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: mr. is a 57-year-old man with a complicated past medical history including cerebrovascular accident, seizure disorder, coronary artery disease, congestive heart failure and recurrent aspiration pneumonia who was discharged from on with aspiration pneumonia. he was at his nursing home where he desaturated to 70% on 5 liters nasal cannula and became tachypneic and uncomfortable. he was also febrile and transferred back to for further management. in the emergency department, he was given albuterol and atrovent nebulizers with some relief. his most recent hospital course was significant for methicillin resistant staphylococcus aureus pneumonia diagnosed on bal washings. he was started on vancomycin for a six week course of treatment. he also had a video swallowing study which showed a high risk of aspiration, however at that time the patient elected to take continued po intake with thickened liquids. past medical history: 1. cerebrovascular accident in with residual left sided hemiparesis 2. history of seizure disorder 3. borderline diabetes mellitus 4. coronary artery disease 5. depression 6. congestive heart failure with an ejection fraction of 30%. 7. hypertension 8. hypothyroidism 9. bilateral hip fractures. 10. paroxysmal atrial fibrillation, status post cardioversion in 11. recurrent aspiration pneumonia admission medications: 1. oxycodone 10 mg q6h prn 2. celebrex 200 mg po q day 3. tylenol 500 mg po tid 4. neurontin 300 mg po bid 5. vancomycin 1 gm intravenous q 24 hours 6. flagyl 500 mg po tid 7. colace 100 mg po bid 8. spironolactone 25 mg po q day 9. valproic acid 500 mg po q a.m., 750 mg po q noon, 500 mg po q p.m. 10. enteric coated aspirin 81 mg po q day 11. synthroid 0.125 mg po q day 12. dulcolax prn 13. captopril 50 mg po tid 14. lasix 20 mg po bid 15. zoloft 200 mg po q day 16. vitamin c 500 mg po q day 17. buspar 10 mg po bid 18. senna 2 tablets po q hs 19. zinc sulfate 220 mg po q day 20. combivent metered dose inhaler 2 puffs q6h 21. multivitamin 1 tablet po q day 22. protonix 40 mg po q day allergies: the patient has documented heparin induced thrombocytopenia. social history: the patient is currently a resident of . he denies alcohol or tobacco use. his code status is do not resuscitate, however intubation, unit and pressors are permitted. physical examination: vital signs: temperature 100.8??????, heart rate 79, blood pressure 94/63, oxygen saturation 90% on a 100% nonrebreather, respiratory rate 22. general: the patient was a middle aged man in mild respiratory distress. head, ears, eyes, nose and throat: pupils were equal, round and reactive to light. sclerae were anicteric. oromucosa was dry. the oropharynx was without lesion. neck: supple with no lymphadenopathy or jugular venous distention. chest: notable for rancorous breath sounds with no wheezes. cardiovascular: irregularly irregular rhythm with a normal s1 and s2 and a 2/6 systolic ejection murmur. abdomen: the abdomen was soft, nontender, nondistended with hypoactive bowel sounds and no hepatosplenomegaly. extremities: the patient had palpable peripheral pulses with no cyanosis, clubbing or edema. neurologic: the patient was somnolent, but arousable and not cooperative with neurologic exam. he was moving all four extremities. initial laboratory studies: chest x-ray indicated near complete opacification of the left hemithorax with a small portion of minimally aerated lungs seen laterally at the apex with progression of left upper lobe air space opacification since the prior study. there is also diffuse increased density of the right hemithorax with apical capping most likely representing a layering pleural effusion on the right. arterial blood gases indicated a ph of 7.43, paco2 of 48 and pao2 of 36. cbc was notable for a white count of 6.6 and a history of 29.3. inr was elevated a 4.8. ptt was 58.7. chem-7 was notable for a bun of 15, creatinine of 1.0, bicarbonate of 31 and glucose of 59. phosphate was elevated at 4.6. hospital course: the patient was transferred to the medical intensive care unit within hours of his admission secondary to worsening hypoxia and respiratory distress. following is a description of the hospital course in the medical intensive care unit by system. 1. pulmonary: the patient's oxygen saturation remained stable on a 100% face mask and shovel mask. a chest ct indicated severe tracheomalacia involving the carina and origin of the main stem bronchus bilaterally. bilateral pleural effusions which were increased since the last study were also noted, as well as widespread atelectasis in the right lower lobe, right middle lobe, lingula and left lower lobe. there were scattered ground glass opacities and enlarged pulmonary arteries. the patient was weaned down to a 70% face mask with oxygen saturation in the mid 90s. the medical team felt that the patient's respiratory status would not significantly improve with thoracentesis. 2. cardiovascular: the patient was noted to be hypotensive in the medical intensive care unit with a systolic blood pressure of 70. he was therefore started on levophed. his hypertension was thought to be most likely related to his circulating volume. he was therefore treated with intravenous fluids and levophed was weaned. he was also evaluated by the cardiac electrophysiology service for an episode of asymptomatic nonsustained ventricular tachycardia as well as for the question of whether the patient would benefit from cardioversion given his atrial fibrillation and hypotension. the electrophysiology service elected not to place a defibrillator secondary to the patient's do not resuscitate wishes. the also did not believe the patient would benefit from cardioversion. 3. renal: the patient remained stable from a renal perspective with his creatinine in the range of 1.1 to 1.4. 4. infectious disease: the patient was continued on vancomycin and flagyl for treatment of his aspiration pneumonia. blood cultures were sent and were negative. sputum cultures were sent and grew out only oropharyngeal flora and sparse gram negative rods. flagyl was discontinued on hospital day #5. the patient's white blood count remained stable and he remained afebrile. 5. fluids, electrolytes and nutrition: the patient remained npo while he was in the intensive care unit receiving only d5 normal saline for nutrition. 6. hematology: the patient remained coagulopathic initially with an inr of 4.8. he was corrected to a value of 2.6 with vitamin k. his coagulopathy was thought likely secondary to his decreased nutrition. the patient's hematocrit remained stable. 7. endocrine: given the patient's persistent hypotension, an a.m. cortisol was sent and found to be 5. however, on repeat testing with a cosyntropin stimulation test, the patient ruled out for adrenal insufficiency. he was continued on regular insulin sliding scale and synthroid. 8. neuropsychiatric: the patient was continued on valproic acid. pain control was initially achieved with a patient controlled analgesic pump which was weaned. the patient's pain control was adequately treated subsequently with a fentanyl patch and dilaudid prn for breakthrough pain. psychiatry was consulted and the patient was found to be competent to make decisions about his medical care. 9. dermatology: plastic surgery service was consulted and debrided a left elbow pressure ulcer. the patient was to k2 having dressing changes wet to dry . 10. prophylaxis: the patient was maintained on protonix and auto anticoagulated. on hospital day #5, the patient was transferred to the floor for continued management. interventional radiology was consulted for placement of a gastrojejunostomy tube. the interventional radiology service was not able to place the tube until the patient's inr fell to a level of approximately 1.5. the patient's coumadin continued to be held and on hospital day #9 he was taken to the interventional radiology suite for placement of the gj tube. the patient tolerated the procedure well and there were no complications. the patient was subsequently started on coumadin 1 mg po q hs and started on tube feeds the following morning. at the time of this discharge dictation, it was planned that the patient would be transferred back to . discharge diagnoses: 1. recurrent aspiration pneumonia 2. status post cerebrovascular accident 3. methicillin resistant staphylococcus aureus pneumonia and bacteremia 4. atrial fibrillation 5. tracheomalacia 6. code status do not resuscitate, may intubate 7. seizure disorder 8. borderline diabetes mellitus 9. coronary artery disease 10. congestive heart failure 11. hypertension 12. hypothyroidism 13. history of bilateral hip fractures discharge medications: 1. coumadin 1 mg per gj tube q hs 2. vancomycin 1 gm intravenous q 24 hours x26 days for a total course of 6 weeks 3. morphine sulfate 1 mg intravenous q4h prn pain 4. tylenol 650 mg per gj tube q 4 to 6 hours prn 5. fentanyl 25 mcg transdermal q 72 hours 6. synthroid 0.125 mg per gj tube q day 7. dulcolax 10 mg pr prn constipation 8. nystatin powder prn groin rash 9. asa 81 mg per gj tube q day 10. atrovent metered dose inhaler 2 puffs qid 11. albuterol metered dose inhaler 2 puffs q4h prn 12. protonix 40 mg per gj tube q day 13. zinc sulfate 220 mg per gj tube q day 14. senna 2 tablets per gj tube q hs prn 15. vitamin c 500 mg per gj tube q day 16. zoloft 200 mg per gj tube q day 17. multivitamin 1 tablet per gj tube q day 18. valproic acid 500 mg q a.m., 750 mg q noon, 500 mg q hs via gj tube 19. colace 100 mg per gj tube 20. neurontin 300 mg per gj tube tid the patient would need daily dressing changes for his gj tube and wet to dry dressing changes for his left elbow pressure ulcer. the patient would also require chest physical therapy . his tube feeds were started at promod with fiber with a goal of 55 cc per hour, hold for abdominal distention or abdominal pain. the patient also required oxygen via 70% face mask. discharge condition: stable disposition: the patient was transferred back to . , m.d. dictated by: medquist36 procedure: parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances thoracentesis non-invasive mechanical ventilation arterial catheterization other intubation of respiratory tract nonexcisional debridement of wound, infection or burn percutaneous (endoscopic) jejunostomy [pej] diagnoses: thrombocytopenia, unspecified unspecified pleural effusion congestive heart failure, unspecified atrial fibrillation other convulsions acute respiratory failure pneumonitis due to inhalation of food or vomitus late effects of cerebrovascular disease, hemiplegia affecting unspecified side 

Answer: The patient is high likely exposed to