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: lorazepam attending: chief complaint: transferred for respiratory failure major surgical or invasive procedure: intubation x2 picc line placement knee arthrocentesis x2 septic bursectomy tracheostomy peg tube placement history of present illness: 53 yo f with a questionable history of prior post-surgical pe, copd and bullous emphysemia admitted to on with a septic bursitis of the right knee, transferred with acute onset hypoxia, hypotension, and tachycardia. . one day after attending a town fair (approximately 3-4 days prior to admission) the patient noted right knee swelling and discomfort. the patient attributed her symptoms to walking and standing at the fair and took ibuprofen. her pain and swelling worsened. over the following 2 days the patient developed associated fevers, chills. she noted malaise and general fatigue. she also endorsed a severe headache and loose stool with associated bowel incontinence. with this constellation of symptoms, the patient presented on to the ed at 2345. she was noted to have a leukocytosis (14) with bandemia (6) and to be in acute renal failure (cr 2.1). the patient underwent drainage of her right knee bursitis revealing many gram positive cocci in clusters. she also had a negative head ct and negative lp. . the patient was admitted to the medicine floor where she was started on kefzol 1g iv q6h out of concern for a septic bursitis. overnight with iv hydration, the patient's renal failure resolved. on the medical floor within 24 hours of the time of transfer, the patient developed abrupt onset of hypoxemia, tachycardia and hypotension (with a ?chest pain?). she was transferred to the icu. in the icu, she was noted to be in new-onset a. fib with a troponin leak (0.14). she received a total digoxin 0.75 mg. there was high concern for a pe. the patient was felt too unstable to travel for a cta and she was started empirically on heparin gtt. thrombolysis was considered though her recent lp was felt to be a contraindication. she received 3500cc ns over the last 24 hours. she was noted to have respiratory distress following this administration and she was given small dose of furosemide for possible volume overload. she required a neosynephrine drip to maintain blood pressure. a swan-ganz catheter was placed. her pre-transfer co 4.93, index 3.01, pa 38/20, ra 11, pcwp 17, svr 8.6, pvr 1.46. prior to transfer she received 1amp calcium gluconate for svr 6. . ros: prior to admission, no chest pain, shortness of breath, abdominal pain, melena, hematochezia, hematuria, dysuria, hematemesis, hemoptysis, productive cough, sick contacts. past medical history: reflux sympathetic disorder causing joint swelling and pain with intermittent weakness. gluten allergy mva s/p knee arthroscopy, no known hardware cellulitis r arm pvd social history: she lives with her husband. currently between jobs. denies etoh or iv drugs. no tobacco x1 year, prior to that with 1ppd for >10 years. family history: non-contributory. physical exam: current exam pe: 99.8 140 141/63 21 98% trach collar trach settings: ps 8/5 fio2 50%. gen: nad, comfortable on trach. heent: perrl/eomi. trach collar in place cv: rrr. normal s1 and s2. no m/r/g. pulm: coarse breath sounds bilaterally. abd: soft, nontender, no organomegaly. +peg tube in place ext: no edema. neuro: aaox3. pertinent results: pertinent lab testing: 07:26pm blood wbc-18.2* rbc-3.47* hgb-10.6* hct-31.0* mcv-89 mch-30.7 mchc-34.3 rdw-14.0 plt ct-292 03:40am blood wbc-8.3 rbc-2.62* hgb-8.1* hct-24.9* mcv-95 mch-30.9 mchc-32.6 rdw-16.8* plt ct-747* 03:40am blood pt-13.1 ptt-34.0 inr(pt)-1.1 03:40am blood glucose-110* urean-10 creat-0.4 na-140 k-3.7 cl-105 hco3-27 angap-12 05:15am blood ld(ldh)-180 totbili-0.3 03:13am blood alt-29 ast-21 ld(ldh)-251* alkphos-256* totbili-0.4 03:55am blood type-art po2-90 pco2-43 ph-7.46* caltco2-32* base xs-5 04:20am blood type-art po2-96 pco2-39 ph-7.47* caltco2-29 base xs-4 12:59pm blood type-art po2-92 pco2-41 ph-7.46* caltco2-30 base xs-4 . microbiology: 03:45pm joint fluid wbc-7 rbc-1170* polys-9 lymphs-79* monos-5 macro-7 12:38am joint fluid wbc-9100* rbc-* polys-69* lymphs-16 monos-10 mesothe-5* . swab cx 12:44 am swab source: r knee bursa. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. wound culture (final ): staph aureus coag +. heavy growth. _________________________________________________________ staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin-------------<=0.25 s penicillin------------ =>0.5 r trimethoprim/sulfa---- <=0.5 s . . imaging: chest ct : 1. no central pulmonary embolism, however, it is not possible to exclude a subsegmental pulmonary embolism due to extensive interstitial lung change, pleural effusions, and atelectasis at lung bases. 2. extensive emphysematous changes along with interstitial and subpleural pulmonary fibrosis, the appearances may represent nsip along with superimposed cardiac failure. 3. scattered enlarged mediastinal and subcentimeter bilateral axillary lymph nodes. . tte : the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal (abnormal septal motion). overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. . mr : 1. marked prepatellar bursitis. equivocal overlying soft tissue defect along the anterolateral knee is seen and correlation with physical exam is requested. 2. moderate joint effusion. . cta : 1. no visualized pulmonary embolus. 2. interval worsening of multilobar pneumonia, likely explaining increased hypoxia. 3. bilateral pleural effusions. 4. no change in extensive emphysema with fibrosis and bilateral upper lobe destruction. . tte : the left atrium is normal in size. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild-moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , left ventricular systolic function is improved (septal motion is now normal) and the estimated pulmonary artery systolic pressure is higher. . cxr : the endotracheal tube, upper mediastinal drain, left subclavian catheter, and nasogastric tube are stable in satisfactory position. the cardiomediastinal silhouette is within normal limits. there has been slight improvement in aeration of the right and left middle and upper lungs. underlying emphysematous changes are stable. brief hospital course: a/p: 53 yo f with a questionable history of prior post-surgical pe, copd and bullous emphysemia admitted to on with a septic bursitis of the right knee, transferred with acute onset hypoxia, hypotension, and tachycardia. . # hypoxic respiratory failure. she was transferred from osh with hypoxic respiratory failure already intuabeted. a chest ct showed severe bullous emphysema that was likely leading to poor oxygenation. additionally, there was concern for ards from systemic inflammation in the setting of her septic bursitis leading to worsening oxygenation. she was ventilated on lung protective strategies including ardsnet volume-control and aprv. she was treated with zosyn/vanco to cover a potential community/hospital acquired pna although no objective evidence for this was found (multiple negative endotracheal and bal sputum cultures were negative). she was treated with a course of steroids and inhaled corticosteroids/b-agonists to treat any potential copd exacerbation. she was slowly weaned to pressure support ventilation on and her peep was slowly weaned down from 15-> 10 over several days. she was extubated on but persisted to have tachypnea and profound hypoxemia despite being on a high flow mask. given her persistent hypoxemia, she was re-intubated on . a cta on was performed to rule out pulmonary emboli to rule out other causes for her profound hypoxemia - this was negative. a tte with bubble study was obtained on to rule out any anatomic shunting but was also negative. it was felt that likely her poor baseline respiratory function coupled with slowly resolving ards was likely the etiology of her persistent hypoxemia. she was empirically started on high dose iv steroids to treat potential etiologies such as eosinophillic pna or fibrotic ards without much improvement in her respiratory status. given her persistent vent requirements, she had a tracheostomy placed on for eventual transfer to vent rehab for long term vent wean. her settings remained at ps 5/5 at 50% fi02 on her day of discharge. a trach collar trial was not yet attempted during her hospitalization. . # septic r knee bursitis. had a bursa tap at the osh that grew mssa with a knee arthrocentesis that did not reveal any septic knee joint involvement. she was initially on vanco for empiric coverage which was switched to nafcillin 2g iv q6 on . given rising wbc and persistent fevers, she was switched back to vanco/zosyn on . ortho was consulted and performed a bursectomy in the or on to complete remove the septic bursa. her fever curve eventually trended downward, and her wbc returned to ; she was transitioned back to nafcillin on . an additional knee arthrocentesis in the or again demonstarted sterile joint space and no joint wash-out was performed. her stitches were removed on . . her nafcillin 2gm iv q6 should be continued for 6 weeks from her bursetomy on (end date ). a picc line was placed for long term antibiotics. . # sedation: she was initially on fentanyl/versed gtt while intubated. she was placed on a fentanyl gtt and given valium to help her slowly wean off her sedation and not precipitate withdrawal. please remove fentanyl patch on . . # fen: a peg tube was placed on for long term nutrition needs given her persistent vent needs. please continue replete full strength at 70ml/hr with 100ml free water flushes q6h. . # dmii: pt was on humalog sc sliding scale while in patient. pt's fs was in 100s-200s mostly. pt was discharged with glipizide 2.5mg qday and metformin 500mg which pt was on at home but re-started at a lower dose. these can be titrated up as needed for glucose control in addition to sliding scale insulin. # prophylaxis: please continue hep sq tid and a ppi daily. . # access: r picc line inserted. . # communication: husband, (c) . # code: full. . # dispo: to pulmonary vent rehab for long term weaning. medications on admission: meds (prior to admission): unknown, the patient's husband will make a list of her medications. . (on transfer): neo gtt 40mcg dilaudid prn dig 0.75mg heparin 1000u gtt kefzol day 1: vanco day 1: lasix 20mg iv x1 given on the day of transfer for concern of volume overload discharge medications: 1. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). 2. oxycodone-acetaminophen 5-325 mg tablet : 1-2 tablets po q4h (every 4 hours) as needed. 3. insulin lispro 100 unit/ml solution : as per standard sliding scale units subcutaneous asdir (as directed). 4. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 5. docusate sodium 50 mg/5 ml liquid : ten (10) ml po bid (2 times a day). 6. guaifenesin 600 mg tablet sustained release : one (1) tablet sustained release po bid (2 times a day). 7. metoprolol tartrate 25 mg tablet : one (1) tablet po tid (3 times a day). 8. fluticasone 110 mcg/actuation aerosol : four (4) puff inhalation (2 times a day). 9. albuterol-ipratropium 103-18 mcg/actuation aerosol : six (6) puff inhalation q4h (every 4 hours). 10. nafcillin in d2.4w 2 gram/100 ml piggyback : two (2) gram intravenous q6h (every 6 hours): continue until . 11. zolpidem 5 mg tablet : one (1) tablet po hs (at bedtime) as needed. 12. glipizide 2.5 mg tab,sust rel osmotic push 24hr : one (1) tab,sust rel osmotic push 24hr po once a day. 13. metformin 500 mg tablet : one (1) tablet po twice a day. discharge disposition: extended care facility: - discharge diagnosis: septic bursitis c/b ards bullous emphysema hypoxemic respiratory failure due to copd/ards discharge condition: stable to be discharged to a vent rehab discharge instructions: you are being transferred to hospital for long term ventilator weaning. you will be administered medications as below. followup instructions: please follow up with interventional pulmonology clinic for assistance with trachesotomy revision or removal. call ( to scheduled follow up as needed. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy arthrocentesis open biopsy of soft tissue repair of blepharoptosis by tarsal technique bursectomy diagnoses: unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified atrial fibrillation acute respiratory failure methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site enthesopathy of knee, unspecified 

Answer: The patient is high likely exposed to