is no supraclavicular, mediastinal, hilar or axillary lymphadenopathy. scattered nonenlarged nodes are seen. the heart and pericardium are unremarkable with physiologic pleural fluid. atherosclerotic calcification of the coronary vessels and aortic arch are noted. left-sided picc line terminates in the mid distal svc. aortic and mitral valvular calcifications are also noted. dense consolidative process is seen involving the basal portion of the right upper lobe as well as the entire right lower lobe in a similar fashion as on the prior with slight improved aeration in the right middle lobe. patient is status post what appears to be partial right upper and right lower lobectomies. aspirated secretions are seen in bronchus intermedius and right lower lobe bronchus as well as in the left main stem bronchus concerning for continued aspiration with a bolus of secretion seen immediately superior to the tracheostomy tube (601b:21). scattered ground-glass and tree-in- opacification is seen in the remaining lobes concerning for milder aspiration related changes versus infectious or inflammatory process. in this setting of bronchoalveolar carcinoma, this could also reflect foci of malignant involvement and followup to resolution should be performed. small left pleural effusion is seen and improved from the prior study with improved aeration of the left lower lobe. though the indication describes a left-sided empyema what appears to be a loculated air-fluid collection in the prior study in the right pleural space is improved on the current examination resembling a partially loculated right pleural effusion which is small and simple in appearance. evaluation for empyema is limited by non-contrast technique. paraseptal and centrilobular emphysema is noted. though this study is not tailored for subdiaphragmatic evaluation, limited upper abdominal evaluation demonstrates numerous surgical clips compatible with history of gastrectomy and billroth ii reconstruction. multiple left-sided rib fractures are seen along with diffuse osteopenia. impression: 1. aspiration with secretions within bronchus intermedius, right lower lobe bronchus and left main stem bronchus along with dense opacification in the right lower lobe and basal right upper lobe. impending aspiration of additional bolus of secretions proximal to the tracheostomy tube. 2. ground-glass/tree-in- opacities in the left upper, right upper and right middle lobes could be additional foci of aspiration versus infectious or inflammatory process. given the history of bronchoalveolar carcinoma, these pulmonary opacifications should be followed up for resolution. 3. though the indication describes left-sided empyema, it appears the prior empyema was on the right according to the outside hospital ct and this collection appears to have improved now reflecting a smaller loculated effusion, though determination of empyema is limited by non-contrast technique. 4. decrease in size of small left effusion with improved left lower lobe aeration. ct abdomen/pelvis : findings: the heart is enlarged. the patient is status post surgery in the right lung. consolidation is observed in the superior segment of the right lower lobe with air bronchogram which is highly suspicious for aspiration pneumonia. loculated right pleural fluid is observed with enhancement of both the visceral and parietal pleura most probably represent empyema. moderate amount of left pleural fluid with secondary atelectasis. abdomen: many artifacts due to retained contrast media from previous fluoroscopic examination and from many surgical clips. the liver is within normal limits regarding size and morphology. the hepatic veins are patent as well as the portal vein. to note, the smv is not clearly visualized. status post cholecystectomy. no intra- or extra-biliary dilatation is noted. the pancreas is not well visualized. the spleen, the kidneys and the adrenals are within normal limits. the stomach is not well observed. a jejunostomy tube is seen. no dilatation of the large or of the small bowel. the appendix is detected and is within normal limits. tubular air filled structures that branch are seen on series 2, image 75, free air cannot be ruled out definitely. free fluid that is of slightly high density is observed in the abdomen and in the pelvis. no mesenteric or retroperitoneal lymphadenopathy is observed. the aorta is heavily calcified. a foley catheter is detected within the urinary bladder. fractures of ribs 10, 9, 8, 7 and 6 on the left side some of them with calus and some may be acute. fractures of right ribs 11 and 10 with no calus formation. impression: 1. consolidation of the superior segment of the right lower lobe with air bronchogram consistent with aspiration pneumonia. 2. loculated fluid with enhancement of the visceral and parietal pleura, highly suggestive of empyema. 3. air-filled tubular structure within the right lower quadrant, cannot rule out free air we recommend further clinical follow up or an interval ct examination with oral contrast ( through j tube ). echo () the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50-55%). the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. echocardiographic signs of tamponade may be absent in the presence of elevated right sided pressures. compared with the prior study (images reviewed) of , left ventricular systolic function is now slightly less vigorous. tricuspid regurgitation is now more prominent and the right ventricle cavity size appears larger. mitral regurgitation is now more prominent. estimated pulmonary artery systolic pressure is now higher. : ueni: findings: grayscale and doppler son of the right upper extremity performed. the left and right subclavian veins are patent. the right internal jugular vein, right axillary vein, right basilic and right brachial veins are patent and compressible. the right cephalic vein is not visualized. no thrombus identified. there is a picc line in situ within the right subclavian and right basilic veins. no thrombus identified in relation to the intravenous line. impression: no evidence of right upper extremity thrombus. picc line in situ within the right subclavian and right basilic veins. brief hospital course: 78 y/o m with h/o malnutrition requiring j-tube with recent respiratory failure from aspiration pna c/b mrsa empyema now s/p tracheostomy transferred with j-tube evaluation found to have profound malnutrition who clinically deteriorated during micu stay and after multiple family meetings was ultimately made cmo. . # micu course: patient was transferred to the micu for evaluation of j tube. micu admission was warranted as patient was recently trached for respiratory failure. upon evaluation, it was clear that patient was suffering from several malnutrition which was contributing to his overall ability to heal from his multiple j-tube revisions. his j tube site appeared macerated. ir was consulted who performed a j tube study which confirmed placement and patency. surgery was consulted and upsized the tube however j tube continue to leak. ultimately the j-tube was removed. tpn was started and family was approached regarding -jujenal feedings. after a series of several family meetings, given patients decline and likelihood for requiring a long recovery, family decided to move towards comfort measures. patient was ultimately called out to general medicine floors with palliative care to aide in this transition. # floor course: mr was continued on his morphine and ativan with transition to iv morphine drip the following morning. on , he expired at 145 pm. family requested an autopsy given possibility of surgical trauma at outside hospital - the case was submitted to the medical examiner because the suspicion of trauma was raised. medications on admission: - albuterol/ipratropium nebs - linezolid 600mg iv q12h - started on - imipenem/cilastatin 250mg iv q6h - nitropaste 1" q6h prn sbp > 140 - nystatin unit po qid - fondaparinux 2.5mg sc - prednisone 20mg daily - potassium chloride 40meq daily - mvi - fluoxetine 20mg daily - amlodipine 10mg daily - tylenol 650mg q6h prn - aspart flex pen - lisinopril 10mg daily - pantoprazole 40mg daily - terazosin 5mg daily discharge medications: (expired) discharge disposition: expired discharge diagnosis: expired secondary to pneumonia, empyema discharge condition: expired discharge instructions: expired followup instructions: expired procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances diagnoses: unspecified essential hypertension chronic airway obstruction, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere pneumonitis due to inhalation of food or vomitus malignant neoplasm of upper lobe, bronchus or lung diarrhea encounter for palliative care pulmonary congestion and hypostasis mechanical complication of colostomy and enterostomy empyema without mention of fistula stricture and stenosis of esophagus adult failure to thrive oliguria and anuria chronic respiratory failure tracheostomy status other abnormal glucose other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms nutritional marasmus personal history of peptic ulcer disease methicillin resistant pneumonia due to staphylococcus aureus 

Answer: The patient is high likely exposed to