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: erythromycin base / tetracycline / penicillins / cephalosporins / vinorelbine / peanut / oxycodone hcl / hydrocodone / atrovent attending: chief complaint: dyspnea major surgical or invasive procedure: - two bronchoscopies (one with y-tube removal) - mechanical intubation/extubation history of present illness: 65yo f pmhx nsclc s/p rul vats lobectomy c/b lul subsegmental pe now s/p bronchoscopy and y stent placement with short portion in trachea placed yesterday , p/w acute dyspnea x 2hrs hours. pt reports that since bronching "has not felt right". overnight, patient resp status worsened, called ems. on ems arrival, o2 sat 90%, respiratory rate 40. denies fevers, chills, nightsweats, chest pain. notes that was not taking mucinex because pills were too large to swallow. . in ed, initially vs hr106 134/94 40 97%fm, patient w loud ronchi bilaterally, reports some relief from mucomyst, but remaining very uncomfortable. cxr w/o focal opacities. admitted emergently to icu for further management. past medical history: past medical history: - nsclc s/p lllobectomy ' c/b recurrences/p l lingulectomy ' - right upper lobe nodule s/p right vats lobectomy/superior segmentectomy , exploratory r vats/rml detorsion - oa - chronic lower back pain - hypothyroidism - benign right parotid mass - htn - hld . past surgical history: c-section, hemorrhoidectomy, tonsillectomy, rul vats lobectomy/superior segmentectomy , exploratory r vats/rml detorsion social history: she lives with her husband. she does not have any pets. she is a lifetime nonsmoker. sales clerk. occasional etoh. family history: her son has allergies. her brother has thyroid disease, otherwise no pulmonary history. physical exam: on admission: vs: 96.9 104 154/91 32 99%on bipap gen: tachypnic, mild distress heent: perrl, eomi, mmm neck: no jvd, no lad, supple lungs: loud rhonchi throughout, very junky, moving air well bilaterally heart: tachy, regular, abd: soft, nt/nd, no rebound/guarding ext: warm, sweaty, 2+radial pulses, no cyanosis/edema pertinent results: admission labs: 04:30am blood wbc-9.8# rbc-3.93* hgb-12.6 hct-36.9 mcv-94 mch-32.0 mchc-34.1 rdw-12.9 plt ct-172 04:30am blood neuts-75.3* lymphs-18.7 monos-5.6 eos-0.1 baso-0.3 04:30am blood pt-13.9* ptt-31.3 inr(pt)-1.2* 04:30am blood glucose-120* urean-17 creat-0.9 na-140 k-4.1 cl-102 hco3-22 angap-20 04:01am blood calcium-9.1 phos-2.5* mg-1.7 08:13am blood type-art po2-154* pco2-43 ph-7.37 caltco2-26 base xs-0 08:13am blood lactate-3.1* other labs: 04:01am blood wbc-13.1* rbc-3.26* hgb-10.3* hct-30.1* mcv-92 mch-31.7 mchc-34.3 rdw-12.9 plt ct-111* 04:01am blood neuts-93.8* lymphs-3.6* monos-2.3 eos-0.2 baso-0.2 05:15am blood wbc-7.8 rbc-3.63* hgb-11.6* hct-33.1* mcv-91 mch-31.9 mchc-35.1* rdw-12.9 plt ct-189 06:00am blood pt-13.1 ptt-30.9 inr(pt)-1.1 05:15am blood pt-19.1* ptt-40.8* inr(pt)-1.7* 05:15am blood glucose-85 urean-20 creat-0.8 na-138 k-3.9 cl-104 hco3-28 angap-10 05:15am blood calcium-8.7 phos-2.9 mg-1.9 06:05am blood vanco-16.6 08:13am blood type-art po2-154* pco2-43 ph-7.37 caltco2-26 base xs-0 01:42am blood type-art po2-152* pco2-50* ph-7.28* caltco2-24 base xs--3 03:12am blood type-art po2-100 pco2-36 ph-7.41 caltco2-24 base xs-0 11:38am blood type-art peep-5 po2-199* pco2-37 ph-7.43 caltco2-25 base xs-1 intubat-intubated 02:11pm blood lactate-4.2* 03:12am blood lactate-2.8* 03:39am blood lactate-1.0 microbiology 9:24 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs and clusters. 3+ (5-10 per 1000x field): gram positive rod(s). 2+ (1-5 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram positive cocci. in chains. respiratory culture (final ): moderate growth commensal respiratory flora. staph aureus coag +. moderate growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- 2 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s 9:30 am blood culture (x2)final : no growth. radiology chest (portable ap); 4:28 am again seen are changes of right upper lobe wedge resection with chain sutures, staples, and superior retraction of the inferior pulmonary ligament. discoid atelectasis in the left upper lobe has improved. there is no focal consolidation. heart size is normal. there are no pleural effusions or pneumothorax. impression: no acute cardiopulmonary process. chest (portable ap); 9:25 am impression: increasing left lower lung consolidation consistent with edema study date of chest (portable ap); 10:49 am findings: single portable view of the chest shows an et tube to be in proper position. there is an oropharyngeal tube whose port is seen within the region of the stomach. the previously seen consolidation of the left lower lung has resolved. again, consistent with resolving edema. post-surgical changes as described previously. impression: appropriate et tube placement ct trachea w/o c w/3d rend 9:12 am reason: evaluate for tracheobronchomalacia impression: 1. no dynamic changes of the tracheobronchial tree on dynamic expiration versus inspiratory series. 2. interval development of multifocal ground-glass opacification, compatible with multifocal pneumonia. 3. interval improvement though with small residual fluid collection in the right lateral chest wall. brief hospital course: is a 65 year old woman with recurrent lung ca s/p multiple lobectomies (lll, lingula, rul, r superior seg) admitted to the micu with respiratory distress 5 days s/p y-stent placement. # y-stent occlusion/respiratory distress - the patient presented with respiratory distress in the setting of recent bronchial y-stent placement. bronchoscopy demonstrated partial occlusion of branching bronchi and the stent was removed; however, the patient remained tachypneic and continued to have non-productive cough. at this point, the patient was afebrile and without leukocytosis and had a cxr without clear focal opacities. for 24 hours following bronchoscopy, the patient had intermittent episodes of acute dyspnea and tachypnea with loud expiratory upper airway sounds requiring intubation. given high suspicion for upper airway process, bronchoscopy and direct vocal cord visualization was performed, which demonstrated infraglottic edema/ulceration. the patient was treated with iv dexamethasone tid, nebulizers, racemic epinephrine, and heliox. she improved and was extubated and then remained stable >24hrs in the micu prior to transfer to the medicine service. after 5 days of dexamethasone 10mg tid, steroids were tapered over two days. the patient sometimes required albuterol nebulizers and o2 by nc while on the medicine service. with extensive walking including stairs, the patient's oxygen saturation did not drop below 96% and thus did not meet requirements for home oxygen. pt evaluated and recommended outpatient pulmonary rehab, which was arranged for after discharge. she was walking and sleeping comfortably without supplemental oxygen on the day of discharge. . the patient had evidence of intermittent airway closure with respiration seen during bronchoscopy and was started on bi-pap at night. a dynamic airway ct to evaluate for tracheobronchomalacia did not show dynamic changes of the tracheobronchial tree on dynamic expiration versus inspiratory series. continuing bi-pap was recommended by interventional pulmonology due to closure seen during bronchoscopy; however, the patient would not tolerate bi-pap while sleeping and it was discontinued. an outpatient evaluation for osa was recommended after discharge, as outpatient positive pressure ventilation would not be covered by insurance without this study. . # mrsa positive sputum cultures the patient developed a leukocytosis to 13.7 on the day after admission and sputum cultures obtained during bronchoscopy grew out mrsa. a course of 8 days vancomycin iv was completed prior to discharge and leukocytosis resolved. on discharge, the patient was started on a 6 day course of bactrim to continue treating positive mrsa cultures per thoracic surgery recommendations. . # history of pulmonary embolism the patient is on home warfarin for history of pe. she was transitioned to lovenox prior to bronchoscopy. lovenox was held for the bronchoscopies and restarted following the procedures. she was bridged to warfarin for dvt prophylaxis after transfer to the medicine service. on discharge, pt was 1.7. she was instructed to have her pt/inr checked the day after discharge and to continue sq lovenox until instructed that inr was therapeutic by primary care clinic. the patient was discharged on her normal home warfarin dosing with possible changes implemented by her primary care clinic pending results of pt/inr the day after discharge. . # anemia/thrombocytopenia the patient developed both anemia and thrombocytopenia after icu admission. hct fell from 37 on admission to 28; plts fell from 172 to 111. thrombocytopenia resolved with plts of 189 on the day of discharge. anemia improved to hct of 33 on the day of discharge. . # tongue swelling/throat itching patient reported symptoms possibly associated with restarted warfarin dose, though she had taken warfarin chronically prior to admission. the symptoms never caused respiratory distress or changes appreciable on physical exam. symptoms may have been due to anxiety and improved on subsequent days prior to discharge. . # bradycardia ?????? the patient had an episode of bradycardia in the icu in the setting of propofol. this did not reoccur in the icu or after transfer to the medicine service. . # gerd the patient was treated with iv ppi for gerd and switched to po ppi prior to discharge. she sometimes required additional prn maalox for gerd. medications on admission: albuterol sulfate - 2.5 mg/3 ml (0.083 %) solution for nebulization - 3 ml inhaled via nebulizaiton every six (6) hours as needed for shortness of breath or wheezing albuterol sulfate - 90 mcg hfa aerosol inhaler - 2 (two) puffs inhaled a4h prn for sob or wheezing levothyroxine - 75 mcg tablet - 1 tablet(s) by mouth once a day warfarin - 1 mg tablet - 2 to 3 tablet(s) by mouth daily or as directed based on inr medications - otc sennosides-docusate sodium - 8.6 mg-50 mg tablet - 1 (one) tablet(s) by mouth twice a day as needed for constipation acetaminophen prn pain discharge medications: 1. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). tablet(s) 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 2-4 puffs inhalation q4h (every 4 hours) as needed for wheezing. disp:*qs * refills:*0* 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. docusate sodium 100 mg capsule sig: one (1) capsule po twice daily as needed as needed for constipation. 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 8. warfarin 1 mg tablet sig: 2-3 tablets po once a day: 2 tablets m,w,f; 3 tablets tu,th,,. 9. guaifenesin 1,200 mg tablet, er multiphase 12 hr sig: one (1) tablet, er multiphase 12 hr po bid (twice a day) as needed as needed for cough, sputum. 10. bactrim ds 800-160 mg tablet sig: one (1) tablet po twice a day for 6 days. disp:*12 tablet(s)* refills:*0* 11. enoxaparin 60 mg/0.6 ml syringe sig: one (1) injection subcutaneous every twelve (12) hours: take this medication until your inr is . . 12. calcium 600 + d(3) 600 mg(1,500mg) -400 unit tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnoses # airway obstruction # mrsa pneumonia secondary diagnoses # anemia # thrombocytopenia # history of dvt discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent; with pulmonary limitations discharge instructions: dear ms. , it was a pleasure taking care of you at . you were admitted because you had difficulty breathing which was likely due to problems with the that had recently been placed to keep your airway open. the stent was removed and you were treated with antibiotics for a pneumonia, steroids for airway inflammation, and an acid blocking medication for ulcers in your airway. you will be discharged home today with outpatient pulmonary rehabilitation and follow-up with multiple providers. medication changes start bactrim ds 1 tab twice per day for 6 more days start pantoprazole 40mg twice per day for your airway ulcerations start guaifenesin 1200mg twice per day as needed for cough or sputum start enoxaparin 60mg subcutaneous injection every 12 hours until your inr is therapeutic continue warfarin: you will need to get your inr checked tomorrow. you should take your usual home schedule of 2mg on m,w,f; 3mg on t,th,, unless you get different directions from your primary care clinic after your inr is checked. followup instructions: please follow-up with all of your outpatient appointments scheduled below: 1. department: west clinic when: tuesday at 10:30 am with: , md building: de building ( complex) campus: west best parking: garage 2. department: west clinic when: tuesday at 11:00 am with: , md building: de building ( complex) campus: east best parking: garage 3. provider: , pt, ccs phone: wednesday 2:45 4. department: - adult med when: monday at 10:50 am with: , md, mph building: (, ma) campus: off campus best parking: free parking on site 5. department: otolaryngology-audiology when: monday at 2:30 pm with: , md building: lm bldg () campus: west best parking: garage *there is a shuttle that goes to this location from the office. check with your pcp if you are interested in using this. 6. department: pulmonary function lab when: thursday at 10:10 am with: pulmonary function lab building: campus: east best parking: garage 7. department: medical specialties when: thursday at 10:30 am with: , m.d. building: campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube other bronchoscopy endoscopic removal of bronchial device(s) or substances diagnoses: thrombocytopenia, unspecified anemia, unspecified esophageal reflux unspecified essential hypertension other and unspecified hyperlipidemia acute respiratory failure other specified cardiac dysrhythmias malignant neoplasm of bronchus and lung, unspecified personal history of venous thrombosis and embolism methicillin resistant pneumonia due to staphylococcus aureus other diseases of vocal cords 

Answer: The patient is high likely exposed to