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: tetanus diphtheria / lisinopril / mavik attending: chief complaint: copd exacerbation/hyponatremia major surgical or invasive procedure: intubation and extubation history of present illness: this is a 66 year-old male w/ stage iv copd on home o2, htn, h.o. ugi bld, + mrsa and pseudomonas in sputum during recent admission at who presented to the ed from rehab for suspected copd exacerbation. pt was recently discharged from for complaints of wheezing and worsening dyspnea. his dyspnea was attributed to copd exacerbation likely tracehobronchitis. following + culture of pseudomonas pt was treated with a 10 day course of , pt also had sputums + for mrsa that was thought to be a colonizer. it does appear though that he was discharged on a 5 day course of bactrim per id recs for mrsa. pt was initially noted to be on prednisone 60mg daily upon that admission that was self-titrated without consulting a physician, discharge he was given a steroid taper. since his discharge on , the patient had been reporting increasing tightness in his chest and shortness of breath. his wife notes that he had not slept for at least 48 hours due to his persistent respiratory discomfort. additionally, he had been eating minimally, and had begun to develop increased lower extremity, worse than ever in the past. of note, lasix had been discontinued during his most recent admission due to hyponatremia to 133 and hypovolemia. however, the patient's wife believes it was restarted yesterday due to his progressive lower extremity edema and decreased urine output. records from the nursing home are not available at this time. the patient's family also notes that he had been mildly confused, even before discharge from , however, this has worsened in the last 24 hours. he had been having hallucinations and talking to people who were not in the room. additionally, he had been "pretend eating," and not fully oriented. of note, he had also been complaining of back pain, so had been receiving increased doses of percocet since his discharge as well. in the ed, initial vitals showed t 97.6 bp 162/85 hr 98 rr 18 satting 97% on 2l nc. he was noted to have increased work of breathing. initially this was thought to be related to a chf exacerbation so nitropaste was placed on the patient without improvement. he was trialed on cpap which he did not tolerate, and he was satting 100% on nrb. 80 mg lasix were given without improvement, so patient was intubated due to increased work of breathing after discussing intubation with his wife and daughter (however, patient has been dni in the past). he was then placed on a nitro gtt which was discontinued prior to arrival to the icu. he was also given ctx and levaquin for possible infection. cta was done which showed no pe and a possible recent aspiration on prelim read. he was observed having myoclonic jerking during his cta scan, and neurology was curbsided to ensure that this was not seizure activity due to his hyponatremia. a ct scan of the head was done to look for possible etiology. he also rec'd 1/2 l of ns for his hyponatremia prior to transfer. patient arrived to the icu intubated and sedated. ros: unable to obtain. laboratories: notable for ?????? . see below for rest. . ecg: sinus tach at 124, occasional pvcs, pr wnl, biphasic tw in v4-v6, q waves in ii, iii, avf that are old compared to prior . imaging: cxr: no evidence of infiltrate . ct head: motion limited study, but no obvious acute process. . cta chest prelim read: no pe rll atelectasis, and mild bronchiolar impaction, ? recent aspiration t8 compression fx, new from 8/. no signif. retropulsion. . . past medical history: 1) cad s/p mi 2) hypertension 3) ? h/o chf x2: ef 60% on echo , moderate symmetric lvh 4) severe copd on home o2: fev1 29% , fev1/fvc 52% predicted, reduced fvc 5) osa not on cpap 6) h/o mrsa + sputum 7) anemia 8) s/p rectus sheath hematoma 9) alcohol abuse/dependence s/p multiple rehab stays 10) cervical radiculopathy 11) chronic pancreatitis 12) diverticulosis (last scope ) past surgical history: s/p knee surgery s/p le venous stripping age 28 social history: per omr history pt was a heavy drinker (8-10 beers per day), no history of severe withdrawals, reportedly now limits his drinking to 2/night. smokes 6 cigarettes per day, former 80 pack year history of smoking. he is married and lives with wife with no drug use. family history: mother had a dvt and diabetes. father died of coronary artery disease at age 35. physical exam: gen: nad / well-appearing eyes: eomi / conjunctiva clear / anicteric ent: moist mucous membranes neck: supple cv: rrr s1s2 ii/vi sem lusb pulm: diffuse inspiratory and expiratory wheezes but improved, decreased breath sounds gi: nabs / nd / soft / nontender back: no paraspinal tenderness ext: warm , 4+ pedal edema bilaterally skin: erythematous healing vesicular rash on left buttock neuro: alert / oriented x 3/ answers ? appropriately / follows commands / normal gait psych: appropriate / pleasant pertinent results: 11:45am glucose-89 urea n-21* creat-0.9 sodium-118* potassium-5.3* chloride-81* total co2-25 anion gap-17 11:45am ck(cpk)-77 11:45am ctropnt-<0.01 11:45am ck-mb-notdone probnp-364* 11:45am wbc-12.6* rbc-3.95* hgb-11.1* hct-32.5* mcv-82# mch-28.0# mchc-34.1# rdw-15.9* 11:45am neuts-95.4* lymphs-3.0* monos-1.5* eos-0.1 basos-0.1 11:45am plt count-264 11:45am pt-13.1 ptt-28.7 inr(pt)-1.1 11:52am lactate-1.3 01:26pm type-art tidal vol-550 peep-5 o2-50 po2-190* pco2-52* ph-7.36 total co2-31* base xs-3 intubated-intubated 04:47pm freeca-1.03* 04:47pm glucose-101 na+-118* k+-4.5 cl--81* tco2-29 07:18pm urine blood-mod nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-6.0 leuk-neg 07:18pm urine rbc-34* wbc-1 bacteria-few yeast-none epi-0 07:18pm ck-mb-6 ctropnt-0.07* 07:18pm ck(cpk)-62 12:00am ck-mb-5 ctropnt-0.04* 12:00am ck(cpk)-45 imaging: cxr (): no acute intrathoracic process. cta (): (replim) no pe; rll atelectasis, and mild bronchiolar impaction, ? recent aspiration; t8 compression fx, new from 8/. no signif. retropulsion. head ct (): motion limited study, but no obvious acute process. brief hospital course: 66 year-old male with severe copd and recent admission for copd exacerbation who was admitted intubated after experiencing increased wob and hyponatremia. #. respiratory failure: pt presented to the ed with complaints of dyspnea, upon assessment required intubation currently on ventilatory support. pt has a history of dyspnea that improves only with an increase in his steroid doses. his last spirometry in showed stage iv copd with an fev1 28%; fev1/fvc 55%. he did not improve with diuresis, nitro page or nitro gtt, so this did not likely represent a chf exacerbation. also bnp was low at 364. had recent admission for copd exacerbation and was treated with 10 days of ceftaz and 5 days of bactrim for pseudomonas/mrsa + sputum. patient presumed to have copd exacerbation wasn was treated with iv solumedrol and transitioned to po prednisone. patient did not appear to have much of a cough or sputum production prior to intubation. however, he does have evidence of infiltrate on ct scan, ? new aspiration. he was treated with vanc/zosyn for pna given gram + rods in his sputum cx and hx of mrsa in his sputum. mrsa was felt to be a colonizer and vanc was discontinued on discharge. pseudomonas was pan-sensitive so zosyn was changed to cipro and he will complete a 14-day course. this antibiotic treatment plans was discussed with his outpatient pulmonology team. he was also treated with iv steroids, atrovent nebs, advair, albuterol prn, and guafenesin. he was discharged on a slow steroid taper and will follow up with his pulmonologist as an outpatient. # hyponatremia: unclear what precipitated such as drop, likley to significnat home lasix dose (60mg ) had been slightly hyponatremic during his admission at and lasix had been discontinued. his family believes lasix was restarted, and the patient had been eating and drinking minimally since his discharge. also given his chronic steroid use, there is a question of possible adrenal insufficiency (elevated potassium/hyponatremia) though chronic steroid use does not cause primary adrenal insufficiency so mineralocorticoid axis should be intact. his na began correcting after he was given ivf and his hypovolemia was fully corrected once he was extubated and was able to control his po intake. he received one dose of po lasix in order to restart him on his home medications and na dropped to 132, so it was discontinued. he was advised to remain off lasix for the time being. # delirium: resolved. multifactorial. likely acutely worsened by his hyponatremia. however, he had also been taking increased narcotic medication, had minimal sleep over multiple days and had not been eating or drinking. his mental status cleared once his hyponatremia was partially corrected and he was alert and oriented x3 by the time he was called out to the floor, and remained so until discharge. # lower extremity edema: per the family, this has been an ongoing problem, never any definitive etiology. he has diasolic heart failure, but no pnd/orthopnea or other symptoms suggestive of acute chf. also, bnp was less than 400. there may also be a contribution from his recent steroid use. his lasix was held as above due to hyponatermia. he was also given compression stockings to wear and instructed to elevate his legs as much as possible. # hypertension: his bp regimen was continued with slight changes to his doses of verapamil and amlodipine while in-house. he was advised to follow up with his pcp for management. ## rash on buttock: the patient had a vesicular-appearing rash on his left buttock. he stated this is herpes that breaks out intermittently and has been treating it with fluocinonide ointment which clears it up. he reports his pcp prescribed it but he has also been to a dermatologist. although the rash had a somewhat vesicular appearance (but no open or draining vesicles), it would not be expected to heal with topical steroids if it were herpes, so this diagnosis is in question. his dermatologist's office was , but there was no clear reference in the records by review of a nurse to indicate herpes; he has had an irritant dermatitis treated with topical steroids including clobetasol. topical steroids were not given in-house, and he was advised to follow up with his dermatologist as an outpatient. # code: full code. the patient had been dnr/dni in the past, appears family made a quick decision to intubate while he was in the ed and now wish him to be full code. medications on admission: medications on discharge : ? lisinopril 10 mg daily (has documented allergies) ambien 10 mg prn spiriva 18 mcg daily bupropion 150 mg sr fexofenadine 60 mg folic acid 1 mg daily calcium +d duonebs q4h prn percocet q6h prn senna colace fluticasone-salmeterol 250 mcg-50 mcg 1 puff prednisone taper, 35 mg for now verapamil 240 mg daily asa 81mg daily discharge medications: 1. cipro 750 mg tablet : one (1) tablet po every twelve (12) hours for 8 days. :*16 tablet(s)* refills:*0* 2. spiriva with handihaler 18 mcg capsule, w/inhalation device : eighteen (18) mcg inhalation once a day. 3. bupropion 150 mg tablet sustained release : one (1) tablet sustained release po bid (2 times a day). 4. fexofenadine 60 mg tablet : one (1) tablet po twice a day. 5. folic acid 1 mg tablet : one (1) tablet po daily (daily). 6. calcium+d 500 (1,250)-200 mg-unit tablet : one (1) tablet po once a day. 7. duoneb 0.5-2.5 mg/3 ml solution for nebulization : one (1) neb inhalation every four (4) hours as needed for shortness of breath or wheezing. 8. oxycodone 5 mg tablet : one (1) tablet po q4h (every 4 hours) as needed for pain. :*30 tablet(s)* refills:*0* 9. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 10. senna 8.6 mg capsule : one (1) capsule po once a day. 11. fluticasone-salmeterol 250-50 mcg/dose disk with device : one (1) disk with device inhalation (2 times a day). 12. verapamil 180 mg tablet sustained release : two (2) tablet sustained release po q24h (every 24 hours). :*60 tablet sustained release(s)* refills:*2* 13. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). :*30 tablet,rapid dissolve, dr(s)* refills:*2* 14. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed. 15. guaifenesin 600 mg tablet sustained release : one (1) tablet po q12h (every 12 hours). 16. amlodipine 5 mg tablet : two (2) tablet po daily (daily). :*60 tablet(s)* refills:*2* 17. prednisone 10 mg tablet : one (1) tablet po daily (daily) for 8 days: take four tablets for two days, then three tablets for two days, then two tablets for two days, then 1 tablet for two days, then stop. :*20 tablet(s)* refills:*0* 18. outpatient physical therapy outpatient pulmonary pt discharge disposition: home with service facility: discharge diagnosis: primary: respiratory failure, pneumonia, severe copd secondary: hypertension, hyperlipidemia, coronary artery disease, anemia, hyponatremia discharge condition: good, stable, at baseline oxygen requirement of 1-2l nc discharge instructions: you were evaluated for respiratory distress. you were intubated for a short period of time and have improved since then. you should continue antibiotics for eight more days. you may take tylenol and oxycodone for your back pain. do not drive or operate heavy machinery while taking oxycodone due to the risk of sedation. do not take lasix for the time being, as it has led to low sodium levels that can be dangerous. follow up with your primary care physician for consideration of restarting this or an alternative medication. our physical therapists have recommended home physical therapy, although you would probably benefit from outpatient pulmonary physical therapy in the future. if you have worsening shortness of breath, fevers, chills, chest pain, lightheadedness or episodes of loss of consciousness, call your doctor or seek medical attention immediately. followup instructions: follow up with your pulmonary physician weeks. dr. office will call you with an appointment. if you do not hear from them, call them at (. follow up with your primary care provider 1-2 weeks. call dr. office at for an appointment. follow up with your dermatologist, dr. , regarding the rash on your left buttock. call her office at to make an appointment. provider: function lab phone: date/time: 11:10 provider: ,interpret w/lab no check-in intepretation billing date/time: 11:30 provider: np/dr phone: date/time: 11:30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube insertion of other (naso-)gastric tube diagnoses: anemia of other chronic disease obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension adrenal cortical steroids causing adverse effects in therapeutic use hyposmolality and/or hyponatremia obstructive chronic bronchitis with (acute) exacerbation acute respiratory failure pneumonia due to pseudomonas old myocardial infarction rash and other nonspecific skin eruption carrier or suspected carrier of methicillin resistant staphylococcus aureus hypovolemia chronic pancreatitis other and unspecified alcohol dependence, unspecified diverticulosis of colon (without mention of hemorrhage) leukocytosis, unspecified chronic diastolic heart failure other alteration of consciousness other diuretics causing adverse effects in therapeutic use edema 

Answer: The patient is high likely exposed to