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 (sulfonamide antibiotics) / grass pollen-bermuda, standard attending: chief complaint: ischemic stroke. major surgical or invasive procedure: tracheostomy intubation bronchoscopy history of present illness: is a 48 year old man with a history of hypertension, copd and obesity presenting for evaluation of new left-sided weakness. the patient's wife states he had been feeling unwell since friday when he developed a respiratory illness with cough (she has it as well). he was seen by his pcp on saturday and recommended q4 neubulizer treatments. the patient continued to feel unwell over the weekend, with poor appetite and complaint of a mild headache on saturday. he missed his grandaughter's birthday party because of his illness. this am, he was planning on staying home from work. he woke up around 6am and walked into the kitchen; his wife noticed that his breathing was wheezy and she told him to take a nebulizer. he went to the bathroom and then laid down on the couch. a few minutes later she walked into the living room to give him the treatment when she noticed his left face was drooping and he was weak; this was around 6:10 in the morning. she immediately called 911. he was initally brought to . vitals there bp was initially 180/130. nihss was 17 and the decision was made to give iv tpa. this was given at 7:30. the patient was then transferred to for further treatment. past medical history: 1. anxiety, working with a therapist. 2. asthma and copd, has required prednisone in the past (greater than two years ago). 3. hypertension. 4. sleep apnea requiring cpap. 5. allergic rhinitis. 6. fatty liver. 7. history of h. pylori positivity, status post treatment. social history: former smoker, quit three years ago. does not use drugs. former heavy alcohol use, none in 18 years. he is married, lives with his wife and two sons. they have two sons. is a foreman and estimator, runs demolition crews. his sister is a nurse here at . family history: significant for obesity and diabetes. physical exam: on discharge: t 98.6 hr: 72 bp: 117/73 rr: 20 (-25) o2: 95% on ra (passy-muir) or otherwise on 35% trach mask. transmitted tracheal sounds on auscultation with rare wheeze. regular, distal sounds. abdomen soft. alert and communicative. oriented to self, "bank", "", "", but will agree with correct answers. cranial nerves notable for umn left facial. does not typically look past midline to right. tone flaccid on left, normal on right. power full on right and absent left, varying ability to move left foot, but typically does not. on admission: t 97.6 hr:75 bp:148/86 resp:12 o(2)sat:97 normal general: awake, agitated cooperative, nad. head and neck: no cranial abnormalities, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs clear to auscultation bilaterally cardiac: regular rate and rhythm, no murmurs. abdomen: soft, non-tender extremities: well perfused skin: no rashes or lesions noted. neurologic: -mental status: awake, agitated. head turned to the right, will look towards examiner when prompted, tracks past the midline but eyes do not move completely to the left. able to state name, dob, month and follows commands. naming intact, intact. language fluent but speech mildy dysarthric. -cranial nerves: i: olfaction not tested. ii: perrl 4 to 3mm on the right, on the left. appears to have partial left vf neglect (unable to fully cooperate with confrontation testing) iii, iv, vi: eomi able to slightly pass midline on left, but unable to adduct to the left. v: facial sensation intact to light touch. vii: partial left facial droop viii: hearing intact to voice xii: tongue protrudes in midline. -motor: normal bulk. decreased tone on left side. moving both legs spontaneously, moving right arm, no clear spontantous movement of the left arm. able to keep right arm and leg antigravity. -sensory: able to appreciate touch on right. neglects left sided sesory stimuli, no withdrawal of the left arm to noxious, withdraws left leg. -deep tendon reflexes: unable to elicit. left toe up. -coordination: no intention tremor on right. -gait: unable to assess pertinent results: 05:02am blood wbc-8.4 rbc-3.98* hgb-11.5* hct-33.5* mcv-84 mch-28.9 mchc-34.3 rdw-14.8 plt ct-293 06:11am blood neuts-69.2 lymphs-20.5 monos-4.8 eos-4.2* baso-1.4 03:23am blood pt-14.4* ptt-25.7 inr(pt)-1.2* 05:25am blood glucose-96 urean-25* creat-0.7 na-138 k-3.6 cl-101 hco3-29 angap-12 11:40am blood alt-24 ast-20 ld(ldh)-156 ck(cpk)-111 alkphos-52 totbili-0.6 05:25am blood calcium-8.9 phos-4.0 mg-2.1 11:40am blood %hba1c-5.5 eag-111 11:40am blood triglyc-112 hdl-24 chol/hd-5.8 ldlcalc-92 urine 10:45am urine color-yellow appear-hazy sp -1.020 10:45am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-neg 06:15am urine rbc-0 wbc-3 bacteri-none yeast-none epi-0-2 microbiology blood culture blood culture, routine-pending inpatient urine urine culture-pending inpatient urine urine culture-final inpatient catheter tip-iv wound culture-final inpatient bronchoalveolar lavage gram stain-final; respiratory culture-final {staph aureus coag +} inpatient mini-bal gram stain-final; respiratory culture-final {staph aureus coag +} inpatient mrsa screen mrsa screen-final inpatient urine urine culture-final {staphylococcus, coagulase negative} inpatient sputum gram stain-final; respiratory culture-final {staph aureus coag +} inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient mrsa screen mrsa screen-final (negative) inpatient urine culture sensitivities: 9:34 pm urine source: catheter. **final report ** urine culture (final ): culture workup discontinued. further incubation showed contamination with mixed skin/genital flora. clinical significance of isolate(s) uncertain. interpret with caution. staphylococcus, coagulase negative. >100,000 organisms/ml.. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. coag neg staph does not require contact precautions, regardless of resistance oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus, coagulase negative | gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s nitrofurantoin-------- <=16 s oxacillin------------- =>4 r tetracycline---------- =>16 r vancomycin------------ 2 s sputum culture 9:35 pm sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): commensal respiratory flora absent. staph aureus coag +. heavy growth. this isolate is presumed to be resistant to clindamycin based on the detection of inducible resistance . staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s cta head and neck with perfusion study impression: 1. large right middle cerebral arterial distribution infarction, without evidence of mean transit time/cerebral blood volume mismatch on perfusion imaging. these findings are related to a filling defect in the distal portion of the m1 segment on the right. 2. no intracranial hemorrhage. 3. hilar and mediastinal lymphadenopathy of uncertain etiology. these findings could be correlated to dedicated imaging of the chest or compared to prior imaging if available. mri brain impression: large right middle cerebral artery territory infarction and hemorrhagic transformation in the right caudate and putamen with mild mass effect on the right lateral ventricle. echocardiogram conclusion: there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). the right ventricular cavity is dilated with normal free wall contractility. the aortic valve is not well seen. the mitral valve leaflets are not well seen. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. bubble study negative x 2, but imaged suboptimal. impression: suboptimal image quality. hyperdynamic left ventricle; due to the technically suboptimal nature of this study, an intracardiac shunt cannot be esxcluded with certainty. if clinical suspicion is high, tee with bubble study is preferable. ct torso w/ contrast impression: 1. mild mediastinal and bilateral hilar lymphadenopathy. this is a nonspecific finding and differential diagnosis includes infection and inflammatory processes such as sarcoidosis. malignancy is in the differential diagnosis, but seems less likely. 2. several small lung nodules measuring up to 6 mm in size. these are nonspecific in appearance and may represent granulomas. metastatic disease cannot be excluded and therefore followup examination in three months is recommended, at which time the lymphadenopathy can be reassessed. if prior outside studies are available for comparison, an addendum can be dictated to this report. transesophageal echo no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. mild spontaneous echo contrast is seen in the body of the right atrium. no mass or thrombus is seen in the right atrium or right atrial appendage. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to 34 cm from the incisors. the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: no asd or pfo by contrast study at rest. no intracardiac thrombus seen. mild mitral regurgitation. video swallow findings: barium passes freely through the oropharynx and esophagus without evidence of obstruction. evaluation is limited due to difficulty positioning of the patient secondary to left-sided hemiparesis. there is penetration with thin- and nectar-thickened liquids and probable aspiration with thin liquids. for details, please refer to speech and swallow division note in omr. impression: penetration with thin- and nectar-thickened liquids with possible aspiration. please see speech and swallow note for details. ct head findings: again demonstrated is evolving right mca territory infarction with hemorrhage in the region of the basal ganglia. there is no acute intracranial hemorrhage. the degree of leftward midline shift is increased compared with prior, now measuring 11 mm. the right lateral ventricle is compressed as a result, and there is mild hydrocephalus of the left lateral ventricle, unchanged. elsewhere, matter/white matter differentiation appears preserved. there is opacification of the ethmoid air cells and of the sphenoid sinuses consistent with intubated state. brief hospital course: summary mr was admitted to the icu after being found to have a large proximal right-sided mca stroke. he recieved tpa at an osh before transfer to but this was not successful. no acute intervention was completed. he was intubated for airway protection but failed extubation and had a trach placed. peg was not placed owing to leukocytosis. while in the icu he developed a vap on . he was treated with antibiotics. he was placed on a full dose aspirin for future prophylaxis. there was no embolic source identified. a tee was completed which failed to demonstrate a thrombus or pfo. aspirin was held when craniectomy was likely, but this surgery was not needed. with trach in place and stable, he was transferred to step-down then the floor service. aspirin was restarted. persistent leukocytosis prompted broadening to vancomycin/zosyn antibiotic coverage. his gastric band was deflated but left in place. he succeeded in safe swallowing, so peg was not necessary. he had a passy-muir valve fitted and was communicative. hospital course by problem stroke no etiology identified presently, except for hypercoagulability of recent infection. at the time of discharge, lupus-anticoagulant and anti-cardiolipin antibodies are pending. no abnormalities were seen on imaging of vessel or either transthoracic or transesophageal echo. we recommend continuing aspirin 325 mg and a statin at this time. he will follow-up in stroke clinic with dr. . his deficits are described above. midline shift reached 11 mm with following clinical improvement. craniectomy was not required. eosinophilia climbed during the admission. approximately 2% on admission and 4% at discharge. this should be followed, but appeared indolent and does not appear to represent a medication allergy. parasitic infection may be considered if this does not resolve. respiratory distress on the evening of he was tachypneic to 33 breaths per minute. this was worked up thorooughly and finally attributed to position and copd. ipratropium and albuterol along with elevating the head of the bed to 45 degrees were helpful. this may also have represented pneumonitis in the presence of low-grade or resolving infection. pneumonia coagulase positive staph and rising wbc, without frank respiratory distress or fever prompted antibiotic coverage. chest x-ray was also normal. we recommend continuing his course of two weeks of vancomycin and zosyn, to end on . please don't hesitate to contact us to discover final culture results which may enable narrowing of antibiotics, to nafcillin, for example for isolated mssa. mrsa testing was negative. gastric band this is considered an infection risk and is likely not presently needed. removal is elective and will likely be considered at follow-up in with surgery. this does mean that large meals should be avoided. the small pouch created by this band, despite its deflation, may be a risk for reflux and aspiration when large quantities of food are given at once. please divide meals. pulmonary nodules and hilar nodes follow-up imaging will be required as described above. copd smoking history. controlled on ipratropium, fluticasone and albuterol. steroids were not given. medications on admission: - albuterol sulfate 2 puffs four times a day - albuterol sulfate neb q4 hours - fluticasone 2 sprays once a day - fluticasone-salmeterol (2 times a day). 7. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 8. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 9. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours). 11. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 12. vancomycin 1000 mg iv q 12h 13. piperacillin-tazobactam 4.5 g iv q8h 14. 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. 15. ondansetron 4 mg iv q8h:prn nausea discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses ischemic stroke pneumonia secondary diagnoses dyslipidemia discharge condition: level of consciousness: alert and interactive, left sided neglect. activity status: out of bed w/ assist mental status: confused - sometimes. at time of discharge not oriented to place or day/month. discharge instructions: you came to the hospital after having a right sided stroke. this has resulted in left-sided weakness. you stayed in the icu for some time given swelling of your brain. you were also intubated. after you were stable and extubated, you were transferred to the floor service. you developed an elevated count of white blood cells. given bacteria in your lungs, antibiotics were started. you now are able to eat, have a tracheostomy and can communicate with a passy-muir valve. you are now safe to go to rehabilitation. followup instructions: surgery (gastric band follow-up): provider: , rd,ldn phone: date/time: 1:00 provider: , md phone: date/time: 1:30 neurology: provider: , md, phd: , , building, level 8 date/time: 3:00 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances temporary tracheostomy closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled personal history of tobacco use other and unspecified hyperlipidemia acute respiratory failure other diseases of lung, not elsewhere classified obesity, unspecified chronic obstructive asthma, unspecified ventilator associated pneumonia cerebral artery occlusion, unspecified with cerebral infarction leukocytosis, unspecified bariatric surgery status tachypnea other dysphagia other specified hemiplegia and hemiparesis affecting nondominant side status post administration of tpa (rtpa) in a different facility within the last 24 hours prior to admission to current facility 

Answer: The patient is high likely exposed to