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: hypotension, hypoxia major surgical or invasive procedure: insertion of peripherally inserted central catheter insertion and subsequent removal of internal jugular central venous catheter history of present illness: ms. is a 55 yo woman with down's syndrome living at an facility who was sent in for hypotension. by report from staff at her facility, she has appeared more lethargic over the past week. again by report, she has had baseline sbp on order of 90's. she was referred initially to hospital where she was found to have sbp in 70's. she was was given ivf, stress dose steroids (solumedrol 100mg), and empiric zosyn (3.375mg). ekg was nsr at 67bpm with nl axis, intervals with no diagnostic st/twave findings. no prior for comparison. trop i was 0.04 (ref range < 0.10). wbc 8.9. hct 35.1. plt 347. abg (unspecified o2) was 7.39/46/101/27. urine and blood cultures were sent. . in our ed, initial vitals were 97.0, 72, 74/25, 18, 98% 4l nc (sats in 88% on ra). a r. ij catheter was placed under sterile conditions. she had very low cvp readings (reportedly 0 to -3), which responded to ivf boluses. she was also started on dopamine. her pressures increased to low 100's sbp after these interventions. bp increased to 113/84 after 4l ns in total and starting dopamine gtt to 7.5mcg/kg/hr. the etiology of her hypotension was unclear, but considered likely from hypovolemia. otherwise she did not meet sirs criteria. she did have an elevated wbc at 14.7, but did not have fever, tachycardia, tachypnea. ua was normal from outside hospital. . in the micu, her dopamine was quickly weaned off. stim was negative. all cx were negative. bp was ten points higher by a line. she was called out several days ago, but has not gotten a bed. her bps have been consistently 90s-110. she had some mild hypoxia, attributed to sleep apnea which was treated with oxygen via nasal cannula at night. she has been sad and not taking pos--conversation was had with her brother, who is her guardian and he does not want peg. past medical history: 1. down's syndrome 2. gerd 3. h/o adrenal insufficiency 4. bipolar 5. hypothyroidism 6. h/o urosepsis 7. on aspiration precautions social history: lives at an facility. her brother live in . she was previously cared for by her mother who is now ill and living in . family history: not obtained physical exam: 96.9 90/51 75 14 95%ra nad, sleepy mmm&clear ctab nl s1/s2 soft, nt, nd, +bs wwp x 4 pertinent results: labs on admission: wbc 14.7 (90% neutrophils, 6% bands), hct 36.9, plt 423,000 inr 1.3 retic count 1.5% creatinine 1.1 glucose 206 lfts within normal limits iron 34, albumin 2.8 vitamin b12 759, folate 19.8 tsh 4 cortisol 11.9 --> 26.4 negative urine eosinophils . imaging: cta chest (): there is no evidence of main or segmental pulmonary embolism. evaluation of the subsegmental pulmonary arteries is slightly limited by respiratory motion and atelectasis; however, no secondary signs of distal pulmonary emboli are identified. there is no ct evidence of right heart strain. prominent mediastinal lymph nodes measuring upwards of 1 cm are seen. no pathologically enlarged hilar or axillary lymphadenopathy is identified. the esophagus appears slightly patulous with fluid level noted. there is evidence of right neck hematoma, incompletely evaluated on this study, possibly secondary to right-sided central venous line placement. also noted is an aberrant right subclavian artery. . echo (): the left atrium is normal in size. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. right ventricular systolic function is normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. impression: normal global and regional left ventricular systolic function. mild mitral regurgitation. . ct chest (): the overall findings are most consistent with hydrostatic pulmonary edema, with septal thickening, ground glass and bilateral pleural effusions. hydrostatic pulmonary edema could potentially obscure a viral or pcp . . ct neck (): the previously noted soft tissue fluid has resolved. there is no evidence of a soft tissue hematoma on today's exam. no fluid collections are identified. there are bilateral pleural effusions present. please refer to the ct of the chest from the concurrent day. aberrant left subclavian artery. enlarged temporal horns of the lateral ventricles as well as enlarged fourth ventricle could be consistent with communicating hydrocephalus. please correlate the patient's history on prior examinations. . renal ultrasound (): 1) normal greyscale appearance of the kidneys. no hydronephrosis. 2) asymmetric decreased vascularity of the right kidney of unclear etiology and significance; if warranted this could be further evaluated by dedicated mra on a non-emergent basis. . microbiology: blood culture (): negative blood culture (): anaerobic bottle (final ): reported by phone to -cc7- @ 14:05 . staph aureus coag +. final sensitivities. 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------------ =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s vancomycin------------ <=1 s . blood culture (, , ): negative stool negative for c diff x 3 (, 15, 16) urine culture (, 11, 12, 14): negative . labs at discharge: wbc 4.4, hct 26.4, plt 378 creatinine 1.3 inr 1.2 vancomycin level 18.6 brief hospital course: ms. is a 55 year old female with down's syndrome and recent hospitalizations for hypoxia/hypotension here with same now called out of the micu and found to have mrsa sepsis. . # hypotension/fever: on arrival from the micu, the etiology of the patient's hypotension was unknown. potentially, her presentation could be due to dehydration/volume depletion. her blood pressures improved with fluid boluses. on the floor, the patient again had low blood pressures into the 70s systolic and was febrile. originally, we thought she had aspiration pneumonia and she received levofloxacin/flagyl. another possibility was seeding of neck hematoma (secondary to line insertion) but neck ct demonstrated resolution of the hematoma. she was persistently febrile so vancomycin was added to her antibiotic regimen. subsequently, blood cultures demonstrated mrsa growing from blood cultures from ; there was no sign of aspiration pneumonia. when these cultures returned, we discontinued the levo/flagyl. it is thought that this bacteremia resulted from her central line placed in the icu. her blood pressures improved on treatment; as her po intake has been poor, she intermittently required normal saline boluses. later, she developed diarrhea but was c diff negative. - no sign of adrenal insufficiency by labs. - she will need one more dose of vancomycin on to complete a 2-week course of antibiotics for bacteremia. - she has a right-sided picc line for antibiotics. - at times, she is found to be hypotensive while sleeping. when this occurs, it is usually in conjunction with slight hypoxia which we believe is secondary to sleep apnea. when this occurs, the patient should be roused as necessary (cool towels to face, talking with her). her blood pressure repeats when this happens return to baseline which is 90s-100s. . # arf: the patient's creatinine was 1.1 on arrival and peaked at 1.4. it is 1.3 at the time of discharge. the patient was evaluated by the renal team here. we believe that her hypotension caused an element of atn (fena was 3.9%). renal ultrasound demonstrated decreased blood flow to the right kidney but this is of uncertain significance. she received fluid boluses as above to keep blood pressures ~ 90. she had no evidence of urine eosinophils. . # hypoxia - the patient's intermittent hypoxia is probably secondary to baseline sleep apnea in this patient with down's syndrome. since arrival on the floor, she has been comfortable on room air. she does intermittently dip her sats during sleep. - she should have a sleep study as an outpatient to further evaluate this. . # diarrhea: the patient developed diarrhea after one week of antibiotic therapy. her c diff screens were negative x 3 and a stool culture was also negative. this could be a side effect of antibiotic therapy. this is improved at the time of discharge. . # hypothyroidism: on levothyroxine. tsh normal. . # anemia: the patient, after hydration in the micu, had stable but low hematocrit ranging from 24-27. her ferritin was 89, iron 34 with tibc 160 (> 17%). her b12 and folate were wnl. she should have this followed as an outpatient. colonoscopy could be considered by her pcp; however, this would be an invasive procedure and it is unclear if she has had this further evaluated in the past. . # increased inr: her inr was slightly elevated during her stay and is 1.2 on discharge. she did receive po vitamin k x 3 doses. this could be secondary to poor nutrition as her albumin was 2.8 on admission. . # fen - the patient tolerated a thin liquid diet with pureed solids. she enjoys boost pudding. she should have 1:1 supervision with meals. when her po intake was poor, we discussed with (the patient's brother) in fl the possibility of peg placement. he feels that this would be too invasive for a long term intervention. he thought that she would do better in a more familiar environment. she received ivf as necessary for poor po intake and when her diarrhea was profuse. . # code: full for now, the patient's brother expresses wish for short-term reversible problems to be addressed but recognizes that long-term quality of life is larger issue. . # access : has right-sided picc line as above for antibiotics. . # dispo: to extended care facility that can manage her picc line. she should continue pt/ot as appropriate. . # comm- , brother, in (cell), (; (home); her case manager at her group home is . medications on admission: celexa 20 daily asa 81 mg daily lipitor 40 mg daily gabapentin 300 tid depakote 250 mg tid synthroid 50 mg daily levaquin x 4 days evista 50 mg daily vitamins discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 4. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 5. raloxifene 60 mg tablet sig: one (1) tablet po daily (). 6. 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. 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 8. divalproex 250 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po tid (3 times a day). 9. vancomycin 1,000 mg recon soln sig: 1000 (1000) mg intravenous once for 1 doses: please give one dose on . thanks. 10. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for agitation. discharge disposition: extended care facility: highgate manor discharge diagnosis: methicillin-resistant staph aureus sepsis with resultant hypotension hypoxia, resolved down's syndrome gastroesophageal reflux hypothyroidism history of bipolar disorder history of urosepsis history of adrenal insufficiency discharge condition: afebrile, normotensive, comfortable on room air discharge instructions: please take your medications as prescribed. please call your physician or return to the emergency room should you develop any of the following symptoms: fever > 101, chills, nausea or vomiting with inability to keep down liquids or medications, diarrhea, low oxygen saturations, low blood pressure, dizziness, passing out, decreased mental status, or any other concerns. . you have been evaluated for your low blood pressure and your low oxygen saturation. you were found to have a blood infection which is being treated with antibiotics. your oxygen is low at times while sleeping. you will need an outpatient sleep study. followup instructions: please follow up with your primary care physician, . , within 1-2 weeks. call for an appointment. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux acute kidney failure with lesion of tubular necrosis unspecified acquired hypothyroidism infection with microorganisms resistant to penicillins methicillin susceptible staphylococcus aureus septicemia sepsis hypotension, unspecified hypoxemia diarrhea down's syndrome 

Answer: The patient is high likely exposed to