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: patient recorded as having no known allergies to drugs attending: chief complaint: mental status changes major surgical or invasive procedure: central line placement history of present illness: mr. is an 81 year old man with a history of paf, pvd, hypertension and mssa endocarditis who presents from home with mental status changes. he was accompanied by his daughter who stated that she had noticed the patient was increasingly confused, and had subjective fevers. he had a fall last night without hitting head or loss of conciousness. he also has been having increased dyspnea on exertion that has progressed over several weeks. the patient has also had worsening lower extremity edema. today, his legs have become warm, red and tender. he also has difficulty walking due to the pain. he was diagnosed with mssa endocarditis in and he finished a 6 week course of iv abx in mid . he later had mssa grow out from his knee and had hardware there removed. he has no knee pain currently. in the ed he was started on iv oxacillin. past medical history: paroxysmal atrial fibrillation peripheral vascular disease hypertension mssa mitral valve endocarditis septic left knee joint prosthesis, status post surgical removal of left knee hardware history of clostridium difficile gastritis history of an elevated psa with reported negative biopsies. social history: any tobacco, alcohol, and ivda currently lives at rehab facility, but prior to that was living w/ daughter was able to do , drive car prior to left knee replacement family history: non-contributory physical exam: vs: t 100.1 hr 89 bp 114/71 rr 20 sat 94%ra gen: elderly man in bed in no apparent distress. heent: ncat, mmm, perrl. cv: irregular, iii/vi hsm radiating to axilla. pulm: catb/l with bibasilar scant crackles, no rhonchi abd: +ecchymosis ext: +ttp below knees, bilateral swelling, weeping. neuro: a/a ox3, president , location, date, day. pertinent results: 02:45am glucose-127* urea n-52* creat-2.2* sodium-140 potassium-3.6 chloride-96 total co2-30 anion gap-18 02:45am calcium-9.5 phosphate-2.6* magnesium-1.8 02:45am wbc-21.2*# rbc-4.50*# hgb-12.5* hct-38.5* mcv-86 mch-27.8 mchc-32.5 rdw-14.7 02:45am plt count-263 02:45am urine blood-neg nitrite-neg protein-tr glucose-neg ketone-tr bilirubin-sm urobilngn-0.2 ph-5.0 leuk-neg 02:45am urine hyaline-* 02:45am pt-28.0* ptt-45.5* inr(pt)-5.8 02:45am ctropnt-0.04* 02:45am ck(cpk)-55 03:23am lactate-3.4* cxr: interval development of small bilateral pleural effusions and mild left lower lobe atelectasis. cardiomegaly without evidence for heart failure. nchct: stable appearance of the brain without evidence of intracranial hemorrhage or mass effect lenis: no evidence of deep venous thrombosis in either lower extremity. ecg: atrial fibrillation with rapid ventricular response loss of r waves in leads v1 and v2 consider old anteroseptal infarct inferior/lateral st-t changes may be due to myocardial ischemia repolarization changes may be partly due to rate/rhythm no change from previous echo: () the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 60-70%). right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is a moderate sized pericardial effusion subtending primarily the inferior and posterior walls. the effusion appears circumferential. there are no echocardiographic signs of tamponade. no right atrial or right ventricular diastolic collapse is seen. video swallow: mild-to-moderate oropharyngeal dysphagia and weakened oral phase, resulting in premature spillover and silent aspiration of thin liquids. echo (): 1. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. 2. the aortic valve leaflets are moderately thickened. mild to moderate (+) aortic regurgitation is seen. 3. the mitral valve leaflets are mildly thickened. 4. there is moderate pulmonary artery systolic hypertension. 5. there is a moderate sized, circumferential, pericardial effusion with fibrin deposits on the surface of the heart. there are no echocardiographic signs of tamponade. 6. compared with the findings of the prior report of , the pericardial effusion may be smaller. brief hospital course: 1) pneumonia: patient was initially admitted due to cellulitis and delirium. on hospital day # 3 patient became more agitated and was noted to be hypoxic. a new left lower lobe pneumonia was found on cxr. given his poor mental status, aspiration was presumed. he was transferred to the icu due to hypoxia, hypotension , and atrial fibrillation with rapid ventricular response. his pneumonia was treated with levofloxacin and metronidazole and subsquently vancomycin as well (sputum grew mssa). he required significant amount of supplemental oxygen, however mechanical ventilation was avoided (he is dnr/dni in any case). his mental status improved with treatment and his oxygen was weaned. he had a speech and swallow evalutaion which showed a significant risk for further aspiration and so he was maintained on thickened liquids, and pureed solids with aspiration precautions at meal times. he will require a repeat evaluation as his mental status returns to normal. 2) cellultitis: given history of mssa endocarditis, he was initially started on oxacillin for bilateral lower extemity cellulitis. his chronic lower extremity edema was felt to be the risk factor for developing this infection. his antibiotic was changed to vancomycin when he clinical course worsened. an attempt to change back to oxacillin resulted in a worsening of the cellulitis so he was changed to vancomycin to complete a 14 day course. he also had local wound care and his cellulitis resolved nicely. 3) atrial fibrillation: he has a history of paf was was in atrial fibrillation throughout his hospital course. his rate was difficult to control and was complicated by episodes of hypotension. he was tried on a sotalol drip and a diltiazem drip, but these medications had to be stopped due to low blood pressure. eventually he was loaded on digoxin with good effect. metoprolol was started and titrated up and a heart rate of 80-90 bpm was achieved. he may need further titration of his lopressor dose for rate control. he will need to have digoxin levels checked if his renal function worsens in the future. he was maintained on coumadin and was supratherapeutic at time of discharge. he will need his coumadin restarted once his inr drops to below 2.5. 4) delirium: the patient was intermittently delirious throughout his hospital stay. it was felt to be due to his infections. his mental status improved as his clinical status improved. low dose seroquel at bedtime and prn was utilized. wean off psychotropic meds as mental status improves. 5) chf: patient likely has diastolic dysfunction worsened by atrial fibrillation and tachycardia. his echocardiogram revealed a normal ef. after his fluid resuscitation in the icu, he required aggressive diuresis with iv lasix. he was then transitioned to his home po regimen of lasix 40mg daily. his beta blocker was titrated up as above. he would benefit from an ace-i being restarted as an outpatient. 6) pericardial effusion: a moderate effusion was seen by echo. serial echocardiograms were followed and the effusion remained unchanged of slightly improved. the etiology was not clear, although fluid overload was possible. as the patient and family did not wish for aggressive diagnostic measures and the patient's clinical course was positive, no further diagnostic studies were performed. patient should have a follow-up echo to evaluate this as an outpatient. 7) hypernatremia: due to free water deficit from poor po intake. treated with d5w for 2-3 liters. sodium improved as mental status improved and po intake increased. will need periodic (2x/week) sodium checks at rehab and needs encouragement to have good free water intake. 8) acute on chronic renal failure: baseline creatinine is about 1.2-1.6. early in hospital course creatinine ranged from 2.2-2.4. by the time of discharge, creatinine was stable near baseline at 1.6. 9) urinary retention: still with foley in. needs foley to be removed and have voiding trial at rehab. it still retaining, needs urology follow-up. 10) code status: dnr/dni medications on admission: 1.acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 2.diltiazem hcl 180 mg capsule, sustained release sig: one (1) capsule, sustained release po qd (once a day). 3.lisinopril 20 mg tablet sig: one (1) tablet po qd (once a day). 4.furosemide 40 mg tablet sig: one (1) tablet po qd (once a day). 5.sertraline hcl 50 mg tablet sig: one (1) tablet po qd (once a day). 6.oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 7.docusate sodium 100 mg capsule sig: one (1) capsule po qd (once a day). 8.metoprolol succinate 100 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po qd (once a day). 9.warfarin sodium 5 mg tablet sig: one (1) tablet po hs (at bedtime). discharge medications: 1. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed. 2. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 3. ascorbic acid 90 mg/ml drops sig: five hundred (500) mg po daily (daily). 4. digoxin 125 mcg tablet sig: one (1) tablet po every other day (every other day). 5. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. quetiapine 25 mg tablet sig: 0.5 tablet po qhs (once a day (at bedtime)). 8. quetiapine 25 mg tablet sig: 0.5 tablet po bid prn (). 9. metoprolol tartrate 50 mg tablet sig: 1.5 tablets po tid (3 times a day). 10. acetaminophen 325 mg tablet sig: two (2) tablet po q4-6h (every 4 to 6 hours) as needed for pain. 11. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q4h (every 4 hours). 12. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 13. coumadin 2.5 mg tablet sig: one (1) tablet po once a day: start when inr < 2.5. titrate to goal inr 2.0-3.0. discharge disposition: extended care facility: rehab unit at - discharge diagnosis: aspiration pneumonia diastolic congestive heart failure atrial fibrillation delirium cellulitis pericardial effusion hypernatremia acute renal failure chronic renal failure urinary retention discharge condition: good, mental status improved, oxygenation improved discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet notify your doctor if you experience chest pain, shortness of breath, palpitations, or other concerning symptoms. followup instructions: follow up with dr. in 1 week. please call to schedule appt. ( repeat echocardiogram in weeks repeat speech and swallow evaluation in weeks procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation transfusion of packed cells infusion of vasopressor agent diagnoses: abnormal coagulation profile acute kidney failure with lesion of tubular necrosis toxic encephalopathy other pulmonary insufficiency, not elsewhere classified unspecified septicemia severe sepsis atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease unspecified disease of pericardium hypotension, unspecified pneumonitis due to inhalation of food or vomitus cellulitis and abscess of leg, except foot retention of urine, unspecified acute diastolic heart failure hypovolemia hyperosmolality and/or hypernatremia ulcer of calf 

Answer: The patient is high likely exposed to