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: shellfish attending: chief complaint: a 70yof with recent influenza a infection complicated by ards, now transferred from with pneumomediastinum likely tracheal perforation, and mrsa pna and pseudomonas uti. major surgical or invasive procedure: bronchoscopy egd tracheosteomy peg history of present illness: a 70yof who presented to in with lethargy and fevers, and was found to have influenza a. her hospital course was complicated by ards. she was treated with ceftriaxone, azithromycin, and then levofloxacin and vancomycin, as well as a long course of steroids. she was intubated, and later trached for on-going respiratory support at pulmonary rehab in . she went to rehab with a tracheostomy tube and off ventilatory support, but returned after a short period of time with lethargy, hypercarbic respiratory distress requiring mechanical ventilation (trach was decannulated and replaced with button, and et tube was replaced), a new lll pna, paroxysmal rapid afib (hr 180s), diarrhea, and upon workup was found to have a pneumomediastinum, upper esophageal dilatation, and an lll pna and uti. she underwent bronchoscopy which was apparently unremarkable, and was treated empirically with vancomycin and ceftazidime for pneumonia, and flagyl (for diarrhea). her course has been complicated by hypotension requiring levophed and rapid afib for which conversion was attempted unsuccessfully with ibutilide. cultures revealed mrsa pna/bacteremia, and pseudomonas uti, and treatment was initiated with vancomycin and zosyn. past medical history: 1. influenza a in complicated by ards eventually leading to intubation, ventilatory support, and tracheostomy. 2. remote history of pneumonia. 3. status post left eye cataract surgery. social history: no significant tobacco or alcohol use. family history: non-contributory. physical exam: vs: 96.6 | 110/65 | 74 | 30 | 100% o2 sat; wt=59kg. vent settings: ps 100% fio2, peak pressure 31 +5 peep, vt 400-450 gen: intubated, sedated. heent: pupils 2mm->1mm, accomodation intact, midline, eom could not be assessed, op clear, mmm, no jvd, no carotid bruit. neck: no masses, no lad, mild subcutaneous crepitus/emphysema noted on left neck. cv: rrr, nl s1s2, no murmurs. chest: crackles and rales, halfway up on left, dullness on left base, no wheezes, right lung clear. abd: soft, nt/nd, +bs, no organomegaly. extr: warm well perfused, 2+ dp pulses, no cyanosis, pitting edema up to thighs b/l. neuro: sedated, nl tone; cn's, strength, sensation, coordination, language not assessed. pertinent results: 08:29pm blood wbc-12.3* rbc-3.09* hgb-9.1* hct-29.4* mcv-95 mch-29.5 mchc-30.9* rdw-17.8* plt ct-115* 08:29pm blood neuts-87.9* lymphs-8.6* monos-3.4 eos-0.1 baso-0.1 08:29pm blood pt-15.4* ptt-25.2 inr(pt)-1.4* 08:29pm blood plt ct-115* 08:29pm blood fdp-0-10 08:29pm blood fibrino-586* d-dimer-1891* 08:29pm blood glucose-76 urean-31* creat-0.3* na-150* k-3.4 cl-119* hco3-28 angap-6* 08:29pm blood alt-8 ast-11 ld(ldh)-197 alkphos-72 amylase-27 totbili-0.4 08:29pm blood albumin-1.8* calcium-7.2* phos-1.4* mg-2.2 09:02pm blood type-art temp-35.9 rates-18/12 peep-5 fio2-100 po2-157* pco2-59* ph-7.31* calhco3-31* base xs-1 aado2-507 req o2-84 intubat-intubated vent-controlled 09:02pm blood freeca-1.14 09:02pm blood lactate-0.6 . ct neck : pending. . cxr: : 1. interval worsening of the consolidation in the right lower lobe superimposed on bilateral chronic lung changes. 2. slight interval improved appearance of the subcutaneous emphysema and no clear visualization of the previously noted pneumomediastinum. . tte : all cardiac normal in size. the ascending aorta is mildly dilated. lv systolic function is preserved with an estimated ef of 60%. rv systolic function is preserved. mitral leaflets are minimally thickened with mild mr. there is mild tr with moderate pulmonary hypertension. estimated pasp is 40 mmhg + cvp. minimal pericardial effusion as well as significant pleural effusion is noted. compared to a prior study dated , the pa pressure is now elevated. . ct chest : 1. interval decrease in the pneumomediastinum and subcutaneous gas. 2. overdistention of the endotracheal tube balloon, which increases risk of tracheal injury. 3. slight increased air space consolidation in the superior segment of the left lower lobe. 4. nasogastric tube terminating in the distal esophagus well above the level of the diaphragm. . ct chest : 1. extensive pneumomediastinum and subcutaneous emphysema on the left axillary and supraclavicular regions without evidence of pneumothorax. 2. extensive bilateral alveolar opacities with small pleural effusions. . blood cx : mrsa. blood cx : ngtd. urine cx : pseudomonas. sputum cx : mrsa. ------------------ ct abdomen with contrast : impression: 1) moderate abdominal and pelvic ascites without evidence of acute intra- or retroperitoneal hematoma. 2) bibasilar fibrosis and bronchiectasis with a small anterior right basilar pneumothorax and small bilateral pleural effusions. 3) anasarca. 4) dilated gallbladder with layering sludge/gallstones. 5) scoliosis. ------------------ brief hospital course: 70yof with recent influenza a infection complicated by ards, now with pneumomediastinum likely tracheocutaneous fistula. . # pneumomediastinum: evidence for pneumomediastinum is that respiratory symptoms (hypercarbic failure) and af with rvr became worse when et tube was in higher position, and resolved when et tube was repositioned lower, presumably below the site of a fistula. a bronch at osh revealed no defects in the tracheal wall, and an esophageal gastrograffin study was negative as well. patient was trach'd for respiratory distress. multiple imaging studies did not reveal any pneumomediastinum. repeat egd/rigid bronchoscopy did not show any te fistula. the tracheostomy site was revised and a new #8 portex per-fit tube was placed. patient was continued on supportive ventilation. . #respiratory failure: pt. recovering from ards, which occurred in the setting of influenza a infection in , and also with lll mrsa pna on arrival -finished full course of vanco. likely will take some time to resolve full lung function. pt. has been on a chronic vent previously. now pt. w/ new trach. pt's respiratory status has not been improving much - difficult to wean pt. pt. has failed multiple attempts at weaning--tires out quickly on pressure support, and had to be placed back on assist control and be fully supported. sedation was weaned off, and the patient was placed on prn sedation/pain meds. patient's abgs remained great, inhalers were continued. a peg tube was placed for enteral feeds. patient was maintained on full respiratory support, breathing on ac, failed psv multiple times. patient is to be weaned off the vent at pulmonary rehab. . #hct drop. crit is stable at this point. no source has been found- no hemolysis noted on lab work, cxr neg for bleeding into mediastinum and no evidence of rp bleed on ct. stool guaiac was negative. . # afib: has been refractive to both medical and chemical treatments. likely occurring secondary to respiratory decompensation, rapid afib resolved when et tube was advanced, decreasing the tension pneumomediastinum. has not been a problem ever since the pneumomediastinum/te fistula issue has been resolved. patient remained very well rate-controlled. responds to lopressor. heart rate to be re-assessed at rehab. . # id: pt. w/ icnreased wbc a few days ago, but was found to have c. diff and is receiving flagyl for this. pt. continue to be afebrile. pt. completed course of vancomycin for mrsa lll pna/bacteremia and s/p 1 week cipro treatment of cipro-sensitive pseudomonas uti. was transiently on stress dose steroids while exhibiting septic physiology, but once bp stabilized, steroids were tapered off. the patient should complete 14 day course of flagyl while at rehab, day 6 out of 14 today. . # fen: pt became hyponatremic during her hospital course with ~2l free water deficit, so she was corrected slowly with d5w. other electrolytes were repleted as well. . # psych - during the last few days of the hospital course, pt was very depressed, expressing wishes of dying. psychiatry consult was consulted, but due to the patient's respiratory status, conmmunications with a psychiatrist unlikely that pt. will be able to communicate w/ a psychiatrist. low dose of celexa was started . # fen: pt. had peg placed (has trach, aspiration risk). continue tfs at goal, lytes prn. . # ppx: bowel regimen, ppi, sc heparin (hit negative), insulin gtt (sepsis protocol), pneumoboots, nystatin. . # access: piv, a-line. . # code: full, corroborated with family. . # dispo: to rehab tomorrow pending family's approval. . # ppx: bowel regimen, ppi, riss, pneumoboots, nystatin. . # access: pt has a picc, will need picc care at rehab. . medications on admission: (meds on transfer) 1. nystatin swish/swallow 5 mg p.o. q.i.d. 2. fosamax 5 mg p.o. daily. 3. ferrous sulfate 325 mg p.o. daily. 4. multivitamin 1 tab p.o. daily. 5. vitamin d 800 units p.o. daily. 6. insulin gtt. 7. combivent 2 puffs q.6h. 8. vancomycin 1 gm iv q.12h. 9. hydrocortisone 60 mg iv q.8h. 10. nexium 40 mg iv daily. 11. zosyn 4.5 gm iv q.6h. 12. levophed gtt. discharge medications: 1. nystatin 100,000 unit/g cream sig: one (1) appl topical (2 times a day). 2. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q4h (every 4 hours) as needed. 3. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 4. docusate sodium 150 mg/15 ml liquid sig: one y (150) mg po bid (2 times a day) as needed for constipation. 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 6. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 8. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 1 weeks: last day = . 9. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 10. fentanyl 75 mcg/hr patch 72hr sig: one (1) patch 72hr transdermal q72h (every 72 hours). 11. diazepam 2 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 12. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 13. lansoprazole 30 mg susp,delayed release for recon sig: thirty (30) mg po daily (daily). 14. potassium & sodium phosphates mg packet sig: one (1) packet po once a day: please check phosphate frequently, pt is often low and needs repletion. 15. potassium chloride 10 meq capsule, sustained release sig: two (2) capsule, sustained release po once a day: pt frequently requires potassium repletion, please check levels daily. 16. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 17. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 18. morphine 2 mg/ml syringe sig: one (1) mg injection q4h (every 4 hours) as needed for pain. discharge disposition: extended care facility: & rehab center - discharge diagnosis: ards discharge condition: stable discharge instructions: call your doctor or come to the er if you develop fevers, chills, chest pain, difficulty breathing, trouble with your tracheostomy tube, abdominal pain, diarrhea, problems with the peg tube or any other concerns. followup instructions: follow up with your primary care doctor and with the doctors . procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] transfusion of packed cells revision of tracheostomy diagnoses: urinary tract infection, site not specified atrial fibrillation infection with microorganisms resistant to penicillins other chronic pulmonary heart diseases acute respiratory failure hypotension, unspecified bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site intestinal infection due to clostridium difficile other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation methicillin susceptible pneumonia due to staphylococcus aureus pressure ulcer, lower back accidents occurring in other specified places emphysema (subcutaneous) (surgical) resulting from procedure hyperosmolality and/or hypernatremia scoliosis [and kyphoscoliosis], idiopathic pseudomonas infection in conditions classified elsewhere and of unspecified site influenza with pneumonia 

Answer: The patient is high likely exposed to