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: hypoxic respiratory distress major surgical or invasive procedure: bronchoscopy history of present illness: 67yom w/ h/o squamous cell esophageal cancer s/p xrt with a gastric pull-up in w/ subsequent tracheo-esophageal fistula and eventual tracheostomy/ peg tube placement who presents from rehab with respiratory distress. apparently pt vomiting earlier in the day, then noted to desaturate down to 70s off vent and became apneic (up until this point pt had been doing well off the vent per report). he has been placed back on the vent since the desaturations and is noted to be tachypnic. . initially presented on with complaints of difficulty swallowing and productive cough and who was found to have a right base pneumonia. a failed swallow evaluation prompted a ct neck that revealed a tracheoesophageal fistula just below the level of the thoracic inlet, confirmed via barium swallow, then at bronchoscopy. te fistula determined to be benign by pathological exam of biopsies. after j-tube placement for nutrition support, the te fistula was repaired and esophageal stricture resected on . this was c/b left vocal cord paralysis after the operation (had to remove left recurrent laryngeal nerve), and required tracheostomy from respiratory failure after anastomotic incompetence on . since discharge after an admission - for large bowel obstruction, he has been weaned from the ventilator to trach collar with humidified air. she continued to have a tef and underwent a rigid bronchoscopy with fibrin injection into the fistula on . apparently the fibrin clotted the fistula and he was admitted overnight for monitoring, though no other complications per omr. . in the ed, initial vs were: t98.6 hr88 bp106/76 po288% (though noted to be difficult to get an accurate sat). cxr showed right upper lobe opacity concerning for pna, pulmonary vascular congestion and small b/l pleural effusions. ekg was reportedly unremarkable. abg was 7.41/38/184/25 on pressure support ventilation. remarkable labs include lactate 2.7, wbc 13.7 with 94% pmn no bands, na 147. patient was given levaquin in the ed (ordered also for ctx and levaquin, but not yet received). patient was noted to gradually drop systolic pressure to 70's. felt to be mentating well in the ed, though orientation was not assessed. no uop as per ed resident. received 2l ivf. on the way to the icu, levophed gtt was started for hypotension. . on arrival to icu, patient noted to have low tidal volumes, elevated airway pressures, bp's in 70's systolic, and saturations in 70's to 80's. with anesthesia and rt at bedside, trach was repositioned (likely had been auto-peeping). bronch performed which showed trach well-seated in trachea. currently pt states breathing more comfortable, c/o pain at site of abdominal wound. denies cp, states intermittent diarrhea. states he doesn't remember what brought him to the hospital. does not recall vomiting. past medical history: -hypertension -hypothyroidism -prostate cancer s/p xrt -h/o esophageal ca s/p xrt with 3-hole esohagectomy in at . recently hospitalized at for pna and found to have stricture near cricopharyngeus, with evidence of tef. egd showed no cancer recurrence. j-tube placed -small bowel obstruction -cognitive deficit nos vs limited safety awareness -orthostatic hypotension - hospitalization after fall -dvt of the l subclavian and l axillary vein -r hip fracture s/p orif by dr. @ -rll pna , treated with levofloxacin -multiple stab wounds to the abdomen in the -right sided ptx after bronchoscopy s/p ct placement -tonsillectomy and adenoidectomy -r wrist and hand surgery -large bowel obstruction in s/p exploratory laparotomy with reduction of a paraesophageal hernia and was left with an open abdomen due to edema and bowel distention s/p closure on social history: originally from . he has three daughters. one daughter lives in , another is in , who is very involved. reports he recently stopped smoking. although he has a history of binge drinking, he reports he hasn't drank since of . retired construction worker and plumber. family history: mother died of a blood clot. doesn't know what his father died of. sister died of obesity and "fat around her heart" physical exam: on admission to the micu: vitals: t 101 hr 77 bp 72/45 18 97% on ra -low tidal volumes, elevated airway pressures, bp's in 70's systolic, and saturations in 70's to 80's general: alert, no acute distress heent: sclera anicteric, mm dry, oropharynx clear neck: trached lungs: upper airway sounds heard throughout cv: tachycardic rate, regular abdomen: scaphoid, soft, non-tender, bowel sounds present, no rebound tenderness or guarding, peg in place, well healing abdominal wound with pink granulation tissue gu: no foley ext: warm, well perfused . on discharge, o2 sats 97% on 50% trach mask; equal breath sounds bilaterally j tube site with mild erythema around site abd wound with granulation tissue, appears to be healthy and healing pertinent results: admission labs: . images: cxr : 1. increased right upper lobe opacity concerning for pna. 2. pulmonary vascular congestion with mild interstitial edema. 3. small bilateral pleural effusions. . ekg: rate 138, lad appears to be sinus but unclear if consistent p waves given poor baseline. again difficult to assess but ? rate related st depressions in v4-v6 in lateral leads. . 03:05am blood wbc-13.7* rbc-3.30* hgb-9.2* hct-29.1* mcv-88 mch-28.0 mchc-31.7 rdw-17.7* plt ct-422 03:05am blood neuts-94.0* lymphs-3.9* monos-1.6* eos-0.3 baso-0.2 03:05am blood pt-14.4* ptt-33.6 inr(pt)-1.3* 03:05am blood glucose-125* urean-31* creat-1.3* na-147* k-5.9* cl-112* hco3-25 angap-16 02:27am blood calcium-7.5* phos-2.5* mg-1.4* iron-14* 03:05am blood tsh-27* 03:05am blood free t4-0.98 03:51am blood type-art po2-184* pco2-38 ph-7.41 caltco2-25 base xs-0 03:10am blood lactate-2.7* k-4.3 12:20pm blood lactate-3.2* 03:08pm blood lactate-1.8 . discharge labs: 03:33am blood wbc-6.3 rbc-3.55* hgb-10.0* hct-30.8* mcv-87 mch-28.3 mchc-32.6 rdw-17.2* plt ct-222 03:33am blood glucose-91 urean-11 creat-0.5 na-138 k-3.9 cl-102 hco3-30 angap-10 03:33am blood calcium-8.4 phos-3.0 mg-1.4* 02:27am blood caltibc-183* ferritn-687* trf-141* . sb follow-through: impression: within the limits of a small bowel follow-through, there are no fistulae or strictures identified. transit time through the small intestine is within expected (normal) range. . cxr: impression: 1. increased right lower lobe density, which may either represent fissural fluid or consolidation. 2. stable bilateral loculated pleural effusions. 3. stable left lower lobe atelectasis. 4. mild worsening pulmonary edema. 5. contrast opacification of the large bowel with further small bowel opacification, if an enteroenteric fistula is suspect, further evaluation with fluroscopy or an abdominal radiograph is suggested to localize the small bowel loop and assess a potential fistulous communication with large bowel. brief hospital course: 67yom h/o squamous cell esophageal cancer s/p xrt with a gastric pull-up in w/ subsequent tracheo-esophageal fistula and eventual tracheostomy/ peg tube placement who presents from rehab with respiratory distress. . # shock: pt with bp in 70s/40s on arrival to the micu and febrile to 101. lactate 2.7 -> 3.2 -> 1.8 in first 24 hours with ~7-8l of fluid. was initially on levophed but this was weaned by hospital day #2. antibiotics were started on arrival to the icu - were eventually broadened to meropenem/linezolid as patient had persistent hypotension. cxr showed new rul infiltrate concerning for pneumonia. u/a looked infected. sputum culture grew morganella morganii, sensitive to meropenem - identical culture to earlier admission. patient's lactate normalized and he was weaned off pressors. he was continued on meropenem for g-negative rods in sputum and finished his course on . . # hypoxemic respiratory distress: given timing of hypoxic respiratory distress, likely had aspiration event most immediately. on arrival to the floor, patient was seen by anesthesia and a bronchoscopy was performed out of concern for trach displacement. the trach was visualized in the correct location. the patient was initially ventilated on a-c, but this was weaned and on icu day #2 was on psv. antibiotics were administered as above out of concern for rul pneumonia. the patient's trach was changed on hd #2 because of problems with ongoing cuffleaks. the original trach was found to have a defective balloon. the patient's tidal volumes improved with new trach. the patient remained stable from a respiratory standpoint for the rest of his micu stay and tolerated trach mask; he was satting in the high 90s on 50% trach mask prior to discharge. . # te fistula: pt is s/p fibrin injection . patient with known tef s/p recent injection. on hd #5, ip performed a bronchoscopy, which showed a partially closed te fistula. the patient had 2 episodes of bilious contents being suctioned from his trach. thoracic surgery was consulted and attempted to place an ng tube endoscopically; the attempt was not successful given his complicated anatomy and will not attempt again. ip has no plans to attempt another injection for pts te fistula. . # j tube leakage: the patient has had a chronic problem with his jtube leaking and has had it changed 3 times in the recent past. the patient had continued profuse leakage while in the micu. his tube feeds were stopped and ppn was started. surgery was consulted who recommended a kub with gastrografin, which was normal. care was also consulted. patient complained of abdominal pain and received prn iv morphine. abd exam was benign. thoracics recommended a barium swallow through the j tube with small bowel follow through showed no abnormalities. given this, tube feeds were re-started on . thoracics will not attempt to replace the j-tube given his complicated anatomy. . # anemia: the patient had a hct of 20.5 on icu day #2. stool was guaiac negative. he was transfused 2u prbc with appropriate response. iron studies showed elevated ferritin (likely as acute phase reactant). his hct stayed stable ~27 to 28 for the remainder of his hospitalization. . # hypernatremia - na in the 145-150 range; stable over recent admissions. tf and free water flushes were utilized. na was trended daily and improved to the normal range for the remainder of his admission. . # prophylaxis was with subcutaneous heparin. communication was with the patient and daughter . he remained full code during this admission. medications on admission: 1. kayexelate mwf 2. citalopram 20 mg tablet daily 3. prilosec 20mg daily 4. ergocalciferol (vitamin d2) 8,000 unit/ml drops : 5000 units weekly 5. combivent/albuterol nebs 6. levothyroxine 125 mcg tablet *** tsh 16***** need adjustment per last dc summary. 7. tylenol 325 mg tablet : 1-2 tablets po every 4-6 hrs prn pain discharge medications: 1. citalopram 20 mg tablet : one (1) tablet po daily (daily). 2. ergocalciferol (vitamin d2) 8,000 unit/ml drops : 5000 (5000) units po once a week. 3. ipratropium-albuterol 18-103 mcg/actuation aerosol : puffs inhalation q6h (every 6 hours) as needed for wheezing. 4. levothyroxine 125 mcg capsule : one (1) capsule po once a day. 5. acetaminophen 325 mg tablet : 1-2 tablets po every hours. 6. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr once a day. 7. oxycodone 20 mg/ml concentrate : 2.5-5 mg po every hours as needed for pain. 8. acetaminophen 325 mg/10.15 ml suspension : 325-650 mg po every 4-6 hours as needed for pain. discharge disposition: extended care facility: hospital - discharge diagnosis: primary: sepsis pneumonia te fistula anemia . secondary: hypertension s/p esophageal radiation and gastric pull-up surgery discharge condition: mental status: clear and coherent --> pt did not use speaking valve but would communicate by writing and mouthing words level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair discharge instructions: dear mr. , you were admitted for respiratory distress and with low blood pressure. we treated you with iv fluids, blood pressure-supporting medications, and antibiotics and you improved. you were initially on a breathing machine to help support your lungs. we believe the source of the low blood pressure was an infection in your lungs. you were able to breathe well with the trach mask in place prior to your discharge. the pulmonary doctors also looked to see if the abnormal connection between your trachea and esophagus was healed - they found that it was partially healed. finally, we had the thoracic surgeons evaluate your j-tube. a study was performed, which showed that the j-tube was working normally and that you had normal bowel function. you did have leakage around the j-tube but the surgeons thought it would be too dangerous to attempt to fix. . we made the following changes to your medications: we stopped kayexelate because your potassium levels were normal we started oxycodone 2.5-5 mg (liquid) every 6-8 hours as needed for abdominal pain we stopped prilosec we started lansoprazole (rapid dissolve tablet) 30 mg once per day . you should continue to see the medical doctor at your rehab facility. your follow-up appointments are listed below. followup instructions: department: west clinic when: tuesday at 9:45 am with: , md building: de building ( complex) campus: west best parking: garage department: west clinic when: tuesday at 10:30 am with: , md building: de building ( complex) campus: east best parking: garage procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances bronchoscopy through artificial stoma bronchoscopy through artificial stoma replacement of tracheostomy tube injection or infusion of oxazolidinone class of antibiotics diagnoses: anemia, unspecified unspecified essential hypertension unspecified septicemia severe sepsis unspecified acquired hypothyroidism personal history of malignant neoplasm of prostate acute respiratory failure pneumonitis due to inhalation of food or vomitus cachexia septic shock hyperosmolality and/or hypernatremia tracheoesophageal fistula personal history of malignant neoplasm of esophagus mechanical complication of tracheostomy other colostomy and enterostomy complication body mass index less than 19, adult 

Answer: The patient is high likely exposed to