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: neck mass and abdominal distension for 1 day major surgical or invasive procedure: bronchoscopy esophagogastroduodenoscopy right subclavian line placement history of present illness: 35 yo m w/ hx muscular distrophy w/ chronic resp failure on home mechanical ventilation a/w abd distention and neck mass s/p trach placement. patient first had a trach placed in skin break down w/ bipap. he subsequently had trach replacement on and was treated w/ azithromycin tracheal infection diagnosed by purulent drainage from trach. in pt was treated w/ 10d course of keflex from ed. at home yesterday, patient's cuff blew out and his family attempted replacement w/ his old trach which didn't work. subsequent replacement w/ his back-up trach worked, however increased abdominal distention was noted and air expelled from his peg. pt was brought to mc. neck xr there showed no air, cxr negative, and abd xr showed dilated bowel loops w/out free air. pt remained hd stable throughout this course of events and was transferred to for further evaluation. additionally a new soft tissue neck mass was noted to be gradually increasing over the past 4 months. it was noted on at his clinic visit w/ dr. . at that time, pt was also noted to have increased secretions and a therapeutic bronchoscopy was done increased ventilatory pressures. after the procedure, which included removal of secretions, pt's airway pressures dropped significantly from 70's to 20-30's. pt communicates via laser pointer w/ chart, understands via writing on dry erase board. he reports some sob this am, now improved. reports increased secretions over time (c/w prior clinic notes ~ 1 mo ago) and reports improvement of his sob post-suctioning. additionally, reports his hearing has deteriorated significantly over the past several months. in pt requested multiple suctioning and was con't on his home vent settings: cmv 750 x 14 x 5; fio2 50%. past medical history: 1. fasciouscapulohumoral muscular dystrophy w/ chronic mech resp failure on home vent 18/8. bipap x 9 yrs s/p trach placement skin breakdown from nasal pillows now on mech vent at ac 750 x 14 x5 30-40% fio2; lms bronchus stent 2/2 l main stem airway compression, replaced supraglotting bstruction (clin insignificant given trach) 2. s/p peg 3. b/l congenital hearing loss w/ hearing aids 4. seasonal allergies 5. occ macular rash ? etiology, per father assoc w/ "stress" social history: lives at home w/ his parents and sister. hx etoh, tobacco use. communicates via laser pointer. family history: no fh of md; fh + breast ca. physical exam: vitals: 98.4 hr 106 bp 123/82 rr 15 96% on ac tv 750 f 14 peep 5 fio2 50% gen: cauc young m severely contracted lying on stretcher in nad w/ laser pointer in r hand and trach in place neck: 4x6 cm mass under trachea, non-fluctuant, no calor, rubor, or induration; air sounds audible over mass; non-tender; heart: rrr, s1, s2 ,no m/r/g lungs: coarse bs b/l, l ant bronchial breath sounds over l main stem stent; occ coarse crackles, no wheezing; abd: peg in place, cachectic, post-spine easily palpable on abd exam; no masses, non-distended, nontender; no masses ext: extremely cachectic, no edema, no rash pertinent results: laboratory data on admission: 11:41am blood wbc-7.0 rbc-4.30* hgb-12.6* hct-36.2* mcv-84 mch-29.4 mchc-34.8# rdw-14.9 plt ct-318 04:11am blood neuts-87.7* lymphs-9.0* monos-3.0 eos-0.1 baso-0.2 11:41am blood pt-14.2* ptt-32.1 inr(pt)-1.3 11:41am blood glucose-100 urean-33* creat-0.3* na-143 k-3.0* cl-103 hco3-22 angap-21* 05:16pm blood glucose-101 urean-34* creat-0.3* na-144 k-3.7 cl-108 hco3-19* angap-21* 11:41am blood alt-17 ast-23 alkphos-154* amylase-143* totbili-0.6 11:41am blood lipase-49 11:41am blood albumin-4.5 calcium-10.2 phos-3.6 mg-2.6 ------ pertinent studies in hospital: ct neck : findings: small scattered cervical lymph nodes are identified. muscles of mastication and parotid glands are symmetric. thyroid gland enhances homogeneously throughout. tracheostomy tube is noted and terminates approximately 4.3 cm above the level of the carina. there is marked gaseous distention of the tracheostomy balloon consistent with placement of an oversized device. the stent is seen in the left main stem bronchus. there is gaseous distension of the esophagus. the tracheostomy balloon corresponds to the palpable abnormality identified in the patient's anterior neck. visualized lung fields demonstrate patchy parenchymal opacities, most confluent in the right upper lobe. these are grossly unchanged since the prior study from and most likely represent chronic aspiration pneumonia. impression: 1) tracheostomy balloon appears to correspond to the palpable swelling in the neck. 2) stable appearance of patchy parenchymal opacities, most confluent at the right upper lobe, consistent with chronic aspiration pneumonia. ------ ct chest//pelvis : ct chest with iv contrast: as before, there is a very small ap diameter of the chest and abdomen. tracheostomy tube is noted in satisfactory position above the level of the carina. there is proximal gaseous distension of the trachea and proximal esophagus. the airways appear patent. no pathologically enlarged mediastinal, hilar, or axillary lymph nodes are identified. no mediastinal inflammatory changes are identified to suggest underlying mediastinitis. the heart, pericardium, and great vessels appear grossly normal. evaluation of the lung parenchyma again demonstrates patchy consolidation, most confluent within the right upper lobe, consistent with aspiration. there is a trace amount of right pleural fluid. ct of abdomen with iv contrast: there is vicarious contrast within the gallbladder. a small stone is visualized, but there are no seconday signs of cholecystitis. the liver, spleen, pancreas, kidneys, and adrenal glands are grossly normal in appearance. percutaneous gastrostomy tube is noted within the stomach. there are prominent fluid-filled loops of small bowel within the left hemiabdomen with more collapsed loops distallu without evidence of a true transition point or frank obstruction. there is no bowel wall thickening or surrounding inflammatory change. small to moderate amount of free ascites is present. there is no free air. ct of pelvis with iv contrast: a small amount of gas is visualized within a foley-containing urinary bladder. there is a moderate amount of free ascites within the pelvis. visualized collapsed pelvic loops of bowel appear grossly normal. bone windows: there is diffuse osteopenia of the visualized osseous structures. soft tissues are notable for profound cachexia and muscle atrophy. impression: 1. patchy parenchymal consolidation, most confluent within the right upper lobe. this most likely reflects aspiration pneumonia and is unchanged since the prior ct chest. 2. gaseous distension of the trachea and proximal esphagus as above, not significantly changed since the prior study. 3. small to moderate amount of free fluid within the abdomen and pelvis. 4. prominent, fluid-filled loops of small bowel within the left hemiabdomen with relatively collapsed loops distally. this could represent a partial small bowel obstruction or evolving obstruction. clinical correlation is recommended. ----- echo : the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity is unusually small. left ventricular systolic function is hyperdynamic (ef 80%). right ventricular chamber size and free wall motion are normal. the aortic valve is not well seen. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is no pericardial effusion. ----- egd : findings: esophagus: excavated lesions a fistula was found in the esophagus at 20cms. there was yellowish mucus seeping from the fistula into the esophagus. stomach: a gastrostomy tube was seen in the stomach body. duodenum: not examined. impression: esophageal fistula. brief hospital course: mr. hospital course will be reviewed by problems. 1. neck mass: in the icu, the patient's lung mechanics were suggestive of high airway resistance with elevated pips and plateaus 15-17. in am , the patient was noted to have increased work of breathing, with desaturation. a bedside flexible bronchoscopy was performed and revealed 80% occlusion of the tracheostomy tube with secretions, which were removed. pressures subsequently improved. also on , a rigid bronchoscopy was performed which showed tracheal distension at the cuff pressure site, with posterior tracheal wall necrosis. the site was bypassed with a longer trach repositioned above the carina. a small air leak was left to avoid further airway damage. 2. leukocytosis, hypothermia, tachycardia: in the icu, the patient was noted to be hypothermic, with rising wbc. cultures were sent and empiric antibiotic coverage was started with vanco/levo/flagyl. a ct chest ruled out mediastinitis, but revealed chronic rul destructive changes and query lll infiltrate. ct was without intraabdominal infection. lactate 1.7, mvo2 nl. antibiotics were continued until direction of care clarified. 3. te fistula: on , the patient was noted to have abdominal distension, with gastric distension evident on abdominal films. distension relieved with intermittent suction of peg tube. tef became was a concern, but available studies were limited given that the patient could not swallow or tolerate lying prone for a airway ct. of note, a ct on revealed small to moderate amount of ascites, no free air or obstruction. an egd was performed on , which confirmed the presence of a tracheoesophageal fistula visualized at 20 cm from teeth. no intervention was possible by ip or gi. ct surgery was informed. options were reviewed with the family. per family's wishes, the decision was taken not to proceed with surgery and to institute comfort measures only. hence, antibiotics, ivfs and nutrition were d/c'd on and the patient was made cmo. he was continued on his home ventilator. psychosocial support was offered, with involvement of the social worker, palliative care and dr. . on , per family's wishes, mechanical ventilation was stopped and the patient expired. medications on admission: zoloft 50mg po qd pepcid kcl 1tsp qd ativan 0.5mg po qd prn duralgesic q72h placed sat hyoscyamine 1ml q8h on hold discharge medications: expired discharge disposition: expired discharge diagnosis: muscular dystrophy chronic mechanical ventilation trachoesophageal fistula tracheal necrosis discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other endoscopy of small intestine other lavage of bronchus and trachea replacement of tracheostomy tube diagnoses: pneumonitis due to inhalation of food or vomitus unspecified hearing loss calculus of gallbladder without mention of cholecystitis, without mention of obstruction hyperosmolality and/or hypernatremia flatulence, eructation, and gas pain unspecified intestinal obstruction disorder of bone and cartilage, unspecified chronic respiratory failure tracheostomy status other specified disorders of esophagus mechanical complication of tracheostomy hereditary progressive muscular dystrophy 

Answer: The patient is high likely exposed to