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: tracheostomy conversion peg to pej tube history of present illness: 70yo f with als (nonverbal at baseline but hearing is ok and communicates via keypad), ra, and g-tube, with multiple past admissions for aspiration pna admitted for sob. additional sx included subjecive choking, cough and increased secretions which have been difficult to celar. patient reported no fevers or chills and no dysuria. home nebulizer did not help. . in the ed, the pt was afebrile but tachycardic and hypertensive. she was given nebs, decadron and levo/falgyl with some improvement in her sx and vitals. . on the floor she did well. tube feeds were continued. she developed worsening hyponatremia with a stable na of 118. this was managed with salt tabs and fluid restriction. she remained afebrile. she started bipap for the first time on the day she was tx'd to the icu in the early afternoon. her settings were . she tolerated it for a short time during the day and then it was taken off. at 7pm she was in her room and called the nurse to tell her that she felt sob. o2 sat was 88% on ra. prior to this she had been 95% on ra. trigger was called and the ho ordered a cxr that showed blurring of the r hemidiaphragm and increasing rll infiltrate. she was started on bipap nasal mask at 10/5 with 10lpm of oxygen with 93-95% oxygen sats. she was transfered to the icu for further monitoring. past medical history: 1. als - diagnosed in . seen recently in neuro clinic and felt to have a grave prognosis. no longer walking, communicates with keypad as is non-verbal. started on inexsufflator. 2. recurrent aspiration pna. 3. recent distal tib-fib fracture s/p fall 4. recent hospitalization in for pna/uti 5. ra 6. s/p g-tube placement social history: lives at home with her husband, at home. has two daughters nearby that are involved with care. does not smoke or drink. family history: nc physical exam: vs: af, 120/86, 98, 94%10l bipap 10/5 gen: thin, weak appearing woman in nad on bipap heent: pupils dilated at 5mm bilaterally, eomi, op clear, neck supple cv: mild tachycardia, regular rhythm, no m/r/g chest: no crackles nor rhonchi, but some transmitted bipap sounds. prolonged expiratory phase. scattered expiratory wheezes abd: soft, nt, nd, bs present, g tube in place ext: wwp, no c/c/e neuro: non-verbal but makes her needs known. answers yes and no with head nod. no facial asymmetry. shrug . sensation intact to lt. motor: delt/biceps/hip flexors. grip, plantarflexion. dorsiflexion, wrist extension. fasciculations in upper and lower limbs bilaterally. bulk reduced. tone somewhat flacid. no clonus. reflexes 3+ bilaterally. pertinent results: admission labs: 02:45am blood wbc-13.5*# rbc-4.28 hgb-13.0 hct-38.0 mcv-89 mch-30.4 mchc-34.2 rdw-14.4 plt ct-397 02:45am blood neuts-89.8* lymphs-6.9* monos-3.1 eos-0 baso-0.1 02:45am blood plt ct-397 02:45am blood glucose-148* urean-17 creat-0.4 na-129* k-3.9 cl-87* hco3-33* angap-13 06:45am blood calcium-9.5 phos-3.1 mg-1.8 06:45am blood tsh-1.6 06:45am blood cortsol-9.0 . discharge labs: 04:15am blood wbc-12.4* rbc-3.13* hgb-9.9* hct-28.1* mcv-90 mch-31.7 mchc-35.3* rdw-15.3 plt ct-317 04:15am blood plt ct-317 05:00am blood pt-12.7 ptt-35.7* inr(pt)-1.1 04:15am blood glucose-113* urean-14 creat-0.3* na-132* k-4.1 cl-95* hco3-35* angap-6* 04:19am blood alt-13 ast-25 ld(ldh)-130 alkphos-59 totbili-0.2 04:15am blood phos-3.1 mg-1.8 11:58am blood type-art temp-36.8 rates-10/1 peep-5 fio2-50 po2-140* pco2-61* ph-7.39 calhco3-38* base xs-9 comment-ax=96.2 11:58am blood lactate-0.9 02:55am blood lactate-1.8 06:16am blood freeca-1.24 . 06:05am urine color-straw appear-slhazy sp -1.025 06:05am urine blood-sm nitrite-neg protein-neg glucose-neg ketone-15 bilirub-neg urobiln-neg ph-6.5 leuks-neg . clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. reference range: negative. sputum below: considered colonizer; no fevers, no coughing: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram positive cocci. in pairs, chains, and clusters. respiratory culture (preliminary): ? oropharyngeal flora. staph aureus coag +. heavy growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | . uctx no growth bctx no growth . echo: the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). regional left ventricular wall motion is normal. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a small partially echo-filled inferolateral pericardial effusion without evidence for tamponade physiology. brief hospital course: a/p: 70yo f with als and ra who presented with difficulty clearing secretions and coughing. given her known als, previous hx of aspiration pna, and elevated wbc count, this is most likely was a repeat aspiration event. . 1. secretions/coughing: likely aspiration pna as above. as the pt is on chronic prednisone 3mg daily for ra, she was given stress dose steroids in the ed. these were switched to oral prednisone and she was tapered back to her baseline 3 mg daily during this admission. she was treated with levofloxacin/metronidazole 10 day course. received nebulizer tx c albuterol/atrovent. underwent intermittent chest pt with good effect. had sputum gram stain near d/c () with + gs for coag + staph; no fevers, no cough. likely colonizer; sensitivities pending. please follow-up on speciation and sensitivities. . 2. als: the pt was diagnosed in and progression of als is most likely contributing to her repeated aspiration pna. underwent placement of a tracheostomy . sutures around trach need to be removed in 10 days. did well on ventilatory support; was on ps 10/5/fio2 0.4; seemed comfortable. tried on ps 5/5/fi02 0.4 with some success. could consider trach mask trials if pt. wants time off vent. . 3. hyponatremia: the pt has baseline hyponatremia ranging between 120 to 134 with averages in mid 120s. therefore this degree of hyponatremia is baseline for pt. however the etiology of the hyponatremia remains unclear. the pt does not appear particularly hyper or hypovolemic on physical exam making siadh more likely. tsh and cortisol levels wnl. plan to continue salt tabs and bolus free water through pej tube as needed. should have biweekly (at least) sodium levels monitored. . 4. ra: continued prednisone and methotrexate 12.5mg weekly. . 5. fen: peg tube converted to pej tube without complications by gi service. novasource 2.0 @ 40 cc/hr. . 6. depression: continued fluoxetine 20 mg/5 ml solution daily. . 7. ppx: ranitidine 15 mg/ml as well as colace for gi ppx; stopped hep sc on d/c given chronic quadriplegia . 8. code status: full code as per pt and her husband. palliative care consulted and pt. focusing on 1 day at a time and wants full measures at this time. should be readdressed periodically with patient and family. medications on admission: 1. acetaminophen 325 mg 1-2 tablets po q4-6h prn 2. prednisone 3 mg daily. 3. methotrexate 12.5 mg weekly. 4. multivitamin (liquid) 5. folic acid 1 mg daily. 6. ascorbic acid 90 mg/ml drops daily. 7. fluoxetine 20 mg/5 ml solution daily. 8. ranitidine 15 mg/ml . 9. benztropine 0.5 mg daily. discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. ascorbic acid 90 mg/ml drops sig: one (1) po daily (daily). 3. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 4. ranitidine hcl 15 mg/ml syrup sig: one (1) po bid (2 times a day). 5. sodium chloride 0.65 % aerosol, spray sig: sprays nasal (2 times a day) as needed. 6. lorazepam 1 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 7. sodium chloride 1 g tablet sig: two (2) tablet po bid (2 times a day). 8. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 11. methotrexate 2.5 mg tablet sig: five (5) tablet po 1x/week (tu). 12. methylphenidate 5 mg tablet sig: one (1) tablet po bid (2 times a day). 13. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 14. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). 15. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours) as needed. 16. ipratropium bromide 17 mcg/actuation aerosol sig: six (6) puff inhalation q4h (every 4 hours). 17. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 18. prednisone 1 mg tablet sig: three (3) tablet po daily (daily). discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary als aspiration pneumonia discharge condition: good discharge instructions: take all medications as instructed. keep appointments with health care providers. rehabilitation as per protocol at pulmonary rehab; can attempt trials off vent if patient desires. settings on discharge: cpap c ps: ps 10/peep 5/fio2 0.4. return to the ed or call your pcp if you experience fevers, chills, shakes, light headedness, dizziness, nausea, vomiting, worsening cough. followup instructions: you should call dr. at to arrange follow up in the next two weeks. please follow up on sputum (coag + staph) for further speciation/sensitivities. patient afebrile, most likely colonization. procedure: other endoscopy of small intestine enteral infusion of concentrated nutritional substances temporary tracheostomy percutaneous [endoscopic] gastrojejunostomy diagnoses: amyotrophic lateral sclerosis pneumonitis due to inhalation of food or vomitus retention of urine, unspecified rheumatoid arthritis other disorders of neurohypophysis 

Answer: The patient is high likely exposed to