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: zosyn attending: chief complaint: gib major surgical or invasive procedure: edg with clips ir guided embolization vagotomy, pyloroplasty, oversew of duodenal ulcer, j tube placement tunnelled line placement, left ij picc line placement, left arm, picc line repositioning history of present illness: 79 yo f w/ h/o esrd on hd (recently started), was at hd when she developed aphasia (could not express words). pt went to hospital, where head ct was wnl, and her symptoms resolved. she was given one dose asa 325. while there she used the commode, she passed brbpr and had episode of bright red hematemesis. she got a bolus of protonix and was started on a gtt. she was also started on octreotide, that was d/c'd, given no history of liver disease. hct in the low 20s, she was transfused 2u prbc and transferred to . when arriving at , 2nd unit still going in when hct was drawn. in the ed, initial vs were: 98.6, 68, 108/40, 18, 100% on 2l. ng lavage cleared w/ 200 cc. rectal exam guaiac +, no melena. trop 0.05, cr 2.3, hct 24.4. hds, vs 73, bp 122/43, rr 18. 18/22 gauge pivs. past medical history: hypertension, hyperlipidemia, diabetes (diet controlled), esrd on hd admitted social history: patient lives wtih husband. alcohol, no tobacco. family history: non-contributory physical exam: vs: 98.5, 80, 127/47, 14, 95% ra general: alert, oriented x3, pale, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cn2-12 grossly intact, muscle strength in rue, otherwise intact throughout. pertinent results: 12:13 am blood culture **final report ** blood culture, routine (final ): staph aureus coag +. final sensitivities. consultations with id are recommended for all blood cultures positive for staphylococcus aureus, yeast or other fungi. this isolate is presumed to be resistant to clindamycin based on the detection of inducible resistance . staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s aerobic bottle gram stain (final ): gram positive cocci in pairs and clusters. reported to and read back by () @1700. anaerobic bottle gram stain (final ): gram positive cocci in pairs and clusters. labs: test name value reference range units 05:45 renal & glucose glucose 125* 70 - 100 mg/dl if fasting, 70-100 normal, >125 provisional diabetes urea nitrogen 66* 6 - 20 mg/dl creatinine 4.3* 0.4 - 1.1 mg/dl sodium 128* 133 - 145 meq/l potassium 5.1 3.3 - 5.1 meq/l chloride 86* 96 - 108 meq/l bicarbonate 29 22 - 32 meq/l anion gap 18 8 - 20 meq/l chemistry calcium, total 8.1* 8.4 - 10.3 mg/dl phosphate 6.0* 2.7 - 4.5 mg/dl magnesium 2.5 1.6 - 2.6 mg/dl 05:45 hematocrit 31.6* 36 - 48 % 12:01 report comment: source: line-aline basic coagulation (pt, ptt, plt, inr) pt 13.9* 10.4 - 13.4 sec ptt 28.1 22.0 - 35.0 sec inr(pt) 1.2* 0.9 - 1.1 tte , ef 75%, the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. left ventricular systolic function is hyperdynamic (ef 75%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. there are focal calcifications in the aortic arch. the aortic valve appears bicuspid. the aortic valve leaflets are moderately thickened. the study is inadequate to exclude significant aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. the supporting structures of the tricuspid valve are thickened/fibrotic. there is a small pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. pertinent studies # carotid us () findings: duplex was performed of bilateral carotid arteries. the left carotid could not be visualized through the central line placement and would recommend alternative imaging for further characterization of this area. right ica demonstrates a heterogeneous plaque with a peak velocity of 181/51. the right cca velocity is 63 and the right eca velocity is 88. the ica/cca ratio is 2.8. this is consistent with 60-69% right ica stenosis. the right vertebral is antegrade. impression: 60-69% right ica stenosis. unable to visualize the left carotid system and therefore recommend alternative imaging. . # cta abd/pelvis () 1. right rectus sheath and retroperitoneal hematoma with overlying soft tissue stranding without evidence for active bleeding. 2. hyperdense foci in the duodenum suggesting active bleeding. at the time of this dictation, the patient is status post embolization by interventional radiology. 3. stenosis or occlusion of mid-superficial femoral arteries bilaterally. 4. right femoral catheter not definitively in the venous system. these findings were discussed with dr. by dr. by telephone at 1:45 p.m. on . . # echo () the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . impression: mild symmetric left ventricular hypertrophy with normal global and regional biventricular systolic function. mild mitral and aortic regurgitation. elevated filling pressures and borderline pulmonary hypertension. . # angiography () 1. sma angiography demonstrates a focal area of extravasation within the second part of the duodenum corresponding to cta findings. the source of bleeding came from likely two third order of branches of the ipda. both of these were successfully using gelfoam and coils, with no active extravasation identified post-embolization. 2. celiac and gda angiography demonstrates a patent proximal gda with filling of several gda collaterals that were not embolized previously. the proximal portion of the gda was then coiled additionally, with good stasis of flow and no filling of additional gda collaterals identified. . impression: active extravasation seen within the second part of the duodenum from branches of the sma, with successful embolization as described above. . # cta head/neck () 1. no evidence of acute intracranial abnormalities. mri would be more sensitive for an acute infarction, if clinically indicated. 2. multifocal irregularity and narrowing of the cervical and intracranial left vertebral artery. while this could be related to atherosclerosis, dissection cannot be excluded. neck mra with fat-suppressed axial t1-weighted images is recommended to exclude dissection. 3. atherosclerosis in the proximal right and left internal carotid arteries, without evidence of a hemodynamically significant stenosis. 4. short segments of narrowing proximal m1 segment of the left middle cerebral artery and in the distal a1 segment of the left anterior cerebral artery may be related to atherosclerosis. 5. 2.3 cm right thyroid nodule. recommend thyroid son for further evaluation, if not performed previously. 6. emphysema. 7-mm spiculated density at the left lung apex. recommend follow-up chest ct in three months. . brief hospital course: 79 yo f w/ h/o esrd on hd (recently started), presented w/ hematemesis and brbpr, concerning for gi bleed, found to have duodenal ulcer bleed and question of stroke. she was admitted directly to micu. pt received immediate transfusion and close hct monitoring. she was intubated and egd was performed within 24 hours, which identified a duodenal ulcer with high probability of bleed. the ulcer was clipped. however, pt continued to have large volume maroon stool, drop in hct, and evidence of active bleeding by cta. massive transfusion protocol was activated. she underwent repeated egd, and attempts of embolization twice in the ir suite. eventually, the ega bleeding was stopped by coiling via sma and celiac. pt received a total of 26u prbc, 13u ffp and 5u platelets. the resuscitation was complicated retroperitoneal bleed, which was managed conservatively. she was transferred out of the icu. however, on , hct dropped to 29->25 w/ melena and coffee grounds. she was retransferred to the micu, where she received 2 units prbc and post-transfusion 28. her hct dropped to 25 and patient was transfused 2 more units prbc. patient was intubated for egd that showed esophagitis, duodenitis and non-bleeding duodenal ulcers. repeat hct remained stable between 32-35. on she was transferred out of the unit to floor. on , she had more melenatic stool, underwent a tagged red blood cell scan which showed bleed at 2nd part of the duodenum. ir and surgery were contact. ir deferred to further intervene unless absolutely necessary. she underwent another egd with side viewing camera, two clips were placed. her hct dropped to 24 after the procedure, she was transfused during hemodialysis. on , she underwent truncal vagotomy and pyloroplasty, tru-cut biopsy of the liver, and feeding jejunostomy for bleeding duodenal ulcer, poor nutrition, end stage renal disease. surgeon was dr. . postop, she was kept npo for approximately 6 days. tube feeds started via the j tube on postop day 2. a gastrografin study was performed on demonstrating normal passage of contrast through a patent pylorus through the duodenum and into the jejunum without evidence of leaks. diet was slowly started and advanced. intake was poor. ensure supplements were encouraged. she experienced frequent loose, non-bloody stools. stool was sent x3 for c.diff. this was negative. imodium and psyllium were started with dose adjusted for persistent frequent stools. at time of discharge to rehab she had 1 bm during the day. abdominal incision staples were removed on . the medial aspect of the wound had small amount of drainage and was not well approximated. this was opened ~ 9cm x 2.5cm x 1.5cm and packed loosely with normal saline damp gauze . # esrd: pt was recently started on hemodialysis. we resumed her hemodialysis after achieving hemodynamic stability. she received dialysis on t/th/sa. a temporary dialysis line had been placed via the left ij. subsequently a tunnelled line was placed on the left side as well. after evaluating the rue avf, it was determined that this was mature enough to use for hd. the temporary line was removed and tip was cultured. culture was negative. the left ij tunnelled line remained in place. plan was to remove in weeks once it was clear rue avf was functioning well at dialysis sessions. on , blood cultures isolated mssa 4/4 bottles. nafcillin was started. id was consulted and recommended a tte. tte on was negative for vegetations. given sub-optimal quality of study, murmur and high grade bacteremia, id recommended a full 6 week course of antibiotics. nafcillin was continued started on and continued thru . kefzol was then started on after hemodialysis. kefzol was to continue for 4 more weeks dosed after hd (tues-2grams, thurs-2grams & sat-3grams). surveillance blood cultures were negative on , and . # stroke: pt presented to osh for aphasia prior to transfer to . initial neural exam showed lue weakness. code stroke was called. however, full neural exam was limited by overall weakness. neurological imaging was deferred in the setting of massive gib. of note, ct head at osh showed no bleed. after pt was stabilized, carotid us showed 60-70% stenosis on r; cta head & neck showed no acute intracranial process. no hemodynamically significant carotid stenosis. on departure from micu, neuro exam was notable for right-sided pronator drift. pt evaluated and worked with her recommending rehab. she was oob to chair with assist and ambulating short distances with walker. bradycardia: during the egd procedure, pt was bradycardic to 30s. ekg showed weinkenbach blocks exacerbations of sinus bradycardia consistent with increased vagal tone. pt required pretreatment with atropine to complete subsequent procedures. she remained normal sinus rhythm during rest of the hospital stay. we withheld all nodal agents initially. it is possible that vagal episodes and heart block were the underlying cause for her recurrent syncope. # uti: pt developed fever on hd#4, and was found to have ua concerning for uti. urine culture grew pansensitive e.coli. pt was initially treated with iv ceftriaxone, which was later switched to cefpodoxime to complete an full 10 day course (last dose 10/26). . # sacral ulcer: pt was found to have a stage 1 gluteal ulcer. wound care was provided under the guidence of wound consult service. . chronic issues . # hypothyroidism - we continued her levoxyl 0.137 qd transitional isses - surgical clips over the duodenal ulcer are not compatible with mri in the first month after placement - code status: pt initially declared dnr/dni. her code status was reversed during this hospital stay given need for procedures. will need to readdress after clinical improvement. - vagal tone: pt was found to have severe vagal tone during procedures. the underlying wenchenbach and severe vagal episodes may be the underlying cause for her syncope. she will need ep workup longterm disposition: rehab, in . a bed was available on . she was transferred there in stable condition after hd was done on . . medications on admission: furosemide 40 mg requip 0.25 mg qhs neurotin 300 mg qam zocor 80 mg qd levoxyl 0.137 mg qd imdur 30 mg qd metoprolol 100 mg qpm asa 325 mg qd prilosec 20 mg vitamin d 50,000 qwk spetrum silver iron ambien procrit 10,000 qmonthly vicodin (? taking it) discharge medications: 1. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 2. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical prn (as needed) as needed for itching. 3. insulin regular human 100 unit/ml solution sig: follow sliding scale units injection asdir (as directed). 4. levothyroxine 137 mcg tablet sig: one (1) tablet po daily (daily). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 6. miconazole nitrate 2 % cream sig: one (1) appl vaginal hs (at bedtime) for 1 days: to complete a 7 day course. 7. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 8. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 9. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily): hold for sbp <110 or hr <60 . 10. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection (2 times a day). 11. psyllium 1.7 g wafer sig: three (3) wafer po bid (2 times a day). 12. loperamide 2 mg capsule sig: two (2) capsule po qid (4 times a day). 13. cefazolin 1 gram recon soln sig: two (2) grams intravenous 2x/week for 4 weeks: on tuesdays and thursdays at dialysis. 14. cefazolin 1 gram recon soln sig: three (3) grams intravenous once a week for 4 weeks: on saturdays at dialysis. discharge disposition: extended care facility: discharge diagnosis: ugib, duodenal ulcer esrd mssa bacteremia e.coli uti depression discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: -you will be transferring to in -hemodialysis should continue on a tuesday-thursday-saturday schedule -kefzol (antibiotic)to be given at dialysis for 4 weeks for mssa bacteremia followup instructions: provider: , md, phd: date/time: 2:40 md, procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more other enterostomy other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis closed (percutaneous) [needle] biopsy of liver venous catheterization for renal dialysis endoscopic control of gastric or duodenal bleeding endoscopic control of gastric or duodenal bleeding endoscopic control of gastric or duodenal bleeding arteriography of other intra-abdominal arteries arteriography of other intra-abdominal arteries transcatheter embolization for gastric or duodenal bleeding transcatheter embolization for gastric or duodenal bleeding other pyloroplasty central venous catheter placement with guidance central venous catheter placement with guidance central venous catheter placement with guidance truncal vagotomy diagnoses: end stage renal disease coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified toxic encephalopathy acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia unspecified acquired hypothyroidism hematoma complicating a procedure hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia acute respiratory failure cardiac arrest bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site pressure ulcer, lower back do not resuscitate status chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction unspecified transient cerebral ischemia other second degree atrioventricular block pressure ulcer, stage i other and unspecified escherichia coli [e. coli] other fluid overload bloodstream infection due to central venous catheter malnutrition of mild degree 

Answer: The patient is high likely exposed to