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: patient recorded as having no known allergies to drugs attending: chief complaint: non-responsiveness major surgical or invasive procedure: - intubated in ed of , admitted to & mechanically vented - s/p double lumen picc placement, left basilic, 60 cm insertion length - s/p bronchoscopy - patient extubated - patient re-intubated - patient extubated history of present illness: this is a year-old female with a history of cad s/p mi, htn, dm, hypothyrodism, depression, cva (non-verbal at baseline) discharged from on after hospital course for respiratory failure requiring micu stay related to acute on chronic diastolic/systolic hf who presents from nh with tachycardia, increasing secretions, and tachypnea non-responsive to supplementatal oxygen. given patient's baseline status, history obtained from ed records and ed resident. per report, patient was found unresponsive to verbal or painful stimulation, with pale skin and diaphoretic by the staff at nh. ems was called and patient presented to ed. in the ed, vs t 98.6 bp 122/63 hr 92 rr 53 o2sat 88% on ra. patient was placed on a nrb with saturations improving to 100% but no improvement in rr. patient's family was contact and patient was intubated at their request. patient received levofloxacin 750mg iv, etomidate 20mg, succinylcholine 120mg, 4mg versed, and ceftriaxone 1gm. patient then found to be febrile to 101.4 and with heme positive coffee ground secretions in ngt. guiac negative stool rectally. gi was contact and recommended initiation of pantoprazole 40mg iv bid. sent to floor on . triggered for hypoxia, low uop, ? of aspiration & returned to on . pt was found to have worsening bilateral pleural effusions l>r, left main stem bronchus obstruction (secretions) with associated almost complete left lung collapse. rectal mushroom catheter placed for liquid stool. returned to 11r on . past medical history: 1. coronary artery disease, s/p mi, s/p 4 stents placed at 2. chf, systolic and diastolic dysfunction (cardiologist - , md) 3. hypertension 4. diabetes mellitus type 2, with h/o hypoglycemia 5. s/p cva (), right basal ganglia, cerebellar, left mca territory, nonverbal at baseline 6. seizure disorder nos 7. dementia 8. macular degeneration, legally blind 9. s/p g-tube placement (all nutrition via g-tube per gi) 10. hypothyroidism 11. hyperlipidemia 12. anemia of chronic disease 13. depression 14. h/o utis ( admission for mdr e. coli infection) 15. h/o stool impaction 16. splenic/hepatic nodules, per ct 17. h/o pna ( admission) 18. osteopenia social history: from nh. son is hcp. smoked, minimal prior alcohol use, no illicit drugs. of latvian descent and has devoted children. lives at senior care. retired from working at histology lab at . was very independent prior to cva. family history: noncontributory physical exam: admission pe: ============ vitals: t: 97.6 bp: 123/58 hr: 79 rr: 14 o2sat: 100% on ac 550 rr 14 peep 5 fio2 40% gen: intubated and sedated heent: eomi, perrl, sclera anicteric, no epistaxis neck: upable to appreciate jvd, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline cor: rrr, hs distant, no m/g/r appreciated pulm: coarse bs throughout, occasional expiratory wheeze abd: soft, nt, nd, +bs, no hsm, no masses, g-tube without erythema ext: no c/c/e, cool to touch neuro: intubated, sedated patellar dtr +1. plantar reflex downgoing. skin:+ left abdominal dry crusting lesions in dermatomal distribution pertinent results: on admission: 03:15pm fibrinoge-400 03:15pm pt-18.7* ptt-33.9 inr(pt)-1.7* 03:15pm plt count-268 03:15pm neuts-89.4* lymphs-5.1* monos-5.3 eos-0 basos-0.2 03:15pm wbc-12.1* rbc-4.25 hgb-12.5 hct-39.9 mcv-94 mch-29.4 mchc-31.3 rdw-19.1* 03:15pm haptoglob-158 03:15pm albumin-3.1* 03:15pm ctropnt-0.11* 03:15pm lipase-20 03:15pm alt(sgpt)-48* ast(sgot)-156* ld(ldh)-1134* ck(cpk)-90 alk phos-79 tot bili-0.7 03:15pm glucose-254* urea n-67* creat-1.6* sodium-145 potassium-6.6* chloride-112* total co2-23 anion gap-17 03:31pm lactate-2.4* k+-4.8 04:55pm urine rbc-0-2 wbc->50 bacteria-many yeast-many epi-0-2 04:55pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 04:55pm urine color-yellow appear-hazy sp -1.012 10:37pm type-art po2-54* pco2-34* ph-7.45 total co2-24 base xs-0 -assist/con intubated 10:37pm lactate-1.9 05:57pm type-art po2-432* pco2-38 ph-7.39 total co2-24 base xs--1 imaging: ======= cxr on persistent left pleural effusion with associated atelectasis. superimposed consolidation at the left lung base cannot be excluded. the right lung remains well aerated. ct of the head w/o contrast on : no intracranial hemorrhage or acute abnormalities. chronic left temporoparietal infarct. enlarged ventricles suggesting normal-pressure hydrocephalus. ct of abdomen and pelvis on ct abdomen: small bilateral pleural effusions, left greater than right, have increased. there is also mild bibasilar atelectasis, left greater than right. dense coronary artery calcifications are unchanged. likely non-calcified pleural plaque at the right lung base between right ribs 10 and 11 is unchanged. absence of intravenous contrast limits evaluation of the abdominal parenchymal organs and vasculature. mild-to-moderate ascites throughout the abdomen is new. there is diffuse anasarca within the soft tissues. liver is grossly unremarkable. there is no biliary ductal dilatation. mild gallbladder wall edema is likely secondary to ascites. gallbladder is not distended. pancreas remains fatty and atrophic. scattered periportal and gastrohepatic lymph nodes measure up to 8 mm in size, not meeting ct criteria for pathologic enlargement. spleen is diminutive, but otherwise unremarkable. non-contrast appearance of the kidneys is unremarkable. g-tube remains in place within a nearly completely decompressed stomach. intra-abdominal loops of bowel are unremarkable. there is no sign of obstruction. diffuse atherosclerotic calcification of the abdominal aorta and its branches is unchanged. there is no free intraperitoneal air. ct pelvis: pelvic loops of large and small bowel are unremarkable. rectal tube is in place. foley catheter is in place within decompressed bladder. small amount of air remains within the dorsal aspect of the bladder, likely related to instrumentation. previously noted rectal stool impaction has resolved. diffuse osteopenia is unchanged. multilevel degenerative changes in the thoracolumbar spine are stable. there is no fracture. there is no osseous lesion suspicious for malignancy. echocardiogram on : the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is severely depressed (lvef= 20-30 %) secondary to extensive apical akinesis (with focal dyskinesis), anterior septal akinesis, and hypokinesis of the rest of the left ventricle with relative sparing only of the basal inferior and posterior segments. the right ventricular free wall is hypertrophied. the right ventricular cavity is dilated with focal hypokinesis of the apical free wall. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the supporting structures of the tricuspid valve are thickened/fibrotic. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. the main pulmonary artery is dilated. the branch pulmonary arteries are dilated. there is a trivial/physiologic pericardial effusion. bronchoscopy: ============ - findings: thick mucopurulent secretions in mainstem bronchi l>r. impression: bronchopneumonia, respiratory failure discharge labs: ============== complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:07am 7.5 3.91* 11.9* 37.0 95 30.5 32.2 20.5* 228 renal & glucose glucose urean creat na k cl hco3 angap 05:10am 190* 59* 1.0 140 4.8 105 29 11 brief hospital course: on arrival to the medical icu patient was febrile, with increased wbc, edema and bilateral consolidation on cxr. she was found with hypoxemic respiratory failure thought to be due to volume overload and hostpial-acquired pneumonia. she was originaly diuresed and started on vancomycin/cefepime. patient was bronched on , not growing any bacteria from sputum. when cultures came back positive for staph aureus cefepime was stopped. patient was extuabted on . however, after <24 hours she required re-intubation due to worsening infiltrates on cxr, hypoxia and hypothermia. infectious disease was curbside and suggested vancomycin/meropenem since she is widely known for her multiple visits (day 1 ). patent's respiratory status has been improving and she was extuabted on . patient was stable in the icu for 30 hours prior to transfer to the floor. she is breathing on shevel mask and occassionaly has apneic periods and -strokes respiration, which are normal at her baseline since the stroke 2 years ago. during those episodes patient de-sats up to 88% and within seconds goes back up to 98-100%. during course patient was worked up for etiologies of worsening chf, including multiple cardiac enzymes, telemetry and ekgs. she has a baseline lbbb, which was unchanged from before. her echocardiogram showed worsening ef at ~15% and mr (ef reported 20-25%, but worse than pior echo of ~15%). patient's ideal weight was hard to achieve due to poor urine output. patient required standing doses of lasix (at home) and extra iv doses to maintain adequate fluid balance. on admission patient had increased creatinine up to 1.6 from her baseline of 1.0. most likely due to chf exacerbations and poor renal flow. it was corrected with adequate fluid/balance management. patient started with watery diarrhea during first days of admission. she was c. dif negative x3. diarrhea resolved by its own. patient required rectal tube and was having an output of ~3l/day. now patient improved. stool studies negative. patient had some coffee ground emesis on arrival, which were thought to be due to ng placement. her hct was table and she was guaiac negative. icu course hypoxemic respiratory failure: patient with mrsa pna and vap pna on vamcomycin/meropenem (last day ) with known - breathing, whith worsening of her pleural effusions and colapse of the left lung. patient got ct scan of the chest that confirmed above findings. patient responded to nrb, pulmonary therapy and aspiration and mild diuresis. post icu -9/25/ 1. chf: cardiac enzymes were repeated and negative, ekg done without changes from prior, bnp was >70,000. bp medications were continued and patient was diuresed based on uo, kidney function, tachypnea, lung sounds and vs. she becomes dehydrated with diuretics and is managed within a very narrow therapeutic window, with difficulty in managing her tendency to go into pulm edema, which requires lasix and then easily going into arf from lasix use. she should be maintained on lasix 40 mg qod as judged appropriate by the above parameters. 2. hyperkalemia/arf: on the floor she developed hyperkalemia to 5.5 and was treated with kayexalate and ivf at 50cc/hour for one liter. her k on dc was 4.8, and bun/cr had improved also. 3. end of life issues: a palliative care consult was done. they will follow up by calling her son. i spoke with her son on the phone on and explained the options for his mother as she becomes more compromised. i emphasized her poor quality of life and her negligible potential for any meaningful recovery. i encouraged him to speak to the staff at of about comfort measures and hospice care. 4. mental satus: opens eyes at times, does not track, non-verbal, occ moves r side sponatneously. two head cts and were neg for acute changes. 5. diabetes: please check blood sugars q6hrs and cover with sliding scale 6. herpes zoster: t7-t8 deratome. completed valtrex course. non-active now. 7. seizure h/o: on keppra; continued. posibly due to cva. 8. ?depression: she continues of effexor but the reason she is taking it is unclear. if there is no known indication for it it should be stopped. 9. hypothyroidism: continuing outpatient regimen. 10. stage ii decubitus ulcer: wound care continued. fen: tf through g tube. ppx: ppi, bowel regimen, heparin sc code: dnr, may be intubated comm: (hcp) -2248. medications on admission: bisacodyl 5 mg tablet po daily as needed. senna 8.6 mg po bid as needed. heparin sc tid timolol maleate 0.25 % one drop ophthalmic venlafaxine 37.5 mg one tablet po bid metoclopramide 10 mg one tablet po bid aspirin 81 mg one tablet po daily. docusate sodium 50 mg/5 ml liqui po bid ferrous sulfate 300 mg (60 mg iron)/5 ml liquid po daily levetiracetam 100 mg/ml one po daily levothyroxine 125 mcg one tablet po daily insulin regular human 100 unit/ml as directed. carvedilol 12.5 mg one tablet po bid furosemide 40 mg/5 ml solution po daily lisinopril 10 mg (2) tablet po daily albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one inhalation prn for wheezing. ipratropium bromide 0.02 % solution : one inhalation q6h (as needed for wheezing. discharge medications: 1. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 2. venlafaxine 37.5 mg tablet : one (1) tablet po bid (2 times a day). 3. levothyroxine 125 mcg tablet : one (1) tablet po daily (daily). 4. timolol maleate 0.25 % drops : one (1) drop ophthalmic (2 times a day). 5. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 6. levetiracetam 100 mg/ml solution : one (1) po daily (). 7. miconazole nitrate 2 % powder : one (1) appl topical prn (as needed). 8. insulin regular human 100 unit/ml solution : one (1) injection asdir (as directed). 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 10. carvedilol 6.25 mg tablet : one (1) tablet po bid (2 times a day). 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed. 12. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours). discharge disposition: extended care facility: senior healthcare of discharge diagnosis: primary diagnoses: ================= hypoxemic respiratory failure requiring intubation & mechanical ventilation heart failure mrsa pneumonia with acute oxygen desaturation on uti acute renal failure secondary diagnoses: =================== s/p cva, non-verbal @ baseline cad, h/o mi htn diabetes ii coffee-ground emesis coagulopathy elevated lfts elevated troponins, felt to be demand ischemia hypothyroidism decubiti depression discharge condition: stable (patient's baseline): tachypneic at times, intermittent upper extremity edema, no meaningful communication, opens eyes, does not track, no purposeful movements, appears comfortable. discharge instructions: you were admitted to the hospital because you were found at your nursing facility to be unresponsive, with a fever & had trouble breathing necessitating intubation and admission to the icu. adhere to 2 gm sodium diet followup instructions: provider: west outpatient radiology phone: date/time: 9:00, please cancel this appt. if the family decides not to re-evaluate. please continue discussion with son regarding a dni order. the icu staff and i have spoken with him recommending against re-intubation. i have advised him to consider cmo and hospice care. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified hyperpotassemia anemia, unspecified coronary atherosclerosis of native coronary artery unspecified pleural effusion urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism infection with microorganisms resistant to penicillins percutaneous transluminal coronary angioplasty status acute respiratory failure methicillin susceptible pneumonia due to staphylococcus aureus pressure ulcer, lower back epilepsy, unspecified, without mention of intractable epilepsy other and unspecified complications of medical care, not elsewhere classified chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to