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: sulfa (sulfonamides) / bactrim attending: chief complaint: right shoulder pain, fever major surgical or invasive procedure: intubation . urethral dilatation for foley placement . : right shoulder mri impression: 1) tendinosis in the distal supraspinatus and infraspinatus tendons without evidence of tearing. 2) edema in the medial aspects of the supraspinatus and infraspinatus muscles without associated atrophy, which is nonspecific. 3) mild acromioclavicular osteoarthritis. . : thoracic spine mri impression: multilevel degenerative disease with at least moderate spinal canal narrowing as above. no abnormal signal within the cord. study is severely limited due to patient motion artifact. however, given the absence of abnormal t2 signal in the disc spaces or within the vertebral bodies, osteomyelitis is considered unlikely. . abd us impression: unremarkable abdominal ultrasound. no evidence of cholecystitis, cholangitis, or focal mass lesion identified. no fluid collection or source of mrsa identified. . tee conclusions: 1. the left atrium is moderately dilated. 2. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50-55%). 3. the ascending aorta is mildly dilated. 4. the aortic valve leaflets are mildly thickened. trace aortic regurgitation is seen. 5. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. 6. no obvious vegetations are seen. 7. compared with the prior study (images reviewed) of , lv function may have improved. . video speech and swallow () findings: oropharyngeal swallowing evaluation was performed today in collaboration with speech and swallow pathologist. the thin liquid, nectar thick, pureed, and of cookie were administered. there were moderate defects with decreased bolus control and premature spillover of thin and thick liquids to the valleculae and piriform sinuses. there was a decreased high laryngeal excursion, laryngeal valve closure, and only partial epiglottic deflection. there was mild-to-moderate deep penetration that occurred during the swallow with both thin and nectar thick liquids. however, though barium was seen on the vocal cords, no aspiration below the vocal cords was definitively demonstrated. impression: a moderate dysphasia with deep penetration to thin and nectar thick liquids. . shoulder xray no fracture or dislocation is detected. no bony destructive changes are seen. no obvious soft tissue abnormalities are appreciated. minimal degenerative changes of the acromioclavicular joints are present. . cta impression: 1. no aortic dissection or pulmonary embolism. 2. coronary artery bypass graft. severe coronary artery calcifications. 3. unchanged cardiomegaly. trace bilateral pleural effusions, decreased from the prior study. 4. unchanged compression deformities of the thoracic spine . ct head impression: no acute intracranial hemorrhage. no change compared to the prior study. history of present illness: pt is an 81 yo priest w/ h/o cad s/p mi, htn, dm2, who p/w altered mental status, r shoulder pain x 5d and fever spike to 99.9 at home. he had apparently had worsening shoulder pain for five days, wincing when the shoulder was touched. pt initially treating shoulder pain at w/ asa, heat pack per his pcp. , noted to have altered ms changes by his , he was brought to ed. in , pt noted to be febrile to 101.9, other vss. labs notable for wbc 14.2, lactate 2.4. lp normal. while in the ed, he became increasingly hypertensive, up to the 230's systolic, difficult to control with a ntg-gtt and eventually became increasingly hypoxic. there was questionable seizure activity, and the patient was intubated for acute respiratory failure. at this point, he underwent cta showing no pe, dissection, or pulmonary abnormality, as well as no soft tissue or osseous abnormalities that could explain his shoulder pain. he also received ceftriaxone, metronidazole, vancomycin, and furosemide 40mg iv x 1. . past medical history: -htn -dm2 -hypercholesterolemia -cad with 4 prior mis, prior ptca, s/p cabg in with lima to lad, svg to d2/om3, svg to rca; cath with stent to svg-rca, 40%lmca lesion, patent lima-lad, diffusely disease lcx. -bladder outlet obstruction and bph -multiple prior utis -depression -tardive dyskinesia -anxiety -status post tkr . social history: reverend. lives in facility at jp. history of tobacco in the past. no alcohol or ivdu history. his niece is his hcp. . family history: non-contributory. . physical exam: t 100.0 (rectal), bp 135/72, hr 87, rr 17, spo2 98% vent- a/c 600/5/14/1.00 peak 25/plateau 14 gen- sedated, intubated; non-acutely-ill appearing heent- anicteric, op with mmm cv- rrr, s1s2, no m/r/g; cabg scar pulm- moves air well, no w/r/r abd- soft, nt, nd, nabs extrm- no cyanosis/edema, warm dry, full dp pulses bilat nails- no clubbing, no pitting/color changes/indentations neuro- sedated, not following commands, perrl, mae . pertinent results: 03:20pm blood wbc-14.2*# rbc-5.40 hgb-16.8 hct-46.3 mcv-86 mch-31.1 mchc-36.2* rdw-14.8 plt ct-166 03:21am blood wbc-17.6* rbc-5.59 hgb-17.0 hct-47.7 mcv-85 mch-30.4 mchc-35.7* rdw-14.6 plt ct-164 05:34am blood wbc-9.3 rbc-5.14 hgb-15.3 hct-44.9 mcv-87 mch-29.8 mchc-34.1 rdw-14.6 plt ct-199 . 03:20pm blood glucose-261* urean-14 creat-0.9 na-131* k-3.5 cl-92* hco3-27 angap-16 12:20pm blood glucose-153* urean-21* creat-1.0 na-135 k-3.6 cl-96 hco3-27 angap-16 05:34am blood glucose-142* urean-33* creat-0.8 na-140 k-4.0 cl-101 hco3-30 angap-13 . 03:20pm blood ck(cpk)-69 03:20pm blood ctropnt-<0.01 11:55pm blood ck(cpk)-261* 11:55pm blood ck-mb-3 ctropnt-<0.01 03:21am blood ck(cpk)-102 03:21am blood ck-mb-4 ctropnt-0.06* 12:20pm blood ck(cpk)-109 12:20pm blood ck-mb-4 ctropnt-0.02* . brief hospital course: pt is a 81 yo man with pmh cad s/p mi, htn, dm2, who p/w altered mental status, r shoulder pain x 5d and fever. . #respiratory failure -- given overall story, normal initial cxr, lack of presenting respiratory complaints, pre- and post-intubation cxr's, and post-intubation cta, it seems the most likely diagnosis was acute pulmonary edema secondary to a hypertensive emergency. he has known depressed systolic function and mr and likely could not tolerate the elevated afterload, causing sudden fluid back-up into the pulmonary tree. this scenario is further supported by his rapid improvement (in terms of o2 sats, abg, and post-intubation cxr) as the positive-pressure ventilation likely dropped both his preload and afterload. there was probably a modest contribution from his rul pneumonia, seen on the next day's cxr as well. other possibilities, such as aspiration and pe were excluded his post-intubation cta. no known history of obstructive lung disease and was moving air well on exam. on the second day of admission, he was easily reduced to minimal ventilatory settings and then extubated with the use of a nitroglycerin drip to control both preload and afterload. a moderate diuresis was he did quite well afterwards, quickly being weaned down from a 70% face-mask to 4l nc with good o2 saturations. on the floor he was satting in the mid 90s on room air and did not have any further respiratory difficulties. he was found to have a rul pneumonia (likely mrsa). will continue furosemide 40mg po. wbc stable and afebrile. . #chf -- pt seems to have experienced acute pulmonary edema as above. has baseline systolic dysfunction, last ef was 30-40%, and current ef on after acute exacerbation was 50-55%. continued on lisinopril, metoprolol for afterload reduction and isosorbide dinitrate for afterload/preload reduction. arrempted to keep balance -500cc per day. . #. htn -- unclear cause of sudden elevation in ed, possibly to pain, confusion, anxiety. better controlled on the floor with no issues in terms of hypertension. continued home meds. . #. fever/leukocytosis -- although it's of unclear etiology, clinically the only presenting symptom was his right shoulder pain. id work-up in ed included: csf negative, cxr with rul pneumonia, blood cxs positive for mrsa (last +bcx was on ), 3/4 bottles with mrsa, urine culture negative. c. diff was negative. id consulted while in house. shoulder mri did not show any evidence of osteo, and neither did thoracic mri. ruq ultrasound and repeat echo did not show a source. the plan is to treat him for four weeks (started should end vancomycin course on ). he will need weekly cbc, lft, bun/cr, vanc trough, which should be faxed to dr. (id fellow) at (. . #right shoulder pain -- as above, main clinical sx. . #ms changes -- likely underlying infectious process, possibly pain. lp negative for infection. he was mentating well on the floor. haldol was given as needed for agitation. . #cad -- no evidence of active ischemia on ecg or by cardiac enzymes. pt on numerous cardiac meds. mi was ruled out with enzymes. con't asa, clopidogrel, atorvastatin, metoprolol. he had multiple episodes of chest pain while in house with negative ecgs. the pain was reproducible on palpation and likely secondary to sternotomy scar. . # dm: pt on glyburide as outpt. he was kept on an insulin sliding scale while in house and his glyburide should be restared once at the rehab facility. (he was taking glyburide 5 mg po qd). . # anxiety/ocd: pt on numerous anxiolytics. continue home meds. . # bph: patient had urethral dilatation by gu and foley was left in place for duration of his hospital stay. he should have his foley in place on discharge to the rehab facility. he has an outpatient follow up with dr. on (from urology) for a voiding trial. he was started on flomax and continued his proscar while in house. . # fen: video speech and swallow done in house. recommended nectar prethickened liquids please crush po meds, assist patient with feeding. cue patient to swallow every bites/sips, and cute patient to clear cough and swallow every bites. . # ppx: sc heparin, ppi . # code status: presumed full . # dispo: to rehab facility. . # pcp (gershegorn ) medications on admission: lisinopril 20 mg po daily (daily). finasteride 5 mg po daily (daily). folic acid 1 mg po daily (daily). glyburide 5 mg po daily (daily). clopidogrel 75 mg tablet po daily hydrochlorothiazide 25 mg po daily furosemide 40 mg po bid aspirin 325 mg po daily (daily). atorvastatin 10 mg po daily isosorbide mononitrate 240 mg po hs trazodone 50 mg po hs metoprolol tartrate 25 mg po tid nitroglycerin 0.3 mg sublingual prn bisacodyl 10 mg tablet, po daily (daily) as needed. ferrous sulfate 325 (po daily (daily). multivitamin po daily polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: 1-2 drops tid docusate sodium 100 mg po bid lorazepam 0.5 mg po q4-6h (every 4 to 6 hours) as needed. clonazepam 0.5 mg po bid fluvoxamine 50 mg po tid mirtazapine 15 mg po hs pantoprazole 40 mg po q24h discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. fluvoxamine 50 mg tablet sig: two (2) tablet po bid (2 times a day). 4. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 5. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 8. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 9. tamsulosin 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po hs (at bedtime). 10. risperidone 1 mg tablet sig: one (1) tablet po hs (at bedtime). 11. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 12. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 13. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 14. morphine 2 mg/ml syringe sig: one (1) injection q4h (every 4 hours) as needed for chest pain. 15. isosorbide dinitrate 20 mg tablet sig: two (2) tablet po tid (3 times a day). 16. phenol-phenolate sodium 1.4 % mouthwash sig: one (1) spray mucous membrane q4h (every 4 hours) as needed. 17. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 18. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 19. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 20. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 21. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) intravenous q 12h (every 12 hours): continue through . 22. glyburide 5 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: discharge diagnosis: . mrsa bacteremia: you have a bloodstream infection with mrsa (a resistant bacteria). you need treatment with vancomycin intravenously for at least four weeks (started on , need to continue through ). . flash pulmonary edema: you had a sudden increase in fluid in your lungs because of your high blood pressure. you need to keep your blood pressure under control. discharge condition: good discharge instructions: please call your pcp if you have high fevers, chills, chest pain uncontrolled with nitro. followup instructions: dr. , urologist, as an outpatient for a voiding trial. you will be discharged with a foley in place. - ; tuesday, @ 8:15, , , surgery specialty . dr. , id specialist will follow up on mr. labs, to be drawn by rehab facility. they should include a weekly cbc, lfts, bun/cr and vanc trough. they should be faxed to ( . dr. of id will follow up with him in clinic prior to antibiotic completion on @ 10am. , , medical building. ( procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances ureteral catheterization dilation of urethra diagnoses: congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled aortocoronary bypass status percutaneous transluminal coronary angioplasty status methicillin susceptible staphylococcus aureus septicemia hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) acute respiratory failure old myocardial infarction methicillin susceptible pneumonia due to staphylococcus aureus knee joint replacement disorders of bursae and tendons in shoulder region, unspecified osteoarthrosis, unspecified whether generalized or localized, shoulder region 

Answer: The patient is high likely exposed to