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: confusion/agitation major surgical or invasive procedure: none history of present illness: 89 m with cad and pafib presented from home with ms change. he sustained a mechanical fall in and was discharged from to rehab on . at that time, notes already suggests that he had some confusion. i talked to the daughter this evening and she reports that he was intermittently confused at rehab as well. the family took the patient home five days ago and then brought him to the ed for ongoing and worsening confusion and agitation. . in the ed, a ct head was ordered but he was unable to cooperate so he was sedated and intubated for the study. he was obtunded after the study and was tranferred to the micu because there was difficulty extubating him. . in the micu, there was a concern for acute stroke since his pupils were noted to be unequal. the stroke team was called and mri/mra was done that did not show acute stroke. apparently, his unequal pupils are not new. . the cause of his mental status change was unclear. the thought at this time is toxic metabolic, which neuro agrees with. there was a question of seizure in the micu but eeg was unrevealing. lp was done and did not show infection. . currently he is still agitated and the daughter notes a waxing and course. past medical history: past medical history: per omr coronary artery disease; had imi, s/p ptca of rca and lcx pafib not on anticoag hypertension seizure disorder, last 20yrs ago systolic chf with ef 40-50% on echo in glaucoma glucose intolerance social history: denies etoh, tobacco, illicit drug, or herbal medication use. native of , lives with his wife. family history: non-contributory physical exam: physical exam: vs: 98.1, 92, 142/97, 23, 94%ra gen: agitated trying to climb out of bed, moans intermittently in creole heent: left pupil 5mm fixed, right 3mm fixed. op clear, mmm. neck: no jvd, no carotid bruits . resp: mild crackles at bases bilaterally, no wheezes, rhonchi cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e, warm, good pulses skin: no rashes/no jaundice neuro: limited, left pupil 5mm fixed, right 3mm fixed, moves all extremities bilaterally spontaneously. pertinent results: admission labs: 11:30am plt count-276 11:30am neuts-67.4 lymphs-20.5 monos-8.3 eos-3.3 basos-0.6 11:30am wbc-8.9 rbc-4.60 hgb-14.2 hct-42.9 mcv-93 mch-30.9 mchc-33.1 rdw-13.7 11:30am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 11:30am phenytoin-14.9 11:30am ck-mb-4 ctropnt-0.06* 11:30am lipase-28 11:30am alt(sgpt)-17 ast(sgot)-44* ck(cpk)-188* alk phos-106 amylase-39 tot bili-0.4 11:30am estgfr-using this 11:30am glucose-87 urea n-19 creat-1.1 sodium-139 potassium-5.3* chloride-102 total co2-29 anion gap-13 01:50pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 01:50pm urine color-yellow appear-clear sp -1.013 01:50pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 01:50pm urine hours-random last set of labs obtained on : wbc rbc hgb hct mcv mch mchc rdw plt ct 9.5 3.87* 12.0* 35.5* 92 31.0 33.9 14.8 370 pt 18.1* ptt 38.0* inr 1.7* glucose urean creat na k cl hco3 93 13 1.1 137 4.0 102 27 micro: urine culture- negative urine culture- mrsa csf- no organisms three sets and two sets on blood cultures -no growth to date pertinent studies: ct head w/o contrast impression: no evidence of acute intracranial hemorrhage. mr head w/o contrast; mra brain w/o contrast 5:13 am brain mri: there is no acute infarct identified. there is no midline shift, mass effect, or hydrocephalus. there is moderate ventriculomegaly and prominence of sulci including prominence of temporal which has increased since the previous mri of . these findings would indicate brain and medial temporal atrophy. there are mild-to-moderate changes of small vessel disease in the periventricular white matter. no evidence of chronic blood products identified in the brain. impression: no evidence of acute infarct. moderate brain and medial temporal atrophy. the medial temporal atrophy has progressed since the previous mri. mra of the neck: neck mra demonstrates normal flow signal in the carotid and vertebral arteries. the right vertebral artery origin is not well seen due to technical reasons. otherwise, both vertebral and carotid arteries demonstrate normal flow signal. on fat-suppressed images, no evidence of fat suppression is seen. impression: normal mra of the neck. mra of the head: head mra demonstrates normal flow signal within the arteries of anterior and posterior circulation. no evidence of vascular occlusion or stenosis is seen. the left posterior cerebral artery is fetal in origin, a normal variation. distal left vertebral artery is small in size which is a normal variation. slight narrowing in the distal left vertebral artery on post-contrast images could not be confirmed on 3d images of the head and could be artifactual. impression: normal mra of the head. video oropharyngeal swallow 1:04 pm oropharyngeal video fluoroscopic swallow: an oropharyngeal swallow evaluation was performed in conjunction with the speech and swallow pathology division. this demonstrated mild to moderately reduced bolus formation and control with premature spillage consistently noted. once swallow was initiated, laryngeal elevation, valve closure, and epiglottic deflection were within functional limits. no episodes of penetration or aspiration were noted. chest (portable ap) 1:03 pm findings: in comparison with study of , the endotracheal tube has been removed. there is again opacification at the left base consistent with pleural effusion and underlying atelectasis. the possibility of aspiration pneumonia cannot be excluded without a lateral view. the right lung is essentially clear with mild atelectatic changes at the bases. brief hospital course: 89 m, creole only speaking, admitted for confusion and found to have mrsa uti and pneumonia. patient was initially admitted to the micu after being intubated and sedated for agitation as in hpi. briefly, he was delirious and required intubation for airway protection and to undergo imaging studies and lp safely. he was initially difficult to ween and eventually was weened and transferred to the floor. hospital course outlined by problem below: # delirium/agitation: the patient was admitted in a severely confused and agitated state. he had an extensive workup for delirium, all of which was unrevealing. ct head was negative. mri/mra head was negative. eeg was abnormal due to toxic metabolic encephalopathy (likely infection, metabolic, but workup was initially negative). lumbar puncture was negative, and csf culture was negative. he was transferred to the floor, where he was still severely agitated nightly. repeat ua was positive for mrsa uti, and cxr showed left sided atelectasis vs. pneumonia. he was placed on vanco/levo for uti and aspiration pneumonia coverage. after antibiotics were started, his delirium dramatically improved, but he was still moderately agitated. he required soft restraints for agitation and protection of the patient himself and for the staff (he was hitting and scratching staff and pulling out foley and ivs). making the delirium worse is the fact that he can speak clearly for a few sentences and then will speak nonsensical language and shout in the air. he is legally blind in both eyes and hard of hearing (hears best out of left ear). per his family's report, this is the best mental status they have witnessed from the patient in the last year. however, his baseline end stage dementia remained. a family meeting decided that the patient would become comfort measures only (cmo) (hcp is his son , with no gastric tube for feeding, pain control prn, and completion of antibiotic treatment for his infections. (see below for details under code status) he responds well to zyprexa 2.5 mg qam and 5mg qpm standing, zyprexa 2.5 iv/im prn, and/or haldol 0.5 iv prn. geriatric consult assessed the patient and recommended these medications for the patient. # nutrition: patient has minimal oral intake and needs help with eating and drinking. he occasionally expectorates out his food and drink, and he cannot take po pills reliably (he expectorates out pills or crushed pills, but will take pills once every day or few days). speech and swallow consult performed bedside assessment and video swallow, and recommended thin liquids and pureed consistency. video swallow showed normal swallowing ability and was unremarkable. he may eat any foods that he would like, but he does not have drive to eat and drink. family understands aspiration risk but wants to focus on comfort care at this point. # diffuse body pain: no etiology could be found for the patient's diffuse body pain. he was given morphine 2 iv prn, tylenol 1 g prn with no change in patient's report of diffuse body pain. workup was unrevealing. # inferior myocardial ischemia: the patient had new t wave inversions in leads ii, iii, avf on with 2 sec pauses on telemetry. he had moderately severe bradycardia and hypotension during this event. cardiology was consulted and the decision was made to medically manage the patient and not do invasive workup. he was maintained on asa, metoprolol. # systolic chf chronic: has ef 45% on echo from . currently euvolemic. has 3+ tr and 2+mr as well. not on acei given bp and issue with low oral intake. # paroxismal afib: he was rate controlled on metoprolol, and anticoagulation was on asa pr. no coumadin given fall risk. # bilateral eye pain/blindness: the patient was assessed by ophthalmology consult who recommended glaucoma and prophylactic erythromycin eyedrops for the patient. # seizure disorder: continued po phenytoin at baseline. no seizures while in house. # sacral decubitus ulcer: stage ii, continue care per protocol. # inr: inr elevated to 1.7, likely secondary to vit. k deficiency from antibiotic use. he has pafib and thus was not given vitamin k. # dnr/dni/cmo: family meetings including the hcp concluded that dnr/dni/cmo was the appropriate goal of care for the patient. ethics consult recommended that the decision for cmo not be changed for the patient and for the patient to be maintained in comfort inhouse, with encouragement of po intake but no artificial means of nutrition. palliative care recommended that the patient not be re-hospitalized unless his mental status clears further from currently. his current mental status baseline is apparently much better than it has been over the past 6 months to 1 year, per the patient's hcp and family. the patient's family agrees with these recommendations. medications on admission: medications on admission: aspirin 325 mg daily calcium-cholecalciferol twice a day. furosemide 20 mg po once a day. atorvastatin 10 mg tdaily metoprolol tartrate po bid hexavitamin po daily (daily). pantoprazole 20 mg once a day. phenytoin sodium extended 100 mg tid docusate sodium 100 mg po bid cosopt r eye alphagan r eye xalata b eye erythromycin ointment both eyes discharge medications: 1. dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 2. brimonidine 0.15 % drops sig: one (1) drop ophthalmic q8h (every 8 hours). 3. aspirin 300 mg suppository sig: one (1) suppository rectal daily (daily). 4. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 5. phenytoin 100 mg/4 ml suspension sig: one hundred (100) mg po tid (3 times a day). 6. olanzapine 5 mg tablet, rapid dissolve sig: 0.5 tablet, rapid dissolve po qam (once a day (in the morning)). 7. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po qhs (once a day (at bedtime)). 8. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 9. erythromycin 5 mg/g ointment sig: 0.5 in ophthalmic qid (4 times a day). 10. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). discharge disposition: extended care facility: manor nursing center in discharge diagnosis: primary diagnosis: mrsa uti pneumonia aspiration dementia delirium inferior mi sacral decubitus ulcer stage 2 secondary diagnosis: cad s/p imi paroxysmal atrial fibrillation not on anticoagulation hypertension seizure disorder, last 20yrs ago systolic chronic chf with ef 40-50% glaucoma glucose intolerance discharge condition: vital signs are stable. eating 1 meal every 3 days, drinking one small cup of water or juice every 3 days. baseline mental status is responsive to voice and minimal stimulus with opening eyes or moaning. withdraws all 4 extremities to noxious stimulus. occasionally communicates with creole interpreter but rarely forms complete thoughts. discharge instructions: admitted for delirium/agitation. found to have mrsa uti and aspiration pneumonia both treated complicated by acute myocardial infarction. now discharged to rehab. please call the patient's primary care physician, . , , with questions. patient's family wants patient to be dnr/dni and cmo. they do not want him rehospitalized. they do not want peg tube for feeding. they want to keep him comfortable and allow him to eat or not eat based on his wishes. followup instructions: 1. provider: , m.d. phone: date/time: 10:45 md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung insertion of endotracheal tube diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified toxic encephalopathy unspecified essential hypertension atrial fibrillation infection with microorganisms resistant to penicillins unspecified glaucoma other persistent mental disorders due to conditions classified elsewhere other specified cardiac dysrhythmias hypotension, unspecified pneumonitis due to inhalation of food or vomitus methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site acute myocardial infarction of other inferior wall, initial episode of care chronic systolic heart failure pressure ulcer, lower back epilepsy, unspecified, without mention of intractable epilepsy profound impairment, both eyes, impairment level not further specified anisocoria 

Answer: The patient is high likely exposed to