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: ativan attending: chief complaint: altered mental status major surgical or invasive procedure: none history of present illness: 52 y.o female with pmhx of copd on home 2l nc, recurrent pneumonia, paraplegia, and recent admission for hypercarbic resp failure,mdr pneumonia,proteus uti discharged last week presenting with altered mental status. she has been noted by her caretaker to be more confused at home. in the ed she was alert and oriented x 3,with no complanits.in the ed she trigerred for a oxygen saturation of 82% ra with insp crackles and some wheezing, afebrile. she was diagnosed with recurrent rll pnemonumona, and given meropenem and vancomycin. her sbp briefly was 72 and with 500cc ns increased to sbp 100. prior to transfer her vitals were: t-99 hr 99,107/60, rr 20 86% 6l with bipap being started. in the ed initial vitals were: 99 100 140/122 24 92%. she was given meropenem and vancomycin. on arrival to the micu, the patient is on bibap and able to answer some questions. she knows its , oriented to denies chest pain, abdominal pain,diarrhea, fevers/chills,dizziness, dysuria at home. denies headaches, syncope and vision changes at home. she does endorse tan sputum production and cough for the past few weeks. past medical history: # t1 to t2 paraplegia status post a motor vehicle accident. # recurrent pneumonia - per pulm, recurrent pneumonia likely from pulmonary toilet issues secondary to neuromuscular disease with improvement with consistent and aggressive bronchopulmonary therapy. - prior sputum cultures + for mrsa, pan-sensitive klebsiella, and pseudomonas. # recurrent utis in the setting of urinary retention requiring straight catheterization # hepatitis c # anxiety # dvt in -ivc filter placed in # pulmonary nodules # hypothyroidism # chronic pain # chronic gastritis # anemia of chronic disease # s/p pea arrest during hospitalization in social history: lives at home with husband - : 35-pack-years, currently abusing tobacco - alcohol: denies. - illicits: denies. family history: mom - lung cancer dad - healthy physical exam: admission physical exam: vitals: t:99.1 bp:93/62 p:94 r:16 18 o2:95% bipap general: alert, oriented, not retracting, has bipap mask on, mouthing words and nodding yes/no to questions appropiately. heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: insp/ exp. wheezes difussely,insp rales in rll, some exp ronchi diffusley. abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no current foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, discharge physical exam: vs - t97.8 hr 73 bp 100/60 rr 20 o2sat 97% 2l nc general - awake, nad lungs - no increased work of breathing, no wheezes or crackles heart - rrr, s1-s2 clear, no mrg abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding gu - foley in place neuro - a&ox3, cn 2-12 grossly intact pertinent results: admission labs: 02:45pm blood wbc-13.4*# rbc-3.26* hgb-8.9* hct-28.7* mcv-88 mch-27.2 mchc-30.9* rdw-16.0* plt ct-282 02:45pm blood neuts-90.9* lymphs-4.7* monos-3.3 eos-0.9 baso-0.2 02:45pm blood pt-13.7* ptt-29.7 inr(pt)-1.3* 02:45pm blood glucose-135* urean-18 creat-0.4 na-141 k-4.2 cl-102 hco3-33* angap-10 02:45pm blood calcium-8.8 phos-3.3 mg-2.2 02:45pm blood probnp-927* 05:29pm blood type-art po2-76* pco2-76* ph-7.25* caltco2-35* base xs-2 03:06pm blood lactate-1.4 05:40pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-mod 02:45pm blood asa-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg relevant labs: 07:37am urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-pos 06:05am blood wbc-7.0 rbc-3.43* hgb-8.9* hct-29.3* mcv-85 mch-25.9* mchc-30.4* rdw-16.3* plt ct-274 06:05am blood glucose-96 urean-6 creat-0.2* na-143 k-3.6 cl-101 hco3-38* angap-8 06:05am blood calcium-8.9 phos-3.9 mg-2.0 08:10pm blood type-art po2-86 pco2-58* ph-7.44 caltco2-41* base xs-12 pertinent micro: blood culture -pending ngtd at discharge urine legionella urinary antigen -final neg urine culture-final neg blood culture -pending ngtd at discharge 2:45 pm blood culture blood culture, routine (preliminary): staphylococcus, coagulase negative. isolated from only one set in the previous five days. sensitivities performed on request.. aerobic bottle gram stain (final ): reported to and read back by dr. on at 0645. gram positive cocci in clusters. 4:45 pm sputum source: expectorated. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). respiratory culture (final ): rare growth commensal respiratory flora. haemophilus influenzae, beta-lactamase negative. heavy growth. beta-lactamse negative: presumptively sensitive to ampicillin. confirmation should be requested in cases of treatment failure in life-threatening infections.. staph aureus coag +. sparse growth. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s blood culture, routine (final ): no growth. legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. pertinent imaging: pcxr comparisons: multiple prior chest radiographs, most recently of . findings: single frontal portable view of the chest was obtained. the heart is enlarged and its right border is silhouetted by right lung base consolidation, which is increased since and compatible with pneumonia, pleural effusion, or a combination of both. the left lung is clear. no pneumothorax is identified. a right central catheter terminates in the low svc. left humeral hardware is similar to prior and right humeral hardware is incompletely imaged. impression: right lung base parenchymal opacity, increased since prior, compatible with pneumonia in the correct clinical setting. probable superimposed right pleural effusion. brief hospital course: 53 y.o woman with pmhx of copd on home 2l nc, recurrent pneumonias and utis, t1-t2 paraplegia , and recent admission for hypercarbic resp failure, mdr pneumonia, proteus uti discharged one week prior who presented with altered mental status and hypoxia, found to have new rll haemophilus influenzae and mrsa pneumonia. # pneumonia: rll pneumonia with mrsa and heavy haemophilus influenzae on sputum cultures. patient was initially started empirically on vancomycin, cefepime, meropenem, and was able to be narrowed to vancomycin and meropenem only following speciation of sputum cultures. pneumonia was most likely cause of hypotension, leukocytosis, hypoxia on admission. patient has history of recurrent pneumonias and most recently completed eight-day vancomycin and meropenem course for hcap on . given frequent ams and rll pna, high suspicion for aspiration. she was treated for a total of 10 days with vancomycin and meropenem. she was counseled on the contribution of underlying substance dependence/polypharmacy leading to readmissions for ams and aspiration pneumonia. # positive blood cultures: one of four blood cultures positive for coagulase negative staph, most likely contaminate. patient with indwelling cvc which did not appear infected, pneumonia was treated as above. repeat blood cultures showed no growth. #hypotension- most likely medications or infection. fluid responsive in the ed, lactate normal, patient did not require pressors in the micu. sbp at baseline fluctuates between 100-150 according to past records. infection treated as above, weaned to half doses of sedating medications. no signs of cardiogenic cause or adrenal cause. bps were stable to elevated during her stay on the medicine floor. #altered mental status- patient presented with decreased responsiveness and likely aspiration pneumonia similar to prior hospitalizations, and was found to have utox positive for methadone, which patient admitted to taking without prescription "from a friend" at unknown dose, for her chronic leg pain, as narcotics agreement was termintated with pcp. spoke at length with patient about this. psychiatry consult was offered but patient declined. patient was not treated with narcan this admission, but was known to have be responsive to narcan during the previous admission. opioid abuse and polypharmacy are the most likely culprits for her recurrent admissions with ams and pneumonias most likely caused by aspiration, ams compounded by infection and poor pulmonary toilet. sedating medication doses were decreased by half. chronic issues: # copd: on 2l o2 nc at baseline; resumed tobacco use last month. -continued home albuterol, ipratroprium, supplemental o2 # chronic pain: foot and shoulder pain related to prior mva and likely neuropathy. narcotics contract terminated by pcp as documented in omr. utox positive for methadone (not prescribed) this admission as discussed above. -lidocaine patches, baclofen, continued -gabapentin, pregabalin intially held for ams, pregabalin restarted, gabapentin restarted at half home dose when mental status improved. -follow up at pain clinic as outpatient # urinary retention: patient usually self-catheterizes at home but prefers to use foley when hospitalized. foley was placed on admission and removed before discharge. oxybutin held initially for ams but restarted when mental status improved. # anxiety/depression: continued on citalopram, sedating medications were held on admission for ams, and were restarted at half home dose when mental status improved, including clonazepam, trazadone. patient declined psychiatry consult but opened up to sw during this admission about home stressors, including her relationship with caregivers and husband. # hypothyroidism: continued levothyroxine # hypercholesterolemia: continued simvastatin # hep c: stable, no current treatment, no lft abnormalities this admission. # gerd: continued omeprazole transitional issues for this patient include: - continued investigation into options of treatment of methadone abuse and dependence medications on admission: 1. albuterol 0.083% neb soln 1 neb ih q6h:prn dyspnea 2. baclofen 20 mg po qam, qpm 3. baclofen 10 mg po 4pm 4. citalopram 40 mg po daily 5. clonazepam 1 mg po tid:prn anxiety 6. lidocaine 5% patch 1 ptch td daily feet and shoulder blade 7. omeprazole 20 mg po daily 8. polyethylene glycol 17 g po daily 9. simvastatin 10 mg po daily 10. trazodone 100 mg po hs:prn anxiety 11. clonazepam 2 mg po qhs 12. ipratropium bromide mdi 2 puff ih q6h:prn dyspnea 13. oxybutynin 10 mg po qam, qhs 14. oxybutynin 5 mg po 4pm 15. sucralfate 1 gm po tid 16. levothyroxine sodium 112 mcg po daily 17. gabapentin 600 mg po tid discharge medications: 1. albuterol 0.083% neb soln 1 neb ih q6h:prn dyspnea 2. baclofen 20 mg po qam, qpm 3. baclofen 10 mg po 4pm 4. citalopram 40 mg po daily 5. levothyroxine sodium 112 mcg po daily 6. omeprazole 20 mg po daily 7. oxybutynin 10 mg po qam, qhs 8. oxybutynin 5 mg po 4pm 9. polyethylene glycol 17 g po daily 10. simvastatin 10 mg po daily 11. lidocaine 5% patch 1 ptch td daily feet and shoulder blade 12. ipratropium bromide mdi 2 puff ih q6h:prn dyspnea 13. sucralfate 1 gm po tid 14. pregabalin 100 mg po tid 15. clonazepam 1 mg po qhs 16. clonazepam 0.5 mg po tid:prn anxiety hold for sedation or rr<10 17. gabapentin 300 mg po q8h 18. trazodone 50 mg po hs:prn insomnia discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis: pneumonia (haemophilus influenzae, methicillin resistant staph aureus) secondary diagnosis: opioid dependence chronic obstructive pulmonary disease t1/t2 paraplegia with neurogenic bladder discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mrs. , it was a pleasure taking part in your care during your hospitalization at . you were admitted with confusion, difficulty breathing, and low blood pressure and were found to have a pneumonia. you were briefly admitted to the intensive care unit for your symptoms, but did not require intubation. you improved with iv antibiotics and were able to be discharged. please be aware that taking medications that are not prescribed to you can be dangerous to your health and is likely contributing to your recurrent hospitalizations. it is very important that you follow up with the pain clinic to treat your pain in a safe manner. also please follow up with your pcp at the appointment below. please note that the following changes have been made to your medications: 1. your dose of gabapentin was decreased to 300 mg po q8hrs 2. please only take 1 mg of clonazepam by mouth at bedtime and/or 0.5 mg by mouth up to 3 times per day as needed for anxiety followup instructions: department: post clinic when: thursday at 1:10 pm building: sc clinical ctr campus: east best parking: garage note: this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider department: pain management center when: tuesday at 8:40 am with: , md building: one place (, ma) campus: off campus best parking: parking on site department: when: tuesday at 10:40 am with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: non-invasive mechanical ventilation central venous catheter placement with guidance diagnoses: anemia of other chronic disease other chronic pain anemia, unspecified pure hypercholesterolemia chronic hepatitis c without mention of hepatic coma unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified constipation, unspecified dysthymic disorder acute respiratory failure hypotension, unspecified pneumonitis due to inhalation of food or vomitus long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits opioid abuse, unspecified mononeuritis of unspecified site paraplegia pneumonia due to hemophilus influenzae [h. influenzae] leukocytosis, unspecified foreign body accidentally entering other orifice atrophic gastritis, without mention of hemorrhage foreign body in larynx personal history of sudden cardiac arrest family history of malignant neoplasm of trachea, bronchus, and lung neurogenic bladder nos solitary pulmonary nodule 

Answer: The patient is high likely exposed to