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: morphine attending: chief complaint: shortness of breath, admit for rigid bronchoscopy major surgical or invasive procedure: intubation and mechanical ventilation bronchoscopy x 2 atrial line placement picc line placement history of present illness: mrs. is a 70 yo female with fibrosing mediastinitis and resultant left main occlusion 15 mos s/p metallic l main stent palcement complicated by severe granulaltion tissue at both ends of the stent who presents for rigid bronchoscpoy for debridement on wed . mrs. reports increased sob x 1 month, low grade fevers and chills in the afternoons, decreased appetite, mild weight loss. not on home o2. can walk up 10 steps; has more difficulty walking up stairs lately. chronic cough productive of brown sputum in am, yellow in pm, no hemoptysis. she underwent flexible bronchoscopy on the afternoon of admission, and airways were found to be narrowed throughout, l main stent in good position, moderate granulation tissue at proximal end with 80% obstruction and severe granulation at distal end of the stent with only a pinhole opening to the lower and upper segments of the left upper and lower lobes. also noted were thick purulent secretions. (severe granulation tissue and almost complete occlusion of left upper and lower lobes.) . review of systems: (+) per hpi (-) denies rhinorrhea or congestion, chest pain or tightness, palpitations, nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: past medical history: - fibrosing mediastinitis: symptoms of sob since . s/p lung bx , hospital. positive (1:160), rnp (1:), mildly positive rf, elevated ace level(191), cytoxan -. s/p l main stent placement in - hypothyroidism (self discontinued levothyroxine) social history: no tob, no asbestos, no etoh, no illicits lives with husband in ct, two children also in ct. retired, worked for insurance company family history: mother-sudden cardiac death at age 64 sister-cardiac disease and lupus, death at age 55 physical exam: vitals: t: 98.1 bp: 120/68 p: 121 r: 20 o2: 94 ra general: alert, oriented, no acute distress, voice hoarse heent: sclera anicteric, mmm, oropharynx clear neck: supple, submandibular fullness, jvp not elevated, no lad lungs: high pitched inspiratory wheezes, mild expiratory wheezes in proximal airways. increased expiratory duration cv: tachycardic, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cn iii-xii intact, grossly wnl pertinent results: admission labs- 07:20am blood wbc-7.2# rbc-4.43 hgb-11.5* hct-35.3* mcv-80* mch-26.0* mchc-32.6 rdw-13.8 plt ct-250 06:45am blood wbc-4.1 rbc-4.18* hgb-10.8* hct-32.6* mcv-78* mch-25.8* mchc-33.0 rdw-13.6 plt ct-224 07:20am blood pt-13.9* ptt-32.4 inr(pt)-1.2* 06:45am blood pt-13.4 ptt-31.0 inr(pt)-1.1 07:20am blood glucose-107* urean-9 creat-0.5 na-138 k-3.9 cl-100 hco3-30 angap-12 06:45am blood glucose-105* urean-6 creat-0.4 na-137 k-3.7 cl-101 hco3-30 angap-10 07:20am blood calcium-8.7 phos-2.9 06:45am blood calcium-8.3* phos-2.5* mg-1.9 discharge labs- 05:12am blood wbc-4.6 rbc-3.69* hgb-9.5* hct-29.4* mcv-80* mch-25.6* mchc-32.2 rdw-14.8 plt ct-239 04:11am blood neuts-83.4* lymphs-9.9* monos-4.3 eos-2.1 baso-0.3 05:30am blood pt-14.4* ptt-29.3 inr(pt)-1.2* 05:12am blood glucose-103* urean-10 creat-0.4 na-140 k-3.8 cl-101 hco3-33* angap-10 05:12am blood calcium-8.6 phos-3.8 mg-1.9 pathology left mainstem tumor, debridement: 1. squamous and respiratory epithelium with reactive epithelial atypia, necrosis, fibrosis, acute and chronic inflammation with abscess formation and granulation tissue. 2. small nodule consistent with actinomycotic granule. 3. multiple levels are examined. echo the left atrium and right atrium are normal in cavity size. the estimated cardiac index is normal (>=2.5l/min/m2). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal biventricular cavity sizes with preserved global and regional biventricular systolic function. mild pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , the findings are similar. ct chest without iv contrast: impression: 1. interval increase in soft tissue material within the left main stem bronchial stent and segmental airways immediately distal to the stent. marked interval increase in postobstructive consolidation in the left lower lobe. 2. overall increase in multifocal ground-glass opacities, particularly in the right lower lobe, compatible with chronic infection. 3. otherwise, stable marked bronchiectasis in the left upper lobe, right middle lobe and lingula. radiology report quantitative lung scan study date of regional analysis of tracer distribution in the lungs shows: right lung: perfusion/ventilation upper third 18% / 11% middle third 29% / 36% lower third 38% / 21% left lung: perfusion/ventilation upper third 5% / 10% middle third 8% / 15% lower third 4% / 7% total perfusion/ventilation right lung: 84%/68% left lung: 16%/32% impression: hypoperfusion and hypoventilation of the left lung. 10:44 am bronchoalveolar lavage **final report ** gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram negative rod(s). respiratory culture (final ): 10,000-100,000 organisms/ml. commensal respiratory flora. staph aureus coag +. ~5,000 cfu/ml sensitivities performed on request.. isolates are considered potential pathogens in amounts >=10,000 cfu/ml. sensitivities requested by dr () . 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. this isolate is presumed to be resistant to clindamycin based on the detection of inducible resistance . sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=0.5 s brief hospital course: ms. is a 70 year old woman with inflammatory pulmonary disease who was admitted for observation s/p bronch, c/b intubation and pneumonia. # sob / fibrosing mediastinitis: pt had a flex bronch that showed severe stenosis of l main stent granulation tissue. v/q scan showed hypoperfusion and hypoventilation of l lung, ct chest, bronchial washings with commensal resp flora. rigid bronch was completed wed . pt remained intubated. pt was taken back to or on fri for stent removal and further debriding of granulation tissue. pt was extubated on sat after her 2 procedures. she was breathing and satting well initially, but became acutely tachypneic and tachycardic. she had to be re-intubated. she was started on prednisone 30mg po daily on , tapered off on . she was also found to have mrsa in her , the patient was started on vancomycin on for a 7 day course. she was extubated successfully on . she is satting well on ra. picc was placed for abx. pt will need f/u with pulm as an outpatient for reevaluation. she is off of her cellcept due to her infection; this will need to be restarted by her outpatient providers. . # tachycardia: pulse in 120s on admission, sinus tach with baseline nonspecific st-t wave changes unchanged from baseline. tachycardia resolved with fluids. on hd 2 she was noted to have frequent extra beats on morning physical exam. ecg was repeated which showed decreased rate in the 60s with frequent pacs of unclear etiology. on the morning of hospital day 3 cardiac exam was normal. she remained stable. . #pna: she has a history of spiking a fever post procedures similar to this one. pt had a fever post procedure. levaquin and metronidazole were started initially on and cultures were sent. levaquin was changed to cefepime on for concern for worsening fevers. vanc was added on for gpc in her , which grew out mrsa for a 7 day course. cefepime and flagyl were discontinued on . fevers resolved on vancomycin. vanco levels were borderline low (9.5 and 9.7) therefore doses of vanco were increased to 1250mg and then 1500mg for the last 2 days of treatment respectively. . #pulmonary edema: there was a question of pulmonary edema at admission. cxrs did not show any convincing evidence, with hilar opacities perhaps related to fibrosing mediastinitis. an echocardiogram showed ef >60%, preserved global systolic function and mild pulmonary artery systolic hypertension. . #anemia: hct dropped to 30 from 35 with recent baseline in mid-to-low 30s. microcytic. normal coags, platelets and had scant hemoptysis post procedure. considered likely chronic disease. pt was cleared by pt for home and discharged after her abx were complete. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ outstanding issues: - cellcept will need to be restarted by ip medications on admission: - cellcept mg , started 1 month prior to admission - combivent 18-103 mcg/actuation aerosol 1-2 puffs q4h prn - estradiol patch 0.05 2x/week - tylenol pm prn discharge medications: 1. combivent 18-103 mcg/actuation aerosol sig: 1-2 puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. 2. estradiol 0.025 mg/24 hr patch semiweekly sig: one (1) transdermal once a week: use as before. 3. acetaminophen 650 mg/20.3 ml solution sig: po q6h (every 6 hours) as needed for pain, fever. 4. multivitamin tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: fibrosing mediastinitis mrsa post-obstructive pneumonia anemia discharge condition: activity status: ambulatory - requires assistance or aid (walker or cane). level of consciousness: alert and interactive. mental status: clear and coherent. discharge instructions: you were admitted to the hospital due to needing your lung stent removed. you had 2 procedures to debrid the fibrosis of your lung and remove your stent. you required intubation and being on a breathing machine, you are now breathing much better. you also had bacteria found in your lungs, and it was treated with antibiotics. the following changes were made to your medications: - you were started on a multivitamin - your cellcept was stopped, discuss restarting this with your doctor followup instructions: please see your primary care doctor in the next 1-2 weeks. please call monday for an appointment to see next week to discuss your cellcept prior scheduled appointments- department: west clinic when: tuesday at 11:15 am with: , md building: de building ( complex) campus: west best parking: garage department: west procedural center when: tuesday at 11:30 am building: building ( complex) campus: west best parking: garage department: west procedural center when: tuesday at 12:00 pm with: , md building: de building ( complex) campus: west best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization other intubation of respiratory tract closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus endoscopic excision or destruction of lesion or tissue of bronchus endoscopic excision or destruction of lesion or tissue of bronchus bronchial dilation bronchial dilation endoscopic removal of bronchial device(s) or substances central venous catheter placement with guidance diagnoses: acidosis anemia, unspecified unspecified acquired hypothyroidism acute respiratory failure hypotension, unspecified surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation mechanical complication due to other implant and internal device, not elsewhere classified methicillin resistant pneumonia due to staphylococcus aureus other diseases of mediastinum, not elsewhere classified rheumatoid lung 

Answer: The patient is high likely exposed to