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: cough, fever, increased sputum production major surgical or invasive procedure: right internal jugular venous catheter cosyntropin stimulation test history of present illness: hpi: yo female w/ medical problems presents with hypercarbic resp failure requiring intubation in the ed. pt presented w/ 3 day h/o sob then acute worsening on day of admission. unclear if she had any recent fevers. she did complain of a productive cough productive cough. denied any orthopnea, pnd. * pt was recently admitted to in for influenza a pna and sepsis requiring intubation and pressors and complicated by malignant htn, hyponatremia, chf exacerbation. also had amarosis fugax but with ct with no acute changes, felt to be high risk, but didn't start coumadin because of known history of falls. * in the ed , he went into hypercarbic respiratory failure and was intubated. chest xray showed retrocardiac density, and so she was started on cefepime/ vancomycin for presumed ventilator-associated pneumonia given recent hopitalization for influenza. started on dopamine for hypotension which was changed to levophed. was extubated morning of and ocntinued on levophed for support of hypotension. transferred from icu to west icu given bed availability. past medical history: -chf- echo ef 50-55% with mild mr -coronary artery disease- s/p atheterization : left dominant system; pci lcx, lpda, 50% rca -paroxysmal atrial fibrillation- treated w/ amiodarone, off coumadin due to risk of falls -asthma -s/p thyroid sx -diverticulitis -hypercholesterolemia -right hip fracture -history of tears -chronic renal insufficiency- baseline creatinine low 2's *** meds on transfer : norepinephrine 0.1 mcg/kg/min vancomycin hcl 1000 mg iv q48h cefepime 1 gm iv q24h albuterol-ipratropium 8 puff ih q6h albuterol 0.083% neb soln 1 neb ih q6h amiodarone hcl 200 mg po daily lansoprazole oral suspension 30 mg ng daily aspirin 325 mg po levothyroxine sodium 75 mcg po daily bisacodyl 10 mg po daily: calcium carbonate 500 mg po tid w/meals miconazole powder 2% 1 appl tp tid primidone 50 mg po qod docusate sodium (liquid) 100 mg po bid promethazine hcl 25 mg iv q6h:prn dolasetron mesylate 12.5 mg iv q8h:prn senna 1 tab po bid:prn simvastatin 20 mg po daily ferrous sulfate 300 mg ng daily social history: lives alone; home health aid helps with acitivites of daily living. tobacco: quit in etoh: rare family history: non-contributory physical exam: pe on day of transfer: t 98.0 tm 98.9 hr 72 (62-91) 121/37 (80-133/27-51) face tent 12l rr 20 o2 sats 100% ins/outs 1000/1200 2000l genwell appearing elderly female in nad heent chest diffuse wheezes, no crackles, good aeration cv rr, nl s1, s2, no murmurs abd soft, nt/nd/ nabs ext 1+ pitting edema bilateral lower extermities neuro pertinent results: labs on admission: 08:51am wbc-19.4*# rbc-3.26* hgb-9.5* hct-31.9* mcv-98 mch-29.1 mchc-29.7* rdw-16.1* 08:51am glucose-325* urea n-27* creat-2.1* sodium-138 chloride-106 total co2-21* calcium-8.4 phosphate-7.0*# magnesium-2.3 : cosyntropin stimulation test: negative labs on day of transfer: 03:55am blood wbc-11.5* rbc-2.69* hgb-7.7* hct-25.3* mcv-94 mch-28.7 mchc-30.5* rdw-15.8* plt ct-386 03:55am blood glucose-122* urean-26* creat-2.1* na-141 k-3.6 cl-109* hco3-21* angap-15 07:20am blood ld(ldh)-241 07:20am blood albumin-2.9* phos-7.0* iron-13* 07:20am blood caltibc-233* hapto-239* ferritn-168* trf-179* radiology: : portable chest xray 1) persistent congestive failure. 2) persistent opacity at the left base as described. 3) possible pneumomediastinum. per discussion with the resident caring for the patient, the patient has not undergone a procedure since the prior exam. microbiology: : blood culture: no growth to date (as of ) sputum gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram negative rod(s). echo: the left atrium is moderately dilated. the right atrium is moderately dilated. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. compared with the prior study (tape reviewed) of , significant aortic valve gradient was not detected in the prior study (probably due to suboptimal doppler study). cxr: (): slight increase in chf labs on transfer from micu to floor on : 02:48am blood wbc-3.9* rbc-3.07* hgb-9.1* hct-28.1* mcv-92 mch-29.5 mchc-32.2 rdw-16.4* plt ct-355 02:48am blood plt ct-355 02:48am blood glucose-149* urean-28* creat-2.0* na-142 k-4.1 cl-109* hco3-24 angap-13 02:48am blood calcium-7.8* phos-3.4# mg-2.0 brief hospital course: a/p yo with nosocomial pneumonia/chf leading to respiratory failure and resulting sepsis, resolved s/p extubation. * 1. sepsis. on admission, pt intubated in ed, started on dopamine for hypotension and sent to micu on levophed. felt that patient likely developed bronchopneumonia with resulting chf in setting of tachycardia - resulting in hypercarbic respiratory fl. dopamine was changed to levophed given persistent tachycardia. patient diuresed while in unit and she was successfully extubated on but remained on pressors transiently given hypotension - which resolved s/p blood transfusion on . patient stablized in micu and transferred to floor on . on floor, held off on aggresive ivf given that she is extubated and presented with chf, but will also held off on diuresis as already diuresed well. no other clear etiology of hypotension. sbp up to 140's and metoprolol restarted . pt had negative stim test so no role for steroids during admission. of note, echo with lvef 55%, mildly dilated lv, mod dilation of bilateral atria, mild as and +ar, 1+mr, moderate pulm htn * 2. nosocomial pt presented w/ fevers, increasing sputum production. cxr w/ retrocardiac density. was intially on levo/vanc, but given gnr in sputum gram stain, she was originally continued on cefepime for gram negative coverage. rpt cxr w/ slight increase in chf. sputum cx from growing mrsa, therefore pt abx were again changed to vancomycin and levoquin - levoquin was used given initial concern for gnr in sputum. given severity of respiratory failure/sepsis and possibility of vent associated pna, will cont full course of levoquin. unclear etiology of mrsa, however pt with recent hospitalization with influenza a and pna and was d/ced at that time to . will cont both abx for 14 day course with last dose on . will dose vanc 1gm q24hrs as troughs were <5 initially. her last dose of vancomycin was at 6pm on . given that vanc level on is 11, please give another dose of vanc tonight. given that am vanc levels are persistently low, consider daily dosing (with daily trough level checks) although creatinine clearance would suggest less dosing needed - or may dose according to level by getting daily trough checks and dosing for level <15. last dose of levoquin also . patient started on prednisone 60mg on admission. will cont slow taper. received 50mg prednisone po this am. will decrease dose to 40mg daily tomorrow () and decrease by 10mg every three days until course complete. supplmental o2 needed prn after extubation, but sating mid 90's ra by time of discharge without need for supplemental o2. chest pt and nebs prn wheezes. will cont home nebs on discharge. of note, picc line was placed on as initially planning on home abx administration. * 3. chf- most recent echo w/ ef 50-55%. likely has diastolic dysfunction as well. had been diuresed in micu prior to transfer to floor. cause of resp failure likely mixed pna and chf. continue asa and statin. beta blocker held given concern for sepsis, but restarted on at outpt dose of 12.5mg . toelrated this dose well with sbp in 130-140s. * 4. cad- s/p pci of lcx and lpda, 50% lesion in the rca. no ecg changes during admission, however pt with baseline lbbb. ruled out for mi on admission with troponin leak felt secondary to renal insufficiency. continued statin and asa during admission and on d/c. * 5. pt in nsr on admission. continue amiodarone. no coumadin given falls risk. beta blocker cont on transfer to rehab at outpt dose. * 6. chronic renal insufficency- at baseline creatinine of 2.1. high phosphate at 7.0 and known elevated pth. pt has secondary hyperparathyroidism due to cri, however, now that gfr is ~25, she is unable to exrete phosphate thus levels slowly increasing. levels also likely high calcitriol that she had been taking prior to admission. calcitriol d/c'ed. continue tums with meals. renally dosing medications. continue low phosphate diet. creatinine 1.6 on discharge. * 7. anemia. iron studies show mixed pciture with mcv 96 with anemia of chronic disease given low fe and low tibc. folate and b12 were checked given macrocytosis. b12 wnl, but folate less than 20. pt started on 1gm folic acid per day during admit. pt had hct drop to 25 on . she was transfused 2 units of prbcs with app bump. hct stable throughout remainder of admission. however,stools guiaic positive. given hct is stable, will hold off on w/u while inpt but will need gi eval in future. * 8. hypothyroid- cont levothyroxine at outpt dose during admit and on d/c. * 9. ? conjunctivitis: clinically improving. coag - seen on culture - like skin flora contaminant. currently on erythromycin eye drops. day at time of discharge. 10. fen- after extubation, pt had speech/swallow eval which she passed. tolerated po diet. continue heart healthy diet. * 11. ppx- ppi, heparin sc, cont primidone for h/o tremors. 12. code- full 13. contact- (daughter) medications on admission: meds on transfer from micu to floor: albuterol 0.083% neb soln 2 neb ih q3h ipratropium bromide neb 1 neb ih q6h amiodarone hcl 200 mg po daily levothyroxine sodium 75 mcg po daily aspirin 325 mg po daily miconazole powder 2% 1 appl tp tid apply to area under left breast bisacodyl 10 mg po daily:prn pantoprazole 40 mg po q24h calcium carbonate 500 mg po tid w/meals polysaccharide iron complex 150 mg po daily cefepime 1 gm iv q24h primidone 50 mg po qod dolasetron mesylate 12.5 mg iv q8h:prn promethazine hcl 25 mg iv q6h:prn docusate sodium (liquid) 100 mg po bid prednisone 60 mg po daily duration: 2 doses order date: @ 1009 erythromycin 0.5% ophth oint 0.5 in ou qid senna 1 tab po bid:prn guaifenesin 15 ml po q4h simvastatin 20 mg po daily heparin 5000 unit sc tid discharge medications: 1. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. amiodarone hcl 200 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. levothyroxine sodium 75 mcg tablet sig: one (1) tablet po daily (daily). 5. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 6. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid w/meals (3 times a day with meals). 7. polysaccharide iron complex 150 mg capsule sig: one (1) capsule po daily (daily). disp:*30 capsule(s)* refills:*2* 8. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 9. guaifenesin 100 mg/5 ml syrup sig: fifteen (15) ml po q4h (every 4 hours) as needed for cough. 10. levofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 9 days. disp:*9 tablet(s)* refills:*0* 11. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours). 12. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 13. primidone 50 mg tablet sig: one (1) tablet po qod (). 14. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 15. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 16. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). 17. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day) as needed for constipation. 18. erythromycin 5 mg/g ointment sig: one (1) drop ophthalmic qid (4 times a day) for 7 days: please d/c on . 19. menthol-cetylpyridinium cl 2 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed) as needed for cough. 20. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 21. prednisone 20 mg tablet sig: two (2) tablet po once a day: please continue steroid taper by giving 40mg for three days () and then decreasing by 10mg every three days. tablet(s) 22. zolpidem tartrate 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 23. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 24. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 25. vancomycin please continue to dose vancomycin according to trough level. vanc level was 11 so she mrs. is due for 1mg vanc tonight, . thanks. discharge disposition: extended care facility: - tcu discharge diagnosis: primary diagnosis: 1. respiratory failure requiring intubation 2. mrsa pna 3. guiaic positive stool with stable hct 4. asthma exacerbation secondary diagnosis: 1. recent admission for respiratory distress 2. recent epsiode of malignant hypertension 3. recent admission for influenza a 4. paroxysmal atrial fibrillation. 5. asthma. 6. diverticulitis. 7. hypercholesteremia. 8. chronic renal insufficiency. 9. systolic heart failure. 10. mitral and aortic insufficiency. 11. s/p left hip fracture. 12. tear. 13. hypothyroidism. 14. left bundle branch block. 15. two vessel coronary artery disease s/p stenting of the mid lcx and origin lpda. discharge condition: stable discharge instructions: please call your pcp and schedule /u appointment within weeks of discharge. please discuss further gi work up for blood in stool at that time. please take all medications as prescribed. you are being discharged to rehabilitation center to complete course of iv antibiotics. followup instructions: provider: , m.d. where: medical specialties phone: date/time: 10:00 please call dr. at to make a follow up appointment within 1-2 weeks of discharge. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube transfusion of packed cells diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension unspecified septicemia hyposmolality and/or hyponatremia severe sepsis atrial fibrillation infection with microorganisms resistant to penicillins other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status other specified forms of chronic ischemic heart disease acute respiratory failure alkalosis unspecified disorder of kidney and ureter methicillin susceptible pneumonia due to staphylococcus aureus secondary hyperparathyroidism (of renal origin) chronic obstructive asthma with (acute) exacerbation nonspecific abnormal findings in stool contents combined systolic and diastolic heart failure, unspecified postsurgical hypothyroidism shock, unspecified other conjunctivitis 

Answer: The patient is high likely exposed to