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: no known allergies / adverse drug reactions attending: chief complaint: ams/fever major surgical or invasive procedure: none history of present illness: 55m with ms (non-verbal at baseline), diabetes and untreated prostate cancer presents from w/ fever/ams. this morning at nursing home was noted to be more lethargic and not responding like normal. he was also noted to have fever. of note he has had repeated episodes of pna, most recently 2-3 weeks ago and was treated with azithromycin. per his sister he initial got better but 3 days ago began to have cough again. he was also noted to have chills and night sweats. also of note he has had daily loose foul smelling stools. he does not respond to questions so it is difficult to ascertain symptoms but he does not have obvious abd pain or dysuria. . in the ed initial vitals were: 98, 125, 139/69, 18, 93% on 2l. an ekg showed sinus tachy at 119, na, ni, pr depression in v2, no ischemic changes. cxr showed possible retrocardiac opacity per ed read. he was given flagyl/levo/vanc for possible aspiration pna. initial lactate was 3.3. he received 2l ns and repeat lactate was 3.7 and he was still tachycardic to the 120s. . on arrival to the micu, initial vitals were: 117 140/81 18 97% on 2l. he was uncomfortable appearing with some tremulousness. he does not respond to querstions. . review of systems: (+/-) per hpi past medical history: multiple sclerosis diabetes type 2 prostate cancer dementia neurogenic bladder obesity osa - not on cpap osteoporosis gerd neuropathy social history: previously lived in , , with his wife and daughter. now lives in home . no tobacco or etoh. previously worked as security guard and as worker for troubled youth. family history: second cousin has multiple sclerosis. positive family history for hypertension. physical exam: admission exam: vitals: t: 98.3 bp:117 bp 140/81 rr18 o2 97% on 2l general: makes eye contact but does not repsond to questions or commands. uncomfortable appearing, mildy tremoulous. heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: tachycardic, normal s1 + s2, no murmurs, rubs, gallops lungs: coarse breath sounds from upper airway transmitted throughout lungs. no complying with exam but within limits no obvious wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . discharge exam: vitals: t: 98.7 bp 117-127/70-71 hr 85-88 rr 18 o2 97% on ra 800/875 + bm 0/500 general: makes eye contact but does not respond to questions or commands. nad. heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: normal s1 + s2, no murmurs, rubs, gallops lungs: diffuse coarse breath sounds, no wheezes. mild crackles. abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: condom cath in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: unable to answer questions appropriately, does track with eyes, cannot follow commands. he reflexively grips his hands. unable to lift arms, move legs. pertinent results: admission labs: 01:18pm wbc-15.9*# rbc-4.99 hgb-13.4* hct-41.5 mcv-83 mch-26.8* mchc-32.2 rdw-13.5 01:18pm neuts-93.5* lymphs-2.8* monos-2.4 eos-0.8 basos-0.4 01:18pm glucose-156* urea n-9 creat-0.4* sodium-141 potassium-3.1* chloride-98 total co2-26 anion gap-20 01:18pm alt(sgpt)-32 ast(sgot)-23 ld(ldh)-182 alk phos-65 tot bili-0.6 01:18pm lipase-26 01:18pm ctropnt-<0.01 01:39pm lactate-3.3* 02:25pm urine color-yellow appear-clear sp -1.013 02:25pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-6.0 leuk-neg 03:49pm d-dimer-805* . lactate 01:39pm blood lactate-3.3* 03:15pm blood lactate-3.7* 08:23pm blood lactate-6.5* k-3.3 12:32am blood lactate-6.7* k-3.4 03:55am blood lactate-3.0* 11:07pm blood lactate-2.0 . 03:47am blood ld(ldh)-142 totbili-0.5 05:13am blood calcium-8.4 phos-3.1 mg-2.3 03:49pm blood d-dimer-805* 03:47am blood hapto-462* 06:00am blood vanco-18.9 . cxr findings: single frontal view of the chest was obtained. no focal consolidation, pleural effusion, or evidence of pneumothorax is seen. cardiac silhouette is top normal, likely accentuated by ap technique. no overt pulmonary edema is seen. impression: low lung volumes; however, given this, no acute cardiopulmonary process is seen. . ct chest/abd/pel impression: 1. no evidence of pulmonary embolism. 2. bilateral bibasal patchy opacification consistent with pneumonia. 3. cholelithiasis without evidence of acute cholecystitis. 4. hepatosteatosis 5. bilateral hypodensities within the kidneys bilaterally, which are too small to characterize. 6. moderate prostatic enlargement. 7. hypertrophied bladder wall with possible nodular filling defect superiorly. cystoscopy is recommended. . video swallow aspiration or penetration of all barium consistencies, although less with nectar-thick liquids. please refer to the speech language pathology report for further detailed of the findings. . cxr picc placement the tip of the right picc now terminates in the low svc. there is no pneumothorax. low lung volumes and bibasilar atelectasis are unchanged. the cardiomediastinal silhouette is stable. impression: right picc terminates in low svc. . ekg sinus tachycardia. qs complex in lead v2 consistent with an anteroseptal myocardial infarction, age undetermined. otherwise, no other diagnostic abnormalities. no previous tracing available for comparison. . cxr findings: ap and lateral chest radiographs demonstrate persistent low lung volumes and opacification at the left lung base that may represent pneumonia in the proper clinical setting. the cardiomediastinal silhouette is stable. the right lung is clear. there is no pneumothorax. the right picc terminates in a standard position. impression: probable left basilar pneumonia. blood culture x2-pending urine culture-negative urine culture-negative stool c. difficile negative blood culture -negative sputum gram stain-oropharyngeal flora; respiratory culture-oropharyngeal flora mrsa screen -{positive for methicillin resistant staph aureus} urine legionella urinary antigen -negative blood culture negative urine culture-negative blood culture -negative . 09:57am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-neg 09:57am urine color-yellow appear-clear sp -1.010 . discharge labs 10:50am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-tr 10:50am urine color-yellow appear-clear sp -1.006 05:59am blood wbc-11.1* rbc-3.81* hgb-10.1* hct-32.2* mcv-84 mch-26.4* mchc-31.3 rdw-13.6 plt ct-499* 05:59am blood glucose-144* urean-7 creat-1.1 na-143 k-3.4 cl-108 hco3-26 angap-12 brief hospital course: 55m with ms, diabetes and untreated prostate cancer presents from w/ fever/ams and possible pna admitted to the micu for concern for evolving sepsis, with hypernatremia and concern for likely repeated aspiration pneumonias. . #sepsis, pneumonia: met 3 sirs criteria with fever, tachycardia, and elevated wbc count at time of admission. pna seen on chest ct. treated with vancomycin, zosyn, levofloxacin for hcap since he lives in a nursing facility and has recently received antibiotics. his urine legionella was neative so the levofloxacin was discontinued. his fever, tachycardia and elevated wbc count resolved. he was not able to produce a sputum sample so he was continued on vanc/zosyn for a planned 7 day course, started , completed . he did have a fever to 100.8 on the day following discontinuation of abx, but remained afebrile since. he also developed a leukocytosis on the day prior to discharge, which was up to 11 and stayed stable on day of discharge. the patient had repeat ap and lat cxr to evaluate for pna, which showed lll pna, but this is consistent with prior known pna and felt to likely represent no new process. . # goals of care: the patient developed hypernatremia to 148, which resolved with free water ivf. this is likely secondary to decrease in free water po given change in speech and swallow recommendations to take nectar thick liquids. the possibility of peg was raised with the family, which would ensure adequate hydration and avoid hypernatremia and renal failure. , hcp and patient's sister, as well as his mother, felt strongly on repeated occasions that peg is not what would desire. they choose to continue to administer free water by mouth despite risk of aspiration. they understand that continued administration of water will likely lead to repeated pneumonias, and that he may not be able to meet his needs for free water, and hypernatremia or pneumonia could lead to death. they also desire to avoid repeated courses of antibiotics. the possibility of "do not rehospitalize, do not escalate care" was broached, but it was not agreed upon. the family, at this point, do continue to desire antibiotics, ivf and hospitalization if indicated. . # hypernatremia: up to 148, improved with free water by ivf. please see discussion of goals of care above. . #multiple sclerosis: his clinical condition has continued to decline, particularly over the past three years. because of his frequent pnas and risk for aspiration he was evaluated by speech and swallow. after a video swallow study he was started on nectar thick liquids and full solids. please see discussion of goals of care, above. . #anemia: he presented with a hematocrit >40 but decreased to 32.9. hemolysis labs were negative and his stools were guaiac negative. his hct stayed stable around 33 and was felt to be likely related to draws from his picc not being adequately flushed and phlebotomy. he remained hemodynamically stable and did not require transfusion. . #: his creatinine was 0.6 on admission then increased to 1.5. review of prior records showed that his baseline is actually closer to 0.9. he was given ivf since his po intake was poor. his cr trended to 1.1 at time of discharge. this is likely secondary to pre-renal etiology. . chronic issues . #diabetes type 2. on metformin at home. insulin sliding scale was started on admission and he was transitioned back to metformin on discharge. . #prostate cancer: elevated psa to 11.4 in . followed by dr. here at . . transitional issues: code: dnr/dni contact: sister, , hcp. (work) pending studies to address at follow up: - blood cultures x2 issues to address at follow up - hypertrophied bladder wall noted on ct pelvis. cystoscopy is recommended. - resolution of pna - goals of care discussions with family medications on admission: alendronate 70mg qmonday loratadine day acetaminophen 1000mg qday calcium carbonate 625mg cranberry docusate 100mg famotidine 10mg fluticasone propionate nasal 50 mcg metformin 1000mg mucinex 600 mg mvi azelastine 137 nasal spray tid gabapentin 300 mg qhs mylanta cepacol senna loperamide milk of magnesia guaifenesin discharge medications: 1. alendronate 70 mg tablet sig: one (1) tablet po once a day. 2. loratadine oral 3. acetaminophen 500 mg tablet sig: two (2) tablet po once a day. 4. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: two (2) po bid (2 times a day). 5. cranberry oral 6. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 7. famotidine 10 mg tablet sig: one (1) tablet po twice a day. 8. fluticasone 50 mcg/actuation spray, suspension sig: one (1) nasal twice a day. 9. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 10. mucinex 600 mg tablet extended release sig: one (1) tablet extended release po twice a day. 11. therapeutic multivitamin liquid sig: five (5) ml po daily (daily). 12. azelastine 137 mcg aerosol, spray sig: one (1) nasal three times a day. 13. gabapentin 300 mg capsule sig: one (1) capsule po at bedtime. 14. mylanta oral 15. cepacol sorethroat-cough oral 16. senna 8.6 mg tablet sig: 1-2 tablets po daily (daily) as needed for constipation. 17. loperamide oral 18. milk of magnesia oral 19. guaifenesin oral 20. thiamine hcl 100 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: home inc discharge diagnosis: primary diagnosis: hospital associated pneumonia multiple sclerosis diabetes mellitus secondary diagnosis: prostate cancer discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: dear mr. , you were admitted with pneumonia. you are being treated with antibiotics for this infection. you should complete your course of these antibiotics and follow up with your physicians. we discussed your hospital stay with dr. . please note the following changes to your medications. - please start thiamine daily followup instructions: department: neurology when: monday at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: thursday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: obstructive sleep apnea (adult)(pediatric) anemia, unspecified esophageal reflux diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin osteoporosis, unspecified malignant neoplasm of prostate multiple sclerosis hyperosmolality and/or hypernatremia mononeuritis of unspecified site neurogenic bladder nos dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to