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: lipitor / sulfa (sulfonamides) / clarithromycin / epinephrine / thiopental / tetanus / shellfish / iodine; iodine containing attending: chief complaint: transferred from osh for trach + peg micu transfer: pneumonia on vent major surgical or invasive procedure: -tracheostomy -g-tube placement -right thoracentesis history of present illness: 68f h/o 02-dependent copd, chronic hypercapneia, s/p mult admits in last 6mo's copd exacerbations, though never intubated until current admission, who was transferred to for trach and peg on . on arrival to , pt spiked fever to 103. workup of the fever revealed severe rll as well as large, loculated r pl. effusion (see full report below). trach and peg postponed to treat these issues. pt being transferred to micu service for management and tx of pna. . relevant recent hx includes admission to on w/ hypercarbic resp failure & ms changes. admission abg on was 7.13/>115/64 on of bipap. she was treated w/ iv steroids, abx, and lasix. she was thought to have copd exacerbation & pna, as well as possible chf exacerbation. pt failed bipap & required intubation. a triple lumen r-ij was placed on in the setting of hypotension: she reportedly had sbp into the 80s & required pressors for a short period--dopamine initially (which made her tachycardic) then vasopressin. cause for her hypotension is unclear. sputum from grew pseudomonas (sensitive to gent, tobra, cefepime, imipenem, and zosyn). because of this cx data, her abx were changed from levoflox to cefepime. bld cx's there were w/o growth. pt was started on tf via ngt. . despite tx, pt was unable to be weaned off of vent. abg on was 7.36/83/78 on ac , tv 450, fi02 45%. given overall picture, pt evaluated for trach & peg at osh; however, it was felt that she would be high risk for procedure given her kyphosis & body habitus, so she was transferred here for intervention. . on arrival to , pt was con't on cefepime for tx of pna as well as iv steroids & nebs for copd and dilt gtt for rapid afib. the day following admission, , wbc 20 (up from 15 day prior) and pt febrile to 103. she was started on vanc in addition to cefepime. she underwent chest ct which showed pna w/ large, complex effusion. additionally, ct showed possible filling defect in pulm artery, for which cta was recommended to further eval. however, b/c of pt's allergy to iodine, she did not undergo cta. pt underwent flex bronch on , which showed small white exophytic playw in rml (likely aspirated food). biopy x2 of rml orifice and bal of lll performed. ppd performed--result pending. . pt currently c/o dyspnea--stable since admission. she has had moderate amount of secretions. her afib has improved w/ regard to rate control. she was transitioned off dilt gtt and controlled with dilt po. . ros: pt notes no pain, including cp. fever y'day. feels "scared" about all that is going on medically. this is her first time being intubated. she feels like she needs lasix. no le swelling, she notes that she only has diabetes while on steroids. past medical history: -copd 02 dependent, chronic hypercapnia, never intubated prior to current admission -mild chf-->lved 40-45% on osh echo -mild pulm htn w/ pa pressure of 35mmhg by osh echo -p-afib-->not on coumadin, unclear why not ->pt reports this is only present while on steroids -kyphosis -pvd w/ le ulcers physical exam: vs: t: hr: 87 (70-110s) bp: 130/50 rr: 19 sat: 96 on ac 15/8, 0.45 gen: awake, alert, oriented x3, mouthing words/writing to communicate, sl uncomfortable appearing heent: ncat, perrl, sclera anicteric neck: supple, no lad, no jvd cv: rrr s1/s2, no m/r/g resp: roncherus w/ exp wheezes throughout anterior fields abdomen: soft, ntnd, bs+ ext: trace le edema dp pulses are 2+ bilaterally neuro: a + o x 3, cn ii-xii grossly intact, motor both upper and lower extremities skin: b/l le healed scars from old wounds/ulcers; scattered ecchymoses on b/l feet. skin warm. pertinent results: 08:21pm wbc-15.7* rbc-3.96* hgb-11.4* hct-34.7* mcv-88 mch-28.8 mchc-32.9 rdw-16.3* 08:21pm neuts-88* bands-0 lymphs-5* monos-7 eos-0 basos-0 atyps-0 metas-0 myelos-0 08:21pm glucose-295* urea n-18 creat-0.4 sodium-134 potassium-4.6 chloride-88* total co2-42* anion gap-9 08:21pm calcium-8.9 phosphate-2.2* magnesium-2.0 08:47pm type-art po2-58* pco2-47* ph-7.52* total co2-40* base xs-13 brief hospital course: 68f h/o severe copd, vent-dependent, planned for trach & peg on admission deferred after finding mrsa lll pna + b pleural effusions (l>r), treated with vanc/cefepime, also on heparin gtt for pe. . # mrsa pneumonia: pt was found to have lll pneumonia, initially considered cap vs. nosocomial as pt had been transferred from after being admitted there from home w/ pna, and because pt had been vented for over a week before transfer. pt received cefepime for pseudomonal coverage per osh cultures, and was started on vancomycin for mrsa in sputum. she should be continued on vancomycin and cefepime until . . # respiratory distress: pt originally intubated at osh because of hypercarbic failure related to severe copd, pna, and pleural effusions. pt found to have bilateral pleural effusions likely chronic process, and possibly related to previous infection (considered unlikely acute empyema). because of pna, pt initially continued on vent. a right-sided thoracentesis was performed on seeking to drain an effusion; this was complicated by the development of a pneumothorax which required the placement of a chest tube. bedside tracheostomy was subsequently performed by interventional pulmonology on . . # pulmonary embolism: ct w/o contrast demonstrated filling defect in pulmonary artery. pt administered heparin gtt and to r/o possible future pe source, bilateral lower extremity ultrasounds were obtained and confirmed no dvts. pt's outpatient mgt will require long-term anticoagulation. anticoagulation was held briefly in anticipation of her multple procedures; warfarin was re-started on . inr 1.3 on . . # copd, possible exacerbation: pt's baseline pulmonary function marked by severe copd with hypercarbia & baseline 02 requirement. pt was therefore maintained on nebulizers and guaifenesin, and was started on methylprednisolone (solumedrol) iv at 40mg iv q8h, which was tapered to 20mg q8h. before procedure, pt was maintained on stress-dose steroids. on , she was transitioned to 15 mg daily of po prednisone. this dose may be tapered as follows: 15mg on , 10mg on , 5mg on , 3mg on mg on and then discontinue. . # chf: pt uses furosemide 60mg daily as home regimen for baseline chf, and was restarted on furosemide 60mg qod to maximize respiratory capacity and was increased to 60mg po daily. she should continue on lasix 60mg po daily. . # type ii dm: per pt, elevated glucose only when steroids used. pt was initially placed on insulin gtt, which was then changed to nph 30units x1 dose am after micu transfer. nph was titrated to control sugars fs<150, and as of , was 20 units . this may require adjustment as steroids are tapered and eventually discontinued. . # afib: patient was rate-controlled initially on diltiazem gtt and later on diltiazem po. anticoagulation was held in the setting of surgial procedures but restarted on . continue warfarin and titrate to inr 2.0-3.0. . # nutrition: nutrition was consulted and recommended tube feeds as follows: half strength nutren 2.0 at 50ml/hour with 15g benepro, 1251kcal, 61g protein. medications on admission: medications on transfer: diltiazem 10 mg/hr iv drip infusion docusate sodium (liquid) 100 mg ng ipratropium bromide mdi 8 puff ih qid miconazole powder 2% 1 appl tp acetaminophen 650 mg po/pr q6h:prn albuterol 8 puff ih q6h:prn lorazepam 2-4 mg po/iv q4h:prn morphine sulfate 2-4 mg iv q1h:prn insulin sc heparin 5000 unit sc tid famotidine 20 mg po bid cefepime 1 gm iv q8h dexamethasone 4 mg iv q6h tobramycin-dexamethasone ophth oint 1 appl both eyes qid digoxin 0.25 mg iv daily metoprolol 5 mg iv q2-3h prn ibuprofen suspension 400 mg ng q6h:prn pain vancomycin 1000 mg iv q 12h ibuprofen suspension 400 mg ng q6h:prn pain discharge medications: 1. digoxin 250 mcg tablet sig: one (1) tablet po daily (daily). 2. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day) as needed. 3. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. 4. coumadin 5 mg tablet sig: one (1) tablet po once a day: please monitor inr until stable. 5. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 6. tobramycin-dexamethasone 0.3-0.1 % ointment sig: one (1) appl ophthalmic qid (4 times a day). 7. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day): hold for loose stools. 8. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 9. lorazepam 1 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety. 10. levalbuterol hcl 0.63 mg/3 ml solution sig: one (1) ml inhalation q6hr prn () as needed for sob, wheezing. 11. oxycodone 5 mg tablet sig: one (1) tablet po with dressing changes () as needed for administer 30 min prior to dressing changes. 12. insulin regular human 100 unit/ml solution sig: per sliding scale injection four times a day: per sliding scale. 13. insulin nph human recomb 100 unit/ml suspension sig: twenty five (25) units subcutaneous twice a day: require titration as prednisone is tapered. 14. furosemide 40 mg tablet sig: 1.5 tablets po daily (daily). 15. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours). 16. diltiazem hcl 30 mg tablet sig: one (1) tablet po qid (4 times a day). 17. prednisone 10 mg tablet sig: 1.5 tablets po daily (daily) for 1 days: to be followed by 10mg daily for 1 day then 5 mg daily for 1 day then 3mg daily for 2 days then discontinue. 18. cefepime 1 gram recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 2 days: to be completed on . 19. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 12h (every 12 hours): to be completed on . discharge disposition: extended care facility: hospital discharge diagnosis: primary diagnoses -ventilator dependent copd -mrsa lll pna and bilateral pleural effusions -tension pneumothorax -question of pe secondary diagnoses -chf -diabetes -atrial fibrillation discharge condition: good; discharge instructions: you are being transferred to a rehabilitation facility for further care and treatment to improve your breathing over the long-term. while at the rehab, be sure to alert your caregivers should you experience any fever, chills, chest pain or pressure, shortness of breath, nausea, vomiting or change in your bowel or urinary functions. followup instructions: schedule a follow-up appointment with dr. when you are discharged from your rehabilitation facility. . you were given the number for pulmonology clinic at . call ( to make an appointment. procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances thoracentesis percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus diagnoses: unspecified pleural effusion congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation infection with microorganisms resistant to penicillins obstructive chronic bronchitis with (acute) exacerbation other chronic pulmonary heart diseases acute respiratory failure iatrogenic pneumothorax other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation methicillin susceptible pneumonia due to staphylococcus aureus pressure ulcer, lower back kyphosis (acquired) (postural) other pulmonary embolism and infarction atherosclerosis of native arteries of the extremities with ulceration ulcer of calf 

Answer: The patient is high likely exposed to