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: history of present illness: the patient is a 40 year old female with a past medical history of quadriplegia following c3-c4 spinal injury in status post mva. she has anemia, osteomyelitis, gerd, depression, renal insufficiency for which she is on chronic steroids, multiple aspiration pneumonia, intubation five times in the last nine months. she is mrsa positive with penicillin and sulfa allergies. she was in her usual state of health prior to hospitalization when at 5:30 p.m. the patient was smoking outside. she called the hospital staff for shortness of breath. patient wanted nasal suction for "jelly stuff." patient was given neb treatment which increased her o2 sat to 89% which later fell to 87%. patient was taken to by ambulance. in the emergency room patient was given vanco, levo, flagyl, hydrocortisone, multiple nebs with improvement in sats. patient had sats of 89% in room air and 100% on 100% nonrebreather. patient had increasing pco2 blood gas 7.35, 49, 86. subsequent blood gas 7.26, 65, 103. patient intubated with purulent material rising through the tube. patient received 6 liters of normal saline in the e.d. she had previous been admitted for aspiration pneumonia in . she was treated with vanc, levo and flagyl. physical examination: temperature was 96.5, blood pressure 123/90, heart rate 106, respirations 17, sating 100% with 7.5 et tube. she had no jvd. cardiac regular rate and rhythm. she was tachy, normal s1, s2. she had bilateral crackles. abdomen had positive bowel sounds, soft, nontender. extremities had multiple decubs, yeast and 2+ edema. laboratory data: white count 10.4, bandemia 17, hematocrit 40.1, platelets 119. all other labs were normal. ua has large blood, positive nitrites, ph 8, small leukocyte esterase, greater than 50 red blood cells, 20 white blood cells, moderate bacteria. chest x-ray pertinent left lower lobe collapse versus consolidation, blunting of the left diaphragmatic angle, haziness at the right base, atelectasis, no effusion and no left catheter tip. ekg sinus tachy, normal intervals, axis, no st-t changes. hospital course: patient was subsequently extubated on in the morning and patient did very well from then. patient continued on levo, vanc and flagyl until , day of discharge when levo and flagyl were discontinued because culture came back mrsa positive sensitive to vancomycin. blood cultures remained negative. patient will need pfts for questionable copd and respiratory mechanics studied as an outpatient since this pneumonia might not be aspiration, but might be due to poor diaphragmatic and chest wall muscular function with c3-c4 quadriplegia. patient probably has low respiratory reserve. would also recommend that patient discontinue smoking stat. infectious disease. patient with pneumonia. discussed cultures and previous antibiotics. also gave nystatin powder. cardiac. patient was tachy. when we treated the pneumonia and gave fluids, patient was brady which is her normal state with c3-c4 quadriplegia. neuro. patient was sedated over the course of the stay with propofol because it is easily turned off. propofol was discontinued on the 20th and patient was extubated as previous mentioned. psych. at the time we just continued her outpatient psych meds. gi. patient was given an aggressive bowel regimen with a large bowel movement on . renal. patient has foley with leaking around the foley. was evaluated by gu, but they wanted to do a dye study and the patient has sulfa allergy, so patient with continue with 30 french catheter foley. extremities. patient has multiple decubs which were treated with wet to dry. had wound care nurse evaluate. patient was given frequent turns and first step mattress was continued on an outpatient basis. decubs are getting better. pain. patient was treated with neurontin, valium, oxycodone and morphine iv with continued outpatient pain. endocrine. patient was started on hydrocortisone for renal insufficiency. it was subsequently decreased. will give outpatient dose as necessary. disposition: patient is ready to go back to . condition on discharge: patient is in stable condition. discharge status: patient is stable, ready for , status post pneumonia. discharge diagnosis: pneumonia. discharge medial: 1. oxycodone 5 q.four. 2. zinc. 3. prednisone 5 mg p.o. q.day. 4. scopolamine q.72 hours. 5. albuterol. 6. klonopin 0.05 b.i.d. 7. ms contin 15 b.i.d. 8. zoloft 25 q.day. 9. iron 325 t.i.d. 10. dulcolax and lactulose. 11. prilosec 20 q.d. 12. atrovent. 13. estraderm 0.05 q.three days. 14. baclofen 38 q.six hours. 15. neurontin 900 t.i.d. 16. reglan 10 q.d. 17. ditropan 5 b.i.d. 18. valium 5 b.i.d. would also recommend for outpatient facility pfts and ventilatory mechanics as an outpatient. please emphasize once again that patient has had five intubations in nine months as a pertinent point. , m.d. dictated by: medquist36 d: 10:32 t: 10:40 job#: rp procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: esophageal reflux chronic airway obstruction, not elsewhere classified acute respiratory failure pneumonitis due to inhalation of food or vomitus methicillin susceptible pneumonia due to staphylococcus aureus quadriplegia, unspecified 

Answer: The patient is high likely exposed to