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: succinylcholine / penicillins / sulfa (sulfonamides) attending: chief complaint: resp distress, somnolence major surgical or invasive procedure: intubated , extubated history of present illness: this is a 44 y/o female with cad s/p multiple stents, s/p cabg at age 34, who was recently at from for hypoxic respiratory failure requiring intubation and arf thought to be rhabdo and hypovolemia, who now p/w hypoxia, lethargy, and acute renal failure. per report, she was found by her sister to be unresponsive today at home, and per son who saw her this morning, thought she was just "sleeping" but difficult to arouse. her sister last talked to the patient yesterday evening around 6pm. per history, pt was c/o of worsening back pain. it is unknown how long patient was down. sister called ems and pt was brought into the ed. pt was noted by ems to be cyanotic and no o2 sats were obtainable. . in the ed, vs were tc 98.8, bp 138/77, hr 100, rr 28, sao2 100%/nrb, ao x 1. labs were significant for an abg 7.01/77/113 on a nrb, k of 8.0 initially, cr of 6.0. phos was also markedly elevated at 16.7. she was given a dose of narcan and awoke marginally, but was still somnolent. for hyperkalemia, she was given 1 amp calcium gluconate, insulin 10 units iv, 1 amp of d50, 60 mg of kayexalate, and 1 amp of bicarb. she was afebrile, but given an elevated wbc of 19, was pan-cultured and given one dose of levofloxacin. during her course, her sbp's dropped to the 60's-70's systolic and she was given a total of 5 l ns with response of sbps to 110's. she was also started on a bicarb gtt given the metabolic acidosis. she was tried on bipap initially for a hypercapnia, however patient did not tolerate and was subsequently intubated. post-intubation, she was hypotensive to 70's and was started on dopamine transiently, now weaned off. she is currently receiving her 6th l of ns, with 7th l hanging. continues on bicarb gtt. serum tox was negative, urine tox not obtainable at that time as pt was anuric in ed. . from the ed, she was transferred to the micu for respiratory failure and arf. pt is currently sedated and intubated. past medical history: stent of rca graft (, , 5 overlapping stents rca to pda in ), om1 des in ) chf (ef 30-40%, 2+mr, 2+ tr in ) htn hypercholesterolemia obesity gerd depression pvd hypothyroidism dm ii social history: pt lives with husband, mother-in-law and along with two kids. pt smoked 2ppd x30years and drinks 3 drinks/mo- quit 2 months ago but still smokes occasionally-one or two cigarettes per day. pt denies any illicit drug use. family history: as per patient there are 7 generations of women on her mother's side who have all died at a young age of heart disease. mother - died of mi at age 50 grandmother - died with asd father - dm, etoh abuse, no cvd grandfather - dm 2 brothers - one died of fat embolus at age 18 and another died recently of opiod overdose. physical exam: vs: tc 98.1, bp 101/58, hr 84, rr 24 on ac 550 x 24, fio2 100%, peep 5, sao2 97% general: sedated and intubated. heent: nc/at, pupils pinpoint and minimally reactive, mm dry, op clear neck: supple, difficult to appreciate jvd chest: diffusely rhonchorous and wheezy anteriorly cv: rrr, s1 s2 normal, 2/6 sem abd: obese, mild distension, hyperactive bs, soft, nt ext: no c/c/e, w/w/p, faint distal pulses neuro: sedated pertinent results: 02:30pm blood wbc-19.0*# rbc-4.52 hgb-13.6 hct-42.0# mcv-93 mch-30.0 mchc-32.3 rdw-15.5 plt ct-320 04:12am blood wbc-12.9* rbc-3.35* hgb-10.0* hct-29.3* mcv-88 mch-29.9 mchc-34.2 rdw-15.8* plt ct-190 02:30pm blood neuts-90.5* bands-0 lymphs-6.1* monos-3.2 eos-0.1 baso-0.1 04:12am blood pt-11.5 ptt-30.9 inr(pt)-1.0 05:10pm blood pt-11.5 ptt-29.8 inr(pt)-1.0 04:12am blood glucose-105 urean-24* creat-0.9 na-137 k-3.9 cl-99 hco3-32 angap-10 02:30pm blood glucose-213* urean-64* creat-6.0*# na-128* k-8.0* cl-89* hco3-19* angap-28* 03:39am blood alt-37 ast-33 ld(ldh)-344* ck(cpk)-850* alkphos-54 amylase-88 totbili-0.3 02:30pm blood alt-31 ast-74* ck(cpk)-5593* alkphos-80 amylase-167* totbili-0.4 03:39am blood lipase-88* 02:30pm blood lipase-122* 02:30pm blood ck-mb-69* mb indx-1.2 ctropnt-.23* probnp-* 04:12am blood calcium-8.6 phos-3.8 mg-2.2 03:39am blood hapto-445* 11:43pm blood cortsol-48.2* 01:15am blood cortsol-49.7* 04:00pm blood hcg-<5 02:30pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 05:49pm blood type-art po2-102 pco2-47* ph-7.42 caltco2-32* base xs-4 03:53pm blood lactate-3.4* 02:42pm blood lactate-5.5* 03:29am blood freeca-1.11* 09:05pm urine color-yellow appear-clear sp -1.016 09:05pm urine blood-sm nitrite-neg protein-tr glucose-250 ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-neg 09:05pm urine rbc-* wbc-0-2 bacteri-occ yeast-none epi-<1 04:04pm urine hours-random urean-491 creat-44 na-64 07:48pm urine bnzodzp-neg barbitr-neg opiates-pos cocaine-pos amphetm-neg mthdone-neg . cxr : right subclavian vascular catheter has been placed, with the tip terminating within the lower superior vena cava. no pneumothorax is evident on this semi-upright radiograph. the lung volumes are lower on the current study compared to the previous exam. new area of air space opacity has developed in the right lower lung region, and may be due to an area of asymmetrical edema or acute aspiration superimposed upon underlying edema. small right pleural effusion is also noted. examination is otherwise without change from the recent study of earlier the same date. . cxr : single portable radiograph of the chest demonstrates an endotracheal tube with its tip at the level of the clavicular heads. there is a nasogastric tube present with its tip in the stomach. cardiomediastinal contours are similar to that seen on radiographs obtained earlier the same day. the patient is status post cabg. there may be a small left-sided pleural effusion. surgical staples project over the epigastrium, left upper quadrant, and left lateral chest wall. no pneumothorax. no consolidation. impression: support lines in place. no consolidation. . ct abd/pelvis/chest : 1. no evidence of dissection or aortic aneurysms is seen. 2. status post cabg with dehiscence of sternum. 3. moderate fatty stranding around the pancreas. this is of undetermined significance and might suggest pancreatitis. 4. compressive atelectatic changes at both lung bases. . ct head : the study is limited by motion artifact. there is no evidence of hemorrhage, mass effect, hydrocephalus, shift of normally midline structures, or infarction. the density values of the brain parenchyma are within normal limits. surrounding osseous and soft tissue structures are unremarkable. impression: limited study due to motion. no abnormalities detected. . cxr : comparison is made to and multiple prior chest radiographs dating back to . there is stable marked cardiomegaly. no evidence of pulmonary edema or sizable effusions. there are no focal consolidations. there may be mild plate-like atelectasis at the left lung base. again seen are cabg markers. impression: stable cardiomegaly without evidence of chf or pneumonia. . echo : the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. there is mild to moderate global left ventricular hypokinesis. the right ventricular cavity is mildly dilated. there is mild global right ventricular free wall hypokinesis. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. . cxr : a right subclavian central line is present, tip over distal svc. no pneumothorax is identified. there is cardiomegaly. clips overlie the mediastinum. no chf or gross effusion is identified. there is minimal blunting at the right costophrenic angle. there is some increased retrocardiac density, which is likely accentuated by technique and patient body habitus. no definite focal infiltrate is identified. if clinical suspicion for a focal infiltrate remains high, then this could be further evaluated with a lateral view. compared with , the et tube and the ng tube have been removed. the chf findings are improved and the atelectasis is also somewhat improved. . cxr : 1. vague areas of consolidation at the lung bases concerning for developing infiltrate. aspiration cannot be excluded. 2. cardiomegaly, stable. . sputum : staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin------------ =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- 2 s vancomycin------------ <=1 s . sputum : streptococcus pneumoniae | ceftriaxone----------- <=1 s erythromycin---------- r levofloxacin---------- s penicillin------------ i tetracycline---------- r trimethoprim/sulfa---- r vancomycin------------ s brief hospital course: she was found in the ed to have sao2 100% on nrb, with severe acidosis (7.01/77/113 on nrb), hypercalemia, and acute renal failure (creat 6.0). she awoke somewhat to narcan. she was pan-cultured, given one dose of levofloxacin, and started on bicarb gtt; she was eventually intubated after a trial of bipap was not tolerated. post-intubation, she was hypotensive but responded to 7 liters of fluid resuscitation and levophed. serum tox was negative, urine tox (not obtainable in ed secondary to anuria) eventually was positive for opiates and cocaine. her initial bnp was and ck 5593 (peaked ). she was transferred to the micu for respiratory failure and arf. . in the micu, she was on a ventilator and treated for copd and broadly covered for pneumonia (levo/flagyl). the renal team was consulted for emergent hemodialysis. a hemodialysis catheter was placed in preparation for hd, which was never required. tte showed global hypokinesis. sputum grew 4+ gpc's (speciated strep pneumo, mrsa). vancomycin was added. she had copious purulent sputum suctioned early in the course and had episodes of hypoxia; she was placed on a lasix drip with good response. she had fevers, which prompted a change in antibiotic coverage from levofloxacin to aztreonam and ciprofloxacin. given persistent fevers, clindamycin was started for question of sinusitis. she self-extubated on and was tolerating room air on and was transferred to the floor. . she was discharged the day after admission with a prescription for clindamycin to complete a 7-day course. at that time, she had completed a 10day course of vancomycin. she had follow up in the renal clinic as well as with her pcp. medications on admission: 1. atorvastatin 80 mg qd 2. toprol xl 50 mg qd 3. lisinopril 5 mg qd 4. clopidogrel 75 mg po daily 5. pantoprazole 40 mg po q24h 6. aspirin 325 mg po daily 7. furosemide 80 mg qd 8. citalopram 40 mg qd 9. glyburide 5 mg 10. synthroid 50 mcg qd 11. percocet 2 tabs q4 hrs 12. folic acid 1 mg qd 13. morphine sulfate 60 mg tid 14. prilosec 15. trazadone 300 mg qhs 16. albuterol prn 17. cytomel 5 mg qd 18. compazine 5 mg prn discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. 3. toprol xl 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 4. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. furosemide 80 mg tablet sig: one (1) tablet po once a day. 8. citalopram 40 mg tablet sig: one (1) tablet po once a day. 9. glyburide 5 mg tablet sig: one (1) tablet po once a day. 10. synthroid 50 mcg tablet sig: one (1) tablet po once a day. 11. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 12. folic acid 1 mg tablet sig: one (1) tablet po once a day. 13. morphine 30 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for pain. 14. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 15. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical 12 hrs on; 12 hrs off (). disp:*30 adhesive patch, medicated(s)* refills:*2* 16. clindamycin hcl 300 mg capsule sig: one (1) capsule po every six (6) hours for 4 days. disp:*16 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: respiratory failure, respiratory acidosis + anion gap metabolic acidosis mrsa/strep pneumoniae pneumonia acute renal failure rhabdomyolysis septic shock . secondary: coronary artery disease congestive heart failure diabetes mellitus hypercholesterolemia hypertension discharge condition: stable, satting well on room air discharge instructions: you were admitted with respiratory failure and acute renal failure. you were intubated in the emergency and treated in the intensive care unit for eight days. your renal improved with iv fluids. you had fevers and were given broad coverage with antibiotics. your respiratory failure was resolved, the breathing tube was removed on , and you were transferred to the regular medicine floor. . please complete your course of antibiotics as prescribed. all of your other medications should be continued. . please keep all of your follow up appointments as listed below (note: you have a follow up appointment with your pcp on of this week). . if you notice any worsening shortness of breath, chest pain, diarrhea, fever, nausea, vomiting, or other concerning symptoms, please seek medical attention immediately. followup instructions: please follow up with dr. on friday, , at 1pm. . provider: , md phone: date/time: 1:00 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances venous catheterization for renal dialysis diagnoses: pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis infection with microorganisms resistant to penicillins obstructive chronic bronchitis with (acute) exacerbation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status acute respiratory failure septic shock methicillin susceptible pneumonia due to staphylococcus aureus pneumococcal pneumonia [streptococcus pneumoniae pneumonia] rhabdomyolysis mixed acid-base balance disorder 

Answer: The patient is high likely exposed to