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: no known allergies / adverse drug reactions attending: chief complaint: dizziness major surgical or invasive procedure: ir guided tunneled dialysis line exchange history of present illness: patient is a 61 male with history of seizure disorder, nonischemic cardiomyopathy ef 20-30%, renal disease on hd, hepatitis b, cad and cva with residual right lower extremity weakness, gout, wheelchair-bound presents with dizziness per report at rehabilitation facility for the past 4-5 hours. patient denies ever feeling dizzy and is complaining of right knee pain that began 2 days ago. per ems, patient was hypotensive to the 70s systolic. patient had dialysis , reports less fluid removed than usual. denies fever, chest pain, shortness of breath, abdominal pain, nausea, vomiting but did endorse diarrhea x 4 on . in the ed, initial vs were: 10 96.3 89 79/47 18 100%. exam was notable for baseline rle weakness, r knee swollen and infrapatellar ttp. ekg was sinus 88 ivcd qtc 455. cxr showed no pneumonia or pleural effusion. bedside u/s showed no frank pericardial effusion but difficult anatomy. labs were significant for troponin 0.14 (baseline 0.12-0.16). he was given a 500 cc fluid bolus and sbp improved to the 80s. he was mentating well. vs on transfer were p: 79, bp: 79/69, o2 sat 99% on ra on the floor, patient is complaining of right knee pain. he has not taken any medication for the pain. he also complained of intermittent cramping of the leg that is now resolved. past medical history: - seizure disorder since mid 's after starting dialysis - mssa hd line infection with septic lung emboli with left pleural effusion - h/o hepatitis b, treated - non-ischemic cardiomyopathy, last ef 20-30% - mi per pt - cva per pt (?residual le weakness) - esrd on hemodialysis htn. edw 80 kg as of . - multiple thrombectomies in lue and r thigh av fistula - graft excision for infected thigh graft - hungry bone syndrome status post parathyroidectomy - pituitary mass - anemia of chronic disease - s/p peg tube placement - admission to micu in for seizure and hypotension - swab positive for mrsa and vre at left groin site in and mrsa positive from same site social history: retired piano and organ teacher. has 2 phds (history and music) and prefers to be called "dr. ." walks with a walker at baseline. never smoker, no other drug use. drinks 1 drink/week. has 2 sisters that live out of state, son died 3 years ago ("was shot to death"). family history: father with dm, mother died at age 41 of renal failure physical exam: on admission: vitals: t: 97.1, p: 73, bp: 93/51, rr: 14, 99% on ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: right knee with effusion, ttp, minimal warmth, no erythema. pain with active and passive rom neuro: a&ox3, cnii-xii intact, baseline rle weakness on discharge: vitals: 98.7 118/59 76 20 96%ra general: alert, oriented, no acute distress neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally cv: regular rate, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: right knee with minimal effusion, no erythema, denies pain pertinent results: on admission: 12:40am blood wbc-10.8# rbc-3.96* hgb-11.0*# hct-34.6* mcv-87 mch-27.7 mchc-31.7 rdw-15.3 plt ct-448*# 12:40am blood pt-12.5 ptt-34.2 inr(pt)-1.2* 12:40am blood glucose-107* urean-38* creat-8.6*# na-139 k-4.5 cl-92* hco3-27 angap-25* 05:06am blood ck-mb-2 ctropnt-0.11* 12:40am blood ctropnt-0.14* 05:06am blood calcium-8.0* phos-4.4 mg-1.6 05:06am blood tsh-0.68 06:33am blood cortsol-22.1* 06:00am blood cortsol-27.6* 05:21am blood cortsol-12.2 05:06am blood digoxin-<0.2* on discharge: 06:20am blood wbc-6.0 rbc-3.36* hgb-9.0* hct-29.3* mcv-87 mch-26.7* mchc-30.6* rdw-15.1 plt ct-398 06:20am blood glucose-85 urean-47* creat-9.5*# na-135 k-5.3* cl-95* hco3-31 angap-14 06:20am blood calcium-9.7 phos-4.2 mg-2.3 05:06am blood ck-mb-2 ctropnt-0.11* 06:33am blood cortsol-22.1* 06:20am blood vanco-14.3 right knee arthrocentesis: 09:05am joint fluid wbc-140 rbc-0 hct,fl-4.0* polys-39* lymphs-37 monos-24 09:05am joint fluid crystal-none gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. microbiology: blood culture, routine (final ): no growth. blood culture, routine (final ): staphylococcus epidermidis. sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus epidermidis | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ =>16 r levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- =>32 r tetracycline---------- 2 s vancomycin------------ 1 s aerobic bottle gram stain (final ): gram positive cocci in pairs and clusters. anaerobic bottle gram stain (final ): gram positive in pairs and clusters. blood culture, routine (final ): staphylococcus epidermidis. sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus epidermidis | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ =>16 r levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- =>32 r tetracycline---------- 2 s vancomycin------------ 2 s aerobic bottle gram stain (final ): gram positive cocci in clusters. anaerobic bottle gram stain (final ): gram positive cocci in clusters. blood culture, routine (final ): staphylococcus, coagulase negative. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus, coagulase negative | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ =>16 r levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- =>32 r tetracycline---------- 2 s vancomycin------------ 2 s aerobic bottle gram stain (final ): gram positive cocci in clusters. anaerobic bottle gram stain (final ): gram positive cocci in clusters. blood culture, routine (final ): no growth. blood culture, routine (pending): 8:00 am blood culture 1 of 2. blood culture, routine (pending): 8:15 am blood culture #2. blood culture, routine (pending): 11:19 am blood culture source: line-dialysis. blood culture, routine (pending): 6:21 am blood culture source: line-dialysis. blood culture, routine (pending): 3:56 pm catheter tip-iv source: tunneled ij hemodialysis line. wound culture (preliminary): gram positive coccus(cocci). >15 colonies. ecg : sinus rhythm. left bundle-branch block. compared to the previous tracing of there is no significant change. portable cxr : findings: single frontal view of the chest in semi-erect position demonstrates stable position of a dual-channel central venous catheter with tip terminating in the upper right atrium. the patient is slightly rotated to the left. cardiomediastinal silhouette is within normal limits. multiple clips are seen overlying the right apex. rightward upper tracheal displacement is related to known enlarged left thyroid lobe as seen on ct dated . the lungs are clear with trace, if any, basilar atelectasis. there is no pneumothorax, vascular congestion, or pleural effusion. multiple remote fractures are seen on the left posteriorly, unchanged. impression: no definite evidence to suggest pneumonia or fluid overload. right knee x-ray : findings: no previous studies available for direct comparison. there is a small joint effusion. there are no signs for acute fractures or dislocations. there is mild lateral compartmental joint space narrowing. vascular calcifications are seen. prominent spur at the inferior pole of the patella is seen, which may be sequela of remote trauma. impression: small joint effusion without signs for acute fracture. tte : the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. there is moderate regional left ventricular systolic dysfunction with hypokinesis of the inferior and inferolateral segments.. left ventricular dyssynchrony is present. right ventricular chamber size and free wall motion are normal. there is abnormal septal motion/position. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , there is probably less dyssynchrony present. the inferior and inferolateral walls appear hypokinetic on the current study. they may have been hypokinetic on prior also but image quality limited assessment. cannot exclude endocarditis on the basis of this study - if clinically indicated, a transesophageal echocardiogram may better assess for valvular vegetations. right lower extremity ultrasound : impression: no right lower extremity dvt. brief hospital course: patient is a 61 male with history of seizure disorder, nonischemic cardiomyopathy ef 20-30%, esrd on hd, hepatitis b, cad and cva who presented with dizziness and hypotension in the setting of diarrhea. #hypotension: patient has low baseline blood pressure. from records he has had systolic bp as low as 77 but on repeat was 92. he was never symptomatic from hypotension. his relative hypotension was likely worsened by acute episodes of diarrhea or secondary to bacteremia. hypotension resolved with ivfs. his cortisol level was normal. bps were taken from his leg per his usual. bps ranged 90s to 140s throughout remainder of hospital stay. his lisinopril continued to be held. #bacteremia: blood cultures from and grew coag neg staph. he was started on vancomycin on , given at hemodialysis. he was seen by infectious disease who recommended continued antibiotics for total course of two weeks after first negative blood culture (). subsequent blood cultures did not show growth to date but final results were pending at time of discharge. his presumed source of bacteremia was his tunneled dialysis line. after discussion with interentional radiology and infectious disease, it was decided to exchange the line over wire after 48hours of negative blood cultures. this was decided because the patient had very limited options in terms of access. pt underwent ir guided hd line exchange over wire on . he subsequently developed small hematoma at the site. he tolerated dialysis the following day and was discharged to rehab. he reported feeling well and had no leukocytosis for his entire hospital stay. he had low grade temp of 100.5 on but was afebrile thereafter. this may have been due to the hematoma at his new dialysis line site. the tip of the old hd line was sent for culture and was growing gpcs by time of discharge (final speciation pending). a vancomycin antibiotic lock was placed before discharge and will be continued at outpatient dialysis. of note, tte was performed that did not show evidence of vegetations. # right knee effusion: pt has rle weakness at baseline. he presented with swelling and pain in the right knee. joint aspiration was performed by rheumatology and revealed hemarthrosis. patient denied trauma and unclear etiology. pain improved after fluid removal and with minimal doses of oxycodone prn. fluid culture showed no growth. right lower extremity ultrasound was negative for dvt # diarrhea: pt initially reported watery, non-bloody. this resolved after admission. there was no sign of infection- no fever or leukocytosis. etiology may be related to home laxatives which were held during hospital stay. # esrd: pt undergoes hd on tu, th, sat. he underwent hd according to his schedule without complications. tunneled line was exchanged over wire per above. # cad/chf: no sign of volume overload or acs. troponin at baseline. he was continued on his home simvastatin, aspirin, digoxin. # seizure disorder: stable. continued on levetiracetam and oxcarbezepine. medications on admission: (per omr- confirm with in am) allopurinol - 100 mg po every other day calcium acetate - 667 mg- 4 capsule(s) tid with meals digoxin - 125 mcg po every other day folic acid - 1 mg po once a day gabapentin - 100 mg capsule - 2 capsule(s) by mouth daily levetiracetam - 500 mg po tid extra dose post hd. lisinopril - (on hold from to unknown for due to low bps) - 2.5 mg tablet - 1 tablet(s) by mouth daily omeprazole - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth daily oxcarbazepine - 300 mg tablet - 1 tablet(s) by mouth tid. on hd days take one extra tab post hd. sevelamer hcl - 800 mg tablet - 2 tablet(s) by mouth with meals tid simvastatin - 20 mg tablet - 1 tablet(s) by mouth daily acetaminophen - 325 mg tablet - 2 tablet(s) by mouth every 6 hours as needed for as needed for pain not exceed 4grams in 24 hours aspirin - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth daily bisacodyl - 5 mg tablet, delayed release (e.c.) - 2 tablet(s) by mouth daily as needed for constipation chlorhexidine gluconate - 4 % liquid - use daily for 7 days, then 1-2 times/week daily ferrous sulfate - 325 mg (65 mg iron) tablet - 1 tablet(s) by mouth daily sarna - 0.5-0.5% lotion - apply liberally to skin on hands, feet sennosides - 8.6 mg capsule - 1 capsule(s) by mouth at bedtime discharge medications: 1. allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). 2. calcium acetate 667 mg capsule sig: four (4) capsule po tid w/meals (3 times a day with meals). 3. digoxin 125 mcg tablet sig: one (1) tablet po every other day (every other day). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. gabapentin 100 mg capsule sig: two (2) capsule po daily (daily). 6. levetiracetam 500 mg tablet sig: one (1) tablet po 3x/week (tu,th,sa): extra dose to be given on dialysis days after dialysis. 7. levetiracetam 500 mg tablet sig: one (1) tablet po tid (3 times a day). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. oxcarbazepine 300 mg tablet sig: one (1) tablet po three times a day. 10. oxcarbazepine 300 mg tablet sig: one (1) tablet po three times a week (tues, thurs, sat): extra dose to be given on dialysis days after dialysis. 11. sevelamer carbonate 800 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 12. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 13. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain: do not exceed 4 grams in 24 hours. 14. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 15. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 16. bisacodyl 5 mg tablet sig: two (2) tablet po once a day as needed for constipation. 17. senna 8.6 mg capsule sig: one (1) capsule po at bedtime: hold for loose stools; pt may refuse. 18. chlorhexidine gluconate 4 % liquid sig: one (1) topical times each week. 19. sarna anti-itch 0.5-0.5 % lotion sig: one (1) topical once a day: apply liberally to skin on hands, feet . 20. vancomycin in d5w 1 gram/200 ml piggyback sig: as directed intravenous hd protocol (hd protochol): to be dosed based on trough and given on hemodialysis; continue until . 21. oxycodone 5 mg tablet sig: one (1) tablet po every twelve (12) hours as needed for pain. discharge disposition: extended care facility: senior healthcare of discharge diagnosis: primary: bacteremia with staph epidermidis right knee effusion secondary: esrd on hd discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: it was a pleasure taking care of you in the hospital. you were admitted with low blood pressures and your blood cultures were growing a bacteria called staph epidermidis. you were started on vancomycin which you will continue to receive at hemodialysis for a total course of two weeks. this infection could have been caused by your dialysis line; this line was exchanged during your hospital stay. you were also seen by our rheumatology team for right knee swelling. this showed blood in your knee joint. please continue dialysis on tues, thurs, sat. you will be seen by dr who will be monitoring your tunneled line site. weigh yourself every morning, md if weight goes up more than 3 lbs. the following changes were made to your medications: 1) vancomycin, dosed by level at hemodialysis, for a total course of two weeks (stop on ) 2) oxycodone 5mg every 12 hours as needed for pain followup instructions: we are working on a follow up appointment in infectious disease. the office will contact you at the facility with the appointment information. if you have not heard within 2 business days or have any questions please call . procedure: hemodialysis venous catheterization for renal dialysis arthrocentesis removal of other device from thorax diagnoses: other primary cardiomyopathies anemia in chronic kidney disease end stage renal disease renal dialysis status coronary atherosclerosis of native coronary artery congestive heart failure, unspecified gout, unspecified personal history of other infectious and parasitic diseases hypotension, unspecified bacteremia other late effects of cerebrovascular disease old myocardial infarction chronic systolic heart failure epilepsy, unspecified, without mention of intractable epilepsy diarrhea kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus other musculoskeletal symptoms referable to limbs bloodstream infection due to central venous catheter hemarthrosis, lower leg hungry bone syndrome other specified disorders of parathyroid gland 

Answer: The patient is high likely exposed to