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: codeine attending: chief complaint: chest pain, nausea, vomiting major surgical or invasive procedure: chest tube placement ir guided drainage of lung empyema intubation ij line for hemodialysis intra-aortic balloon pump placement history of present illness: patient is a 67 y/o with pmh of cad s/p mi , h/o ugib, dm, hyperlipidemia, as and chf (ef 25%) who presented to osh today with nausea and vomiting as well as chest pain. per the patient's wife the patient was very tired today, with decreased appetite and poor energy. he took oxycodone for l rib fracture pain and immediately began vomiting. he continued to feel tired and seemed "out of it" to his wife who then brought him into the . of note, the patient was recently admitted to on after a fall on which he slipped on ice. he sustained l-sided 7th-9th rib fractures. he has had ongoing l-sided cp since he was discharged yesterday. in osh ed initial vs were t 99.4, hr 110, bp 86/62, rr 24, 94% ra. pt reportedly looked lethargic and pale. initial labs revealed trop 17.93, ck 1756 and mb 225. ekg showed sinus tach, lvh, and worsened st depressions in v4-v6. he was given zofran 4mg iv x 1, dilaudid 1mg iv x 2, and asa 325mg po x 1. after discussion with covering cardiologist he was also started on hep gtt and given lopressor 2.5mg iv x 1. cta was performed which showed known rib fractures and l pleural effusion, neg. for pe. given elevated ce he was transferred to ccu for further management. on arrival to the ccu the patient was sleepy but alert. he complained of intermittent chest pain, however he was unable to qualify whether this was different than his rib fx. pain. pt was continued on heparin gtt 1000u/hr. he was maintained on 100% nrb satting in high-90s. labs were sent, and were notable for a bump in cr (1.9 at osh->2.5). on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism. he reports a history of bleeding on heparin (colonic avm source requiring 17 units blood). he denies recent fevers, chills or rigors. the patient denies any melena, rectal bleeding, or transient neurologic deficits. no change in weight, bowel habit or urinary symptoms. no arthralgias, myalgias, headache or rash. all other review of systems negative. cardiac review of systems is notable for + chest pain. patient has dyspnea on significant exertion, however denies paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. hypertension 2. coronary artery disease s/p mi , medically managed, no stent. 3 vessel disease on cardiac catheterization in . 3. type 2 diabetes mellitus complicated by peripheral neuropathy and gastroparesis 4. hyperlipidemia 5. aortic stenosis, valve area 0.9cm2 6. dilated cardiomyopathy, ef 25% 7. h/o gib avm in distal duodenum 8. anemia, on procrit and iron injections 9. h/o epistaxis on plavix 10. h/o r hip fracture 11. peripheral vascular disease 12. l 7-9th rib fx social history: - home: lives with his wife - occupation: retired forensic engineer. works in stable with horses. - tobacco: denies - etoh: rare family history: unknown, adopted. possible h/o dm. physical exam: vs- 98.0 107 93/58 28 100%nrb general: appears uncomfortable, sleepy but arousable heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink. neck: supple with jvp at jaw line. cardiac: tachy, regular, normal s1, s2. no m/r/g audible. lungs: no chest wall deformities, scoliosis or kyphosis. + tachypnea, no accessory muscle use. cta anteriorly. abdomen: soft, mildly distended. nt. no hsm appreciated. + bs extremities: cool. multiple small excirations on b/l le. no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: moving all extremities, oriented to person and time pertinent results: admission labs wbc 11.3 / hct 29.3 / plt 183 n 87 / l 7 / m 6 / e 0 / b 0 inr 1.4 / ptt 40.5 na 133 / k 4.9 / cl 91 / co2 29 / bun 46 / cr 2.5 / bg 325 alb 3.9 / ca 8.9 / phos 5.9 alt 30 / ast 237 / ldh 618 / alk phos 70 / tuberculosis .5 ck 2843 / mb 262 / trop t 3.88 iron 14 tchol 113 / hdl 36 / ldl calc 56 : na 137, k 3.7 (repleted), cl 101, bicarb 28, bun 40, creat 2.7. hct 25.2, wbc 5.0, inr 1.4. cr peak 4/0 and cardiac markers ck-mb mb indx ctropnt 07:06am 6 4.18*1 chems added 8:58am 04:06am 2 5.90*2 source: line-aline 08:43am 17* 1.5 13.50*1 09:15am 149* 5.4 7.31*1 source: line-a line 12:15am 262* 9.2* 3.88*3 alt ast (ldh) (cpk) ap dbili ibili 05:34am 45* 33 295* 54 0.9 04:02am 69* 21 63 1.1 03:59am 94* 24 337* 68 1.8* 1.2* 0.6 04:09am 683 185 663* 213* 4.1* 3.5* 0.6 08:43am 1480* 1543* 1151* 68 1.0 04:58am 2737*4183* 5796* 70 09:15am 37 272* 2777* 61 12:15am 30 237* 618* 2843* discharge labs 137 101 40 61 agap=12 3.7 28 2.7 ca: 8.0 mg: 2.1 p: 4.8 wbc 5.0 hgb 8.4 plt 145 hct 25.2 mcv 90 pt: 15.9 ptt: 28.1 inr: 1.4 cardiac catheterization - 1. selective coronary angiography of this right-dominant system revealed multi-vessel coronary artery disease. the lmca was without significant stenoses. the lad had a 60% mid-vessel stenosis. d1 had a 70% stenosis. the lcx and ramus each had 70% stenoses. a small om branch was occluded and a second om had a 70% stenosis. the rca was occluded proximally with left-to-right collaterals. 2. limited resting hemodynamics demonstrated markedly elevated biventricular filling pressures, with an rvedp of 20mmhg and a mean pcwp of 36 mmhg (before lasix given). the mixed venous 02 saturation was 48, giving a cardiac output of 4.0 and a cardiac index of 1.8, indicating cardiogenic shock prior to placement of the iabp. the aortic valve gradient was 22, yielding a valve area of 0.9, indicating moderate-to-severe as. final diagnosis: 1. three vessel coronary artery disease. 2. moderate aortic stenosis. 3. cardiogenic shock. echocardiogram - focused study by on call fellow. left ventricular wall thicknesses are normal. the left ventricular cavity is severely dilated. there is severe global left ventricular hypokinesis (lvef = 15 %). no masses or thrombi are seen in the left ventricle. the right ventricular cavity is moderately dilated with severe global free wall hypokinesis. the aortic valve leaflets are moderately thickened. significant aortic stenosis is present (not quantified). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. tricuspid regurgitation is present but cannot be quantified. there is no pericardial effusion. ct abd/pelvis - 1. moderate left pleural effusion with subjacent atelectasis. 2. no evidence for intra-abdominal abscess or acute intra-abdominal pathology. 3. very mild edema in subcutaneous tissues of bilateral thighs. no loculated fluid collections are identified. 4. displaced fractures of the left seventh, eighth, and ninth ribs, which appear to be acute. 5. nonobstructive subcentimeter bilateral renal calculi. no hydronephrosis. ruq us indication: 57-year-old man with enlarged gallbladder on bedside ultrasound, normal lfts, and normal clinical exam, evaluate for cholecystitis. findings: a limited portable ultrasound was done in the icu. transverse and sagittal images of the gallbladder demonstrate some sludge within the gallbladder but it is not overly distended and there is no gallbladder wall thickening or pericholecystic fluid identified. no gallstones are seen. impression: sludge within the gallbladder but no signs of cholecystitis echo akinetic, infarcted inferior and inferolateral segments with severe hypokinesis of all other segments. dilated and hypokinetic right ventricle. aortic stenosis that is probably moderate to severe. moderate to severe mitral regurgitation. ct chest - 1. interval decrease in multiple loculated hydropneumothorices within the left pleural cavity. 2. interval resolution of the right upper lobe collapse. 3. new septal thickening attributed to hydrostatic edema. 4. unchanged displaced fracture of left seventh, eighth and ninth ribs. 5. improving bilateral pleural effusions. cxr findings: in comparison with the study of , there is little overall change. again there are patchy areas of increased opacification on the left that could reflect pneumonia. left chest tube remains in place, and there is no pneumothorax. the right lung is essentially clear, given the lower level the lung volumes. micro data pleural analysis wbc rbc polys lymphs monos other * * 0 0 0 01 * * 0 0 0 02 rij tip/blood cx sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus, coagulase negative | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ =>16 r levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- 2 s vancomycin------------ 2 s pleural fluid staph aureus coag + | erythromycin---------- r gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s brief hospital course: 67 yo male with a history of coronary artery disease s/p mi, diabetes mellitus, hyperlipidemia, and recent fall with rib fractures was admitted with nausea and vomiting, found to have myocardial ischemia. his hospital course was complicated by multifactorial shock, empyema formation, community acquired pneumonia, acute renal failure, and heart failure. 1. myocardial infarction upon admission to the hospital, patient was found to have st depressions in v4 through v6 with markedly elevated ck to a peak of 2843 with mb 618 and troponin t peaked to 13.88. he was taken emergently to catheterization where he was found to have 3 vessel disease, aortic stenosis (valve area of .9), and cardiogenic shock. he had an intra-aortic balloon pump placed for improved blood pressures and coronary perfusion. he also required multiple vasopressors during his stay in the cardiac intensive care unit. his blood pressure slowly improved, and he was then restarted on his cardiac regimen of an aspirin, beta blocker, acei, and statin. he will need to follow-up with his primary cardiologist within 1-2 weeks of his discharge from the hospital. 2. shock patient was in shock during this hospitalization. etiology was thought initially due to cardiogenic shock in the setting of his acute myocardial infarction. his blood pressure improved; however, he was then thought to be septic due to bacteremia. he was initially maintained with an intra-aortic balloon pump, levophed, and dopamine. his blood pressure improved with medical management of his heart disease and bacteremia. his liver function tests and creatinine were transiently elevated in the setting of his hypotension but improved throughout hospital course. 3. sepsis patient was found to have mssa bacteremia with an associated mssa empyema. with the help of infectious disease, he was ultimately treated with 3 week course of nafcillin to be completed on . he also had line associated coag negative staph bacteremia (1/4 bottles) and was treated with 7 day course of vancomcyin to be completed on . repeat blood cultures were negative ad line was discontinued. please see empyema discussion below. 4. pneumonia patient had an initial sputum culture which was positive for moraxella catarrhalis. he was treated with a course of levofloxacin with improvement in his symptoms. 5. empyema during his hospitalization, patient developed recurrent fevers. repeat chest ct imaging demonstrated development of a complicated left sided effusion. he underwent a thoracentesis by thoracic surgery and his effusion was consistent with an empyema. cultures were positive for mssa for which he was treated wtih nafcillin. he initially was maintained with a pleurex catheter. he self discontinued the pleurex catheter and his chest tube was slowly withdrawn by thoracic surgery. the empyema drain is still in place and daily cxr were done to monitor progress. he has an appt with a thoracic surgeon in 1 week with a cxr before the appt to evaluate the tube and possibly remove it. his nafcillin course is to be completed on . 6. bacteremia during his hospitalization, patient developed recurrent fevers. blood cultures and a catheter tip culture returned positive with mssa. he was treated with a 7 day course of vancomycin which was to be completed on . weekly labs need to be faxed to dr. , the id fellow. 7. respiratory failure patient was initially intubated within 24 hours of admission to the hospital due to desaturations presumed related to his shock. he underwent bronchoscopy on which did not demonstrate a clear cause of his respiratory failure. his respiratory status improved with diuresis, treatment of his underlying infection, and treatment of his cardiac disease. he had oxygen saturations in low-mid 90s on room air at time of discharge 8. acute kidney injury patient initially presented with marked acute kidney injury with a creatinine that peaked at 4 during his admission. given his shock, fluid overload, and respiratory failure, patient was started on cvvh for a short time during his admission for aggressive fluid removal. his creatinine slowly improved back to approximately 2.7 - 2.9. etiology of his renal failure was thought likely related to shock, infection, sepsis, and bacteremia. 9. type 2 diabetes mellitus patient was converted from multiple outpatient oral medications to insulin with an insulin sliding scale. his blood sugars were maintained on adequate control with fingerstick ranging from 100-200 on his sliding scale and long-acting basal insulin. upon discharge, he was recommended to either transition back to his oral agents or consider starting insulin as an outpatient regimen and conducting insulin teaching. 10. anemia etiology appears most likely related to chronic inflammation, chronic renal insufficiency, sepsis, and multiple blood draws. patient's baseline hematocrit appears to be in the low 30s with a previous hematocrit of 31.6 in . he is maintained on erythropoeitin and iron as an outpatient. his hematocrit has remained stable between 26-30 during the last 5 days of his admission. 11. hyperlipidemia patient was on vytorin as an outpatient. he was started on simvastatin during this admission. his liver function tests were abnormal during his admission, although this was thought likely related to his shock liver. his liver function tests were improved after starting simvastatin. 12. peripheral neuropathy he was continue on his gabapentin during his admission. lyrica was also restarted during this admission as well as cymbalta. 13. hypernatremia patient did have complications of hypernatremia during this admission with a peak sodium of 150. he received free water to replete his free water deficit. upon discharge, his sodium was 139. 14. acute systolic heart failure patient was found to have a markedly reduced ef of % thought likely related to ischemic heart disease. as patient's blood pressure improved, he was restarted on beta blocker, acei, and a decreased dose of lasix. we would recommend that his lasix be increased if he develops any signs of fluid overload. 15. aortic stenosis patient was found to have a moderate aortic stenosis with a valve area of .2cm2. 16. delirium patient had brief episodes of delirium thought related to prolonged hospitalization and icu course, medications related to benzodiazepines and opiates. his symptoms improved quickly with frequent reorientation and avoiding further sedating or altering medications. upon discharge, he was oriented x 3. access: l picc in place full code contact: wife (h), (c) medications on admission: lasix 40mg -tid glipizide 20mg gabapentin 400mg, 3 in am, 3 in midday, 3 in pm, 1 at bedtime metformin 1000mg lyrica 50mg daily prandin 2mg, 3 in am, 2 in midday, 2 in evening carvedilol 3.125mg nexium 40mg cymbalta 60mg dialy vytorin daily trazodone 50mg qhs prn (not taking) januvia 100mg daily provigil 200mg daily discharge medications: 1. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day): please hold for bowel movements > 2. thanks. . 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 7. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 8. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 9. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed. 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: inhalation q4h (every 4 hours) as needed. 11. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours) for 4 days: please continue through . . 12. nafcillin in d2.4w 2 gram/100 ml piggyback sig: one (1) intravenous q4h (every 4 hours): please continue through . . 13. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 14. haloperidol 2 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 15. pregabalin 50 mg capsule sig: one (1) capsule po once a day. 16. duloxetine 30 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (). 17. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 18. quetiapine 100 mg tablet sig: one (1) tablet po daily (daily). 19. haloperidol 2 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 20. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day). 21. furosemide 20 mg tablet sig: one (1) tablet po twice a day. 22. nafcillin 2 gram piggyback sig: one (1) dose intravenous every four (4) hours for 9 days: last day . 23. insulin glargine 100 unit/ml solution sig: seventeen (17) units subcutaneous at bedtime. 24. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q48h (every 48 hours) for 1 days: last day . 25. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). discharge disposition: extended care facility: northeast - discharge diagnosis: primary diagnosis: 1. empyema 2. acute renal failure 3. myocardial infarction 4. acute on chronic systolic heart failure 5. aortic stenosis secondary diagnosis: 1. anemia discharge condition: stable. patient is tolerating oral intake and is alert and oriented x 3. discharge instructions: you were admitted to the hospital with chest pain. this was thought likely related to a heart attack, lung infection related to your recent falls and rib fractures, and rib fractures. for your heart attack, we started you on several new medications. for your infection, you are being treated with antibiotics. your hospital course was also complicated by a severe blood infection for which you were treated with antibiotics. we made the following changes to your medications: - vancomycin - this is a medication to treat your infection. this should be stopped on - nafcillin - this is an antibiotic to treat your lung infection and this should be continued until . - insulin - this is a medication to treat your diabetes. while you are at rehab, they should be checking your blood sugars and will restart you on your home diabetes regimen of metformin, prandin, and januvia. - provigil - we have discontinued this medication -your ace inhibitor was stopped because of acute renal failure, it should be restarted once your kidneys improve. . please return to the hospital if you have any fevers, shaking chills, night sweats, worsening or changing shortness of breath, chest pain, lower extremity swelling, nausea, vomiting, diarrhea, or abdominal pain. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1.5 liters/day followup instructions: please follow-up with your primary care physician . within 2 weeks of discharge from rehab. cardiology: dr. phone: ( date/time: monday at 2:15pm. thoracic surgery: dr. phone: please follow-up your thoracic surgery team at your appointment scheduled on tuesday at 1:00 pm in chest disease center . infectious disease: provider: phone: ( date/time: at 11am. , basement of . procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances hemodialysis injection or infusion of thrombolytic agent thoracentesis other bronchoscopy implant of pulsation balloon other incision of pleura diagnoses: other primary cardiomyopathies anemia of other chronic disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery pneumonia due to other gram-negative bacteria acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension acute and subacute necrosis of liver severe sepsis aortic valve disorders diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes methicillin susceptible staphylococcus aureus septicemia paroxysmal ventricular tachycardia other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure cardiogenic shock septic shock old myocardial infarction hyperosmolality and/or hypernatremia other and unspecified infection due to central venous catheter ventilator associated pneumonia acute on chronic systolic heart failure fall from other slipping, tripping, or stumbling examination of participant in clinical trial empyema without mention of fistula gastroparesis closed fracture of three ribs other specified forms of effusion, except tuberculous 

Answer: The patient is high likely exposed to