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: prednisone attending: chief complaint: right bronchopleural fistula major surgical or invasive procedure: dr. : 1. bronchoscopy with aspiration of secretions. 2. right thoracoplasty with closure of bronchopleural fistula. flexible bronchoscopy. . dr. : combined pectoralis major musculocutaneous flap containing entire right breast, transferred into the fistula area and split-thickness skin graft, 200 cm2. . dr. flexible bronchoscopy . dr. flexible bronchoscopy history of present illness: ms. is a 53-year-old former smoker with a prior history of resected chest wall with invasive carcinoma of the lung approximately 8 years ago. this was a right upper lobectomy with en bloc chest wall resection, reconstructed with mesh. she also had received postoperative radiotherapy. she presented several months ago with a empyema necessitans draining through the low right flank. this was traced up to a source arising from the apical pleural space and mesh. i had previously reopened the posterior aspect of her thoracotomy, removed the mesh, and performed window to marsupialize this and place her on dressing changes. at this time, she was still smoking and severely malnourished. we placed a percutaneous gastrostomy for nutritional supplements, and she has gained approximately 4 to 5 pounds. she has been successful in quitting smoking. dr. of plastic surgery has also placed a tissue expander under the right breast as she has very little muscular tissue to help close this flap. it is our hope that a de-epithelialized flap including the right breast skin and breast tissue along with the pectoralis, as well as remaining tissue above the thoracotomy, would be adequate to help close the defect if i could also collapse the chest using a thoracoplasty. it was our hope, with this combined technique, that we could close the bronchopleural fistula and eradicate the space. she understood the risks involved, including that this would not work and she would be left with a chronic wound. she agreed to proceed. past medical history: squamous cell ca- right lung s/p right lung upper lobectomy and right lower lobe wedge resection with excision of ribs 5,6, and 7 s/p chemo, radiation social history: married. works as waitress. smokes cigs/day (20+ pack-years). recently quit smoking. family history: noncontributory physical exam: discharge pe: vitals: 98.4 94 131/57 18 96% room air gen: nad cvs: rrr resp: cta bilaterally abd: soft, nd, nt, nabs incisions: clean, dry, intact ext: pulses palpable distally in all extremities pertinent results: 04:57am blood wbc-12.5* rbc-3.24* hgb-10.5* hct-32.3* mcv-100* mch-32.4* mchc-32.5 rdw-15.6* plt ct-543* 04:57am blood glucose-102 urean-21* creat-0.4 na-135 k-5.1 cl-97 hco3-34* angap-9 04:57am blood calcium-9.7 phos-4.3 mg-1.8 . pathology examination name birthdate age sex pathology # , 53 female specimen submitted: right nipple, tissue expander right breast, right 2nd, 3rd, and 4th rib (5). procedure date tissue received report date diagnosed by dr. . brown/vf previous biopsies: chest wall prosthesis. consult slides referred to dr. . diagnosis: 1. nipple, right (a): no evidence of malignancy. 2. tissue expander, right breast. gross exam only. 3. rib, right fourth (b): bone and marrow with no evidence of malignancy. 4. rib, right third (c): bone and marrow with no evidence of malignancy. 5. rib, right second (d): bone and marrow with no evidence of malignancy. . chest (pa & lat) 8:05 am reason for this examination: eval need for bronch impression: continued improving aeration in the right mid and lower lung regions status post right thoracoplasty. brief hospital course: the patient is a 53 year-old female admitted to dr. surgery service at the on for surgical management of chest wall reconstruction. she underwent a bronchoscopy with aspiration of secretions, right thoracoplasty with closure of bronchopleural fistula, and combined pectoralis major musculocutaneous flap containing entire right breast, transferred into the fistula area and split-thickness skin graft, 200 cm2 on by dr. and dr. . for details operation, please refer to the operative reports. following the surgery, she was transferred to the csru. . on pod 1, she was continued on levofloxacin and ancef. her pain was well-controlled with a dilaudid pca, she was afebrile, had good oxygenation, and adequate urine output. her vac was functioning, ct was continued to wall suction, and her arm sling was continued. . on pod 2, her pain was well-controlled, however, she was over sedated from the narcotics and her pca was discontinued. she continued to remain afebrile with o2 saturation at 97% on 2l nc. her antibiotics were continued. her vac remained intact and her ct was continued on wall suction. . on pod 3, she continued to remain afebrile and pain was controlled with po dilaudid. the drain was placed to bulb suction. a cxr demonstrated almost complete opacification of the right lung and a bronch was performed with removal of thick brown/bloody secretions and mucus plugs from the right mainstem bronchus, resulting in improved aeration of right lung. . on pod 4, her antibiotics was switched to cefepime to pseudomonas cultured from bal. she remained afebrile and pain well-controlled with po dilaudid. again the patient required another bronch following a chest x-ray with progressive opacification of the right lung. clear thick secretions were removed from the right mainstem bronchus. the vac continued to be and continued on suction and her drain was continued to bulb suction. . on pod 5, she was continued on the cefepime and remained afebrile. the vac was continued as well as her drain. her pain continued to be well controlled with po dilaudid. no bronch was required on this day. . from pod , the patient continued to remain afebrile in the icu, requiring a bronch on pod 7 and pod 9 for removal of thick secretions. her vac was continued on suction and her was continued on bulb suction. pain continued to be well-controlled with input from acute pain service. . on pod 10, she had a fever of 101.9 with increased wbc to 45.6 and a ct chest demonstrated severe pna of the right lung. her antibiotics were broaden to include vancomycin, tobramycin, flagyl, and the cefepime was continued. the decision was made at this point to have daily bronchs for removal of purulent secretions from the right mainstem bronchus. she also complained of diarrhea and c.diff cultures were sent. her vac was continued on suction and her was continued on bulb suction. . on pod 11, she continued to have low grade temperatures and her antibiotics were continued. a ct chest/abdomen/pelvis was performed showing thickening and pericolonic inflammatory change of the cecum and ascending colon, consistent with colitis. bronch today demonstrated moderate thick prurlent secretions in the right mainstem bronchus. her vac was continued on suction and her was continued on bulb suction. . on pod 12, she was found to be c.diff positive and was continued on the flagyl, vancomycin, and cefepime. the tobramycin was discontinued. her vac was continued on suction and her was continued on bulb suction. she remained afebrile and continued to oxygenate well, not requiring a bronch today. . on pod 13, she continued to remain afebrile and her diarrhea was resolving. her drain was discontinued. bronch demonstrated moderate secretions in right mainstem bronchus and she was deemed stable to be tranferred to the floor. she continued to oxygenate well on 2 liters nasal cannula. the vancomycinwas discontinued and the flagyl and cefepime were continued. . on pod 14, she was started on a clear liquid diet, which she tolerated well, and tf were started at 30 cc/hr. she was continued on the flagyl and cefepime. her diarrhea continued to resolve and she remained afebrile. she was advanced to a regular diet, which she tolerated well. . on pod 15, she remained afebrile but continued to have copious secretions requiring a bronch. her wound continued to heal wellwith the d/c'd and the vac d/c'd. she continued to tolerate her regular diet. . on pod 16, she was continued on the flagyl and cefepime without fevers. her pain was well-controlled, she was tolerating a regular diet with increasing po intake, and starting to ambulate well. her wound continued to be clean, dry, intact, and well. . on pod 17-19, her tfs were cycled overnight, she remained afebrile and continued to increase her po intake. her chest x-ray continued to show improvement without a need for further bronchs. her antibiotics were continued as well as aggressive pulmonary toilet and ambulation. . on pod 20-21, she continued to improve clinical and remain afebrile. her chest x-rays remain unchanged with no indication for a bronch. she was deemed stable for discharge home. she will be discharged home with vna and will continue her cefepime for 3 weeks and flagyl for 4 weeks. she has been been instructed to follow-up with dr. next week and to follow-up with dr. in 1 week. medications on admission: neurontin percocet ultram discharge medications: 1. tramadol 50 mg tablet sig: one (1) tablet po tid (3 times a day). 2. gabapentin 300 mg capsule sig: three (3) capsule po tid (3 times a day). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. disp:*30 capsule(s)* refills:*2* 5. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 6. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. disp:*30 tablet(s)* refills:*2* 7. equipment peri-trek-s portable nebulizer. 8. cefepime 2 g recon soln sig: one (1) recon soln injection q12h (every 12 hours) for 21 days. disp:*42 recon soln(s)* refills:*0* 9. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 28 days. disp:*84 tablet(s)* refills:*0* 10. heparin lock flush (porcine) 100 unit/ml syringe sig: five (5) ml intravenous daily (daily): 5 ml (100units/ml) flush to each lumen daily. disp:*qs qs* refills:*0* 11. normal saline flush 0.9 % syringe sig: ten (10) ml injection once a day: 10 ml ns flush to each lumen daily. disp:*qs qs* refills:*0* 12. guaifenesin 600 mg tablet sustained release sig: two (2) tablet sustained release po bid (2 times a day). disp:*30 tablet sustained release(s)* refills:*2* 13. metoprolol tartrate 25 mg tablet sig: three (3) tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 14. aquaphor ointment sig: one (1) topical three times a day as needed for dryness: apply to skinas needed for dryness. disp:*2 2* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: right empyema with chronic bronchopleural fistula. discharge condition: stable discharge instructions: call dr. / thoracic surgery office ) for: fever, shortness of breath, chest pain, exscessive foul smelling drainage from incision sites . please follow-up with as instructed. . continue medications as previous to surgery. please take new medications as directed. . you may leave incisions/wounds open to air. apply aquaform cream twice a day as instructed by plastic surgery. you may shower, please pat incisions dry. followup instructions: scheduled appointments : provider , md phone: date/time: 3:30 . appointments to be made: please call dr. / plastic surgery at to schedule a follow-up appointment in 1 week. procedure: venous catheterization, not elsewhere classified fiber-optic bronchoscopy fiber-optic bronchoscopy fiber-optic bronchoscopy fiber-optic bronchoscopy other intubation of respiratory tract other intubation of respiratory tract other intubation of respiratory tract other skin graft to other sites graft of muscle or fascia closure of other fistula of thorax other immobilization, pressure, and attention to wound removal of breast tissue expander excision of nipple diagnoses: pneumonia, organism unspecified other and unspecified noninfectious gastroenteritis and colitis asthma, unspecified type, unspecified pulmonary collapse intestinal infection due to clostridium difficile accidents occurring in other specified places surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation acute bronchitis accidents occurring in residential institution gastrostomy status empyema with fistula persistent postoperative fistula foreign body in main bronchus inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation 

Answer: The patient is high likely exposed to