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 63-year-old spanish-speaking gentleman with a history quadriparesis following a cervical crush injury approximately 10 years ago, history of tracheostomy at time of cervical crush injury, history of decannulation of tracheostomy, history of interstitial lung disease times 10 to 15 years of unknown etiology, and chronic obstructive pulmonary disease who was transferred from hospital on to the . the patient was in a good state of health until approximately 10 years ago when he had a crush injury to his neck resulting in quadriparesis. at that time, he was working underneath a motor vehicle when its support slipped. this resulted in quadriparesis with a prolonged hospital course, prolonged ventilation dependence necessitating tracheostomy placement. shortly after his original injury, the patient's tracheostomy was decannulated, and he was able to breathe independently. in the intervening years, he had a history of multiple recurrent pneumonias and bronchial infections. he was recently admitted to hospital on with a chief complaint of neck pain and abdominal pain. the patient has a history of chronic constipation requiring fleet enemas every other day. secondary to his abdominal pain and bloating, he is unable to tolerate his oral pain medication for his chronic neck pain. during that admission, he also developed bronchitis resulting in a chronic obstructive pulmonary disease flare. for the bronchitis, he was started on clindamycin, ciprofloxacin, and prednisone. a sputum sample from also showed yeast. the patient was started on diflucan. on , the patient had an episode of respiratory distress while at hospital resulting in decreased oxygen saturations on 3 liters nasal cannula oxygen to the low 80s. he was transferred from the medicine floor to the intensive care unit at hospital where he was intubated for hypercapnic respiratory failure. prior to intubation, the patient's chronic opiate use was attempted to be reversed with narcan with only transient improvement in his respiratory status. arterial blood gas at the time of intubation was a ph of 7.27, pco2 of 62, po2 of 115, and bicarbonate of 28. during his intensive care unit admission, he completed a 7-day course of ciprofloxacin and clindamycin. however, at hospital, the intensive care unit staff felt it difficult to wean the patient from the ventilator. this was felt to be multifactorial in nature secondary to the patient's history of hypercapnia from chronic obstructive pulmonary disease flare, neuromuscular weakness from his underlying quadriparesis, as well as poor lung reserve from his history of interstitial lung disease. therefore, he underwent tracheostomy and percutaneous endoscopic gastrostomy tube placement on . during the hospital course at hospital, the pulmonary staff noted abnormalities on his chest x-rays including bilateral pleural effusions. a chest computed tomography was performed at hospital with evidence of pleural thickening and loculated pleural effusions bilaterally. also noted was calcified lung parenchyma seen in the apices with retraction consistent with chronic lung disease. in light of these abnormalities, the patient's case was discussed with dr. (a thoracic surgeon a ). therefore, the patient was transferred to on in order to undergo open lung biopsy. the end goal was to establish a diagnosis or etiology for his interstitial lung disease. past medical history: 1. cervical spine injury at level c5; resulting in quadriparesis approximately 10 years ago (status post cervical crush injury). 2. chronic obstructive pulmonary disease. 3. interstitial lung disease times 10 to 15 years; etiology never characterized. 4. chronic pain; status post crush injury with intrathecal pump containing morphine, baclofen, and clonidine. 5. hypertension. 6. gastritis. 7. depression. 8. history of recurrent bronchial and pneumoniae infections. 9. history of tracheostomy; status post initial cervical spine injury. 10. sleep apnea (on -level positive airway pressure at night). 11. neurogenic bladder requiring suprapubic foley. 12. chronic constipation. medications on admission: (medications prior to admission included) 1. elavil 75 mg by mouth at hour of sleep. 2. fleet enemas every other day. 3. zoloft 200 mg by mouth once per day. 4. trazodone 100 mg by mouth once per day. 5. oxycontin 40 mg by mouth twice per day as needed (for pain). 6. oxygen 2 liters via nasal cannula. 7. prednisone (admits to being tapered). 8. albuterol meter-dosed inhaler. 9. atrovent meter-dosed inhaler. 10. flovent 110-mcg inhaler 2 puffs inhaled twice per day. 11. intrathecal pump containing morphine, baclofen, and clonidine. allergies: the patient has a reported allergy history of oral baclofen; however, please noted that baclofen is a component of his intrathecal pump and he tolerates this without a reaction. social history: the patient is a former 40-pack-year tobacco smoker. he quit smoking in . his is primarily spanish-speaking. he is married. he is confined to a chair and is dependent in all of his activities of daily living. code status: the patient is a full code. physical examination on presentation: physical examination upon admission revealed the patient's temperature was 97.2 degrees fahrenheit, his blood pressure was 128/63, and his heart rate was 66. ventilator setting on continuous positive airway pressure with pressure support tidal volume was 480 to 550, his respiratory rate was 14 to 19, and his oxygen saturation was 97% to 100% on these settings with a pressure support of 12, positive end-expiratory pressure of 5, fio2 of 0.40. general appearance revealed the patient was a well-developed obese gentleman who was depressed in appearance with a flat affect. in no acute distress. head, eyes, ears, nose, and throat examination revealed left internal jugular central venous line was in place. no erythema, edema, or purulent discharge from the internal jugular site. right neck with multiple ecchymotic lesions. otherwise, normocephalic and atraumatic. pupils were equal, round, and reactive to light and accommodation. the oral mucosa were moist. the neck was supple. no masses or lymphadenopathy. lung examination revealed coarse breath sounds anterolaterally with scattered rhonchi. cardiovascular examination revealed a regular rate and rhythm. normal first heart sounds and second heart sounds were auscultated. no murmurs, rubs, or gallops. the abdomen was obese, soft, nontender, and nondistended. quiet bowel sounds. positive percutaneous gastrostomy tube site. no evidence of erythema, edema, or purulent discharge around percutaneous endoscopic gastrostomy tube site. genitourinary examination revealed positive suprapubic foley catheter was in place. extremity examination revealed 2+ pitting edema to the mid thighs bilaterally. pertinent laboratory values on presentation: pertinent laboratories revealed complete blood count on admission with a white blood cell count of 8.1, his hemoglobin was 10.6, his hematocrit was 32.2, and his platelets were 351. coagulation profile revealed his prothrombin time was 13.6, his partial thromboplastin time was 24.1, and his inr was 1.2. serum chemistry revealed the patient's sodium was 136, potassium was 3.5, chloride was 97, bicarbonate was 34, blood urea nitrogen was 14, creatinine was 0.1, and blood glucose was 148. calcium was 8.1, phosphorous was 4.2, and magnesium was 2.4. liver function tests revealed his alt was 98, his ast was 35, his alkaline phosphatase was 74, his amylase was 69, his lipase was 80, and his total bilirubin was 1. his total protein was 5.5. albumin was 3.1. globulin was 2.4. urinalysis showed large blood, trace ketones, and 4+ urobilinogen. negative leukocyte esterase and nitrites. microanalysis revealed 3 to 5 red blood cells, 0 to 2 white blood cells, and occasional bacteria. urine culture grew greater than 100,000 enterococcus. pertinent radiology/imaging: studies available from hospital included an abdominal x-ray from with very few air/fluid levels present within nondilated small bowel loops. no free air was identified. no abnormal masses or abnormal calcification was seen. a chest computed tomography without contrast on at hospital showed pleural thickening with loculated pleural fluid present bilaterally. calcified lung parenchyma seen in both apices with retraction; consistent with chronic lung disease. diffuse air space and interstitial changes in both lungs could represent a combination of acute or acute-on-chronic changes. there were multiple enlarged mediastinal lymph node, the largest of which pretracheal at 1.5 cm. electrocardiogram from revealed a normal sinus rhythm at 80 beats per minute, normal axis, and a right bundle-branch block. there was a q wave noted in lead iii. no st-t wave changes when compared to study. concise summary of hospital course by issue/system: 1. respiratory failure issues: it was felt that the patient's respiratory failure and prolonged ventilator dependence was likely multifactorial in nature. namely, this was most likely contributed to by his hypercapnia secondary to his chronic obstructive pulmonary disease flare, his neuromuscular diminished strength secondary to his cervical spine injury, as well as poor lung reserve secondary to his interstitial lung disease. his airway mechanics were assessed via upright and supine studies. upright, his negative inspiratory force was negative 32 and his vital capacity was 410. supine his negative inspiratory force was negative 42 with a vital capacity of 500. the patient was slowly weaned from ventilation; primarily via decrease in his level to pressure support. he was continued wit aggressive pulmonary toilet and atrovent and albuterol meter-dosed inhalers. he was admitted on high-dose steroids which were initiated at the outside hospital. these were tapered during this hospitalization. he was able to tolerate weaning to a tracheostomy collar mask on . a venous blood gas on tracheostomy collar mask showed adequate oxygenation and ventilation. in light of the patient's history of persistent bilateral pleural effusions, an echocardiogram was ordered to assess for a possible cardiac component to his pulmonary edema. at the time of this dictation, the results of this study were still pending. 2. interstitial lung disease issues: on original admission, we were unable to get a full occupation, travel, and social history on the patient secondary to his depressed state and flat affect and nonparticipation in the history and physical. his occupational history was discussed with his wife who reported that the patient had previously worked as a chemical and insecticide sprayer. however, it was unclear if this contributed to his development of interstitial lung disease. although the differential diagnosis for interstitial lung disease is extremely broad, the patient's chest imaging was highly suggested of a upper lobe predominant process. this is more commonly due to sarcoid, silica, or coal exposure. ideally, the patient should undergo high-resolution computed tomography scanning when he is stable off the ventilator. in light of his underlying quadriparesis, it was felt that pulmonary function tests would not be revealing as the patient would likely have evidence of an obstructive process secondary to longstanding quadriparesis. in order to rule out a rheumatologic cause of his interstitial lung disease, antinuclear antibody and rheumatoid factor laboratory values were evaluated. these were both negative. the presence of the ground-glass, in addition to fibrotic and calcified changes on his computed tomography scan, were highly suggestive of an acute-on-chronic process. in light of the presence of both ground-glass as well as fibrotic and calcified changes on his computed tomography scan, it was felt that the patient was most likely suffering from an acute-on-chronic process in terms of his interstitial lung disease. therefore, there a possibility that an open lung biopsy; particularly a biopsy of an acutely inflamed or active area, could contribute much to understanding the etiology of his interstitial lung disease. therefore, the patient underwent an open lung biopsy on . the patient tolerated the procedure quite well. he was readmitted to the medical intensive care unit with a chest tube drain in place. he was able to have the chest tube removed on . he tolerated this well. at the time of this dictation, the tissue biopsy sample showed a gram stain with 2+ polymorphonuclear leukocytes, no antineutrophil cytoplasmic antibody organisms. tissue culture had no growth. anaerobic culture was still pending. an acid-fast smear was negative for acid-fast bacilli. acid-fast culture was still pending. a fungal culture showed no fungus isolated. additionally, there were no fungal elements on potassium hydroxide smear. studies for legionella were negative. immunofluorescent staining for pneumocystis carinii pneumonia were also negative. further discussion of the patient's laboratory and imaging findings with the pulmonary staff led us to the opinion that the patient's interstitial lung disease was most likely secondary to silicosis; however, this was a clinical diagnosis, and ultimately the final pathology should be followed up on. 3. delirium issues: status post biopsy, the patient had a waxing and mental status. a psychiatry consultation was obtained. they felt the patient's presentation was consistent with delirium. he was evaluated with a head computed tomography which was negative for any acute intracranial bleed or other intracranial process. thyroid-stimulating hormone levels were checked and were normal. the patient's outpatient psychiatric medications including zoloft, trazodone, and elavil were held. these can be reinstituted once his mental status is stable at his baseline. at the time of this dictation, the patient's mental status was much improved. 4. hypertension issues: upon admission, the patient was on a regimen on clonidine patch, hydralazine, and captopril. due to the effects of rebound hypertension with clonidine and hydralazine, the patient's clonidine and hydralazine were discontinued while he was in a monitored intensive care unit setting. his captopril dose was increased and should be titrated up further as needed for adequate blood pressure control. 5. gastritis issues: the patient was continued on his outpatient proton pump inhibitor dose. 6. chronic pain issues: the patient was continued on his intrathecal pump as well as morphine sulfate for breakthrough pain. 7. fluids/electrolytes/nutrition issues: the patient was tolerating tube feeds at goal. he was fitted with a passey muir valve by the speech and swallow department. in light of previous speech and swallow evaluations at hospital, the patient will be undergoing a video swallow examination on . the results of that evaluation were still pending. 8. infectious disease issues: the patient had a low-grade temperature on . he was pan-cultured. the results of this culture was pending at the time of this dictation. the patient's left internal jugular central venous line was removed. intravenous access was reestablished with a right femoral line. he was not started on any antibiotic therapy. the results of his cultures will be followed up by the accepting medicine team. 9. code status issues: the patient is a full code. 10. communication issues: the patient's plan of care was discussed extensively with his wife ). she serves as his primary health care decision maker when the patient is unable to make decisions for himself. the remainder of the patient's discharge summary including his condition on discharge, discharge status, discharge diagnoses, discharge medications, as well as follow-up plans will be dictated as a separate addendum to this report. , m.d. dictated by: medquist36 procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances transpleural thoracoscopy open biopsy of lung replacement of tracheostomy tube removal of thoracotomy tube or pleural cavity drain other surgical collapse of lung diagnoses: urinary tract infection, site not specified obstructive chronic bronchitis with (acute) exacerbation acute respiratory failure postinflammatory pulmonary fibrosis quadriplegia, unspecified tracheostomy status infection and inflammatory reaction due to other internal prosthetic device, implant, and graft late effect of spinal cord injury pneumoconiosis due to other silica or silicates 

Answer: The patient is high likely exposed to