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: this is an 86 year-old male status post abdominal aortic aneurysm repair in by dr. who presents with right groin pain and back pain. the pain began yesterday afternoon. he denies any chest pain, shortness of breath. he denies nausea, vomiting or diarrhea. the patient denies any cardiac history. he is admitted to the emergency room and on vascular service for urgent abdominal exploration. past medical history: hypertension, two transient ischemic attacks. past surgical history: abdominal aortic aneurysm repair in , renal artery aneurysm repair in , carotid endarterectomy in , transurethral resection of the prostate remote. medications on admission: labetalol 200 mg b.i.d. allergies: penicillin, reaction unknown. clindamycin causes gastrointestinal upset. physical examination: the patient was comfortable. heart was regular rate and rhythm with a 2 out of 6 systolic ejection murmur. lungs were clear to auscultation bilaterally. abdominal examination was soft, nontender, nondistended. no discreet mass palpated. well healed median line incision. extremities warm and perfuse. no edema. pulse examination was 2+ pulses bilaterally. popliteals, dorsalis pedis pulses and posterior tibial pulses were palpable, but diminished. neurological is intact. laboratory: cbc white blood cell count 10.6, hematocrit 46.5, platelets 237k, pt/inr and ptt were normal, bun 17, creatinine 1.2, k 4.8. urinalysis was negative. cat scan was obtained of the abdomen, which showed an 8 by 4 aneurysm at the bifurcation of the aorta and a right iliac artery aneurysm. hospital course: the patient was transferred to the intensive care unit and hemodynamic lines were placed. blood pressure control was begun. the patient was placed on a nipride drip to maintain a systolic blood pressure of less then 120, beta blockade would be done postoperatively. the patient had a right ij and pa swan catheter placed. he underwent emergent abdominal exploration with a repair of abdominal aortic aneurysm with a aortobifemoral bypass graft. he received 1 unit of packed red blood cells, 1 unit of platelets and 2 fresh frozen platelets and 2500 cc from the cellsaver intraoperatively. findings showed aneurysm distal to the distal anastomosis of the tube graft. the patient tolerated the procedure well. he was transferred to the sicu in guarded, but stable condition intubated. the patient was continued on perioperative kefzol. he required intravenous nitroglycerin for systolic blood pressure control. there were no overnight events. they did require transfusion of red blood cells postoperatively. hematocrit of 29. his white blood cell count was 15, bun 18, creatinine 1.1, k 5.0, pt, inr and ptt were normal. he remained in the sicu for continued hemodynamic monitoring. serial troponin levels were obtained postoperatively. he peaked at 3.7 and over the next 24 hours came down to 2. he required continued respiratory support. there was an episode of bronchospasm. blood gas was 7.35, 41, 125, 29, -2 on peep of .5. the patient's hematocrit remained stable after transfusion with a hematocrit of 28.5, bun and creatinine continued to remain stable. potassium returned to baseline after supplementation. he continued to remain npo with nasogastric in place. postoperative day three he continued to remain in the sicu and continued on intravenous lopressor and nitroglycerin. he was placed on cpap with pressure support 7.5/12, fio2 was 0.5. blood gases were 7.35, 41, 125, 24-2. hematocrit remained stable at 28.5. bun and creatinine continued to show increase in the bun to 31 and creatinine to 1.3. his cks remained flat. his ckmbs remained flat. his troponin remained stable. abdominal examination was softly distended, bowel sounds were not present and there was no flatus. he continued npo with nasogastric suction. postoperative day three he was extubated, fluids were kept at kvo. he was diuresed with lasix times three doses. he received one unit of packed red blood cells for his hematocrit of 26.3 down from 28.5. bun and creatinine remained stable at 32 and 1.3, k was 3.8, which was supplemented. pt/inr were normal. glucose is fasting remained less then 125. his nasogastric was removed. he remained npo. he required increasing doses of lopressor for his hypertension and adjustment in his labetalol dosing. the swan-ganz was discontinued. he continued to remain stable. on postoperative day number four he required 2 units of packed red blood cells for his hematocrit of 28.3. her required lasix, dropped intravenous to begin, blood gases were 7.35, 46, 89, 28, +1. his bun remained at 31 with a creatinine that improved to 1.2. he did have bowel sounds present on examination. lopressor required increased dosing for systolic hypertension and he continued on his nitroglycerin drip. he remained npo except for medications and he remained in the sicu. his right cordis was changed on without complications to a triple lumen catheter. by postoperative day five his troponin level was 0.8, total ck was 136, mbs were negative. he continued to require o2 by nasal cannula and a shovel mask. blood gases were 7.5, 33, 69, 27, 2. his hematocrit remained stable at 29.3 post transfusion of 2 units of red blood cells. he continued to remain npo. he required some diamox times three doses for assistance in diuresis and fluid mobilization. her remained in the intensive care unit. on postoperative day six his gases improved at 7.45, 34, 84, 24, base excess is 0. his hematocrit was 32. white blood cell count had jumped to 14 from 11.7, bun was 37, creatinine 1.1, which was stable. diamox was discontinued and his diet was begun on clears and advanced as tolerated. nutritional support with total parenteral nutrition was begun. the patient required reintubation on . chest x-ray showed patchy atelectasis on the right side. there was a question of whether the patient had aspirated. his antibiotics were continued. his lasix intravenous was discontinued. he continued on a total parenteral nutrition and remained in the sicu for continued monitoring and care. the patient underwent a bronchoscopy on . there was noted increased secretions on the right middle lobe. cultures were sent. the left side was without pathology. he tolerated the bronchoscopy. during his sicu stay physical therapy did follow the patient and began range of motion exercises. postoperative day eight the patient continued to remain in metabolic acidosis. he was continued on levofloxacin and ceptaz for his right lung infiltrate. his white blood cell count remained stable at 15.5, hematocrit 30.7, bun 40 and creatinine 1.6. x-rays now showed bilateral pulmonary infiltrates. sputum cultures showed 1+ gram negative rods. adjustments were made in his total parenteral nutrition and the patient remained intubated and npo. his sputum culture grew pseudomonas and gram negative rods. on and sputum culture grew pseudomonas serratia. he was continued on ceptaz, levofloxacin, ceftriaxone was discontinued. blood, urine and cordis cultures were all negative. his white count was 14.0, polys 78, bands 2, lymphocytes 8, monocytes 2, eosinophils 8, basophils 0. his creatinine remained stable at 1.0. post pyloric tube was placed on . he was continued on his total parenteral nutrition and tube feeds were begun. the patient's tube feeds were not instituted secondary he was still intubated on . he did have episodes over the next several days of episodic hypotension requiring adjustment in his beta blockade. white blood cell count continued to rise to 16.7 on postoperative day 12. the patient's respiratory secretions improved. he continued to remain intubated on cpap and nutritional support by total parenteral nutrition. repeat sputum cultures on gram stains and gram positive coxae and vancomycin were instituted along with the levofloxacin and ceptaz. the patient was begun on transfers from bed to chair on . the patient was extubated on . his white blood cell count continued to rise at 17.1, hematocrit 29.1, bun 32, creatinine 1.0. the patient was extubated on . his white blood cell count remained at 17. the patient was to be seen by speech and swallow service for assessment for aspiration before beginning any po. by white blood cell count showed a downward trend. his sputum cultures remained gram positive coxae. he is continued on his vancomycin, ceptaz and levofloxacin. vancomycin levels were obtained with the third dose. peak was 34.0, trough was 24.3 on . sputum cultures of grew some gram negative rods and mixed oral flora. the patient's bedside swallow done on , impressions were that the patient would not participate in adequate po assessment to determine po readiness. not appropriate at this time to participate in video swallow. recommendations were continue the npo and nasogastric tube feedings. the patient would be reassessed. the patient was reassessed on . findings were that the patient was with moderate oral and severe profound laryngeal dysphagia characterized by a reduced ap tongue movement, severely impaired high low laryngeal excursion and poor aortic closure with severely weakened pharyngeal contraction and propulsion, which resulted in severe pharyngeal residue with all consistencies that could not be cleared and it was subsequently aspirated. recommendations were for her to continue the npo, consider peg placement for long term nutrition hydration, consider speech therapy or laryngeal strengthening exercises and the patient would require further video fluoroscopic study at a later date. the patient underwent on an upper endoscopy with a percutaneous gastrostomy tube placement 20 french catheter without difficulties. his esophagogastroduodenoscopy was normal to the second part of the duodenum. tube feeds through the peg were begun 24 hours after placement. the patient was then after transferred to the vicu for 24 hours and then transferred to the regular nursing floor for continued care. the patient's levofloxacin and ceptaz were discontinued on . vancomycin will be continued for a total of fourteen days. his tube feeds were begun with respalor at 10 cc per hour and to be increased as tolerated q 6 hours for a goal of 60 cc per hour. the head of the bed should be elevated at all times and the peg tube feeds should be checked q 4 hours for residuals and held if residual greater then 100 cc. the remaining hospital course was unremarkable. the patient was discharged to rehab in stable condition. he will require evaluation of his swallowing mechanism at a later date at rehab. he should follow up with dr. in two to three weeks time. wounds were clean, dry and intact. discharge medications: sodium chloride 1 gram b.i.d. times 48 hours, this was started on . sodium chloride nasal spray one to two q.i.d. prn, metoprolol 25 mg po b.i.d., vancomycin 1 gram q 24 hours, this was a dose change which was instituted on . peak and trough levels were pending at the time of dictation. labetalol, hydrochloride 100 mg t.i.d. hold for systolic blood pressure of less then 110, heart rate less then 60. insulin sliding scale please see flow sheet, this is to cover his tube feeds. albuterol nebulizers one to two nebulizers q 4 hours, acetaminophen 325 mg to 650 mg q 6 hours prn, artificial tears one to two drops ou prn, lacrilube ointment application one ou prn, albuterol inhaler one to two puffs q 4 hours prn. tube feeds are impact with fiber full strength at 60 cc per hour. this should be advanced q 6 hours until goal rate is obtained at 80 cc per hour, residuals should be checked q 4 hours and hold for residuals greater then 100. the patient is to remain npo. medications should be given through his peg tube. discharge diagnoses: 1. status post aortobifemoral for abdominal aortic aneurysm, status post right iliac aneurysm repair. 2. oliguria secondary to volume overload corrected. 3. pseudomonas pneumonia treated. 4. prolonged intubation secondary to respiratory failure. 5. blood loss anemia corrected. 6. pulmonary infiltrates with sputum cultures gram positive coxae on vancomycin, total course should be fourteen days. 7. hypertension requiring medication adjustment treated. 8. aspiration requiring total parenteral nutrition/percutaneous gastrostomy placement. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances aorta-iliac-femoral bypass percutaneous [endoscopic] gastrostomy [peg] diagnoses: acidosis unspecified essential hypertension acute posthemorrhagic anemia pulmonary collapse acute respiratory failure pneumonia due to pseudomonas pneumonitis due to inhalation of food or vomitus abdominal aneurysm without mention of rupture aneurysm of iliac artery 

Answer: The patient is high likely exposed to