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: captopril attending: chief complaint: respiratory failure major surgical or invasive procedure: none history of present illness: pt is a 50 y/o male with dm2, chf, copd, pul htn who was admitted to an osh with aflutter, devloped respiratory failure, and was transferred to for ongoing respiratory failure. the patient saw his pcp and was found to be in aflutter at 156 and hypotensive to the 90's with evidence of volume overload. previous to this he had been treated with furosemide for severe chf sx, with orthopnea (slept sitting up) with good effect, a 20lb weight loss and improved sx; he'd also been developing dysphagia, choking on solids, liquids, and pills. he was admitted to a medicine floor at the , where his respiratory status worsened (an abg showing worsening hypercarbia at 7.27/96/72) and he was transferred to the icu and intubated. since that time, his course has been marked by persistent volume overload and the one febrile spike, with a sputum cx growing out strep pneumoniae. interestingly the patient recently returned from the phillipines. blood thick and thin smears were negative for parasites. past medical history: 1.)dm2 2.)history of svt 3.)chf with diastolic dysfunction 4.)copd 5.)osa 6.)pulmonary hypertension social history: lives with his wife and 2 daughters, recently laid off as electrician. 48 pack yr hx, quit 12 yrs ago. occ etoh. no ivda. family history: mother died of aneurysm. brother and sister with dm, brother with prostate cancer. physical exam: t 98.6, bp 113/74, hr 76, rr 18, spo2 96% vent- a/c vt 500, rr 14, peep 5, fio2 0.6 gen- obese male, sedated and intubated heent- anicteric sclera cv- rrr, s1s2, no m/r/g pul- moves air well, bibasilar rales, no wheeze abd- obese, soft, nabs extrm- no cyanosis/edema, warm/dry nails- no clubbing, no pitting/color changes/indentations neuro- sedated, does not respond to pain, perrl pertinent results: 09:44pm type-art temp-36.7 rates-/14 tidal vol-450 peep-5 o2-60 po2-123* pco2-54* ph-7.29* total co2-27 base xs--1 intubated-intubated 10:30pm urine rbc-* wbc-0-2 bacteria-occ yeast-none epi-<1 10:30pm urine blood-sm nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 10:30pm urine color-amber appear-clear sp -1.034 11:17pm type-art temp-36.7 rates-/14 tidal vol-550 peep-5 o2-50 po2-104 pco2-45 ph-7.32* total co2-24 base xs--3 intubated-intubated ............. cxr impression: ap chest reviewed in the absence of prior chest radiographs: lung volumes are quite low exaggerating the caliber of the cardiomediastinal silhouette. nevertheless, there is substantial real mediastinal widening, but whether this is due to vascular engorgement alone or a combination of vascular engorgement and adenopathy is difficult to assess. in addition to interstitial abnormality throughout the lungs most likely edema. there are more focal areas of consolidation predominantly in the left suprahilar and basal lung concerning for pneumonia. et tube is in standard placement. right internal jugular line tip projects over the superior cavoatrial junction and the nasogastric tube is looped in the stomach. .............. ekg probable atrial flutter with variable block. diffuse low voltage. delayed r wave transition. no previous tracing available for comparison .............. echo conclusions: 1. the left atrium is mildly dilated. 2. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. brief hospital course: a/p: 50 y/o male with chf and copd admitted on with respiratory failure from pneumococcal pneumonia and volume overload, in atrial flutter with chf, s/p cardioversion on (heparinized for 3 weeks s/p cardioversion) who grew mrsa in his sputum while he was difficult to wean and eventually underwent trach and peg placement and is being discharged to rehab for continued wean off vent. . 1)respiratory failure/pneumonia -- likely a multifactorial problem, including chf decompensation, pneumonia (gpc in chains at osh, presumes streptococcus), and copd. wheezes on exam, but not really responsive to bronchodilators. pt was intubated on day of admission with respiratory distress. initial cxr was read as: "there is substantial real mediastinal widening, but whether this is due to vascular engorgement alone or a combination of vascular engorgement and adenopathy is difficult to assess. in addition to interstitial abnormality throughout the lungs most likely edema. there are more focal areas of consolidation predominantly in the left suprahilar and basal lung concerning for pneumonia." despite all initial micro data being negative, he was continued on vancomycin (7 days total), azithromycin (total 5 days given) and ceftriaxone (10 days) started on the day of admission. in addition, on , he was started on hydrocortisone for adrenal insufficiency. he was volume overloaded on exam and diuresed daily. ct chest on revealed: "impression: 1. findings consistent with background pulmonary edema. 2. partial consolidations in the right upper and lower lobes, and increased ground-glass in the left upper lobe. findings most likely relate to multifocal pneumonia. 3. bilateral pleural effusions, moderate on the right and small on the left." during this time, attempts to wean were unsuccessful with high risbs and agitation if not sedated. bronchoscopy performed on revelaed a clear l side and r sided secretions. micro data from the bal was positive for mrsa. vanc and zosyn (4 days given) were restarted on for continued secretions and inability to wean. he underwent trach on without event. risb data was as high as 600s at this time. ps trials were not successful. on , pt spiked fever to 101. secretions increased but micro data revealed only mrsa with blood and urine cx negative. ct chest on revealed: "there is interval decrease in bilateral pleural effusions. there is also improvement in the right upper lobe atelectasis. there are persistent partial atelectasis of the lower lobes likely due to associated pleural effusion. there is also interval improvement in the ground-glass opacities likely due to pulmonary edema. impression: 1. interval improvement in pulmonary edema, pleural effusions, and atelectasis. 2. cardiomegaly. 3. calcifications of the right coronary artery. 4. small amount of ascites." vanco was stopped on the s/p >2 weeks of coverage. throughout this time, he retained a good amount of fluid and daily lasix was required to diurese him and prevent effusions. all remaining micro data yielded only mrsa in the sputum. for increased secretions and elevated temperature, he was restarted on vancomycin on per id with a goal of a 7 day course. ct sinus done on to rule out sinusitis revealed: "impression: mild mucosal thickening in the maxillary sinuses and sphenoid sinus. partial opacification in the mastoid air cells bilaterally." by day of discharge, secretions are improved and pt feels significantly better. he has been out of bed to the chair for over a week. he had good urine output. he is afebrile x 2 days. the goal is to discharge to rehab for eventual wean from trach. . 2) pt initially hypotensive but eventuall hypertensive and thus started on ace inhibitor. initially this was captopril but pt developed a rash and peripheral eosinophilia after 3 days and was switched per pharm recommendations to lisinopril. the rash subsequently resolved and the bp is well controlled at time of discharge. . 3) chf -- pt with ct consistent with pna on admission. echo here on not indicative of systolic failure, only mild , no clear diastolic failure. repeat echo on revealed: "the left atrium is moderately dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). the aortic valve leaflets appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion." . 5)copd -- resistance has been consistently low by vent, however, therefore unclear how much of a role copd is playing. --continue mdi's --steroids were weaned. . 6) a-flutter -- unclear what set off aflutter (brewing infection?). cardioverted on , successfuly. heparinized for 3 full weeks per cards s/p carioversion. he has remained in sinus rhythm since cardioversion without event. . 7) fen -- --continue low na tube feeds (at goal 55cc) --euvolemic at time of discharge. --repleat lytes as necessary . 8) ppx -- heparin gtt, lansoprazole, pneumoboots (until oob more frequently) . . 10)comm -- with wife and pt. . 11)code -- full medications on admission: haldol 1-2mg iv q6` prn digoxin 0.125mg iv daily heparin gtt at 1150 units/hr diltiazem gtt at 10mg/hr simvastatin 20mg daily pantoprazole 40mg daily propofol gtt discharge medications: 1. simvastatin 10 mg tablet : two (2) tablet po daily (daily). 2. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 3. ipratropium bromide 18 mcg/actuation aerosol : two (2) puff inhalation qid (4 times a day). 4. docusate sodium 150 mg/15 ml liquid : one (1) po bid (2 times a day). 5. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day). 6. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 7. albuterol 90 mcg/actuation aerosol : 4-6 puffs inhalation q4h (every 4 hours). 8. olanzapine 5 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po tid (3 times a day) as needed. 9. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day). 10. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 11. lactulose 10 g/15 ml syrup : thirty (30) ml po q4h (every 4 hours) as needed. 12. insulin regular human 100 unit/ml solution : one (1) injection asdir (as directed). 13. diltiazem hcl 30 mg tablet : one (1) tablet po qid (4 times a day). 14. lisinopril 20 mg tablet : one (1) tablet po daily (daily). 15. vancomycin in dextrose 1 g/200 ml piggyback : one (1) intravenous q 12h (every 12 hours) for 5 days. 16. heparin lock flush (porcine) 100 unit/ml syringe : one (1) ml intravenous daily (daily) as needed. discharge disposition: extended care facility: - discharge diagnosis: respiratory failure s/p pneumonia discharge condition: stable discharge instructions: pls take all meds as prescribed. pt has frequent known secretions and is chronically colonized by mrsa. should improve s/p trach wean. call with any ?s or evolving symptoms including fevers, etc. followup instructions: as outpatient md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] atrial cardioversion temporary tracheostomy closed [endoscopic] biopsy of bronchus diagnoses: congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified infection with microorganisms resistant to penicillins atrial flutter candidiasis of mouth acute respiratory failure other specified cardiac dysrhythmias hypotension, unspecified methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site unspecified sleep apnea pneumococcal pneumonia [streptococcus pneumoniae pneumonia] diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to