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: dyspnea major surgical or invasive procedure: right ij catheter intubation for mechanical ventilation right picc line history of present illness: 48 year-old gentleman with severe copd (2-5l home o2), chf and multiple lengthy prior admissions. initially presented to osh with 2-3 weeks increased sob and cough productive of yellow/whote sputem but signed out ama. admitted to micu on with copd flare and treated with solumedrol, nebs, cefodoxine/azithromycin, and diuretics. called out from micu but then taken back to micu due to increased dyspnea and tachypnea. intubated and extubated on . was net negative 15l across micu stays. also received 7-day course of vanc/zosyn for hap. at time of transfer patient was stable. per icu patient is still volume overloaded and needs further diuresis. patient would be appropriate for transfer to ltac bed after the weekend. on the floor pt was not in any acute distress, lying in a reclining position, and requesting to go home tomorrow. when asked why he said "to smoke". vitals were stable. patient was tolerating regular diet without n/v. . review of sytems: as noted in hpi past medical history: - dm2 - on insulin - chf - avr in (metal valve, st. , @ x2) - cardiologist is dr. . - copd prescribed 2l nc at home, but for past 2 weeks on 5l nc. - chronic venous stasis changes b le. - h/o schizophrenia, psychotic disorder. - per wife, denies h/o pe/dvt/cri/cva. social history: social history: lives with his wife and two sons. on disability since when had mechanical valve. smokes 2 ppd since 18yo. denies etoh and illicit drugs. family history: non-contributory physical exam: vitals: t-97.6 bp-102/50 p-68 r-22 o2-96% on 4l general: alert, oriented, no acute distress, eager to go home heent: mmm, eomi neck: supple, unable to assess jvp, no lad lungs: clear but decreased breath sounds, patient not moving much air, scattered wheezes and coarse breath sounds cv: rrr, nl s1, sharp mechanical s2, iii/vi sem, no rubs, no gallops abdomen: obese, soft, nt, distended, nabs, no rebound/guarding; cannot assess organomegally ext: appear wwp, unable to feel pulses, lower extremities full of ecchymoses, chronic venous stasis changes, 1+ edema bilaterally neuro: aox3, unable to assess dtr due to patient positioning pertinent results: <b>labs </b> on admission (): 121 / 80 / 16 ===========< 170 5.0 / 37 / 0.9 cbc: 5.8 < 10.4 / 32.6 > 122 pt: 36.3 ptt: 36.7 inr: 3.7 dig: 1.0 mg: 2.1 pre intubation abg: type-art po2-64* pco2-131* ph-7.16* caltco2-49* base xs-12 abg at icu discharge: type-art temp-37.2 po2-91 pco2-70* ph-7.42 caltco2-47* base xs-16 labs on transfer from icu (): 139 / 92 / 16 ==========< 87 3.8 / 43 / 0.6 4.3 > 8.4 / 27.0 < 126 mcv 82 pt-17.4* ptt-56.1* inr(pt)-1.6* 04:35am blood calcium-8.5 phos-2.9 mg-2.3 04:58am blood type-art temp-37.2 po2-91 pco2-70* ph-7.42 caltco2-47* base xs-16 intubat-not intuba labs at discharge: 137 / 91 / 11 ==========< 113 3.1 / 41 / 0.8 cbc: 3.7 > 7.9 / 26.4 < 98 ptt-54.9* alt-44* ast-22 ld(ldh)-233 alkphos-78 totbili-1.1 calcium-8.6 phos-2.6* mg-2.1 cholest-123 caltibc-371 ferritn-97 trf-285 triglyc-71 hdl-45 chol/hd-2.7 ldlcalc-64 type-art po2-49* pco2-58* ph-7.48* caltco2-44* base xs-16 blood lactate-1.1 k-3.1* <b>microbiology</b> mrsa screen: positive for mrsa <b> imaging: </b> cxr : comparison is made to the prior study from . patient is rotated. the endotracheal tube has been removed. right ij catheter terminates in the superior vena cava. heart is enlarged. patient is status post cabg. there is patchy consolidation of both lower lobes. there is also underlying congestive failure, unchanged from prior study. there is a small right pleural effusion, unchanged since the prior study. . egd : old blood in stomach, small amounts diffusely, no active bleeding. likely blood from trauma from intubation. otherwise normal egd to second part of the duodenum. echo () - the left and right atra are moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. there is abnormal septal motion/position suggestive of right ventricular volume overload. the diameters of aorta at the sinus, ascending and arch levels are normal. a bileaflet aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. no aortic regurgitation is seen. ?moderate (2+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: technically suboptimal study. mild symmetric left ventricular hypertrophy with preserved global biventricular systolic function. right ventricular cavity enlargement with free wall hyopokinesis. normal functioning aortic valve prosthesis. ?moderate mitral regurgitation. if clinically indicated, a tee would be better able to define the severity of mitral regurgitation. brief hospital course: ## dyspnea - the patient's chief complaint on admission was dyspnea. it was felt that this dyspnea was consistent with a chf exacerbation. although, based on his lung exam with wheezing and rhonchi, it was felt that there was also a copd component to the patient's dyspnea. dfa for flu was negative; urinary legionella antigen was also negative. over the course of his initial icu stay, he was treated with iv solumedrol, nebs, and cepodoxime/azithromycin for copd flare. he was also diuresed with lasix 120mg iv prn, though he autodiuresed aggressively on his own. he was transfered to the medical floor on the evening of . around midnight of that day, he was noted to have increased agitation. he was then noted to become hypoxic and tachypneic. he was evaluated by the floor team and noted to have diffuse crackles without significant wheezing. he was given lasix but remained tachypneic low oxygen sats. a cxr revealed bilateral opacification consistent pulmonary edema or new lul infiltrate. additionally, he was visibly oozing from his left face wound, his nose, and his lower extremity chronic venous stasis ulcers. . at this point, he was transferred back to the micu. upon arrival to the micu, he appeared uncomfortable and tachypneic. upon placement of bipap, he became acutely more uncomfortable, sitting forward, pursed lip breathing. the decision was made to intubate him. he was treated as a flash pulmonary edema case; he also completed a 7 day course of vanco/zosyn for possible hospital acquired pneumonia. . the patient remained intubated for 4 days, during which time he was diuresed with lasix. eventually, on , he was able to be extubated. in the days following his extubation, he still appeared to be fluid overloaded. therefore, he continued to be diuresed aggressively. over this time, he reported that his dyspnea was improving. on , the patient was transferred from the unit to the medical floor. on the floor he was continued to be diuresed and his respiratory status continued to improve. by the time of admission his oxygen requirement had decreased to his baseline regimen of 2l nc. we increased his home dose of lasix for discharge to the rehabilitation facility and recommended strict daily weights. . finally, based on his anatomy and observing him at sleep in the morning, he also may have a component of obstructive sleep apnea which may contribute to his pulmonary problems. outpatient workup for osa might be reasonable for this patient. . # chf - as stated above, when the patient was admitted, it was determined that some of his dyspnea was secondary to a chf exacerbation. it was felt that he was fluid overloaded. he was kept on his home lisinopril on admission, and he was diuresed. echo done on showed mild symmetric left ventricular hypertrophy, right ventricular cavity enlargement with free wall hyopokinesis, and moderate mitral regurgitation. diuresis continued through most of the patient's icu stay. however, after his readmission to the icu and intubation, he did have some episodes of hypotension. at this point, his lisinopril was also held. after the hypotension resolved, he continued to be diuresed. by the time the patient was discharged from the micu, he had diurese a total of 14.9 l during his admission. on the medical he was further diuresed down to a discharge weight of 250lb. given the diastolic nature of his failure and no recent history of atrial fibrilation we decided to stop the patient's digoxin. his diltiazem had also been discontinued at admission as he remained normotensive. diltiazem and lisinopril may need to be restarted if he returns to hypertensive state, particularly his lisinopril from which he would likely derive benefit both for chf and renal protection. . # copd - as stated above, on admission, it was also believed that some of the patient's dyspnea was associated with a copd exacerbation component. he was ronchorous and tight with wheezing on his initial micu exam. on admit, he was placed on albuterol/atrovent nebs, steroids, and antibiotics. he was continued on the albuterol and atrovent throughout his course in the micu. his steroids were tapered down and stopped prior to his transfer out of the micu. on the floor he was continued on his albuterol/atrovent nebs. he was discharged to the rehabilitation facility with albuterol/atrovent inhalers. the patient notes, however, that he does not feel that these treatments work, and does not plan to take them. . # hyponatremia - the patient also presented with hyponatremia. his initial chemistry panel revealed a sodium of 119. it was believed that this hyponatremia was secondary to fluid overload. the patient's sodium levels began to normalize with diuresis. his hyponatremia had resolved by the third day of admission and remained stable across the remainder of his admission. . # hypotension - after his readmission to the micu and intubation, the patient had some problems with hypotension. it was felt that this was most likely secondary to repeated sedation boluses. he did require transient pressors for a short period of time to maintain his blood pressure. furthermore, the patient had some problems with bleeding from his oropharyngeal cavity after intubation. in the setting of this bleeding, the patient received blood on . by the time the patient was discharged from the micu, he was normotensive, off pressors, and with a low but stable hematocrit. his antihypertensives other than lasix continued to be held in the setting of aggressive diuresis and low normal blood pressure, but lisinopril in particular should likely be restarted once his blood pressure returns to higher levels. . # oropharyngeal bleeding - as mentioned above, the patient had profuse bleeding during intubation. this was felt to likely be oropharyngeal trauma in the setting a supratherapeutic ptt. he also had dark maroon aspirated from his og tube. as stated above, the patient received blood on . by the time of his discharge from the micu, the patient had a low but stable hematocrit between 25 and 27 and without further signs of esophageal or oropharyngeal bleeding. . # bleeding from wounds - mr. had a scab on his right face that he sometimes compulsively picked at despite expressing a wish not to, and for some time needed constant bandage changes in the setting of heparin and coumadin. this was resolving at time of discharge. additionally, he had a central line pulled and the scab at this site was stable, he did not pick at it, and there was no further bleeding. he also has chronic bleeding from his lower extremity wound, described below. # cytopenia - the patient remained thrombocytopenic across his entire admission, with platelet counts averaging approximately 90-100. the cause of this was unclear at the time of discharge, but it was noted that the patient had had a normal platelet count as recently as . he also had a low white count, and was anemic. the most likely explanation for this is that he was nutritionally and metabolically challenged by his acute illness episode and that it will take some time to rebuild his cell lines. this should be followed as an outpatient and if it does not resolve as he continues to recover from his acute illness episode, he may warrant workup for hematologic problems. . # anticoagulation - because of his mechanical aortic valve, the patient has a goal inr of 2.5 to 3.5. on admission, he had a supratherapeutic inr and his coumadin was held. he was put on a heparin drip for anticoagulation, and his coumadin was soon restarted. however, these were stopped around the time of his intubation. after the patient was more stable, the heparin drip was restarted. after some adjustments, it was decided to keep the patient on the heparin drip until he reached his goal ptt of 60-80. at that point, he would begin to be transitioned to coumadin. the patient remained on a heparin drip across his admission. coumadin was restarted at 5mg and then raised to 7.5mg, and the patient's inr rose to 1.9 at the time of discharge. he was discharged on a lovenox bridge with daily inr checks. . # dm - the patient was put on sliding scale insulin while he was in the hospital. he was also put on 70/30 with a split dose and placed on a diabetic diet. his blood sugars varied during his hospitalization but generally were <200. his home regimen of insulin was continued at the time of discharge. . # lower extremity skin changes - the patient had skin changes in his lower extremities that were consisent with chronic venous changes. he was treated with lidex to his lower extremities and wound care by his nurses. additionally, he has a wound on his left cheek that bled frequently. wound care was consulted for this wound. dressing changes and wound care were provided by his nurses. he was discharged with instructions for his wound care during rehabilitation. . # h/o schizophrenia and psychotic disorder - throughout his icu course, the patient had several incidents of wanted to leave ama. apparently, this is consistent with his actions on previous admissions. while hospitalized, the patient was kept on his home regimen of geodon 80mg . initially, he was kept on his home regimen of trazodone 600mg po qhs. however, the trazodone was discontinued while he was intubated. after extubation, he was started back on a lower dose of trazodone with the plan to wean him back up to his normal dose. however, the patient's trazodone dose was held at half its original amount secondary to sedation. the patient continued to be somnolent and was therefore discharged on this lower dose (300mg) of trazadone, which might be increased if he continues to have sleep problems. medications on admission: medications on transfer: heart failure: 1. furosemide 40 mg iv tid 2. digoxin 0.375 mg po daily nebulizers/copd: 3. albuterol 0.083% neb soln 1 neb ih q4h:prn dyspnea 4. ipratropium bromide neb 1 neb ih q4h:prn dyspnea psych: 5. ziprasidone 80 mg po bid 6. trazodone 300 mg po hs bowel regimen: 7. docusate sodium (liquid) 100 mg po bid 8. lactulose 30 ml po prn constipation titrate to 1 bm/day sliding scales & prophylaxis: 9. heparin iv sliding scale 10. insulin sc (per insulin flowsheet) sliding scale & fixed dose 11. pantoprazole 40 mg po q24h prn: 12. miconazole powder 2% 1 appl tp :prn rash 13. ondansetron 8 mg iv q8h:prn nausea 14. senna 1 tab po bid:prn constipation 15. potassium chloride 40 meq po daily duration 24 hours allergies: nkda discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: inhalation q4h (every 4 hours) as needed for dyspnea. 2. ipratropium bromide 0.02 % solution sig: inhalation q4h (every 4 hours) as needed for dyspnea. 3. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). disp:*60 tabs* refills:*4* 4. ziprasidone hcl 80 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 5. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po twice a day. disp:*60 tab sust.rel. particle/crystal(s)* refills:*2* 6. trazodone 100 mg tablet sig: three (3) tablet po hs (at bedtime). disp:*90 tablet(s)* refills:*2* 7. warfarin 2.5 mg tablet sig: three (3) tablet po daily, monday through friday: please take 3 tablets in the morning on monday, tuesday, wednesday, thursday and friday. please take 4 tablets by mouth on saturday and sunday. disp:*100 tablet(s)* refills:*2* 8. insulin nph & regular human 100 unit/ml (70-30) insulin pen sig: ninety (90) units subcutaneous once a day: inject 90 units under the skin every morning only. 9. insulin aspart 100 unit/ml insulin pen sig: five (5) units subcutaneous three times a day: inject 5 units in the morning, 5 units at noon, and 5 units at night. 10. enoxaparin 120 mg/0.8 ml syringe sig: one (1) injection subcutaneous (2 times a day). 11. lasix 40 mg tablet sig: three (3) tablet po twice a day: consult patient's physician about changing this dose if patient gains more than 5 pounds in one day. 12. weights of greater than 3 pounds per day. 13. outpatient lab work please obtain inr daily until therapeutic (2.5-3.5), then q2 days until stably within range for >5 days; then coordinate labs and coumadin dosing with outpatient coumadin clinic 14. miconazole nitrate 2 % powder sig: one (1) topical twice a day as needed for erythematous skin on thighs and buttocks. 15. blood pressure medication patient's blood pressure should be taken regularly. if patient's blood pressure is >140/90 more than once, or is ever >165/90, contact md, and consideration should be given to restarting patient's home diltiazem and/or lisinopril. discharge disposition: extended care facility: - colonial heights - discharge diagnosis: primary: 1. acute-on-chronic diastolic heart failure 2. copd exacerbation 3. hospital-acquired pneumonia secondary: 1. dm-ii 2. schizophrenia discharge condition: stable, on 2l oxygen, tolerating regular diet, no pain, not actively bleeding discharge instructions: you were admitted to the hospital with shortness of breath, which was probably caused by a combination of heart failure and lung disease. while you were here you were treated with several different medications including antibiotics for a pneumonia. for a time, you were also intubated and placed on a ventilator in order to assist your breathing. while you were in the hospital we stopped some of your medications. you should stop taking your digoxin, lisinopril, and diltiazem until you next see your doctor. in addition, you should now take only 300mg of trazadone at bedtime. you can discuss adjusting your dose of this medication when you next see your doctor. finally, we have suggested increasing your dose of lasix, to 120 mg . you should discuss this with your physician . you should continue taking all of your other medications as prescribed before you were hospitalized. please call your doctor or return to the emergency department if you experience any of the following: increased shortness of breath, chest pain, coughing up blood, vomiting blood, bloody stool, bloody urine, severe headache, loss of consciousness, or any other concerning symptoms. please also return to the emergency department if you experience bleeding from any part of your body that lasts more than 5 minutes or involves the loss of significant amounts (more than a few teaspoons) or blood. followup instructions: please schedule a follow up appointment with your primary care doctor, dr. , at , to see her within 1 week of being discharged from your rehabilitation facility. please schedule an appointment with your cardiologist, dr. , at cardiology associates, , for 1-3 weeks after your discharge from the rehabilitation facility. please follow up with your psychiatrist, dr. , , within 1-3 weeks after your discharge from the rehabilitation facility. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: pneumonia, organism unspecified acidosis other iatrogenic hypotension obstructive sleep apnea (adult)(pediatric) abnormal coagulation profile tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure aortocoronary bypass status heart valve replaced by other means acute respiratory failure long-term (current) use of insulin morbid obesity long-term (current) use of anticoagulants anticoagulants causing adverse effects in therapeutic use venous (peripheral) insufficiency, unspecified schizophrenic disorders, residual type, chronic 

Answer: The patient is high likely exposed to