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: cough, shortness of breath major surgical or invasive procedure: none history of present illness: hpi: mr. is a 66 yo male with history of cad s/p, chf (ef 15-20%), diabetes type ii, pvd, copd who presents with cough and shortness of breath x 3 days. patient states that he is able to ambulate around his house from room to room at baseline. on saturday, he became dyspneic with exertion and noted reduction in his exercise tolerance. he states that he has been short of breath with any movement for the past few days. his vna called his pcp on saturday who started him on levofloxacin. he states that he has had a cough which is productive of brown/green blood-tinged sputum. he denies any fevers or myalgias at home. he endoreses chills and diarrhea since saturday. he lives alone and denies any sick contacts. states that he received both the flu vaccine and pneumovax this year. . on arrival to the ed, t 98.3, hr 115, bp 110/60, rr 24, spo2 90% on ra. he received 1l ns, combivent nebs x 2, azithromycin 500 mg po x1 and ceftriaxone 1 g iv x 1. cxr and cta chest were performed. he was enrolled in the nac study. . past medical history: past medical history: 1) cad: recent anterior stemi in with stents x 2 to lad, course c/b cardiogenic shock requiring balloon pump. - h/o bms to proximal and distal lad in 2) copd: on 2l nc at home. pft's : marked obstructive ventilatory defect. the reduced fvc is likely due to gas trapping but a coexisting restrictive defect cannot be excluded. suggest lung volume measurements if clinically indicated. fvc 62% predicted, fev1 39% predicted, fev1/fvc 63% predicted. 3) severe regional left ventricular systolic dysfunction, ef 15-20% 4) hypercholesterolemia 5) gout 6) peripheral vascular disease s/p left iliac artery stent in . 7) diabetes mellitus 8) non-small-cell lung carcinoma, status post left pneumonectomy 9) gastroesophageal reflux disease 10) paroxysmal atrial fibrillation, chronically anticoagulated on coumadin social history: h/o prior tobacco abuse x 60 pack years; quit in . there is no history of alcohol abuse. . family history: there is no family history of premature coronary artery disease or sudden death. father had cad in old age. sister with mvp. physical exam: vs: afebrile, bp 91/59 hr 102 rr 22 o2 100% 4l pulsus 8 gen: nad, aox3 heent: op clear, mm dry, jvp 15cm, no kussmauls cardiac: rr, tachycardic, hsm at llsb pulm: left sided lung sounds are absent, diffuse ronchi on r sided without rales abd: soft, nt, nd, no masses, bs+ ext: wwp, 2+ pitting pedal edema to knees neuro: grossly normal pertinent results: 12:00pm blood wbc-6.1 rbc-4.23* hgb-10.6* hct-35.2* mcv-83# mch-25.0*# mchc-30.1* rdw-15.6* plt ct-408 12:00pm blood pt-60.7* ptt-59.3* inr(pt)-7.2* 12:00pm blood glucose-200* urean-36* creat-1.6* na-132* k-4.8 cl-89* hco3-25 angap-23* 03:02am blood ck(cpk)-27* 03:08pm blood probnp-* 03:02am blood calcium-8.8 phos-4.1 mg-2.2 12:08pm blood lactate-3.7* 03:13pm blood lactate-3.8* 10:25am blood lactate-2.9* 12:00pm wbc-6.1 rbc-4.23* hgb-10.6* hct-35.2* mcv-83# mch-25.0*# mchc-30.1* rdw-15.6* 12:00pm neuts-81.4* bands-0 lymphs-11.1* monos-7.1 eos-0.2 basos-0.2 12:00pm hypochrom-2+ anisocyt-normal poikilocy-2+ macrocyt-normal microcyt-occasional polychrom-normal ovalocyt-1+ teardrop-1+ pappenhei-occasional 12:00pm plt smr-normal plt count-408 12:00pm pt-60.7* ptt-59.3* inr(pt)-7.2* 12:00pm glucose-200* urea n-36* creat-1.6* sodium-132* potassium-4.8 chloride-89* total co2-25 anion gap-23* 12:00pm ctropnt-0.04* 12:00pm ck-mb-4 12:08pm lactate-3.7* 03:08pm probnp-* . ekg: sinus tachycardia, normal axis, rate 115, qwaves previous seen in v1-v4 . radiologic data: cxr : stable examination demonstrating post left pneumonectomy with no acute process in the right lung. . ct chest : 1. moderate pulmonary edema superimposed on severe emphysematous changes in the right lung. new right-sided pleural effusion. 2. post left-sided pneumonectomy changes appear stable. . tte : the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is an apical left ventricular aneurysm. there is severe regional left ventricular systolic dysfunction with anterior/anteroseptal, apical and inferior/basal inferolateral akinesis (lvef 15-20%). no masses or thrombi are seen in the left ventricle. the right ventricular cavity is mildly dilated with moderate global free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: severe regional left ventricular systolic dysfunction, c/w cad. moderate right ventricular systolic dysfunction. moderate mitral regurgitation. moderate pulmonary hypertension. . 9:06 pm sputum site: induced **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): oropharyngeal flora absent. staph aureus coag +. moderate growth. 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. yeast. rare growth. 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 trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=1 s . 9:47 am aspirate site: nasopharynx r/o respiratory viruses add on rapid respiratory viral screen per dr. . **final report ** viral culture (final ): test cancelled, patient credited. please refer to respiratory id result. rapid respiratory viral antigen test (final ): positive for respiratory syncytial viral antigen. specimen screened for: adeno,parainfluenza 1,2,3 influenza a,b and rsv. this kit is not fda approved for direct detection of parainfluenza virus in specimens; interpret parainfluenza results with caution. reported by phone to (4i) at 1637. . brief hospital course: mr. is a 66 yo male with chf, cad, copd, remote h/o lung cancer s/p left pneumonectomy presents with respiratory distress x 3 days- found to have a rsv respiratory infection and subsequently mrsa pneumonia. in addition he was severely fluid overloaded and required much diuresis. . #.mrsa pneumonia/rsv - the patient presented with a new productive cough in the absence of clear pulmonary infiltrate. he failed levofloxacin x 3 days at home as empiric treatment for community acquired pneumonia. on admission he was found to have an elevated lactate, chills, and sputum production. pe ruled out by cta in ed. he was started on vanc/levo, but was found to have + rsv nasopharyngeal aspirate and antibiotics were dc initally discontinued, however on sputum culutre was obatined and found to have mrsa. he was treated with a course of vancomycin, now completed. urine legionella negative. he oxygen was weaned as tolerated and is currently afebrile and on his home rate of 2l nc. . #.copd exacerbation - the patient has a long-standing history of copd, admission exam consistent with a compenent of copd exacerbation as a cause of dyspnea. he was treated with a prednisone taper, completed on . he was also continued on spiriva and albuterol as outpatient. #.acute on chronic systolic congestive heart failure - the patient has a history of severe systolic chf s/p large anterior stemi. ef 15% following a large anterior mi in . since that time he had been milrinone dependant and had previously been discharged on home milrinone at a rate of 0.5mcg. upon this admission he was massively fluid overloaded and was diuresed with a lasix drip. his lungs remained relatively clear of edema on cxr and on exam but he did have significant dyspnea on exertion indicative of left sided heart failure which improved with diuresis. in addition he had very significant peripheral edema, with 3+ pedal edema to his upper thighs and also sacral edema, this also improved greatly with diuresis. during his diuresis hyponatremia down to 118 and renal failure were limiting factors but these improved eventually with further diuresis and uptitration of milrinone. milrinone upon discharge is at 0.8mcg. he is on lasix 60mg po bid and digoxin 0.125mcg every other day. multiple attempts have been made in the past with an ace inhibitor, on this admission he was tried on 1.25mg of lisinopril daily which his blood pressure did not tolerate. baseline sbps is between 70-90 but his sbp dropped to the mid 60s with an acei. at his baseline sbp he is asymptomatic. he was continued on pseudoephedrine 30mg po q6hrs for bp augmentation and on spironolactone. his baseline bp is 80s systolic and he continues on a milrinone infusion at 0.8mcg/kg/min. he should continue to maintain a 1l fluid restriction daily. please md if weight increases greater than 3lbs as his lasix should be uptitrated if blood pressure allows. he continues on coumadin for his akinetic anterior wall as well as history of paf. . #.cad - the patient was admitted from - with a large anterior stemi. he was found to have an lad with a 70% stenosis after a proximal stent and then a total occlusion without collateral flow and stent was placed. his hospital course was complicated by cardiogenic shock requiring balloon pump. he has continued to be pressor dependent as above. he was continued on aspirin and plavix. . #.paf - the patient has a h/o paf. he was continued on amiodarone 200 mg daily, anticoagulated on coumadim, current dose 1.5mg daily. . #.arf: on admission the patient presented with creatinine 1.8 up from baseline of 1.2. he improved to 1.4 with hydration, and believed to be likely prerenal in the setting of intravascular volume depletion, superimposed on mild chronic renal insufficiency. his cr is now ranging from 1.2-1.4. . #.dm2: on admission his glyburide held in the setting of acute illness. he was maintained on ssi and lantus. he is currently on lantus 11 units dosed with breakfast and a ssi. his flingerstick should continue to be monitored four times daily and lantus titrated as needed. . #.fen: cardiac/dm diet. fluid restriction 1l daily . #.ppx: ppi, systemically anticoagulated with coumadin . #. full code medications on admission: amiodarone 200 mg daily asa 325 mg daily calcium carbonate 500 mg tid w/ meals plavix 75 mg daily senna 2 tabs colace 100 mg flonase 2 sprays each nostril daily lasix 100 mg glyburide 5 mg qam milrinone gtt @ 200 mcg/ml daily mvi protonix 40 mg daily kcl 10 meq aldactone 25 mg daily spiriva 18 mcg daily coumadin simethicone 80 mg q6 hours prn gas tylenol prn pain discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 5. hexavitamin tablet sig: one (1) cap po daily (daily). 6. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. furosemide 20 mg tablet sig: three (3) tablet po bid (2 times a day). 9. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 10. warfarin 1 mg tablet sig: 1.5 tablets po daily16 (once daily at 16). 11. digoxin 125 mcg tablet sig: one (1) tablet po every other day (every other day). 12. pseudoephedrine hcl 30 mg tablet sig: one (1) tablet po q6hrs (). 13. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 14. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid w/meals (3 times a day with meals). 15. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed. 16. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). 17. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 18. glipizide 5 mg tab,sust rel osmotic push 24hr sig: one (1) tab,sust rel osmotic push 24hr po daily (daily). 19. zinc oxide-cod liver oil 40 % ointment sig: one (1) appl topical prn (as needed). 20. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 21. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. 22. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 23. heparin lock flush (porcine) 100 unit/ml syringe sig: two (2) ml intravenous daily (daily) as needed. 24. insulin glargine 100 unit/ml cartridge sig: thirteen (13) units subcutaneous qam at breakfast. 25. insulin lispro 100 unit/ml solution sig: one (1) unit subcutaneous four times a day: per sliding scale provided. 26. milrinone 1 mg/ml solution sig: 0.8 mcg/kg/min intravenous infusion (continuous infusion). discharge disposition: extended care facility: - discharge diagnosis: primary: 1. mrsa pneumonia 2. rsepiratory synctial virus 3. acute on chronic systolic heart failure 4. chronic obstructive pulmonary disease exacerbation discharge condition: afebrile, vss, bp at baseline 80s systolic discharge instructions: you were admitted with shortness of breath and were found to have pneumonia. you have completed your course of antibiotics for your pneumonia. you were also treated with steroids for an exacerbation of your chronic obstructive pulmonary disease which you have also completed. . you should continue to weigh yourself every morning, md if weight > 3 lbs. please continue to adhere to 2 gm sodium diet. restrict your fluid intake to 1l daily. you should continue to take lasix 60mg twice daily. you have also been started on digoxin 0.125mcg every other day and pseudoephedrine 30mg every six hours. you are also continuing on milrinone. please continue to take the remainder of your medications as directed. . please return or call dr. if you experience chest pain, shortness of breath or worsening of your lower extremity edema. please call with any questions. you are being disharged to acute rehab for continued care. followup instructions: please follow up with dr. on at 3:00pm at 430 , . please call with any questions. . please maintain your scheduled follow up listed below: provider: , md phone: date/time: 1:00 provider: function lab phone: date/time: 1:10 provider: , .d. phone: date/time: 1:30 procedure: venous catheterization, not elsewhere classified diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux pure hypercholesterolemia acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation personal history of malignant neoplasm of bronchus and lung obstructive chronic bronchitis with (acute) exacerbation chronic kidney disease, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus long-term (current) use of anticoagulants methicillin susceptible pneumonia due to staphylococcus aureus pressure ulcer, lower back acute on chronic systolic heart failure other disorders of neurohypophysis pneumonia due to respiratory syncytial virus 

Answer: The patient is high likely exposed to