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: atenolol attending: chief complaint: hypoxia major surgical or invasive procedure: endotracheal intubation tracheotomy tube placement placement of peg (feeding) tube history of present illness: 86 year old male with pmh of copd, cad, htn, dmii who was feeling weak and having difficulty standing at the and was found to have an o2 sat of 46% on 2l np, and only marginal improvement to 63% on 5l np. he was placed on nrb and transported to . full vitals prior to transfer were t 98.4, bp 149/84, p121, rr22. allergies atenolol and tylenol #3. . in the ed, he was able to state his name, though appeared distressed. he was moving all of his extremities. intial vitals were: t: 100.5 bp 133/68, hr 114, sat 100% on nrb with a rr in the 30s. his rectal temperature was 101 f. he was intubated and sedated on fentanyl and versed. he had a cxr that showed multifocal pneumonia. he was given 1g tylenol, 750mg of iv levofloxacin and 750cc of ns. ekg showed, sinus tach at 111, lad, ni, twf in avl, poor baseline. on transfer vitals: t 98.3 hr 101 bp 110/61 sat 98% on cmv mode, tv 500, fio2 50%, rr 24 and peep 5. . on transfer to the micu, he is intubated and completely sedated. not responding to commands. past medical history: (per omr) dm (diabetes mellitus) lung disease, chronic obstructive hypertension, essential low back pain ftt (failure to thrive) in adult hypotension blindness - legal history cornea transplant glaucoma - primary open angle depressive disorder cancer of prostate tuberculosis bronchiectasis coronary artery disease rectal bleeding social history: former truck driver, and prior worked in a defense factory. currently residing in . hcp , daughter . also, granddaughter in the area, involved in his care. - tobacco: quit smoking 20 years ago, smoked from 18 - 65; used to smoke 1ppd - alcohol: heavy drinker while a smoker - illicits: unknown family history: dm in father and mother. cancers. physical exam: admission exam: vitals: t: 98.5 bp: 119/63 p: 101 r: 20 o2: 100% on cmv, 500, 50%, 14 and 5. general: intubated, sedated not responding to commands heent: sclera anicteric, cataracts bilterally, non-responsive pupils (blind) mildly dry mm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: mechanical breath sounds with minimal wheezing. rhonchi in the right upper lung zone cv: normal rate regular rate, ii/vi holosystolic murmur obscuring s1 no rubs, gallops abdomen: soft, mildly distended, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place ext: warm, + clubbing on right hand, missing 4 digits on left hand, chronic venous stasis changes on bilateral lower extremities, and multiple 1cm areas of ulceration, no edema neuro: non-responsive on sedation discharge physical exam general appearance: thin eyes / conjunctiva: cataracts, nonresponsive pupils b/l head, ears, nose, throat: normocephalic, poor dentition peripheral vascular: (right radial pulse: not assessed), (left radial pulse: not assessed), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: crackles : , no(t) rhonchorous: ) abdominal: soft, non-tender, bowel sounds present, peg site intact musculoskeletal: muscle wasting skin: not assessed neurologic: responds to: not assessed, movement: not assessed, tone: not assessed pertinent results: admission labs: 08:05am blood wbc-8.8# rbc-3.43* hgb-9.9* hct-29.2* mcv-85 mch-28.9 mchc-34.0 rdw-14.0 plt ct-217 08:05am blood neuts-81.1* lymphs-12.5* monos-5.6 eos-0.4 baso-0.4 08:05am blood pt-13.0 ptt-25.3 inr(pt)-1.1 08:05am blood glucose-234* urean-19 creat-1.1 na-141 k-4.9 cl-103 hco3-31 angap-12 08:05am blood probnp-754 08:05am blood ctropnt-0.01 08:05am blood triglyc-64 09:27am blood type-art temp-38.6 rates-/28 peep-5 po2-53* pco2-67* ph-7.28* caltco2-33* base xs-2 intubat-intubated vent-controlled 08:12am blood lactate-1.1 . discharge labs: 05:41am blood wbc-10.4 rbc-2.85* hgb-8.2* hct-24.7* mcv-87 mch-28.6 mchc-33.1 rdw-13.9 plt ct-462* 05:41am blood pt-14.0* ptt-26.7 inr(pt)-1.2* 05:41am blood glucose-123* urean-20 creat-1.0 na-140 k-3.9 cl-102 hco3-33* angap-9 05:41am blood calcium-8.8 phos-4.1 mg-2.5 03:38am blood vanco-15.3 06:08am blood type-art temp-37.2 rates- tidal v-500 peep-5 fio2-40 po2-97 pco2-53* ph-7.43 caltco2-36* base xs-8 intubat-intubated vent-controlled 02:01pm blood lactate-0.7 k-3.9 05:10pm other body fluid polys-44* lymphs-19* monos-0 mesothe-17* macro-20* . cxr 1. multifocal opacities with a more confluent opacity in the right upper lung field. these findings are worrisome for multifocal pneumonia. 2. bilateral small pleural effusions. 3. mild to moderate pulmonary edema. . echo normal biventricular cavity size with normal regional and low normal global left ventricular systolic function. pulmonary artery hypertension. mild-moderate mitral regurgitation. these findings are suggestive of a primary pulmonary process (osa, copd, etc.). . ct chest 1. multifocal pneumonic consolidation predominantly involving the right upper lobe. 2. moderate loculated effusion along right minor fissure and minimal simple effusion bilaterally. 3. borderline enlarged mediastinal lymph nodes. prominent right hilar appearance could be due to enlarged lymph node or from enlarged vessles, however defining a cause was limited due to lack to intravenous contrast administration. 4. bilateral pleural calcifications. please correlate with clinical history for asbestos exposure. if a history is established, follow-up imaging surveillance is recommended. . dishcarge chest xray : in the interval from the prior examination, an endotracheal tube has been removed and tracheostomy has been placed in standard position. right-sided picc is unchanged with tip reaching the low svc. there is no significant change in multifocal opacities, greatest at the right base. trace pleural effusions may be present. no pneumothorax is seen. the cardiomediastinal silhouette is not significantly changed. . microbiology: bal respiratory culture (final ): commensal respiratory flora absent. staph aureus coag +. ~/ml. 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. _________________________________________________________ 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------------ 1 s brief hospital course: 86 year old male with a history of copd, dmii, cad and htn who was admitted with respiratory failure and multifocal pneumonia. . # respiratory failure: history of copd, found to be hypoxic at to 46% on 2l. cxr showed multifocal pneumonia. he was given levofloxacin in the ed and was intubated. febrile to 101 rectally in the ed. failed extubation due to respiratory fatigue, tachypnea, and worsening shortness of breath. he was re-intubated and underwent bronchocopy. bal revealed mrsa. ip has was consulted for a tracheotomy tube/peg which were performed on . pt to continue vanco for a total of 14 days to end . he may continue to require oxycodone as needed for pain related to his tracheostomy tube. his discharge chest xray showed increased opacities that were attribute to de-recruitment off the higher ventilator settings. would recommend monitoring respiratory status, fever curve (currently afebrile) and ventilator requirements and would re-image or consider antibiotics if his clinical status changes. plan to wean ventilator as tolerated. . # dmii: on oral hypoglycemics at home. on insulin ss in house. he was started on tube feeds which were at goal at discharge. home metformin and glipizide were held- would restart at time of discharge to home. . # htn: on diltiazem at home (er). he was started on lisinopril which was at 40mg. he initially required iv hydral, which was transitioned to amlodipine 10mg daily. . # chf/venous stasis: on furosemide. chronic venous stasis changes. ef 50-55% this admission, echo showed pulmonary htn. he was diuresed, ultimately put on a standing dose of lasix to remain euvolemic. lytes were checked and k was replaced aggressively. he was on furosemide 40mg daily at discharge. would recommend checking electrolytes and replete as necessary. goal for diuresis has been 500 cc negative daily following in/outs. . # glaucoma: legally blind due to acute angle glaucoma, also with bilateral cataracts. continued home eye drops. . # anemia: unclear baseline. mcv normal. will monitor. no signs of bleeding, hct stable. . full code medications on admission: ( med rec) metformin 1000mg po bid dorzolemide/timolol 2%-0.5% 1gtt both eyes, erythromycin opth, 5mg/gm, apply left eye hs lumigam 0.03% gtt, 1 gtt each eye hs glipizide 10mg po bid 128; 5% gtts - 1 gtt each eye q6h famciclovir 500mg; 0.5 tabs po daily omeprazole 20mg po daily citalopram 10mg po daily diltiazem cr 180mg po daily fluticasone nasal spray 1 spray each nostril daily furosemide 20mg po daily spiriva 18mcg 1 cap, daily artificial tears bromide tartrate 0.2% 1 gtt each eye calcium cab w/ d 600mg-400iu 1 tab guaifenesin 100mg/5ml; 30mls po bid trazadone 50mg po hs tylenol 650mg po prn bisacodyl 10mg pr prn constipation milk of mag 30mls daily prn compazine 10mg tid prn nausea fleet enema daily prn albuterol nebs q6h prn sob discharge medications: 1. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : drops ophthalmic prn (as needed) as needed for dry eyes. 2. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for pain/fever: do not exceed 3 grams daily. 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : six (6) puff inhalation q4h (every 4 hours) as needed for sob/wheeze. 4. acyclovir 200 mg capsule : two (2) capsule po q12h (every 12 hours). 5. amlodipine 5 mg tablet : two (2) tablet po daily (daily). 6. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 7. calcium carbonate 200 mg calcium (500 mg) tablet, chewable : one (1) tablet, chewable po bid (2 times a day). 8. citalopram 20 mg tablet : 1.5 tablets po daily (daily). 9. chlorhexidine gluconate 0.12 % mouthwash : fifteen (15) ml mucous membrane (2 times a day): use only if patient is on mechanical ventilation. 10. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 11. glucagon (human recombinant) 1 mg recon soln : one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 12. dorzolamide-timolol 2-0.5 % drops : one (1) drop ophthalmic (2 times a day). 13. docusate sodium 50 mg/5 ml liquid : ten (10) ml po bid (2 times a day). 14. erythromycin 5 mg/gram (0.5 %) ointment : 0.5 gram gram ophthalmic qhs (once a day (at bedtime)). 15. fluticasone 50 mcg/actuation spray, suspension : one (1) spray nasal daily (daily). 16. furosemide 40 mg tablet : one (1) tablet po daily (daily). 17. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 18. heparin (porcine) 5,000 unit/ml solution : one (1) injection injection tid (3 times a day). 19. insulin regular human 100 unit/ml solution : one (1) sliding scale injection asdir (as directed): following enclosed humalog sliding scale. . 20. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler : six (6) puff inhalation qid (4 times a day). 21. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 22. latanoprost 0.005 % drops : one (1) drop ophthalmic hs (at bedtime). 23. lorazepam 0.5-1 mg iv q4h:prn aggitation 24. lisinopril 20 mg tablet : two (2) tablet po daily (daily). 25. lactulose 10 gram/15 ml syrup : thirty (30) ml po q8h (every 8 hours) as needed for constipation. 26. cholecalciferol (vitamin d3) 400 unit tablet : one (1) tablet po daily (daily). 27. oxycodone 5 mg/5 ml solution : ten (10) ml po q6h (every 6 hours) as needed for pain: hold for sedation. 28. vancomycin 500 mg recon soln : 1250 (1250) mg intravenous q 24h (every 24 hours) for 7 days. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: pneumonia discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: dear mr. it was a pleasure taking care of you here at . you were admitted with pneumonia and required iv antibiotics. these will be continued at rehab. due to respiratory distress, you were intubated and placed on a ventilator ("life support") until your lungs fully recovered. you continued to show improvement but will benefit from a longer weaning from the ventilator, thus a trachestomy tube was placed. this will be removed when you are fully able to breathe on your own. a peg tube (feeding tube through your stomach) was also placed to facilitate feeding until you are able to eat fully. you will need to continue the iv antibiotics for another week. the following changes were made to your medications. started albuterol inhaler 6 puffs prn sob started acyclovir 400mg q12 started amlodipine 10mg daily for hypertension started docusate sodium for constipation started heparin subcutaneous tid started ipratropium bromide inhaler started lansoprazole for reflux started lorazepam for anxiety started lisinopril for hypertension started lactulose for constipation started oxycodone for pain related to your tracheostomy started vancomycin (iv antibiotic) for your pneumonia, this will complete on for total 14 day course. started insulin coverage increased furosemide/lasix dose to 40mg daily increased citalopram 30mg daily stopped glipizide stopped omeprazole stopped diltiazem stopped metformin stopped trazodone stopped compazine stopped famciclovir followup instructions: you will need to follow up with your primary care doctor when you are discharged from rehab. md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified other chronic pulmonary heart diseases personal history of tobacco use depressive disorder, not elsewhere classified acute and chronic respiratory failure other diseases of lung, not elsewhere classified legal blindness, as defined in u.s.a. ulcer of other part of lower limb venous (peripheral) insufficiency, unspecified personal history of tuberculosis methicillin resistant pneumonia due to staphylococcus aureus other finger(s) amputation status open-angle glaucoma, unspecified 

Answer: The patient is high likely exposed to