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: penicillins / codeine / bactrim / iv dye, iodine containing contrast media attending: chief complaint: fever, lethargy, abdominal pain major surgical or invasive procedure: none history of present illness: 84 yo female with copd, dchf, htn, hl, colon cancer s/p resection presents with fever, lethargy, and abdominal pain. she was in her usual state of health until she went grocery shopping with her neighbor and began falling asleep. her neighbor decided to bring her to the emergency department. she denied any cough or any other associated symptoms. of note, the patient had a recent egd 1 week ago. she is also on 2lnc at rest and 4lnc with exertion at baseline. . in the ed, the patient had the following vital signs: 101 84 93/44 14 98% 10l non-rebreather. her blood pressure dropped as low as 64/30 and she was started on peripheral levophed until cvl access was attained. tmax was 102r. she was guiac negative. cxr revealed lll pneumonia. she underwent bilateral le u/s for her le edema that was negative for dvt. ct abdomen/pelvis w/o contrast confirmed lll pna. labs were notable for a wbc of 14.4 with a left shift (87% n, 4% band). vbg revealed 7.35/73/61/42 with normal lactate. the patient was given ceftriaxone 1gm and levoquin 1gm iv for cap coverage. she was given vancomycin 1gm for ?cellulitis. she was given acetaminophen for fever. given her persistent hypotension, she was started on a small dose of norepinephrine gtt with good effect. she received 1l of ns and made 500cc of urine. a subclavian line was misplaced initially, and was repositioned prior to transfer. last set of vitals prior to transfer: 101 77 103/63 17 100%4lnc. . ros: (+)she reports constipation and poor adherance with her bipap. (-)she denied any chest pain, shortness of breath, cough, sputum, fevers, chills, sweats, nausea, vomitting, diarrhea, black, bloody stools, weakness on one side of the body or the other, dysuria. no recent travel or sick contacts. past medical history: 1) diastolic congestive heart failure (nyha class iv) 2) atrial fibrillation (refuses coumadin) 3) symptomatic bradycardia status post vdd pacemaker in 4) obstructive sleep apnea (on cpap at 8-10 cm of h2o) 5) coronary artery disease 6) hyperlipidemia 7) hypertension 8) colon cancer s/p resection 9) copd (on o2 2-4 liters at home) 10) bronchiectasis 11) gerd 12) pulmonary hypertension 13) anemia 14) pneumonia () 15) acute respiratory failure in and again in 16) history of methicillin resistant staphylococcus aureus in her sputum following hernia repair and again in with documented pneumonia . past surgical history: 1) status post hernia repair. 2) status post appendectomy. 3) status post total abdominal hysterectomy. 4) status post back surgery. 5) status post right total hip social history: lives in . worked as a printer many years ago. not married and does not have any children. no family in the area. uses a walker or wheelchair at baseline. patient is quite independent, and she manages her finances, cooks, and cleans herself. she is accompanied to the supermarket. patient quit smoking >25 years ago. drinks one whiskey a week. no illicit drug use. family history: sister has endometriosis and breast cancer physical exam: on admission: gen: pleasant, comfortable, nad heent: perrl, eomi, anicteric, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd, cv: rr, s1 and s2 wnl, no m/r/g resp: cta b/l except rales at the bases with fair air movement throughout abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c, 3+ edema of lle, 2+ edema of rle skin: no rashes/no jaundice/no splinters neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. on discharge: vitals: 98.2 76 116/62 18 96 2l gen: a/ox3, pleasant, comfortable, nad cv: rr, s1 and s2 wnl, no m/r/g resp: crackles at the bases b/l with fair air movement throughout abd: soft, nt, nd ext: 2+ edema of lle, 1+ edema of rle, erythema of lle improved with small residual anterior region of tibia remaining. pertinent results: admission labs: 10:34pm blood hgb-10.3* calchct-31 o2 sat-87 cohgb-2 methgb-0 10:34pm blood type- po2-61* pco2-73* ph-7.35 caltco2-42* base xs-10 comment-green top 07:40pm blood lactate-1.7 03:40am blood calcium-7.7* phos-3.4 mg-1.8 03:40am blood ck-mb-2 ctropnt-0.07* probnp-7662* 07:34pm blood alt-17 ast-25 alkphos-94 totbili-0.3 07:34pm blood glucose-99 urean-18 creat-0.8 na-139 k-3.4 cl-92* hco3-36* angap-14 07:34pm blood pt-13.2 ptt-28.0 inr(pt)-1.1 07:34pm blood wbc-14.4*# rbc-4.08* hgb-12.5 hct-37.6 mcv-92 mch-30.7 mchc-33.3 rdw-13.4 plt ct-246 imaging: le us: no dvt. calf veins not well assessed. ab ct: impression: 1. no evidence of bowel perforation. 2. left lower lobe pneumonia. emphysema cxr: left lower lobe pneumonia. mild chf. cxr: compared with earlier the same day (7:22 a.m.), the right apical pneumothorax is no longer seen distinctly visible. otherwise, no significant change is detected. micro: blood cxs: pending urine cxs: no growth sputum cxs: 3:22 am sputum source: expectorated. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive rod(s). 1+ (<1 per 1000x field): gram positive cocci. in pairs. 1+ (<1 per 1000x field): gram negative rod(s). smear reviewed; results confirmed. respiratory culture (final ): moderate growth commensal respiratory flora. staph aureus coag +. moderate growth. this isolate is presumed to be resistant to clindamycin based on the detection of inducible resistance . 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----------- r erythromycin---------- 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 legionella culture (preliminary): no legionella isolated. labs on discharge: 06:55am blood wbc-7.8 rbc-3.41* hgb-10.3* hct-32.0* mcv-94 mch-30.2 mchc-32.2 rdw-13.8 plt ct-213 07:34pm blood neuts-87* bands-4 lymphs-3* monos-0 eos-0 baso-0 atyps-0 metas-3* myelos-3* 05:48am blood glucose-79 urean-11 creat-0.7 na-140 k-3.7 cl-101 hco3-35* angap-8 05:48am blood calcium-8.0* phos-3.4 mg-2.0 brief hospital course: 84 yo female with copd, diastolic chf, htn, hyperlipidemia, history of colon cancer s/p resection who presented with fever, lethargy, and abdominal pain, and was transferred to the icu for hypotension and concern for sepsis with pulmonary source. . #. severe sepsis: patient presented with 2/4 sirs criteria positive, fever, white count, with presumed pulmonary source and hypotension requiring pressors resulting in diagnosis of severe sepsis. possible concominant left lower extremity cellulitis was considered as a source on admission as well. she was at risk for health care associated organisms. also given recent egd 1 week pta, also concern for aspiration. u/a clear, blood cxs without growth, and urine legionella was negative. considered relative adrenal insufficiency given fluticasone inhaler (last documented oral steroid use in our omr is ), however cortisol was elevated. she was weaned from pressors after receiving 3 l fluid treated with vancomycin, cefepime, levofloxacin and her hypotension resolved. . #. pneumonia: patient was on baseline 2l at home but hypoxia on admission was likely secondary to pneumonia on top of known copd, osa with associated cor pulmonale. hypercarbia likely chronic due to retention from bronchiectasis, kyphosis, osa. bnp was elevated suggesting a component of hf, however no evidence of volume overload on ct. she was continued on bipap. patient had radiographic evidence of left lower lobe pneumonia and was treated with vancomycin and cefepime for a total of 14 day course ending . sputum cx grew out mrsa however this was unclear as to whether this was a 'contaminant' or a true mrsa pneumonia given her baseline colonization. her oxygen status improved to her baseline 2l of o2. an iatrogenic small right apical pneumothorax was discovered s/p central line placement which resolved without further intervention. . #. cad: asymptomatic. pt was ruled out for mi with ekg's without acute changes and ckmb's flat however she did have mildly elevated troponins of unknown clinical significance. she was continued on asa and simvastatin. . #. dchf/cor pulmonale: no evidence of pulmonary edema on ct, torsemide and spironoactone was held given hypotension initially. her last echo reveals normal ef, diastolic dysfunction. . #. a fib: rate controlled, refuses warfarin. she was continued on aspirin. bblocker was held given copd. . # abd pain: with normal ct abd/pelvis, no bm in several days. improved with bowel regimen. . #. osa: bipap was continued. . #. copd: stable, without wheezes at present. surprisingly undewhelming spirometry. patient likely with concominant interstitial disease and kyphosis contributing. fluticasone and standing albuterol/ipatroprium were continued. . contact: (hcp) , friend phone number: code: full code (confirmed) . transition of care: pending completion of iv vanc and cefepime on , her picc line can be discontinued. her weight on discharge is 147 lbs. pending labs: blood cultures medications on admission: albuterol sulfate - 1.25 mg/3 ml solution for nebulization - 1 nebulizer(s) by mouth every 4 hours as needed for shortness of breath / wheezing to use with nebulizer azelastine - 137 mcg (0.1 %) aerosol, spray - 2 sprays intranasal twice daily bipap auto sv 11/9/6, 4 liters oxygen n.c. - (for complex sdb (rdi 45/ahi 36/71%, psg)) - dosage uncertain fluticasone - 50 mcg spray, suspension - 2 sprays intranasal once daily fluticasone-salmeterol - 100 mcg-50 mcg/dose disk with device - 1 puff by mouth in the morning and 1 puff at night gabapentin - 400 mg capsule - 2 capsule(s) by mouth three times a day - - use as directed morphine - 60 mg tablet extended release - 1 tablet(s) by mouth twice a day omeprazole - 20 mg capsule, delayed release(e.c.) - one capsule(s) by mouth daily oxygen - (prescribed by other provider) - - 2liters nc q24h potassium chloride - 10 meq tablet extended release - 1 tablet(s) by mouth twice a day primidone - 50 mg tablet - 2 tablet(s) by mouth at night simvastatin - 40 mg tablet - 1 tablet(s) by mouth once a day spironolactone - 25 mg tablet - 1 tablet(s) by mouth once a day tiotropium bromide - 18 mcg capsule, w/inhalation device - inhale contents of 1 capsule daily torsemide - 20 mg tablet - 2 tablet(s) by mouth once a day medications - otc aspirin - (prescribed by other provider) - 325 mg tablet - 1 tablet(s) by mouth daily calcium carbonate - (prescribed by other provider) - 750 mg tablet, chewable - 2 tablet(s) by mouth daily cholecalciferol (vitamin d3) - (prescribed by other provider) - 1,000 unit capsule - 1 capsule(s) by mouth daily docusate sodium - (prescribed by other provider) - 100 mg capsule - 1 capsule(s) by mouth twice a day ferrous gluconate - 240 mg (27 mg iron) tablet - 1 tablet(s) by mouth daily multivitamin-minerals-lutein - (otc) - tablet - 1 tablet(s) by mouth once a day discharge medications: 1. albuterol sulfate 1.25 mg/3 ml solution for nebulization sig: one (1) inhalation every four (4) hours as needed for shortness of breath or wheezing. 2. azelastine 137 mcg aerosol, spray sig: two (2) sprays nasal twice a day. 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. fluticasone 50 mcg/actuation spray, suspension sig: two (2) sprays nasal once a day. 5. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. gabapentin 400 mg capsule sig: two (2) capsule po tid (3 times a day). 7. morphine 60 mg tablet extended release sig: one (1) tablet extended release po twice a day. 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. potassium chloride 10 meq tablet extended release sig: one (1) tablet extended release po twice a day. 10. primidone 50 mg tablet sig: two (2) tablet po at bedtime. 11. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 12. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 13. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. 14. torsemide 20 mg tablet sig: two (2) tablet po daily (daily). 15. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: two (2) tablet, chewable po daily (daily). 16. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 17. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 18. multivitamin tablet sig: one (1) tablet po daily (daily). 19. ferrous gluconate 240 mg (27 mg iron) tablet sig: one (1) tablet po once a day. 20. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 21. cefepime 1 gram recon soln sig: one (1) gram injection q12h (every 12 hours) for 9 days: to finish on . 22. vancomycin 500 mg recon soln sig: five hundred (500) mg intravenous q 12h (every 12 hours) for 9 days: to finish on . 23. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: pneumonia left leg cellulitis secondary: chronic diastoloic congestive heart failure bronchiectasis methicillin resistent staph aureus colonization 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: you were admitted to for fever, lethargy, and abdominal pain. you were found to have pneumonia and left lower leg cellulitis. you were treated with antibiotics and a "picc" iv line was placed for you to continue these antibioitcs at rehab. your breathing improved and fevers went away with treatment. medication changes: start: vancomycin 500mg iv bid and cefepime 1 gram iv q12 until please otherwise resume your home medications. followup instructions: please follow-up with your primary care doctor after you leave the rehabilitation facility. otherwise, please follow-up with the appointments listed below: department: cardiac services when: monday at 3:00 pm with: dr. building: sc clinical ctr campus: east best parking: garage md procedure: other incision of skin and subcutaneous tissue diagnoses: obstructive sleep apnea (adult)(pediatric) anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension unspecified septicemia severe sepsis atrial fibrillation other and unspecified hyperlipidemia cellulitis and abscess of leg, except foot septic shock personal history of malignant neoplasm of large intestine cardiac pacemaker in situ surgical or other procedure not carried out because of patient's decision carrier or suspected carrier of methicillin resistant staphylococcus aureus bronchiectasis without acute exacerbation chronic diastolic heart failure hip joint replacement chronic pulmonary heart disease, unspecified methicillin resistant pneumonia due to staphylococcus aureus 

Answer: The patient is high likely exposed to