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: sixty-seven-year-old male with history of cad status post mi, type 2 diabetes, history of dvt on coumadin, status post renal transplant on immunosuppressants, who presents with fevers and hypoxia x1 day. the patient reports that he initially felt chills, feeling tired all over for the last several days, and then developed acute worsening of shortness of breath over the last day prior to admission. denies headache, chest pain, diarrhea, pain of any kind, dysuria, lower extremity pain, recent surgeries, cough, or sputum. he does note decreased p.o. over recent days. his last bowel movement was yesterday, which was normal. in the emergency department: he was febrile to 101.6 with saturations of 83% on room air improving to 97% on 100% nonrebreather. he received lasix, vancomycin, levofloxacin, and was placed on bipap and transferred to the sicu on . past medical history: 1. cad status post stent x2 to the lad in . ef of 35% with regional left ventricular dysfunction. 2. type 2 diabetes diagnosed in complicated by peripheral neuropathy and retinopathy. 3. end-stage renal disease on hemodialysis status post cadaveric renal transplant in . 4. hypertension. 5. hyperlipidemia. 6. peripheral vascular disease status post left fem- in , status post multiple toe amputations. 7. dvt on coumadin "for years". 8. mrsa toe ulcers. 9. group g strep bacteremia in treated with intravenous antibiotics complicated by mrsa bacteremia line infection of his picc in . medications on admission: 1. alprazolam 1-2 mg p.o. q.h.s. 2. aspirin 325 mg p.o. q.d. 3. cyclosporin 100 mg p.o. b.i.d. 4. colace 100 mg p.o. b.i.d. 5. gabapentin 900 mg p.o. t.i.d. 6. hydralazine 75 mg p.o. t.i.d. 7. metoprolol 150 mg p.o. b.i.d. 8. senna. 9. mycophenolate 1 gram p.o. b.i.d. 10. lisinopril 20 mg p.o. b.i.d. 11. multivitamin. 12. pantoprazole 40 mg p.o. q.d. 13. insulin 26 units nph q.a.m., 35 units nph q.p.m. 14. warfarin 7.5 mg p.o. q.h.s. allergies: atorvastatin (elevated creatine kinase). social history: retired car salesman. denies tobacco, ethanol, or other drug use. lives at home alone with vna. family history: father with diabetes. physical exam on admission: temperature 98.5, blood pressure 150/64, pulse 74, respirations 18, and 94% on nonrebreather. general: obese, chronically ill-appearing male in mild distress. heent: oral mucosa dry, nonrebreather in place, conjunctivae pink. neck is supple, jvp at 9 cm. pulmonary: difficult to examine. decreased breath sounds everywhere, but clear to auscultation bilaterally. cardiac: regular rate and rhythm, holosystolic murmur at the left upper sternal border radiating to the apex. abdomen: distended, soft, nontender, tympanitic, no hepatosplenomegaly. extremities: bilateral erythema anterior lower extremities consistent with venous stasis skin changes, multiple toe amputations, 4 x 3 cm left heel ulcer with minimal drainage right lateral malleolar ulcer appears to be healing well. neurologic: 5/5 strength bilaterally in upper and lower extremities. laboratory studies on admission: notable for a white blood cell count of 18.7 with 81% polys and 6 % bands, hematocrit of 35.1. potassium 5.5, bun 36, creatinine 1.8 from a baseline of 1.2. inr 4.3. ck 91, troponin 0.04. lactate 2.5. abg on nonrebreather: 7.27/46/130/22. chest x-ray on admission with right base atelectasis and right hilar prominence. ekg: normal sinus rhythm, st depressions in ii, no peaked t waves, and no change since last ekg. summary of hospital course: 1. hypoxia: patient was admitted to the icu in order to be placed on bipap. given the initial read on the chest x-ray, there was a concern for aspiration versus community acquired pneumonia in the setting of immunosuppression. he was initially treated with levofloxacin, vancomycin, and zosyn. given the concern congestive heart failure as a possible contributor for exam, the patient had an echocardiogram, which showed a moderately depressed left ventricular function. following the institution of antibiotics, patient's oxygen requirements markedly improved. subsequent chest x-rays showed no evidence of clear pneumonia. at time of discharge, the patient was saturating 96% on 2 liters. he will require close following of his oxygen saturation with a hope to gradually wean oxygen as tolerated. 2. sepsis: patient has septic physiology on admission with hypotension with systolic blood pressures in the 80s and fever. the differential diagnosis includes pneumonia, but there was no evidence on chest x-ray, uti, bacteremia (history of mrsa bacteremia as well as strep bacteremia), cellulitis (no evidence on physical exam), other seeded sites in the setting of prior mrsa bacteremia. as such, the patient will continue on levofloxacin and vancomycin to cover for potential pneumonia as well as mrsa. he will complete a total 14-day course. 3. acute renal failure: creatinine rose to a maximum of 2.4 from a baseline of 1.2. the differential diagnosis included atn from transient hypotension versus cyclosporin, prerenal, ain (no new medications). patient had urine electrolytes performed while he was in the unit with a fena of 1%. sediment of his urine was consistent with tubular necrosis. the transplant renal service was consulted, who felt that the patient's acute tubular necrosis was likely secondary to his transient episode of hypertension. in order to rule out cyclosporin toxicity, a cyclosporin level was drawn and his cyclosporin was held. cyclosporin level returned at 114 indicating that patient was not toxic on cyclosporin at admission. patient was restarted on home doses of cyclosporin. patient also had a renal ultrasound on admission of his transplanted kidney, which showed no abnormalities. patient's creatinine gradually improved over the course of admission with good urine output. at time of discharge, creatinine was 1.1. 4. transaminitis: patient had a mild transaminitis with elevated t bilirubin occurring late in the course. this is felt to be secondary to mild hypoperfusion during his transient hypotensive episodes while in the unit. differential diagnosis included hepatic congestion secondary to right heart failure and zosyn toxicity. zosyn was discontinued three days into the hospital course. hepatitis panels were negative. patient's lfts gradually trended down. he will required additional monitoring of his lfts until they return to baseline. 5. anemia: patient's hematocrit gradually drifted down following admission to 26. iron studies from were consistent with anemia of chronic disease (iron 27, tibc 224, ferritin 82). patient received 1 unit of packed red blood cells and hematocrit was stable at time of discharge at 32. patient maybe considered for erythropoietin subcutaneous injections as an outpatient. 6. coronary artery disease: patient was noted to have a troponin leak to 0.09 in the setting of hypoxia, acute renal failure, and possible chf. there were no significant ekg changes compared to prior ekgs. no further workup was pursued at this time, although an outpatient stress test may be considered. 7. coagulopathy: despite holding coumadin on admission, inr rose to a maximum of 5.4. patient received 2.5 mg of vitamin k and subsequently patient's inr decreased to 1.4. coumadin was restarted. he will require monitoring of his inr as an outpatient with a goal level of 2 to 3. 8. hypertension: in the unit, the patient was intermittently hypotensive likely secondary to a sepsis physiology. for this reason, his antihypertensive medications were held while he was seen in the unit. however, following treatment with antibiotics, patient returned to baseline hypertension and his antihypertensives were restarted. his blood pressure was monitored closely. his medications were gradually adjusted over the course of his hospital stay. on day of discharge, lisinopril was increased to 40 mg p.o. b.i.d. and hydralazine was discontinued. should patient's blood pressure remain elevated, an addition of a calcium-channel blocker such as norvasc may be considered. 9. pulmonary hypertension: on echocardiogram of , moderate pulmonary artery systolic hypertension was noted. however, this echocardiogram was obtained in the setting of possible left ventricular failure and pneumonia. patient will require a follow-up echocardiogram in weeks following discharge to monitor for possible resolution of pulmonary artery systolic hypertension. 10. foot ulcers: as mentioned above, patient is noted to have a right lateral malleolar ulcer as well as left heel ulcer. a podiatry consult was obtained, who recommended obtaining bilateral x-rays of the feet. these showed multiple toe amputations, but no areas of bone destruction to suggest osteomyelitis. patient will continue to have wet-to-dry dressing changes b.i.d. with feet placed in multipodus boots, nonweightbearing status on the left with full weightbearing status on the right. discharge condition: good. discharge status: discharged to rehabilitation facility. discharge diagnoses: 1. sepsis of unclear etiology. 2. acute renal failure. 3. hypertension. 4. hyperlipidemia. 5. coronary artery disease. 6. history of deep venous thromboses. 7. status post renal transplant. medications on discharge: 1. lisinopril 40 mg p.o. b.i.d. 2. heparin 5000 units subq q.8 until the patient becomes therapeutic on his coumadin. 3. vancomycin 1 gram iv q.12. x7 days to complete on . 4. warfarin 5 mg p.o. q.h.s. 5. levofloxacin 500 mg p.o. q.d. x7 days to complete . 6. metoprolol 100 mg p.o. b.i.d. 7. neoral 100 mg p.o. q.12h. 8. alprazolam 2 mg p.o. q.h.s. prn. 9. tramadol 50 mg p.o. q.4-6h. prn pain. 10. ferrous gluconate 300 mg p.o. t.i.d. 11. celexa 10 mg p.o. q.d. 12. cyanocobalamin 100 mcg p.o. q.d. 13. folic acid 1 mg p.o. q.d. 14. nph 20 units q.a.m., 16 units q.p.m. 15. humalog sliding scale q.i.d. 16. pantoprazole 40 mg p.o. q.d. 17. multivitamin one capsule p.o. q.d. 18. mycophenolate 1 gram p.o. b.i.d. 19. senna one tablet p.o. b.i.d. 20. gabapentin 600 mg p.o. q.12. 21. colace 100 mg p.o. b.i.d. 22. aspirin 325 mg p.o. q.d. follow-up appointments: 1. patient should follow up with primary care physician 1-2 weeks following discharge from rehabilitation facility. 2. discharge services: patient will require close monitoring of blood pressure with titration up of metoprolol as needed and may consider adding another such as a calcium-channel blocker like norvasc. patient will require monitoring of his inr to a goal of . at time of discharge, the patient is taking coumadin 5 mg p.o. q.h.s. this will changed as needed for a goal inr of . 3. patient will require monitoring of lfts at least 2x/week in order to ensure that they return to baseline. 4. patient will require wet-to-dry dressings to foot ulcers changed twice a day. 5. he also requires physical therapy to increase strength and mobility. 6. patient will also need gradually to wean off oxygen as tolerated for an oxygen saturation greater than 93%. , m.d. dictated by: medquist36 procedure: transfusion of packed cells diagnoses: pneumonia, organism unspecified acidosis acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified septicemia severe sepsis ulcer of other part of foot complications of transplanted kidney 

Answer: The patient is high likely exposed to