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: dyspnea/hypoxia major surgical or invasive procedure: chest tube insertion history of present illness: 55 yo male with h/o cirrhosis (hep c v. autoimmune) transferred from with sob x 1 week, pneumonia on cxr, elevated lactate and hypoxia. he notes worsening sob for past week with pleuritic chest pain in r side. he also complains of fatigue and dysuria. he has some cough but only occasionally brings up sputum. he went to and was given ceftriaxone, azithro and solumedrol. he was also found to be in acute renal failure with cr 4.9, k 5.7. tox screen positive for opiates. he was transferred to on nrb bc they did not have any icu beds available. he denies fevers, chills. he does complain of itchy skin. . on arrival to ed, his vital signs were t97.6 p104 bp105/57 r28 94% on nrb. he was given zosyn, vitamin k 10 mg sq, kayexalate past medical history: cirrhosis: autoimmune v. hep c with possibility of alcoholic hepatitis(s/p tx with interferon and ribiviron 18 mos ago with recurrence). seen by dr. . chronic hepatitis c diagnosed on routine blood work (genotype 3 and had a liver biopsy on noting grade and stage ) alcohol excess, quit 20 years ago pancreatitis hard of hearing, wears a hearing aid splenic rupture secondary to a fall off a roof bilateral lower leg edema diverticulosis by history left femur fx with orif appendectomy social history: he is single, has a 29 year old son, is on disability, used to work as a roofer x 30 years he stopped smoking 20 years ago. no alcohol in 24 years. family history: mother is living, age 77, macular degeneration father is living, age 80, has glaucoma and djd he has 4 brothers, 3 living, one deceased in from aids no sisters physical exam: vs: tc 97.9 tm 98.4 rr 62-75 bp 105-140/61-84 rr 14-31 o2sat 95% on 5l gen: wdwn man sitting in bed crying heent: head-excoriations on head from scratching, perrla, eomi, op clear neck: no jvd cv: rrr, nl s1, s2, no m/g/r lungs: decreased r base breath sounds, crackles bilaterally midway up back abd: bs+, soft, nt, nd, no hepatomegaly ext: bilateral 1+ pedal edema, + asterixis pulses: 2+ radial and dp a/p 55 yo male admitted with pneumonia on cxr w/ complicated effusion s/p chest tube placement on vancomycin/daptomycin. pertinent results: radiology . us abd limit, single organ 1. slightly and coarse liver consistent with patient's known history of cirrhosis. 2. no intra- or extra-hepatic bile duct dilatation. 3. the gallbladder is not distended but the wall is edematous. these are most likely secondary to periportal hypertension. clinical correlation is recommended. 4. moderate-sized right pleural effusion. 5. no evidence of ascites. chest (portable ap) impression: moderate right pleural effusion. right middle and lower lobe consolidation may represent pneumonia or compressive atelectasis. left basilar atelectasis versus pneumonia. renal u.s. 3:09 pm reason: mrsa bacteremia ,eval for abscess impression: normal-sized kidneys. splenomegaly. no evidence of perirenal abscess. ************ ct pelvis w/contrast 4:15 pm 1. interval placement of a right-sided chest tube. there is a small associated right pneumothorax. there has been interval decrease in the degree of atelectasis in the right lung. no definite empyema is identified. 2. findings consistent with cirrhosis, including nodular liver, and ascites. no enhancing fluid collections within the liver or within the abdomen, to suggest the presence of an intra-abdominal source of infection. ***************** bone scan reason: 55 yr old man w/ hep c cirrhosis w/ mrsa pneumonia w/ empyma please eval for osteo l hip impression: no evidence for osteomyelitis. small amount of increased uptake in the right anterior lower ribs suggests prior trauma. . cardiology . echo study date of 1. the left atrium is moderately dilated. 2. the left ventricular cavity size is normal. overall left ventricular systolic function cannot be reliably assessed. 3. the aortic valve leaflets are mildly thickened. the aortic valve is not well seen. mild (1+) aortic regurgitation is seen. 4. no obvious evidence of endocarditis seen. . echo study date of conclusions: the left atrium is dilated. no spontaneous echo contrast is seen in the body of the left atrium. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. impression: no valvular vegetations seen. cytology . cytology report pleural fluid procedure date of negative for malignant cells. numerous neutrophils, scant reactive mesothelial cells and inflammatory cells. . cytology report peritoneal fluid procedure date of negative for malignant cells. macrophages, mesothelial cells and blood. brief hospital course: 55 yo male with h/o cirrhosis (hep c v. autoimmune) transferred from with sob x 3 week and r sided chest pain, pneumonia on cxr, elevated lactate and hypoxia. he notes worsening sob for past week with pleuritic chest pain in r side. he also complains of fatigue and dysuria. he has some cough but only occasionally brings up sputum. he went to and was given ceftriaxone, azithro and solumedrol. he was also found to be in acute renal failure with cr 4.9, k 5.7. tox screen positive for opiates. he was transferred to on nrb bc they did not have any icu beds available. he denied fevers, chills, but complained of itchy skin. in the micu, he was started on vanc, levo and ceftriaxone, which was eventually broadened to include flagyl. a noncontrast ct showed a rll consolidation and r pleural effusion without evidence of loculation. thoracic surgery was consulted and they placed a chest tube with development of small basilar ptx --> small r lateral ptx , with drainage of ~1.2 l. pleural fluid showed 51,500 wbc, 74% pmns, 2% bands, 23% monos, 16,900 rbc, tp 4.4, ldh 5108, glucose 6, amylase 21, albumin 2.1 and grew out mrsa. blood cultures and urine cultures also grew out mrsa. serial cultures have since been ngtd from and . his abx regimen was changed to vanc and levo. his arf was thought to be prerenal and he was gently hydrated with ivf with a cvp between to keep cvp > 12. urine eos were negative. a renal ultrasound was also ordered given mrsa in his urine to assess for renal abscess and was negative, revealing only trace ascites and an enlarged spleen. his bun/cr eventually improved from 85/4.2 to 65/1.2 hepatology was called because of his hx of hep c hepatitis vs. autoimmune hepatitis with ast 79, alt 71, alk phos 151, bili 7.1 and believed that it was more likely an hcv flare with hepatic encephalopathy and cholestasis. they recommended lactulose tid to qid, volume resuscitation, holding aldactone until after ivf resuscitation and stress dose steroids as well as variceal screening once his respiratory status had improved (meld 31). his liver panel improved to ast 89, alt 58, alk phos 130, bili 4.6. he was started on labetalol and his aldactone was restarted. on , he was d/c'ed to the floor. 55yo man with history of cirrhosis likely secondary to hepatitis c presented with rml/rll pneumonia, complicated parapneumonic effusion, and high grade mrsa bacteremia. # mrsa pneumonia this was heralded by progressive dyspnea, fever, pleuritic symptoms, and hypoxia. he was found to have rml and rll pneumonia. sputum cultures grew out mrsa. additionally, he had a complicated parapneumonic effusion, which required the placement of a chest tube for drainage. pleural fluid grew out mrsa as well. he was initially treated with vancomycin/levaquin/flagyl, which was tapered down to vanco/levaquin. he made progressive improvement and was weaned from nrb to 5l nasal canula. . # high grade mrsa bacteremia initial blood cultures were significant for 4/4 bottles with mrsa. he was continued on vancomycin. tee did not show any vegetations. he also had a renal us to rule out a perinephric abscess, as he had mrsa in the urine as well which is not uncommon with mrsa bacteremia. he was also started on gentamycin and daptomycin as his bacteremia did not clear with vancomycin. subsequently his vanc was d/c'ed as patient responded to daptomycin. gentamycin was d/c'ed as patient developed acute renal failure most likely related to gentamycin toxicity. daptomycin to be continued for 4 weeks after its initiation on . . # acute renal failure: most likely atn gent toxicity; urine sed showed brown muddy casts. fena intially did improve with hydration and so was thought to be prenal most likely hepato-renal. however given the brown muddy casts and improving fena, most likely atn. negative urine eos consistently. 25 g iv albumin given . peak creatinine was 6.6 which started trending down at the time of discharge. he did not have any signs of uremia or severe volume overload and so was not started on hd. will need to check creatinine every 3-4 days. . # medical regimen was optimized with beta blocker for variceal bleeding prophylaxis, aldactone for diuresis, and lactulose titrated upward for encephalopathy. liver team was following. bilirubin peaked at 8.9. egd negative for varices, but showed some gastritis - was on ppi. u/s showed small amount of ascites --> ct showed large amount of ascites --> diagnostic/therapeutic paracentesis removed 2 l with saag of -0.2. hepatology of opinion that this was not unusual for bad cirrhosis. vit k 10 mg sc x 3 days finished without improvement in inr. . # hyponatremia: sodium of 132 on admission, was likely to portal hypertension from cirrhosis. low albumin can cause dilutional effect . he was on free water fluid restriction at 1.5 l. . # thrombocytopenia - plt ct of 97 on admission. likely due to cirrhosis with secondary hypersplenism (large spleen on u/s). was not on heparin gtt during this course of hospital admission. . # anemia - hct of 36.3 on admission, macrocytic anemia. likely secondary to cirrhosis and anemia of chronic disease. hemolysis labs showed indirect bili 4.2, retic % 2.6% (ri 1.6 - inadequate), ldh 283 (slightly high), but haptoglobin 110. given splenomegaly - believe this to be hemolysis in spleen from cirrhosis. he was guaiac negative. he was being transfused for hct < 24. . # copd: continued on nebs . # psych: he was occasionally agitated (likely component of hepatic encephalopathy) with labile mood and expressed feelings of hopelessness, depression. no active suicidal ideation, though expressed thoughts of "if only i just didn't wake up". no hi. was continued on sertraline. . # pruritus - derm was consulted. most likely from hyperbilirubinemia, uremia. recommended sarna, hydroxyzine, (hydrocortisone tried for pruritus without much effect). also had herpes ii positive (back lesion) -> holding on acyclovir as pt in renal failure. did not consider increasing doxepine to 50 mg qhs (as recommended by derm) because of renal/hepatic toxicity. . # rle slight warmth and swelling - mostly pitting edema. rle u/s negative for dvt. not on heparin because of thrombocytopenia. continued on pneumoboots, heparin sq . # diarrhea - likely from all of his lactulose, but given recent low grade fever and multiple abx, a c diff was negative. . # ppx: ppi, pneumoboots, heparin sq medications on admission: meds spironolactone 50 mg (for leg swelling) lactulose (for constipation) zyrtec zoloft 200 mg protonix 40 mg daily prednisone 10 mg daily ibuprofen prn vicodin prn discharge medications: 1. albuterol sulfate 0.083 % solution sig: inhalation q6h (every 6 hours) as needed. 2. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. sertraline 100 mg tablet sig: one (1) tablet po bid (2 times a day). 5. haloperidol 1 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for agitation. 6. lactulose (for encephalopathy) 10 g/15 ml solution sig: three hundred (300) ml po q3-4h (every 3 to 4 hours) as needed. 7. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day). 8. oxycodone 5 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for pain. 9. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 10. multivitamin capsule sig: one (1) cap po daily (daily). 11. outpatient lab work please check your creatinine every 5 days and report it to your primary care physician or your kidney doctor. 12. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 13. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 14. hydrocortisone 0.5 % ointment sig: one (1) appl topical tid (3 times a day) as needed. 15. prochlorperazine 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 16. doxepin 25 mg capsule sig: one (1) capsule po hs (at bedtime). 17. white petrolatum-mineral oil cream sig: one (1) appl topical (2 times a day). 18. terbinafine 1 % cream sig: one (1) appl topical (2 times a day) for 4 weeks. 19. pramoxine-mineral oil-zinc 1-12.5 % ointment sig: one (1) appl rectal (2 times a day): please apply to itching area. 20. cholestyramine-sucrose 4 g packet sig: one (1) packet po bid (2 times a day). 21. ketoconazole 2 % shampoo sig: one (1) appl topical asdir (as directed). 22. clotrimazole 1 % cream sig: one (1) appl topical (2 times a day). 23. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 24. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 25. clobetasol 0.05 % cream sig: one (1) appl topical tid (3 times a day). 26. lactulose 10 g/15 ml syrup sig: fifteen (15) ml po bid (2 times a day). 27. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 28. fluocinolone 0.01 % solution sig: one (1) appl topical tid (3 times a day) as needed for scalp itching. 29. sodium chloride 0.65 % aerosol, spray sig: sprays nasal (2 times a day) as needed. 30. pramoxine 1 % lotion sig: one (1) topical qid (4 times a day). 31. pramoxine-hydrocortisone % cream sig: one (1) topical qid (4 times a day) as needed for pruritis. 32. gabapentin 300 mg capsule sig: one (1) capsule po daily (daily). 33. daptomycin 500 mg recon soln sig: one (1) intravenous once a day for 12 days. discharge disposition: extended care facility: healthcare center discharge diagnosis: 1. cirrhosis 2. mrsa pneumonia, complicated parapneumonic effusion 3. high grade mrsa bacteremia 4. hepatic encephalopathy 5. acute renal failure discharge condition: stable discharge instructions: 1. continue to take your medications as prescribed 2. call your doctor or return to the emergency room for any fever/chills/chest pain/cough/trouble breathing/ or any other concerning symptoms. 3. you should take your antibiotic for 4 weeks from . 4. please check your creatinine every 5 days to monitor its trend and report it to your pcp or your kidney doctor. followup instructions: please make an appointment to see your primary care physician weeks. . for your chest tube drainage and collection: provider: . , multi-specialty thoracic unit-cc9 phone: date/time: 1:30 . infectious disease specialist: provider: . tan phone: date/time: 10:00 . kidney disease specialist: provider: , .d., ph.d. date/time: 3:00 . if you wish to see the dermatologist, you can call to make an appointment with dr. who saw you as an inpatient. procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified other endoscopy of small intestine diagnostic ultrasound of heart thoracentesis percutaneous abdominal drainage arterial catheterization transfusion of packed cells transfusion of other serum diagnoses: thrombocytopenia, unspecified unspecified pleural effusion congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma alcoholic cirrhosis of liver acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis other and unspecified alcohol dependence, in remission chronic airway obstruction, not elsewhere classified infection with microorganisms resistant to penicillins methicillin susceptible staphylococcus aureus septicemia bacteremia methicillin susceptible pneumonia due to staphylococcus aureus hepatic encephalopathy chronic pancreatitis unspecified gastritis and gastroduodenitis, without mention of hemorrhage unspecified deficiency anemia jaundice, unspecified, not of newborn unspecified disorder of stomach and duodenum 

Answer: The patient is high likely exposed to