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: hypercarbic respiratory failure. major surgical or invasive procedure: tracheostomy replacement. history of present illness: this is a 68 m with lung cancer, status post trach with vent dependence, recent post obstructive pneumonia on broad spectrum antibiotics, prior pulmonary embolus, copd, hypertension and diabetes. he presented from a rehabilitation facility to the ed, with increased respiratory distress and new opacities seen on chest x-ray. he had recently been discharged from the icu of an osh for dyspnea and lethargy. there he had been diagnosed with the pneumonia and started on a 14 day course of vancomcyin/cefepime/flagyl (last day ), at 11 am yesterday he was noted to be increasingly tachypneic, a chest x-ray reveal "white out" in the l lung field (per facility report). in the ed the pt was initially alert and interactive. he was afebrile but tachypneic, hypertensive and tachycardic. wbc and lactate were normal. chest x-ray revealed l perihilar lung mass and opacities in the l lower lobe. cta confirmed presence of these findings and, in addition, was negative for pulmonary embolus. after the cta the patient's mental status began to decline and he became increasingly difficult to ventilate. he became poorly responsive and a blood gas returned as 7.02/144/402/40. it was believed that there were air leaks around his trach and there also was possibly some obstruction. also of note he was given labetalol for control of his hypertension and tachycardia. he was therefore transferred to the micu. in the micu, the patient was poorly responsive and exhibited agonal breathing. a bronchoscopy was urgently performed and revealed an obstruction in the trach. the patient was therefore intubated. past medical history: 1) lung adenocarcinoma 2) tracheostomy, chronically ventilator dependent 3) post obstructive pneumonia 4) history of vre and mrsa infection 5) s/p g-tube placement 4) history of pulmonary embolism, not on anticoagulation 5) history of retroperitoneal bleed 6) copd 7) hypertension 8) diabetes type ii. 9) urethral tear social history: widowed, has been in chronic vent facility. daughter is health care proxy. family history: non-contributory. physical exam: vs: temp: 96.8 bp: 109-153/69 hr: 110-120 rr: 21 o2 sat 100 vent: ac tv 600 rate 20 fio2 0.8 peep 5 gen: alert, follows commands heent: perrl, eomi, anicteric, mouth mm moist, edentulous, op without lesions neck: trach in place, intubated. trach site c/d/i. no jvd, no carotid bruits, no thyromegaly, resp: course breath sounds decreased on left, no wheezes, scattered rales. no rhonchi cv: rr, s1 and s2 wnl, no m/r/g abd: mildly distended, not tympanic. non tender hypoactive bowel sounds, ext: no edema, distal pulses normal skin: no rashes/no jaundice. pertinent results: 09:58pm wbc-10.9 rbc-3.22* hgb-10.5* hct-29.7* mcv-92 mch-32.5* mchc-35.3* rdw-15.9* 09:58pm neuts-75.0* lymphs-18.7 monos-3.1 eos-2.7 basos-0.5 09:58pm plt count-262 09:58pm glucose-109* urea n-15 creat-0.8 sodium-142 potassium-3.8 chloride-103 total co2-35* anion gap-8 12:50am blood rates-/14 peep-2 fio2-100 po2-402* pco2-144* ph-7.02* caltco2-40* base xs-1 aado2-191 req o2-39 -assist/con 04:00am blood type-art po2-20* pco2-87* ph-7.22* caltco2-38* base xs-3 04:52am blood type-art rates-20/ tidal v-500 peep-5 fio2-40 po2-131* pco2-52* ph-7.42 caltco2-35* base xs-8 intubat-intubated vent-controlled 04:16pm blood type-art rates-20/ tidal v-600 peep-5 fio2-60 po2-100 pco2-45 ph-7.49* caltco2-35* base xs-9 -assist/con intubat-intubated 12:38pm blood type-art temp-37.2 rates-20/ peep-0 fio2-40 po2-69* pco2-53* ph-7.42 caltco2-36* base xs-7 intubat-intubated brief hospital course: this is a 68 year old gentleman with lung adenocarcinoma, chronic vent dependence, s/p trach and peg placement, recent pneumonia on broad spectrum antibiotics presents with respiratory failure that appeared secondary to blockage seen on bronchoscopy. the patient was intubated and placed on assist control mechanical ventilation with respiratory and mental status returning to baseline as a result. through the remainder of his admission the patient remained hemodynamically stable. he underwent repeat bronchoscopy which revealed near complete occlusion of the trach tube. the patient did complain of dyspnea intermittently and there was some concern that he had an air leak around his tracheostomy tube. his respiratory status did remain stable with good oxygen saturation. for the air leak the tracheostomy tube was replaced with a larger tube. . 1) respiratory failure. the patient arrived with tracheostomy tube misplaced. the tracheostomy tube was changed and lumen changed to size 8. speech and swallow was consulted for passy-muir placement but were unable to see the patient due to his recent trach change. because he has been intermittently unable to speak, would recommend passy-muir placement at rehab facility. the patient was weaned off the ventilator once his new tube was in place and currently at 600/20/40%/5. patient should be aggressively weaned from ventilator as tolerated. please encourage out of bed and continue physical therapy (begun in hospital). he should receive humidified o2 while on trach collar . 2) pneumonia. likely lobar pneumonia rather than post-obstructive (as indicated in notes from osh) given absence of obstruction noted on bronchoscopy. a 15-day course of broad spectrum antibiotics (vancomycin, cefepime, metronidazole) was completed. osh had recommended this duration given patient's history of mrsa and vre. blood and sputum cultures were negative at the time of discharge. . 3) copd. as above. the patient was continued on bronchodilator therapy. . 4) history of pulmonary embolus. no evidence of pe on cta. patient has ivc filter in place and history of retroperitoneal bleed and is therefore not anticoagulated. . 5) hypertension/grade i chf with diastolic dysfunction. metoprolol 50 mg was initiated after patient's respiratory status stabilized. . 6) anemia. patient's hematocrit ranged from 24-26 during hospital stay. iron studies were sent but pending on discharge. guaiac negative. although likely secondary to chronic disease, please follow-up iron studies. 6) diabetes. no record of medications for glycemic control. pt was maintained on a regular insulin sliding scale during his hospital stay. . 7) history of ureteral tear. mild hematuria on urinalysis. the patient was maintain with a foley catheter. he may need evaluation from urology in future. . 8) non sclc stage iiib. according prior records, this has been deemed unresectable and patient is on no treatments at this time. please consider reopening discussion of lung cancer treatment with his family. . access: r ij was removed and a left picc line was inserted. . fen: patient had episode of clogged g-tube refractory to flushing efforts, but an abdominal x-ray with gastrografin contrast through g-tube showed contrast in stomach. subsequently, tube feeds were successful. please continue with tube feeds. . prophylaxis: hep sq, ppi, bowel regimen. . code status: full, discussed with hcp. . contact: hcp, daughter cell , home . medications on admission: cefepime flagyl vancomycin combivent calcium acetate colace senna protonix discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po hs (at bedtime). 2. docusate sodium 150 mg/15 ml liquid sig: fifteen (15) ml po bid (2 times a day). 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 4. lansoprazole 30 mg susp,delayed release for recon sig: thirty (30) mg po daily (daily). 5. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 6. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed. 7. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. 8. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane qid (4 times a day) as needed. 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp < 100 or hr < 60. 10. insulin use regular insulin sliding scale discharge disposition: extended care facility: hospital discharge diagnosis: primary hypercarbic respiratory failure. obstruction of tracheal tube. secondary non small cell lung cancer pneumonia hypertension diabetes mellitus type ii discharge condition: good, respiratory status now returned to baseline. mentating at baseline; alert, following commands, and interactive. otherwise, afebrile and hemodynamically stable. discharge instructions: please return patient to emergency department for any sign of respiratory failure including: hypoxemia unresponsive to adjustments in ventilation declining mental status also seek emergent medical intervention for any signs or symptoms of sepsis followup instructions: patient to extended care facility. please have patient follow up with his pulmonologist. please have patient and family follow up with oncologist to discuss treatment options for lung cancer. please have patient follow up with urology should hematuria recur. procedure: venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances replacement of tracheostomy tube diagnoses: pneumonia, organism unspecified anemia, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified candidiasis of mouth acute respiratory failure malignant neoplasm of other parts of bronchus or lung other tracheostomy complications 

Answer: The patient is high likely exposed to