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: lasix / betalactams / haldol attending: chief complaint: respiratory failure major surgical or invasive procedure: rigid bronchoscopy with stent removal intubation tracheostomy picc line placement history of present illness: 61 yo russian-speaking man w/anoxic brain injury and with hx of dmi, s/p cadaveric kidney transplant(), h/o cva and chronic aspiration (multiple admissions for aspiration pna - last ), cabg in , widespread tracheomalacia with trach stent, who presented to an osh with respiratory distress. at the osh, he was intubated for tachypnea and relative hypoxia to 93% on a nrb. thought to possibly have an aspiration vs. cap pneumonia. in the ed, initial vs were t 97.3, p 79, bp 114/61, r 20, 100%. patient was given broad spectrum abx. received moxifloxacin at the osh. received vanco and clindamycin in ed. on the floor, he was intubated and sedated and comfortable. ip saw the patient and reviewed his ct scan. he was taken immedicately to a rigid bronchoscopy where he stent was removed successfully. they saw diffuse airway inflammation and granulation tissue in the airway. he was given a dose of decadron in the or. he was brought back to the floor intubated and sedated. tacro level ordered for am with goal , per renal. review of systems: (+) per hpi (-) otherwise unable to obtain past medical history: - cadaveric renal transplant in - cva-residual right hemiparesis - dm type i - htn - hx non-qmi and vfib arrest with anoxic brain injury - cad/cabg - swallow study-showed silent aspiration - hx of aspiration pneumonia - tracheomalacia after long intubation requiring trach stent and button complicated by site cellulitis and granulation tissue requiring cryoptherapy. social history: lives with wife. former endocrinologist in . has homemaker who comes in 5 times a week. has 3 daughters who visit him. family history: no h/o lung disease physical exam: vitals: t: afebrile, bp 92/27, p 71, r 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: labs on admission: 07:30pm pt-12.0 ptt-24.1 inr(pt)-1.0 07:30pm plt count-251 07:30pm neuts-97.0* lymphs-2.0* monos-0.9* eos-0.1 basos-0.1 07:30pm wbc-15.5* rbc-3.98* hgb-9.1* hct-31.1* mcv-78* mch-22.9* mchc-29.3* rdw-16.1* 07:30pm calcium-9.0 phosphate-5.1*# magnesium-1.7 07:30pm ck-mb-notdone 07:30pm ctropnt-<0.01 07:30pm lipase-19 07:30pm alt(sgpt)-14 ast(sgot)-15 ck(cpk)-44* alk phos-83 tot bili-0.3 07:30pm glucose-255* urea n-35* creat-1.6* sodium-140 potassium-4.3 chloride-102 total co2-23 anion gap-19 07:42pm lactate-3.7* 07:51pm type-art rates-/18 tidal vol-430 o2-100 po2-180* pco2-46* ph-7.31* total co2-24 base xs--3 aado2-499 req o2-83 intubated-intubated ecg : sinus rhythm. baseline artifact. left axis deviation likely due to left anterior fascicular block. poor r wave progression. consider prior anteroseptal myocardial infarction. compared to the previous tracing of the findings are similar. cxr : findings: consistent with the given history, an endotracheal tube is present with the distal tip approximately 3.3 cm from the carina. the previously noted tracheal stent which had been at the thoracic inlet is now situated in the distal trachea with the distal tip at the ostium of the right mainstem bronchus. there is extensive lucency over the left superior and mid mediastinum paralleling the course of the distal trachea. in addition, there is a relatively sharp definition of the medial left hemidiaphragm and the descending thoracic aorta, resulting in a v-shape of air. there are streaky opacities in both depended lungs medially with air bronchograms. post-surgical changes consistent with prior cabg and median sternotomy are noted. the cardiac silhouette is within normal limits for size. there is no effusion or pneumothorax. the visualized osseous structures are grossly unremarkable. impression: there has been apparent migration of the previously noted tracheal stent now in the distal trachea, leading to the right mainstem bronchus ostium. this is in the presence of an apparently newly introduced endotracheal tube. there is also increased lucency over the mediastinum and a sharp v-sign of , which is a radiographic finding suggestive of pneumomediastinum. the streaky opacities in the lower lobe are highly suggestive of airspace disease likely aspiration. chest ct without contrast : comparison: chest ct, , and multiple prior radiographs, most recently earlier today. technique: mdct helical acquisition was performed from the thoracic inlet through the diaphragm without iv contrast. multiplanar reformations were provided. ct chest without iv contrast: the patient has been intubated, with an endotracheal tube terminating approximately 2 cm above the carina, which is somewhat low in position. additionally, a tracheal stent previously just below the thoracic inlet is now seen in the lower aspect of the trachea, with the distal tip at the ostium of the right main stem bronchus (2:20), raising the possibility of migration possibly related to intubation. as seen on chest radiograph, there is bilateral lower lobe atelectasis without total lower lobe collapse on either side. in addition, a few more nodular appearing airspace opacifications are seen in the left lower lobe as well as lingula, and both lung bases demonstrate apparent air-bronchograms, thus a combination of atelectasis and airspace consolidation/asipration are suspected. aortic arch calcifications are seen, as is ascending aortic thin rim of hyperdensity that may represent a stent-graft, though no history of such could be elicited from online medical record. although not tailored for subdiaphragmatic evaluation, there are again seen gallstones (2:51). there is severe vascular calcification of the abdominal aorta and mesenteric branches. the right kidney is atrophic, and the left is not visualized. the visualized spleen is unremarkable. a large cystic structure at the level of the pancreatic head/body junction is seen measuring 5 cm and is simple fluid density but better evaluated on prior ct abdomen/pelvis and mrcp. coronary calcifications are severe; but, unchanged since the prior study. the projecting over the sternum on the chest radiograph is seen due to patulous esophagus, with no evidence of pneumomediastinum. osseous structures are unremarkable, except for intact midline sternal wires related to prior cabg. note that previously described foci of narrowing in the central airways are not well assessed on this study due to lack of dedicated technique, presence of an endotracheal intubation, and significant atelectasis. impression: 1. post-intubation, tracheal stent has been advanced into the distal trachea, with tip at the origin of the right main stem bronchus. 2. endotracheal tube 2 cm above carina, slightly low in position. 3. bilateral lung consolidations seen on previous radiograph are likely combination of atelectasis and aspiration/airspace consolidation. 4. multiple additional incidental findings as described, essentially unchanged since prior. cxr : one view. comparison with . an orogastric tube has been inserted and terminates below the diaphragm, its side hole and tip projected in the region of the gastric antrum. there are bilateral streaky densities at the lung bases consistent with atelectasis and consolidation as before. mediastinal structures appear unchanged although a tracheal stent is no longer identified. an endotracheal tube remains in place. impression: orogastric tube placement as described. a tracheal stent is no longer identified. cxr : findings: endotracheal tube tip terminates 3 cm above carina. cardiomediastinal contours are unchanged. worsening retrocardiac atelectasis and questionable small left pleural effusion. cxr : the et tube tip is 3.3 cm above the carina. the ng tube tip is in the stomach. cardiomediastinal silhouette is stable. bibasilar opacities are consistent with areas of atelectasis and are unchanged. small amount of pleural effusion, left more than right, is unchanged as well. there is no apparent pneumothorax. cxr : chest, ap: the og tube has been retracted, with tip in the distal stomach. other monitoring and support devices are unchanged in course and position. there is no pneumothorax. bibasilar atelectasis and small pleural effusions, left greater than right, are unchanged. the cardiomediastinal silhouette is slightly enlarged. impression: devices in standard position. small effusions and bibasilar atelectasis. cxr : impression: devices in standard position. small effusions and bibasilar atelectasis. eeg : findings: abnormality #1: throughout the recording, the background remained of low voltage, slow and disorganized typically reaching a 7 hz maximum. abnormality #2: there were intermittent bursts of low voltage generalized 1 hz delta slowing with fronto-temporal predominance lasting three to four seconds in duration. hyperventilation: could not be performed due to patient's altered mental status. intermittent photic stimulation: could not be performed due to the patient's altered mental status. sleep: the patient progressed from wakefulness to drowsiness and attained stage ii sleep. cardiac monitor: showed a generally regular rhythm with an average rate of 60 bpm. impression: this is an abnormal portable eeg due to slowing, disorganization, and attenuation of the background suggestive of a mild to moderate encephalopathy. medications, toxic/metabolic disturbances, and infections are common causes. note is also made of intermittent bursts of low voltage generalized 1 hz delta activity lasting three to four seconds' duration suggestive of defective sleep transition or subcortical deep or midline dysfunction. no epileptiform discharges or electrographic seizures were seen during this recording. brief hospital course: # hypoxic respiratory failure: the patient's respiratory failure was likely secondary to an aspiration event with an aspiration pneumonia. he required intubation and had complication with stent displacement at osh. in ed at concern for stent migration distally (presumably related to ett placement) and possibility of pneumomediastinum. stat ct chest confirmed stent displacement but no pneumomediastinum. ip performed rigid bronch, pulled stent and reintubated successfully. transferred to micu from or post procedure for further management of airway and respiratory failure. he initially did well on ac and was transitioned to psv. he briefly received steroids (decadrom 10mg x 3 days) in an attempt to minimize airway inflammation. he was initially treated with with flagyl, levofloxacin, and vancomycin for presumed pneumonia. these antiobiotics were later changed to azithromycin and cefepime (course outlined below). on , the patient was taken back to the or and had a tracheostomy placed. he was initially maintained on ac and then psv. he easily transitioned to trach mask and has been maintained on trach mask for the past 4 days without the need for additional ventilation. . # pneumonia: likely had aspiration event, with question of pneumonia/ventilator associated pneumonia as a result. distress was so acute that he likely just has pneumonitis but should he was covered for hospital-aquired pathogens in the setting of respiratory failure. of note, the patient has a beta-lactam allergy. patient received a total 10 day course of antibiotics. . #tremulousness: during this admission, the patient was noted to have several episodes daily of upper extremity shaking accompained by large volumes of diaphoresis. according to his family, this is consistent with the patient's anxiety and agitation. the patient was treated with ativan iv with resolution of each episode. he was then placed on clonazepam 0.5mg tid, though over the next several days he appeared to be more sedated. the clonazepam was discontinued, and he remained on ativan 0.5-2mg iv prn anxiety/agitation. the shaking episodes became less frequent and were occurring approximately once daily. . # arf: creatinine rose to 1.6 from a baseline of about 1.1-1.3. the renal transplant service was aware of patient and followed throughout the admission. it was postulated that the patient was likely fluid down in the setting of npo and insensible losses on the day of admission. his home enalapril was held pending resolution of his renal failure. he intermittently received ivf boluses for low fluid output. at one point, he appeared slightly volume overloaded clinically and on chest film so he was given bumex 1mg with good effect (allergy to lasix). his renal function improved to 1.0-1.4 throughout the remainder of his admission. . # immunosuppression (s/p renal transplant): patient is s/p a cadaveric renal transplantand was on chronic immunosuppression which put him at risk of uncommon infections, however, he had no signs of fever or sepsis at time of admission. the patient was continued on his home cellcept and prograf. his prograf levels were followed, and his dosage was changed to q 3mg each evening and q 4mg each morning with a goal tacrol level of . the patient was also continued on his home dose of prednisone at 4mg daily. he was also maintained on his home prophylactic dose of bactrim ds, one tab on m/w/f. . # diabetes mellitus: the patient had labile blood sugars throughout his admission requiring titration of his lantus and iss. the patient's lantus was increased to 27 units daily and his insulin sliding scale was tightened. he subsequently had an episode of hypoglycemia (40) and his lantus was changed to 20 daily with the same sliding scale. . # urinary tract infection on routine laboratory testing, the patient was noted to have a urinary tract infection on with 21-50 wbcs, moderate leukocyte esterase, and moderate bacteria. he was started on ciprofloxacin 500mg ng x 7 days (complicated uti with foley catheter in place). urine culture pending at time of discharge. a urinalysis should be completed after completion of antibiotics. his foley catheter was removed and a condom catheter was placed. on hospital day 13, patient had urinary retention and had a foley catheter placed with 400cc of uop. . # htn: the patient remained normotensive throughout most of the admission. as his hospitalization progressed, he was restarted on his home medications including metoprolol and enalapril. . # hypernatremia the patient's sodium level rose to a high of 147. at that time, he began to receive free water boluses (200-250ml) through his ngt every six hours. his sodium corrected and was 139 at the time of discharge. . # cad: serial ekgs were checked without changes and his cardiac enzymes were flat on initial check, no signs of cardiogenic shock, no hx of chest pain. the patient was continued on his home dose aspirin and statin. . # dementia and s/p anoxic brain injury: initially, the patient's sedating psychiatric medications were held while he was intubated, and they were added when he was no longer intubated. the patient was maintained on his home ssri throughout the admission. . # access the patient had a picc placed in interventional radiology. . # nutrition the patient had a dobhoff feeding tube placed and was started on tube feeds for nutrition. medications on admission: # enalapril 20 mg daily # fluvoxamine 100 mg # metoprolol tartrate 25 mg # mupirocin calcium 2 % cream # mycophenolate mofetil 500 mg # pravastatin 20 mg daily # prednisone 4 mg daily # quetiapine 50 mg # trimethoprim-sulfamethoxazole 80-400 mg qmwf # aspirin 81 mg daily # guaifenesin 1200 mg # insulin regular human sliding scale # insulin glargine 17 u qhs # simethicone 80 mg qid prn # clotrimazole 10 mg troche daily # hydrochlorothiazide 12.5 mg daily # tacrolimus 2 mg qam, 2 mg qpm # omeprazole 40 mg # acetylcysteine 20 % (200 mg/ml) ih discharge medications: 1. mycophenolate mofetil 200 mg/ml suspension for reconstitution : 2.5 ml po bid (2 times a day). 2. pravastatin 20 mg tablet : one (1) tablet po daily (daily). 3. fluvoxamine 50 mg tablet : two (2) tablet po bid (2 times a day). 4. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 5. docusate sodium 50 mg/5 ml liquid : ten (10) ml po bid (2 times a day). 6. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 7. prednisone 1 mg tablet : four (4) tablet po daily (daily). 8. sulfamethoxazole-trimethoprim 800-160 mg tablet : one (1) tablet po qmowefr (monday -wednesday-friday). 9. metoprolol tartrate 25 mg tablet : one (1) tablet po tid (3 times a day). 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q2h (every 2 hours) as needed for wheezing/sob. 11. insulin glargine 100 unit/ml solution : twenty five (25) units subcutaneous at bedtime. 12. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 13. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 14. enalapril maleate 10 mg tablet : two (2) tablet po daily (daily). 15. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 16. ipratropium bromide 0.02 % solution : one (1) neb inhalation q6h (every 6 hours). 17. tacrolimus 1 mg capsule : three (3) capsule po qpm (once a day (in the evening)). 18. tacrolimus 1 mg capsule : four (4) capsule po qam (once a day (in the morning)). 19. polyethylene glycol 3350 17 gram/dose powder : one (1) dose/capful po daily (daily) as needed for constipation. 20. quetiapine 25 mg tablet : one (1) tablet po qhs (once a day (at bedtime)). 21. sodium chloride 0.9 % 0.9 % solution : three (3) ml injection q8h (every 8 hours) as needed for line flush. 22. morphine 100 mg/4 ml solution : 2-4 mg intravenous q6h (every 6 hours) as needed for pain. 23. lorazepam 2 mg/ml syringe : 0.5-2 mg injection q4h (every 4 hours) as needed for agitation. 24. ciprofloxacin 500 mg tablet : one (1) tablet po q12h (every 12 hours) for 7 days: last dose . discharge disposition: extended care facility: hospital - discharge diagnosis: primary: (1) respiratory failure (2) pneumonia (3) pulmonary stent migration (4) acute renal failure (5) diabetes mellitus (6) htn (7) urinary tract infection secondary (1) cadaveric renal transplant (2) coronary artery disease (3) hypercholesterolemia (4) cva discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: dr. , it was a pleasure caring for you in the intensive care unit at the . you were evaluated in the hospital for respiratory distress that required intubation. a pulmonary stent needed to be removed. while you were in the hospital, a tracheostomy was performed. you were treated for acute renal failure, a pneumonia, and a urinary tract infection. you are being discharged to a rehabilitation center that can better care for your long term needs. please feel free to contact us with any additional questions or concerns. followup instructions: provider: , md phone: date/time: 10:50 provider: clinic interventional pulmonary (sb) phone: date/time: 12:00 provider: - please schedule an appointment with dr. in the next 2-3 weeks. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances other bronchoscopy other intubation of respiratory tract temporary tracheostomy other operations on trachea bronchoscopy through artificial stoma diagnoses: acute kidney failure, unspecified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status other persistent mental disorders due to conditions classified elsewhere other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure pneumonitis due to inhalation of food or vomitus mechanical complication due to other implant and internal device, not elsewhere classified accidents occurring in other specified places hyperosmolality and/or hypernatremia surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled complications of transplanted kidney legal blindness, as defined in u.s.a. other diseases of trachea and bronchus 

Answer: The patient is high likely exposed to