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: aspirin / hydralazine / ace inhibitors / diovan attending: chief complaint: fever, chills major surgical or invasive procedure: central line placement (change over a wire) central line removal x 2 femoral line placement history of present illness: 73 y.o. female with h/o dmii, ischemic chf (ef ~30%), cad s/p nstemi and 2 to rca () c/b dye nephropathy and esrd (hospitalized - ), on hd with recent tunneled line and fistula creation, who presented , 1 day after leaving (7 week stay, just discharged ), with fevers to 104 c, rigors, and hypotension. she had just undegone placement of tunneled hd catheter (r ij) and also had av fistula placed (). ed course notable for initiation of vancomycin, levofloxacin and flagyl, and placement of femoral line. she was found to have a high grade mrsa bacteremia, with 7/8 bottles positive from . micu course notable for clearance of blood cultures on vancomycin, with hemodynamic stabilization. line changed over a wire, though catheter tip from original line then grew out mrsa. past medical history: hypercholesterolemia dm-2 htn cad - cath with 3vd, s/p cypher 2 to rca. pulmonary htn chf (ef 30%), afib, esrd on hd severe lumbar spondylosis and spinal stenosis social history: denies tobacco, etoh, ivda. ambulates with walking assist device (walker), which she has required since 'being dropped by emts' prior to her surgical repair for spinal stenosis. uses also electronic wheelchair. family history: fhx: father died of cva at 64yo. mother died of mi @ 86yo. brother had cad. physical : gen: patient appears stated age, found lying flat in bed, talking with family, in nad heent: sclera anicteric, conjunctiva uninjected, perl, eomi, mmm, no sores in op neck: jvp difficult to assess, no lad, nl rom cor: rrr nl s1 s2 no m/r/g chest: clear to percussion and asculation abd: soft, nt/nd, +bs. no hsm appreciated. ext: no calf tenderness. 2+ edema to mid tibia. also with sacral edema. 2+dp, 1+ pt pulses neuro: ms , cn ii-xii in tact, ue/le strength 5+ bilaterally, 2+ dtrs, toes , nl cerebellar . gait not tested. pertinent results: 10:22pm lactate-1.5 10:22pm hgb-10.0* calchct-30 09:27pm lactate-1.5 08:05pm lactate-1.7 07:04pm lactate-1.7 06:33pm lactate-2.3* 06:00pm glucose-215* urea n-50* creat-3.5* sodium-138 potassium-5.1 chloride-102 total co2-27 anion gap-14 06:00pm alt(sgpt)-4 ast(sgot)-12 ck(cpk)-67 alk phos-81 amylase-49 tot bili-0.3 06:00pm lipase-27 06:00pm ck-mb-notdone ctropnt-0.32* 06:00pm albumin-3.4 calcium-8.6 phosphate-3.1 magnesium-1.3* 06:00pm cortisol-30.0* 06:00pm crp-8.69* 06:00pm wbc-28.5* rbc-3.33* hgb-10.2* hct-29.5* mcv-89 mch-30.6 mchc-34.6 rdw-14.9 06:00pm neuts-73* bands-25* lymphs-0 monos-1* eos-0 basos-0 atyps-0 metas-0 myelos-0 young-1* 06:00pm hypochrom-1+ anisocyt-1+ poikilocy-1+ macrocyt-1+ microcyt-1+ polychrom-normal ovalocyt-1+ teardrop-1+ 06:00pm plt count-178 06:00pm urine color-straw appear-clear sp -1.021 06:00pm urine blood-lg nitrite-neg protein-500 glucose-100 ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 06:00pm urine rbc-* wbc-0-2 bacteria-mod yeast-none epi- 06:00pm urine amorph-mod 04:12pm type- 04:12pm lactate-2.2* 12:35pm urine color-straw appear-clear sp -1.020 12:35pm urine blood-mod nitrite-neg protein-500 glucose-250 ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 12:35pm urine rbc-* wbc-0-2 bacteria-few yeast-none epi-0-2 12:35pm urine granular-<1 hyaline-<1 12:35pm urine amorph-few 12:01pm lactate-2.7* 11:50am glucose-196* urea n-48* creat-3.4*# sodium-141 potassium-5.4* chloride-102 total co2-29 anion gap-15 11:50am alt(sgpt)-6 ast(sgot)-11 ck(cpk)-46 alk phos-98 amylase-60 tot bili-0.4 11:50am ctropnt-0.11* 11:50am ck-mb-notdone 11:50am albumin-3.8 calcium-9.0 phosphate-3.6 magnesium-1.4* 11:50am wbc-19.9*# rbc-3.64*# hgb-11.2*# hct-32.4* mcv-89 mch-30.6 mchc-34.5 rdw-14.7 11:50am neuts-92* bands-5 lymphs-2* monos-1* eos-0 basos-0 atyps-0 metas-0 myelos-0 11:50am hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 11:50am plt smr-normal plt count-159 11:50am pt-13.7* ptt-25.4 inr(pt)-1.2 brief hospital course: a/p: 73 yo f with cad, chf, esrd, htn, hyperlipidemia, spinal stenosis who p/w high grade mrsa bacteremia after recent placement of hd line. (1) mrsa bacteremia - initial source for infection was likely the tunneled hd catheter. the catheter was removed, and a temporary line was placed over a wire at the same site initially. however, as her blood cultures failed to clear, the temporar hd line was removed , and a new l-sided temporary hd line was placed. nonetheless, her blood cultures remained positive, despite apparently therapeutic levels of vancomycin, with worsening leukocytosis, and gentamycin was added for synnergy. tte and tee did not reveal evidence of endocarditis, though chest ct suggested probable mrsa pneumonia. diagnostic thoracentesis was performed and negative for infection. us of the r sided arm and neck veins was negative for clot as a source of infection. blood cultures remained positive until . on she was started on daptomycin iv 6 mg/kg q 48 hours and on the temporary dialysis catheter was changed over a wire and the tip cultured with no growth. ct of the entire spine with contrast and of the torso was also performed with the following results: ct results : * chest and abdomen * 1. no discrete abscesses or abnormal fluid collections are seen aside from right-sided pleural effusion and associated atelectasis. 2. markedly distended gallbladder, with gallstones. this can be seen in the setting of prolonged fasting, although if there are symptoms referrable to this region, right upper quadrant ultrasound could be performed. 3. marked coronary artery calcifications. 4. equivocal soft tissue filling defect adjacent to the left ij central venous catheter, which could represent adherent thrombus at the tip. note that ct is neither sensitive nor specific for detection of adherent thrombus. 5. two or three areas of focal consolidation in subpleural locations within the right upper lobe as described above. * spine * ct of the cervical spine: evaluation of the soft tissue windows demonstrates no evidence of abnormal fluid collection or bony destruction. there is no cervical lymphadenopathy present. there is a 7 mm low density right thyroid nodul, which can be evaluated by ultrasound if clinically indicated. also, right-sided pleural effusion is seen, indeterminately evaluated on this examination. evaluation of the coronally and sagittally reformatted images demonstrates appropriate alignment of the cervical spine, without significant abnormal soft tissue swelling. degenerative narrowing of the disc spaces at c6-7, c7-t1, are seen without significant facet changes at these levels. note is made of marked vascular calcifications involving the cavernous internal carotid arteries as well as a left-sided internal jugular central venous catheter. ct of the thoracic spine: scans are marred by artifact and of limited diagnostic quality. no fracture is identified. alignment is normal. the vertebral body heights are normal, however there is marked diffuse disc space narrowing. there are a few small areas of decreased attenuation in somee of the vertebral bodies. this is of uncertain nature. no endplate cortical destruction is seen. vertebral bodies have bridging osteophytes. there is poor visualization of the intraspinal structures. there are no gross abnormalities observed in the perivertebral soft tissues. there is a moderate-sized right pleural effusion. ct lumbar spine: again seen is grade 1 anterolisthesis of l4 in relation to l5 and new grade 1 to 2 anterolisthesis of l5 on s1. the remaining vertebral bodies are well aligned. there is vacuum disc phenomenon at l5-s1. there is disc space narrowing at t12-l1, l1-l2, l2-l3, likely l3-l4, l4-l5, and l5-s1. again noted are pedicle screws and posterior rods transfixing l3 through l5. there is associated laminectomy at these vertebral levels. the neural foramina in the lower lumbar region are difficult to assess secondary to hardware artifact. no vertebral fractures or hardware loosening is appreciated. there are no destructive changes of the endplates to indicate osteomyelitis. the prevertebral soft tissues appear morphologically normal. the posterior soft tissues are obscured by artifact from the fusionhardware. the intraspinal contents are not well seen. she was unable to fit into an mri scanner for evaluation of possible osteomyelitis or epidural abscess given persistent postitive cultures and back pain. ct scan was done as above and plan for open mri as an outpatient. she remained culture negative despite daily surveillance cultures until . she was switched back to vancomycin. from to her blood cultures (collected at each dialysis) were negative. should they have vecome positive again, plan was to pursue a white blood cell tagged scan to identify a source of infetion. due to mechanical falure of the line her dialysis catheter was changed over a wire on and then a tunneled catheter was placed . she has been awaiting placement with no events occurring since . (2) cri/esrd - upon admission, it was hoped that the patient's renal function had recoverd to the extent that hd could be delayed for several months. however, attempts to achieve fluid balance with diuretics, including lasix and metalozone, were unsuccessful, and given worsening cr, the decision was made to proceed with hemodialysis. phoslo was titrated. she has been on t/th/saturday dialysis since admission. ultrafiltration has been pursued to remove fluid. on one occasion , she experienced hypotension with nausea after dialysis. the hypotension responded to 1l fluids. given this was like her presentation with nstemi, a set of cardiac enzymes was checked (troponin still trending down from previous event) and an ekg (no changes). the nausea resolved with the hypotension. likely etiology was too much fluid removal with ultrafiltration. (3) anemia - patient required several units of prbc transfusions, and was started on erythropoietin 8000u thrice weekly. this is most likely because of chronic kidney disease combined with extensive phlebotomy here (many many blood cultures and chem 10, cbc daily until when they were changed to dialysis days only). (4) chf - patient noted to have mildly decompensated heart failure,likely secondary to volume overload while dialysis was on hold. she was not started on an ace or , given prior adverse reactions, but was maintained on low-dose beta-blocker. (5) back pain - no clear etiology evident on ct scan, doubt abscess or osteomyelitis. this is may be from anterolisthesis of l5 on s1 as seen in ct scan. (6) a-fib - continued b-blocker. re-starting anticoagulation with coumadin, please maintain inr between 2 and 2.5. on aspirin/plavix. (7) cad - continued aspirin, plavix, statin, b-blocker. medications on admission: 1. citalopram hydrobromide 20 mg tablet sig: one (1) tablet po daily (daily). 2. gabapentin 300 mg capsule sig: one (1) capsule po daily (daily). 3. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. atorvastatin calcium 40 mg tablet sig: two (2) tablet po daily (daily). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 7. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). 8. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 3 days: last dose is . 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 11. trazodone hcl 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 12. calcitriol 0.25 mcg capsule sig: one (1) capsule po every other day (every other day). 13. calcium acetate 667 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 14. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 15. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. 16. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation every 4-6 hours as needed for sob. 17. insulin regimen nph regimen of 4 units of nph at breakfast and 6 units and dinner with sliding scale which is attached. thank you. discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 4. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). 5. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed. 6. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. gabapentin 300 mg capsule sig: one (1) capsule po daily (daily). 8. citalopram hydrobromide 20 mg tablet sig: one (1) tablet po daily (daily). 9. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). 10. zolpidem tartrate 5 mg tablet sig: 1-2 tablets po hs (at bedtime). 11. epoetin alfa 4,000 unit/ml solution sig: two (2) injections injection qmowefr (monday -wednesday-friday): for a total of 8000 unit sc qmowefr . 12. calcium acetate 667 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 13. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 14. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 15. magnesium oxide 400 mg tablet sig: one (1) tablet po daily (daily). 16. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day). 17. tramadol hcl 50 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 18. vancomycin hcl 10 g recon soln sig: one (1) gram intravenous prn (as needed) as needed for for level less than 15, dosed at dialysis. discharge disposition: extended care facility: medical center - discharge diagnosis: sepsis mrsa bacteremia chf cad hypertension hypotension end stage renal disease on hemodialysis anemia atrial fibrillation hyperlipidemia discharge condition: fair discharge instructions: please take all of your medications as instructed. please return to the hospital or call you doctor if you have any further fever, chills, persistently low blood pressures that do not respond to fluids, racing heart or other symptoms. followup instructions: 1. please follow up with your primary care doctor ( ) one to two weeks after your discharge from the rehabilitation facility. 2. you have an appointment with dr. of the infectious disease department at on tuesday, at 11:00 am. his office is located in the medical office building at 110 st. next to the medical center . phone:. procedure: diagnostic ultrasound of heart hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis venous catheterization for renal dialysis venous catheterization for renal dialysis thoracentesis transfusion of packed cells infusion of vasopressor agent diagnoses: anemia in chronic kidney disease unspecified pleural effusion congestive heart failure, unspecified severe sepsis atrial fibrillation infection with microorganisms resistant to penicillins methicillin susceptible staphylococcus aureus septicemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease methicillin susceptible pneumonia due to staphylococcus aureus infection and inflammatory reaction due to other vascular device, implant, and graft backache, unspecified subendocardial infarction, subsequent episode of care diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled mechanical complication of other vascular device, implant, and graft hypotension of hemodialysis arthrodesis status chronic ulcer of other specified sites 

Answer: The patient is high likely exposed to