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: phenobarbital attending: chief complaint: respiratory distress major surgical or invasive procedure: tracheostomy changed to a #6 adjustable phalange tracheostomy. note: this patient cannot be intubated from above due to heavy tumor burden. history of present illness: this is a 51-year-old gentleman with a past medical history significant for laryngeal cancer s/p radiation and chemotherapy, copd, hypertension, narcotic dependence, now ventilator dependent with a tracheostomy tube, transferred from rehab for difficult suctioning and worsening respiratory distress. mr. was first diagnosed with laryngeal cancer about 2.5 months ago, and has had a complicated medical course since that time; he was initially treated with taxotere, cisplatin, and infusional 5-fu but missed multiple treatments due to hospitalizations and infections. most recently he has had c.diff and is currently on vancomycin through his g-tube. during the afternoon on day of admission, patient was having increasing respiratory distress at rehab. he was apparently bronched at that facility with report of tumor invading the trach. he was transported to for further work-up by ip. upon arrival to the micu, patient was anxious with increased work-of-breathing. vitals were:97.6, 127/94, 127, and 100% tached on 100%fi02. upon transfer of patient from ems stretcher to micu bed, patient desatted precipitously. respiratory therapy attempted to suction and "bag him," but initially met a lot of resistance. patient was repositioned and sats climbed up from 80s to 100%. ip was called urgently and took patient to or for trach revision. t-tube was found to be flush against the trachea, preventing adequate aeration. trach was changed to #6 adjustable and sutured in. looking from above, tumor was found to be occluding entire posterior pharynx down to vocal cords. patient had immediate improvement in symptoms and was transferred back to micu without incident. patient is unable to provide detailed history due anxiety and subsequent sedation after procedure. according to his sister , he has had a very rough couple of months, in-and-out of the hospital with multiple infections and complications. past medical history: --sqaumous cell carcinoma of the supraglottic larynx well-moderately differentiated, s/p chemo and radiation --copd --hypertension --chronic low back pain --enterobacter + sputum cultures from hospital in --pseudomonal growth in tracheal aspirate (sensitive to impipenem by report) social history: long history of smoking. now coming from rehab. other details unable to obtain. family history: non-contributory physical exam: vs: temp: 97.6 bp: 127/94 hr: 127 rr: 40 o2sat 100% fi02 gen: acute distress, tripoding heent: eomi, nc/at, temporal wasting, trach in place resp: dimished breath sounds with poor air movement bilaterally cv: rr, s1 and s2 wnl, no m/r/g abd: +bs, soft, g-tube in place ext: no c/c/e skin: pale, no rashes neuro: patient in extremis, unable to fully assess rectal: deferred pertinent results: admission labs: 08:04pm type-art temp-36.1 po2-123* pco2-69* ph-7.35 total co2-40* base xs-9 08:04pm lactate-0.6 07:07pm glucose-122* urea n-11 creat-0.4* sodium-136 potassium-4.4 chloride-96 total co2-36* anion gap-8 07:07pm alt(sgpt)-23 ast(sgot)-19 ld(ldh)-125 alk phos-128 tot bili-0.5 07:07pm albumin-3.8 calcium-12.5* phosphate-3.5 magnesium-1.5* 07:07pm wbc-17.6* rbc-3.55* hgb-10.6* hct-33.4* mcv-94 mch-29.9 mchc-31.7 rdw-18.0* 07:07pm neuts-89.8* lymphs-6.8* monos-2.0 eos-0.9 basos-0.5 07:07pm plt count-436 07:07pm pt-13.2 ptt-26.1 inr(pt)-1.1 discharge labs: 04:19am blood wbc-12.7* rbc-3.15* hgb-9.6* hct-29.2* mcv-93 mch-30.6 mchc-32.9 rdw-18.1* plt ct-403 12:03pm blood hct-28.7* 04:19am blood neuts-83.2* lymphs-11.2* monos-3.5 eos-1.1 baso-1.0 04:19am blood pt-12.9 ptt-27.0 inr(pt)-1.1 04:19am blood glucose-88 urean-9 creat-0.5 na-134 k-4.0 cl-96 hco3-35* angap-7* 12:03pm blood na-134 k-3.9 cl-95* 04:19am blood calcium-11.9* phos-1.2*# mg-2.7* 12:03pm blood calcium-11.6* phos-3.1# mg-2.0 radiology chest (portable ap) , m. findings: as compared to the previous radiograph, the tracheostomy tube has been changed. the tip of the current tube projects 4.5 cm above the carina. unchanged overinflation with scarring at the right lung. normal size of the cardiac silhouette. no pleural effusions. radiology chest (portable ap) , m. marked overinflation. scarring at the right lung apex. no safe evidence of pneumonia, no pleural effusions, no pulmonary edema. borderline size of the cardiac silhouette. tracheostomy tube in situ. left pectoral port-a-cath. brief hospital course: this is a 51-year-old gentleman with a pmhx. of laryngeal cancer s/p chemo and radiation, now vent dependent, presents from for respiratory distress and difficulty suctioning trach. # respiratory distress: most immediate etiology of respiratory distress is mal-placement of trach tube. upon investigation of trach placement by ip, it was determined that trach tube was completely flush with anterior trachea, with end occluded. there was also extensive tumor invasion of the upper airway, superior to the trach tube. original trach tube was exchanged for one with a better fit. tube was also sutured in place to prevent further migration. after procedure, patient was breathing comfortably with normal sats, normal respiratory rate. patient was transitioned to psv the following morning without complication. ip mentioned that close follow up was not necessary, however, patient could follow with ip as needed. ****key is that he cannot have this trach changed because his airway is so tenuous that any trach change would cause imminent airway collapse. any trach change would lead to imminent airway collapse**** # elevated wbc: patient presented with leukocytosis and left shift. although there has been concern for pseudomonas and enterobacter pneumonia in the past, it appears (from previous notes) that these organisms were thought to be contaminants. patient was treated briefly with imipenem, but was not transferred here on any antibiotics for these organisms. patient's leukocytosis may just be in the setting of multiple tracheal manipulations as well as high tumor burden. he is afebrile currently and has no other labs to suggest sepsis (lactate is 0.6). patient was given one dose of zosyn on arrival to the micu, but we did not give him any further antibiotics. he remained stable, afebrile and without any # c diff: continued po vancomycin. no clear course was documented. patient to continue his extended course per his regimen continued at rehab. # anxiety/depression: according to notes and patient's sister, mr. has been anxious as of late. he seems to respond well to seroquel. continued duloxetin, continued seroquel standing and prn, and continued clonazepam prn. patient remained relatively free of acute attacks of anxiety. # pain: continued home regimen of fentanyl patch, morphine prn, oxycodone prn, plus-lidocaine patch. patient's chronic pain remained at baseline and was well controlled. # hypercalcemia: likely in setting of malignancy. gave gentle fluids and his calcium somewhat improved from 12.6 to 11.5. he was net positive 1l for his length of stay in the icu. # laryngeal cancer: patient is s/p chemo and radiation. patient is apparently scheduled for laryngectomy according to sister. we will defer treatment to primary oncologist and pcp. medications on admission: medications on transfer: jevity 1.5 cal rate 60ml/hour lactobacillus acidophilus 2 tab q8h quetiapine fumarate 25 mg po/ng q6h:prn anxiety clonazepam 0.5 mg po/ng tid:prn agitation pyridoxine 100 mg po/ng daily oxycodone (immediate release) 10 mg po/ng q4h:prn pain lidocaine 5% patch 1 ptch td daily (unclear location) lansoprazole oral disintegrating tab 30 mg po/ng daily fentanyl patch 100 mcg/hr tp q72h duloxetine 30 mg po daily 650 mg po/ng q4h:prn pain or fever albuterol-ipratropium puff ih q2h:prn shortness of breath albuterol-ipratropium puff ih q6h vancomycin oral liquid 250 mg po/ng q6h quetiapine fumarate 50 mg po/ng morphine sulfate 2 mg iv q2h:prn respiratory distress/agitation discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 3. vancomycin 250 mg capsule : one (1) capsule po q6h (every 6 hours). 4. quetiapine 25 mg tablet : two (2) tablet po bid (2 times a day). 5. ipratropium-albuterol 18-103 mcg/actuation aerosol : puffs inhalation q6h (every 6 hours). 6. ipratropium-albuterol 18-103 mcg/actuation aerosol : puffs inhalation q2h (every 2 hours) as needed for shortness of breath. 7. acetaminophen 650 mg tablet : one (1) tablet po q4h (every 4 hours) as needed for pain or fever. 8. duloxetine 30 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po daily (daily). 9. fentanyl 100 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 10. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 11. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily). 12. oxycodone 5 mg tablet : two (2) tablet po q4h (every 4 hours) as needed for pain. 13. pyridoxine 50 mg tablet : two (2) tablet po daily (daily). 14. clonazepam 0.5 mg tablet : one (1) tablet po tid (3 times a day) as needed for agitation. 15. quetiapine 25 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for anxiety. 16. nicotine 21 mg/24 hr patch 24 hr : one (1) patch 24 hr transdermal daily (daily). 17. chlorhexidine gluconate 0.12 % mouthwash : one (1) ml mucous membrane (2 times a day). 18. heparin flush (10 units/ml) 5 ml iv prn line flush indwelling port (e.g. portacath), heparin dependent: flush with 10 ml normal saline followed by heparin as above daily and prn per lumen. 19. heparin flush (100 units/ml) 5 ml iv prn de-accessing port indwelling port (e.g. portacath), heparin dependent: when de-accessing port, instill heparin as above per lumen. 20. morphine 5 mg/ml solution : two (2) mg injection q2h (every 2 hours) as needed for respiratory distress/agitation. discharge disposition: extended care facility: northeast - discharge diagnosis: 1) central airway obstruction 2) tachypnea 3) hypercarbia 4) malpositioned trachea tube 5) laryngeal cancer discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you mr. . you were admitted to the hospital after you developed difficulty breathing. your breathing tube was noted to be compressed against your trachea (wind pipe), and this was the reason you had difficulty breathing. you were brought to the or, where the tube was re-positioned and sutured in place and is now functioning properly. it is very important that any future movements or changes in your trach tube should be done in the operating room. followup instructions: please follow up with your primary care doctor rehab. please follow up with your primary oncologist regarding your throat cancer. please follow with interventional pulmonology as needed. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours replacement of tracheostomy tube diagnoses: unspecified essential hypertension chronic airway obstruction, not elsewhere classified dysthymic disorder intestinal infection due to clostridium difficile hypercalcemia gastrostomy status mechanical complication of tracheostomy malignant neoplasm of supraglottis 

Answer: The patient is high likely exposed to