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: history of present illness: this 77-year-old woman, with a past medical history significant for head and neck cancer (diagnosed in , status post radical neck dissection and radiation treatment), recently seen on at for shortness of breath, hoarseness, and respiratory stridor. she was initially treated with levaquin for suspected bronchitis, given nebulizers, and discharged with close ent follow-up. she was scheduled for elective tracheostomy on after a ct chest on demonstrated a probable mass involving the larynx on the left. over the last 24 hours prior to admission, according to her son she has had worsening dyspnea/stridor. her son called ems, and an oxygen saturation was noted to be 89%. in emergency room at , heliox was considered but unavailable. the oxygen saturation was 100% on nonrebreather mask after suctioning and nebulizers. the patient received 8 mg of decadron and was then transferred to for elective tracheostomy on . she was also started on unasyn for a question of aspiration pneumonia and prophylaxis? prior to tracheostomy. past medical history: 1. head and neck cancer diagnosed in , status post radical neck dissection and radiation treatment. there is extensive involvement of the left portion of the larynx and unilateral vocal cord paralysis on that side as a result. 2. cva x 2. 3. status post g-tube placement for nutrition. 4. raynaud's phenomenon. 5. copd with pfts and more details unknown. 6. cholangitis in . 7. left carotid stenosis demonstrated on mra and ultrasound. 8. vertebral artery stenosis. 9. hypertension. 10.peripheral vascular disease, status post femoral-popliteal bypass in . allergies: no known drug allergies. medications: 1. zocor 40 mg qd. 2. plavix 75 mg qd. 3. aspirin 325 mg qd. 4. vitamin b12 1,000 mg qd. 5. folate 1 mg po qd. 6. diluted tincture of opium prn. 7. lomotil qid prn. 8. roxicet 5 mg prn. social history: lives at home, fully independent. has son, , who is her healthcare proxy. smoked extensively in the past, but number of pack years unknown. no known alcohol use. physical exam at admission: temperature 94.6, heart rate 102 and regular, blood pressure 188/67, respiratory rate 20, satting 100% on a 10 liter face mask. general: in no apparent distress, resting comfortably. heent: uncooperative with eye exam. oropharynx clear. moist mucous membranes. cardiovascular: regular rate and rhythm, tachycardic, i/vi early systolic murmur at the right upper sternal border without s4 or s3, nondisplaced point of maximal impulse. pulmonary: hoarse voice and stridor on inspiration, fair air movement, clear to auscultation posteriorly in all lung fields. abdomen: soft, nontender, nondistended, active bowel sounds present. extremities: no clubbing, cyanosis or edema, palpable pulses at the radial arteries bilaterally. neurologic: alert and oriented x 3. cranial nerves ii through xii grossly intact. skin: warm, dry and intact without rashes. initial data: white blood cell count 21.2, with 82% neutrophils, 9% bands, 6% lymphocytes, hematocrit 32.1, platelets 401. chest x-ray demonstrates consolidation of the left lower lobe, likely aspiration pneumonia, also with overinflation, flat diaphragms, consistent with emphysema. ekg - sinus rhythm at 108 beats per minute, axis normal, qt segment mildly prolonged, specific number no, poor r wave progression in v1 through v3, slight st segment depressions of less than 1 mm in the inferior leads. ct scan without contrast demonstrates probable mass involving the larynx in the left, low attenuation within the isthmus and left lobe of the thyroid gland, severe atherosclerotic disease with occlusion of the left internal carotid artery, and stenosis of the right internal carotid artery with mural thrombus within the proximal descending aorta, emphysema, tiny noncalcified nodule in the right lower lobe of the lung, multiple cysts within both kidneys which cannot fully be characterized on this study. ct neck with iv contrast - low attention within the left and right lobes of the thyroid, slightly prominent, slight irregularity of the mucosa inferior to the anterior commissure on the left and the right posteriorly at the level of the false cords, unusual calcification in the right cricoid cartilage suggestive of prior injury. brief summary of hospital course: the patient was initially admitted to the intensive care unit for management of her respiratory distress. she was then transferred to the medical team on the floor on . hospital course by issue - 1) airway obstruction: the ent service was consulted and given the patient's declining oxygen saturation and extensive involvement of her squamous cell ca of the left pharynx, it was their impression that she would require placement of a tracheostomy tube. initially, a cuffed 6.0 shiley tube was placed on by dr. . this was later revised to an uncuffed 6.0 shiley tube on . the aspirin and plavix were held periprocedure and were restarted 2 days following procedure. the patient appeared much more comfortable postprocedure and had adequate oxygenation and ventilation at 100% on a 60% face mask. this was weaned down to 40% trach face mask, and eventually she was weaned to room air on . initially, she did have thick secretions requiring frequent suctioning. however, with the use of humidified oxygen and humidified room air, the secretions decreased significantly, and she was able to have suctioning as of . there were conflicting impressions regarding the patient's prognosis of phonation. there was definitely unilateral left-sided cord paralysis. however, the patient was able to make some sounds, and able to say the word hello. a speech consult was obtained on , and their impression is pending at this time. 2) tuberculosis: no acid-fast bacilli were seen on direct smear; however, on the concentrated smear there were rare afb+ cells. a genetic probe was sent to the state lab for further dna analysis by direct probe. on , it was reported that it was negative for mycobacterium tuberculosis. the patient was initially placed on respiratory droplet precautions. ppd was placed and read as 5 mm which would be negative in this patient for whom a threshold of 10 mm was set, given her history of malignancy. thus, given the negative ppd, as well as the negative genetic probe, the patient was taken off respiratory precautions as of . 3) left lower lobe pneumonia: the patient was initially on unasyn for left lower lobe pneumonia. a bal was performed on , and the bal demonstrated moderate growth of oropharyngeal flora, but coag-positive staph aureus that was sensitive to oxacillin. given the sensitivities of the coag-positive methicillin sensitive staph aureus, she was changed to levofloxacin on . this should be continued for a 14-day course, given the patient's slight increase in progression on chest x-ray of , and underlying risk factor for complicated pneumonia. 4) ?valvular disease: the patient does have a murmur suggestive of either aortic stenosis or pulmonic stenosis (given the increase with inspiration). however, given the patient's current goals of care and lack of therapeutic significance, no further work-up will be recommended at this time. 5) abdominal pain: her abdominal pain was chronic and well controlled with liquid percocet, as well as dto. an abdominal ultrasound was performed which was negative for any evidence of abdominal aortic aneurysm. we did speak with her surgeon who placed her g-tube, who states that abdominal pain has been a chronic issue for her. kub demonstrated the g-tube to be in good position. the ostomy nurses were consulted and did change the stoma site. however, it should be noted that it was the opinion of gastroenterology that the g-tube was in a very tenuous position and should be readdressed within the next 2 weeks. the patient does have an appointment to see the surgeon who initially placed the g-tube for revision, and this would be highly recommended. 6) hypertension: the patient was somewhat hypertensive during her inpatient stay. she was started on metoprolol which was gradually titrated up until adequate blood pressure and heart rate control were achieved at a dose of 37.5 mg po bid. there was initially some concern for b2 antagonist effects. however, no change in respiratory status was noted once metoprolol was initiated. 7) cerebrovascular accident: the patient does have a history of cva, and her aspirin and plavix were continued. her mental status remained within normal limits during her hospital course. 8) carotid stenosis: this was reassessed by ultrasound and mra, and the left common carotid artery was found to be totally occluded. the right common carotid artery does have a mild stenosis. however, the icu team evaluated this and consulted vascular surgery who felt that this should be checked with serial ultrasounds; however, no acute intervention was required. 9) fluids, electrolytes and nutrition: at this point, the patient is on tube feeds at goal. she is receiving probalance full-strength at 45 cc/h with residual check q 4 h. hold for residual greater than 150 cc. flush with 60 cc of water q 8 h. initially, there was some concern for drainage around the ostomy site. the ostomy nurses were consulted and did change the dressing, and also placed a stoma cap at the skin site to prevent leakage--please see above for further recommendations regarding follow-up with the surgeon who initially placed this g-tube for possible revision. 10) goals of care: given the patient's poor prognosis with her squamous cell ca of the neck that seems to have recurred since , and limited possibility for additional therapeutic intervention, a discussion was conducted with the patient and her 2 sons, and it was decided that she would not want aggressive measures. these include resuscitation, cpr, intubation, pressors, prolonged antibiotics, any painful procedures which include any revisions of the tracheostomy. at this point, her goals are to maximize her physical function to be able to go home and spend time with her family, and to continue working 3 days per week as a clerk and not have additional time spent in the hospital with aggressive procedures. she was officially made dnr/dni on . discharge condition: fair. discharge status: the patient will be discharged to a pulmonary rehabilitation facility where it is recommended that the possibility of a passy-muir valve be considered, as well as optimizing the patient's trach care and g-tube care. please note that she does not require droplet precautions, as the genetic tuberculosis probe was negative. discharge medications: 1. opium deodorized tincture 10 drops po q 3-4 h prn pain. 2. subcu heparin . 3. levofloxacin 500 mg through the g-tube qd for a 14-day course. this medication was begun on . 4. sarna lotion 1 application topically prn to shoulders. 5. cyanocobalamin 50 mcg through the g-tube qd. 6. folic acid 1 mg through the g-tube qd. 7. aspirin 325 mg po qd. 8. plavix 75 mg po qd. 9. metoprolol 37.5 mg po qd. 10.ipratropium nebulized solution 1 nebulizer q 6 h. 11.albuterol nebulized solution 1 nebulizer inhaled q 6 h. 12.oxycodone/acetaminophen elixir ml po q 4-6 h prn pain. 13.morphine 2 mg iv q 4 h prn pain. although the patient declines revision of the tracheostomy at this time, if there are any questions regarding the tracheostomy itself, dr. in the clinic can be contact at (. the patient's primary care doctor , (. , m.d. dictated by: medquist36 procedure: enteral infusion of concentrated nutritional substances other bronchoscopy laryngoscopy and other tracheoscopy temporary tracheostomy closed [endoscopic] biopsy of larynx pharyngeal biopsy diagnoses: pneumonia, organism unspecified other pulmonary insufficiency, not elsewhere classified chronic airway obstruction, not elsewhere classified cachexia unilateral paralysis of vocal cords or larynx, partial other diseases of respiratory system, not elsewhere classified malignant neoplasm of subglottis malignant neoplasm of pyriform sinus malignant neoplasm of laryngeal cartilages 

Answer: The patient is high likely exposed to