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: patient recorded as having no known allergies to drugs attending: chief complaint: chronic respiratory failure major surgical or invasive procedure: -flexible bronchoscopy -flexible bronchoscopy, cryotherapy and mechanical debridement of granulation tissue history of present illness: 38 yo m w osteogenesis imperfecta and trach placement with vent dependence after intubation for seizure in along with recent hospitalization at for hypoxic respiratory failure being transferred from an osh after increasing vent requirements and difficulty ventilating. the patient was recently discharged to chronic care facility from rih on after hospitalization for hcap and coag neg staph bacteremia. per notes from , they were having difficulty ventilating to patient on ac due to continuously high pressures. at one point he was found unresponsive with his eyes open. he was bagged and vs were 170/91 109 24. they were initially unable to obtain an o2 sat but after suctioning o2 sat was 99%. he was placed on ac w tv 350 rr 14 o2 40% and transported to rih where he was bronched and found to have a flap lesion 1-2cm above the carina as well as extensive blood tinged secretions. it was felt that this lesion was creating a one-way valve allowing him to inhale but not to exhale. his trach was advanced in an attempt to transiently remove the obstruction. labs at rih were notable for wbc 19. he was given zosyn, cipro and vanco. he was transferred to for interventional pulmonary evaluation and possible excision of the lesion seen on rigid bronch. . upon arrival to the micu the patient reports feeling at baseline. he recalls "passing out" earlier in the day and having trouble breathing at that time. he denies any ongoing sob, chest pain, n/v, or abd pain. he does endorse "diarrhea" but reports 2 normal volume loose stools a day. past medical history: -osteogenesis imperfecta complicated by multiple fractures including a recent humeral fracture -gerd -diverticular disease -seizure in (? alcohol associated) and chronic intubation with tracheostomy after this seizure -h/o etoh abuse -h/o cocaine abuse -heart murmur social history: - tobacco: tobacco history - alcohol: history of abuse, none currently - illicits: history of cocaine, marijuana - living: lives at nursing home. prior, he lived alone family history: unknown physical exam: general appearance: thin eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic cardiovascular: (s1: normal), (s2: normal), (murmur: systolic) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), pectus cavinatum, severe kyphosis abdominal: soft, non-tender, g-tube in place c/d/i extremities: right lower extremity edema: absent, left lower extremity edema: absent musculoskeletal: muscle wasting, unable to stand skin: not assessed neurologic: attentive, follows simple commands, responds to: not assessed, movement: not assessed, tone: not assessed pertinent results: ct chest: 1. multifocal consolidation, worst in the right upper lobe, most likely represents aspiration. 2. marked bilateral lower lobe atelectasis, worse on the left, secondary to the patient's severe scoliosis. 3. incidental finding of left-sided svc and malposition of kinked central venous catheter in the coronary sinus. if retracted by approximately 7 cm, this may result in straightening of the catheter tip in the coronary sinus. 4. mild collapsibility of the lower trachea, although the presence of a tracheostomy tube limits evaluation of the airway. . granulation tissue (): tracheal granulation tissue, debridement: - respiratory mucosa with squamous metaplasia and reactive epithelial changes. - submucosal fibrosis and granulation tissue. . 05:20am blood wbc-4.0 rbc-2.69* hgb-8.4* hct-24.4* mcv-91 mch-31.3 mchc-34.5 rdw-19.0* plt ct-166 05:20am blood neuts-65.5 lymphs-23.1 monos-4.5 eos-6.4* baso-0.5 05:20am blood plt ct-166 05:20am blood pt-13.2 ptt-35.7* inr(pt)-1.1 05:20am blood glucose-85 urean-28* creat-0.9 na-138 k-4.1 cl-98 hco3-37* angap-7* 03:53am blood glucose-106* urean-19 creat-0.8 na-138 k-3.8 cl-98 hco3-35* angap-9 05:20am blood calcium-9.0 phos-4.0 mg-1.9 04:30am blood caltibc-220* ferritn-555* trf-169* brief hospital course: assessment: 38m with osteogenesis imperfecta and resultant severe restrictive lung disease requiring tracheostomy and chronic respiratory failure, admitted with increasing ventilator support requirements and found to have obstructing tracheal tissue. . . # respiratory distress. prior to admission the patient was found to have high airway pressures on the ventilator thought to be due to obstruction from tracheal granulation tissue. chest ct obtained on admission showed multifocal consolidation possibly due to aspiration, although clinically there was not evidence of pneumonia and the patient had recently completed a treatment course for pneumonia. he underwent flexible bronchoscopy on by the interventional pulmonary service and was found to have granulation tissue partially blocking the end of his endotracheal tube. on , during repositioning for cleaning he had a brief episode of respiratory distress, diaphoresis, hypoxia that resolved with repositioning of his tracheostomy tube; this was thought to be due to obstruction by the granulation tissue. on he was taken to the operating room where he underwent flexible bronchoscopy, cryotherapy and mechanical debridement of granulation tissue. large areas of granulation tissue were then noted and the flexible bronchoscope was introduced back through the lma, where cryotherapy was performed on the area, followed by mechanical debridement. while 100% patency was achieved, he was also found to have severe malacia that was not amenable to intervention. the plan was for ip follow up in 1 month (this may occur again and will require cryotherapy). there were no further episodes of acute respiratory distress after he returned from the or. . #chronic respiratory failure: the patient has osteogenesis imperfecta with resultant severe restrictive lung disease requiring tracheostomy and chronic respiratory failure. following removal of the granulation tissue as above, he intermittently was placed on trach mask ventilation, which he would tolerate for a period of hours before tiring and then being placed back on pressure support. he was evaluated by speach and swallow for possible placement of a passey muir valve, which thought might help limit airway collapse in the future, however he was aphonic, likely not able to generate the sufficient pressures. . # coag negative staph bacteremia: he had cultures growing coag negative staph from the outside hospital. he was continued on vancomycin during the hospitalization, completing a treatment course on . here he remained afebrile without localizing symptoms of infection. . #hypertension: it was not clear if he had a history of hypertension. blood pressures were obtained from his leg and were found to be suboptimally controlled. he was started on captopril, which was changed to lisinopril for easier dosing. he still had poorly controlled blood pressure so he was started on labetolol. this resulted in improved control (130s-150s systolic measured non-invasively on leg). he should continue on lisinopril 20mg daily and labetolol 200mg tid and these can be uptitrated as needed. . #anemia: his hematocrit was stable in the mid-twenties. there was no evidence of active bleeding. anemia labs were consistent with anemia of chronic disease. he was not transfused during the hospitalization. . . #nutrition: he was evaluated by speech and swallow with the following recomomendations: do not place pmv at this time, po diet of thin liquids and ground solids, meds crushed with puree, assistance during meals as needed to help with set-up and feeding, please ensure trach cuff is deflated when giving pos, trach care and oral care as you are doing, recommend peg remain in place to supplement po, pt will benefit from continued speech/swallowing services at rehab facility. . # dvt prophylaxis: he was placed on sc heparin which was decreased to 2500 units because the standard dose was increasing his ptt. he should continue on sc heparin to prevent blood clots. . # iron-deficiency anemia: he was found to have iron deficiency anemia with an iron level of 22, ferritin of 555 but low tibc/ferritin ratio. he was started on iron supplementation. hct on discharge was 24.6 which was stable for his duration of stay. . # osteogenesis imperfecta: he was continued on pain control with oxycodone. . # anxiety. he was continue home dose of seroquel and paxil. . # code status: no chest compressions but all other interventions should be done. medications on admission: roxicodone 5mg tid seroquel 25mg daily albuterol neb prn prevacid lorazepam 1mg qid paxil 20mg daily discharge medications: 1. lisinopril 20 mg tablet : one (1) tablet po daily (daily). 2. labetalol 100 mg tablet : two (2) tablet po tid (3 times a day). 3. paroxetine hcl 20 mg tablet : one (1) tablet po daily (daily). 4. quetiapine 25 mg tablet : one (1) tablet po qhs (once a day (at bedtime)). 5. lorazepam 1 mg tablet : one (1) tablet po qid (4 times a day). 6. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : six (6) puff inhalation q4h (every 4 hours) as needed for wheezing. 7. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 8. oxycodone 5 mg tablet : one (1) tablet po every six (6) hours as needed for pain. 9. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 10. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 11. docusate sodium 50 mg/5 ml liquid : one (1) po once a day. 12. heparin (porcine) 5,000 unit/ml solution : 2500 (2500) units injection (2 times a day). 13. heparin flush 10 unit/ml kit : two (2) ml intravenous once a day: heparin dependent: flush with 10ml normal saline followed by heparin as above daily. 14. ferrous sulfate 300 mg (60 mg iron) tablet : one (1) tablet po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: extensive granulation around tracheostomy site which has caused occlusion of tracheostomy tube. secondary diagnoses: 1. osteogenesis imperfecta 2. chronic respiratory failure 3. depression discharge condition: activity status: bedbound. level of consciousness: alert and interactive. mental status: clear and coherent. discharge instructions: it was a pleasure to participate in your care mr. . you were admitted to due to difficult ventilation. you were found to have granulation tissue at the end of your trancheostomy. you were also found to have tracheobronchial malacia. you underwent debridement of the granulation tissue. your breathing improved. your vancomycin was stopped because the course was completed. you were started on lisinopril 20 mg by mouth daily and labetolol 200 mg by mouth three times of day for your blood pressure. followup instructions: please follow-up with your primary care doctor at rehab. you need to follow-up with interventional pulmonary in 1 month. you can call dr. office to schedule this appointment at . procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances bronchoscopy through artificial stoma bronchoscopy through artificial stoma revision of tracheostomy diagnoses: anemia, unspecified esophageal reflux unspecified essential hypertension acute kidney failure, unspecified other, mixed, or unspecified drug abuse, unspecified dysthymic disorder epilepsy, unspecified, without mention of intractable epilepsy chronic respiratory failure osteogenesis imperfecta other tracheostomy complications 

Answer: The patient is high likely exposed to