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 attending: chief complaint: mssa endocarditis, nafcillin desensitization major surgical or invasive procedure: pars plana vitrectomy intravitreal antibiotic injection, & transesophageal echocardiogram, & history of present illness: 60f w/ esrd on hd, dm she was transferred from osh icu for further management of endocarditis and mssa bacteremia. very limited historian and most of history obtained from osh records. she was at hd when developed t 101.4 which grew 4/4 bottles mssa. she was intiially at and was started on vanc/gent and tte revealed thickened mitral valve with vegetation. she then became hypotensive to 70/50 requiring a low dose levophed and was transferred to icu on . . at icu, she was desensitized to pcn and started on nafcillin. id consult recommended against continuing gent. she had some loose stools, was empirically started on flagyl, but then c. dif neg x 1 and flagyl stopped. u/s of avf negative for abscess; however, renal felt that if she peristantly spiked temps, then she should have tagged wbc scan to rule out avf infection. . upon arrival to , she has no complaints, answering only yes/no answers. she denies pain, sob, palpitations, fever, chills, n/v, diarrhea. past medical history: esrd on hd t/th/sat cad s/p imi dm2 htn hyperlipidemia s/p ccy social history: -lives at home, independently -never smoked -no etoh -no drug use family history: father with prostate ca physical exam: admission physical exam vs: afebrile, sbp 90-100s general: very flat affect, nad heent: normocephalic, atraumatic. mm dry. op clear. cardiac: reg rate nl s1s2 ii/vi holosystolic murmur at apex lungs: ctab abdomen: nabs. soft, nt, nd. no hsm extremities: no edema or calf pain skin: no splinters, oslers neuro: oriented to being in a hospital and name. does not know date. decreased le strength, right>left psych: listens and follows only simple commands, but answers mainly only yes or no; stares off blankly pertinent results: osh micro: 4/4 bottles mssa . blood cx negative . 6:55 pm stool consistency: loose source: stool. **final report ** clostridium difficile toxin a & b test (final ): reported by phone to @ 5:30a . clostridium difficile. feces positive for c. difficile toxin by eia. (reference range-negative). a positive result in a recently treated patient is of uncertain significance unless the patient is currently symptomatic (relapse). . rpr non-reactive . osh echo: lvef 45%, mv thickened with densities which prolapse into la. 2+ mr, trace ar and thickening of leaflets. pi present. 3+ tr, pa pressure 51; ra pressure 15 . cardiology report ecg study date of 9:59:44 pm sinus rhythm. left axis deviation. inferior wall myocardial infarction probably old. poor r wave progression - cannot rule out old anteroseptal myocardial infarction. compared to the previous tracing of there is no significant diagnostic change. . tee no atrial septal defect is seen by 2d or color doppler. there is mild global left ventricular hypokinesis (lvef = 45-50 %). right ventricular chamber size and free wall motion are normal. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. no aortic valve abscess is seen. no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is a large vegetation with calcifications on the mitral valve (1.7cm in length) extending from the anterior mitral annulus. no mitral valve abscess is seen. moderate (2+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is no pericardial effusion. impression: large mitral valve vegetation consistent with endocarditis. moderate mitral regurgitation is present. no abscess was apparent. ct with contrast of head impression: 1. no acute intracranial process; specifically, no evidence of abscess or enhancing mass. 2. ill-defined low-attenuation in right more than left periventricular white matter, likely representing chronic microvascular infarction. 3. no pathologic focus of enhancement. ct with contrast of torso impression: 1. slowly progressive patchy and nodular consolidations predominating in the right upper lobe most likely represent an indolent granulomatous process, possibly sarcoidosis though granulomatous infection/bronchiolitis are other diagnostic considerations. 2. prominent retroperitoneal and pelvic lymph nodes, more prominent compared to but of unclear etiology. 3. massive right hydronephrosis and cortical thinning likely secondary to chronic right upj obstruction. 4. findings raising the question of chronic pancreatitis. 5. anasarca with bilateral small effusions and small ascites. doppler le impression: no evidence of dvt in the bilateral lower legs. ___________________________________ mra/mri of brain impression: multiple infra- and supratentorial foci of restricted diffusion as described in detail above likely consistent with thromboembolic ischemic events. mra of the head: there is evidence of vascular flow in both internal carotids, the left vertebral artery is patent and also the basilar artery, the right vertebral artery is not completely visualized and possibly ends in pica, however occlusion secondary to arteriosclerosis cannot be completely excluded, diffuse lack of signal is visualized in the distal branches also possibly representing atherosclerotic disease, this is a limited examination secondary to motion artifacts, therefore the distal branches of the circle of are not completely evaluated. _______________________________________ tee on no thrombus is seen in the left atrial appendage. there is moderate regional left ventricular systolic dysfunction with inferior and inferolateral hypokinesis. overall left ventricular systolic function is moderately depressed (lvef= 35-40 %). there are complex (>4mm) atheroma in the aortic arch and descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. the mitral valve leaflets are moderately thickened. there are 2 large vegetations (1.7cm and 1.4 cm in lengths) and a third smaller vegetation (0.3 cm) arising from the base of the anterior mitral valve leaflet. also seen is a possible small vegetation associated with the right cusp of the aortic valve. moderate (2+) mitral regurgitation is seen. due to acoustic shadowing, this study was not adequate to exclude an abscess. there is a small pericardial effusion. no definite abscess seen, but cannot be excluded with certainty. compared with the findings of the prior study (images reviewed) of , the mitral valve vegetations appear larger and left ventricular contractile function is more depressed along with inferolateral hypokinesis. impression: large vegetations consistent with endocarditis of the mitral valve. this study was not able to exclude the presence of an abscess. ____________________________________________ tagged wbc scan impression: normal white blood cell study. no abnormal tracer uptake. ___________________________________________ ct abd/pelvis without contrast impression: 1. massive right hydronephrosis and cortical thinning consistent with a classic longstanding ureteropelvic junction obstruction dating back to at least . 2. pelvic nodes are unchanged. 3. possible chronic pancreatitis. 4. anasarca with unchanged effusions. ___________________________________________ mr head w/o contrast findings: again multiple areas of slow diffusion are identified in the white matter in the periventricular region including involvement of the corpus callosum. the areas are seen in both frontoparietal lobes as well as in the temporal lobe. small focus of signal abnormalities seen in the right cerebellum and also in the left side of the brain stem. overall the foci have evolved since the previous study and no definite new abnormalities are seen. there is no midline shift noted. mild brain atrophy identified. impression: evolution of previously noted acute subcortical infarcts in the supra and infratentorial regions. no new signal abnormalities are seen. . eeg impression: this is an abnormal routine eeg recording in the awake and sleeping states due to the slow background suggestive of a mild encephalopathy. metabolic disturbances, medications, and infections are among the most common causes. there were no lateralized or epileptiform features seen. . brief hospital course: #methicillin-senstive staph aureus mitral valve endocarditis - osh blood cultures showed high-grade mssa bacteremia and echo demonstrated mitral thickening with 2+ mr densities prolapsing into the left atrium la. ultrasound and tagged wbc scan did not reveal a source of infection in the lue av graft. she was had transient hypotension requiring levophed prior to transfer. she was desensitized to nafcillin in the icu. tee showed a 1.7 cm mitral valve vegetation, moderate mr but no apparent abscess. repeat tee showed 3 vegetations (1.7 cm,1.4 cm,0.3 cm) on the mitral valve but could not definitively exclude an abscess. nafcillin was changed to vancomycin on out of concern for drug fever. daily surveillance blood cultures remained negative. daily ekgs and telemetry monitoring did not show any evidence of conduction abnormality. the patient expressed an unequivocal desire to forego valve replacement surgery. her family agreed. given their preferences, as well as high operative morbidity, that the patient defervesced on antibiotic therapy, and that a repeat mri did not show further evidence of cerebral septic emboli, the medical team agreed to continue with 6 weeks of antibiotic therapy (through ). she underwent repeat nafcillin desensitization on in the micu without complication. she may benefit from surveillance cultures and repeat tee at the conclusion of her antibiotic course. she will follow-up with her pcp and id as an outpatient. . #endogenous staph aureus endophthalmitis, right eye - the patient was evaluated by ophthalmology for right eye visual complaints. she was found to have evidence of endophthalmitis on exam and was treated immediately with intravitreal vancomycin and then with ppv on . she will follow-up with ophthalmology as an outpatient. . #cerebral septic thromboembolic disease - mri of the brain on showed multiple infra- and supratentorial foci of restricted diffusion consistent with thromboembolic ischemic events. there were no focal neurological findings on examination. repeat mr on showed evolution of these previously noted acute subcortical infarcts but no new signal abnormalities. eeg showed mild non-specific encephalopathy. she will follow-up with neurology as an outpatient. . #clostridium difficile colitis - started on flagyl to be continued for 1 week beyond the course of nafcillin (). maintained on contact precautions. . #end-stage renal disease on hemodialysis - continued hd tu/th/sa with vancomycin given per hd protocol. . #diabetes mellitus type ii - well-controlled on an insulin sliding scale. . #hypertension - well-controlled on reduced dose of metoprolol 12.5 mg which was started when the patient was hemodynamically stable. therefore, amlodipine and benicar were discontinued. . #transaminitis - alt 77 ast 123 on . patient did not have fever, nausea, abdominal pain or tenderness. therefore, planned to monitor expectantly and repeat lft's . medications on admission: home medications: pantoprazole 40 daily calcium acetate 1337 tid amliodipine 10 daily metoprolol 25 benicar 40 daily asa 81 . medications on transfer: nafcillin iv q4h ppi calcium acetate discharge medications: 1. aspirin 81 mg tablet sig: one (1) tablet po once a day. 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. insulin lispro 100 unit/ml solution sig: one (1) inj subcutaneous asdir (as directed): per attached sliding scale. 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 5. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day): hold for sbp<100, hr<55. 6. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation: please give if no bm in 2 days. 8. bacitracin 500 unit/g ointment sig: one (1) appl ophthalmic qid (4 times a day). 9. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain, fever. 10. ondansetron 8 mg iv q8h:prn nausea 11. nafcillin 2 g iv q4h 12. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection injection tid (3 times a day). 13. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain, fever. 14. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for irritation. 15. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day): please administer after hemodialysis on tuesday/thursday/saturday last dose . 16. prednisolone acetate 1 % drops, suspension sig: one (1) drop ophthalmic q1h (every hour). 17. scopolamine hbr 0.25 % drops sig: one (1) drop ophthalmic (2 times a day). 18. bacitracin 500 unit/g ointment sig: one (1) appl ophthalmic qhs (once a day (at bedtime)). 19. ciprofloxacin 0.3 % drops sig: one (1) drop ophthalmic qid (4 times a day). 20. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 21. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. discharge disposition: extended care facility: tba discharge diagnosis: primary 1) methicillin-senstive staph aureus mitral valve endocarditis 2) endogenous staph aureus endophthalmitis, right eye 3) cerebral septic thromboembolic disease 4) clostridium difficile colitis secondary 1) end-stage renal disease on hemodialysis 2) diabetes mellitus type ii 3) hypertension discharge condition: clinically improved with stable vital signs. discharge instructions: you were admitted to the with endocarditis, an infection on one of the heart valves. your infection caused damage to your right eye, as well as small strokes in the brain. your infection was partially treated with antibiotics. you will need to complete a total of 6 weeks of antibiotics (through ). the following medication changes were recommended: 1) nafcillin 2 grams every 4 hours through , . 2) metoprolol was decreased to 12.5 mg twice daily. 4) eye drops were started after your right eye surgery. 5) amlodipine was discontinued. 6) benicar was discontinued. 7) calcium acetate was discontinued. please attend all of your follow-up appointments. please call your physician or return to the emergency department if you experience fever, chills, sweats, dizziness, lightheadedness, passing out, chest pain, palpitations, cough, wheezing, shortness of breath, abdominal pain, back pain, leg swelling, rash, vision changes, numbness, weakness, tingling, or other worrisome symptoms. followup instructions: please follow-up with at the clinic on wednesday, at 9:30 am. please call if you wish to reschedule. please follow up with the department of infectious diseases on at thursday, at 9 am. please call ( if you wish to reschedule. please call the office of dr. at for an appointment at your earliest convenience. provider: , dpm phone: date/time: 1:50 provider: , m.d. phone: date/time: 9:30 provider: , .d. phone: date/time: 11:40 procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances hemodialysis injection of vitreous substitute mechanical vitrectomy by anterior approach diagnoses: end stage renal disease diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled methicillin susceptible staphylococcus aureus septicemia sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site intestinal infection due to clostridium difficile acute and subacute bacterial endocarditis cerebral embolism with cerebral infarction hydronephrosis purulent endophthalmitis, unspecified 

Answer: The patient is high likely exposed to