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: history of present illness: this is a 67-year-old woman with lupus scleroderma, chronically on steroids, with multiple past pneumonias; who, two days prior to admission started feeling extremely fatigued. on the morning of admission she was unsteady on her feet. her husband noted her temperature at home to be up to 103 degrees. he brought her to the emergency department for evaluation where she developed respiratory distress and was intubated. she denied not have any nausea, vomiting, or cough while at home. she has had multiple pneumonias in the past; usually levofloxacin-sensitive streptococcus pneumoniae and has had multiple sputums with mycobacterium avium intracellulare. she has had sputum smears taken ever since a positive purified protein derivative dating back to . she does not have a history of tuberculosis. past medical history: 1. lupus. 2. migraine headaches. 3. autoimmune hepatitis. 4. severe gastroesophageal reflux disease. 5. status post colectomy (atonic colon as a complication of lupus). 6. in , rheumatoid arthritis. 7. status post appendectomy. 8. status post hysterectomy. 9. she also had revealed endoscopic retrograde cholangiopancreatography on for pancreatitis; at which time she received sphincterotomy of a stenosis in the major papilla. medications on admission: medications at home included prednisone 15 mg p.o. q.d., prevacid 30 mg p.o. b.i.d., folic acid 1 mg p.o. q.d., celexa 20 mg p.o. q.d., vioxx 25 mg p.o. q.d., dilantin 200 mg p.o. b.i.d., vivelle patch (estrogen) two times per week, keppra 500 mg p.o. b.i.d. (antiepileptic), estrace cream 0.01% q.d., procardia 10 mg p.o. t.i.d. p.r.n. for migraine headaches, imitrex 25 mg p.o. p.r.n. for migraine headaches, verapamil 180 mg p.o. q.d. (migraine prophylaxis), vicodin 5/500 p.o. b.i.d. p.r.n. allergies: a rash with naproxen (she reports no problems with ibuprofen), methotrexate causes nausea, codeine causes nausea. she is allergic to penicillamine (note that she is not allergic to penicillin). plaquenil causes visual disturbances. social history: immigrated from in the . she is a retired nurse. she has three daughters who are nurse anesthetizes and a son who is film maker. review of systems: she has fair exercise tolerance at baseline. she can walk eight flights of stairs without dyspnea, although she gets occlusion fatigue. she takes some oral food, but her nutrition is mostly vital high nitrogen 1 liter every night. she has had chronic diarrhea since her colectomy in . physical examination on presentation: temperature of 99.9, pulse of 106, blood pressure of 81/55, respiratory rate of 18. in general, a thin woman who was intubated and sedated, occasionally moved four extremities. chest revealed coarse breath sounds on the right but with good air movement. the left side was clear. cardiovascular was tachycardic, normal first heart sound and second heart sound. no murmurs. the abdomen was soft, nontender, and nondistended, with positive bowel sounds. she had a jejunostomy tube present in the left upper quadrant. extremities were warm and well perfused with 2+ dorsalis pedis pulses. pertinent laboratory data on presentation: laboratories on admission revealed a white blood cell count of 7.7, hematocrit of 35.6, platelets of 251. differential revealed neutrophils of 52%, bands of 31%. pt was 12.8, ptt was 24.5, inr was 1.1. sodium of 136, potassium of 4.2, chloride of 108, bicarbonate of 19, blood urea nitrogen of 18, creatinine of 0.5, glucose of 121. alt of 83, ast of 87, ldh of 297, creatine kinase of 108, alkaline phosphatase of 143, total bilirubin of 0.5, lipase of 31, albumin of 3.9. calcium of 8.7, phosphate of 2.2, magnesium of 2.3. arterial blood gas prior to extubation (on 15 liters of oxygen) was 7.31/42/45. arterial blood gas was 7.35/33/92 on assist control 16 x 600. gram stain showed 3+ gram-positive cocci in pairs. immunoglobulin levels showed severe immunoglobulin a deficiency. radiology/imaging: a chest x-ray showed right-sided multifocal pneumonia. a chest ct angiogram showed no evidence for pulmonary embolus. a cardiac echocardiogram showed an ejection fraction of 55% to 60% on . hospital course: assessment and plan revealed a 67-year-old woman with a history of frequent streptococcus pneumoniae who now comes in with complaints of cough, fever, and respiratory difficulty. the patient was intubated in the emergency department on because of impending respiratory failure. 1. cardiovascular: she was initially hypotensive and required levophed pressor in order to maintain her blood pressure. she also received frequent boluses of normal saline. the levophed was stopped on . she initially required fluid boluses after the levophed was stopped but did not require any further use of pressors while in the medical intensive care unit. 2. neurology: she has a history of seizure disorder; and per her online outpatient notes, it appeared that her neurologist had been trying to transition her from dilantin to keppra. therefore, her dose of dilantin had been getting gradually reduced while as an outpatient. her dilantin level was 3.7 on admission. we opted to load her with dilantin and to maintain her at a therapeutic level given our concerns about a possible seizure in the setting of acute illness. 3. endocrine: she was on oral prednisone daily at home for her lupus scleroderma. she was started on stress-dose steroid of hydrocortisone 100 mg intravenously t.i.d. which was, in subsequent days, converted to p.o. prednisone as the patient takes at baseline. 4. pulmonary: the patient's chest x-ray on admission revealed a large right-sided multilobar pneumonia. follow-up x-rays during the hospitalization initially demonstrated some involvement of the left lung as well, followed by eventual clearing of the right lung. she was extubated without incident on . given that she has a history of frequent recurrent pneumoniae, the allergy/immunology team was consulted, and they found her to be profoundly immunoglobulin a deficient. this was likely the source of her frequent pneumonias, her immune system dysfunction. 5. infectious disease: she had a pan-sensitive streptococcus pneumoniae and was therefore started on levofloxacin 500 mg q.d. she continued to be febrile. her arterial line tip was positive for methicillin-resistant staphylococcus aureus, and she also had blood culture bottles that grew methicillin-resistant staphylococcus aureus. therefore, she was stated on vancomycin on . with the administration of the vancomycin her fever and white blood count began to fall. she has a history of chronic sinusitis. a head ct was performed which showed evidence of chronic sinusitis as well as multiple sinus surgeries. she was started on ceftazidime and flagyl on (as recommended by the infectious disease team). 6. gastrointestinal: she continued to be fed through her jejunostomy tube while she was here. she had a gradual increase of pancreatic enzymes, amylase and lipase, to close to 300 before they started decreasing on . her primary gastroenteritis (dr. who had performed endoscopic retrograde cholangiopancreatography on her last month advised that she simply needed an elective repeat endoscopic retrograde cholangiopancreatography after she was extubated and more stable. 7. hematology: she required 1-unit transfusions of packed red blood cells while she was her. per her family, she is believed to have chronic gastritis and to have a certain baseline blood loss through the presumed slow gastrointestinal bleeding. 8. pulmonary: she was very slowed weaned off the ventilator on a pressure support trial. she was extubated on the morning of and appeared to be in good spirits. note: this discharge summary is dictated through the morning of . an addendum to this discharge summary will follow. dr., 12-207 dictated by: medquist36 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis diagnoses: systemic lupus erythematosus iron deficiency anemia secondary to blood loss (chronic) other convulsions methicillin susceptible staphylococcus aureus septicemia acute respiratory failure unspecified gastritis and gastroduodenitis, with hemorrhage infection and inflammatory reaction due to other vascular device, implant, and graft pneumonia due to streptococcus, unspecified selective iga immunodeficiency 

Answer: The patient is high likely exposed to