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: dyspnea major surgical or invasive procedure: none. history of present illness: 56 yo m admitted overnight to micu after presenging to ed with fever, cough and need for nrb. treated for hap now stable for transfer to medical floor. pmh of recurrent aspiration pna, s/p transhiatal esophagectomy/pyloroplasty/hiatal herniorrohapy for high grade esophageal dysplasia in . patient initially presented to ed with 1 week of productive cough and low grade fevers and doe. in the ed, patient was febrile to 101.7 and was 83% on ra----->98% on nrb. he had a leukocytosis to 13.7 with left shift, elevated lactate to 2.2 and a lll infiltrated of . he was recently admitted late - early for recurrent multifocal aspiration pna. has had numerous similar admission following his surgery. in icu, was treated with vanc/zosyn overnight and solumedrol for presumed copd flare. he was stable for floor transfer. of note, patient has been evaluated by s&s, who felt that aspiration was due to gerd over silent aspiration. pt was evaluated by thoracic surgery in and recommended a roux-en-y. patient was evaluated in the icu. he currently feels comfortable on nasal cannula, no sob. denies cp, ha, change in vision, change in bowel habits, nausea or vomiting, dizziness or lightheadedness. past medical history: -esophageal ca s/p transhiatal esophagectomy/pyloroplasty/hiatal herniorrohapy in , no xrt or chemo, currently stable -hx of recurrent aspiration pneumonia, mrsa in bal from -diabetes ii -copd, intermittently on home o2 by nc when he feels short of breath -osa, refusing home cpap -gerd -hyperlipidemia -chronic back pain s/p back fusion for slipped discs. no hardware per patient. -diverticulosis -tuberculosis exposure at a young age, never treated. ppd positive per his report. exposures include grandparents from and backpacking in europe in the 70s. he was ruled out for active tuberculosis with 3 neg afbs in . social history: the patient is married, has 2 daughters. former (40pack-years), quit spring . used to be a heavy drinker in the 70s but no longer drinks. on disability for back issues. previously worked for family construction supplier business. family history: mother died of head/neck ca. father died of pulmonary issues related to copd/asbestosis/polio. physical exam: on transfer to floor: vs: 98.3 149/82 96 18 97% on 3l nc gen: nad, comfortable heent: eomi, perrl, no op lesions, mmm cv: regular no mrg pulm: decreased breath sounds throughout with scattered rhonchi and wheezing abd: obese, +bs, soft, ntnd ext: no , warm 2+ dp pulses b neuro: a/o x3 psych: appropriate pertinent results: admission : a suggestion of somewhat vague ill-defined opacity involving the left lower lobe, although this is compromised somewhat by ap portable technique and body habitus and may reflect an element of soft tissue attenuation. if further imaging is desired to help management, consider pa and lateral views in the radiology suite for more sensitive evaluation. discharge labs: - wbc-6.1 rbc-3.84* hgb-11.4* hct-33.8* mcv-88 mch-29.8 mchc-33.9 rdw-13.6 plt ct-269 - glucose-169* urean-11 creat-0.6 na-142 k-3.7 cl-103 hco3-30 angap-13 brief hospital course: 56 yo m with recurrent aspiration pneumonia after esophageal resection who presents with pneumonia initially required nrb, stabilized in icu and transferred to floor. treated for health-care associated pna with 8 days of iv vancomycin and zosyn. discharged off of oxygen with visiting nurse s teaching. #. healthcare-associated pneumonia: thought to be aspiration given multiple prior aspiration-associated pna. treated as hcap given recent hospitalization (discharged on ). to complete 8 days of iv vancomycin and zosyn, last dose on . also discharged on guaifenesin prn. patient's sulfacrate was stopped and ppi was decreased as they were thought to increase risk of pna by altering stomach acid. additionally, patient has been seen multiple times by speech and swallow at previous admission and has been instructed on specifics to reduced risk of aspiration. spoke with ct surgeon dr. who said there was not a surgical role. #. hemoptysis: had on admission, but only one episode. possibly bronchiectasis due to recurrent pneumonias though not . on recent ct chest. pt has been ruled out for tuberculosis by neg. afb x3, latest sample from . did not have repeated episodes. #. copd exacerbation. treated with short prednisone burst og 60 mg for 6 days, last dose . should have outpatient follow up with clinic for repeat spirometry given recurrent pneumonias. #. diarrhea: resolved prior to discharge. likely viral as family members have it as well. c. diff was not checked as patient did not have stool. #. dm2: held home metformin and covered with ssi. restarted home metformin upon discharge. #. hyperlipidemia: continued home statin. #. chronic back pain: pain was well controlled on home regimen of vicodin, lidocaine patches, celebrex, duloxetine, doxepin. medications on admission: 1. hydrocodone-acetaminophen 5-500 mg po q6h as needed for pain. 2. metoclopramide 10 mg po qidachs 3. montelukast 10 mg po daily 4. duloxetine 60 mg po daily 5. diazepam 10 mg po q12h as needed for anxiety. 6. oxycodone 40 mg tablet sustained release 12 hr po q12h 7. doxepin 300 mg po hs 8. butalbital-acetaminophen-caff 50-325-40 mg po q6h as needed for headache. 9. fluticasone-salmeterol 100-50 mcg/dose disk inhalation 10. multivitamin po daily 11. lidocaine 5 %(700 mg/patch) adhesive patch 12. celebrex 200 mg capsule po daily 13. metformin 500 mg po twice a day. 14. sucralfate 1 gram po qid 15. omeprazole 40 mg po twice a day. 16. simvastatin 80 mg po once a day. discharge medications: 1. hydrocodone-acetaminophen 5-500 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for pain. 2. metoclopramide 10 mg tablet : one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). 3. montelukast 10 mg tablet : one (1) tablet po daily (daily). 4. duloxetine 30 mg capsule, delayed release(e.c.) : two (2) capsule, delayed release(e.c.) po daily (daily). 5. diazepam 10 mg tablet : one (1) tablet po q12h (every 12 hours) as needed for anxiety. 6. oxycodone 40 mg tablet sustained release 12 hr : one (1) tablet sustained release 12 hr po q12h (every 12 hours). 7. doxepin 150 mg capsule : two (2) capsule po at bedtime. 8. fioricet 50-325-40 mg tablet : one (1) tablet po every six (6) hours as needed for headache. 9. fluticasone-salmeterol 100-50 mcg/dose disk with device : one (1) disk with device inhalation (2 times a day). 10. multivitamin tablet : one (1) tablet po daily (daily). 11. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily). 12. celecoxib 200 mg capsule : one (1) capsule po daily (). 13. metformin 500 mg tablet : one (1) tablet po twice a day. 14. simvastatin 80 mg tablet : one (1) tablet po at bedtime. 15. omeprazole 20 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 16. colace 100 mg capsule : one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*2* 17. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. disp:*60 tablet(s)* refills:*2* 18. guaifenesin 100 mg/5 ml syrup : 5-10 mls po q6h (every 6 hours) as needed for cough. disp:*500 ml(s)* refills:*0* 19. prednisone 20 mg tablet : three (3) tablet po once a day for 2 days. disp:*6 tablet(s)* refills:*0* 20. heparin, porcine (pf) 10 unit/ml syringe : ten (10) ml intravenous prn (as needed) as needed for line flush. disp:*30 flushes* refills:*0* 21. vancomycin in dextrose 1 gram/200 ml piggyback : one (1) gram intravenous q 12h (every 12 hours) for 5 days. disp:*10 gram* refills:*0* 22. piperacillin-tazobactam 4.5 gram recon soln : 4.5 gm intravenous every eight (8) hours for 5 days. disp:*68 grams* refills:*0* discharge disposition: home with service facility: home therapies discharge diagnosis: primary diagnosis: 1. aspiration pneumonia secondary diagnosis: 1. chronic obstructuve pulmonary disease 2. diarrhea 3. type 2 diabetes mellitus 4. hyperlipidemia 5. chronic back pain discharge condition: vitals stable. ambulating without difficulty or pain. discharge instructions: you were admitted with aspiration pneumonia. you were given iv antibiotics and improved with these medications. you are being discharged on iv antibiotics which you will receive until . please continue to take all your medications as prescribed. the following changes have been made: added: * zosyn iv until for pneumonia * vancomycin iv until for pneumonia * prednisone 60mg for 2 days for copd exacerbation * colace and senna to soften stools * cough medicine as needed changed: * omeprazole was decreased to 20mg once day (down from 40mg). stopped: * sulfacrate - you should stop taking this please adhere to the follow recommendations for eating: 1. po diet of thin liquids and regular solid consistencies. 2. pills may be taken whole with puree. 3. aspiration precautions: a. chin tucked to chest for small cup sips of thin liquids. b. repeat swallow after sips of liquids with chin still tucked to chest. c. no straws. d. cough intermittently when drinking liquids. e. follow reflux precautions (stay upright after meals, wait 2-3 hours after meal before going to bed, keep head of bed elevated above 30 degrees). if you have any of the following symptoms, please call your doctor or go to the nearest ed: fever > 101, chest pain, shortness of breath, abdominal pain, or any other concerning symptoms. it was a pleasure meeting you and participating in your care. followup instructions: , md (allergy) phone: date/time: 4:45 procedure: venous catheterization, not elsewhere classified diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux chronic airway obstruction, not elsewhere classified other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus personal history of malignant neoplasm of esophagus 

Answer: The patient is high likely exposed to