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: heparin agents attending: chief complaint: transfer for mrsa bacteremia/?endocarditis major surgical or invasive procedure: left internal jugular central venous line placement () history of present illness: 53 year old male with past medical history significant for marginal zone non hodgkin's lymphoma s/p splenectomy and rituximab with post-op course complicated by gastric perforation. he was recently admitted to hospital in novemember for generalize weakness and discharge without any cause of his weakness. . he recently moved to massachussets from so his sister could take care of him. he was admitted to on after five days of worsening fatigue, moaning, agitation and fall with a head trauma on . on admission, vs noted to have a t of 100.3, cre of 2 (baseline 1.8-1.9), wbc of 32, hct of 30, trop-i of 0.052, bnp of 15,000. tox screen positive for opiates. . he was noted to have mrsa in his blood cultures with concern for aortic valve endocarditis. he was initially started on vancomycin and oxacillin which was switched to vancomycin 1500 mg iv bid and rifampin once it was confirmed to be mrsa. he had a ct torso/head that did not show any clear abscesses. his hospital course was notable for acute kidney injury which was initally oliguric but improved with intravenous hydration. he was intubated on for worsening mental status and agitation. ct head without contrast did not show any acute intracranial pathology. abg was 7.48/32/74/24 on 2 l nc prior to intubation. . abg on transfer was ac 500 x 16 40% fio2 peep 5 = 7.39/32/149/19. hct 20.6 prior to transfer and received 1 u prbcs. . on the floor, patient was intubated and sedated. past medical history: 1. splenic marginal zone lymphoma - s/p splenectomy in - post-op course complicated by atrial fibrillation/sick sinus syndrome/reentral atrial tachycardia, gastric tear requiring re-exploration and repair of gastric perforation, post-operative pancreatitis and autoimmune hemolytic anemia requiring prednisone. 2. cad s/p mi - s/p cardiac cath with no abnormalities - tte : ef 60%, normal systolic function, mild tr, borderline pah, mild mr, trivial pericardial effusion 3. rheumatoid arthritis controlled with prednisone 4. antiphospholipid antibody syndrome c/b dvt in - was on coumadin, currently on aspirin 5. ger 6. sleep apnea 7. hepatitis c 8. h/o loculate pleural effusion 9. s/p pancreatic stent .vitamin b12 deficiency 11. chronic kidney disease (baseline creatinine 1.5) 12. ?hit social history: the patient still lives at home. divorced and has been depending on his care by his ex-wife and son. recently moved to so his sister could take care of him. ambulates with a walker but has become more dependent on others for care recently. he recently started smoking. no clear history of increased alcohol abuse and no drug history. family history: positive for a father who died from colon cancer at the age of 55. his mother died from head and neck cancer at age 59. multiple other siblings with cancers and a sister with splenectomy also after a non-hodgkin lymphoma. physical exam: vs: 98.6 92 121/70 96% 40%fio2 peep 5 cm gen: intubated. sedated. heent: normocephalic. normotraumatic. anicteric. neck: supple neck pulm: clear to auscultation bilaterally. no crackles or wheezing appreciated. card: holosystolic murmur best heard at apex but could not appreciate it radiating to the axilla. no gallops abd: soft, nontender and nondistended. nabs ext: no edema skin: b/l stasis dermatitis. chronic skin changes at b/l ue. no osler nodes or janeaway lesions noted neuro: sedated. not following commands. perrla pertinent results: () na 136 cre 2 wbc 32 hct 30 (20.6 prior to transfer, received 1 u prbcs) inr 1.3 ptt 53 nh4 18 albumin 1.6 ap 207 alt 43-> 70 ast 36-> 87; lipase 46 trop-i 0.052, 0.056 bnp: 15,000; hga1c 7.4 tsh: 0.849 b12: 610 folate > 20 . imaging: ct head showed no acute intracranial pathology but this was the motion degraded study. ct of the cervical spine: no cervical spine fracture, subluxation or prevertebral soft tissue swelling; however, the djd changes at c5-c6 place the patient at a greater risk for cord injury and if needed an mri could be obtained. . chest x-ray: there is a right upper lobe opacity that potentially may represent an area of aspiration versus contusion, although definitive developing infectious process cannot be entirely excluded. . hip x-ray showed no fracture. . pelvic x-ray: no pelvic fractures. . ct torso showed infiltrates and effusions at both lung bases, small amount of ascites. he is status post splenectomy. no obvious intra-abdominal abnormality. . tte (): lvef of 50%. moderate vegetation at aortic valve. . urine culture (): no growth todate . blood culture (): 1. meth resistant staph aureus target route dose rx ab cost m.i.c. iq ------ ----- ------------------ ------ -- ------ --------- ------ cefazolin r ciprofloxacin r >=8 clindamycin r <=0.25 erythromycin r >=8 gentamicin s <=0.5 inducible clind + pos levofloxacin r >=8 linezolid s 2 benzylpenicilli r >=0.5 oxacillin r >=4 tetracycline s <=1 trim/sulfa s <=10 vancomycin s <=0.5 . blood culture (): positive surveillance culture . blood culture (): no growth todate . cxr (): cardiomegaly. et tube 4 cm above carina. b/l infiltrate @ rll and lll . ekg (): nsr. normal axis. normal intravals. no st-t changes.. . pertinent labs 07:50pm blood hct-25.8* 04:15am blood wbc-22.1* rbc-3.12* hgb-9.1* hct-28.6* mcv-92 mch-29.4 mchc-32.0 rdw-16.4* plt ct-58* 03:37pm blood wbc-23.4* rbc-2.55* hgb-7.8* hct-23.7* mcv-93 mch-30.5 mchc-32.8 rdw-16.1* plt ct-100* 04:33am blood wbc-21.6* rbc-2.76* hgb-8.6* hct-25.4* mcv-92 mch-31.0 mchc-33.7 rdw-16.3* plt ct-128* 10:25am blood inh scr-pos lupus-pos 04:47am blood glucose-258* urean-54* creat-1.9* na-147* k-3.8 cl-116* hco3-21* angap-14 03:54pm blood glucose-145* urean-62* creat-2.0* na-148* k-4.1 cl-117* hco3-21* angap-14 02:50am blood glucose-150* urean-59* creat-2.0* na-148* k-3.9 cl-121* hco3-19* angap-12 04:33am blood glucose-138* urean-69* creat-2.8* na-148* k-4.5 cl-120* hco3-16* angap-17 04:47am blood alt-49* ast-32 alkphos-176* totbili-0.6 04:33am blood alt-23 ast-46* ld(ldh)-374* alkphos-266* totbili-0.6 09:13pm blood caltibc-147* hapto-533* ferritn-1128* trf-113* 09:13pm blood tsh-0.55 04:47am blood cortsol-44.2* 04:47am blood hbsag-negative hbsab-negative hbcab-negative . heparin dependent antibody positive () . pertinent imaging tte (): moderate sized mass on the right coronary cusp of the aortic valve which is consistent with vegetation, tumor, or thrombus. moderate to severe aortic regurgitation. mild to moderate mitral regurgitation. moderate pulmonary hypertension. . ecg (): atrial fibrillation with rapid ventricular response. compared to the previous tracing of no diagnostic interval change. . mri (): multiple foci of restricted diffusion, distributed in both cerebral hemispheres as described above, the possibility of septic emboli and thromboembolic ischemic events are considerations. few of these lesions demonstrate magnetic susceptibility at the frontal lobes and punctate enhancement in the left parietal lobe. bilateral mucosal thickening is identified at the mastoid air cells and sphenoid sinus. subtle high signal intensity foci are demonstrated in the pons on t2 and flair, possibly reflecting chronic microvascular ischemic disease. . tte (): aortic valve vegetation with moderate associated regurgitation. mildly dilated right ventricle with normal global and regional biventricular systolic function. moderate pulmonary hypertension. limited study. . cxr (): in comparison with the study of , the tip of the endotracheal tube now lies approximately 4 cm above the carina. the other monitoring and support devices are unchanged. diffuse bilateral pulmonary opacifications persist. multiple nodules are again consistent with the clinical diagnosis of septic emboli. . brief hospital course: 53 year old male with past medical history significant for marginal zone non hodgkin's lymphoma s/p splenectomy and rituximab, rheumatoid arthritis on chronic prednisone, ?hit, autoimmune hemolytic anemia transfer to micu for further management of mrsa bacteremia. . 1. mrsa bacteremia: positive blood cultures on @ with positive surveilllance culture on and no growth on blood cultures since . tte showed moderate vegetation and 2+ mr of 50% which has stayed stable on tte on . mri head significant for > 20 foci concerning for septic emboli to brain which might have caused his acute agitation leading to his intubation at . has been continued on iv vancomycin throughout his hospital stay. cardiac surgery was consulted early but have decided not to intervene surgical due to multiple comorbidities along with septic emboli to his brain which would not be able to handle heparin load during open heart surgery. ct abdomen/pelvis done on showed no intra-abdominal abscess, although study was limited without iv contrast. was started on zosyn on for continued leukocytosis and fever; these initially improved but have remained elevated. . 2. respiratory failure: intubated in the setting of agitation which could be due to septic emboli vs nonpulmonary ards from sepsis vs toxic/metabolic injury. his respiratory status did improve over the course of his stay, however he remained intubated due to sedation and poor neurologic exam. . 3. acute kidney injury: pt has chronic kidney disease, with baseline creatinine around 1.5. his creatinine has continually increased to max of 3.5, concerning for septic emboli to kidney versus atn vs volume depletion (though urine lytes not consistent with prerenal state). . 4. anemia: iron studies consistent with anemia of chronic disease. stool guiaic has been negative along with hemolysis labs. pt received one blood transfusion on , and a second on . crit has remained stable since that time. . 5. elevated lfts: history of hepatitis c ab with negative viral load in the past along with abnormal lfts. differential also includes emboli to the liver but ct abdomen without contrast did not show any abscess vs amiodarone toxicity. . 6. ?hit: ? of hit from records obtained from osh (only in one note though). contact primary oncologist who could not give any further information. optical density came back minimally positive. heme consulted, who felt that this was likely not hit, but recommended no heparin x24 hours. . 7. r foot discoloration: concern for arterial septic embolization. vascular consulted, felt that no intervention indicated until amputation needed. family discussion held on . family aware that pt very sick, and feel that he would not want amputation, trach, or to be in a nursing home for the rest of his life. given his poor pre-hospital functional status, it was felt that all of these things were very likely to happen. the family decided to make the patient cmo. he passed away at 1858 on . medications on admission: medications (on transfer) 1. versed gtt 2. fentanyl gtt 3. vancomycin 1500 mg iv q12 with trough of 15.8 4. rifampin 300 mg po bid 5. metoprolol 12.5 mg po tid . medications (prior to admission to ) 1. amiodarone 200 mg twice a day 2. cymbalta 60 mg twice a day 3. folate 1 mg po qdaily 4. lyrica 75 mg once a day 5. lisinopril 20 mg a day 6. metoprolol 100 mg twice daily 7. oxycodone/apap every 4 hours as needed 8. pravastatin 80 mg at bedtime 9. prednisone 20 mg 3 times daily 10. lantus insulin 11. vitamin a 12. stool softener 13. mva . discharge medications: pt passed away discharge disposition: expired discharge diagnosis: pt passed away discharge condition: pt passed away discharge instructions: pt passed away followup instructions: pt passed away procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of endotracheal tube central venous catheter placement with guidance diagnoses: anemia of other chronic disease coronary atherosclerosis of native coronary artery esophageal reflux chronic hepatitis c without mention of hepatic coma acute kidney failure, unspecified atrial fibrillation chronic kidney disease, unspecified other b-complex deficiencies acute respiratory failure bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site rheumatoid arthritis acute and subacute bacterial endocarditis primary hypercoagulable state do not resuscitate status other pulmonary embolism and infarction arterial embolism and thrombosis of lower extremity methicillin resistant pneumonia due to staphylococcus aureus marginal zone lymphoma, spleen 

Answer: The patient is high likely exposed to