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: inability to replace trach at home major surgical or invasive procedure: tracheostomy replacement history of present illness: pt is a 65 y.o male with h.o severe osa (central and peripheral), who is usually trached with cannula who presents after trach had not been in place for a few days. pt ordinarily changes his trach by himself q3months. however, on this occasion, it was too difficult to replace and now the trach has been off for a few days. pt did go to local er yesterday (), but he was unable to have the trach replaced and was noted to have significant granulation tissue at the stoma site. . in the ed, initial vs were: t p bp r o2 sat. + 17:15 0 98.4 68 146/94 20 96 ip was consulted and observed that ordinarily pt needs to close the stoma to talk and now can talk without closing the stoma. ip suggests bipap overnight. if pt required intubation, the cuff would have to be placed below the stoma. ip is planning to do a rigid bronch tomorrow to either revise the stoma vs. place a t-tube. . pt states that over the last few months, he has noticed increased difficulty when changing his trach every 4-6months. this week, pt noticed increased difficulty when changing his trach, a few days ago, he also noticed that something did not feel right after he coughed and eventually the tube feel out and pt was unable to replace it. in addition, pt states he has had a multiple revisions and was told there is a great deal of scar tissue at the site. he has not tolerated bypap in the past and states he uses 4l at tm at night at baseline. . on the floor, pt feels well. he denies sob/pnd, fever/chills, cp/palp, uri/cough, abd pain/n/v/d/c/melena/brbpr/dysuria/hematuria, skin rash, +chronic b/l ankle pain. however, pt reports that he has been unable to sleep for the last 3 days trach malfunction, he has been sleeping upright and did awake with an am headache yesterday. in addition, he reports palp ~1months ago, with a reportedly negative w/u. past medical history: -obstructive and central sleep apnea-dx 20 years ago s/p uvulopalatopharyngoplasty, multiple attempts with cpap,tracheostomy eight years ago. -hypothyroid -oa -asthma social history: works in sales, selling sheet metal. he lives with his wife, drinks 1 etoh drink daily, denies any w/d symptoms or seizures, denies drug use. family history: sister with dm physical exam: pe on admission: vitals: t 97.3, bp 145/77, hr 76, rr 18 sat 87-93% on ra general: alert, oriented, no acute distress, occasional sounds of air from trach. heent: nc/at, perrla, sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad, +trach site with granulation tissue, pink mucosa, no drainage/c/d/i. lungs: b/l ae +crackles at bases, no w/r cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 08:34pm blood wbc-7.1 rbc-5.27 hgb-15.8 hct-48.3 mcv-92 mch-30.0 mchc-32.8 rdw-13.5 plt ct-219 08:34pm blood neuts-52.9 lymphs-34.9 monos-7.2 eos-4.1* baso-0.9 08:34pm blood pt-12.1 ptt-26.5 inr(pt)-1.0 08:34pm blood glucose-95 urean-16 creat-0.9 na-140 k-4.1 cl-105 hco3-27 angap-12 04:12am blood alt-34 ast-32 ld(ldh)-184 alkphos-58 totbili-0.9 04:12am blood albumin-4.4 calcium-9.3 phos-3.6 mg-2.1 . cxr: lateral aspect of the left lower chest is excluded from the examination. other pleural surfaces and the imaged portions of the lungs are clear. heart size is normal. trachea is grossly intact, but not fully imaged by this type of examination. pending upon clinical circumstances, chest ct should be considered. brief hospital course: pt is a 65 y.o male with h.o severe osa (central/peripheral) s/p trach who now presents s/p trach dislodgement. . # airway management - pt with h.o severe osa who failed trials of cpap in the past. pt with trach x15+ yrs per history. now, has been a few days w/o trach in place and with evidence of granulation tissue and healing stoma. ip consulted and recommended micu observation o/n. rigid bronch was performed and they were able to balloon dilate the stoma and replace the trach. they used the same type as before. see omr for procedure note. he tolerated the procedure well and came back to the micu with his new trach in place and capped. he was talking and without pain. his oxygenation was normal. ip saw patient on the floor and cleared him for home with follow up in two weeks to have the stitch in his trach removed. he will now have it exchanged in office visits rather than at home. . #osa-with management as above. pt with h.o central and peripheral sleep apnea. did fine overnight with humidified air over stoma. trach now back in place. . #asthma-home advair, albuterol, ipratropium were continued. . #hypothyroidism-continued home levoxyl. discharged home in good condition post-op. patient was advised not to drive for 24 hrs after getting sedation. medications on admission: glucosamine-chondroitin 250 mg-200 mg cap advair diskus 500 mcg-50 mcg/dose for inhalation 1 puff twice a day salmon oil-1000 1,000 mg-200 mg cap multivitamins chewable tab ventolin 5 mg/ml (0.5 %) neb solution 1 puff as neded levothyroxine 125 mcg tab 1 tablet(s) by mouth rhinocort aqua 32 mcg/actuation nasal spray 1 puff twice a day ipratropium bromide 0.03 % nasal spray aerosol 1 as needed discharge medications: 1. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 2. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) puff inhalation q6h (every 6 hours) as needed for sob/wheeze. 4. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. rhinocort aqua 32 mcg/actuation spray, non-aerosol sig: one (1) puff nasal twice a day. discharge disposition: home discharge diagnosis: primary: obstructive sleep apnea . secondary: asthma hypothyroidism osteoarthritis discharge condition: good. discharge instructions: you were admitted because your trach fell out and you were unable to replace it. the interventional pulmonary physicians replaced your trach site and sutured it. you will need to have the sutures removed in 2 weeks. . please resume taking all medications as you were previously taking prior to admission. . please call dr. if you develop significant pain at the trach site, increased redness or drainage from from the site, difficult breathing, or any other concerns. followup instructions: please follow up with dr. in 2 weeks for removal of the sutures. they will call you to schedule this appointment. his phone number is . procedure: other bronchoscopy revision of tracheostomy replacement of tracheostomy tube diagnoses: obstructive sleep apnea (adult)(pediatric) unspecified acquired hypothyroidism asthma, unspecified type, unspecified osteoarthrosis, unspecified whether generalized or localized, site unspecified mechanical complication of tracheostomy 

Answer: The patient is high likely exposed to