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: penicillins attending: chief complaint: shortness of breath major surgical or invasive procedure: plasmapheresis central line placement picc line placement history of present illness: 24 yo female with pmh asthma, gerd presents with asthma exacerbation. pt states that she had a uri 3 weeks ago with sx of congestion, sore throat, dry cough, with residual symptoms over the past few weeks. over the past 3 days, pt has developed increasing sob and increasing usage of albuterol nebs ~q1.5 hours. her usually triggers are uris, environmental triggers such as pollen in the spring, and the winter season. she denies any significant symptoms with exercise or exertion. she believes her current trigger may have been the uri; she also went outdoors 3 days ago. denies recent sx of productive cough. states a fever of 101 a few weeks ago. her baseline peak flow is 350. . ros: cp with coughing. vomited x 1 yesterday. no abd pain, dysuria. . in the ed her initial vitals were 98, p72, 135/81, rr30, rr99%ra. initial peak flow was 280. she was given frequent nebs, prednisone 60mg x 1, magnesium 2gm over the course of 9am to midnight. peak flow improved to 330. in the evening around 10pm, pt c/o feeling tired out and continued to have sob and was placed on continuous nebs and tx to the unit. cxr with peribronchial cuffing, but no infiltrate. vbg was 7.45/35/38. . on admission to the , vitals were stable with o2 sat 100% on ra and rr 15-20. during the first part of our conversation, pt appearing to be breathing comfortably and able to complete full sentences. continuous nebs were removed briefly, after which pt began to make erratic bilateral eye movements and c/o double vision. then began to look increasingly sob with use of accessory muscles. abg was 7.56/23/98 on ra. pt was placed back on continuous nebs and rr decreased to 14 and pt appeared more comfortable. a repeat abg on neb showed 7.47/32/286/24 past medical history: asthma -2 ed visits/hospitalizations in , last -never been intubated gerd social history: single mom of 3.5yo son. bf. smokes 2pk/wk for past 10 years; quit 5 months ago. works as medical assistant. drinks 2-3 times a month. denies drugs. family history: first cousins with asthma. physical exam: vs: t95.3, p74, 144/88, rr20, 100%ra gen: see hpi above heent: perrl, clear op cvs: rrr, nl s1 s2, no m/g/r lungs: diffuse expiratory wheezing abd: soft, nt, nd, +bs ext: no edema neuro: difficulty with eye movements. bilateral upper extremity strength. repeat exam revealed improved ability to follow finger with eyes, cn o/w intact, 4+ bilateral le strength. pertinent results: 09:40am wbc-5.6 rbc-4.86 hgb-14.7 hct-42.5 mcv-88 mch-30.3 mchc-34.6 rdw-13.5 09:40am neuts-56.4 lymphs-31.8 monos-4.0 eos-5.5* basos-2.4* 11:01pm freeca-1.16 11:01pm type-art po2-38* pco2-35 ph-7.45 total co2-25 base xs-0 comments-ionized ca . cxr: no focal infiltrates are identified. there is mild peribronchial cuffing noted bilaterally (left greater than right). no evidence of pneumothorax, pulmonary edema, or pleural effusions. cardiomediastinal silhouette and hilar contours are unremarkable. impression: mild bilateral peribronchial cuffing may suggest underlying bronchitis with no focal infiltrates or pneumothorax identified. . emg (): motor nerve conduction studies (ncss) of the right median and left tibial nerves were normal, including f responses. sensory ncss of the right median and left sural nerves were normal. slow (3-hz) repetitive nerve stimulation of the right facial nerve produced an abnormal decrement of 11.5% which was not reproduced on further testing of the right facial nerve. exercise testing was not possible due to the patient's mental status. concentric needle electromyography (emg) of right deltoid, biceps, and tibialis posterior was normal. emg of right vastus lateralis showed normal insertional activity and no motor unit activity due to the patient's sedation. single-fiber emg was not possible secondary to the patient's mental status. impression: nondiagnostic study. based on the studies performed, a disorder of neuromuscular transmission (as in myasthenia or botulism) or a demyelinating polyneuropathy cannot be definitively excluded. . ct chest/abd/pelvis (): 1. multifocal pulmonary opacities concerning for right upper lobe and left lower lobe pneumonia or aspiration. the more mass-like 2.1 cm airspace opacity in the left lower lobe has an atypical appearance for infection and dedicated imaging following treatment to exclude underlying mass is recommended. 2. no acute intra-abdominal process to explain the patient's pain. the appendix is not visualized, however there are no inflammatory changes in the right lower quadrant. 3. incidentally noted malrotation of the small bowel. 4. residual thymic tissue with no evidence of a thymoma. . brief hospital course: the patient was admitted with apparent complaints of an asthma exacerbation, incluidng shortness of breath and decreased peak flow. the patient was started on nebulizers and oral steroids with some improvement in peak flow. the patient had persistent shortness of breath with complaints of fatigue including clinical signs of respiratory distress, including use of accessory muscles. on abg she was found to have hypoxemia. the patient had no signs of an acute infiltrate on chest x-ray. the icu team noted that the patient had diplopia, extraocular muscle paresis in addition to the respiratory weakness and called a neurology consult. she was clinically diagnosed with myasthenia on the day after admission. two days after admission, the patient developed myasthenic crisis with respiratory failure requiring intubation and plasmapheresis. the patient had a nondiagnositc emg revealing a disorder of neuromuscular transmission (differential of myasthenia vs. botulinum) or a demyelinating polyneuropathy. achr ab and modulating ab were negative. botulinum toxin was negative. the patient underwent plasmapheresis every other day x10 days (5 total treatments) with good response. the patient was successfully extubated on . she was started on pyridostigmine 60mg q8h and called out to the general neurology service. . the patient's icu course was complicated by a ventilator associated pneumonia with growth of mssa and h. flu beta lactamase positive in the sputum. the patient will complete a 14 day total course of mssa coverage. she was started on vanco (day 1: ) though she was then switched to a 14 day course with bactrim once sensitivities returned, given her history of allergy to penicillin. the patient's mssa coverage will complete on . the patient will complete a 10 day total course of azithromycin for the h. flu (day 1: , to be completed on ). the patient will complete a longer than usual course of both antibiotics given recent plasmapheresis and possible complication of underdosing due to drug removal with pheresis. . she was also found to have an lung nodule discovered incidentally on ct scan. patient needs to have f/u ct scan in 6 months to follow r lung nodule. . the patient remained stable on the floor, although her neurological exam still showed evidence of mild residual fatiguability. thymectomy was discussed with the patient at length, as was the seriousness of her medical condition. she was started of prednisone 20 mg po qod and mycophenolate mofetil 500 mg po bid, in addition to the pyridostigmine 60mg q8h. she was discharged in stable condition, on these medications,along with her usual home meds (advair, ranitidine, albuterol) and her remaining antibiotics (bactrim and azithromycin) with scheduled appointments with neurology and pulmonary. medications on admission: advair diskus albuterol in prn atrovent qid claritin discharge medications: 1. mycophenolate mofetil 250 mg capsule sig: two (2) capsule po bid (2 times a day). disp:*120 capsule(s)* refills:*0* 2. azithromycin 250 mg capsule sig: one (1) capsule po q24h (every 24 hours). disp:*2 capsule(s)* refills:*0* 3. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*14 tablet(s)* refills:*0* 4. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). disp:*1 disk with device(s)* refills:*0* 5. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 6. pyridostigmine bromide 60 mg tablet sig: one (1) tablet po q8h (every 8 hours). disp:*90 tablet(s)* refills:*0* 7. prednisone 20 mg tablet sig: one (1) tablet po every other day (every other day). disp:*15 tablet(s)* refills:*0* 8. albuterol 90 mcg/actuation aerosol sig: one (1) inhaler inhalation four times a day as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*0* discharge disposition: home discharge diagnosis: myasthenia pneumonia asthma discharge condition: stable discharge instructions: you have myasthenia . you need to follow up with your primary care doctor and your neurologist. in addition, you have a nodule on your chest ct. this may represent an infection or a cancer. you need to have a follow up ct scan in 6 months. please work with your primary care doctor this study. take all medications exactly as prescribed. you must finish all of your antibiotics even if you are feeling better. not taking all of your antibiotics can lead to a relapse. you are on three medications for your myasthenia : prednisone, mycophenolate mofetil. and pyridostigmine. you must take these medications as they are prescribed. if you stop taking these medications or miss too many doses, you are at high risk of having a relapse which could lead to needing to be brought back to the hospital. if you have any fevers, chills, worsening weakness, or any other concerning symptoms, either call your doctor or come to the emergency room. followup instructions: 1. pulmonary: provider: breathing tests phone: date/time: 7:40 on the of the building followed immediately by... provider: . /dr. phone: date/time: 8:00 2. primary care: please call to make a follow appointment with your primary care doctor in weeks. at that visit you should discuss this hospitalization. please take these papers with you to the visit. - ct chest in 6 months to evaluate progression of right lung nodule. 3. neurology provider: , md phone: date/time: 8:00 md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube therapeutic plasmapheresis diagnoses: esophageal reflux acquired coagulation factor deficiency infection with microorganisms resistant to penicillins hypopotassemia acute respiratory failure methicillin susceptible pneumonia due to staphylococcus aureus pneumonia due to hemophilus influenzae [h. influenzae] asthma, unspecified type, with (acute) exacerbation myasthenia gravis with (acute) exacerbation 

Answer: The patient is high likely exposed to