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: dyspnea with fever major surgical or invasive procedure: icd extraction history of present illness: 61m hx icm ef 15-20%, cad with ami , vfib arrest from ist s/p icd implantation, copd on 2l o2 baseline, dm, transferred from for icd explantation. . recently admitted to from for respiratory failure secondary to chf and copd exacerbation. patient with chronic exertional dyspnea with mild-moderate activity, minimally ambulatory, lives in a nursing home due to his medical comorbidities. the staff at his nh noted that he was tachypneic (rr 28) and requiring additional oxygen supplementation. his temperature at the time was 100.2f and he was transferred to the . he remained febrile (temp 100.5-104f as per report) and his sbp was noted to be 80-90s. blood cultures were obtained and he was given ceftazidime, vancomycin, and levofloxacin. at he grew mrsa from the bloodstream. over the course of his hospitalization there, his icd pocket became erythematous, warm and swollen. it had increased to baseball sized by the time of transfer, and was fluctuant and warm. tee was negative for vegetations there, and blood cultures have since been negative or ngtd per report (not included in osh transfer records). . he was transfered to for icd explantation. on arrival, he was in mild respiratory distress and was found to have bibasilar crackles and a swollen ~4 inch fluctuant mass over the icd implant that was erythematous, warm, and tender. vitals were t 98.2, bp 105/73, hr 87, rr 20, and spo2 97% on 3lnc. he was continued on vancomycin for mrsa infection, and diuresed overnight using furosemide 40 mg iv followed by 5 mg/hr drip. he had good urine output and fluid balance negative 1500 ml overnight. he was taken to the or morning of . his icd was removed with purulent material in the pocket. after explantation, there was continued oozing from the site and a drain was left in place. he remained intubated following the procedure, and was transferred to the pacu in stable condition. past medical history: # cad -- h/o mi -- ?stent thrombosis in with subsequent thrombectomy -- stent placement x3 to his lad in # vfib arrest -- s/p icd implantation in # ischemic cardiomyopathy -- lvef 15-20% # copd -- on 2l home oxygen # hypertension # hyperlipidemia # anemia -- with h/o transfusions, etiology unclear # chronic kidney disease -- (time course unclear, cr 0.91 in ) social history: # home: married, lives at . # work: former electrician. # tobacco: 40 pack year smoking history, quit 5 months ago # alcohol: alcohol abuse history but also quit 5 months ago # illicit: none family history: father with mi physical exam: admission: vs: 98.2 105/73 87 20 97%3lnc general: older male in nad, intubated and sedated. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple without elevated jvp . cardiac: rrr, normal s1, s2. no m/r/g. lungs: synchronous on vent. ctab without crackles, wheezes, or rhonchi. abdomen: soft, nt, nd. no hsm. extremities: no c/c/e. no femoral bruits. skin: pressure dressing over left chest icd site c/d/i. drain with serosanguinous fluid. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ discharge: vs: 98.7 81 108/73 18 general: older male in nad, intubated and sedated. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple without elevated jvp, large ej. cardiac: rrr, normal s1, s2. no m/r/g. lungs: decreased breath sounds over lower lung fields. no crackles, wheezes, or rhonchi. abdomen: distended, firm. non-tender, +bs. extremities: no c/c/e. no femoral bruits. no edema. skin: dressing over pocket, with serosanguinous fluid. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: admission: 11:27pm blood wbc-10.5 rbc-2.94* hgb-8.4* hct-26.5* mcv-90 mch-28.5 mchc-31.7 rdw-21.8* plt ct-153 11:27pm blood neuts-87.4* lymphs-8.2* monos-2.6 eos-1.3 baso-0.5 11:27pm blood pt-15.3* ptt-39.1* inr(pt)-1.4* 11:27pm blood glucose-92 urean-22* creat-0.8 na-130* k-4.7 cl-99 hco3-26 angap-10 11:27pm blood alt-15 ast-18 alkphos-119 totbili-1.5 11:27pm blood calcium-8.5 phos-2.2* mg-2.4 studies: (cxr ) moderate-to-large right greater than left pleural effusions. the additional presence of pneumonia cannot be excluded . (echo ) the left atrium is moderately dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is at least 15 mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = 15 %). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. moderate (2+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. no vegetation/mass is seen on the tricuspid or pulmonic valves. there is no pericardial effusion. brief hospital course: 61m with history of cad, mi, schf ef 15-20%, vfib arrest s/p icd placement in , copd on 2l home o2, who presents from with mrsa bacteremia and icd pocket infection. . # mrsa icd infection with bacteremia: mrsa bacteremia found at osh, positive growth of staph aureus from icd pocket, blood cx negative since admission here. pocket has appeared infected over the past few days, culminating in a ~4 inch fluctuant mass that was erythematous, warm, and tender over the icd implant. s/p icd explantation and pocket washout with placement of drain. pt required temporary phenylephrine, and epinephrine. he had a drain placed which was pulled on . he had a transient decrease in hct with oozing around pocket, and was 26.7 on day of discharge. he will require monitoring of his cbc at rehab. id was consulted who recommended 6 weeks of vancomycin. pt has picc line in right basilic vein for vancomycin 750mg q12 (stop date ). . # acute on chronic systolic chf: initially hypoxic beyond baseline (3l on admission, 2l at home) with bibasilar rales and bilateral effusions, jvp elevation, peripheral edema. likely due to iatrogenic causes in setting of mrsa bacteremia and initial presentation of sepsis. pt initially on pressors, weaned on the first day. , pt was started on lasix drip fluid status improved and we continued prn lasix to goal of -1l/day. lisinopril and spironolactone were initially held due to sbps 80s-90s, lisinopril restarted several days prior to discharge, and spirolactone will need to be added on as an outpatient with better sbps. pt discharged on metop succinate xl 25mg daily, lisinopril 2.5mg daily, dig .25mg/day, and furosemide 80mg tid. his bps were in the 80-90s on d/c but patient was asymptomatic with no orthostasis on exam. in addition, he was able to ambulate with no lightheadedness, dizziness, sob, or syncope. . # copd: during this admissio patient was weaned to his home baseline oxygen requirement of 2l day and night. home 2l nc at baseline. no cough or increased sputum to suggest copd exacerbation. hypoxia/dyspnea likely related to chf as above. pt did require intubation after icd extraction for less than 24 hours. we continued ipratropium, albuterol and advair. . # cad / vfib arrest: large mi in with ist and vfib arrest, s/p desx3 to lad. currently cp free. icd placement , extracted on this admission per above. per report no further episodes of vfib or vtach. we continued his aspirin and statin and increased metoprolol xl to 25mg po daily which decreased the ectopy captured on tele. . # ckd: reportedly with elevated cr in the past (1.2 +) although during this admission patient discharged with cr 0.8, and range was .8 - 1.0. cr 1.3 on osh admission, 0.8 prior to transfer. we monitored renal function daily and dosed medications renally. . # transitional - add spironolactone as outpatient if sbp tolerates. - monitor weekly vancomycin troughs, cbc and cmp (electrolytes) - discussion of future icd need medications on admission: preadmission medications listed are correct and complete. information was obtained from webomr. 1. tiotropium bromide 1 cap ih daily 2. fluticasone-salmeterol diskus (250/50) 1 inh ih 3. duoneb *nf* (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg base)/3 ml inhalation q6h sob/wheeze 4. thiamine 100 mg po daily 5. folic acid 1 mg po daily 6. neutra-phos 1 pkt po daily 7. digoxin 0.25 mg po daily 8. lisinopril 2.5 mg po daily 9. metoprolol succinate xl 12.5 mg po bid 10. furosemide 40 mg po bid 11. pantoprazole 40 mg po q24h 12. spironolactone 25 mg po daily discharge medications: 1. digoxin 0.25 mg po daily 2. fluticasone-salmeterol diskus (250/50) 1 inh ih 3. folic acid 1 mg po daily 4. lisinopril 2.5 mg po daily hold sbp< 90 5. metoprolol succinate xl 25 mg po daily 6. pantoprazole 40 mg po q24h 7. thiamine 100 mg po daily 8. 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. 9. potassium chloride 20 meq po daily duration: 24 hours hold for k > 4.5 10. duoneb *nf* (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg base)/3 ml inhalation q6h sob/wheeze 11. tiotropium bromide 1 cap ih daily 12. vancomycin 750 mg iv q 12h please give at 8am and 8pm 13. torsemide 60 mg po daily discharge disposition: extended care facility: healthcare/pediatric center at discharge diagnosis: 1) implantable cardioverter-defibrillator (icd) pocket infection 2) staph coag positive bacteremia 3) coronary artery disease 4) acute on chronic systolic congestive heart failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , you were transferred from due to fevers and elevated levels of blood cells that fight infection. it was determined that your icd(implantable cardioverter-defibrillator) was infected and we removed it to prevent the infection from getting worse. we also started you on an antibiotic called vancomycin through your vein. followup instructions: . department: infectious disease when: tuesday at 3:30 pm with: , md building: lm campus: west best parking: garage department: infectious disease when: friday at 11:30 am with: , md building: lm bldg () campus: west best parking: garage department: cardiac services when: tuesday at 11:30 am with: , np building: campus: east best parking: garage name: , md location: cardiology address: , phone: appt: at 1:50pm procedure: removal of lead(s) [electrode] without replacement revision or relocation of cardiac device pocket diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia bacteremia old myocardial infarction surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site acute on chronic systolic heart failure precipitous drop in hematocrit other dependence on machines, supplemental oxygen infection and inflammatory reaction due to cardiac device, implant, and graft 

Answer: The patient is high likely exposed to