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: lower back pain major surgical or invasive procedure: t4-l5 laminectomies with epidural abcess drainage right first toe amputation peg tube placement picc line placement picc line change (to double-lumen from single lumen) history of present illness: patient is a 73 year old gentleman with a history of cad s/p cabg and , chronic atrial fibrillation on coumadin, and pvd. he presented to hospital on with 3 day hx of back pain, which came on gradually, until pt was not able to get out of bed pain. pt was taken by ambulance and was found to be febrile and in afib w/ hr to the 150s. he was found to have an infected right first toe, mrsa bacteremia (+ blood cxs) -started on vanco q12hrs, and a tnt leak (1.78->4.77->5.45). pt was transfered to for further care. he was admitted to ortho/spine service on , he grew mrsa in 2 blood cxs, and was found to have an epidural abcess from his sacrum to t5 that was evacuated by the spinal service and required t4-l5 laminectomy. started on iv vanco q12hrs. blood cultures have been negative sinceadmission. cards followed pt for troponin leak (0.48 x3)-> consistent w/demand ischemia and medically manged pt. because he continued to be febrile and confused despite evacaution and iv abxand because of an episode of vtach on tele, he was transferred to medicine from spinal service for further w/up of fever and management of multiple medical issues. ros: denies headache, visual changes, fevers, chills, sweats, nausea, vomiting, shortness of breath, chest pain, dysuria, abdominal pain, diarrhea. past medical history: 1. hyperlipidemia 2. cad s/p mi s/p cabg in and . last stress was an adenosine stress in showing fixed mid-lateral wall defect 3. chf with normal ef (last echo ) 4. mild aortic stenosis 5. mild mitral regurgitation 6. hypertension 7. chronic atrial fibrillation/flutter since on coumadin 8. right foot cellulitis 9. osteoarthritis 10. does not have dmii (as all previous notes have said). this was confirmed with the daughter past surgical history: 1. cabg x2 in and 2. multiple toes right foot amputated from dry gangrene following aneurysm rupture in right leg (unclear what caused anyersum) 3. right leg aneurysm repair 4. tonsillectomy 5. appy social history: social history: lives w/ wife. active @ physical exam: o: vs:99.3 99.6 168/90 100 20 95%ra tele: 4 beat run of nsvt at 00:57 this am gen: comfortable,alert in nad, lying in bed heent: mmm, jvp flat lungs: clear to auscultation bilaterally, without crackles heart: irreg irreg rythm. no m/g/r abd: soft nt/nd, nabs, peg tube in place without erythema or edema ext: right toe amp with dressing c/d/i. skin: warm and dry brief hospital course: 1.)infectious disease: the pt was transferred from hospital on where he was found have + bcx for mrsa + where r 1st toe abcess culture grew mrsa. the pt was admitted to dr. service where he was tx w/ vanc 500mg po tid, levo 250mg po qd and 500mg po tid. bcx (10/4+) grew mrsa. the pt continued to complain of lower back pain and got a head and spine mri which showed a massive epidural abcess extending from the beginning of the c-spine to the end of the sacral spine. the pt was taken to the or the next day by dr. and underwent t4-l5 laminectomies w/ drainage of the epidural abcess in the thoracic and lumbar spine but with limited drainage of the abcess in the cervial spine. it was decided that the remainder of abcess would be treated w/ abx and followed clinically. cultures from the epidural abcess grew mrsa. after surgery + levo were disontinued. on pod #2 the pt started spiking fevers and became more confused. his wbc went up to 19.4. the pt was transferred to medicine service and a massive id work-up was begun to identify possible sources of infection. the pt was started empirically on metronidazole to cover for c. diff and cefepime for pna. pt's repeat bcxs + ua w/cx came back negative. he was c. diff neg x4. tee was negative for endocarditis or thrombi. pt's ap cxr () showed lll opacity consistent w/pna, but torso ct () only revealed small bilateral pleural effusions and bibasilar atelectasis and no infectious collections were identified in the chest, abdomen or pelvis. repeat mri of head and spine was attempted (), but due to the pt's confusion he couldn't tolerate it and the study was limited in time and quality-> thus the pt was sent for cervical ct () which showed-> epidural abcess in the cervical spine (c1-c5) the pt's white count went down on and the pt was afebrile for 5 days althoough he continued to be intermittently confused and disoriented. cefepime and metronidazole were stopped per ids recs since no other source of infection was found except for the epidural abcess. the pt continued to improve clinically and went for amputation of r first toe. the pt tolerated the surgery well, but on pod#2 he spiked a temp-> 101.3 and his wbc went up to 12.2. bcx + ua were resent and were negative. the pt also developed a productive cough and started choking when eating. repeat pa cxr showed no evidence of pna or aspiration. the pt was sent for repeat mri to assess for change in epidural abcess, which showed an interval improvement. he was restarted empirically on + cefipime for possible aspiration pna and was treated for a 7 day course. he has remained afebrile since then. the plan is to continue vancomycin for an 8 week course and to have another mri in weeks to assess for resolution of the epidural abscess. he will follow up with infectious disease, ortho/spine and vascular surgery as an outpatient. 2. )delerium: the pt was highly functional @ baseline + had no hx of dementia. afer admission to osh the pt became intermittently disoriented and confused, which worsened s/p t4-l5 laminectomy w/ epidural abcess drainage. the pt's delta ms was likely the result of toxic metabolic encephalopathy due to infection exacerbated by anesthesia since the pt wasn't in any sedating or anticholinergic meds, and head ct and mri showed no intracranial process. the pt's mental staus cleared after starting triple abx therapy vanco//cefapime upon transfer to the medicine service. eventhough the pt continued to be intermittently confused and disoriented, he was easilily redirected and more alert. the pt underwent r 1st toe amputation which he tolerated well. 3. )dysphagia. on , the rn and wife noted increasing dyspahgia, this was in the setting of his temp to 101.3. initially it was felt to be due to toxic/metabolic effects of worsening infeciton, however after he was treated for aspiration pna wtih cefepiome/flagyl and became afebrile, his dysphagia remained. speech swallow was consulted and recommended npo. ng tube was attempted, but the patient pulled it out and then refused re-placement. neurology service was consulted, and they were concerned for possible brainstem cva, but also thought that parkinsonism could be contribnuting and recommended sinemet trial. mri head was performed that showed no cva. gi was consulted and placed a peg tube on without complications. if still with ongoing dysphagia after addition of sinemet, would need ent evaluation as an outpatient. 4. )afib w/ rvr: on admission to osh pt was found to be in afib w/ rvr to the 150s. the pt's rate was difficult to control w/ metoprolol, dig, + dilt drip. coumadin was held since pt had to undergo surgery. the cardiologist felt this was likely a result of the infectious process and that the priority was to tx the infection. the possibilty of cardoverting the pt while at tee was discussed w/ cardiology, which thought it could wait to be done as outpt since he was hemodynamically stable. he was staretd on heaprin drip and coumadin initally after okay iwth ortho spine service, but then his coumadin was held due to npo status and in preparation for peg tube placement. the pt was continued on metoprolol 200mg which achived some control->pt's hr stayed btw the 90s-110s. the pt's hr became harder to control when he was lost his inability to take po medications and he was changed to lopressor 20mg iv q6hr. once the peg tube was placed, he was resumed on metoprolol 200mg po bid. recommend f/u with cardiology to consider possible dc cardioversion. continue heparin gtt until inr therapuetic on coumadin. 5. )nsvt: the pt started having asymptomatic runs of nsvt around pod#2 (t4-l5 laminectomies). cardiology thought this was most likely the result of the infection,. they recommended a tee, since endocarditis could be a possible cause. the tee was negative for endocarditis. cardiology thought the pt would benefit from an outpt ep study for risk stratification (since hx of cad) for possible icd implantation, but that it should wait until the infection was under control. pt's electrolyte were monitored closely and repleated accordingly. of note, he did not have runs of nsvt for the last 7 days of hospitalization. 6.) cad: the pt was found to have a troponin leak (1.78->4.77->5.45) at osh. on admission to the the pts troponins were (0.44->0.44->0.40), which was most consistent w/ demand iscgemia per cardiology. there were no signs of acute mi on ecg. the pt was started on heparin, which was stopped when the pt had to undergo epidural abcess drainage. the pt was continued on asa, atorvastatin, metoprolol and vasotec. 7. )fen: after the dysphagia ( problem 3 above) started, he was made npo. he was initially staretd on ppn and then tpn once picc line was changed to double lumen. peg tube was placed on and tube feeds were initiated. his electrolytes were agressively repleted given nsvt, to goal of k 4.5 and mg 2.5 per cardiology recommendations. 8)leucocytoclastic vascultiis. hd a small amount of purpura in his left groin which resovled. was seen by derm who perfmored bx which showed leucocytoclastic vasculitis. could be due to cefepime which was discontinued, however dermatology is unsure and recommends not labeling him as an "allergy" to cefepime. 9) anemia. his hct remained stable at 27-30. he remained guaiac negative throughout hosptilazation. medications on admission: home medications: coumadin 2mg po coumadin 1mg po tueday + thursday lipitor 40mg po qd toprol xl 50mg po qd vasotec 5mg po qd . transfer medications: atorvastatin 40mg po metoprolol 150mg po bid asa 325mg po qd pantoprazole 40mg iv vanco 1500mg iv bid day - ipratropium inh qhrs prn- sob discharge medications: 1. vancomycin 1,000 mg recon soln sig: 1500 (1500) mg intravenous every twelve (12) hours for 8 weeks. 2. insulin lispro (human) 100 unit/ml solution sig: as directed units subcutaneous four times a day: per sliding scale. 3. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed. 4. acetaminophen 650 mg suppository sig: one (1) suppository rectal q6h (every 6 hours) as needed. 5. aspirin 325 mg tablet sig: one (1) tablet po once a day. 6. lansoprazole 30 mg susp,delayed release for recon sig: thirty (30) mg po once a day. 7. heparin lock flush (porcine) 100 unit/ml syringe sig: two (2) ml intravenous daily (daily) as needed. 8. heparin (porcine) in d5w 100 unit/ml parenteral solution sig: as directed units intravenous asdir (as directed): see weight based guideline. until inr is therapeutic. 9. coumadin 7.5 mg tablet sig: one (1) tablet po at bedtime: goal inr . 10. lipitor 40 mg tablet sig: one (1) tablet po once a day. 11. enalapril maleate 5 mg tablet sig: one (1) tablet po daily (daily). 12. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po bid (2 times a day). 13. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day). 14. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 15. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: & rehab center - discharge diagnosis: epidural abcess first right toe abcess mrsa bacteremia atrial fibrillation asymptomatic non sustained ventricular tachycardias methicillin-resistent staph aureus bacteremia epidural abscess right big toe abscess dysphagia delirium non-sustained supraventricular tachycardia rapid atrial fibrillation discharge condition: good discharge instructions: follow up as below continue antibiotcs as below followup instructions: with your new pcp . in weeks after discharge from rehab. , , ( with id clnic dr. in 8 weeks with dr. in vascular surgery clinic is 2 weeks for removal of sutures( with dr. (orthopedics) in 4 weeks for mri scan at ( with dr. (neurology)in 4 weeks( with electrophysiology (cardiology) in 4 weeks ( procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified imageless computer assisted surgery excision or destruction of lesion of spinal cord or spinal meninges parenteral infusion of concentrated nutritional substances diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances amputation of toe percutaneous [endoscopic] gastrostomy [peg] other exploration and decompression of spinal canal transfusion of packed cells excision of lesion of other soft tissue closed biopsy of skin and subcutaneous tissue transfusion of other serum diagnoses: other iatrogenic hypotension cellulitis and abscess of trunk toxic encephalopathy unspecified essential hypertension acute posthemorrhagic anemia severe sepsis atrial fibrillation infection with microorganisms resistant to penicillins aortocoronary bypass status methicillin susceptible staphylococcus aureus septicemia paroxysmal ventricular tachycardia rheumatic heart failure (congestive) pneumonitis due to inhalation of food or vomitus mitral valve insufficiency and aortic valve stenosis intraspinal abscess gangrene acute osteomyelitis, ankle and foot cellulitis and abscess of toe, unspecified other acute and subacute forms of ischemic heart disease, other other specified hypersensitivity angiitis 

Answer: The patient is high likely exposed to