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: respiratory failure major surgical or invasive procedure: bronchoscopy tracheal stent removal history of present illness: mr. is an 87 yo male admitted to on for severe pneumonia. he was sent home on antiobitics but re-presented five days later with increasing sob, productive cough, and confusion. at that time, he underwent bronchoscopy which showed lll secretions and tbm. he was transfered to for stent was placed by thoracic surgery. he was then discharged to rehab on vancomycin/cipro. he developed acute respiratory failure at rehab on day 10 of antibiotic courserequiring intubation prior to emt arrival. initial abg noted to be 7.10/101/103/31. she was then trasnfered to . . at , he was remained intubated for approximately one day and initially required levophed to maintain bp. sputum cultures on admission were positive for mrsa, so he was treated with vanco/zosyn/levo. he was hydrated with fluids and his pre-renal arf resolved. he was extubated prior to . he was tolerating bipap for 2 days but required re-intubation today for unclear reasons. he was found to have a new lll pneumonia. he underwent another bronch on , where his stent was found to have migrated distally. he was started on levophed drip. . an echo on showed elevated pa pressures ( 49-54) though unchanged from previous echo). pa pressure on was noted to be 52.1. he was started empirically on heparin on but this was held prior to transfer to at 11:30 am for unclear reasons. of note, patient failed bedside swallow eval on . . he is being transferred to for stent removal and y-stent placement following recovery of pneumonia. past medical history: htn elevated creatinine (baseline 1 - 1.2) h/o diverticulosis gerd chronic anemia social history: retired architect. patient is married and lives with his wife in . from medical record, patient smoke 1 ppd for 25 years, but quit in . family history: nc physical exam: vs: bp 121/56, hr 72, rr 18, hr 84, vent settings: fio2 60%, tv 400, rr 16, peep 5 gen: intubated, sedated heent: et tube, og tube present, right ij site without erythema or discharge cv: rrr, no m/r/g pulm: breath sounds present bilaterally, no crackles/wheezes abd: soft, nt, nd, bowel sounds present ext: no peripheral edema, decreased skin turgor, no rashes noted pertinent results: labs on admission: 12:08am blood wbc-15.9* rbc-3.67* hgb-10.6* hct-32.1* mcv-88 mch-28.8 mchc-32.9 rdw-15.1 plt ct-266 12:08am blood neuts-74.7* lymphs-7.8* monos-3.9 eos-13.5* baso-0.1 12:08am blood pt-14.6* ptt-35.9* inr(pt)-1.3* 12:08am blood glucose-102 urean-8 creat-1.2 na-136 k-3.6 cl-99 hco3-28 angap-13 12:08am blood alt-17 ast-18 ld(ldh)-180 alkphos-56 amylase-138* totbili-0.6 12:08am blood albumin-3.0* calcium-8.6 phos-2.2* mg-1.8 01:06am blood type-art po2-83* pco2-44 ph-7.46* caltco2-32* base xs-6 01:06am blood lactate-0.8 admission cxr: ap semi-upright frontal chest radiograph is compared to four hours prior. there is no marked interval change aside from improved technique which better delineates the inferior margin of the tracheal stent to lie within the carina. lines and tubes are in standard fashion and unchanged. there is mild pulmonary overload and a moderate left effusion. there is scattered atelectasis. impression: 1. no marked interval change in mild pulmonary overload and moderate left effusion. 2. suboptimal tracheal stent position. . cxr - right upper lobe and bibasilar opacities have worsened partially due to increased atelectatic component. superimposed infection cannot be excluded. cardiomediastinal silhouette is unchanged. small right pleural effusion is stable. left lateral cp angle was not included on the film. . microbiology bld cx , - no growth . urine cx , , - 10-100k yeast . urine cx - approx 8000 yeast . rpr negative mrsa screen negative . bronchial washings - gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): oropharyngeal flora absent. staph aureus coag +. ~/ml. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. yeast. ~3000/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin g---------- =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=1 s fungal culture (final ): yeast. . sputum - gram stain (final ): <10 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): gram positive rod(s). quality of specimen cannot be assessed. smear reviewed; results confirmed. respiratory culture (final ): yeast. rare growth. . c diff toxin a and b negative . bal - gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): oropharyngeal flora absent. staph aureus coag +. >100,000 organisms/ml.. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin g---------- =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=1 s potassium hydroxide preparation (final ): test cancelled, patient credited. this is a low yield procedure based on our in-house studies. if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). fungal culture (preliminary): yeast. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): pending . labs on discharge: brief hospital course: in summary, mr. is an 87 yo male with htn, cri, tbm admitted with respiratory failure secondary to migrated tracheal stent and pneumonia. . 1) respiratory failure mrsa pna and tracheobronchomalacia - patient had a migrated tracheal stent with distal collapse and post-obstructive pneumonia on presentation. sputum cultures from osh positive only for mrsa. patient intially treated with vanco/zosyn, but this was switched to vanco/cefepime due to concern for eosinophilia. patient went to or for stent removal on , which revealed a distally migrated stent that obstructed the left mainstem bronchus, followed by successful y-stent placement by interventional pulmonary on . he was successfully extubated that afternoon and was called out to the medical floor on . noted to have increasing lethargy with tachypnea to 30-40s, o2 sats dropping to 83% on ra that night and retransferred back to micu where large amounts of tan secretions and mucous plugs were immediately suctioned out with improvement in both the patient's mental status and respiratory status. he was rebronched with removal of thick mucous and again was transferred back to the medical floor on . he did well from a respiratory standpoint and was about to be transferred to pulmonary rehab when he again had another episode of tachypnea to the 30-40s, hypoxia to mid 80s, tachycardia to 130s, and lethargy which prompted retransfer back to micu. once again, he was deep suctioned with removal of large amounts of thick, tan secretions. at this time, he was also noted to have a temperature to 101.2f. he was rebronched and bal culture revealed > 100k mrsa in the sputum. he was placed back on iv vancomycin for treatment of mrsa pna. aggressive, standing pulmonary toileting with chest pt q4h, deep suctioning q4h, acetylcysteine and albuterol nebs q4h, ipratropium nebs q4h, albuterol nebs q2h prn, and guaifensisn was initiated with good result. the patient's o2 requiement was weaned down to 2.5 l nc. he was again trasnferred out to the medical floor on and placed on the above pulmonary toileting regimen. he was also continued on iv vancomycin, with the dose adjusted for a vancomycin trough goal of 15-20 for a total of another 2 weeks. picc placed for iv abx administration. o2 sats mid 90s on 2-3l nc at the time of discharge. . 2) hypotension - patient was initially hypotensive, requiring levophed on presentation. he was found to have low cvp of 2 and improved with ivf boluses. he was quickly weaned off levophed. he was continued on broad spectrum antibiotics for pneumonia as above and had no positive blood cultures. no further episodes of hypotension at the time of discharge. . 3) delirium - hospital course complicated by waxing and mental status consistent with delirium prolonged icu and hospital admission. the patient required intermittent prn doses of zyprexa while in the micu for agitation and sundowning. on the medical floor, he required frequent reorientation and was continued on prn zyprexa and haldol. briefly required 1:1 sitter as attempting to get oob without assistance. benzodiazepenes and anti-cholinergics were avoided. foley was d/c'd but unfortunately had to be replaced for failure to void and 1000 ccs in bladder. foley d/c with void trial will need to be attempted again at ltac. . 4) chronic renal insufficiency - baseline cr 1.0 - 1.2. meds were renally dosed. . 5) eosinophilia - patient had eosinophilia on admission to osh. he was on vanco/levaquin/zosyn. he did not develop a drug rash, but due to persistent eosinphilia, he was switched to vanco/cefepime with improvement of eosinophilia. . 6) nutrition - followed by speech and swallow consult in the hospital out of concern for aspiration due to mental status and poor cough reflex. he was briefly kept npo while in the icu given concern for aspiration and dobhoff tubes were placed; however, were d/c'd by the patient within 24 hours. thus, tube feeds were never able to be titrated up to goal. upon transfer out of the icu, the patient was again reevaluated by speech and swallow who cleared the patient for a soft solids, thin liquid diet. he was also placed on ensure supplementation with meals. he will require 1:1 assistance with meals. dentures should be in place for meals. aspiration precautions with hob > 30 degrees was also continued. medications on admission: combivent as needed famotidine 20 mg daily fentanyl drip ferrous sulfate 300 mg tid heparin drip (stopped at 11:30 am on ) levaquin 750 iv q 48 hours versed drip multivitamins levophed drip zosyn 3.375 q 6 hours vancomycin 1 gram q 24 hours colace mucomyst 600 mg discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 2. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed). 3. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 4. guaifenesin 100 mg/5 ml syrup sig: five (5) ml po q6h (every 6 hours). 5. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup sig: five (5) ml po q6h (every 6 hours) as needed. 6. acetylcysteine 20 % (200 mg/ml) solution sig: 3-5 mls miscellaneous q4h (every 4 hours). 7. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q4h (every 4 hours). 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q2h (every 2 hours) as needed. 10. olanzapine 5 mg tablet, rapid dissolve sig: 0.5 tablet, rapid dissolve po bid (2 times a day) as needed. 11. haloperidol lactate 5 mg/ml solution sig: 0.5 - 1 mg injection tid prn as needed for agitation. 12. vancomycin 500 mg recon soln sig: seven y (750) mg intravenous q 24h (every 24 hours) for 7 days. 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 15. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 16. picc line care picc line care per routine 17. heparin flush 10 unit/ml kit sig: two (2) ml intravenous once a day: picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: mrsa pneumonia respiratory failure tracheobronchomalacia s/p y stent secondary diagnosis: htn chronic renal insufficiency gerd anemia discharge condition: stable. o2 sat 94-97% on 2.5 l nc. requiring q4h chest pt, deep suctioning, nebs for pulmonary toileting. discharge instructions: you were admitted to the hospital with respiratory failure in the setting of a misplaced tracheal stent and mrsa pneumonia. you had your prior stent removed and a new y stent placed by the interventional pulmonologists. you also were treated with 2 courses of iv antibiotics for mrsa pneumonia. you will need to complete another 2 week course of iv vancomycin for the pneumonia. you are now being discharged to a long term acute care hospital for further chest physical therapy, pulmonary toileting, and iv antibiotics. please take all medications as prescribed. call your doctor or return to the emergency room for fever > 101, worsening trouble with breathing, decreased oxygen saturation on oxygen supplementation, or worsening confusion. followup instructions: please f/u with your pcp 1 week. md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more fiber-optic bronchoscopy other bronchoscopy other lavage of bronchus and trachea other intubation of respiratory tract other intubation of respiratory tract closed [endoscopic] biopsy of bronchus endoscopic removal of bronchial device(s) or substances diagnoses: anemia of other chronic disease hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other chronic pulmonary heart diseases personal history of tobacco use pulmonary collapse other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure hypotension, unspecified retention of urine, unspecified mechanical complication due to other implant and internal device, not elsewhere classified hyperosmolality and/or hypernatremia tachycardia, unspecified senile dementia with delirium other specified vaccinations against streptococcus pneumoniae [pneumococcus] other diseases of trachea and bronchus chronic kidney disease, stage ii (mild) methicillin resistant pneumonia due to staphylococcus aureus eosinophilia 

Answer: The patient is high likely exposed to