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 61-year-old male with multiple medical problems including chronic aspiration, chronic obstructive pulmonary disease, and tracheomalacia who was transferred from an outside hospital with respiratory failure and tracheomalacia for tracheal stenting by interventional pulmonology. the patient arrived intubated and was therefore unable to provide any history. per chart review from the outside hospital, the patient had a prolonged hospitalization for respiratory failure last year and had placement of a temporary tracheostomy and percutaneous endoscopic gastrostomy tube. over the last year he has had multiple recurrent admissions, and he is known to have tracheomalacia by bronchoscopy at . initial plans for surgery were postponed until the patient was weaned from his prednisone which proved difficult, and the patient's pulmonary status was likely compromised by aspiration in the setting of possible noncompliance with nothing by mouth. on , he had acute respiratory failure with hypoxemia, tachycardia, tachypnea, and a fever to 104 degrees fahrenheit. he was intubated with a subsequent return of a large amount of tube feeds from his endotracheal tube. he was started on vancomycin, gentamicin, and clindamycin. of note, the patient's wheezing and rhonchi improved after endotracheal tube placement. his initial chest x-ray showed bibasilar infiltrates (right greater than left), and he remained intubated on arrival to . past medical history: 1. aspiration pneumonia; status post percutaneous endoscopic gastrostomy tube. 2. chronic obstructive pulmonary disease; on 2.5 liters home oxygen. 3. tracheomalacia. 4. peripheral neuropathy. 5. gastroesophageal reflux disease. 6. coronary artery disease. 7. diabetes. 8. history of ruptured diverticulum requiring colectomy and ileostomy. 9. incisional abdominal hernia. allergies: the patient has no known drug allergies. medications on transfer: 1. clindamycin 600 mg intravenously three times per day. 2. decadron 4 intravenously q.6h. 3. colace 100 mg by mouth once per day. 4. prozac 60 mg by mouth once per day. 5. lasix 20 mg by mouth once per day. 6. neurontin 1600 mg by mouth three times per day. 7. subcutaneous heparin. 8. trimax 500 mg q.6h. 9. insulin sliding-scale. 10. nph 8 units subcutaneously twice per day. 11. combivent 8 puffs inhaled four times per day. 12. prevacid 30 mg by mouth twice per day. 13. singulair 10 mg by mouth at hour of sleep. 14. morphine 2 mg intravenously q.4h. 16. theophylline 200 mg by mouth twice per day. 17. vancomycin 1 gram q.18h. 18. itraconazole 200 mg by mouth twice per day. physical examination on presentation: on admission the patient's temperature was 98.6 degrees fahrenheit, his heart rate was 55, his blood pressure was 130/68, and his oxygen saturation was 98% on intubation. in general, the patient was intubated and sedated but arousable and comfortable. head examination was notable for pale conjunctivae. neck examination was notable for a right internal jugular in place. cardiovascular examination was notable for bradycardia and distant heart sounds. lung examination was notable for decreased breath sounds on the right laterally and at the bases, but otherwise clear with no wheezes or rhonchi. the abdomen was soft and nontender. there were positive bowel sounds. there was a colostomy on the right side with brown-appearing stool, pink stoma. a midline incision with a small hernia and no incarcerated bowel. no hepatosplenomegaly. extremity examination revealed pulses were intact with no edema. on neurologic examination, the patient was able to follow simple commands. he could squeeze hand and wiggle his toes bilaterally, but his strength and sensation were difficult to assess given his sedation. pertinent laboratory values on presentation: laboratories from the outside hospital on the day of transfer showed a white blood cell count of 5.4 (with 87% neutrophils and 3 bands). chemistry-7 with a potassium of 3.4, his creatinine was 0.7, and his glucose was 245. microbiology data from the outside hospital showed sputum with abundant klebsiella, and a second sputum sample with pseudomonas. pertinent radiology/imaging: a chest x-ray with bibasilar infiltrates; improved from previous study. an electrocardiogram had sinus bradycardia with normal axis and normal intervals. no significant q waves, and no st-t wave changes. concise summary of hospital course by issue/system: 1. pulmonary issues: the patient presented in respiratory failure likely secondary to multiple causes including his aspiration pneumonia, tracheomalacia, and underlying chronic obstructive pulmonary disease. the patient respiratory failure improved over several days in the medical intensive care unit with treatment of his aspiration pneumonia. repeat sputum cultures obtained at showed that his sputum continued to be positive for pseudomonas, and he was eventually on a regimen of ceftazidime and gentamicin with good results. he will be continued on a total of 21 days of these two antibiotics to insure that his pseudomonas pneumonia has completely resolved. tracheal stenting by interventional pulmonology was deferred until treatment of his pseudomonal pneumonia was effective in clearing pseudomonas from his sputum, as pseudomonas has a high likelihood of adhering to tracheal stents. this was successfully achieved after approximately one week to ten days on this antibiotic regimen, and two stents (one to his trachea and one to his left main stem bronchus) were placed without complications on by dr. . additionally, the patient's chronic obstructive pulmonary disease continued to be treated with his home regimen of singulair and meter-dosed inhalers as well as continuing his home oxygen once his pneumonia had resolved. 2. cardiovascular issues: while in the medical intensive care unit, the patient developed some abdominal pain that subsequently resolved with an unclear etiology. however, as part of the workup for this abdominal pain, and abdominal computed tomography was obtained with cuts through the lung bases which were significant for small nodules at the peripheral lung bases with cavitations raising a concern for a possible septic emboli and/or septic infarction. even though blood cultures had been negative while in house, a transesophageal echocardiogram was obtained to evaluate for possible endocarditis and possible source of these essentially septic emboli. the transesophageal echocardiogram revealed no vegetations on any of his valves; however, there was small echolucency just posterior to the posterior cuff of the aortic valve. the etiology of this was unclear; whether it was a normal anatomic variant involving possible fat pad in the pericardium or if this could possibly represent an abscess. a repeat transesophageal echocardiogram was recommended for followup. while here, approximately one week later, a repeat transesophageal echocardiogram was performed which showed absolutely no change in the size or location of this echolucency. additionally, no blood cultures had ever been positive, and the patient remained afebrile. therefore, it was felt that this was simply a normal anatomical variant and did not represent an abscess. 3. aspiration issues: the patient has an apparent long history of possible aspiration pneumonias and currently has a tracheostomy tube in place, as previous workups had in fact indicated that he was aspirating. however, suctioning of a large amount of tube feeds on intubation suggested that the aspiration might be secondary to reflux rather than to difficulties in swallowing. once he was extubated and on the floor, a speech and swallow evaluation was performed. the bedside evaluation revealed no difficulties with swallowing. this was followed up with a video swallow which again revealed no evidence for aspiration. therefore, tube feeds were discontinued and the patient was allowed to eat. he was maintained on aspiration precautions, however. additionally, we started reglan to increase gut motility and hopefully decrease the possibility of him aspirating from reflux. 4. hypotension issues: the patient had some trouble for several days with relative hypotension though he remained largely asymptomatic during these periods. this was easily and rapidly corrected by the administration of intravenous fluids as it had occurred in the setting of the patient being nothing by mouth for various tests. 5. question methicillin-resistant staphylococcus aureus issues: the patient was transferred with an apparent history of methicillin-resistant staphylococcus aureus at the outside hospital; however, information obtained from them about recent cultures showed no evidence of any recent methicillin-resistant staphylococcus aureus infection. therefore, the patient had a nasal swab and a perirectal swab while here at ; neither of which grew any methicillin-resistant staphylococcus aureus. therefore, the patient does not need to be on precautions for methicillin-resistant staphylococcus aureus. 6. diabetes issues: the patient's blood sugars were well controlled with an insulin sliding-scale and nph. 7. other medical problems: the patient's other medical problems (namely his peripheral neuropathy, depression, and chronic abdominal pain) were stable while he was in house, and his outpatient regimens were continued. the patient did well with a significant improvement in his respiratory status during his hospitalization; although, secondary to his prolonged course, he will need acute rehabilitation level care for physical and occupational therapy. note: the remainder of this dictation (namely discharge diagnoses, medications, and followup) will be dictated in a subsequent addendum. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances other lavage of bronchus and trachea other lavage of bronchus and trachea other lavage of bronchus and trachea other intubation of respiratory tract closed [endoscopic] biopsy of bronchus other repair and plastic operations on trachea other repair and plastic operations on bronchus removal of intraluminal foreign body from trachea and bronchus without incision diagnoses: esophageal reflux other pulmonary insufficiency, not elsewhere classified chronic airway obstruction, not elsewhere classified pneumonia due to pseudomonas pneumonitis due to inhalation of food or vomitus mechanical complication due to other implant and internal device, not elsewhere classified unspecified hereditary and idiopathic peripheral neuropathy ileostomy status 

Answer: The patient is high likely exposed to