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: codeine / lipitor attending: chief complaint: anemia work-up major surgical or invasive procedure: endotracheal intubation left ij cvc placement right arm picc line placement history of present illness: 66 yo f with pmh of multiple cvas, cad, htn, hld, esrd on hd m/w/f, h/o ugib, gastritis, duodenitis, with recent admission for hcap c/b new left parietal stroke, seizure and hypertensive urgency, now admitted from rehab for work-up of anemia, with development of septic shock in the ed. per report from ed, patient had persistent anemia at rehab, and was undergoing work-up there. she was transfused with 4 units prbcs over the several days prior to admission, with subsequent h/h 6.6/19.8 prior to admission (from 9.3/29.5 at the time of prior ). at , she did not have any reported melena, hematochezia or hematemesis; she was guaiac negative. anemia work-up was pursued with ct/abd pelvis which was negative for rp bleed (), ruq scan showed subcutaneous edema but not fluid collections. gi team consulted at on did not believe that patient had gi bleed; their gi lavage was negative. of note, she was dialyzed with 2l taken off on prior to transfer to ed. doctors requested neuro and heme/onc consults at for anemia work-up, as it was thought that recently initiated dilantin may be contributing. baseline neuro status at includes arousal to noxious stimuli. in the ed, initial vs were: t 98.0 hr 80 bp 146/60 rr 14 sao2 98% 2l nc. she was guaiac negative, with no noted melena, brbpr or hematochezia. was noted to be non-verbal with occasional eye-opening and moaning to noxious stimuli. labs were notable for wbc 17.5 with n 93%, h/h 7.2/22.2, probnp 1872, na 130, cl 93, bun 23, cr 3.1, glucose 231, alt 91, ast 124, alk 328, lipase 138, phenytoin 9.7, and initial lactate 1.8. ua showed large le, neg nitrites, 100 pr, 2 rbcs, 92 wbcs, few bacteria, no epis. cxr was rotated, and showed no focal consolidation/effusion with possibly enlarged cardiac silhouette. at 22:00, developed hypotension with decrease in bp from 158/61 to 90/39, along with apneic breathing at 7 breaths per minute. at that time, hr remained in the 80s with rr 14-16 and sao2 96% on 2l nc. a left ij triple lumen cvl was placed for resuscitation. patient was intubated with etomidate/rocuronium. initial abg was 7.48 / 34 / 223/ 26 with lactate 3.9. cxr confirmed placement of ett 4 cm above carina and cvl in lower svc. in the ed, she was given etomidate 20 mg iv x1 and rocuronium 80 mg iv x1 for intubation, and maintained on fentanyl/midazolam for sedation. she was started on norepinephrine drip for pressor support initially at 0.03 mcg/kg/min and uptitrated to 0.05 mcg/kg/min. she was also given vancomycin 1 g iv x1 and cefepime 2 g iv x1. she was given 1 unit of blood and 1l ns fluid bolus. vs prior to transfer were: t 98.7 bp 137/72 hr 93 rr 30 sao2 100% on vent settings 450 tidal vol / 16rr /5peep 50%. most recent abg at 23:57 was 7.48 / 34 / 223 / 26 with ical 1.11 and lactate 3.1. on arrival to the micu, patient was intubated and sedated. second unit of blood ordered from ed was continued. review of systems: unable past medical history: 1. coronary artery disease - s/p cath (): mild epicardial disease, collalateral flow to distal inferior wall, no intervention 2. hypertension 3. hyperlipidemia 4. diabetes: complicated by retinopathy, neuropathy, and nephropahy 5. esrd on hd mwf 6. stroke: left frontal mca and occipital pca stroke 7. impaired memory s/p mva 8. anemia 9. history of mssa pna, 10. treated for presumptive endocarditis, 11. h/o upper gi bleed nos, gastritis, duodenitis social history: born in . denies tobacco, etoh. now at rehab since last hospitalization. family history: -father died in his 70's with heart disease -siblings (two sisters) with diabetes mellitus (type ii). physical exam: admission exam: vitals: t: 97.2 bp: 153/66 p: 90 r: 20 sao2: 100% on cmv assist tv 400 x 14 rr with peep 5, fio2 40% cvp: general: intubated/sedated, appears comfortable heent: sclera anicteric, mmm, oropharynx clear, +anisocoria with left pupil constricted to 1 mm responsive to light; left pupil 2 mm and unresponsive to light. neck: left ij central line with edema, unable to assess jvp secondary to habitus cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: poor air movement with coarse upper respiratory sounds tramsitted throughout. abdomen: nabs, soft, non-tender, non-distended gu: +foley ext: warm, well perfused, 2+ distal pulses, 3+ nonpitting edema in right hand, 2+ nonpitting edema in left hand, 2+ nonpitting edema of upper extremities neuro: intubated/sedated, anisocoria as above, no response to voice, touch, sternal rub or nailbed pressure. toes are downgoing bilaterally, with wincing and leg movement in response to babinski reflex exam. exam: vitals: 98.5 160/74 r16 84 98%ra gen: awakens to verbal stimuli. in no apparent distress. appears comfortable heent/neck: left ij s/p removal lungs: coarse breath sounds anteriorly. no wheezes cv: s1, s2. systolic ejection murmur, no gallops/rubs aprpeciated. pulses 2+ throughout. no jvd appreciated. extremities: 2+ pitting edema b/l les, nonpitting edema of ues but rue >l . + bruits left arm with overlying dressing at renal fistua site neuro: grips right hand and tracks. pertinent results: i. microbiology blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-final inpatient catheter tip-iv wound culture-final inpatient blood culture blood culture, routine-final inpatient mrsa screen mrsa screen-final inpatient mrsa screen mrsa screen-final inpatient blood culture blood culture, routine-final emergency urine urine culture-final {lactobacillus species} emergency blood culture blood culture, routine-final emergency ii. labs a. admission 06:08pm blood wbc-17.5*# rbc-2.26* hgb-7.2* hct-22.2* mcv-98 mch-31.9 mchc-32.5 rdw-16.5* plt ct-404 06:08pm blood neuts-93* lymphs-2* monos-3 eos-2 baso-0 06:08pm blood pt-10.8 ptt-29.3 inr(pt)-1.0 06:08pm blood fibrino-301 07:00am blood ret aut-3.5* 06:08pm blood glucose-231* urean-23* creat-3.1*# na-130* k-4.2 cl-93* hco3-28 angap-13 06:08pm blood alt-91* ast-124* alkphos-328* totbili-0.5 06:08pm blood probnp-1872* 01:31am blood ck-mb-2 ctropnt-0.07* 08:33am blood ck-mb-3 ctropnt-0.08* 04:15pm blood ck-mb-3 ctropnt-0.06* 06:08pm blood albumin-3.5 calcium-9.0 phos-3.1# mg-2.1 06:08pm blood hapto-128 03:00pm blood vanco-9.3* 06:08pm blood phenyto-9.7* 09:49pm blood type-art po2-110* pco2-35 ph-7.49* caltco2-27 base xs-3 intubat-not intuba 06:35pm blood lactate-1.8 11:57pm blood o2 sat-97 11:57pm blood freeca-1.11* b. 07:00am blood wbc-9.6 rbc-2.78* hgb-8.8* hct-27.2* mcv-98 mch-31.6 mchc-32.3 rdw-17.9* plt ct-519* 07:00am blood pt-19.1* ptt-45.2* inr(pt)-1.8* 07:00am blood glucose-126* urean-21* creat-3.8*# na-136 k-4.2 cl-98 hco3-25 angap-17 07:00am blood alt-3 ast-34 alkphos-386* totbili-0.3 04:15pm blood ck-mb-3 ctropnt-0.06* 07:00am blood albumin-3.2* calcium-9.0 phos-2.9 mg-2.1 iii. radiology a. radiology unilat up ext veins us impression: no acute deep vein thrombosis seen in the right arm. the cephalic vein is very small and appears to contain old thrombus. b. radiology picc line placment sch impression: uncomplicated fluoroscopically-guided double-lumen picc placement preliminary reportvia the right basilic venous approach, the final internal length is 41 cm, preliminary reportwith the tip positioned in the distal svc. the line is ready to use. c. radiology chest port. line placem conclusion: new right-sided picc line has some redundancy in its course and ends in proximal subclavian vein. icu team has been verbally contact with the results. d. cardiovascular echo the left atrium is mildly dilated and elongated. the estimated right atrial pressure is 0-5 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. there is borderline pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , findings are similar. there is no evidence of valvular vegetations (better excluded by tee). e. radiology unilat up ext veins us impression: no evidence of deep vein thrombosis in the right arm. note is made that the right cephalic vein could not be visualized. edematous superficial tissues noted. f. radiology ct head w/o contrast conclusion: no evidence of acute hemorrhage or infarction. g. cardiovascular ecg sinus rhythm. within normal limits. compared to tracing #2 no diagnostic interim change. intervals axes rate pr qrs qt/qtc p qrs t 77 154 92 72 h. radiology ct abd & pelvis w/o con impression: 1. no evidence of retroperitoneal hematoma. 2. calcified fibroids. 3. sub-4-mm right lower lobe pulmonary nodule for which no additional followup is required as it is stable since . i. radiology ct up ext w/c right impression: 1. diffuse subcutaneous edema. 2. mild degenerative changes. brief hospital course: reason for hospitalization: 66 f with complicated pmh including multiple cvas, cad, esrd on hd (mwf), and seizure disorder admitted to micu for respiratory failure requiring intubation and mssa septic shock and bacteremia thought to be secondary to a picc line. acute diagnoses: # respiratory failure: pt was intubated in the ed for apnea in context of sepsis and acidosis. no evidence for active pulmonary disease or pneumonia. extubated on after confirmation of her baseline mental status. breathed and saturated well on room air thereafter. # refractory septic shock: pt was admitted with vasopressor dependent septick shock and subsequently found to have mssa bacteremia which was felt to be secondary to a picc line. the picc was removed in the icu. her graft site for dialysis access did not clinically appear infected making the midline catheter more suspected site. given staph aureus bacteremia, id was consulted and felt that no further work up was indicated given her poor health at baseline. culture data was obtained from the outside hospital and the patient was started on cefazolin based on the sensitivities. she is being treated with cefazolin on hd protocol with 2 grams after monday and wednesday hd and 3 grams after hd session. her course will run from to . patient remained afebrile and without sirs criteria throughout the rest of her stay. # upper extremity swelling: patient developed left upper arm swelling after left cvc placement. she also developed right upper arm swelling after right picc line placement. upper extremity dopplers were negative for dvt (see radiology section). her left central line was discontinued on . her arm swelling sites should be monitored carefully with consideration for repeat dopplers to assess for dvt if indicated. her left arm fistula was functioning properly on . # normocytic anemia: the patient was initially referred to the ed for the evaluation of her anemia, however, she decompensated in the ed and found to have septic shock. patient has hct stable at ~ 27-28 and similar to prior admission. she did need transfusions at an osh for unclear reasons likely from esrd and poor rbc production given her reticulocyte index. she had no signs/symptoms of active bleeding. she should continue on her epo medication in setting of esrd. #nutrition: there is a concern that she will not be able to eat enough to maintain caloric intake. there is thoughts of a peg discussion, but goals of care should be discussed with family as peg has not been to prolong life, improve comfort, or reduce aspiration events in this type of patient. a discussion was held with her daughters, and they want to continue to see how she progresses after this hospitalization. her diet is as follows: 1. po diet: thin liquids, pureed solids. 2. meds crushed with applesauce. 3. 1:1 supervision with pos. 4. feed only when awake and participatory. 5. nutrition consult as needed for oral supplements based on overall po intake. 6. tid oral care. # chronic encephalopathy: as per family, patient is currently at baseline. she is aaox0, arousable to verbal stimuli and touch, and will say one word expressions to family members but not to the medical team. # history of seizures: neurology saw the patient in the er and thought she was stabilized on keppra and phenytoin regimen. her phenytoin level imiproved although not within lab range of (likely closer to based on ablumin). it was felt that there is not likely a need to chagne phenytoin dosing unless the patient has a repeat seizure (last was in during last hospitalization at during hd). # esrd on hd: patient continued on m/w/f schedule. she received her keppra and cefazolin post hd per protocol. # hypertension: upon resolution of septic shock, the patient was restarted on her home anti-hypertensives. # cad: she continues on aspirin and beta-blockade # elevated alp - most likely related to secondary hyperparathyroidism in setting of ckd. phenytoin can also increase alp. as patient has transaminitis, checking ggt to ensure this is indeed bone source and not cholestasis although pending at time of . # transamnitis (wnl in ), likely elevated in setting of sepsis/severe illness. lfts normalized after acute illness # hyperlipidemia: she continues on pravastatin # diabetes complicated by retinopathy, neuropathy, and nephropahy she continued on hiss insulin. # left frontal mca and occipital pca stroke: she continues on asa/plavix # h/o upper gi bleed nos, gastritis, duodenitis - her ppi was changed to a dissolving version given her mental status. # prophylaxis: pneumoboots, heparin sc # access: right antecubital picc placed on by ir and confirmed under fluroscopy. # communication: primary: daughter at other daughter: # code: full (confirmed with daughter ) # transitional issues - continue treatment for mssa bacteremia - continue to monitor nutritional intake - continue to monitor upper extremity swelling - continue goals of care discussion - follow-up with pcp, after rehab medications on admission: amlopidine 10 mg po daily biacodyl 10 mg pr daily prn constipation clopidogrel 75 mg po daily darbepoetin alpha 40 mcg subcut q7 days (last dose ) diazepam 10 mg pr gel daily prn seizure docusate sodium 200 mg po q12 hours hydralazine 75 mg po q8 hours insulin sliding scale: fsbs < 180 no insulin; fsbs 181-250 1 unit; fsbs 251-300 2 units; fsbs > 301 3 units; qachs lacutlose 30 ml q12hours prn constipation levetiracetam 1000 mg po qhs levetiracteam 500 mg po 3x per week on m/w/f at 12pm lisinopril 40 mg po daily metoprolol tartrate 50 mg po q8hours nephrocapes 1 cap po daily pantoprazole 40 mg iv q12hours phenytoin 150 mg po q8 hours polyethylene glycol 17 g po daily pravastatin 40 mg po qhs senna 2 tabs po q24 hours sevelamer carbonate 800 mg powder w/meals medications: 1. amlodipine 10 mg po daily hold for sbp < 100 2. bisacodyl 10 mg po/pr daily:prn constipation 3. clopidogrel 75 mg po daily 4. darbepoetin alfa in polysorbat *nf* 40 mcg/ml injection weekly last dose 5. diazepam *nf* 10 mg other prn seizure diazepam 10 mg pr gel daily prn seizure 6. docusate sodium (liquid) 100 mg po bid 7. hydralazine 75 mg po q8h hold for sbp < 100 8. insulin sc sliding scale fingerstick qachs, hs insulin sc sliding scale using hum insulin 9. lactulose 30 ml po q8h:prn constipation 10. levetiracetam oral solution 500 mg po post hd 11. levetiracetam oral solution 500 mg po bid 12. lisinopril 40 mg po daily hold for sbp < 100 13. metoprolol tartrate 50 mg po tid hold for sbp<100, hr<60 14. nephrocaps 1 cap po daily 15. lansoprazole oral disintegrating tab 30 mg po daily 16. phenytoin infatab 150 mg po tid 17. heparin 5000 unit sc tid 18. senna 1 tab po bid:prn constipation 19. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 20. sevelamer carbonate 800 mg po tid w/meals 21. aspirin 81 mg po daily 22. cefazolin 2 g iv post hd monday and wednesday only course: 23. cefazolin 3 g iv post hd only fridays course: disposition: extended care facility: - diagnosis: primary: methicillin sensitive staphylcoccus aureus bacteremia, upper extremity swelling secondary: end-stage renal disease, seizure disorder condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: bedbound. instructions: you were admitted to the hospital with a bacteria infection in your blood from an iv. you will continue treatment with antibiotics to cure the infection. weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: follow-up with your primary care doctor (pcp: , . ) follow-up with your kidney doctor dr. ( procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis central venous catheter placement with guidance central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: acidosis end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere renal dialysis status coronary atherosclerosis of native coronary artery severe sepsis diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes methicillin susceptible staphylococcus aureus septicemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia acute respiratory failure other late effects of cerebrovascular disease septic shock epilepsy, unspecified, without mention of intractable epilepsy other encephalopathy other and unspecified infection due to central venous catheter diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] 

Answer: The patient is high likely exposed to