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: addendum: see previous discharge summary for events up to . after his sodium normalized he was transferred from the icu to the neurology floor. during his icu stay, he spiked to 102.7 on , and blood cx and urine cx were done. blood cx returned positive for mssa. ua was positive for enterobacter pansensitive. the bacteremia was thought to be due to an arterial line infection, thus the line was pulled and he was started on vancomycin . antibiotics were changed to oxacillin on as sensitivities came back sensitive to oxacillin. repeat blood cultures were drawn on and grew mssa, on one out of two bottles + mssa, & - ngtd. he was continued on oxacillin per id recs. in addition, tte and tee were negative for endocarditis. he will continue a bacteremia workup on the medicine service that includes ct chest and wbc scan to look for osteomyelitis. he was subsequently found to have aspiration pneumonia and uti was treated with clinda and cipro. f/u urine cx on showed no growth. lfts should be followed as patient is on oxacillin. on , he was found to be in rapid afib while getting his tte. he was sent back to the floor and cardiology was consulted. his metoprolol was increased and aspirin was started. tee showed ef 50-55%, simple atheromas, + pfo, 1+ mr, 1+ ai. he is currently being trasferred to the medicine service for further management of his medical issues. hospital course from time of transfer to medicine on : hpi: 56 yo m with remote h/o tob, etoh, migraines, cataract surgery, p/w 5-6 weeks of progressive worsening ha, then developed left eye ptosis, double vision and was admitted on . subsequently found to have multiple (at least 5)aneurysms on mri now s/p clipping of 2 of those aneurysms, the left mca and posterior communicating artery. post op course was intially complicated by hyponatremia attributed to siadh, now resolved, high grade mssa bacteremia on () secondary to a line infection (also cultured mssa) with persistent bactermeia on ( still positive for mssa), switched from vancomycin (started ) to oxacillin on , now s/p negative tee, chest ct showing possible septic emboli in addition to possible aspiration pneumonia, and with new onset afib, now in sinus rhythm. he is transferred to medicine service from neurosurgery on . . at this time he reports some difficulty with word finding/cognition that he thinks has improved since surgery. he denies double vision, light-headedness, dizziness or headache. additionally, he complains of cough with mucous production that he feels has worsened over the past few days. he denies fevers, chills, night sweats, chest pain or shortness of breath. denies hemoptysis. reports feeling some fatigue from everything he has been through. denies abdominal complaints including abdominal pain, nausea, vomiting, diarrhea, constipation, hematochezia, melena. no fecal incontinence. denies dysuria, incontinence or hesitancy or incomplete voiding. he denies other pains/arthralgias. says his former picc site is not painful, does have soreness at current iv site. hospital course on: this is a 56 y/o with h/o smoking, alcohol abuse, migraines who presented with headaches, cniii nerve palsy on admited to neurosurgery found to have multiple intracranial aneurysms incl l mca aneurysm with mass affect, now 2 of which are s/p clipping. post-op course complicated by hyponatremia/siadh now resolved, afib-also now resolved in nsr, and high grade mssa bacteremia with current work-up ongoing for possible localizing source . 1)infectious disease: on transfer to medical service on , patient with high grade bacteremia-mssa since -still positive on , switched from vanc to ox on , tee negative. because of high grade bacteremia, surveillance cultures were sent on , and were all negative. additionally, patient underwent chest x-ray on then ct of chest on which showed multiple septic embolic presumed secondary to mssa bacteremia. given negative tee, other sources were investigated as possible source. patient subsequently underwent ct abdomen which showed no abdominal source, wbc scan which showed some enhanced uptake in right anterior skull. neurosurgery reviewed study and does not feel there is indication for drainage. mr/mra of head was then done to better assess this area and showed no specific abnormalities. of note, that patient has been afebrile throughout this time, with negative surveillance cultures and is without change in symptomatology or neuro exam. given that he has had no clinical neurologic change and has been afebrile throughout this time with negative surveillance cultures, in consultation with id and neurosurgery, medicine team does ot feel as though patient has mycotic aneurysm or other concerning fluid collection/source of infection that warrants intervention at this time. the patient was continued on iv oxacillin and will receive 6 weeks starting from which is the first day of negative cultures. additionally, will need id follow-up, along with weekl lft's and cbc's to assess for oxacillin toxicity. as further work-up for other possible sources and to complete basic id work-up, urine, c. diff, stool, o and p studies were sent and all returned negative. additinoally, patient was treated for a separate pneumonia: he received a seven day course of clindamycin/cipro. 2)cardiac: ischemia: patient was maintained on aspirin for primary prophylaxis. pump: low nl ef, pfo, some evid of fluid by chest ct, no vegetations by tee. attempt was kept to maintain patient euvolemic, and patient maintained on metoprolol. rhythm: patient had episode of afib before transfter to medicine. he was in nsr while on the medicine service. a fib was felt likely 2nd to incre adrenergic tone with intracranial process. he was maintained on metoprolol. decision was made not to anti-coag given risk for brain bleed. 3) renal: hyponatremia attributed to siadh--patient was continued on fluid restriction and remained normo-natremic throughout his stay on the medicine service. 4)gi: patient with elevated lft's on transfer, felt possibly oxacillin. lft's were normal on discharge (from ). will need to be monitored on oxacillin. also with some diarrhea which was improving on discharge. says he had some diarrhea before coming to hospital. sent stool studies, o and p (wife with history of parasitic infection-works with handicapped children), and repeated c. diff which were all negative. nutrition: patient had poor po intake throughout hospital course. he says that this is his baseline and as a truck driver he just doesn't eat much. nutrition recommended consideration of g-tube or ng tube but patient did not desire and medical team felt that given patient has ability to eat and no cause for his poor intake other than his usual habits, did not place ng tube. we have provided extensive education, encouragement and he has been followed by nutrition. 5)neuro: patient had no major neurologic issues while on the medicine service. he was followed by neurosurgery. no neurologic changes noted. mental status continues to progress to baseline. left subdural/epidural collection has significantly diminished in size. 6)patient maintained on heparin subcu and famotidine for dvt and gi prophylaxis respectively. patient had picc line placed on for iv antibiotic course. full code throughout this admission. chief complaint: see d/c summary major surgical or invasive procedure: see d/c summary history of present illness: see d/c summary past medical history: see d/c summary social history: see d/c summary family history: see d/c summary physical exam: see d/c summary pertinent results: see d/c summary micro:blood mssa 2/24-6/6mssa , , negative urine: enterobacter aerogenes 10-100,000 and negative stool: negative, also o and p negative c. diff: and negative tee: 1. the left atrium is normal in size. a patent foramen ovale is present. a left-to-right shunt across the interatrial septum is seen at rest. 2.left ventricular wall thicknesses are normal. overall left ventricular systolic function is low normal (lvef 50-55%). 3.right ventricular chamber size and free wall motion are normal. 4.there are simple atheroma in the ascending aorta. there are simple atheroma in the descending thoracic aorta. 5.there are three aortic valve leaflets. mild (1+) aortic regurgitation is seen. 6.the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. 7.there is no pericardial effusion. chest ct:ct chest following iv contrast: there are slightly enlarged right hilar and precarinal lymph nodes. there is no pericardial effusion. the heart size is at the upper limits of normal. there are bilateral pleural effusions, right greater than left. multiple nodules are seen predominantly within the right lung. several are cavitated. additionally, there are diffuse peripheral ground-glass opacities bilaterally. there is a moderate amount of compressive atelectasis at the right base. there is opacity at the left base out of proportion to the adjacent effusion. no suspicious lesions are seen within the bones. there is a left exophytic renal cyst. a granuloma is seen within the liver. within segment 6 of the liver is a 1 cm area of abnormal enhancement with smooth margins. there is early filling of an adhacent segment of hepatic vein. this suggests a portal/hepatic venous fistuliza or vascular lesion with shunting. has the patient had biopsy or instrumentation in this region? this area could be further assessed with ultrasound or mri if indicated impression: 1) cavitary and noncavitary nodules, which are highly suggesive of septic emboli in this patient with history of staph bacteremia. 2) evidence of a vascular lesion in the right posterior liver (segment vi). correlation with ultrasound may be helpful for further characterization. ct abdomen:ct of the abdomen with oral and iv contrast: there are small bilateral pleural effusions with associated atelectasis. the liver, gallbladder, spleen, and pancreas are unremarkable. the kidneys and adrenal glands are within normal limits with the exception of a simple cyst in the lower pole of the right kidney which measures 1.7 x 2.0 cm. the stomach and opacified loops of small bowel are of unremarkable appearance. there is a small hiatal hernia. there is no free fluid in the abdomen. there is no free air in the abdomen. there is diverticular disease without evidence of diverticulitis. no intra-abdominal abscess was identified. the appendix was not identified, but there is no evidence of appendicitis. there are multiple mesenteric small lymph nodes that do not meet ct criteria for pathology. there are no significant retroperitoneal lymph nodes. ct of the pelvis with oral and iv contrast: there is diverticular disease of the sigmoid colon without evidence of diverticulitis. the opacified intrapelvic bowel loops are unremarkable. the distal ureters and urinary bladder are unremarkable. the prostate is unremarkable. there is no free fluid or free air in the pelvis. bone windows: there is a mild left convex scoliosis. there are degenerative changes of the lumbar spine. there are no suspicious lytic or blastic lesions. impression: 1. no intra-abdominal source for mssa bacteremia was identified. 2. small bilateral pleural effusions. 3. atelectasis vs pneumonia in the lung bases. wbc scan: interpretation: following the injection of autologous white blood cells labeled with indium-111, images of the whole body, wrists and skull were obtained at 24 hours. these images show increased tracer uptake within the right lateral frontal skull and parts of the overlying soft tissues. on the static images of the wrist, there is a small focus of increased tracer activity in the right wrist. this is rather subtle. no other areas of abnormal tracer uptake are identified. the above findings are consistent with infection in the right frontal and lateral skull. there is also possibly a small focus of infection within the right wrist. impression: uptake of radiolabeled white blood cells within the right anterior skull. there is also a subtle increased uptake in the right wrist. these are consistent with infections in these sites. /nkg 3/5mr/mra brain mri: on the diffusion images, no evidence of acute infarct is seen. there is a left frontal extra-axial hematoma identified with mixed signal intensities. postoperative changes are seen in this region with craniotomy for aneurysm clipping. artifacts are seen in the left supraclinoid region and projected over the left temporal lobe secondary to aneurysm clipping. there is no midline shift, mass effect or hydrocephalus seen. small amount of blood products are seen in the subarachnoid space and along the sulci at convexity. following gadolinium administration, there is no evidence of abnormal parenchymal, vascular or meningeal enhancement seen. there are no signs of cerebritis or cerebral abscess. there is also no significant enhancement seen along the left frontal extra-axial collection. impression: status post aneurysm clipping. no evidence of acute infarct. left frontal extra-axial collection due to hematoma as on the ct of . no abnormal enhancement seen. mra of the head: the head mra demonstrates normal flow signal in the right carotid circulation and in the posterior circulation. the flow signal in the left middle cerebral artery is not visualized, which most likely secondary to artifacts from the adjacent aneurysm clip. subtle flow signal is identified in the branches of the left sylvian fissure indicating perfusion in this region. impression: proximal left middle cerebral artery flow signal is obscured by artifact from adjacent clips. no other abnormalities. it should be noted that the mra examination is not a sensitive method for evaluation for mycotic aneurysm. brief hospital course: see d/c summary medications on admission: see d/c summary discharge medications: 1. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 3. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q4h (every 4 hours) as needed. 4. albuterol sulfate 0.083 % solution sig: one (1) inhalation q2h (every 2 hours) as needed. 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 6. metoprolol tartrate 25 mg tablet sig: three (3) tablet po bid (2 times a day). 7. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 8. multivitamin capsule sig: one (1) cap po daily (daily). 9. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 10. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily) as needed for h/o etoh. 11. oxacillin sodium 10 g recon soln sig: two (2) grams injection q4h (every 4 hours) for 34 days: 6 weeks from , so will receive for 42 days-continue until . 12. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. discharge disposition: extended care facility: sachem skilled nursing & rehabilitation - discharge diagnosis: intracerebral aneurysms s/p clipping cerebral salt wasting (hyponatremia) bacteremia, high grade, tee neg for endocarditis aspiration pneumonia uti, enterobacter discharge condition: stable discharge instructions: please call if you have headache or any other pain that does not respond to pain medication. call if you develop any sudden weakness or mental status change. call if you have a fever/chills/sweats, or for significant change in bowel movements. take all medications as prescribed. follow-up as below. you will need weekly lab testing. followup instructions: 1. dr. . , , - ( . 1:00 pm. please note that dr. will set you up for follow-up with an infectious disease doctor. 2. follow up chest ct with and without contrat. building, . ;12:45 pm. do not eat anything after 10 am on the day of your appointment. you may drink water and you should take your medication. md procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart clipping of aneurysm arteriography of cerebral arteries other repair of aneurysm transfusion of packed cells diagnoses: urinary tract infection, site not specified unspecified essential hypertension atrial fibrillation infection with microorganisms resistant to penicillins cerebral aneurysm, nonruptured pneumonitis due to inhalation of food or vomitus bacteremia cellulitis and abscess of upper arm and forearm infection and inflammatory reaction due to other vascular device, implant, and graft other disorders of neurohypophysis third or oculomotor nerve palsy, partial vascular complications of other vessels embolism and thrombosis of unspecified artery 

Answer: The patient is high likely exposed to