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: morphine / codeine attending: chief complaint: respiratory failure major surgical or invasive procedure: bronchoscopy intubation attempted post-pyloric dobhoff placement by ir (unsuccessful) picc line placement history of present illness: pt is an 85 y/o f with h/o cva, cri, asthma p/w respiratory failure. pt seen by her son on am of admission coughing after taking pills, increased coughing "fit" after breakfast. pt noted to be "wheezy" this am and given alb/ipratropium neb. add'l neb given after breakfast for repeat wheezing. hr in 140s per son after 2nd neb. pt noted to be getting more dyspneic and tachypneic. epi 1:1000 solution given in neb form by son. pt then became apneic with "thready" pulse. son initiated cpr. 20-30 seconds to return of spontaneous breathing. ems arrived and unable to intubate. bvm until arrival in ed. ed reports tachypnea (rr 30s), hypoxia (o2 sat 91% with 100%fio2 on bvm). intubated with some difficulty, gastric contents found in oral cavity on intubation. given levofloxacin and flagyl in ed for presumed aspiration pna. bp and hr stable (sbp 130s, hr 90s) in ed. ros (-) per family and caretaker. cp, no f/c, no n/v/d. past medical history: -- asthma, allergy-induced during early summer months -- cva x 3 with residual r sided deficits and expressive aphasia -- h/o pneumococcal pna x 3 in past (last 3yrs ago) -- cri (bl cr 1.7-2.2) -- paraesophageal hernia/gerd -- h/o dvt -- h/o gib on coumadin social history: lives with son (a physician), has 24hr care at home, no h/o tob or etoh family history: nc physical exam: vs:t 98 bp150/80 hr70s resp: 100%o2sat ac 450/16/peep 8/fio2 50% gen: elderly female, intubated, sedated, responds to noxious stimuli, moving l ue/le heent: perrl, anicteric, poor dentition, sl dry mm neck:no jvd, no bruits cv:ii/vi hsm at apex, rrr chest:bronchial bs, rhonchi at r base > l base abd:sl distended, + bs, tympanitic extr:1+ pitting le, chronic stasis changes, 3 x 2 cm excoriation at r calf, r ue contracture neuro: r le clonus with crossover, upgoing babinski on r, l patella dtr + rectal pertinent results: 03:09pm plt count-139* 03:09pm hypochrom-2+ anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 03:09pm neuts-89* bands-1 lymphs-5* monos-2 eos-2 basos-1 atyps-0 metas-0 myelos-0 nuc rbcs-1* 03:09pm wbc-12.1* rbc-3.38* hgb-8.7* hct-27.5* mcv-81* mch-25.7* mchc-31.6 rdw-13.3 03:27pm glucose-197* lactate-4.2* na+-137 k+-5.4* cl--103 tco2-20* 03:30pm pt-11.4 ptt-16.1* inr(pt)-0.9 03:30pm ck-mb-7 ctropnt-0.09* 03:30pm ck(cpk)-155* 03:30pm glucose-180* urea n-39* creat-1.6* sodium-136 potassium-5.0 chloride-102 total co2-21* anion gap-18 05:13pm type-art po2-467* pco2-43 ph-7.36 total co2-25 base xs--1 intubated-intubated 10:05pm ret aut-1.1* 10:05pm plt count-127* 10:05pm wbc-16.8* rbc-3.44* hgb-9.0* hct-27.8* mcv-81* mch-26.2* mchc-32.3 rdw-14.0 10:05pm tsh-3.8 10:05pm caltibc-264 vit b12-1188* folate->20 haptoglob-87 ferritin-77 trf-203 10:05pm albumin-3.4 calcium-8.5 phosphate-3.0 magnesium-1.9 iron-65 10:05pm ck-mb-10 mb indx-4.5 ctropnt-0.10* 10:05pm alt(sgpt)-22 ast(sgot)-34 ld(ldh)-369* ck(cpk)-220* alk phos-70 tot bili-0.2 discharge : 02:53am blood wbc-8.6 rbc-4.11* hgb-10.9* hct-33.7* mcv-82 mch-26.5* mchc-32.4 rdw-16.5* plt ct-227 02:53am blood plt ct-227 02:53am blood alt-26 ast-26 alkphos-76 totbili-0.2 02:53am blood calcium-9.0 phos-3.3 mg-1.8 studies: cxr : a right picc line remains in satisfactory position within the superior vena cava. the heart is mildly enlarged but stable. pulmonary vascularity is within normal limits for technique. there is improving aeration at both lung bases with residual patchy opacity in the left retrocardiac region as well as residual small pleural effusions, left greater than right. impression: 1) no evidence of pulmonary edema. 2) improving aeration at the lung bases with residual atelectasis predominantly at the left lung base. echo: impression:preserved global biventricular systolic function. at least mild mitral regurgitation. based on aha endocarditis prophylaxis recommendations, the echo findings indicate a moderate risk (prophylaxis recommended). clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. ct head: findings: there is no intraparenchymal or extra-axial hemorrhage. there is no shift of normally midline structures, mass effect or hydrocephalus. there are large chronic-appearing infarcts involving the left frontal lobe and the left temporoparietal regions with an aca and mca distribution respectively. there is also extensive bilateral subcortical and periventricular white matter hypodensities consistent with chronic small vascular ischemic change. there is mild prominence of the ventricles and sulci consistent with age related involutional change. the visualized paranasal sinuses and osseous structures are unremarkable. impression: 1. no intracranial hemorrhage or mass effect. 2. multiple large chronic-appearing infarcts involving the left frontal and left temporoparietal regions. 3. extensive chronic small vessel ischemic change and age involutional change. 6:20 pm bronchial washings gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. respiratory culture (final ): oropharyngeal flora absent. yeast. ~6ooo/ml. isolates are considered potential pathogens in amounts >=10,000 cfu/ml. staph aureus coag +. 10,000-100,000 organisms/ml.. sensitivities performed on culture # (). legionella culture (final ): no legionella isolated. viral culture (preliminary): no virus isolated so far. 12:42 am sputum site: 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. 2+ (1-5 per 1000x field): budding yeast with pseudohyphae. 1+ (<1 per 1000x field): gram negative rod(s). respiratory culture (final ): sparse growth oropharyngeal flora. due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. staph aureus coag +. moderate growth. yeast. sparse growth of two colonial morphologies. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- 1 s penicillin------------ =>0.5 r legionella culture (final ): no legionella isolated. brief hospital course: 1) respiratory failure ?????? etiology presumed to be asthma exacerbation complicated by pneumonia. pt was intubated in ed, and given levaquin and flagyl for a presumed aspiration pneumonia. on arrival to the , vancomycin was added to pt's abx regimen. pt remained on mechanical ventilation, with good ventilation and oxygenation, but unable to extubate copious secretions. a bronchoscopy was performed which showed minimal secretions, but some airway collapse with cough. a bal was obtained. when sputum cx and bal cx came back positive for , pt was changed to oxacillin. extubation was attempted on hd #6, but failed supraglottic edema. pt was reintubated and started on iv steroids. pt completed a 7 day course of oxacillin and was successfully extubated on hd #10. pt was transferred to the floor on . by , pt's respiratory status improved with nebs. cxr showed increased airation at bases. 2) coagulopathy - early in hospitalization, pt had coag panel wnl. on hd #7, pt was noted to have bleeding into an infiltrated piv site and an isolated elevated ptt. pt had only been on prophylactic sq heparin and heparin flushes for a picc line placed during this hospitalization. per nursing reports, samples were from peripheral venipuncture sites, and not drawn from lines with heparin. however, sq heparin was empirically decreased to and a thrombin time study was sent. when the thrombin time study was found to be markedly elevated, a followup reptilase study was sent. ptt levels were then inconsistently elevated on subsequent labs. the coagulopathy was presumed heparin-induced due to the inconsistent nature of the ptt elevation. however, without any intervention, the pt's ptt was normal at times. 3) htn ?????? while intubated, pt's bp was well-controlled on propofol gtt and metoprolol. after extubation, diovan was started for elevated bp and metoprolol d/c'ed for bradycardia. however, pt then had 12 beats of svt and metoprolol was restarted. on transfer to floor, bp was well-controlled on metoprolol iv and hydralizine. pt can be transitioned back to oral anti-htn agents now that she can take pos. 4) anemia ?????? pt has chronic anemia of unknown etiology. pt was on qd iron at home, and by report from son had a recent neg . during hospitalization, hemolysis labs, iron studies, and stool guaiac were nl. pt did receive 1u prbcs on hd #3 for hct of 24, but was otherwise stable. 5) h/o cvas ?????? pt has baseline expressive aphasia and r-sided upper motor neuron signs (hyperreflexia and sustained clonus) from prev cvas. pt did have a noncontrast head ct in ed which was negative for acute bleed or mass effect, but was consistent with chronic small vessel dz. she was continued on plavix qod (home regimen) during hospitalization and asprin. 6) cardiac enzyme leak ?????? pt had small trop leak up to 0.10 on admission with non-specific t wave changes in lateral leads. findings were attributed to demand ischemia epinephrine administration during respiratory arrest. pt did have a tte during hospitalization which was essentially nl (ef > 55%). pt was on b-blocker, statin, and plavix during hospitalization. 7) cri ?????? by history from son, pt has a baseline cr 1.7-2.2. however, during admission baseline was noted to be ~1.2. pt did have mild arf during hospitalization, presumed lasix diuresis. 8) osteoporosis - pt is on home regimen of vit d, calcium, and premarin which were all held during hospitalization. please restart these medications at your discretion. 9) fen ?????? following intubation, multiple attempts were made for bedside ng tube placement. however, were unsuccessful due to pt's hiatal hernia. an ng tube was eventually placed by ir under radiographic guidance (a technically difficult 2-hour procedure), but was subsequently lost during pt positioning. pt was kept npo following extubation risk of aspiration. speech and swallow eval was requested, but deamed inappropriate as pt was not able handle secretions. replacement of ng by ir was attempted, but unsuccessful after a long procedure. speech and swallow evaluation was requested again and pt was deemed to be able to take pos with a modified diet. she was discharged to rehab facility with a soft solid po diet order. 10) access ?????? a r picc line was placed by the iv nurse n for iv abx. she will be d/c'd with the picc line and this can be removed if it is not needed for blood draws or nutrition on discharge to . 11) prophylaxis ?????? pt was given a ppi for dvt prophylaxis, and sq heparin for dvt prophylasix 12) code ?????? full 13) - pt was discharged to facility once she was cleared by speech and swallow and her respiratory status was stable. 14) comm ?????? son . ofc ; cell ; home or ; (caretaker) 978-492-05 medications on admission: singular 10 qd 180 duonebs :prn asa 81 qd plavix 37.5mg daily lipitor 40 qd ditropan 15 qhs paxil 25 qam provigil 200 provera 3.125 premarin 0.3 avapro 150/300 qd folic vit e ferrous sulf calcium/vit d actonel 35 qwk xanax prn vicodin prn discharge medications: 1. fexofenadine 60 mg tablet sig: three (3) tablet po twice a day. 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin calcium 40 mg tablet sig: one (1) tablet po daily (daily). 4. valsartan 160 mg tablet sig: one (1) tablet po daily (daily). 5. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 7. ferrous sulfate 300 mg/5 ml liquid sig: four (4) mls po daily (daily). 8. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 9. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation every 6-8 hours as needed. 10. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation every 6-8 hours as needed. 11. singulair 10 mg tablet sig: one (1) tablet po once a day. 12. calcium 500 mg tablet sig: one (1) tablet po three times a day. 13. actonel 35 mg tablet sig: one (1) tablet po once a week. 14. aspirin 81 mg tablet sig: one (1) tablet po once a day. 15. plavix 75 mg tablet sig: 0.5 tablet po once a day. 16. paxil 10 mg tablet sig: 2.5 tablets po qam. discharge disposition: extended care facility: - discharge diagnosis: primary dx: hypoxic respiratory failure aspiration pneumonia asthma exaccerbation hypertension chronic anemia hyperchloremic metabolic acidosis secondary dx: asthma htn chronic renal insufficiency gerd history of cvas osteoporosis discharge condition: stable, afebrile, breathing room air discharge instructions: if you experience fever, chills, shortness of breath, chest pain, or other concerning symptoms, please call your doctor or come to the ed for evaluation. 1. please take all medications as directed 2. please attend all follow-up appointments. followup instructions: please follow-up with your pcp . within weeks after discharge. please call to schedule an appointment. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: acidosis anemia, unspecified unspecified essential hypertension acute kidney failure, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus osteoporosis, unspecified methicillin susceptible pneumonia due to staphylococcus aureus asthma, unspecified type, with (acute) exacerbation 

Answer: The patient is high likely exposed to