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: sulfa (sulfonamide antibiotics) / bactrim / cozaar / captopril attending: chief complaint: hypotension major surgical or invasive procedure: mechanical ventilation blood transfusion history of present illness: 77 y/o lady with chf, af, htn was discharged from trauma service yesterday after she was admitted here with c7 fracure secondary to fall. she initially presented to an outside hospital prior to the recent admission and was intubated for ? respiratory distress vs glottic swelling. her course here was complicated by unable to wean her off of vent and she eventually underwent a trach/peg placement on . patient was discharged to . . patient states that she has felt tired and sleepy in the last two days. otherwise denies any symptoms. patient has had episodes of tachycardia to 150s at rehab facility yesterday. cxr this morning there was concerning for chf. she recieved 40 mg of furosemide ivp, cardizem 30 mg pgt (1444) and 1 mg of ativan (1255). her bp dropped to 60s/40s. she received some fluid boluses. her vent setting there was acmv peep 5, rate 12, volume 500 fio2 40%. she was taken to . she recieved 500 mg of levofloxacin. she was transfered here given recent hospitalization. . in ed her vitals were t 99.5 hr 79 bp 84/50 rr 18 100% o2sat. patient received 1.5 l ns, 1 gram iv vancomycin and started on 1 u prbc. currently she is asymptomatic. . she denies any chest pain, shortness of breath, fever, chills, nightsweats, abdominal pain, headache, acute change in vision, hearing, new weakness, change in sensation. no diarrhea, constipation, hematuria, dysuria, or blood in stool. she occasionally feels nauseous. past medical history: - chf, unclear history - af - htn - nhl - ? radiation treatment to thyroid, ? hypothyroidism - anxiety - intermittent diarrhea - trach/peg - c7 fx 2/4/009 s/p fall - vent dependent respiratory failure - multiple pleural taps; right-sided thoracentesis , left-sided thoracentesis , ? r ptx, s/p right chest tube placement - s/p trach/peg social history: patient is coming from rehab. denies ever using tobacco/etoh/street drugs. family history: htn, cad physical exam: gen: alert and awake, pleasant lady in nad, following commands heent: eom-i, mmm, op clear, trach in place heart: s1s2 holosystolic murmur audible throughout precordial area best heard at apex radiating to axilla lungs: wheezes r>l abdomen: bs present, soft ntnd ext: wwp, no edema neuro: strenght in r ext and 3+/5 in l ext guaic negative in ed pertinent results: 05:20am blood pt-40.8* ptt-30.8 inr(pt)-4.5* . 05:20am blood glucose-99 urean-20 creat-0.8 na-141 k-4.2 cl-107 hco3-26 angap-12 . 12:23am blood lactate-1.4 . 08:16am blood wbc-9.8 rbc-2.94* hgb-9.3* hct-26.6* mcv-91 mch-31.7 mchc-35.0 rdw-14.5 plt ct-296 05:00pm blood hct-28.3* . microbiology: 9:33 am sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram positive cocci in pairs and clusters. respiratory culture (final ): oropharyngeal flora absent. staph aureus coag +. sparse growth. clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin-------------<=0.25 s trimethoprim/sulfa---- <=0.5 s . radiology: ct c-spine: the alignment is normal. there is a depressed fracture of the endplate of the c7 vertebra. there is no significant canal stenosis at this level. there is a posterior endplate fracture of the t2 vertebral body, without significant canal stenosis at this level. there is again multilevel degenerative disc and facet disease on the left at c2-3. there is scarring at the lung apex. the right pleural effusion is again noted. no significant canal stenosis at these levels. multilevel degenerative change is similar to prior. impression: no change in the appearances of c7 and t2 fractures. no significant new abnormality. . cxr: in the interval the amount of hazy opacity projecting over the right hemithorax with regions of lucency within it has significantly increased causing obscuration of the right hemidiaphragm. mild blunting of the left costophrenic angle persists. the pulmonary vasculature appears distinct without any significant kerley b lines noted. there is continued opacity in the retrocardiac region. right-sided picc, tracheostomy, and calcifications within the aorta are unchanged. impression: increased effusions, moderate-to-large on right and small-to- moderate on left. persistent adjacent opacities, probably compressive atelectasis, although infection cannot be excluded within these regions. no edema is noted. . ct head: conclusion: no definite new intracranial abnormality. bilateral mastoid and right middle ear abnormality, raising question of an ongoing inflammatory process, also involving the right sphenoid sinus air cell. note: please note that the present study was obtained only with a soft tissue algorithm. therefore, maximum bone detail was not depicted at this time. finally, mr scanning of the brain, if feasible, offers far greater sensitivity in the detection of acute brain ischemia, compared with the present ct scan . kub : findings: unchanged position of the access line. no gastric or intestinal distention. visible psoas opacity. gas in the rectum. no evidence of pathological air-fluid levels. . cxr : since , there is no overall change. tubes and catheters are in unchanged position, including a right picc ending in the right brachiocephalic vein. moderate-to-large right pleural effusion, small left pleural effusion and moderate-to-large bibasilar atelectasis are unchanged. there are no signs of volume overload. the study and the report were reviewed by the staff radiologist. . ekg : atrial fibrillation low limb lead qrs voltages delayed r wave progression with late precordial qrs transition modest low amplitude lateral t wave changes findings are nonspecific since previous tracing of , t wave abnormalities decreased and q-tc interval appears shorter . ekg : atrial fibrillation. low voltage in the standard leads. decreased r wave and t wave inversion in leads v2-v3. occasional ventricular premature beats. t wave inversion in leads v4-v6. consider anterior wall myocardial infarction of undetermined age. compared to the previous tracing of , when there was left and right arm lead reversal, the precordial t wave inversions are new and may represent acute ischemia. in addition, anterior voltage is decreased which may be related to lead placement. clinical correlation is suggested. brief hospital course: 77 y/o lady with chf, af, htn was discharged from trauma service yesterday after she was admitted here with c7 fracure secondary to fall now presents with hypotension. # hypotension: initial differential was that this was secondary hypovolemia in the setting of aggressive diuresis and diastolic heart failure vs. autonomic instability vs. medication effect. patient underwent an infectious work-up which revealed only mssa in sputum, presumed colonization given lack of fevers and leukocytosis. patient was noted to have episodes of low systolic bp's (high 60's), but bp improved after discontinuing clonidine as there was no clear indication for her to be on this medication. she continues to have episodes of hypotension while sleeping, but no changes in mentation. she was started on coreg for management of her heart failure, which bp tolerated. midodrine administration was changed to 10 mg qhs. patient should not return to hospital for low bp's unless accompanied by alteration in mental status. # chronic vent dependence: patient was trached on during previous admission following 3 failed extubation attempts. her son at that time gave the surgical team a vague history of a possible prior tracheostomy, and radiation to her neck -- perhaps causing some tracheal stenosis. on bronchoscopy, close evaluation demonstrated upper airway edema, with no leak when the cuff was down. she was placed on steroids, but given these findings, the decision was made to proceed with a trach/peg for ? glottic swelling. vent settings at time of this icu were ac 15/5/50%. of note, a thoracentesis was also performed during previous admission for evaluation of her pleural effusion, with results consistent with a transudative process. her pcp was by the icu team and confirmed that her pleural effusions were chronic. patient also appears to have weakened diaphragm as indicated by low nif. she was gently diuresed during this hospitalization, with vent settings successfully reduced to pressure support ventilation at . scarce mssa was cultured from sputum, but given radio in the absence of leukocytosis, fever, radiographic changes, or hemodynamic instability, antibiotic therapy was deferred. cxr on the morning of discharge showed a chronic right pleural effusion but overall improvement. # diastolic heart failure: has chronic transudative right pleural effusion. she has a documented acei and allergy. she was started on beta-blockade with coreg 6.5 mg . she was discharged on a standing dose of lasix 40 mg po daily. she also responds to prn dosing of lasix 40 mg iv prn. # atrial fibrillation: patient had episodes of rapid afib with hr 150's - 180's, triggered by suctioning, manipulations in the bed, and interactions with the healthcare team. she received lopressor 5 mg iv for these epidodes, with resolution. she was started on carvedilol for rate control. she is anticoagulated on coumadin with a target inr . her coumadin dose was adjusted for both supratherapeutic inr and subtherapeutic inr. inr on the morning of discharge was 1.8. coumadin dose was readjusted to 2 mg daily. # anemia: normocytic, most likely secondary to recent admission and frequent phlebotomy. she received 1 unit prbc's on arrival to for hematocrit of 24 in the setting of hypotension. hct 29.7 on day of discharge following diuresis and 1 unit prbc's. normal vit b12 nd folate in . # thyroid disease: thyroid ca s/p surgery and radiation. tft's previously consistent with sick thyroid with elevated tsh but normal free t4. she was continued on thyroid replacement therapy with levothyroxine 200 mcg daily. tft's should be rechecked in one month following resolution of acute illness. # c7-t2 fractures: no clear history of stroke after comparing pcp??????s note. ct of her c-spine was repeated during this hospitalization at the request of the ortho spine service, demonstrating no interval changes of c7/t2 fractures. per ortho, she was scheduled for follow-up with dr. in late . she has been instructed to continue wearing the c-collar for a total of 8 weeks (end date ). # low-grade fever: on patient was documented to have a low-grade fever to 100.3. her picc line was discontinued. patient had no subsequent fevers and wbc on morning of discharge was 6k. her only positive culture data from this hospitalization revealed scarce mssa in sputum culture from sample collected on . # fen: continued tube feeds via peg tube with replete with fiber at goal 60 ml/hour. # contact: . # code status: full code. medications on admission: warfarin 2.5 mg pg daily docusate sodium 50mg liquid pgt albuterol sulfate 90 mcg 6 puffs inhalation q4h prn bisacodyl 10 mg pr daily prn insulin sliding scale camphor-menthol 0.5-0.5 % lotion tid prn acetaminophen 325 mg pg q4h prn senna 8.6 mg po bid prn lansoprazole 30 mg pg daily clonidine 0.1 mg pg tid midodrine 10 mg pg tid quetiapine 50 mg pg qhs levothyroxine 200mcg pg daily chlorhexidine mouthwash discharge medications: 1. levothyroxine 200 mcg tablet : one (1) tablet po once a day. 2. ipratropium bromide 17 mcg/actuation aerosol : two (2) puff inhalation qid (4 times a day). 3. chlorhexidine gluconate 0.12 % mouthwash : one (1) ea mucous membrane (2 times a day). 4. midodrine 10 mg tablet : one (1) tablet po at bedtime. 5. quetiapine 50 mg tablet : one (1) tablet po at bedtime. 6. guaifenesin 100 mg/5 ml syrup : fifteen (15) ml po q6h (every 6 hours). 7. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : six (6) puff inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 9. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 10. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 11. coreg 6.25 mg tablet : one (1) tablet po twice a day. 12. coumadin 2 mg tablet : one (1) tablet po once a day: goal inr . 13. lasix 40 mg tablet : one (1) tablet po once a day. discharge disposition: extended care facility: medical center - discharge diagnosis: hypotension anemia c7 fracture atrial fibrillation respiratory failure discharge condition: bp 117/50, hr 90-100 (afib), spo2 94% on pressure support 10/5/50% inr 1.8 discharge instructions: you were admitted to the hospital with hypotension. you were evaluated for infection, but none was identified. you were noted to have episodes of hypotension while sleeping, during which you were asymptomatic. your clonidine was discontinued with improvement. you were started on coreg for heart rate control. you should return to the hospital for fevers, persistent hypotension with altered mental status, or other concerning symptoms. followup instructions: you have been advised to wear your c-collar for a total of 8 weeks (start date was ). you are scheduled to follow-up with dr. in the department of orthopaedics on at 11 am. his office is located on of the building on . please call if you need to reschedule. you should follow-up with your primary care physician . following your discharge from rehabilitation. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnoses: unspecified pleural effusion congestive heart failure, unspecified atrial fibrillation acute respiratory failure hypotension, unspecified diastolic heart failure, unspecified closed fracture of seventh cervical vertebra other specified anemias delirium due to conditions classified elsewhere personal history of irradiation, presenting hazards to health gastrostomy status tracheostomy status postsurgical hypothyroidism personal history of malignant neoplasm of thyroid late effects of accidental fall 

Answer: The patient is high likely exposed to