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: trach obstruction major surgical or invasive procedure: flexible bronchoscopy through the tracheostomy tube. 1. rigid bronchoscopy using the dumon yellow tracheoscope. 2. flexible bronchoscopy. 3. tracheostomy tube change from #7 to #8 adjustable placed at 12 cm. history of present illness: pt is a 74 y/o morbidly obese male s/p hypercapnic resp failure s/p trach now complicated by granulation tissue at distal end of the trach. admitted to on with respiratory distress and ams, found to be in renal failure and chf with increased troponin question leak vs nstemi. transfered to on . developed respiratory distress, emergently intubated on with suction of purulent secretions. on vanc and cefepime for possible pna until . transfered to medical center icu for management of airway. underwent tracheostomy on , peg placement . transfered back to on for weaning of mechanical ventilation and further management. on , patient had increased respiratory distress, patient had bronch and 2 trach changes, now with #7 in place. found to have granulation tissue obstructing the distal end of his trach. he is now transfered to for further management of his airway and operative management of trach obstruction. past medical history: morbid obesity hypoventilation syndrome with osa cpap/o2 at home, hx of non-compliance htn iddm chf ef 45% () hypothyroidism social history: exsmoker quit 10 years ago family history: non-contributory physical exam: vs: t: 99.3 hr: 83 bp: 97/39 sas: 100% cpap 50% 16/618/10 general: no apparent distress neck: trach in place pertinent results: wbc-12.9* rbc-2.87* hgb-8.3* hct-26.1* plt ct-303 wbc-20.4* rbc-3.43* hgb-9.7* hct-31.3* plt ct-429 wbc-19.1* rbc-3.50* hgb-9.8* hct-32.2* plt ct-354 neuts-89.2* lymphs-6.0* monos-3.8 eos-0.7 baso-0.2 glucose-218* urean-79* creat-1.6* na-135 k-4.5 cl-91* hco3-37 glucose-173* urean-77* creat-1.7* na-137 k-5.2* cl-84* hco3-43* type-art po2-77* pco2-73* ph-7.38 caltco2-45* base xs-13 cultures: bal 4+ pmn normal flora urine cx pending blood cultures: no growth to date cxr: findings: in comparison with the study of , there is progressive clearing of the right base. some persistent atelectatic changes or effusion at the left base. stable enlargement of the cardiac silhouette. right lower lobe collapse is new. left upper lobe collapse has resolved. moderate left basal atelectasis present but improved. tracheostomy tube is in standard placement. partial opacification of the entire tracheobronchial tree suggests considerable retention of secretions. heart is probably large but difficult to assess given the low lung volumes. left lung is almost entirely collapsed, reflected in a uniform opacification and ipsilateral mediastinal shift. heterogeneous opacification in the right upper lung could represent incipient collapse or pneumonia. heart size is obscured. brief hospital course: mr. was transferred for further trach management. on a flexible bronchoscopy showed granulation tissue that was completely occluding the lumen of the trachea. he was immediately taken to the operating room for rigid and flexible bronchoscopy; tracheostomy tube change from #7 to #8 adjustable placed at 12 cm. of note: the previously-placed shiley #7 at an outside hospital tracheostomy tube and introduced our flexible bronchoscope through the stoma and were able to visualize the subcutaneous tissue which was previously thought to be central airway obstruction. the tube was passed into the trachea. #8 adjustable tracheostomy tube was then introduced via the stoma. repeat flexible bronchoscopy revealed granulation tissue in the subglottic region, vocal cord edema, and supraglottic edema. the patient was receiving adequate volume through the ventilator and maintaining his oxygen saturation very well. he was transferred back to the surgical intensive care unit in stable condition. pulmonary: his oxygen saturations remained in the high 90's on cpap 50%. aggressive pulmonary toilet and nebs were continued. his trach was changed to a #7 . attempted to wean from ventilator patient became tachypnic, saturation 90-92% .50% fio2 but the patient complained of shortness of breath (high anxiety) on t-tube. id: his wbc was elevated. he was pan cultured. ua was positive he was started on vanco and zosyn empirically then converted to cipro 500 mg x 3 days. he wbc on was 12.9. he remained afebrile throughout his stay. miconazole powder to groin region. cardiac: immediately postoperatively he required small amount of neo for blood pressure support. he was immediately wean off with sbp 100's. he remained in sinus rhythm. gi: benign. peg in place. renal: cre 1.6 with gentle diuresis. on admission 1.7. urine output good. endocrine: was maintained on a sliding scale insulin nutrition: tube feeds were resumed replete with fiber at 50 ml/hr disposition: he returned to . medications on admission: asa 325mg po daily lasix 20mg po daily amlodipine 7.5mg po daily lopressor 50mg po q8h riss flunisolide inh 2 puffs colace 100mg po bid miconazole powder nexium 40mg po daily tube feeds: jevity 1.2 goal 70cc/hr plus 210cc free water q6h discharge medications: 1. insulin sliding scale glucose insulin dose 0-50 mg/dl 1 amp d50 51-150 mg/dl 0 units 151-200 mg/dl 4 units 201-250 mg/dl 6 units 251-300 mg/dl 8 units > 300 mg/dl notify m.d. 2. lorazepam 1 mg tablet : one (1) tablet po bid (2 times a day). 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : 1-2 puffs inhalation q4h (every 4 hours) as needed for wheezing. 4. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 5. metoprolol tartrate 25 mg tablet : three (3) tablet po tid (3 times a day). 6. amlodipine 5 mg tablet : two (2) tablet po daily (daily). 7. aspirin 325 mg tablet : one (1) tablet po daily (daily). 8. ciprofloxacin 500 mg tablet : one (1) tablet po q12h (every 12 hours) for 5 doses. 9. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day) as needed for fungal rash. 10. ipratropium-albuterol 18-103 mcg/actuation aerosol : puffs inhalation q6h (every 6 hours). 11. docusate sodium 50 mg/5 ml liquid : ten (10) ml po twice a day: via peg. 12. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). discharge disposition: extended care facility: - discharge diagnosis: trach mislplaced/trach obstruction discharge condition: stable discharge instructions: please call dr. with any questions or concerns . call with fevers greater than 101.5 call lwith increased cough secretions or shortness of breath. followup instructions: patient needs to follow up with his pcp in the next few weeks. md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances other bronchoscopy closed [endoscopic] biopsy of bronchus bronchoscopy through artificial stoma bronchoscopy through artificial stoma replacement of tracheostomy tube replacement of tracheostomy tube diagnoses: acidosis other iatrogenic hypotension obstructive sleep apnea (adult)(pediatric) urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism alkalosis morbid obesity gastrostomy status chronic respiratory failure dependence on respirator, status other tracheostomy complications sleep related hypoventilation/hypoxemia in conditions classifiable elsewhere surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation 

Answer: The patient is high likely exposed to