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: nafcillin / aminoglycosides / bactrim / ceftriaxone / penicillins attending: chief complaint: respiratory distress, change in mental status major surgical or invasive procedure: 1. intubation history of present illness: 83-year-old female with myasthenia, dementia, afib not on coumadin, chf, s/p mvr who has been having recurrent aspiration pna presented with cough, low-grade fever. patient unable to give any history. per family, the patient had been more somnolent and coughing for more than 1 week. the family also noted that she has slightly increased respiratory rate. she was bought to the ed where her vitals were stable but an xray showed increase in bilateral pleural effusions and perihilar opacities consistent with congestive heart failure. she got iv lasix, clindamycin, levofloxacin and transferred to the micu for possible intubation for increased work of breathing. the family was not infavour of an intubation unless it was unavoidable. past medical history: 1. myasthenia on chronic prednisone. 2. alzheimer's dementia such that she is noncommunitive at baseline. 3. atrial fibrillation that is rate controlled. she is not on anticoagulation. 4. congestive heart failure on chronic lasix. 5. status post mitral valve replacement from endocarditis. 6. status post splenectomy. 7. status post orif for hip fracture. 8. history of frequent urinary tract infections. social history: she lives with her daughter who is her primary caretaker. at baseline, she is noncommunitive and spends most of her day in bed or in a chair. she can ambulate with assistance and will walk about 3 times per day. she doesn't drink alcohol or smoke. family history: non-contributory. physical exam: gen: 98.3, 152/87, 90, 18, 98%/2l nc heent: perla, eomi, mmm neck: jvd flat heart: s1/s2, rrr, holosytolic murmur at the apex/lusb lungs: clear anteriorly, decreased bs in bases, ? crackles posteriorly abdomen: s/nt/nd ext: no edema pertinent results: 10:16pm pt-12.9 ptt-24.8 inr(pt)-1.1 10:16pm plt count-598*# 10:16pm neuts-76.9* bands-0 lymphs-18.6 monos-3.9 eos-0.5 basos-0.2 10:16pm wbc-20.0*# rbc-3.70* hgb-9.3* hct-28.2* mcv-76*# mch-25.1*# mchc-32.8 rdw-16.6* 10:16pm ctropnt-<0.01 10:16pm ck(cpk)-53 10:16pm glucose-176* urea n-39* creat-0.8 sodium-135 potassium-5.1 chloride-92* total co2-27 anion gap-21* 11:08pm lactate-3.0* 12:05am urine rbc-0-2 wbc->50 bacteria-many yeast-none epi-0-2 03:25am wbc-13.5* rbc-3.33* hgb-8.2* hct-25.1* mcv-75* mch-24.8* mchc-32.9 rdw-16.4* cardiology report echo study date of conclusions: the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. the prosthetic mitral valve leaflets are thickened. the gradients are higher than expected for this type of prosthesis (likely related to mitral regurgitation rather than prosthesis stenosis). an eccentric, anteriorly directed jet of at least moderate to severe (3+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the severity of mitral regurgitation may be slightly higher (was at least moderate on review of the prior study). the estimated pulmonary artery systolic pressure is slightly increased. if clinically indicated, a tee is suggested to better evaluate the mitral prosthesis and to quantify the severity of mitral regurgitation. brief hospital course: this is an 83 year-old female myasthenia, dementia, afib not on coumadin, chf, s/p mvr now with recurrent aspirations, cough and respo distress. . # respiratory distress: patient was admitted with respiratory distress, likely multifactorial in etiology from aspiration pneumonia, myasthenia , pleural effusions, pulmonary edema, and 3+ moderate mitral regurgitation as confirmed by echo. patient's respiratory distress worsened, was initially ventilated unsuccessfully with bipap, and was then intubated on . while patient was intubated, attempts were made to further improve respiratory status with aggressive diuresis to treat pulmonary edema likely secondary to mitral regurgitation and also with antibiotic treatment of likely aspiration pneumonia. patient initially treated broadly with levofloxacin, vancomycin, and flagyl but were further tailored as sputum cultures returned. during her micu course, sputum cultures grew the following bacteria: 1) stenotrophomonas maltophila sensitive only to bactrim to which the patient has an allergy, 2) mssa for which she received vancomycin due to a nafcillin allergy. after one week of mildly improved pulmonary edema with diuresis, continued antibiotic treatment, and discussion with the family regarding the goals of hospitalization, the patient was extubated without any complications and has remained stable on nasal canula. after discussion with id, it was felt that the stenotrophomonas was possibly only a colonizer rather than a pathogen and did not need to be treated. the course of vancomycin was completed and patient remained afebrile with improved respiratory status. she was maintained on her daily furosemide regimen while on the floor to ensure that pulmonary edema was kept to a minimum. patient was on room air at discharge, not requiring any supplemental oxygen. . #. arf/hypernatremia: the patient's creatinine began rising due to diuresis for pulmonary edema. eventually a fluid balance was achieved such that the creatinine was able to stabilize and the patient's respiratory status was also able to stabilize. . #. atrial fibrillation: the patient also has a history of atrial fibrillation which has been controlled primarily with rate control not anticoagulation. the anticoagulation was not done due to history of gi bleed. while patient was hypotensive, her metoprolol was held and then restarted once her blood pressure became more stable. patient was without complications regarding her atrial fibrillation. upon return to the general medical floor she did have episodes of sinus tachycardia that responded to fluid repletion. her metoprolol was titrated back up to 25mg and she was discharged on this dose. . # valve: patient is s/p mitral valve replacement due to a past episode of endocarditis. subsequently, echo during this admission demonstrated 3+ mitral regurgitation. patient's mitral regurgitation was thought to be contributing to her respiratory distress and worsening pulmonary edema. . # myasthenia : patient also has a known history of myasthenia and was continued on her prednisone without complication. neurology was consulted during this admission and did not feel her myasthenia was contributing to her respiratory distress. . # alzheimer's dementia: patient with alzheimer's dementia and is noncommunicative and nonverbal at baseline, according to the family. medications on admission: lopressor 37.5 lasix 20 qd prednisone 10 mg qd ranitidine 300 mg colace ca carb triamcinolone acetate . discharge medications: 1. prednisone 5 mg tablet sig: two (2) tablet po daily (daily) for 1 months. disp:*30 tablet(s)* refills:*0* 2. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day) for 1 months. disp:*60 tablets* refills:*0* 3. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily) for 1 months: please take with meals. disp:*30 tablet(s)* refills:*2* 4. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily) for 1 months: please give with iron. disp:*30 tablet(s)* refills:*2* 5. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day) for 1 months. disp:*60 tablet(s)* refills:*0* 6. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) for 2 days: please apply to groin area twice per day for 2 days. disp:*qs 1 bottle* refills:*0* 7. furosemide 20 mg tablet sig: one (1) tablet po daily (daily) for 1 months. disp:*30 tablet(s)* refills:*2* 8. glyburide 2.5 mg tablet sig: one (1) tablet po once a day for 1 months. disp:*30 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnoses: respiratory failure aspiration pneumonia chf exacerbation acute renal failure dehydration/hypernatremia iron deficiency anemia secondary diagnoses: atrial fibrillation mitral valve regurgitation myasthenia alzheimer's dementia decubitus ulcer h/o cva osteoporosis discharge condition: afebrile, blood pressure and heart rate stable, kidney function and electrolytes improved, and respiratory status stable. discharge instructions: you were diagnosed with pneumonia, congestive heart failure and dehydration. your pneumonia was treated appropriately with antibiotics for 2 weeks. your heart failure was also treated with diuretics and iv fluids. please contact your physician if you develop worsening shortness of breath, fevers greater than 101.5 degrees, or any other concerning symptoms. also please check your weight daily and contact your physician if you have weight gain greater than 3 pounds. please continue with the prescribed medication regimen. followup instructions: please follow up with your primary care physician. appointment has been made with a resident in the clinic who will be precepted by your primary care physician. provider: , md phone: date/time: 1:30 please continue with this tube-feed regimen: bolus tubefeeding: novasource pulmonary full strength 240ml per feeding 3 feedings per day at 8am, noon, and 4pm. residual check: before each feeding hold feeding for residual greater than 100 ml flush with 160ml of water before & after each feeding. also flush with 325ml of water at 8pm. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation arterial catheterization transfusion of packed cells diagnoses: mitral valve disorders urinary tract infection, site not specified long-term (current) use of steroids acute kidney failure, unspecified atrial fibrillation acute respiratory failure pneumonitis due to inhalation of food or vomitus alkalosis personal history of other diseases of circulatory system pressure ulcer, lower back iron deficiency anemia, unspecified heart valve replaced by transplant pressure ulcer, heel hyperosmolality and/or hypernatremia myasthenia gravis without (acute) exacerbation pressure ulcer, hip 

Answer: The patient is high likely exposed to