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: verapamil / iodine; iodine containing / zoloft / atenolol attending: chief complaint: cough and fever major surgical or invasive procedure: right internal jugular vein central venous catheter picc line cardioversion for a-fib history of present illness: pt is an 80 yo f w/ hx of copd, htn, and two recent admissions for paf and chf exacerbation who presents with exacerbation of chronic cough and nausea with fever for two days. pt. states that she has experienced a chronic cough which is mostly dry but with occasional clear sputum production for around 5 months. this cough, however, does not limit her adls or exercise tolerance as pt states she can usually walk "as far as i want." about 3 weeks prior to presentation ()the pt presented to for similar dyspnea and was admitted with a dx of a-fib, anticoagulated, and cardioverted. she was discharged on to a rehab facility where poor monitoring of inr on coumadin resulted in an inr of 9.1 when the pt. again presented to complaining of doe. during this admission, pt. was found to have a chf exacerbation with bnp=1425 in the context of a tee from which had shown diastolic dysfunction. the pt. was discharged to home on and reports feeling "back to her usual self" until two days prior to presentation. two days prior to presentation, pt reports increased cough with wheezing along with severe nausea such that she "wishes she could throw up" and fevers with rigors up to 102 degrees accompanied by confusion. she denies associated cp, emesis, diarrhea, dysuria, or urinary frequnecy. she reports decreased po intake (both food and fluids) during this time. on arrival to the , pt was febrile to 100.4 with map = 51 and hr= 65,rr=18 and o2 sat = 95 on ra . sepsis protocol was initiated; a lij cvl was placed, she received 5l ivf, and was started on a levophed ggt. blood and urine cxs were sent and pt was subsequently broadly covered with levofloxaxin and vancomycin. past medical history: diastolic congestive heart failure ef>=60% atrial fibrillation - s/p cardioversion. not anticoagulated. rate controlled on nadolol. htn - labile cardiac history: cabg: none catheterizations: none pci: none cardioversion: 2x for afib - most recently pacemaker/icd: none stress tests: not available on computer social history: lives alone in . smoked ppd x 40 years - quit 16 years ago. glass wine with dinner. able to do adls. family history: father: lung ca and cad physical exam: 69 134/58 25 95% on 4l nc cvp13 gen-pt. tired appearing, a and o x 3, coughing loudly heent- nc/at, perrl, mmm, no lad, no jvd, sclera anicteric cardio-nl s1 and s2, rrr pulm-exp wheezes and sparse "dry" rales throughout, increased exp phase, no rhonchi abd-bs+, soft, nt, nd, no organomegaly ext-warm and dry, 2+distal pulses throughout, no c/c/e neuro- no gross lesions pertinent results: admission hct 36.8, discharge 31.9. wbc admission 13.4, discharge 10.6. plts 488. inr upon discharge was 2.5 bun upon discharge 12, cr 0.9 sodium 128, cl 94, k 3.8, bicarb 28. lfts normal. 3 sets cardiac enzymes negative. iron 17, tibc 140, ferritin 234. b12 757, folate 7.7. serum lactate 0.5 to 1.0. u/a small blood with no rbcs otherwise normal. micro blood culture: 4/4 bottles s.aureus (mssa) sensitive to clindamycin, erythromycin, gentamicin, levofloxacin, bactrim, oxacillin blood culture no growth to date (as of ) blood culture no growth to date (as of ) blood culture no growth to date (as of ) urine culture negative echo (): the left atrium is moderately dilated. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. transmitral doppler and tissue velocity imaging are consistent with normal lv diastolic function. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. no masses or vegetations are seen on the aortic valve. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. compared with the prior study (images reviewed) of , estimated pulmonary artery systolic pressures are now higher. there are no obvious vegetations are visualized. the severity of mitral regurgitation is slightly reduced. the other findings are similar. left lower extremity ultrasound (): no evidence of dvt in the left leg. hip x ray (): prominent multilevel degenerative changes of the lower lumbar spine, incompletely evaluated. mild degenerative changes of the sacroiliac joints and hips. pelvic / l spine mri () 1. no evidence of discrete fluid collections, abnormal enhancement, or underlying osteomyelitis. 2. soft tissue fluid consistent with anasarca, likely from third spacing of fluid. this may reflect underlying hypoalbuminemia or fluid overload. left upper extremity ultrasound () 1. no evidence of dvt in the left upper extremity. 2. non-occlusive thrombosis of the left cephalic vein within the forearm. brief hospital course: sepsis: blood cultures from positive for mssa, treated with nafcillin x 14 days starting with end date . patient in icu requiring pressors and fluid boluses, then transferred to the floor where she was afebrile and improving, she continually diuresed much fluid. source likely iv catheter which was placed upon previous visit to the er in the left antecubital fossa. no evidence of pelvic abscess or osteo (checked given hip/groin pain) or of seeding of valves (checked by transthoracic echo). blood cultures have been negative to date since . atrial fibrillation: in the setting of large fluid shifts (diuresed negative 5 liters 1 day post icu discharge) she returned to atrial fibrillation rhythm after just being cardioverted a few weeks ago. attempted rate control with lopressor and diltiazem had little effect, patient was cardioverted and started on norpace to keep her in sinus rhythm. qtc was followed while on this drug and she showed no significant qtc prolongation. continue coumadin anticoagulation. hyponatremia: thought to be due to chf versus siadh. follow na as patient autodiureses. if still hyponatremic once euvolemic, should be fluid restricted. medications on admission: diovan 80mg po bid asa 81 mg po daily lasix 20 mg po daily nadolol 10 mg po daily xanax 0.25 mg po bid discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. ipratropium bromide inhalation 5. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 6. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for fever. 8. alprazolam 0.25 mg tablet sig: one (1) tablet po bid (2 times a day). 9. menthol-cetylpyridinium cl 2 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed). 10. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. 11. disopyramide 100 mg capsule sig: one (1) capsule po q8h (every 8 hours). 12. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 13. valsartan 80 mg tablet sig: one (1) tablet po bid (2 times a day). 14. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). 15. nadolol 20 mg tablet sig: 0.5 tablet po daily (daily). 16. nafcillin in d2.4w 2 g/100 ml piggyback sig: one (1) intravenous q4h (every 4 hours): continue for an additional 7 days. 17. outpatient lab work please draw pt, ptt, and inr on monday and fax results to dr. at 18. valsartan 40 mg tablet sig: 2.5 tablets po bid (2 times a day). 19. warfarin 1 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: hospital - discharge diagnosis: primary: 1. septicemia 2. diastolic congestive heart failure 3. hypertension secondary: 1. sepsis with mssa 2. diastolic congestive heart failure 3. hypertension 4. atrial fibrillation discharge condition: stable, afebrile. discharge instructions: you were admitted to the hospital because you were experiencing chills, fever and weakness. in the emergency department, you had signs of severe infection and received a large amount of fluids and needed to be admitted to the intensive care unit. during our workup, we found you to have an infection of in your blood. a picc line was placed so you could finish your 14 day course of antibiotics. you were resuscitated with a lot of fluid while in the icu due to your low blood pressure, and were cardioverted back to sinus rhythm and started on a new medication (norpace) to keep you in that rhythm. please weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet please keep all your appointments and take all medicines as written. if you begin to experience fever, chills, or other symptoms that worry you please call your primary care doctor or come into the emergency department. followup instructions: you have the following appointments: , md phone: date/time: 1:40 pulmonary breathing tests phone: date/time: 10:10 pft,interpret w/lab no check-in pft intepretation billing date/time: 10:30 please call your pcp 2 weeks to make an appointment. md procedure: venous catheterization, not elsewhere classified atrial cardioversion injection of antibiotic diagnoses: congestive heart failure, unspecified unspecified essential hypertension hyposmolality and/or hyponatremia atrial fibrillation infection with microorganisms resistant to penicillins personal history of tobacco use methicillin susceptible staphylococcus aureus septicemia sepsis infection and inflammatory reaction due to other vascular device, implant, and graft diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to