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: the patient is a 78 year old female with a history of idiopathic tracheomalacia status post tracheostomy on bipap at night who presents as transfer from an another hospital on for tracheotomy and stent placement. the patient was initially admitted to an outside hospital on with mental status changes and in acute respiratory distress. she had undergone tracheostomy change on . later that day at approximately 10 pm she noticed increasing dyspnea, particularly while lying flat with increased frothy and blood-tinged secretions. reportedly she called emergency medical services and then went to the hospital. on arrival to , the patient was found to be minimally unresponsive with respiratory rate in the 30s. she ultimately progressed to hypoxic and hypercarbic respiratory failure. there an arterial blood gas showed values of 7.09/ carbon dioxide 118/oxygen 88 on 6 liters of nasal cannula oxygen. she was treated for a chronic obstructive pulmonary disease exacerbation with decadron, nebulizers, and ceftriaxone and azithromycin. she was also treated for congestive heart failure exacerbation with lasix and ace inhibitor. initially she required assist control mechanical ventilation but it rapidly improved allowing weaning of her oxygen back down to 30% tracheostomy collar mask during the day and her normal bipap settings at night. as the patient has had progressive dyspnea on exertion, and frequent hospitalizations for respiratory failure, plan was made to transfer her for y stent placement at to prevent further tracheal collapse. she was admitted on , to the medical intensive care unit. she stayed there over night. she was transferred onto a regular medicine floor on . attempt at stent was made on . bronchoscopy at that time noted severe right and left main stem tracheobronchomalacia greater than 99% and 90% respectively, however, the procedure is complicated by a left main stem endobronchial tear and therefore aborted. however, tracheostomy revision was completed. the patient was placed on cpap pressure support for ventilator support. post procedure imaging indicated evidence of a pneumomediastinum. therefore she was started on empiric antibiotics, namely zosyn out of concern for her mediastinitis. she was therefore then transferred back to the medicine intensive care unit for further monitoring. her medicine intensive care unit course was notable for some extension of the pneumomediastinum, post procedure, associated with chest pain, shortness of breath, agitation and intermittent left lower lobe collapse. she also complained of chest pain and shortness of breath on . this was treated with metered dose inhalers, morphine, and nitroglycerin. the cardiac enzymes were cycled and the patient was ruled out for myocardial infarction. since that time she had remained hemodynamically stable with no evidence of pneumopericardium, tamponade or infection. serial chest x-rays demonstrated resolution of the pneumomediastinum. repeat bronchoscopy was performed on and showed severe tracheobronchomalacia in both main stem bronchi. the left main stem tear appeared to have healed completely. the right side was notable for milky secretions. bronchoscopy was repeated on for therapeutic aspiration of purulent right-sided secretions. the patient was able to be weaned back to her baseline daytime tracheostomy collar setting with bipap at night. steroids were weaned as well. nutritional goals were originally not with tube feeds. she did, however, pass a speech and swallow evaluation on followed by video stroboscopy on and was not able to tolerate a regular diet. of note, the stroboscopy showed right vocal cord paralysis which she felt to be a complication of her longstanding tracheobronchomalacia. after completing a seven day course of zosyn as well, she was deemed stable for transfer out to the floor pending stent provision. the patient underwent stent revision on with no immediate post procedure complications. past medical history: 1. idiopathic tracheobronchomalacia, status post tracheostomy, status post attempted stent revisions. 2. gastroesophageal reflux disease. 3. depression. 4. osteoporosis. 5. coronary artery disease, status post myocardial infarction in with catheterization in showing a 50% lesion in the left anterior descending coronary artery with no intervention performed at that time. 6. congestive heart failure with an ejection fraction of 45% and evidence of concentric left ventricular hypertrophy on echocardiogram from with question of some diastolic dysfunction. 7. hypertension. 8. hypercholesterolemia. 9. history of methicillin-resistant staphylococcus aureus positive sputum. 10. polymyalgia rheumatica on home steroid regimen of prednisone 10 mg p.o. q. am and 5 mg p.o. q. pm. 11. anxiety. medications prior to admission: 1. zocor 20 mg p.o. q.h.s. 2. aspirin 325 mg p.o. q.d. 3. zoloft 25 mg p.o. q.d. 4. accupril 20 mg p.o. q.d. 5. lopressor 75 mg p.o. b.i.d. 6. protonix 40 mg p.o. q.d. 7. azithromycin 500 mg p.o. q.o.d. 8. lasix 80 mg p.o. q.d. 9. prednisone taper. 10. albuterol 2 puffs inhaled q. 6 hours 11. atrovent nebulizers t.i.d. allergies: the patient reports no known drug allergies. social history: the patient lives with her husband, no alcohol or tobacco use. she has a history of prior pesticide exposure which is postulated to be the possible etiology of her tracheobronchomalacia versus idiopathic causes. family history: non-contributory. physical examination on admission: vital signs showed temperature 98.4, pulse 72, blood pressure 139/40, respiratory rate 20, oxygen saturation 92% on 30% tracheostomy collar mask. general appearance: well-developed, obese, well-appearing female in no acute distress. head, eyes, ears, nose and throat: moon facies, arcus senilis, pupils equal, round and reactive to light and accommodation. oral mucosa is moist. neck: tracheostomy site and collar unremarkable. tracheostomy site clean, dry and intact. jugulovenous pressure at 7 cm of water. neck supple with no masses. lungs: transmitted upper airway sounds. positive scattered bilateral expiratory and inspiratory wheezing. no rhonchi, no rales. cardiovascular: regular rate and rhythm, normal s1 and s2 heart sounds auscultated. no murmurs, rubs or gallops. abdomen: soft, nontender, nondistended, positive normoactive bowel sounds. no hepatosplenomegaly. extremities: 1+ pitting bipedal edema to the knees, with 2+ dorsalis pedis and posterior tibial pulses. neurologic: alert and oriented times three. cranial nerves ii through xii grossly intact. upper extremity and lower extremity motor strength bilaterally. sensation is grossly intact to light touch. laboratory data, x-rays and other studies: complete blood count on admission showed white blood count 10.8, hematocrit 36, glucose 247. serum chemistries showed sodium 142, potassium 2.9, chloride 101, bicarbonate 33, bun 21, creatinine 0.6, glucose 101, calcium 8.5, phosphorus 2.7, magnesium 1.9. liver function tests showed ast 14, alt 18, alkaline phosphatase 48, albumin 315, total bilirubin 0.4, ldh 220. electrocardiogram from , showed sinus tachycardia with poor r wave progression. there was 0.1 to depressions in leads v4 and v5, questionably in lead 6 as well. t wave flattening was noted in leads adl and lead 1. hospital course: 1. tracheobronchomalacia - this was felt to be idiopathic in etiology versus related to the patient's prior history of pesticide disorder. she was transferred here for a planned y stent procedure. attempt was made at y stent on , however, this was complicated by left main stem endobronchial tear and development of a pneumomediastinum. as such, the patient was monitored for several days in the medical intensive care unit for hemodynamic and respiratory monitoring. she completed the seven day course of zosyn as prophylaxis against mediastinitis. she underwent a video stroboscopy which demonstrated evidence of right vocal cord paralysis which is likely a complication of her tracheobronchomalacia. status post the endobronchial tear, she did require increased ventilatory support but was able to wean back to a baseline setting of tracheostomy collar during the day with bipap at night over the course of several days. her prednisone was tapered down to a baseline of 10 mg p.o. q. am and 5 mg p.o. q.h.s. she was treated symptomatically with aggressive pulmonary toilet and nebulizer treatment. additionally, she underwent two repeat bronchoscopies for aspiration of purulent secretions in the right side of the lung as well as interval evaluation of the endobronchial tear. of note, the endobronchial tear appeared to have resolved. she underwent repeat attempt at stent placement on . stents were placed in the main stem bronchi bilaterally. there were no immediately complications of this procedure. 2. congestive heart failure - the patient was continued on afterload reduction with ace inhibitor and lopressor therapy. lopressor was titrated up as tolerated by her blood pressure and heart rate. lasix was used no a prn basis with daily assessment of her volume status and use of lasix to keep her euvolemic. she followed a 2 gm sodium diet with fluid restricted to 1.5 liters daily and had strict inputs and outputs and fluid analysis calculated. 3. coronary artery disease - the patient has a history of coronary artery disease, status post myocardial infarction in . she did have one episode of chest pain while she was in the medical intensive care unit. at that time chest pain was relieved with morphine and nitroglycerin. the cardiac enzymes were cycled at that time and were negative for any evidence of myocardial infarction or ischemia. she was continued on aspirin, beta blocker, zocor. the beta blocker was titrated up as tolerated by her blood pressure. 4. diarrhea - with the onset of tube feeds while in the medical intensive care unit, the patient had diarrhea. several changes were made to her tube feeding regimen but the diarrhea persisted. as she had recently had a course of antibiotics, namely zosyn, clostridium difficile toxin was evaluated. at the time of this dictation, two clostridium difficile toxin assays were negative. toxin #3 is pending. 5. gastroesophageal reflux disease - the patient was continued on outpatient dose of proton pump inhibitor. while she was in the medicine intensive care unit with evidence of pneumomediastinum and was npo, she had high dose proton pump inhibitor therapy. 6. fluids, electrolytes and nutrition - the patient was initially npo after transfer back to the medicine intensive care unit, status post endobronchial tear. she did, however, pass a speech and swallow evaluation. additionally she underwent a video swallowing study and video stroboscopy which demonstrated some right vocal cord paralysis. she continued on a 2 gm sodium heart healthy diet. electrolytes were followed serially and repleted. 7. code status - the patient is a full code. an interval addendum will be added by the next intern covering this service with future information regarding the hospital course, discharge condition and disposition, and discharge addendums, diagnosis and medications. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more other bronchoscopy other bronchoscopy non-invasive mechanical ventilation other intubation of respiratory tract other intubation of respiratory tract closed [endoscopic] biopsy of bronchus other operations on trachea other operations on trachea revision of tracheostomy replacement of tracheostomy tube bronchial dilation bronchial dilation removal of intraluminal foreign body from trachea and bronchus without incision diagnoses: congestive heart failure, unspecified unspecified essential hypertension accidental puncture or laceration during a procedure, not elsewhere classified pulmonary collapse acute respiratory failure intestinal infection due to clostridium difficile mechanical complication of tracheostomy 

Answer: The patient is high likely exposed to