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: tongue laceration major surgical or invasive procedure: picc line placement teeth extraction, omfs tee, cardiology history of present illness: 43 yo male with a history of anoxic brain injury living at a radius, who is trach and peg dependent, who presents from his rehabilitation facility with a tongue laceration. patient is s/p brain injury after a pea event following a vt ablation procedure in the ep lab here at and is vent dependent. he was seen by ent in the ed, who said he can have an out-patient elective procedure if his family elects to repair the tongue, which is forked. vs were t 96, bp 132/80, hr 79, 100% on vent on 100% o2. past medical history: diabetes dyslipidemia hypertension s/p stemi , w/ large thrombus in the proximal lad complicated by cardiogenic shock w/ des to prox lad : placement for low ef, runs of nsvt. h/o alcohol and substance abuse h/o deep vein thrombosis partially treated with coumadin positive hepatitis b serologies in the past s/p pea arrest in with resulting anoxic brain injury during vt ablation in ep lab. at baseline, the pt is responsive only to deep painful stim (such as deep suctioning), although he does appear alert and open his eyes (no tracking). he is completely dependent for all adls. social history: he had been on disability for 10 years since his first heart attack. prior to that he was a manager at 's. he reported smoking approximately one pack of cigarettes per week. he also reported history of etoh but denied any ivda. now unresponsive to all but deep painful stim, and completely dependent for all adls. family history: non-contributory. no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs on arrival to the floor: t 98.7, hr 93, bp 127/75, 100% trach with bipap rate 31 general: trached on vent, sleeping, some contractures of upper extremities heent: missing several teeth in front both upper and lower; cannot open mouth fully to see in while sleeping; no gross blood; nml sclera lungs: cta anteriorly (per surgery note: "tongue with 1.5 cm old laceration, covered in granulation tissue and mucosa, just left of midline") cardio: rr, ii/vi sem at usb b/l, no r/g abd: + bs, peg; somewhat distended and firm though no rebound or guarding, no fluid wave or hsm appreciated extremities: + right slightly greater than left but fairly symmetric, no erythema or ttp; arms somewhat contracted though mobile; right piv skin: no ecchymoses; no evidnece of trauma neuro: sleeping when seen, arousable to voice though falls back asleep quickly; non-verbal at baseline per ed notes pertinent results: repeat k 4.2 . gross hemolysis; grossly hemolyzed specimen 139 103 37 ------------ 86 6.3 25 1.0 . alt: 93 ap: 637 tbili: 1.8 alb: 2.7 ast: 159 ldh: 687 dbili: tprot: : lip: 44 comments: alt: hemolysis falsely elevates alt ast: hemolysis falsely elevates ast. ld(ldh): specimen slightly hemolyzed ld(ldh): hemolysis falsely elevates ldh. . .....9.7 7.7 ----- 338 ....31.4 n:81.3 l:11.5 m:4.4 e:2.3 bas:0.5 . pt: 16.6 ptt: 34.1 inr: 1.5 . labs on discharge: 03:57am blood wbc-8.2 rbc-3.11* hgb-8.8* hct-28.2* mcv-91 mch-28.4 mchc-31.2 rdw-17.5* plt ct-316 03:57am blood plt ct-316 03:57am blood glucose-137* urean-20 creat-0.9 na-138 k-4.1 cl-104 hco3-27 angap-11 03:57am blood alt-53* ast-40 ld(ldh)-204 alkphos-467* 03:57am blood calcium-8.8 phos-3.6 mg-2.0 07:38am blood vanco-35.8* eeg - this is an abnormal portable eeg due to slowing and disorganization of a low voltage background rhythm. this finding is consistent with a mild to moderate encephalopathy. medications, toxic/metabolic, infection, and anoxia are common causes. no epileptiform discharges or electrographic seizures are seen during this recording. note is made of a bifid p wave in a single ekg channel. . kub - there is relative paucity of the bowel gas with the bowel loops centered in the mid lower abdomen. there is no evidence of bowel dilatation.there is no evidence of extensive amount of stool within the colon. the gastrostomy is projecting over the left upper quadrant. bilateral pleural effusions are present. . lue us - left brachial vein thrombus with questionable minimal flow around it, new since prior exam from . . tee - no valvular or pacemaker associated vegetations seen. moderate to severe tricuspid regurgitation (leaflets do not coapt). severely depressed left ventricular systolic function. . ruq us - 1. contracted gallbladder without stones. no son evidence for cholecystitis or significant biliary ductal dilatation. 2. equivocal nodularity to the hepatic contour may suggest underlying chronic liver disease. . ct neck w. and without contrast -1. no obvious large focus of abnormal enhancement rim-enhancing lesions to suggest abscess. 2. obliteration of the oropharynx secondary to apposition of nasopharyngeal soft tissues, the soft palate and the base of the tongue. 3. prominence of hypopharyngeal and nasopharyngeal soft tissues, which requires clinical correlation with direct ent examination. 4. thickening of palatine tonsils, right greater than left, which require clinical correlation by direct ent examination. 5. mildly enlarged level iia lymph node, most likely reactive, less likely infective. 6. changes in the lung apex- likely pleural- consider dedicated chest imaging, if not performed earlier. . cxr: the cardiomegaly is unchanged. the left retrocardiac opacity has increased in the interim slightly, but it might be associated with interval development of mild interstitial pulmonary edema that contributes to worsening of the left basal opacity. the tracheostomy and the pacemaker leads are in unchanged position. the left costophrenic angle was not included in the field of view. brief hospital course: 43yom with anoxic brain injury, s/p peg & trach, after a pea arrest on the ep table in (pt was undergoing vt ablation); admitted with stable tongue laceration (1 week old) from biting tongue, found to be bacteremic with mrsa. . #. tongue laceration: the laceration was covered with granulation tissue, no purulence/erythema, and ent (who was consulted in the ed) thought no urgent intervention was required. on talking to the patient??????s sister and mother further, it seems that the patient??????s tongue biting occurred intermittently for the week or two prior to admission, when he was on medication ??????to bring down his k??????. he underwent ct neck w/contrast to evaluate for an irritative focus (no abnormality was seen). he then bit off more tongue on , omfs was consulted, and pulled 2 loose teeth that were thought to be the culprit. finally on the pt underwent total teeth extraction. he will need an out-pt appointment with ent if family elects to have tongue fixed for cosmetic purposes. . # mrsa bacteremia: high grade bacteremia with 6/6 bottles positive on , negative cultures since then. the patient will need a 4 week course of vanc 1g q12h, ending on , and will need vanc level, bun, cr weekly until then. additionally, the patient will be treated with possible vap with cefepime/cipro (day 1 = , 7 day course will end on ). tee did not show vegetations or involvement of ; per id recs, will keep cardiac hardware in place for now. . # aspiration pna: resolved. sputum cx c/w aspiration pna, pt noted to also have secretions and suspect high aspiration risk. sputum growing respiratory flora and gnr; however, this is not uncommon in pts with a trach, so will d/c antibiotics given admission cxr did not show infiltrates. on , concern for aspiration pneumonia given fever, ?infiltrate on cxr. continued . #. l ue thrombus: lue us showed thrombus of brachial vein. lovenox was held while hospitalized given bleeding risk. at discharge will restart lovenox on . . #. s/p anoxic brain injury: ct head with stable reduction in -white differentiation, unchanged from previous. eeg results: abnormal portable eeg due to slowing and disorganization of a low voltage background rhythm. this finding is consistent with a mild to moderate encephalopathy. medications, toxic/metabolic, infection, and anoxia are common causes. no epileptiform discharges or electrographic seizures are seen during this recording. patient continued with trach/vent. . #. chf: pt appears volume up on exam, with peripheral edema (off baseline, per pt??????s family), jvd difficult to assess. increased volume on cxr. holding spironolactone for now, while monitoring k. patient continued on lasix 20mg daily. restarted lisinopril on . lisinopril initially held given elevated potassium. plan to restart spironolactone after labs are checked as outpatient and creatinine and potassium are normal. . #. abd distention: unclear why he is distended; kub ordered from radius on shows no evidence of obstruction. two bms overnight. abdominal exam very tympanitic, with gush of air when peg tube accessed. continues to be non-tender. reassuring labs (incl lfts and lipase) and kub. think pt??????s distension likely due to air swallowing. mildly lft??????s today, stable. ggt elevated. consider drugs versus biliary source. ruq u/s showed no stone, no cholecystitis and ?nodularity to hepatic contour that may suggest underlying chronic liver disease. hep panel neg for hepb or c infections. . #. hyperlipidemia, h/o stemi: continue home regimen of asa, lipitor. continued carvedilol. lisionopril restarted at discharge. . #. gerd: continued home omeprazole 40 mg qd . #. diabetes: continued humalog ssi (decease to checks as pt is not requiring any insulin) . #. fen: continued home mvi, b1, folic acid. continued on tube feeds (replete with fiber at 70 cc/hr), free water flushes 200 ml q6 hours, however holding tfs for now. . #. access: picc on right placed . #. ppx: pneumoboots for dvt ppx, bowel regimen, home omeprazole . #. code: full medications on admission: asa 325 mg qd carvedilol 25 mg lasix 20 mg qd lipitor 10 mg qd lasinopril 10 mg qd spironolactone 25 mg qd lactulose (for constipation?) prilosec 40 mg qd mvi, thimaine, folate tylenol peridex combivent sqh novolin discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 3. aspirin 325 mg tablet : one (1) tablet po daily (daily). 4. atorvastatin 10 mg tablet : one (1) tablet po daily (daily). 5. acetaminophen 160 mg/5 ml solution : ten (10) ml po q6h (every 6 hours) as needed for pain, discomfort. 6. therapeutic multivitamin liquid : one (1) tablet po daily (daily). 7. ipratropium-albuterol 18-103 mcg/actuation aerosol : puffs inhalation q6h (every 6 hours) as needed for wheezing. 8. furosemide 20 mg tablet : one (1) tablet po daily (daily). 9. ciprofloxacin 750 mg tablet : one (1) tablet po q12h (every 12 hours): last dose on . . 10. insulin sliding scale see attached insulin sliding scale 11. carvedilol 12.5 mg tablet : two (2) tablet po bid (2 times a day): hold for sbp<100 or pulse<60. 12. lorazepam 2 mg/ml syringe : one (1) mg injection q8h (every 8 hours) as needed for anxiety. 13. heparin, porcine (pf) 10 unit/ml syringe : one (1) ml intravenous prn (as needed) as needed for line flush: picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. order was filled by pharmacy with a dosage form of syringe and a strength of 10 unit/ml. 14. pantoprazole 40 mg recon soln : one (1) recon soln intravenous q24h (every 24 hours). 15. vancomycin in dextrose 1 gram/200 ml piggyback : one (1) intravenous every twenty-four(24) hours: last dose 1/17. pt will need vanc level, bun, creatinine weekly while on vancomycin. 16. cefepime 2 gram recon soln : one (1) recon soln injection q12h (every 12 hours): last dose on . . 17. lovenox 80 mg/0.8 ml syringe : one (1) subcutaneous twice a day: please start . . 18. lisinopril 10 mg tablet : one (1) tablet po once a day. 19. outpatient lab work weekly vancomycin trough, chem10, and cbc. discharge disposition: extended care facility: hospital discharge diagnosis: primary: tongue laceration secondary to tongue biting, anoxic brain injury, bacteremia secondary: diabetes, hyperlipidemia discharge condition: mental status:confused - always level of consciousness:lethargic but arousable activity status:bedbound discharge instructions: dear mr. . you were admitted to the hospital after lacerating your tongue at your rehabilitation facility. during your stay you were found to have bleeding secondary to tongue laceration. oral maxillofacial surgery removed your teeth and bleeding was controlled. you were found to have bacteria in your blood. your heart was evaluated for endocarditis and was negative. you were also found to have a ventilator acquired pneumonia. you were started on iv antibiotics to treat this infection. please see attached list for up to date medication list. weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: device clinic phone: date/time: 9:30 phone: date/time: 10:00 , : date/time: 11:00 . ear nose throat: please call at your earliest conveniecne for further evaluation regarding your tongue laceration repair. (. procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances other surgical extraction of tooth alveoloplasty diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus bacteremia old myocardial infarction chronic systolic heart failure automatic implantable cardiac defibrillator in situ methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site encephalopathy, unspecified tracheostomy status acute venous embolism and thrombosis of deep veins of upper extremity open wound of tongue and floor of mouth, without mention of complication human bite other specified psychophysiological malfunction 

Answer: The patient is high likely exposed to