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: penicillins attending: chief complaint: respiratory distress . reason for micu transfer: critical tracheal stenosis major surgical or invasive procedure: tracheostomy rigid bronchoscopy history of present illness: 39 yo wf with a hx of cad s/p 5 vessel cabg in complicated by cardiogenic shock requiring iabp, lv systolic dysfunction (ef 35%), htn, hld, dm who presented with to an osh 3 days ago with dyspnea and was intubated and transferred to the for further evaluation. . her respiratory problems date back to her hospitalization for her cabg on , after which she was intubated for 7 days for cardiogenic shock, successfully extubated and discharged on . however, she re-presented to an osh on with chest pain and dyspnea and was found to have mrsa pna and was treated with vanc/moxi. during that hospitalization, she was also noted to have upper airway stridor and hoarseness tracheal stenosis found on ct-chest that was treated with steroids and transferred to on . during that hospitalization, the patient had a rigid bronchoscopy which revealed mucoid concretions that were obstructing the tracheal lumen and given a presumptive diagnosis of tracheitis. tissue culture grew out corynebactrium however bals were negative. she was covered empirically with vancomycin, clindamycin, and aztreonam, as well as micafungin for possible fungal infection and bactrim for pcp prophylaxis given her course of steroids. post-bronch, her breathing was unlabored with no evidence of inspiratory stridor or hypoxia. ct-chest also demonstrated lad thought to be secondary to her infection. she was subsequently discharged home on . . most recently, she presented to an osh three days ago with worsening dyspnea was intubated and transferred to . here, she had another rigid bronchoscopy that revealed tracheal stenosis with friable/necrotic tracheal mucosa obstructing ~80% of her tracheal lumen that was subsequently removed. she ultimately underwent tracheostomy and was admitted to the micu. ct-chest revealed a small amount of mediastinal air thought to be iatrogenic, lad which was increased in size from prior, and diffuse ground glass opacities consistent with aspiration. she was started on vanc+cipro on for recurrent tracheitis and clinda was added on . she had also been diuresed ~1.5l while in the micu. prior to transfer, id recommended discontinuation of vanc and cipro and continuation of iv clindamycin for 10 days. . prior to transfer, the patient states that she is still short of breath, unable to take deep breaths, but feels better than when she came in. she also describes a periodic cough productive of small amounts of green-yellow sputum. she continues to have pain over both her tracheostomy site and her sternotomy site. she denies any fevers, chills, abdominal pain, or change in her bowel habits. past medical history: anterior nstemi s/p 5 vessel cabg (one note of this actually being a stemi in the dc paperwork) chf (ef 35-40% on tte ) type 2 diabetes mellitus crohns disease hypertension hyperlipidemia asthma depression fibromyalgia s/p ventral hernia repair s/p appendectomy s/p cholecystectomy s/p c-section with tubal ligation social history: lives with husband in . - tobacco: smokes 2ppd x >14 years. - alcohol: social drinker. - illicits: no drug use. family history: no family history of coronary artery disease physical exam: admission physical exam: general: intubated and sedate, not arousable to verbal stimuli. heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge physical exam: vitals: 98.1, 92/66, 89, 20 99 trach mask fsbs 135-264 general: sitting up in bed in nad neck: trach tube in place heart: rrr, nml s1/s2. no m/r/g lungs. respirations unlabored. ctab with transmitted upper airway sounds abdomen: soft, nt/nd. +bs extremities: wwp, mild le edema pertinent results: on admission: 10:33pm blood wbc-13.0* rbc-3.35* hgb-10.0* hct-30.0* mcv-90 mch-29.8 mchc-33.3 rdw-16.5* plt ct-299 10:33pm blood neuts-87.0* lymphs-9.5* monos-3.1 eos-0.3 baso-0.1 10:33pm blood pt-12.6 ptt-19.7* inr(pt)-1.1 10:33pm blood glucose-301* urean-9 creat-0.4 na-139 k-4.1 cl-103 hco3-28 angap-12 10:33pm blood alt-22 ast-14 ld(ldh)-238 ck(cpk)-32 alkphos-88 totbili-0.3 10:33pm blood ck-mb-3 ctropnt-<0.01 probnp-2382* 10:33pm blood albumin-3.1* calcium-9.0 phos-1.9* mg-1.6 12:51pm blood type-art temp-37.5 rates-15/ fio2-100 po2-220* pco2-51* ph-7.34* caltco2-29 base xs-0 aado2-461 req o2-77 -assist/con intubat-intubated 12:51pm blood lactate-1.9 other relevant labs: 03:26am blood esr-62* 03:26am blood crp-48.1* imaging 1. new tracheostomy with air visualized in the soft tissue spaces of the neck and tracking down to the mediastinum. no ct evidence of tracheal perforation or mucosal tear (trachea above the tube is opacified with secretions and this section is not fully assessed) these findings are likely post-procedural. however, correlation with physical exam and continued clinical monitoring is recommended. 2. extensive bilateral opacities with bilateral ground-glass opacities with sparing of the periphery and more focal parenchymal opacities at bilateral bases. these findings are concerning for edema overlying aspiration pneumonia. edema may be cardiogenic or noncardiogenic and an early ards picture cannot be excluded. 3. nodal mass at the level of the right bronchus intermedius extending to the level of the takeoff of the superior segment of the right lower lobe superior segment bronchus appears more prominent. prior to discharge: 07:00am blood wbc-7.2 rbc-3.68* hgb-10.8* hct-32.2* mcv-88 mch-29.4 mchc-33.6 rdw-15.9* plt ct-351 08:20am blood glucose-152* urean-11 creat-0.6 na-139 k-5.0 cl-98 hco3-33* angap-13 08:20am blood calcium-9.5 phos-4.9* mg-1.8 brief hospital course: primary reason for hospitalization: this is a 39 year old female with h/o cad s/p cabg complicated by cardiogenic shock with iabp, ef 30%, possible dressler's syndrome, pneumonia, and recent admission for tracheal stenosis who was transferred to for management of respiratory failure in the setting of tracheal stenosis. . active issues: . #. respiratory failure: presented to an osh with dyspnea and was intubated and transferred to the for further evaluation. in the ed, her ett appeared to be obstructed, anesthesia was emergently consulted, and ultimately she went to the or with ip ?????? rigid bronch was performed which revealed tracheal stenosis with friable tracheal mucosa for which she underwent cryotherapy and forceps removal of the necrotic-appearing respiratory mucosa; she ultimately underwent a tracheostomy with a long tube (terminating ~2cm above the carina). she was admitted to the micu for further evaluation. she was able to be weaned off positive pressure ventilation down to 40% fio2 with trach mask. she was then able to be transitioned to the floor and continued to improve with regards to her oxygen requirement. she was weaned to a high flow trach mask and was cleared by pt to go home. she was taught how to manage her trach by respiratory therapy and demonstrated an understanding of how to manage her secretions. case management was able to coordinate the appropriate home devices (suction, humidified air, oxygen tanks, and hospital bed) and she was setup to follow-up with interventional pulmonology as an outpatient. . #. tracheitis/tracheal stenosis(s/ long trach): the exact etiology is still unclear. likely this was a bacterial superinfection over already weakened/necrotic mucosa (patient had tracheal trauma from prior intubation). she was initially treated with broad empiric coverage but this was narrowed to clindamycin after cultures on this admission grew mixed oral flora. alternatively it could be related to crohn??????s or another inflammatory process however this is less likely given she recently received high dose steroids. her tracheal tissue was noted to have grown fungal elements that were not treated and thought to be a contamination. final tracheal biopsy results were still pending. pt continues to have mild pain in the throat and on the skin about the incision site which was well controlled with ms contin and msir. she will need to follow up with interventional pulmonology clinic after discharge. per id recommendations she will continue clindamycin for a total of 10 day course. she was unable to tolerate passey muir valve prior to discharge given her current degree of stenosis. it is hoped, however, with speech evaluation at home and an appointment at on for follow up that with a few weeks of healing that the patient will be able to communicate via speech through a passey muir valve. ** please note: shortly after discharge, was called by a rite aide pharmacy in who endorsed concern re: this patient obtaining narcotics. they have "red flagged" her file and those of her husband and sister in the past for possible narcotic dependence/abuse as they have frequently purchased large quantities of various narcotics, paying out of pocket, from multiple hospitals and clinics. the sister was requesting this rite aide fill only the narcotic medications, none of the antibiotics, nebulizers, other medications. we requested that the patient's antibiotics also be filled - her narcotic prescriptions we provided are of limited quantity (~35 tablets each). . #. pulmonary edema: ct scan on admission showed diffuse ground glass opacities that were thought to be most likely pulmonary edema. the etiology was suspected to be chf vs negative pressure pulmonary edema from inspiration against narrowed trachea. she diuresed well with iv lasix. on the floor, she demonstrated a mild increase of her lower extremity edema and was effectively diuresed with po lasix and did not have any worsening in her respiratory status. . chronic issues: . # cad s/p cabg: no acute evidence suggestive of acs. she was continued on her home dose of aspirin, plavix, metoprolol and statin. given her cardiac risk, a low-dose ace inhibitor was added on to her home regimen. . # t2dm: her home regimen was initially held because she was npo. she was then transitioned back to her home dose of lantus 30u daily with sliding scale to cover. given a sliding scale insulin requirement, her daily lantus was increased to 35 units with minimal subsequent sliding scale requirement. . # crohn's: stable for now. she will continue her home dose of mesalamine . # depression: she will continue her home paroxetine and seroquel . transitional issues for pcp: . #. tracheostomy care: the patient underwent tracheostomy teaching. the cuff should not be inflated as this may cause further tracheal trauma. she could not tolerate a passey muir valve because of the degree of tracheal narrowing. she may be able to be transitioned to a smaller trach in the future. she will follow up with interventional pulmonology clinic for further management. #. lymph nodes on ct: she will need to follow up with interventional pulmonology for possible biopsy after resolution of her acute illness #. studies still pending at the time of discharge: final tracheal biopsy pathology #. please follow-up pain management as patient was given enough pain medication to cover her until her pcp #. please follow-up her blood pressure as she was started on lisinopril 2.5mg daily #. please follow-up her blood sugars as her insulin regimen was changed will inpatient. medications on admission: 1. mesalamine 400 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po bid (2 times a day). 2. paroxetine hcl 20 mg tablet sig: two (2) tablet po daily (daily). 3. quetiapine 100 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. clindamycin hcl 150 mg capsule sig: two (2) capsule po q6h (every 6 hours) for 5 days. 6. hydromorphone 2 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain for 6 days. 7. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed for shortness of breath. 8. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 9. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 10. insulin detemir 100 unit/ml solution sig: seventy (70) units subcutaneous at bedtime. 11. insulin aspart 100 unit/ml solution sig: fifteen (15) units subcutaneous three times a day: take with meals. 12. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 13. oxycodone 20 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po q12h (every 12 hours) for 10 days. 14. clindamycin hcl 300 mg capsule sig: one (1) capsule po every six (6) hours for 4 days. discharge medications: 1. hospital bed sig: one (1) bed ongoing: diagnosis: tracheal stenosis/tracheitis s/p tracheostomy. needs hospital bed. pt unable to lay flat and needs to change positions quickly. disp:*1 bed* refills:*2* 2. portable suction sig: two (2) suctions ongoing : dx: tracheitis, tracheal stenosis s/p tracheostomy. disp:*2 suctions* refills:*2* 3. home oxygen sig: one (1) unit ongoing: dx: tracheitis, tracheal stenosis s/p tracheostomy. pt needs o2 50% with trach mask, humidified air. disp:*1 unit* refills:*2* 4. catheter 14 fr misc sig: five (5) catheters miscellaneous ongoing: 14 french suction catheters dx: tracheitis, tracheal stenosis s/p tracheostomy. disp:*5 catheters* refills:*2* 5. mesalamine 400 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po bid (2 times a day). 6. paroxetine hcl 20 mg tablet sig: two (2) tablet po daily (daily). 7. quetiapine 25 mg tablet sig: four (4) tablet po qhs (once a day (at bedtime)). 8. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 9. ipratropium bromide 0.02 % solution sig: one (1) nebulizer solution inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. disp:*25 nebulizer solution* refills:*0* 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer solution inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. disp:*25 nebulizer solution* refills:*0* 11. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 12. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 13. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 15. morphine 15 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*35 tablet(s)* refills:*1* 16. morphine 30 mg tablet extended release sig: two (2) tablet extended release po q12h (every 12 hours). disp:*35 tablet extended release(s)* refills:*1* 17. lidocaine hcl 5 % ointment sig: one (1) appl topical qid (4 times a day) as needed for pain. disp:*1 tube* refills:*2* 18. insulin glargine 100 unit/ml solution sig: thirty five (35) units subcutaneous at bedtime. disp:*1 bottle* refills:*2* 19. insulin lispro 100 unit/ml cartridge sig: sliding scale units subcutaneous with meals: per insulin sliding scale that is printed. disp:*1 bottle* refills:*2* 20. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 21. miconazole nitrate 2 % cream sig: one (1) appl vaginal hs (at bedtime) for 7 days. disp:*1 tube* refills:*0* 22. mucinex 600 mg tablet extended release sig: one (1) tablet extended release po twice a day. disp:*60 tablet extended release(s)* refills:*2* 23. clindamycin hcl 300 mg capsule sig: two (2) capsule po three times a day for 4 days. disp:*26 capsule(s)* refills:*0* discharge disposition: home with service facility: city of home health discharge diagnosis: primary: tracheal stenosis chf pneumonia secondary: cad htn discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mrs. , thank you for allowing us to participate in your care. you were admitted to the hospital because you were having significant trouble breathing. in the emergency room, you were intubated, and subsequently had a procedure known as a bronchoscopy, where the pulmonary physicians were able to look down your airway and see what was causing your shortness of breath. they found that your airway was narrowed due to ongoing inflammation. given your difficulty breathing, you had a tracheostomy tube placed and were transferred to the medical intensive care unit. there, you were treated with antibiotics and pain medications, which continued when you were transferred to the general medical floor. your breathing subsequently improved and your pain was managed and you will be discharged home with appropriate respiratory services. please note the following changes in your medications: -start clindamycin 600mg by mouth three times a day for the next four days -start metoprolol 12.5mg by mouth twice a day -start lisinopril 2.5mg by mouth daily -start insulin glargine 35 units at bedtime -start insulin lispro per the sliding scale we print out following your blood sugars with meals -start morphine (extended release) 60mg by mouth twice a day -start morphine (intermediate release) 15mg by mouth every hours as needed for pain -start lidocaine ointment around your trach site as needed every 4 hours -start pantoprazole 40mg by mouth twice daily -start mucinex 600mg by mouth twice daily -start micanazole cream and apply to vaginal area -start ipratropium-bromide nebulizer every 4-6 hours as needed for shortness of breath -start albuterol nebulizer every 4-6 hours as needed for shortness of breath -continue your home atorvastatin, aspirin, plavix, mesalamine, paroxetine, quetiapine please bring this paper work with you to your doctors that they are aware of your recent hospitalization. followup instructions: name: , l. location: coos county family health services address: , , phone: appointment: wednesday 10:15am department: radiology when: tuesday at 9:30 am with: cat scan building: cc clinical center campus: west best parking: garage department: west clinic when: tuesday at 11:45 am with: , md building: de building ( complex) campus: west best parking: garage department: voice speech & swallowing when: tuesday at 1 pm with: baars building: span building ( complex) campus: west best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other bronchoscopy temporary tracheostomy bronchial dilation local excision or destruction of lesion or tissue of trachea diagnoses: tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension aortocoronary bypass status asthma, unspecified type, unspecified polyneuropathy in diabetes accidental puncture or laceration during a procedure, not elsewhere classified constipation, unspecified other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure regional enteritis of unspecified site acute respiratory failure hypotension, unspecified pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin emphysema (subcutaneous) (surgical) resulting from procedure acute on chronic systolic heart failure enlargement of lymph nodes myalgia and myositis, unspecified subendocardial infarction, subsequent episode of care other diseases of trachea and bronchus diabetes with neurological manifestations, type ii or unspecified type, uncontrolled vaginitis and vulvovaginitis, unspecified personal history of allergy to penicillin acute tracheitis with obstruction 

Answer: The patient is high likely exposed to