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: aspiration major surgical or invasive procedure: peg tube placement, trach tube replacement history of present illness: yo m w/ h/o endstage alzheimer's, afib, esophageal stricture s/p 3 diliataions, and recurrent aspiration who presented from nursing home for lethargy, and cough w/sputum over last couple days. wife says 1 wk ago pt (?partially)pulled out his g-tube, and nurse put back in place. pt was looking more emaciated and his feeds were increased from 12h to continuous over 24h, which is when she thinks pt started to decline, and may have been aspirating. over the last couple days pt became more unresponsive and also developed a cough w/ sputum. pt was on levoflox for pna as outpt. of note pt was discharged on with asp pna, treated with vanco/cipro/zosyn. during that admission pt failed extubation twice due to mucous pluging and tracheostomy was placed. j-tube and g-tube were placed to prevent aspiration. (also had c5-6 fusion then) required bag masking at nh, hemodynamically stable, then transported to , cxr showed pna, no ivf, then transferred to . in ed, t99.8, 136/91, 104, 22, 99%ra, cachectic, non-responsive, rhonchi at r base, suctioning pus from lungs, abd soft, ivf initiated - given 1.5l, ceftaz, vanco, and azithro initiated. hr 88, sats 50% 15l, rr26, 149/94, t 100.8 on transfer. past medical history: esophageal stricture ? s/p hiatal hernia hypertension s/p aortic valve replacement 3 years ago bovine per wife hip fracture s/p repair h/o aspiration pneumonia, ? recurrent aspiration h pylori gastritis dementia social history: patient is a retired ent surgeon per out side hospital report. he lives at home with his wife. independent adls until last summer family history: non contributory physical exam: general: late-stage alzheimer's - nonresponsive heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrl 2mm->1mm. mmm. op clear. neck: trach present. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . jvp=flat lungs: course rhonchi, and rales throughout abdomen: +bs soft, nt, nd. no hsm extremities: no edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. skin: no rashes/lesions, ecchymoses. neuro: pt non-responsive to commands. somnolent. pertinent results: 04:06am blood wbc-7.6 rbc-3.87* hgb-11.3* hct-33.5* mcv-87 mch-29.3 mchc-33.8 rdw-15.8* plt ct-373 02:30pm blood neuts-85.0* lymphs-10.6* monos-4.0 eos-0.2 baso-0.2 04:00pm blood pt-13.7* ptt-24.9 inr(pt)-1.2* 04:06am blood glucose-115* urean-19 creat-0.7 na-141 k-3.8 cl-106 hco3-28 angap-11 02:30pm blood ck(cpk)-16* 02:30pm blood ctropnt-0.01 04:06am blood calcium-8.0* phos-2.6* mg-2.2 03:30pm blood lactate-1.9 04:49am urine color-pink appear-hazy sp -1.013 04:49am urine blood-lg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-lg 04:49am urine rbc-756* wbc-87* bacteri-few yeast-none epi-0 sputum culture: mrsa urine and blood cultures: neg cxr: 1. patchy opacity in the right lower lobe concerning for pneumonia. 2. dense retrocardiac opacity, which could represent second area of pneumonia or atelectasis. replacement of g/j tube: uncomplicated placement of gastrojejunostomy tube through the patient's existing tract. the tube may be used immediately. brief hospital course: yom htn, afib, esophageal stricture transferred from nursing home with lethary and fever, diagnosed at osh ed with pna, transferred to , diagnosed with pna, admitted to for tx of aspiration pna/hap. # pt has had recurrent pneumonia. pt had aspiration pneumonia on this admission. it is possible that pt had aspiration with increasing his feeds from 12h to continuous 24h. his trach was also replaced with one with a cuff to further prevent aspiration risk. he was treated w/ vancomycin and zosyn. cipro was not started during this admission as there is no recorded pseudomonas infection on cultures. pt required frequent suctioning initially q1h, which is now improved. pt is now afebrile and wbc is coming down. he showed moderate growth of staph aureus coag +, and his zosyn was discontinued. pt needs vanc 1g iv q24 (as only coag + sa on cx data) x8 days () for two more days. # hypernatremia - pt's na was 158, and improved with free water replacement. now resovled at 141. # 1st degree av block - overnight once, now resolved in sinus 60-80s hr #. h/o atrial fibrillation - currently not in afib, but rate controlled. #. hypertension- currently controlled, will moniter #. uti- ua with neg nitrates but pos leukocytes, few bacteria, wbc 21-50, 90 on repeat, urine culture with minimal yeast and gnr. treated while pt was on zosyn #. hiatal hernia- gave home omezprazole medications on admission: lasix 40 aricept 10 qd asa 81 omep 40 qd kcl suspension 20 levaquin 250 x9d ativan 0.5mg q6 prn twocal hn continuous @ 50ml/h via g-tube discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: aspiration pneumonia, mrsa secondary: alzheimers dementia discharge condition: stable, afebrile discharge instructions: you were admitted with fevers, increased secretions thought to be due to an aspiration pneumonia. we treated you with antibiotics to cover the bacteria which grew from your cultures. followup instructions: please follow up with your pcp as necessary md procedure: enteral infusion of concentrated nutritional substances percutaneous (endoscopic) jejunostomy [pej] replacement of tracheostomy tube diagnoses: unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation diaphragmatic hernia without mention of obstruction or gangrene pneumonitis due to inhalation of food or vomitus alzheimer's disease heart valve replaced by transplant hyperosmolality and/or hypernatremia stricture and stenosis of esophagus methicillin resistant pneumonia due to staphylococcus aureus other protein-calorie malnutrition 

Answer: The patient is high likely exposed to