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: this 69 year-old man with end stage renal disease on hemodialysis, coronary artery disease, congestive heart failure, atrial fibrillation who was recently admitted for an infected av graft, clot and mssa infection with septic pulmonary emboli. this admission required a micu stay for increased oxygen requirement as well as surgical removal of the infected av graft. a transesophageal echocardiogram at that time did not show any evidence of endocarditis and a bone scan was negative for lytic lesions suspicious of osteomyelitis. the patient was discharged on on a four week course of cefazolin for his mssa infection. the patient then returned for this admission on with one to two days of shortness of breath, fevers, chills and productive cough. the patient denies chest pain, nausea, vomiting and diarrhea, however, he did complain of worsening orthopnea. past medical history: 1. end stage renal disease on hemodialysis. 2. diabetes mellitus. 3. congestive heart failure with an ejection fraction of 20%. 4. coronary artery disease status post coronary artery bypass graft surgery in . 5. status post myocardial infarctions in and . 6. atrial fibrillation. 7. anemia. 8. peripheral vascular disease. 9. history of prior cerebrovascular accidents. 10. protein s deficiency? 11. history of seizures in the setting of sepsis. allergies: doxycycline. medications on admission: 1. cefazolin 1 gram intravenously dosed at hemodialysis. 2. aspirin 325 mg daily. 3. lopressor 25 mg b.i.d. 4. captopril 12.5 mg t.i.d. 5. amiodarone 200 mg daily. 6. digoxin 0.125 mg daily. 7. calcium acetate 667 mg po t.i.d. with meals. 8. protonix 40 mg daily. 9. vicodin 5/500 one to two tablets po prn. 10. albuterol and atrovent nebulizers prn. 11. regular insulin sliding scale. 12. colace. social history: prior to his admission in the patient lived at home and was ambulatory. he was a former security officer and is retired. he has a positive history of tobacco use. he has smoked one pack a day for 52 years. up until his recent admission he was a smoker. he reports occasional alcohol use. physical examination on admission: temperature 101.5. heart rate 87. blood pressure 133/58. respiratory rate 20. oxygen saturation 100% on nonrebreather. general middle aged male sitting in mild respiratory distress. heent pupils are equal, round and reactive to light. clear oropharynx. supple neck. no lymphadenopathy. cardiovascular examination tachycardic, regular. pulmonary examination positive rhonchi heard throughout. decreased air movement at the left middle and lower lung fields. bibasilar crackles. abdomen soft, nontender, nondistended. extremities trace bilateral edema. faint dorsalis pedis pulses. neurological examination alert and oriented times three. cranial nerves ii through xii are intact. moves all four extremities. decreased sensation over his feet. skin has multiple necrotic lesions on shin, chest and feet. laboratory: white blood cell count 13.6 with 90% polys, 5% lymphocytes, hematocrit 32.9, platelets 274, sodium 127, potassium 6.7, chloride 92, bicarb 22, bun 37, creatinine 4.2, glucose 317, free calcium 1.01. magnesium 1.4, phosphorus 5.1, lactate 4.4. arterial blood gas on 100% nonrebreather 7.46. pco2 28, po2 100. no gross liver function test abnormalities. urinalysis was negative for infection. chest x-ray revealed interval development of opacification within the left mid lung field with air bronchograms and a left sided pleural effusion. also there was evidence of mild congestive heart failure. ct of the chest revealed no evidence of pulmonary emboli, new extensive consolidation in the lingula and left lower lobes, new left pleural effusion partially entrapped by consolidated lung and unchanged multiple pulmonary nodules consistent with septic emboli unchanged from the previous study. electrocardiogram on admission revealed regular tachycardia most likely atrial flutter with 2 to 1 block. hospital course: 1. sepsis: the patient rapidly developed respiratory distress, increasing tachypnea, tachycardia and persistent fever. he was treated aggressively based on the sepsis protocol. he had central intravenous access placed and was intubated for airway protection. he was started on antibiotics to cover his previous mssa infection as well as to treat for a new community acquired or possibly nosocomial pneumonia. he was initially covered with vancomycin and ceftriaxone, however, this was changed to oxacillin and ceftriaxone after several days. the patient underwent a bronchoalveolar lavage on , which revealed 2+ polys, but no microorganisms. legionella culture was negative as well as negative acid fast smear, negative immunofluorescent test for pcp. patient responded well to antibiotic therapy and was extubated on . he was continued antibiotics for his pneumonia and was transferred out to the medical floor the following day. despite his clinical improvement there was concern over the partially loculated left sided pleural effusion that was abutting the area of consolidation. a thoracentesis was performed under ultrasound guidance on to ensure that this was not a peripnuemonic effusion or an empyema. the fluid was clear yellow and was transudative. this was felt to be secondary to his congestive heart failure. the patient will be discharged on an additional four days of levaquin therapy for his pneumonia, which will be renally dosed at 250 mg q 48 hours. 2. septic pulmonary emboli: the patient has received greater then four weeks of appropriate antibiotic coverage for his mssa septic pulmonary emboli. the patient has had multiple ct scans of his chest, which revealed stable appearance of the septic pulmonary emboli suggesting successful treatment of his disease. the patient will have a follow up cat scan on and will follow up with dr. in the department of infectious disease on . 3. congestive heart failure: the patient has an ejection fraction of 20% from his ischemic cardiomyopathy. he has had multiple myocardial infarctions in the past as well as coronary artery bypass graft surgery. the patient was slightly volume overloaded on admission and also experienced some mild congestive heart failure during his admission, which was likely due to volume overload during his treatment for sepsis. the patient's volume status was managed with hemodialysis. in addition, the patient's left sided pleural effusion was drained and approximately 800 cc of clear yellow fluid were removed. the patient will be continued on his beta-blocker, ace inhibitor and digoxin. 4. atrial fibrillation: the patient's prevailing rhythm during this admission was atrial fibrillation. the patient reports that he is not on anticoagulation therapy, however, he does take an aspirin a day. the patient does not have a primary care physician and is unsure of why he is not on coumadin therapy. he states that he may have a protein s deficiency. he believes that may be why he is not on anticoagulation. the patient was continued on his beta blocker and his amiodarone and was given a follow up appointment with his outpatient cardiologist dr. on . in addition, the patient will find a new primary care physician . with whom he will meet on at which time the issue of anticoagulation can be addressed. 5. coronary artery disease: the patient was continued on his aspirin, beta-blocker, ace inhibitor and was started on a statin during this admission. the patient should have his liver function tests checked in approximately three months after discharge. 6. diabetes mellitus: the patient was maintained on a regular insulin sliding scale, however, during this admission he was started on nph for better blood sugar control. the patient's insulin regimen should be titrated as an outpatient. 7. end stage renal disease: the patient was continued on hemodialysis during this admission through his new left chest av graft. 8. code status: the patient clearly expressed his wishes to be a full code during this admission. condition on discharge: stable. discharge status: to acute rehab. discharge instructions: please follow a 1.5 to 2 liter a day fluid restriction, please follow up with your new primary care physician, cardiologist and your infectious disease doctor . discharge diagnoses: 1. left lower lobe and lingular pneumonia. 2. bilateral pleural effusions. 3. end stage renal disease on hemodialysis. 4. systolic congestive heart failure. 5. diabetes mellitus. 6. peripheral vascular disease. 7. atrial fibrillation. 8. anemia. 9. coronary artery disease status post coronary artery bypass graft surgery. 10. multiple myocardial infarctions. 11. protein s deficiency? discharge medications: 1. aspirin 325 mg daily. 2. amiodarone 200 mg daily. 3. digoxin 0.125 mg daily. 4. calcium acetate 667 mg po t.i.d. with meals. 5. colace 100 mg b.i.d. 6. lopressor 25 mg po b.i.d. 7. atrovent nebulizers q 6 hours prn. 8. flovent 110 micrograms inhaler two puffs b.i.d. 9. albuterol nebulizer q 4 hours prn. 10. pancrease three caps t.i.d. with meals. 11. lisinopril 10 mg daily. 12. atorvastatin 10 mg po q.h.s. 13. levofloxacin 250 mg tablets po q 48 hours for four days. 14. nph insulin 8 units q.a.m. and 4 units q.h.s. 15. regular insulin sliding scale. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube hemodialysis thoracentesis closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified unspecified pleural effusion congestive heart failure, unspecified unspecified septicemia atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure chronic systolic heart failure primary hypercoagulable state 

Answer: The patient is high likely exposed to