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: history of present illness: mr. is a 54 year old gentleman with a history of supraventricular tachycardia, hypothyroidism, hypercholesterolemia who was transferred from hospital to for failure to wean from ventilator and persistent fevers. please see hospital discharge summary for further details of his initial presentation and hospital course there. in brief, he presented to hospital complaining of shortness of breath for two days following a recent upper respiratory tract infection two weeks prior to admission. on admission he was tachypneic to the 40s, hypoxic to 93% on 100% nonrebreather, tachycardiac to 180 and hypotensive. labs were notable for a white blood count of 5 with 49% neutrophils and 40% bands. chest x-ray revealed left lower lobe and possibly right lower lobe infiltrates. blood cultures grew out six out of six bottles with streptococcus pneumoniae. he was begun empirically on unasyn and the azithromycin which was subsequently switched to vancomycin when an organism was identified. on , he was switched to penicillin when the organism was found to be pansensitive. despite therapy, he continued to spike fevers to 101 to 102 on a daily basis despite subsequent cultures being negative. he had an exhaustive workup for alternative etiology of his persistent fevers including right upper quadrant ultrasound which was negative for cholecystitis, lower extremity noninvasives which were negative for deep vein thrombosis, chest computerized tomography scan which was negative for empyema. an echocardiogram was negative for endocarditis. he did have a head computerized axial tomography scan which revealed sinusitis. gram stain and cultures of sputum and nasal swabs revealed pseudomonas aeruginosa and so levofloxacin was added to his regimen. on , per infectious disease consult recommendation, penicillin and levofloxacin were discontinued and he was switched to ceftazidime and gentamicin to treat his pneumococcal pneumonia and pseudomonas sinusitis. on the day of transfer, he was also started on empirically on flagyl and p.o. vancomycin for oppression of clostridium difficile, however, clostridium difficile toxin subsequently returned negative. despite all of these treatments, he continued to spike fevers on a daily basis. his hospital course at was also notable for respiratory failure. he was intubated on admission for hypoxic respiratory failure which was felt to be due to his pneumonia, presumably from pneumococcus, although this organism was never cultured from his sputum, only from his blood. it is not clear whether he was attempted to be weaned from the ventilator, but he required persistent sedation, due to tachypnea to the 50s and desaturation whenever attempts at weaning sedation were made. his tachycardia and hypotension on admission was felt likely due to sepsis. his hemodynamics stabilized with fluids, dopamine, and antibiotics by hospital day #3 and he was able to be weaned off of dopamine at that time. he ruled out for a myocardial infarction and echocardiogram revealed ejection fraction of 75% with mild left ventricular hypokinesis. mr. was transferred to for persistent fevers and inability to wean from the ventilator. past medical history: 1. history of supraventricular tachycardia 2. hypothyroidism, status post thyroidectomy in 3. hypercholesterolemia 4. neuralgia allergies: no known drug allergies on admission. during admission haldol was noted to cause seizures. medications on transfer: 1. ceftazidime 1 gm intravenously q. 8 hours (day #2) 2. gentamicin 160 mg intravenously q. 12 hours (day #2) 3. vancomycin 250 mg p.o. q. 6 hours, (day #1) 4. flagyl 500 mg intravenously q. 6 hours (day #1) 5. albuterol metered dose inhaler 4 to 6 puffs q.i.d. prn 6. tylenol prn 7. propofol drip (3 mcg/kg) 8. ativan drip (3 mg/hr) 9. pepcid 20 mg q.d. 10. heparin 5000 units subcutaneously b.i.d. 11. haldol prn agitation 12. total parenteral nutrition social history: mr. works as a history professor at a nearby community college. he smokes two packs per day. he drinks occasional alcohol. he has a wife and two children. family history: mother has diabetes mellitus and coronary artery disease. physical examination: on admission he was intubated and sedated. temperature is 101.4, heartrate 78, blood pressure 128/50, respiratory rate 20 to 30. ventilatory settings were pressure support 20, positive end-expiratory pressure 5, fio2 40%, pulling title volumes of 850 cc. pupils were equal, round, and reactive to light. neck was supple. there was no jugulovenous distension or lymphadenopathy. heart had a regular rate and rhythm with normal s1 and s2 and no murmurs, rubs or gallops. lungs had decreased breathsounds at the left base with bronchial breathsounds in the left lower lobe. abdomen had normoactive bowel sounds, was obese and soft. there was no hepatosplenomegaly. extremities showed no edema, clubbing or cyanosis. on neurological examination he was sedated without spontaneous movements. laboratory data: (on transfer) white blood cell count was 8.9, hematocrit 27.5, platelets 415, sodium 142, potassium 3.7, chloride 109, bicarbonate 24, bun 27, creatinine 0.8, glucose 166, calcium 8, magnesium 2.1, phosphate 3.6. arterial blood gases showed ph 7.46, pco2 31, po2 128. culture data and imaging studies as in history of present illness and hospital course. hospital course: (by system) 1. infectious disease - on transfer his antibiotics were switched to levofloxacin 500 mg intravenously q.d. and ceftazidime 1 gm intravenously q. 8 hours. it was issued adequately that two organisms had been cultured to date - 1. streptococcus pneumoniae which had been cultured from his blood at and was presumed for sepsis pneumonia and sepsis; 2. pseudomonas which had been cultured from endotracheal secretions at and was felt to be a cause of sinusitis. despite this coverage, he remained persistently febrile to 101 to 102 on a daily basis. the infectious disease service was consulted, and an exhaustive workup was continued to determine the source of these fevers. he underwent a chest computerized tomography scan to evaluate for possible empyema, which revealed resolving left lower lobe infiltrate and only small uncomplicated pleural effusion, not enough fluid to tap safely. sinus computerized tomography scan was repeated here which did reveal sinusitis and otorhinolaryngology was consulted. they were not too impressed with the sinusitis as the cause of his fevers. an abdominal computerized tomography scan was negative for any intra-abdominal source. the lumbar puncture was negative. head magnetic resonance imaging scan was negative for intracranial source other than the known sinusitis. transthoracic and transesophageal echocardiograms were negative for endocarditis. all of his lines were switched on more than one occasion. he was repeatedly pancultured and all cultures were negative at this hospital, with the exception of one culture from an arterial line which subsequently grew out staphylococcus epidermidis-the arterial line was discontinued and vancomycin was begun on . sputum cultures from also grew out methicillin-resistant staphylococcus aureus, and this in the setting of increasing respiratory secretion became an indication for continuing vancomycin for methicillin-resistant staphylococcus aureus tracheobronchitis. furthermore, when he developed worsening purulent nasal secretions on and head imaging revealed worsening sinusitis, otorhinolaryngology was reconsulted and performed maxillary sinus biopsy. the gram stain was negative, but the culture subsequently grew out methicillin-resistant staphylococcus aureus. drugs were also considered as a cause of his fevers and on , ceftazidime was discontinued given that the pseudomonas was only grown from endotracheal suctioning at an outside hospital and was not felt to be a pathogen. finally, chest computerized tomography scan on was positive for bilateral pulmonary emboli suggesting this as a possible contributing source of his fevers. in summary, his fevers were felt to be multifactorial due to pneumococcal pneumonia and sepsis initially followed by pulmonary emboli and methicillin-resistant staphylococcus aureus tracheobronchitis. there also might have been some contribution of a reaction to medications. by , his fever curve had decreased to only lowgrade temperature to 99. he did have a transient fever spike to 102 in the setting of a seizure on , but has since defervesced. at the present time, he had only lowgrade fevers to 99 and his white blood cell count is normal. he finished a 21 day course of levofloxacin for pneumococcal pneumonia and sepsis on , and a one course of vancomycin for methicillin-resistant staphylococcus aureus tracheobronchitis . finally, he is being anticoagulated for pulmonary emboli. 2. respiratory - he was intubated on admission to hospital for hypoxic respiratory failure felt to be due to pneumococcal pneumonia and sepsis. at he remained sedated and unable to be weaned from the ventilator due to tachypnea and desaturation. upon transfer to his sedation was weaned but he was noted to have difficulty weaning from the ventilator due to rapid shallow breathing. he was subsequently diagnosed with bilateral pulmonary emboli by chest computed tomographic angiography and begun on heparin. despite heparin treatment for his pulmonary emboli and antibiotics for his pneumonia with evidence of resolving pneumonia by computerized tomography scan, he remained unable to be weaned due to rapid shallow breathing. it was felt that there was also a component of muscular weakness to prolonged illness and intubation contributing to this difficulty. he is status post tracheostomy . by he was able to be weaned off of the ventilator and doing well on tracheostomy mask. he was transiently placed back on the ventilator to in the setting of a seizure, but has since been transitioned back to the tracheostomy mask on which he is doing well. 3. cardiovascular - he has been stable from a cardiovascular standpoint throughout his hospitalization at on lopressor 50 mg b.i.d. for hypertension and paroxysmal supraventricular tachycardia. 4. hematologic - as noted above, he had chest computed tomographic angiography , which was positive for bilateral pulmonary emboli. he was begun on a heparin drip. on , once all procedures were felt to be completed, he was started on coumadin load. he was also switched from a heparin drip to low molecular weight heparin subcutaneously to prepare him for discharge until his coumadin is therapeutic. on he was transfused with 2 units of packed red blood cells for slowly declining hematocrit felt to be due to prolonged hospital stay and phlebotomy. 5. neurology - on he had new onset of three generalized tonic clonic seizures in the setting of respiratory distress from mucous plugging and 8 mg of haldol the night prior for agitation. he was loaded on dilantin given the recurrent seizures. he underwent extensive workup to look for etiologies of his seizures including head computerized tomography scan which was negative for bleed, lumbar puncture, head magnetic resonance imaging scan, electroencephalogram all of which are negative. he was also evaluated by the neurology service. it is felt that the seizures were likely due to hypoxia/respiratory distress in combination with lowered seizure threshold from haldol in the setting of prolonged illness. it is recommended that he continue on dilantin for six months and then be re-evaluated by the neurologist at which time he will likely be able to come off of this medication. 6. nutrition - for unclear reasons, he was unable to tolerate tube feeds via nasogastric or orogastric tube throughout his hospital stay both at and here at . abdominal computerized tomography scan was negative for evidence of obstruction and he has been passing stool. he was maintained on daily total parenteral nutrition while unable to give tube feeds. he is status post j-tube placement on and was started on promote with fiber tube feeds on . he has been advanced to his goal which is 80 cc/hr which he has been tolerating well. he has been evaluated by the speech and swallow service here and they recommend trying judiciously some custard and sips of water p.o. and advancing his diet slowly as tolerated. 7. endocrine - he has a history of hypothyroidism status post thyroidectomy, however, he was not on thyroid replacement medication on admission. tsh and free t4 were checked and were within normal limits. 8. access - he currently has a right arm picc line which was placed on . disposition: mr. was discharged to rehabilitation in stable condition. discharge instructions: 1. he should continue to receive aggressive pulmonary toilet and should undergo pulmonary rehabilitation. 2. he should continue coumadin load 7.5 mg p.o. per j-tube q.d. and adjust dose as needed for goal inr 2 to 3 for pulmonary emboli. he should be maintained on lovenox 120 mg subcutaneously b.i.d. until coumadin is therapeutic. he should remain on coumadin for six months and his anticoagulation can then be discontinued as they were the clear predisposing cause for his pulmonary emboli immobilized in the hospital. 3. he should continue on dilantin 500 mg per j-tube q.d. (divided t.i.d. 200/200/100). follow levels and adjust dose as needed for goal level of about 15. he should follow up with neurologist, dr. at once he is discharged from rehabilitation. call to schedule an appointment. 4. he should be placed on methicillin-resistant staphylococcus aureus precautions. 5. he should receive both influenza and pneumococcal vaccines. 6. he should follow up with his primary care physician, . outside discharge from rehabilitation. discharge medications: 1. coumadin 7.5 mg p.o./per j-tube q.d. follow inr and adjust dose as needed for goal inr between 2 and 3. he should be continued on this for six months. 2. lovenox 120 mg subcutaneously b.i.d. this should be continued only until inr is therapeutic. 3. dilantin 500 mg per j-tube q.d., (divided t.i.d. 200/200/100) follow dilantin levels until stable and therapeutic at goal level around 15. 4. lopressor 50 mg p.o./per j-tube b.i.d. 5. protonix 40 mg p.o./per j-tube q.d. 6. promote with fiber tube feeds (goal 80 cc/hr) discharge diagnosis: 1. streptococcus pneumoniae pneumonia and sepsis 2. methicillin-resistant staphylococcus aureus tracheobronchitis 3. bilateral pulmonary emboli 4. respiratory failure and inability to wean from ventilator due to diagnoses 1, 2 and 3 as well as muscular weakness 5. new onset generalized tonic clonic seizures 6. hypertension 7. supraventricular tachycardia , m.d. dictated by: medquist36 d: 17:13 t: 17:13 job#: procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances other permanent tracheostomy percutaneous [endoscopic] gastrojejunostomy diagnoses: unspecified acquired hypothyroidism other convulsions acute respiratory failure other specified cardiac dysrhythmias methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site iatrogenic pulmonary embolism and infarction acute bronchitis pneumococcal septicemia [streptococcus pneumoniae septicemia] pneumococcal pneumonia [streptococcus pneumoniae pneumonia] 

Answer: The patient is high likely exposed to