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: the patient is an 86 year old man with a history of laryngeal cancer status post radiation, who initially was admitted to the plastics service on , after increased secretions from an oral cutaneous fistula as 20 and with a history of bleeding from an oral cutaneous fistula on his left neck which was approximately 7 by 8 centimeters in size, and at that time, a skin flap was placed. past medical history: 1. laryngeal cancer status post laryngectomy in . therapy. the patient also had radiation therapy on , as well. 3. coronary artery disease. 4. aortic valve replacement with st. jude's valve. 5. subdural hemorrhage noted incidentally on ct scan of the head in . allergies: the patient has no known history of any allergies. hospital course: as noted, the patient was admitted on for increased secretions from the oral cutaneous fistula. pulmonary was consulted at that time and they felt that he likely had an aspiration pneumonitis and hypoxia with chronic obstructive pulmonary disease. he was treated with ceftazidime as well as clindamycin. also, it was felt at that time that he might have some possible congestive heart failure and he was diuresed as well. on , the patient was seen by surgery for severe acute bleeding from his tracheostomy site. he required eight units of packed red blood cells as well as seven units of fresh frozen plasma. his throat was packed and there was a suspicion for fistula close to his right carotid. of note, at that time the patient had been anti-coagulation and on coumadin for his avr. on , there were no signs of acute bleeding from his fistula sites and plastics as well as surgery were following him. the plan was to discuss with interventional radiology the possible angiography with wound blockage of the carotid with or without embolization. plans from plastic therapy was for possible hyperbaric oxygen therapy as well as closure of the oral cutaneous fistula. a family meeting with the intensive care unit team occurred and the family elected for a conservative approach which included no angiography or no surgical repair at the time. in addition, there was the decision not to continue anti-coagulation with coumadin on this patient. the family is aware of the risks of not anti-coagulating including the risk of stroke, given that the patient has an aortic valve replacement. in addition, for the patient's bleeding at that time, it was a self-limited bleed requiring multiple units, however, there was still felt to be a high risk of the patient to rebleed. as stated, the family elected for conservative therapy at this time. also of note, the patient has been noted to be in atrial fibrillation. he became bradycardic when treated with a beta blocker per report. the patient also had a ct scan of the chest which showed moderate pleural effusions as well as interstitial lung disease. during the patient's course in the medical intensive care unit, the patient was diuresed for mild congestive heart failure. in addition, the patient was attempting to wean on trache collar. the patient was placed on pressure support of 5 and 5 and as possible was weaning on trache collar. the patient had hypertension treated with captopril as well. there was a concern for a possible recurrence of the patient's pseudomonas tracheobronchitis. sputum was sent which had four plus gram negative rods and was treated with a ten day course of ceftazidime for the pseudomonas tracheobronchitis. in addition, the patient had a thoracentesis for the pleural effusion on his left side; 1.8 liters were removed and the pleural fluid was consistent with a transudative fluid. the pleural total protein to serum protein was less than 0.5. the pleural ldh to serum ldh was less than 0.6. there were 111 white cells, 2500 red cells and less than 6 protein. the patient also had been on captopril for hypertension and the captopril was held for systolic blood pressures in the 90s. during the hospital course, the patient was noted to have had a decrease in his hematocrit which required approximately four units of blood over a period of about four days. the patient was noted to have had clots removed during suctioning from his trachea. the patient also had guaiac positive stools. it was felt at that time that the bleeding was occurring from the fistulas which previously had been bleeding. the patient also had an episode of acute renal failure with creatinine rising from his baseline of approximately 0.7 to 3.2. it was felt that the renal failure that he was experiencing was acute renal failure secondary to hypoperfusion causing acute tubular necrosis. the renal failure is resolving. in addition, we are continuing to follow the hematocrit which has been stable. the patient also was seen by psychiatry for agitation and depression. psychiatry felt that the agitation may be secondary to delirium and the decision was made at that time to decrease the patient's paxil dose. in addition, standing doses of haldol were added to the patient's regimen for agitation. the patient, in addition, had a bronchoscopy on , for an episode of bleeding mentioned earlier at that time. normal mucosa was noted with clots in the left base and a left lower lung basilar segment. an adherent clot was noted in basilar segment. attempts to clear it were unsuccessful so could not exclude endobronchial lesion distal to the clot. throughout the admission, we continued to wean the patient from his ventilator with trache mask trials. also of note, please note that the patient's captopril doses had been held while the patient had been in acute renal failure. in summary, this is an 85 year old male with a history of laryngeal cancer with a oral cutaneous fistula with bleeding from the fistula. the patient also has a history of aortic valve replacement which, per family discussion, is not being anti-coagulated with coumadin, given the high risks of possible re-bleeding. condition on discharge: fair. discharge status: the patient to be discharged to rehabilitation services. discharge medications: 1. albuterol two to four puffs q. six hours. 2. ipratropium two puffs q. six hours. 3. vitamin e, 400 units p.o. q. day. 4. colace 100 mg p.o. twice a day. 5. nystatin 5 ml p.o. three times a day. 6. aspirin 81 mg p.o. q. day. 7. insulin sliding scale. 8. flovent 4 puffs twice a day. 9. lansoprazole 30 mg p.o. q. day. 10. haldol 0.5 mg p.o. q. day. 11. haldol 1 mg p.o. q. h.s. 12. lasix 40 mg q. day p.r.n. diuresis. 13. captopril titrating per blood pressure. 14. bisacodyl 10 mg p.o. or p.r. q. day p.r.n. 15. senna one tablet p.o. twice a day p.r.n. 16. lactulose 30 ml p.o. q. eight hours p.r.n. 17. acetaminophen 325 to 650 mg p.o. q. four to six hours p.r.n. , m.d. dictated by: medquist36 d: 16:28 t: 16:39 job#: procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances thoracentesis diagnoses: congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation acute respiratory failure pneumonitis due to inhalation of food or vomitus persistent postoperative fistula 

Answer: The patient is high likely exposed to