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 / bactrim ds attending: chief complaint: cc: fever, mental status change major surgical or invasive procedure: none history of present illness: hpi: yo m c hx squamous cell ca on scalp presenting from osh with fever, mental status change and concern for sepsis. in , pt. placed on sepsis protocol and events as per note. . in , bctx from osh returned growing gpc, later noted to be + mrsa. pt. treated with iv vancomycin, remained hd stable off pressors. pt. noted to be hypernatremic on presentation; likely dehydration. free water deficit corrected with d5w and on transfer, na 143. pt. received 2 u prbcs in for hct drop to 19 from 28; noted to be guiaic negative and felt to have combination of iron deficiency and anemia of chronic disease. acute renal failure thought atn vs. prerenal; urine lytes not revealing. on txf, cr at 1.5 down from 2.3 in ed (baseline 1.1). urine eosinophils rarely positive. noted to be coagulopathic with inr 1.4. dic considered and fibrinogen sent --> 531, pt, ptt modestly elevated, + schistoscytes on smear. pt. noted to have neck mass; ct done --> difficult to r/o abscess but likely benign enlargement of submandibular gland briefly started on tube feeds but on transfer, ng tube removed by pt. and pt. taking pos past medical history: 1. multiple skin cancers: facial squamous cell carcinoma () followed by dermatologist dr. , plan for mohs for removal by dr. 2. h/o mrsa skin infection treated with bactrim and zyvox . 3. back pain (last hospitalization in , old compression fx of t12 l1 l2, dx most likely musculoskeletal) 4. anemia ( bone marrow depression from extended course of bactrim and linezolid) 5. macular degeneration 6. prostate ca s/p turp many years ago 7. colon ca s/p resection many years ago social history: uses wheelchair, was previously able to do transfers on his own. his family lives nearby. he does not smoke cigarettes or drink etoh family history: not assessed physical exam: vs - 97.3, tm 98.8, 93, 141/58, 97% ra, 15 heent - 4*4 cm erythematous circular, raised lesion over anterior scalp, tender to palpation. op dry, poor dentition, 2-3 cm neck mass over region submandibular gland, telengectasias diffusely over face, lower r facial droop c nasolabial fold flattening. lungs - + rhonchi on expiration, no wheeze, no crackles heart - rrr, s1, s2, + 2/6 systolic murmur diff usely over chest (not noted on prior d/c summary) abd - soft, nt, nd, bs+ - r aka; ms , lower . ms over l foot. no pain over hip. pertinent results: micro - - dfa (-) influenza a/b - uctx p - uctx no growth - bctx * 3 p - csf ctx no growth - osh bcts, + staph aureus, mrsa - urine ctx no growth. . ct neck: 1. asymmetric appearance of the submandibular glands, with the right gland larger than left with thickening of the adjacent skin. these are consistent with inflammatory change. no definite abscess is seen, although the evaluation is more limited given the lack of iv contrast. 2. left thyroid nodule. statistically, this is most likely benign, especially given the lack of invasion of surrounding structures. however, if further imaging evaluation is required, ultrasound could be performed. 3. vascular calcifications at the carotid bifurcations. . echo: the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). the aortic valve leaflets are moderately thickened. there is moderate aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. no definite vegetation seen but cannot exclude. . ct head in ed 1. no acute hemorrhage. 2. chronic microvascular ischemia. 3. no definite mass effect. if clinically indicated, the patient may be reimaged with his head in neutral position. 4. large ventricles, which may be related to involutional change. please correlate clinically to exclude communicating hydrocephalus. . abdomen single supine film history of inguinal hernia and fever. gas and fecal residue are present throughout the colon. there are a few gas-filled loops of nondilated small bowel. no evidence for intestinal obstruction. there is a left-sided inguinal hernia. right hip prosthesis in situ. . ekg sinus tachycardia frequent supraventricular extrasystoles st junctional depression is nonspecific no previous tracing . admission labs: 12:40pm wbc-21.5*# rbc-2.27* hgb-7.2*# hct-22.4* mcv-99* mch-31.6 mchc-32.1 rdw-26.2* 04:00pm neuts-92* bands-0 lymphs-3* monos-3 eos-0 basos-0 atyps-0 metas-1* myelos-1* 04:00pm hypochrom-2+ anisocyt-2+ poikilocy-1+ macrocyt-1+ microcyt-2+ polychrom-normal ovalocyt-1+ target-2+ schistocy-occasional teardrop-occasional 04:00pm plt smr-normal plt count-339 04:00pm pt-16.8* ptt-27.8 inr(pt)-1.6* 04:00pm fibrinoge-531* 12:40pm glucose-151* urea n-83* creat-2.3*# sodium-161* potassium-3.5 chloride-123* total co2-26 anion gap-16 12:40pm wbc-21.5*# rbc-2.27* hgb-7.2*# hct-22.4* mcv-99* mch-31.6 mchc-32.1 rdw-26.2* 02:10pm cerebrospinal fluid (csf) wbc-1 rbc-1* polys-50 lymphs-13 monos-37 02:10pm cerebrospinal fluid (csf) protein-153* glucose-52 10:30pm glucose-126* urea n-73* creat-2.1* sodium-158* potassium-3.1* chloride-122* total co2-25 anion gap-14 10:30pm calcium-7.2* phosphate-3.9 magnesium-1.3* 10:26pm urine hours-random tot prot-57 10:26pm urine u-pep-multiple p ife-no monoclo 10:26pm urine eos-positive 10:12pm type-art po2-330* pco2-35 ph-7.48* total co2-27 base xs-3 10:12pm lactate-0.9 10:12pm o2 sat-98 07:55pm type-art temp-36.7 po2-54* pco2-41 ph-7.43 total co2-28 base xs-2 intubated-not intuba 04:00pm glucose-133* urea n-74* creat-2.0* sodium-161* potassium-3.3 chloride-125* total co2-24 anion gap-15 04:00pm alt(sgpt)-40 ast(sgot)-36 ld(ldh)-183 alk phos-190* amylase-35 tot bili-0.6 04:00pm lipase-12 04:00pm tot prot-5.5* albumin-2.5* globulin-3.0 calcium-7.2* phosphate-3.5 magnesium-1.4* iron-12* 04:00pm caltibc-90* vit b12-664 folate-9.7 haptoglob-206* ferritin-> trf-69* 04:00pm osmolal-345* 04:00pm tsh-0.56 04:00pm pep-no specifi 04:00pm asa-neg ethanol-neg acetmnphn-10.1 bnzodzpn-neg barbitrt-neg tricyclic-neg 04:00pm urine hours-random urea n-530 creat-31 sodium-66 . discharge labs: wbc 14, hct 28, plt 326, na 142, k 4.3, cl 111, hco3 27, bun 32, cr 1.0 last vanco level - am - 13.2 brief hospital course: a/p: yo m c hx squamous cell carcinoma over scalp, mrsa infections p/w likely mrsa sepsis discharged hd stable on vancomycin. . 1. mrsa sepsis: ddx includes scalp lesion abscess, submandibular gland abscess, hip arthroplasty. bladder unlikely given urine culture. endocarditis also unlikely given echo report and negative follow up blood cultures though can't exclude with tte. ct of neck showed swelling of r submandibular gland w/o evidence of abscess, unlikely cause of sepsis. we think the etiology of his mrsa sepsis is from skin infection; we obtained a skin swab of the lesion which grew staph aureus, coag +, senstivities pending. picc placed; pt. will require 6 week course with regular follow up of levels and creatinine. wound care for scalp lesion as directed. seen by derm team in house; plan for mohs under local anesthesia pending improval in mental status/ability to cooperate during procedure. if mental status does not improve, may require general anesthesia for procedure. dr. is aware of these plans. . 2. acute renal failure: ddx includes prerenal vs. atn vs. ain. post renal unlikely given normal uop. resolved on discharge. foley catheter left in on discharge to facilitate monitoring of uop. can remove 1-2 days post discharge. . 3. heme: anemia has improved. drop to have reflected fluid resuscitation. initial drop to 22 on presentation may reflect transient hemolysis given schistoscytes. dic unlikely given fibrinogen level. hct stable on discharge at 28. . 5. neck mass: as per team, ct scan suggestive of benign process; unlikely to be abscess. likely enlargement of submandibular gland. . 6. back pain: continued oral morphine - fall precautions medications on admission: meds on transfer: vancomycin 1000 mg iv q48h heparin sc pantoprazole 40 mg qd po docusate 100 mg riss mvi citalopram 10 mg qd ipratropium 1 neb q6h discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 3. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 4. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 5. therapeutic multivitamin liquid sig: five (5) ml po daily (daily). 6. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 7. vancomycin 500 mg recon soln sig: one (1) recon soln intravenous q48h (every 48 hours) for 6 weeks. 8. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 9. morphine 10 mg/5 ml solution sig: two (2) mg po q6h (every 6 hours) as needed for pain. 10. mupirocin calcium 2 % cream sig: one (1) appl topical (2 times a day). 11. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous daily (daily) as needed. discharge disposition: extended care facility: tcu discharge diagnosis: primary 1. mrsa bacteremia 2. squamous cell carcinoma of scalp discharge condition: good discharge instructions: this patient needs to be on iv vancomycin for 6 weeks. he should have vancomycin levels checked periodically (q3d) and the nursing home. he should also have his creatinine monitored periodically (q3d). he should return to the hospital/er if he develops hypotension, light headedness, fever, worsening shortness of breath, chest pain, or other concerning problems. should keep all his appointments and take medications as directed. he has an appointment with dr. of dermatologic surgery in for mohs removal of the lesion on his scalp. followup instructions: after discharge. your dermatology appointment is listed below. provider: , m.d. phone: date/time: 2:15, md procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances transfusion of packed cells diagnoses: anemia of other chronic disease acute kidney failure, unspecified severe sepsis personal history of malignant neoplasm of prostate infection with microorganisms resistant to penicillins methicillin susceptible staphylococcus aureus septicemia personal history of malignant neoplasm of large intestine iron deficiency anemia, unspecified swelling, mass, or lump in head and neck hyperosmolality and/or hypernatremia lumbago other and unspecified coagulation defects above knee amputation status 

Answer: The patient is high likely exposed to