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: ciprofloxacin attending: chief complaint: fever and hypotension major surgical or invasive procedure: picc line placement history of present illness: 68 year old man with a past medical history significant for diffuse large b-cell lymphoma, status post two cycles of r-chop, who originally presented to from rehab with fever, chills, and malaise the day prior to admission. he had been feeling relatively well over days prior to admission. he denied any nausea, vomiting, diarrhea, or recent fever, but endorses slight tenderness and redness over the picc insertion site. concerned due to his previous medical history, his rehabilitation facility sent the patient to the . . on presentation to the ed, patient was noted to have a temperature of 101.7, heart rate of 115, blood pressure of 72/38, rr of 16, and oxygen saturation of 96%. he received cefepime 2gm iv, vancomycin 1 gm iv, and tylenol. his picc line was removed and sent for culture. due to concern for hypotension and sepsis, he was transferred to the icu. . in the icu, he was given ivfs to which his blood pressures responded and have been stable in the 90s systolic (his baseline). blood cultures from admission grew pansensitive staph aureus as well as hafnia alvei which was sensitive to ceftriaxone, thus he was started on nafcillin and ceftriaxone. source was thought to be his picc line which, as above, was removed on admission. cellulitis of the sking surrounding the picc was also noted. additionally, while in the icu, he was found to have a dvt right basilic vein extending to axillary vein; for this he was started on heparin gtt with plan to transition to coumadin. prior to his admission, he was being treated for c. diff with po vanco. he has had persistent diarrhea while here, c. diff was sent and was negative x3. he has, however, been continued on his po vanco. . ros: significant weight change from his baseline 175 to his current 139 over the past year. he attributes this to poor appetite alcohol abuse. negative for chest pain, sob past medical history: 1. prostate cancer status post turp and radiation per patient 2. disease treated with ptu/levoxyl 3. hypertension 4. hyperlipidemia 5. alcohol abuse (last used 2 months ago) 6. status subarachnoid hemorrhage and subdural hematoma following an alcohol-related fall in . 7. diffuse large b-cell lymphoma, diagnosed , now receiving chemotherapy. 8. c. difficile colitis 9. vre 10. hyponatremia (siadh) . onc history: pt initially presented to in early with cachexia, pour appetite, and right hydronephrosis secondary to a testicular mass and retroperitoneal lymphadenopathy. a biopsy showed diffuse large b-cell lymphoma and he received two cycles of rituxan-chop on and . social history: currently lives at rehabilitation center/nursing home. prior to lived alone in . separated from his wife. a son who lives in and a daughter who lives in . tobacco: 1.5 ppd x 50 years. alcohol: used to drink bottle of wine and four bottles of beer daily but stopped 2 months ago. denies illicit drugs. family history: brother with question of sudden cardiac death, second brother with diabetes and coronary artery disease who died at age 57, third brother with history of cerebrovascular accident. physical exam: vital signs: t 98.6, hr 121, bp 108/36, rr 28, 97% on ra general: cachectic. in no apparent distress. heent: anicteric sclera. no oropharyngeal lesions. poor dentition. slightly dry mucous membranes. neck: supple. no jvd. no cervical lymphadenopathy. heart: tachycardic. normal s1 and s2. no murmurs, rubs, or gallops appreciated. lungs: clear to auscultation bilaterally. no crackles. abdomen: soft. hypoactive bowel sounds. nontender throughout. no rebound or guarding. extremities: warm and well perfused. 2+ radial pulses. no peripheral edema appreciated. pertinent results: 09:10pm plt count-392# 09:10pm hypochrom-normal anisocyt-occasional poikilocy-occasional macrocyt-occasional microcyt-occasional polychrom-normal burr-occasional 09:10pm neuts-77* bands-0 lymphs-15* monos-5 eos-0 basos-0 atyps-3* metas-0 myelos-0 09:10pm wbc-1.5* rbc-3.43* hgb-10.9* hct-30.7* mcv-90 mch-31.7 mchc-35.5* rdw-17.9* 09:10pm lipase-14 09:10pm alt(sgpt)-13 ast(sgot)-12 alk phos-68 tot bili-0.6 09:10pm glucose-106* urea n-10 creat-0.7 sodium-129* potassium-4.0 chloride-93* total co2-24 anion gap-16 09:16pm lactate-1.4 09:50pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-8.0 leuk-neg 09:50pm urine color-yellow appear-clear sp -1.013 . pcxr : single ap upright portable chest radiograph is reviewed and compared to . heart size is normal. mediastinal and hilar contours are unremarkable. pulmonary vasculature is not enlarged. there is no focal consolidation. there is no significant amount of pleural fluid. there is no pneumothorax . r upper ext u/s : occlusive thrombus in the right basilic vein extending into the axillary vein. . tte : the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated. right ventricular systolic function is normal. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , there is no significant change. . tee : no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. a catheter is seen in the right atrium coming in contact intermittently with the triscuspid valve. no mobile elements are seen attached to the catheter. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch and descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no vegetations are seen on the aortic valve. an eccentric jet of probable mild aortic regurgitation is seen; however, given the eccentric nature of this flow, cannot exclude the possibility of a small aortic leaflet perforation. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. mild to moderate (+) mitral regurgitation is seen. there is no pericardial effusion. . left upper ext u/s : no evidence of dvt in the left upper extremity. . micro: , blood cultures 4/4 bottles: staph aureus coag +. final sensitivities. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. penicillin sensitivity available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin-------------<=0.25 s . , blood cultures 2/4 bottles: hafnia alvei. final sensitivities. trimethoprim/sulfa sensitivity testing available on request. staph aureus coag +. sensitivities performed on culture # 231-0361l . sensitivities: mic expressed in mcg/ml _________________________________________________________ hafnia alvei | ampicillin------------ <=2 r ampicillin/sulbactam-- <=2 r cefazolin------------- =>64 r cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s imipenem-------------- <=1 s meropenem-------------<=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s . picc cath tip : staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin-------------<=0.25 s trimethoprim/sulfa---- s . urine cx : mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. . , blood cultures: 1/4 bottles with staph aureus (sensitivies same as blood cx from ) . blood cultures , , : ngtd . stool: negative for cdiff x 3, negative for o&p, stool culture negative brief hospital course: 68 year old man with diffuse b cell lymphoma status post two cycles of r-chop who presented with fever and hypotension in the setting of infected picc line. he also was noted to have an upper extremity dvt associated with the line. . 1) sepsis/infected picc/upper dvt: he received ivfs in the icu and did not require pressers. his picc line was removed; blood cultures and picc catheter tip grew mssa and hafnia alvei. he was given nafcillin and ceftriaxone. r upper extremitiy u/s revealed a dvt of the right basilic vein extending into the axillary vein (this is where the old picc had been). he was placed on a heparin drip. trans-thoracic and trans-esophageal echos were done; neither revealed a vegetation but the tee showed an eccentric jet of aortic regurgitaion which could not be ruled out as a manifestation of endocarditis. id was consulted, and felt he should be treated for endocarditis. the ceftriaxone should be given for a 2-week course (hafnia alvei is not a common cause of endocarditis), and nafcillin should be given for 6 weeks (as mssa commonly causes endocarditis). he will f/u with dr. from infectious diseases on at 9:30am. he will need weakly labs while on abx, including cbc w/diff, chemistry panel, lfts. these can be faxed to clinic (dr. ) at fax # . . 2) rue dvt: at site of former picc, u/s showed occlusive thrombus in the right basilic vein extending into the axillary vein. he was on a heparin drip for 1 week. heparin was d/c'd and no further anticoaggulation started for the following reasons: the dvt was associated with a line that was removed, and the patient has a h/o subdural & subarachnoid hemorrhage 3 months ago. . 3) diarrhea: the patient had recent c. diff infection for which he was on po vanco. he continued to have loose stools. c. diff toxin was sent and was negative x4 during this admission. toxin b sent. - cont. po vanco - f/u c. diff toxin b . 4) diffuse large b cell lymphoma: received two cycles of r-chop previously. chemotherapy started in . he was on allopurinol for tumor lysis and neupogen for cell count enhancement. neupogen was d/c'd in the icu when counts rose. due to the infection and possible endocarditis, his chop chemotherapy will be held, but he was given 1 dose of rituximab while inpatient. he will f/u with his outpatient oncologist, dr. one week after discharge. . 5) disease: followed by endocrine as an outpatient. the patient was continued on levothyroxine dose of 25mcg daily. he should f/u with his endocrinologist, dr. as previously scheduled. . 6) hyponatremia: during previous hospitalization, patient was noted to have low sodium level, thought to be secondary to siadh. he received fluid resuscitation in the icu initially. after his sepsis physiology resolved, he was placed on a free h2o restriction of 1500 ml. his sodium was stable in the low 130s. . 7) fen: regular diet. continued on multivitamins, thiamine, folic acid. . . 8) prophylaxis: was given heparin gtt for dvt as above, then ambulating. also given ppi and bowel regimen. . code: full. medications on admission: -hexavitamin po qd -folic acid 1mg qd -thiamine 100 mg qd -protonix 40mg qd -clotrimazole 1% topical q12hr -levothyroxine 25 mcg qd -nystatin 5cc po q6hr swish and swallow -triamcinolone 1% cream tp qd -lovenox 40 mg sc qd -allopurinol 200 qd -tylenol 325mg po q6hr prn pain -megestrol 40 mg qd prn -lactulose 30 cc q6hr prn -colace 100 po q12hr prn -zofran 4mg po q8hr prn -dilaudid 4mg po q4hr prn -calcium carbonate 1250 po q12 -epogen 12,000 units sc qt,th, sa -magnesium oxide 400 mg po bid -filgastrim 480 mcg q24 hr discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q4-6h (every 4 to 6 hours) as needed. 2. allopurinol 100 mg tablet sig: two (2) tablet po daily (daily). 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 4. calcium carbonate 500 mg (1,250 mg) tablet sig: one (1) tablet po bid (2 times a day). 5. ceftriaxone 1 gm iv q24h 6. nafcillin 2 gm iv q4h 7. clotrimazole 1 % cream sig: one (1) appl topical (2 times a day). 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 9. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 10. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 11. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 12. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed for diarrhea. 13. multivitamin,tx-minerals tablet sig: one (1) cap po daily (daily). 14. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day). 15. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 16. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 17. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 18. vancomycin 250 mg capsule sig: one (1) capsule po q6h (every 6 hours). discharge disposition: extended care facility: n.e. hospital discharge diagnosis: 1. sepsis secondary to infected picc line and bacteremia 2. right upper extremitiy dvt related to old picc line 2. endocarditis 3. lymphoma discharge condition: afebrile, stable discharge instructions: please take your medications as prescribed. you will not be taking blood thinners. continue to take ceftriaxone for 1 more week (last full day is ). continue to take nafcillin for 5 more weeks (last day is ). . you will need weakly labs while on antibiotics, including cbc w/differential, chemistry panel, lfts. these can be faxed to clinic (dr. ) at fax # . call your doctor if you have fever, chills or any other symptom that concerns you. followup instructions: - please see dr. /dr. on at 11am. provider: , md: date/time: 11:00 - you are scheduled to follow up with the infectious diseases team, dr. , as below. provider: . phone: date/time: 9:30 - you are scheduled to see your endocrinologist, dr. . provider: , md phone: date/time: 11:00 procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart injection or infusion of cancer chemotherapeutic substance diagnoses: unspecified essential hypertension unspecified acquired hypothyroidism methicillin susceptible staphylococcus aureus septicemia sepsis other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypotension, unspecified methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site cellulitis and abscess of upper arm and forearm intestinal infection due to clostridium difficile other complications due to other vascular device, implant, and graft acute and subacute bacterial endocarditis infection and inflammatory reaction due to other vascular device, implant, and graft other disorders of neurohypophysis neutropenia, unspecified anemia in neoplastic disease other malignant lymphomas, lymph nodes of inguinal region and lower limb 

Answer: The patient is high likely exposed to