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: shortness of breath major surgical or invasive procedure: bipap history of present illness: hpi: year old lady with copd, myasthenia , dementia presented to for respiratory distress from a nursing home. she was noted to be hypoxic to 70s after liquid dinner (history of aspiration). patient was placed on bipap and saturation improved to 100s per record. she received zosyn 3.375 gram iv and vancomycin 500 mg iv once for pneumonia and ? uti. patient also received solumedrol iv 125 mg once and ns 500 ml bolus with ns at rate of 100 ml/hour for unknown duration. her na was found to be 170. she was transfered here for further workup. in ed her vitals were t 99.8 hr 114 bp 113/71 rr 34 100% o2 sat on bipap 13/5. patient was obtunded and unable to give history. patient was started on insulin drip (fs > 400) and started on d5w at 75 ml/hour. on arrival to micu her vitals were t 94.8 hr 124 bp 103/79 rr 37 95% on bipap 13/5. she responds only to painful stimuli. her son was who stated that patient's baseline mental status is limited to orientation to self only. she sometimes answers appropriately. she is bound to wheel chair. she has had decreased appetite in the last few weeks. did not complain of chest pain, shortness of breath, palpiations, abdominal pain, nausea, vomitting, diarrhea, dysuria. past medical history: pmhx: - copd - myasthenia - hypertension - iddm - hypothyroidism - dementia - ? history of mrsa pneumonia, one month ago - dry gangrene of left foot social history: shx: lives in a nursing home. son is involved in her care. she is wheel chair bound. family history: noncontributory physical exam: vitals: t 94.8 hr 124 bp 103/79 rr 37 95% on bipap 13/5 gen: obtunded. responding to painful stimuli. tachypnic. heent: mm dry, ? cataract heart: s1s2 rrr lungs: crackles at bilateral bases abdomen: soft ntnd ext: dry gangrene in left lower extremity. dopplerable right dp. neuro: obtunded. plantars unchanged. pertinent results: at : wbc 17.2 n60 band18 hct 41.4 plt 396 na 170 k 5.1 cl 134 co2 24 bun 99 cr 4.5 glu 279 ca .4 inr 1.6 bnp 1686 (0-450) trop t 0.13 (0-0.3) abg 7.43/39/70 . ekg : nsr. pvc. rate 102. non specific st-t flattening in i,avl, v5 and v6. . . head ct noncontrast at osh: severe peripheral atrophy and moderate ventricular enlargement. no acute intracranial abnormalities. . 01:20am urine rbc-* wbc-21-50* bacteria-many yeast-none epi- 01:20am urine blood-mod nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-sm urobilngn-neg ph-9.0* leuk-mod 01:20am pt-19.1* ptt-22.1 inr(pt)-1.8* 01:20am neuts-91.3* lymphs-7.3* monos-1.1* eos-0.2 basos-0.1 01:20am albumin-2.8* calcium-9.7 phosphate-4.2 magnesium-3.3* 01:20am lipase-48 01:20am alt(sgpt)-44* ast(sgot)-27 ld(ldh)-183 ck(cpk)-106 alk phos-125* tot bili-0.4 01:20am glucose-362* urea n-104* creat-4.9* sodium-170* potassium-4.7 chloride-132* total co2-18* anion gap-25* 01:40am glucose-318* lactate-4.7* na+-173* k+-4.9 cl--129* tco2-20* na 170, 167, 162, 158, 154, 153, 150, 152, 153 vanco level 27.2 . cxr: : several opacities are seen in the left lower lung as well as in the right upper and right lower lung that might represent multifocal pneumonia or areas of aspiration. there is no evidence of failure. there is no pleural effusion or pneumothorax. the cardiomediastinal silhouette is unremarkable except for tortuous and prominent aorta and the aneurysmatic dilatation of the aorta cannot be excluded based on single projection radiograph. brief hospital course: year old lady with copd, myasthenia , dementia presented with respiratory distress and hypernatremia. . # hypernatremia: most likely secondary to dehydration. pneumonia, uti and hyperglycemia are contributing to this. started d5 1/2 ns to correct it slowly , in first 24 hrs decreased from 170 to 158. overnight the pace of correction has slowed, now plateaued in low 150s. clinically much improved, less obtunded. patient was then transferred from the micu to the floor, with sodium of 152. we did q12 hour na+ checks and increased her fluid to 200/hr and the sodium continued to trend down slowly. her mental status remained unchanged. . # pneumonia: leukocytosis and bandemia. elevated lactate. aspiration vs. nursing home acquired pna. cxr consistant with aspiration pna. blood cultures were negative. respiratory status greatly improved, oxygen requirement decreased with vanco and zyosyn. on transfer from the micu to the floor the patient had 02 sats >96% on 2l. 02 was weaned and vanc/zosyn was continued for planned 14 day course. given her quickly changing renal function, vanc was dosed based on trough level after each dose. . # uti: ua consistent with uti. urine culture grew providencia stuartii. this was sensitive to zosyn which she was already on for pneumonia, so this was continued. the patient's foley was dc'd on arrival to the floor. . # acute renal failure: unclear baseline creatinine. most likely prerenal. uop increasing and cr steadally improving to 3.0. on arrival to the floor, her creatinine improved to 2.0 with continued iv fluids. . # copd: history of copd. was originally on solumedrol 125 iv and titrated down yesterday. discontinued solumedrol ( 40 iv daily) as copd exacerbation unlikely, not wheezing. on the floor she was continued on albuterol and ipatropium nebs. . # hyperglycemia: known dm2. most likely in the setting of stress (infection, respiratory distress) and steroids. on the floor her blood sugars were in the high 200s, we increased her glargine and continued sliding scale insulin. . # lower extremity dry gangrene: patient has neuropathy and dm2. long term problem per family. on the floor, her foot was noted to be odorous and have slight drainage. we spoke to the family who re-iterated that they did not want amputation at this point as the patient would not likely survive the surgery. we continued wound care. . # fen: npo for now as high aspiration risk, replete lytes prn. disucussed with family option to feed with known aspiration risk vs no further nutrition. family responsable and had started hospice care discussion prior to this hospitalization. would benefit from palliative care, sw after transferred out of icu. on the floor, the patient was continued on po meds, had a repeat swallow study which showed chronic aspiration. there was a family meeting planned to discuss issues of eating on the day that the patient was transferred back to the micu. . # gi bleeding: on day 2 on the floor, the patient was noted by nursing to have upper extremity swelling. an upper extremity doppler ultrasound showed evidence of dvt. the patient was started on a heparin gtt. later that night she was noted to be hypotensive. a stat hematocrit was checked and was 18. the heparin was stopped and she was transferred to the micu. upon arrival to the icu, per family's wishes ej access x2 and a-line were established. on arrival sbp in 60s. she was aggressively repleted with ivf and blood. heparin was reversed with protamine. bp was supported with levophed. after further discussion with the family the pt was made cmo and started on a morphine gtt. the died on the morning of . medications on admission: medications: aspirin 81 mg daily metoprolol 25 mg novolin 70/30 10 units in am levothyroxine 100 mcg daily pyridostigmine 60 mg every 6 hours iss calcium carbonate with vit d 200 units lorazepam 0.5 mg qid prn acetaminophen 650 mg q4h prn antacid albuterol inh q4h prn milk of magnesia prn bisacodyl prn . allergies: nkda discharge medications: expired discharge disposition: expired discharge diagnosis: alzheimer's disease gastrointestinal bleeding leading to hypotension aspiration pneumonia hypernatremia, resolved discharge condition: expired. discharge instructions: ms. was admitted with respiratory failure and hypernatremia. she then developed worsening gastrointestinal bleeding with hypotension. given goals of care discussed with her family, she was made comfort measures only and expired on . followup instructions: n/a md procedure: venous catheterization, not elsewhere classified non-invasive mechanical ventilation transfusion of packed cells diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes ulcer of other part of foot acute respiratory failure pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin blood in stool pressure ulcer, lower back alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance hyperosmolality and/or hypernatremia gangrene mixed acid-base balance disorder pressure ulcer, stage ii other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled myasthenia gravis without (acute) exacerbation personal history of methicillin resistant staphylococcus aureus 

Answer: The patient is high likely exposed to