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 / quinolones / cefazolin attending: chief complaint: dyspnea major surgical or invasive procedure: cvvh hemodialysis tunneled hd catheter placement history of present illness: 84 yo m hx of chf ef of 40% who was transfered form rehab due to worsening of sob and arf. he was recetly admitted from and discharge to rehab. he was on lasix 80mg , then 2 days ago, lasix was adjusted to 80mg am and 40mg pm. per rehab his cr has been trendeding up and his dypsnea has been worsening. at discharge his cr was 0.9, then 1.1 and now 2.2 today. uo has been decreased per pt. wt gains of 2 lbs over last few days. . during his last hopsitalization he was treated for a sternal wound infection from his cabg on . on he had a debridement and wound closer, with pacer lead removal on . epicardial leads were paritally removed. old ppm remained in place. he also had a flap closure. culture of his infeciton showed mssa. he developed ain, so his antibiotics were changed to vancomycin. he will be on lifelong suppresive therapy after his regiment of iv therapy. hardware in the sternum is in place. his stay was complicated by chf and arf from diuresis, later this improved to a cr of 0.9 and he was sent to rehab. . on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, cough, hemoptysis, black stools or red stools. denies recent fevers, chills or rigors. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, palpitations, syncope or presyncope. . in the ed, initial vitals were 96.8 67 128/58 20 94% 3l nc. pt was given 250mg ivf over 2 hours. pt's oxygen was increased to 4l. on transfer temp 97.9 67 120/45 18 96% 4 liters. cxr with pulm edema. pt admitted to . . past medical history: -coronary artery disease, s/p cabg (see below) -hypertension -hyperlipidemia -s/p st. ppm for third degree heart block -arthritis -sleep apnea noted after administration of narcotics -diverticulitis s/p left hemicolectomy -s/p back surgery -s/p appendectomy -s/p tonsillectomy - sternal debridement, closure of the sternal wound dehiscence with four synthes plates, bilateral pectoralis musculocutaneous advancement flap. -arf due to questionable ain due to cephalosporin or hemodynamically mediated arf, in social history: -tobacco history: quit 25 yo ago -etoh: 1 pint a day until cabg in -illicit drugs: none lived with wife before going to rehab, now using a walker family history: noncontributory physical exam: general: some tachypea with talking, otherwise nad. oriented x3. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp at his chin while sitting at 45 degrees cardiac: difficult to hear cardiac sounds, no murmur, sternal wound dressing in place small drainage lungs: resp were slightly labored, pursed lip breathing, able to speak full sentences, no accessory muscle use. soft breath sounds, crackles half way up. abdomen: soft, ntnd. no hsm or tenderness. no abdominial bruits. extremities: no c/c. 2+ edema to the knees. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: 2+ radial, 2+ pt pertient discharge physical exam: general: nad, heent: ncat, slcera anicteric. neck: supple res: clear to ascultation posteriorly on the r, with decreased breath sounds at the left base. chest: sternal wound: c/i, tunnel catheter in place with no erythema or tenderness. suture in place. pertinent results: pertinent labs: . 04:40pm blood wbc-9.2 rbc-2.99* hgb-8.8* hct-27.3* mcv-92 mch-29.5 mchc-32.2 rdw-16.1* plt ct-300 06:08am blood pt-13.5* ptt-31.5 inr(pt)-1.1 04:40pm blood glucose-99 urean-46* creat-2.1* na-137 k-5.7* cl-98 hco3-35* angap-10 04:40pm blood albumin-3.0* calcium-8.8 phos-4.9* mg-2.3 06:08am blood vanco-18.1 05:15am blood vanco-28.0* . cxr: studies: the patient's sternotomy fixators are unchanged in appearance. the pacemakerleads are unchanged in appearance as well. the temporary pacemaker leads projecting at the expected location of the left epicardium are unchanged as well. left picc line tip is obscured by the pacemaker but is most likely not extending beyond the junction of the axillary vein and the subclavian vein. bilateral pleural effusions have slightly improved. bibasilar atelectases are unchanged. . lenis: impression: no evidence of deep vein thrombosis in the right leg. cxr portable chest is compared to multiple prior examinations. sternal plates, dual-lead pacer is present. mild-to-moderate congestive failure, new from prior study from . right ij cordis terminates in the superior vena cava. no pneumothorax. echo : ef 30-35%. suboptimal image quality. regional left ventricular systolic dysfunction c/w multivessel cad. pulmonary artery systolic hypertension. severe tricuspid regurgitation. mild-moderate mitral regurgitation. compared with the prior study (images reviewed) of , regional left ventricular systolic dysfunction appears to be more extensive, and the severity of mitral regurgitation, tricuspid regurgitaiton, and pa systolic pressure are all increased. ap-l & decubitus cxr the decubitus images in both the left position show moderate bilateral pleural effusions. the right effusion is minimally more extensive than the left effusion. with respect to the sternal fixations, the size of the cardiac silhouette and the aspect of the lung parenchyma, today's images provide no new information. tunneled catheter impression: uncomplicated placement of a tunneled hemodialysis catheter through the right internal jugular venous approach. the line is ready for use. cxr: summarized: effusion on the left, and decreased/absent pleural effusion on the r. for a full report, please see radiology note. discharge labs: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:31 9.5 3.24* 9.4* 28.9* 89 29.2 32.7 15.9* 335 renal & glucose glucose urean creat na k cl hco3 angap 06:31 101*1 46* 3.2* 136 3.8 100 28 12 chemistry totprot albumin globuln calcium phos mg uricacd iron 06:31 9.0 3.6 2.0 brief hospital course: 84 yom with hx of cad s/p recent cabg c/b sternal wound mssa infection, chf and arf, now presenting with dyspnea and . . active issues upon discharge: # : thought to be multifactorial, with the underlying precipitant ain secondary to the significant nephrotoxic antibiotic load the patient received for mssa treatment; decreased effective circulatory volume due to chf decompensation was likely to also be a contributor to pre-renal pathophysiology. on presentation, the patient was hyperkalemic, prompting the administration of kayexalate, which normalized his potassium. following consultation with infectious disease and nephrology, iv vancomycin was stopped during the 6th of 8 weeks of treatment; at this time, the patient's vancomycin trough was supratherapeutic. to optimize volume status and forward flow, cvvh was started and continued until the patient was net -10l; the patient's home acetazolamide and furosemide were held. hemodialysis was started and patient remained oliguric after two sessions. as a result, a tunneled hemodialysis catheter was placed and patient was set up for outpatient hemodialysis. of note, he has made minimal urine during his hospital stay. his largest urine output was 250 cc. however, the day before discharge he had no urine output. - leave r side suture above catheter in place until . - dialysis as an outpatient. last dialysis . . # dyspnea: the patient was admitted with worsening heart failure symptoms with the most recent echo showing an ef of 40-45% in the setting of known copd. diuresis was initially attempted with iv lasix and drip, but the patient was eventually transitioned to cvvh and diuresed aggressively with subsequent improvement of his clinical exam and symptoms; he remained rate controlled with metoprolol 50 mg tid (decreased from admission dose) and acei was held in the setting of but started upon discharge. during the hospitalization, he was kept on a copd regimen of guaifenesin, ipratropium / albuterol nebs, and fluticasone. cxr upon discharged showed l pleural effusion, with decreased/absent r pleural effusion. he has good ambulatory saturation and will require continued hd. it is expected that his left pleural effusion will decrease with continued hd. - hd as above . # mssa sternal wound infection: infectious disease was consulted; their recommendations were to stop iv vancomycin on week 6 of 8 of therapy and to start doxycycline hyclate 100 mg po q12h po (d1 ) for chronic suppressive therapy given his indwelling hardware. plastic surgery was consulted for serous wound drainage; their impression was that the wound was not infected and recommended to continue wound care and suppressive therapy without further changes. patient will follow up with plastics as an outpatient. - continue doxycycline (requires life long suppressive therapy) . # anxiety: patient become anxious at night, and states that he has fears regarding his estate planning and continued medical management. he was not given any benzodiazepines secondary to his history of hypercapnia. he was started on low dose olanzapine. - continue olanzapine 2.5 mg - please do not give benzodiazepines . inactive issues upon discharge: # hypercapnia / hypoxia: copd = chronic retainer. serial abgs reassuring for decreased co2, but o2 in 50s. respiratory drive hypoxia driven. normalized during hospitalization. - please avoid central acting pain medications - please avoid benzodiazepines . #chronic systolic heart failure: ef 30-35%, and mitral regurgitation, tricuspid regurgitaiton, and elevated pa systolic pressures. - continue metoprolol succinate 100 mg daily - continue lisinopril 2.5 mg daily . # cad: - continue atorvastatin 10 mg po/ng daily - continue aspirin 325 mg po/ng daily . # ams change: toxic metabolic delirium; hypoxia unlikely because ams predated hypoxia. likely multifactorial (low threshold given age, azotemia, icu setting.) resolved prior to discharge. . # anemia: stable during admission ~27. normocytic. . # r le swelling: likely secondary to chf; lenis negative. . # poor nutrition: a nutrition consult was placed. albumin returned at 3. speech and swallow cleared him for full solids and thin liquids. . # the patient remained full code during this admission. medications on admission: atorvastatin 10 mg po daily -docusate sodium 100 mg po bid -vancomycin in d5w 1 gram/200 ml. end date . -oxycodone 5 mg tablet po q6h prn -acetaminophen 1000 mg tablet po tid prn -aspirin 325 mg tablet po daily -metoprolol tartrate 75 mg po tid -cholecalciferol 1000 unit po daily -calcium carb 500mg -senna 17 mg tablet po hs and 8.6mg prn -mv 1 tab po daily -magnesium hydroxide 400 mg/5 ml suspension po q6h prn -guaifenesin 100 mg/5 ml 5-10 mls po q6h prn -trazodone 50 mg po hs prn -sodium chloride 0.65 % aerosol, sprays nasal tid prn -clonazepam 0.5 mg po bid scheduled and hs prn anxiety. -fluticasone 50 mcg/actuation spray -morphine 15 mg tablet po qhs hs prn sob. -morphine concentrated solution 4mg q3h prn sob sl -furosemide 80 mg po bid, changed to 80am and 40pm 2 days ago -duoneb 0.5 mg-3 mg(2.5 mg base)/3 ml solution q4h -albuterol neb q4h prn sob -bowel meds prn . discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 3. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po once a day. 6. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 7. senna 8.6 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for constipation. 8. multivitamin tablet sig: one (1) tablet po daily (daily). 9. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 10. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 11. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insominia. 12. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for dry nose. 13. duoneb 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: puff inhalation every four (4) hours as needed for shortness of breath or wheezing. 14. doxycycline hyclate 100 mg capsule sig: one (1) capsule po q12h (every 12 hours). disp:*60 capsule(s)* refills:*0* 15. albuterol sulfate 0.63 mg/3 ml solution for nebulization sig: one (1) inhalation every four (4) hours as needed for shortness of breath or wheezing. 16. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*0* 17. olanzapine 2.5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 18. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day: only take on days that you do not receive hemodialysis. disp:*30 tablet(s)* refills:*0* 19. lidoderm 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) patch topical once a day as needed for pain: pain at tunnelled site, please do not place over site or dressing. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: acute on chronic diastolic congestive heart failure exacerbation acute kidney injury . secondary: coronary artery disease hypertension dyslipidemia pacemaker for complete heart block s/p recent sternal wound infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr , it was a pleasure caring for you at . you were admitted for worsening shortness of breath and also for decreasing kidney function. we helped remove fluid using medications and different types of dialysis. unfortunately, your kidneys did not completely recover function and so we placed a hemodialysis catheter so that you can have hemodialysis as an outpatient. . also while you were here, we started your antibiotic doxycycline for your past chest wound infection. you will be on this indefinitely to prevent further infections. . we made the following changes to your medications: stopped vancomycin and started doxycycline 100 mg twice daily stopped metoprolol 75 mg three times daily and started toprol xl 100 mg daily. stopped lasix. started lisinopril 2.5 mg daily (only take on days that you are not going to hemodialysis.) stopped clonazepam and started olanzapine 2.5 mg daily. you were confused with clonazepam type medicine so we have discontinued them. stopped fluticasone spray per your request . your follow-up appointments are listed below. . please also weigh yourself every morning before dialysis. followup instructions: hemodialysis: every tues/thurs/sat . dr. location: plastic surgery p.c. , , phone: ( at 4:15 pm . department: infectious disease when: friday at 10:30 am with: , md building: lm bldg () campus: west best parking: garage . department: cardiac services when: please call on friday for appt at number below with: , m.d. building: sc clinical ctr campus: east best parking: garage department: cardiac services when: friday at 3:30 am with: device clinic building: sc clinical ctr campus: east best parking: garage department: cardiac services when: friday at 4:00 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis diagnoses: hyperpotassemia congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified acute on chronic diastolic heart failure coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status other and unspecified hyperlipidemia unspecified sleep apnea acute glomerulonephritis with other specified pathological lesion in kidney cardiac pacemaker in situ arthropathy, unspecified, site unspecified 

Answer: The patient is high likely exposed to