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: morphine / amlodipine attending: chief complaint: transfer for nstemi, respiratory failure major surgical or invasive procedure: intubation central line placement history of present illness: 82m h/o htn, chronic back pain presented at 10:30am to dr. office at complaining of 2 days chest congestion and nausea. he denied chest pain, but for the chest congestion he had been using a heating pad with some improvement allowing him to sleep. on further review, he had been feeling somewhat unwell for 4-5 days with increased doe, easily fatiguable, and some breathlessness at rest noticed by his wife. denied orthopnea, pnd, lower extremity edema. was having nausea, dry heaves, and anorexia. the night prior to presentation he developed fever to 101.6f, and was also complaining of nasal congestion and cough. history is otherwise per transfer notes and limited due to patient intubated and sedated. . at the osh, he remained chest pain free but was noted to have new deep precordial t-wave inversions. cardiac enzymes revealed tni 8.0 and ck 287. he was given asa 325, beta-blocker, and started on a heparin iv gtt with plans for medical management of nstemi pending further clincial change. an echo showed mild global hk and new depressed ef 35-40%. . the evening prior to transfer the patient became increasingly dyspneic. cxr was consistent with acute pulmonary edema and he was given iv nitro and lasix without significant improvement. he was intubated and became hypotensive with sbp 70s. transferred to ccu for further care. . on review of systems, per hpi and otherwise limited due to intubation/sedation. according to osh records, the patient denied chills, abdominal pain, diarrhea, urinary frequency, or dysuria at presentation. . cardiac review of systems is notable per hpi. past medical history: 1. cardiac risk factors: dyslipidemia, hypertension 2. cardiac history: no known cardiac history -?cad -?afib 3. other past medical history: past medical history: -hypertension -asthma -dyspnea on exertion -nocturia -arthritis -chronic low back pain due to severe degenerative disease -spinal stenosis -transaminitis, possibly due to history of alcohol abuse -rosacea . past surgical history: -s/p laminectomy of l4-5 in -s/p repair of a deviated septum in , knee surgery in , open reduction internal fixation of the right wrist in the and a right carpal tunnel release. social history: married, otherwise unknown occupation. -tobacco history: none. -etoh: prior heavy use, but not recently per wife according to transfer notes. -illicit drugs: none. family history: per old discharge summ his father died at 65 from a stroke. brother had a cabg, died at 65. mother died at 65 of heart failure. physical exam: on admission - vs: t=102.8 bp=94/55 hr=79 rr=27 o2 sat= 99% on cmv,fio2 100, peep 5 general: elderly man intubated and sedated in nad. able to follow commands, move all extremities heent: perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 13 cm. cardiac: mild burns on left anterior chest with erythema, no tenderness. pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: rhonchorous anteriorly abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. there is a burn from a hot water bottle in the left precordial area. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: ========== labs ========== on admission - 02:50am blood wbc-8.4 rbc-3.55* hgb-12.2* hct-35.7* mcv-101* mch-34.3* mchc-34.1 rdw-13.2 plt ct-98* 02:50am blood neuts-72* bands-8* lymphs-10* monos-8 eos-0 baso-0 atyps-2* metas-0 myelos-0 02:50am blood glucose-122* urean-35* creat-2.0* na-133 k-3.8 cl-97 hco3-21* angap-19 02:50am blood alt-118* ast-193* ld(ldh)-366* ck(cpk)-276* alkphos-36* totbili-1.0 04:24am blood alt-66* ast-116* alkphos-58 totbili-4.9* dirbili-4.1* indbili-0.8 05:00am blood anca-negative b 05:00am blood -negative 02:50am blood triglyc-136 hdl-37 chol/hd-4.0 ldlcalc-83 . on discharge : bun 30, creat 1.9, hct 27.3, wbc 12.8, bc ngtd gram stain (final ): <10 pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. ========= micro ========= respiratory culture (final ): heavy growth oropharyngeal flora. staph aureus coag +. moderate growth. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s . ============ radiology ============ ct chest ground-glass opacities with central distribution, although more prominent on the right than on the left, are most consistent with pulmonary edema, with small right greater than left pleural effusions. no definite infectious process seen, although enhancement pattern of the pleural effusion cannot be assessed without iv contrast. . ruq u/s 1. diffusely echogenic liver, compatible with fatty infiltration. other forms of liver disease and more advanced liver disease including fibrosis/cirrhosis cannot be excluded on this study. no focal hepatic lesion. 2. no biliary ductal dilatation. . ct torso 1. worsening bilateral pulmonary edema, although underlying pneumonia remains an increasingly likely possibility given persistent fevers. 2. endotracheal tube tip is 1.5 cm above the carina . ct chest 1. improved multifocal consolidations, no evidence of lung abscess. it is a combination of improved pulmonary edema and pneumonia. 2. decrease in size of bilateral pleural effusions. . ========== cardiology ========== tte suboptimal image quality.the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. there is mild to moderate regional left ventricular systolic dysfunction with infero-lateral and apical hypokinesis suggested. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. with normal free wall contractility. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion . c. cath final diagnosis: 1. no flow-limiting coronary artery disease. 2. severe left ventricular diastolic dysfunction. 3. moderate pulmonary arterial hypertension. . tte the left atrium and right atrium are normal in cavity size. the estimated right atrial pressure is 0-10mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is a very small circumferential pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global biventricular systolic function. dilated ascending aorta. compared with the prior brief hospital course: 82m h/o htn presents with >48 hours chest congestion, nausea found to have nstemi complicated by lv systolic dysfunction and acute pulmonary edema resulting in respiratory failure. . mssa pneumonia/respiratory failure: intubated at osh for dyspnea thought to be secondary to decompensated heart failure in setting of acs. given fever, infiltrate, and mssa in sputum, patient was treated with nafcillin for 3 week course per id. flu and legionella ruled out on admission. patient also received 8 dayd of levaquin for atypical coverage, and flagyl for anaerobic coverage. pt was re-intubated on hd#4. ct chest x2 did not reveal significant abscess or empyema and patient was persistent febrile throughout much of his hospital course. cxr and chest ct were consistent with ards. pulmonary edema improved with diuresis and cpap at night. pt's cxr still show multilobar consolidations but pt has no sig cough, temp or wbc elevation. the cause of consolidations on cxr and intermittant wbc elevation were thought to be pneumonitis aspiration. pt was on a 2 week course of nafcillin that finished today and flagyl po for 1 week. . coronaries: nstemi. no prior known history of cad with normal stress-echo in . echo at osh reveals global hk without clear focal wma and newly depressed ef. ecg with t wave inversions suspicious for apical ballooning, although unclear evaluation of degree of apical hypokinesis on osh echo. patient treated with asa, beta-blocker, and plavix 300, then 75 daily. cath revealed clean coronaries and nstemi felt to be due to demand in the setting of pneumonia. plavix and heparin stopped. pt is on metoprolol and statin. . pump: acute decompensated chf with newly depressed ef 35-40% with mild global hk on echo at osh. repeat tte here shwoed moderate , mild lvh, ef 40% infero-lateral and apical hypokinesis, no thrombi, no as, 1+ ai, 1+ mr, moderate pulmonary artery systolic hypertension. patient was intubated for acute pulmonary edema at osh and respiratory failure and was re-intubated on hd#4 but was successfully extubated after treatment for pulmonary edema and pneumonia. pt has been stable for last 3-4 days, low dose po lasix started at discharge. due to patient's renal failure, he was on hydralazine for afterload reduction instead of ace inhibitor. this should be reconsidered as pts renal function improves. . acute renal failure: cr elevation felt to be to shock in the setting of sepsis. renal ultrasounds showed no evidence of hydroephrosis or calculi, but were unable to assess for renal artery stenosis. cr impoved to 1.9. . transaminitis: chronically elevated but higher than recent baseline, monitor daily in setting of initiating statin therapy. downtrended and may have been due to shock liver. ruq u/s without ductal dilitation. now resolved. . aspiration: pt found to have sig aspiration thought weakness, illness and gulping of food. please see attached recs from speech therapist for precautions. . hypertension: on hydralazine for afterload reduction along with metoprolol. would change hydralazine to ace once creat normalizes. medications on admission: dyazide 37.5-25 daily inderal 20mg po bid plendil er 2.5mg daily uroxatral 10mg qhs doryx 50mg qsun folate mvi vitamin e glucosamine protonix . discharge medications: 1. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): hold for diarrhea. 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) syringe injection tid (3 times a day): d/c when pt ambulating. 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for pain: apply to back at site of pain as needed. 9. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 10. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 11. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 12. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 13. insulin regular human 300 unit/3 ml insulin pen sig: sliding scale units subcutaneous four times a day: see sliding scale attached. 14. hydralazine 10 mg tablet sig: one (1) tablet po q6h (every 6 hours). discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: mssa pneumonia, nstemi, aspiration secondary: essential tremor discharge condition: stable. discharge instructions: you were transfered to for concern of a heart attack. a cardiac catheterization revealed that you had healthy blood vessels in your heart. you were felt to have some excess demand on your heart because of breathing difficulties. you were found to have a severe pneumonia and were treated with antibiotics. . please seek immediate medical attention if you experience fevers, chest pain, shortness of breath, abdominal pain, dizziness, palpitations, or any change in your baseline health status. followup instructions: cardiology: dr. phone: ( date/time: at 2:30pm. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified acute on chronic diastolic heart failure pneumonitis due to inhalation of food or vomitus primary pulmonary hypertension methicillin susceptible pneumonia due to staphylococcus aureus alcohol withdrawal essential and other specified forms of tremor 

Answer: The patient is high likely exposed to