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: history of present illness: the patient is an 87-year-old male with a complicated past medical history, who presents to and dense right-sided hemiparesis on . the patient was evaluated by the stroke team, and mri showed a left inferior mca cerebrovascular accident with evidence of m2 segmental occlusion. the patient is status post treatment with intra-arterial tpa. the patient was then transferred to the neurology intensive care unit where, after tpa, he was noted to have improvement in right extremity strength, speech pressure was closely monitored, with a goal of systolic 140 to 160, titrating intravenous labetalol and neo-synephrine. anticoagulation with heparin drip and coumadin, with an inr goal of 2 to 3, and ptt goal of 40 to 60. the patient was continued on vancomycin for endocarditis (mssa) diagnosed in . the patient was then transferred, after stabilization in the neurology intensive care unit, to the medicine team for further management of the patient's multiple comorbidities. on arrival to the medical , the patient notes positive productive cough with mild shortness of breath. otherwise denies fevers, chills, chest pain, abdominal pain, nausea, vomiting, constipation, diarrhea, headache. past medical history: 1. cardiomyopathy- ef 25% 2. sick sinus syndrome status post pacer which was removed one month ago secondary to endocarditis 3. hypertension 4. history of diverticulosis 5. benign prostatic hypertrophy 6. mild peripheral neuropathy 7. status post appendectomy 8. history of abdominal aortic aneurysm 9. anxiety disorder 10. history of atrial fibrillation allergies: oxacillin, penicillin, codeine medications on admission: colace, amiodarone, protonix, aspirin, proscar, vancomycin, motrin, lopressor, megace, coumadin, captopril, atrovent, albuterol, lasix. on transfer: heparin drip, protonix, amiodarone, megace, vancomycin, atrovent, albuterol nebulizers, coumadin, colace, epogen, proscar, and haldol. physical examination: vital signs: temperature 95.8, blood pressure 130/60, heart rate 85 which was irregular, respiratory rate 18, oxygen saturation 95% on 3 liters. in general, the patient is an elderly white male, lying in bed, dysarthric. head, eyes, ears, nose and throat: normocephalic, atraumatic, pupils equal, round and reactive to light, extraocular movements intact, mucous membranes dry. neck: soft, supple, no jugular venous distention, no lymphadenopathy. heart: heart sounds difficult to auscultate secondary to coarse breath sounds. lungs: coarse breath sounds diffusely bilaterally, no wheezing or rhonchi. abdomen: soft, nontender, nondistended, normal active bowel sounds. extremities: no cyanosis, clubbing or edema, warm, dorsalis pedis pulses 2+ bilaterally.bilat necrotci heel ulcers- dry wtih eschar. neurologic: full range of motion of all extremities x 4, motor in right upper extremity and right lower extremity, sensory intact bilaterally. laboratory data: on , white cells 8.6, hematocrit 27.4. sodium 136, chloride 106, bicarbonate 23, bun 23, glucose 84. on the day of transfer to medicine service, , white cells 13.1, hematocrit 27.8. sodium 147, potassium 4.2, chloride 112, bicarbonate 20, bun 28, creatinine 1.7, glucose 141. pt 25.8, ptt 66.8, inr 4.6. calcium 8.0, phosphate 5.3, magnesium 1.9. urine culture from showed 10,000-100,000 yeast. chest x-ray from showed perihilar haziness, slight vascular engorgement suggestive of pulmonary edema, persistent dense left retrocardiac opacity, right pleural effusion, mass-like opacity centrally in the right upper lobe. impression: 87-year-old male with extensive past medical history, who presented with aphasia and right-sided hemiparesis and found to have a left mca cerebrovascular accident on mri status post intra-arterial tpa treatment and then subsequent monitoring in the neurology intensive care unit, who is now transferred to the medical service for further management. hospital course by system: 1. neurology: the neurology team continued to follow the patient during the remainder of his hospital stay, and it was noted that the patient was making great progress with relation to improvement in his right hemiparesis. the patient was noted to still be dysarthric as well as aphasic intermittently. based on recommendations by the neurology team, a repeat mri and mra were performed of the head. findings included no definite area of restricted diffusion was identified. the previously-identified subtle area of restricted diffusion with increased signal in the left parietal temporal lobe is no longer visible. an old right cerebellar infarct was visualized. no new infarcts or evidence for hemorrhage were noted. no evidence of high-grade stenosis or vascular occlusion in the arteries of the anterior and posterior circulation of the circle of . it was the feeling of the neurology team, based on this study from , some 13 days after his stroke, that the patient's prognosis for improvement was "excellent." the patient continued to have difficulties handling his secretios with weak cough. a swallow eval was ordered however was delyaed due to lack of availability of speech/swallow satff. finally a video swallow was done and pt found to have aspiration of all consistencies. neuro felt this could be due to delirium as there were no other focal signs of cva. the speecha dn swallow service as well as ent consult did not feel that diffuse weakness was due to delirium however they were not sure what could cause this. repeat eval done showed noimprovemend so a peg tube was placed. lastly, the patient was noted to have intermittent periods of delirium with marked sundowning, which was treated moderately well with haldol as needed. he did not receive haldol for the last 2 weeks ofstay due to concerns of sedation with increased risk of aspiration. he improved wihtout it. he continued to have occasional hallucinations but overall has greatlyimproved mental status. he is alert and orineted x3 most of the time. 2. cardiac: a. ischemia: the patient was not noted to have any chest pain while an inpatient at , however, was intermittently noted to be in respiratory distress, which was thought to be possibly secondary to worsening congestive heart failure of possible ischemic origin. electrocardiograms were obtained and showed no ischemic changes and cardiac enzymes were cycled intermittently and showed no elevation. the patient was maintained on his cardiac medications, including aspirin and beta blocker.isordil was added. b. pump: patient with a history of idiopathic dilated cardiomyopathy with a reported ejection fraction of 25-30% , as well as 3+ mitral regurgitation and severe tr. the patient's intermittent episodes of dyspnea as well as occasional - breathing was thought to be possibly secondary to worsening congestive heart failure. chest x-rays were obtained, however, did not show pronounced vascular engorgement. congestive heart failure service was consulted and plan on , was to have the patient transferred to the coronary care unit for right heart catheterization and subsequentadjustment of therapy. swan numbers showed that the patient had an elevated wedge as well as pulmonary artery pressure which was attributed to the patient's 3+ mitral regurgitation. the patient was thought to actually be total body fluid depleted, and was hydrated during his stay in the coronary care unit rather than diuresed. the patient was maintained on beta blocker and ace inhibitor, and the doses of both were titrated upwards based on blood pressure tolerance. c. rhythm: patient with a history of atrial fibrillation, however, on transfer from the neurology service on , the patient was noted to have an inr of 4.6. the patient's coumadin was held until the patient trended down into the therapeutic range, and then restarted. the patient's goal inr was 2 to 3. in addition, the patient was maintained on his outpatient amiodarone dose. d. hypertension: the patient's blood pressure was well controlled during his hospital stay, and the patient was maintained on lopressor and captopril. 3. pulmonary: the patient was noted to have marked respiratory secretions and associated coarse breath sounds on physical examination. the patient's oxygen saturations remained in the mid-90s on initially 2 liters of oxygen, and later on during his hospital stay on room air. aggressive pulmonary toilet with associated deep suctioning were performed daily, however, the patient was still unable to mobilize the majority of his secretions. in addition, the patient benefited from the use of albuterol and atrovent nebulizers as needed for dyspnea. it was thought that the mass-like opacities in the right upper lobe were a septic emboli from the patient's recent endocarditis and, on repeat serial chest x-rays, it was noted that this opacity was improving and resolving gradually. on hospital day number 17, a pulmonary consult was obtained in order to better manage the patient's poor mobility of respiratory secretions as well as intermittent periods of dyspnea. they suggestesd possible bronchoscopy however pt seemed to improve without it so we did not pursue this. 4. infectious disease: as above, on admission to , the patient was in the midst of being treated for endocarditis, with the portal of access thought to be from the patient's pacemaker, which was subsequently removed. the patient was maintained on his vancomycin dose to complete a course on . in addition, at the time of transfer to the coronary care unit on , the patient's poor respiratory status and the inability to rule out an infiltrate in the left lower lobe, the patient was empirically started on levofloxacin and flagyl in spite of no fever spike at that time. the patient was maintained on those antibiotics, and had the addition of vancomycin when methicillin resistant staphylococcus aureus sparse growth was isolated from a sputum obtained in the coronary care unit. vancomycin levels were checked, and the patient was noted to have peaks and troughs within the normal limit.he completed 2 weeks of these atibiotics and then they were dc'd. on the night of , the patient was noted to have a fever spike to 101.4. the patient was pancultured and, at the time of this dictation, no data had returned. in addition, it was noted that the patient had a picc line in his right upper extremity for the past six weeks, and the decision was made to remove the picc line with culturing of the tip.the cx was neg and pt did not have further fevers. 5. renal: the patient was noted to have an elevated creatinine to as high as 2.2, up from his baseline of 1.0. this was thought to be likely pre-renal, with a fena of less than 1. the patient was hydrated, with gradual improvement to a value of 1.0 at the time of this dictation. 6. fluids, electrolytes and nutrition: the patient was noted to have a hypernatremia as high as 152. free water deficit was calculated, and the patient was noted to be 3 liters free water deplete. the patient was initially repleted with intravenous fluids, however, hypernatremia did not improve on this regimen. the patient was then hydrated via a nasogastric tube with free water boluses, and the patient's hypernatremia resolved to a value of 140 at the time of this dictation. 7. hematology: patient with a chronic anemia, likely of chronic disease. the patient's hematocrit has remained relatively stable during his hospital stay, and the patient has been transfused only one unit of packed red blood cells without complication. this has been a dictation detailing the hospital course events between , and . the remainder of the hospital course will be accounted for in an addendum. , m.d. dictated by: medquist36 d: 23:01 t: 00:00 job#: procedure: enteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent arteriography of cerebral arteries percutaneous [endoscopic] gastrojejunostomy diagnoses: other primary cardiomyopathies mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation pneumonitis due to inhalation of food or vomitus acute and subacute bacterial endocarditis hyperosmolality and/or hypernatremia cerebral artery occlusion, unspecified with cerebral infarction 

Answer: The patient is high likely exposed to