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: this is a 79 year old female patient with a history of chronic obstructive pulmonary disease, coronary artery disease status post non-q wave myocardial infarction in , chronic renal tracheostomy, gastrostomy tube, and chest computerized tomography scan. the patient was initially admitted to the hospital status post a fall. the patient was found to have a left pneumothorax and during the hospital course developed a right lower lobe pneumonia. the patient was treated with antibiotics and transferred to for rehabilitation where she had acute respiratory decompensation requiring intubation. the patient was extubated within 24 to 48 hours of readmission to hospital, however, the patient failed this extubation and the remainder of the hospital course included an additional two episodes of failed extubation for a total of three failed extubations. it was felt that these failed extubations were likely secondary to right lower lobe pneumonia versus right lower lobe collapse. of note, bronchoscopy obtained two weeks prior to transfer revealed pus in the right lower lobe positive for stenotriphomonas. the patient's treatment for the stenotriphomonas included cefepime, levaquin, ceptaz according to the physician at . other significant hospital course includes the patient being found to have sputum that was positive for methicillin-resistant staphylococcus aureus and stool that was positive for clostridium difficile. past medical history: 1. hypertension 2. chronic obstructive pulmonary disease 3. coronary artery disease status post non-q wave myocardial infarction in 4. chronic renal insufficiency 5. history of gastrointestinal bleed secondary to non-steroidal anti-inflammatory drugs 6. left femoral condyle fracture in 7. history of obstructive sleep apnea requiring home oxygen with 2 liters of nasal cannula medications on transfer: 1. flagyl 500 q. 8 2. levofloxacin 250 q. day 3. cefipime 1 gm intravenous q. day 4. diltiazem 30 mg p.o. q. 6 5. labetalol 200 mg p.o. b.i.d. 6. atorvastatin 10 mg p.o. q.h.s. 7. terazosin 10 mg p.o. q. day 8. protonix 40 mg p.o. q. day 9. 220 mcg b.i.d. 10. salmeterol 2 puffs b.i.d. 11. quinapril 40 mg p.o. b.i.d. 12. clonidine 2 puffs q.i.d. allergies: aspirin social history: the patient has a 60 pack year history of tobacco use. denies any alcohol use. the patient stopped smoking five years ago. physical examination: the patient is afebrile, pulse 83, blood pressure 146/82, oxygen saturation 96% on 2 liters of nasal cannula. generally, the patient was intubated in no apparent distress, alert and oriented. head, eyes, ears, nose and throat examination reveals him to be normocephalic, atraumatic with pupils are equal, round, and reactive to light and accommodation. extraocular movements intact. there is presence of orogastric tube and endotracheal tube in place. mucous membranes were dry. lungs were clear to auscultation bilaterally except for sparse coarse breath sounds at the right base. heart was irregular without any murmurs, rubs or gallops. abdomen was soft, obese, nontender and nondistended with decreased bowel sounds. extremities examination reveals there was 3+ pitting edema of the left lower extremity and 1% nonpitting edema of the right lower extremity. neurological, the patient was alert and oriented times three. cranial nerves ii through xii were intact. laboratory data: white count 11.5, hematocrit 27.0, platelets 317, pt 13.4, ptt 34.3, inr 1.1, calcium 7.7, albumin 2.3, magnesium 2.3, phosphorus 4.1, sodium 138, potassium 5.1, chloride 103, bicarbonate 26, bun 69, creatinine 1.1, glucose 85. hospital course: the patient is a 79 year old female patient status post intubation secondary to pneumonia. she has had failed extubation times three at an outside hospital admitted for tracheostomy, percutaneous endoscopic gastrostomy tube and a chest computerized tomography scan. 1. pulmonary - the patient is status post intubation secondary to pneumonia. the patient received a tracheostomy the morning of . there were no complications. the patient is scheduled for a noncontrast chest computerized tomography scan which is not performed at the time of dictation but will be performed prior to discharge. addendum will be dictated with the results of computerized tomography scan. the patient will also receive a bronchoscopy to evaluate the right lower lobe pneumonia/pus previously found on previous bronchoscopy. the patient has had increased secretions while in this hospital and it was felt that bronchoscopy would be beneficial to this patient. there was also bronchoscopy done at the time of dictation and cultures will probably be pending at the time of discharge. the patient's chronic obstructive pulmonary disease was stable during this hospital stay controlled with albuterol and atrovent metered dose inhalers. 2. infectious disease - history of pneumonia and clostridium difficile positive. the patient was placed on contact precautions for clostridium difficile as well as history of methicillin-resistant staphylococcus aureus. the patient will be continued on flagyl 500 mg p.o. t.i.d. for the clostridium difficile and pneumonia coverage was covered with levofloxacin 250 mg p.o. q. day. an infectious disease consult was obtained to evaluate for the necessity of cefepime. it was felt that with stenotrophomonas, the patient would benefit from bactrim for more specific coverage. although outside hospital states that the stenotrophomonas was sensitive to levofloxacin and cefepime it is felt that bactrim is better activity against this microbiology and in the future if not contraindicated would recommend switching antibiotics to bactrim. it was also felt that the patient did not need to be on cefepime for double coverage given no evidence of pseudomonas with current cultures. the patient was just kept on levofloxacin 250 mg p.o. b.i.d. 3. gastrointestinal - the patient had a percutaneous endoscopic gastrostomy tube placed at 2:30 pm on . there were no complications post procedure and tube feeds began 24 hours after placement. 4. cardiac - history of coronary artery disease with nonspecific myocardial infarction. the patient was continued on chronic medications including labetalol, flagyl, quinapril and atorvastatin. the patient was found to be in atrial flutter which apparently was known at the outside hospital. 5. renal - patient has a history of chronic renal insufficiency, the patient showed no evidence of an elevated creatinine while at this hospital. chest computerized tomography scan obtained is no contrast and should not affect the renal function. discharge status: the patient is stable at the time of discharge. discharge condition: the patient will be discharged back to vancouver/ for further rehabilitation after percutaneous endoscopic gastrostomy, tracheostomy, chest computerized tomography scan and bronchoscopy performed at this hospital. discharge diagnosis: 1. respiratory failure secondary to pneumonia with recurrent failed extubation attempts. 2. placement of percutaneous trachesostomy 3. stenotrophomonas pneumonia dr., p. 12-948 dictated by: medquist36 d: 14:39 t: 15:33 job#: procedure: percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension chronic airway obstruction, not elsewhere classified acute respiratory failure old myocardial infarction 

Answer: The patient is high likely exposed to