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: respiratory distress major surgical or invasive procedure: bronchoscopy history of present illness: 39yof s/p left cranioplasty and temporal lobectomy on for decompression after left mca dissection and infarct, s/p tracheostomy for subglottic tracheal stenosis followed by ip who initially presented to for pain at the tracheostomy site, transferred for concern for dislodged tracheostomy, being admitted to the micu for further evaluation and management. . past medical history significant for a left mca dissection and large left mca territory infarct with residual expressive aphasia and hemiplegia. she underwent a bronchoscopy by ip at the time for residual dysphagia which showed subglottig stenosis above the stoma, and a t-tube was placed. however, the t-tube was subsequently removed due to severe mucus plugging and a #6 cuffed portex tracheostomy tube was placed. she had been tolerating a passe-muir valve, but has been unable to tolerate capping for prolonged periods. she is being evaluated for a possible button vs cannulation of the tracheostomy as an outpatient, and is scheduled to see interventional pulmonology on for this evaluation. per family, she has not been using her passe-muir valve at home very much, and has been only requiring humidified oxygen at night to sleep. . currently, per family report and ed report, the patient has had increasing pain at the site of the tracheostomy tube since yesterday with mild erythema at the site of the tracheostomy but without swelling, drainage, or fevers. per family, she was short of breath since the onset of her pain but has not been wheezing, and there was a question of whether the dyspnea was related to her anxiety about the tracheostomy. she has a chronic cough which has increased in frequency but she has not had increased sputum and has not had yellow or green sputum. the family was concerned as the tracheotomy tube appeared slightly displaced, and the patient was having discomfort at the site, and transported her to . . in the ed, initla vs were: 97.8 124/88 61 24 100% on 10l trach mask. the patient was not noted to be in respiratory distress at that time and was breathing comfortably. she was given nebs and suctioned small amount of white sputum. cxr at osh showed no displacement of the tracheotomy tube. her family requested transfer to , as she is followed by ip here, and she was transferred to for further management. . in the ed, initial vs: 97.8 73 133/80 16 99% ra for respiratory distress and wheezing, the patient was given 1 albuterol neb on arrival, and morphine 4mg iv for pain at the tracheostomy site. subsequently she had no respiratory symptoms and the trach was suctioned without difficulty. the osh images were uploaded and ip was consulted, who felt the tracheostomy tube was not displaced and recommended no further imaging studies and recommended discharge with outpatient f/u on wednesday. however, the ed physicians recommended further monitoring in-house, and following rediscussion with interventional pulmonology, empirical antimicrobials were initiated and patient admitted for monitoring of the pain at the trach site. the patient was given keflex 500mg po and vancomycin 1gm iv and 1l ns. she developed red man syndrome during vancomycin infusion, no wheezing or airway involvement, and was given benadryl 50mg iv. she was admitted to micu for pulmonary toilet given her frequent suctioning requirement for regular, non-purulent mucus (q2-3 hr per ed report). on transfer, vs were: afebrile 105 124/78 99% on humidified o2 10l which was increased given the patient's significant anxiety. . on arrival to the micu, the patient was comfortable and with adequate sao2 on high flow humidified air and denied shortness of breath on limited history while communicating with the use of hand signals. she did acknowledge pain at the tracheostomy site but denied pain at any other site. past medical history: - ich - s/p peg, tracheostomy, switched to t-tube for tracheostenosis but subsequently reversed to tracheostomy on for respiratory distress - s/p right carpal tunnel release - s/p hysterectomy 3 years ago - htn - seizures - migraines - gerd - hap with gnr complicating icu course - s/p endometrial ablation under general anesthesia social history: - tobacco: denies any history of tobacco use. - etoh: denies. - illicit drugs: denies. expressive aphasia and hemplegic but able to communicate with yes and no signs and pictures. currently resides at home with husband and children. former special ed teacher. family history: sister also with stroke in 30's though etiology unknown. sister also w/ dvt and headaches. father with stroke in his 60's. physical exam: admission exam: vs: 98.8 68 127/73 22 100% high flow trach mask gen: pleasant, alert, interactive, comfortable, nad heent: pupils equal and round, eomi, sclera anicteric, mmm, op without lesions, tracheostomy in place with high flow mask. cv: rrr, normal s1 and s2, no m/r/g resp: cta b/l with good air movement throughout, no wheezes or rhonchi abd: +b/s, soft, nt/nd, no masses or hepatosplenomegaly ext: no c/c/e, increased warmth and mild erythema and fullness of lle compared to rle, 2+ dp pulses b/l skin: no rashes/no jaundice/no splinters neuro: alert, interactive, uses yes and no hand signals and follows basic commands but comprehension difficult to assess given expressive aphasia. moving all extremities. pertinent results: 04:57am blood wbc-6.7 rbc-4.06* hgb-11.1* hct-33.5* mcv-82 mch-27.2 mchc-33.1 rdw-14.2 plt ct-288 07:40pm blood wbc-10.0 rbc-4.55# hgb-12.1 hct-36.5 mcv-80*# mch-26.5*# mchc-33.0 rdw-14.2 plt ct-372 08:44am blood glucose-91 urean-13 creat-0.4 na-139 k-4.1 cl-107 hco3-22 angap-14 07:40pm blood glucose-99 urean-14 creat-0.5 na-139 k-4.8 cl-105 hco3-20* angap-19 brief hospital course: 39yof s/p left cranioplasty and temporal lobectomy on for decompression after left mca dissection and infarct, s/p tracheostomy for subglottic tracheal stenosis followed by ip who initially presented to for pain at the tracheostomy site, transferred for concern for dislodged tracheostomy, being admitted to the micu for management of acute tracheobronchitis or tracheal tube site infection and intermittent respiratory distress. #. tracheostomy tube placement: pt was transferred to with concern for malpositioning of her tracheotomy tube. the patient's osh cxr was uploaded and reviewed by interventional pulmonology and the ed. the patient's tracheostomy tube was able to be suctioned without difficulty and the placement was not felt to be dislodged based on imaging and clinical assessment. pt was noted during her hospitalization to be very wheezy, she was thus given albuterol nebulizers, pulmonary toilet. she was discharged with follow-up with interventional pulmonary. she was also recommended to use her albuterol inhaler more frequently. #. pain at tracheostomy site: she was also noted to have at the tracheostomy site which was likely due to mild irritation. as a cellulitis process could not be ruled out she was discharged on a regimen of bactrim and keflex. oxycodone was also prescribed prn for pain control. #. h/o ich: recently evaluated by neurosurgery in with documented slow improvement of mental status, speech, and motor skills. she was continued on her home regimen of levetiracetam. #. htn: she was continued on metoprolol, hydralazine per home regimen. #. dyslipidemia: she was continued on simvastatin per home regimen. #. depression: continued citalopram per home regimen. #. psych: continued home methylphenidate and haldol medications on admission: - albuterol sulfate neb q6h prn sob - levetiracetam 100 mg/ml solution: 7.5 ml - metoprolol tartrate 25 mg tid - hydralazine 25 mg q6h prn sbp>160. - methylphenidate 5 mg - haloperidol 1 mg po bid - citalopram 10 mg daily - omeprazole 20 mg (e.c.) q 12h - simvastatin 40 mg daily - acetaminophen 325 mg tablet: 1-2 tablets q6h prn pain - oxycodone-acetaminophen 5-325 mg tablet: 1-2 tablets q4h prn pain - docusate sodium 100 mg - senna 8.6 mg tablet daily - bisacodyl 5 mg (e.c.): two tablets daily - simethicone 80 mg q6h - sc heparin 5,000 units tid discharge medications: 1. cephalexin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 10 days: last dose . disp:*40 capsule(s)* refills:*0* 2. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po bid (2 times a day) for 10 days. disp:*20 tablet(s)* refills:*0* 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 4. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 6. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 7. levetiracetam 100 mg/ml solution sig: seven y (750) mg po bid (2 times a day). 8. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 9. methylphenidate 5 mg tablet sig: one (1) tablet po bid (2 times a day). 10. haloperidol 1 mg tablet sig: one (1) tablet po twice a day. 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation every four (4) hours as needed for dyspnea: please take your nebs every hours for the first 4 days, then take your nebs as you usually do. 12. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 13. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 14. senna 8.6 mg tablet sig: one (1) tablet po once a day as needed for constipation. 15. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 16. hydralazine 25 mg tablet sig: one (1) tablet po every six (6) hours as needed for high blood pressure. 17. oxycodone 5 mg capsule sig: one (1) capsule po every hours as needed for pain: cause drowsiness. disp:*30 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: cellulitis around tracheostomy site discharge condition: mental status: clear and coherent but expressive aphasia. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you presented to the hospital with pain at your tracheostomy site and concern for the placement of the tracheostomy tube. you had a chest xray which did not show concerns for displacement of your tracheostomy tube, and the interventional pulmonary specialist evaluated you and performed a bronchoscopy which did not show any concerning findings. you were started on antibiotics for a possible skin infection around your tracheostomy tube. you had shortness of breath initially on presentation to the emergency room but this improved with pain control and your oxygen saturations were excellent throughout your hospital stay. just before leaving the hospital yesterday you had another episode of difficulty breathing, we think this is from your wheezing and the pain at your trach site. you were observed overnight and had no other issues. the following changes were made to your home medications: - start keflex 500mg every 6 hours for 7 days, to end . - start bactrim ds tablet twice daily, to end . - metoprolol was decreased to twice daily for lower blood pressures. - you should increase your albuterol nebulizer treatments to every four hours for the next 4 days, after that you can take as much as you did before - you can take oxycodone 5mg every 4-6 hours as needed for your neck pain at the trach site. if you do not have any pain you do not have to take this medication. this medication causes sedation. as we discussed it does not appear that you were taking the subcutaneous heparin injections (to prevent blood clots) that was on your medication list, so this has been removed from you med list. please follow up with your primary physician and neurologist/neurosurgeon about your blood pressure medications. followup instructions: you will be contact to follow up at the interventional pulmonary clinic within the next 10 days. if you do not receive a phone call from them, please call ( to schedule an appointment to be seen within the next 7-10 days. we have emailed the surgeon who placed your peg tube about removing it, as it was unable to be done while inpatient. they should be in contact with you about this, but if you do not hear from them, please call ( to follow up. alternatively, dr. in interventional pulmonology may choose to do this at your next visit with him. you have the following appointments scheduled: department: neurology when: monday at 4:30 pm with: , md building: sc clinical ctr campus: east best parking: garage department: west clinic when: tuesday at 9:00 am with: , md building: de building ( complex) campus: west best parking: garage md procedure: bronchoscopy through artificial stoma diagnoses: late effects of cerebrovascular disease, hemiplegia affecting unspecified side late effects of cerebrovascular disease, aphasia infection of tracheostomy cellulitis and abscess of neck surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation 

Answer: The patient is high likely exposed to