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: no known allergies / adverse drug reactions attending: chief complaint: respiratory distress major surgical or invasive procedure: right internal jugular line () history of present illness: 53 yo m w/ h/o down's syndrome, non-verbal at baseline, hypothyroidism, cataracts, dysphagia s/p g-tube, h/o aspiration pna's, hypona on 4lnc qhs who presents w/ cough and hypoxia from group home. per report, patient with acute on chronic cough found to desat to 88% on ra this am. looked as if he were in respiratory distress. per omr had been empirically treated for pna back in w/ multiple notes documenting cough. in the ed, initial vs were: 98.2 74 92/50 28 100% nrb. tmax 100.2. on exam +crackles l>r. labs notable for na 129, cl 93, hco3 28, bun 11, cr 0.8, glu 114, lactate 1.4, ua neg leuk/nitr/3wbc/neg bact/epis o, wbc 7.2, hct 41.3, plt 313. cxr: gastric distention, bibasilar atelectasis. he received ceftriaxone and levo, vanc, and flagyl, 1lns. a right ij was placed and followup chest x-ray showed small right upper lobe pneumothorax. on the floor, abx were narrowed to zosyn. he became hypotensive to 76/doppler, thick secretions on nasotracheal suctioning and increased work of breathing. mentation was unchanged during event and held his sats at 100% on 3lnc. cxr showed new pneumothorax and bilateral infiltrates. he received albuterol/impratropium and 500cc ns, pressures improved to 83/doppler. he was transferred to the micu for hypotension. on arrival to the micu, the patient is lethargic, awakens to sternal rub, does not interact. not in acute distress. past medical history: down's syndrome, non-verbal at baseline -alzheimer's -b12 deficiency -hypothyroidism -cataracts, legally blind -dysphagia s/p g-tube -h/o aspiration pna's -h/o dvt -h/o cdiff social history: lives in a group home, brothers very involved with care. family history: no memory disorders physical exam: general: lethargic, arouses to sternal rub, no acute distress heent: pupils equal, round and reactive neck: no lad cv: regular rate and rhythm, no murmurs lungs: no accessory muscle use, no retractios. good air movement. diffuse ronchi throughout. abd: soft, gtube site c/d/i, normoactive bs, nontender nondistended gu: foley in place ext: warm, well perfused, 2+ pulses pedal pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 11:02pm urine hours-random urea n-59 creat-7 sodium-127 potassium-11 chloride-126 11:02pm urine osmolal-291 11:02pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 10:32pm glucose-96 urea n-6 creat-0.5 sodium-135 potassium-3.4 chloride-99 total co2-31 anion gap-8 10:32pm calcium-7.9* phosphate-2.6* magnesium-1.8 10:32pm tsh-3.0 10:32pm wbc-5.9 rbc-3.55* hgb-12.5* hct-36.9* mcv-104* mch-35.3* mchc-33.9 rdw-13.3 10:32pm plt count-262 09:07am lactate-1.4 08:55am glucose-114* urea n-11 creat-0.8 sodium-129* potassium-4.4 chloride-93* total co2-28 anion gap-12 08:55am wbc-7.2# rbc-3.99* hgb-14.0 hct-41.3 mcv-104* mch-35.2* mchc-34.0 rdw-12.9 08:55am neuts-79.7* lymphs-13.4* monos-4.5 eos-1.5 basos-0.9 08:55am plt count-313 : 06:36am blood albumin-2.9* calcium-7.9* 10:32pm blood tsh-3.0 03:28am blood cortsol-11.9 05:13am blood vanco-24.9* 09:58pm blood vanco-19.8 discharge labs: 05:50am blood wbc-5.4 rbc-3.71* hgb-13.1* hct-39.9* mcv-108* mch-35.2* mchc-32.8 rdw-12.9 plt ct-264 05:50am blood glucose-94 urean-7 creat-0.9 na-138 k-4.2 cl-97 hco3-31 angap-14 microbiology: sputum gram stain-final; respiratory culture-final; fungal culture-preliminary urine legionella urinary antigen - final urine culture - final mrsa screen - positive for methicillin resistant staph aureus blood culture - pending imaging: cxr : two frontal radiographs were obtained. lung volumes are low. there is no focal consolidation, large effusion, or pneumothorax. there are no abnormal cardiac or mediastinal contours. basilar atelectasis is noted. cxr : as compared to the previous radiograph, there is increasing radiodensity in the right lung, predominating in the right upper lobe. developing pneumonia cannot be excluded. cxr : as compared to the previous radiograph, the current image is taken in a highly rotated patient position. as a result, hyperlucency of the left lung apex without definite signs of pneumothorax is seen. the pre-existing opacity at the right lung apex is unchanged. lung volumes have minimally decreased, but the pre-existing signs suggesting fluid overload have decreased. no evidence of pleural effusions, interposition of colon between the liver and the abdominal wall. unchanged position of the right internal jugular vein catheter. unchanged appearance of the cardiac silhouette. cxr : the lungs are now clear. right upper lobe opacity has completely resolved. there is only minimal bibasilar atelectasis. right jugular line ends in upper svc. mediastinal and cardiac contours are normal. no significant pleural effusions or pneumothorax. ct head without contrast : pending at time of discharge brief hospital course: summary: 54 yo m w/ h/o down's syndrome, non-verbal at baseline, hypothyroidism, dysphagia s/p g-tube, h/o aspiration pna's, hypona on 4lnc qhs who presents w/ cough and hypoxia from group home. # hypotension: blood pressure on the floor dropped to 92/50 and he was transferred to the micu where his blood pressure responded to fluid boluses (total 3l). the etiology of his hypotension is likely secondary to acute infection. on cxr he has a possible right lobe infiltrate that could represent infection, pneumonitis or pulmonary edema. he was started on iv vanc and zosyn for coverage of healthcare associated pneumonia since he lives in a group home. at the time of discharge, his blood pressure was at baseline (100s/80s) and did not require pressors. # respiratory distress: initially hypoxic to 88% at group home. no evidence of chf by exam or cxr. no history of chf in past. could be secondary to infiltrate in right lobe that could represent pneumona, pneumonitis or pulmonary edema. ekg did not have any ischemic changes. on patient had rij placed and follow up cxr showed small pneumothorax but there was no change in the patient's respiratory status. he was put on supplemental oxygen, and on cxr showed resolution of the pneumothorax. he was discharged on a total 14 day course of antibiotics for his presumed hcap, due to complete . at the time of discharge, his oxygen saturation was high 90s on 2l nasal cannula. # pulmonary edema: no cardiac history, but patient developed findings c/w pulmonary edema on cxr after minimal fluids. ekg was unconcerning. # seizure disorder: etiology unclear. myoclonic jerks observed after transfer from micu to the floor, and eeg showed seizure activity. his home keppra was increased to 1.5g . # hypona: chronic per facility records, though hypovolemic this admission. resolved with fluid resuscitation. # down's syndrome, non-verbal at baseline: per nh at baseline. given his lack of responsiveness, head imaging was performed to ensure lack of new pathology. # hypothyroidism: continued on home synthroid. tsh was normal. # social: over the last few months that patient's health has been declining and he was made dnr/dni by hcp (brother). currently in discussion with pcp about making and moving to hospice care. during this admission a meeting with the patient's group home, dmh case worker, social work and case management, medical staff, and the patient's two brothers was held to discuss his prognosis and goals of care. the medical team stated that the patient's overall life expectancy is in the range of months, but that this could be much shorter if he has an acute respiratory event. he will continue to aspirate and may continue to have infections. however, treating these infections may require him to remain in a hospital, which his family agrees is not the best setting for his comfort. his brothers recognized that moving to hospice/dnh and taking him back to the group home would improve his quality of life, but they were concerned that this might shorten his overall lifespan. after discussion of the options, they decided to complete this course of antibiotics (2 weeks) and then plan to return him to the group home. they recognized that this course of treatment may not provide him any long-term benefit, and that he could die while undergoing the treatment. they stated that they would consider a dnh order after this current course of antibiotics. follow-up issues 1. please follow up on his blood cultures and sputum cultures. they were pending at the time of discharge. 2. please evaluate for evidence of seizure-like activity. at the time of discharge, he was having occasional myoclonic jerks that did not correspond to epileptiform discharges on eeg. he may need an eeg at a future time. 3. please check his sodium and fluid balance, as he presented initially with hyponatremia, likely secondary to dehydration. 4. patient tested positive for mrsa, and should be on contact precautions. 5. head ct read pending on discharge, may show signs of subacute pathology that changes his overall prognosis. 6. iv zosyn and vancomycin planned 14 day course through , however this may be adjusted by the patient's response and clinical situation. medications on admission: - acetaminophen 650 mg po q4h:prn pain/fever - atropine sulfate 1% 2 drop sl q4h:prn secretions - bacitracin ointment 1 appl tp :prn open wounds - bisacodyl 10 mg po/pr daily:prn constipation - denta 5000 plus *nf* (sodium fluoride) 1.1 % dental - fleet enema 1 enema pr daily:prn constipation - haloperidol 0.5-1 mg ng q4h:prn agitation - kaopectate (bismuth subsalicy) *nf* (bismuth subsalicylate) - levetiracetam 500 mg po qam - levetiracetam 1000 mg po qpm - levothyroxine sodium 88 mcg po/ng qam - lorazepam 0.5 mg po/ng q4h:prn anxiety - milk of magnesia 30 ml ng prn constipation - multivitamins 5 ml po/ng daily - neutra-phos 1 pkt po bid - oxycodone (immediate release) 5 mg po q4h:prn pain/shortness of breath - simethicone 40 mg po q4h discharge medications: 1. acetaminophen 650 mg po q4h:prn pain/fever 2. bacitracin ointment 1 appl tp :prn open wounds apply to open wounds on coccyx and buttocks 3. bisacodyl 10 mg po/pr daily:prn constipation 4. fleet enema 1 enema pr daily:prn constipation if dulcolax not effective 5. haloperidol 0.5-1 mg ng q4h:prn agitation via g tube 6. levetiracetam 1500 mg po bid 7. levothyroxine sodium 88 mcg po qam via g tube 8. lorazepam 0.5 mg po q4h:prn anxiety via g tube 9. milk of magnesia 30 ml po prn constipation if no bm for 3 days. give via g tube 10. multivitamins 5 ml po daily via g tube 11. oxycodone (immediate release) 5 mg po q4h:prn pain/shortness of breath 12. simethicone 40 mg po q4h 13. denta 5000 plus *nf* (sodium fluoride) 1.1 % dental 14. kaopectate (bismuth subsalicy) *nf* (bismuth subsalicylate) 262 mg/15 ml oral qd:prn diarrhea per g tube 15. neutra-phos 1 pkt po bid 16. atropine sulfate 1% 2 drop sl q4h:prn secretions 17. vancomycin 1000 mg iv q 12h rx *vancomycin 500 mg 1000mg iv twice a day disp #*44 each refills:*0 18. piperacillin-tazobactam 4.5 g iv q8h rx *piperacillin-tazobactam 4.5 gram 4.5mg iv every 8 hours disp #*33 each refills:*0 19. ipratropium bromide neb 1 neb ih q6h wheezing, dyspnea rx *ipratropium bromide 0.2 mg/ml (0.02 %) 1 neb every six hours disp #*15 each refills:*1 20. albuterol 0.083% neb soln 1 neb ih q6h:prn dyspnea, wheezing rx *albuterol sulfate 2.5 mg/3 ml (0.083 %) 1 neb every six hours disp #*15 each refills:*1 discharge disposition: extended care facility: - discharge diagnosis: primary: - aspiration pneumonia secondary: - hypvolemia - hypotension - hyponatremia - seizure disorder - down's syndrome - alzheimer's dementia discharge condition: mental status: confused - always. level of consciousness: lethargic and not arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , it was a pleasure taking care of you in the hospital. you were admitted for shortness of breath, and were found to have an infection of your lungs from chronic aspiration. you were treated with iv antibiotics and regular suctioning of oral secretions, and your breathing improved. your blood pressure was also occasionally low, and received iv fluids. you were found to have seizure activity during this hospitalization, and your home doses of keppra was increased. please start taking the following medications: 1. iv vancomycin 1gm twice a day 2. piperacillin-tazobactam 4.5 g iv every 8 hours 3. albuterol 0.083% neb soln every 6 hours as needed for shortness of breath 4. ipratropium bromide neb every 6 hours as needed for shortness of breath please change the dosing on the following medications: 1. levetiracetam 1500 mg twice a day please continue to take your other medications. followup instructions: department: podiatry when: monday at 2:20 pm with: , dpm building: ba ( complex) campus: west best parking: garage department: medical specialties when: thursday at 2:00 pm with: , md building: campus: east best parking: garage md procedure: enteral infusion of concentrated nutritional substances central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: hypocalcemia hyposmolality and/or hyponatremia unspecified acquired hypothyroidism constipation, unspecified anxiety state, unspecified acute respiratory failure hypotension, unspecified pneumonitis due to inhalation of food or vomitus iatrogenic pneumothorax pressure ulcer, lower back epilepsy, unspecified, without mention of intractable epilepsy personal history of venous thrombosis and embolism do not resuscitate status alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance legal blindness, as defined in u.s.a. gastrostomy status quadriplegia, unspecified unspecified cataract down's syndrome pressure ulcer, stage ii dysphagia, unspecified wheelchair dependence 

Answer: The patient is high likely exposed to